Pearls for your Practice
Joshua Austin, DDS, FAGD
Triodent V3 SuperCurve kit by Triodent
Restoring small to moderate Class II lesions is one of the most stressful yet minimally reimbursed procedures we do on a regular basis. Nothing is more of a beatdown than a quadrant of a few Class IIs in the middle of the day. Having a good matrix system is hugely important in increasing efficiency and productivity with these restorations. For most Class II restorations, I think segmental matrices are the best at creating anatomical embrasures and good interproximal contacts. I have tried many segmental matrix systems in my years of practice, and the one I have liked the most is the Triodent V3 SuperCurve kit.
Included in the kit is a sampler platter of the different matrices, a sampler of the different anatomic "Wave-Wedges," pin tweezers (for the matrices and wedges), and two different "V3 Rings." Sold through Ultradent Products Inc., the Triodent V3 SuperCurve kit can help you anatomically restore all sorts of lesions. The system has a wide variety of matrix sizes from 3.5 mm to 7.5 mm. I frequently use the 4.5-mm and 5.5-mm sizes. I rarely use the others, but they're nice to have. Deep Class II lesions are extremely difficult, and having these deeper-sized matrices can really save you from time to time. The matrices have a nonstick finish that makes post-curing retrieval a breeze, and their anatomical shape helps to yield nice, rounded embrasures.
The V3 Rings themselves are very nice. Made from a nickel-titanium alloy, they are strong and resilient. They stretch during application but rebound back to their original shape well. The green version is generally used for molars, while the yellow ring is generally used on premolars, but this is more of a guideline than a hard-and-fast rule. There have been situations in which I have used the green ring on premolars and the yellow ring on molars. It's all a matter of feel and what fits best.
The Wave-Wedges are anatomical in that they help to shape the gingival embrasures more than traditional wooden wedges do. The tines of the V3 Ring straddle the wedge, allowing the ring to grip both teeth equally, which results in maximum separation and better contact. Just like everything else in the system, the wedges are color-coded for easy selection. I most commonly use the pink, medium-sized wedge.
Applying the Triodent V3 system is very easy. I always pre-wedge with one of the Wave-Wedges, then prepare the tooth. I then remove the wedge, insert the appropriate matrix, reinsert the wedge, and apply the V3 Ring of choice. As with every segmental matrix system, care must be taken when applying the ring to make sure the matrix isn't pulled occlusally, exposing the gingival portion of the preparation. Once everything is applied appropriately, I make sure that the matrix is correctly positioned against the adjacent tooth. Because of how well the matrices fit, there is rarely any need to strongly burnish the contact area. Most of the time, the contact area is exactly where you want it to be because of the shape of the matrix. The system also helps isolate the tooth pretty well. The ring and wedge are held tight enough against the tooth that it seals off any fluids from seeping in around them.
After using this kit for a few months, it is definitely my favorite segmental matrix system on the market. It gives me the best contacts with the easiest application procedure I have found yet. A smash triple to the fence for Triodent on their Triodent V3 SuperCurve Matrix system!
DirectDia Polishing Paste by Shofu Dental
I don't frequently find the need for a polishing paste, but there are situations when it is nice to have one around, such as when I see patients with anterior porcelain restorations who also wear retainers, sleep appliances, night guards, or partials that engage the porcelain. It is not uncommon for these appliances to leave little gray lines on the ceramic where the appliance engages. Whenever I see these, it's a perfect situation for polishing paste. Polishing paste can remove those gray lines without removing 50-100 microns of porcelain, like traditional porcelain polishing might. Detailed anterior composites are another indication of polishing paste, as it can help you to achieve a very high luster without compromising surface texture. There are several good polishing pastes on the market, but I recently tried out Shofu Dental's DirectDia Polishing Paste, and I have really enjoyed it.
When used in conjunction with a Super-Snap SuperBuff disk, also made by Shofu, DirectDia paste gives a high luster on porcelain, composite, and enamel. A little bit generally goes a long way; the diamond-impregnated paste coats the area well. The Super-Snap SuperBuff disk reminds me of a buffing wheel that might be used for auto-detailing, while the DirectDia Polishing Paste acts like a carnauba wax finish would. After polishing, the paste rinses away easily, showing gloss and luster.
Again, I don't often find the need for a polishing paste. For most restorations, my usual polishing product works well. In situations when I want extra luster, DirectDia is a great paste to use. It also works great on existing porcelain restorations and for polishing enamel-say, after Invisalign button removal. It's a nice product to have around for those instances in which you might need it. Texas-league bloop single for Shofu!
SonicFill 2 by Kerr
In one of my very first pearls for Dental Economics, I covered SonicFill by Kerr, which has become one of my go-to products in clinical practice. It makes my life easier almost every day. At the most recent IDS meeting, Kerr introduced SonicFill 2.
With SonicFill 2, Kerr improved its formula in several different ways. When developing bulk-fill composites, manufacturers have a couple of different strategies up their sleeves that help larger increments to cure fully. One strategy is to play with the photoinitiator to make it more sensitive. Another is to increase translucency in order to allow the light to penetrate deeper. This means that many bulk-fill composites show through much of the darkness from the inside of the tooth. SonicFill 2 has improved this translucency to make esthetics and shade-blending better without affecting the depth of cure. The change is noticeable. SonicFill 2 restorations do match the surrounding tooth better without showing through as much of the stained, dark dentin that we often leave behind because it is otherwise healthy.
The polishability also seems improved in SonicFill 2 (although it wasn't bad, by any means, in the original SonicFill). With the new improvements, SonicFill 2 still has the same great handling and curing characteristics as the original but with new esthetic enhancements. It has become my go-to composite for most posterior situations.
Some of the same barriers still exist, though. SonicFill 2 still requires a special handpiece for dispensing the composite into the preparation. If you don't have an extra slot in your delivery system, it will be tough to use SonicFill 2 regularly. This really shouldn't be an issue for most dentists, but I'm sure there are some of you out there who may have some other devices in your delivery system like intraoral cameras or micro-etchers that might be taking up the spot where you could possibly fit a SonicFill 2 handpiece.
I also understand that many dentists are leery of investing in the handpiece and buying a bunch of composite without having used it previously. To that, I say, call your Kerr rep! A Kerr rep will gladly schedule a demo and let you try out SonicFill 2 and the handpiece. That's exactly how I got started with using SonicFill. I had heard about it from colleagues and seen advertisements for it, so I wanted to try it. A week later, my Kerr rep was in my office, and I was playing with it. Once I saw how the composite was pushed into the corners of the box, I was sold.
I think SonicFill 2 is a great product. I already loved the original SonicFill, and with the new improvements, SonicFill 2 is even more enjoyable to use. This is a two-run homerun for Kerr!