Townie Clinical: Premise-Kerr’s New Universal Composite By: Bruce J. LeBlanc, DDS

I have been a big fan of Kerr products for many years. In 1993, I began using OptiBond FL, a two bottled total etch agent and have had tremendous success continuously since that time. Although I occasionally have tested other bonding agents, none have given me the predictable results that I routinely have with OptiBond FL. Generally speaking, concerns with sensitivity, microleakage, and white lines around the margins have not been issues to deal with. Over that time period I have used several composite resins depending on strength and esthetic demands. From 1993 until recently, my materials of choice for posterior restorations were Kerr Herculite and Ivoclar Vivadent Tetric. These hybrid resins have excellent strength but not the polishability of microfils. For anterior restorations my choice has been Cosmedent Renamel and Heraeus Kulzer Durafil. These microfil resins look terrific but do not have the strength of hybrids. Many companies have introduced a new class of materials called microhybrids in an attempt to combine the best of both products. I have used several of these materials, but for various reasons did not see them as an improvement on what I was already using. Recently, however, Kerr has introduced a microhybrid called Premise, that combines the best of all of these products allowing me to now use only one composite system for all applications.

My direct bonding protocol for placing these restorations using the OptiBond FL two bottle system and Premise Trimodal composite is as follows:

Essentials:
• Air used is clean and dry from an oilless compressor
• Curing light is routinely tested to insure proper intensity
• Curing light used and photoinitiators used are compatible.

1) Using a rubber dam improves the bonding environment eliminating moisture contamination as well as preventing amalgam and tooth debris from being swallowed by the patient.
2) Prep tooth and rinse with water to clean then air dry.
3) Total etch the tooth with phosphoric acid for 30 seconds and then rinse. I dry moderately leaving very slightly moist, almost dry.
6) Apply primer in bottle 1 and message into dentin and enamel allowing to dry for at least 30 seconds. It is critical with all primers that the solvent is completed evaporated from the applied primer so that full curing of the resin will occur. I then lightly dry about 5 more seconds with clean dry air.
7) Apply bonding resin in bottle 2 to dentin and enamel and cure for 10 seconds
8) Apply premise resin in increments and cure each increment. (About four to 6 for a molar). Ramp curing is preferable to reduce shrinkage of the composite during initial curing.
9) Apply resin sealer over final layer and light cure.
10) Place deox glycerine over resin and final light cure.
11) Remove rubber dam. Use finishing burs (I love Ultradent’s 48L12 Carbide) to refine tooth anatomy and adjust occlusion. Use polishing cups (I like KerrHawe’s) to improve polish.
12) Re-etch, seal, and reapply deox glycerine and final cure.

My enthusiasm for Premise continues to grow with it now being my choice of material for almost all composite restorations I do. The qualities I like best are:

1) Polishes like a microfil (due to being a true microhybrid)
2) Very low shrinkage in comparison to many composites.
3) Great color matches blending into the tooth as you can see in the pictures.
4) Nice selection of shades and translucencies.
5) Easy to handle. (I prefer handling from unidose compules)
6) Great strength to use in both posterior and anterior teeth.
7) Excellent shade guides that really help match material in color and translucency.
8) Great wear resistence. You can tell when you finish it with a bur.
9) Made by Kerr—I love their products and have bought them for many years. OptiBond FL 2-step remains my favorite direct bond agent after 11 years and no change in sight. They consistently have a number of products ranked 5 star by Reality Magazine. Company credibility makes a difference to me and Kerr is one of several great dental companies that have earned my respect.

It is my opinion that OptiBond FL and Premise composite produce outstanding restorations that will remain serviceable for many years.

Dr. Bruce J. LeBlanc is a graduate of Jesuit High School in New Orleans and LSU School of Dentistry. In the early 1980’s, his interest in the adhesive bonding revolution influenced the development of his practice. Dr. LeBlanc practices in Baton Rouge, Louisiana, offering adhesive and cosmetic solutions that minimize tooth removal. Dr. LeBlanc has conducted seminars since 1988 that help participants achieve an increased knowledge of adhesive dental techniques making an immediate impact on the quality, productivity, and enjoyment of their practices. Any questions, comments, or inquiries are welcome by email at bjleb@cox.net