Class II Direct Composites

A clinical case by our Community member Dr. Muhammad Alhafudh

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.

This patient came to the clinic complaining of food impaction between teeth 45 and 46, both of which presented carious infiltration.

styleitaliano style italiano opening of proximal decayed space

Fig.1
The proximal area was opened before isolation in order to avoid rubber dam lacerations. A wedge was used to protect the papilla.

styleitaliano style italiano rubber dam isolation before cavity cleaning

Fig.2
After isolation, it was possible to proceed to cavity cleaning.

styleitaliano style italiano clean class II cavities

Fig.3
Decayed tissue was removed. Enamel was finished with fine burs to prevent the detachment of unsupported enamel prisms and micro-leakage.

styleitaliano style italiano sectional matrices and wedge in place

Fig.4
Matrices were placed and secured with a wedge.

styleitaliano style italiano ring adapting sectional matrices for class II restoration

Fig.5
To allow the matrix to embrace the tooth, we used a special NiTi ring, which presses the matrix onto the proximal wall, and creates forces that enhance separation between walls to create an optimum seal during proximal modeling and a tight contact point.

styleitaliano style italiano etched cavities

Fig.6
After enamel etching, the cavities were dried.

styleitaliano style italiano bonding of proximal cavity

Fig.7
Bonding was brushed into the cavity of 46 and air-blown to remove excess and make the solvent evaporate. The cavity of tooth 45 was protected with teflon tape to support the matrix and avoid contamination.

styleitaliano style italiano build up of mesial wall of upper molar

Fig.8
The mesial wall of 46 was layered by Enamel shade from the Professional CompoSite System (White Dental Beauty), which is easy to model and has very good optical properties.

style italiano styleitaliano white dental beauty composite system
style italiano styleitaliano white dental beauty composite system
styleitaliano style italiano layering of composite inside cavity

Fig.9
Before removing the sectional matrix, the dentin was sealed with flowable composite (0.5 – 1 mm).

styleitaliano style italiano adjacent class II cavities during restoration

Fig.10
The distal wall of tooth 45 was built. Before layering the occlusal surface, the outline of the restoration was finished with discs.

styleitaliano style italiano composite polishing paste Lucida Diashine

Fig.11
After layering the occlusal anatomy, the restorations were polished by using the Lucida Star felt and sub-micron, hybrid and water-soluble paste.

style italiano styleitaliano diashine lucida
style italiano styleitaliano diashine lucida
styleitaliano style italiano polished class II cavities

Fig.12
The finished and polished restorations.

styleitaliano style italiano finished and polished class II cavities

Fig.13
Immediately after rubber dam removal and bite check.

Conclusions

The reconstruction of the original anatomical structures is a very important, as every groove, fossa and ridge have their role in functional contacts and movements. So when a tooth is restored according to an anatomically guided pattern, very few occlusal adjustments are required.

Bibliography

1. Manauta J, Salat A. Layers An Atlas of Composite Resin Stratification. 2012. Quintessence Pub.
2. Dias W. New techniques and tools for approximal restorations of class II. Walter Dias. DentArt Magazine 2012 No66.
3. Chiodera G. Simplify class 2 restoration. 2020. Styleitaliano.org.

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