Opposing Occlusal Stamp Technique (MOOS technique by Maroun-Motawie et al.)

Tips and tricks - Community - Direct posteriors
10 Jan 2017

The restorative procedures of posterior areas are very frequent in our daily practice. As we can see in the past year, posterior restorations had a large platform in styleitaliano philosophy, treating many topics as restoring the occlusal anatomy, the proximal ridge, the vestibular and lingual contour and indirect posterior restorations. The posterior build up can be done using different techniques; the stamp, incremental, simultaneous modeling, and centripetal cusp build up techniques… Until now we have not solved the problem of occlusion. How can we perform a correct and functional anatomy without touching the occlusal anatomy after removing rubber dam?

It’s always the same problem: you take your time to create an ideal anatomy and when you check the occlusion you realize that the restoration is too high. You start correcting it and at the end all your hard work seems to be gone in vain. The other problem that we frequently confront is that after removing the rubber dam our patient can’t bite properly because of the anesthesia’s effect and the muscular spasm that occurs at the end of a long session.  Even after checking with an articulating paper sometimes we still have small high spots that can cause severe pain to the patient the next day.

While I am restoring the cavity, I always wish that the patient can bite before polymerizing the composite restoration to prevent problems in the final occlusion. That’s how I got the idea: having a duplicate of the antagonist teeth would help us find the occlusion while I am doing the layering steps. This technique will be illustrated in the following case.

Fig. 1

Image 1: A 22 year old female patient came to the clinic asking for a regular check-up. We started inspecting the teeth and taking bitewing x-rays. Decays on the lower and upper arch where detected, we decided to start restoring teeth number 46 (MOD) and 47(Cl I).

Fig. 2

Image 2: Occlusal view of the antagonist teeth.

Fig. 3

Image 3: The occlusion was checked before starting for reference. 

Fig. 4

Image 4: A silicone key of the antagonist teeth was done using C-silicone impression material.

Fig. 5

Image 5: A duplicate of the antagonist teeth was created using bisacrylic resin.

Fig. 6

Image 6: The acrylic duplicate's fitting and stability was checked in occlusion . 

Fig. 7

Image 7: A second try-in of the acrylic duplicate.

Fig. 8

Image 8: Etching gel was rinced with an air/water spray for 30 seconds.

Fig. 9

Image 9: Sectional matrices were adapted using plastic wedges and rings to restore the proximal walls.

Fig. 10

Image 10: 2% chlorexidine was applied for 30 seconds before the application of the bonding agent.

Fig. 11

Image 11: Two coats of universal adhesive system was applied to the enamel and dentin . every every coat, the solvant was evaporated using air and suction.

Fig. 12

Image 12: Polymerization for 40 seconds was performed.

Fig. 13

Image 13: The bottom of the cavity was filled with low stress flowable composite (SDR) and polymerized for 20 seconds.

Fig. 14

Image 14: Proximal walls was done. 

Fig. 15

Image 15: The classe I cavities were filled with a low stress bulk fill composite (A2 color).

Fig. 16

Image 16: A teflon tape was applied on the occlusal surface of the teeth for two purposes:

1) to avoid composite sticking to the acrylic duplicate previously prepared.

2) to compensate the volumetric shrinkage of the acrylic resin.

Fig. 17

Image 17: Some grooves were created in the occlusal surface. These are the contact points of the palatal upper cusps.

Fig. 18

Image 18: Composite excess was removed, the primary and secondary anatomy were defined using fissura instrument. At this stage, we used the acrylic duplicate a second time just to be sure that the occlusion is stil good while doing the anatomy.

Fig. 19

Image 19: After polymerization for 40 seconds, some brown stains were applied.

Fig. 20

Image 20: Glycerin gel was applied on the occlusal surfaces and polymerized for 20 seconds.

Fig. 21

Image 21: Final aspect of the restorations before removing the rubber dam.

Fig. 22

Image 22: Occlusal contacts after rubber dam removal.

Fig. 23

Image 23: Final restorations after polishing.

 

Conclusions

This technique has many advantages:
1) Very easy to do: we don’t need a sophisticated material to perform it, just C-silicone impression material and acrylic resin.
2) Very quick: it takes only few minutes to do the silicone key and the acrylic duplicate
3) Time saving technique: if we have two or three cavities, sometimes it takes 15 minutes to correct the occlusion.
4) We can use it with any modeling technique.
5) We can use it in very big cavities where we don’t have occlusal references.
6) All the hard work that we did in the sculpting step is preserved.
7) The risk of postoperative sensitivity, due to high occlusion, is very diminished.
A special thanks to Dr Sarah Dabagh my teammate, for her contribution to this technique.

Bibliography

1) Kim RJ, Kim YJ, Choi NS, Lee IB. Polymerization shrinkage, modulus, and shrinkage stress related to tooth-restoration interfacial debonding in bulk-fill composites. J Dent. 2015 Apr;43(4):430-9.
2) Lafuente D. SEM analysis of hybrid layer and bonding interface after chlorhexidine use. Oper Dent. 2012 Mar-Apr;37(2):172-80.
3) Saber MH1, 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.
4) Scolavino S, Paolone G, Orsini G, Devoto W, Putignano A. The Simultaneous Modeling Technique: closing gaps in posteriors. Int J Esthet Dent. 2016;11(1):58-81.