Posterior direct restorations
Choose material and cavity design according to load, remaining tissue, moisture control and patient factors. Aim for contact, contour and cleansability.
Understand
Posterior restorations must withstand load while preserving tooth. Proximal contour, contact, marginal adaptation and occlusion are as important as material choice.
Assess
Assess crack risk, residual cusp thickness, deep margins, matrix access, opposing contacts and isolation. A large failing restoration may be a symptom of broader disease or occlusal stress.
Apply
Choose direct or indirect care on the overall tooth prognosis. Finish and polish for cleansability; explain potential sensitivity, fracture or replacement in consent.
Key distinctions
A posterior restoration's success depends on proximal contact, cervical seal, cusp support and occlusal load. Large deep preparations may threaten pulp vitality as well as fracture resistance. A wedge and matrix influence emergence profile and overhang risk. Discuss whether the patient can clean the final contact before considering the restoration complete.
Think through a case
A heavily restored lower molar has a thin functional cusp and an opposing high contact. A small direct repair might leave the mechanical problem unresolved.
The distinction to remember
Do not choose material before assessing residual tooth structure, cusp coverage and occlusion.
Test your recall
Why assess remaining cusps before a large restoration?
Show answer
Weakened cusps may need protection or a different restoration.