GAETANO PAOLONE

DIRECT POSTERIORS
CUSTOM SHIELD PART 2

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When treating class II cavities very often the buccal, palatal or lingual cusp thickness is too thin. Generally
when the thickness is less than 2-2.5mm reducing cusp’s height is a recommended procedure. After that a
direct or an indirect restoration solution has to be taken. If a direct restoration is chosen, it is very difficult
to restore cusp’s height and shape in a free-hand method. With the “Custom Shield technique” the height
and the anatomy of the cusp are registered before its reduction through the use of a silicone index. This
index is then used to mold directly the cusp exactly as it was before reduction.

Fig. 1- Initial situation: an old filling with secondary caries has to be treated on this upper molar.

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Fig. 2- Isolation is performed

Fig. 3- During the preparation it is suddenly clear that buccal cusp will be very thin, for sure less than 2mm
thick.

Fig. 4- The custom shield is obtained placing a small amount of impression material buccally and slightly
occlusally.

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Fig. 5- Once the silicone has polymerized, the cavity is completed and the cusp reduced.

Fig. 6- The custom shield is then marked with a sharpened instrument (Fissura – LM Arte) and the
composite is placed on the marked area without curing.

Fig. 7- The custom shield is then placed on the teeth after adhesive procedures and the composite adapted
with brushes or instruments. After the adaptation, composite is cured.

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Fig. 8- After curing, the buccal wall of the interproximal space has to be finished with a bur or with a disc.
In this way a conventional sectional matrix can be placed along with a wedge and a ring. Class II is then
transformed in class I.

Fig. 9- The Simultaneous Modelling Technique (SMT) is used to achieve a natural anatomy in an easy way.

Fig. 10- The final result after polishing

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Fig. 11- Right after dental dam removal

Fig. 12- Occlusal check 1 week post-op

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Fig. 13- 3 months post-op.

To read about the first part of the article click here Custom Shield Part 1

• [1] Lopes GC1 et al. Direct composite resin restorations: a review of some clinical procedures to achieve
predictable results in posterior teeth. J Esthet Restor Dent. 2004;16(1):19-31; discussion 32. • [2] Boer WM.
Simple guidelines for aesthetic success with composite resin–part II: posterior restorations. Pract Proced
Aesthet Dent. 2007 May;19(4):243-7; quiz 248. • [3] Schlichting LH, Monteiro S Jr, Baratieri LN. A new
proposal to optimize the occlusal margin in direct resin composite restorations of posterior teeth. Eur J
Esthet Dent. 2008 Winter;3(4):348-60. • [4] Klaff D. Blending Incremental and Stratified Layering
Techniques to Produce an Esthetic Posterior Composite Resin Restoration with a Predictable Prognosis. J
Esthet Restor Dent 2001;13:101-13. • [5] Dietschi D., Spreafico R. Adhesive metal free restorations – current
concepts in the aesthetic treatment of posterior teeth. Quintessence Publ 1997. • [6] Baratieri LN, Monteiro
Júnior S, Correa M, Ritter AV. Posterior resin composite restorations: a new technique. Quintessence Int.
1996 Nov;27(11):733-8. • [7] Bichacho N. The centripetal build-up for composite resin posterior restorations.
Pract Periodontics Aesthet Dent 1994;6:17-23. • [8] Kano P. Challenging Nature: Wax-up Techniques in
Aesthetics and Functional Occlusion. Quintessence Publishing Co Ltd • [9] Krifka S, Anthofer T, Fritzsch M,
Hiller KA, Schmalz G, Federlin M. Ceramic inlays and partial ceramic crowns: influence of remaining cusp
wall thickness on the marginal integrity and enamel crack formation in vitro. Oper Dent. 2009 Jan-
Feb;34(1):32-42. • [10] Fichera G., Re C. Restauri estetico-adesivi indiretti: modello per diagnosi di
configurazione cavitaria. Dentista Moderno 2006:21-57 • [11] Denehy G, Cobb D. Impression matrix
technique for cusp replacement using direct composite resin. J Esthet Restor Dent. 2004;16(4):227-33

Visit: http://proyectoshm.com/style/custom-shield-part-2

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