Stop Getting Open Contacts in Tricky Class II Restorations – GF008

TIME SENSITIVE – 50% off Maciek’s Online Contact Point Ambassador Course! Click here

Let’s face it, Class IIs may be our bread and butter Restorative Dentistry but they are ANYTHING but simple. In some scenarios, achieving a perfect contact on a class II restoration seems impossible.You have likely been in a scenario where everything is going to plan and your matrix is looking like it will achieve a lovely contact area – however, as soon as you insert the wedge or tighten the band (circumferential matrices) the matrix leans away from the adjacent tooth, revealing a ghastly looking open contact. How can we overcome this? Is soft tissue removal an option? In this Group Function, I’m again joined by my boy Dr Maciek Czerwinski who answers this emphatically!

The full episode! Minor video issues with Maciek
How to do Teflon Floss Technique – the Main Interview Podcast Video has some syncing issues, please bare with us!

Need to Read it? Check out the Full Episode Transcript below!

“If you use the stiff wedge, if the wedge is too big it will just move the matrix (and you lose your contact), but if you’ve got something soft, it will go under the curvature of the matrix, and then it will just self adapt.” – Dr Maciek Czerwinski

In this group function we also discuss:

  • Is it necessary to remove soft tissue? – Why? How? What to use? 
  • How to improve the contact area
  • Why and when to place an orthodontic separator to help your future restoration

Tired of spending hours just to customise your stiff wedges and matrices? Check this gem shared by Dr Maciek – FINALLy the video on how to do the Teflon Floss technique (as promised in the episode):

Also, Dr Maciek is giving 50% off to all Protruserati up until June 30. Click here to check it out! I have done his online course and it was very comprehensive and is guaranteed to improve your contact points no matter how tricky the situation. It is an all-encompassing direct restorations online course – with play by play explanation of matricing, wedging, ring selection and isolation!

Click on the image to check out Maciek’s course!

If you have any other questions that would make a good group function, please do message me on @protrusivedental Instagram page or the Facebook Page

If you enjoyed this, you might also like my other episode with Dr Maciek Czerwinski on Which is the Best Matrix System for Class II Restorations 

Click here for Full Episode Transcription:

Opening Snippet: When I first saw this I was disgusted when I first saw this I was like you're removing healthy papilla, you're gonna destroy the biological width. The patient will die, the patient will get necrosis you know all these things.

Jaz’s Introduction: 
Have you ever had that scenario where you’ve got your matrix band in and you’ve got this lovely looking contact area and thinking great there’s gonna be a home run restoration but then you put in your wedge and okay the whole contact is now open right? The matrix that was beautifully contacting the adjacent tooth before is no longer contacting that tooth. What’s happened there and how can we overcome this really simple basic but daily bread and butter issue? I’ve got none other than Maciek Czerwiński obviously came on to do an amazing episode all about Matrix Selection which is the best Matrix and I hope you enjoyed that episode.

So today we’re gonna be talking about this class two woes. Do you make these class two mistakes? We’re gonna be talking about the importance of recognizing how to overcome this issue that as soon as you put wedge in the contact area opens or the second scenario is the importance of soft tissue removal. Like I couldn’t believe that when I spoke to Maciek, He revealed that in 70% of his Class II cases he’s having to remove some soft tissue.

Now if you’ve seen some of his work on Facebook you’ll see why he’s dealing with some pretty deep lesions the whole time. So that makes perfect sense. And he gives you one more pearl as well. So welcome Protruserati. I’m Jaz Gulati to this group function all about how can you IMPROVE your Class II contacts and how to OVERCOME common scenarios.

We’ll catch the main episode and I’ll catch you in the outro. If you catch the outro you will see a massive discount on Maciek’s Class II course. It’s called Contact Point Ambassador, it’s way more than a Class II course. It’s like getting solid contacts consistently. So if you want to kind of cases he does on social media in terms of like really solid dentistry, restorative dentistry without never having open contacts again from all different types of rings, Teflon floss, matrices, the whole dissection of it for the cost of one restoration. You can do his course with this 50% off. So catch that in the outro and I’ll see you there.

