In My view GC ever X Posterior ( fiber Reinforced composite) can be used for such things.

Thank you for your advice Neeraj..... regards.

Dear Alain. According to my expertise, I think we could use nanocomposites commonly used in the restorations of one or two faces. Therefore, we have to take into consideration aspects like oclusal stability; presence of enamel in the margins; oral hygiene level and the kind of restoration of the antagonist (if it is restored). We also have to keep this tooth under observation, along the time.

I have had success with Gradia Direct X from GC america as well in several cases but i thibk success hinges on planning the restoration to mininize the occlusal loading. Usually in cases with 3 walls missing i lower the remaining wall by 2mm and overlay the composite onto that wall. The icclusion is then adjusted to pinooint icclusal stops with no interferences on excursion. Although the attached file is for 2cusps i hope it helps. Current survival in this tooth is 2 years so far, no repairs good oral hygiene maintenance

Dear Alain, I know that sometimes we want to be very conservative, but from my point of view an indirect restoration i think will be more predictavel in your case, because from your question i am thinking that the teeth is very destroyed and a direct restauration will last less time. But, if you want an option, i have used Z350 from 3M and it has given me very good results in posterior restaurations. Also a good oclusion adjustment could be good in order to stabilize the loads. 

3M 's Filitex over Glass ionomer/resin base.

With a Master's in Biomaterials and Clinical Research, the best composite resin restoration for cusp replacement or other posterior composite restorations from class 1, 2 and multiple cusp replacements is going to be a true hybrid composite like P-60, Heliomolar or since you are outside the US, Clearfil Photoposterior which has been the best wearing composite to my knowledge tested.  I wrote the paper on the 1 and 3 year clinicals and it was and is superior in both lab and clinical applications.  After over 35 years of studying composites and bonding, the new nanofil composites will start to act as the "microfils" they are after 2-3 years if not sooner.  And you should be using a 4th generation bonding resin such as Clearfil SE Bond or my favorite Kerr Optibond FL.  The others lose their bond strengths 70+ % at about 3 years.  I remove too many failures where they come out like amalgams...in other words not bonded anymore.

Thank you for your valiable information Mr Stanley, could you please explain us "microfils"?

You must deal with the Matrix metalloproteinase that are activate in an acidic environment under any composite or the bond will simply deteriorate. The new bioactive hybrid composites/glass ionomer/urea material may be the solution. The high pH may deactivate the MMPs. If mot then treating the exposed collagen complex with a gluteraldehyde or CHX may be needed prior to placement of any  composite material.

If, Paul, indeed the material you are talking about is a high pH material, then MMPs are activated by acids, and the reason that self etching bonding materials lose their bonds within generally 3-5 years.  That is why 4th generation bonding materials work the best long term as they are not subjected to a long term acid environment such as those produced from self etching bonding materials.  Using gluteraldehyde or Chlorahexadine which is usually suspended in gluteraldehyde presents a problem not well presented in the literature with enamel bonding.  Acid etching of the enamel exposes the prisms of the enamel and increases the surface energy of the enamel, but gluteraldehyde and gluteraldehyde based products are very tenacious and coat the etched enamel and will presume to decrease the long term bond strength of enamel.  This I see clinically almost everyday in my private practice as leaking and stained margins of nanofilled composites after 3-5 years.

These new hybrids do not require acid etching other to enhance the bond. There is an ionic bong to calcium of the tooth. This maybe the strongest bond to date. Time will tell.

Christensen says gluteraldehyde will actually enhance the composite bond. It certainly protects the collagen. Maybe SDF is a better solution as that solution protects the collagen too.

Dear Alain,

you can use hybrid composite which shows better results.