Managing contact points in multiple tooth rotation cases

In daily routine of direct posterior composite restorations, the time is still a challenge for treating multiple teeth with reconstructing the proximal walls as healthy as possible and restoring with a natural and functional anatomy, this article will focus on dealing with multiple proximal cavitaties to make the best final outcome.

styleitaliano style italiano old amalgam fillings

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.

styleitaliano style italiano multiple posterior cavity preparations

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.

styleitaliano style italiano simultaneous matrix placement

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.

styleitaliano style italiano divergent axis in rotated teeth

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

styleitaliano style italiano teflon tape to adapt matrix

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.

styleitaliano style italiano teflon tape used to make matrix extra adherent to tooth

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.

styleitaliano style italiano picture explaining differently contoured matrices

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.

styleitaliano style italiano composite posterior restorations in the making

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).

curing pen light style italiano styleitaliano eighteeth
curing pen light style italiano styleitaliano eighteeth
styleitaliano style italiano bulk composite masses inside cavities

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.

style italiano styleitaliano white dental beauty composite system
style italiano styleitaliano white dental beauty composite system
styleitaliano style italiano finished composite posterior restorations before staining

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.

LM ARTE kit posterior banner mobile style italiano styleitaliano
LM ARTE kit posterior banner desk style italiano styleitaliano
styleitaliano style italiano complete composite fillings with lifelike stained sulk

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.

styleitaliano style italiano composite restorations after rubber dam removal

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

styleitaliano style italiano occlusal check of composite posterior restorations

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.

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