How to Assemble and Place a Tofflemire Matrix Band

Placement and Removal of a Tofflemire Matrix Band: Procedure and Guidance

Purpose

The Tofflemire matrix band and retainer are used to recreate a missing proximal (mesial or distal) wall on a prepared tooth so the dentist can restore the contour and contact. The band:

• Provides a temporary wall to contain restorative material.
• Prevents the restored tooth from bonding to the adjacent tooth.
• Helps re-establish proper anatomical form and contact.

This technique is commonly used for premolars and molars.

Required Personal Protective Equipment (PPE)

• Gloves
• Jacket
• Mask
• Protective eyewear (glasses or goggles)

Instruments and Materials

• Tofflemire (matrix) retainer
• Matrix band
• Wedges
• Cotton pliers
• Cotton rolls and 2x2 gauze
• Prepared tooth (example: DO preparation on tooth #3/13)

Suggested layout:

• Retainer and band assembled nearby
• Wedge(s) and cotton pliers ready
• Isolation material (cotton rolls, suction) in place

Orientation and General Notes

• Handle the matrix band gently; do not crease it.
• Form the band into a slight “smile” curve before inserting—curve only, no sharp folds.
• The band has a larger and a smaller side:
  • Smaller side faces the gingiva (toward the gums).
  • Larger side faces occlusally (upward).
• The U-shaped frame of the retainer must face the operator.
• The assembled retainer typically sits outside the mouth when in place (the tail of the band extends out).

Step-by-Step Assembly and Placement

1. Prepare materials and confirm isolation and anesthesia.
2. Form the band:
   • Hold the matrix band and curve it slightly into a smile. Avoid creating creases.
   • Identify the larger and smaller sides; determine which side will face the gingiva.
3. Assemble band into the retainer:
   • Position the smaller side of the band toward you (operator) and toward the tooth when inserting.
   • Insert the band into the retainer slots so the U-shaped frame faces you.
   • Place the band on the left side of the retainer (as typically demonstrated) and pass the band through the retainer.
4. Initial tightening and sizing:
   • Use the lower (smaller) knurled screw/knuckle to engage and tighten the band in the retainer.
   • Use the larger knob to increase or decrease the circumference to fit the tooth (larger knob adjusts for molars vs premolars).
   • Tighten the retainer so the band approximates the tooth contour but remains adjustable for final seating.
5. Position retainer and band around the tooth:
   • Seat the band at the gingival margin with the smaller side toward the gum line and the larger side occlusally.
   • Confirm the U of the retainer faces the operator and that the tail of the band is accessible outside the mouth.
6. Place the wedge:
   • Use cotton pliers to pick up a wedge with the pointed ends oriented upward.
   • Insert the wedge into the gingival embrasure on the preparation side (distal if the prep is distal).
   • Rotate the pliers as needed and press the wedge in firmly to secure the matrix band against the gingival margin and to separate the teeth slightly for proper contact.
   • Patients are commonly anesthetized for these procedures; insertion should not cause pain if anesthesia is effective.
7. Final adjustment:
   • Re-check band adaptation to the preparation and marginal seal.
   • Finalize retainer tightening if needed to stabilize the band during restoration.

Removal of the Matrix Band and Retainer

1. Remove the wedge first (if not already removed during final procedures).
2. Support the restoration area with a finger (to prevent dislodgement of any restorative material).
3. Loosen the retainer by turning the small tightening knob to release band tension.
4. Gently pull the band out of the retainer and away from the tooth.
5. Remove the retainer and band from the mouth with cotton pliers.
6. Inspect the restoration and proximal contacts; adjust as necessary.

Tips and Common Pitfalls

• Do not crease the matrix band; creases can cause poor adaptation and ledges in the restoration.
• Ensure the U of the retainer faces the operator so the band follows the intended orientation.
• The smaller side of the band must be placed toward the gingiva for proper marginal adaptation.
• Use wedges to seal the cervical margin and to slightly separate teeth for correct contact formation.
• Verify that the band circumference is appropriately tightened for the treated tooth (use the larger knob for gross sizing, the smaller knob for final tightening).
• Always stabilize the area with a finger during band removal to avoid disturbing the restoration.

Summary

Proper assembly, orientation, and wedging of the Tofflemire matrix system are essential to recreate missing proximal walls, obtain a good marginal seal, and restore proper contact with adjacent teeth. Follow the steps above carefully to ensure predictable, high-quality restorations.