Main Episode
Maciek A.K.A. Magic welcome back to protrusive dental podcast. Had to bring you back one more time, my friend. Because you absolutely blew everyone’s mind when we talked about, which is the best matrix system. How are you, my friend?

Thank you. I’m fine, thank you for invitation. It’s a big pleasure for me to be with you second time. Nothing really big change except I did something for the very first time. I launched my first online course and I was very happy about it also a little bit nervous because it’s a little bit nervous when you do something for the very first time also like in dentistry. But yeah, it’s everything is really great. Thank you.

I’m so glad you did that because Maciek is someone who creates online education myself. I was waiting for you to do that because the matter value that you give on your social media posts. I was waiting for something a bit more structured and you finally did that. And I was happy to say I was one of the first students and thank you for giving the opportunity to work through it.

And oh my God, like from the Teflon floss, to matrix selection to wedge modification, you covered everything beautifully. But today, what I wanna do is extrapolate maybe just pinch squeeze out of you some gems that can help everyone. Right? So this is today. It’s like it’s the Protrusive Dental Podcast episode. But it’s also like a group function. Okay.

Group function is what I do when we have a problem in our community, the listeners and they have a problem and they need the answer to that one specific problem. And that problem at the moment is a contact points. Right? So the reason I got you on is because who better to get you on Maciek because your course is called Contact Point Ambassador So great. Great name. And I think the times as a dentist where I felt the lowest after a clinical day is when I in my mind I cannot get rid of that stupid, silly open contact. Right? And you try your best, you do everything and you still left an open contact, right? It’s not nice. It’s not nice feeling. And sometimes you think I could have done something better or was that impossible?

Now I know in your vocabulary there is no such thing as impossible. I’ve seen any contact. I’ve seen you closed it. But I also appreciate, by the way for those who don’t know is that you share your failures, your past failures and how you learned and adapted. Which is why it sets up perfectly to the first question Maciek, which is that annoying scenario whereby you put your matrix in. So this could be a circumferential matrix or a sectional matrix. Right? You put the matrix in, okay? You’re sealing the cervical area of the cavity. So remember we’re on video but also for the audio listeners. Need to be very descriptive what we’re describing. Okay, so the matrix has a good seal and the matrix looks like it’s got a nice contact to the opposed adjacent tooth, which is good. But as soon as you put the wedge in, the contact is gone and now you have like a one millimeter open contact. What are we doing wrong when this happens? And what tip can you give to the dentist who are having this problem now and again?

Probably this is one of the most common problem. And that was also my problem for many, many years. And so I know this frustrating moment when you see it, especially that very often we don’t have enough time to correct it. And it would be superb if we have some solution for that. And that was the beginning of the idea of the Teflon floss. So the biggest problem is the fact that the wedge is a stiff material. So if you use the plastic wedge or the wooden wedge, very often those wedges are just too big or they’re moving just too close to the occlusal surface.

And this is the biggest reason for losing the contact point. So my advice would be to try to use the Teflon floss because Teflon floss is a game changer because this is something that we’re going to adapt to the space that is the Interdentally and it’s pretty soft at the beginning. So if you’ve got the matrix with some kind of the curvature, if use the stiff wedge suddenly if the wedge is too big, it will just move the matrix. But if you’ve got something soft, Teflon floss will go under the curvature of the matrix and then it will just self-adapt.

So if you’re using the stiff wedges, you always have to customize it. So you have to cut it, so you have to reduce it from the [cape] or you have to cut the plastic wedges. That is pretty time consuming as well, because as you know, we also have to customize often our matrices, so there is so many things to customize that suddenly turned out that there is no enough time for finishing the whole THING. So Teflon floss make everything much much easier. However, you have to learn how to use it, like with everything.

Well those people listening right now who maybe didn’t catch our first episode, we discussed Teflon floss, great depth, essentially, this floss is – you’ll describe much more intricately than what I’m describing, but wrapped in Teflon and essentially you get like a softer wedge, but I can get a really nice seal that is adaptable and I’m definitely sold on the Teflon floss and I believe you released a video recently as a preview for your course and I’ll add that on my website, so people can check it out how to do the Teflon floss and then they can start seeing the advantages of switching to a Teflon floss rather than a stiff wedge.

