We have a solution for most situations we are presented with in dentistry. We have solutions for caries. We have solutions for periodontal disease. We have solutions for abrasion and erosion. Almost everything a patient can present us with, we have an option for.
The exception is black triangles. We don’t have great solutions for those annoying negative embrasure spaces between anterior teeth. Veneers might be an option, but they are expensive and aggressive based on just black triangles. And no one loves veneering lower anteriors, where we often see these! Crowns are a possibility, but again, this is very aggressive treatment based on just black triangles. Bioclear, in my opinion, is the only option for this clinical situation.
Bioclear does more than just make matrices, though. Bioclear is a system. The Bioclear system can be used to restore any interproximal surface, posterior or anterior. In this Pearl, we will focus on closing black triangles, which obviously involves interproximal surfaces. Bioclear systems typically involve heating both paste resin composite and flowable resin composite to 155 degrees, which makes it more flowable. Working with heated paste and flowable allow you to fill all those nooks and crannies that are especially important when closing black triangles.
Another facet of all the Bioclear systems that might be different from what you are used to is using a “bioblaster,” which is basically a chairside air abrasion unit that connects to your handpiece adapter. This is used to remove all the biofilm around the tooth to ensure a clean bond all the way around. Managing biofilm has become a very hot topic in dentistry, especially in the perio world. We need to be managing it better in the restorative world if we are going to rely on adhesive dentistry.
The Bioclear Black Triangle matrices themselves are color coded so that you can pick the appropriate curvature for the triangle you are trying to fill. A corresponding gauge comes in the kit to help you determine the appropriate matrix. There are four different curvatures in two different sizes, meaning there are eight different matrices in total to choose from. Bioclear has updated the Black Triangle kit a few times over the years. The newest iteration requires no trimming at the gingival prior to seating. This saves a step and eliminates some error.
The process begins with cleaning and debriding the triangle you are working on. This gets the enamel ready to bond. Gauge the curvature with the included sizing gauge and then select your matrices. When restoring a black triangle, we always put on both matrices at one time. We then pick the side we’re going to do first. After the first one is done, the first matrix is removed and we restore the second one. To restore, we follow the etch and bond protocol for our bonding agent. Then heated flowable composite is applied, followed by heated paste. Bioclear’s founder, David Clark, DDS, calls this step “injection molding.” That’s basically what it is. The matrices form a shape and we want to fill that shape with heated resin composite. That yields an incredibly dense and shiny restoration. We then use disks to shape and finish these. This produces a black triangle that is well filled and adapted with resin composite. This treatment is incredibly esthetic and conservative.
It is difficult to just jump into Bioclear. It really takes education and practice. If you are interested in adding this to your practice, I recommend taking a course with Dr. Clark. There are plenty of videos on the Bioclear website to get you started, but a hands-on education really makes a difference here. Dr. Clark also has a teaching center in Tacoma, Washington, for Bioclear. That is the next educational course I plan on attending. Line drive single into right field for Bioclear Black Triangle matrices!
Joshua Austin, DDS, MAGD, writes the Pearls for Your Practice column in Dental Economics. After graduating from the University of Texas Health Science Center Dental School, Dr. Austin associated for several years. In October of 2009, he opened a solo general practice in a suburban area of San Antonio, Texas. Dr. Austin is involved in all levels of organized dentistry and can be reached at [email protected].
