Timing Composite Restorations- By Thomas W. Mitchell, DDS, FAGD

Introduction: 

I get a lot of questions about how long it takes me to do these procedures, so I timed one. This is back-to-back 4DO / 5MOD. I allowed 1 hr 15 minutes of my time, with 15 minutes of assistant time before and after doctor time. I gave the injection during the 1st 15 minute assistant time. My assistant then placed the dam before I came back to that room. I take a lot of photos which adds time, but I recommend you take a few as you're working to educate your patient and to help you improve your procedures.

Thomas W. Mitchell, DDS, FAGD
We're doing 4MOD and 5DO. #2 has already been restored.
Thomas W. Mitchell, DDS, FAGD
Old beat up composites placed in India a few years ago.
Thomas W. Mitchell, DDS, FAGD
Prepping these 2 took me 15-20 minutes. As I sit here I think that's really kind of slow, but I am careful with my final margin finishing and that detail work can go slowly.
Thomas W. Mitchell, DDS, FAGD
This is a contoured Toffelmeyer band. These matrixes can be placed faster than sectional matrixes, but I know I'll spend more time finishing and polishing when I use a Toffelmeyer.
Thomas W. Mitchell, DDS, FAGD
This is after Clean and Boost for 30 seconds, Rinse, Dry, Bondsaver D, Surpass 2,3 and A2 Titan flowable on the gingival floors with WO Titan flowable over the deep area on the pulpal floor, then all that co-cured for 3 seconds with the Valo light set on Xtra Power.
Thomas W. Mitchell, DDS, FAGD
I added Exquisite for the distal wall.
Thomas W. Mitchell, DDS, FAGD
Then the mesial wall.
Thomas W. Mitchell, DDS, FAGD
Then the central area. All 3 were individually cured for 3 seconds.
Thomas W. Mitchell, DDS, FAGD
And #4 finished. I spent 20 minutes from the finished prep to this point. I'm aware that filling MOD's takes much more time than filling a 2 surface.
Thomas W. Mitchell, DDS, FAGD
Garrison sectional matrix system.
Thomas W. Mitchell, DDS, FAGD
Clean and Boost, Bond Saver D, Surpass plus A2 Titan flowable all co-cured for 3 seconds.
Thomas W. Mitchell, DDS, FAGD
Then 2 layers of Exquisite and then removed the matrix system and finished #5. I spent about 10 minutes getting #5 filled and polished.
Thomas W. Mitchell, DDS, FAGD
Final finishing and adjusting took another 10 minutes. These look ok to me. That lingual embrasure on 5 could have been a little smoother. The contacts are good.

Conclusion: 

So I was done a couple of minutes early, thankfully. Time is money so it's important to be quick. Bulk filling can speed this up, and I regularly bulk fill preps like 5 DO with Exquisite, but 4 might have been too large for that. Taking photos definitely slows things down but I hope you do that. One key I need to mention is how important it is to have a well trained assistant who knows these procedures as well as you do. I've got 2, Karen who's been doing this for 30+ years and Tiffany who's a rookie but very quick and smart. I sincerely hope you all can get results as nice or even better than these with your procedures. I know these materials I'm using are without a doubt the best available, and I hope you have access to them as well.

Case by: 

Thomas W. Mitchell, DDS, FAGD