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The Simultaneous Modeling Technique: closing gaps in posteriors

Article · March 2016

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 Clinical Research

Predictable direct composite

restorations in posteriors.
The Simultaneous Modeling
Technique
Salvatore Scolavino, DDS
Private Practice, Nola, Naples, Italy

Gaetano Paolone, DDS

Private practice, Rome, Italy
Lecturer, Master of Endodontics and Restorative Dentistry, University of Siena, Italy
Lecturer, Faculté d’Odontologie de l’Université de la Méditerranée Marseille, France

Giovanna Orsini, DDS, PhD

Associate Professor, Restorative Dentistry, School of Dentistry,
Polytechnic University of Marche, Ancona, Italy

Walter Devoto, DDS

Private and Referral Practice, Sestri Levante, Italy
Lecturer, Master of Endodontics and Restorative Dentistry, University of Siena, Italy
Visiting Professor, University of Marseille, France, and International University of Catalonia,
Barcelona, Spain

Angelo Putignano, MD, DDS

Professor, Restorative Dentistry, Head of Department of Endodontics and Operative Dentistry,
School of Dentistry, Polytechnic University of Marche, Ancona, Italy

Correspondence to: Gaetano Paolone, DDS

address???; gaetano.paolone@gmail.com

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Abstract
Direct posterior restorations represent
a widespread procedure in daily prac-
tice. Occlusal layering is often con-
sidered a complex task, generally not
predictable and often requiring several
occlusal adjustments. Moreover, direct
posterior restorations are time consum-
ing, as many small increments must be
applied and cured individually to con-
Scolavino et al
trol shrinkage stress. Several authors
have proposed different material layer-
ing techniques for posteriors.1-8 The au-
thors of this article propose a simplified
approach, which primarily aims to help
the clinician perform quick, simple, pre-
dictable, and natural-looking occlusal
modeling, reducing the need for oc-
clusal adjustments.
(Int J Esthet Dent 2016;11:XXX–XXX)
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Introduction
Occlusal anatomy is very variable; it can
be steep, flat, smooth or very irregular
(Fig  
1). All these surface characteris-
tics are unique, and the clinician should
avoid trying to replicate identical mor-
phology for every restoration.
When part of the occlusal anatomy
is missing, due either to caries or an
unsuitable filling, an accurate analysis
of the anatomical information of the re-
maining occlusal tissue is very useful.
Information taken from the residual oc-
clusal table tissue such as steepness of
the ridges, position of primary and sec-
ondary ridges, grooves, etc, allows for
the creation of a custom modeling rather
than a standardized one.
The technique proposed in this article
is based on the following points:
„„Multiple, simultaneous yet segmented
(not in contact) composite increments
to define occlusal anatomy.
„„Occlusal modeling always starts from
a standardized cavity depth.
„„Use of the following anatomical in-
formation: a) from the tooth before
Fig 1    (From left to right): Variability in occlusal surface anatomy morphology.
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its preparation; b) from the residual
healthy tooth tissue after preparation;
c) from the adjacent teeth; and d) from
the contralateral.
The advantages of this technique are:
1. Time saving: simultaneous compos-
ite increments reduce the number of
curing cycles.
2. Easier modeling: the centripetal pro-
jection of the peripheral sound tissue
means fewer occlusal adjustments.
3. 
Occlusal preview: preview, verify,
and modify the position, extent, and
orientation of the simultaneous ridg-
es before light curing.
4. Shrinkage management: due to the
non-contact of multiple increments,
shrinkage stress can be controlled.
5. Standardized procedure: a standard-
ized cavity depth as a starting point
for the occlusal layer makes the pro-
cedures repeatable.
The limits of this technique are that the
peripheral sound tissue, from which the
central projection starts, can be discon-
tinued by the loss of one or both marginal

