Fig.1
Initial situation. The patient was suffering from sensitivity on sweets and difficulty in flossing between the teeth. There was a proximal carries between the teeth 15 and 16, and the old amalgam fillings were leaking we decided to replace them.

Fig.2
Old amalgam was removed under complete isolation, the cavity design was made by removing all the unsupported tooth structure, the gingival seats were straightened to make it easier to get a better seal by the matrix system. A micromotor from Eighteeth with the Intensiv burs kit was used for the cavity design, and then the teeth were sandblasted by aluminum oxide 29 micron particles using the AquaCare device.

Fig.3
Building proximal walls, two matrices were placed at the same time to avoid over contouring of one wall in the space of the adjacent tooth. So the proximal wall of tooth 14 was built first.

Fig.4
As tooth 16 was tilted, the large palatal embrasure made sealing the matrix by wedge impossible.

Fig.5
So after closing the small distal cavity of tooth 15, a matrix was placed to restore the proximal of the 16, and some teflon was packed (black arrow) on the palatal side to create a better seal.

Fig.6
Restoring proximal wall of tooth 15 using heavy contoured band, as the first band was not curved enough as shown in Fig 3. If we pushed it, the contact area would be in a high level and the gingival embrasure would be larger than normal and food impaction would happen.

Fig.7
If the band is not contoured enough, the contact area is either to be an open and if we push it to touch the adjacent the contact area would be in a high level as shown in (1), in figure (2) anatomically contoured band was used so the contact area is at the right position with correct and healthy occlusal and gingival embrasures.

Fig.8
You can see how the contact areas are correctly positioned. The dentin was then sealed with a low stress flowable material. The curing was performed with a powerful light curing unit in the soft start curing mode (Eighteeth Curing Pen).

Fig.9
The final anatomy was restored with SI P composite (White Dental Beauty) in a fast and predictable way using the FMT (Fast Modeling Technique) as described by Louis Hardan et al.

Fig.10
The P composite shade from WDB was adapted and then modeled by the Fissura instrument (LM powered by Styleitaliano) to create highly defined grooves. Micro brushes were used for refining and details.

Fig.11
The fissures were sealed by dental stains (brown and ochre colors). Then the fillings and the tooth structure were blasted with prophyflex (sodium bicarbonate) to enhance the final polishing.

Fig.12
After removing the rubber dam, Immediate final result after polishing, simple and natural anatomy with a good contact areas.

Fig.13
Occlusal check, only a slight reduction on the distal ridge of tooth 16 was needed.

Conclusions

There is no such thing as two identical cases in actual, everyday dentistry, and we might need to modify our most reliable and smart protocols to adapt the procedure to a case with the aim of making healthy and functional final restorations.

Bibliography

1. Hardan L, Sidawi L, Akhundov M, Bourgi R, Ghaleb M, Dabbagh S, Sokolowski K, Suarez C, Szymanska M. One-Year Clinical Performance of the Fast-Modelling Bulk Technique and Composite-Up Layering Technique in Class I Cavities. Polymers 2021;13:1873.
2. Manauta J, Salat A. Layers An Atlas of Composite Resin Stratification. 2012. Quintessence Pub.
3. Van Dijken JW, Pallesen U. 2016. Posterior bulk-filled resin composite restorations: a 5-year randomized controlled clinical study. J Dent. 51:29–35.