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  • Press Release
  • Restorative

Survey results show what is key: Class II fillings - routine but still challenging

For general dentists and those specializing in restorative dentistry, Class I and Class II posterior tooth fillings made of composite are among the most frequently occurring restorations [1]. According to a publication by the American Dental Association, half of all composite fillings are Class II fillings [2]. Yet, in spite of its everyday nature, this treatment type entails a number of challenges. The following article shows what aspects of the Class II workflow are of particular importance for a successful outcome, including references to survey results on the individual steps taken.

[1] Ruiz JL. (2011) Dental Technique—Restorations with Resin-Based, Bulk Fill Composites. Compend Contin Educ Dent, 31: Special issue 5, p. 1417.

[2] American Dental Association Procedure Recap Report (2006).

Fig. 3: The "Class II Solution" from Dentsply Sirona offers perfectly matched, innovative products with a unique adaptation for every step in a Class II restoration – for tightly sealed margins, also at the base of the cavity!

The restorative treatment of Class II cavities is one of the most demanding, and, at the same time, most common tasks performed in dental practices. For the treatment to be a long-term success, various components need to work together perfectly and enable the practitioner to use them simply and reliably. In particular, it is important to ensure that the margins are tightly sealed. After all, secondary caries is the main reason for the failure of Class II restorations. The base of the proximal box proves to be particularly vulnerable in this context, but other areas and certain steps are also important for the success of the treatment, as the following overview shows.

Challenge of shaping the contact point

A Class II restoration has to recreate not only the natural contour of the tooth, but also the corresponding proximal contact. Many dentists consider this point, in particular, to be the most demanding part of the treatment. A survey from 2012 [1], for example, shows that the overwhelming majority (70% of dentists) consider shaping contact points to be the most difficult step in this context. At the same time, it is also crucial for the success of the treatment. After all, if the proximal contact is not correctly modeled, or there is even a gap, the result can be fractures, periodontal inflammation, inclusion of food residues and secondary caries. Accordingly, it is important to have a matrix system which allows the practitioner to design the contact points simply, reliably and in an anatomically correct manner.

A strong bond to avoid hypersensitivity

Another factor whose role should not be underestimated when filling cavities is the adhesive bond. If the adhesive does not form a homogeneous layer, postoperative hypersensitivity may occur. Some 10 to 15 percent of all composite restorations in the posterior area are affected by this phenomenon [2]. One risk factor has proven to be the level of dentin moisture. A surface which is too dry or too moist can have a negative effect on the adhesive bond. In the case of a deep proximal box, in particular, the ideal moisture level cannot always be reliably achieved. With this in mind, it is advantageous to have an adhesive which forms a reliable bond not only in an ideal situation but also with excessively dry or moist dentin.

A long lifetime thanks to tightly sealed margins

82% of all dentists use a liner to improve the seal along the margins of Class II fillings [3]. In this context, the flow behavior and self-leveling of the material used is particularly important. Flowable materials adapt more easily to the shape of the cavity and thus ultimately provide a tighter marginal seal. This prevents hypersensitivity, secondary caries and discoloration and thus contributes significantly to the longevity of the treatment.

Room for improvement in terms of handling

In addition, the composite should also be convenient for the dentist to apply. The fact that this is not always the case is demonstrated by a recent survey on composite processing properties [4]. Of the 297 dentists surveyed across Europe, nearly three quarters (74%) were dissatisfied with certain aspects of handling. They complained about the adaptability and stickiness of the composite they had been using. Both factors, however, are of major importance with regard to the sensitive area at ​​the base of the proximal box. For example, a material that is too sticky can adhere to instruments too strongly, perhaps ultimately leading to the composite being inadvertently removed from the cavity base. In addition, a composite’s stickiness, its modeling, and color matching are particularly important with respect to natural esthetics and correct occlusal anatomy, as shown by a user test [5].

The bottom line for the practice

When it comes to restoring Class II cavities, a number of factors are important. The contact point design, tightly sealed margins and the adhesive bond are among the most significant. With the right tools, today these challenges are easier to tackle than ever before. One example of this is the "Class II Solution" filling concept (Dentsply Sirona Restorative). It includes, among other things, the Palodent V3 matrix system, which is the focus of the second part of this series of articles.  



[1] DentalTown (2012). Restorative Dentistry. Monthly Poll: What is the most challenging part of a Class II restoration?

[2] Usman et al., Sensitivity in composite restorations, Pakistan Oral & Dental Journal Vol 34, No. 3 (09/2014); Berkowitz et al., Postoperative Hypersensitivity in Class I Resin-based Composite Restorations, Compend Contin Educ Dent. 2009; 30(6): 356–363; Haller, Die Postoperative Hypersensibilität, zm 99, N0. 6a, March 13, 2009 pp. 44-51; Briso et al., Clinical Assessment of Postoperative Sensitivity in Posterior Composite Restorations, Operative Dentistry, 2007, 32-5, 421-426.

[3] Council on Scientific Affairs of the American Dental Association. Spring 2009;4(2).

[4] Dentsply Sirona Restorative, User Survey 2015 (297 dentists in Europe)

[5] Based on a user test for ceram.x universal.

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