Now, the issue that I described, you stick your wooden wedge in and the contact opens. Do you think that also happens? Not just because it’s a stiff wedge, but maybe because the wedge is too coronal i.e. it’s not deep enough, it’s not gingival, or cervical enough. Could that be a cause of this issue as well?

SURE, that’s the another reason. So this is why it’s very easy when we’ve got pretty shallow cavities because then the wet will go always under the curvature of the tooth. But if you are pretty deep then it will always move. One of the solution is definitely to remove the gum. So to create more space for the wedge. Because it’s impossible if you’ve got a lot of the gum interdentally it’s impossible to squeeze all that tissue with a wedge. Or you have to use very big force. That will be not very pleasant for the patient, especially if you work without anesthesia but probably not. But sometimes it’s really necessary to remove the gums. So probably in my case is like the second class cases. Almost 70% of the cases I will going to remove the gum. So this is like the really essential element of the restorative treatment. When we talk about the Class II, to remove the gum because then it’s much easier not only with the wedging but also with the matrix placing with the rubber dam placement. So a lot of the advantages of doing that.

There are so many advantages of removing soft tissue and I believe it was you and Pasquale Venuti who I first saw on social media many years ago removing soft tissue. And you know what, Maciek? When I first saw this I was disgusted. When I first saw this I was like you’re removing healthy papilla. You’re gonna destroy the biological width the patient will die, the patient will get necrosis, all these things you think. But man when I started to do it, wow the rubber dam started to see more apically, my matrix was able to sit and get a better cervical seal. My wedge finally had the correct position to go to. Right? So there are so many advantages of soft tissue removal. It did surprise me that 70% of the cases you removing soft tissue. But then again, if you look at Maciek’s population base and you look at the kind of carries bombs that you get, like they’re always so deep. And then I think that’s why because you’re having to remove the gum because you’re dealing with really deep lesions. So it makes perfect sense. Now, the most common question people are thinking now while we’re talking about this is okay, what do you got to use a laser or what I mean? I know what I use. But I want to hear about what kind of things do you use to remove the soft tissue in an efficient way, in an idiot proof way?

I was trying almost everything because for me it was also like the complete switch of my approach in the restorative treatment. So even that I want it in the past to be a surgeon. I really don’t like to use a blade during the restorative treatment because you have to tell your patient why you are taking the blade, why you want to cut him. And it’s not so not so easy. Also, the whole management and all the manual connected with using the blade. It’s not so easy especially when we talk about the interdental space. So for me when Pasquale Venuti shot for the very first time, this magic bur that is not covered with the diamond, this very smooth bur that you can really easily remove the gum. That was the completely switch for me. And it’s really probably the best possible option to do that. I was trying also the laser however to be honest, I am not a fan of laser, especially in this area because you never know how deep you’re gonna burn the tissue with the laser. So the friend of mine sent me a message that he made the bony crosses because he was cutting the gum but it was just too deep. So he also cut the bone. So I also like to have like very simple protocol and using the bur is just the easiest solution for us because you can just put the bur into the hand piece into the turbine and you can remove it. So this is also a very important factor to use something that is very very quick because also I was using the [cauter] electro surgery in such situations however it’s not always ready. So I had to ask my dental assistant to prepare it. And then, and if if something [class more land than three] or four minutes, you will probably resign using that. So the bur is the easiest, the quickest and probably the best possible option to do that.

Well, I’ve used Electrocautery firstly out of dental school. I start using Electrocautery. I wish I knew at that stage about matricing and getting the best seal and stuff. And I suffered a lot at that time, as you do when you were learning right? And then I would use Electrocautery when it’s like really deep and I had no choice. But then I also used a laser, but I agree with you, you don’t know exactly the depth that you’re penetrating the soft tissue. But when I switched to the thermal cut bur, this bur without any diamonds and they come in. The one I recommend to buy if anyone’s gonna buy it is you have an assorted set of like five different sizes, six different sizes. That’s the best one because you got a tiny one for really tight spaces and the fat one for really fatspaces for really meaty papillas and just put that on high rev no water. And I just love just all the papilla comes away so precisely and very minimal bleeding. Painless. And obviously as part of this, you’re doing anesthesia anyway for your Class II restoration. And I’m giving a little bit in the papilla buccally going all the way and it’s just a great way to do it. So it’s a thermal cut bur that really made a huge difference. And yeah, you’re right. you’re completely right, like if you’re gonna be using Electrocautery and if you already have this expensive system or laser and stuff then to actually tell your nurse ‘oh can you please get it, wait for it set up.’ When you can just stick this bur in. It’s so so good. And what do you say to patients like we’re having this papillectomy for afterwards and after care? That’s the most common question I get as well.

