Tools of the Composite Trade

Tedious. Time-consuming. Exacting. These terms and many others are familiar when describing the process of placing direct composite restorations. Success with composites is equally dependent on 3 elements: material, instrumentation, and technique. Proper isolation, appropriate preparation burs, matrix systems, placement instruments, curing lights, finishers, and polishers must be part of your armamentarium to ensure good clinical outcomes with direct restorations.

This is not only a clinical issue. It affects productivity and, in turn, profitability. Considering overhead costs along with third-party reimbursement rates, you need the latest tools to help place composites as quickly and as simply as possible—without taking compromising shortcuts. The adjunct systems presented on the pages ahead are designed to do just that.

Isolation
It can be challenging enough placing difficult restorations without having to worry about controlling moisture, increasing visibility, and retracting the cheek and tongue. That’s why using isolation in the operatory not only saves time during procedures but reduces stress on both clinicians and patients. Many devices are all-in-one—offering isolation, retraction, suction, and evacuation in one system, with dental dams also helping to protect soft tissue and prevent patients from swallowing things they shouldn’t. Here’s nearly a dozen isolation products that help make restorations easier.

The heart of the Isolite 3 dental isolation system from Zyris is a patented mouthpiece made of flexible polymer that offers dual-channel suction, retraction, and an integrated bite block for patient safety and comfort. Shadowless illumination is guaranteed through both a white light and a cure-safe amber light. For operatories with limited HVE ports, an adjustable Y-adapter can be directly connected to the power supply in dental chairs.

Isodry is designed to isolate 2 quadrants at once while providing tongue and cheek retraction and continuous suction. Dual vacuum controls allow for better moisture and oral humidity control. An affordable and versatile option for oral control, the Isovac dental isolation adapter has a strong, ultra-lightweight control head assembly that’s autoclavable. Plug its adapter into any available HVE line in the operatory.

On the disposable side, Zirc’s Mr. Thirsty One-Step is a hands-free isolation device that retracts, isolates, and evacuates. Inexpensive and efficient, this easy-to-use, handsfree device allows clinicians to work continuously. It easily connects to an HVE line and is portable to any operatory.

DryShield is an autoclavable, all-in-one isolation system that combines a high-suction evacuator, saliva ejector, bite block, tongue shield, and oral pathway protector into one easy-to-use device. It’s simple to install and its patented mouthpiece comes in 4 sizes for maximum patient comfort.

For a suction device that easily connects to existing dental vacuum systems, Kulzer’s Ivory ReLeaf features a mouthpiece made from a custom blend of latex and BPAfree polymer so it feels soft and comfortable inside patients’ mouths. Clinicians can easily work in all 4 quadrants, subtracting 15 minutes of chair time per patient.

Featuring exceptional strength and tear resistance, Cranberry’s Smart Dam comes in latex and nonlatex varieties, high-contrasting colors, and is available with a refreshing peppermint scent. With a protein rating below 50g, it helps prevent adverse latex reactions in patients and clinicians.

Relaxed-Fit Insti-Dam from Zirc offers comfortable isolation in hardto-reach areas. Its compact design fits outside patients’ lips for ideal comfort and is easily folded to the side for radiograph removal. Made for single use, the dams come latex-free and preassembled.

With a built-in flexible frame that fits comfortably around the oral cavity, COLTENE’s Hygenic Framed Non-Latex Flexi Dam eliminates the time-consuming and techniquesensitive fitting of the frame. Highly elastic material contracts closely around the tooth for effective isolation. It is powder-free, odorless, and comes in a medium gauge, nonreflective purple color.

Virtually eliminating failure, Zendo’s Silk Rubber Dam offers strength, tear resistance, and durability. The precut latex dental dams create a barrier against moisture and provide an uncontaminated working field that’s free of visual obstructions.

Crosstex Dental Dams are nonlatex and offer excellent tear resistance in a lavender color that contrasts with teeth and enhances tooth visibility. The dams isolate procedures from blood and saliva, prevent tongue and cheek interference, and reduce contaminated aerosols and the risk of patients swallowing or aspirating foreign bodies.

Cavity Prep Burs
Creating the appropriate preparation is the first critical step for placing direct composites. Literally, thousands of configurations—shape, grit, size, cutting medium, reusable vs. single-patient use—are available to custom-design cavity preps while minimizing the removal of healthy tooth structure.

A&M Instruments’ multiuse and single-use Diamond Dental Burs are bonded via a proprietary coating process with a double layer of diamonds, ensuring diamond longevity while minimizing clogging and resulting in efficient cutting and heat reduction.

