R e s t o r a t i v e
The Continued Evolution of Class II
Matrix Armamentarium
Leendert (Len) Boksman, DDS, BSc, FADI, FICD; Brad Carson, BSc, DDS; Gildo Coelho Santos Jr., DDS, MSc, PhD
I
n his Meta-analysis of the clini-
cal effectiveness of direct Class
II restorations, Heintze states
that, “more than five hundred
million direct dental restorations
are placed each year worldwide”
and “in about 55 percent of the
cases, resin composites or com-
pomers are used.” When evalu-
ating the clinical trials in the
literature, he found that “resto-
rations with hybrid and micro-
filled composites that were placed
with enamel etching techniques
and rubber dam showed the best
overall performance, with resin
restorations having no etching
or self-etching adhesives demon-
strating significant shortcomings
and shorter longevity.”1 The den-
tal research for the mean annual
failure rate for Class I and Class
II composite restorations ranges
from 1-3 percent,2,3 while other
reviews place the median fail-
ure rate after 10 years at about
eight percent when compomers
are excluded.1 This failure rate
www.oralhealthgroup.com 
has been mostly attributed to sec- place­
ment in small 2 mm in-
ondary caries due to the inher- crements 9 include horizontal
ent characteristic of composite layering,10 angled placement or
resin polymerization shrinkage.4 oblique layering,11-13 the directed
This failure occurs especially in gingival shrinkage technique,
high C-factor restorations where also called the three-site tech-
Oblique layering in increments showed higher
stress concentration than a horizontal
gingivo-occlusal incremental filling technique
either gap formation is induced nique,14 or individual cusp build-
due to the failure of the adhesive up.15 However, the use of these
bond,5,6 or due to micro-crack incremental insertion techniques
development just outside of the to reduce polymerization shrink-
cavo-surface margins.7,8 age has been challenged, and in
a study by Versluis et al. he has
To help mitigate the effects of shown that no reduction in stress
composite shrinkage, many in- or improved marginal integrity is
sertion techniques for Class I evident between small increments
and Class II composite resin res- and bulk filling techniques.16 Of
torations have been suggested. particular note in this study was
Variations utilizing composite the fact that oblique layering in
October 2013 oralhealth 67

Figure 1—Composi-Tight 3D Clear
Ring.
Figure 4—Triodent V3 Ring two sizes.
Figure 6b—V4 Molar Ring.
increments showed higher stress
concentration than a horizontal
gingivo-occlusal incremental fill-
ing technique.
The reduction of stress with
the use of a flowable low-vis-
cosity composite resin has been
documented and attributed to
its low elastic modulus.17-19 The
flowable composite, when used
as a liner, is thought to have an
ability to deform, thereby reduc-
ing the polymerization stress a
68 oralhealth October 2013
R e s t o r a t i v e
Figure 2—Composi-Tight 3D XDR.
Figure 5—Super Curve Coated
Matrix.
Figure 7—ClearMetal Matrix.
resultant decrease in cuspal de-
flection.20 When evaluating lin-
ing with a flowable composite
on the internal adaptation of the
composite restorations using all-
in-one adhesives, Yahag found
void formation at the composite-
adhesive-dentin interface in ev-
ery all-in-one adhesive system.21
Percolation or water movement
from the dentin through the ad-
hesive layer causing adhesive
degradation, has been shown by
Tay when simplified adhesives
Figure 3—Composi-Tight Slick Bands.
Figure 6a—V4 Premolar Ring.
Figure 8—V4 Plastic Segmental Wedge.
are not covered by a hydrophobic
resin layer.22 It may be that the
addition of a flowable low viscos-
ity hydrophobic resin over the
dentin adhesive used, can play
a role in reducing this “water
tree” effect. In a clinical in-vivo
setting, when using multiple step
adhesives, even this lining tech-
nique can demonstrate inconsis-
tent results.23
The disparity between the clin-
ical in-vitro results of many of
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Figure 9—Pre-operative photograph of
tooth #45 with a defective DO amal-
gam restoration.
Figure 12—Lateral view of the new
non-stick ClearMetal Matrix System
with its micro-windows.
