18-19 back to back composite technique- By Thomas W. Mitchell, DDS, FAGD

Introduction: 

There's always lots of questions about back to back composite technique. This is mine using Apex Dental Materials products. I originally did these 2 years ago, and with his massive masseters he succeeded in breaking both. We're giving him one more chance before resorting to crowns.

Thomas W. Mitchell, DDS, FAGD
Nicely crushed 2 year old Heliomolars bonded with Surpass
Thomas W. Mitchell, DDS, FAGD
I extended the proximals a bit and changed the exit angle to get 90 degree angles on the composite at the margins.
Thomas W. Mitchell, DDS, FAGD
This is a Getz Dixieland Band in a Toffelmeyer retainer. No wedge.
Thomas W. Mitchell, DDS, FAGD
First layer is Clean and Boost, Surpass 1,2,3 and Titan Flowable co-cured with Valo light on XTRA POWER for 3 seconds.
Thomas W. Mitchell, DDS, FAGD
2nd layer with Exquisite fills the proximal box. Then I remove the matrix so I have more room to shape the rest of the composite. 3 secs Valo light on XTRA POWER.
Thomas W. Mitchell, DDS, FAGD
3rd layer of Exquisite fills the buccal side. The ridges are shaped to the same angle as the remaining cusps. 3 secs Valo light
Thomas W. Mitchell, DDS, FAGD
4th layer fills the lingual side. 3 secs Valo light
Thomas W. Mitchell, DDS, FAGD
Then polish so the proximals are flush and the marginal ridge is at the right height.
Thomas W. Mitchell, DDS, FAGD
Triodent sectional matrix with a medium Wave Wedge and the Green ring.
Thomas W. Mitchell, DDS, FAGD
First layer is Clean and Boost, Surpass 1,2,3, Titan Flowable co-cured for 3 secs with the Valo light on XTRA POWER.
Thomas W. Mitchell, DDS, FAGD
2nd layer with Exquisite in the proximal box. then 3 secs light then remove the ring.
Thomas W. Mitchell, DDS, FAGD
3rd layer of Exquisite is the buccal side. 3 secs light
Thomas W. Mitchell, DDS, FAGD
4th layer is the lingual. 3 secs light.
Thomas W. Mitchell, DDS, FAGD
Disc the proximal box and remove the dam.
Thomas W. Mitchell, DDS, FAGD
First occlusion check is high on 18. Only took one adjustment to dial that in.
Thomas W. Mitchell, DDS, FAGD
Final glaze on 18 with Surpass 1,2,3. Didn't adjust 19 so no need to glaze.
Thomas W. Mitchell, DDS, FAGD
Final film shows a good contact point.

Conclusion: 

We injected at 3 PM and dismissed him at 4:15 PM even with all the photos. This is as fast as I can go, and I never felt rushed. I just stuck with the procedure and went from one step to the next. As I've mentioned before having world class assistance really helps.

Case by: 

Thomas W. Mitchell, DDS, FAGD