DentaltownUK March 2018 - 28

restorative
dentistry

Posterior Composite
Stratification:
A Clinical Case Report

Dr. Shiraz Khan's case study demonstrates a
reproducible, predictable and robust protocol
to restore posterior teeth with composite resin

Fig. 1. Preoperative assessment.
Occlusal caries present in both
LR7 and LR6.

28

MARCH 2018 // dentaltownuk.com

Introduction

Case presentation

Posterior composites are increasingly
considered the restoration of choice by
practitioners and patients.1,2 Amalgams have
provided restorative solutions for patients
with dental caries for more than a century3;
however, technological advances in adhesion,4
minimal cavity design and preparation, and
increased strength of composite resin restorations5 have led to the increased popularity
of posterior composite resin restorations.
While there is still a place for the use of
amalgam in restorative situations, over the
past decade it is becoming apparent there
has been a reduction in the use of it and a
concomitant increase in the use of composite.3
In some parts of the world, a composite resin
is the only direct option available.1
Carefully selected clinical scenarios, good
isolation and an understanding of the adhesive
techniques being employed will lead to
posterior composite resin success, with a
g o o d c h a nc e of c l i n ic a l lon g e v it y,
minimisation of secondary caries at the
tooth/restorative interface, and reduction
in postoperative sensitivity.
The following case study demonstrates
a reproducible, predictable and robust
protocol to restore posterior teeth with
composite resin.

A 28-year-old patient attended the dental
surgery for the first time in around 10 years.
After using systematic desensitisation to help
her overcome her fear, the patient began her
restorative work. The patient had a tooth that
had been previously restored with amalgam
adjacent to another tooth which had never
been restored. Whether or not a tooth has
previously been restored does not indicate
whether a tooth is suitable for a composite
resin restoration. Both had clinical and
radiographic caries and the probe was catching
in the patient's central fissure (Fig. 1).

Isolation
Isolation of the tooth from oral fluids-
saliva, blood, gingival fluid, etc.-has been
accepted as an important step to achieving
clinical excellence in operative dentistry.6
In any procedure that requires resin
chemistry, isolation from the oral fluids is
paramount. Whether this is with the use of
simple techniques, such as cotton wool roll
isolation, all the way through to the use of
specialist equipment, such as the Isolite oral
isolation system, is irrelevant. The key is
ensuring that adequate isolation is achieved.
Rubber dam is regularly used in the process
of adhesive dentistry.3 It has been shown



http://www.dentaltownuk.com

Table of Contents for the Digital Edition of DentaltownUK March 2018

Cover
Mike Gow editorial
Howard Speaks
Continuing Education Update
The Hall Technique
Message Board - Am I too Conservative?
Top 10 Tips for starting a successful clinic
Message Board - Knock to a Front Tooth 12yo
The British Dental Confeerence and Dentistry Show 2018
Anterior Surgical Crown Lengthening
Cover Story - The Dancing Dentist
Posterior Composite Stratification
Indirect vs. Direct Restorations
Orthodontic Restorative Interface
BACD News
Through the Keyhole
Lifestyle
Dental Aid Network
Students
Wish List
Quiz
DentaltownUK March 2018 - Cover
DentaltownUK March 2018 - Cover2
DentaltownUK March 2018 - 3
DentaltownUK March 2018 - 4
DentaltownUK March 2018 - Mike Gow editorial
DentaltownUK March 2018 - Howard Speaks
DentaltownUK March 2018 - 7
DentaltownUK March 2018 - Continuing Education Update
DentaltownUK March 2018 - 9
DentaltownUK March 2018 - The Hall Technique
DentaltownUK March 2018 - 11
DentaltownUK March 2018 - 12
DentaltownUK March 2018 - Message Board - Am I too Conservative?
DentaltownUK March 2018 - 14
DentaltownUK March 2018 - Top 10 Tips for starting a successful clinic
DentaltownUK March 2018 - Message Board - Knock to a Front Tooth 12yo
DentaltownUK March 2018 - 17
DentaltownUK March 2018 - 18
DentaltownUK March 2018 - The British Dental Confeerence and Dentistry Show 2018
DentaltownUK March 2018 - 20
DentaltownUK March 2018 - Anterior Surgical Crown Lengthening
DentaltownUK March 2018 - 22
DentaltownUK March 2018 - 23
DentaltownUK March 2018 - Cover Story - The Dancing Dentist
DentaltownUK March 2018 - 25
DentaltownUK March 2018 - 26
DentaltownUK March 2018 - 27
DentaltownUK March 2018 - Posterior Composite Stratification
DentaltownUK March 2018 - 29
DentaltownUK March 2018 - 30
DentaltownUK March 2018 - Indirect vs. Direct Restorations
DentaltownUK March 2018 - 32
DentaltownUK March 2018 - 33
DentaltownUK March 2018 - Orthodontic Restorative Interface
DentaltownUK March 2018 - 35
DentaltownUK March 2018 - 36
DentaltownUK March 2018 - BACD News
DentaltownUK March 2018 - Through the Keyhole
DentaltownUK March 2018 - 39
DentaltownUK March 2018 - Lifestyle
DentaltownUK March 2018 - 41
DentaltownUK March 2018 - Dental Aid Network
DentaltownUK March 2018 - 43
DentaltownUK March 2018 - 44
DentaltownUK March 2018 - 45
DentaltownUK March 2018 - 46
DentaltownUK March 2018 - Students
DentaltownUK March 2018 - 48
DentaltownUK March 2018 - Wish List
DentaltownUK March 2018 - Quiz
DentaltownUK March 2018 - Cover3
DentaltownUK March 2018 - Cover4
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