Direct composite onlay made simpler with occlusal stamping.

Posted on January 08 2019

Introduction:

I have had great success with composite onlays, including teeth with root canals. Composite onlays are much more conservative than crowns. It is important to have a minimum of 2 mm composite thickness over the cusps.

 

Before #30

Step 1

Mesial caries and DL cusp fracture.

Closing mesial hole

Step 2

Small increment of composite closes off mesial hole. Another increment of composite temporarily replaces fractured DL cusp. Composite not bonded and loosely placed to fill out lost occlusal anatomy.

Triad Gel Cured

Step 3

Triad Gel (Dentsply) positioned and cured across the occlusals of #'s 28-31. Triad Gel extended just over the edges of the cusp tips of #30 and the occlusals only of 28, 29 and 31.

Triad Gel Stamp

Step 4

Look closely and you can see the temporary DL cusp pulled with the Triad Gel. The temporary composite was quickly removed by cutting it back to the clear triad gel.

Tooth #30 prepped

Step 5

Teeth in full occlusion. VERY IMPORTANT! Need at least 2 mm of occlusal clearance for the direct composite onlay.

U-Band in place

Step 6

Greater Curve U-Band placed and cut away at the buccal. There was a MB Class V extension which was restored first with Activa. I used the U-Band because of the larger than normal embrasure space at the mesial.

 

Seating the stamp

Step 7

Triad Gel stamp fully seats after interference's from the band has been removed at the mesial and distal contact areas.

Occlussal view of GC matrix

Step 8

I did not make the typical contact window at the mesial and distal. The marginal ridge portion of the band had to be removed to allow the Triad Gel stamp to fully seat. In this case, the contact window is a "U" shaped contact opening. Note, there is a small gap at the MB portion of the GC Band. How this gap will be addressed will be seen on the next photo.

Gingival view

Step 9

The gingival portion of the restoration is restored with bonded Activa. While the Activa is light cured by my dental assistant, I'm closing the above mentioned gap with a condenser.

First layer of Activa

Step 10

The first layer of Aciva is completely cured.

Teflon tape

Step 11

Teflon tape is encircled around the #30 portion of the stamp.

Second layer of Activa

Step 12

Thin layer of uncured Activa is laid over the cured Activa. Followed up with a patty of composite (Filtek Supreme) lightly pushed into the uncured Activa.

 

Stamp pressing into uncured Filtek

Step 13

The Triad Stamp is pushed into the uncured Filtek until it is fully seated. Filtek is light cured through the Triad Gel and teflon tape.

Appearance after the stamp

Step 14

Appearance of the composite immediately after the stamp is removed.

Severing GC band

Step 15

GC band is severed into a mesial and distal segment to make removal of the band easier.

Band removed

Step 16

Ready for shaping. Occlusal stamping reduced the time needed to make occlusal adjustments.

Tight contacts

Step 17

Tight mesial and distal contacts are evident with floss.

Occlusal view

Step 18

Occlusal view of final direct composite onlay #30. I have had great success with composite onlays.

Isolation

Step 19

Isolation was maintained by using a buccal and lingual Neodry pad. The lingual Neodry pad is held in place by the Saliva Ejector Holder. Besides retaining the lingual Neodry, the holder removes saliva and keeps the tongue out of the way.

Conclusion:

This restoration took me one hour to complete with one "How you doin? You look good." hygiene check thrown in.

Not long ago this type of restoration would be time consuming and unpredictable to do. Today we have materials and techniques that make a huge difference:

1) Bioactive materials such as Activa that can be placed quickly as a base.

2) The Greater Curve technique which produces tight anatomical contacts both mesial and distal in one step.

3) Occlusal stamping reduces finishing time.

7 comments

  • Dr Vance Wascom: January 23, 2019

    Dr Brown, thanks for this valuable technique, have a similar case scheduled, can’t wait to try the this. Thanks….Vance

  • David Price DDS: January 18, 2019

    What you illustrate here requires great clinical skill which I think you minimize in your comments. Shaping the contact openings, especially against the amalgam, which is the same color as the band and is softer than enamel, is not easy. Removing the occlusal portion of the band without creating gaps at the facial and lingual edge of the contact opening, is not easy. Shaping the embrasures after band removal, is not easy. I congratulate you on ability to perform such a complicated procedure in a reasonable amount of time. I personally would have not capped the cusps and used ribbond to try to prevent cusp fracture in the future.

  • Dennis Brown: January 12, 2019

    The “Standard” is the “go to” for posterior teeth.

    The “Wide” band works well for anterior teeth and for clinically tall posterior teeth (deep root decay or perio involved molars). The “Wide” band can be customed shape to fit below deep margins and still have enough height to extend to the occlusal table.

    The “U-band” works well for Class V’s because it provides more visibility and access. Great for isolating and providing marginal access for shaping direct composite veneers For Class IV Apple Core preps the U-band is an excellent choice. For molars with large interproximal gaps the U-band will traverse the Class II space better

  • Dennis Brown: January 12, 2019

    Nathan,
    I have not used Beautifil Flow. I will give it a try.
    Dennis

  • Nathan Mayo DDS: January 09, 2019

    I will give you major points for creativity. I hope your patients appreciate what you are doing for their pocket books, and I agree that our modern composites are amazing in their physical properties. Have you used Beautifil Flow yet? The stuff is incredible in its ability to shade match. A-2 blends with almost any situation.

  • Mack Snead: January 09, 2019

    How do you determine whether to use U band or standard or wide band?

  • John: January 09, 2019

    Thanks I appreciate all your tips

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