OMG please give me tips, how do you do that. I calculated myself today - 30 mins for 12 DO and 13 MO. Caries prep took 10 mins, then putting sectional matrix took few mins, then placing composite in layers and finishing the prep, checking occlusion took the remaining time. How could you accomplish everything in 5 mins, please give some tips, I don't know what I am missing.
Look at the steps of your procedure:
1. Anesthetic: Rapid anesthetic via infiltration on maxilla or premolar to premolar on mandible by using prilo/septo. Regardless, you probably have other things to do, so numb and do what you need to do. 1st/2nd man molars, either block, PDL, and/or lingual infiltration. (30s-1min administration)
2. Prep: You should have your diagnostic information memorized already. If you're doing interproximals, you should know approx depth, location relative to where contact would be broken, is it leaning more towards buccal or lingual, etc... With knowing where the lesion is located, drill initially at the marginal ridge, open up B-L sections for visibility, band placement, finishing, convenience form, etc... Using the proper burs makes this process way easier, but training yourself for tactile sensation is a different story. I use an 830-008 diamond for conservative preps, then finish with a 557 to remove all undermined enamel and smooth all walls. I don't do extension for prevention. You need to master the feel of cutting into enamel, dentin, infected dentin, affected dentin, and pulp tissue. Think about it this way, if you don't have to look, you don't need to keep checking. You can feel the caries and let your bur guide you. Preps should be 1 min or less. Remember, the more you are prepping, the more you're removing valuable tooth structure.
Placement of the matrix. I use sectional matrices. If you want to go speed mode, but sacrifice contact quality, use a supermat from garrison. Superfast placement, contacts are meh. How do you do sectionals fast? Your prep needs to have at least 0.5mm clearance on the gingival floor and bucco/lingualproximal walls. That way, you have both matrices in hand, push both in, hold it in, you have about 1-2 seconds to put your wedge, if you put your wedge but notice no engagement on the bands, you need to take the wedge partially out, push bands more gingivally, and put it back in to ensure a better gingival floor seal, then place your ring within 10 seconds, especially with the mandible. Once the whole apparatus is placed, burnish them against each other, then you can start isolation.
3. Fills: You need to be very fast at placement, remember this, every second you waste is an opportunity for contamination. For bonding agent, I prefer self-etch with option for total etch. Look for single bottle systems that require 0-10 second of wait time before initiating drying. For composite placement, you can do this in various ways: use bulk flow flowable only, incremental flowable only, incremental flowable with capped packable composite or bulk flow flowable with capped packable composite. The viscosity of the capped packable composite is important because it affects your ability to handle and the overall adaptability of the material. Use 1-3 second curing lights. You should test this invitro to determine if the lights can cure your composite as advertised (use those light cure/step guide to determine if it works).
4. Adjustments: Forgot to mention, keep a mental note of where the ridge was originally. I prefer to keep the MRs out of occlusion, but design them for cleansability as well. I like arkansas white stones for polish/finish with a 7902 carbide for nice flowing ridges to allow for cleansability
5. Check occlusion, check with floss. Nothing high, must have snap through flossing. Not too tight, not too loose. Remember, the patient has to be able to floss in between, but it should not just slide through, if done correctly. If you find that it slides, redo one of the back to back composites, preferably the more conservative one.
