Esthetic and functional integration with direct composite in posterior region

A clinical case by our Community member Dr. Ali Almasoudi

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.

The satisfactory direct composite restoration of a proximal surface in class-II cavities requires the fulfillment of several criteria, including attainment of an anatomically correct contour and tight contact area, adequate marginal adaptation and accurate marginal ridge placement.

styleitaliano style italiano premolars and molars with caries and old fillings

Fig.1
The initial situation is showing caries on both premolars. Also the first molar have an old restoration need to change because of poor integration and inadequate morphology and function. A pre-operative occlusal check is very useful to plan restoration of multiple complex cavities.

styleitaliano style italiano clean cavities after rubber dam isolation

Fig.2
Rubber-dam isolation is a requirement for successful placement of a direct composite restoration.

styleitaliano style italiano etched multiple cavities

Fig.3
Cleaning of the caries and refining the enamel with fine grained diamond burs are two essential steps in cavity preparation to avoid detachment of unsupported enamel and micro-leakage. All the cavities were sandblasted by 29 micron aluminum oxide.

styleitaliano style italiano wedges in between teeth for proximal restoration

Fig.4
To finish the proximal margins, wedges were placed to protect the rubber dam and to separate the teeth.

styleitaliano style italiano simultaneous matrix placement for multiple cavity restoration

Fig.5
Matrices were placed simultaneously, with the advantage of time saving, and of preventing contamination of neighboring cavities during treatment.

styleitaliano style italiano ring placement to tighten sectional matrix

Fig.6
To allow the matrix to embrace the tooth, we use the rings. The tightest the contact between the matrix and the tooth surface, the less time will be needed for corrections at the end of the restoration.

styleitaliano style italiano restoring medial wall of first upper molar

Fig.7
Matrices were removed from the second premolar after building the proximal walls. The ring is placed again to proceed to the restoration of the medial surface of tooth 26. The contact point will be strong as only one matrix is left separating the teeth, and the wedging and ring are very strong.

styleitaliano style italiano restoring distal wall of upper first premolar

Fig.8
Then we proceeded to restore the proximal walls of the the first premolar.

styleitaliano style italiano multiple cavities after proximal build-up

Fig.9
After building up, one by one, all the proximal alls, we got easy-to-fill class I cavities.

styleitaliano style italiano finished class II restorations

Fig.10
To create the final anatomy, the P (posterior) shade composite from the CompoSite kit (White Dental Beauty) was used.

style italiano styleitaliano white dental beauty composite system
style italiano styleitaliano white dental beauty composite system
styleitaliano style italiano polishing composite restorations with Diashine Lucida star felt

Fig.11
The Lucida™ Composite Gloss System by Styleitaliano was used to polish the restorations.

style italiano styleitaliano diashine lucida
style italiano styleitaliano diashine lucida
styleitaliano style italiano polished composite restorations

Fig.12
Aspect after finishing and polishing.

styleitaliano style italiano finished composite proximal restorations

Fig.13
After rubber dam removal. The second premolar will be restored with a crown later on.

styleitaliano style italiano upper teeth restored with composite resin

Fig.14
3-week follow-up.

Conclusions

It is very important recreate a proper shape and contact points when restoring teeth. There are three things that can really make this procedure predictable and durable:

  • a good and thin matrix system, to allow modeling of the matrix itself and good adaptation
  • tough rings, that’ll adapt and push the matrix effectively
  • active wedges, for an efficient separation of teeth

Bibliography

1. Marchetti G. 10 TIPS on Posterior direct restoration in daily flow. 2018 styleitaliano.org
2. Manauta J, Salat A. Layers, An atlas of composite resin stratification. Quintessence Books, 2012
3. Akhundov M. Managing multiple contact points, step by step. 2017 styleitaliano.org

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