Methods and Techniques of Tooth Separation

Tooth Separation: It is the procedure used in obtaining separation between two adjacent teeth to help in Class 2 restorations of Amalgam, Composite or Miracle Mix.

Slow or Delayed Separation:

It is the slow/ gradual repositioning or separation of teeth by inserting some foreign material between the teeth which takes some weeks to show result.

1. Wood:
2. Rubber Dam: It is placed inter proximally between the teeth, the type of rubber dam used is mostly Heavy (0.010”) or Extra Heavy (0.012”) and wait for 1 hour to 24 hours for the separation. In case of any swelling or pain a Gloss can be used by the patient to remove it.
3. Separating rubber ring:
4. Ligature wire/Copper wire: Wire is passed beneath the contact area and wire loop is tightened by twisting the 2 together which leads to increase in separation achieved in 2 to 3 days.
5. Base Plate:
6. Gutta Percha stick: The GP points are softened/heated and and placed into the proximal area. It is placed in between the posterior teeth which leads to separation after cooling of the Gutta percha which takes 1 to 2 weeks.
7. Oversized temporary crowns: Acrylic resin is used for making temporary crowns and the resin is periodicals added in the distal contact area to increase separation.
8. Orthodontic Wire

Advantages of Slow Separation:

• Tooth repositioning takes place without injuring the periodontal ligament fibers and maintaining the integrity of the PDL

Disadvantages of Slow Separation:

• Time taking
• Many patient appointments / visits required to get results

Rapid or Immediate Separation:

Rapid or Immediate form of tooth preparation is done by following 2 main principles:

Wedge Principle: It is i a mechanical method of tooth separation where a wedge or Conical shaped device is inserted between adjacent teeth beneath the contact area of teeth which leads to separation by 2 types of devices mentioned below.

1. Elliot Separator: It is also known as ‘Crab Claw’ and used to get rapid separation.
2. Wedges: It helps in stabilization of retainer and matrix during restorative procedures. It provides close adaptability in cervical portions of the proximal restorations, there by help in achieving correct contour and shape at cervical area. Used to prevent Rubber dam coming out from interproximal area.

The various types of Wedges are:

• Wooden wedges: There of 2 types based on shape Round and Triangular used in tooth preparations with deep gingival margins and helps in stabilization and retraction of gingival. Round wedges are used in Conservative Class 2 restorations, Triangular wooden are used in preparation with deep gingival margins, Plastic wooden are used in preparation with deep gingival margins, light transmitting wedge is used in Cervical portion of class 2 composite restoration.
• Metal wedges
• Silver wedges
• Celluloid / Plastic wedges
• Medicated wood wedges

Types of Modified Wedging Techniques:

1. Double Wedging: 2 wedges are used one on opposing the other which are inserted from the one from the buccal embrasure and the other from Lingual embrasure. Used mainly in wide Inter proximal cases.
2. Wedge Wedging: 2 wedges are used in this as well with one inserted from lingual embrasure area while the other is inserted between the wedge and matrix band at right angle to first wedge. Used mainly while treating mesial aspect of maxillary first premolar because of flutes in root near the gingival area.
3. Piggy back Wedging : 2 wedges are used one larger than the other where hte larger one is inserted normally and the smaller wedge is placed on top (piggy back) of the larger one. Use in shallow proximal box with gingival recession and to achieve a closer adaptation and contour of the matrix band.

Traction Principle: It is a Mechanical principal which engages the proximal area of the tooth with holding arms. These holding arms are moved apart to create the separation between the contacting teeth. These 2 devices are based on this principle of tooth preparation.

1. Non interfering True separator: Used when continuous stabilized separation is required. Its main advantage is that Separation can be increased or decreased after stabilization.
2. Ferrier double bow separator: It has 2 bows each of which engage the proximal surface of the tooth placed just gingival to the contact area. A Wrench system is used for turning the threaded bars which leads to separation. It is used for tooth preparation and during finishing and polishing of Class III direct gold restoration.

The other types of devices using Traction principle are

• Iwory adjustable separator
• Perry separator
• Wood ward separator
• Parr’s universal separator
• Dentatus – Nystrom separator

Tooth separation is a temporary procedure