I am writing in response to "Establishing a Tight Contact in a Class II Resin-Based Composite Restoration" by Dr. Richard E. Derrick in the September JADA Clinical Directions section. His technique for obtaining a tight contact in a Class II composite restoration is, to say the least, interesting.
In this rather complicated technique, Dr. Derrick places the composite only below the proximal contact with a band in place. He then places the remainder of the restoration after removing the band, and he sometimes lubricates the adjacent tooth with petroleum jelly.
He then has the patient bite down into centric before contouring and curing the restoration. And all of this is done without a rubber dam. This technique would seem to have the following flaws:
- – after the band is removed, it is likely that gingival bleeding would contaminate the prep;
- – petroleum jelly could easily be incorporated into the composite, possibly compromising the margins;
- – having the patient bite into the uncured resin would likely contaminate the field with saliva, not to mention the possibility of the composite sticking to the opposing tooth and pulling as the patient opens;
- – finishing and polishing of excess and overhangs will be much more time-consuming than other techniques;
- – the literature clearly shows that rubber dam isolation is a must for composite restorations.
JADA has an obligation to present sound clinical advice to practicing dentists. This technique is fraught with difficulty and potential problems that can easily undermine the success of the restoration. With the introduction of sectional matrix/ring systems (Composi-Tight, Palodent and others), establishing predictable, tight contacts has been made simple and reliable.
Why JADA would choose to promote this dubious technique is beyond me. The editors should be much more careful in the future before publishing such a technique.
