How many composite systems do you really need?
Deciding which composite systems are right for you is a really big decision. Joshua Austin, DDS, FAGD, offers some tips on assessing and exploring your options.
In the past, composite systems were categorized by filler type. The problem with that now is that many manufacturers of dental materials are hiring sophisticated marketing employees who develop all kinds of crazy names for fillers, so you can’t always tell how a product might traditionally be classified by reading the marketing literature about it. So instead of trying to sift through the marketing mumbo jumbo, let’s just look at composites by the categories in which they are best placed. Most of them fall into a few different categories. How many of those categories do you need in your practice? The answer is (obviously) different for every single clinician reading this article.
Universal systems are composite systems that can be used successfully in both anterior and posterior applications. They’re typically available in a wide array of shades and layers.
Examples: 3M ESPE’s Filtek Supreme Ultra, Kerr’s Herculite Ultra, Ivoclar Vivadent’s Tetric EvoCeram, Cosmedent’s Renamel Microhybrid, Tokuyama’s Estelite Omega, Dentsply’s Esthet.X HD, etc.
Bulk fill systems are made for Class I and II applications in the posterior and aren’t usually esthetic enough for anterior applications.
Examples: Kerr’s SonicFill, 3M ESPE’s Filtek Bulk Fill, Ivoclar Vivadent’s Tetric EvoCeram Bulk Fill, Dentsply’s SureFill SDR Flow, etc.
Posterior systems are made for Class I and II applications in the posterior but are not able to be cured in bulk and are not really esthetic enough for anterior placement.
Examples: 3M ESPE Z100, Ivoclar Vivadent’s Heliomolar, etc.
Anterior systems are made for Class III, IV, and V applications in the anterior and generally consist of microfilled resins.
Examples: Cosmedent’s Renamel Microfill, etc.
Over the past five to 10 years, we have seen a decrease in the development of different anterior and posterior systems in favor of simplified universal systems. Most universals are nano-hybrid filled systems that are strong enough for posterior restorations but have the esthetic flexibility and layering capability of older, microfilled systems. From a simplicity standpoint, I think it’s time to move on from posterior and anterior systems in favor of a united universal system. It is entirely possible that any of the universal systems listed above can fulfill all of the composite needs in your practice. You can use them for your general Class I and II applications in the posterior, and you can layer them to nicely restore a big Class IV. They are strong, but they also polish well.
Where you might want to consider throwing a little complexity in is with bulk fill systems. I have had great success with bulk fill posterior composites in my practice. The materials have improved remarkably since their initial introduction to the market. I find them to be simpler to place than traditional incremental posterior composites—so much simpler that it warrants having a second composite system in my practice. The materials tend to be too translucent to use on anteriors, however, so you still need a universal system.
Deciding which composite systems are right for you is a really big decision. Go to the closest big dental meeting and walk the exhibit hall. Try all of these out. See which ones work best in your hands. Try bulk fills on a typodont. Check out the shading and layering of universal systems to figure out which system makes the most sense in your head. The only way to know that you are using the right ones for you is to try as many as you can. What you find might surprise you!
Editor's Note: This article first appeared in Pearls for Your Practice: The Product Navigator. Do you have a question for Dr. Austin? Is there a product you'd like to see him review? Or would you like to submit your own products article or "Pearl"? Tweet to @pearlmail or send an email to email@example.com. _________________________________________________________________________________________________________
Joshua Austin, DDS, FAGD, is the editorial director for Pearls for Your Practice: The Product Navigator, an e-newsletter from DentistryIQ.com and Dental Economics. He also writes the "Pearls for Your Practice" column in Dental Economics. After graduating from the University of Texas Health Science Center Dental School, Dr. Austin associated for several years. During October of 2009, he opened a solo general practice in a suburban area of San Antonio, Texas. Dr. Austin is involved in all levels of organized dentistry and can be reached at firstname.lastname@example.org.