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Title:
DENTAL INSTRUMENT FOR RESTORATIVE PROCEDURES
Document Type and Number:
WIPO Patent Application WO/2017/144974
Kind Code:
A9
Abstract:
This invention presents "respect" for the adjacent tooth by providing an instrument and method that presses the matrix band against the adjacent tooth, and presents inventive examples of the concave shape of its prongs (to match the convex contour of the adjacent tooth) and the hinged couplings that translate well the clinician's personal efforts to press against the adjacent tooth in what are otherwise, awkward ergonomic angles. By moving the mechanical levers of his own body more proximate the treated tooth and by using a stabilizing arm that establishes a fulcra point of stability in the tooth adjacent to the treated tooth, the clinician can better achieve the objectives of good physiologic fit of the matrix band with the adjacent tooth.

Inventors:
KATZ, Stuart, Jeffrey (2003-125 Columbia St, New Westminster, BC V3L 0G8, V3L 0G8, CA)
BEHRAD, Mohssen (4192 Winnifred Street, Burnaby, BC V5J 2S4, V5J 2S4, CA)
Application Number:
IB2017/000244
Publication Date:
October 12, 2017
Filing Date:
February 23, 2017
Export Citation:
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Assignee:
KATZ, Stuart, Jeffrey (2003-125 Columbia St, New Westminster, BC V3L 0G8, V3L 0G8, CA)
International Classes:
A61C5/85; A61C5/80
Attorney, Agent or Firm:
YANG, Mark Ming-Jen (10291 St. John's Court, Richmond, British Columbia V7E 5S2, CA)
Download PDF:
Claims:
Claims.

1. A dental instrument for assisting in the restoration of a patient's tooth ("treated tooth") having a proximal box, in conjunction with a matrix band, comprising:

(a) an elongate handle for hand gripping, having first and second opposed end portions;

(b) a first tool portion at said first handle end portion (whether integral or detachable, said first tool portion including (i) a first abutment portion and (ii) a first stabilizing arm that extends longitudinally posteriorly of said first abutment portion when the instrument is located within the proximal box of treated tooth, for abutting contact with the tooth posteriorly adjacent to the treated tooth.

2. The instrument of claim 1, wherein said first abutment portion includes a first condenser.

3. The instrument of claim 2, wherein said first condenser includes first and second prongs, vertically extending (generally orthogonal to the longitudinal asexiO, generally parallel, spaced apart (or a bi(tri)furcated or tined portion) with a width less than the width of the part of the proximal box closest to the adjacent tooth.

4. The instrument of claiml, further comprising, a second tool portion at said second handle end portion (whether integral or detachable).

5. The instrument of claim 1, wherein said second tool portion includes a second abutment portion and a second stabilizing arm that extends longitudinally anteriorly of said second abutment portion when the instrument is located in the proximal box, for abutting contact with the tooth anteriorly adjacent to the treated tooth.

6. A dental instrument for assisting in the restoration of a patient's tooth ("treated tooth") having a proximal box, in conjunction with a matrix band, comprising:

(a) an elongate handle for hand gripping, having first and second opposed end portions;

(b) a first tool portion at said first handle end portion (whether integral or detachable), said first tool portion including (i) a first abutment portion and (ii) a first stabilizing arm that extends longitudinally anteriorly of said first abutment portion when the instrument is located within the proximal box of treated tooth, for abutting contact with the tooth anteriorly adjacent to the treated tooth.

7. The instrument of claim 6, wherein said second tool portion including a second abutment, and said abutment portion, wherein said second abutment portion includes a second condenser.

8. The instrument of claim 2, wherein said second condenser includes two, parallel vertically extending prongs (or a bi(tri] furcated or tined portion] with a width less than the width of the portion of the proximal box closest to the adjacent tooth.

9. The instrument of claim 6, wherein said second condenser includes two, parallel prongs (or a bifurcated surface) with a second separation that is different than sajd first condenser prong separation.

10. The instrument of claims 1-8, wherein each said prongs is tapered vertically.

11. The instrument of claims 1-10, wherein each said prong is curved to maximize conformance with the convex contour (incisial to middle third) of adjacent tooth; and includes (metallic or plastic) differently curved tips detachable/rotatable to the shank of the prong.

12. The instrument of claims 1-11, wherein said curved prongs are rotatable

13. The instrument of claims 1-12, wherein said first tool portion prongs separation is adjustable.

14. The instrument of claims 1-13, wherein said prong adjustment is opcratively coupled with said handle.

15. The instrument of claims 1-14, wherein the stabilizer bar provides a stabilizing contact point to the working surface that in turn is a fulcrum of a leverage point providing side to side stability.

16. The instrument of claims 1-15, wherein said prongs separation adjustability is effected by a mechanism that translates rotary motion into linear motion that controls the separation (including hinge screws, scissors and forceps-like mechanisms).

