Composite Restoration 

  1. Composite restoration (filling) is a common dental procedure.  Please review restoration cassette for sequence of instruments.  It is the sequence of procedure
  2. Doctor needs mirror and explorer to check caries before working on it.  Occasionally he uses cotton pliers to place cotton in the buccal vestibule for isolation and exposure.  Place these three instruments on doctor’s tray.  Load injection syringe if necessary: #30 gauge for all upper teeth and all Cl V composite, #27 for lower posteriors
  3. If we work on child, rubber dam or Isolite may be needed
  4. High-speed handpiece is used to remove major chunk of caries.  Please use saliva or high (preferably) volume suctions.  If we work upon upper teeth, use 3-way syringe to blow mirror with air or both water and air.  As soon as high-speed handpiece is not used, blow air into cavity (drying) so that doctor can check whether the work is done or not
  5. Sometimes doctor uses slow-speed handpiece to remove remaining caries.  Please use air as well as high vacuum suction to blow away dust so that doctor can see what is going.  If curet is used to remove remaining caries, get 2x2 ready
  6. If cavity is deep, Vitrebond is needed for base.  Please help doctor dry the tooth and isolation (cotton rolls: 2 for lower tooth, 1 for upper).  Dry again with air. Then mix Vitrebond with spatula.  Pass the mixed Vitrebond and Dycal applicator to doctor.  Light cure for 30s (3M) or 20s (Heraeus-Kulzer).  For both curing lights, each beep lasts 10s. For 3M curing light, push button once to start, and push again to stop.  For Heraeus-Kulzer to last 20s, continuously push button until you hear 2nd beep.  Let it go
  7. If we restore a proximal cavity, we need Mylar strip (plastic transparent) for anterior teeth and Toflemire (metal) for posteriors.  Toflemire bands have three types: child (narrow), type I (for MO or DO), and type II (for MOD, two humps). Sometimes wedge is required.  The step can be done after acid etch and Prime and Bond to be discussed below
  8. Acid etch (so called total etch) is next.  We etch tooth so that composite can stick to tooth tightly.  To reduce post-op sensitivity, we now use self etch bonding (Japanese brand).  That is we do not use acid etch, one step procedure
  9. Rinse tooth to remove acid etch.  Use high-volume vacuum for suction
  10. Pass Prime and Bond (adhesive).  After doctor blows away excess adhesive.  Light cure 10s, since it is very thin.  It does not need too long to cure
  11. We use flowable composite as a liner quite often.  Exception is anterior lingual shallow cavity, because gravity prevents flowable to get to right area.  Light cure every type composite for 30s (3M) or 20s (Heraeus-Kulzer).  When we use flowable, be ready to light cure as soon as doctor says yes, because it flows to wrong place if there is a delay
  12. When we use regular composite (gun (TPH for small cavity, Japanese for large one) or from tube), pass amalgam burnisher, amalgam condenser, or gingival retraction instrument
  13. Articulating paper
  14. For polishing, use disks for anteriors and Class V defects and cups for posteriors (occlusal).  Sometimes polishing strips are needed for proximal restoration.  Spray minimal water for wetting while doctor is polishing using slow-speed handpiece
  15. For Class V defects or caries, we may label them as MBD composite in Dentrix.  We need to prepare #0 or 1 gingival retraction cord.  Look at patient’s mouth for how large the defects or caries is so that you can decide how long the cord is needed
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Xin Wei, DDS, PhD, MS 1st edition 05/19/2011, last revision 06/01/2011