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5 Best Tips For Class II Restorations

Bread & Butter

dental class II
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Tips on Class Composition Restorations​

Any pre-dental student, current dental student, and eager clinician motivated to refine their daily practice by improving the quality of their class II composite restorations.

Direct class II composite restorations are one of the most common procedures done in a general dentist’s office. This “bread and butter” procedure warrants being proficient and investing the time to improve your clinical skills.

I’m so happy to have my guest co-writer, Dr. Jenny Giao. A rising star in the US Navy Dental Corps. In true alignment with my slogan ‘solo dentistry bites,’ we are here as an operative and general dentist duo, summarizing (5) clinical tips to help you improve on efficiency and quality of your class II restorations.

I’m constantly reminding myself that dentistry is a lifelong practice of continual learning.

For the pre-dental student: If you are shadowing a general dentist for the first time, you will benefit greatly from this short read on class II composite restorations to familiarize yourself with the steps your dentist takes to excavate the decay and restore a tooth's ideal function and esthetic.

For the current dental student (D1-D4): Whether you’re learning to restore a 19 MO composite in the sim lab or preparing for your CDCA licensing exam, utilizing these following tips will give you a reliable workflow to reproduce on your test days amidst stressful academic moments in your training.

For the practicing dentist: Mastering class II composite restorations is a great tool kit in our arsenal to provide a conservative treatment option that provides longevity to the life cycle of a tooth.

When compared to the traditional class II amalgam restoration, the composite relies on a proper adhesive bonding protocol rather than GV Black’s “extension for prevention” in adding an occlusal dovetail.

These tips will also prevent your patients from suffering from issues such as postoperative sensitivity or issues with flossing due to overhangs or poor interproximal contour.

With that being said, here are some clinical tips to help you restore your class II composites like a champ!

1. Rubber dam:​

dental rubber dam for class II

Despite the eye rolls and sighs, studies (1) have shown a properly placed rubber dam is the best form of isolation especially for class II composite restorations.

While an Isolite is more convenient, there is a higher risk for contamination from saliva, heme, or moisture from a patient's breathing which can weaken bond strength.

This works great with or without an assistant (I'll show you how here) and the best part is, once you are out of dental school, you can train your dental assistant to place your rubber dams for you!

2. Sectional matrix​

class II restoration tips

Utilizing a sectional matrix system ie. Garrison V3 or Palodent provides reliable contact and embrasures of your restoration.

*Burnishing is not needed with this matrix system. It is key to ensure with your mirror or direct vision that your wedge and matrix band fully seal the gingival floor of your preparation.

Pro-tip: if you can, avoid tofflemire for composite restorations as this combination can lead to open contacts in your restoration (reserved for amalgam).

If you use it in a clinical setting where you are limited to only Tofflemire matrix and wooden wedges, burnish your contact aggressively after doing a quarter-turn release of the band.

3. Consider the snow plow technique

  • Seal the floor of preparation using a combination of uncured flowable along edges of preparation layered with packable composite and cure in increments.

  • Clean-up is important to remove flash.

class II restoration bonding

This will depend on what materials are offered at your dental school/dental office, but generally reliable bonding results come with using either a 4th, 6th, or 7th generation bonding agent (generally…bonding agents are a bit more complicated to overgeneralize into one category)

In the last year, we've been using ScotchBond Universal Plus (7th generation) which is the first radiopaque adhesive agent. This is revolutionary with class II composites to distinguish recurrent decay vs adhesive agents in your post-operative bitewings and at recall exams.

5. One lobe at a time

Restoring a composite one “lobe” at a time allows the provider to reduce the C factor of a restoration. The C- factor is the ratio of bonded to unbonded surfaces of the tooth. the higher the c factor (ie. highest c-factor in an occlusal restoration 5:1).

Decreasing the c-factor prevents polymerization shrinkage when curing resin, which can decrease patient post-op sensitivity.

*This is a great technique to more accurately mimic the tooth's natural anatomy and even incorporate stains for a more realistic tooth.

Bonus: Light cure​

When it comes to light curing, distance plays a major factor in the depth of cure in class II composite restorations.

The light’s reach can significantly compromise the full cure of your restorative material. We recommend light curing yourself as your assistant is often farther away from the patient’s mouth.

Curing your restoration from different angles will also help to ensure a full cure.

Caution: uncured resin can lead to patient post-op sensitivity and staining of restorative material.

Finish interproximally very carefully with 12-blade or interproximal strips to create smooth margins and occlusal embrasures.

Check occlusion with articulation paper (tells you where the occlusion is) and shimstock (tells you how hard the occlusion is) to avoid minor changes in the patient’s occlusion. Utilize the shimstock before AND after to identify occlusal stops and avoid occlusal changes.

Taking intraoral photos and post-operative bitewing of your restoration is the best way to seek constructive feedback and improve your clinical skills with class II composites!

If you enjoyed this blog post on class II composite restorations, check out our latest reel on restoring your class II composites like a champ on Instagram @thepredentalguide @dr.charliecage and subscribe to the newsletter!​

Falacho RI;Melo EA;Marques JA;Ramos JC;Guerra F;Blatz MB; (n.d.). Clinical in-situ evaluation of the effect of rubber dam isolation on bond strength to enamel. Journal of esthetic and restorative dentistry : official publication of the American Academy of Esthetic Dentistry ... `{`et al.`}`."


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