HANDBOOKS

HANDBOOKS:

There are three technique Handbooks under construction, summarizing the procedures that Dr. Walford has developed from 44 years of practice and 16 years of teaching.

WHY I WRITE

We have many problems in composite dentistry. Most DDSs are placing composites without continuity; suffering 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. I wanted to join an existing group. But I could not find an operating study club in my home province of British Columbia, Canada, nor in the adjacent province of Alberta.

British Columbia has a very diverse network of over 75 study clubs but at that time, and still to this day, none focus on composite resin technique.

In fact nowhere in Canada at that time was there a vigorous composite study club; this may still be 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, in 2003 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 I created a website, which eventually grew to 400 pages, supporting the teaching. This newer website inherits some of that material.

I published spreadsheets and warehoused scientific references. 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 my expertise grew, I invented procedures, clarified concepts, codified approaches to treatment,evaluated products, improved my presentation skills and became the mentor that  I earlier wanted to meet.

I have taken an extraordinary amount of time and effort to find effectiveness in the composite realm,  for these 16 years, presenting to over 4000 dentists over this period. It has been an active and rewarding pastime ; live clinics, demonstrations, inventing devices, originating techniques, and assembling a large website and putting in the hours necessary for mastery.

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. But the foundations of the field remain muddy.

The fruits of this you now see on this site.

WHERE ARE WE NOW?

The last 16 years there has been progress in the composite resin field, but we principally 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 in turmoil
  • Dentistry  is practiced in as a cottage industry with little consistency from practice to practice.

I hope that these Handbooks will contribute to better dentistry and clearer concepts against which the profession can make progress.

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, a new category of treatment, which could be called Class VII, which also includes material about Class VI (Cuspid and molar cusp tip restorations) and Class IV

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

Direct restorations are less destructive and inherently less invasive than most laboratory procedures because there is no tooth structure sacrificed for taper for a path of insertion. Direct resin  restoration would be dentistry’s principle modality if they were not so hard to do and so time-consuming.

However, widespread technique dysfunction and low fees relative to procedure time still  propel dentistry backwards into laboratory procedures based on old-school mechanical reduction rather than new -school adhesive addition.

In many dental minds and hearts, adhesion has not penetrated deeply. The principles remain horse-and-buggy-era thinking, 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

Change is moving through the dental profession like all cultural revolutions. First the inventors bring new ideas to life.Then they are picked up by early adopters,  middle adopters, late adopters, and finally there may be practitioners who refuse change and remain non-adopters.

If we take adhesive direct restorations back to the foundations of the profession, are they acceptable?

Resin restorations meet all above criteria when well-done. From 1. (above), adhesive resin restorations are more conservative of tooth structure  than any indirect procedure. In addition, new goals, see below, become possible with the advent of additive, adhesive direct composites. 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.


ADVANCED GOALS OF COMPOSITE DENTISTRY: SETTING THE BAR HIGHER

  1. To preserve and promote the appearance of the patient
  2. To avoid systemic ill-health
  3. To deliver treatment without emotional or physical trauma
  4. To respect the economic well-being of the patient

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.