Conservative Adhesive Composite Restoration of a Deep Posterior Lesion
Controlled Caries Removal, Biomimetic Layering, and Functional Rehabilitation
Author: Dr Hamza Zahid
Clinic: Dr Hamza Dental Center, Lahore, Pakistan
Category: Restorative Dentistry | Adhesive Dentistry | Biomimetic Composites
Abstract
This case report demonstrates the management of a deep posterior carious lesion using a strictly conservative, adhesive composite approach. Emphasis was placed on proper isolation, selective caries removal, preservation of sound tooth structure, and biomimetic reconstruction using contemporary resin composite materials. Anatomical layering, stress control, and a structured finishing–polishing protocol were employed to restore form, function, and long-term biological stability without resorting to indirect restorations.
Introduction
Modern restorative dentistry prioritises tissue preservation and adhesion-driven rehabilitation over aggressive mechanical preparation. With advancements in composite chemistry and bonding systems, deep posterior lesions can be predictably restored using direct techniques while maintaining tooth biomechanics and reparability.
This case highlights a composite-only restorative workflow, following principles of minimally invasive dentistry and enamel–dentin bio-emulation.
Case Description
A posterior molar presented with:
- Extensive occlusal caries
- Undermined dentin beneath intact enamel
- No clinical or radiographic signs requiring endodontic intervention
The treatment objective was to restore strength, anatomy, and occlusion using a direct composite restoration while preserving maximum sound structure.
Clinical Procedure (Step-by-Step)
Step 1: Rubber Dam Isolation
Absolute isolation was achieved using a rubber dam and clamp selection that ensured cervical sealing and full moisture control. This created a clean, dry, and predictable adhesive field.
Clinical significance: Rubber dam isolation is essential for bond durability, contamination control, and marginal integrity.
Step 2: Controlled Caries Removal
Caries excavation was performed conservatively using a selective approach:
- Infected dentin was completely removed
- Affected dentin was preserved where biologically acceptable
- Peripheral enamel and dentin margins were cleaned to sound structure
This approach reduced unnecessary dentin loss and maintained structural resilience.
Step 3: Cavity Evaluation and Stress Management
After caries removal, the cavity was evaluated for:
- Remaining cusp thickness
- Enamel continuity
- Stress concentration zones
Areas of deep dentin were managed using stress-reducing composite placement to improve adaptation and reduce polymerisation stress.
Step 4: Adhesive Protocol
A universal adhesive system was applied following manufacturer guidelines, ensuring:
- Proper dentin infiltration
- Reliable enamel bonding
- Optimal hybrid layer formation
No shortcuts were taken at this stage, as adhesive success dictates long-term performance.
Step 5: Biomimetic Composite Layering
The restoration was built incrementally using:
- Dentin shades to reproduce internal opacity and strength
- Enamel shades to restore translucency and surface brightness
Anatomical layering respected natural cusp orientation, marginal ridge height, and occlusal table width, avoiding over-bulking.
Step 6: Anatomical Characterisation
Subtle fissure and groove enhancement was performed using ochre-toned composite stains to recreate depth and natural occlusal anatomy without compromising structure or wear resistance.
This step improved visual integration while maintaining a conservative philosophy.
Step 7: Finishing and Polishing
A structured polishing protocol was followed:
- Pre-polishing to refine anatomy and remove surface irregularities
- Progressive polishing to close the resin surface
- Final high-gloss polishing using a Style Italiano–based protocol
The result was an enamel-like surface with reduced plaque affinity and improved longevity.
Outcome
The final restoration demonstrated:
- Excellent marginal adaptation
- Anatomically correct occlusal morphology
- Smooth, glossy enamel-like surface
- Stable proximal and occlusal contacts
Postoperative radiographic assessment confirmed complete caries removal and a well-adapted composite restoration.
Discussion
Direct composite restorations, when executed with strict isolation and biomimetic principles, can successfully rehabilitate deep posterior lesions without the need for indirect restorations. Preservation of dentin elasticity, controlled layering, and proper finishing are key factors influencing fracture resistance and long-term success.
This case reinforces that technique sensitivity, not material alone, defines outcomes in adhesive dentistry.
Conclusion
Conservative composite restorations remain a cornerstone of modern restorative dentistry. By respecting biology, mechanics, and adhesion principles, clinicians can restore compromised teeth predictably while maintaining future treatment options and structural integrity.
References
- Opdam NJM, et al. Longevity of posterior composite restorations: A systematic review. J Dent Res. 2014;93(10):943–949.
- Magne P, Douglas WH. Porcelain veneers: Dentin bonding optimisation and biomimetic recovery of tooth biomechanics. Int J Prosthodont. 1999;12:111–121.
- Dietschi D, Spreafico R. Adhesive metal-free restorations: Current concepts. Quintessence Int. 1998;29:409–420.
- Van Meerbeek B, et al. State of the art of self-etch adhesives. Dent Mater. 2011;27(1):17–28.
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