State of the Art Posterior Composites- By Thomas W. Mitchell, DDS, FAGD

Introduction: 

I know this is the state of the art for posterior composite restorations with Apex Dental Materials products. The goal is to very efficiently produce an excellent quality restoration. In this case I'm using Clean and Boost, Surpass 1,2,3, Titan A2 Flowable, Seamfree and Exquisite. I'm curing each increment for 3 seconds only with my Valo light set on XTRA POWER, or 3200mW/cm2.The increments are as thick as 4 mm's each, and I'm placing 3 increments only. After the restoration is finished and the occlusion is adjusted, I'm sealing the surface with a quick, thin coat of Surpass 1,2,3.

Thomas W. Mitchell, DDS, FAGD
This is a worn out pre-2005 composite of unknown origin and material.
Thomas W. Mitchell, DDS, FAGD
A quick prep leaving all cusps with plenty of dentin support. The adjacent proximal surface is simply polished with discs.
Thomas W. Mitchell, DDS, FAGD
Triodent matrix applied with a White Wave Wedge. Here the gingival floor was curved to the distal so I used a Garrison Ring to bend the wedge against the gingival .Then I cleaned the prep with Clean and Boost, washed and dried completely, placed Surpass 1, agitating it for 10 seconds, then added 3 brushfulls of Surpass 2, dried completely for 10 sec., Surpass 3, air thinned and placed a thin coat of Titan A2 Flowable over the gingival floor and the pulpal floor, and co-cured the Surpass 3 and the Titan for 3 seconds with the Valo light on XTRA POWER. Sorry but I lost that photo.
Thomas W. Mitchell, DDS, FAGD
Then the first of 3 layers of Exquisite is placed against the matrix forming the proximal surface. I use Seamfree on an applicator tip to coalesce the material and shape it against the matrix. I try to match the height of the adjacent marginal ridge. That layer is cured for 3 seconds. Then I remove the Garrison Ring so I have more room to work.
Thomas W. Mitchell, DDS, FAGD
The 2nd layer is placed against the lingual walls forming the lingual triangular ridges. It's shaped using a flat bladed composite instrument and an Acorn carver, with Seamfree helping to smooth the shapes. It's cured for 3 seconds. The layers can be up to 4 mm's thick.
Thomas W. Mitchell, DDS, FAGD
The 3rd layer forms the buccal triangular ridges. When forming the ridges I use the angles of the uncut enamel to guide the angles of the ridges. That reduces the amount of occlusal adjustment that will be needed. Then cured for 3 seconds.
Thomas W. Mitchell, DDS, FAGD
With the matrix removed the proximal surfaces are disked with red 3M Softflex discs. This is the stage when we usually notice "white lines". Note that even though we were blasting this with very intense light, there are no white lines.
Thomas W. Mitchell, DDS, FAGD
Then the dam is removed and the occlusion adjusted.
Thomas W. Mitchell, DDS, FAGD
The final step is to reseal the restoration where it was adjusted with a quick thin coat of Surpass 1,2,3. Then the final cure is for 3 seconds from each direction.

Conclusion: 

This is an efficient technique with less than 30 seconds spent actually light curing. We only know that this can be done with Exquisite, and that's due to its’ low amount of shrinkage (less than 2%) and the composition of the resin molecules. The layers we're curing are up to 4 mm's thick. With shallower preps than this we've been able to bulk fill the prep and cure the whole thing for only 3 seconds. I tend to spend more time adjusting those cases so I prefer this layering technique.

Case by: 

Thomas W. Mitchell, DDS, FAGD