429 Too Many Requests

Case by CDT Daniele Rondoni

When planning to replace Class II restorations, many things need to be considered. In order to select the most appropriate restorative technique and preparation design, it is essential to evaluate the amount and state of the remaining tooth structure, first. After repeated restoration replacement or in teeth originally restored with amalgam, for example, the remaining walls and cusps are often weakened and prone to fractures and cracks. When the cavity walls appear to be too thin or the structure is weak at the time of restoration replacement, it may be better to remove walls and cusps and opt for indirect adhesive restorations (overlays) instead of direct composite restorations. Due to favourable material properties – in particular a high flexural and compressive strength while being gentle to the opposing dentition and not too rigid for the surrounding tooth structures – we often opt adhesive restorations made of KATANA™ AVENCIA™ Block in those situations.

The following clinical case is used to describe the replacement of two composite restorations with overlays made of the innovative hybrid ceramic material.

Fig. 1. Initial clinical situation with composite restorations on the second premolar and first molar in need of replacement. The tooth structure particularly of the first molar was weak, with the distobuccal cusp already fractured.

Fig. 2. Prepared tooth structure ...

Fig. 3. Restorations milled from a KATANA™ AVENCIA™ Block after high-gloss polishing and characterization.

Fig. 4. Finalized restorations on a resin model.

Fig. 5. Adhesively cemented restorations in the patient’s mouth.

FINAL SITUATION

Fig. 6. Treatment outcome with a nice transition from the tooth structure to the restoration.

Dentist:

DANIELE RONDONI, MDT

Born in Savona in 1961 where he lives and has worked in his own laboratory since 1982 with his collaborators. Graduated from the dental technician school IPSIA “P. Gaslini” in Genoa in 1979. He continued his education by attending relevant workshops for the “Italian dental school“ and broadened his professional experience in Switzerland, Germany and Japan. Since 2011 Kuraray Noritake Dental International Instructor.

Case by Dr. Jusuf Lukarcanin

Restoring posterior cavities is a standard task we perform virtually every day. Yet, it is a challenging procedure as access to the affected teeth is often limited. This fact complicates many steps from working field isolation to material application and sculpting. By streamlining procedures and establishing protocols that are followed every time, it is possible to achieve predictable outcomes even in difficult situations, as shown below.

Fig. 1. Class II cavity in a second molar after caries removal and cavity preparation.

Fig. 2. Working field isolation.

Fig. 3. Application of adhesive (e.g. CLEARFIL S³ BOND PLUS) into the cavity.

Fig. 4. Build-up of the proximal wall with CLEARFIL MAJESTY™ ES-2 Classic (Kuraray Noritake Dental Inc.) in the shade A2.

Fig. 5. Build-up of the dentin core using the incremental technique with CLEARFIL MAJESTY™ ES-2 Premium in the shade A2D.

Fig. 6. Contouring of the occlusal enamel layer made of CLEARFIL MAJESTY™ ES-2 Premium in the shade A2E.

Fig. 7. Polishing of the restoration with Twist DIA for Composite.

FINAL SITUATION

Fig. 8. Treatment outcome.

Dentist:

DR. JUSUF LUKARCANIN

Dr. Jusuf Lukarcanin is a Certified Dental Technician (DCT) and a Doctor of Dental Science (DDS). He studied dentistry at the Ege University Dental Faculty in Izmir, Turkey, where he obtained a Master‘s degree in 2011. In 2017, he received a Ph.D. degree from the Department of Restorative Dentistry of the same university. Between 2012 and 2019, Dr. Lukarcanin was the head doctor and general manager at a private clinic in Izmir. Between 2019 and 2020, he worked at Tinaztepe GALEN Hospital as a Restorative Dentistry specialist, between 2020-2022 he worked at MEDICANA International Hospital Izmir as a Restorative Dentistry specialist. Currently he is an owner of a private clinic for aesthetics and cosmetics in Izmir.

