HOME

CASES

SHADE GUIDES

MASTER COURSES
ENDODONTICS

COMMUNITY

EVENTS

SHOP

PHILOSOPHY

SUGGESTIONS

OUR FRIENDS

CONTACT

EGR CORNER

UPCOMING EVENTS

ANDI MODENA
CASES

ARTICLES - BACK - NEXT

DAN LAZAR
DIRECT POSTERIORS - CASES - SHADEGUIDES

BACK TO BASICS: A STEP BY STEP PROTOCOL

RECIPE FOR CLASS IV
RESTORATIONS
23869 Views - Dec 2015

234

Download PDF

2216

Favourite Watch later

The use of the composite materials to restore form and function of posterior teeth damaged by
disease, age or trauma is gaining wide acceptance by the dental community.
The dental practician and also the patient have the same desire regarding the posterior composite
restorations, which is that those restorations has to last many years.
While there are numerous recommendations regarding preparation design, restoration placement,
and polymerisation technique, current research indicates that restoration longevity depends on
several variables that may be difficult for the dentist to control.
SHOP

These variables include the patients caries risk, tooth position, patient habits, number of restored
surfaces, the quality adhesion and the ability of the material to produce a sealed tooth- restoration
interface.
So, the success of posterior restorations depends a lot on the dentists procedure and his clinical
experience. In this article is described a clinical step by step procedure in order to create and
develop a protocol for daily practice. Working with an understandable and clear protocol, the dental
clinician can pay attention on many details during composite reconstruction, can prevent the
technical errors, can hold the flow estate, leading to a better result with every restoration.

CASES OF THE WEEK

JAN 18 TO JAN 24
Adam Zawadka
Marc Kaloustian
Marino Sutedjo
Ivan Mirovic

First Name
Last Name
E-mail
Submit

LATEST ARTICLES

COMPOSITES IN THE
AESTHETIC ZONE: YES, WE
CAN
TESTIMONIALS

The protocol proposed for posterior reconstruction is described in 6 STEPS

1.Diagnostic and initial occlusal check
2.Isolation and pre-wedging
3.Cavity preparation and cavity finishing
4.Proximal reconstruction and occlusal layering
5.Straining (Optional) and finishing
6.Polishing and final occlusal check

ANNIKA KORVO
Styleitaliano has easy recipes that
we can follow. I find it a great
course for the general practitioner
and for the expert.

FACEBOOK

Style Italiano
Like Page 39K likes

Style Italiano
18 hrs Genova, Italy

Highly aesthetic restorations

in anteriors a community case
by Rodrigo Cavaco
http://www.styleitaliano.org/co
mposites-in-the-aestheticzo
You can submit yours in the
following link
http://www.styleitaliano.org/ad
min/community

The initial situation is showing caries on both premolars and on both molars. Also the first and second
molar have old restorations that they have to be change because of poor integration and inadequate
morphology and function.

TWITTER
Tweets

Follow

Style Italiano
18h
@styleitaliano
Highly aesthetic restorations in
anteriors a community case by
Rodrigo Cavaco... fb.me/7OrATfDnl
Expand
Style Italiano
9 Feb
@styleitaliano
Let's steps! ;) fb.me/74W3DdxlH

Tweet to @styleitaliano

FOUNDERS

The initial occlusal check was made using a 40 microns articulating paper. This stage is made to help
the dental clinician to see the contact points in order to prepare and restore properly.

Walter Devoto
Dr. Walter Devoto Born in
Chiavari on 29/03/1965
graduated in Dentistry in 1991
at Genova University.

Angelo Putignano

After the occlusal check the isolation with rubber dam is used.When restoring the posterior region I
prefer to isolate al working quadrant. Using this technique help the dentists and also the dental
assistant to have a better view and a better access to all cavity preparations.After isolation a cleaning
is made with brushes and paste and also airflow, to remove al the plaque and stains. This step is
mandatory to prevent the contamination of adhesion procedure.

M.D. degree and D.D.S. post

graduate certificate from
University of Ancona-Italy.

FOUNDERS ENDO

Pio Bertani
Pio Bertani is a full member of
the prestigious association...

