Posterior_Direct_Restorations Salvatore_compressed

FIG 7-33 Subtractive technique. (a to d) For small and medium-sized cavities, the subtractive technique is easier to manage than the additive technique.

Cusp-by-cusp technique: Medium-sized cavities

The cusp-by-cusp technique is best for cavities large enough to involve more than half the occlusal surface as well as Class 1 cavities converted from extensive Class 2 cavities (Fig 7-34). A direct restoration was performed in the clinical case shown, even though a distobuccal cusp was missing. For the same restoration size, there were no significant differences in longevity between a direct and an indirect restoration (see “Decision-Making Criteria for Direct Versus Indirect Restorations” in chapter 5). After reconstructing the missing cusp while managing height and volume by analyzing the second molar shape, the restoration was completed by applying the cusp-by-cusp technique.

FIG 7-34 Cusp-by-cusp technique. (a to f) In medium-sized cavities, the cusp-by-cusp technique is a predictable method.

SMT: Medium-sized and large cavities

SMT is the best choice when cavities are large enough to involve more than half the occlusal surface or extend to the limits of the occlusal perimeter and in cases of Class 1 cavities converted from extensive Class 2 cavities. In this specific case (Fig 7-35), SMT was used to reconstruct molar cavities, while the cusp-by-cusp technique was used to reconstruct the premolar cavity after converting it from Class 2 to Class 1.

FIG 7-35 SMT. (a to f) With medium-sized to large cavities, it is advisable to reduce the cavity size using SMT to rule out the possibility of incorrectly proportioned increments. (Cusp-by-cusp technique used to reconstruct the premolar.)

References

1.Arnheim R. Arte e percezione visiva. Milan: Feltrinelli Editore, 2002.

2.Oskoee SS, Navimipour EJ, Bahari M, Ajami AA, Oskoee PA, Abbasi NM. Effect of composite resin contamination with powdered and unpowdered latex gloves on its shear

bond strength to bovine dentin. Oper Dent 2012;37:492–500.

3.Martins NM, Schmitt GU, Oliveira HL, Madruga MM, Moraes RR, Cenci MS. Contamination of composite resin by glove powder and saliva contaminants: Impact on mechanical properties and incremental layer debonding. Oper Dent 2015;40:396–402.

4.Münchow EA, Sedrez-Porto JA, Piva E, Pereira-Cenci T, Cenci MS. Use of dental adhesives as modeler liquid of resin composites. Dent Mater 2016;32:570–577.

Liebenberg WH. Occlusal index-assisted restitution of esthetic and functional anatomy in

5.direct composite restorations. Quintessence Int 1996;27:81–88.

6.Liebenberg WH. Posterior composite resin restorations: Operative innovations. Pract Periodontics Aesthet Dent 1996;8:769–778.

7.Dietschi D, Spreafico R. Adhesive metal-free restorations: Current concepts for the esthetic treatment of posterior teeth. Berlin: Quintessence, 1997.

8.Liebenberg WH. Successive cusp build-up: An improved placement technique for posterior direct resin restorations. J Can Dent Assoc 1996;62:501–507.

9.Ferracane JL, Hilton TJ, Stansbury JW, et al. Academy of Dental Materials guidance—Resin composites: Technique sensitivity (handling, polymerization, dimensional changes). Dent

Mater 2017;33:1171–1191.

10.Mantri SP, Mantri SS. Management of shrinkage stresses in direct restorative light-cured composites: A review. J Esthet Restor Dent 2013;25:305–513.

11.Scolavino S, Paolone G, Orsini G, Devoto W, Putignano A. The simultaneous modeling technique: Closing gaps in posteriors. Int J Esthet Dent 2016;11:58–81.