Opposing occlusal stamp technique. The MOOS Technique

A clinical case by our Community member Dr. Ahmed M. Motawie

This is a case report for a new technique to minimize the need to finish and remove high spots on occlusal surfaces of composite restorations before rubber dam removal without the need of the patient to bite in centric occlusion.
The technique was developed because most of the times the operator works hard to mimic the occlusal anatomy of the restored tooth, but after the removal of the rubber dam and the patient bites in centric occlusion, high spots are discovered. The operator is guided to remove these high spots following demarcations of the articulating paper. The removal of the high spots sometimes removes most of the fine details and the hard work the operator did to mimic the occlusal anatomy.
This technique enables the operator to have a nearly accurate perception of the opposing occlusal surface before curing the final composite increment and before removing the rubber dam.

Case History:
A 34 year old female had a chief complain of food stagnation between two teeth in her left maxillary posterior area.
After examination, an open contact was revealed between tooth number 25 and 26. The 25 was endodontically treated and was scheduled for a crown preparation along with tooth number 24, and, the 26 had an old defective occluso-mesial amalgam restoration.
Treatment plan is to remove the defective amalgam restoration and replace it with a composite restoration.

Opposing Occlusal Stamp Technique Moos technique styleitaliano style italiano

Fig.1
Preoperative – occlusal view
Tooth number 26 with the defective amalgam restoration that needs to be replaced by a composite restoration.

Opposing Occlusal Stamp Technique Moos technique styleitaliano style italiano

Fig.2
Preoperative – buccal view of occlusion
This is the centric occlusal relationship that should be mimicked for the operator to use to avoid any occlusal interference before curing the last increment of composite and before rubber dam removal.

Opposing Occlusal Stamp Technique Moos technique styleitaliano style italiano

Fig.3
Centric Occlusion Registration Stent
The centric occlusion relationship was taken using a putty condensational silicone material.

Opposing Occlusal Stamp Technique Moos technique styleitaliano style italiano

Fig.4
Temporary Crown & Bridge Material
A temporary crown and bridge material was injected into the maxillary fitting surface of the silicone stent.

Opposing Occlusal Stamp Technique Moos technique styleitaliano style italiano

Fig.5
Opposing Acrylic Duplicate (AOD)
An opposing acrylic duplicate was created.
(The duplicate could also be created more accurately by injecting flowable composite material into an alginate impression of the opposing arch for more accurate anatomical registration.)

Opposing Occlusal Stamp Technique Moos technique styleitaliano style italiano

Fig.6
Cutting Away the Occlusal Surface
The occlusal surface of the silicone stent was cut away using a blade leaving the buccal, lingual/palatal surfaces, and the embrasures intact to accurately guide the acrylic duplicate into place.

Opposing Occlusal Stamp Technique Moos technique styleitaliano style italiano

Fig.7
Fitting the AOD into the Stent
Just for confirmation, making sure that the AOD accurately fits into its key holes in the silicone stent.

Opposing Occlusal Stamp Technique Moos technique styleitaliano style italiano

Fig.8
Rubber Dam Placement.

Opposing Occlusal Stamp Technique Moos technique styleitaliano style italiano

Fig.9
Amalgam Restoration Removal.

Opposing Occlusal Stamp Technique Moos technique styleitaliano style italiano

Fig.10
Cavity Preparation.

Opposing Occlusal Stamp Technique Moos technique styleitaliano style italiano

Fig.11
Sectional Matrix Placement.

Opposing Occlusal Stamp Technique Moos technique styleitaliano style italiano

Fig.12
Restoring the Mesial Wall
After restoring the mesial wall of the cavity, the matrix was removed and the cavity was filled with a bulk fill composite material leaving a 1.5 mm space for the last composite increment.

Opposing Occlusal Stamp Technique Moos technique styleitaliano style italiano

Fig.13
Fitting the Stent Around Preparation
After placing the final increment of composite material, and before curing, the silicone stent is placed in place and stabilized by the operator’s fingers.

Opposing Occlusal Stamp Technique Moos technique styleitaliano style italiano

Fig.14
Fitting the AOD into the Stent
The AOD is fitted into the stent using the buccal and lingual embrasures in the silicone stent as a guide to accurately fit it into place.

Opposing Occlusal Stamp Technique Moos technique styleitaliano style italiano

Fig.15
Pressing the AOD into Place
The operator’s index finger is placed over the AOD while exerting pressure, and the silicone stent is removed for confirmation of equal occlusal contact to all neighboring teeth surfaces.

Opposing Occlusal Stamp Technique Moos technique styleitaliano style italiano

Fig.16
Occlusal Anatomy
Occlusal anatomy was mimicked as close as possible with some staining.

Opposing Occlusal Stamp Technique Moos technique styleitaliano style italiano

Fig.17
Post-operative
Proper finishing and polishing was carried out.

Conclusions

This technique was definitely a time saving technique.
The frustration of the need to remove high spots that would ruin your hard work of mimicking the occlusal anatomy is gone. Although there was very minute occlusal interference at the mesial marginal ridge but it was successfully removed without the need to ruin the mimicked occlusal anatomy. Maybe if I try using an alginate impression for the opposing and creating the opposing duplicate using a flowable composite material might give me better details and eventually better final results.

Acknowledgements

Special thanks to the entire Style Italiano Team for helping me find my eye glasses after so many years of a blurred vision. Finally I can see things clearly now, although I’m still recovering and trying to work as hard as possible to make-up for all the past years when I thought that I do good composite restorations.
Special Thanks to:
Dr. Walter Devoto
My Mentors: Dr. Jordi Manauta and Dr. AnnaSalat
My Co-worker: Dr. Mohammed Khaled who helped me out to finalise the MOOS Technique.
UpTown Dental Team

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