Figure 15—The clear ends of the V4
separation ring fits easily over the
gingival wedge.
these studies (when looking at
the effects of polymerization con-
traction, insertion technique and
flowable lining), can be attributed
to and explained by: the tooth
type that is restored (premolar,
molar, bovine, human), the posi-
tion in the dental arch, the type
(particle size and resin structure)
and colour of composite used, the
70 oralhealth October 2013
R e s t o r a t i v e
Case Presentation
Figure 10—Precise rubber dam
isolation.
Figure 13—The matrix band is ide-
ally curved bucco-lingually and
occluso-gingivally.
Figure 16—The gingival margin is com-
pletely closed and the V4 ring does
not affect the contour of the matrix
band even in the wide lingual area.
type and reactivity of photo initia-
tor present in the composite, the
size of the cavity preparation in
width, depth and volume, the type
of adhesive used, in-vivo versus
in-vitro dentin characteristics,
type and density of the light en-
ergy used, and by the realization
that there is no standard testing
methodology.
Figure 11—Preparation of the DO with
all caries removed.
Figure 14—The transparent V4 Wedge
is placed interproximally from the wid-
est embrasure.
Figure 17—Ultra-Etch is placed on the
enamel first and then into the cavity
preparation for a total of 15 seconds.
When looking at retrospective
studies, it is important to remem-
ber that materials and techniques
have evolved since the restora-
tions in these studies were placed.
To address the ever-present clini-
cal challenge of polymerization
contraction, new composite resin
systems have been recently de-
veloped. A new low shrinkage
www.oralhealthgroup.com

Figure 18—The cavity preparation is
washed thoroughly and then lightly
dried.
Figure 21—The MPa is fully polymer-
ized with the Valo broad spectrum LED
curing light.
composite with a silorane resin
matrix containing oxirane and
siloxane has recently been intro-
duced to the marketplace which
has a polymerization contraction
of less than one percent (Filtek
Silorane Low Shrink Posterior
Restorative, 3M/Espe St. Paul
MN).24 There are many current
studies evaluating the newly in-
troduced flowable bulk fill resin-
based composites such as Venus
Bulk Fill (Heraeus Kulzer Gmbh,
Hanau, Germany) and Surefil
SDR (Dentsply/Caulk, York, PA)
which are recommended for bulk
fill to expedite the restorative
process and also to be used as
liners in Class I and Class II res-
torations.25-27 When evaluating
Surefil SDR, a dentin replacement
product that contains a resin that
has been modified by the addition
of a polymerization modulator
which reduces the polymerization
contraction, these studies show:
72 oralhealth October 2013
R e s t o r a t i v e
Figure 19—G5 desensitizer is applied
over the dentin.
Figure 22—DeMark radiopaque liner
is thinly teased over the dentin and
gingival floor.
a reduced shrinkage stress on
polymerization, lower shrinkage
values than silorane composites,
a reduction in cuspal deflection,
and satisfactory bond strengths
regardless of the filling technique
and cavity depth. These bulk fill
composites have a good depth of
cure because of more potent ini-
Miller has raised concerns that Surefil SDR might
not be wear-resistant enough for contacts
tiators and a higher translucency,
which means that clinically, a
composite overlay is required for
good esthetic results.28 As well
Ilie and De Biasi have raised con-
cerns about the physical proper-
ties such as micro-hardness when
Figure 20—Application of the MPa
bonding agent.
Figure 23—Renamel Nano composite
is placed incrementally.
compared to other composite resin
systems,29,30 with these systems
being more prone to wear. As well,
Miller has raised concerns that
Surefil SDR might not be wear-
resistant enough for contacts.31
Fortunately for clinicians, the
one area where there is no cur-
rent controversy, is the fact that
the negative periodontal results
of inflammation,32 bone loss33
and caries,34 created because of
open contacts34 when Class II
composite resins are placed, has
been solved. The challenge and
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 R e s t o r a t i v e

Figure 24—Upon removal of the V4 Figure 25—The lateral view upon re- Figure 26—The D-Fine Double
and ClearMetal Matrix the embra- moval of the matrix shows minimal Diamond primary polisher is initially
sures are fully formed. flash. used for pre-polishing the restoration.

Figure 27—The final polish is attained Figure 28—An occlusal view of the
with the use of the D-Fine Double final restoration.
Diamond final high shine polisher.