ridges, or one or more cusps. Clinicians
can face two different situations with two
different outcomes:
1. 
Marginal ridges: these can be re-
stored in a predictable way using
proven techniques.9
2. Cusps: freehand modeling of a cusp
(height, thickness, and tip position) is
difficult, arbitrary, and unpredictable,
mainly due to the lack of references.
Due to rubber dam isolation, it is im-
possible to verify the interocclusal
relationship. Indirect restorations can
provide a more practical and predict-
able solution for the clinician in these
situations.
Description of the
technique
Knowledge of dental anatomy is cru-
cial. Although this technique presents a
workflow that allows for simplified mod-
eling in posteriors, the main aspects
of occlusal anatomy and their possible
variability should be known for every
tooth, including the average position of
grooves, pits, ridges, triangular ridges,
oblique ridges, and marginal ridges, as
well as the size ratio of ridges.
Observation
The preliminary stage of gathering in-
formation should be performed prior to
rubber dam isolation.
Analysis of the teeth to be treated
Observation plays a very important role
in the initial stage. If the teeth to be treat-
ed are not already destroyed or do not
contain incongruous extensive restor-
Scolavino et al
Fig 2  The modeling of the occlusal layer starts
from a standardized cavity depth.
ations, the analysis of these teeth allows
the clinician to define the position of the
grooves and pits, as well as the orienta-
tion and steepness of the crestal slopes.
Analysis of the adjacent teeth
The depth of the grooves, the inclina-
tion of the crestal slopes, and the height
of the marginal ridges (in the case of
class II) can be quickly detected from
the neighboring teeth.
Cavity requirements
Cavity floor
The technique described here is referred
to as modeling the anatomy of the oc-
clusal layer. This technique starts from a
simplified cavity floor, with no anatomic
pre-modeling and approximately 1 to
2  mm deeper than the marginal ridge
(Fig  2). The cavity floor is then flat or
slightly rounded.
A cavity depth of 1.5 to 2  mm allows
for an average depth of 3 to 3.5  
mm
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Fig 3    Grooves and pits are generally 3 to 3.5  mm from the top of the cusps.

Fig 4    A standardized cavity floor depth of about 1 to 2  mm (measured at the marginal ridge) allows for
reproducibility of the correct position and depth of pits and grooves.

Fig 5   Simultaneous increments are applied to each corresponding cusp.

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1 2 3 4 5

Diagrams 1 to 5    1 and 2: Simultaneous increments. 3: Centripetal projection of composite increments

to define ridges. 4 and 5: Excess removal following the residual anatomy.

Fig 6   Increments are pushed centripetally in order to define ridges.

from the top of the buccal cusp tip of the
grooves (Figs  3 and 4), as suggested by
Kano.10
The above-mentioned cavity
can be obtained with different materials
(flowables, bulk-fill materials, regular
composites), depending on the clinical
situation and the clinician’s choice.
Cuspal thickness
Cuspal thickness is ≥  2  mm. Structural
issues related to cuspal thickness thin-
ner than 2 to 2.5  mm have been report-
ed.11,12 Cusps thinner than this value
should be lowered and, as previously
floor mentioned, an indirect restoration could
be a more predictable solution.
Cuspal ridges
The first composite increments are per-
formed simultaneously, in correspond-
ence with two or more cusps (Fig  5; Dia-
grams  1 and 2) in order to better preview

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Fig 7   Excesses are removed by dragging a sharpened instrument along the sound residual tissue.

Fig 8   All ridge characteristics (width, length, height, etc) can be modified simultaneously before light
curing.

Fig 9    Composite is spread on the margin with brushes for margin adaptation.

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5 6 7 8 9

Diagrams 5 to 9    5 to 7: Once excess is removed, composite is spread on the margin with a brush.
8 and 9: All the increments are light cured at once.

Fig 10    Definition of marginal ridges. (From left to right): simultaneous application, centripetal spreading,
excess removal. A different color has been used for teaching purposes.

cuspal relationships. Composite is then 1. Main ridge orientation, location, and

squeezed and pushed toward the cent-
er of the occlusal table (Fig  6) to extend
the ridge bodies (Diagram  3). To con-
trol shrinkage stress, ridge extensions
should not be in contact with each other.
The occlusal table will be closed in the
final step, allowing further anatomy ad-
justments. Any excess composite can
be removed by dragging along a sharp-
ened instrument parallel7 to the sound
residual tissue (Fig  7; Diagrams  4 and
5). Final ridge adjustments are done be-
fore light curing (Fig  8). Margin adapta-
tion is achieved by spreading compos-
ite on the margin with a brush (Fig  9;
Diagrams  5 to 7).
In this step, we define the anatomic
sketch that outlines:
volume.
2. Approximate path of the primary
and secondary grooves.
3. Approximate position of the main pits.
In this step, the clinician can check
and correct length, orientation, and
ridge volumes before light curing (Dia-
grams  8 and 9). The first increments can
be slightly undersized, both to manage
shrinkage stress and to allow appropri-
ate corrections with further increments.
Marginal ridges
The mesial and distal ridges are mod-
eled in the same way as the cuspal
ridges (Fig  10). Composite is added as

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small drops, and spread with a sharp-

ened instrument. Excesses are removed
by pushing a sharpened probe into the
sound tissue. Sometimes, they are split
into two or more ridges, and this can be
detected on the residual marginal crest.
Triangular ridge extension merges into
the distal or mesial triangular pit. Mar-
ginal ridge composite adaptation is
obtained through the use of brushes
(Fig  11).

