Restaurarea coronară cu rășini compozite utilizând „stamp technique” – prezentare de caz

Introduction

Dental caries and periodontal disease are among the important public health conditions. The carious lesions are one of the most frequent diseases of the dento-maxil­lary system, afflicting about 80-90% of the Romanian population.

Dental caries represents both a pathological entity itself and the starting point for numerous local, locoregional and even general complications, therefore it is very important to understand and promote the prophylaxis of dental caries. To the same extent, early diagnosis, as well as adequate restoration of the hard dental substance losses that occurred as a result of carious processes evolution, constitutes the premises for maintaining long-term oral health and for preventing the aforementioned complications^(1,2).

The phenomenon of destruction in posterior teeth, caused by dental caries, has a significant implication in the normal functioning of the stomatognathic system. Therefore, any structural alterations of premolars and molars affect the main functions, namely mastication and deglutition⁽³⁾. Their consequences are examined according to several existing factors. For example, the type of dentition (temporary, permanent, mixed), the number of affected teeth, the etiological factor (caries, wear lesions, trauma, iatrogenic) and, also, the general condition must be taken into account. Dental restorations in the posterior area, whether direct or indirect, aim to restore the masticatory function; they must withstand the functional necessities of the dento-maxillary system, especially occlusal forces⁽⁴⁾.

Nowadays the modern direct coronal restoration materials (resin composites, glass ionomer cements) present biomechanical and aesthetic characteristics which make them appropriate for almost any clinical situation. The resin composites have become in fact the most widespread and used direct restoration materials for the posterior teeth restorations^(5-7). Applicating and inserting techniques are varied, being chosen depending on the respective clinical situation; thus, restorations with resin composites materials can be performed using the layering/incremental technique, sandwich technique, bulk fill technique, centripetal technique, stamp technique, or successive cusps build up technique^(8,9).

The stamp technique (or “microbrush stamp” technique) is a therapeutic method for restoring the occlusal anatomy of posterior teeth in the case of a direct restoration, by making an “imprint” (copy) of the occlusal morphology of the unprepared tooth⁽¹⁰⁾. With its help, the composite restoration resin is modeled before being light cured, thus obtaining an anatomically and functionally correct rehabilitation, without the need for occlusal adaptation^(11,12). In order to be able to apply this method, it is necessary that the evolution of the dental caries does not greatly affect the occlusal surface of the involved tooth, and its integrity and morphological particularities are preserved, respectively that dental caries is limited in extent. The impression is made with materials such as flowable composite resins (used for dental restorations or as a liquid rubber dam).

Case report 

In this paper, we present the stamp technique method of direct dental restoration, with resin composite materials, of a dental caries in tooth 37. A 25-year-old male patient has attended the dental practice for coronal restoration of limited carious lesion located in the occlusal pits and grooves of second left mandibular molar, with minimal structure alterations and the occlusal integrity maintained, which allowed us to use the aforementioned treatment technique (Figure 1). The restoration resin composite we used was Estelite Bulk Fill Flow® (Toku­yama) which offers strong, quick curing and esthetic restorations. The isolation method was rubber dam.

The treatment steps were as follows: removing the dental plaque with professional brushing and applying a lubricant on the occlusal surface, so the light cured impression material which reproduces the morphology will detach easily. For this stage of impression, we used liquid rubber dam (Rubber dam liquid, Cerkamed®), on the entire occlusal surface, in which we inserted an applicator and light curing. The applicator will act as a handle for the stamp (Figures 2 and 3).

The next stage was to treat the dental caries; we removed the altered dental structures, and we obtained a medium class I cavity (Figure 4).

In order to perform the direct resin composite restoration, we followed the specific adhesion step, using etch and rinse method: 37% orthophosphoric acid (Alpha Etch-37R®) for 30 seconds on enamel and 15 seconds on dentin, then rinse, gently dry and applied the adhesive system (Universal Bond II, Tokuyama®). We light cured it for 20 seconds.

The material we used is a flowable, radiopaque, bulk fill resin composite, which can be placed in up to 4-mm increments, permitting a shortened light curing time, so the entire cavity was filled in one stage. Also, its low viscosity is ideal for the stamp technique we used for this clinical case (Figure 5). 

Before light curing the resin, we applied a Teflon tape over it, in order to act as a separation medium between resin composite and occlusal stamp which was firmly placed, allowing to obtain the initial anatomical details of occlusal surface (Figure 6).

The stamp was then removed and resin composite light cured for 30 seconds. This working technique offers a restoration which no longer needs occlusal adaptation in relation with the antagonistic dental arcade – only a brief finishing with polishing gums may be needed (Figure 7).

Conclusions

Resin composites direct restoration of limited posterior teeth hard tissues loss, when the occlusal surface is slightly affected, keeping the anatomical and morphological integrity, can be easily achieved using the stamp technique method. The main advantages of this working technique are the simplicity, the high efficiency and the predictable results⁽¹³⁾. The stamp technique is one of the most promising treatment options for selected clinical cases.

Autor corespondent: Mihai Mitran  E-mail: michael_digital@yahoo.com; Loredana Mitran E-mail: loribucan@yahoo.com

CONFLICT OF INTEREST: none declared.

FINANCIAL SUPPORT: none declared.

This work is permanently accessible online free of charge and published under the CC-BY.