I know composite allows versatility in prep design, but do you always prep the whole occlusal surface?

[sicemdude]

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So if a patient needs a class 2 and the caries don't extend more than a few millimeters toward the middle of the tooth, do you just do half of the "class 1 portion", or do you go all the way?

 

[schmoob]

You can do a slot prep and just excavate the interproximal decay. But if you need to prep the occlusal then you should extend the outline form for resistance. You don’t want the restoration to fracture at the marginal ridge.

 

[P7898]

To each their own. I know guys that won't do slot preps because they argue there is not much retention. But I would try and keep it as conservative as possible. You can always add retention at the axial walls in the slot.

 

[TanMan]

Extension for prevention is such an old concept... I don't support it because it requires the destruction of more good tooth structure. That is one of the advantages of composite - you can be much more conservative than an amalgam restoration. If you're going to destroy that much tooth structure, you might as well do a conservative amalgam.

 

[P7898]

Extension for prevention is such an old concept... I don't support it because it requires the destruction of more good tooth structure. That is one of the advantages of composite - you can be much more conservative than an amalgam restoration. If you're going to destroy that much tooth structure, you might as well do a conservative amalgam.

Or get you some gold 😉

 

[TanMan]

Or get you some gold 😉

Or gold foil w/ the subsequent RCT due to pulp necrosis.

 

[sicemdude]

You can do a slot prep and just excavate the interproximal decay. But if you need to prep the occlusal then you should extend the outline form for resistance. You don’t want the restoration to fracture at the marginal ridge.

So if you are going to do a legitimate class 2, then you should extend all the way to the opposite pit/marginal ridge?

 

[TanMan]

So if you are going to do a legitimate class 2, then you should extend all the way to the opposite pit/marginal ridge?

If you're thinking "legitimate" as in "dental school", then yes, unless you were taught otherwise. The spirit of GV Black still haunts the many basements of dental schools. Some schools also have the Tucker gold club but that gave me the creeps of how cult-like the members can be. Adhesive dentistry has changed how aggressive some these preps had to be. Micromechanical retention has changed some of the ways we look at prep design.

 

[schmoob]

So if you are going to do a legitimate class 2, then you should extend all the way to the opposite pit/marginal ridge?

There’s no such thing as a “legitimate” class II. If you have a little interproximal E2 lesion, you’re not going to GV Black the whole tooth. In the real world, you chase the decay because you really want to preserve as much tooth structure as possible.

However, in dental school bench/sim lab, you must follow the instructions for your typodont. Make the preps the way they tell you to, extend it as far you’re told to, make your dovetails, etc

 

[Frychicken]

Real world dentistry is rarely ever “ideal”. I’m a fan of natural healthy tooth structure, but I also don’t do slot preps because they have a high chance of failing.

 

[TXftw]

I’m my opinion it’s best to just do a slot prep in that case. A slot prep will provide more than enough retention for composite. Extending to the distal/mesial pit (which ever is opposite the proximal decay) is an outdated way of thinking. Even CDCA allows slot preps for composite.

 

[SirBrotherJam]

I’m my opinion it’s best to just do a slot prep in that case. A slot prep will provide more than enough retention for composite. Extending to the distal/mesial pit (which ever is opposite the proximal decay) is an outdated way of thinking. Even CDCA allows slot preps for composite.

I personally don't do slot preps and stick to conservative class II preps as I have redone a lot of them through patients that I have seen in the military. Not saying that you cant do them, but they require a dry field and retention. Plus the microleakage of the composite over time. And usually when you see that they need to be redone you are looking at probably an endo too.

 

[P7898]

I personally don't do slot preps and stick to conservative class II preps as I have redone a lot of them through patients that I have seen in the military. Not saying that you cant do them, but they require a dry field and retention. Plus the microleakage of the composite over time. And usually when you see that they need to be redone you are looking at probably an endo too.

Boom.

