Enhanced Verifiable CPD from the
University of Birmingham

Direct Restorations
Wedges

Wedging is an essential part of restorative dentistry: their main use is for adapting a matrix band to the proximal part of a cavity. They have a number other uses which will be considered here.

There are many types and sizes of dental wedge. Originally made of sycamore wood, they are now available in a variety of plastics, with customised designs for different situations.
The dentaljuce favourite is the Flexiwedge, made by Optident.

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Wedge Selection
Use the largest wedge that fits. This is especially important when the space between the teeth is wide.

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The wedge should not encroach towards the contact area: this will deform the matrix and leave a large approximal gap under the contact point.

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In areas of difficult anatomy (eg: canine groove on mesial aspect of Upper 1st premolars) more than one wedge may be required to seal cavity.

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Wedges used during preparation improve visibility, accurate cavity assessment, and caries removal. Some wedge designs are especially effective for haemostasis, by exerting pressure on the papilla.

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Consequences of poor wedge technique
Amalgam condensation requires high packing forces if it is going to be adequate. These forces will always push amalgam beyond the matrix unless it is wedged, causing overhangs.

Overhangs will often (but not always) result in periodontal disease (+ bone loss), and caries.

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Accidents can happen both when a practitioner is inexperienced, and when (over-) confident of their skills. The wedge in this radiograph had encroached towards the contact area, leaving a poor contour. This results in food packing and plaque accumulation.
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Assess yourself...

What are the purposes of wedging?

Very impressed - keep being interrupted by patients turning up!
JW

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