Looking back on my thoughts part 2
http://dental-tidbits.blogspot.com/2014/03/composite-restorations.html
1. Putting a thick layer of flowable doesn't compromise the strength of the restoration due to poor retention form, it is due to the lower filler content.
2. The way you place the composite into the cavity matters as trying to force a large blob of composite into a small cavity will result in voids. Flowable composite can be placed at the base of a cavity and heated composite can be injected into this to minimise voids. You must place the composite precisely and deliberately to reduce shrinkage stress.
3. I stopped using bond on instruments many years ago. It helps to stop instruments sticking but acts as a weak plane in your restoration (lower filler content again) and will lead to staining of your restoration. To avoid material sticking ensure a clean instruments i.e no material cured onto it and you can clean it with alcohol. Gold coated instruments can be used as well. Don't manipulate your material too firmly as if you sink the instrument into the composite resin it will contact too much area and stick no matter what you do. If you want to use a liquid to avoid sticking you need to use unfilled resin not bond (as some have filler particles) i.e wetting aka sculpting resin.
6. I suppose you can use the high speed suction to thin the bonding resin but it is uncontrolled. Use a triplex from far away to lightly evaporate the solvent then thin the bond.
8. I don't get the patient to tap tap tap anymore. Once bite down is sufficient to mark the tooth. Multiple taps can cause false markings. I no longer believe that occlusal contacts should be taken off the restoraiton and put on natural tooth structure. What if the whole tooth is covered by restoraiton? Should it be out of occlusion? Instead, the occlusal contacts should be in harmony with the rest of the dentition and should allow force to be placed in the long axis of posterior teeth (i.e on cusp tips, mid marginal ridges and in the central fossae). I almost never use interproximal strips, I find that to get them in between the teeth you end up opening up the contact. It can be useful where there is a black triangle and you want to remove an overhang but a No. 12 scalpel blade can be more effective.
9. Don't get them to describe the location of the rough spot to you. Get them to leave their tongue (most sensitive organ) on the rough/ sharp spot, dry the tooth really well and check it from multiple angles and use an explorer if you can't see it.
1. Putting a thick layer of flowable doesn't compromise the strength of the restoration due to poor retention form, it is due to the lower filler content.
2. The way you place the composite into the cavity matters as trying to force a large blob of composite into a small cavity will result in voids. Flowable composite can be placed at the base of a cavity and heated composite can be injected into this to minimise voids. You must place the composite precisely and deliberately to reduce shrinkage stress.
3. I stopped using bond on instruments many years ago. It helps to stop instruments sticking but acts as a weak plane in your restoration (lower filler content again) and will lead to staining of your restoration. To avoid material sticking ensure a clean instruments i.e no material cured onto it and you can clean it with alcohol. Gold coated instruments can be used as well. Don't manipulate your material too firmly as if you sink the instrument into the composite resin it will contact too much area and stick no matter what you do. If you want to use a liquid to avoid sticking you need to use unfilled resin not bond (as some have filler particles) i.e wetting aka sculpting resin.
6. I suppose you can use the high speed suction to thin the bonding resin but it is uncontrolled. Use a triplex from far away to lightly evaporate the solvent then thin the bond.
8. I don't get the patient to tap tap tap anymore. Once bite down is sufficient to mark the tooth. Multiple taps can cause false markings. I no longer believe that occlusal contacts should be taken off the restoraiton and put on natural tooth structure. What if the whole tooth is covered by restoraiton? Should it be out of occlusion? Instead, the occlusal contacts should be in harmony with the rest of the dentition and should allow force to be placed in the long axis of posterior teeth (i.e on cusp tips, mid marginal ridges and in the central fossae). I almost never use interproximal strips, I find that to get them in between the teeth you end up opening up the contact. It can be useful where there is a black triangle and you want to remove an overhang but a No. 12 scalpel blade can be more effective.
9. Don't get them to describe the location of the rough spot to you. Get them to leave their tongue (most sensitive organ) on the rough/ sharp spot, dry the tooth really well and check it from multiple angles and use an explorer if you can't see it.
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