A clinical case by our Community members Dr. Ahmed Saad
This article and its content are published under the Author’s responsibility as an expression of the Author’s own ideas and practice. Styleitaliano denies any responsibility about the visual and written content of this work.
Caries in posterior teeth represent a significant portion of daily dental treatments. Direct resin composite restorations offer a reliable and long-lasting solution. However, the longevity of such restorations depends on multiple factors, including the patient’s caries risk, tooth position, oral habits, the number of surfaces involved, adhesive performance, and the clinician’s technical skills.
Traditional restorative techniques typically require multiple incremental layers, making the procedure time-consuming when performed correctly. This article presents a detailed, step-by-step clinical protocol designed for daily practice. The proposed protocol aims to improve efficiency and cost-effectiveness by incorporating bulk-fill resin composites in a body shade, allowing for faster placement with fewer increments.
By establishing a clear and standardized approach, practitioners can focus on essential clinical details during composite restorations, minimizing technical errors and enhancing the overall quality and predictability of the final result.
Fig.1
Initial clinical situation showing a Class II cavity on tooth #37 in a young female patient referred by the orthodontist for restorative treatment prior to orthodontic management.
Fig.2
Rubber dam isolation was performed after occlusal assessment. For posterior restorations, quadrant isolation is preferred to improve accessibility and visibility during the procedure.
Fig.3
Caries removal was performed following the selective caries removal protocol, preserving affected dentin near the pulp to minimize the risk of pulp exposure while ensuring removal of infected tissue.
Fig.4
This schematic highlights the principle of selective caries removal: in the peripheral seal zone, caries are removed until hard dentin is reached to optimize adhesive bonding; in the central zone, the goal is to retain firm dentin to preserve pulpal vitality and reduce the risk of exposure.
Video.1
This video illustrates the proper use of a rose-head carbide bur on a low-speed contra-angle to remove caries in the peripheral seal zone, followed by the use of an AquaCare device to gently clean the central zone, preserving firm dentin for pulpal protection.
Fig.5
Undermined tooth structure was removed, and the cavity margins were smoothed and finished using a red-coded diamond finishing stone to ensure optimal adhesion and restoration integrity.
Fig.6
The matrix is positioned in place. At this stage, the height of the matrix is critical to ensure the correct formation of the proximal ridge. In this particular case, a separating ring was not used at the orthodontist’s request, as tooth rotation will be corrected later through orthodontic treatment.
Video.2
This instructional video illustrates each stage of the restorative protocol:
- Resin coating technique to protect freshly cut dentin and enhance bond strength.
- Centripetal build-up technique, beginning with the reconstruction of missing proximal walls to convert a Class II cavity into a Class I.
- Application of bulk-fill composite as a dentin substitute for efficient volume build-up.
- Use of body shade composite for enamel replacement and final cusp anatomy sculpting.
Fig.7
Final build-up with essential contouring lines.
Fig.8
The final aspect of the restoration.
Fig.9
Final x-ray.
Conclusions
With these strategies, dentists can achieve success in everyday dentistry within feasible timeframes and obtain long-term results, regardless of the material used, because the approach is both fast and effective.
Bibliography
- Bohaty BS, Ye Q, Misra A, Sene F, Spencer P. Posterior composite restoration update: focus on factors influencing form and function. Clinical, cosmetic and investigational dentistry. 2013 May 15:33-42.
- Hassan K, Khier S. Composite resin restorations of large class II cavities using split-increment horizontal placement technique. General Dentistry. 2006 May 1;54(3):172-7.
- Ferraris F. Adhesion, layering, and finishing of resin composite restorations for class II cavity preparations. European Journal of Esthetic Dentistry. 2007 Jun 1;2(2):210.