Compact, time-saving and aesthetic

How many different shades of composite do you need to create appealing restorations in virtually every clinical situation? If you opt for “CLEARFIL MAJESTY™ ES-2” Universal shade concept, a few shades will do the trick.

With wonderful support of our internationally recognized key opinion leaders, we have prepared a Clinical Case brochure of “CLEARFIL MAJESTY™ ES-2” Universal for you. The brochure highlights a variety of clinical cases in the anterior and posterior region to show the all about excellent properties of our latest composite. Let the pictures speak for themselves!

Click here to view. Enjoy!

Start Reading: Special MAJESTY ES-2 Universal - Clinical Cases Brochure

Case by Dr. Nicola Scotti

When restoring posterior teeth with resin composite, functional aspects such as tight and anatomically correct proximal contacts and a naturally shaped occlusal surface that is wear-resistant and antagonist-friendly are even more important than a perfect optical integration. This is why every dental practitioner should avoid spending a lot of time on shade selection in these cases and focus on the factors that have an impact on the reliability and longevity of the restoration. Great support in accomplishing this task is offered by CLEARFIL MAJESTY™ ES-2 Universal, a resin composite with a single universal shade (U) for the posterior region that eliminates the need for shade taking and selection. At the same time, it offers good marginal adaptation, low shrinkage stress and high wear resistance needed for great long-term results.

Fig. 1. Initial situation with a wide primary carious lesion in the distal aspect of the second premolar.

Fig. 2. Premolar after isolation of the working field with rubber dam, caries excavation and cavity preparation.

Fig. 3. Placement of a sectional matrix and a wedge to optimize the fit. Both are held in place with a separation ring, which increases the interproximal space and hence ensures tight, anatomically correct proximal contacts.

Fig. 4. Build-up of the proximal wall with CLEARFIL MAJESTY™ ES-2 Universal (U shade) following selective enamel etching with phosphoric acid (K-ETCHANT Syringe) and bonding with CLEARFIL™ SE Bond.

Fig. 5. A thin layer of flowable composite (CLEARFIL MAJESTY™ ES FLOW High) applied to the cavity floor to act as a resin coat.

Fig. 6. Restoration completed with CLEARFIL MAJESTY™ ES-2 Universal (U shade). While the universal shade composite blends in very well with the surrounding tooth structure, the natural look is completed by adding a tiny bit of brown tint to the fissure.

Fig. 7. Treatment outcome immediately after rubber dam removal. The proximal contact is tight and the occlusal anatomy well-shaped for the patient’s individual masticatory dynamics. The margin of the restoration is virtually invisible, while the buccal cusp appears lighter due to dehydration of the natural tooth structure.

FINAL SITUATION

Fig. 8. Treatment outcome after two months.

Conclusion

The present case demonstrates that the selected composite is well-suited for simplified restoration procedures in the posterior region. The material handles well, offers the same mechanical properties as other materials from the CLEARFIL MAJESTY™ ES-2 series and blends in harmoniously with the surrounding structures without being too translucent. This way, it is possible to waive the shade-taking process without compromising the treatment outcome. The time saved in this context may be spent on functional aspects – or even on another patient.

Dentist:

DR. NICOLA SCOTTI

Case by Adham Elsayed

If we ask dental patients what they expect from direct restorative treatments, they will most probably mention a quick procedure – as nobody wants to sit in a dental chair for a long time – and highly aesthetic outcomes. Reducing the treatment time is also something every dental practitioner should strive for, as their own time is the most precious asset they have. Fortunately, saving time becomes easy when appropriate high-quality materials and techniques are selected, as demonstrated using the following patient case.

The patient presented with several small carious lesions in the lower anterior region. In order to save time without compromising the quality of the outcomes, it was decided to opt for a simultaneous direct treatment approach involving the use of a universal adhesive and a universal restorative with a streamlined shade offering. It consists of two shades for the anterior region, which are typically applied in a single-shade approach and have optimized optical properties that allow for a smooth optical integration. The images shown below speak for themselves…

Fig. 1. Initial situation. Several caries lesions are detected on the lower anterior teeth.