Alpen Speedster carbides from COLTENE feature durable one-piece construction and high concentricity. They cut freely and aggressively without stalling or clogging and with minimal chatter.

Johnson-Promident Diamond Burs are available in more than 100 shapes and sizes and a wide range of grits for every procedure. They are manufactured to enable cutting with maximum precision and efficiency.

Razor Sculpt from Kerr Rotary features an optimized blade profile with rake and relief angles. The design provides aggressive cutting when desired, while clearing away excess materials quickly without gouging or striations.

Microcopy’s NeoBurr carbides incorporate a Blended Neck design on select operative shapes to provide strength and durability. Designed with optimum blade geometry, the carbides offer a faster, smoother, vibration-free performance.

DuraBraze diamonds from Brasseler integrate patented Spot-Brazing technology that creates self-cleaning channels and smooth cutting performance. They also feature optimal diamond crystal bonding and spacing for enhanced performance and precision.

The diamond line of Dentsply Sirona’s Midwest Burs combines 7 levels of grit (ultra-fine through ultra-coarse and dual-grit options), 2 shank variations—friction grip and short shank—and more than 80 shapes in a selection of more than 500 diamonds.

For efficient cutting, Maxima One-Piece Carbide Burs from Henry Schein are made from fine-grade tungsten carbide. They provide maximum blade contact on tooth surfaces and reduced risk of chipping or breakage.

Made of Austrian carbide, Mydent’s DEFEND Carbide Burs offer fast, smooth, vibration-free performance, reducing patient discomfort and procedure time. With minimal pressure on turbine, the burs offer maximum precision and minimum vibration.

For patient comfort and cutting efficiency, Two Striper diamonds from Premier are manufactured via the P.B.S. Braze process and a select grade of natural diamond crystals. The brazing process maximizes the exposure of diamond-cutting surfaces, especially at the tips and upper circumference of the diamond instrument where most cutting occurs.

Matrix Systems
Until the advent of the sectional matrix system in the mid-1980s, simple circumferential matrices, most notably Tofflemire, were the only option for Class IIs. While they are still available and adequate for sealing certain preparations, achieving ideal interproximal contact can be challenging. Today's sectional systems overcome the limitations of circumferential matrices and include anatomic wedges to improve the ability to produce proper contour and contact.

Palodent Plus from Dentsply Sirona Restorative features 5 sizes of matrices with maximum curvature on the horizontal plane and a gingival apron that prevents gaps in the gingival/axial corner. Offered in universal and narrow sizes, the nickel-titanium rings incorporate V-shaped glass-fiber reinforced plastic tines.

Garrison’s Composi-Tight 3D Fusion has Soft-Face silicone ring tips with optimal marginal ridge anatomy; they hug the precontoured deadsoft matrices to the tooth for flashfree anatomical contours. Tru-Stack technology simplifies ring stacking.

Available from Ultradent, the Triodent V3 SuperCurve Kit comprises all components necessary for placing Class II composites. In addition to 2 V3 rings (universal and narrow), it contains 20 of each of the 5 sizes of SuperCurve matrices with a micro-thin nonstick finish to simplify removal. Wave Wedges, tweezers, and forceps are also included.

To accommodate differing proximal curvatures from tooth to tooth, Directa’s ProxyPal has a preshaped progressive curvature that is vague at one end (e.g., for lower incisors) and distinct at the other (e.g., for diastema closure). It can be manipulated to create the precise curvature on any tooth.

ContactPro from Microbrush includes the ContactPro Ring that provides consistent clamping force over its life to minimize flash and optimize contact. Offered coated and uncoated, the system’s Smartbands matrices create a tight fit at the gingival margin.

The Mega V matrix system from Zest Dental Solutions has rings with a “V” design to simplify wedge placement and with converging tines to prevent                                                                                                           pop-off. Their alloy construction resists distortion.

CLINICIAN'S CHOICE offers the Dual-Force system with NiTi rings; their interproximal separating prongs are angled to engage the tooth firmly, thus helping seal the vertical margins and prevent composite overhangs.

Henry Schein’s Sectional Matrix System is designed to provide anatomically precise contacts for Class II restorations. Available in 3 sizes, these preformed sectional matrices allow for easy reconstruction of contact points, maintain the tooth’s natural anatomy, and improve patient comfort.

