Which is the Best Matrix System for Class II Restorations – PDP053

Jaz’s Introduction: Class two restorations are not easy, let’s face it. Matrix selection and matrix adaptation is only easy if you don’t use magnification, I mean the first time I start using magnification, that’s when I started to notice all these gaps and imperfect cervical seals on my matrix bands. And then we start getting into wedge modification, wedge selection, wedge enhancement with ptfe, rubberdam inversion, these little fiddly details will drive you nuts. You know what? All these challenges are part of the beauty of daily bread and butter dentistry. Protruserai, we’ve got an absolute treat day, were really going to give so many gems thanks to Maciek Czerwinski I mean, you’re going to absolutely love this episode because for me, class two restoration, I love doing, okay? Because they’re not easy and take it’s taken me years to master and I’m still learning and I’m still improving, day by day, thanks to awesome dentists like Maciek Czerwinski, who’s so selfless in sharing these tips like every little daily challenge that you can think of Maciek has a hack for it. So you’re gonna love this, we’re going to tackle all sorts like how to ensure that you don’t get any sort of gaps under your matrix, the most common question that he gets, and the reason I got him on is to choose, which is the best matrix. At dental school, I was only taught the Siqveland as a champion. And the second best one was Tofflemire, that’s when I was taught. There was no hint of any sectional systems. I only learned them when I got out of dental school as a practicing dentist. And you know what they were a steep learning curve, getting the whole ring properly positioned, the matrix correctly positioned without deforming. I mean, all these things are stressful. And of course, when you’re getting the right isolation as well, I mean, class two restorations are a steep learning curve. And you really can feel really proud when you get a lovely contact that are nice curve with the correct seal. But it’s not easy to get that but after this episode, I’m hoping it’s going to be a little bit just that little bit easier. The Protrusive Dental pearl I have for this episode is very much relevant to class two restorations. Sometimes, if you’re using a sectional band system, you place a sectional matrix band in and you’ve got your cervical seal great, you’ve got your ring on, good but not perfect. So along the proximal walls buccal and palatal for example, there might be these gaps. Now, it’s not the end of the world because when you place your composite, you’re gonna get some flush buccally, you’re gonna get some flush palatally, and you can just disc it away. But if you spend a little bit of time getting that seal perfected buccally and palataly, then it just means an easier and quicker and less messy process at the end, you don’t have to tidy up as much. So how can you improve your seal? If the ring isn’t 100% doing his job? Well, what you can do is use balls of ptfe type, of course what else and then you feed that in, so that when you then put your ring on, it’s gonna create that added compression on to the matrix band to hopefully improve your seal and this can be used also for the cervical seals. So the gingival area, if you find the matrix band is not fully adapted to the cavity, even though you’ve got the right wedge in there. Sometimes all you need to do is wrap the wedge in ptfe. And obviously, part of this episode one cool thing that you might learn is the Teflon wedge technique. Now, I do urge you to perhaps watch this episode, as well as listening if you’re usually a listener to the podcast, I’m always I really appreciate you, Thanks so much. But for this one, I think you can if he does have a few cases and they are amazing, right? You should definitely catch us on protrusive.co.uk, on Facebook or on Tubules wherever you usually consume the video version. So do check that out and I hope you find that pearl useful. But to be honest with you, the whole episode is just a massive Protrusive Dental pearl. So Maciek, Thank you so much for absolutely a really amazing episode, which we’re going to go into right now.

Main Interview:

[Jaz]
Maciek, Welcome to Protrusive Dental podcast. How are you my friend?

[Maciek]
It’s really nice to meet you. And it’s a great pleasure for me that you invited me so yeah, it’s really great honor for me.

[Jaz]
No, honestly, it’s great because you are someone who I have seen and learn so much from your social media presence, the detail that you go into with the restorations that you post with the dentistry and what I love about your dentistry, Maciek, is it’s not all like fancy. I mean, you got you do fancy stuff as well don’t get me wrong, okay, but it’s not all fancy class fours with 27 different layers and stuff and texturing, you do the daily dentistry and you document it so well, because ultimately, what this podcast episode is about is one of the most difficult things in dentistry, which is to do well, is actually the humble class two or the isolation and the matrixing and that sort of stuff. So the reason I got you on is because every now and then on the Facebook groups, people are, dentists are asking the question, the question they’re asking is, which is the best matrix, okay? And since about a year and a half, every time someone asked that question on Facebook, I am there straightaway. And I post your photo, the MSS, the Matrix Selection System. And that photo has educated so many dentists because now they understand a bit more. So before we dive into the first question, which is, which is the best matrix now know how you can answer it. Just tell us a little bit about where you’re from? Okay? A little bit about yourself Maciek. By the way, we had a chat earlier and if you’re an island, you will call Maciek, magic. And I quite like the name magic. But to me, I’m trying to say in a Polish way, Maciek. So Maciek, please over to you.

