How To Efficiently Create Great Restorations

When I was in dental school, we learned to create primary and secondary anatomy of the posterior teeth by carving wax blocks according to diagrams in a flip chart. It was very straightforward.

By the time I actually started placing restorations in patients’ posterior teeth, things were less clear. It seems every professor we asked had their own protocol for the placement and postcure finishing and polishing of direct esthetic restorations.

In essence, they left us to find our own way of finishing polish restorations to our own satisfaction. Now, 25 years later, I have found a system that I wish I’d had in school.

The Occlusinator from Strauss Diamond and its corresponding Posterior Packer Sculptor (PPS) instrument simplify the technique and save time, materials, and steps. Efficiency is more crucial than ever.

Figure 1

The Acorn Burnisher and the Acorn Burs have the same 97º angulation as the posterior cusp inclines (Figure 1).

Figure 2

When I inject and place proximal boxes, the PPS has 2 small condensers at 1 end (Figure 2) so I can do slot preps down to 0.8 mm wide.

Figure 3

I then place the bulk-fill composite in the main prep and “flatten it out” into contact with the enamel using the ball burnisher. This is with minimal overfill (Figure 3).

Figure 4

I flip the instrument to the Acorn Burnisher and poke the composite into occlusion. There’s no guesswork; I just follow the existing anatomy (Figure 4).

Figure 5

Having sculpted this way, I have less shaping to do with the burs, which is another time-saver. Depending on the width of the isthmus, I choose 1 of the 3 Acorn Bur sizes. I drop it to create pits, then simply connect the pits (Figure 5).

Figure 6

The Acorn Burs have a 50 µm diamond particle for efficient reduction but also have a diamond-free safe zone to keep me from scarring the enamel. The ring acts as a limit-stop to keep me from overcarving. It’s a drop-and-drag protocol, which makes it much simpler (Figure 6).

Figure 7

Once the anatomy is done, I can polish with the Xmas Trees, which have a 15 µm particle and leave a surface that rarely needs additional polishing. Like the Acorns, the Xmas Trees have a diamond-free safe zone that lets me reach the deepest points without scratching the enamel (Figure 7).

Figure 8

The Occlusinator protocol reduces the number of instruments I need (Figure 8). It gives consistent performance in creating anatomy-in occlusion in approximately 50% of the time I used to spend.

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