Direct Posterior 18y follow up

A clinical case written by Paulo Monteiro and Carlos Fernandez Villares

How long we can guarantee our composite restorations? Normally this is a question that many patients ask prior to receiving their dental treatment. As we always say, one of the keys to long term success lies in the care we take in our step by step procedure. In the case presented, the patient complained of the unaesthetic amalgam restoration that she had in the left second lower premolar, which she asked to replace with an aesthetic restoration.
This case shows an 18-year longevity of a direct posterior composite restoration still in function and fulfilling all aesthetic criteria.

style italiano styleitaliano screenshot of preoperative photograph

Fig.1
Screenshot of the photo from 2005.

style italiano styleitaliano rubber dam sheets

Fig.2
After the application of the anesthetic, we proceeded to isolate the field with the rubber dam. This step is crucial to obtain a dry area were we can work in the best possible conditions.

style italiano styleitaliano rubber dam isolation

Fig.3
Putting the rubber dam allow us to eliminate the amalgam in a safe way and to avoid the patient to aspirate toxic parts of the material.

style italiano styleitaliano clean cavity after amalgam removal

Fig.4
When everything is ready we check the cavity. Normally after removing an amalgam, some cracks could appear and we would need to seal them properly to avoid postoperative sensitivity.

style italiano styleitaliano etching of the enamel

Fig.5
Recent days lead us to the use of universal adhesive systems to get proper adhesion in dentin and avoiding the denaturalization of dentin with the total etch systems, but when we made this restoration, these systems were not available, so we proceeded with the etching system in two steps (3M™ Adper™ Scothbond™ 1XT) etching the enamel during 15 seconds (3M™ Etchant™) as a first step.

style italiano styleitaliano 3m
style italiano styleitaliano 3m
style italiano styleitaliano etching of enamel and dentin

Fig.6
Then, another 15 seconds of etching for the dentin to obtain different levels of demineralization between dentin and enamel.

style italiano styleitaliano drying the enamel selectively

Fig.7
To avoid excess dehydration of the dentin we put a cotton pellet inside the cavity and blowed air to get the proper chalky surface of enamel without damaging the dentin.

style italiano styleitaliano filling of cavity

Fig.8
After the application of the adhesive system (3M™ Adper™ Scothbond™ 1XT) we proceeded with the application of a small quantity of dentin shade composite (3M™ Filtek™ Supreme XT A3D) respecting the exact thickness for the subsequent enamel layer.

style italiano styleitaliano finished class I restoration before polishing

Fig.9
After that, a Body shade layer (3M™ Filtek™ Supreme XT A2B) was applied following the anatomy of the natural premolar.

filtek supreme style italiano dual-shade technique 3M
filtek supreme style italiano dual shade technique 3M
style italiano styleitaliano composite restoration after rubber dam removal

Fig.10
We removed the rubber dam and checked the occlusion.

style italiano styleitaliano polished composite restoration right after procedure

Fig.11
Immediate result after finishing and polishing.

style italiano styleitaliano bitewing x-ray for 18 years follow up

Fig.12
Bitewing of the restoration in 2023.

style italiano styleitaliano composite restoration 18 year follow up

Fig.13
Result after 18 years of service in the patient’s mouth.

style italiano styleitaliano screenshot of 18 years composite follow up

Fig.14
Screenshot of the photo in 2023.

Conclusions

Proper isolation, a correct bonding procedure, together with highly performing materials and thorough polishing are the basics to long-term restorations.
Through these steps you can achieve optimum results to function optimally in your patients mouths for many many years.

Bibliography

Manauta J, Salat A. Layers: An Atlas of Composite Resin Stratification; Quintessence. Print; 2012.
Dietschi D, Spreafico R. Current clinical concepts for adhesive cementation of tooth-colored posterior restorations. Pract Perio Aesthet Dent 1998;10:47-54
Opdam NJ, van de Sande FH, Bronkhorst E, Cenci MS, Bottenberg P, Pallesen U, Gaengler P, Lindberg A, Huysmans MC, van Dijken JW. Longevity of posterior composite restorations: a systematic review and meta-analysis. J Dent Res. 2014 Oct;93(10):943-9.

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