Composite Restoration
- Composite restoration
(filling) is a common dental procedure.
Please review restoration cassette for sequence of instruments.
It is the sequence of procedure
- 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
- If we work on child, rubber dam or
Isolite may be needed
- 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
- 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
- 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
- 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
- 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
- Rinse tooth to remove acid etch.
Use high-volume vacuum for suction
- 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
- 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
- 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
- Articulating paper
- 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
- 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
- Return
Assistant Page
Xin Wei, DDS, PhD, MS 1st edition 05/19/2011, last revision
06/01/2011