difficulty of creating tight inter-
proximal contacts35 and proper
anatomic profile, has been elimi-
nated by advancements in matrix
and separating ring systems. It is
now possible to create tighter con-
tacts intra-orally than those that
existed prior to the restoration.36
It has always been obvious that,
when tightening a Tofflemire
retainer with a circumferential
metal matrix band, even when
the band is anatomically con-
toured, the band tends to flatten
out interproximally due to ten-
sioning, and an open contact is
almost always the only possible
outcome.37 Therefore, when pos-
sible, a sectional matrix which
facilitates contact creation should
be used. As well, when properly
contoured occluso-gingivally, a
sectional matrix will place the
contact in its normal anatomic
position rather than migrating
the contact occlusally, which re- Plus Sectional Matrix System.
sults in a weakened marginal
ridge.38 It has been shown that The Composi-Tight Matrix
a separating ring has a larger System (Garrison/Clinical Re­
influence on the tightness of the search Dental) has evolved from
new interproximal contact, than the original Composi-Tight Silver
the physical consistency or flow of Plus G-Rings which are made
the material.36 from circular stainless steel en-
cased in plastic,39 and now fea-
The ring penetrates the interproximal areas well to
adapt the matrix band, minimizing proximal flash
while giving good separation
The three matrix systems that ture a more anatomic soft silicone
have emerged as the market lead- face. The ring penetrates the in-
ers for restoring class II restora- terproximal areas well to adapt
tions are the Garrison Composi- the matrix band, minimizing
Tight 3D Sectional Matrix proximal flash while giving good
System, the Triodent Sectional separation. The gingival contour
Matrix System, and the Palodent is U-shaped to fit effortlessly over

74 oralhealth October 2013 www.oralhealthgroup.com


a gingival wedge. Recent improve-
ments in the ring system include
a better over-mould covering of
the stainless steel, the introduc-
tion of the 3D Clear soft face
ring (Fig. 1) which can be used
with clear celluloid matrix bands
(Composi-Tight 3D Clear Matrix
bands) for lateral and improved
interproximal light penetration,
and the recent introduction of the
Composi-Tight 3DXR ring, which
is designed to grab the infra-
bulge better, thereby resisting
slip off, especially in short teeth
(Fig. 2). A recent addition to the
matrix choice is the addition of
slick bands, which are coated to
facilitate removal due to the fact
that they do not stick to the bond-
ing agent (Fig. 3). The Composi-
Tight system works well when the
proximal box extent is minimal,
but when the preparation is wide,
this system tends to collapse the
The matrix bands have an anatomic occlusal
embrasure design, which minimizes finishing time
if the band is placed in the proper position
matrix band, indenting it to cre-
ate poor anatomic form. Repeated
heat cycles when autoclaving
stainless steel can create metal
fatigue and brittleness.
The Triodent V3 Ring Matrix
System (Triodent/Clinical Re­
search Dental) and the Palodent
Plus Sectional Matrix System
(Dentsply/Caulk, Milford DE) are
similar in that they have a ring
that is fabricated from high elas-
tic memory nickel titanium. It
was introduced in two sizes; one
for premolar applications and the
other for molars (Fig. 4). The
V-shaped notch in the plastic
tines allows placement over the
76 oralhealth October 2013
R e s t o r a t i v e
wedge and hence the name of
the product line, while the inter-
proximal shape of the tines does
not readily fall into wide embra-
sure preparations due to their
rounded design. Since the tines
do not go as deep interproximally,
there may be more flash at the
proximal margins when a “pack-
able” type composite is placed.
The matrix bands have an ana-
tomic occlusal embrasure design,
which fits into the occlusal tab’s
perforations well as the small
perforations placed laterally on
the matrix wings. The matrix
bands have good occluso-gingival
contour, and are easily placed
and removed with the accom-
panying pin-tweezer which fits
into the occlusal tab which has a
small perforation and the small
perforations placed laterally on
the matrix wings. The matrix
system was recently expanded
with the new Super Curve coated
matrix with a deeper gingival
design which accommodates deep
class II restorations, has a bet-
ter curvature, and has a non
stick surface (Fig. 5). The new
V4 ClearMetal Matrix System
(Clinical Research Dental) in-
corporates three major changes.
The rings have new transparent
tips, allowing a cure-through op-
tion (Fig. 6). A new ClearMetal
Matrix has been introduced with
“micro-windows” to allow light
to pass through. This design
retains the rigidity of a metal
matrix, but adds transparency
(Fig. 7). The ClearMetal matrix
is also non-stick as it is coated
with PTFE. The plastic wedge
has been updated, with the V4
wedge having a segmented de-
sign adapting the matrix well,
and it better resists “backing
out” as some plastic wedges have
a tendency to do (Fig. 8).