[Maciek]
Thanks, Jaz. I’m from Poland, from beautiful city that is Toruń. This is the city of Nicholas Copernicus. So I still work with my dad in a little single office, dental office. We’re in one office, we’ve got two dental chairs. And I started my dental story, probably something around like 11, or maybe 12 years ago right now. So Time flies really, really quickly.

[Jaz]
You’re, so your father and yourself, you both run the practice together?

[Maciek]
Yes. And to be honest, at the beginning, I thought that this is a very good advantage of possessing my father nearby because you know, when ever I had an any problem with the difficult extraction, with some prosthetic planning, and I’ve had some doubts, it’s always much better to have more experienced doctor nearby you. However, after sometimes I realized that it’s not so cool situation for me, because I took everything from my dad. So I had only my dad, not like many dentists like in big dental offices. And I took also his style of work that at the beginning was really cool. But later on, it was a huge problem for me to switch to do something in a different way than my father. And yeah, that was probably the biggest shift in my career when I decided that I have to change something because it wasn’t enough for me.

[Jaz]
That’s very interesting. I’ve seen your YouTube videos. And I believe when you’re teaching like with the Teflon floss technique, and we’ll come on to that later all the nitty gritty. But I remember I think your surgery had a microscope, right?

[Maciek]
Yes.

[Jaz]
So how long have you been using the scope for? Is this something that your dad inspired you to use a microscope or is this your you sort of discovering your own style of dentistry?

[Maciek]
The funny situation is that it wasn’t my dad who pushed me into the microscope, I’m trying to push my dad to try the microscope, but it’s not so easy, because you know, when you are experienced, it’s probably much more difficult to change your style of work. So right now I work with microscopes, probably for more than five, maybe six years. And at the beginning, it was probably the most expensive light in my dental office because I didn’t use it at all. So I bought it. And it was waiting for only difficult cases because they thought that this is only about the microscopic thing. But later on, it turned out that when I tried it, and I was trying the microscope more and more almost in every single case, after two weeks, I couldn’t just work without the microscope. So the funny story was the fact that at the beginning, I couldn’t afford the microscope and they but I really wanted to work on it. So my story was that I was purchasing the microscope from different company to try it. So they give me the microscope for like, one week, two week and I was just taking, like 10 microscope from different companies just to carry the microscope in my office. But after half a year of trying different scopes I decided okay, that’s the moment that I have to buy it and probably

[Jaz]
What did you buy? So you tried all these different companies? I’m just curious. Which one did you go for?

[Maciek]
You know, I was trying to Leica, I was trying Ziess, I was trying Kaps and the Kaps was my final choice. And when we talk about the ergonomic about the optics, it’s really, really good microscope.

[Jaz]
Fantastic. But today, I’m just setting the scene so we know a little about you, your level of work, your working in the scope, but really today is about this segment of the episode. Every episode has a theme, and today is really about matrix selection. So tell me, when did you come up with the matrix selection system? How did you think to organize it? Why did you think this was an issue that dentists need to learn about, because I see that you’re very active in dental education, which is amazing. Again, I learned so much from it. But tell us a little bit about which, in your opinion, is the best matrix and tell us about the matrix selection system.

[Maciek]
The funny story about the matrix selection system is the fact that I invented it, after the very good party. So I have no idea why. But suddenly, there was like the, you know, that’s something that Okay, let’s think about the matrix. Why, because probably, I had always a lot of problems with matrix ring. So you know, I develop the Success Stairs sequence it and that was at the beginning this sequence just for my work, I didn’t realize that it can be helpful also for other people. But later on, it turned out that you can even make a courses from the restorative treatment, and people will really like it. So I’m really happy about it. But in fact, that was the sequence just for me, just to improve my work, because at some moment, at some point in my career, I decided that I will not go on to hide my problems, and I will try to solve it. So whenever I had a problem, I just took the photo of the problem. And after the work, I was thinking how I can change a little bit to be better next time. At the end, I almost didn’t have any problems. But the last part of the most problematic part was the matrixing. So I didn’t have any problem with the isolation with the safe preparation of carious, with anatomy or anything other but the matrixing was always 100 the biggest one,

[Jaz]
I’ll say, what are the common problems that you get with matrix? Let’s just go over it like, you know, open contacts. And that’s what are the main common challenges we face as dentists when we’re doing good standard of Class twos and just Restorations in general? What are the main problems that you found in your journey that led you to go deeper and deeper and deeper to learn to improve to the standard that you’re working out today?

