Posterior inter-proximal restorations class II restoration

Simplify Class 2 restoration

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 inter-proximal restorations class II restoration

Fig.1

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.

Posterior inter-proximal restorations rubber dam isolation

Fig.2

Rubber dam isolation.

Posterior inter-proximal restorations class II restoration after removing old restoration

Fig.3

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

Posterior inter-proximal restorations class II restoration after removing old restoration

Fig.4

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.

Posterior inter-proximal restorations class II restoration selective etching of the enamel

Fig.5

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.

Posterior inter-proximal restorations class II restoration cavity dry ready to the adhesive

Fig.6

Cavity dry and ready to the adhesive.

Posterior inter-proximal restorations class II restoration placing Scotchbond Universal adhesive

Fig.7

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 !

Posterior inter-proximal restorations class II restoration with black matrix

Fig.8

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.

Posterior inter-proximal restorations class II restoration curing light

Fig.9

Curing at least 40 seconds. In the picture Elipar deep cure 3M.

Posterior inter-proximal restorations class II restoration with 3M composite

Fig.10

The pressure of the material extruding from the capsules helps to adapt it on the margin also during the construction of the mesial crest.

Posterior inter-proximal restorations class II restoration 0.5 mm 3M Filtek Supreme body

Fig.11

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 in posterior inter-proximal restorations class II restoration

Fig.12

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.

Posterior inter-proximal restorations class II restoration after polymerized open matrix

Fig.13

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.

posterior inter-proximal restorations class II restoration 3M flowable layer

Fig.14

A flowable layer is an excellent system to make the bottom of the cavity more regular.

Occlusal view of the flowable layer

Fig.15

Occlusal view of the flowable layer.

Direct reconstruction of the distal crest

Fig.16

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.

Posterior inter-proximal restorations fill the cavity

Fig.17

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.

Posterior inter-proximal restorations fill and press the cavity

Fig.18

The material is positioned and fills the cavity very well, thanks to the good pressure of the capsule. (3M Body Filtek A2) then we will press it with Condensa LM.

Posterior inter-proximal restorations distribute the material with LM Arte kit Anterior

Fig.19

With Condensa LM, distribute the material in the cavity trying to follow the anatomy written in the tooth.

Posterior inter-proximal restorations essential lines technique

Fig.20

The informations are written in the tooth, the next step will be designing the lines following the ‘’essential lines ‘’ using Fissura LM.

Posterior inter-proximal restorations essential lines technique

Fig.21

How to design the lines using Fissura LM.
It is important to fix the center, and always design the lines starting from the center.

Posterior inter-proximal restorations essential lines technique

Fig.22

Design the lines using Fissura LM, it is important to always start from the center.

Posterior inter-proximal restorations polishing with 3M Sof-Lex

Fig.23

Polishing with Sof-Lex™ Diamond Polishing System is a quick and easy way to get fantastic result, just in two steps:

First step the brown spiral.

Posterior inter-proximal restorations polishing with 3M Sof-Lex

Fig.24

Second step the pink spiral.

Posterior inter-proximal restorations Occlusal view of final the restoration under rubber dam

Fig.25

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.

Posterior inter-proximal restorations final result without rubber dam

Fig.26

Final result without rubber dam.

Posterior inter-proximal restorations 1 year follow up result

Fig.27

1 year follow up.

Conclusions

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.