Speeding up back to back composite restorations- By Thomas W. Mitchell, DDS, FAGD

Introduction: 

Always challenging are the back to back composites. This is 29 DO / 30 MO done in Surpass and Exquisite with my Valo light on XTRA POWER, or 3200 mW/cm2 (aka "plasma mode").We are working on techniques to speed up these procedures and still get excellent results. With Exquisite we can cure to a 4 mm depth, so we don't need any more than 3 layers, and each one cures as completely as possible with only 3 seconds of light initially and 3 more seconds from each direction at the completion.

Thomas W. Mitchell, DDS, FAGD
Decay present on films at 29 DO / 30 MO.
Thomas W. Mitchell, DDS, FAGD
I always take this photo with the decay stain to show the patient.
Thomas W. Mitchell, DDS, FAGD
Simple final preps
Thomas W. Mitchell, DDS, FAGD
I fill these one at a time and I use a contoured Toffelmeyer band for the first one. I choose the one that will be easiest to recontour the proximal surface with discs. This shows my first layer which starts with Clean and Boost, Surpass 1,2,3 + co-cured Titan A2 Flowable.
Thomas W. Mitchell, DDS, FAGD
Second layer of Exquisite forms the proximal surface. I use Seamfree to help condense and smooth the Exquisite. Then in this small prep the 3rd layer fills the occlusal. Each layer is cured for 3 seconds only with the Valo light on XTRA POWER.
Thomas W. Mitchell, DDS, FAGD
Once I've got the distal surface shaped and polished then I place a Triodent matrix and go thru the same steps with Clean an Boost, Surpass 1,2,3 + Titan Flowable and co-cure for 3 seconds.
Thomas W. Mitchell, DDS, FAGD
Then add the proximal in Exquisite, cure that and add first the lingual triangular ridges, then the buccal triangular ridges. Each layer is up to 4 mm's thick.
Thomas W. Mitchell, DDS, FAGD
I disk the proximal surface of 30 MO with red 3M Softflex discs.
Thomas W. Mitchell, DDS, FAGD
After occlusal adjustment I seal the surface with a quick add of Surpass 1,2,3. Note that even though I'm blasting these restorations with light there are no "white lines".
Thomas W. Mitchell, DDS, FAGD
Final x-ray (which I rarely take) shows nice dense fillings with no radiolucent layer at the gingival.

Conclusion: 

We're working on speeding up these restorations while maintaining excellent results. Because of Exquisites low rate of shrinkage and very low shrinkage stress we're curing with the Valo light on it's highest setting, yet there are no white lines, aka enamel margin fractures, forming and we're getting as complete of a cure as is possible. We know that with Exquisite in small preps you can "bulk fill" the whole prep. But it's easier to develop good occlusal contours when we fill the buccal and lingual halves separately.

Case by: 

Thomas W. Mitchell, DDS, FAGD