Minimizing occlusal corrections in posterior multiple restorations

A clinical case by our Community member Dr. Elias Abboud

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.

Most clinicians share the experience of having found themselves spending a lot of time making occlusal corrections after finishing a direct composite restoration, especially when multiple teeth were involved. Although checking occlusion and taking pictures before starting the procedure may help in layering functionally and anatomically, these strategies are most effective when we only have one tooth to restore. Instead, in cases where we have multiple teeth in a quadrant to restore, a slightly more elaborate strategy may be the best option to optimize the final result.

style italiano styleitaliano silicone impression to create copy of opposing teeth

Fig.1
To get control over the occlusal anatomy while under rubber dam isolation, the MOOS technique was used (as described by Maroun Ghaleb). First of all, we created a silicone index of the opposing teeth, with a one- or two-step impression. This index can then be injected with acrylic resin to create an exact copy of the quadrant opposing the one we need to restore.

style italiano styleitaliano caries detector to check cavity cleaning

Fig.2
After isolating with the rubber dam, cavities can be cleaned. A caries detector can help in ensuring all decay is removed.

style italiano styleitaliano clean cavities before restoration

Fig.3
Also, all unsupported and decalcified enamel was removed with stone burs.

style italiano styleitaliano selective etching

Fig.4
Wedge and matrices were placed back to back, Selective etching was used to minimize the sensitivity after restoration, and to achieve a strong bond with enamel and dentin (superficial, middle and deep dentin).

style italiano styleitaliano using acrylic model of the opposing arch to check occlusion under rubber dam isolation

Fig.5
The acrylic copy of the opposing arch can be used as a guide in order to check occlusion while layering. Whenever we go too high during layering, placing the bite model before light curing helps mold the raw composite down to the correct level of occlusion.

style italiano styleitaliano restoring proximal area

Fig.6
After the restoration of the molar was finished, the matrix was removed to only leave one in order to achieve a tight proximal contact.

style italiano styleitaliano restored quadrant before polishing

Fig.7
To obtain a polished and smooth surface, firstly, glass discs were used to get a proper contour in the proximal surfaces. Also, the restorations were sandblasted to prepare them for optimum polishing and to remove the oxygen inhabited layer.

style italiano styleitaliano polished multiple posterior restorations

Fig.8
After polishing using EVE pink and gray Twists.

style italiano styleitaliano restored quadrant after rubber dam removal

Fig.9
Final result, right after rubber dam removal.

style italiano styleitaliano 3 week follow up of quadrant composite restoration

Fig.10
Recall after 3 weeks, final aspect.

style italiano styleitaliano occlusal check of restored teeth

Fig.11
Recall after 3 weeks, occlusion was checked without anesthesia.

Conclusions

The reconstruction of the original anatomical structures is very important, as every groove, fossa and ridge have their role in functional contacts and movements. So when a tooth is restored according to an anatomically guided pattern, very few occlusal adjustments are required.

Bibliography

1.Dias W. New techniques and tools for approximal restorations of class II. Walter Dias. DentArt Magazine 2012 No66.
2.Ghaleb, Opposing occlusal stamp technique – styleitaliano.org
3.Motawie, Opposing occlusal stamp technique. The MOOS technique. styleitaliano.org
4.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 MayJun;36(3):304-10.
5.Hardan L, Sidawi L, Akhundov M, Bourgi R, Ghaleb M, Dabbagh S, Sokolowski K, Cuevas-Suárez CE, LukomskaSzymanska M. One-Year Clinical Performance of the FastModelling Bulk Technique and Composite-Up Layering Technique in Class I Cavities. Polymers (Basel). 2021 Jun 4;13(11):1873.
6.Chiodera G. Simplify class 2 restoration. 2020. Styleitaliano.org.
7.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

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