It’s one of the most common procedures we perform and yet it still can offer us so many headaches. Recently I’ve been getting a lot of questions about what I use for composite resin restorations.
By the way, I love reading questions from fellow curious dentists via email, so keep them coming! As always, you can reach me at: curiousdentist*gmail.com (replace the * with an @)
So we start with our basic preparation. I do not follow the traditional GV Black preparation outlines because bonding allows us to be so much more conservative. For example, I frequently use the “slot prep” for Class II decay. Why remove occlusal enamel and dentin that is perfectly sound? I just go through the undermined marginal ridge, eliminate decay, and call it a day.
I use a fresh 557 carbide bur (Meisinger) to get my basic outline. Old burs are clumsy and can lead to sloppy preps. Next I remove deeper areas of decay with a slow speed round bur size 6 (Meisinger). To fine tune the outline and remove unsupported enamel I use an 858 tapered diamond finishing bur (Meisinger) rather than hand instruments. I know my former operative instructor will probably weep to hear that last bit, but hey, that’s what works in my hands.
I like the V3 System (Triodent) It’s a sectional martix, which offers some advantages over the traditional Tofflemire matrix band. There’s a closer adaptation to the natural tooth contours, which means less flash after curing. It also can permit the same tooth to have a rubber dam clamp, as illustrated to the right.
I will still use the Tofflemire matrix band system if the tooth won’t accept the V3 for some reason. Just use the thinnest bands possible! Thicker bands will slip in easier but will make it harder to get a strong interproximal contact with composite. The thicker bands are best reserved for amalgam restorations, which can get packed down with furious abandon.
If I have a small pulpal exposure or I can see the shadow of the pulp, I use Dycal (Dentsply) to build some secondary dentin. For preparations that are deep into dentin, I use Vitrebond (3M). It’s a fluoride-releasing glass ionomer that will decrease pesky post-op sensitivity. No need to etch and bond first; just mix, apply, and cure. If I’ve placed Dycal, I’ll always lay some Vitrebond on top.
I mostly use self-etch systems for composites since they offer less post-op sensitivity. I’m currently using Clearfil SE Protect (Kuraray). Etch and prime in one bottle, bond in another. When I’m bonding mostly to enamel, such as restoring a chipped incisal edge, then I like to use a traditional total-etch system. Phosphoric acid gel, prime and bond in a bottle.
I’ve used a lot of different composite resin systems out there. Currently I’m a fan of Esthet X HD (Dentsply). I like the enamel shades for maximum cosmetic flexibility. I like their shade guide, which tells you opaquing dentin, body, and enamel shades. They even have ultra light shades for patients who have bleached.
Finally, not all curing lights are created equal. Some of you may have noticed issues with inconsistent cures of different materials. Also, if you’re cordless, the battery may not adequately charge in its base which leads to frustrating brown outs during a procedure. I’m a fan of the new bluephase style (Ivoclar). It emits a wide spectrum of light for more consistent cures of materials and the charging is idiot-proof. It’s also pretty slender and can get to hard to reach places. Extra points for looking cool, too.