The advantages of the V4 sys-
tem include:
•T
 wo ring sizes to give consistent
separation force for premolars
and molars;
•N
 ickel titanium metal which re-
sists metal fatigue better than
stainless steel;
•A
 ring tip design that does not
readily “fall into” the prepara-
tion when the proximal box is
extended more than ideal;
•A
 new plastic clear ring tip de-
sign to facilitate interproximal
curing;
•A
 new ClearMetal matrix with
micro-windows allowing light
penetration;
•M
 atrix designs which give bet-
ter anatomic form occluso-gin-
givally and bucco-lingually;
•M
 atrix designs which facilitate
deep proximal boxes.
Matrices that are easier to place
and remove due to the holes al-
lowing the pin tweezers to handle
and grab the matrix
Clinical Case Presentation:
A female patient presented to
the dental clinic with a defective
DO amalgam restoration (Fig. 9).
After colour selection, anaesthe-
sia and precise rubber dam ap-
plication to minimize moisture
contamination (Fig. 10), the amal-
gam and all caries were removed
resulting in a wider than ideal
www.oralhealthgroup.com

lingual box extension (Fig. 11).
The non-stick ClearMetal Matrix
with micro-windows was inserted
using the pin-tweezers (Fig. 12)
with the curvature bucco-lin-
gually and occluso-gingivally ob-
vious in Figure 13. The transpar-
ent V4 wedge was placed with
pin tweezers from the widest
embrasure to adapt the matrix
to the gingival margin (Fig. 14),
with the V4 ring applied over the
gingival wedge adapting the ma-
trix and creating separation. The
angulation of the V4 ring allows
for stacking when restoring MOD
restorations and for better place-
ment of the curing light close to
the occlusal surface of the tooth
structure (Fig. 15). Note that the
gingival margin is completely
The angulation of the V4 ring allows for stacking
when restoring MOD restorations and for better
placement of the curing light close to the occlusal
surface of the tooth structure
closed and even in a preparation
with a wide lingual embrasure,
the V4 does not distort the contour
of the matrix band (Fig. 16). The
enamel margins were etched first
by placing Ultra-Etch (Ultradent)
phosphoric acid for five seconds
and then the cavity preparation
was etched for another ten sec-
onds (Fig. 17). The cavity prepa-
ration was thoroughly rinsed for
15 seconds and lightly dried (Fig.
18). Application of G5 All Purpose
Desensitizer (Clinician’s Choice)
to the dentin coagulated the
plasma proteins in the tubules,
decontaminated the preparation
(anti-microbial) and strengthened
the collagen by cross-linking (Fig.
19). The excess was removed with
dry air and suction, leaving the
surface moist with no puddling.
The MPa Maximum Performance
78 oralhealth October 2013
R e s t o r a t i v e
Adhesive (Clinician’s Choice) was
liberally applied, and the solvent
evaporated with a dry air syringe
for 10 seconds (Fig. 20). The MPa
was fully polymerized with a Valo
broad spectrum LED curing light
(Ultradent) placed at 90 degrees
to the surface for 10 seconds (Fig.
21). DeMark radiopaque flowable
liner (Cosmedent) is teased into a
fine layer over the dentin and over
the gingival floor of the prepara-
tion (Fig. 22). This created a sec-
ondary hydrophobic layer, while
closely adapting the composite to
the gingival margin and, as well,
introducing a “stress absorbing
layer.” The DeMark was cured
for 10 seconds with the Valo.
Renamel Nano A2 (Cosmedent)
was incrementally placed into the
cavity preparation with the gin-
gival layer cured for 20 seconds
and the successive layers for 10
seconds each (Fig. 23). Upon re-
moval of the V4 and ClearMetal
Matrix the occlusal and inter-
proximal embrasures were fully
formed with minimal occlusal
finishing required (Fig. 24). The
lateral photograph Figure 25
shows minimal flash with proper
anatomic contour immediately af-
ter matrix removal. The D-Fine
Double Diamond primary polisher
(Clinician’s Choice) was used with
light pressure for pre-polishing
the restoration (Fig. 26), followed
by a D-Fine Double Diamond high
shine polisher, which has a finer
diamond polishing particle (Fig.
