Tips and Advice for Composite Fillings?

[dentalnerd18]

I am having difficulties with making my class I filling as flush and smooth as possible as I place the increments of composite. After placing composite and curing, I always end up with catches and slight irregularity on the occlusal surface. I understand that finishing and polishing may solve these issues, but I am trying to avoid it in the first place.

Could it be how I place the composite increments? What tips do you guys have with instrumentation or techniques? Thank you!

I am new here, so I apologize if this is posted in the wrong section.

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[Fadebuster81]

For the topmost layer, I just pick up my favourite flat instrument or explorer and remove excess composite by making sure the instrument is resting on the tooth and not on the composite. This way the composite will be at the level of the tooth structure. It is difficult to get a perfectly flush surface without polishing, so I just use the flame bur to create my occlusal embrasure, polishing discs for anterior teeth, and polishing cones/cups for posterior teeth. This has been working well for me!

 

[Ivy.ch]

“Brush” the composite over the borders of your prep onto tooth structure. You should then cure. As you finish and polish, the excess flash will be removed, leaving a nice transition between material and tooth.

 

[schmoob]

Are you talking patients or typodont?
Try not to get any bonding material on the occlusal surface, wipe it clean before curing. Once you get the composite layered to the occlusal, use your instrument to shape your composite OUT of the prep. Try to avoid going from the tooth structure to the restoration, you want it the other way around. Also there’s nothing wrong with finishing and polishing. You need to do that anyway.

 

[AONLINE]

D4 here. Despite having been in clinic for over a year, I’m still having a lot of trouble with class IV composite. I used Mylar strips and wedges but my contacts ended up being opened most of the time. Also my lingual and buccal surfaces are very rough and have flashes after I cure so I always have to go back and smooth the heck out of them. Any advice on how I can improve the filling? Thank you!

 

[Soleus715]

It depends too on what types of materials you have access to.

If you like spending time to smooth out the composite to margins for minimal adjustments, it'd be wise to use glycerin to prevent the formation of oxygen-inhibited layer that does not cure properly.

If you bulk out the areas and need to adjust occlusion & catches frequently, see if you have wetting resin that you can use with a microbrush to really blend in the composite to the margins of your prep.

If you do not have access to any of these things, try not to overbuild but shape as much as possible prior to curing.
As mentioned by others above, try to place just the right amount and blend from composite to tooth.
One tip is to use articulating paper before placing the rubber dam.
Visualize where the occlusion is high, check for plunging cusps on opposing teeth and plan your fill accordingly.

Often times catches are from voids in composite exposed from polishing.
Some brands of composites are firmer/stickier than others and are prone to voids from lifting off the tooth during placement or not being packed enough. Just a little bit of wetting resin can help composite from sticking to instruments.

When polishing, use multi-fluted polishing carbides or fine diamonds instead of burs that chatter on the teeth (prone to chipping/fracturing).
Use lots of water! Make sure to check for excess flash (bonding or composite) stuck to the tooth with a spoon or scaler.

As you can see, there are many ways composite placement can be difficult.
It is indeed a very technique sensitive procedure compared to placing amalgam or GI.
With enough practice and attention to detail you'll be proficient at this in no time!

 

[dentalnerd18]

Thank you so much for the advice everybody!

 

[Molar Whisperer]

I am having difficulties with making my class I filling as flush and smooth as possible as I place the increments of composite. After placing composite and curing, I always end up with catches and slight irregularity on the occlusal surface. I understand that finishing and polishing may solve these issues, but I am trying to avoid it in the first place.

Could it be how I place the composite increments? What tips do you guys have with instrumentation or techniques? Thank you!

I am new here, so I apologize if this is posted in the wrong section.

If you're doing increments on a class 1 (one surface occlusal), it can be messy. If it is a deep prep, then possibly 2 increments. I would put a thin layer of uncured flowable comp before adding your bulk comp. Prior to curing, I would use a burnishing instr (ball burnisher) and wet it with bond resin (so the comp won't stick) to smooth out the fill. I don't like to polish it too much since it builds up too much heat which can make the tooth more sens post-op. After light polish and the occlusion verified, add a thin layer of bond resin over the filling and cure it again for a "clear coat" sealant.

If the prep is very big leaving thin axial walls and requiring numerous increments, you may consider crowning the tooth.

 

[Anass Habrah]

There are many factors that cause this issue, you can start with the composite type and the plastic filling instruments (especially the burnisher non-sticky) from high-end brands. if the issue persists try to apply pit and fissure sealant after curing till you fetch the reason

 

[kamal.rafi]

80% of time , you find that the composite needs some adjustments wether its excess removal or occlusion adaptations
the best solution is to learn how to polish and remove excess and draw a beautiful anatomy at once .