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Show Your Work: Warm Up to Something New by Dr. Ron Kaminer

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Categories: Restorative Dentistry;
Show Your Work: Warm Up to Something New 

A novel approach to posterior restorative dentistry

by Dr. Ron Kaminer

When we talk about any restorative material, how it handles is one of the main attributes that attracts or repels a dentist. Many dentists prefer firm composites that can be compressed into the preparation, while others like creamier ones that handle more smoothly.

Over the years, in the interest of searching for that perfect handling, many dentists have tried to alter a material’s consistency by heating it in a water bath or composite heater. An ideal heated composite would initially handle like a flowable—filling every little nook and cranny in the preparation—and, upon returning to its initial state at body temperature, become condensable for a tight contact and an optimal fill.

Heating composites makes sense—and not only for the physical benefits that may be achieved, such as softening the material to an optimal consistency. Composites contain monomers and preheating the material can increase the monomers’ degree of conversion. Some studies have shown that increasing composite temperature allows for reduced light exposure and lower polymerization stress (both maximum and final) while maintaining or increasing the monomers’ degree of conversion.1 Other studies have shown that even if you reduce the light exposure by 50–75%, you achieve the same or better degree of conversion of those monomers.2

Some composites, when heated and then allowed to cool off, seem to have a different consistency from their original state; I’ve noticed a firmer feel and chalky appearance numerous times with a variety of materials.

The following case study outlines the use of a new material that’s been developed specifically to be heated for ease of placement in a bulk fashion, with a quick recovery for ideal compression. VisCalor Bulk thermoviscous nanohybrid composite (Voco) is indicated for Class 1, Class 2 and Class 5 restorations. It can also be used as a base if a doctor prefers another composite on the occlusal surface. VisCalor Bulk has a 4 mm depth of cure, is highly filled and has extremely low shrinkage (< 1.4%). This material can be heated via a customized traditional heater or a new delivery gun that heats the composite before dispensing.

 Case Report
Posterior restorative dentistry
Fig. 1: A 29-year-old patient presented with occlusal decay on #30 and interproximal decay on the distal of #29.
 Posterior restorative dentistry
Fig. 2: Using a 330 bur in an electric handpiece (Ti-Max, NSK) at 200,000 rpm and 1:5 torque reduction, the rough preparations were completed and followed by a round bur at 20,000 rpm for complete decay removal.


Posterior restorative dentistry
Fig. 3: A red stripe polishing football diamond (Microcopy) was used to bevel the enamel margins. Beveling the margins allows for a stronger enamel bond and, with proper adhesive technique, eliminates potential white lines.
 Posterior restorative dentistry
Fig. 4: A sectional matrix band and ring (Garrison Dental Solutions) was placed, facilitating outstanding marginal ridge contours and solid interproximal contact.

Posterior restorative dentistry
Fig. 5: The enamel was selectively etched for 15 seconds, followed by a 10-second rinse. The dentin was left moist in anticipation of the universal adhesive placement.
 Posterior restorative dentistry
Fig. 6: A universal adhesive (Futurabond U, Voco) was applied to the entire preparation and agitated for 20 seconds. The adhesive was dried slowly with an air-only syringe, then light-cured for 20 seconds.

Posterior restorative dentistry
Fig. 7: The heated bulk-fill composite (VisCalor Bulk) was dispensed into the entire preparation, overfilling to allow for condensing and sculpting.
 Posterior restorative dentistry
Fig. 8: The matrix band and ring were removed, and the excess material was removed with finishing carbide burs (Microcopy). Note the high sheen even without polishing.

Posterior restorative dentistry
Fig. 9: The restorations were polished and the occlusion checked. Note once again how the restorations disappear into the tooth structure with beveled margins.


Conclusion
New materials are consistently being created to solve clinical problems that dentists face every day. Very often, however, many practitioners find something lacking in the material, which prevents its widespread adoption. This case illustrates the use of a new bulk-fill material that I consider to be not only easy to place, but also very aesthetic. If you’ve thought about heating composites but have not tried it yet, it may be for you. You won’t know until you try!
Show your work in Dentaltown!

If you’ve got a case you think might be a great study for Show Your Work, email editor Sam Mittelsteadt: sam@farranmedia.com. Be sure to include a sentence that sums up why the case is so special to you, to help us review and select the best contenders for publication.


References
1. Calheiros, F., Daronch, M., Rueggeberg, Frederick A., and Braga, R. “Effect of Temperature on Composite Polymerization Stress and Conversion.” 0109-5641/ 2014 Academy of Dental Materials
2. Daronch, M., Rueggeberg, F.A., and De Goes, M.F. “Monomer Conversion of Preheated Composite.” J Esthet Restor Dent 18:340–351, 2006



Author Bio
Dr. Ron Kaminer Dr. Ron Kaminer, a 1990 graduate from SUNY Buffalo School of Dental Medicine, maintains practices in Hewlett and Oceanside, New York. He is director of the Masters of Laser training program in New York and a clinical instructor with the International College of Laser Education. Kaminer has lectured internationally about dental lasers and minimally invasive dentistry for several companies, including GC America, AMD Lasers, SDI, Camsight, NuCalm and Smile Reminder.

Kaminer, who maintains a teaching appointment at Peninsula General Hospital in Far Rockaway, New York, is a member of the Academy of Laser Dentistry, the Academy of General Dentistry, the International Academy of Facial Aesthetics and the American Dental Association. He lives in Hewlett, New York, with his wife, Jackie, and three children.
 

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