Fig. 2. Situation after placement of rubber dam for moisture control.

Fig. 3. Appearance of the teeth following caries removal.

Fig. 4. Application of CLEARFIL™ Universal Bond Quick.

Fig. 5. Labial view of the final restorations produced with CLEARFIL MAJESTY™ ES-2 Universal (UD) before finishing and polishing.

FINAL SITUATION

Fig. 6. Final situations after rubber dam removal.

Dentist:

Dr. Adham Elsayed
Clinical and Scientific manager, Kuraray Europe GmbH, Hattersheim, Germany.

Case by Dr. Kristine Aadland.

Fig. 1. Preparation.

The patient’s old PFM bridge (shown here) was removed, and the existing preps for teeth #6 and #8 were modified with a medium chamfer with smooth and rounded edges to accommodate a 3-unit KATANA™ Zirconia bridge. There was no abutment for tooth #7, as that space serves as the pontic. Tooth #9 was similarly prepared to receive a single-unit KATANA™ crown.

Fig. 2. Define Restorations.

To begin, each restoration type is defined in the CEREC software, as the design mode (Biogeneric Individual), material type (KATANA™ Zirconia Block), and milling device (CEREC MC XL).

Fig. 3. Digital Impression.

A digital impression of the upper arch was performed using CEREC Primescan.

Fig. 4. Restoration Design.

The patient did not like the size of her centrals and wanted them smaller. She also didn’t like that her smile was slanted/canted. While designing, it really helps to use the patient’s old smile as a reference. This is why I used Bioindividual when designing the restorations, and added a BioCopy folder in the acquisition screen. I can ghost over the previous smile and readily see where I am.

Fig. 5. Restoration Design: Occlusal.

The BioCopy design function is also utilized to ensure a correct occlusal profile.

Fig. 6. Milling.

A KATANA™ Zirconia Block for bridge (14Z L) was used for the 3-unit bridge, and a KATANA™ Zirconia 12Z single-unit block was used for the single crown. The bridge block mills out in about 18 minutes, which is the fastest-milled chairside bridge block currently available.

Fig. 7. Characterization & Sintering.

Kuraray Noritake CERABIEN™ ZR FC Paste Stain and Glaze Kit was used for characterizing. The colors are very natural and it is not simply a metal oxide like other stains, but actually adding porcelain, giving the restorations more vitality. The oven cycle is quick at approximately 10 minutes, which means multiple fires are easy to do without excess time.

Fig. 8. Seating & Final Smile.

PANAVIA™ SA Cement Universal and CLEARFIL™ Universal Bond Quick were used for cementation and bonding. I love the ease of use and clean-up with PANAVIA™ SA Cement Universal, and its MDP monomer creates a strong chemical bond to the tooth structure and zirconia. CLEARFIL™ Universal Bond Quick has a quick technique without reducing bond strengths, releases fluoride and has a low film thickness. I simply rub CLEARFIL™ Universal Bond Quick into the tooth for a few seconds and air dry. There is no need to light-cure, since it cures very well with PANAVIA™ SA Cement Universal. The patient was very happy with the results. She loved that she no longer saw metal margins, and her smile was much more uniform and lifelike.

DR. KRISTINE AADLAND

Using KATANA™ Cleaner and PANAVIA™ SA Cement Universal

Case by Dr. Richard Young

Fig. 1. HF etch and try-in complete.

Fig. 2. Dispense KATANA™ Cleaner into mixing well.

Fig. 3. Rub for 10 seconds, then rinse and dry.

Fig. 4. Rub for 10 seconds, then rinse and dry. KATANA™ Cleaner contains MDP based surfactant that breaks down blood and saliva - removing contamination.

Fig. 5. Apply cement directly onto restoration (glass ceramic, zirconia, metal or composite resin).

Fig. 6. PANAVIA™ SA Cement Universal contains MDP and LCSi monomers, providing for durable bonding even to lithium disilicate restorations.