Yeah, that’s a very good question to be honest definitely, in the past I was telling to my patient before that probably we’re going to have to cut the gum. Right now, when I’m doing it with a bur I even don’t mention it before because sometimes we’ll make patients more stressful and we know that it’s nothing really big. So very often they will not even have been after the visit but it’s very important to say it after the visit. So I always said that they should take some painkiller that they can feel some pain afterwards. However, in 90% of cases they feel just nothing. So on the next visit, when I asked do you have any pain after the previous visit, they said no it wasn’t painful at all. So but there should be always the information also what was pretty important for me and this. Let’s treat it as a like a hint. And I always had a problem with making my price is a little bit higher. So if we are using the Gingivectomy at the beginning I was telling to my patient that will have to make some extra surgery because of the filling and they will have to pay extra for this. So for me it was much easier to rise my prices because I just added the price for the gingivectomy. So that is the best possible business because you know how is it can be and how quick it can be. But this is also one of the options how if you don’t know how you can increase your prices. This is also one of the solution to just divide the whole restoration to the restoration and the gingivectomy. Right now, I don’t have this this problem. But in the past it was a problem for me. So it was really useful trick. Let’s call it.

And that’s important to discuss because when we’re less experience where a bit more trying to charge and we have that whole dilemma about charging. So you’re right, you can say to the patient to add value to treatment saying, you know what? This is a tricky one. The hole is under your gum. I need to perform a very small surgery. Don’t worry. Mrs smith. It won’t hurt very much. You will be numb, you won’t feel anything and then you’re right. Afterwards, I find that patients hardly feel a thing. Now some things that I do as a precaution and there’s zero evidence of this, Maciek, in terms of what I say. But I do follow like as if someone’s had a crown lengthening surgery, the similar advice that you might give like, don’t do too much aggressive flossing there. let it heal. do some warm water, salt rinse. And then one more thing I say actually, which is like a funny thing, right? Is that just before I do it because I’m using no water, using it dry. I will say to the patient, it will smell like a barbecue, don’t worry. And we just laugh about it, right? It’s a little thing to say as well just before you do it and stuff. So yeah, absolutely ise a thermal cut bur. Use to remove soft tissue where it’s appropriate. And you will find so many benefits of doing that and you can get the thermal cut bur pretty much worldwide. I believe it’s made from dentsply. There might be some fake ones out there as well, whatever. it’s just steal, right? It’s just diamond, no diamond on it. It’s very simple thing. So, Maciek, I’m gonna end this group function now. But can I just ask you can you just give us one more because you mentor people and you teach on this all the time, what is a common dilemma that you find dentists are doing as well as the ones I told you already like the lack of soft tissue removal, the wedge getting in the way, and moving removing your contact. One more issue that you think that we could have a little trick. A little gem you can give us to help improve our contact areas or contact points.

I think that one of the most important part also that I didn’t know for many many years is to prepare our visit to make the restoration. So in the past I thought that we need some preparation always when we are doing this digital smile design and so on. We have to plan everything. But to be honest it’s also very important to check how much space do we have for our filling. Because very often when we deal with the very old fillings sometimes the one tooth overlap the another one. And then it’s very important if you see on the dental checkup that you’ll have to make the restoration on the next visit. And there is a really small amount of space or there is a very flat filling that is almost connected to the neighbor tooth. It’s sometimes it’s much better to place the ortho ligature in between the teeth just to create more space because when we talk about-

Like an ortho separator, right?

An the separator or the there is something like wedged, to make the rubber and more stable. So this is just a piece of the rubber. So like with the Gingivectomy, we’ve got the some surgery here. We’ve got even some orthodontic connected with the restoration. Because the most difficult, at least for me is the situation when we’ve got a very small amount of space in between because then any matrix will be good. So then we’ll have to use like the stripe and it will just make our contact point very, very bad. So it’s much easier if you’ve got more space than if we’ve got just a little bit. So it’s much easier when we create additional space, we put just the wedged for two weeks and then we’ve got extra one millimeter. That makes everything much much easier during the visit.

