Free hand vs Sectional band

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.

Trying to rebuild a wall with its cusp is a big challenge, and it starts with a big question each and every time: is it possible to use a band here? Or is free-hand is enough? Ad in many cases, there is no one answer, and in this case I’m going to show the use of bands for building the proximal walls, and a free-hand build-up for the buccal wall.

style italiano styleitaliano large carious cavity and proximal caries

Fig.1
Initial view showing the caries at teeth number 16 and 15.

styleitaliano style italiano rubber dam isolation before cleaning of caries

Fig.2
Rubber dam isolation of the teeth to get better vision and clean area for work.

styleitaliano style italiano clean and sandblasted large cavities

Fig.3
After removing the carious lesion and preparing the cavities, sandblasting with 50 micron Aluminum Oxide powder was carried out. A clean cavity with good design, showing no unsupported enamel and ready for applying the bonding system. This step is important to increase the longevity of the restoration.

style italiano styleitaliano matrices and ring positioning for contiguous class II cavities

Fig.4
Matrices applied together with a ring to adapt them to the walls. Proximal walls are built one at a time, and one matrix is removed after building the wall to ensure a tight contact point.

styleitaliano style italiano posterior composite by white dental beauty

Fig.5
Build up of the buccal wall and the distobuccal cusp using Si P composite (White Dental Beauty).

styleitaliano style italiano finished composite restoration of upper posterior teeth

Fig.6
After building up the buccal wall, the final touches are added to create the final anatomy of the teeth. As the natural teeth had little white spots on the tip of the cusps, the Si 0 shade (White Dental Beauty) was used to enhance the natural appearance of the restorations.

styleitaliano style italiano composite restorations after removal of the rubber dam

Fig.7
Finishing and polishing of the teeth using Lucida System from (Diashine) for the final step of polishing to create the best final luster.

style italiano styleitaliano occlusal check after composite restoration

Fig.8
Final view with the occlusion check using 40 micron articulation paper.

Conclusions

It is always a big challenge for the dentist to build up the buccal and lingual walls with their cusps. This article shows combination of two approaches based on the possibility of using matrices or free-hand modeling at their best effectiveness. Moreover, using a lighter shade in the occlusal third of the buccal surface greatly enhances the natural look of a restoration.

Bibliography

1. Ritter AV, Boushell LW, Walter R, Sturdevant CM. Sturdevant’s Art and Science of Operative Dentistry. Elsevier, 2019.
2. Marchetti G. 10 TIPS on Posterior direct restoration in daily flow. 2018. Styleitaliano.org
3. Siri VK. Textbook of operative dentistry 4th ED. CBS Publishing, 2017.

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