Class II Composites WITHOUT a Wedge + Contact Opening Technique – PDP188

Class II’s are only easy when they are small (but not too small), supragingival, easily accessible with straight-forward anatomy. In other words, about 1% of the Class IIs we encounter - because the vast majority I see are subgingival, wide, with awkward root concavities and tricky access. I went from using sectional matrices 97% of the time to now just using them 30% of the time - this is thanks to a circumferential matrix I started to use last year which is a game changer. I now do not need to use a wedge in most scenarios (something I used to think was a crime!) and have been using the ‘contact opening technique’. Meet Dr Sunny Sadana, who has brought the Greater Curve system to the UK and taught me a lot about efficiency with direct restorations. We also discuss fee-setting and patient communication - this part of the video is only available for those on our Protrusive Guidance network. https://youtu.be/QF3b8V_29Vw Watch PDP188 on Youtube Protrusive Dental Pearl  Pre-wedging; use this technique before beginning any restorative work on the tooth you are working on, this will allow a greater field of view to work in. It also helps suppress the papilla to get better access to the caries. This can all be achieved by numbing the area first and wedging with adequate enough pressure for there to be separation. It also reduced iatrogenic damage and is also worthwhile considering using a wedge-guard/fender wedge. Check out the DRE Composite Course Need to Read it? Check out the Full Episode Transcript below! Access the CPD quiz through our app on https://www.protrusive.app, either on your browser or by downloading our mobile app. For the full educational experience, our Ultimate Education Plan gives you access to all our courses, webinars, and exclusive monthly content. Join us on Protrusive Guidance, our own platform for dental professionals. No need for Facebook anymore! 😉 If you liked this episode, you will also like PDP104 Back to Back Class II Secrets (Sectional Matrix Troubleshooting) Click below for full episode transcript: Jaz's Introduction: The humble wedge gives us so many benefits when it comes to class II. Like, going back to basics, you put a wedge in for your class II, and it ensures that the matrix is right up against that cavity margin. So, wedging is important. Jaz’s Introduction:The other benefit, of course, is that it gives you some separation. And this helps to accommodate for the actual width of the matrix span, so that once you finish your restoration, you remove the wedge and hopefully the teeth will rebound and you'll have a contact. Another benefit of wedges is actually suppressing or depressing that papilla. It allows you to manage those deeper cavities with much more ease. So as you can see, I'm a fan of wedging and I even invest in all sorts of different types of wedges and those low profile diamond wedges for those trickier and deeper scenarios. So why is this episode on doing your class two restorations without a wedge? Isn't that a little bit crazy? Hello Protruserati, I'm Jaz Gulati and welcome back to your favorite dental podcast. So let me tell you, it was like a paradigm shift. It was a big shift in my thinking when I started to use this technique without a wedge because the wedge has so many benefits, but how many times have you introduced the wedge and seen that your matrix band has completely now moved away from your contact? You have an open contact now. And sometimes a bit like the ring, the wedge can distort your matrix. So if there is a way to do good quality class three restorations and get a contact and get a seal without needing to use a wedge, then that is worth exploring. And that's exactly what we're doing today. My guest, Dr. Sunny Sadana is a major fan of the greater curve matrix band. He's a distributor in the UK. Now, many of you in the States watching, listening to this. are already very familiar with the greater curve matrix band. It's something that I discovered probably about 18 months ago through Sunny, and now about 70 percent of the cases I do are with a greater curve matrix band. I still use sectionals, and we'll come on to that in the meat of the podcast, because Sunny doesn't use any sectionals at all. Whereas I think there's still a place for sectionals. For your smaller cavities, the nice contour that you get is great. But for those big behemoth amalgam replacements, those MODs, those subgingival areas, I went through a phase of trying to make a sectional work. Like, the sectional just wasn't going to work, but I was trying to make, I was desperate to make the sectional work. So in my aging population of patients, I see the greater curve has been absolutely brilliant. And so two shocking things you must know about the greater curve. Maybe should I give it a spoiler? Should I not? I'll do a little bit of a spoiler. So if you follow the