Indirect adhesive restorations represent a conservative and predictable treatment option for the rehabilitation of posterior teeth with extensive loss of tooth structure or inadequate pre-existing restorations. Advances in adhesive procedures, restorative materials, and simplified preparation concepts have progressively streamlined clinical workflows, making it possible to rehabilitate multiple posterior teeth within a limited number of appointments.
Despite these improvements, adhesive cementation remains one of the most technique-sensitive phases of indirect restorative treatment. When multiple restorations are cemented during the same appointment, the management and removal of excess luting material can be particularly challenging. The clinician must work within a limited time window: excess cement should be removed when it has reached a suitable consistency, while avoiding premature removal, which may interfere with marginal integrity, or delayed removal, which can make excess elimination more difficult.
Dual-cure resin cements may facilitate this step by combining chemical and light-activated polymerization. A brief preliminary light exposure, commonly referred to as tack curing, can be used to bring the excess cement to a gel-like consistency, allowing its controlled removal before completion of polymerization. This approach provides the clinician with greater control over the luting procedure, particularly when several restorations are managed sequentially.
This clinical report describes a simplified two-appointment workflow for the simultaneous replacement of three inadequate direct composite restorations in the mandibular right posterior region with indirect adhesive restorations. Particular emphasis is placed on preparation simplification and on a controlled cementation protocol combining the color-change indicator with tack curing to facilitate excess removal. The workflow reflects a routinely applicable clinical approach aimed at making multiple indirect adhesive cementation more manageable, efficient, and reproducible.
Fig.1
Rubber dam application.
Fig.2
Old composite restoration removal.
Fig.3
Following cavity cleaning, vanadium distal and mesial enamel chisels were used to refine the preparation margins and remove unsupported enamel prisms.
Fig.4
Final configuration of the three posterior preparations after removal of the pre-existing composite restorations, showing different Class II cavity designs.
Fig.5
Dentin sealing and blocking-out of the undercuts were performed using SimpliShade™ Bulk Fill composite (Kerr, Orange, California, USA), followed by final refinement of the preparations according to the principles of smooth preparation.
Fig.6
At the second appointment, the temporary restorations were removed to proceed with the adhesive cementation of the indirect restorations.
Fig.7
The three indirect overlay restorations ready for adhesive cementation.
Fig.8
Considering the composite-based composition of the indirect restorations, the intaglio surfaces were conditioned prior to adhesive cementation. A 37% phosphoric acid gel was first applied as a cleaning step to remove residual contaminants, as an alternative to ultrasonic cleaning, and thoroughly rinsed off. A silane primer was then actively applied to the entire intaglio surface using a rubbing motion to promote chemical coupling with the resin-based luting materials. Finally, a 10-MDP-containing adhesive was applied before resin cementation.
Fig.9
Rubber dam isolation was performed to ensure optimal moisture control and provide a clean and stable operative field for the subsequent adhesive cementation of the composite overlay restorations.
Fig.10
Starting from the premolar, 37% orthophosphoric acid was applied to the entire prepared surface, including both enamel and composite substrates, for 20 seconds. After thorough rinsing and drying, OptiBond™ Universal 360 adhesive (Kerr, Orange, California, USA) was actively applied to both the tooth substrate and the intaglio surface of the restoration. The overlay was then adhesively cemented using Maxcem Elite™ Chroma resin cement (Kerr, Orange, California, USA).
Fig.11
Finishing and polishing procedures were performed to refine the margins and optimize the esthetic appearance of the overlay restorations. Polishing discs were followed by the blue and gray Opti1Step™ polishers (Kerr, Orange, California, USA), with Occlubrush™ (Kerr, Orange, California, USA) used for the final polishing step.
Fig.12
Gray Opti1Step™ polishers (Kerr, Orange, California, USA) and Occlubrush™ (Kerr, Orange, California, USA) used for the final polishing step.
Fig.13
Following cementation of the premolar overlay, the restorative procedure continued with adhesive cementation of the overlay on the first mandibular molar.
Fig.14
For the first mandibular molar, selective enamel etching was performed using 37% orthophosphoric acid for 20 seconds.
Fig.15
Typical appearance of a properly etched enamel surface.
Fig.16
The universal adhesive was also actively applied to the tooth surfaces using a rubbing and scrubbing motion, ensuring thorough coverage of both enamel and dentin before adhesive cementation.
Fig.17
Tack-curing technique performed during adhesive cementation of the first mandibular molar overlay. A brief initial light-curing step was used to stabilize the restoration and facilitate the controlled removal of excess resin cement before final polymerization.
Fig.18
Also for the second mandibular molar, 37% orthophosphoric acid was applied to the entire prepared surface, including both enamel and composite substrates, for 20 seconds.
Fig.19
A dual-cure resin cement with a visual color-change indicator (Maxcem Elite Chroma (Kerr, Orange, California, USA)) was used. The material changes from pink to its final cement shade as polymerization progresses, providing a visual indication of the transition toward the setting phase and helping the clinician identify the appropriate time for excess cement removal.
Fig.20
Final appearance of the restorations after careful removal of the cement excesses and completion of the final polymerization procedure.
Fig.21
Immediate postoperative appearance of the restorations after rubber dam removal, showing their anatomical integration and harmonious aesthetic outcome.
Fig.22
Final clinical appearance of the restorations at the three-month follow-up, showing satisfactory aesthetic integration, preserved marginal adaptation, and healthy surrounding soft tissues.
Fig.23
Radiographic evolution of the clinical case, showing the initial condition and the final appearance of the definitive adhesive restorations at the 3-month follow-up.
Conclusions
The simultaneous rehabilitation of multiple posterior teeth with indirect adhesive restorations can be efficiently managed through a simplified two-appointment workflow. Standardized preparation and a controlled cementation protocol can improve clinical efficiency and reproducibility. In particular, the combination of a dual-cure resin cement with a visual color-change indicator and tack curing facilitates the critical phase of cement excess removal by providing both visual and operative control during the setting process. This approach may therefore simplify multiple adhesive cementation and make it more manageable in everyday clinical practice.
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