Page 24 - GP Spring 2022

The Use of a Modified Tofflemeyer Matrix for the

Restoration of Cervical Lesions

By Arthur R Volker, DDS and Mohammed El-sayed Abdulhady, DDS

When restoring a cervical lesion, there are various factors which
must be considered, such as subgingival access, isolation, and the
ability to replicate anatomical form. Ancillary aids such as retrac-
tion cord or tape may be utilized to assist the clinicians in the class
IV lesion. There are also a number of matrices on the market which
help in the containment of the restorative material as well as help
shape the restoration. This article will demonstrate a method for
restoring a cervical lesion using a standard Tofflemeyer matrix that
has been modified to simplify completion of the restoration. Figure 4. Removing excess with a scissor.

There are several advantages in using this method. The metal matrix mately 2 cm is removed from each end (Figure 4). Figure 5 demon-
will navigate interproximal contours more easily than a mylar one. strates the final shape of the modified Tofflemeyer matrix.
Secondly, in conjunction with wedges, the matrix will sit strongly
in the sulcus and allow access to the subgingival region, negating
the need for retraction cord. Finally, the shape of the matrix will
provide an anatomic form which will require less finishing than a
free-hand approach.
Protocol:
A standard sized Tofflemeyer matrix is shown in Figure 1. A por-
tion of its outer curvature is outlined with a marker as shown in Figure 5. Trimmed matrix.
Figure 2. Using a coarse diamond bur, the matrix is trimmed un- Case Presentation
The patient, a 47-year-old male with no contributing medical con-
ditions, presented to the office with a chief complaint of sensitivity
on the lower left when brushing or consuming cold beverages. A
non-carious cervical lesion (NCCL) was noted on #20, which re-
sponded positively when exposed to thermal stimuli.
Figure 1. Standard Tofflemeyer matrix.
The patient was anesthetized with 1.8cc 3% mepivicaine without
epinephrine. An Isolite (Zyris, Goleta, CA) was used for access. Us-
ing a round diamond bur, a bevel was placed on the tooth to allow
for an optical transition of composite to tooth. Biofilm was removed
using aluminum tri-hydroxide powder (Bioclear Blaster, Tacoma,
WA). Interproximal contacts were smoothed with a single-sided in-
terproximal sander (Contact-EZ, Vancouver, WA).

The modified Tofflemeyer was placed interproximally. The ma-
Figure 2. Marking the matrix. trix was tilted to the facial to ensure it was seated fully into the
til the appropriate shape is obtained (Figure 3). As the ends of the sulcus”(Figure 6). Wooden wedges were placed on both prox-
matrix may interfere with seating of the opposing arch, approxi-

Figure 3. Shaping the matrix using a coarse Figure 6. Matrix seated.
diamond bur.

www.nysagd.org l Spring 2022 l GP 24