17. The instrument of claims 1-16, further comprising a second stabilizing arm attached to one of said two prongs.

18. The instrument of claims 1-17, wherein each prong continues so that there are two stabilizing arms.

19. The instrument of claims 1-18, wherein said first tool end portion has first and second longitudinal, spaced apart extenders, that couple said first and second prongs to said handle.

20. The instrument of claims 1-19, wherein said extenders are adjustable in their space- apartedness.

21. The instrument of claims 1-20, wherein wherein said (first/second) stabilizing arm is adjustable vertically with respect to the occlusal plane

laterally adjustable prongs but with a single stabilizing arm by use of a rectangular bracket, friction fit.

22. The instrument of claims 1-21, further comprising a sliding frame (bracket) where two prongs are slidable horizontally with respect to each other.

23. The instrument of claims 1-22, wherein said sliding frame is/provides a "finger pad" for digital pressure by the clinician.

24. The instrument of claims 1-23, wherein said first too! portion has a first, attachable and detachable mechanism with a corresponding mechanism part of said first handle end., wherein said first tool portion has a second, attachable. detachable mechanism on the opposed end, and i.e push becomes pull device by detaching the tool portion and reversing it and re-attaching handle.

25. The method of restoring with composites and a Tofflemire band retainer, whereby after tightening the band around the treated tooth, the band is then loosened and the instrument of claims 1-14 is used to abut the band against the convext contour of the adjacent tooth.

26. The instrument of claims 1-24, wherein said handle has a hand-gripping friction enhancing surface - trigger (to facilitate manual grasping including a pulling and pushing action] or an enlarged, bulbous central portion, and/or knurled, series of concentric annular grooves

Description:
DENTAL INSTRUMENT FOR RESTORATIVE PROCEDURES

Field of the Invention

[001] The field of the invention is dental instalments.

Background

[002] The background description includes infomiation that may be useful in understanding the present invention, It is not an admission that any of the information provided herein is prior art or relevant to the claimed invention, or that any publication specifically or implicitly referenced is prior art.

[003] Tooth decay, also known as dental caries, is an oral disease that affects many people. When treating decay, recreating the anatomy of the damaged tooth, after the removal of the decay, is crucial not just to restore tooth form, but also to re-establish function. This is usually done by removing the affected portion of the tooth and restoring the prepared tooth with restorative materials. Based on the tooth type, location and tooth surfaces, restorations can be classified into classes I through. V. Of these, Class II restorations involve the proximal surfaces of teeth, and pose unique challenges to restorative dentists. Normally, adjacent healthy teeth are in proximal contact with each other. However, this interproximal contact is lost when interproximal decay is removed. The challenge in Class II restorative techniques is to re-establish good physiologic, interproximal contact and a well-sealed gingival margin devoid of gaps or overhangs.

[004] hi conventional practice, interproximal decay is filled utilizing a matrix band. A matrix band acts as a form that holds dental restorative materials within the cavity preparation

(commonly called the "proximal box") of the tooth being restored. To hold a matrix bands in place, a wedge is placed in the interproximal space between the matrix band and the adjacent tooth. Wedges acts to both force the adjacent teeth apart and to force the matrix band against the tooth being restored ("treated tooth") to achieve isolation from blood, saliva, and crevicular fluids.

[005] hi the case of sectional matrix bands, ring-clamps are used with wedges. They serve to adapt the matrix band to the coronal aspect of the tooth being restored. They also act by holding the matrix band against the proximal surface of the adjacent tooth while slightly forcing the teeth apart. The ring-clamps could be placed either after or before the wedge depending on the system. As well, the matrix band can be burnished against the surface of the adjacent tooth with which the contact is to be formed. Once the matrix, wedge, and/or ring-clamps are in place, the tooth is primed for restoration.

[006] Traditional matrix band holders (such as "Tofflemire" matrix band retainers), allow the matrix band to be tightened around the tooth being restored. As such they provide predictable isolation even in more difficult sihiatioiis; however, the contact pressure is often weak when they are used to place composite restorations. Because of the difficulties in establishing predictable proximal contact when placing composites with Tofflemire matrix bands, various sectional matrix bands and rings-clamp systems have been developed to address achieving predictable proximal contact. These systems can be time-consuming to place, expensive, and do not achieve the degree of predictable isolation that Tofflemires bands do.

[007] To enhance proximal contact, numerous hand instalments have been developed to push matrix bands against the proximal surfaces of adjacent teeth. These instruments can be used with both sectional and Tofflemire matrix bands.

[008] In one technique, a condenser or OptraContact®-type instalment is used to displace the restorative material in a gingival direction while pushing the matrix band against the proximal surface of the adjacent tooth. This acts to enhance the contact pressure by extending the proximal dimension of the restoration. When the first layer of composite is cured with the instrument in place, a "contact bridge" of composite material, is formed. The instrument is then removed and the resulting holes are filled with a flowable composite.

