Direct Posterior Bonded Restorations - An Outline of a Clinical Technique

Author(s):

Sergio Rubinstein, DDS; Alan J. Nidetz, DDS, Manal Ibrahim, DDS

Date Added:

1/1/2002

Modern dentistry has experienced a major shift on patients’ demands from health and function to cosmetics. Materials and techniques are constantly evolving to adapt to these ever-changing needs. One major purpose of modern dentistry is not only to deliver this type of care with excellence but the preservation of healthy tooth structure is just as essential. This article describes current concepts to help consistently obtain an excellent, predictable and long lasting restoration with the direct posterior bonded restoration. Research has show that the direct posterior composite fits all of these criteria while also strengthening a tooth that has lost its integrity.

When either decay or removal of a previous restoration weakens a tooth, the direct posterior composite is the most conservative technique that can restore the original contours and colour.

While any restorative technique requires meticulous steps to achieve success, the intermediate steps during bonding are sensitive and critical. Furthermore, we recognise that if we do not control the shrinkage of the composite during its polymerisation it can create stress, microleakage, marginal breakdown, fractures and secondary caries. All of these could lead to the failure of the restoration and might necessitate endodontic therapy.

It is the Class I direct occlusal composite restoration that carries the highest stress due to the lack of free surface areas within the cavity. Therefore, the ratio between the bonded and free restoration surfaces (C-factor) is high, creating shrinkage stresses that are higher than the bond strength.