Posterior Composites – Module 6 PG Cert Operative Dentistry

Clinically, the placement of composite restorations must be accompanied by presence of rubber dam. This is highlighted in the photos from a recent case with Performace Smiles. In practice we always use rubber dam as a routine procedure to ensure appropriate moisture control. In conjunction with RD, when restoring class II cavities we use either palodent sectional matrices or automatrix depending on the situation. This session introduced the opportunity to use other matrix systems, including  V3 (prestige).

The thought process and selection of bonding system must be considered before commencing a restoration and the different generations of bonding systems were considered. In practice we currently use a 5^th generation system with a separate etch and combined prime and bond. (optibond solo plus). This is used in a total etch technique.

The session covered the importance of re-wetting the dentine after the etching and drying process. This can be achieved with use of a mild disinfectant such as tublicid to remove bacteria from the dentinal tubules after the etching process has removed the smear layer. Equally, 2% chlorhexidine can be used or hypochlorite.

This session on placement of posterior composites reinforced the importance of considering the impact of C-Factor. Where polymerisation shrinkage can result in post-operative sensitivity and unfavourable internal stress within restorations the method of incremental placement of layers of composite was put into practice. The layering process also ensures that the curing process was slowed down. The use of flowable composite as a base, followed by layering dentine shade composite, followed by enamel shades was carried out. Taking time to create the appropriate cusp inclinations and fissure patterns takes practice and a methodical approach. The finishing of the composite restoration requires the systematic use fine diamond burs, brown and green stones and diamond polishing paste with rubber cups. To enhance wear resistance, a final resin seal can be placed by further etching the surface of the composite restoration and placing a number of air thinned resin layers before curing.