New Trends Center on Simplicity
Q&A With Gary M. Radz, DDS
Inside Dentistry interviews Gary M. Radz, DDS, the owner of Cosmetic Dentistry of Colorado in Denver, Colorado, and the director of industry relations for Smile Source
Inside Dentistry (ID): What are some of the newest developments in direct resin composite formulations that are making an impact in clinical dentistry?
Gary M. Radz, DDS (GR): The most significant development has been in manufacturers' attempts to provide single shade materials. Most dentists have multiple shades and carry significant inventory in order to accommodate every patient. Selecting the correct shade can become complicated, and some composites end up expiring before ever being used. Single-shade composites offer simplicity and reduce necessary inventory. These products are best suited for smaller, more shallow restorations. Because they work by utilizing light to pick up the characteristics of the surrounding tooth structure and mimic them within the composite, with larger restorations, less natural tooth color is available to pull color from and create that ideal match.
Bulk-fill composites represent another important development. They have been around for several years, but recently, they have gained a lot of traction and acceptance and are now being widely utilized.
ID: Are microfilled composites still popular?
GR: They are still popular within a certain segment of the dentist population. Many of us who are older and were trained with microfilled composites still default to them because of their high polishability. However, the industry appears to be moving in the direction of an effort to make composites simpler and reducing the number of composites and shades. We certainly do not see microfilled materials as often as we once did.
ID: Do you prefer universal or nanofilled composites?
GR: One of the reasons that microfilled composites are starting to disappear is that, in general, the filler particles are becoming smaller in nature, which provides higher polishability and better wear characteristics. Various terminologies are used to describe the particle sizes and shapes, such as nanofilled, hybrid, microhybrid, etc. The filler particles themselves differ based on each manufacturer's chemical formulation, but the trend has been for them to be smaller.
ID: What about curing times and methods? Are there any new developments regarding ensuring an efficient and complete cure?
GR: Curing times have definitely decreased, but not significantly so. Manufacturers of composites recognize that curing time and curing depth are issues. One of the reasons that bulk-fill composites have become so popular is that they permit dentists to cure deeper in the same amount of time. Regarding curing methods, the industry has introduced better lights. They are not necessarily any faster; however, they are stronger and provide more predictable output.
ID: Do any new protocols for placement reduce technique sensitivity, particularly in the anterior region?
GR: The new universal bonding agents allow dentists to choose their preferred bonding method, so they can decide whether they want to use a total-etch, self-etch, or selective-etch technique on a preparation before bonding a restorative material into place. The technique chosen can be based on the preparation to help minimize the amount of sensitivity associated with the bonding process. For example, if a preparation is very deep, it is wise to avoid using a phosphoric acid etchant on that part of the tooth because of sensitivity issues, and universal bonding agents make that possible.
ID: Do you foresee any developments on the horizon that could have a significant impact in this area?
GR: As an industry, we are working on trying to create restorative materials with more biomimetic properties. We are starting to see cements with these properties become available, and because many cements had their genesis in composite resin technology, it is easy to see how the next step of that technology is being brought into restorative materials. We are starting to see some of those materials coming to market.
In addition, one company has developed a tooth-colored restorative material that no longer requires a bonding system because it is self-adhesive in nature. This is an interesting step in an important direction. That direction being the evolution toward an ideal, tooth-colored biomimetic restorative material that requires no bonding step.
Gary M. Radz, DDS
Director of Industry Relations