Advanced Adhesive Posterior Restorations Hands-On Course

Esthetic posterior restorations describe the entire field of modern restorative dentistry in the posterior dentition. It consists of workflows for direct and indirect restorations and refers to adhesive dentistry.

The term “Esthetic Posterior Restorations” stands as a synonym for: 

• Biomimetic Dentistry
• Adhesive Restorative Dentistry
• Bonded Restorative Dentistr

All terms describe the same concept, philosophy and procedures, emphasizing the minimally invasive approach of dental treatment preserving tooth structure, functional integrity, and natural appearance of teeth to secure their longevity in the patient’s mouth. This approach has been the state-of-the-art in dentistry for decades.

To come back to the question “Which cases are best suited for esthetic posterior restorations over indirect options like onlays or crowns?”, the answer is that any case is suited best for esthetic posterior restorative dentistry. This is not a question of direct or indirect – it is a question of defect extension and the appropriate adhesive work protocols and materials.

Based on a vast amount of scientific evidence, almost all teeth should be treated with adhesive, bonded restorative techniques, including cracked and non-vital teeth, since these modern protocols promise the most atraumatic treatment while providing highest longevity.

Therefore, the question of direct or indirect restoration is not a question of treatment philosophy but a question of defect extent and adhesive related protocols.

In this state-of-the art treatment approach “Full Crowns”, if they were not existing before treatment, are considered historical treatment due to harmful stress factors to the tooth.

Success depends on proper isolation (rubber dam mandatory), selective etching protocols dependent on several clinical conditions, and using a reliable adhesive system (science has shown large differences in bond strength between bonding systems).

Also the application of Immediate Dentin Sealing (IDS) developed by the world-leading clinician Didier Dietschi, has a significant impact on bond strength for indirect restorations.

It is important to restore a tooth to its natural morphology. Tooth contacts can be on both, natural tooth structure or restorative material since contacts are determined by the defect and restoration extent.

Also, modern science has shown that the use of fiber reinforcement or bulk-fill base materials in deeper restorations to support load have no clinical benefit and add unnecessary steps to the clinical work flow (ref. Didier Dietschi).

Therefore, learning precise techniques for anatomical sculpting and understanding occlusion surfaces and function of teeth is invaluable to minimize time consuming equilibration after polymerization.

Both principles are taught in IDEA’s leading hands-on classes called advanced adhesive posterior restorations and occlusion dental course.

To identify occlusal interferences also the use of the BruxChecker developed by Sadao Sato, a colored ultra-thin folie to identify occlusal interferences is highly recommended (ref. IDEA Faculty Sadao Sato, Heike Kraemer, Roberto Velasquez).

Nanohybrids offer strength and polishability, making them well-suited for posterior load-bearing areas. They are also used preferably for anterior rehabilitations due to their color stability and wear strength while using the unmatched options of free-hand bonding in the Didier Dietschi “Natural Layering Concept” with dentin and enamel shades.

Nowadays, microfills are still used but are greatly replaced by Nanohybrids in all indications, for example the “Controlled Adhesive Cementation” (CAC) with heated composite developed by Didier Dietschi. Nanohybrid composite is.suiting the convenience of a one-practice-concept composite for all work protocols, perfectly saving money and practicing organizational efforts.

Use a gentle air-drying technique to avoid desiccation, apply a bonding agent with a hydrophilic primer, and “filled” bonding agent.The use of micro suction is also very helpful. Light-cure in increments and avoid over-curing with too high light intensity to prevent heat buildup.

The use of a “filled” bonding agent eliminates the additional unnecessary step of a flowable liner and also shows many advantages especially in margin adaptation of cavities and in overall higher bond strength.

It is also recommended to be used in the Immediate Dentin Sealing (IDS) protocol developed by Didier Dietschis to reduce postoperative sensitivity in indirect restorations and to provide additional bonding strength.