Today has been strangely exciting because I’ve devoted it to reading a fantastic book by Burkard Hugo called “Aesthetics With Resin Composites“. I was lent the book a few weeks ago and I’ve been dipping into it but today I gave it some undivided attention.top-10

Couple this with the day spent with the guys from the Academy Of Clinical Excellence on anterior and posterior composites and I have to admit my resin based world has been rocked.

I think there is a little too much information to dissect into a blog post but can I give you a taster with my top ten learning points.

1) The importance of layering enamel and dentine shades and how to use the various systems. I recently bought in the 3m filtex supreme system and that seems to do the job well. A really good point I didn’t realise was that the enamel layer you place should be far thinner than in an natural tooth: 0.5 mm maximum. That is because composite refracts light differently to enamel and so the restoration must be dentine heavy to appear natural.

2) That you should not use bond on your instruments to stop the composite sticking because it seriously impairs the quality of the composite and makes it pick up stain. However there are wetting agents available designed for this purpose… though using nothing is still the best. Gentle pats are required to manoeuvre the composite.

3) That the best bond strengths are still made with 4th generation bonds. This means separate etch, primer and bond is still the way forward but I think this issue is a blog post in itself.

4) By polishing cavities before restoring and rinsing with chlorhexidine you improve your bond strength.

4) Flowable composite can be used to seal cavities and avoid air inclusions on delicate areas which are hard to place composite.

5) If you have sealed a cavity (with flowable composite) then if the composite gets wet or adjusted (by a burr) then you can still add to it by simply drying the area thourghly. There should still be plenty of free monomer available and the bond strength obviously won’t be effected.

6) I’ve read up on using ligatures for rubber dam technique around anterior teeth by tying floss around the dam so you can isolate anterior teeth fantastically.

7) Not to use soft flex discs to polish composite…. teeth are not supposed to be smooth or flat. You can use polishing burrs or brushes instead.

8) The importance in posterior work to avoid curing composite between 2 walls at it places husge stresses on the teeth. It is much better to work in triangles.

9) That you should wedge teeth before you prepare there cavities (and gradually insert it further as you work)  as this makes restoration easier and will allow a tighter contact.

10) The biggest learning point however was the use of a customised matrix for your anterior work.

I’ll break this down into two matrix’s both of which are the first part of your restoration and build the framework for you so you can just concentrate on building up a really aesthetic finish:

a) The palatal matrix: This is a very thin wall of enamel composite which forms the back wall of your composite. It can be made from a putty impression of a diagnositc wax up or a previous restoration. You can pat material into the matrix then place on the tooth and polimerise or place the composite while the putty is in position. Alternatively you can build it free hand against your glove. Either way one this floor of the restoration is made it becomes easy to layer up your dentine shades upon it.

b) The interproximal matrix: This is the single most exciting technique I’ve learnt for ages. Basically you use it to create a really nice anterior interproximal contact. This is always a difficulty in my experience. Previously I’ve tried working with a clear matrix strip which is often fiddly and leaves you with a very flat broad contact and you have to work hard to polish away ledges cervically. The other way I used to use was protecting the adjacent tooth from etch or bond then building the contact free hand. I’d then break the contact with a metal matrix or wedge (as there was no bond) and polish in the finish. This gave me a better aesthetic but the polishing could be laborious and this new method is far better.

What you need to do is cut you clear matrix strip short to just over the length of the tooth then insert it length-ways between the teeth. Wedge it in place if you can fit a wedge but if not that is no problem because then you place systemp (This is an Inlay temporisation material that sets like a firm jelly) against the adjacent tooth and contour the clear matrix how you want for the ideal contact and cervical shape before setting the systemp (20 secs each side). You then will be left with an ideal, customised, secure matrix to build your contact against!!! I’ve included a scan from Mr Hugo’s amazing book on the blog which explains this far better than I could. I hope I’m not done for plagiary (it is only one diagram after all)ant composites

I’ve tried both these matrix  methods over the past 2 weeks and both have just transformed the quality of the work I’ve provided. The control and the ease with which you can establish contact points has left me speechless ( and yes I do know I’m a very, very sad man)

Still I can’t wait to go into work now tomorrow, so I can try the techniques out, continue to improve slowly and challenge myself for perfection.

Christmas is coming up and I’ve got my eyes on some other books to read…

If anyone does have any good book recommendations, or composite tips of their own please let us know!

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