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.
Restoring posterior teeth is about 80% of our daily practice, and most cavities are class II type, so it is all about restoring a healthy and functional proximal anatomy, which means creating correct sizes, profiles and, most importantly, height. The proximal ridges are, in fact, the guide plane for occlusal movements.
Initial situation, the patient was complaining about food impaction between teeth 15 and 16.
Before cleaning the cavities, prewedging was done to separate the teeth and to prevent unnecessary damage to the gingiva.
Complete isolation was achieved by using heavy gauge sheet of rubber dam to have a better retraction for the soft tissues. Then cleaning and cavity design were carried out.
Using periodontal probe to measure the height of the tooth to help us in matrix height selection.
For the premolar, a transparent sectional matrix was used to ensure better penetration of the curing light, as the occlusal entrance for the cavity is very constricted, and wedge was inserted to have a better seal. Teflon was packed for better adaptation of the matrix.
After restoring the premolar, a sectional matrix was placed, secured with an active wedge to separate the teeth. Then a ring was applied to make the matrix embrace the tooth and to gain more separation. A small piece of teflon was packed for better adaptation of the matrix at the palatal side (black arrow).
To level the height of the proximal build-up, the Posterior Misura instrument (LM Finland) was used. This step is crucial to get a functional anatomy with minimum high spot, as the proximal ridge will be the guide for the whole occlusal anatomy.
For the premolar, a conservative removal of the fissure caries was done by only sandblasting with 29-micron aluminum oxide particles with the AquaCare device.
The final cavity executed, even if the cavity is small, it is complicated to restore it, due to the complexity of the anatomy in this narrow region.
Final anatomy after occlusal assessment, no adjustment was needed.
Restoring class II cavities with direct composite with healthy and functional fillings requires good management of the proximal areas to restore, a tight contact area, and a correct height of the proximal walls to guide the final modeling of the occlusal anatomy to make a functional restoration.
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