We all have procedures we love and those we love to hate; class V resins fall into the latter category for me, so when I posted a video asking you all for help, you came through with fantastic tips, tricks, and suggestions to make my life (and my patients’ experiences) that much better.
I’m going to share some of the information I received. SO MUCH GOOD STUFF HERE! Take a look, glean what you will, and apply accordingly. Furthermore, keep in mind that what works for one provider may not work for another. There are even a few product suggestions to mull over. It doesn’t get better than this—real-world dentistry without the pomp and circumstance of a lecture hall and a cold cup of coffee.
Provider suggestions:
• Don’t use resin; use glass ionomer. Pros: versatile in hard-to-isolate areas, bonds to dentin, fluoride release. Try GC FUGI II LC capsules. If you want a smother shine after polishing, you can place bond and a thin layer of resin/flow over the top.
• Use AlCh solution on the tissue; if it’s a good bleeder, apply Expasyl (Safco Dental) paste and let it sit for a bit; this dries up the area for placement of the filling.
• Contrary to what many are taught, some dentists don’t bevel the margin as the flexural properties of the tooth cause the resin to break at the thinner margin areas, subsequently causing a defect.
• Always place retraction cord; place prior to prepping and don’t forget to take it out!
• Place an undercut in the tooth at the root and at crown margin of the prep.
• Use incremental placement of the resin to reduce shrinkage, even if the prep isn’t that deep.
- For the last increment, put a touch of resin on your finger and work the resin toward the gingiva to encourage the bond toward the root. Yes, the finger is a great instrument and tends not to pull the material away from the location where the bond is most wanted.
- Trim well with ET burs (Brasseler); they cut nicely and are thin. Be careful not to ditch the root, and always make sure to go around the line angle where visibility can be an issue (especially the distal buccal).
• Try G-aenial Universal Flo by GC America—numerous properties make it easy to use and an excellent restorative material:
- Position the patient’s head so that the restoration is parallel to the flo (very important).
- Place the tip (of the resin applicator) in the middle of the restoration and on the pulpal wall; fill slowly so it evenly spreads into the corners.
- Wait 30-40 seconds and the material will level out by itself and the face will be parallel with the floor. A slight overfill is recommended for an ideal finish.
- Apply your light. Finish with a fluted blade bur or a white stone on an electric handpiece.
• Cut a prep without touching the tissue. If bleeding occurs, touch it for three seconds with Superoxol, a 35% hydrogen peroxide bleaching agent that can be used to stop minor bleeding; working time is about five minutes before it starts bleeding again:
- Use a ½ round bur for mechanical retention as you cannot rely solely on bond strength.
- If the margin is sub-g and retraction is needed, use a Greater Curve (GC) Band pinched with your fingers. No need for a retainer.
- Etch, wash, and apply MicroPrime Glutaraldehyde Desensitizer B. Dry and apply three consecutive coats of Parkell Brush & Bond and cure between each.
- Fill with Beautifil Flow shade A-2 which blends well, is hard, and rarely bubbles.
- Because of the GC band, there will be some excess resin, but it trims easily supra gingival and your sub-g margin is sealed without any ledges. Polish with your go-to burs.
• Use a FlipMirror to access those hard-to-see areas.
• Remove decay, if any, and use a long bur to bevel the enamel (not always necessary):
- Place retraction cord, especially if tissue is overgrowing the gingival portion of the Cl V.
- Use microabrasion of Cl V lesion, up onto the enamel until visibly clean—there should be NO plaque (make sure to get into the MB and DB line angles to avoid potential future staining). Rinse thoroughly.
- Etch enamel, rinse, and isolate.
- Apply Brush & Bond adhesive, dry, and cure.
- Mix a small amount of Geristore to thinly cover the root/dentin surface and cure.
- Place composite of choice to match shade (suggestion: Filtek Supreme Body shade) and cure (low power).
- Trim off XS composite at gingival (suggestion: ET3 as the tip has a rounded end and is not cutting) as close as possible to retraction cord.
- Pull out the retraction cord and use ET3 again until there is no overhang.
- Polish and do a final cure.
- Note: The biggest problem with Cl V lesions is that there is little to no enamel to bond to. Also, the use of a microabrasion unit, while messy, will clean out any deep crevices that a rubber cup can’t access. Adhesives will not stick to plaque, so this is a vital component to making this composite work for a long period of time.
• Consider the differences between nanocomposite and microfill products.
• OptraSculpt (Ivoclar Vivadent) is great for class V restorations because it allows you to model/sculpt the composite without pull-back and leaves the surface about 95% finished and polished. It's also atraumatic to soft tissue, which is ideal when at the gingival or slightly sub-gingival level. There are even wedge-shaped tips and wedge-shape to discs (4 or 6 mm) to create a quick and easy class V restoration.
I’d love to hear your feedback. For me personally, the “cringe factor” for class V resins has lessoned significantly, and that’s a really, really satisfying feeling!
What are other clinical topics you want insight or help on? Shoot me an email—I’ll make it happen.
Cheers!
Editor’s note: This video first appeared in Through the Loupes newsletter, a publication of the Endeavor Business Media Dental Group. Read more articles at this link and subscribe here.
Stacey L. Gividen, DDS, a graduate of Marquette University School of Dentistry, is in private practice in Hamilton, Montana. She is a guest lecturer at the University of Montana in the Anatomy and Physiology Department. Dr. Gividen is the editorial co-director of Through the Loupes and a contributing author for DentistryIQ, Perio-Implant Advisory, and Dental Economics. She serves on the Dental Economics editorial advisory board. You may contact her at [email protected].