That’s amazing. And to make it even more tangible-

and it looks so cool on the photo.

That’s another reason to if you’re not gonna do it already, but to make it tangible to listeners like something, I do quite a lot of his whole crown. So these like stainless steel crowns for children without any preparation. and sometimes not always, but sometimes we need to plan ahead and create some space because you’re not doing any prep, you want this metal crown to seat? It’s like preformed metal crown. Right. And that’s when commonly we’ll be using these ortho separators or ligatures. So just like you said, we’ve all seen that restoration of that premolar commonly it’s a premolar. It’s almost like impacted into next pre molar and you don’t have any room. It can be difficult to floss. It can be difficult to give you a very nice contour. So your gem there is brilliant. Use an orthodontic ligature or a separator and put it in a few weeks before your appointment opens up that space and now it will give you better control, a better curvature on your contact and therefore more chance of getting a contact area than a contact point with less deformation of your matrix. So amazing. Maciek, thank you so much. Please tell us which is the website. We need to go on to check out your new course contact point ambassador. And do you have any closing enrollment or any dates we need to know. So I know when to get this podcast down as well.

So I think we’ll link the address to the website under this talk. But yeah, there is this special promotion that will last only this month. So till the end of the June this is the 50% off from the original price of the course. So I believe that it’s a very good moment to watch all the course.

Amazing. That’s fantastic. And like I said, I’ve done it and there are so many gems in there and I’m not gonna give away too many secrets. But one thing I know is where do I buy and Elliot separated from?

There are many distributors right now, I bought a couple of them. So right now, I like to check different brands, different instruments. So right now I’ve got one like the Chinese version, one from the Japan. So there are many, many places that where you can buy in important, when you type the Elliot separator, you will definitely find one. where to buy it.

Amazing. Cause I haven’t looked, I just was wondering basically because I don’t know many UK dentist who have one. But I think it’s time because I’m not gonna give away the secret because you have to do the course. I mean there’s such a beautiful way to use these in a really clever way. I mean, I’m not gonna get away with the Teflon floss as well. Like you will never have an open contact ever again. And it’s just, that’s our bread and butter and for the cost of one, I mean privately for the cost of one restoration. You’re putting on the whole masterclass on contact points. That’s amazing value. So, okay. That’s putting it very tight for me. So now as we’re recording, this is June 24th by the time this episode comes on will be Monday. Okay, so that will okay, you’ll have around about four or five days to get this discount. But honestly, even if the price rises, it doesn’t matter. It’s a fantastic course. You should do it. But definitely check it out. I’ll link the website in the outro if I can or if not it will definitely in the website as well. So it’s protrusive.co.uk/contact points I’m gonna make it contact points. There we are. Thank you so much, Maciek for your time. I really appreciate you coming on again and giving so much value.

Thank you, Jaz.

Jaz’s Outro: 
Well there we have it guys, that was Maciek Czerwiński on this group function. All about how to improve your contact areas and contact points and have to overcome these common challenges. So take away points were make sure you modify or select an appropriate wedge, something like a Teflon floss, which he covers really well. Now, as promised, if you’re watching the video version on the website or on YouTube, I’ve got a link to how to do the top Teflon floss so you can do it in full and it’s really, you know, a little bit [50] at first. But once you do it and you see that beautiful contact, maintained its awesome the importance of soft tissue removal. So again, I will link you to the thermal cut burs they are brilliant. Every practitioner should have a pack, a multi assorted pack of thermal cut burs and of course the ortho ligature tip was absolutely fantastic. Now, if you wanna take advantage of this discount, that Maciek is offering 50% off before the end of June, please go to protrusive.co.uk/contactpoint or one word. That’s contact point. And I’ll take you to exactly where you need to go to take advantage of this offer to do his amazing class twos and contact point. Course, I’ll catch you in the next episode. Protruserati. Thanks so much for listening all the way to the end.

Hosted by
Jaz Gulati

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