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Show Your Work: Stacking the Odds for Success by Dr. Nichole Lubberts

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Show Your Work: Stacking the Odds for Success 

Creating Class II restorations on multiple teeth in the same quadrant

by Dr. Nichole Lubberts

Introduction
A 29-year-old male patient presented for Class II restorations because of interproximal caries on teeth #13-MOD (Fig. 1) and #14-DO (Fig. 2). The caries was just below the contact points of the teeth and visible on radiographic images (Fig. 3). Both teeth tested vital during the initial examination but were sensitive to cold liquids. Treatment focused on forming a gap-free marginal seal and natural tooth contour to reduce his sensitivity.
Class II restorations
Fig. 1: Tooth #13 before treatment. Interproximal decay found radiographically.
Class II restorations
Fig. 2: Tooth #14 before treatment. Interproximal decay found radiographically.
Class II restorations
Fig. 3: Preoperative X-ray.


After rubber dam isolation, each prep was selectively etched using 34% etchant for better bond strength to the enamel margins (Fig. 4). The Palodent Plus Sectional Matrix System (Dentsply Sirona, Fig. 5) was used to replicate each tooth’s natural contours and ensure tight contacts, while providing optimal isolation from contaminants. Palodent Plus retaining rings were stacked together in the same arch (Fig. 6) to allow for multiple restorations simultaneously. For adhesive placement, Prime&Bond Elect Universal Dental Adhesive was chosen based on its ability to chase water molecules away, enabling a strong bond with less sensitivity.
Class II restorations
Fig.4: Selective etching for better bond strength to the enamel margins.
Class II restorations
Fig.5: Confirming adjacent contacts after placement of the Palodent Plus Matrix System.
Class II restorations
Fig.6: Three Palodent Plus Sectional Matrix Rings are stacked together easily in the same arch.


For the base composite layer, SDR Flow+ Bulk Fill Flowable (Figs. 7 and 8) was used for each interproximal box because of its self-leveling properties, even when used upside down in the maxillary arch. This created gap-free adaptation to the margins of the prep with less technique sensitivity. Each preparation was finished with TPH Spectra ST Universal Composite (Fig. 9) in Shade A2 for easy handling, along with durability and stain resistance for lasting aesthetics. Curing was completed using the Smart- Lite Pro Modular LED Curing Light (Fig. 10), which was able to evenly cure each molar in 10 seconds.
Class II restorations
Fig.7: SDR Flow+ material is placed in the interproximal boxes.
Class II restorations
Fig.8: The SDR Flow+ material selflevels even upside down in the upper arch for gap-free adaptation.
Class II restorations
Fig.9: TPH Spectra ST composite Shade A2 placed as final layers.
Class II restorations
Fig.10: The SmartLite Pro curing light.

Finishing and occlusal interferences were adjusted appropriately to the patient’s occlusion using the one-step Enhance Finishing System (Fig. 11) for a smooth finish. The postoperative X-ray (Fig. 12) showed excellent anatomy of the restorations, as well as a high radiopacity of the composite materials. The patient later reported that his cold sensitivity had been successfully treated.
Class II restorations
Fig. 11: Finishing with Enhance finishers for a smooth surface.
Class II restorations
Fig. 12: Postoperative X-ray shows excellent anatomy and radiopacity.


Discussion
Class II restorations do not have to be tedious or time-consuming. In our patient’s case, the caries were easily treated using resin-based composite materials for natural aesthetics (Figs. 13 and 14). Meanwhile, the sectional matrix, retaining rings, LED curing light and one-step finishing system ensured a streamlined workflow for the practitioner and long-lasting results for the patient—simplifying the Class II procedure without sacrificing quality. Finally, the low film thickness of the bonding agent and excellent cavity adaptation of the bulk-fill flowable were used to reduce sensitivity and ensure a gap-free restoration.
Class II restorations
Fig. 13: #13-MOD was completed using a Class II composite restoration.
Class II restorations
Fig.14: #14-DO was completed using a Class II composite restoration.
Author Bio
Dr. Nichole Lubberts Dr. Nichole Lubberts is a graduate of Marquette University School of Dentistry and the owner of a private dental practice in Grand Rapids, Michigan. She has made it her mission to stay abreast of dental advancements to deliver the best care for her patients, and has received advanced training and education in laser dentistry, Botox therapy, orthodontics and children’s sleep therapy. Lubberts, who has been named one of the Top Dentists of Grand Rapids, enjoys giving back to the community by volunteering her services to organizations such as Donated Dental Services for Veterans and Lighthouse for Teen Moms.
Dentaltown Magazine
November 2023
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