Posterior composites ... enjoyable and profitable again

April 1, 2011
One of the most common procedures in the dental practice has to be the placement of the direct filling.

by Christopher Pescatore, DMD

One of the most common procedures in the dental practice has to be the placement of the direct filling. For many years, the predominant material used for this type of restoration was the amalgam filling material. Due to concerns over the potential health issues of this material, many practitioners switched from placing amalgam fillings to composite resin restorations using adhesive. However, much to the clinician's dismay, the placement technique for them is not as straightforward as that of amalgam. It requires further understanding of proper isolation, adhesion, and the properties of composite resins. All of this equates to additional chairtime and an efficient placement protocol for composite resins.

Currently, numerous composite restorative systems are available, yet all require time to place utilizing a very strict protocol; thus, for many practitioners the economics are questionable. According to a leading expert on dental insurance, the average fee paid by insurance companies for a Class II composite is less than $180. This begs the question, Are direct composites profitable for the dentist?

Before we can look at profitability, we have to look at potential longevity. The longevity of the Class II composite restoration seems to logically be proportional to the size.

One expert says, "The use of composite should be limited to small- or medium-sized tooth preparations." This satisfies two conditions: the patient's desire to have a restoration that will last an acceptable amount of time, and the dentist's desire to have a profitable appointment. "For patients who prefer tooth-colored restorations, preparations wider than one-third of the isthmus width are better served with indirect laboratory-made or in-office milled ceramic or polymer restorations."

If large direct composite restorations are placed, the average fee collected will not support ongoing practice due to the excess time involved. Therefore, it is important to create a process, or processes, to perform these direct composite procedures in an expeditious fashion, without sacrificing quality or longevity.

In an effort to decrease the time involved to perform a direct composite restoration, many techniques and products have evolved to (mostly) eliminate the need for layering of the composite resin. The layering, which is so crucial to eliminate possible postoperative sensitivity and potential shortening of the restoration's life span (due to polymerization shrinkage as well as other factors), is unfortunately very time-consuming, especially when compared to the traditional amalgam filling.

What makes the amalgam filling so cost-efficient is the method of inserting the material, commonly referred to as "bulk filling." The theory of bulk filling a cavity preparation is only advised with amalgam filling materials at this point, though some composite resins offer a 4 mm bulk fill based on the depth of cure. Unfortunately, these composites lack the esthetic quality we are used to with the traditional layer technique, and the 4 mm maximum depth of cure still does not allow us to place the composite in only one bulk fill increment.

SonicFill™ is a new breed of composite resin that allows the placing of a bulk fill in the vast majority of restorations. There are only three shades currently available (A1, A2, A3), and while this might seem too limiting, this clinician has been very impressed with its chameleon-like properties and ability to blend with all shades of teeth.

This new and unique composite comes in a unidose tip that is inserted into a special sonic handpiece. Once the tip is placed into the adhesively prepared cavity preparation, the sonic headpiece is activated and the SonicFill composite drops in viscosity almost 90%, thereby flowing into and filling the preparation within seconds. The handpiece is then removed and the material's viscosity will quickly return to the familiar viscosity of most composite resins, allowing sculpting and anatomy creation immediately. The nonsticky characteristic of the SonicFill composite is ideal.

Since this resin material does not slump and any carving or sculpting stays in place, the most demanding clinicians can create the absolute in anatomical contours to mimic nature and function. A CompoRoller™ is used to remove any excess and to ensure that margins are sealed. Regular composite instruments are used to establish a marginal ridge and create the occlusal anatomy of the tooth, restoring function and esthetics.

Kerr SonicFill is a new and unique composite technology that changes the material to a free-flowing state, quickly (in a few seconds) bulk filling a tooth cavity without increments. This technique makes placing a composite restoration easy, fast, and profitable.

Christopher Pescatore, DMD, is a national and international lecturer who has written articles for numerous publications. He lectures on state-of-the-art esthetic procedures, techniques, and materials, and also evaluates and assists in the development of products for several leading dental manufacturers. Dr. Pescatore maintains a full-time practice dedicated exclusively to esthetic restorative dental procedures in Danville, Calif. He can be reached at [email protected].

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