Quadrant Restorative Rehabilitation with a Premolar Composite Overlay and Molar Class II Restoration: A Biomimetic and Microscope-Assisted Workflow
Abstract (≈480 characters)
This case demonstrates a quadrant restorative rehabilitation involving a premolar overlay and a Class II molar restoration performed under microscope isolation. Using GC EverX Flow and Tokuyama Estelite Sigma Quick, both teeth were restored with a biomimetic, adhesive, and minimally invasive approach. The workflow focused on stress distribution, functional morphology, and esthetic integration within the same quadrant.
Author CV
Dr Hamza Zahid, BDS
Microscopic Restorative & Cosmetic Dentist
CEO – Dr Hamza Dental Center, Lahore (Pakistan)
Focus Areas – Microscope Dentistry | Adhesive Biomimetic Restorations | Quadrant Dentistry | Functional Esthetics
Clinical Workflow
1️⃣ Pre-operative Assessment
The patient presented with localized food impaction, deep caries in the lower right molar, and an endodontically treated premolar showing structural loss (Fig 1). A quadrant plan was developed to restore both teeth functionally and esthetically in a single session.
2️⃣ Isolation and Field Control
Rubber-dam isolation achieved for both teeth using a single quadrant clamp system (Fig 2). Proper moisture control was essential for simultaneous adhesive procedures. Teflon tape and floss ligatures ensured gingival retraction and seal.
3️⃣ Premolar Overlay Preparation
The premolar, previously endodontically treated, was prepared conservatively for a direct composite overlay. Minimal occlusal reduction (1.5 mm) with rounded internal angles preserved enamel support (Fig 3). The cuspal coverage aimed to restore lost structural stiffness and functional integrity.
4️⃣ Molar Class II Preparation
Adjacent molar showed proximal caries extending sub-gingivally. Caries removal was done conservatively, followed by Deep Marginal Elevation (DME) using the Matrix-within-Matrix technique with flowable composite and a sectional matrix system (Fig 4).
5️⃣ Adhesive Protocol
Both teeth underwent selective enamel etching (37 % phosphoric acid – 15 s) followed by 3M Scotchbond Universal Adhesive in active application. Light cured for 20 s per surface under magnification.
6️⃣ Dentin Replacement and Reinforcement
A 1 mm base of GC EverX Flow was placed in both teeth to act as a dentin-reinforcing substructure. This short-fiber composite enhanced internal strength and minimized stress concentration at the cavity floor (Fig 5).
7️⃣ Enamel Build-Up and Overlay Formation
Incremental composite layering using Tokuyama Estelite Sigma Quick (A2 shade) recreated occlusal morphology. Each cusp was sculpted individually for the premolar overlay, while the molar was built incrementally to restore the Class II anatomy (Fig 6).
8️⃣ Finishing and Polishing
Contours refined with Sof-Lex XT discs and fine-grit diamond burs. Final gloss achieved using the Lucida Polish System (Style Italiano), reproducing the natural enamel luster (Fig 7).
9️⃣ Post-Operative Evaluation
Final restorations exhibited perfect proximal contact, smooth occlusal transition, and natural optical blending across the quadrant (Fig 8). At 3-month review, both teeth remained symptom-free with stable margins and ideal occlusion.
Outcome
This quadrant restorative workflow successfully rehabilitated both posterior teeth in a single session using biomimetic layering, isolation control, and fiber-reinforced reinforcement. The combination of GC EverX Flow and Tokuyama Estelite Sigma Quick achieved anatomical, functional, and esthetic harmony.
Image Captions
- Fig 1: Pre-operative quadrant showing caries and structural loss.
- Fig 2: Rubber-dam isolation for quadrant control.
- Fig 3: Premolar conservative overlay preparation.
- Fig 4: Molar Class II with Deep Marginal Elevation.
- Fig 5: Dentin replacement using GC EverX Flow.
- Fig 6: Incremental layering of Tokuyama Estelite Sigma Quick.
- Fig 7: Lucida Polish System application for final gloss.
- Fig 8: Post-operative quadrant result showing functional and esthetic integration.
Bibliographic References
- Magne P, Belser UC. Bonded Restorations in the Posterior Dentition: A Biomimetic Approach. Quintessence Publ, 2002.
- van Dijken JWV et al. Durability of Short Fiber-Reinforced Composites in Posterior Restorations. Dent Mater 2015; 31(5): 545–554.
- Dietschi D. Layering Techniques for Functional Esthetics in Posterior Composites. Pract Periodontics Aesthet Dent 1997; 9(2): 127–138.
- Clark D, Khademi J. Modern Adhesive Concepts and Dentin Conservation. Dent Clin North Am 2010; 54(2): 249–273.
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