 

[TXftw]

Slot prep or GV Black class II, if you don’t control contamination, cure the composite all the way through, etc. you’re gonna have failed composites due to micro leakage.

 

[Molar Whisperer]

Extension for prevention (for amalgams) was taught at my school. While serving in the military, the USAF have a Dental Investigation Service now called Dental Research and Consultation Svs that does not recommend unnecessary extensions as TanMan mentioned. Slot preps should have enough retention/resistance for any filling materials if adequate depths are placed.

 

[TXftw]

Extension for prevention (for amalgams) was taught at my school. While serving in the military, the USAF have a Dental Investigation Service now called Dental Research and Consultation Svs that does not recommend unnecessary extensions as TanMan mentioned. Slot preps should have enough retention/resistance for any filling materials if adequate depths are placed.

Exactly, we’re talking composite here. You’re etching the tooth and creating micro mechanical retention on 4+ walls. If it pops out of the prep, it’s very likely that it wasn’t due to preparation design

 

[TanMan]

Another thing to think about - the less margins you have exposed on the oral cavity, the less points of failure your restoration will have from a recurrent caries standpoint. That's why I prefer slot preps. Slot preps, from my experience, tend to fail on patients that have poor OH. Then again, with composite, I see higher rates of recurrent decay regardless.

 

[WolftheDentistStanson]

not necessary at all. with proper isolation a slot prep composite shouldn't fail. but, to each his/her own.

When doing composites I use isovac or rubberdam. most failed composites in my experience are from poor isolation, improper bonding protocol, inadequate condensation of composite.

 

[TanMan]

When it comes to composite, speed is key. You have to work fast enough to keep contamination out of the work area. Usually, that means finish the restoration portion within 1-2 minutes. Ways to do it faster: bulk fill + 1s/3s curing lights + 7th gen bond.

 

[LaughingGas]

You can do dove extension, somewhat between slot prep and traditional class II.

 

[tinman831]

Supposedly the reason for the dovetail is to aide in retention, since bonding to primary teeth is not the best. I believe there is literature out there that says retention rates are fairly similar between slot preps and dovetails. I think it more or less boils down to what you were taught in school and what you're comfortable with. I know pediatric dentists that do dovetails and some that don't.

 

[AONLINE]

While dental students are still taught according to GV Black’s principles, including prevention by extension, I’ve found that faculty at my school are pretty relaxed about this concept. Nowadays with advancement in adhesive dentistry, there’s really no need to extend beyond a slot prep if the caries is limited to the interproximal and you’re going to fill with resin composite . However, I have noticed that some of my pediatrics faculty ask me to add a dovetail to the occlusal portion of my pediatric class IIs, even when they’re resin composite. Has anyone else experienced this?

I have experienced the same thing. I have only done slot preps for my adult patients, but in the pediatric rotation they taught us to add a dovetail for all composite preps.

 

[lemoncurry]

Exactly, we’re talking composite here. You’re etching the tooth and creating micro mechanical retention on 4+ walls. If it pops out of the prep, it’s very likely that it wasn’t due to preparation design

This. Get a nice tight matrix band and wedge, keep it dry, and trust in the bonding agent. It works. I do slot preps all the time, sometimes an MO and DO on the same tooth if I don't see decay in the pit. I usually extend the prep if I see darkness in the grooves unless it is superficial.

 

[lemoncurry]

When it comes to composite, speed is key. You have to work fast enough to keep contamination out of the work area. Usually, that means finish the restoration portion within 1-2 minutes. Ways to do it faster: bulk fill + 1s/3s curing lights + 7th gen bond.

Also this. Once you are in a groove with your assistant, you can usually get the band, wedge, and ring on in 15 seconds or less; scrub prep for 20s with an all-in-one, cure 10s, place bulk fill for maybe 10 seconds tops, cure for roughly 20s depending on your light. Boom. Patients love you because it is done so quickly.