Fig 11    Composite is spread on the margin.

10 11 12 13

Diagrams 10 to 13    First increments should be applied and cured simultaneously. When grooves and
pits need to be defined, increments should be cured one by one.

14 15 16 17

Diagrams 14 to 17   A natural-looking groove is obtained by pushing a drop of composite towards a

cured one.

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Closing the occlusal table brush (Diagram  18). A sharpened instru-

The central gap, derived from the in-
complete modeling of the vertexes of the
ridges, is closed by adding small drops
of composite and squeezing them to es-
tablish the correct final relationship that
defines grooves and pits (Diagrams  10
to 13).
In this step, composite increments are
pushed towards an already cured incre-
ment. To obtain a natural-looking groove,
composite should be pushed downwards
with instruments or brushes to meet the
opposite cured cusp (Diagrams  
14 to
17). Increments are then smoothed with a
ment can be used to redefine pits and
grooves (Diagram  19), and final light cur-
ing is performed (Diagrams  20 and 21).
Closing the occlusal table can be
achieved in the following ways:
1. Extending the vertex of a ridge with
a small drop of composite (Fig  12).
2. Extending the marginal ridges
(Fig  13).
3. Adding the oblique ridge in the
maxillary molars (Fig  14). In this
step, every little increment is added,
then modeled and cured.
4. Adding or extending secondary
ridges (Fig  15).

18 19 20 21

Diagrams 18 to 21    18: Composite is spread following the anatomic profile. 19: A sharpened instrument
can be used to redefine pits and grooves if they disappear during modeling. 20 to 21: Final light curing of
the increment.

Fig 12   The vertex of a ridge can be lengthened with a little increment.

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Fig 13   A centripetal extension of the marginal ridge is another way to close the occlusal table.

Fig 14   The oblique ridge can be modeled in one increment, and its central groove is generally not deep.

Fig 15   Secondary ridges, detected on the peripheral ridge, are added with a small drop of composite
and modeled with a sharpened instrument.

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Fig 16   Small cavities: one ridge is modeled and cured at a time.

Fig 17   A natural-looking groove can be obtained by pushing a small drop of composite towards a well-
defined cured one.

Small cavities Materials and shades

The technique presented here is applica-
ble not only to large cavities, where many
ridges have to be restored, but also to
small cavities. When the clinician has to
deal with small cavities, the steps shown
in Diagrams  1 to 9 can be skipped, and
those shown in Diagrams  9 to 21 should
be followed, relative to closing the oc-
clusal table. To give pits and grooves
a natural aspect, increments should be
cured one by one (Figs  16 and 17).
While this article describes a modeling
technique for occlusal anatomy, it is
not dependent on the type and shade
of composite used. The authors do not
ascribe much importance to color in
posterior direct restorations, but believe
that a correct anatomical modeling rep-
resents the best mimesis, independently
of the shades used.

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Shrinkage in the occlusal layer The simultaneous split incremental pro-

„„Although none of the layering tech-
niques can avoid the effects of poly-
merization shrinkage,13 many studies
have shown that an incremental layer-
ing technique results in better perfor-
mance than does bulk placement.14-17
„„Shrinkage stress seems to relate more
to the volume of the restoration than to
its ‘C’ factor.18,19
„„In a multi-layered restoration, if the fi-
nal occlusal increment is cured all at
the same time, it produces the highest
cuspal deflection.20
„„The shrinkage direction of compos-
ite increments is affected by both the
bonded surfaces and the free ones.21
cedure proposed here is based on re-
specting all the above-mentioned issues
aimed to reduce polymerization shrink-
age stress. In particular, among all the
composite ridges, the final connection
(closing the occlusal table) is achieved
with only a little increment that fills the
small residual occlusal gap in the least
stressful way.
Clinical cases
The following clinical cases have been
restored using the technique described
in this article.

Case 1

Fig 18    Initial situation: class I on 3.6. Fig 19  Isolation. Fig 20  Cavity preparation.

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Fig 21  After adhesion and flowable composite on the bottom of the cavity, simultaneous increments
are placed to restore DL and MB ridges. Fig 22   Ridges are driven centripetally. Residual anatomy on
sound tissue is important to understand a ridge’s orientation and steepness. Margin adaptation is achieved
through the use of brushes. Fig 23  Simultaneous increments on ML and DB.