[Maciek]
First of all, the biggest problem is was the fact that I bought the microscope. So before microscope, I didn’t have the problem with matrix adaptation, because I didn’t see it. But when I bought the microscope, and suddenly I saw every single detail, then it turned out that I really got a big problem with matrixing. So at the beginning, the problem of matrix adaptation, so probably all of us would like to have the perfectly adapted matrix. And it is so frustrating when you see this little gap inside, and you just try everything, you just take the bigger wedge, you push it with your [knee], your patient is screaming, because there is some pain. And still, there is no anytime stirred up the matrix. And that was probably the biggest problem. Later on, the problem with wedges that when I placed the wedge, it totally damaged my isolation and there was a leakage from everywhere. Another [overlapping conversation] [Jaz]
The issue I get as well is when you put the wedge in and then it actually displaces your matrix fully come out, move around. These are old issues. But the funny thing, Maciek, is all these issues that we face, and I know gonna say a few more, but I just thought something interesting. We are stuck inside this problem. Okay? Let’s call it a single tooth, right? You put the matrix inside and you’re experimenting, you say to nurse, can you get me a different size wedge? I want to try this matrix, okay? But the funny thing is, the nurse is not seeing the problem. And the nurse is probably thinking just fill it, just fill it, right? Because every other dentist, they just fills it. Why are you asking those? So the nurse probably thinks that we’re really crap dentist because thinking here “Hey, this other dentists, he spends half an hour, okay, the first matrix are given always fit. And now you will always spend one hour and you will need seven different matrices to four different wedges, a whole tape of the Teflon for every case.” So the nurse is thinking, ‘why is this dentist not very good?’

[Maciek]
‘How bad you are?’

[Jaz]
Exactly.

[Maciek]
Yeah, that’s right. You know, the good thing about it is the fact that when we start work with rubber dam and we’ve got final, we’ve got time to spend some time to play with the matrix. So definitely, it was really cool for me at the beginning that I don’t have to think about the cotton rolls, I don’t have to think about the tongue or cheeks. I can finally work a little bit on the matrixing, so that was okay. However, you know, I don’t know how much time or what was the biggest amount of time that you spend on choosing the matrix. But sometimes let’s be honest, we can spend like half an hour trying different matrices or trying to adapt the matrix in a different way. And probably if you spend like 30 minutes, at the end, very often we are not very satisfied from the final result. So that was my really big problem, I decided that let’s try to check what we can do. And the good thing is about the isolation about working under the microscope. And probably the biggest shift in my career was the fact that I realized that I can make a mistake, that’s the first thing, but I’ve got time to correct it. Because sometimes we just play the matrix, we see “okay, it’s not very cool. Okay, maybe it will be better next time.” But the thing is that even if we spend like 20 minutes, some time, it’s good to start from the very beginning, and just try to find the perfect solution for that and just not to hide the problem, or at least, to think about it at the end of the day. And this is cool when we take a photo and you can check maybe what wasn’t okay. Can we correct something? Can we do something in a different way? And when I was trying to find some solution about the wedging and I was trying to develop this Teflon wedge, that was the very cool adventure from the beginning because now sometimes I think too much I think, do you know the MacGyver? Did you watch the MacGyver movie?

[Jaz]
I never watched it. It was a show that is coming in the evenings. And he was a detective right?

[Maciek]
Not the, he was like more like the special agent. So he was doing almost everything. So if there was any problem, he could take just like the pencil and he could build the shuttle or the plane with the pencil. So that was the really cool guy. And I was watching MacGyver, like for whole my childhood. So maybe this is the reason that I was trying to find some solution also for dentistry, and probably like 1 of 20 ideas, 1 is good. So like, Teflon floss technique is really something that really changed my approach for matrixing And to be honest, I just switched almost completely, like from the traditional plastic or wooden [wedges] to the Teflon one. And it helps your

[Jaz]
Most of my listeners are listening right now. And they have no idea what the Teflon floss is. But what we’re gonna touch on that in a second, but I just want that one, two line answer, but I’m waiting for which is, which is the best matrix because this is what everyone wants to know everyone wants the money answer, they want us to Hey, which is the best matrix. So what is the matrix selection system which by the way, I’ll need your permission, I will post a photo on the Protrusive Dental Community Facebook group and on the website so people can see what I mean about the different types of cavities and why it may be different matrices. So which is the best matrix?

[Maciek]
The answer will be not easiest as you probably know, there is no like the universal matrix. So depending on the case, we’ve got many different options to choose. And probably if you asked me like three four months ago, I would tell you that the metal matrices are the best one and because you’re asking me this question today I will tell you that today I am trying to use like more and more celluloid, transparent matrices and I see more and more advantages of doing it but probably I will be more objective in one month so probably there will be some 1:1 ratio between the metal and the celluloid so they’re just different and we can work that way.

[Jaz]
Absolutely. They work differently but even then what dentists that I think the trap dentists fall into is that they want to buy the one solution that will fit every situation. They want to buy, they want to spend the money once they want to buy one matrix system that will do all the class twos, class threes, everything okay? But I’m sorry to break it to you all but from what Maciek has taught me from his MSS and what I learned from failing so many times myself is that there is no one magic matrix solution. Every cavity will be unique with its own curvatures, own in even every cavity need a different wedge, different matrix, different way of isolating, some will remove, some will need gingival removal, some will not and in all these aspects is something that I’ve learned from a lot from your posts actually. So one on the other on that note of things that we learn from Maciek, your Teflon floss, please describe to the listeners and people who are watching, what is the Teflon floss technique? And it’s Teflon floss or Teflon wedge? We can talk about it obviously because there’s

[Maciek]
Obviously. Teflon floss is like my trademark so let’s stay with Teflon floss.

