Posterior inter-proximal restorations are more frequent and complicated but much more satisfactory when winning. In this case we will share with you how to simplify a class II restoration and much more.
Posterior restorations can be a challenge for the Dentist .
Sometimes it can be difficult to manage different aspects of the restoration :
How to manage the contact point , the shape and the occlusion.
In this case I will tell you the story of a patient who came to my practice because she had a lot of pain in the lower left area. All the teeth were vital no periodontal pocket, only a great inflammation of the gum between 3.6 and 3.7.
The diagnosis was gingivitis given by the inconsistency of the contact point.
The problem of molar 3.7 was represented by the impact of food in the space between 3.6 and 3.7 and also the distal portion was over-contoured.
We decided to improve the shape of the restoration on 3.7 in order to achieve a proper contact point and distal emergency profile.
Rubber dam isolation.
After removing the old restoration, we prepare the cavity .
It is important to etch all the enamel surface to have the best adhesion in all the marginal area
It can be a good strategy to etch not only the proper margin of the preparation , but over extend a little more.
One of the problems of adhesive restorations is the possible contact between the restoration margin and not-etch enamel.
Selective etching of the enamel , 30 seconds.
The universal adhesives such as ( Scotchbond Universal™ etchant 3M ) adhesive is much more effective on not-etched dentine, so we DO NOT ETCH DENTINE.
Usually we protect the neighbour teeth, but in this case 3.6 it’s a ceramic overlay so we don’t need isolation.
Cavity dry and ready to the adhesive.
After placing Scotchbond Universal adhesive 3M in all the cavity by a brush ,it is mandatory leave it in the cavity for at least 20 seconds.
Then distribute it with a light air gentle jet until it becomes impossible to see the small waves when the air intercepts the adhesive. The surface must always be glossy !
By using a black matrix (Polydentia lumicontrast) it is possible to have a better control of adaptation of the matrix on the margin thanks to its high contrast. To allow the matrix to embrace the tooth, we use a special Niti ring with specific silicone tips (My Polydentia classic ring with diamond 24 silicone tips). The most precise is the embrace between the matrix and the ring, the less time it will take for the correction at the end of the restoration.
The pressure of the material extruding from the capsules helps to adapt it on the margin also during the construction of the mesial crest.
The good opacity of the material combined with the darkness of the matrix allows us to understand the thickness of the wall we are building. When it is possible to see the darkness of the matrix through the uncured composite, it means that the wall is thinner than 0.5 mm (3M Filtek body). This value changes with different composites!
Misura posterior on the uncured crest , will can easy copy from the neighbour how tall the crest has to be. Using the neighbour crest as a stamp, then polymerize 40 seconds.
One of the most important steps!
once the marginal crest has been polymerized.
it is a good idea to open the matrix to check if the margins are good.
if we have bubbles , it will be easy to fill them with a drop of flowable composite.
A flowable layer is an excellent system to make the bottom of the cavity more regular.
Occlusal view of the flowable layer.
Direct reconstruction of the distal crest. Now it is just a class one restoration.
Always dividing a complex problem into many easy problems is a good strategy this is why the choice is to always transform class 2 into class 1 restoration.
In one shot we will fill the cavity, it was not a deep cavity and thanks to the flow layer, now it is less deep than 2 mm.
Second step the pink spiral.
Occlusal view of final the restoration under rubber dam.
Before cut and remove the rubber dam we will finish and polish the buccal and lingual surface by Sof-Lex™ Pop-On, and Polish the cervical portion and finish it with sof-lex strips.
Final result without rubber dam.
1 year follow up.
Reliable, stable materials with excellent polishing characteristics such as the 3M Filtek Supreme body, allows us to manage long-lasting reconstructions while maintaining the aesthetic & function for a long time.
Both are important target the clinicians.
In this case the tips it is what we need to give a good contact point stable during the time and an anatomy easier to be cleaned by the patient and maintained by the hygienist.