Hello all I thought I’d start my blogging career with a summary of my learning points from the BDA conference. I’m going to do it in 3 parts and hopefully give those who couldn’t make it (like Chris) an idea of what they missed.

After an early start and a three hour train ride, we arrived at Glasgow ready to start our learning curve at our first BDA conference. The Northern Deanery were out in force with all five schemes making the trip north of the border.

The venue was the fantastic Scottish Exhibition and Conference Centre; the design mimics the Sydney Opera House but affectionately called the armadillo by the locals.

So the stage was set, the lights dimmed and the BDA President John Drummond entered the stage to welcome the crowd. Peter Ward the BDA Chief Executive warmed the audience for the Keynote Speaker Charan Gill MBE, a Glaswegian entrepreneur and owner of the Harlequin Leisure Group. Known as Glasgow’s Curry King and was featured on the 3rd episode of ‘The Secret Millionaire’.
Charan spoke about his journey from his childhood experiences in the Punjab to prejudice streets of 1960’s Glasgow to owning the largest curry chain in Europe. An intriguing man with a fantastic story to tell, If you want to read more his cleverly named book ‘Tikka Look At Me Now’ is out now (sorry for the plug but the proceeds do go to charity and not the Inci-Dental blog).

The main objective of the lecture was to show how composite can be used in multiple clinical scenarios such as treating cracked cusp syndrome, tooth wear and full core build ups negating the need for an indirect restoration.

The first part of the lecture was comparing composite to amalgam. Obviously the main advantage most people think of is aesthetics, but they don’t stop there. Composite is an ideal restoration in small carious lesions as less tooth tissue is removed for the cavity outline form. So the old days of G.V Blacks ‘extension for prevention’ is long gone. Another advantage is the bonding of cusps together reducing the chance of cracks forming below the restoration. The data that Niek collated showed most of the amalgam failures are due to tooth fracture.

Some reported disadvantages of composite are post-operative sensitivity, reduced strength and poor contact points. Niek believes that 4th generation bonding system (which incorporate a separate prime and bond stage) reduces the post-operative sensitivity due to a stronger hybrid layer that doesn’t insult the dentinal tubules. With respect to strength of composite, most hybrid composites nowadays are durable to stand clinical practice so this should no longer be an issue. Niek mentioned that most of cracked or broken composite restorations were due to a GIC base (open sandwich technique) so this should be avoided.

Tight contact points are achieved using a sectional matrix system. They work by taking advantage of physiological tooth movement and wedging the teeth apart. There are several systems out there but they are more expensive then conventional matrix bands. Sectional matrix bands are all well and good for MO, DO or MOD cavities but for useless for large cuspal replacements or core build ups.

Niek gets round the problem by using a conventional matrix band to build the lingual and buccal aspects first i.e. restoring to an MOD cavity then swaps the matrix band for a sectional matrix for the contact points.

So what important points did I learn?
•    Adhesive dentistry is ideal for minimally invasive dentistry.
•    Hybrid composites are ideal for posteriors.
•    A three bottle bonding system is the gold standard (separate stages for Etchant, Primer and Bond) but following the manufactures instructions is key.
•    Enamel, dentine and staining shades are really not necessary; Niek only uses A2 or A3 depending on the age of the patient. Time is better spent on incremental layering of the composite.
•    To achieve an ideal tight contact point sectional matrices are needed.
•    Research has shown that open sandwich techniques (GIC under the composite) have a higher failure rate then total etching composite.
•    Rubber dam is not necessarily needed but good isolation is the key, be it with cotton wool rolls and suction or a rubber dam.
•    Composite can be used to bond cusps together to treat cracked tooth syndrome.

For further information about the speaker:
Niek Opdam, a Specialist in Adhesive Dentistry and Assistant Professor in Cariology and Restorative Dentistry at the University of Radboud, Nijmegen, Netherlands.

So overall it was a very interesting and informative lecture. The main reason for Nieks interest in composite is due to the shift from amalgam to composite in the Netherlands, with many countries doing the same who knows when the UK will follow suite. The only concern I have with posterior composites is it takes a lot longer to distinguish between restoration and tooth. So what do you guys think? Any tips or techniques is most welcome.

Zaid

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