[009 ] One problem with the dental instalments like OptraContact® is that the stabilization of the instrument is usually achieved by the clinician's finger rest or fulcrum on a tooth that is more forward (i.e. anterior) of the treated tooth in the dental arch, and is often a front tooth. As this fulcrum is relatively far from the point of proximal surface contact of the treated tooth, there is inherent positional instability of the working end tool portion of the instalment. Without adequate stabilization, a loading force may be exerted by the clinician (e.g., dentist, dental assistant, et al), operating in economically awkward position, in a slightly incorrect direction, or against the wrong part of the matrix band. As such, the effectiveness of the instrument is compromised.

[0010] The prior art appears to be completely focused on handling the treated tooth and seems oblivious (in paying no "respect" to the adjacent tooth. Dryer (US publication 2004/0142303) discloses members which are curved or angled to match the curvature of the treated tooth, not the adjacent tooth. Slone (USP 6280187 and 5318446) are for explicitly convex interaction with adjacent concave tooth and are thus geometrically unfit for each other. Similarly Stasiak (USP 6261095) teaches a strut that is "generally symmetrically conical", again, the focus is on the geometry of the treated tooth and not the adjacent tooth. Meinershagen (USP 4836781) is a post- restoration invention for amalgam restoration (not composite) where two teeth are restored (hence two bands), which explains why the bifurcated ends of its instrument terminate at the same distance relative to the occlusal plane; and in case, it is focused on keeping the amalgam will not be frictionally dislodged and earned upwardly by the surface of the two bands as they are being removed,

[0011] Inadequate proximal contact can result in irritating food impactions and plaque accumulation, that can damage interproximal tissue and lead to recurring decay. Improper isolation can result in improper bonding and overhanging restorations that can lead to gingival irritation and post-operative sensitivity and recurrent decay. Hence, there is a need for dental instruments and restorative procedures that can predictably achieve adequate proximal contact pressure and gingival isolation while placing class II composite restorations,

[0012] If a dental instrument were to achieve predictably adequate proximal surface contact pressure in class II composite restorations using Tofflemire matrix bands that are easier to place, achieve more predictable isolation, and are less expensive than sectional matrix batids, then such an instrument would be widely adopted.

[0013] Thus, there remains a need for improved dental instruments for restorative procedures. Summary of the Invention

[0014] A key to success in class II restorations is to establish good physiologic contact between the restored tooth and its adjacent tooth. This invention recognizes that the proximal surface of the adjacent tooth has a quasi-bulbous, generally convex profile and so provides a device and method to assist the dentist to conform the matrix band as closely as possible to such adjacent tooth convex profile, hi summary (and as elaborated below), this invention presents "respect" for the adjacent tooth by providing an instrument and method that presses the matrix band against the adjacent tooth, with inventive features such as the concave shape of its abutment prongs (to match the convex contour of the adjacent tooth) and the hinged couplings that translate well the clinician's personal efforts to press against the adjacent tooth in what are otherwise, awkward ergonomic angles. By moving the mechanical levers of his own body more proximate the treated tooth, and in particular, without limiting the generality of the preceding, by the use of a stabilizing ami that establishes a fulcra point of stability in the tooth adjacent to the treated tooth, the clinician can better achieve the objectives of good physiologic fit of the matrix band with the adjacent tooth.

[0015] The present invention provides apparatus, systems, and methods in which a dental restorative instrument has a stabilizing arm that allows for a controlled and strategically applied pressure during a dental restorative procedure that results in a predictably reinforced contact pressure. The dental instrument features an elongated member that has a handle portion and a tool portion. The tool portion has a condenser for packing restorative composite material. The condenser extends from an end of the elongated member and preferably comprises two prongs or legs that are separated by a space. The dental instrument also has a stabilizing ami extending from the tool portion beyond the condenser prongs and over the marginal ridge of the adjacent tooth, to rest (adjustably) on the occlusal surface thereof. The stabilizing arms may also extend from the condenser prongs at right angles.

[0016] The prongs of the condenser tool are used to condense or pack a restorative material (e.g., packable or flowable composite, or certain plastics, such as glass ionomer, that sets in the mouth) into a cavity preparation. The condenser is also used to press outward against a matrix band to increase the contact pressure of proximal wall of the restoration against the adjacent tooth. More specifically, the space between the prongs allows the restorative material to flow between the prongs and outward against the matrix band as the prongs are pushed against the matrix band against the proximal surface of the adjacent tooth. The prongs are slightly curved concavely to maximize contact with the convex proximal surface of the adjacent tooth. The prongs are tapered vertically to facilitate removal from the hardening composite.

