Back to Basics: A step by step protocol
The use of the composite materials to restore shape and function of posterior teeth damaged by decay, age or trauma is gaining wide acceptance by the dental community.
The dental practitioner and also the patient have the same desire regarding posterior composite restorations, which is that those restorations has to last many years.
While there are numerous recommendations regarding preparation design, restoration placement, and curing technique, current research indicates that restoration longevity depends on several variables that may be difficult for the dentist to control.
These variables include the patient’s caries risk, tooth position, patient habits, number of restored surfaces, the quality adhesion and the ability of the material to produce a sealed tooth- restoration interface.
So, success of posterior direct restorations strongly relies on the dentist’s procedure and his clinical experience. In this article is described a clinical step by step procedure in order to create and develop a protocol for daily practice. Working with an understandable and clear protocol, the dental clinician can pay attention on many details during composite reconstruction, can prevent the technical errors, can hold the “flow” estate, leading to a better result with every restoration.
1. Diagnostic and initial occlusal check
2. Isolation and pre-wedging
3. Cavity preparation and cavity finishing
4. Proximal wall build-up and occlusal layering
5. Straining (Optional) and finishing
6. Polishing and final occlusal check
1. Protect the proximal rubber to be broken during the cavity preparation
2. Push the rubber and the gingiva more apically
3. Separate the teeth so the proximal preparation is easier
2. Removal of the caries
3. Finishing of the cavity
The bur that I use most for access is the cylindric-round burr with a diameter of 0,9 mm.
A daily protocol understand by the dentist and also by the dental assistant can provide very good posterior restorations with every patient.
1. Bohaty BS, Ye Q, Misra A, Sene F, Spencer P. Posterior composite restoration update: focus on factors influencing form and function
2. Hassan K, Khier S. Composite resin restorations of large class II cavities using split-increment horizontal placement technique
3. Ferraris F. Adhesion, Layering, and Finishing of Resin Composite Restorations for Class II Cavity Preparations