Fig 24    Closing the occlusal table: a drop of composite is placed on the apex of DB to extend it. Fig  25  The
ridge tip of DB is extended centripetally. Fig 26   DB ridge extended. To achieve a natural-looking anatomical
modeling in mandibular molars, the vertices of ridges do not generally merge in the same pit.

Fig 27    Distal marginal ridge is added, as well as secondary ridges on the cusps of ML and DL. A small
increment is added on the ridge tip of DL to define the distal groove. Fig 28  Staining is placed to outline
anatomy and to give a better three-dimensional aspect. Fig 29  Final result.

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Case 2

Fig 31    Cavities prepared.

Fig 30   Initial situation and isolation.

Fig 32   After adhesion, a flowable base is placed Fig 33  Simultaneous placement of ridges and
at the bottom of the cavities, and the buccal surface centripetal projection in accordance with residual
of 4.6 is restored. anatomical information.

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Fig 35    6-months recall.

Fig 34   Final result before and after dental dam

removal.

Case 3

Fig 36   Initial situation, isolation, and cavity prep-
aration.
Fig 37   A base is placed at the bottom of the cav-
ity, after which simultaneous increments are placed
to define MB, DB, and MP ridges. Marginal ridges
and secondary ridges are added to complete the
occlusal table.

Fig 38    Final result. Fig 39    Final result after dental dam removal.

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Case 4

Fig 40    Initial situation: 4.7, 4.6, and 4.5 with un- Fig 41    On 4.5, class II is transformed to class I.9
suitable restorations.

Fig 42  A small amount of flowable material is Fig 43  Simultaneous increments are placed in-
placed to level the bottom of the cavities. side the opposite cusps of the first molar.

Fig 44    On 4.6, composite is pushed centripetally,

but the extensions of the ridges are not in contact.
After having defined the length and orientation of
the ridges, composite is spread on the margin of
the restoration with a brush for better marginal ad-
aptation and to make it anatomically consistent with
the residual tooth structure. On 4.7, increments are
placed for ML and DB ridges.

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Fig 45   On 4.7, ridges are pushed centripetally Fig 46    4.5: projections of ridges pushed centrip-
and the margin is smoothed with a brush, as de- etally. 4.6: increments for MB and distal ridges 4.7:
scribed for 4.6 (Fig 44). On 4.5, increments are increments for MB and DL ridges.
placed for all the three ridges.

Fig 47    4.6: buccal cavity restored, and final incre- Fig 48   Stains have been placed to enhance the
ments on the tip of the ridges to close the occlusal three-dimensional aspect of the restoration.
table.

Fig 49    Final result after dental dam removal. Fig 50    6-months recall.

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Fig 51    Final radiograph.

Case 5

Fig 52    2.6: initial situation, and after dental dam isolation.

Fig 53   Two sectional matrixes are placed in order Fig 54   The occlusal perimeter restored.
to restore marginal ridges. DP cusp is missing. As it
is quite small, it will be restored directly.

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Fig 55   Increments for DB and MP ridges. Fig 56   Increments for MB and DP ridges.

Fig 57   MB and DP ridges pushed through the Fig 58   Increments for the mesial marginal ridge
center, and margin smoothed with a brush. and the oblique ridge.

Fig 59   Increments for the distal marginal ridges Fig 60    Occlusal anatomy finished.
and for a DB secondary ridge.

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Fig 61   Staining.

Fig 62  Final result after dental dam removal. Fig 63    6-months recall.
Sound tissue is dehydrated.

Fig 64    Final radiograph.

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Case 6

Fig 65    Initial situation. 2 class I on 3.6 and 3.7. Fig 66   After isolation, cavities are prepared.

Fig 67   Self-etching adhesive system with enamel Fig 68   A small amount of flowable composite has
pre-etching has been performed. been placed on the floor cavities.

Fig 69    (Left): Contemporary increments of disto- Fig 70  Last increments for small cavities and
buccal and mesiolingual cusps. (Right): Mesiolin- definition of grooves.
gual and distobuccal.

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Fig 71   An oblique view before dental dam removal.

Fig 72    Final result after dental dam removal.

