Aesthetics in Posterior Composites

The clinical case refers to a young patient, 33 years old, who required a revision of the second upper quadrant with the old amalgam fillings being replaced by composite restorations.

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Fig.1
Isolation of the quadrant with the rubber dam and ligatures.

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Fig.2
I proceeded to remove the old restorations and to clean and prepare the cavities.

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Fig.3
At this point, I began with the restoration closest to the back of the mouth to save the patient from becoming tired and having to close his mouth too often and thus complicating the procedure. A MetaFix matrix was applied before I pre-etched the enamel using orthophosphoric acid to improve the adhesion of OptiBondTM XTR.

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Fig.4
The pre-etching of the enamel, followed by rinsing and drying, was followed by etching and priming, as per the first step of OptiBond XTR.

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Fig.5
After about 20 seconds, I gently used an air spray and proceeded to the second step of the etch and dry system.

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Fig.6
Taking a small quantity of composite (Herculite® XRV UltraTM, enamel A1), I adapted the material with the condensing tip of Compothixo, using the continuous vibration mode.

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Fig.7
Once the restoration was adapted with the spatula tip in intermittent vibration mode (this method facilitates smoothening out without the composite rolling around the spatula), I adapted the material to the matrix. This made it easy to build up the interproximal wall preventing air bubbles or voids.

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Fig.8
The matrix is removed after polymerization of the distal wall.

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Fig.9
Now the cavity is much more simple to fill up, without any interferences.

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Fig.10
The cavity was then filled, leaving space for the last layer of saturated dentine (A4) using the condensing tip of Compothixo, used in intermittent vibration mode (it is enough to rest your finger on the switch without pressing all the way down on the release)

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Fig.11
A thorough polymerization followed this stage.

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Fig.12
The coronal dentine was applied in two steps, the cusps being modeled alternatively with the Compothixo pointed tip.

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Fig.13
Used with intermittent vibration in this step too to enhance the adaptation and morphology, without the material becoming rolled up around the tip.

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Fig.14
Ochre and Brown, Kerr Kolor + Plus®

Ochre was used in order to achieve an even more saturated dentine, and Brown was used characterize the fissures.

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Fig.15
The final layer of enamel (Incisal medium) was also applied in two stages; first using the spatula tip in continuous vibration…

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Fig.16
…And then the modeling tip in intermittent vibration, in order to further enhance adaptation and morphology.

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Fig.17
A thin layer of glycerine was applied to the surface before the final polymerization, thus avoiding the occurrence of surface oxygen inhibition.

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Fig.18
The finishing is thus made much easier as, by constructing the occlusal table step by step, excess is kept to a minimum. A diamond-coated bur (20 microns) or multi-bladed burs with 8-12 blades were used.

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Fig.19
The interproximal finish was achieved using an EVA handpiece with blades of decreasing grain size.

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Fig.20
The exact same steps were carried out on tooth 25, first, placing and wedging the matrix.

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Fig.21
Build-up of the proximal walls and matrix removal.

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Fig.22
Dentinal core build up, stains….
And final enamel layer.

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Fig.23
This clinical case was concluded by carrying out the restoration procedure on 24.

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Fig.24
Using the same composite.

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Fig.25
When everything is complete, the polishing phase can be simplified by using Rubber Points (Opti1Step)

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Fig.26
And OptiShine, pre-impregnated brush.

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Fig.27
Aspect after rubber dam removal.

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Fig.28
The aesthetic appearance achieved shows that modern composites, if the dentist is familiar with their properties, can be selected for posterior restoration work, also in consideration of the positive response of the periodontal tissues.

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Fig.29

Conclusions

Bibliography

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