Working with Posterior Misura

Shadeguides - Direct posteriors - Products - Tips and tricks
25 Sep 2017

What we are looking in the successful daily practice – acceptable restoration for the patient, simple protocols for dentists and  minimum time managment for both. 

Restoration of the class II cavitys is always one of the most difficult challenge for dentists. In this case we will try to explain the most apropreate way of the restoration in class II cavitys using instrumentents and materials to simplify the work.

Fig. 1

Img. 1 – First of all we should apply a rubberdam. For this particular case we use (Non Latex Flexi Dam, Coltene/Whaledent) As preparation is done, it is time to think about how to restore proximal wall at the same height with adjacent tooth.

Fig. 2

Img. 2 – In the past, for measuring the height of the adjacent proximal wall a perio probe was used and then a mark of the marginal ridge was made. It used to be a very complicated work, but now with this new instrument its not anymore

Fig. 3

Img. 3 – For simplifying our daily dentistry today we have new posterior version of the popular Misura instrument with 2 tips on it

Fig. 4

Img. 4 – The fork shaped tip of the instrument allows measuring and modeling of the composite wall with the presence of a matrix.

Fig. 5

Img. 5 – Another tip designed for the horizontal and vertical measuring of thickness of last composite layer on posterior restorations. To block the color of the bottom layer we always need minimum 1,5 mm of Body shade composite

Fig. 6

Img. 6 – We placed black matrix (LumiContrast Sectional Matrices, Molar 0.025mm / 6.4mm) wedge and MyRing Classico with delta tubes (Polydentia)

Fig. 7

Img. 7 – Now we can start adhesive protocol. First step is to etch enamel for 30 second with selective etching technique – in this case we use 35 % phosphoric acid Etchant Gel S (Coltene)

Fig. 8

Img. 8 – After rinsing the etching gel from enamel, it is time to place self etching One Coat Universal Adhesive (Coltene) We start to apply the new generation of adhesive (multilayer) by brushing actively, more on the the dentin and less on the enamel. We must wait minimum 20 seconds for the exposition of the adhesive followed by 5-10 second air drying for removing the solvent.

Fig. 9

Img. 9 – Light curing for adhesive layer will be minimum 20 seconds. We have to finish adhesive layer with a small drop Bulk fill flowable composite for creating hydrophobic protection layer. For Light curing we used S.P.E.C.® 3 lamp (Coltene) In these lamp we have 3 curing modes (Standard Mode), (3K Mode), (Ortho Mode) • Standard Mode: Ideal for most composite curing scenarios. • 3K Mode: For rapid curing when time is an issue, like pedo or patients with gag reflex. • Ortho Mode: Cures an entire full-arch of brackets with 2 three second intervals per bracket.

Fig. 10

Img. 10 – For great sealing of the margins we need to apply a little drop of Bulk-flow composite between the matrix and tooth. Then immediately to place regular composite above flowable composite without curing

Fig. 11

Img. 11 – Placing Bulk-flow between matrix and tooth. spreading with Fissura by (LM Arte)

Fig. 12

Img. 12 – Placing regular body shade composite from Brilliant Ever glow (Coltene)

Fig. 13

Img. 13 – Applying to the vestibular and palatal walls with LM condensa instrument (LM Arte) U can notice that the height of the new wall is more than our line

Fig. 14

Img. 14 – Now is time for the main step. TIP: If u want to have the same height of wall with adjacent tooth use the Posteiror Misura instrument

Fig. 15

Img. 15 – We can easily eliminate excess material with half of fork when the second part is controlling the height

Fig. 16

Img. 16 – And then we apply material and smooth the surface with Compo Brush (Smile Line)

Fig. 17

Img. 17 – The wall is ready and now we can check the height with the same instrument. U can notice that both approximal walls at the same level

Fig. 18

Img. 18 – After we transfered class II cavity to the class I it’s time to fill all cavity. For these we can use incremental layering technique but using this technique will take to much time. Today we have a lot of bulk fill composites in the market. In this case, we use Fill-up! (Coltene) because we can place this dual curing bulk composite in deep cavitys for one layer. No matter what layer thickness is applied, there is no need to worry about thorough curing, as Fill-Up! consists of both light and chemically curing properties. Light-curing for for just 5 sec.

Fig. 19

Img. 19 – As the dentin layer is finished, it is time to switch to enamel layer. As we mentioned we need just 1,5 mm thickness of the last layer If we want to avoid to have highspots after restoration. Another Tip of this instrument gives us a chance to leave this space for final layer.

Fig. 20

Img. 20 – Final occlusal anatomy is always a problem for the dentist. But we think that it is important to follow the nature. Occlusial map is always guiding us. You can see on the picture occlusion map. This show us the place where the sulcus will be between the cusps

Fig. 21

Img. 21 – For this case we use easily polishable Brilliant Ever glow composite material (Coltene)

Fig. 22

Img. 22 – Occulusal view after aplying composite to the walls with Condensa (LM Arte) instrument and with Compo Brush (Smile Line)

Fig. 23

Img. 23 – Now it is the time to follow to the natural GPS. You can see that with this essential lines we can easily recreate the anatomy. Today we have a new FMT with Essential lines technique by Styleitaliano which give us a chance to model the last layer just for 2 minutes

Fig. 24

Img. 24 – Modelling was done in 1-2 minutes max.: FMT with Essential Lines technique will be described very soon

Fig. 25

Img. 25 – Stain application with Fissura instrument (LM Arte)

Fig. 26

Img. 26 – This stage is the final polymarization after glycerine. We need minumum 1 minute of polymerization for blocking of oxygen inhibition layer

Fig. 27

Img. 27 – Finishing and polishing starting with abrasive rubber cups for cusps then the rubber points for deep fissura and finished with a silicone abrasive wheels without any polishing paste at low speed . (Diatech Polishers by Coltene)

Fig. 28

Img. 28 – Final view of the proximal walls after restoration

Fig. 29

Img. 29 – Final view of occlusion surface view after restoration

 

Conclusions

Measuring thicknesses is always a benefit in everyday dentistry, makes it fast, reliable and more predictable.
The two measures “posterior misura” gives have changed and speed up my practice.

Bibliography

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Monterubbianesi R, Orsini G, Tosi G, Conti C, Librando V, Procaccini M, Putignano A. Spectroscopic and Mechanical Properties of a New Generation of Bulk Fill Composites. Front Physiol. 2016 Dec 27;7:652. doi: 10.3389/fphys.2016.00652 http://styleitaliano.org/lm-arte-posterior-misura
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JORDI MANAUTA- BACK TO BASICS: BULK AND BODY http://www.styleitaliano.org/back-to-basics-bulk-and-body
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MURAD AKHUNDOV- BULK AND BODY 2YEARS RECALLhttp://styleitaliano.org/bulk-and-body-2-years-recal