How to simplify composite selection, procedures

Since the first resin-based light-cured composites were introduced many decades ago, there have been significant advancements realized in resin and filler technology.

Practitioners are faced with ever-increasing composite choices that are designed to give better results during placement and over the lifespan of the restoration. Ironically, the introduction of sophisticated materials designed to improve restorative procedures can have the opposite effect. Today’s clinicians can be easily confused about the subtle differences between the many available composite materials and may find it more difficult to make the correct decision about which material is best for each clinical situation. 

Choosing which composite material to purchase can be a difficult decision. Ideally, practitioners should rely on published reports and a careful review of a product’s physical properties when selecting a material. However, this level of review is generally not realistic for everyday providers.

Dentists’ purchasing decisions may be based on cost, brand preference, and the “works best in my hands” argument, rather than a strict review of each product’s fracture toughness, volumetric shrinkage, or other properties. Clinicians become more confident in their procedures and materials through repetition of use and clinical observations. This is especially true when considering material choices: exacting use of poorly selected materials will not offer better clinical results than use of ideally chosen materials.

To simplify decision-making and to offer a composite that can ensure excellent performance in all clinical situations, DENTSPLY Caulk has introduced TPH Spectra Universal Composite. It is based on the resin technology of TPH3 and contains nanohybrid- and micro-filler components. The result is a composite that has the potential to perform well in either the anterior or posterior, and should have tooth-like translucency, improved polishability and color stability, and good wear resistance. TPH Spectra also comes in two handling choices: a creamy light-viscosity formulation and a packable high-viscosity formulation.

For both viscosities, the physical properties are similar. Because handling preference is subjective and highly individualized, practitioners are now able to select the right viscosity for all clinical situations.  

In order to make shade selection simpler, the material is available in the seven most popular shades. According to DENTSPLY’S internal data, the seven shades of TPH Spectra represent more than 80 percent of total sales from the previous TPH3 formulation.

The TPH Spectra shade guide was condensed for several reasons. First, some practitioners may be overwhelmed with the number of current shades; the Vita Classic (Vident) shade guide has 16 shades, and the TPH3 shade guide has 26. Because only seven of the current 26 TPH3 shades are regularly purchased, the color difference (i.e., Delta-E value) between shades was calculated to determine if a top-seven shade could be used in place of another shade not offered.

Available data shows that it will be possible to “cover” all the Vita shades with the existing TPH Spectra offerings by keeping the Delta-E less than four (if the two shades, tooth-composite or composite-composite, have a Delta-E difference of less than four, the difference is difficult to distinguish for the human eye).  

TPH Spectra also offers optimal color blending between restorative materials and natural tooth, often called, “the chameleon effect.” 

How to simplify composite selection, procedures

from

ldorr

CLINICAL PROCEDURES
Case 1

Step 1: An intraoral exam revealed a fractured composite resin restoration on tooth No. 29. The patient’s chief complaint involved food impaction in the area leading to discomfort after meals (Fig. 1).  After verifying the medical history and reviewing the radiographs, a direct composite resin restoration of the disto-occlusal surfaces was treatment planned.  

Step 2: Anesthesia was achieved with one carpule of 4% Articadentwith 1:100,000 epinephrine (DENTSPLY Pharmaceutical) via buccal infiltration. Caries excavation was completed using a 330 carbide bur on a high-speed handpiece and a #4 round bur on a low-speed handpiece. The preparation was verified caries-free with Snoop caries detector from PULPDENT Corp.  (Fig. 2).  

Step 3: A rubber dam was placed and isolation of the preparation was accomplished with Palodent Plus Sectional Matrix System (DENTSPLY Caulk) [Fig. 3]. Because of the depth and size of the final preparation, a selective etch technique with Prime&Bond Elect (DENTSPLY Caulk) was used. This technique was chosen to maximize enamel bonding while minimizing the potential for post-operative sensitivity. The enamel was etched with 34 percent phosphoric acid for 15 seconds and then rinsed. Prime&Bond Elect was scrubbed into the preparation for 20 seconds followed by a five-second air drying to remove the solvent. The adhesive was light cured for 10 seconds (Fig. 4).

Step 4: The first restorative layer was placed using a Surefil SDR flow (DENTSPLY Caulk), a low stress bulk fill material with excellent cavity adaptation (Fig. 5). TPH Spectra Low-Viscosity shade A2 was selected for the final occlusal layer because of its creamy handling and placed in 2mm increments (Figs. 6-7). Each composite increment was light cured for 20 seconds. After the last layer of composite was cured, the Palodent Plus ring and sectional matrix were removed (Fig. 8).

Step 5: The final restoration was finished with fluted composite finishing burs and white stones to achieve proper shape and contour. After occlusal adjustment, the composite was polished with DENTSPLY Caulk’s Enhance Finishing System points and cups (Fig. 9).  

Case 2

Step 1: During a periodic exam, caries was noted on the mesial and distal of tooth No. 30  (Fig. 10). After local anesthesia with one carpule of 4% Articadent^© with 1:100,000 epinephrine (DENTSPLY Pharmaceutical) via inferior alveolar nerve block, Palodent Plus Wedge Guards (DENTSPLY Caulk) were inserted mesially and distally to prevent iatrogenic damage to adjacent teeth during preparation (Fig. 11).

Step 2: Because of the large amount of dentin present in the preparation, a selective-etch technique was chosen. The exposed enamel surfaces were etched with 34 percent phosphoric acid for 20 seconds and then thoroughly rinsed with water (Fig. 12). Isolation of the preparation was achieved using Palodent Plus Sectional Matrix System (Fig. 13).

Prime&Bond Elect was scrubbed into the preparation for 20 seconds followed by a five-second air drying to remove the solvent. The bonding agent was light cured for 10 seconds. An initial layer of Surefil SDR flow was placed into the preparation, followed by a 20-second light cure. 

Step 3: TPH Spectra High-Viscosity shade A2 was packed into the preparation and cured in 2mm increments. The final restoration was finished with fluted composite burs and polished with Enhance Finishing System and PoGo Micro Polishers (DENTSPLY Caulk) (Fig. 14).

CONCLUSIONS

With the introduction of TPH Spectra Universal Composite by DENTSPLY Caulk, dentists now have one material that can be used for all situations. As a result, no longer do practitioners need to struggle with decisions of shading or selecting the material with the most appropriate physical properties.

TPH Spectra’s characteristics and excellent chameleon effect will provide the dentist and patient with predictable results not only during placement at chairside but for years to come.