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

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.

Fig.3
Initial cleaning and cavity design.

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.

Fig.5
After sandblasting with AquaCare.

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

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.

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).

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.

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.

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.

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

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

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

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

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.

Fig.17
Final view after polishing.

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