[Jaz]
Let’s stay with Teflon floss. Okay, so what is a Teflon floss and when is the ideal situation to use it?

[Maciek]
And to be honest, like I told you before I switch almost 100% into the Teflon floss right now. So I’m using it like almost all the time, maybe not 100% but probably 98% of the cases I will going to use the Teflon floss and Teflon floss is something that we can call individual wedge. So when you ask me about what is the best matrix system. And they told you that there is no one, the universal one. So we could, you could ask the same question about the wedge. And the good thing about the wedges is that the Teflon floss is something like more universal one, because it can adapt to every space that we’ve got. So at least I don’t have to choose between the small or big or medium wedges, or the plastic or wooden one, I will just take the one Teflon floss that will adapt to almost every space. So this is a really cool option for us. And the second very good option is the fact that it’s not stiff because a lot of the problems connected with wedging was because we work on the stiff way this, so like the wooden one or the plastic one, and they will gonna move our rubber dam, we will lose the isolation, or it’s difficult to press it inside the interdental space. But the soft wedges like the Teflon floss, give you completely different options during the wedging. This is like the completely different vehicle for matrix adaptation and completely different scenario because I often regret that I in the past that I couldn’t use, like the two wedges from the both sides from the palatal and the in the lingual side, because sometimes we would like to just push it from the both side. But with the plastic and wooden, impossible. With the Teflon floss, we’re using two separate Teflon flosses, we’ve got two wedges that we will pull from both sides. And we’ve got the matrix adaptation from both sides and because the force is going from both sides, then we will not move the rubber dam. So there are many, many advantages of the Teflon floss and project.

[Jaz]
No, no, of course, but make it really make a tangible. So you I did appreciate that you were using it so often. I mean, I’ve seen your cases. But it’s good to learn this from you that actually you are actually depending on your Teflon floss 90% of the time rather than a wedge whereas I’m mostly still wedging, but occasionally from what I learned from you, I am using the Teflon floss. And I love that adaptation you get. So instead of a wedge, use a Teflon floss. Now, do you have a photo that you can share the screen and show an example of the Teflon floss. And of course, I will also put your YouTube link that you kindly explained for the Teflon floss, which would be really great for everyone to see. So in those situations, you want a much nicer adaptation then the Teflon floss is the one. So I made the co host. So you should be able to share an image if you have one?

[Maciek]
Okay. Can you see this right now? So we’ve got slides around the comparison,

[Jaz]
I just wanted to because a lot of people listening you see a lot of people listen, and I need we need to also describe what’s happening on the screen as well. So you’ve got the middle matrix, the yellow matrix is what is the name given to that matrix is the bioclear, right? Diamond wedge.

[Maciek]
Of course. So on the picture, we’ve got the comparison of three different wedges. The first one is the wooden wedge that is covered with Teflon and I was using this for some time. The middle one is the the wedge from the bioclear company that I also from time to time use together with the bioclear matrix system. And the third picture is the Teflon floss or maybe better even call it the part of the Teflon floss that because you can see only the wedge here. But the whole idea about this wedge is the fact that it’s connected to the floss. So there is also that you can see on the picture, this part that the figure of one is the part where we scroll the Teflon on the dental floss and on the dental floss, we have to place the knot, then it’s much easier to scroll the Teflon tape around it. And then we can produce something that in shape looks like the wedge. But the whole idea is the fact that this wedge will adapt to this face. So if you want, Jaz, if I should play them the movie about how to use that or do you want me to play the movie?

[Jaz]
If you play it, then what we can do is for those who are watching, it’ll be on Instagram, on YouTube and stuff they can they can watch this. For the audio? I will remove it. Don’t worry. So yeah, play it and then the people who are more visual, okay, you can still be able to see it.

[Maciek]
[movie playing] So on this picture you can see exactly the full Teflon flosses and as you can see there is a floss and there is a knot on the floss and around the knot there is the scrolled Teflon tape and on this movie you can see exactly what idea is behind the Teflon floss so when we pull it, it will fill the gap and it will adapt the matrix perfectly and because we’ve got two teflon flosses in the same time, it will adapt the matrix from the both sides.

[Jaz]
So you pull on one side and you pull on the other side, the two teflon flosses.

[Maciek]
Sorry, Jaz, I will just okay, can you repeat the question because there was a music in the movie.

[Jaz]
No problem but I can’t hear the music by the way so that’s all fine. So you’ve got two teflon flosses one on either side, so you’re pulling buccally and you’re also pulling from the palatal side, the two teflon flosses?