The thin matrices in Kerr Resoratives' Hawe Adapt system come in transparent and blue to contrast with tooth structure and provide visual control of composite application, filling, and handling. The transparent approximal shapers create optimal adaptation and shaping of sectionals interproximally.

Single use and preassembled, Pro-Matrix from Medicom features a sliding band deflector and a smooth tightening mechanism. The circumferential band accommodates any size restoration.

Composite Instruments
What most suppliers categorize as composite instruments are intended for one or two general tasks: carry material to the tooth and manipulate it once it is in or on the tooth. Variables to be aware of among brands include type of coating (to resist sticking), tip material, and handle design and construction. Here’s a selection of available brands.

The Dr. Belvedere Composite Contact Series from American Eagle features serrated, oval, cross-section heads for maximum mechanical retention. The lightweight handle’s flat torquing surface enhances leverage when placing composite.

The tips of Premier’s Slix composite manipulation instruments are treated with a protective coating that imparts nonstick properties and a highshine appearance. The lightweight ergonomic grips are medical-grade silicone.

Brasseler’s Composite Placement Instruments feature titanium nitride coating to resist scratching and minimize composite tug-back. They’re available in the popular, lightweight No. 6 handle and in 2 other handle styles.

Karl Schumacher’s CompoSmooth DCR Kit contains a variety of instruments for forming and finishing. The silicone tips have a soft give to impart a sleek, feathered surface without hard edges or impresssions.

Offered in 8 double-ended configurations, Gold-Line instruments from Paradise Dental Technologies are weighted to minimize hand fatigue. The solid resin handles are knurled all the way to the shank to minimize the pinch force required for maneuvering.

Cosmedent’s Anterior Composite Instrument Kit contains a selection of titanium-coated, double-ended instruments for nonstick placement, sculpting, and contouring. Multiple indications include gingival retraction for sculpting under free margins, a flexible instrument for use interproximally, a multiuse instrument for placing incisal grooves in body material, and more.

Featuring a black finish for contrast between the instrument, tooth structure, and composite, XTS composite instruments from Hu-Friedy are constructed of Immunity Steel for durability. They're coated with aluminum titanium nitride for smooth, nonstick handling.

Available from DenMat, Hartzell Instruments’ HZ-COMPKIT composite instrument kit contains a wide range of nonstick instruments supplied in a prefilled sterilization cassette.

LED Curing Lights
From ultraviolet almost 50 years ago, to halogen and plasma arc, dental curing lights have followed the same path as so many lightsource technologies. So LED now rules. The vast majority of currently available curing lights now use LED technology, which maximizes bulb life and minimizes heat generation. This following selection includes the most popular options.

Ultradent’s VALO Grand is a cordless unit with a lens 50% bigger than the standard VALO for quick, effective curing of a large surface area. It also has a second activation button on its underside for intuitive operation.

The SmartLite Focus Pen Style from Dentsply Sirona delivers a collimated light beam for reliable curing even in deep proximal boxes up to 8 mm deep. Its homogenous beam profile makes it less sensitive to movement during the curing cycle for consistent performance across the restorative surface.

Incorporating the U-40 Ultracapacitor that re-energizes to full power in less than 40 seconds, Demi Ultra is based on Kerr Restoratives' proprietary C.U.R.E. technology that delivers a uniform depth of cure with minimal heat generation.

FlashLite Magna 4.0 from DenMat integrates proprietary optics that minimize beam divergence to maximize curing in deeper preps. Its wide beam saves chair time by eliminating the extra time needed to overlap exposures on large restorations.

Pac-Dent’s cordless iCure delivers 1,400+ mW/cm2 output and offers 3 preprogrammed modes: fast, ramp, and pulse. Its light guide rotates 360°.

Featuring a sealed aluminum body for quick and easy disinfection between patients, COLTENE’s S.P.E.C. 3 is powered by a lithium polymer battery that can perform more than 300 10-second cures without recharging.

The cordless Mini LED Black from ACTEON delivers a 10-second fast-cure mode, 1,250 mW/cm2 power, and a light spectrum from 420 to 480 nm. It is powered by 3 AA batteries.

Weighing 5.25 oz, Johnson-Promident’s Clear Blue Digi 2.0 provides a digital display of working time as well as visual and audible alerts during programmed exposure times.

The Light 405 from GC America delivers light in the 405 to 490 nm wavelength range with high intensity at each of its 4 modes: high, low, soft-start, and pulse. Its lithium-ion battery has no memory effect.

Incorporating a built-in safety sensor that measures light intensity and probe temperature, Henry Schein’s Maxima 2000 has a 10 mm standard light guide and delivers 2,000 mW/cm2 high-output intensity.

