Formation of Diagonal Gaps as Stress-Relieving Sites: Rethinking the Concept of Increment Splitting in Direct Occlusal Composite Restorations

Abstract

The split-increment horizontal placement technique is currently used, along with other restorative techniques, in moderate-to-large occlusal cavities for reducing the shrinkage stress generated during light polymerization. Such stress, if released uncontrolled, may cause damage within the composite, tooth or at the adhesive interface. The term “diagonal cut” was used in our original paper published in 2005 to refer to the action of dividing each composite increment into segments prior to light polymerization and was presented in two-dimensional illustration. Besides, we made no mention in the original paper of the term “diagonal gap” as an outcome of such diagonal cutting. We currently recognize the importance of introducing the “diagonal gap” term and the need for shedding some light on its role to help provide a more comprehensive view of the split-increment technique. The purpose of the current paper is to rethink our increment splitting concept used in direct occlusal composite restorations by introducing the term “diagonal gap” as a stress-relieving vertical site and demonstrating it in a three-dimensional illustration for providing a more comprehensive understanding of the split-increment technique. Conclusion: In the current paper, the term “diagonal gap” is introduced to refer to the vertical gap created by diagonal cutting of the horizontal composite increment, before light curing. This gap enables the segmented composite increment to undergo unrestrained shrinkage, where each segment being free from adhesion at the gap site can deform independently from the other segments. The relief of the polymerization shrinkage stress generated during light curing prevents formation of cracks in enamel and/or composite, and debonding of adhesive interfaces. Keywords: deformation; diagonal gap; incremental; occlusal; polymerization shrinkage; posterior composite; segment; split-increment; stress reduction; stress-relieving site