[Maciek]
Exactly but on this film I was just recording it only for purpose of the film to show how it’s working but the whole idea is that you have to pull it in the same time. So we shouldn’t on this film i was pulling it from one side and later on from another one

[Jaz]
But in that situation, I was going to ask while you’re finding somebody is that sometimes it can happen with wedges as well you place your wedge or maybe you do the Teflon floss. And although you get a very good cervical seal, you lose the contact. So what is your advice in those situations to now that you’ve secured your cervical seal of the matrix which is so important? How can you then what do you need to do to get a better contact? Is that a sign that you’ve chosen the incorrect matrix or can you improve it?

[Maciek]
So you know at the beginning, I felt that this is the biggest disadvantage of the celluloid matrix that when I was pulling the two Teflon flosses, the Teflon was going inside the matrix. And then we was losing the contact point. And that was the problem. This is why I thought that it’s much better to use the metal matrices with the Teflon plus technique, because it’s much more difficult to deform the metal matrix than the celluloid one. However, from probably a couple of months, I realized that it’s not such a big disadvantages because if we’ve got the transparent matrix, we can take the bow applier. And we can burnish the matrix from the inside. And that is another advantage of the Teflon floss technique. So with the transparent matrices, you can just do what you want. And even if you’ve got the Teflon inside the matrix, you can just push it deeper from the outside using that plastic or you can use the the ball burnisher and to burnish the matrix from the inside. So this option you get only with the transparent matrices with the metal one if we if you choose the like the very hard the metal matrix, it’s very difficult to have the Teflon inside the matrix. This is why this is probably my the best possible mix for deep margin elevation cases when we connect the third saddle matrix that is really hard matrix with the Teflon force technique. And to be honest, the matrix adaptation of very deep cases with the saddle matrix and Teflon floss is really really easy. So this is like my best possible mixed for the deep margin elevation. But when we talk about the beautiful contact points by beautiful contacts and the curvatures, the profile, then we the transparent matrices, we’ve got more options to do.

[Jaz]
That’s awesome actually use the saddle matrix myself today. And I should have I probably should have used Teflon floss technique but I was lazy, I just use a normal wedge I managed to get a good result. But it would have been better if I use a Teflon floss but in this situation that I use it today, sometimes the caries is so deep that you just want to get a nice seal. And then I will revisit in the future for indirect restoration, which is the long term one, but I really admire how you, you know, execute to the perfection so many times to get the seal and the nice contact. It just reminded me seeing that video that you showed at that point. Do you tend to use a ring thereafter? Do you always use a ring and which is the best ring? Because a lot of people say that Garrison ring is the best. Some people say the Palodent ring is the best. Some people say the one that comes with the bioclear is okay and even the Tor VM comes with the ring. Any advice on a ring that you prefer?

[Maciek]
Yeah, to be honest, there are many features of the rings. But the most important one is that the separation force. So we need this strong separation force if we want to use the thicker matrix and we like to work on the thicker matrix because then it’s much more easy to put it inside the cavity. So my personal choice would be the Palodent thing, because I don’t like when the ring invade the internal part of the matrix. So when we compare for example the Garrison they have this small team that goes inside the matrix and very often result is the fact that it will therefore make our matrix so with the Palodent one will just let the matrix go exactly like the matrix one so we’ve got more natural profile of the matrix, this is why I really like Palodent ring. What is more Palodent is pretty strong ring. However, I can tell you in the secret that I’m working on my own ring and all the

[Jaz]
Can you create and call it the ‘magic ring’?. Can you call it, you have to the ‘magic ring’?

[Maciek]
It definitely is the ‘magic ring’. I will not tell you everything about it but because I wanted to check it out but the thing is that I can make the as big separation as I want. So the first tries are really promising so I hope that in the near future I will show it

[Jaz]
When it does come out because it because I you know I really admire everything you do and the fact that you’re in now being inventive and being creative. When it does come out. Please share it with me. I want to share it to the world. So that’s amazing. Tell us the magic ring. I’m very excited by the magic ring. Right? [overlapping conversation] Maciek, Go for it.

[Maciek]
Sure. Only because I you know I was starting to inventing this new ring. That is the reason that right now I’m using the more transparent mattresses because the biggest problem with the transparent mattresses was the separation effect that was too small and very often, we finished without the contact point at all like with the biofit from the bio clear, it’s just too fake. And the separation effect is not not too big, but with this ring, there is no any problem. So that is the reason that I can use the transparent matrix more and more,

[Jaz]
Someone like you, myself, doing lots of posterior dentistry. A lot of my patients are 50, 60+ the majority of patients and so I’m having these deep caries issues, removing old amalgams. So I’m very excited for the magic ring. I’ve asked you a number of questions ready. The next one I want to do to really get value for everyone listening is what is your number one tip if despite a tight wedge, let’s say if you’re using the most people using wedges, a lot of people listening is the first time they learned about the Teflon floss. Now maybe they will start to use a Teflon floss. But what advice can you give to someone if tight wedging and using a ring, there is still a gap at the cervical seal of the matrix. What is it that needs to be done at that point?