Pre-wedging is very important and useful because

1. protect the proximal rubber to be broken during the cavity preparation
2. push the rubber and the gingiva more apically
3. separate the teeth so the proximal preparation is easier

Fabio Gorni
Fabio Gorni is an active
member of the Italian Society
of Endodontics and the Italian
Academy...

MEMBERS
Monaldo Saracinelli
Ive been a student of prof.
Fabio Toffenetti and
Riccardo Garberoglio.

Jordi Manauta
Was born in Mexico City,
where he graduated cum
laude. in dentistry from
UNITEC.

Gaetano Paolone
My passion is aesthetic
direct and indirect
adhesive dentistry in
anterior and posterior
teeth.

Daniele Rondoni
Born in Savona in 1961
where he lives and has

Cavity preparation have 3 steps

1. Access
2. Removal of the caries
3. Finishing of the cavity
The burr that I use most for access is the cylindric-round burr with a diameter of 0,9 mm.

worked in his own

laboratory since...

Vincenzo Musella
Vincenzo Musella
graduated in dental
technician. Proud friend
and student of...

Giuseppe Marchetti
Giuseppe Marchetti was
born in Parma (Italy) in
October of 1972 and
graduated from...

Simone Grandini
Chair of Endodontics and
Restorative Dentistry,
University of Siena, Italy.

Giovanna Orsini
Giovanna Orsini is a well
known researcher in Italy
and internationally.

Paulo Monteiro
My passion for esthetic
dentistry began when I
attended the last year...

The second step of the cavity preparation is caries removal and I use a round low speed bur.

Louis Hardan
Head of Restorative and
Esthetic department in
Saint-Joseph University
in...

Patrizia Lucchi
Patrizia Lucchi Graduated
in Dentistry cum Laude in
1995 at the University of
Verona

Anna Salat
Dr Anna Salat graduated
with a degree in dentistry
from the International
University of Catalonia

Giulio Pavolucci
After graduation magna
cum laude in Dentistry, I
started focusing my daily
work on...

Marcos Vargas
Dr. Marcos Vargas
attended Cayetano
Heredia University School
of Dentistry in Lima...

Stefan Koubi

Finishing the cavity using a fine bur is also very important for a better seal between tooth and
restoration. I use for this stage an Arkansas bur on micromotor with low speed. As a general rule - the
cavity preparation starts with high speed and water and finish with low speed and no water.

Dr. Koubi graduated from

University of Marseille
where he...

Engin Taviloglu
Dr. Taviloglu graduated
from ?stanbul University
School of Dentistry in...

Dimitar Filtchev
Co-founder of the Laser
Dental Center and the
Implant...

Angie Segatto
My commitment to arts has
determined my
specialisation.

Kilian Molina
Kilian is required as a
regular lecturer in indirect
restorative...

Gregory Camaleonte
I was born in 1980 in
Marseille-France and i have
graduated in 2006 from...

Caroline Werkhoven
Caroline Werkhoven
graduated in 2002 at
ACTA, the dental faculty in
Amsterdam..

Ajay Juneja
Ajay Juneja finished his
BDS in the year 1995...

The aspects of cavity preparation. The wedges were very helpful for the proximal areas
preparations.

Carlos Fernndez
Villares
Member of SEPES Spanish
Soc...

Sulivan Leite
Sulivan Leite graduated
from the Ribeirao...

Maciej Zarow
Author of book edited by
Quintessence: EndoProsthodontics: guidelines
for clinical practice ...

Dan Lazar
Dan Lazar, graduated from
the Faculty of Dentistry in
2005 in Cluj-Napoca...

Murad Akhundov
Dr. Murad Akhundov
graduated from the
Faculty of Dentistry in
Baku...

Janos Grosz
Graduated summa cum
laude in 2006 from the
University of Szeged,
Faculty of Dentistry,
Hungary...

The proximal wall is restored using a metallic matrix and a ring. First I apply the matrix, then the
wedge after that I use two pieces of teflon tape and after that I place the V-ring. The teflon tape is
used for a better fitting of the matrix in contact with the proximal walls.

MEMBERS ENDO
Simone Grandini
Chair of Endodontics and
Restorative Dentistry,
University of Siena, Italy.