[0017] In one aspect of some embodiments, the tool portion of the dental instalment can be movably coupled with the elongated member at a (conventional) flexible and/or rotatable coupling. This allows for more stable and strategic orientation of the prongs against the adjacent tooth. The tips of the prongs should extend just apical or gingival to the height of contour of the adjacent tooth. Should the initial pushing force not be correctly applied at right angles to the proximal surface of the adjacent tooth, the flexible coupling would allow for correction and a resultant force that is applied at right angles to the adjacent tooth. There is also a coupling mechanism to allow the clinician to adjust the position and/or orientation of the tool portion relative to the handle portion to treat upper and lower teeth from different working angles.

[0018] hi another aspect of some embodiments, the stabilizing ami has an adjustable vertical length relative to the occlusal plane. By adjusting the (vertical) length that the stabilizing arm extends, the clinician can influence (as elaborated below) the depth of the prongs against the adjacent tooth (because the stabilizing ami is connected to the prongs in respect of vertical distance - the prongs and stabilizing arm move in adjustable coordination relative to the occlusal plane). Prongs would require adjustment when teeth of varying clinical heights are being restored.

[0019] hi yet another aspect of embodiments, the distance between the prongs could be adjusted by turning a screw that would effect movement of the prongs towards or away from each other. The (final) separation of the prongs represents the limits of the contact area being formed, Prong separation would be adjusted with the various buccolingual dimensions of the teeth being restored.

[0020] From a method perspective, the present invention provides apparatus, systems, and methods in which a restorative composite material is placed in a cavity of a tooth (specifically, the cavity preparation or proximal box) using a dental instrument. The method comprises the steps of: (i) placing a matrix band around the prepared proximal surface of the tooth (as with a Tofflemire matrix band holder) or a sectional matrix band between the prepared tooth and the adjacent tooth; (ii) wedging the matrix in place; (iii) placing a restorative material inside the cavity preparation; (iv) pushing the condenser tool down on the restorative material on the occlusal surface of the tooth such that at least some of the restorative material occupies the space between the prongs of the condenser; (v) placing the stabilizing arm against an appropriate structure of the adjacent tooth to facilitate stabilization of the instrument; (vi) pushing the condenser tool against the matrix band to extend the proximal dimension of the restorative material; and (vii) allowing the restorative material to solidify, hi some embodiments, the method can further comprise the step of adjusting the length of the stabilization arm prior to placing the stabilizing ami against an appropriate structure of the adjacent tooth, its occlusal surface being a stable location (and in particular, the central groove is an ideal location to establish a fulcra-point). On its occlusal surface. In other embodiments, various sizes of condensers can be chosen in accordance the size of contact area needed. [0021 ] One should appreciate that the disclosed subject matter provides many advantageous technical effects including providing a stabilizing arm on a dental restorative instrument for better control of applied pressure. The instruments and their methods of use as described herein also facilitate creating predictable proximal contact between adjacent teeth during a dental restorative procedure.

[0022] Various objects, features, aspects and advantages of the inventive subject matter will become more apparent from the following detailed description of preferred embodiments, along with the accompanying drawing figures in which like numerals represent like components. Brief Description of the Drawing

[0023] FIG. 1 is a perspective view of one embodiment of a dental instalment for restorative procedures.

[0024] FIG. 2 is a perspective view of another embodiment of a dental instrument for :

restorative procedures, The instalment is contacting a treated tooth and an adjacent tooth.

[0025] FIG. 3 is a perspective view of another embodiment of a dental instrument for mesial proximal tooth restorations.

[0026] FIG. 4 is a perspective of a variation of the embodiment of FIG. 3.

[0027] FIG. 5 is a perspective view of a single dental instrument with tools at opposed ends for distal and mesial restorations.

[0028] FIG. 6 are front and top views of linkage of two prongs with the single stabilizing arm. As can be seen, conventional joints interact two prongs 605 with the single stabilizing arm 604, so that adjustment of the lateral separation between prongs 605 result in the movement anteriorly or posteriorly of stabilizing ami 604, ideally along central groove of the adjacent tooth, and thus still provides the instalment a stable fulcrum at the adjacent tooth.

[0029] FIG. 7 are front and top views of linkage of two prongs with the single stabilizing arm.

Rectangular sliding bracket or frame 710 is sized to permit relatively free horizontal movement of prongs 705 with respect to each other within the boundaries of frame 710; however, one prong, 705a is rigidly attached to one end of frame 710, and thereby rigidly stabilizes stabilizing ann 704 (which ultimately rests on the occlusal surface of the adjacent tooth).

[0030] FIG. 8 are four perspective views of the instalment for distal restoration, viewed from underneath.

[0031] FIG. 9 are a transparent version of the views of FIG. 8. [0032] FIG, 10(a) are four views of the instalment for distal restoration.

[0033] FIG. 10(b) are an enlarged version of FIG. 10(a).

[0034] FIG. 11 (a) are a transparent version of the views of FIG. 10(a).