Weighing 2.5 oz, VOCO’s Celalux 3 delivers light in the 450-480 nm range from its 8-mm light guide. A vibrating alert indicates start of cure and after 10 and 20 seconds.

The Translux 2Wave from Kulzer has a 360° rotatable light guide that is angled at 70° for optimal access to molars. Its scratch-resistant surface is easily disinfected.

Providing a wavelength range from 440 to 465 nm, the NuSmile LED Curing Light has an ergonomic, lowprofile design that houses the LED source at the end of the tip for user and patient comfort.

Eliminating the need for a fan, SDI’s Radii-cal uses heat sink technology to minimize heat generation. Additionally, it combines pulse technology and steady current to achieve maximum light output without generating excess heat.

The Cybird Gold from Dentazon offers a broad range of wavelengths (400 to 490 nm) with 3 power modes. Along with a 9-chip LED, it maintains a table light output, facilitating heat emission during use and minimizing heat generation.

Finishing/Polishing Systems
Inadequate finishing and polishing of direct composites has repercussions beyond compromised esthetics. The rougher the finished surface, the greater the possibility of bacterial accumulation, discoloration of the restoration along the margin, and secondary caries formation. Aside from these clinical implications, patients may be able to detect roughness of as little as 0.30 µm with their tongue. Luckily, there are numerous options for creating enamel-like surfaces on modern nanocomposites to maximize esthetics and durability of restorations.

3M Oral Care's Sof-Lex comprises a prepolishing spiral that prepares the restoration surface and a diamond-impregnated spiral to impart a paste-like gloss. Requiring no paste, the rubber polishers are sterilizable and reusable.

Made of silicon-impregnated latex-free rubber, Ultradent’s Jiffy Composite Adjusters and Polishers include cups, disks, points, and brushes. They are autoclavable and available individually and in a kit.

With ComposiPro One-Step from Brasseler, the user can vary working pressure to achieve a highgloss finish with a single diamond-impregnated instrument.

Couture cups and points from Centrix are highly loaded with ultrafine diamonds. They are flexible yet stable for efficient use on all concave and convex surfaces.

Supplied sterile, Henry Schein’s single-use Maestro polishers come in point, disk, and cup shapes. Using a fine diamond powder, they polish quickly and efficiently.

NANO/Microhybrid Diamond Polish Kit from Cosmedent contains 9 instruments: points, cup, and disks. Each reusable tip comes in coarse for initial contouring, medium for finishing, and superfine for final polishing.

BISCO's R.A.P.T.O.R. (Rapid Adapting Precision Transformer for Occlusal Resins) burs feature angulations and planes that quickly establish proper occlusal anatomy and approximate occlusion.

Used in a single-step technique, VOCO’s Dimanto silicone polishers are interspersed with micro-fine diamond powder to quickly impart a high surface smoothness and durable shine. Adjusting the pressure used determines the abrasion performance.

Alpen Polishers from COLTENE provide an ideal distribution of silicone- and diamond-impregnated polishers, designed to handle the unique characteristics of porcelain veneers, inlays, and onlays.

Supplied in the autoclavable BurButler bur block, Shofu’s CompoSite Polishing Kit contains an assortment of stone and silicone polishing instruments in a variety of shapes.

Designed to create a high-gloss finish in a single step, Opti1Step from Kerr Restoratives allows variable abrasion by changing pressure. The autoclavable instruments have goldplated mandrels and a durable abrasive matrix.

Microcopy’s Gazelle polishers are manufactured via theproprietary Silitec process that imparts strength for shape retention and resistance to crumbling. Satin and High-Gloss grits are offered.

Eliminating the need for disks and rubber polishers or paste, the autoclavable burs in Silmet’s ProFil Finishing Kit significantly reduce procedure time and create accurate morphology.

The five 12-bladed, 1-piece finishing carbides in The Ultimate F&P Kit from GC America are used in a logical sequence to create natural primary (geometric form), secondary (developmental grooves, lobes, cingulum, triangular ridges, and fossae), and tertiary (surface texture, pits & fissures) anatomy.

Looking Ahead
According to educator and clinician Bob Lowe, DDS, “Dentists should think creatively, visually, stylistically, morphologically, and most of all, artistically when creating direct restorations.” Toward this goal, you choose your composite judiciously, considering individual case requirements. Putting similar effort into selecting your adjunct tools further enhances your ability to create composite restorations that are functional, durable, and beautiful.