Fig. 7. Tack-cure for 2-5 seconds.

Fig. 8. Tack-curing results in nice gel-like-state and excess is removed with ease.

FINAL SITUATION

Fig. 9. Final situation.

Dentist:

DR. RICHARD YOUNG

Case by Dr. Shoji Kato of Takanawa Dental Office, Japan

1. After preparing the abutments

An anterior bridge made of crown and bridge resin has become dislodged. The abutments are vital teeth.

2. Prosthesis

A PFZ bridge with a frame fabricated using KATANA™ Zirconia HT12.

3. Application of Try-in Paste

Evaluate the shade of the cement before cementation.

4. Try-in

After checking the cement’s shade, rinse the prosthesis and tooth surface with water to remove Try-in Paste.

5. Pretreatment of the prosthesis (A)

Sandblast the prosthesis (at 0.3 to 0.4 MPa), clean with an ultrasonic cleaner for 2 minutes, then dry.

6. Pretreatment of the prosthesis (B)

Apply CLEARFIL™ CERAMIC PRIMER PLUS and blow dry with air.

7. Pretreatment of the abutments (C)

Apply Tooth Primer, allow it to react for 20 seconds, then blow dry with air.

8. Application of Paste

Use Universal.

9. Placement of the prosthesis

After placement, remove excess cement using a piece of gauze, a small brush, etc.

10. Light-curing

Light-cure the entire surface of the prosthesis, including the margins.

11. Final polymerization

Make sure the prosthesis is left in place, unmoved, for 3 minutes.

Case by Dr. Salvatore Scolavino

After decades of developing and improving the matrix chemistry and filler technology contained in resinbased composites, the products available for direct restorative procedures finally seemed technically mature. What remained challenging, however, was the management of the extremely wide range of tooth shades and opacities available for each product: The dentin, body and enamel masses had to be selected and combined in the right way to obtain a perfect colour match and optical integration with the surrounding tooth structure. The difficulties associated with shade selection and calibration of layer thicknesses (particularly the top enamel layer) required to obtain the desired optical (desaturation) effects have now also finally been overcome.

The reason is that further improvements of the composites’ optical properties, mainly achieved through a careful selection and combination of fillers, have enabled the production of materials with optimized light diffusion properties. These properties enable the restorations to blend in smoothly with the adjacent tooth structure, thus paving the way for a single-shade concept (SSC). This concept involves the use of a single mass of composite to restore the function and aesthetics compromised by the loss of dental structure.

This translates into a significant saving of chair time and a high predictability of aesthetic outcome. A composite material supporting a single-shade technique needs to have medium opacity and a technology ensuring that the incoming light is absorbed, reflected and scattered in the right way to merge effortlessly with the surrounding natural dentition and create a biomimetic effect. The following clinical case reveals how the Light Diffusion Technology used in the CLEARFIL MAJESTY™ ES-2 Universal composite system (Kuraray Noritake Dental Inc.) leads to a highly predictable aesthetic integration obtained using the SSC.

Case description

The 30-year-old female patient presented for a check-up, during which it appeared that her composite restorations in the second quadrant (the maxillary left first and second molar) needed to be replaced due to marginal leakage (Fig. 1). Once the rubber dam was in place (Fig. 2), the existing composite restorations were removed using a round multi-blade bur, which allowing for a selective removal of composite and carious tissue. The extension of the cavity was performed with a truncated cone diamond bur (fine). Once the cavity preparation was completed (Fig. 3), the enamel and dentin surfaces were cleaned by sandblasting with aluminium oxide (50 μm). Selective etching of the enamel was performed with K-ETCHANT Syringe (Kuraray Noritake Dental; Fig. 4), followed by thorough rinsing and drying of the tooth (Fig. 5). For the adhesive procedure with CLEARFIL™ SE BOND 2 (Kuraray Noritake Dental), the primer was applied first (Fig. 6), rubbed into the tooth surface for 40 seconds and air-dried. The bond was subsequently applied in the same manner (Fig. 7). After several seconds of air flowing to create homogeneous surface the adhesive was light-cured for 40 seconds (Fig. 8). As the last phase of the adhesive procedure, a 1-mm-thick layer of flowable composite (CLEARFIL MAJESTY™ ES-Flow Super Low A3, Kuraray Noritake Dental) was applied to cover the adhesive on the dentin (Figs. 9 and 10).