[0035] FIG. 1 1(b) are an enlarged version of FIG. 11(a).

[0036] FIG. 12 are four views of the instrument for mesial restoration.

[0037] FIG. 13 are a transparent version of the views of FIG. 12.

[0038] FIG. 14 are four alternate view of the instrument of FIG. 12,

[0039] FIG. 15 are a transparent version of FIG. 14.

[0040] FIG. 16 are a more detailed version of FIG. 14.

[0041] FIG. 17 are alternative views of FIG. 14.

[0042] FIG. 18 is a transparent view of one view of FIG 17, showing the hinge within handle.

[0043] FIG. 19 is a more detailed view of the internal hinge of FIG. 18.

[0044] FIG. 20 are six views of an instrument adapted for both mesial and distal restorations. Detailed Description

[0045] The following discussion provides example embodiments of the inventive subject matter. Although each embodiment represents a single combination of inventive elements, the inventive subject matter is considered to include all possible combinations of the disclosed elements. Thus if one embodiment comprises elements A, B, and C, and a second embodiment comprises elements B and D, then the inventive subject matter is also considered to include other remaining combinations of A, B, C, or D, even if not explicitly disclosed.

[0046] FIG. 1 shows a perspective view of dental restorative instrument 100. Instrument 100 is an elongated member with handle portion 101, middle portion 102, and condenser/tool portion 103. Handle portion 101 and condenser/tool portion 103 are located on opposite ends of the elongated member middle portion 102. Instrument 100 is used for placing restorative material in a cavity preparation of a tooth. The cavity preparation is located on at least a portion of a proximal surface of the treated tooth, wherein the proximal surface abuts an adjacent tooth.

[0047] Condenser/tool portion 103 extends from an end of the elongated member middle portion 102 and has two prongs (or legs, tines or is a bifurcated end) 105 that are separated by a space. Condenser/tool portion 103 is used to pack, move, and/or manipulate a restorative material in the cavity preparation. The condenser portion 103 is also used to expand (e.g., push against and/or stretch) a barrier between the treated tooth and an adjacent tooth to create a restored proximal surface that provides proper proximal contact with the adjacent tooth. The barrier can be a matrix band or any other structure configured to shape and/or hold the restorative material within the cavity preparation.

[0048] Condenser/tool portion 103 also has a stabilizing ami 104 extending from the distal end of condenser/tool portion 103. Ann 104 is sized, dimensioned, and positioned so as to rest on the occlusal surface of the adjacent tooth when prongs 105 are in the cavity preparation. Arm 104 helps the clinician to stabilize instrument 100 during the dental restoration process. Arm 104 preferably has an adjustable length relative to the occlusal surface of the adjacent tooth. For example, arm 104 can comprise pin 210 (better illustrated in FIG, 2) that is threadably coupled with condenser/tool portion 103 (e.g. a convention screw mechanism) such that turning the pin clockwise will shorten pin 210 relative to the remainder of ami 104 relative to the occlusal surface, whereas turning the pin counter-clockwise will lengthen the pin length. It is also contemplated that the pin length could be adjusted by turning handle portion 101 in a

conventional (gear and coupling) mechanism that transfers rotation of handle portion 101 to rotation of stabilizing arm pin.

[0049] The stabilizing ami is disposed to rest against the occlusal surface of the adjacent tooth and the prongs are disposed to approach the floor of the cavity preparation or proximal box of the treated tooth, winch by definition is farther away from the occlusal plane because the proximal box floor was created by drilling tooth structure in a gingival direction to remove the decay.

[0050] Condenser/tool portion 103 is coupled with middle portion 102 of the elongated member at fiexible/rotatable coupling 106. Coupling 106 allows the condenser/tool portion 103 to move relative to the elongated member. This allows the clinician to adjust the orientation and/or position of condenser/tool portion 103 to work on different teeth (e.g., upper teeth, lower teeth, mesial proximal surfaces, distal proximal surfaces). Coupling 106 can be configured to allow condenser/tool portion 103 to bend at different angles, rotate, and/or extend farther out (e.g., telescopically extendmg). Coupling 106 preferably has a locking feature that allows the clinician to lock the condenser/tool portion 103 in place as needed. In some embodiments, it is contemplated that turning handle portion 101 can adjust the position/orientation of

condenser/tool portion 103. In addition, pulling/pushing the handle portion 101 could actuate the locking and unlocking of condenser/tool portion 103. [0051 ] FIG. 2 shows a dental restorative instalment 200. Instrument 200 is functionally similar to instrument 100 in some aspects. However, unlike instrument 100, instrument 200 has angle joint 207 which is approximately 150 degrees but can be adjusted as needed (e.g., acute, obtuse, etc.). The selected angle can help to improve access to certain teeth in the patient's mouth depending on the clinician's work angle (e.g., behind the patient's head, in front of the patient's head, to the side of the patient's head, etc.).

