Treatment of a carious lesion with a composite with a single posterior shade
Dr Nicola Scotti, Italy

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 perfect optical integration. This is why every dental practitioner should avoid spending a great deal 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 “It offers good marginal adaptation, low shrinkage stress and high wear resistance, necessary for great long-term results.”

Universal (Kuraray Noritake Dental), a resin composite with a single universal shade (U) for the posterior region that eliminates the need for shade taking and selection. It offers good marginal adaptation, low shrinkage stress and high wear resistance, necessary for great long-term results.

The initial situation presented a wide primary carious lesion in the distal aspect of the second premolar (Fig. 1).

The working field of the premolar was first isolated with a dental dam, and caries excavation and cavity preparation were performed (Fig. 2).

A sectional matrix and a wedge were then placed to optimise the fit. Both were held in place with a separation ring, which increases the inter-proximal space and hence ensures tight, anatomically correct proximal contacts (Fig. 3).

Build-up of the proximal wall with CLEARFIL MAJESTY ES-2 Universal (Shade U) was then done, after selective enamel etching with phosphoric acid (K-ETCHANT Syringe, Kuraray Noritake Dental) and bonding with CLEARFIL SE BOND (Fig. 4).

After that, a thin layer of flowable composite (CLEARFIL MAJESTY ES Flow High) was applied to the cavity floor to act as a resin coat (Fig. 5).

Restoration was completed with CLEARFIL MAJESTY ES-2 Universal (Shade U). Although this composite blends in very well with the surrounding tooth structure, the natural look was finished off by adding a tiny bit of brown tint to the fissure (Fig. 6).

The restoration and soft tissue looked natural and healthy immediately after removal of the dental dam. The proxi-mal contact was tight, and the occlusal anatomy well shaped for the patient’s individual masticatory dynamics. The margin of the restoration was virtually invisible, but the buccal cusp appeared lighter because of dehydration of the natural tooth structure (Fig. 7).

The final treatment outcome was very satisfying (Fig. 8).

Conclusion

The case presented demonstrates that the selected composite is well suited for simplified restorative 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 mal wall with CLEARFIL MAJESTY ES-2 Universal (Shade U) was then done, after selective enamel etching with phosphoric acid (K-ETCHANT Syringe, Kuraray Noritake Dental) and bonding with CLEARFIL SE BOND (Fig. 4). After that, a thin layer of flowable composite (CLEARFIL MAJESTY ES Flow High) was applied to the cavity floor to act as a resin coat (Fig. 5). Restoration was completed with CLEARFIL MAJESTY ES-2 Universal (Shade U). Although this composite blends in very well with the surrounding tooth structure, the natural look was finished off by adding a tiny bit of brown tint to the fissure (Fig. 6).

The restoration and soft tissue looked natural and healthy immediately after removal of the dental dam. The proximal contact was tight, and the occlusal anatomy well shaped for the patient’s individual masticatory dynamics. The margin of the restoration was virtually invisible, but the buccal cusp appeared lighter because of dehydration of the natural tooth structure (Fig. 7). The final treatment outcome was very satisfying (Fig. 8).

Conclusion

The case presented demonstrates that the selected composite is well suited for simplified restorative 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.