Handbook of Composite Technique
This Handbook promotes beautiful, trouble-free, long-lasting, comfortable, and effective restorations in each traditional GV Black category. This Handbook will not be released as a subscription or a web-based book until it is finished.
Why am I writing this Handbook? Because it needs to be written. There are very few texts available on posterior composites. Those that do exist are seriously out of date and limited in the spectrum of issues addressed. Critical issues affecting the quality of restorations are omitted.
The adage goes, “A chain is only as strong as its weakest link.” Excellent outcomes need to include all steps in the restorative chain from examination to final articulation. A blooper in any one domain dooms the restoration to mediocrity.
The steps in this chain include preoperative occlusal analysis, tissue assessment, pulpal assessment, patient assessment, esthetic design, anesthetic, patient management, isolation, visibility, ergonomics and hand stability, initial preparation, caries removal, final margin smoothing, removing undermined dentin, assuring conformity to enamel axioms and dentin axioms, matrix contour development and wedging, hemostasis, etchant and etchant placement, etch rinsing, dentin priming, adhesive selection and placement, adhesive curing, resin(s) selection, resin placement, layering for contraction management and opacity control, resin curing, shaping, surface morphology, finishing, polishing, checking for bubbles/voids/flash, and final articulation.
Any unrecognized barrier, technique shortfall, or ineffective material lowers performance in this restorative journey, which is the meat and potatoes of daily practice. Are we maintaining the public credibility which is granted to us?
Research indicates profession-wide dysfunction. 25% of new composite Class IIs fail at the gingival margin within 2 years. 70% of all proximal box preparations impose damage on the adjacent proximal surface.
Is this acceptable? Would you accept it if your car didn’t start on every fourth try? If 70% of service visits to your garage resulted in dings to the bodywork? There is a comfortable overlooking of these dysfunctions in the consensus of current treatment practices. Why?
The simplicity and soundness of technique established in 1891-6 by GV Black lasted for nearly 100 years. By the early 1990s, however, we entered this new era. Adhesion to dentin arrived with Generation IV adhesives.
Unfortunately we lost the antibacterial/caries-inhibiting benefit of amalgam and exchanged it for greater discipline- only a perfect and hermetic composite/tooth seal guarantees durability. This level of perfection is a very high bar. How do we achieve it in the pressure cooker of daily practice? We can’t see this perfect bond. In fact, many of the factors in composite technique are inherently invisible – yet must be managed. see problems in composite technique
What do we know? Beyond a correct preparation, we know that a contaminated bond is worthless. How do we exclude all the barriers for a perfect bond? How long does a bond last? Tests of bond longevity are absent or limited. Which resin is appropriate for this patient and is preparation?- resin properties vary by 600%. How do we get the truth about resin properties? Corporate untruths abound and go unpunished. Who is guiding the profession at this point? Academia appears to have lost control of the dental mindset, and defected to corporations. High student debt has forced neophytes to generate high gross before clinical skill is commensurate. Whistle-blowing and curiosity are not encouraged despite the dissonance between high prestige and widespread faulty outcomes. Little concerted effort to clean up this situation has been seen.
End the guesswork. Engage in correcting these shortfalls in your practice with an open and curious mind, determination to excel, and a commitment to comparative and fundamental science, not corporate factoids and marketing.
Learn from a master in a readable, thorough, and scientifically-based program that has been proven in the hands of hundreds of practitioners taught by Dr. Walford over the last 17 years. Subscribe to receive notification when this handbook is ready for release here.
- Class I-Sealant, Fissurotomy, Conventional, Wide,Deep and molar cusp tip lesions
- Class II-Incipient, Conventional, Wide, Deep, MODB, MODBXYZ, Freehanding, Class II furcated proximal box, Pulp Cap and Pedodontic Restorations
- Class III- Incipient, Through and through
- Class IV- Retained buccal wall, replaced buccal wall
- Class V – Caries, Abfraction, Abrasion, and Failed bridgework
- Class VI- cusp tips
- Class VII- (new category beyond GVB) Incisal Attrition-Incipient, Conventional, Mandibular LI, Maxillary LI,Excursive, Mini-shoe,Rolled-edge, and Cuspid cusp tips. This is a new category of treatment for populations with a growing senior component.
