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ANGELO PUTIGNANO
DIRECT POSTERIORS - CASES

AESTHETICS IN POSTERIORS
HOW TO MANAGE ROOTS
DILACERATIONS
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A esthetics in posteriors
An article by Angelo Putignano
Submitted: August 15th 2012
The clinical case refers to a young patient, 33 years old, who required a revision of the second upper
quadrant with the old amalgam fillings being replaced by a composite
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After isolating the quadrant with a rubber dam

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I proceeded to remove the old restorations and to clean and prepare the cavities.

COMPOSITES IN THE
AESTHETIC ZONE: YES, WE
CAN
TESTIMONIALS

ANNIKA KORVO
Styleitaliano has easy recipes that
we can follow. I find it a great
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and for the expert.

At this point, I began with the restoration closest to the back of the mouth to save the patient from
becoming tired and having to close his mouth too often and thus complicating the procedure. A
MetaFix matrix was applied before I pre-etched the enamel using orthophosphoric acid to improve
the adhesion of OptiBondTM XTR.

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The pre-etching of the enamel, followed by rinsing and drying, was proceeded by etching and
priming, as per the first step of OptiBond XTR.

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After about 20 seconds, I gently used an air spray and proceeded to the second step of the etch and
dry system (Photo 6).

Walter Devoto
Dr. Walter Devoto Born in
Chiavari on 29/03/1965
graduated in Dentistry in 1991
at Genova University.

Taking a small quantity of composite (Herculite XRV UltraTM, enamel A1), I adapted the material with
the condensing tip of Compothixo, using the continuous vibration mode.

Angelo Putignano
M.D. degree and D.D.S. post
graduate certificate from
University of Ancona-Italy.

FOUNDERS ENDO

Once the restoration had been adapted with the spatula tip in intermittent vibration mode (this
method facilitates smoothing out without the composite rolling around the spatula), I adapted the
material to the matrix. This made it easy to build up the interproximal wall without any air bubbles or
voids.

Pio Bertani
Pio Bertani is a full member of
the prestigious association...

Fabio Gorni
Fabio Gorni is an active
member of the Italian Society
of Endodontics and the Italian
Academy...

The matrix is removed after polymerization of the distal wall.

MEMBERS
Monaldo Saracinelli
Ive been a student of prof.
Fabio Toffenetti and
Riccardo Garberoglio.

Jordi Manauta
Was born in Mexico City,
where he graduated cum
laude. in dentistry from
UNITEC.

Gaetano Paolone
My passion is aesthetic
direct and indirect
adhesive dentistry in
anterior and posterior
teeth.

Daniele Rondoni
Born in Savona in 1961
where he lives and has

Now the cavity is much more simple to fill up, without any interferences.

worked in his own

laboratory since...

Vincenzo Musella
Vincenzo Musella
graduated in dental
technician. Proud friend
and student of...

Giuseppe Marchetti
Giuseppe Marchetti was
born in Parma (Italy) in
October of 1972 and
graduated from...

Simone Grandini
Chair of Endodontics and
Restorative Dentistry,
University of Siena, Italy.

Giovanna Orsini
Giovanna Orsini is a well
known researcher in Italy
and internationally.

The cavity was then filled, leaving space for the last layer of saturated dentine (A4) using the
condensing tip of Compothixo, used in intermittent vibration mode (it is enough to rest your finger
on the switch without pressing all the way down on the release)

Paulo Monteiro
My passion for esthetic
dentistry began when I
attended the last year...

Louis Hardan
Head of Restorative and
Esthetic department in
Saint-Joseph University
in...

Patrizia Lucchi
Patrizia Lucchi Graduated
in Dentistry cum Laude in
1995 at the University of
Verona

Anna Salat
Dr Anna Salat graduated
with a degree in dentistry
from the International
University of Catalonia

Giulio Pavolucci
After graduation magna
cum laude in Dentistry, I
started focusing my daily
work on...

A thoruogh polymerization is followed at this stage.

Marcos Vargas
Dr. Marcos Vargas
attended Cayetano
Heredia University School
of Dentistry in Lima...

Stefan Koubi
Dr. Koubi graduated from
University of Marseille
where he...

