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Posterior Direct Composite Restoration Within the “Universal Excellence” Concept

Kuraray Noritake
Posterior Direct Composite Restoration Within the “Universal Excellence” Concept 

Abtract
This clinical case report presents a posterior direct composite restoration performed using Kuraray Noritake Dental Inc.’s “Universal Excellence” product concept. A universal adhesive (CLEARFIL™ Universal Bond Quick 2) and a highly filled, universal-shade flowable composite (CLEARFIL MAJESTY™ ES Flow Universal) were utilized to achieve both simplicity and predictability. Step-by-step documentation demonstrates isolation, cavity preparation, deep margin elevation, adhesive protocol, and final restoration.

Case Description
A 38-year-old female patient presented with complaints of interdental bleeding and cold sensitivity between her maxillary left canine and first premolar (teeth #23 and #24, FDI notation). Clinical examination revealed an open margin and secondary caries at the gingival floor of the existing restoration on tooth #23. After rubber dam isolation, the stepwise treatment procedure was initiated.

Clinical Procedure
Step 1. Tooth #23 exhibited an open gingival margin and caries (Fig. 1).
Step 2. After enamel removal, caries was excavated down to the gingival level. The lesion on tooth #24 was observed to extend subgingivally (Fig. 2).
Step 3. After complete caries excavation and cavity refinement, the need for deep margin elevation (DME) on tooth #24 became evident (Fig. 3).
Step 4. Deep margin elevation (DME) was performed on tooth #24 using a custom sectional wedge. First, selective etching and CLEARFIL™ Universal Bond Quick 2 were applied, followed by the placement of CLEARFIL MAJESTY™ ES Flow Universal (Super Low) (Figs. 4 to 6).
Step 5. After completion of the DME (deep margin elevation), appropriate matrix bands were placed, followed by a direct restoration of teeth #23 and #24 with CLEARFIL MAJESTY™ ES Flow Universal (Super Low) (Figs. 7 to 9). Thanks to the material’s easy handling, shade adaptation, and excellent polishability, this challenging DME case was successfully and efficiently managed.

The treatment outcome is shown in Figures 10 and 11.

Fig. 1: Preoperative view under rubber dam isolation

Fig. 1: Preoperative view under rubber dam isolation

Fig. 2: Clinical situation after caries excavation

Fig. 2: Clinical situation after caries excavation

Fig. 3: Refined cavities with a deep margin on the premolar

Fig. 3: Refined cavities with a deep margin on the premolar

Fig. 4: Custom wedge placed to elevate the margin

Fig. 4: Custom wedge placed to elevate the margin

Fig. 5: Buccal view of the teeth after deep margin elevation with universal products

Fig. 5: Buccal view of the teeth after deep margin elevation with universal products

Fig. 6: Occlusal view of the teeth after deep margin elevation with universal products

Fig. 6: Occlusal view of the teeth after deep margin elevation with universal products

Fig. 7: Placement of a sectional matrix

Fig. 7: Placement of a sectional matrix

Fig. 8: Buccal view of the teeth restored with a universal-shade flowable composite with super low flowability

Fig. 8: Buccal view of the teeth restored with a universal-shade flowable composite with super low flowability

Fig. 9: Occlusal view of the teeth restored with a universal-shade flowable composite

Fig. 9: Occlusal view of the teeth restored with a universal-shade flowable composite

Fig. 10: Occlusal view of the final restorations of teeth #23 and #24, showing colour blending, anatomical form, and surface gloss.

Fig. 10: Occlusal view of the final restorations of teeth #23 and #24, showing colour blending, anatomical form, and surface gloss.

Fig. 11: Buccal view of the final restorations of teeth #23 and #24, showing colour blending, anatomical form, and surface gloss.

Fig. 11: Buccal view of the final restorations of teeth #23 and #24, showing colour blending, anatomical form, and surface gloss.

Discussion
Universal adhesives and modern flowable composites simplify posterior direct restorations by reducing technique sensitivity while providing for durable outcomes. In this case, CLEARFIL™ Universal Bond Quick 2 provided strong adhesion with minimal application time. The universal flowable composite demonstrated excellent adaptability, polishability, and durability. Even with a subgingival margin requiring DME, a streamlined approach was achieved without compromising quality.

Conclusion
The combination of CLEARFIL™ Universal Bond Quick 2 and CLEARFIL MAJESTY™ ES Flow Universal allows clinicians to perform predictable, efficient posterior restorations. Their universal applicability and handling properties align with the “Universal Excellence” concept, supporting simplified, yet reliable daily practice.

Dt. Koray KendirDt. Koray Kendir, DDS, Turkey (İzmir)
Dt. Koray Kendir is a graduate of Hacettepe University Faculty of Dentistry and the co-founder of a private dental clinic in İzmir. He specializes in digital dentistry, smile design, and computer-aided restorative treatments. Known for his innovative approach, Dr. Kendir is a frequent speaker at national dental congresses and serves as an advisor to several dental companies.


Ethics & Disclosure
All procedures were performed in accordance with standard dental practice. The patient provided informed consent for treatment and publication of anonymized clinical images. Author collaborates with Kuraray Noritake Dental Inc. as an advisor; content reflects clinical experience.

Clearfil Majesty ES Flow Universal

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