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05 February 2021

Direct posterior restorations: a minimally invasive and predictable solution

Allegra Comba


18-year-old patient with multiple carious lesions located in the first quadrant.
After the radiographic examination, the surgical field was isolated with a rubber dam and the carious lesions were removed with diamond burs with decreasing grain size and multi-blade tungsten carbide burs.
Finally, to finish the cavity preparation, the occlusal margins were finished with low-grain diamond burs mounted on a red ring contra-angle and the interproximal margins were finished and polished with low-grain diamond burs mounted on the EVA handpiece.

Once the cavity preparation was completed, the reconstruction procedures were performed using a direct technique. In order to obtain a correct interproximal anatomy, on each dental element, a sectional metal matrix was placed with a wooden wedge and a separator ring.
Then a 3-step etch-and-rinse adhesive system was chosen and applied with etching for 30 seconds of the enamel and 15 seconds of the dentin followed by primer and bonding and layering of the composite resin (Venus Diamond, Kulzer).
After interproximal wall reconstruction, 0.5mm of flowable composite was placed at the bottom of the cavity followed by 2mm layers of composite. Once the restorations were completed and the glycerin gel polymerization performed, the restorations were completed by finishing and polishing the composite to achieve adequate morphological integration and excellent marginal adaptation.

The 3-month follow-up showed an excellent aesthetic and functional integration of the direct reconstructions.

Below you can see all the clinical steps

  • Image 1: Initial x-rays

    Image 1: Initial x-rays

  • Image 2: Dental field after rubber dam isolation and final cavities after caries removal

    Image 2: Dental field after rubber dam isolation and final cavities after caries removal

  • Image 3: Buccal view of final cavities after caries removal

    Image 3: Buccal view of final cavities after caries removal

  • Image 4: Adhesive procedures on premolars

    Image 4: Adhesive procedures on premolars

  • Image 5: Adhesive procedures on premolars

    Image 5: Adhesive procedures on premolars

  • Image 6: Restorative procedures on premolars

    Image 6: Restorative procedures on premolars

  • Image 7: Restorative procedures on premolars

    Image 7: Restorative procedures on premolars

  • Image 8: Restorative procedures on premolars

    Image 8: Restorative procedures on premolars

  • Image 9: Restorative procedures on premolars

    Image 9: Restorative procedures on premolars

  • Image 10: Final cavities after caries removal and adhesive procedures of molars

    Image 10: Final cavities after caries removal and adhesive procedures of molars

  • Image 11: Restorative procedures on molars

    Image 11: Restorative procedures on molars

  • Image 12: Restorative procedures on molars

    Image 12: Restorative procedures on molars

  • Image 13: Restorative procedures on molars

    Image 13: Restorative procedures on molars

  • Image 14: Adhesive and Restorative procedures on molars

    Image 14: Adhesive and Restorative procedures on molars

  • Image 15: Final restorations and 3-months follow up

    Image 15: Final restorations and 3-months follow up

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