Fig. 1. Pre-operative clinical image.

Fig. 2. Isolation with rubber dam.

Fig. 3. First and second molar after cavity preparation.

Fig. 4. Selective etching of the enamel.

Fig. 5. Cavities ready for the adhesive procedure.

Fig. 6. Application of the tooth primer.

Fig. 7. Glossy appearance of the cavities after application of the bond.

Fig. 8. Light-curing of the adhesive layer.

Fig. 9. Application of flowable composite.

Fig. 10. Cusp-by-cusp modelling of the universal composite.

In the modelling phase, the posterior shade U of the composite CLEARFIL MAJESTY™ ES-2 Universal was placed using the cusp-by-cusp technique (Figs. 11 and 12). In order to improve the optical integration of the restorations, some brown stain (CHROMA ZONE™ COLOR STAIN Dark Brown, Kuraray Noritake Dental) was added to the fissures (Fig. 13). For finishing, we used a multi-blade ball-shaped bur and an Arkansas Flame abrasive stone (Fig. 14). Polishing of the restorations was accomplished with the TWIST™ DIA system (EVE; Fig. 15). After rubber dam removal, the occlusal check was performed with articulating paper (Fig. 16), minimal adjustments were made and the surfaces repolished. The integration of the restorations after 30 days fully meets the clinical expectations (Figs. 17 to 20).

Fig. 11. Glossy appearance of the cavities after application of the bond.

Fig. 12. Completed occlusal anatomy.

Fig. 13. Stained fissures.

Fig. 14. Matte surfaces after finishing.

Fig. 15. High-gloss surfaces after polishing.

FINAL SITUATION

Fig. 16. Whole quadrant after rubber dam removal and the occlusal check.

Fig. 17. Whole quadrant at the 1-month-recall.

Fig. 18. Occlusal view of the restorations …

Fig. 19. … after one month.

Conclusion

The innovative composite system CLEARFIL MAJESTY™ ES-2 Universal, which consists of two shades for the anterior and a single shade option for the posterior region, offers the properties needed for a successful implementation of the single shade technique. Used in the posterior region, the material is sufficiently opaque to mask optical irregularities of the underlying tooth structure, while it is translucent enough to provide for an imperceptible optical transition from the tooth structure to the restoration. Irrespective of the tooth shade, the restoration merges smoothly with the surrounding natural dentition, creating a harmonic overall picture.

Dentist:

DR. SALVATORE SCOLAVINO

Dr. Salvatore Scolavino, graduated with honors in Dentistry and Dental Prosthesis from the University of Naples. Dr. Salvatore is a specialist in aesthetics and direct and indirect anterior and posterior adhesive restorations. His focus lies with Conservation, Endodontics and Prosthetics in particular. He is an active member of prestigious academies and scientific societies: AIC -Italian Academy of Conservation, IAED -Italian Academy of Esthetic Dentistry and SIDOC (Italian Society of Conservative Dentistry. Since 2004, he has private practice Nola, Italy.

Dr. Scolavino is a founder of werestoreit.it, an inspiring site that offers abundance and variety of aesthetic clinical cases. Author of the book published by Quintessence Publishing „Direct Restorations in the posterior regions“, author of scientific publications in national and international journals, he is speaker at courses and conferences in Italy and abroad.

