Modern Materials for DirectPosterior Composite RestorationsArticle by Dr. Todd C. Snyder, DDS, AAACD

Placing a composite filling is not a simple task as there are many steps that must be completed properly to obtain a good immediate result, but more importantly a good long-term result (Fig. 1 Pre-Op).

should have rounded internal line angles which will allow for easy adaptation of materials during placement. Any sharp internal line angles, boxes or grooves should be avoided as they can be difficult to get good adaptation which could create areas of composite that are not adapted well. This would lead to possible voids and heightened stress due to C-factor stress on materials during polymerization.

In some restorative cases where a proximal surface is to be restored additional tools will be necessary. One such tool is the use of a tooth guard when preparing the tooth so as not to cause iatrogenic trauma to the adjacent tooth or restoration. A caries detector solution should also be implemented to verify that any remnants of tooth decay have been completely removed. Furthermore, bond strengths are higher when adhesion is performed on affected tooth structure and can be lower on infected tooth structure by as much as 30% (Fig. 2).

(Fig. 1 Pre-Op)

Proper isolation is critical to the success of any bonded restorative material. In this case the implementation of a rubber dam was utilized. The first step is to properly prepare the cavity preparation. Following the removal of an existing restoration and/or decay, the final preparation

(Fig. 2)

An additional tool that is required when restoring the interproximal surfaces is a matrix system that can contain the filling material, recreate the same anatomical missing tooth structure and re-approximate the interproximal contact. In this example, the TriodentV3 Ring matrix system and wave wedge were utilized to create the ideal

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(Fig. 3)

(Fig. 4)

Apply G-Premio BONDTM to entire preparation and wait 10 seconds (Fig. 5). Next, dry the adhesive for 5 seconds using maximum air pressure. Then light cure for 10 seconds.

The application of a thin layer of G-ænialTM Universal Flo on the pulpal floor is an excellent first increment for adaptation and additional strength. The application of G-ænialTM Universal Flo should be only on the pulpal floor and not touching theaxial walls (Fig. 6). As a first increment, it offers excellent adaptation

(Fig. 5)

anatomical position, shape and pressure for the interproximal contactto be built out of composite. Additionally, the gingival margin was sealed with the wave wedge securely pushing the V3 matrix or super curved matrix tightly against the tooth, while theTriodent V3 ring holds the matrix against the proximal and cavosurface margins and at the same time displaces the teeth slightly (Fig. 3).

Depending on the tooth substructure that is being worked on or the dentist's preference in adhesive bondingtechnique, G-Premio BONDTM (a universal, eighth generation adhesive bonding agent that achieves outstanding performance in all etching techniques and situations) can be implemented. It can be used as a total etch, selective-etch or self-etch. If enamel is present, it is highly recommended to do a selective-etch with phosphoric acid prior to placing the adhesive bonding agent (Fig. 4).

The use of cavity cleansers, disinfectants and glutaraldehyde-based products are not necessary.

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and can help minimize the amount of stress and C-Factor on the adhesive interface with the tooth. This is again followed by light curing for 10 seconds. G-ænialTM Sculpt is to be applied next in 2mm increments to minimize any polymerization stress on the tooth structure (Fig. 7).

G-ænialTM Sculpt is a compactable, universal composite that features the same high density, uniform dispersion nano-filler technology found in G-ænialTM Universal Flo. Incrementally layered composites still are shown to offer the best long-term performance when placed properly.

G-ænialTM Sculpt is easy to shape, sculpt and polish. Using a condenser to adapt followed by various carving or shaping instruments for creating primary and secondary anatomy (Fig. 8).

The composite is then cured to completion followed by the removal of excess composite using various knives, carvers and fluted carbide burs followed by polishing points or cups (Fig. 9).

The final appearance of G-ænialTM Sculpt after removal of the rubber dam is an ideal reproduction of toothstructure in both shape, mechanical properties, color, polish and performance (Fig. 10).

(Fig. 6)

(Fig. 7)

(Fig. 8)

(Fig. 9)

(Fig. 10)

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Dr. Todd C. Snyder, DDS, AAACDDr. Todd C. Snyder, DDS, AAACD, received his doctorate in Dental Surgery at the University of California in Los Angeles (UCLA) School of Dentistry. He has trained at the F.A.C.E. Institute for Complex Gnathological (functional) and Temporomandibular Joint Disorders (TMD). Dr. Snyder is an Accredited Member of the American Academy of Cosmetic Dentistry (AACD). He is also a member of the Catapult Elite Group, which is made up of international speakers and Key Opinion Leaders (KOL). Dr. Snyder helped create and co-direct the first (in the nation) two-year graduate program in Aesthetic and Cosmetic Restorative Dentistry at the UCLA School of Dentistry.

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