27). Figure 28 shows an occlusal
view of the final restoration.
With the newly developed sepa-
rating and matrix armamentar-
ium that is available, it is now
possible for the clinician to pre-
dictably create tight and anatomic
Class II restorations.OH
Disclosures
Dr. Leendert (Len) Boksman is
a paid part time consultant to
Clinical Research Dental.
Dr. Brad Carson has no
disclosures.
Dr. Gildo Coelho Santos Jr. has
received materials support from
Clinical Research Dental.
Dr. Leendert (Len) Boksman
is a former tenured Associate
Professor of Restorative Dentistry
at the Schulich School of Medicine
and Dentistry in London, Ontario.
He has recently retired from pri-
vate practice, and writes exten-
sively and teaches nationally and
internationally on topics related
to Restorative. He currently con-
sults part-time for several dental
manufacturers including Clinical
Research Dental and Clinician’s
Choice. He is an Adjunct Clinical
Professor at the University of
Technology, School of Oral
Health Sciences Dental Faculty
in Jamaica where he donates his
time.
Oral Health welcomes this orig-
inal article.
References
1. Heintze SD, Rouson V. Clinical effectiveness of direct
Class II restorations – a Meta analysis. J Adhes Dent
2012;14:407-431.
2. Kopperud SE, Tveit AB, Gaarden T, Sandvik L,
Espelid I. Longevity of posterior dental restorations
and reasons for failure. Eur J Oral Sci 2012;120:539-
548.
3. Demarco FF, Correa MB, Cenci MS, Moraes RR,
Opdam NJM. Longevity of posterior composite
restorations: not only a matter of materials. Dent Mat
2012;28:87-101.
4. Bernardo M, Luis H, Martin MD, Leroux BG, Rue T,
Leitao J, DeRouen TA. Survival and reasons for fail-
ure of amalgam versus composite posterior restora-
tions placed in a randomized clinical trial. J Am Dent
Assoc 2007;138:775-83.
5. Braga RR, Ballester RY, Ferracane JL. Factors
involved in the development of polymerization shrink-
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age stress in resin-composites: A systematic review. Dent Mat 2005;21:962-970.
6. Eick JD, Welch FH. Polymerization shrinkage of posterior composite resins and its
possible influence on postoperative sensitivity. Quintessence Int 1986;17:103-111.
7. Suh BI. Controlling and understanding the polymerization shrinkage-induced stress-
es in light cured composites. Compend Contin Educ Dent 1999;20(Supplement
25):S34-S41.
8. Kanca J 3rd, Suh BI. Pulse activation: reducing resin-based composite contraction
stresses at the cavosurface margins. Am J Dent 1999;12(3):107-112.
9. Lutz F, Krejci I, Barbakow F. Quality and durability of marginal adaptation in bonded
composite restorations. Dent Mater 191;7(2):107-113.
10. Tjan AH, Bergh Bh, Lidner C. Effect of various incremental techniques on the
marginal adaptation of class II composite resin restorations. J Prosthet Dent
1992;67(1):62-6.
11. Park J, Chang J, Ferracane J, Lee IB. How should composite be layered to relieve
shrinkage stress: Incremental or bulk filling. Dent mat Nov 2008;24(11):1501-1505.
12. Spreafico RC, Gagliani M. Composite resin restorations on posterior teeth. In:
Roulet JF, Degrange M. Adhesion: the silent revolution in dentistry. Chicago :
Quintessence; 200:253-276.
13. Weaver WS, Blank LW, Pelleu GB. A visible light activated resin cured through tooth
structure. Gen Dent 1988;36:236-237.
14. Lutz F, Krejci I, Luescher B, Oldenberg TR. Improved proximal margin adapta-
tion of Class II composite resin restorations by use of light-reflecting wedges.
Quintessence Int 1986;17:659-664.
15. L iebenberg WH. Successive cusp build-up: an improved placement technique
for posterior direct resin restorations. J Can Dent Assoc 1996;62:501-507.
16. Versluis A, Douglas Wh, Cross M, Sakaguchi RL. Does an incremental filling tech-
nique reduce polymerization shrinkage stresses? J Dent Res. 1996;75:871-878.
