Since the development of resin-based composites, their popularity has increased over time as a result of an increase in demand for dental repair solutions with naturally colored teeth in the posterior tooth region. Dental restorations have a limited lifespan, as posterior composite restorations demonstrated a survival rate of 64% after 20 years, 80.7% after 10 years, and 87.7% after 3 years according to previous studies. Therefore, prolonging the lifespan of restorations is crucial in dentistry. Clinical evaluations of posterior composite restorations offer the chance to gain knowledge of the behavior of the material and the outcomes of the used procedure.
You don’t need to have the most sophisticated material to do direct posterior dentistry; all you need are a few methods and tips, right protocol, and skillful manipulation. Thus, this article is intended to introduce a step-by-step approach for the direct restoration of multiple posterior teeth using an easy and fast technique by means of a single mass P composite (White Dental Beauty).
A 30-year-old-female visited the dental office and asked for restoring her teeth using direct composite. Multiple proximal caries lesions were detected in this case.
Isolation was performed with the rubber dam and followed by caries removal. This step is of great importance. An increase in bond strength, and a reduction of microleakage were obtained when using rubber dam instead of cotton roll. Next, all internal angles were rounded to remove caries in a specific way. For enamel a diamond bur should be used, while for dentin a carbide bur must be chosen. In this step, a sandblasting of the margins and walls was done with 29 micron Aluminum oxide.
As multiple contact points should be managed, all matrices were placed at one time. The thinnest and soft matrices were placed one by one using Polydentia matrix system. Clinician should start to restore the contact point of the first tooth randomly (distal wall before, mesial wall after), then a removal of the matrix should be done.
Molars were finished first, this is done according to the preference of the clinician. You can decide to build any tooth first according to your choice. The modeling was done using the Espresso posterior and the P composite (White Dental Beauty) as a single mass. The occlusal anatomy must be created using a quick and easy method that can restore both function and anatomy without the need to layer each cusp one at a time. This objective can be accomplished using a Fast Modeling Technique (Espresso posterior), as explained by Hardan et al., .
With the help of LM Arte fissura (LM-Dental, Parainen, Finland) the grooves were created while taking into account the architecture of the tooth and to define the cusps. The main grooves were drawn by cutting the composite following the remaining fissures of the tooth. The excess was then eliminated using the same probe, and the cusps were brought together harmoniously with the aid of a microbrush in order to lessen the size of the gap formed when the composite was cutted. Finally, the composite was light-cured with a proper light-curing device.
Same steps were repeated in all the teeth. A ring from Palodent was used in order to press the matrix onto the proximal walls, and to create forces that increase separation between teeth. A tight contact point will be obtained in an easy, fast, and predictable way.
Final situation after polishing.
The patient visited the office after one year, so a picture was mandatory to check the field of the completed work.
The patient was happy and satisfied with the result of this approach after 3 years of clinical function.
5 years were passed and all restorations performed were integrated with the tooth in terms of color, shape, and function.
It may be possible to significantly reduce treatment expenses by marginally extending the lifespan of dental restorations. By doing so, dentist must be directed to achieve multiple restorations with good maintenance by following a fast technique and right tool.
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- Hardan L, Bourgi R, Kharouf N, Mancino D, Zarow M, Jakubowicz N, Haikel Y, Cuevas-Suárez CE. Bond strength of universal adhesives to dentin: A systematic review and meta-analysis. Polymers. 2021 Mar 7;13(5):814.
- Alkhatib OA, Bissasu S, Daud A. Dental floss ties for rubber dam isolation: A proposed classification and a new technique. Journal of Prosthodontics. 2023 Jan;32(1):83-9.
- von Gehren MO, Rüttermann S, Romanos GE, Herrmann E, Gerhardt-Szép S. A 23-Year Observational Follow-Up Clinical Evaluation of Direct Posterior Composite Restorations. Dentistry Journal. 2023 Mar 1;11(3):69.
- Hardan L, Sidawi L, Akhundov M, Bourgi R, Ghaleb M, Dabbagh S, Sokolowski K, Cuevas-Suárez CE, Lukomska-Szymanska M. One-year clinical performance of the fast-Modelling bulk technique and composite-up layering technique in class I cavities. Polymers. 2021 Jun 4;13(11):1873.