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Conclusion clinicians to perform simpler, quicker

Direct posterior restorations are a com-
mon task in daily practice. This article
describes a simplified approach, based
on the simultaneous increments for mod-
eling the occlusal table according to the
peripheral residual anatomy. This helps
restorations that need fewer occlusal
adjustments.
Acknowledgments
The authors would like to thank Dr Gurvinder Bhirth
and Dr Ronan O’Donoghue for their valuable sug-
gestions and their help with proofreading this article.

in the aesthetic treatment of

References
1. Tjan AH, Bergh BH, Lidner
C. Effect of various incre-
mental techniques on the
marginal adaptation of class
II composite restorations. J
Prosthet Dent 1992;67:62–
66.
2. Deliperi S, Bardwell DN. An
alternative method to reduce
polymerization shrinkage
in direct posterior compos-
ite restorations. J Am Dent
Assoc 2002;133:1387–1398.
3. Lopes GC, Vieira LC, Araujo
E. Direct composite restor-
ations: a review of some clin-
ical procedures to achieve
predictable results in pos-
terior teeth. J Esthet Restor
Dent 2004;16:19–31;discus-
sion 32.
4. Boer WM. Simple guidelines
for aesthetic success with
composite – part II: posterior
restorations. Pract Proced
Aesthet Dent 2007;19:243–
247;quiz 248.
5. Schlichting LH, Monteiro S Jr,
Baratieri LN. A new proposal
to optimize the occlusal
margin in direct resin com-
posite restorations of poster-
ior teeth. Eur J Esthet Dent
2008;3:348–360.
6. Klaff D. Blending incremen-
tal and stratified layering
techniques to produce an
esthetic posterior composite
restoration with a predictable
prognosis. J Esthet Restor
Dent 2001;13:101–113.
7. Dietschi D, Spreafico R.
Adhesive metal-free restor-
ations – current concepts
posterior teeth. Berlin: Quin-
tessence, 1997.
8. Baratieri LN, Monteiro Júnior
S, Correa M, Ritter AV.
Posterior resin composite
restorations: a new tech-
nique. Quintessence Int
1996;27:733–738.
9. Bichacho N. The centripetal
build-up for composite resin
posterior restorations. Pract
Periodontics Aesthet Dent
1994;6:17–23.
10. Kano P. Challenging Nature:
Wax-up Techniques in Aes-
thetics and Functional Occlu-
sion. Quintessence, 2011.
11. Krifka S, Anthofer T, Fritzsch
M, Hiller KA, Schmalz G,
Federlin M. Ceramic inlays
and partial ceramic crowns:
influence of remaining cusp
wall thickness on the margin-
al integrity and enamel crack
formation in vitro. Oper Dent
2009;34:32–42.
12. Fichera G, Re C. Restauri
estetico-adesivi indiretti:
modello per diagnosi di con-
figurazione cavitaria. Den-
tista Moderno 2006:21–57.
13. Loguercio AD, Reis A,
Schroeder M, Balducci I,
Versluis A, Ballester RY.
Polymerization shrinkage:
effects of boundary condi-
tions and filling technique of
resin composite restorations.
J Dent 2004;32:459–470.
14. Wilson EG, Mandradjieff M,
Brindock T. Controversies
in posterior composite resin
restorations. Dent Clin North
Am 1990;34:27–44.
15. Soares CJ, Bicalho AA, Tant-
birojn D, Versluis A. Polymer-
ization shrinkage stresses
in a premolar restored with
different composite resins
and different incremental
techniques. J Adhes Dent
2013;15:341–350.
16. Kwon Y, Ferracane J, Lee IB.
Effect of layering methods,
composite type, and flow-
able liner on the polymer-
ization shrinkage stress of
light cured composites. Dent
Mater 2012;28:801–809.
17. Park J, Chang J, Ferracane
J, Lee IB. How should com-
posite be layered to reduce
shrinkage stress: incremental
or bulk filling? Dent Mater
2008;24:1501–1505.
18. Braga RR, Boaro LC, Kuroe
T, Azevedo CL, Singer JM.
Influence of cavity dimen-
sions and their derivatives
(volume and ‘C’ factor) on
shrinkage stress develop-
ment and microleakage of
composite restorations. Dent
Mater 2006;22:818–823.
19. Rodrigues FP, Silikas N,
Watts DC, Ballester RY. Finite
element analysis of bonded
model Class I ‘restorations’
after shrinkage. Dent Mater
2012;28:123–132.
20. González-López S, Lucena-
Martín C, de Haro-Gasquet
F, Vilchez-Díaz MA, de
Haro-Muñoz C. Influence of
different composite restor-
ation techniques on cuspal
deflection: an in vitro study.
Oper Dent 2004;29:656–660.
21. Versluis A, Tantbirojn D,
Douglas WH. Do dental
composites always shrink
toward the light? J Dent Res
1998;77:1435–1445.

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