Managing contact points in posterior direct restorations
A clinical case by our Community member Dr. Hassan Hikmat
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.
Treating a multiple posterior teeth with direct composite restorations is still complex in some aspects, especially in the sequence of treatment. This case is meant to highlight the steps to healthy and functional posterior restorations.
The patient’s chief complaint was about sensitivity on cold and food trapping between the teeth 25, 26 and 27. Tooth 24 needed an endodontic retreatment, so it was scheduled for restoration on another appointment.
Isolation, then starting by removing the old fillings.
Cleaning and cavity design including removal of the unsupported structures. Traumatic exposure at tooth 25 was covered by biodentine, then the teeth were sandblasted with 29 micron aluminum dioxide using the AquaCare device.
Placing matrices to build the proximal walls, teflon (black arrows) was wrapped around the wedges to ensure a tighter seal at the proximal.
After building the mesial wall for tooth 27, the matrix was removed, so that the opposing matrix on distal 26 would take its place to avoid creating an open contact. The ring was then applied again to create a tight contact.
Removing the matrices on tooth 26 after building the proximal walls, and sealing the dentin with flowable bulk fill. Then the ring was placed back to finish the proximal walls of tooth 25.
To create the final anatomy, Se posterior composite from the CompoSite kit (White Dental Beauty) was used. This composite it has excellent modeling properties and natural shade matching. Note the contact points.
Prophyflex (Sodium bicarbonate) was used to remove the oxygen-inhibited layer before the final polishing.
Final polishing with Prisma Gloss extra-fine polishing paste.
Final view with minimum occlusal adjustment.
Making healthy and natural posterior composite restorations is a sequence of cross-related steps starting from isolation, and going through contact points and occlusal modeling and polishing. Every step should be accurately executed to make the next step also predictable to obtain the best final result.
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. 2012. Quintessence Pub.
3. Van Ende, J. De Munck, K.L. Van Landuyt, A. Poitevin, M. Peumans, B. Van Meerbeek. Bulk-filling of high C-factor posterior cavities: effect on adhesion to cavity bottom dentin. Dental Materials 29 (2013) 269-277.