protocols, you don't need to use a wedge. So I think that is well worth a listen. So hang with us to find out how that actually works. How can you use a matrix without a wedge? Don't you lose the benefits of the seal and the separation, all that kind of stuff. And secondly, something called the contact opening technique, which I think will blow your mind. It'll feel like dirty. It'll feel like the first time you're learning IPR. I don't want to do this. This feels wrong. But actually this contact opening technique has been absolutely brilliant in the clever way to support a wedgeless technique. Dental PearlThe Protrusive Dental Pearl I have for you today is actually about wedging in a way. It's probably a recycled one from one of the older episodes, but the value of pre wedging, like here I am saying that wedges are important, and then I told you that now I'm not even using a wedge in many scenarios because I'm using the greater curve protocols, but I'm still doing pre wedging. Pre wedging is like, for example, you get a wooden wedge and after you've numbed up the patient, you're going to put the wedge through and you want to get it really through. You want to build some pressure, right? And sometimes when I'm breaking contact, I like to use like a FenderWedge or one of those plastic wedges with that metal shield, right? To make sure you don't damage the adjacent tooth. So we don't want the atrogenic damage either way. I've got some sort of wedge in there and the benefits of pre wedging are brilliant. They really help you out in making your restoration, your class II, which are tricky things. It makes it easier. For those of you who already pre wedge, you know the benefits too well, and you can't imagine doing a restoration without pre wedging first. But if you're not yet converted to pre wedging, give it a go. Get that wedge in before you start to remove the caries or the old amalgam, and you'll see that it gives you access, better access to sub gingival areas. Perhaps it's just slightly sub gingival, but because you introduced a wedge and it's been there for a while already, by the time you take out the wedge to do your matricing, the papilla has now already been suppressed. You don't need to remove the papilla, you don't need a papillectomy because the wedge just suppressed your papilla. So whilst we do talk about not using a wedge, I'm still a big believer and a fan of pre wedging. Hope you enjoyed this episode and just to let you know, some aspects of this episode are exclusively on Protrusive Guidance. Why? Because this is a public forum and some of the things we discuss when it came to communication, fee setting, what is a fair price to charge patients, if the patients kind of come across stuff, it's not really the right platform for them. It's like strictly dentist talk. So the best way to consume this episode would be on Protrusive Guidance. It's our free app. There are also paid plans for CPD and my masterclasses, but essentially the community is free and you can access it. The behind the scenes, the hidden talk that I'm telling you about fully on Protrusive Guidance. But I hope you enjoy this talk about the wedgeless technique and something called the concept opening technique. And I'll catch you in the outro. Main episode: Dr. Sunny Sadana, welcome again to the Protrusive Guidance podcast. This time, actually on the podcast before we went so visual, we had this beautiful visuals. And if anyone hasn't seen this episode I did with Sunny, just walking through like, all the mainstream matrices. There are the pros and cons lovely little table you made. That is an absolute peach of content that's on YouTube, but I want to make something that's widespread spread this knowledge across the world through Spotify, Apple, and other means. How you doing, buddy? [Sunny]I'm good. Jaz. Nice to see you as always. [Jaz]It's been great to see your journey over the years. I briefly I met you when Pay organized this thing with Enlighten, like briefly across the room. And Pay said to me, you know what, you need to meet Sunny, right? And then when you spoke, I was like, wait, who's speaking? And I saw Sunny, you, you have like the most cockney, he's the most cockney, the most cockney person I know, right? So that was quite pleasant. It's been great to know you, your ethos and everything. So Sunny, I know you, the community knows you. For those listening, watching, haven't come across your work before, tell us about you. [Sunny]So I am a practicing dentist. I mainly do restorative. So, and that's mainly on a referral basis. I'm also the head trainer at DRE Composite. So the DRE Composite course, which stands for Direct Restorative Excellence, not Dr. Dre and yeah, composite is my thing and yeah, live and breathe it. And particularly using this matrix system called a greater curve, the greater curve matrix system, which absolutely changed the game for me and for many other delegates now.