Custom rings reloaded, updates and indications
Since its introduction by Jordi Manauta in 2013, the custom rings technique enjoys unparalelled popularity among restorative dentists. We see many cases in social media and publications with custom rings used, what demostrates the effectiveness and simplicity of this technique. However, we also see some cases that could have been solved with less effort as well, hence it is important to emphasize the indications and limitations of the custom rings.
As many of us are using these customized rings on a daily basis, the members of StyleItaliano are constantly working to develop and improve the use of this technique.
Another aspect of this article is to give the reader an update of the fabrication steps. The current improvements are based on the work of Jordi Manauta and co-workers and the use of the MyCustomrings kit.
The author wishes to thank Jordi Manauta for his precious collaboration, his constant help and support in professional development.
Original picture curtesy of Paulo Monteiro.
If we have more rings, then one can be prepared like this, so I can save time during the actual treatment.
TIP 2: Isolate the approximal surface with a water soluble gel to ensure easy detachment of the custom ring from the tooth.
TIP 3: If necessary, you can adapt the ring faces fith a bur or disc.
Approximal caries in tooth no. 26, a typical indication for custom ring.
Indications for custom ring
A custom ring is useful every time we have a wide approximal box extending vestibular and oral from the contact area. It is especially helpful in the upper premolar and molar area, where we can capture and replicate the asymmetric approximal surfaces. These would be difficult to reproduce with conventional sextional matrix systems.
Contraindication: there is no use for a custom ring in case of narrow approximal cavities, where the individual resin index would not reach the cavity vertical margins.
The suggested width of the cavity is big, so a custom ring can help us.
It is clearly visible, that the excess on the approximal surface is minimal, we will barely need any finishing.
In this case the suspected width of the approximal cavity box does not exceed the flat contact area, so a custom ring is not indicated.
Initial situation. Old restorations in teeth 35 and 36, secondary caries distal 35.
The remnant of the old cavity liner is visible.
This step is not necessary, in this case it took about 5 minutes.
The custom rings is until now the best and only technique to copy the original approximal surfaces of the teeth to be restored. Prerequisite for the use of this technique is that the proximal surfaces should be present and enamel should be intact, so that it can be copied. It has especially good use in cavities with wide proximal boxes. In these cases, a more difficult situation can be solved with a simple and reliable tool, saving time both at the matrix placement and the finishing stage.
However in cases with narrow approximal box, where the customized part does not reach the cavity margins, similar results can be achieved with conventional simple rings as well.
Last but not least, in those situations in which the approximal surface does not have proper anatomic contour at the beginning, mainly due to previous restorations, iatrogenic damage during previous restorative procedures or defective shape, we do not have a surface to copy. In these cases, we can use other rings with prefabricated anatomic ring faces.
1. Bichacho N. The centripetal build-up for composite resin posterior restorations. Pract Periodontics Aesthet Dent. 1994 Apr;6(3):17-23;
2. Alleman D, Magne P. A systematic approach to deep caries removal end points: The peripheral seal concept in adhesive dentistry. Quintessence Int. 2012 March.
4. Heintze SD, Rousson V. Clinical effectiveness of direct class II restorations – a meta-analysis. J Adhes Dent. 2012 Aug;14(5):407-31.
7. Van Meerbeek B, Yoshihara K, Yoshida Y, Mine A, De Munck J, Van Landuyt KL. State of the art of self-etch adhesives. Dent Mater. 2011 Jan;27(1):17-28.