Optimizing tooth form with direct posterior composite restorations

Abstract

Advances in material sciences and technology have provided today's clinicians the strategies to transform the mechanistic approach of operative dentistry into a biologic philosophy. In the last three decades, composite resins have gone from being just an esthetically pleasing way of restoring Class III and Class IV cavities to become the universal material for both anterior and posterior situations as they closely mimic the natural esthetics while restoring the form of the human dentition. In order to enhance their success, clinicians have to rethink their protocol instead of applying the same restorative concepts and principles practiced with metallic restorations. Paralleling the evolution of posterior composite resin materials, cavity designs, restorative techniques and armamentarium have also developed rapidly to successfully employ composite resins in Class II situations. Most of the earlier problems with posterior composites such as poor wear resistance, polymerization shrinkage, postoperative sensitivity, predictable bonding to dentin, etc., have been overcome to a major extent. However, the clinically relevant aspect of achieving tight contacts in Class II situations has challenged clinicians the most. This paper reviews the evolution of techniques and recent developments in achieving predictable contacts with posterior composites. A Medline search was performed for articles on “direct posterior composite contacts.” The keywords used were “contacts and contours of posterior composites.” The reference list of each article was manually checked for additional articles of relevance.

Proximal contact tightness of class Ⅱ bulk-fill composite resin restorations: An <i>in vitro</i> study

“…The challenge in getting a tight proximal contact with a resin composite has been ascribed to inherent polymerization shrinkage, absence of condensability of resin composite materials, the use of a rubber dam and the thickness of the matrix band [5][6][7][8][9] . Several techniques and instruments have been proposed to create tighter and more anatomic proximal contacts 5,[10][11][12] . Generally, the key factor in producing a tight proximal contact is obtaining an interdental separation during placement of the composite restoration.…”

Semidirect posterior composite restorations with a flexible die technique

“…Contemporary dentistry demands simple and effective techniques to restore tooth anatomy, replace lost structure, and reestablish ideal form and function. 16,27 With the restriction of amalgam use in several countries, clinicians often consider direct composite restorations a viable treatment alternative for severe tooth structure loss in posterior teeth. 27 However, depending on the extent of tooth destruction, it is difficult to restore anatomy and function properly while working inside the mouth and using regular matrix systems.…”

“…33 Another difficulty involving posterior direct composite restoration is achieving tight, anatomically correct interproximal contact. 16 Contact areas between teeth are important to avoid displacement and rotation, as well as food impaction, which leads to trauma and an inflammatory response of the periodontium. 16 Semidirect composite restorations exhibit more adequate proximal contact, occlusal morphology, and marginal adaptation than do direct restorations 13 because they are made outside the mouth, allowing better visualization and control during resin insertion and sculpture.…”

“…16 Contact areas between teeth are important to avoid displacement and rotation, as well as food impaction, which leads to trauma and an inflammatory response of the periodontium. 16 Semidirect composite restorations exhibit more adequate proximal contact, occlusal morphology, and marginal adaptation than do direct restorations 13 because they are made outside the mouth, allowing better visualization and control during resin insertion and sculpture. The contouring problems associated with matrix systems can be eliminated with this technique because dental separation promoted by wedges is not always sufficient to compensate for metallic matrix thickness.…”

Comparison of temperature change of one-step self-etch adhesive and two-step self-etch adhesive during photo polymerization of composite restoration.

“…Since the advancement in the adhesive dentistry, composite resins are more acceptable form of restoration as compare to gold casts and amalgam. 1 The longevity of composite resins with tooth structure depends on the mechanical interlocking, which is achieved by adhesives and photo polymerization. 2 The primary purpose of adhesives is to produce adhesion between composite material and tooth surface.…”