Louis Hardan
Head of Restorative and
Esthetic department in
Saint-Joseph University
in...

Filippo Cardinali
Graduate in Dentistry and
Dental Prostheses at the
University of Ancona in
1992. Active Member of...

Riccardo Tonini
He is active member of the
Italian Academy of
microscopic Dentistry and
Active member of...

The matrix in place. Also for this stage the high of the matrix is very important to obtain a nice
proximal ridge.

Paolo Generali
Doctor Generali was
graduated from Pavia
University in the year...

Calogero Bugea
Graduate in Dentistry,
Certificate in Oral Surgery.
Active Member of the
International
Piezosurgery...

Clifford Ruddle
Internationally recognized
as a leading expert in all
aspects of clinical
endodontics, Dr. Ruddle is
acclaimed for...

Pierre Machtou
Pierre Machtou was the
first scientific director and
general secretary of the
French Endodontic
society...

Marga Ree
Primary author of several
articles published in
national and international
journals and has ...

Marco Martignoni
Marco Martignoni leads a
private clinic in Rome Italy
and dedicates his practice
mainly to endodontics,
pre-prosthetic...

Massimo Giovarruscio
Massimo Giovarruscio
works in Rome, Bristol and
London, specialising in
Endodontic Treatment
and...

After the proximal wall is restored the ring is removed and the occlusal morphology is created
following the anatomy of the tooth.

For the second premolar no ring were used, just a matrix and a teflon tape. The teflon fix the matrix in
contact with the proximal walls and also helps the dentist to distribute the proximal space with the
mesial cavity of the molar.

Both premolars reconstructed. In this stage any finishing procedure can be made before starting the
molar reconstruction.

The matrix for molar. The high of the matrix regarding the proximal ridge of the premolar is very
important for a very nice reconstruction.

The aspect of the proximal ridges just after matrix and ring removal.

For finishing I prefer to use the same Arkansas bur, a no 12 blade and a rubber wheel. After finishing
if the dentist prefer he can stain the occlusal surface. I have used brown stain.

The occlusal check using the 40 microns articulating paper. The occlusal check should be made in
static and also in dynamic movements.

The final aspects of the restorations. The polishing step is made with a cotton wheel and aluminium
oxide and water. Nice polish can be achieved using this protocol.

The final aspects of the restorations.

And a very nice drawing made by Dan Brazdau a colleague of mine.

Conclusions
A daily protocol understand by the dentist and also by the dental assistant can provide very good
posterior restorations with every patient.
References
- Brenda S Bohaty, Qiang Ye, Anil Misra, Fabio Sene, Paulette Spencer. Posterior composite
restoration update: focus on factors influencing form and function
- Khamis Hassan, BDS, MSD, PhD | Salwa Khier, BDS, MSD, MSc, PhD. Composite resin restorations of
large class II cavities using split-increment horizontal placement technique
- Federico Ferraris, DDS Private Practice, Alessandria, Italy. Adhesion, Layering, and Finishing of Resin
Composite Restorations for Class II Cavity Preparations

ASK THE AUTHOR PRIVATELY

Name
Email
Message

Enviar

234

2216

Favourite Watch later

SIMILAR ARTICLES

ANGELO PUTIGNANO

STYLEITALIANO

RECIPE FOR CLASS IV

RESTORATIONS

RUBBER DAM
PERFORATIONS UPDATED

JORDI MANAUTA

CUSTOM RINGS UPDATE

SULIVAN LEITE

NO PREP - DIRECT
VENEERS SOLVING A
COMPROMISED SMILE

DAN LAZAR

TWO WAYS OF STAINING

POSTERIOR COMPOSITES

CAROLINE WERKHOVEN

THE POWER OF PENCIL

OTHER POSTS BY THIS AUTHOR

DAN LAZAR

TWO WAYS OF STAINING

POSTERIOR COMPOSITES

Back to top

HOME

CASES

MASTER COURSES

COMMUNITY

EVENTS

SHOP

PHILOSOPHY

Styleitaliano 2008-2015. All right reserved.

SUGGESTIONS

OUR FRIENDS

CONTACT