Using the P composite and the Fast Modeling Technique for class II restorations with missing adjacent teeth

In any dental practice, posterior proximal caries is a daily challenge, mostly due to the lack of clear vision of the proximal area. Although when a class II cavity is adjacent to a missing tooth, vision isn’t be an issue better, another problem occurs, which is losing the privilege of using rings and wedges to restore a good proximal wall with the right contour in addition to restoring a good functional anatomy. This article is presenting an easy technique for this purpose.

style italiano styleitaliano old amalgam fillings

Fig.1
Initial situation, defected old fillings on the 14 and 16 with sensitivity to cold water.

style italiano styleitaliano cavities after amalgam removal before cleaning

Fig.2
After isolation, the old defected fillings were removed. The clamp was placed on tooth 17 so it would not interfere with the bands that would be used on the tooth #16.

style italiano styleitaliano clean class II cavities

Fig.3
Initial cleaning and cavity design.

style italiano styleitaliano sandblasting cavities with aquacade

Fig.4
Sandblasting the cavity walls and margins with 29 micron Aluminum oxide. AquaCare device was used to have a clean surface that is ready to be etched and bonded.

style italiano styleitaliano sandblasted cavities

Fig.5
After sandblasting with AquaCare.

style italiano styleitaliano band matrices for class II

Fig.6
As tooth 15 was missing, circumferential matrices were used.

style italiano styleitaliano sectional matrix held in place by circumferential band

Fig.7
To avoid creating overcontoured proximal walls and to achieve a good seal at tooth 16, a sectional band from Polydentia (black arrow) was inserted and held in place by the circumferential band. A small piece of teflon tape was used in between the matrices to achieve adherence of the sectional one to the cervical margin. At tooth 14, the circumferential band was enough to make a good contoured proximal wall, except at the cervical margin, where the small gap was closed by pushing the band with the Condensa instrument (LM Arte kit), just before curing the composite of the proximal wall.

polydentia banner style italiano
polydentia banner style italiano
style italiano styleitaliano class II cavities with built proximal walls and filled

Fig.8
Building the proximal walls by using the P composite from the compoSite system (White Dental Beauty). The hybrid layer was sealed using a bulk flowable to quickly fill the whole cavity, leaving only 1.5 mm space for the final layer to create the occlusal anatomy. This space was gauged by Posterior Misura (LM Finland).

style italiano styleitaliano white dental beauty composite system
style italiano styleitaliano white dental beauty composite system
style italiano styleitaliano raw composite before anatomical modeling with Fast Modeling Technique

Fig.9
The final layer was laid using the P composite (White Dental Beauty) as a single mass, and was then attentively adapted using the Condensa instrument (LM Arte) to create the final anatomy.

style italiano styleitaliano groove definition in raw composite

Fig.10
To create the occlusal anatomy, we need a simple and fast technique that can provide a functional and anatomical restoration without wasting time in layering each cusp one by one. By the Fast Modeling Technique (FMT) – as described by Hardan and Akhundov – this goal can be achieved. The Fissura instrument (LM Arte kit) was used to create the grooves, following the remaining anatomical features of the tooth, to define the cusps. The engraving should be deep to reduce the C factor.

style italiano styleitaliano grooves after tightening in the fast modeling technique

Fig.11
With a micro brush, the grooves were tightened by slightly pushing the composite. After this step the composite is ready to be cured. A soft start curing mode was used.

style italiano styleitaliano occlusal layer of raw composite

Fig.12
The same steps were followed for tooth 14, a single mass P composite, adapted by Condensa (LM Arte kit).

style italiano styleitaliano groove of premolar occlusal anatomy

Fig.13
Deep engraving by Fissura (LM Arte kit). Follow the anatomy of the remaining cusp.

LM ARTE kit posterior banner mobile style italiano styleitaliano
LM ARTE kit posterior banner desk style italiano styleitaliano
style italiano styleitaliano stained composite restorations

Fig.14
Brown stains were added to make the fillings look more natural.

style italiano styleitaliano composite restorations after sandblasting

Fig.15
Removing the resin excess by sandblasting finished restorations and dental surface with prophyflex (sodium bicarbonate) by AquaCare device.

style italiano styleitaliano lucida polishing system

Fig.16
Lucida felt star polishing system with its water soluble paste were used for the final polishing. The Lucida felt star has a rounded points that make it possible for it to reach and polish all the narrow angles and details.

style italiano styleitaliano diashine lucida
style italiano styleitaliano diashine lucida
style italiano styleitaliano composite restorations after rubber dam removal

Fig.17
Final view after polishing.

style italiano styleitaliano composite restorations after 18 months

Fig.18
18 months recall.

Conclusions

Simplicity and excellence are the main targets for every dentist seeking to upgrade his or her skills, and the quality of their daily work. Long-lasting restorations can be achieved and maintained only if we follow simple techniques that are easy to be repeated in everyday practice.

Bibliography

1-Manauta J, Salat A. Layers An Atlas of Composite Resin Stratification. 2012. Quintessence Pub.
2-Marchetti G. 10 TIPS on Posterior direct restoration in daily flow. 2018. Styleitaliano.org.
3-Hardan L, Sidawi L, Akhundov M, Bourgi R, Ghaleb M, Dabbagh S, Sokolowski K, Suarez C, Szymanska M. One-Year Clinical Performance of the Fast-Modelling Bulk Technique and Composite-Up Layering Technique in Class I Cavities. Polymers 2021;13:1873

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

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