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Direct placement resin composite is revolutionizing the restoration of posterior teeth. Compared to amalgam, its use not only improves aesthetics but, more importantly, promotes a minimally invasive approach to cavity preparation. Despite the benefits, the use of composite to restore load-bearing surfaces of molar and premolar teeth is not yet universally applied. This may be due to individual practitioner concerns over unpredictability, time and the fact that procedures remain technique sensitive for many, particularly with regard to moisture control, placement and control of polymerization shrinkage stress. New materials, techniques and equipment are available that may help to overcome many of these concerns. This paper describes how such techniques may be employed in the management of a carious lesion on the occlusal surface of an upper molar.
Clinical Relevance: Direct posterior composite is the treatment of choice for the conservative restoration of primary carious lesions.
Article
A Class I carious lesion (ICDAS 3)1 was detected in the mesial pit of an upper second molar (Figure 1). The lesion was diagnosed as active with respect to enamel cavitation exposing dentine. In addition the patient's dietary habits, oral hygiene measures and the presence of active lesions elsewhere indicated the need for operative intervention.
Placement of direct restorations in the molar regions can present difficulty with regard to moisture control. Use of rubber dam with a single hole and a versatile winged molar clamp (Hygenic 12A, Coltène-Whaledent, Switzerland)) provided rapid isolation, which was completed (Figure 2) by flossing the dam through the mesial contact point. The speed with which this technique achieves isolation and promotes a comfortable experience for the patient and a predicable outcome for the operator cannot be overemphasized. Although the vast majority of practitioners do not routinely use rubber dam,2 the isolation of a single tooth for an occlusal restoration is a perfect starting point for those wishing to learn and refine rubber dam techniques.
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