Flowable composite for class 2

[urooj80]

Hello docs,

Can you please clarify where exactly to use flowable composite in a class 2 box. Some people say don't use it on the gingival floor cause that's where it contacts the band and hence it will be forming contact with the tooth and can be worn off easily and some say doesn't matter use it all over on the gingival floor? Can anyone plz tell?
Also, anyone ever used tofflemire band and retainer for class 2 composites. (The same ones that are used for amalgam)? Any feedback on that will be appreciated.
Thanks

---

Members don't see this ad.

 

[Tooth]

I attended CE in the Navy last month from the former Operative Specialty leader. He informed us that their studies show that 85 percent of dentists in private practice use flowable in with their class II composites. Some fill the proximal box, regardless if it is touching the sectional or tofflemire matrix band, up to 2 mm in depth. Others place the flowable then put a bulk fill on top before curing, compressing it as best as possible before curing. Regardless of whether you believe this is right or wrong to use a flowable in a class II, it is apparently the standard of care.

The justification that providers are using is that the flowable helps ease the internal forces created during polymerization shrinkage of the overlying bulk fill composite. However, with less filler, a flowable will shrink more than anything else. It has never made sense to me to use a flowable in the box except to make the procedure easier.

Using a tofflemire matrix will result in poor emergence profiles and contacts. This is because you cannot condense composite. While more time consuming, a sectional matrix band will provide better results.

 

[sgv]

I looked at my lecture notes and it says that it's for better marginal adaptation.

 

[nuartywayne]

As per our training we usually try to place less than .5mm, and not encroaching gingival margin. If I remember correctly its more to help prevent any possible voids that may arise. We were instructed to cure it once placed before adding any more. 4 days from graduation I don't remember details!!!!!! J/K

 

[playa2652]

I place flowable on the gingival aspect of my box, especially near the axiopulpal wall and the buccoaxiogingival and linguoaxiogingival point angles to avoid voids. For my slot prep close to the cavosurface margin, I place packable composite in at least two layers to minimize shrinkage and ensure better adaptability. We were taught that an open sandwich technique (flowable layer that is thin followed by packable composite in layers) gives a very good outcome and seal.

 

[DrRam121]

According to the guy at my school with a Ph.D in dental materials, placing flow able in any way in a class II restoration decreases the strength of the whole and is a bad idea. Take that for what you will, but I trust his research.


Posted using SDN Mobile

 

[Hedgy]

I believe the literature shows that this risk of cusp fracture is basically equivalent for both materials (JADA June 2007). The risk for secondary caries is higher in composite, thus our desire to use a flowable composite for a better marginal seal.

 

[bsp1013]

If you want to avoid the void, use flow able on the gingival floor, cure, then packable. If it's a smaller prep I find the flowable won't get in every crevice so I'll pinch off some packable and use it too (snow plow technique). Regardless, it will take at least 2 applications of <2mm and cures.