A clinical case by our Community member Dr. Natalia Jakubowicz
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.
For an optimum direct composite posterior restoration, we need to have a realistic anatomy of the occlusal surface, a good contact point, and avoid post-operative sensitivity. Thanks to the use of sectional matrices, rings, and good modeling techniques, the performance of biomimetic restorations becomes easier, predictable with less working time.
This patient came complaining of occasional pain in the upper left region. Upon clinical examination, a carious lesion was suspected to affect the proximal area between teeth 25 and 26. After taking a bitewing X-ray, a deep caries was found affecting the distal part of tooth 25. The replacement of the fillings at teeth 24, 26, and 27 was decided due to their poor marginal seal.
First, tooth 25 was treated. The cavity was opened from the occlusal surface keeping the distal wall not to damage the adjacent tooth’s contact surface.
The damaged carious contact wall was removed with an excavator.
Situation after initial cavity preparation.
A caries detector was used to make sure there was no more caries present in the cavity.
The caries detector showed the presence of caries in some places of the cavity.
After final cavity preparation, the operative field was isolated with the rubber dam.
The use of a sectional matrix and a ring is mandatory to obtain a good contact point. The distal wall was built to transform the class II into a class I cavity. Light curing was carried out with the Eighteeth Curing Pen. This polywave LED curing device features a small and pivoting head which allows to easily reach even difficult areas for optimum light incidence.
Reconstruction of the proximal and occlusal surface with the P shade from the CompoSite kit (White Dental Beauty). The anatomy of the occlusal surface was created following the Espresso posterior philosophy (using the Fast Modeling Technique – FMT – as described by Hardan, Akhundov et al.).
The staining was performed using Enamel HRi Stain Light Brown (Micerium) and the excess was removed using a brush and a microbrush.
Then, on the following appointment the fillings of teeth 24, 26, 27 were to be replace. Since all of them only had class I cavities, the rubber dam was placed directly.
Situation after initial cavity preparation.
A caries detector was used to make sure there was no more decayed tissue in the cavity.
The caries detector showed the presence of caries at the bottom of the cavity.
Final cavity preparation.
Selective enamel etching was performed for 30 seconds with 36% orthophosphoric acid and a Universal bonding system (G-Premio Bond, GC) was applied.
Almost finished fillings with anatomical occlusal surface following the Espresso posterior philosophy (using the Fast Modeling Technique – FMT).
Checking the occlusion with 200 micron articulating paper (blue) and 16 micron articulating foil (red). Blue articulating paper as tissue paper dries the occlusal surface and creates a good contrast for red thin foil. Red articulating foil represents the actual contact points.
Polishing the fillings with a goat brush wheel and diamond paste (Enamel Shiny Paste B, Micerium).
Final result directly after rubber dam removal.
Direct posterior restorations are considered as the most frequent treatment in our daily practice.
Reducing chair time, achieving a good contact point, a nice anatomy and avoiding post operative sensitivity are our mail goals. To make our work easier, we should apply predictable techniques and use smart materials and tools.
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2. 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.
3. Stape THS, Wik P, Mutluay MM, Al-Ani AAS, TezvergilMutluay A. Selective dentin etching: A potential method to improve bonding effectiveness of universal adhesives. J Mech Behav Biomed Mater. 2018 Oct;86:14-22.