Class II Posterior Direct Composite Restorations

A clinical case by our Community member Dr Nasim Akhatov

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.

Dentists frequently encounter proximal walls restoration issues in their regular work with direct composite restorations of chewing teeth. The effectiveness of restoring the chewing tooth groups’ contact points is dependent on selecting the suitable matrix system and tailoring it to the shape and morphology of the tooth to be replaced. In this case, a simple protocol for everyday posterior direct restorations was highlighted.

style italiano styleitaliano initial situation

Fig.1
Clinical symptoms indicate a carious lesion on tooth 45 and a failed restoration on tooth 46.

style italiano styleitaliano Isolation and cavity preparation

Fig.2
After rubber dam isolation, the old restoration and carious tissues were removed. The correct geometric shape of the cavities was created for better adaptation of the composite. This is done since the modification of the cavity shape reduces the degree of internal loading during composite polymerization.

style italiano styleitaliano Sandblasting

Fig.3
After removing the old filling material and carious tissue, the cavity was cleaned and sandblasted with 29-micron aluminum oxide particles using the AquaCare by Velopex machine.

style italiano styleitaliano The cavity after sandblasting

Fig.4
View of the cavity after sandblasting.

style italiano styleitaliano Matrix placement

Fig.5
It was decided to restore the proximal surfaces separately.
Starting with tooth 45, the SuperMat by Kerr matrix system was chosen.

style italiano styleitaliano Matrix placement

Fig.6
After restoring the proximal surface of tooth 45, the tooth 46 was restored and the matrix was adapted. In this manner, a ring was used to improve the matrix fitting to the proximal surface of the tooth.

style italiano styleitaliano Composite polymerization

Fig.7
Polymerization of the composite was performed with the Curing Pen by Eighteeth.

curing pen light style italiano styleitaliano eighteeth
curing pen light style italiano styleitaliano eighteeth
style italiano styleitaliano Composite placement

Fig.8
The packable composite was used to restore the proximal walls.

style italiano styleitaliano Composite placement

Fig.9
The occlusal surface of the teeth was modeled stage by stage and a beautiful natural appearance was achieved using a packable composite. The fissures were modeled using the LM Fissura instrument (LM Arte kit powered by Styleitaliano) according to the anatomy of the tooth.

LM arte kit posterior cusp style italiano styleitaliano instruments
LM arte kit posterior cusp style italiano styleitaliano instruments
style italiano styleitaliano polishing

Fig.10
The polishing steps were carried out using polymer cups, brush and polishing paste.

style italiano styleitaliano class 2 composite restoration final situation

Fig.11
Final result after grinding and polishing the restoration.

style italiano styleitaliano after 1 month of composite restorations

Fig.12
View of the restoration after 1 month.

Conclusions

Restoring the proximal walls and the original anatomical shape of the teeth is very important because each sulcus, fossa and ridge plays their role in functional contacts and movements.

Bibliography

  1. Douglas A.Terry, D.D.S. & Willi Geller. Aesthetic & Restorative Dentistry. 2012;96-117.
  2. Manauta J, Salat A. Layers An Atlas of Composite Resin Stratification. 2012. Quintessence Pub.
  3. Ferraris F. Adhesion, layering, and finishing of resin composite restorations for class II cavity preparations. Eur J Esthet Dent. 2007;2(2):210-21.
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