Reconstruction of the original anatomical structure – Class II Direct composite restoration

A clinical case by our Community member Dr. Muhammad Alhafudh

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.

A male patient come to my clinic suffering from a sharp pain and food impaction in the upper left area.

old amalgam filling on upper molar style italiano styleitaliano

Fig.1
We decided to improve the shape of restoration in order to achieve proper contact point. An endodontic treatment was performed on tooth 26 suffering from pulpitis.

pre-operative occlusal check style italiano styleitaliano

Fig.2
Contact check was carried out before starting using a thin articulating paper. This way you can see where the contact points are, in which areas you have to be very careful during the sculpting of the final layer.

isolation and cavity preparation style italiano styleitaliano

Fig.3
Isolated the operating field with the rubber dam, old filling and decayed tissue were removed.

adaptation of matrices before restorative treatment style italiano styleitaliano

Fig.4
A piece of teflon tape was placed to protect the canals. Matrices were adapted to perform a pre-endodontic restoration.

acid etching for pre endodontic restoration style italiano styleitaliano

Fig.5
Etching was carried out using 37% phosphoric acid for 30 seconds.

brushing of adhesive on enamel style italiano styleitaliano

Fig.6
After drying the cavity, a universal adhesive was applied, using a microbrush for 20 seconds.

flowable composite to adapt proximal composite style italiano styleitaliano

Fig.7
A flowable composite layer is an excellent system to even out the bottom of the cavity.

built proximal wall before endodontic treatment style italiano styleitaliano

Fig.8
The inter-proximal wall was layered by using Enamel shade from the CompoSite system.

matrix adaptation without teflon style italiano styleitaliano

Fig.9
One by one, we start to restore contact points. Just after restoring the firs tooth (mesial wall of tooth 26) we can remove the matrix around the restored tooth.

teflon tape to adapt matrix on premolar styleitaliano style italiano

Fig.10
Teflon tape was used to increase pressure of the ring onto the matrix in the palatal area.

finished composite restorations on upper molar and premolar style italiano styleitaliano

Fig.11
After complete modeling of the occlusal surface with one enamel shade from the CompoSite system.

finished composite restorations after rubber dam removal style italiano styleitaliano

Fig.12
Immediately after removing the rubber dam. Restorations were polished using the simplified Lucida system, star felt and sub-micron, hybrid and watersoluble paste.

Conclusions

Dividing a multi-step treatment into single, easy-solution problems is a good strategy to achieve high-quality results.

Bibliography

1. Manauta J, Salat A. Layers An Atlas of Composite Resin Stratification. 2012. Quintessence Pub.
2. Dias W. New techniques and tools for approximal restorations of class II. Dent Art. 2012 No66.
3. Radilinsky S. Restoration of the contact surfaces in the side teeth. Dent Art. 2015 No79 p.22-40

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