Occlusal Composite Technique- By Thomas W. Mitchell, DDS, FAGD

Introduction: 

One of the key things I learned in all the post doc stuff I did was that if procedures are simple, you will do them consistently even in a busy practice. This is my technique to easily do "anatomically correct" composite restorations. Here I'm replacing an old occlusal amalgam (1969!) that's beginning to show some cracks. I'm using Clean and Boost Dentin and Enamel Cleanser, Surpass Universal Adhesive, White Opaque Titan Flowable Composite and a Microfill shaped with Seamfree Wetting Resin.

Thomas W. Mitchell, DDS, FAGD
#31 Occlusal Amalgam done in 1969 by my long past partner. I don’t know what brand this is but we didn't get the high copper amalgams (Tytin) until the mid 1970's. I'm replacing it now because I'm concerned about the crack lines now showing up at the marginal ridges and the buccal and lingual grooves.
Thomas W. Mitchell, DDS, FAGD
With the old amalgam removed there is lots of oxidation but no decay. As you know the oxidation of these old materials sealed the margins.
Thomas W. Mitchell, DDS, FAGD
With the oxidation cleaned up we can visualize the cracks.
Thomas W. Mitchell, DDS, FAGD
View of the internal buccal surface.
Thomas W. Mitchell, DDS, FAGD
View of the internal lingual surface and the external buccal surface.
Thomas W. Mitchell, DDS, FAGD
Here, after cleaning and preparing the tooth surface with Clean and Boost, I've applied Surpass 1, 2 and 3 and White Opaque Titan Flowable Composite, co-curing it all together for 10-15 secs. using a standard curing light, 1000 mW/cm2. (Total application time is about a minute).
Thomas W. Mitchell, DDS, FAGD
Add the composite across the buccal cusps first, squish it up into intimate contact with the internal buccal walls and down to the pulpal floor but not touching the lingual cusps. Use Seamfree Wetting Resin on the side of an amalgam condenser to squish it against the walls and make the basic triangular ridge shapes, then use an acorn composite instrument to define the groove. I brush on Seamfree to keep the surface smooth. Pulse cure for 5 secs. (Total time for the buccal add 50-60 secs.)
Thomas W. Mitchell, DDS, FAGD
Then add composite across the lingual cusps, squish it in with the side of the condenser, define it with either a flat bladed composite instrument and/or the acorn instrument. Seamfree Wetting Resin is used to keep the areas smooth and flowing. Pulse cure for 5 secs. (Total time for the lingual add 50-60 secs).
Thomas W. Mitchell, DDS, FAGD
Then the dam comes off, occlusion is checked and adjusted, and the composite is resealed with a quick application of Surpass 1,2,3 and then the final cure of 20-30 secs of light. (This step can take 3-4 minutes because of the occlusal adjusting).

Conclusion: 

For this occlusal composite, the bonding/finishing procedures took 5-7 minutes start to finish, and the end result is close to anatomically correct (after all this is restorative dentistry). Of course if you're restoring proximal surfaces this takes a lot more time. This technique makes it possible to produce very high quality restorations very efficiently and translates easily to more complex situations. This procedure can be made even more efficient by incorporating a low shrink composite, such as Exquisite Restoration, and a high power curing light. Hope this helps

Case by: 

Thomas W. Mitchell, DDS, FAGD