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STATE OF THE ART
At the moment there are no generally accepted standard preparations for posterior composite resin, as strange as that may seem. That is why discussion of form begins with enamel axioms for enamel margins, and a similar set for dentin axioms. It would seem that if all the axioms were sound, and scientifically indisputable, then a consensus of design could emerge.
Virgin Teeth: what is the ideal form for virgin teeth? Many departures for GV Black form have been explored- “tunnel preps”, “Minimally Invasive” forms that do not break interproximal contact, the Clark Bioclear method..etc. While dental academics recognize the potential of adhesion to lessen cutting, faculties of dentistry remain feudal on method. State,provincial or national boundaries prevail. In other words, politics not science is running the show. Each dental school seems to have not only its own preferred form, and also its own preferred instrumentation. Preps are created by round diamonds, fissurotomy diamonds, pear- shaped burs, fissure burs, a cacophony over the world.
Re-restoring: Normal practice reality is that 80% of restorations are not on virgin teeth but on teeth already cut to a GV Black form that are being re-restored. So, goodbye to the above notions, the form is already in front of us. How do we modify existing GVB preps for bonded composite?
Our classic training informs shapes and instrumentation: in amalgam, cast gold inlay/ onlay method, bonded porcelain inlay /onlay method. But the goals are different: composite doesn’t need a prep that draws, like indirect forms. It doesn’t need strictly parallel or retentive box forms like amalgam. There is no need to create dentin slots and grooves, all surfaces are adhesive. But one does have to achieve maximum adhesion to both enamel and dentin. Diligent and consistent methods underlie high level, durable and consistent adhesion. Prep forms that distribute stress well are required. Instrumentation that is concise, efficient, and practical is needed in the real world of saliva and tissues. The opaque world of resins- bulk fill, paste, flowable, high modulus, low modulus, flexural strength, curability.. needs to be navigated, and methods to optimize cure need to be routine.
Ultimately, fully reassembled, composite resin is not just a stepping stone on the way to crowns. It is its own universe, permanent, versatile, hard-working, and willing if you have the know-how. That is the meat of this website.