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I enjoyed the above lecture which will possibly be the last postgrad lecture that I will listen to prior to retirement. I have worked in the same practice since I qualified in 1977 so my successes and failures come back to visit me. Like Professor Burke, I have avoided amalgam for many years; I only use it to repair old amalgams and sometimes for a subgingival box where I am unable to ensure an adequate seal. I'm rather quiet and shy but it occurred to me, while I was listening to the lecture, that I should share my experience so that it could be considered as an option. I have only now realized that I may be the only dentist using this technique (Arrrgh!)
I largely stopped using matrix bands for posterior composites over 10 years ago when it dawned on me that you place composites rather than packing them like amalgam. I was using disposable matrix bands and found them awful so this motivated me to find an alternative method. I always wear loupes and they are essential for this technique. I carefully place a layer of composite at the base of the box and use a flat plastic to ensure that there is no ledge, then gently mould the composite out to touch the adjacent tooth. I cure it for 10 seconds, then proceed to build-up the filling incrementally; the walls of the cavity and the adjacent tooth acting as a matrix. If it is a virgin tooth, I try to avoid breaking the contacts palatally and buccally to keep the restoration as minimal as possible. If the contacts are already broken, I use my flat plastic to contour the filling there and use a fine tapered diamond to remove any excess, if needed.
I don't attempt to floss the restoration on the day of placement as the contact will be too tight, but I know that the contact will be flossable within a day or so as the differential movement of the teeth during mastication will break any adhesion to the adjacent tooth. I suppose that you could gently tweak the tooth, after the filling was set, to break any adhesion to the adjacent tooth, but I preferred to let nature take its course with occlusal loading. I have only had one patient return in the last 10 years complaining that they couldn't floss their tooth since I filled it. That was an MO on UR5 adjacent to an old DO composite on UR4. Neither tooth was opposed and thus not subjected to occlusal loading. I rapidly remedied the problem with a metal finishing strip. If I am placing two composites adjacent to each other then I will either use a matrix or place one composite and then lightly smear Vaseline on it as a separating medium before placing the other composite.
I have placed many hundreds (and possibly thousands) of these restorations with few problems and have many bitewing radiographs (see examples above) and I haven't noticed significant failures, otherwise I would have abandoned this technique a long time ago. The advantages of this technique include:
