1. Total etch, selective etch, or self-etch?
Selective etch, all the way. Phosphoric acid is detrimental to dentin. It’s harsh. It’s easy to overetch dentin with phosphoric acid. And phosphoric acid etchants activate matrix metalloproteinases (MMPs) in the dentin that begin the process of breaking down the dentin bond. The self-etch component in our universal bonding systems works great on dentin without overetching and activating MMPs, but it’s just not strong enough for etching enamel. That is where the selective-etch part comes in. Phosphoric acid etches the enamel, which is so much more resilient to etching than dentin is, and we have a great interface for bonding.
2. What bonding system do you use?
I use universal adhesives. The brand names don’t particularly matter. The technique does. With good technique and proper isolation, anything works. I choose universal bonding agents to simplify my armamentarium and because they allow me to selectively etch.
3. What is your flowable composite?
I prefer a bulk-fill flowable, and I use the snowplow technique. The flowable is basically forced out of the prep using the hydraulic pressure of the paste composite, leaving only flowable where there would have been a void.
4. What is your posterior composite?
Again, I prefer a bulk-fill composite. I want to be able to cure the box all in one shot. With most small to moderate preps, you can do that with bulk-fill materials. I find that most clinicians tend to overfill their increments, even when trying to be judicious, so you might as well use a material that is made to be cured in deeper increments. If I have a really deep box, I will fill it incrementally, but that’s an exception. For everyday Class IIs, bulk-fill composite works great. I use the snowplow technique for most of my Class IIs, meaning I put a dot of bulk-fill flowable composite around the edges and then immediately start to load it with bulk-fill composite paste. The bulk-fill composite paste forces the flowable out. The only thing left is filling in where there would have been a void without it. The snowplow technique is a great technique to use with bulk-fill materials.
5. What polishing system do you use?
Polishing has to be practical for me—one or two steps. Let’s be real. I’m on Delta too. I’m getting $138 for that Class II. I don’t have time to spend five-plus minutes polishing it with a four- or five-step polishing system. It ain’t happening. Find a nice one- or two-step system you like. Enhance PoGo, OptraPol Next Generation (Ivoclar Vivadent), and Sof-Lex Diamond (3M Oral Care) all work great—and probably a bunch of other systems do too. The key is to find one you like and use it, but it shouldn’t take more than 30 seconds to a minute. Thanks a lot, Delta.
6. What matrix system do you use?
A sectional matrix system is a must for using bulk-fill composites, and it should definitely be something you own. There are a handful of great sectional matrix kits. Composi-Tight 3D Fusion (Garrison Dental Solutions), Palodent Plus, Bioclear, and Waterpik ClearView are all great. Another thing to keep in mind is that you can assemble your own kit if you’d like. There are things I like about each of those kits. You can use the wedges from one kit, the matrices from another, and the rings from yet another. Try them all out and see what you like best out of each kit. Then put them all together to make the best kit for you.
7.Any tricks or technology that changed your Class II game?
This is so rote and boring, but a rubber dam just makes my life easier and makes me faster.