Case by Dr. Salvatore Scolavino

The establishing of a stable occlusal relationship is one of the biggest challenges dental practitioners are facing when restoring posterior teeth with resin composite, but it is a task with a decisive impact on the integrity of the masticatory apparatus. A poor static and dynamic occlusion may have a negative effect on the restored tooth, the periodontal apparatus, and also on the opposing dentition.¹ Ideally, the occlusal anatomy of direct restorations is designed in a way that occlusal forces are directed along the long axis of the tooth, which is achieved when each cusp tip in occlusal contact touches a flat surface. Horizontally directed forces, on the other hand, should be avoided, as they tend to cause tipping and increase the risk of cuspal fracture, tooth mobility etc.

In cases concerning improper occlusal relationship involving tipping of restored teeth, it may be possible to stabilize the situation by replacing the restoration and re-establishing a proper occlusion. If carried out correctly and early enough, this restorative approach may be a way around orthodontic treatment. The following clinical case is used to demonstrate how to create a functional occlusal surface right away – without larger adjustments. The whole restorative procedure is simplified by the use of a universal composite with a single posterior shade that eliminates the need for shade determination and shade selection, while it produces lifelike treatment outcomes.

Case description

This patient presented with direct composite restorations in the mandibular left first and second molar that were lacking an elaborated occlusal morphology (Fig. 1). The second molar appeared to be tipped mesially towards the first molar (Figs. 2 and 3), which resulted in improper occlusal relationships and a decreased position of the mesial marginal ridge. In order to verify the clinical and radiographic observation of an improper occlusal relationship, the occlusal contacts were recorded with articulating paper (Fig. 4). As expected, there was an uneven distribution of occlusal contacts, which were exclusively located in the distobuccal area on the second molar, and not matching the tooth-restoration interface on both molars.

Fig. 1. Pre-operative clinical situation: Occlusal view.

Fig. 2. Pre-operative clinical situation: Lateral view revealing the tipping of the second molar.

Fig. 3. Pre-operative bite-wing radiograph confirming the tipping issue.

Fig. 4. Checking of the occlusal contacts.

Planned approach

As orthodontic treatment was not an option, it was decided to replace the composite restorations, thereby treating the Class I cavity of the second molar as if it were a Class II cavity. This would allow us to increase the height of the mesial marginal ridge and establish the proper occlusion.

Preliminary measures

Once the rubber dam was placed (Fig. 5), the existing composite restorations were removed and the cavity slightly extended with a diamond chamfer bur (Fig. 6). The result of this procedure is shown in Figure 7. In order to provide an anatomical build-up of the mesial wall, a sectional matrix was mounted with the aid of a wooden wedge and a separator ring (Fig. 8).

Fig. 5. Isolation with rubber dam, held in place with a clamp and a wedge.

Fig. 6. Tooth preparation with a diamond chamfer bur.

Fig. 7. Appearance of the teeth after preparation.

Fig. 8. Sectional matrix, wedge and separator ring in place.

Adhesive procedure

After selective etching of the enamel (K-ETCHANT GEL, Kuraray Noritake Dental Inc.) (Fig. 9), the enamel bonding surfaces had a chalky-white appearance, which indicates properties that are favourable for bonding (Fig. 10). The adhesive procedure was performed with CLEARFIL™ SE BOND 2 (Kuraray Noritake Dental; Fig. 11). In the first step, the primer of the system was applied and actively rubbed into the surface for 40 seconds, and air-dried. Subsequently, the bond was used in the same manner. After complete evaporation of the solvent, the bonding surface was light-cured for 40 seconds to ensure proper polymerisation. The cavity floor was then covered with a 1 mm thick layer of flowable composite (CLEARFIL MAJESTY™ ES FLOW SUPER LOW A3, Kuraray Noritake Dental).

Fig. 9. Selective etching of the enamel.

Fig. 10. Chalky-white enamel surfaces.

Fig. 11. Glossy appearance of the bonding surfaces after application of the tooth primer and bond.

