How to improve Class II composite restorations

Formulating a solution for creating consistently excellent Class II composite restorations requires a process for both materials and techniques.

To this point, many dentists have put varying equipment and materials together to form their own Class II system, but these hodgepodge systems may include materials from different manufacturers. Using the “this-works-best-in-my-hands” argument, practitioners may assemble their own Class II solution based on completion of repetitive procedures and clinical observation.  

DENTSPLY Caulk has designed a Class II composite resin restorative solution based on aligning products to overcome these challenges. From isolation of the preparation to finishing of the cured restoration, the DENTSPLY Caulk solution is said to provide outstanding clinical results with increased efficiency and simplified materials choices.

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Check out the following video for a case presentation:

Continue to page two for a step-by-step breakdown of the case...

Case presentation

Step 1: In this specific case, during an intraoral exam a disto-occlusal carious lesion was noted clinically and on radiograph. The patient’s medical history was non-contributory and a direct resin on tooth No. 29 was treatment planned.

Related reading: How to simplify Class II restorations with Class II Total Practice Solution from DENTSPLY Caulk

Step 2: After administering one carpule of 4% Articadent with 1:200,000 epinephrine (DENTSPLY Pharmaceutical), a Palodent Plus wedge guard is inserted to prevent iatrogenic damage to the mesial of tooth No. 30. These wedgegaurds come in three sizes and not only protect adjacent teeth but allow you to move more quickly during the preparation process.

Step 3: After preparation, the area is isolated with a rubber dam to create an aseptic field, improve infection control, enhance accessibility and protect surrounding tissues. To maximize bond strengths and minimize exposure of dentin to phosphoric acid a selective enamel etching technique was utilized. The 37% phosphoric acid was applied to exposed enamel margins for 15 seconds followed by removal with water rinsing.

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Step 4: Using the three parts of the Palodent Plus Sectional Matrix System (EZ-Coat sectional matrix, nickel-titanium separating ring, and wave wedges), the preparation on tooth No. 29 is isolated. The ring is easily seated with V-shaped tines that allow wedge placement for adaptation of the matrix to the gingival margin.

Step 5: Prime&Bond elect Universal Dental Adhesive (DENTSPLY Caulk) can be used with all three etching modes: total-etch, self-etch and selective-etch. In this case, Prime&Bond elect was scrubbed into the preparation for 20 seconds, making sure all the surfaces of the preparation and margins are thoroughly covered. Following an air-drying step to thin the adhesive and evaporate the solvent, it is light cured for 10 seconds.

Read more steps on page 3...

Step 6:

The most vulnerable interface of a Class II composite is the floor of the proximal box. It is important to seal the gingival margin and effectively cure the restorative material at the preparation’s deepest point.   I use

SureFil SDR flow (DENTPSLY Caulk)

for its excellent cavity adaptation and low stress properties as the first restorative layer in Class II restorations. Additionally, because SureFil SDR

flow

can be placed in increments up to 4mm, fewer material increments are needed to fully restore the preparation. To ensure a proper cure,

Smartlite Focus

is used because of its collimated beam and performance over distance. SureFil SDR flow is light cured for 20 seconds.

Double Take: DENTSPLY Caulk Prime&Bond Elect

Step 7: The final restorative layer is placed using TPH Spectra Universal Composite (DENTSPLY Caulk), which features two handling choices (low and high viscosity), simplified shading and excellent blending effect. In this case TPH Spectra Low-viscosity shade B1 was used because the tooth was polychromatic and included very white cusp tip areas. The material was placed in a 2mm increment and sculpted with composite instruments. Again, Smartlite Focus was used to cure for 20 seconds.  

Step 8: The rubber dam was removed and the restoration was checked for occlusal interferences. After gross finishing with a fluted composite bur, finishing was accomplished with Enhance aluminum oxide impregnated finishers (DENTSPLY Caulk). Using slow, intermittent pressure to avoid heat buildup, it is possible to finish composite surfaces and help prevent surface roughness, stain, gingival irrigation and biofilm accumulation.  

Step 9: The restoration on tooth No. 29 is complete, showing excellent interproximal contact, natural contour, and color blending.

Related reading: DENTSPLY Caulk's TPH Spectra a hit with the whole team

Closing thoughts

Starting with isolation all the way through finishing, DENTSPLY Caulk has developed a Class II solution for practitioners. By aligning products that can be used in a step-wise manner for Class II restorations, clinicians can be more efficient while also providing excellent care to their patients.