DentaltownUK March 2018 - 30

Composite placement

Fig. 5. Conformation
with occlusion.

The technique employed here is the incremental cusp build-up method. This allows
for minimisation of the configuration factor
(or C-factor) and subsequent polymerisation
shrinkage stress. The system used in this
case was Tokuyama Dental Asteria Estelite.
This is a supranano spherically filled
composite which has a dentine shade system
along with an enamel shade system. In this
case, the A2B shade was used along with the
occlusal enamel OcE.
The dentine is built up to approximately
2mm short of enamel margins, being a flat
profile, with the enamel forming the shape of
the cusps subsequently. Finally, in this case,
fissure stain was used sparingly, to mimic
natural toothlike staining.
Although this is not a requirement,
this is a resin that also fills any microvoids between fissures. Each increment is
cured for 20 seconds.
After the final increment is cured, a layer
of glycerine gel is placed and the restoration
is cured through this to remove the oxygen
inhibition layer and subsequently increase
the hardness of the composite restoration.10
The composite placement at its final stage
in Fig. 4.

Conformation to occlusion
The final restoration is cured and polished
using a diamond bur in a speed-controlled
handpiece at low revolutions, followed by the

References
1.
Ritter AV. Posterior composites revisited. Masters Esthet Dent
2008; 20: 57−65.
2.
Hayashi M, Wilson NHF. Failure risk of posterior composites
with postoperative sensitivity. Operative Dent 2003; 28:
681−688.
3.
Mackenzie, L, Shorthall, ACC, Burke, FJT. Direct Posterior
Composites: A Practical Guide. Dent Update 2009; 36: 71-95
4.
Lynch CD, Shortall ACC, Stewardson D, Tomson PL,
Burke FJT. Teaching posterior composite resin
restorations in the United Kingdom and Ireland:
consensus view of teachers.
Br Dent J 2007; 203: 183−187.
Davidson DF, Suzuki M. A prescription for the successful use
5.
of heavy filled composites in the posterior dentition. J Can Dent
Assoc 1999; 65: 256−260.

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MARCH 2018 // dentaltownuk.com

3M ESPE polishing spirals at high revolution.
The rubber dam is removed, along with
any excess composite, and the contact points
are f lossed to ensure no bond has gone
between the contact points. In most instances,
minimal if any adjustment is required, as this
is usually confirmative with the occlusion.
Fig. 5 shows the final restoration, immediately postop. Further aesthetic integration
of the shades will occur after rehydration,
which can take up to 72 hours.

Final comments
Posterior composite stratification can
be a predictable, aesthetic method to restore a
patient's dentition in replacement restorations
or those being placed for the first time.
Robust protocols to ensure moisture
contamination is avoided are paramount
to the longevity of any such restorations.
Likewise, understanding of anatomy
and occlusion before composite placement
allows for the centric contacts to be correct
and offer no interferences during excursions
or function.
Whilst I believe there is still a place for
amalgam restorations-for instance, the deep
Class II cavity-it's clear it is being phased
out and along with patient expectations
increasing and wanting more aesthetic modes
of treatment.
Having a protocol that is repeatable and
executable and avoids excessive steps often
will lead to reproducible results. ■

6.

7.

8.

9.

10.

Cajazeira, M.R.R., De Saboia, T.M., Maia, L.C. Influence of
the operatory field isolation technique on tooth-coloured direct
dental restorations. American Dental Journal (2014); 27: 155159.
Heintze, S.D., Rousson, V. Clinical Effectiveness of direct class
II restorations - a meta-analysis. Journal of Adhesive Dentistry
(2012) 14(5): 407-431
Berglund A, Molin M. Mercury levels in plasma and urine after
removal of all amalgam restorations: the effect of using rubber
dams. Dental Materials 1997;13(5):297-304.
Hedge, VS, Khatavakar RA. A New dimension
to conservative dentistry: Air abrasion. J Conserv Dent.
2010 Jan-Mar; 13(1): 4-8.
Park, HH, Lee, IB. Effect of glycerin on the surface hardness
of composite after curing. J Kor Acad Cons Dent
2011;36(6):483-489.
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