Engin Taviloglu
Dr. Taviloglu graduated
from ?stanbul University
School of Dentistry in...

Dimitar Filtchev
Co-founder of the Laser
Dental Center and the
Implant...

The coronal dentine was applied in two steps, the cusps being modelled alternatively with the
Compothixo pointed tip.

Angie Segatto
My commitment to arts has
determined my
specialisation.

Kilian Molina
Kilian is required as a
regular lecturer in indirect
restorative...

Gregory Camaleonte
I was born in 1980 in
Marseille-France and i have
graduated in 2006 from...

Caroline Werkhoven
Caroline Werkhoven
graduated in 2002 at
ACTA, the dental faculty in
Amsterdam..

Ajay Juneja
Ajay Juneja finished his
BDS in the year 1995...

Also in this case used with intermittent vibration to enhance the adaptation and morphology, without
the material becoming rolled up around the tip.

Carlos Fernndez
Villares
Member of SEPES Spanish
Soc...

Sulivan Leite
Sulivan Leite graduated
from the Ribeirao...

Maciej Zarow
Author of book edited by
Quintessence: EndoProsthodontics: guidelines
for clinical practice ...

Dan Lazar
Dan Lazar, graduated from
the Faculty of Dentistry in
2005 in Cluj-Napoca...

Murad Akhundov
Dr. Murad Akhundov
graduated from the
Faculty of Dentistry in
Baku...

Ocher and Brown, Kerr Kolor + Plus

Ochre was used in order to achieve an even more saturated dentine, and Brown was used
characterize the fissures.

Janos Grosz
Graduated summa cum
laude in 2006 from the
University of Szeged,
Faculty of Dentistry,
Hungary...

MEMBERS ENDO
Simone Grandini
Chair of Endodontics and
Restorative Dentistry,
University of Siena, Italy.

Louis Hardan
Head of Restorative and
Esthetic department in
Saint-Joseph University
in...

Filippo Cardinali

The final layer of enamel (Incisal medium) was also applied in two stages; first using the spatula tip in
continuous vibration

Graduate in Dentistry and

Dental Prostheses at the
University of Ancona in
1992. Active Member of...

Riccardo Tonini
He is active member of the
Italian Academy of
microscopic Dentistry and
Active member of...

Paolo Generali
Doctor Generali was
graduated from Pavia
University in the year...

Calogero Bugea
Graduate in Dentistry,
Certificate in Oral Surgery.
Active Member of the
International
Piezosurgery...

Clifford Ruddle
Internationally recognized
as a leading expert in all
aspects of clinical
endodontics, Dr. Ruddle is
acclaimed for...

and then the modelling tip in intermittent vibration, in order to further enhance adaptation and
morphology.

Pierre Machtou
Pierre Machtou was the
first scientific director and
general secretary of the
French Endodontic
society...

Marga Ree
Primary author of several
articles published in
national and international
journals and has ...

Marco Martignoni
Marco Martignoni leads a
private clinic in Rome Italy
and dedicates his practice
mainly to endodontics,
pre-prosthetic...

Massimo Giovarruscio
Massimo Giovarruscio
works in Rome, Bristol and
London, specialising in
Endodontic Treatment
and...

A thin layer of glycerine was applied to the surface before the final polymerization, thus avoiding the
occurrence of surface oxygen inhibition.

The finishing is thus made much easier as, by constructing the occlusal table step by step, any
excesses are kept to a minimum. A diamond-coated bur (20 microns) or multi-bladed burs with 8-12
blades were used.

The interproximal finish was achieved using an EVA handpiece with blades of decreasing grain size.

The exact same steps were carried out in the tooth 2,5, first, placing and wedging the matrix.

Build-up of the proximal walls and matrix removal

Dentinal core build up, stains.

And final enamel layer.

This clinical case was concluded by carrying out restoration work on 2.4

and on 2.5 (Photos 26-27) using the same type of composite.

When everything is complete, the polishing phase can be simplified by using Rubber Points
(Opti1Step)

and OptiShine, pre impregnated brush.

The aesthetic appearance achieved shows that modern composites, when the dentist is familiar with
their properties, can be selected for posterior restoration work, also in consideration of the positive
response of the periodontal tissues.

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