I first met New Zealand’s Dr. Simon McDonald several years ago at the Greater New York Dental Meeting. His small booth was tucked away in an “end-zone” position, far from the spotlights shared by the major vendors. He sat hunched over his small table quietly demonstrating a composite matrix system that he was intending to bring to market in the U.S. That system was the forerunner of what is now marketed as the Tri-clip, an all-in-one matrix device that has garnered much attention—though not nearly as much as his more recent innovation, the “V-Ring,” the subject of this brief evaluation.
The V-Ring’s “Intro-Pack,” supplied to me by TrioDent, included 3 V-Rings (New and Improved), 1 forceps, 1 Pin-Tweezers (for applying and removing the matrices), 50 x 4.5mm Tab-Matrix, 50 x 5.5mm Tab-Matrix, 50 x 6.5mm Tab-Matrix and the NEW V-Wedge, 25 each of 6 options, and free online Training by Dr. Graeme Milicich. My kit also contained a separate CD by Dr. Milicich that can be purchased for $5.00 and is well worth the cost. The Intro Pack itself presently sells for $375. After viewing Dr. Milicich’s CD I began using the system.
To this point, my primary sectional matrix system has been Garrison’s Composite Gold and their newer Composite Silver Plus, in concert with their Wedge Wands and G Wedges. (To be covered in a future review.) I’ve enjoyed success with this system but have noted its shortcomings when restoring teeth with large proximal sections missing, such as a contiguous MOL or DOL direct composite restoration. The point contact of the Garrison system is apt to collapse the sectional matrix where it is not supported by tooth structure.
Enter the Nickel-Titanium/Stainless V-Ring, whose broad, self-supporting stature engages adjacent interproximal surfaces, providing a non-collapsing retainer. The V-Ring system is versatile in the sense that the clip/retainer can be placed before or after the sectional matrix is placed. Wedge placement can also occur before or after matrix/clip placement, creating versatility previously unrealized in a sectional matrix system. Nickel-titanium has received much attention in the world of endodontics; TrioDent has sought fit to put it to use in the restorative world, producing a matrix retainer that holds its shape well owing to Niti’s reputation for having a “good memory.”
In practice, the V-Ring can be used with other non-TrioDent matrices, including Garrison’s and even the venerable Dentsply Automatrix—notably in restorative situations that demand a circumferential matrix. One can also use one’s own wedge brand of choice although I’ve found the new TrioDent V-wedges to be remarkably kind to the papilla owing to their concave tissue-contacting surface. (Why did it take so long for someone to figure that out?!)
As in all new systems, a short learning curve presents itself. The self-locking pin tweezers used to grasp the matrices might push you into using higher magnification than you do currently. The pin is small and a little tricky to place at first. The matrices themselves are sized so you’ll need to develop a sense of which one best suits the restoration. Both the Garrison and TrioDent matrices are very thin (30 microns), but the configuration and construction of the TrioDent matrices renders them somewhat more delicate and easier to crumple. I also found them a little longer than needed in several instances. On the other hand, they can be easier to position based upon the choice of three holding loops on the band, meant to engage the pin tweezers. The tweezers can also be used to hold them in place when applying either the V-Ring itself or a wedge; this is obviously helpful in posterior regions of the mouth. It is apparent that much thought has gone into the system’s development.
Certain tricks can improve one’s success. Such technique modifications include tilting the V-Ring towards or away from the matrix to enhance matrix formation, as well as using a small burnisher to drag the matrix slightly towards the buccal and lingual cavosurface walls. This physically pulls the matrix through the clip thus optimizing the contour and contact of the matrix against the adjacent tooth. V-Rings can also be “stacked” to allow for simultaneously restoring of mesial and distal proximal walls (not, however, without considerable tinkering).
Any dentist worth his or her salt has multiple approaches to problem solving. Class II composite restorations—previously one of dentistry’s more daunting tasks with respect to proper contact formation—have been tamed. The TrioDent V-Ring and its accompanying matrix and wedge system should most likely be close by your side along with your other favorites, to render you “bullet proof” the next time a tricky restorative procedure rears its ugly head. It works. It’s that simple.
