Posterior Restorations: Materials & Techniques and Patient Care

Posterior restorations refer to dental procedures performed on the back teeth, specifically on premolars and molars. These restorations are aimed at repairing damaged or decayed teeth and restoring their function and aesthetics. 

Essential Treatment Modalities and Classification of Cavities 

The restoration of posterior teeth is one of the main treatment modalities carried out by all practicing dentists.

The main reasons why someone might require a posterior restoration are: 

• Tooth decay: Cavities or decay need to be treated to prevent further damage and to restore the tooth's structure and aesthetics. 

• Chipped or fractured teeth: Accidents or injuries can cause chips or fractures. Posterior restorations can be performed to repair the damaged teeth and restore their natural appearance. 

Based on the anatomical location on the tooth, posterior cavities can be classified on: 

• Class I: located on pits and fissures on occlusal third of molars and pre-molars; 

• Class II: located on proximal surfaces of molars and pre-molars. 

Direct and Indirect Techniques for Posterior Restorations: Material Selection and Considerations 

Posterior restoration can be a challenging procedure. Access to the posterior zone can be difficult, moreover, as these restorations are normally located in load bearing areas, a correct material selection is mandatory for a successful treatment. 

Depending on the selected restorative material, posterior restorations can be performed using a direct placement technique or by means of indirect technique outside the mouth: 

Direct posterior restorations:  

In this type of restoration, the restorative material is applied directly into the tooth to be treated. Different direct restorative materials are available for this type of restoration:  

• Amalgam: Dental amalgam is a mixture of metals, including mercury, silver, tin, and copper, which has been commonly used for many years as a posterior restorative material. However, in response to concerns about the environmental impact of mercury, there have been ongoing discussions about reducing the use of amalgam and finding alternative materials. 

• Resin composite is a popular and versatile material for direct restorations. It’s a mixture of a resin matrix and inorganic fillers that offers several advantages over amalgam, such as improved aesthetics, enhanced bonding capabilities and a more conservative approach, allowing preservation of sound tooth structure. While offering several advantages, some challenges may be considered when working with resin composites. Technique sensitive, polymerization shrinkage and the wear resistance of resin composites, that may be lower than that of amalgam and other indirect restorative materials, are some drawbacks of this material. 

• Glass-ionomers and Glass Hybrids are acid-base materials that have been used to esthetically restore tooth structure since the late 20th century. A relevant benefit of this material is the self- adhesive capacity to tooth structure, that allows the preservation of more sound tooth structure. The strength of Glass ionomers is limited, for this reason this material is more prone to fracture and wear than resin composites. A more advanced category of glass-based material, named Glass Hybrids, overcomes the limitations around abrasion and erosion stability and has significantly higher flexural strength. Clinical studies have proven glass hybrids to be cost-effective long-term restorative alternatives.  

Indirect posterior restorations:  

These are usually recommended for teeth requiring large restorations. It involves the fabrication of restorations outside the mouth, in a dental laboratory or in an in-office milling machine, and their subsequent bonding to the prepared tooth. In cases where a dental lab is used, there are usually two dental appointments required to place an indirect restoration.  

• Custom Made: These restorations are custom-made to fit the unique anatomy and occlusion of each patient, providing a precise and natural-looking result.  Some examples of indirect anterior restorations are crowns, bridges and veneers.  

• Dental ceramics are a common material of choice for indirect restorations. They are widely used in dentistry due to their ability to mimic the optical characteristics of enamel and dentine, as well as their biocompatibility and durability. There are several types of dental ceramics and dentists make the material selection based on the clinical case and patient’s expectation.  

• Hybrid composites are also available as milling blocks for indirect restorations. The attractiveness of this material is based on ease of fabrication and the possibility of an easier and less visible intra-oral repair of minor defects. 

• Metal alloys are also commonly used for indirect restorations. They offer excellent durability and strength, however, due to the color they are more visible than other types of materials. 

Indirect restorations have several benefits, such as enhanced aesthetic, durability, and strength. However, it is important to acknowledge a few drawbacks.  Costs of indirect restorations are normally higher; the process is normally time-consuming, and in most of the cases 2 appointments and a temporary restoration are needed. Increased tooth reduction may be necessary to achieve the correct preparation for an indirect restoration. 

Patient Education and Maintenance for Posterior Restorations 

Posterior restorations can last many years, but for this an appropriate patient education and follow-up maintenances are necessary. Patients must be correctly oriented on oral hygiene practices, diet modification and on the importance of regular dental visits. Instructions on maintaining oral health and potential risks associated with restorations, such as recurrent decay or fracture must also be provided to patients. Regular professional cleanings, oral hygiene reinforcement and periodic radiographic evaluation are essential to detect any potential issues early on. 

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