[Maciek]
You know, when I discovered the solution for your question, I was so surprised because the solution is so so easy, but nobody tells me that before. So I can show you the presentation because I think the much better to describe it on the photo, Play the presentation.

[Jaz]
Let me guess is it like holding a probe and just actually keeping the probe at the bottom?

[Maciek]
No, it’s even easier.

[Jaz]
Oh my god. Okay. I won’t say it. I’m thinking of something. You will have to believe me if I tell you, I’m thinking Teflon balls, I’m thinking balls of Teflon, being fed buccal and lingual, to tighten the seal.

[Maciek]
Now, it’s very often it’s not about the wedge, I thought that the biggest problem with this little gap is because I don’t have proper wedge. But when I got the perfect wedge like the Teflon floss, sometimes I still got this problem. So it turned out that this is not about the wedge. But this is more about it’s not even about the matrix, but it’s even the matrix position. So if I can show the presentation, so we’ll take this case. This is like the our daily bread, like very easy. Second Class cavity on the premolar

[Jaz]
Just share your screen, Maciek, you gotta share your screen.

[Maciek]
So this is our daily bread, the simple class two filling in the first premolar. So after the isolation, after the safe preparation, we’ve got pretty simple case to adapt. So after placing the proper matrix, after placing two Teflon flosses, after placing a ring, what we have to do is just to pull the two Teflon floss and as you can see there is a little gap right here, that can be really frustrating. So why is that there is. So what is the problem? So the problem of this gap is not that there is not enough pressure from the Teflon floss. But this is the because our matrix is very deep under the cavity margin. So this is the cavity margin. And when we really like to work with the very big matrices, because we just will, it’s much easier to push it with our finger. But then our matrix goes very deep under the cavity margin. So when we’ve got the margin right here, it’s very difficult to press this matrix, especially when we use the thick one, the hard matrix, like the metal one, it’s very difficult to press it like here. We can see this gap even even more on this picture. But look what happened when I removed the matrix and the ring, looked at the Teflon floss adopted the whole space in the perfect way. So this is not the reason of the wedging or the matrix, but what we can do is just to take the same matrix and place it in just a little bit different position. So we can go so deep with the matrix placement and this is also the very cool advantage of the Teflon floss technique that you don’t have to remove the wedge but you can take the matrix out and you can place it one more time. But right now in much better position. So right now we are with the our matrix in this position. So we are much closer the gap and look that there is almost no gap at all.

[Jaz]
simpler, that is the right you know, to do that.

[Maciek]
Just move it, move it a little bit

[Jaz]
A tiny bit coronal

[Maciek]
And there is no problem. So you know, this is the answer is so simple, but nobody told me for many, many years and I was trying to push more,Teflon, I was trying to take more bigger wedges or making this strong push on this. And there was no any positive effect. But why don’t we just move the matrix up, it will solve a lot of problems. And then we can make the perfect contact point. And you can see that also in this situation, also, what we can do is just to move a little bit the matrix, and suddenly, from the little gap, there is no gap at all. So it’s so easy. But nobody’s saying that. So that’s not

[Jaz]
Nobody’s telling that, but also, I really liked your diagram that you had there. So again, this is something that I’m gonna have to put in the video portion of the podcast and not the audio. But for those listening on audio, what basically Maciek is saying is, sometimes when you have that gap is not because of the lack of seal, the seal is there. It’s just the matrix is a little bit too gingival, and you’re getting that over curvature. If you lifted up more coronally for those listening, then you can actually get rid of that suppose that gap. And with the Teflon floss, as you showed, you don’t even have to remove the wedge, which is your Teflon floss. So that is amazing. I think you’ve answered that really comprehensively with a such a simple way. So that’s awesome. I saw your Okay, so we already asked his question about you already answered it metal versus celluloid? And sometimes you will change your mind and and they’re both great. And maybe you said maybe the metal one could be more favorable in the long term. But they’re both good. And you use the bioclear. You use the just named the different matrices that you use, what do you have in your practice? Daily.

[Maciek]
I want more time to share one photo with you, because I think that will also answer our To be honest, I wanted even to start this presentation, we have this photo, because this is the cool thing about the dentistry that in the same patient, in the same case, we can choose different solution. And using just the different matrix we can get like the totally different final outcome. So as you can see, we’ve got the three different matrix in the same cavity, and we have the metal one. With the metal matrix, it’s sometimes very difficult, especially when the space is pretty wide between the cavity and the adjacent tooth. So it’s very difficult to catch the contact point. But when we’ve got more curved matrix, and we don’t have very current metal matrix, this is why we like the celluloid matrices, like the biofit, or like the bioclear, we can get totally different outcome. So we can get the beautiful contact point or even instead of the point we can call it even the contact zone that it’s also much better for in the long term. And I don’t know if you had this situation, but sometimes we’ve got the patient with the diastema to close. And this is our like the, this is our goal to call it, if we don’t have the proper matrix, sometimes the visit will be a real nightmare, because we’re not gonna finish that. So, we will try to burnish the metal matrix, we will try to move it but the final result will be really really bad. This is why it’s very good solution to have like the at least couple of matrix from the different scenarios. So, this is why I started the matrix selection system. So one of the features of the matrix selection system is the fact that we will have different distances between the cavity and the adjacent tooth and we can divide it into the field medium and the wide situation. This is why it is good to have like at least couple of matrixes from every group and then it will be much much easier to finish the whole treatment on the single visit because without the good matrix, it’s sometimes impossible.