[0052] Prongs 205 are placed inside matrix band 208 and within cavity preparation or proximal box 212, Matrix band 208 (shown in FIG. 2 in transparent mode to view its content) surrounds the tooth (not shown in FIG. 2 for simplicity of illustration) to be treated and separates the treated tooth from adjacent tooth 209. Stabilization ami 204 (with its threaded pin 210) rests on occlusal surface of adjacent tooth 209 (and in particular, its pin apical tip 211 fulcruiiied in the central groove of the adjacent tooth 209). Flexible coupling 206 has been adjusted to properly orient and locate condenser/tool portion 203.

[0053] Prongs 205 are separated by a distance. The distance is dimensioned to fit inside matrix band 208 and inside the cavity preparation or proximal box. hi some instances (depending on the size of teeth, size and shape of proximal box), the distance or separation between the first prong and second prong is less than 5 mm, and could be even less than 3 mm. The overall width of condenser tool 203 is also less than the width of the cavity in the tooth.

[0054] FIG. 3 shows yet another dental restorative instrument 300. Instrument 300 is similar to instrument 200 in many aspects. For example, instrument 300 has a handle portion 301, middle portion 302, and condenser/tool portion 303 (comprising two prongs 305 and stabilization arm 304). However, instrument 300 is different in that middle portion 302 has an acute angle 307, Angle 307 causes condenser/tool portion 303 to face handle portion 301. This orientation allows the clinical to work on mesial proximal surfaces (e.g., proximal surfaces that are facing the midline or mouth opening).

[0055] For mesial restoration, the embodiment of FIG. 3 shows the tool portion (with stabilizing arm 304 and prongs 305 being identical or very similar to their corresponding components in FIGS. 1 and 2 for distal restoration) being turned around to face mesially the mouth opening and the clinician, and with connection between tool portion and handle, as turning around toward the clinician and the opening of the mouth, to permit the clinician to pull on the instrument to press the tool portion on the adjacent tooth which is anterior of the treated tooth. FIG. 4 is a perspective of a variation of the embodiment of FIG. 3, wherein such connection is linear between tool portion and handle,

[0056] FIG. 5 is a perspective view of a single dental instrument 500 with tool portions 503 and 513 at opposed ends (for respectively, mesial and distal restorations) of central handle 501. In essence, the tool portions of FIGS, 1 and 4 are combined in a single instrument. Central handle 501 can have conventionally (not shown for simplicity of illustration) a trigger-like protrusion (to facilitate pulling by a finger), or an enlarged, bulbous central portion, and/or knurled surface or a series of concentric annular grooves or other friction- enhancing surface to assist the clinician to manipulate the instrument as desired.

[0057] FIG. 6 are front and top views of linkage of two prongs with the single stabilizing arm. As can be seen, conventional joints interact two prongs 605 with the single stabilizing arm 604, so that adjustment of the lateral separation between prongs 605 result in the movement anteriorly or posteriorly of stabilizing arm 604, ideally along central groove of the adjacent tooth, and thus still provides the instrument a stable fulcrum at the adjacent tooth.

[0058] FIG, 7 are front and top views of linkage of two prongs with the single stabilizing arm.

[0059] Rectangular sliding bracket or frame 710 is sized to permit relatively free horizontal movement of prongs 705 with respect to each other within the boundaries of frame 710; however, one prong, 705a is rigidly attached to one end of frame 710, and thereby rigidly stabilizes stabilizing arm 704 (which ultimately rests on the occlusal surface of the adjacent tooth).

[0060] The instrument can be further equipped with a finger pad in vertical alignment with the stabilizing arm and pin. The pad is a generally flat, area shaped to receive a pressed digit (e.g. of the dentist's hand which is not holding the instrument) and possibly coated with friction enhancing surface. As illustrated, the particular top of stabilizing pin 210 is flat. Advantageously (but not necessarily), the fingerpad may be a simple modification of the stabilizing arm pin top 210, or it may be the subject of a discrete extension of the stabilizing arm. In other illustrations and embodiments (e.g. FIGS. 7 and 10(b)), the top of bracket 710 or bracket 1003 my serve as a fingerpad. [0061] FIGS, 8 to 20 are implementations incorporating the inventive features explained above, directed to the mechanism whereby the prongs are adjustable separable. Similarly looking components (whether identified by number or not) are the same as described in FIGS. 1-7. FIG. 10(b) is representative (for both mesial and distal restorations). Prongs 1005 are the distal ends of respective extenders 1006 which connect to the handle (with an advantage hinge mechanism, explained below). The separation between extenders 1006 (and thus prongs 1005) is adjustable by a threaded knob 1002 rotating on a mating pin

1003 which tranverses extenders 1005. The clinician's thumb conveniently dials knob 1002 to effect the desired separation of prongs 1005 upon inspection of the environment of the treated tooth and in particular, the proximal box. The stabilizing arm/pin 1004 is not only adjustable vertically (by convetional threaded means), but the pin top 1001 can serve as the "finger pad" for the clinician to press down on axially, thus stabilizing even more, pin

1004 onto the (ideally, central groove) of the adjacent tooth.

