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Practice Solutions: 3M by Daniel Poticny, DDS

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Header: 10 Strategic Insights
by Daniel Poticny, DDS

We've all seen it (or at least heard about it): A patient has a filling pop out but can't get in to see us quickly, so she goes to the local drugstore and buys one of those "do-it-yourself" dental kits.

I recently had a 21-year-old patient come in with this exact situation, and it gave me a chance to show what kind of efficient, aesthetic dentistry can be done in the posterior of the mouth with modern techniques and materials.

In this case, I'll expound upon gaining efficiency. I'll answer why bulk-fill composite should be considered as a part of your everyday armamentarium, how to provide a means of control and improve outcomes, and how to reduce the time involved in creating lifelike posterior composite restorations. It's an art form much like a dance, which I'll refer to as the "Texas two-step."

Preparing the surface
The aforementioned patient came to the practice with a drugstore temporary that she had applied herself because the popped-out filling had caused a fair amount of pain (Fig. 1). I can't lie—she performed some fairly decent dentistry!

I cleaned out a bit of caries under a split rubber dam (Fig. 2). I didn't achieve perfect isolation but it was adequate, easy to place and infinitely better than using cotton rolls alone, which is the most common approach. Furthermore, using a split rubber dam makes it easier to obtain consistent, reproducible results, saving time (which is costly and can't be recovered).

After the prep was complete, I etched selectively and scrubbed in the adhesive (Figs. 3–4). The "selective etch" technique has become popular, and it's my preference when enamel is involved. Self-etch primers typified as sixth-generation adhesives produce very good results on dentin, comparable to total etch, but lack a low-enough pH to etch like phosphoric acid. The advantage to phosphoric acid is that in nearly all cases, it provides the highest bond values, minimizing the potential for microleakage and stained cavosurface margins.

Every adhesive has its own set of specific instructions that should be followed to the letter. Otherwise, results will be compromised. Products in the same category may also differ in application principles, so be sure you're familiar with your product's specifications. This adhesive must be scrubbed in for 20 seconds and light-cured to activate (Fig. 5). It can feel like a lifetime to a dentist, but the end result is worth it.

Fig. 2c Fig. 2d
Fig. 2c Fig. 2d
Figs. 3-4: A selective etch technique using a self-etch primer (in this case, 3M’s Scotchbond Universal Adhesive)

Making light work of sculpting
In my view, Filtek Bulk Fill Posterior Restorative from 3M merits consideration for routine use in posterior direct restorations (Fig. 6). Layering isn't always predictable and does involve a fair amount of time. In our efforts to control things such as C-factors and adequate depth of cure, even our best efforts often go unrewarded.

You'll notice more translucency in the material (for enhanced cure depth), but in most cases it produces a satisfying appearance—providing "depth" rather than opacity, more like natural tooth structure. It sculpts easily and minimizes or even eliminates bur contouring on the back end, reducing the need for additional difficult finishing steps to eliminate bur scratches.

I'd advise dentists to slightly dim the operatory lights to enable a prolonged working time for sculpting. This material is highly reactive to light at up to 5mm in depth, with very low shrinkage. I prefer the use of pointed-cone composite shapers, which provide enough anatomic detail while the material is still in its plastic state (Fig. 7).

Getting ready to "two-step"
After sculpting, the restoration was ready for simplified finishing and aesthetic touches (Fig. 8).

Now the "Texas two-step" comes into play. The elastomeric spirals of 3M's Sof-Lex Diamond Polishing System fit common snap-on, low-speed mandrels.

In the first step, the beige wheel removes fine scratches, leaving a dull sheen (Fig. 9). In the second, the pink wheel attains a high-gloss finish (Fig. 10). Be sure to use a light touch at relatively low speeds, with intermittent water spray, and that's it! (Fig. 11)

The elastomeric spirals are embedded with proprietary abrasives that adapt to all tooth surfaces from any angle to provide a natural-looking luster to composites (and Lava Ultimate CAD/CAM restorations) in near-record time. This system equals or beats rubber points and muslin buffs using paste, both in terms of results and sheer economics. There's no mess, and the spirals can be autoclaved and used again.

Time is money, yet results still matter. Posterior composites do involve a fair amount of labor, but I believe this composite and finishing system rebalance the equation timewise, financially and clinically in both the dentist's and patient's favor. A fine dance, indeed!

Fig. 2c Fig. 2d
Fig. 2c Fig. 2d
Fig. 2c Fig. 2d
Fig. 2c




Dr. Daniel Poticny Daniel Poticny, DDS, is an adjunct clinical associate professor at the University of Michigan School of Dentistry, and maintains a full-time private practice in Grand Prairie, Texas. He is a graduate of the Ohio State University and Baylor College of Dentistry. Poticny has more than 20 years of experience with digital restorative dentistry and is considered a leading authority on digital process, materials and adhesive dentistry. He is widely published on these topics, with original articles and papers in numerous peer-reviewed journals for dentistry. He also serves in an advisory capacity for major dental manufacturers.



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