Figure 1. Stylization of the occlusion maps using the Y technique for posterior teeth. Left: The three key elements used to construct the posterior teeth. The occlusion maps are inserted into the occlusal tables (gray areas), which in turn have their boundaries established by the cusp tips (white spheres) surrounded more externally by the external tooth silhouette or contour. Right: A stylized drawing of the occlusion maps of the posterior teeth using the Y technique.
Figure 1. Stylization of the occlusion maps using the Y technique for posterior teeth. Left: The three key elements used to construct the posterior teeth. The occlusion maps are inserted into the occlusal tables (gray areas), which in turn have their boundaries established by the cusp tips (white spheres) surrounded more externally by the external tooth silhouette or contour. Right: A stylized drawing of the occlusion maps of the posterior teeth using the Y technique.
Figure 2. Four occlusal levels that must be considered when preparing posterior restorations: cusp tips, marginal ridges, main sulcus, and pits and fossae. Failure to respect this height relationship of the anatomical structures may necessitate extensive occlusal adjustment at the end of the restoration.
Figure 2. Four occlusal levels that must be considered when preparing posterior restorations: cusp tips, marginal ridges, main sulcus, and pits and fossae. Failure to respect this height relationship of the anatomical structures may necessitate extensive occlusal adjustment at the end of the restoration.
Figure 3. Different restorative techniques using conventional resin composites based on the number of shades used (represented by dark green, orange, and red colors): monochromatic (a), bichromatic (b), and polychromatic (c).
Figure 3. Different restorative techniques using conventional resin composites based on the number of shades used (represented by dark green, orange, and red colors): monochromatic (a), bichromatic (b), and polychromatic (c).
Figure 4. Initial aspect of an amalgam restoration to be replaced (a). Selective enamel etching with phosphoric acid (b). Application of self-etch adhesive system (c). A thin layer of opacifier is applied on darkened dentin (d). Insertion of dentin composite and design of occlusal map (e). Ochre, brown, and white tints applied to increase three-dimensionality (f). Enamel composite inserted using a single increment (g). Immediate final aspect of the restoration after removal of rubber dam and occlusal adjustment (h).
Figure 4. Initial aspect of an amalgam restoration to be replaced (a). Selective enamel etching with phosphoric acid (b). Application of self-etch adhesive system (c). A thin layer of opacifier is applied on darkened dentin (d). Insertion of dentin composite and design of occlusal map (e). Ochre, brown, and white tints applied to increase three-dimensionality (f). Enamel composite inserted using a single increment (g). Immediate final aspect of the restoration after removal of rubber dam and occlusal adjustment (h).
Figure 5. Restorative technique using single increment for dentin reconstruction. The cavity (a) is filled by single increment insertion of the dentin composite without photoactivation (b). The occlusion map is started using a very fine instrument (c). The instrument’s tip touches the bottom of the cavity, which allows the increments to be separated (d,e) and speeds up dentin construction.
Figure 5. Restorative technique using single increment for dentin reconstruction. The cavity (a) is filled by single increment insertion of the dentin composite without photoactivation (b). The occlusion map is started using a very fine instrument (c). The instrument’s tip touches the bottom of the cavity, which allows the increments to be separated (d,e) and speeds up dentin construction.
Figure 6. Class II restoration with composite. Positioning of partial matrices and wedges before application of adhesive system (a). Composite is placed in the proximal area and pre-polished with a brush before photoactivation (b). Aspect of the cavity with both proximal walls built with enamel composite (c). Proximal box filled with flowable bulk-fill composite (d). Restoration of artificial dentin and occlusal map design (e). Insertion of enamel composite on the occlusal surface (f). Aspect of the final occlusal anatomy (g) and finishing of proximal surfaces with scalpel blade (h).
Figure 6. Class II restoration with composite. Positioning of partial matrices and wedges before application of adhesive system (a). Composite is placed in the proximal area and pre-polished with a brush before photoactivation (b). Aspect of the cavity with both proximal walls built with enamel composite (c). Proximal box filled with flowable bulk-fill composite (d). Restoration of artificial dentin and occlusal map design (e). Insertion of enamel composite on the occlusal surface (f). Aspect of the final occlusal anatomy (g) and finishing of proximal surfaces with scalpel blade (h).
