Class II Composite Restoration of Premolar and Molar Using GC EverX Flow and Tokuyama Estelite Sigma Quick: A Biomimetic Adhesive Workflow
Abstract (≈480 characters)
This case illustrates a microscope-guided Class II composite restoration of adjacent premolar and molar teeth using a biomimetic layering protocol. Fiber-reinforced GC EverX Flow served as a dentin substitute, while Tokuyama Estelite Sigma Quick provided enamel reproduction and esthetics. The workflow emphasizes proper matrix adaptation, marginal seal, and occlusal morphology under strict rubber-dam isolation.
Author CV
Dr Hamza Zahid, BDS
Microscopic Restorative & Cosmetic Dentist
CEO – Dr Hamza Dental Center, Lahore (Pakistan)
Focus Areas – Microscope Dentistry | Adhesive Posterior Restorations | Biomimetic Rehabilitation | Smile Design
Clinical Workflow
1️⃣ Pre-Operative Assessment
Patient presented with food impaction and secondary caries between a mandibular molar and second premolar (Fig 1). Radiograph revealed proximal caries extending to dentin without pulpal involvement.
2️⃣ Isolation & Matrix Placement
Rubber-dam isolation achieved; floss ligatures secured gingival margins. A sectional matrix system with a separating ring (Palodent V3) ensured tight contact and cervical adaptation (Fig 2).
3️⃣ Caries Removal & Cavity Preparation
Caries was removed conservatively, maintaining pericervical dentin. Cavities were shaped to allow incremental layering and proximal contour control (Fig 3).
4️⃣ Adhesive Protocol
Selective enamel etching with 37 % phosphoric acid (15 s), followed by 3M Scotchbond Universal Adhesive actively rubbed for 20 s, air-thinned, and light-cured (Fig 4).
5️⃣ Dentin Replacement – GC EverX Flow
A 1 mm base of GC EverX Flow was placed as a dentin-mimicking sub-layer. Short fibers provided internal reinforcement and shrinkage control, especially in deep proximal boxes (Fig 5).
6️⃣ Enamel Build-Up – Tokuyama Estelite Sigma Quick
Incremental layering of Tokuyama Estelite Sigma Quick (A2) reconstructed cusp inclinations and occlusal anatomy. Each 2 mm layer was sculpted using a fine brush and light-cured 40 s per surface. The “Cusp-by-Cusp” layering minimized polymerization stress (Fig 6).
7️⃣ Finishing & Polishing
Contours refined with Sof-Lex XT discs, finishing diamonds, and PoGo polishers. Final gloss achieved with the Lucida Polish System (Style Italiano) for enamel-like reflection and surface smoothness (Fig 7).
8️⃣ Post-Operative Evaluation
Radiographic and clinical examination confirmed perfect marginal adaptation, ideal proximal contact, and functional occlusion. The patient reported comfort and elimination of food impaction (Fig 8).
Outcome
A high-strength, esthetic Class II restoration was achieved through a biomimetic dual-composite approach. GC EverX Flow provided structural reinforcement, while Tokuyama Estelite Sigma Quick replicated enamel translucency and gloss, ensuring long-term function and natural esthetics.
Image Captions
- Fig 1: Pre-operative radiograph and occlusal view showing proximal caries.
- Fig 2: Rubber-dam isolation and sectional matrix adaptation.
- Fig 3: Cavity after conservative preparation.
- Fig 4: Selective etching and adhesive application.
- Fig 5: GC EverX Flow dentin replacement.
- Fig 6: Incremental Tokuyama Estelite layering with cusp anatomy.
- Fig 7: Lucida Polish protocol for final gloss.
- Fig 8: Post-operative view showing contact and occlusal harmony.
Bibliographic References
- van Dijken JWV et al. Short Fiber-Reinforced Composite in Posterior Restorations: Long-Term Performance. Dent Mater 2015; 31(5): 545–554.
- Dietschi D. Layering Concept in Composite Restorations for a Natural Esthetic Result. Pract Periodontics Aesthet Dent 1997; 9(2): 127–138.
- Magne P, Belser UC. Bonded Restorations in the Posterior Dentition: A Biomimetic Approach. Quintessence Publ, 2002.
- Clark D, Khademi J. Modern Adhesive Techniques and Dentin Conservation. Dent Clin North Am 2010; 54(2): 249–273.
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