Class II Restorations
are more important to your practice than you might think. In fact, they account for almost half of all direct restorations.
The number one reason for composite failures is recurrent caries and the floor of the proximal box is the most vulnerable area.2
That's why Dentsply Sirona Restorative has developed the first and only Complete Solution for the Class II procedure. From our industry-leading products to continuing education opportunities and expert clinical and product support, it's a holistic solution for optimizing every touch point in a Class II restoration.
2Durable Bonds at the Adhesive/Dentin Interface. Braz Dent Sci. 2012 ; 15(1): 4–18
Class II Procedure Video
Class II Insights
Dentists face a variety of challenges in every step of a Class II restoration procedure. The longevity of each case depends on taking control of as many variables as possible. Here are a few insights on approaching key areas of a Class II.
97% of clinicians say that achieving proper isolation of a Class II cavity is difficult in at least 1 out of 10 cases.³
³ Dental Learning Systems, Direct Restoratives Survey, May 2016. N=143.
Many curing lights deliver less than 35% of their stated output to the floor of a Class II proximal box.⁵
⁵ Irradiance Value Comparison among commercially available curing lights. BlueLight Analytics. (2012).
The human eye is only accurate 27% of the time in composite shade selection.⁷
⁷ Visual and Spectrophotometric Shade Analysis of Human Teeth J DENT RES August 2002 81: 578-582
97% of clinicians state that too dry or too wet dentin sometimes affects the adhesive bond of their composite restorations.⁴
⁴ Exevia Dental Shuttle Q1/2015, n=702 GDPs from Italy, France and Germany.
82% of dentists report using a flowable as a liner in Class II restorations to increase marginal adaption.⁶
⁶ Council on Scientifi c Affairs of the American Dental Association. Spring 2009;4(2).
More than 70% of dentists say that simplicity is one of the most important factors for a finishing and polishing system.⁸
⁸ Exevia: Dental Shuttle Q4, 2016, Germany.
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Palodent V3
Abrading Adjacent Tooth
Whether removing decay or existing restorative material, avoid damaging the adjacent tooth. This is especially challenging in the molar regions, and even more so on maxillary molars.In fact, studies have shown that in 70% or more of Class II restorations, the clinician nicks the adjacent tooth with a bur during prep. When the bur nicks the adjacent tooth, it roughens the tooth surface and creates an area for bacteria to collect more easily and form caries. ¹¹
¹¹Christensen, Gordon J (2012). Protecting the Adjacent Tooth. Clinician’s Report – Volume 5 Issue 11.
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Palodent V3
Excess Flash
The flat surface of a traditional Tofflemire band may not adapt well to the proximal line angles or create a tight seal around the restorative field. This could lead to excess flash on the gingival and lingual surfaces, requiring more finishing time. Additionally, if the matrix moves during burnishing, the gingival seal may be compromised, increasing the likelihood of an overhang, requiring additional finishing.
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Palodent V3
Open Contacts
Achieving proper contact means that the tooth being treated tightly contacts the adjacent tooth at the middle third, and has a natural convex shape. An open or improperly contoured interproximal contact can result in a fracture as well as food impaction in the interproximal space, which can result in periodontal inflammation, bone loss and recurrent caries.
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Palodent V3
Isolation
When using resin-based restorative materials, keeping blood and saliva out of the equation is critical for long-term clinical success. If the restorative field is contaminated with moisture, the physical properties and ultimate success of the restoration may be compromised.¹² The key is to seal in and shape the Class II restoration quickly and effectively.
¹² Gilbert GH, Litaker MS, Pihlstrom DJ, Amundson CW, Gordan VV. Rubber dam use during routine operative dentistry procedures: findings from The Dental PBRN. Oper Dent 2010;35(5):491-9.
97% of clinicians say that achieving proper isolation of a Class II cavity is difficult in at least 1 out of 10 cases.³
Palodent V3 - Sectional Matrix System
Isolate the restorative field.
Clinical success starts with a solid foundation.
When using resin-based restoratives, both isolation and accurate contact creation are essential for success. Choose a matrix system that not only provides anatomically accurate contacts, but also helps create a tight seal around the restorative field.
The Palodent V3 system is designed to create predictable, accurate contacts, a tight gingival seal, and can be configured for multiple restorations at once.
³ Dental Learning Systems, Direct Restoratives Survey, May 2016. N=143.
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Prime&Bond active
97% of clinicians state that too dry or too wet dentin sometimes affects the adhesive bond of their composite restorations.⁴
Prime&Bond active - Universal Adhesive
Create a strong bond.
Proceed with strength and confidence.
A strong adhesive bond without sensitivity is dependent upon achieving complete, uniform coverage and utilizing proper etching technique. Select an adhesive that spreads into a thin uniform layer and is robust to varying moisture levels.
Prime&Bond active with Active Guard Technology actively spreads for complete cavity coverage, provides a reliable bond even if dentin is overly wet or dry, has a low film thickness to avoid pooling, and supports a selective-etch technique to help minimize the chance for sensitivity.
4 Exevia Dental Shuttle Q1/2015, n=702 GDPs from Italy, France and Germany.
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SmartLite Pro - Modular LED Curing Light
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Curing Technique
In a recent study using new curing lights to test the ability of dental professionals to deliver energy to simulated restorations, there was a 10x difference in energy delivery between the best and worst operator.¹² The variable is technique! Choosing a curing light with a lightweight, ergonomic design for stable positioning and simple controls for consistency of use across operators may help reduce the opportunity for technique variability.
