Am I doing something wrong or is the learning curve fairly steep to make your system fly?

Dave,

I was an attendee at your recent class in Lafayette Co, I was excited to see an alternative to the old composite system. I have tried the bioclear on three different occasions and have not been happy with the contact, it seems the plastic wedge rides a little high in the box area. I did not use a ring on any of my attempts, in the class you only thought that to be necessary when doing back to back class 2 restorations. my question is, am I doing something wrong or is the learning curve fairly steep to make your system fly? thanks, and by the way I am seriously looking into buying a microscope, the exposure to that kind of visibility was eye opening.
--Gordon

It is very nice to hear from you.

First things first, I couldn't sleep when I read your email about your problems using the Bioclear system and for your Class II's. There is a learning curve but only because the process is so different than in the past. When you have it down pat it will be EASIER FASTER and BETTER than the old approach.

There are at least 3 things that could happen that would be giving you trouble. Here are some tips. I am going to cc my friend Dr. Steve Urback who has actually done more of these than I have.

1. The prep must clear the neighboring tooth by at least 3/4ths of a millimeter. Otherwise the Interproximator will not pass by and it will "hang up" inside or slightly inside of the saucer prep. Because the Interproximator is so soft, It can actually end up part way inside the prep and part way past the gingival margin. Plus, it is translucent so it can be deceiving to your eyes at first. That is the most common mistake that we made in the beginning. REMEDY: Try the interproximator first, before the matrix. If it doesn't slide easily you will need more clearance. Make the saucer a little bigger. More enamel rods will be opened up. Better bond!
2. The prep may have ended up more like a slice rather than a saucer. REMEDY: Well now we have a bit of a problem. If there is no undercut apical to the prep. then there is nothing to keep the Interproximator from riding up. In that case or in a deep case I will do minor electrosurgery on the "col" or papilla to make a home for the matrix and interproximator. Then I will use a Narrow Isthmus or the Thin Interproximator that will lightly stabilize the matrix without deforming it.
3. What about using a separator routinely? ANSWER: There is no problem using a separator routinely, it just takes a little more time but the contact will be more snug. This will not help, however, if the Interproximator is stuck partly or completely inside of the prep.
4. The prep is ok but the Interproximator is still having trouble passing through to the undercut. REMEDY: Use a little liquid hand soap when you slide the interproximator into position. I'm using liquid soap nearly every time now to make it easier and to not disturb the matrix. I use soap for every Narrow Isthmus Interproximator to avoid breakage.
5. What else helps? REMEDY: Once you have snugged the Interproximator into position, release the ends, relax, and then grab the ends or the hemostats again, apply see-saw pressure and at the same time apical pressure while giving the Interproximator a good hard stretch. Often this second round of pressure is better because you have repositioned your fingertips or hemostats to a more favorable or more apical orientation. Or maybe my hands were tired. Either way I do this "second snug" quite often.
6. What more? REMEDY: Did you aggressively pre-wedge to "deflate" the papilla? The Interproximator is too gentle to do this on its own. YOU MUST PRE-WEDGE EACH CASE!
7. What helps in severe cases such as altered active eruption or Dilantin hyperplasia where the papilla won't go away. REMEDY: I use a tiny electrosurgery tip to trench a nice area for the Bioclear Matrix and Interproximator. If that seems aggressive, compare that to the problems that will ensue if the restoration leaks, packs food, or you give up and cut a normal prep that predisposes the tooth to fracture.

Be patient! It is worth the effort!

P.S. Dear Gordon, I am forwarding a note from Dr. Steve Urback regarding the Bioclear Matrix system.
-- Cheers, David

Dave, I think you gave him great suggestions. All I would add is that, as you said, sometimes it is hard to see if the interproximator is riding up and creating a concavity above the gingival margin. I routinely use a cord placement instrument to push the interproximator down. The clear matrix can be pushed towards the prep to do this, and it springs back into place once you remove the instrument. I would suggest using the bitine ring for a while, and after he has created some very tight contacts, he will have the confidence to try some without. You have to be extra careful with the rings, because when it squeezes the interproximator it can push it up into the prep if it isn’t far enough down to begin with. Encourage him not to give up, this is the best thing that has happened to posterior composites since they came into existence.