A simple and fast way for modeling direct posterior composite restorations

In daily routine of direct posterior composite restorations, we always seek for an easy procedure and a fast reliable technique that can be applied almost in every case in our daily practice and gives us a good, healthy and natural final results with a short chair time, here in this case we share a simple and fast technique for a classical class II composite restoration.

styleitaliano style italiano caries on upper molar

Fig.1
Initial situation, the patient was suffering from sensitivity on sweet and difficulty on flossing between the teeth 16 and 15. Tooth 15 was already endodontically treated and the diagnosis was a deep seated caries and proximal caries for the tooth 26.

styleitaliano style italiano clean cavity and rubber dam isolation

Fig.2
Isolation, Cleaning and Cavity design, and then the tooth was sandblasted by 29 micron aluminum oxide by AquaCare device.

styleitaliano style italiano matrix and wedge positioned before restoring cavity

Fig.3
Sectional band was placed, secured with plastic wedge and teflon wrapped around the wedge for a better seal.
Then the ring was placed without any modifications. Note, a good cavity design will lead to an easier band and ring adaptation.

styleitaliano style italiano flowable composite after proximal build up

Fig.4
Building the proximal wall, then filling the cavity with a layer of flowable bulk fill to seal the dentin to protect the bond. In this step we fill the whole cavity with a low-stress flowable material leaving only a little space for the final layer of composite to make the occlusal anatomy, then after that the band and the ring were removed to add the final layer.

styleitaliano style italiano raw composite layer before modeling

Fig.5
To create the final anatomy with a fast and simple technique, the final layer was placed using the SI P shade from the CompoSite kit (White Dental Beauty) as a single mass. Then it was well adapted and pressed using Condensa instrument (from the LM kit by Styleitaliano) to start modeling it to make the occlusal anatomy.

style italiano styleitaliano white dental beauty composite system
style italiano styleitaliano white dental beauty composite system
styleitaliano style italiano modeled composite restoration before finishing

Fig.6
The Fissura instrument (LM Arte kit) was used to quickly model the final CompoSite (White Dental Beauty) layer to create a simple and natural occlusal anatomy (as described by Hardan and Akhundov). Micro brushes were used for refining the grooves and the simple details then the composite was finally cured as a single mass.

style italiano styleitaliano lm arte anterior instrument
style italiano styleitaliano lm arte anterior instrument
styleitaliano style italiano finished composite restoration on molar with stains

Fig.7
After curing by a powerful light curing unit, the multiwave Curing Pen by Eighteeth, a small amount of brown stain was used to seal the fissures, and to give the final filling a more natural appearance.

curing pen light style italiano styleitaliano eighteeth
curing pen light style italiano styleitaliano eighteeth
styleitaliano style italiano final aspect of composite molar restoration

Fig.8
The filling and the tooth structure were blasted with prophyflex (sodium bicarbonate) by AquaCare device to remove the oxygen inhibited layer and the bond remnants on the tooth structure surface to make the final polishing.

styleitaliano style italiano restored molar after rubber dam removal

Fig.9
Immediate final result, simple and natural anatomy with a good contact point.

styleitaliano style italiano check up after composite restoration

Fig.10
6 months recall visit with a stable result.

Conclusions

The main goal of our daily practice in direct posterior composite restorations is to achieve an easy, fast and reliable technique for a predictable final result. By understanding the steps and designing a good cavity, it’s easier to restore a healthy contact point and obtain a good and fast occlusal modeling. The final anatomy will thus be natural, free of unnecessary complexity, exaggeration, or time consumption.

Bibliography

1. Manauta J, Salat A. Layers An Atlas of Composite Resin Stratification. 2012. Quintessence Pub.
2. Marchetti G. 10 TIPS on Posterior direct restoration in daily flow. 2018. Styleitaliano.org.
3. Murad Akhundov, Managing multiple contact points, step by step. Styleitaliano.org.
4. Van Dijken JW, Pallesen U. 2016. Posterior bulk-filled resin composite restorations: a 5-year randomized controlled clinical study. J Dent. 51:29–35.
5. Hardan L, Sidawi L, Akhundov M, Bourgi R, Ghaleb M, Dabbagh S, Sokolowski K, Suarez C, Szymanska M. One-Year Clinical Performance of the Fast-Modelling Bulk Technique and Composite-Up Layering Technique in Class I Cavities. Polymers 2021;13:1873.

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