Restoration procedure

Before starting to elevate the mesial wall of the second molar using the centripetal build-up technique² (Fig. 12), we analyzed the height of the marginal ridge and anatomical details of the contralateral tooth, while the adjacent molar provided orientation as well. In general, knowledge not only about the tooth’s typical anatomy, but also about the patient-specific anatomical details of the adjacent and contralateral teeth as well as the antagonist is very useful for designing the occlusal anatomy. In addition, remaining anatomical structures should be read and used. In this particular case, the restorations were completed with CLEARFIL MAJESTY™ ES-2 Universal composite (Kuraray Noritake Dental) in the posterior shade U, using the cusp-by-cusp technique (Figs. 13 to 15). In most areas, it was possible to follow the inclination of the remaining cusps and the orientation of the grooves to produce an ideal surface anatomy. For those who would like to speed up the procedure, the simultaneous modeling technique³ may be an option. In this technique, the cusps are built up simultaneously from separate increments, which remain out of contact to each other until light-cured in a single curing cycle.

Fig. 12. Mesial wall built up with composite.

Fig. 13. Application of the first increment for cusp build-up. It is useful to limit the size of the increments for controllability.

Fig. 14. Cusp-by-cusp build-up completed on the second molar.

Fig. 15. Molars with restored occlusal surfaces.

In order to improve the already great optical integration of the restorations, some stain (Dark Brown, CHROMA ZONE™ COLOR STAIN, Kuraray Noritake Dental) was applied to the fissures. A multi-blade ball shaped bur and an Arkansas Flame abrasive stone were used for finishing. Final polishing was accomplished with the TWIST™ DIA system (EVE). The immediate treatment outcome is shown in Figure 16. The patient was released after rubber dam removal, checking the static and dynamic occlusion, and conducting a control radiograph (Fig. 17). The optical integration was even better at the recall after one month due to the rehydration of the surrounding tissues (Fig. 18), while the functional integration was excellent and no occlusal adjustments were required.

Fig. 16. Immediate treatment outcome with a nice optical integration of the restorations providing for a stable occlusal relationship.

Fig. 17. Control radiograph taken after the direct restoration procedure.

FINAL SITUATION

Fig. 18. Treatment outcome at recall after 30 days.

Conclusion

The presented case example reveals how important it is to strive for occlusal stability when restoring posterior teeth with composite. Furthermore, it demonstrates how it is possible to re-establish a stable occlusal relationship, even if some tipping has already occurred. In order to get it right the first time, it is essential to make use of the remaining anatomical structures, which guide the way toward an occlusal surface that ensures a favourable distribution of occlusal forces, and therefore provides optimal conditions for a long life of the freshly restored teeth. The combined use of the presented restorative techniques with innovative materials like CLEARFIL MAJESTY™ ES-2 Universal will make the procedures simpler and even more efficient.

References

1 Sandhu S, Lal J, Singh R, Sandhu R, Sra J. Significance of establishing occlusal anatomy in operative dentistry. Saint Int Dent J 2016;2:7-10.
2 Bichacho N. The centripetal build-up for composite resin posterior restorations. Pract Periodontics Aesthet Dent. 1994 Apr;6(3):17-23.
3 Scolavino S, Paolone G, Orsini G, Devoto W, Putignano A. The Simultaneous Modeling Technique: closing gaps in posteriors. Int J Esthet Dent. 2016 Spring;11(1):58-81.

Dentist:

DR. SALVATORE SCOLAVINO

Dr. Salvatore Scolavino, graduated with honors in Dentistry and Dental Prosthesis from the University of Naples. Dr. Salvatore is a specialist in aesthetics and direct and indirect anterior and posterior adhesive restorations. His focus lies with Conservation, Endodontics and Prosthetics in particular. He is an active member of prestigious academies and scientific societies: AIC -Italian Academy of Conservation, IAED -Italian Academy of Esthetic Dentistry and SIDOC (Italian Society of Conservative Dentistry. Since 2004, he has private practice Nola, Italy.

Dr. Scolavino is a founder of werestoreit.it, an inspiring site that offers abundance and variety of aesthetic clinical cases. Author of the book published by Quintessence Publishing „Direct Restorations in the posterior regions“, author of scientific publications in national and international journals, he is speaker at courses and conferences in Italy and abroad.