Direct Restorations: Posterior Composite
Three techniques for incremental placement of composite
Posterior composite is usually placed in increments. There are a number of ways of doing incremental placement: three are shown here.
Before and after: click to magnify
The treatment shown in the slide-show below was not clinically necessary: it was carried out at the patient’s request after a full discussion of risks/benefits, so that fully informed consent was obtained.
The composite used here was Majesty Esthetic (from J&S Davis if you are in the UK).
Why is it important to control the shape of the restoration before setting the composite with a curing lamp?
Finishing with rotary instruments is undesirable on a freshly set posterior composite: the vibration can cause fractures to appear in the highly stressed composite, or at the interface between restoration and tooth.
What records should you make regarding consent for a cosmetic procedure?
The consent should be "fully informed". This means that the risks and benefits are both explained and understood. To reduce the possibility of litigation, it is advisable for the discussion to be recorded, and have the patient sign it as read and understood.
It is not enough just to record that the patient verbally agreed to the procedure.
Please take a moment to review these points, reflect on their significance, and consider how they apply to your own experiences.
Tick to confirm (optional):
Posterior composite is placed incrementally to reduce contraction stresses and ensure thorough light curing.
Proper shaping of the restoration before curing reduces the need for rotary finishing, which can induce fractures in the composite or at the restoration-tooth interface.
Internal stresses in composite reduce due to water absorption over a period of 1 day to 1 week.
Aesthetic restorations are clinically necessary with good appearance, while cosmetic restorations are not clinically needed.
For cosmetic procedures, fully informed consent should be documented with a detailed discussion of risks and benefits, signed by the patient.
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