Figure 7. Different restorative strategies using bulk-fill resin composites. Green = flowable bulk-fill composite; Pink = conventional composite; Purple = regular bulk-fill composite. Reconstruction of the dentin portion with flowable bulk-fill composite and a conventional composite as the last layer (a). Reconstruction of the dentin portion with flowable bulk-fill composite and regular bulk-fill composite as the last layer for deeper cavities (b). Cavities that respect the limit of the composite polymerization depth can be restored with a single increment of regular bulk-fill composite (c). Deeper cavities can be restored with two increments of regular bulk-fill composite (d). Class II cavities can be restored with conventional composite emulating the enamel and its interior filled with flowable bulk-fill composite for dentin reconstruction. Similar to example (e), a regular bulk-fill composite can be used for the enamel (f). It is also possible to use flowable bulk-fill composite as a liner on the gingival wall for all techniques described here. Two increments of a larger volume of regular bulk-fill composite added above a liner with flowable bulk-fill composite (g).
Figure 7. Different restorative strategies using bulk-fill resin composites. Green = flowable bulk-fill composite; Pink = conventional composite; Purple = regular bulk-fill composite. Reconstruction of the dentin portion with flowable bulk-fill composite and a conventional composite as the last layer (a). Reconstruction of the dentin portion with flowable bulk-fill composite and regular bulk-fill composite as the last layer for deeper cavities (b). Cavities that respect the limit of the composite polymerization depth can be restored with a single increment of regular bulk-fill composite (c). Deeper cavities can be restored with two increments of regular bulk-fill composite (d). Class II cavities can be restored with conventional composite emulating the enamel and its interior filled with flowable bulk-fill composite for dentin reconstruction. Similar to example (e), a regular bulk-fill composite can be used for the enamel (f). It is also possible to use flowable bulk-fill composite as a liner on the gingival wall for all techniques described here. Two increments of a larger volume of regular bulk-fill composite added above a liner with flowable bulk-fill composite (g).
Figure 8. Examples of ‘bulk and body’ and ‘bulk and go’ restorative techniques. Bulk and body: restoring the dentin portion of the cavity with flowable bulk-fill composite (a,b), insertion of enamel composite (c), sculpture (d), and final aspect (e). Bulk and go: insertion of regular bulk-fill composite as single increment (f), accommodation of the increment (g), and final aspect of the sculpture (h).
Figure 8. Examples of ‘bulk and body’ and ‘bulk and go’ restorative techniques. Bulk and body: restoring the dentin portion of the cavity with flowable bulk-fill composite (a,b), insertion of enamel composite (c), sculpture (d), and final aspect (e). Bulk and go: insertion of regular bulk-fill composite as single increment (f), accommodation of the increment (g), and final aspect of the sculpture (h).
Figure 9. Class I restoration using a shade-matching resin composite. Filling irregular areas and rounding internal angles with shade-matching flowable composite (a). Insertion of shade-matching composite to replace dentin (b). Aspect of the artificial dentin after occlusal mapping and design (c). Insertion of the same shade-matching composite for the preparation of dental enamel in a single increment (d). Final aspect of artificial enamel carved in single increment (e). Extrinsic characterization with ochre, brown tints, and dentin composite for bleached teeth emulating regions of large amount of enamel as main lobes of the inclined cuspal planes (f). Final aspect of the restoration (g).
Figure 9. Class I restoration using a shade-matching resin composite. Filling irregular areas and rounding internal angles with shade-matching flowable composite (a). Insertion of shade-matching composite to replace dentin (b). Aspect of the artificial dentin after occlusal mapping and design (c). Insertion of the same shade-matching composite for the preparation of dental enamel in a single increment (d). Final aspect of artificial enamel carved in single increment (e). Extrinsic characterization with ochre, brown tints, and dentin composite for bleached teeth emulating regions of large amount of enamel as main lobes of the inclined cuspal planes (f). Final aspect of the restoration (g).
Table 1. Factors that have significant or limited influences on the clinical longevity of direct resin composite restorations.
Table 1. Factors that have significant or limited influences on the clinical longevity of direct resin composite restorations.
Significant Influence on Longevity Cavity size and volumeGreater loss of dental structure and cavity wallsTable 2. Characteristics of resin composites used for posterior restorations.
Table 2. Characteristics of resin composites used for posterior restorations.
Technique *Type of Resin Composite *CharacteristicsConventional incremental technique (increments typically up to 2 mm in thickness)Microhybrid/NanohybridA resin matrix of dimethacrylate monomers filled with two types/sizes of inorganic particles: nanofillers (<100 nm) and microfillers (>1 μm)Submicron/SuprananoParticle size is above the nano-scale (>100 nm) but below the micro-scale (<1 μm), typically 0.2–0.4 μmNanofillThe filler system contains only discrete
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