Fig.1
The patient presented to the dental clinic seeking comprehensive treatment. Several fillings were identified as needing replacement, including those on teeth 24 and 25 due to leakage and secondary caries. Teeth 24 and 25 had adjacent class II restorations.

Fig.2
First, the filling on tooth 24 was removed, and the height of the mesial proximal wall of tooth 25 was measured using a periodontal probe. The height was marked, as this measurement is essential for replicating the height of the proximal wall.

Fig.3
Next, the filling in tooth 25 was removed.

Fig.4
After the final cavity preparation, the operative field was isolated using a thick rubber dam (NicTone), and selective enamel etching was performed for 30 seconds with 36% orthophosphoric acid.

Fig.5
A universal bonding system was applied.

Fig.6
Two sectional matrices for premolars, with a thickness of 0.04 mm (Quickmatflex, Polydentia), were placed simultaneously and secured with a wooden wedge (Interdental Maple Wood Wedges, Polydentia). Placing two sectional matrices at the same time is necessary to achieve the proper shape of the proximal walls.

Fig.7
Using the previously marked periodontal probe, the height of the new proximal wall was marked on the matrix.

Fig.8
To achieve a proper contact point, a ring was placed (myRing Classico, Polydentia).

Fig.9
The distal proximal wall of tooth 24 was built up using a nano-hybrid composite to the marking previously placed on the sectional matrix. After light curing, the matrix used to rebuild the wall of tooth 24 was removed.

Fig.10
The situation after the removal of the sectional matrix from tooth 24 shows the proximal wall of tooth 25 ready to be rebuilt. Removing one of the two matrices facilitates achieving a better contact point.

Fig.11
The mesial proximal wall of tooth 25 was built, with the height of the wall managed using the Posterior Misura (LM Arte).

Fig.12
The class II cavities were converted to class I, ensuring the accurate height of the proximal walls. The bottom of the cavity was leveled with a bulk flow.

Fig.13
The anatomy of the occlusal surface was created using the FMT (Fast Modeling Technique), as described by Hardan, Akhundov et al.

Fig.14
Staining was performed using Enamel HRi Stain Light Brown (Micerium), and the excess was removed with a brush and a microbrush.

Fig.15
The final result was evaluated immediately after the removal of the rubber dam. The contact points in occlusion were checked using blue articulation paper (200 μm, for drying the surface) and red articulation foil (16 μm, for actual contact points).

Conclusions

Direct posterior restorations are among the most common treatments in our daily practice. Our main goals are to achieve a good contact point, ensure predictable anatomy, and reduce chair time for occlusal adjustments and finishing. To facilitate our work, we should employ reliable techniques and utilize advanced materials and tools.

Bibliography

1. Saber MH, El-Badrawy W, Loomans BA, Ahmed DR, Dörfer CE, El Zohairy A. Creating tight proximal contacts for MOD resin composite restorations. Oper Dent. 2011 May-Jun;36(3):304-10.
2. 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 (Basel). 2021 Jun 4;13(11):1873.
3. Stape THS, Wik P, Mutluay MM, Al-Ani AAS, TezvergilMutluay A. Selective dentin etching: A potential method to improve bonding effectiveness of universal adhesives. J Mech Behav Biomed Mater. 2018 Oct;86:14-22.