 

[1070752]

I didn't read all of the replies, but we really need to move on in dentistry from "retention". Bonding protocols are here, and work tremendously well if done CORRECTLY. Meaning complete isolation, etching (and not over etching), 20 seconds of bonding agent application thoroughly massaging the dentin (primer application prior if you're using 4th gen), and composite.

You can have any prep design you want, tiny slots like this (and even smaller): Restoration

Also, if you're bonding anything (whether composite, onlays, or crowns), slots and grooves in the dentin are completely useless, in fact you're just removing unnecessary tooth structure.

 

[lemoncurry]

I just discovered Dentsply Surefil One, which combines the best of worlds of an RMGI and a composite. No etching or bonding needed, apparently. Can't wait to get some and try it out!

 

[schmoob]

I just discovered Dentsply Surefil One, which combines the best of worlds of an RMGI and a composite. No etching or bonding needed, apparently. Can't wait to get some and try it out!

My boss bought some for the practice. I’ll try it out soon too.

 

[Anass Habrah]

I would like to try but I think in my country has another tradename from Dentsply
Sphere TEC One Nano-Ceramic Dental Composite
could you confirm is it the same?

 

[lemoncurry]

I would like to try but I think in my country has another tradename from Dentsply
Sphere TEC One Nano-Ceramic Dental Composite
could you confirm is it the same?

I do not think it is the same, as the surefil one is in a triturating capsule similar to a glass ionomer.

 

[schmoob]

I do not think it is the same, as the surefil one is in a triturating capsule similar to a glass ionomer.

Do you use it just for operative? Or do you use it for core buildups as well?

 

[Mauricio45]

Not a fan of slot preps. I don't think many dentists are good at them. Seen way too many that debond and have recurrent decay. Better to leave a little "dovetail" occlusion extensive but not all the way to the pit. Had good results this way.

I find the more conservative preps tend to lead to issues.

 

[lemoncurry]

Do you use it just for operative? Or do you use it for core buildups as well?

Haven't used it yet, but it seems like it would be ideal for core buildups as well, as there is really no limit to the thickness you can fill since it is dual cure.

 

[Anass Habrah]

thank you for your response

 

[1070752]

Not a fan of slot preps. I don't think many dentists are good at them. Seen way too many that debond and have recurrent decay. Better to leave a little "dovetail" occlusion extensive but not all the way to the pit. Had good results this way.

I find the more conservative preps tend to lead to issues.

Sure, if you're not doing them properly... The same dentist that is doing clinically unacceptable slot preps, is probably going to do unacceptable extended preps as well (whether leaving caries behind, not sealing the margins, improper bonding, etc).

 

[schmoob]

Haven't used it yet, but it seems like it would be ideal for core buildups as well, as there is really no limit to the thickness you can fill since it is dual cure.

Have you tried it? I haven’t yet but my boss has and he’s not a fan of the dispensing tip. I cut the tip and placed a small applicator used for posts. We’ll see how this works.

 

[lemoncurry]

Have you tried it? I haven’t yet but my boss has and he’s not a fan of the dispensing tip. I cut the tip and placed a small applicator used for posts. We’ll see how this works.

View attachment 327774

We got our shipment in and so far I have used a dozen capsules but only one has actually made it into a patient's mouth. Most of the time, after I triturate, it doesn't dispense. I have tried tapping the hell out of it before mixing to break up any clots, but I so far I haven't been successful. I wish the tip were the kind that fold. I am worried that my mixer damages the tip.

 

[schmoob]

We got our shipment in and so far I have used a dozen capsules but only one has actually made it into a patient's mouth. Most of the time, after I triturate, it doesn't dispense. I have tried tapping the hell out of it before mixing to break up any clots, but I so far I haven't been successful. I wish the tip were the kind that fold. I am worried that my mixer damages the tip.

Maybe try cutting the tip back? Or see if you are over-triturating and it is setting too quickly?

 

[lemoncurry]

Maybe try cutting the tip back? Or see if you are over-triturating and it is setting too quickly?

checked the triturator time and speed and it was according to their directions. I'm hoping it was just a bad batch.