Small tips for an easy and fast class II restoration

A 20 years old male patient came to my attention complaining about not being able to floss properly between the first upper premolar and the first upper molar.
After an X-ray evaluation that revealed secondary caries on 24, it was clear the old restoration had to be replaced.

style italiano styleitaliano rubber dam isolation before old restoration removal

Fig.1
I put the rubber dam on as usual before excavation to retract the soft tissues thus obtaining a more comfortable working space.

style italiano styleitaliano proximal cavity on premolar

Fig.2
As I removed the old restoration, the clean cavity was deep in dentin and really narrow.

style italiano styleitaliano proximal cavity on premolar

Fig.3
Due to the proximity with a healthy molar, I used some teflon tape to protect it during bonding procedures.

style italiano styleitaliano bonding cavity with kulzer ibond universal adhesive

Fig.4
The depth in dentin made me choose a universal adhesive (iBOND – KULZER) with a selective enamel etching.

style italiano styleitaliano flowable composite applied with fissure instrument

Fig.5
A flowable composite was used to perform the Immediate Dentin Sealing and the cervical margin reinforcement. Venus Bulk Flow ONE (Kulzer) is a one-shade bulk-fill flowable that has got a good color adaptation in one single shade and a low shrinkage stress. With a sharpened instrument (Fissura Dark Diamond Edition – LM arte) the flowable was uniformly spread on the exposed dentin.

style italiano styleitaliano kulzer venus Bulk flow ONE one-shade bulk filling composite
style italiano styleitaliano kulzer venus Bulk flow ONE one-shade bulk filling composite
style italiano styleitaliano matrix and ring in place for proximal build-up

Fig.6
A sectional matrix (QuickMat 0.25 – Polydentia) was held in place by a wooden wedge (Polydentia) and a specific ring (myRingClassico – Polydentia) showing a perfect and natural adaptation to the cavity. Then, a packable composite (Venus Pearl ONE, Kulzer, Germany) was used to convert the class II into a class I.

style italiano styleitaliano layering proximal wall

Fig.7
A new edition of a highly performing instrument, called Condensa (LM Arte Dark Diamond Edition, LM, Finland) was the ideal choice to handle the composite, thanks to its new black non-stick coating. Moreover, the Venus Pearl ONE is minimally sticky, so, the combination with its excellent sculptability makes this composite the perfect choice to easily and quickly restore a II class cavity.

style italiano styleitaliano kulzer composite venus pearl and diamond long restorations
style italiano styleitaliano kulzer composite venus pearl and diamond long restorations
style italiano styleitaliano clean proximal build-up

Fig.8
By using Applica (Dark Diamond Edition, LM, Finland) at a 45° angle I could build an almost perfect proximal area, which makes it easier to properly polish and floss afterwards.

style italiano styleitaliano pre-finishing proximal build up

Fig.9
Mistakes or imperfections were corrected with an abrasive disc before going ahead, to make the occlusal layering more anatomically precise.

style italiano styleitaliano layering occlusal anatomy

Fig.10
Exploiting the residual anatomical information, this composite easily allowed me to perform a really tooth-like restoration. The LM Applica, thanks to its flexibility, is highly performing in this kind of situations.

style italiano styleitaliano modeling pits and fissures in composite

Fig.11
The Fissura instrument (Dark Diamond Edition, LM, Finland) is recommended for occlusal details. A brush can be used to make the anatomy more rounded and natural.

style italiano styleitaliano finished proximal restoration

Fig.12
Small corrections were required, but the material kept the given shape very well, and its esthetic aspect made the result very natural and very close to the ideal final outcome.

style italiano styleitaliano wooden wedge removal with bella instrument

Fig.13
The Bella instrument is an additional tool that can make placing and removing a wooden wedge, and the finishing procedures easy even in narrow spaces as in this case.

style italiano styleitaliano bristle brush polishing composite

Fig.14
Polishing was carried out with Venus Supra (KULZER) two-step polishing system with pre- and high-gloss rubs at 5.000 – 8.000 rpm. These silicone brushes are made of highly filled silicone with microfine diamond powder and are tailor-made for Venus composites (Venus Diamond ONE and Venus Pearl ONE). Twist brushes are ideal because their bristles are flexible and can easily access fissures.

style italiano styleitaliano class II distal filling

Fig.15
Final outcome.

style italiano styleitaliano class II filling after rubber dam removal

Fig.16
After rubber dam removal. Even though it’s safer to wait for rehydration of the tooth to evaluate shade, the color matching and the blending of the composite were already impressive.

style italiano styleitaliano check up after proximal filling

Fig.17
One month later, after rehydration nothing changed and the restoration was stunningly integrated.

Conclusions

Venus composites are highly recommended for several reasons:

  • The color matching is no longer a problem because of their chameleonic properties. As clearly shown in the last two pictures, the color integrates with the tooth both when dehydrated and hydrated; in other words, no need to worry about the color in such cases.
  • The handling makes it possible to create realistic anatomical features with primary and secondary ridges. Venus Pearl ONE is soft, but keeps the shape steadily and is not sticky.
  • Their polishing system in two easy steps gives the restoration a beautiful glossy, long-lasting, aspect.
  • The time taken for such restorations is incredibly reduced, and the guarantee of success really high even in less experienced hands.
style italiano styleitaliano kulzer composite venus pearl and diamond long restorations
style italiano styleitaliano kulzer composite venus pearl and diamond long restorations

Bibliography

  1. van Dijken JWV, Pallesen U. Bulkfilled posterior resin restorations based on stress-decreasing resin technology: a randomized, controlled 6-year evaluation. Eur J Oral Sci. 2017 Aug;125(4):303-309.
  2. Fruits TJ, Knapp JA, Khajotia SS. Microleakage in the proximal walls of direct and indirect posterior resin slot restorations. Oper Dent. 2006 NovDec;31(6):719-27.
  3. Ilie N. Sufficiency of curing in highviscosity bulk-fill resin composites with enhanced opacity. Clin Oral Investig. 2019 Feb;23(2):747-755.
  4. Fronza BM, Abuna GF, Braga RR, Rueggeberg FA, Giannini M. Effect of Composite Polymerization Stress and Placement Technique on Dentin Micropermeability of Class I Restorations. J Adhes Dent. 2018;20(4):355-363.
  5. Prager M, Pierce M, Atria PJ, Sampaio C, Caceres E, Wolff M, Giannini M, Hirata R. Assessment of cuspal deflection and volumetric shrinkage of different bulk fill composites using non-contact phase microscopy and micro-computed tomography. Dental Materials Journal, 37(3), 393-399.

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