Proximal ridge height as key for functional posterior composite restorations

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.

premolar and molar with caries style italiano styleitaliano

Fig.1
Initial situation, the patient was complaining about food impaction between teeth 15 and 16.

drilling carious tissue style italiano styleitaliano

Fig.2
Before cleaning the cavities, prewedging was done to separate the teeth and to prevent unnecessary damage to the gingiva.

clean proximal cavities style italiano styleitaliano

Fig.3
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.

probe measuring tooth height style italiano styleitaliano

Fig.4
Using periodontal probe to measure the height of the tooth to help us in matrix height selection.

transparent matrix and teflon for proximal restoration style italiano styleitaliano

Fig.5
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.

teflon used for adapting sectional matrix style italiano styleitaliano

Fig.6
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).

posterior misura to level proximal build-up in class II cavity restoration style italiano styleitaliano

Fig.7
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.

finished class II restoration on upper molar style italiano styleitaliano

Fig.8
After restoring the contact area, the occlusal anatomy was restored using P composite (White Dental Beauty, UK).

sandblasting for caries removal without drilling style italiano styleitaliano

Fig.9
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.

clean cavity after sandblasting styleitaliano style italiano

Fig.10
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.

occlusal cavity restoration on upper premolar styleitaliano style italiano

Fig.11
Final anatomy of the premolar was restored by using P composite and Si0 as a bleach shade (White Dental Beauty, UK).

occlusal check of adjacent class II cavities styleitaliano style italiano

Fig.12
Final anatomy after occlusal assessment, no adjustment was needed.

Conclusions

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.

Bibliography

1. Manauta J, Salat A. Layers An Atlas of Composite Resin Stratification. 2012. Quintessence Pub.
2. 2. Meyer-Lueckel H, Paris S. When and how to intervene in the caries progress. Oper Dent. 2016;41 (S7): S35-47
3. Marchetti G. 10 TIPS on Posterior direct restoration in daily flow. 2018. Styleitaliano.org
4. Murad Akhundove, Managing multiple contact points, step by step. Styleitaliano.org

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