[Jaz]
I totally agree. And this is why I like the matrix selection system so much so for years, you know I was trying to find also I was trying to use a Palodent for everything but then I realized from your teaching that actually no I can’t sometimes I will have to use the bioclear because it has the extra curvature. Sometimes I when I discovered Tor VM I think it’s from tomorrowtooth.org oh my gosh, stiff. I like the sort of convexity it has several advantages in certain cavities compared to Palodent so this was amazing. And your success stairs. Matrix selection system really gave me some clarity on that. But one question I have on that because you mentioned is that sometimes you have the patient with the posterior diastema where the space is just too big. And yes, maybe you can use the curviest bioclear matrix you have. But at which point do you say no, this is going to be indirect. What is your threshold to say no, this will be indirect?

[Maciek]
That’s very good question. When are we talking about the wide situation. So when there is like the huge diastema, when we talk about the direct way, and when we talk about the, for example, the bioclear curved matrix, when we’ve got the two teeth, and the distance is pretty big with the maximum amount of space that we can cover is probably something around three to four millimeters. So we can get the extra curvature of the matrix on everyone, like two millimeters. So when we summarize it, this is like before, four millimeters, the funny thing is that it will be not much more easier for our dental technicians to get the very wide space. So this is why To be honest, right now, a lot of the works I will do in a direct way, because I can be much more accurate than the in doing this in an indirect way. So I was told that if you’ve got a problem, if the cavities too deep, or you’ve got the problem with the matrix adaptation, then you should go to indirect way. But from my experience, right now, the best possible option for me when we talk about the accuracy is the good matrix adaptation. And it’s difficult to beat that. If you adapt the matrix in a proper way, your technician will have very big problem to be so accurate as you in doing that in a direct way. So right now I’ve got very few solution to be honest. So I’ve got direct filling and the vertical crown that I am a fan so that only because I’ve got the tooth just to solution for my patients, it’s much better choice for me. And for my patient, it’s much easier to make a decision because that was also my problem.

[Jaz]
If my directs were as good as yours. I probably won’t need a technician either. So But okay, this, we’ve covered a lot of ground here. And we talked a lot about the nuances and nitty gritty in your visuals, the cases you showed were amazing. The question I asked at the end is a question that again, a lot of people ask, right, and you probably had loads your message in the past about this is how do you restore the last molar? So let’s say you’ve got the do have the seven they don’t have a wisdom tooth. What is your hands, what is the nice technique to get the best cervical seal in those scenarios?

[Maciek]
Yeah, when we talk about the distal cavity of class two this is almost everything is problematic because the problematic is the preparation because when we work with the rubber dam, there is the arm of the clamp. Very often the core isolation is also difficult so it’s difficult to place the clamp to catch the cavity then there is a problematic because of the safe preparation. When we talk about the preparation we will the [microetcher] or with the prophylactic powder. And also matrix adaptation. Of course, is a problem. So my trick, or maybe it’s not even mine, but I can show you some solution for for that,

[Jaz]
because quite often they’re very subgingival because of the distal gingiva is always higher up.

[Maciek]
You know, the funny thing about the distal cavity is that always this will be a member of your family or it will be your friend, or your wife or your mother in law. So the most difficult case always in the family. So the case that you can see this is the friend from my high school, and he came to my office and Maciek just helped me because I began to have the caries on when I saw that case, and I thought you know, you always want to show to your friend how good dentist you are when I look at this photo, I said, Oh my goodness, this will be a really a nightmare, because this is like the biggest nightmare for all the dentists. So what we can do when we talk about the matrix adaptation, so I really like the technique that was presented by Steven [Popanion]. This is the technique that we can call the matrix in matrix. And this is a really cool technique when we can use the the matrix system with the clamp like the also like the Tor saddle matrix, and we can place another matrix inside, and we can pack the Teflon in between the one matrix to another one. So then we can add up the matrix in a perfect way. This is the one thing that we can do. There is also the second option to do that, that we can call this single Floss technique that we can also use the Teflon floss but this time, the single one and when we’ve got the the Teflon on place, then we can just place the celluloid matrix. Of course it’s not very easy, but it’s possible. So also we need celluloid matrix, it’s much easier because it’s not so stiff, but also with the Teflon floss because it’s also not stiff, we can pack the matrix in between. So this is possible. So those are two techniques that I’m using to adapt the matrix on the distal site. And of course, it’s not easy. Sometimes it looks very easy on the photo, but we have to remember that sometimes we have to spend like five to 10 minutes to finish that.

