Direct and semi-direct posterior composite restorations

Since the introduction of composite resins in dentistry, the adhesive properties of the material to enamel and dentin surfaces have been improved considerably, resulting in more conservative cavity preparation and the preservation of natural tooth structure. Patient demand for aesthetic metal-free restorations in the posterior region has resulted in the utilization of tooth-colored composite restorations. The primary disadvantage of composite resins-material shrinkage-can be minimized, but not eliminated. Various techniques have been developed and proposed in order to overcome this important limitation. The learning objective of this article is to provide indications for the direct and semi-direct techniques and to illustrate effective clinical procedures for placement of posterior composite resin restorations. The article outlines the treatment concepts, principles of cavity preparation, direct and semi-direct restorative methods, and the technique-sensitive luting procedures. Several cases are used to illustrate the clinical aspects.