Restoring a posterior quadrant with direct composite in a smart and predictable way

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.

styleitaliano style italiano teeth with suspect proximal caries

Fig.1
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.

styleitaliano style italiano initial preparation of cavity

Fig.2
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.

styleitaliano style italiano class II cavity at II premolar

Fig.3
Situation after initial cavity preparation.

styleitaliano style italiano caries detector used during cavity cleaning

Fig.4
A caries detector was used to make sure there was no more caries present in the cavity.

styleitaliano style italiano caries detector showing little carious residue

Fig.5
The caries detector showed the presence of caries in some places of the cavity.

styleitaliano style italiano class II cavity after rubber dam isolation

Fig.6
After final cavity preparation, the operative field was isolated with the rubber dam.

styleitaliano style italiano diamond 24 ring for proximal build-up

Fig.7
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.

curing pen light style italiano styleitaliano eighteeth
curing pen light style italiano styleitaliano eighteeth
styleitaliano style italiano class II cavity restored before staining of sulci

Fig.8
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.).

style italiano styleitaliano white dental beauty composite system
style italiano styleitaliano white dental beauty composite system
styleitaliano style italiano staining of sulci after composite restoration

Fig.9
The staining was performed using Enamel HRi Stain Light Brown (Micerium) and the excess was removed using a brush and a microbrush.

styleitaliano style italiano rubber dam isolation before replacing old restorations

Fig.10
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.

styleitaliano style italiano clean class I cavities

Fig.11
Situation after initial cavity preparation.

styleitaliano style italiano cavity cleaning check with caries detector

Fig.12
A caries detector was used to make sure there was no more decayed tissue in the cavity.

styleitaliano style italiano depth carious residue

Fig.13
The caries detector showed the presence of caries at the bottom of the cavity.

styleitaliano style italiano clean class I cavities

Fig.14
Final cavity preparation.

styleitaliano style italiano enamel etching of multiple cavities

Fig.15
Selective enamel etching was performed for 30 seconds with 36% orthophosphoric acid and a Universal bonding system (G-Premio Bond, GC) was applied.

styleitaliano style italiano restored cavities with highlight on occlusal anatomy

Fig.16
Almost finished fillings with anatomical occlusal surface following the Espresso posterior philosophy (using the Fast Modeling Technique – FMT).

styleitaliano style italiano staining the sulci of composite restoration

Fig.17
Staining of the tooth 27 with Fissura instrument from the LM Arte kit.

style italiano styleitaliano lm arte anterior instruments
style italiano styleitaliano lm anterior instruments
styleitaliano style italiano occlusal check of multiple composite restorations

Fig.18
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.

styleitaliano style italiano polishing of composite restorations with goat brush

Fig.19
Polishing the fillings with a goat brush wheel and diamond paste (Enamel Shiny Paste B, Micerium).

styleitaliano style italiano finished composite restorations after rubber dam removal

Fig.20
Final result directly after rubber dam removal.

Conclusions

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.

Bibliography

1. Saber MH, El-Badrawy W, Loomans BA, Ahmed DR, Dörfer CE, El Zohairy A. Creating tight proximal contacts for MOD resin composite restorations. Oper Dent. 2011 May-Jun;36(3):304-10.
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.

style italiano styleitaliano Essential Dentistry kit online on demand course
style italiano styleitaliano Essential Dentistry kit online on demand course

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