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.
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.
Rubber-dam isolation is a requirement for successful placement of a direct composite restoration.
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.
To finish the proximal margins, wedges were placed to protect the rubber dam and to separate the teeth.
Matrices were placed simultaneously, with the advantage of time saving, and of preventing contamination of neighboring cavities during treatment.
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.
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.
Then we proceeded to restore the proximal walls of the the first premolar.
After building up, one by one, all the proximal alls, we got easy-to-fill class I cavities.
Aspect after finishing and polishing.
After rubber dam removal. The second premolar will be restored with a crown later on.
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
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