AHMED M.

MOTAWIE
DIRECT POSTERIORS - CASES - COMMUNITY - TIPS
AND TRICKS
OPPOSING OCCLUSAL STAMP TECHNIQUE
(MOOS TECHNIQUE BY MOTAWIE-
MAROUN ET AL.)
13463 Views - Jan 2017

This is a case report for a new technique to minimize the need to finish and remove high spots on occlusal
surfaces of composite restorations before rubber dam removal without the need of the patient to bite in
centric occlusion.

The technique was developed because most of the times the operator works hard to mimic the occlusal
anatomy of the restored tooth, but after the removal of the rubber dam and the patient bites in centric
occlusion, high spots are discovered. The operator is guided to remove these high spots following
demarcations of the articulating paper. The removal of the high spots sometimes removes most of the fine
details and the hard work the operator did to mimic the occlusal anatomy.

This technique enables the operator to have a nearly accurate perception of the opposing occlusal surface
before curing the final composite increment and before removing the rubber dam.

Case History:

A 34 year old female had a chief complain of food stagnation between two teeth in her left maxillary
posterior area.

After examination, an open contact was revealed between tooth number 25 and 26. The 25 was
endodontically treated and was scheduled for a crown preparation along with tooth number 24, and, the
26 had an old defective occluso-mesial amalgam restoration.

Treatment plan is to remove the defective amalgam restoration and replace it with a composite
restoration.

You can read part 1 of this technique in the following link

http://www.styleitaliano.org/opposing-occlusal-stamp-technique-moos-technique-by-maroun-motawie-et-
al

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MAROUN ET AL.)

Preoperative – occlusal view

Tooth number 26 with the defective amalgam restoration that needs to be replaced by a composite
restoration.

Preoperative - buccal view of occlusion

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This is the centric occlusal relationship that should be mimicked for the operator to use to avoid any
occlusal interference before curing the last increment of composite and before rubber dam removal.

Centric Occlusion Registration Stent

The centric occlusion relationship was taken using a putty condensational silicone material.

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Temporary Crown & Bridge Material

A temporary crown and bridge material was injected into the maxillary fitting surface of the silicone stent.

Opposing Acrylic Duplicate (AOD)

An opposing acrylic duplicate was created.

(The duplicate could also be created more accurately by injecting flowable composite material into an
alginate impression of the opposing arch for more accurate anatomical registration.)

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Cutting Away the Occlusal Surface

The occlusal surface of the silicone stent was cut away using a blade leaving the buccal, lingual/palatal
surfaces, and the embrasures intact to accurately guide the acrylic duplicate into place.

Fitting the AOD into the Stent

Just for confirmation, making sure that the AOD accurately fits into its key holes in the silicone stent.

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Rubber Dam Placement

Amalgam Restoration Removal

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Cavity Preparation

Sectional Matrix Placement

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Restoring the Mesial Wall

After restoring the mesial wall of the cavity, the matrix was removed and the cavity was filled with a bulk
fill composite material leaving a 1.5 mm space for the last composite increment.

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Fitting the Stent Around Preparation

After placing the final increment of composite material, and before curing, the silicone stent is placed in
place and stabilized by the operator’s fingers.

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Fitting the AOD into the Stent

The AOD is fitted into the stent using the buccal and lingual embrasures in the silicone stent as a guide to
accurately fit it into place.

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Pressing the AOD into Place

The operator’s index finger is placed over the AOD while exerting pressure, and the silicone stent is
removed for confirmation of equal occlusal contact to all neighboring teeth surfaces.

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Occlusal Anatomy

Occlusal anatomy was mimicked as close as possible with some staining.

Post-operative

Proper finishing and polishing was carried out.

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MAROUN ET AL.)

This technique was definitely a time saving technique. The frustration of the need to remove high spots
that would ruin your hard work of mimicking the occlusal anatomy is gone. Although there was very minute
occlusal interference at the mesial marginal ridge but it was successfully removed without the need to ruin
the mimicked occlusal anatomy. Maybe if I try using an alginate impression for the opposing and creating
the opposing duplicate using a flowable composite material might give me better details and eventually
better final results.

This is the first try-out of this technique which I’m sure could be better developed. Please do not hesitate
to share with me your comments for how could this idea be better executed.
My experience in the Style Italiano Course just motivated me. I’m trying to be innovative as I think I got the
innovative fever from the Style Italiano Team in Santa Margherita.
Please, criticize my work as mush as you want because I know that it will only make me better.
Special thanks to the entire Style Italiano Team for helping me find my eye glasses after so many years of a
blurred vision. Finally I can see things clearly now, although I’m still recovering and trying to work as hard
as possible to make-up for all the past years when I thought that I do good composite restorations.
Special Thanks to:
- Dr. Walter Devoto
- My Mentors: Dr. Jordi Manauta and Dr. Anna Salat
- My Co-worker : Dr. Mohammed Khaled who helped me out to finalise the MOOS Technique.
- UpTown Dental Team.

Visit:
http://www.styleitaliano.org/opposing-occlusal-stamp-technique-moos-technique-by-motawie-maroun-et-
al-part-2

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