The Restorative Pathway
The “direct restorative” procedure remains one of the most common procedures performed in the dental office. Whether a restorative or cosmetic track, anterior or posterior, the procedure potentially represents a large share of expense (both material and chairside time) for the clinician and investment for manufacturers in research/development and production. As such, Inside Dentistry sought to garner and share insights from practicing clinicians into the restorative pathway, from material selection to technique preferences, to see what clinicians felt were the key elements to achieving predictable, successful outcomes.
We began by examining why a matrix band is chosen—ease of use and the ability to establish great contacts were the overriding reasons. The choice of plastic versus wooden wedges was a split decision, but the advent of the ring systems has helped advance successful posterior restorations beyond the use of the Tofflemire band for composite restorations.
Universals Gaining Ground
Adhesive bonding for direct restorative procedures is an area of various opinions and challenges, with sensitivity being the primary indicator of concern. Universal adhesives are rapidly gaining market share for all indications, with primary satisfaction in solving sensitivity, achieving higher bond strengths, and providing versatility. However, it should be noted, universal adhesive use is not exclusive in the operatory, as practices overwhelmingly utilize two adhesive systems.
In Anterior or Posterior, Ease of Placement is Key for Composites
The use of multiple composites to achieve expected outcomes was split equally. Fifty percent of the respondents said they use one composite for both posterior and anterior restorations, while the other half said they use a posterior-only product. Regardless of the clinical application, ease of placement and adaptability were cited as the primary reasons for selecting a composite, with shade being a third factor. Of those surveyed, a majority continue to place traditional composite as opposed to exclusively placing bulk-fill composite for posterior restorations, and growth was seen in using composites for esthetic indications among more than 40% of respondents.
Simplified Finishing Desired
Finishing and polishing is accomplished primarily with points, sandpaper disks, and cups, with multiple systems employed to achieve esthetically pleasing results. Notwithstanding, clinicians surveyed were very interested in finishing and polishing systems that reduced the number of steps and tools involved. Only a scant number (14%) of those surveyed use stains to achieve esthetic results, while roughly 50% recommend whitening of the adjacent teeth when performing direct composite restorations in the esthetic zone.
More than 90% of clinicians surveyed are charging less than $300 for a Class II, three-surface restoration. While admittedly dependent on a multitude of variables, statistics suggest that at such reimbursement rates, after factoring average hourly production rates and the hard costs associated with the procedure, restoring a Class II is routinely being performed at a loss.1 Clinicians will continue to look to manufacturers for advances in materials to help drive efficiencies and thereby increase the value proposition for these procedures.
What attributes do you look for the most when choosing a matrix band system?
Ability to establish contact area: 87%
Ease of use: 73%
Ability to contour the band: 48%
Familiarity with system: 28%
How many different adhesive systems do you use?
Two systems: 57%
One system: 28%
Three systems or more: 15%
What feature do you like best about your composite of choice?
Ease of placement: 36%
Its adaptability to margins: 24%
Matches surrounding dentition: 18%
It polishes well and hold its polish: 7%
It sculptability: 7%
No stickiness: 5%
Multiple-instrument use to achieve results: 2%
What is your standard fee for a Class II (three-surface) composite?
Between $200-$230: 40%
Between $230-$300: 27%
Less than $200: 27%
More than $300: 7%
Would you be interested in finishing and polishing systems featuring fewer components/steps to achieve desired outcomes?
1. Goodchild JH. The Class II restoration: work harder or work smarter? Dental Economics website. May 19, 2016. https://www.dentaleconomics.com/articles/print/volume-106/issue-5/science-tech/the-class-ii-restoration-work-harder-or-work-smarter.html. Accessed July 29, 2016.