HANDBOOKS

HANDBOOKS:

There are three technique Handbooks under construction, summarizing the procedures that Dr. Walford has developed from 45 years of practice and 17 years of teaching. Access will be granted to purchase online once the handbooks are complete.

WHY I WRITE

We have many problems in composite dentistry. Most DDSs are placing composites without continuity; following methods that suffer from loopholes in conceptual integrity; based on sketchy scientific justification; having incomplete awareness of relevant parameters in product selection. This is not their fault, because it is almost impossible to do otherwise.

My Intention: I did not set out to be a study club mentor nor an online vendor of expertise. I wanted to join an existing study group and improve my capability. But I could not find an operating study club in my home province of British Columbia, Canada.

British Columbia has a very diverse network of over 75 study clubs but in 2003 none focused exclusively  on composite resin technique and adhesive reconstruction.

In fact nowhere in Canada was there a vigorous composite study club; to my knowledge this still is the case.  I looked into America through the states of Washington, Idaho, Oregon and California, but all inquiries terminated in dead ends.

So, in the face of this frustration I initiated a study club under the approval of the College of Dental  Surgeons of British Columbia. The format was simple; a group of dentists performing restorations on live patients.  We opened discussions and explored current practices in resin restoration. We began to supplement direct experience by penetrating the world of impartial reviews, subscribing to the most prominent  independent review organizations, viz.,  Reality Publishing, Clinicians Report, and The Dental Advisor.

Soon after, as the internet gained power, I created a website, which eventually grew to 400 pages, supporting my teaching and research. This newer website inherits some of that material.

I published spreadsheets and warehoused scientific references. When I felt I had a base of expertise worth sharing, I took my procedural conclusions to my local dental school, and entered the Canadian dental lecture circuit.

After five years of effort I was invited to join the Canadian Academy of Restorative Dentistry and Prosthodontics www.cardp.ca . Subsequently I became an online mentor for the BC Dental Association, while lecturing nationally at dental society meetings. I published 4 articles -See Published Articles. The Pacific Dental Conference invited me to lecture, and ultimately opened a door to me four times to demonstrate my procedures on the PDC Live Stage

As the adage goes, if you want to learn, read a book. If you want to become  better than that, write a book. If you want to become a master, teach.

So through this process, my expertise grew, I invented altogether new procedures and problem -solvers, clarified concepts, codified approaches to treatment,evaluated products, improved my presentation skills and became the mentor that  I had earlier wanted to meet.

It has taken an extraordinary amount of time and effort to find effectiveness in the composite realm,  for these 17 years, presenting to over 4000 dentists in this period. It has been an active and rewarding pastime ; live clinics, demonstrations, inventing devices, techniques, and assembling a large website and putting in the hours necessary for mastery.Now I about to retire from clinical practice and hand off this learning to those willing to work at improving their skills.

The potential of direct composites has grown; today our resins are better; curing lights are stronger; curing times have reduced; adhesives are better; postoperative comfort has frequently improved ; matrixes and other adjuncts have improved. When all steps are optimum, we have tremendous restorative power.But the foundations of the field remain muddy. Direct resin restoration would be dentistry’s principle modality if they were not so hard to do and so time-consuming.

The completion of this journey you now see on this site.

WHERE ARE WE NOW?

Despite progress in the composite resin field, but we continue to face the same  shortcomings and difficulties.

  • Standard of care remains inconsistent
  • Scientific underpinnings lack continuity
  • Products are over-marketed with frequent unsubstantiated claims
  • Academia remains hesitant and cautious
  • Dentistry  is practiced as if it were a cottage industry with little consistency from practice to practice.

I hope that these Handbooks will contribute to better dentistry and a clearer background against which the profession can make its next evolutions, and continue to progress using a better footing.

THE HANDBOOK OF COMPOSITE TECHNIQUE:

In the Handbook of Composite Technique I have revised GV Black procedures explicitly for composite resin.

  • Class I
  • Class II
  • Class V
  • Incisal Attrition This represents a new category of treatment, which might be called Class VII  It addresses composite treatment for incisors as well as procedures for cuspids and molar cusp tip restorations, which were called Class VI in GV Black nomenclature). There is some applicability to conventional  Class IV and also some cross-fertilization to Full Mouth Composite Rehabilitation  see Handbook of Composite Prosthodontics:

This handbook unifies expertise and advances that lead to excellent restorations that are a source of pride; they meet the expectations of the public and professional and government overseers. They deliver lifespans comparable to amalgam; they  restore the strength of the tooth to a far higher level than amalgam; and are esthetically  sophisticated.

Direct restorations always had this edge over laboratory procedures: they are less destructive and inherently less invasive because there is no tooth structure sacrificed for taper and path of insertion.

However, widespread technique dysfunction and low fees relative to procedure time still  propel dentistry backwards into laboratory procedures based on old-school low-adhesive extensive mechanical reduction rather than new -school high adhesive addition to necessary but intelligently minimal reductions of remaining tooth.

Adhesion has not penetrated deeply into all dental minds and hearts,. Often the principles remain bogged down in the clash between methods deriving from Dentistry’s foundations in the late 1800s,  horse-and-buggy-era, using an adhesive luting agent as an afterthought.


TRADITIONAL GOALS OF DENTISTRY

  1. To conserve tooth structure
  2. To maintain the occlusion
  3. To prevent further breakdown of the clinical crown
  4. To protect the periodontal tissue
  5. To preserve the comfort and vitality of the pulp

To these traditional goals, adhesive composite has added a new set of attainable outcomes, meshing with the development of new tooth colored laboratory procedures, and in some cases, outperforming them:

IMPROVED OUTCOMES IN COMPOSITE DENTISTRY: SETTING THE BAR HIGHER

  1. To preserve and promote the appearance of the patient (Beyond dark metal)
  2. To avoid systemic ill-health (Beyond mercury leachate)
  3. To deliver treatment with less emotional or physical trauma (Retaining their natural facial tooth structure is almost always the patient’s first choice!)
  4. To relate to the economic well-being of the patient ( Viable less costly treatment alternatives to high end fees)

Change moves through the dental profession like all  revolutions in thought. First, inventors bring new ideas to life.Then they are picked up by early adopters,  middle adopters, late adopters, and finally there are practitioners who refuse change and remain non-adopters. I’ve practiced long enough to see many waves pass through our field- Porcelain Laminate Veneers, Invisalign Orthodontics, Implant Reconstruction, Rotary Endodontics,Digital  data management, now Digital everything, and on we go to ever-soaring heights.

Unfortunately, these changes have left about 50% of the patients in the Western World behind, due to cost, and almost 100% of the other 7 billion.

Within the Handbook of Composite Technique lies potential for a broad baseline that reaches downwards into all economic strata of society and out to the so-called Third World, rather than upwards to a narrow elite of the privileged of the western world. It is meant to service dentistry’s mandate to society’s needs, rather than the profession’s upward ambitions. It speaks to our humanitarian purpose, not our business needs.


These goals may seem a tall order, but they attainable. I’ve done it, as have  others when following the  methods of these  Handbooks. So let’s get going.