1-PROTECT THE ADJACENT TOOTH during the prep. Fold a standard band in half, (pedo width works best) and pull through the contact using a HEMOSTAT. Apply a GARRISSON GOLD RING to secure the band and hold the excess band towards the adjacent tooth. As you break contact the ring will continuously secure the band. This will also increase separation as you prep.

 

2-MICROCOPY NEO DIAMOND-PEAR-0512M-More control than a carbide for interproximal prepping.

 

3-BARNHART 1/2 SCALER-My new best friend.  Use the "toe" as an excavator . Use the side to trim enamel rods and plane the gingival margin. Use at the end of the procedure to scale away resin tags and feel for flash.

 

TIP: Use caries indicator solution to find the last trace of decay.

 

4- PACK CORD-anytime there is bleeding or your prep is sub-g. This takes but a moment if you have precut, presoaked cord. Your band will go right on top of the cord.

 

5-MATRIX BANDS-I recommend the SUPERMAT MATRIX SYSTEM, metal bands. These are circumferential and great for MOD's. You can also replace their band within the spool with .001 dead soft tofflemire matrix.

I prefer the smaller width pedo bands in most cases. 

HOME-MADE SECTIONAL BANDS are my other favorites. Simply cut a piece from .001 dead soft bands about one third of full length. Curl on mirror handle. The advantage over pre-made sectionals (besides price) is that the extra length and lack of curvature  makes them easier to place and more stable once placed. The lack of curvature is not an issue-see later steps.

 

6-WEDGE WANDS-I have little need for the handle but this is a great wedge and one needs a plastic wedge (for its flexibility) when using a separating ring.

 

TIP: If the interproximal prep goes far sub-g, it may be best to delay the wedging until after the flowable has been placed to avoid collapsing the band.

 

7-GARRISSON GOLD RING-has the best separating power. If it is too powerful and crushes the band try applying it on the other side of the wedge OR try using the original-silver-GARRISSON ring, easier to use but much less powerful.

 

8-SKIP THE BURNISHER-USE THE OPTRACONTACT INSTRUMENT.-Burnishing creates creases in the band and often forms a contact that curls around the adjacent proximal surface. Better to use this instrument and avoid both problems. This device will place the contact point in the correct place without the need for a curved band. Push the band against the adjacent tooth while curing the resin. This device is similar to the CONTACT PRO but has a slimmer mesial-distal width and is metal not plastic.

 

9-FLOWABLE RESIN-TETRIC FLOW-Reality claims this is the best product to use in a proximal box, mainly because of curing properties at 20 seconds. It flows like water which is great for sealing the band/tooth interface. Use as little as possible as flowables do not have the properties of regular restorative resins. 

 

10-PACKABLE RESIN-SUREFILL-I prefer packables like SUREFILL because of their great handling and no tackiness. SUREFILL  was found by Reality to have the lowest shrinkage and good wear rates.

 

11-HEMOSTAT-needed to remove the band in most cases.

 

12-SHAPE WITH 12 FLUTED BURS-I use 4 shapes:rounds #6 and #8, the football and the egg #7406 (like a flame). I also shape interproximally with a tiny flame diamond. TIP: Toss all the 12 fluted carbides from your bur block on a schedule, eg, every 3 months. New ones work a world better. 

 

13-OCCLUSION:Use 60 micron paper and go for little-to-no contact on the resin.

 

14-FINAL SCALE WITH BARHART 1/2- Don't skip this. Cured bonding agent is invisible. Scale mesial and distal, buccal and lingual of each contact to remove the flash and feel for ledges and overhangs. The scaler hugs the tooth's profile as no explorer can. Now floss again and again.

 

TIP: Somehow, despite the band, teeth often get stuck together. If the floss breaks or you are unable to get through the contact, simply place a large wedge and floss while it is in place. If that fails, use Denmat's CERISAW,  a true must-have item.

 

 

15-TIP FOR ADJACENT PROXIMAL SURFACES-Prep both teeth but fill and contour one restoration-including occlusal adjustment- before filling the other. Reasons: 1-You need one completed restoration to show you the correct height of the marginal ridge. 2-It is easier to create the interproximal "roll" of the first restoration  and remove flash with empty space nearby.

 

TIP: Place compacted cotton in the empty nearby preps to support the band and thus avoid an overly wide filling .