[0062] More details are shown in FIG. 19 of the hinge joint and coupling (such as would implement 106, 206, 207 in FIGS. 1-2) within handle 1900 or similar handle-associated cylindrical housing 1901, where the proximal end portion(s) of extender(s) 1905 (that terminate distally with the abutment prongs) are pivoted on a pin 1906 disposed transversely to cylindrical housing 1901 and wherein the diameter of cylindrical housing 1901 is just large enough relative to the dimensions of the extenders 1905 (with distal prongs) that some constrained pivotable movement is permitted. By this mechanism, the clinician may push linearly (along the linear axis of the instrument) at the adjacent tooth; and then, at the appropriate time in the restoration process by shifting the handle and cylindrical housing 1901 relative to proximal end portions of the extenders, toggle to a slight contra-angle direction, in order to apply an off-linear force. The change in direction from axial (along the longitudinal axis of the instrument handle) and then slightly off the axial to a slight oblique angle) is enough and suitable to bring about desirable angles of attack by the clinician on the adjacent tooth (whether by torque or by orthogonal impact on the adjacent tooth) as (s)he negotiates the abutment of the matrix band against the adjacent tooth (whether pressing or pulling against the adjacent tooth). Although a cylindrical implementation has been shown, other geometries are possible and can bring out the desired range of movement. This range of movement (and translation of clinician's pull or push efforts on the instrument handle), coupled with the finger pressure on the finger pad acting directly axially on the stabilizing arm onto the adjacent tooth (ideally, its central groove), maximizes the mechanical forces on the matrix band onto the adjacent tooth for successful restoration.

[0063] Next is described a method for placing class II composite restorations in a box-type (proximal box) tooth preparation using a conventional Tofflemire matrix band and

Tofflemire matrix band adjustable retainer, with the present invention of a band abutment instrument.

[0064] 1. Wrap the Tofflemire matrix band around the (to be) treated tooth and tighten as much as possible with the adjustable retainer.

[0065] 2. Secure band with wedge(s) and achieve isolation of the treated tooth.

[0066] 3. Burnish the matrix band against the proximal surface of the adjacent tooth.

[0067] 4. Apply etchant and rinse. Apply bonding agent and light cure.

[0068] 5. Position, on a preliminary basis, the abutment instrument into the proximal box with the prongs in contact with the band, and adjust the width of the prongs to match the size of the desired contact area. Place stably the instrument's adjustment screw on the occlusal surface of the adjacent tooth and adjust the height of the instrument's stabilization screw (relative to the occlusal plane of the mouth) to optimally position the instrument's prongs occluso-gingivally (typically just gingival to the contour of the proximal face of the adjacent tooth, around the boundary of the gingival and middle third, with variance from tooth to tooth). Note that this preliminary position step can be performed earlier before step 1 if desired and if dentist has visual access of the adjacent tooth (either before step 1 or after step 3 when the height of the contour of the adjacent tooth becomes evident from the impressions of the burnished band). After this preliminary positioning and adjustment, remove the (adjusted) instrument.

[0069] 6. Place small amount of flowable composite followed by packable composite and lightly condense the composite into the proximal box.

[0070] 7. Loosen the band slightly (in the order of ¾ turn of the retainer nut or knob that controls the size of the band loop) for a bit of "slack".

[0071] 8. Place the (adjusted) instrument into the proximal box and press (e.g. with a finger) on the instrument's finger pad toward the occlusal surface of the adjacent tooth, to stabilize the instrument onto the occlusal surface of the adjacent tooth while pushing on the handle of the (adjusted) instrument to abut the prongs against the (initially, slightly slack) band to conform with the adjacent tooth for a tight distal contact (with the incisal and middle third of the adjacent tooth). For a tight mesial contact, the instrument would be pulled.

[0072] 9. Light cure while maintaining the pressure with the abutment instrument.

[0073] 10, Remove the abutment instrument and light cure.

[0074] 11. Finishing including some or all of: fill the residual holes left in the composite by the abutment instrument, with fiowable composite and cure again; add more composite as needed to restore the treated tooth to the desired occlusal height and light cure this extra layer; remove the band and wedge(s) and light cure the restoration from the buccal and lingual aspects; use finishing burs to remove excess composite and adjust height according to bite.

[0075] Light curing, etching, bonding and like conventional steps, are preformed according to their respective supplier's directions, and are easily adjustable by dental

practitioners. For example, for a common light curing instrument and composites, the light curing is episodic in the order of 10 seconds each.

