Introduction
Restoring adjacent Class II lesions presents a challenge in achieving proper contact, contour, and marginal integrity. Success depends heavily on isolation, matrix selection, and disciplined adhesive protocols.
Diagnosis & Treatment Plan
- Upper premolar: proximal caries
- Adjacent molar: proximal caries
Plan:
- Quadrant rubber dam isolation
- Sequential Class II composite restorations
- Focus on contact integrity and occlusal anatomy
Clinical Procedure
Step 1 – Isolation
Full quadrant rubber dam placed with proper inversion to ensure a contamination-free field.
Step 2 – Caries Removal
- Peripheral seal zones completely cleaned
- Clear margin visibility achieved
- Proximal boxes refined conservatively
Step 3 – Matrix & Wedging
- Sectional matrix system used
- Proper wedging ensured separation and tight contacts
- Matrix adaptation checked before bonding
Step 4 – Adhesive Protocol
- Selective enamel etch
- Application of bonding system
- Proper air thinning and curing
Step 5 – Composite Build-Up
- Proximal wall established first
- Incremental layering technique
- Cusp-by-cusp anatomy recreated
Step 6 – Finishing & Occlusion
- Contacts verified
- Occlusion adjusted
- Final polishing for smooth margins
Key Clinical Points
- Matrix adaptation defines contact quality
- Peripheral seal zone must be clean before bonding
- Incremental layering reduces shrinkage stress
- Isolation is non-negotiable for predictable bonding
Outcome
- Tight and stable proximal contacts
- Natural occlusal anatomy
- Smooth marginal adaptation
- Functional and aesthetic restoration
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