Composites restorations still provide a challenge for the general dentist today.
Many composites are leaking and have recurrent caries several years after placement. You can read many research articles on the topic. In keeping with the Mentoring Dentist theme of providing concise information to help the private practice dentist , I will share what works.
Recurrent caries develops a couple of ways . The most common is that bacteria have penetrated the dentinal tubules from the original lesion. Consequently, it is important to disinfect and desensitize the prep prior to placement of the restorative material.
5%glutaraldehyde and 35% EDTA does the trick .
Products : Gluma, G5, Micro Prime G
Complete the prep and place two 1 minute applications using care to keep off the soft tissue .
Suction after each application do not rinse
Mentoring Dentist Tip
Next place RMGI in the proximal box and pulpal floor ⅓ of the way up the prep. RMGI is cariostatic and has the same thermal coefficient of expansion as the tooth . This prevents sensitivity along with recurrent caries. Remember, you can’t bond to cementum. This is why I used this sandwich technique long before it was taught . In fact , years ago I was attending a Gordon Christensen lecture in Vegas. He asked where the Iowa dentist was sitting? He walked over , gave me the microphone, and asked me to share this technique with several hundred of his attendees.
RMGI : FUJI II LC by GCAmerica
This stuff works!! No post op sensitivity . No recurrent caries. No shrinkage in the proximal box. I would restore Class V cervical and abfraction lesions 100% with it . In the esthetic zone I would veneer over it with a highly polishable composite. I used FUJI II LC before I had learned about Gluma . It worked flawlessly. It is the absolute best product !!! I used Fuji Cem Plus cement to cement all my zirconia and pfm crowns. Crowns stay on with no sensitivity.
Poor Light Curing
The other contributing factor to recurrent caries is incomplete cure of the composite material. Make sure your curing light output is sufficient. Use a radiometer. Make sure that your light’s wavelength is compatible with the composite photoinitiator.
Look at the tip . Is there cured composite present ? This greatly affects the output . Use a wide tip , place material in 2-3 mm increments , and over cure keeping the light close and perpendicular to the tooth . Over-curing ensures adequate polymerization!
Remember there are 2 ways patients evaluate you!
- Doyou hurt them ?
- Does your dentistry last?
Use these materials and techniques and you will be consistent at providing quality pain free dentistry that lasts!