[0076] Many of the above steps are conventional and many are optional. Step 1 is the conventional wrapping and tightening "as much as possible" (e.g. Columbia University standard procedure

http://www.columbia.edu/itc/hs/dental/operative/matrixban d.html). The other steps are conventional with the inventive exceptions of several steps, as noted next,

[0077] Step 7 is the loosening of the band after the earlier "as much as possible" tightening of the band (of Step 1), the result of which is very counter-conventional, if not foolish outside of the context and teaching of the present invention; and

Steps 5 and 8, being, respectively, the preliminary try-in and adjustment of the instrument, and the use of the adjusted instrument against the band and adjacent tooth to maximize the tightness of the inter-proximal contact,

[0078] In the above, both steps 5 (preliminary adjustment) and 7 (loosening of the band) are described above for convenience of expression as being part of one

embodiment. Simpler embodiments are contemplated. For example, with the un- adjustable versions of the abutment instrument, step 5 is obviated; or with the versions of the abutment instrument where only the prong separation is adjustable, or where only the stabilizing arm is adjustable, step 5 is simplified accordingly. Un-adjustable versions include a kit or plurality of instruments whose prong separations are fixed and/or whose stabilizing arm is fixed relative to the remainder of the instrument. For another example, step 7 (the loosening of the band) can be skipped while proceeding to step 8 (pushing down on the instrument). For another example, step 5 (preliminary adjustment) is optional.

[0079] When using a sectional matrix band (instead of a Tofflemire band), the preceding explanations are applicable mutatis mutandi with exceptions obviously flowing from the use of a sectional band without a Tofflermire retainer - there is no tightening or loosening of the band, there is use of bi-tine rings and the like; otherwise the (adjusted) instrument can be used as described above.

[0080] The tool portions of the instrument may be formed conventionally with the handle. Conventional examples include: bayonet attachment, snap-fit, threaded the free end of handle shank to threadably mate with the correspondingly threaded hole of the handle end. Thus, the tool portions of the instrument may be manufactured for easy attachment and detachment. Thus, provided to the clinician is a plurality of differently sized (dependent on the clinician's evaluation of the restoration task and oral environment) can chose stabilizing arms that are at preset vertical lengths. And prongs which are at preset separations. Also, as seen in FIGS. 5 and 20, both the mesial and distal tool portions are provided in a single instrument.

[0081] The instrument wherein said prongs separation adjustability is effected by a mechanism that translates rotary motion into linear motion (or vice vers, and whether directly or indirectly) that controls the separation. Hinge screw, scissors and forceps-like mechanisms are well known. For example, knurled rotary knob 1002 in FIG. 10(b), is a conventional knob threadably interposed between the two prong extenders, and by the clinician's thumb interacting with the knob while holding the instrument in place in the proximal box, the optimal prong separation can be immediately and easily achieved.

[0082] The material used for manufacturing the instrument can be conventionally metallic. Also, advantageously (but not required for this invention), optically transparent, synthetic material to allow passage of light to pass through for curing the composite. For all embodiments, selection of materials for formation of the assemblies will depend on several factors. In all cases, materials selected must be durable enough to withstand the pressures (e.g., grasping, pushing, pulling) applied throughout the system during a procedure.

Furthermore, the materials utilized should be malleable enough to be formed into the desired shapes and orientations. If an embodiment requires a deformable member, the material used to form that member should be flexible enough to provide the desired deformation while remaining durable enough to withstand the pressures applied. If an assembly or a sub-portion thereof is intended to be of a disposable, one-use nature, then a reliable but inexpensive material (e.g., plastic) may be used in production. If an assembly or a member is intended to be of a re-usable nature, then a durable material (e.g., stainless steel), capable of withstanding repeated sterilization procedures, may be used in production.

[0083] As used in the description herein and throughout the claims that follow, the meaning of "a," "an," and "the" includes plural reference unless the context clearly dictates otherwise. Also, as used in the description herein, the meaning of "in" includes "in" and "on" unless the context clearly dictates otherwise.

[0084] Also, as used herein, and unless the context dictates otherwise, the term "coupled to" is intended to include both direct coupling (in which two elements that are coupled to each other contact each other) and indirect coupling (in which at least one additional element is located between the two elements). Therefore, the terms "coupled to" and "coupled with" are used synonymously,

[0085] Thus, specific devices and methods of restoring teeth have been disclosed. It should be apparent, however, to those skilled in the art that many more modifications besides those already described are possible without departing from the inventive concepts herein. The inventive subject matter, therefore, is not to be restricted except in the spirit of the disclosure. Moreover, in interpreting the disclosure all terms should be interpreted in the broadest possible manner consistent with the context, hi particular the terms "comprises" and "comprising" should he interpreted as referring to the elements, components, or steps in a non-exclusive manner, indicating that the referenced elements, components, or steps can be present, or utilized, or combined with other elements, components, or steps that are not expressly referenced.