Composites

When I analyzed the crown procedure, I found efficiencies that would cut time by a factor of four.

Then I decided to tackle endo because endo stressed me. I didn't think I could be as effective because of all the endodontists who study and lecture on the technique. I was wrong. I immediately found efficiencies that they had overlooked that slashed their times in half.

Next I took on prophy's. I was at first sad because I could only reduce this procedure by 20%. Then I analyzed the potential net profit increase that should result. It was $100,000 of net income per year! I hadn''t considered that we do a volume of this procedure so even small efficiency gains add up.

Off and on through all this, my mind wanders to the composite procedure. I look at everything out there I can find. Maybe there''s some hidden secret I've overlooked. Also, I apply my mind to developing a new product or sequence that will create efficiency.

The composite filling is one of the most interesting phenomena in dentistry from a procedural as well as a philosophical aspect. How we do composites, when we do composites and what materials we use to do them with reveal a lot about us.

We do composites more than any other procedure. Most of us when we do a crown or an endo for a build-up. Sealants are a composite. We place them in class IV lesions.

Careers have been built out of lecturing about composite.

It is, by far, the most challenging material we have to work with. It is highly technique sensitive and time consuming to do right.

The proximal box is more difficult to perform than crown preparation or endo access. It requires more fine motor control and carefullness.

KaVo even has sonic tips designed to shape uniform proximal boxes.

Should you use a rubber dam?

Should you do a composite at all?

Should you use caries indicator?

Should you use a low speed?

Should the axial walls be smooth or does it matter?

Which material to bond with is an area of great discussion.

Which device do you use for forming the proximal aspect (there are so many contraptions for this) and how in the world do you keep from getting a diastema?

What light should you cure with? LED? PAC? Etc. How long should you cure?

Should you layer it?

What about dual cured?

And the most challenging part of doing a composite.......Shaping and finishing. What a hassle. Now you're doing a lab techs job. And you complained about their anatomy.

Composites are labor intensive and composites deserve a very long discussion in order to ferret out all the advantages and disadvantages of the different approaches.

As it turns out, one of the most overlooked aspect of the composite is the environment that you placed it in. That''s another story.

It seems to me that more people have taken a crack at ways to do composites than any other restoration.

No huge efficency gains have popped into my head yet but I''m not through analyzing by a long shot.

I predict that I will be able to save some time. Not the dramatic, sensational and unbelievable time savings that occurred in the 15MME and 15MCP but significant time will be saved. Enough to make life a little easier and lift the cieling on productivity a little higher.

Composites may be divided into 3 categories: Occlusal, proximal and anterior. Each has a different approach and a different set of problems.

Proximals are the most complex.

Check back with me on the composite. Composites are going to take awhile.