Premolars with SimpliShade

Reestablishing the point of contact properly in class II has always been a challenge for clinicians, especially in premolars. Success relies on fitting the matrices correctly with appropriate rings and re-establishing the correct proportions. This clinical case involves replacing two incongruous restorations. We employed a simple technique of breaking the wedge to insert the ring, ensuring a proper fit for the two sectional matrices. Finally, we completed the restorations using the Essential Lines technique.

KERR Simplishade bulk fill flow styleitaliano style italiano
KERR Simplishade bulk fill flow styleitaliano style italiano
style italiano styleitaliano old composite fillings direct posterior composite restorations

Fig.1
Initial situation. The 65-year-old patient presented with old infiltrated composite restorations that required replacement to address carious lesions and restore the tooth structure.

style italiano styleitaliano clean class I cavities composite restorations

Fig.2
After applying the rubber dam, the old restorations were removed, revealing two class II cavities.

style italiano styleitaliano positioning matrices and wedge class 2 composite restorations

Fig.3
After cavity preparation, two sectional matrices were placed on each cavity to achieve correct and tight contacts, then secured with an orange wooden wedge.

style italiano styleitaliano broken wedge for better ring positioning class 2 composite restorations

Fig.4
Following this, the outer part of the wedge was broken off, leaving only the portion of the wedge within the interproximal zone.

style italiano styleitaliano tight position of ring to optimize proximal contouring class 2 composite restorations

Fig.5
So, by doing this, the ring we used helped to squeeze the matrix tightly onto the tooth surface, getting the proportions of the two teeth back in shape. It’s worth noting how important it is to seal the matrix properly on the class II cavity box.

style italiano styleitaliano selective enamel etching

Fig.6
A selective enamel etching was performed for 30 seconds.

style italiano styleitaliano lining cavities with flowable composite

Fig.7
After rinsing and drying for about as long as we etched, we put on some OptiBond™ Universal by Kerr for adhesion.

style italiano styleitaliano proximal buildup completed SimpliShde Bulk Fill Flow composite Kerr

Fig.8
For the last part of the adhesion protocol, we put on a thin layer of flow bulk composite (SimpliShade™ Bulk Fill Flow by Kerr) to cover and safeguard the hybrid layer and level the cavity floor. This let us rebuild all the interproximal walls, giving us two class I cavities to fill.

style italiano styleitaliano packed composite and excess removed SimpliShade Bulk Fill Kerr composite

Fig.9
To finish filling the cavities, we used a single mass of bulk-fill composite (Medium shade of SimpliShade™ Bulk Fill composite by Kerr) for each one. After compacting and adjusting the material by removing any excess, we modeled the occlusal morphology.

KERR Simplishade bulk fill flow styleitaliano style italiano
KERR Simplishade bulk fill flow styleitaliano style italiano
style italiano styleitaliano occlusal modeling with essential lines technique class 2 restorations composite restorations

Fig.10
We drew the essential lines of each premolar following the tooth’s anatomy.

style italiano styleitaliano staining the sucli for natural appearance of composite class 2 restorations

Fig.11
The final touch was adding characterizations to complete the restorations.

style italiano styleitaliano finishing composite restorations with an abrasive disc OptiDisc kerr

Fig.12
After that, we used a Medium OptiDisc by Kerr at low speed to finish the restorations.

style italiano styleitaliano polishing composite restorations with hiluster polisher

Fig.13
We polished the restorations using the HiLuster Polishing System at low speed.

style italiano styleitaliano occlubrush for occlusal polishing

Fig.14
Lastly, we used the Occlubrush to complete the polishing of the restorations, all within the same appointment.

style italiano styleitaliano finished direct composite restorations class 2 restoration

Fig.15
The final appearance of the restorations before removing the rubber dam.

style italiano styleitaliano direct composite restorations class 2 restoration after rubber dam removal

Fig.16
The final result after removing the rubber dam.

style italiano styleitaliano direct composite restorations class 2 restoration 1 month follow up

Fig.17
Final aspect after 1 week of follow-up.

style italiano styleitaliano direct composite restorations class 2 restoration 1 month follow-up X-ray

Fig.18
The X-ray investigation shows no apical radiolucencies of the two premolars and therefore the vitality of the pulp is maintained after 1 week of follow-up.

Conclusions

The key to achieving optimal results lies in selecting the simplest technique that works best for your own hands. Choosing the right matrix and wedge is crucial for Class II restorations. The latest bulk-fill composites have impressive properties, including optical characteristics that enhance the aesthetic outcome. Additionally, the Essential Lines technique provides an alternative approach for efficiently completing the restoration and achieving a satisfactory result.

Bibliography

  1. Bailey O. Sectional matrix solutions: the distorted truth. Br Dent J. 2021 Nov;231(9):547-555. doi: 10.1038/s41415-021-3608-5. Epub 2021 Nov 12. PMID: 34773017; PMCID: PMC8589656.
  2. Chiodera G, Orsini G, Tosco V, Monterubbianesi R, Manauta J, Devoto W, Putignano A. Essential Lines: a simplified filling and modeling technique for direct posterior composite restorations. Int J Esthet Dent. 2021 May 10;16(2):168-184. PMID: 33969973.
  3. Hardan L, Sidawi L, Akhundov M, Bourgi R, Ghaleb M, Dabbagh S, Sokolowski K, Cuevas-Suárez CE, Lukomska-Szymanska M. One-Year Clinical Performance of the Fast-Modelling Bulk Technique and Composite-Up Layering Technique in Class I Cavities. Polymers (Basel). 2021 Jun 4;13(11):1873.
  4. Monterubbianesi R, Tosco V, Orilisi G, Grandini S, Orsini G, Putignano A. Surface evaluations of a nanocomposite after different finishing and polishing systems for anterior and posterior restorations. Microsc Res Tech. 2021;10.1002/jemt.23850. doi:10.1002/jemt.23850.

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