Facing the challenge of Class II resin composites By John Kanca, III, DMD, Inventor of Simplicity

Of the many procedures done virtually every day by restorative dentists, placement of the Class II resin composite restoration remains one of the most challenging. Clinicians frequently post questions on Internet forums seeking answers to the best method of restoring teeth in need of these types of restorations. This article presents one method of placing a class restoration using a self-etching adhesive and a micro-hybrid resin composite.

1. Maxillary first molar with carious lesion on the mesial.

2. Tooth is prepared, bevels are placed all around the margins.

3. Composi-Tight matrices (Garrison Dental) are placed and Flexi-wedges (Common Sense Dental) are inserted.

4. Simplicity universal self-etching adhesive.

5. A drop of Simplicity 1 is dispensed into the well. A Hu-Friedy DP 18L locking pliers is used to grasp an applicator sponge through the long axis of the sponge, is soaked with the Simplicity 1 conditioner and is applied to the prep. Simplicity 1 is agitated gently for about 10 seconds.

6. The sponge is dabbed to the patient napkin to remove the Simplicity 1 conditioner.

7. The sponge is then used to blot the excess Simplicity 1 from the cavity.

8. A drop of Simplicity 2 adhesive resin is dispensed into the other well and with a brush is applied to the moist cavity prep in 2-3 coats.

9. The cavity prep is then dried for 5-8 seconds with dried compressed air.

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10. Permaflo, a flowable composite (Ultradent) is applied to the gingival floor up to and including the intersection of the tooth and the matrices.

11. The resin adhesive and flowable are light-activated together for 10-20 seconds. 10 seconds will suffice if the light used has a power density of 600 mW/cm2 or more. 20 seconds is recommended if the light is weaker than that or the operator is uncertain. The resin adhesive and the flowable may be light-activated separately but it is a little more convenient to activate them together. It might be helpful to use a burnisher-type of instrument to displace the matrices mesially and then distally while light-activating the adhesive-flowable. This will help generate the contacts that so often elude practitioners.

12. A small increment of the compomer F2000 (3M) is placed in the proximal boxes and light-activated for 10 seconds.

13. The micro-hybrid Vit-l-escence enamel shade Pearl Neutral (Ultradent) is placed in the proximals and is light-activated for 10 seconds.

14. Vit-l-escence dentin shade A4 (Ultradent) is then placed in the central portion of the cavity prep and light-activated for 10 seconds.

15. Another thin layer of the Pearl Neutral is applied over the central portion of the restoration. It is pulse- activated (4 seconds at 400 mW/cm2).

16. The matrices and wedges are removed and excess composite is removed from the embrasures with a polishing disc. Using the Kanca Posterior Kit from Brasseler, three holes are placed in the restoration in the areas of the fossae with suitable size of the 8905 burs, which are 30 micron diamond type. Using the same burs, the holes are then connected appropriately as grooves, simulating of the occlusal anatomy.

17. Using the 274 and the 379 30-blade finishing burs from the Kanca kit , the anatomy is roughed out.

18. The occlusion is then carefully adjusted.

19. The restoration is then polished using a Jiffy polishing brush from Ultradent.

20. The restoration is then re-sealed using Simplicity and Permaseal (Ultradent). The restoration is then light-activated 10 seconds per surface; occlusal, facial and lingual. The restoration is now complete. The use of the two colors allows for a natural appearance of the restored tooth and there are absolutely no margins visible. The tooth was free of any post-operative sensitivity and the contacts are excellent. Simplicity provides the clinician with a fast, easy and reliable method of bonding resin materials to tooth structure without any sensitivity. The use of the micro-hybrid Vit-l-escence provides the ability to generate life-like and beautiful restorations using only two shades of resin composite. The types of restorations that can be performed with these materials rivals anything that can be done with any indirect resin systems, both in performance and esthetics.

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Simplicity is available from Apex Dental 1-877-APEX123, or 1-877-273-9123. More information is available on the web at www.simplicityadhesive.com.

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Dr. John Kanca, III, is a graduate for the University of Connecticut. Dr. Kanca is a member and holds Fellowships on the Academy of General Dentistry and The Academy of Dental Materials. John is also a member of the International Association for Dental Research, Past-President of the American Academy of Cosmetic Dentistry and an active member of the American Academy of Esthetic Dentistry. He has received numerous awards for his contributions to dentistry.

He reported the first high shear bond strengths to acid-treated dentin and is the discoverer of the technique known as “wet-bonding.” Dr. Kanca showed that resin in specific solvents acted preferentially with wet dentin and enamel surfaces. Much of his recent work focuses on reducing polymerization stresses, and development of the technique known as “pulse activation.”

Dr. Kanca has a financial interest in Simplicity, but no financial interest in the Brasseler Kanca Kit.