Mastering dental composites

Dental composites are an essential part of everyday practice in dentistry – but are clinicians using them correctly? Rachel Derby shares her top tips.

While I love all aspects of dentistry, restorative procedures – especially working with dental composites – truly captivate me.

As I prepare to speak at the Dentistry Show London, I want to share my journey, insights and practical tips for mastering dental composites with my fellow dental professionals.

A journey into restorative dentistry

My journey into dentistry began with a fascination for the intricate and detailed work involved in restorative procedures.

Over the years, I’ve developed a particular affinity for fillings, crowns, bridges and root canals. These aspects of dentistry allow me to blend art with science. This ensures patients not only have functional teeth but also aesthetically pleasing smiles.

Two years ago, my husband and I took a significant step in our careers by purchasing our first practice. This has allowed us to implement our vision of patient-centred care and to focus on areas that we are passionate about, including the meticulous work involved in dental composites.

The challenges of dental composites

Dental composites, particularly Class II posterior composites, are among the most challenging procedures we perform regularly.

A ‘screw-up’ in this context can range from minor issues like improper removal of flash or incorrect contact points to more significant problems such as bonding failures. These screw-ups are not catastrophic, but they highlight the complexities and high standards involved in composite work.

One of the most critical aspects of working with composites is understanding that perfection is a moving target. Even with 14 years of experience, I still encounter challenges. The key is to refine our techniques continually and embrace a mindset of continuous improvement.

Common pitfalls and how to avoid them

When it comes to dental composites, there are two main areas: clinical execution and patient management.

From a clinical perspective, proper isolation is paramount. Utilising the correct matrix band, ensuring complete decay removal, and following precise etching and bonding protocols are all essential steps. Each of these steps must be executed meticulously to avoid common pitfalls.

On the patient management side, it’s vital to recognise that there is a person attached to the tooth. Patients’ comfort and cooperation significantly impacts the success of the procedure. For instance, a patient who dislikes local anaesthetics or rubber dams can make the process more challenging.

Effective communication and managing patient expectations are as crucial as the clinical skills we apply.

Practical tips for success

Based on my experiences and learnings from courses, I’ve developed a process to minimise mistakes and improve outcomes in composite restorations.

Here are some key tips:

1. Effective communication: start with clear communication with the patient about the procedure, expected level of discomfort, and duration. Setting realistic expectations can enhance cooperation and reduce anxiety
2. Proper isolation: use a rubber dam for isolation. This step is non-negotiable for me, as it ensures a dry working field and improves the quality of the restoration
3. Thorough decay removal: ensure all decay is removed, especially in deep cavities. Decide whether to pulp cap or leave areas for remineralisation based on the depth and condition of the decay
4. Precise etching and bonding: follow the manufacturer’s instructions for etching and bonding protocols rigorously. These guidelines are designed based on extensive research and development, akin to assembling IKEA furniture – deviations can lead to failures
5. Incremental placement: place the composite incrementally, curing each layer adequately. Use glycerine for curing the final layer to prevent an oxygen-inhibited layer and ensure a smooth finish
6. Occlusion check: finally, meticulously check the occlusion to ensure that the composite fits well within the patient’s bite. This step prevents future issues like wear or discomfort.

Continuous learning and improvement

My approach to composites is continually evolving. This is thanks to the wealth of knowledge shared by experts in the field, and the advancements in dental materials and techniques.

While I may not consider myself a composite master, I’ve gained valuable insights from various courses and mentors that I implement in my practice daily. Dental composites haven’t changed drastically over the past decade, but our understanding and techniques have. By adhering to established protocols and staying updated with the latest research, we can achieve excellent outcomes consistently.

Dentistry Show London

I’m thrilled to be presenting at the Dentistry Show London, where I’ll discuss ‘How not to screw up your composites’.

My lecture will provide practical tips and tricks that you can apply in your clinic immediately. Whether it’s a refresher on bonding protocols or new ideas about matrix bands and cavity preparation, my goal is to offer insights that enhance your practice.

Additionally, I’ll share some clinical cases that highlight common challenges and solutions, including what I refer to as ‘sexy morphology’ in composites. These visual examples will illustrate key points and provide a tangible reference for implementing best practices.

In restorative dentistry, particularly with dental composites, perfection is a continuous pursuit. Every day presents new learning opportunities and challenges. By focusing on both clinical precision and patient management, we can achieve outstanding results and improve our patients’ oral health.

I look forward to seeing many of you at the Dentistry Show London.

Let’s continue to learn, share, and grow together in our quest for dental excellence.

If you have any questions or would like to discuss further, please feel free to reach out to me on Instagram at @drrachelderby.

This article is sponsored by Closerstill.