Fig.1
Initial situation. A 34-year-old patient presented to the clinic with a chief complaint of cold sensitivity in the lower first molar and second premolar. Intraoral examination revealed an old, infiltrated composite restoration in the first molar, as well as an interproximal lesion in the second premolar.

Fig.2
A preoperative occlusal check was performed using 40-micron articulating paper prior to cavity preparation and isolation.

Fig.3
After rubber dam application, the old restoration and proximal caries were removed, revealing two Class II cavities.

Fig.4
A caries detector dye was used to ensure that no residual caries remained in the cavity. After the initial caries removal, the dye was applied to guide the creation of a peripheral seal zone, which is a critical step for restoration durability. At the cavity margins, it is essential to preserve sound tooth structure, free of caries or even stains, as these can negatively affect the bonding procedure. This step is particularly important in the peripheral zone, which plays a decisive role in determining the longevity of the restoration.

Fig.5
The caries detector dye revealed residual caries in certain areas of the cavity of the second premolar. Maintaining tooth vitality was prioritized in accordance with the principles of selective caries removal, the peripheral seal zone, and the current guidelines for defining the caries removal endpoint.

Fig.6
The internal tooth structure was sandblasted with 29-micron aluminum oxide powder, and the preparation was refined by rounding all sharp internal angles with an Arkansas stone.

Fig.7
Selective enamel etching was performed for 30 seconds to minimize postoperative sensitivity.

Fig.8
The cavities were then ready for the bonding procedure. The photo demonstrates the saddle matrix seal. Matrix sealing is a crucial step for achieving long-lasting restorations and minimizing the risk of recurrent caries.

Fig.9
Choosing the proper matrix contour and height is essential for achieving an optimal restoration. This picture shows the cavity design of the first molar with reduced cusps. The lateral view shows the level of the future contact point.

Fig.10
A universal adhesive system was applied (3M Scotchbond Universal Plus). After completing the adhesive procedure, a thin layer of flowable composite was placed and spread over the dentin to protect the hybrid layer.
Subsequently, the Snowplow Technique was applied proximally to ensure maximum seal at the gingival margin and to prevent gaps. At this stage, the first tooth was converted into a simple Class I cavity.

Fig.11
Close-up of the fabricated stamp, created using flowable composite and a dry bonding brush.
To restore the occlusal anatomy, the Stamp Technique was used, allowing the simple and fast restoration of a functional and accurate anatomy.

Fig.12
The cavity was then filled, leaving a final layer of uncured composite on the surface. The fabricated stamp was pressed into place with the aid of a piece of Teflon tape, which uniformly covered the entire occlusal surface.

Fig.13
After stamping the occlusal surface, the excess material was removed using an LM Fissura instrument, and the restoration was polymerized.

Fig.14
The premolar was finished first. Using the Stamp Technique, the occlusal anatomy was restored to its pre-cavity form, achieving both function and esthetics.

Fig.15
Following the build-up of the reduced cusps of the first molar, the matrix, wedge, and an active ring were carefully applied to ensure proper proximal contour and a tight contact point. This photo shows the matrix seal, a crucial step for achieving long-lasting restorations.

Fig.16
The Snowplow Technique was applied once again. The levels of the proximal walls were carefully checked using the Posterior Misura instrument (LM Arte). Proper leveling of the proximal walls is the first step toward achieving a functional occlusal anatomy without postoperative high spots. At this stage, the Class II cavity was successfully converted into a Class I.

Fig.17
The lateral view shows the satisfactory level of the proximal height and orientation.

Fig.18
The occlusal anatomy was restored using the Espresso Posterior philosophy (Fast Modeling technique). The composite was placed as a single increment, and adapted with the convex side of the smart Replica Posterior instrument (LM).

Fig.19
This shaping stage was carried out using the sharp end of the Smart Replica Posterior instrument, applied perpendicular to the occlusal surface. This technique enables precise sculpting of the central, buccal, and lingual grooves, ensuring accurate anatomical definition and a natural occlusal form.

Fig.20
Immediately after sculpting, stains were applied to enhance the natural appearance and to seal the fissures. The excess stain was carefully removed using a microbrush.

Fig.21
A proper and tight contact point was established, along with well-defined occlusal and gingival embrasures.

Fig.22
The final appearance of the restorations after finishing and polishing demonstrated good functional and esthetic outcomes. Postoperative occlusion was recorded and compared with the preoperative occlusal check, following a confirmative approach.

Conclusions

The reconstruction of the original anatomical structures is of paramount importance. The Stamp Technique is particularly effective when the pre-existing anatomy is well preserved. By following these steps and utilizing modern smart instruments and restorative materials, it is possible to achieve functional and esthetic posterior restorations in a simply, quicly, and predictably.

Bibliography

1. 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.
2. Manauta J, Salat A, Devoto W, Putignano A. Layers 2 Direct Composites: The Styleitaliano Clinical Secrets. 2022. Quintessence Publishing.
3. Chiodera G, Orsini G, Tosco V, Monterubbianesi R, Manauta J, Devoto W, Putignano A. Essential Lines: a simplified filling and modeling technique for direct posterior composite restorations. Int J Esthet Dent. 2021 May 10;16(2):168-184. PMID: 33969973.