¹² Price and Felix IADR 2010 Barcelona #467 Quantifying Light Energy Delivered to a Class I Restoration
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Curing Angle
The light guide tip should be as close as possible and flat against the restorative surface to have the best chance of directing light to all corners of the proximal box. Angled light guides can make it difficult to keep the surface of the light tip flat at the restoration, especially in the posterior, where 74% of direct restorations are performed.¹³ ¹⁴ Pen-style lights make it easier to maintain the proper curing angle when space is an issue—such as the back of the mouth, and in geriatric and pediatric cases.
¹³ Price R., Felix C., (2010). Factors Affecting the Energy Delivered to Simulated Class I and Class V Preparations. JCDA Applied Research.
¹⁴ American Dental Association Procedure Recap Report (2006). -
Curing Distance
When the proximal box is over 6mm deep, dentists often find themselves guessing if the adhesive and composite have been sufficiently cured. Be sure the curing light cures to clinically relevant distances versus higher output power.
"Many curing lights deliver less than 35% of their stated output to the floor of a Class II proximal box.⁵
SmartLite Pro - Modular LED Curing Light
Cure to clinically relevant distances.
Stay focused along the way.
The average depth of a Class II is 6mm.9 Add cuspal inclines, and the curing light tip is easily 8mm from the floor of the proximal box. Large restorations can also be wider than the beam profile of an ordinary curing light. For a reliable restoration, it’s essential to cure materials to full depth and width.
State-of-the-art optics, excellent beam collimation and a 10mm active curing area ensure reliable clinical outcomes for any restoration size. And the modular, quick-change tips support diagnosis, endodontic illumination and more.
5 Irradiance Value Comparison among commercially available curing lights. BlueLight Analytics. (2012).
9 Volchansky A, Cleaton-Jones P. Clinical crown height (length)–a review of published measurements. J Clin Periodontol 2001;28(12):1085-90.
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Layering
A 6mm proximal box can require up to four layers of material and light curing for each layer placed. Using a bulk fill flowable with excellent cavity adaptation ensures material reaches the corners of the proximal box.
82% of dentists report using a flowable as a liner in Class II restorations to increase marginal adaption.⁶
SDR flow+ - Bulk Fill Flowable
Maintain marginal integrity.
Designed for adaptation.
If a restorative material doesn’t take the form of the cavity prep, gaps may occur. This may lead to post-opsensitivity, microleakage or recurrent decay.
SDR flow+ material, the leader in the bulk fill flowable category, can be placed up to 4mm, and has self-leveling properties for excellent cavity adaptation, which is essential for delivering a complete seal at the most vulnerable interface.
⁶ Council on Scientifi c Affairs of the American Dental Association. Spring 2009;4(2).
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Shade matching
Shade matching to the adjacent tooth can be a challenge. Choose a composite material with a chameleon blending ability to ensure the esthetics of the final restoration are not compromised even if the shade match is not perfect.
Always determine the shade(s) needed for the restoration prior to tooth preparation, comparing against a wet tooth. A dehydrated tooth can change as much as 6 shades if under rubber dam isolation for 60 minutes.¹³
Compare tooth color to the shade guide using various types of incident light (natural light, examination light, room light, etc.). Observing the same material/object under different light conditions can alter the perceived color in some materials–this phenomenon, metamerism, results in a shade looking different due to differences in how the type of light is absorbed and reflected from the material.¹⁴
¹³ Haywood, Van (2009). In Office Bleaching: Lights, Applications, and Outcomes.
¹⁴ Lowe Robert A. (2010). Composite Restorations: Subtleties in Shade and Technique.
82% of dentists report using a flowable as a liner in Class II restorations to increase marginal adaption.⁶
Ceram.x Spectra ST - Universal Composite Restorative
Simplify the shade selection process.
Blend in with your surroundings.
The right composite delivers an efficient, profitable procedure for the dentist and an aesthetic result for the patient. Optimized handling can help with placement ease and efficiency. An easyto-use shading system can speed up shade selection. And a strong chameleon blending effect can make a positive impact on aesthetic results and patient satisfaction.
Ceram.x Spectra ST with SphereTEC filler technology takes handling comfort to the next level, and offers a simple path to high-end aesthetics with 5 shades that cover the full VITA range.10
⁷ Visual and Spectrophotometric Shade Analysis of Human Teeth J DENT RES August 2002 81: 578-582
10 VITA is not a registered trademark of Dentsply Sirona.
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Finishing
A smooth surface finish minimizes the presence of surface irregularities that can lead to plaque retention, staining, gingival irritation, recurrent caries, and tactile perception by the patient. Therefore, clinicians can potentially increase the longevity of their Class II restorations with proper finishing technique.¹⁵
¹⁵ Christensen, G J. (2014). Simplifying your Class II Composite Finishing Technique. Clinicians Report, Volume 7 Issue 4.
82% of dentists report using a flowable as a liner in Class II restorations to increase marginal adaption.⁶
Enhance - Finishing System
Finish in one step.
Fewer Steps. Less Time. Impressive Results.
The end of your restoration should be smooth. Surface irregularities left after finishing and polishing can lead to staining, plaque accumulation, gingival irritation and recurrent caries. Also, look and feel can affect patient satisfaction, which is the biggest influencer of returning and referral patients.
The Enhance Finishing System accomplishes the entire process of excess removal, contouring, and finishing simply by varying the pressure. Push harder to remove excess composite, ease it off for final results. In just one step the Enhance Finishing System delivers a smooth, contoured surface with a natural looking finish. It is also available in mini sizes for improved access and versatility on smaller restorative surfaces.
⁸ Exevia: Dental Shuttle Q4, 2016, Germany.
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Class II Solution Brochure
Class_II_Study_and_Case_Compilation
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