Posterior_Direct_Restorations Salvatore_compressed

FIG 5-8 (a) Initial situation with occlusal surface characterized by suspect grooves with negative results on probing and radiographic examination. (b) The tooth is isolated with rubber dam. (c) The occlusal surface is cleaned using a paste containing pumice and chlorhexidine. (d) The grooves are further cleaned using high-pressure glycine sprays. (e) The glycine particles are small enough to clean all grooves very deeply and remove any pigment. The absence of caries can sometimes be established at this early stage. (f) After cleaning, the groove still looks strongly pigmented, and underlying caries activity is still suspected. (g) It is therefore justifiable to carry out a PRR, opening the suspect grooves in a conservative manner. (h) Opening the grooves reveals areas of demineralization that must be cleaned. The status of the preparation has therefore changed from a PRR to a Class 1 preparation. (i) Appearance of completed cavity. It is permissible to keep small undercuts if they do not leave undermined enamel areas. (j) The cavity margins are then ground with a fine-grained (40 µ) diamond bur. (k) Bonding procedures are carried out. In this case, a selfetch system is used with selective enamel etching. (l) Application of the bonding. When performing the bonding procedure on minimal groove cavities, it is advisable to apply the bonding using single-use brushes because they are smaller than microbrushes. (m and n) Although optional, application of a flowable composite to the base of the cavity is a convenient way to perform a visual check that no spaces have been left above the bonding

interface. (o) Composite masses are added bit by bit. (p) A horizontal layer is added before modeling the final layer. (q) Various modeling techniques can be used in small cavities. In this case, subtractive modeling (see chapter 7) makes it possible to finalize the occlusal surface very quickly. (r) The restorations are finished and polished using fine-grained diamond burs and silicone tips. A final step is carried out with silicon carbide brushes. (s) The restoration before removing the rubber dam. (t) Completed restoration.