17. Unterbrink GL, Liebenberg WH. Flowable resin composites as “filled adhesives:
a literature review and clinical recommendations. Quint Int 1999;30:249-257.
18. Davidson CL, De Gee AJ. Relaxation of polymerization contraction stresses by flow
in dental composites. Journal of Dental Research 1984;63:146-148.
19. Feilzer AJ, De Gee AJ, Davidson CL. Quantitative determination of stress reduction
by flow in composite restorations. Dental Materials 1990;6:167-171.
20. Cara RR, Fleming GJP, Palin WM, Walmsley AD, Burke FJT. Cuspal deflection and
microleakage in premolar teeth restored with and without an intermediary flowable
layer. J of Dent 2007;35:482-489.
21. Yahagi C, Takagaki T, Sadr A, Ikeda M, Nikaido T, Tagami J. Effect of lining with
a flowable composite on internal adaptation of direct composite restoration using
all-in-one adhesive systems. Dent Mat J 2012;31(3):481-488.
22. Tay FR, Pashley DH, Yoshiyama M. Two modes of nanoleakage expression in
single-step adhesives. JDR July 2002;81(7):472-476.
23. Migues PA, Pereira PN, Foxton RM, Walter R, Nunes MF, Swift Jr. EJ. Effects of
flowable resin on bond strength and gap formation in class I restorations. Dent
Mater 2004;19:839-845.
24. Papadogiannis D, Kakaboura A, Palaghias G, Eliades G. Setting characteris-
tics and cavity adaptation of low-shrinkage resin composites. Dental Materials
2009;25:1509-1516
25. Czasch P, Ilie N. In vitro comparison of mechanical properties and degree of cure
of bulk fill composites. Clin Oral Invest. Jan 2013;17(1):227-35.
26. Moorthy A, Hogg CH, Dowling AH, Grufferty BF, Benetti AR. Fleming GJP. Cuspal
deflection and microleakage in premolar teeth restored with bulk-fill flowable resin-
based composite base materials. J of Dent 2012;40:500-505.
27. Ven Ende A, De Munck JD, Van Landuyt KL, Poitevin A, Peumans M, Van Meerbeek
BV. Bulk filling of high C factor posterior cavities: Effect o adhesion to cavity bottom
dentin. Dent Mat March 2013;29(3):269-277.
28. Flury S, Hayoz S, Peutzfeldt A, Husler J, Lussi A. Depth of cure of resin composites:
Is the ISO 4049 method suitable for bulk fill materials: Dent Mat 2012;28:521-528.
29. Ilie N, Hickel R. Investigations on a methacrylate-based flowable composite based
on the SDR technology. Dent Mater 27:348-355.
30 De Biasi M, Calvi RM, Sossi D, Maglione M, Angerame D. Microhardness of a new
flowable composite liner for posterior restorations. Dent Mater 2010; 26:e25.
31. Miller M. Reality http://www.realityesthetics.com/portal/index.php?option=com_
content&task=view&id=1277.
32. Bliedent TM. Tooth related issues. Annals of Perio December 1999;4(1):91-96.
33. Neilsen IM, Glavind L, Karhing T. Interproximal periodontal intrabony defects. J of
Clin Perio June 1980;7(3):187-198.
34. Ash MM. Wheeler’s dental anatomy, physiology and occlusion. Dental Anatomy,
Physiology, and Occlusion 8th Edition Philadelphia: Saunders 2003.
35. Raskin A, Michotte-Theall B, Vreven J, Wilson NH. Clinical evaluation of a posterior
composite 10-year report. J Dent 1999;27:13-9.
36. Loomans BA, Opdam NJ, Roeters JF, Bronkhorst EM, Passchaert AJ. Influence of
composite resin consistency and placement techniques on proximal contact tight-
ness of Class II restorations. J Adhes Dent 2006;8:305-310.
37. Boksman L. Matrix systems and the Class II composite resin. Oral Health Nov
2010:23-34.
38. Loomans BAC, Roeters JJM, Opdam NJM, Kuijs RH. Effect of proximal contour of
restorations on fracture resistance. #0031. http://iadr.confex.com/iadr/2008Toronto/
techprogram/abstract_103114htm.
39. Boksman L, Margeas R, BucknerS. Predictable Interproximal contacts in Class II
composite restorations – a fusion of separation armamentarium, composite material
selection and insertion technique. OH March 2008:10-16.

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