[Jaz]
That’s awesome. The only thing that I sometimes do for the last molar that you hadn’t shown the slides just yet maybe you use it is the use of the Hallerklammer Clamp? Is that something that you use?

[Maciek]
You mean, the the gold one, right?

[Jaz]
the very different shape sort of the long one that you put in the premolar, and it moves your rubber dam more buccal and palataI. I quite like that. And then that has helped me in the past in that situation. Have you got an experience of that?

[Maciek]
I have never used. I saw that clamp. And to be honest, I wanted to even to buy, but probably I will, because I really like the new things. But you know, I always try to do it in this way. I am not so sure if there is no any clamp on the last tooth, how stable is the rubber dam? But you can tell me because it

[Jaz]
It depends, you’re right. If you’ve got enough clinical crown height at the distally, then it’s stable. But if it’s you don’t have enough critical crown height, then it slips off. So that is more chances than what you have to do before it slips off, you have to quickly put your clamp on. And usually in that one, you have to use a circumferential matrix, you have to put your matrix on. So you have to put your the circumferential matrix on to stop the rubber dam from coming up and quickly tighten it. So it has some challenges, but it gives you a bit more space. And you know what, Maciek, I think you should get the Hallerklammer Clamp just for the patient who say who says No, I do not want rubber dam and they deny it and they’re claustrophobic. But you put this clamp inside

[Maciek]
there is no such option in my life

[Jaz]
I like that. I like that you’re far too cruel. But in those situations, this clamps I kid you not it just moves the cheek and the tongue. The fact that you know that patient with a fat tongue, who will not tolerate the rubberdam for whatever reason, it just moves everything out away. So it’s great. So we covered a lot there. And that’s amazing. Maciek. I know we’re in a COVID world right now. So it might be difficult by no sometimes now and again. You’ve been to the UK you go around the world I think you’re going to Denmark soon to do some teaching, is that right?

[Maciek]
I hope so. But because of the COVID you never know what will happen. But yes, the plan is for January to go to Argos and to make their the Success Stairs course this will be probably the fourth edition of this course in Denmark.

[Jaz]
Amazing. Yeah, obviously you know you’ll keep those people listening from Denmark obviously. Check them out. But you’ve had you’ve come to the UK before I believe with the with the Stephen Kerr, you’ve set some courses that before right?

[Maciek]
Yes, we organize the course with Ian Kerr. Incredible dentist from UK. I really love this guy. And it’s probably because we talked with Ian probably also make the course also in the 2021 in UK, so maybe it will be a good option to meet,

[Jaz]
Please, I would love to and please do send me the links before that I can just post it to everyone because I you know everyone will see the level of what they are doing. And this is a daily problem that we have. So please do send me that stuff. So when the time comes in 2021 we can give you a good welcome in the UK. But anyone you know people listen from all over the world. Where can they find out your course calendar and the content and your lovely content that you have on on Facebook and on YouTube? How can we see more of it? What are the channels we need to follow?

[Maciek]
Sure, there are like two options. So I’ve got the channel on the YouTube and that is called the Success Stairs. And there is the the web page on the Facebook. So this is probably the best source to if you want to see the cases that I’m presenting this is the best possible options. So I will send you the link that you can paste in this presentation.

[Jaz]
I’ll put it in my show notes to those listening protrusive.co.uk/matrix-system. I’ll name it that episode. And then in the show notes, there’ll be all of Maciek’s links, the link to his YouTube video and the Teflon floss, it will all be there. So check it out. Maciek, when you’re next in the UK do let me know I’d love to come and meet you in person. But for now please, please, please keep posting these daily challenging dilemmas because honestly, we learn so much from all the time. So thank you so much for coming on as a guest. I really appreciate our chat today.

[Maciek]
Thank you, Jaz, that was a real pleasure for me also. So thanks a lot for invitation. And I hope so that we will also have the another meeting soon.

[Jaz]
Thank you very much.

Jaz’s Outro: Thank you so much for listening all the way to the end. Hey, if I was five years ago, just one or two years out of dental school. I heard Maciek and his pearls that would have saved me so many individual sort of moments of absolute grief and agony when I’ve been sort of fiddling around these matrix band. So if you found this useful, and you know, a dentist who really, really struggles we all do we have these daily struggles of class two restorations, right?nd if you think they’ll benefit from this episode, please do share it with them, send them on WhatsApp or email them, that’d be really appreciated. That’s how the podcast grows. So thanks so much for listening all the way to the end. And finally, next episode will be anterior midpoint stop appliances part two, so AMPSA part two, to finish off on the splintember, which was I mean amazingly successful, and of course with the splint course launch coming up, so you can go to www.splintcourse.com to pre register for that, but I’ll tell you more about that in the next episode. I hope make it I’m going to make it an really impactful episode so you can get started with anterior midpoint stop appliances straight away. Thanks again and I’ll catch you in the next one.