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Class II Procedures and Your Dental Practice

A Comprehensive Guide

Class II dental procedures are the heart of dentistry for a dental practice being the most common direct restorative procedure2 and being successful with them requires a perfected technique. They have a large impact on overall practice health as direct resin restorations represent approximately 1/3 of annual dentist generated restorative revenue with an estimated 69% of annual patients receiving a direct restoration.1  

As it currently stands, Class II procedures typically generate less than $200 in revenue and take 30-40 minutes to complete3. That’s why dentists all over the world are using technological advancements that make the procedure faster, easier, and more profitable, without taking compromising shortcuts. Here at Dentsply Sirona, we pride ourselves on bringing predictability, efficiency and optimized performance to Class II restorations every day.

Below, we’ll outline how to increase profitability and predictability while saving time; allowing you to create more positive experiences for your patients.

The Standard Class II Dental Restoration Procedure

The first step to saving time and money for your practice is understanding the key challenges and opportunities to improve efficiency within the procedure. This is critical with Class II procedures, as the average cost to redo a failed Class II restoration is $292 inclusive of the doctor’s time and materials.4 Not only that, but the slightest misstep can cost you hours of time—making the process downright painful for both you and your patient.

Below, we’ll dive into the procedure step-by-step, including tips to help you optimize performance and increase profitability.

Isolation is the next step - and making sure the restorative field isn’t contaminated with blood or saliva will be key to success.

While patient hygiene is out of your control, there are a few things you can control to a degree, including how much you irritate the surrounding tissue during the procedure and how well you seal the restorative field off from moisture. While you may be tempted to use a wooden wedge, it’s better to use a sectional matrix system that includes a plastic wedge. Here’s why:

While light curing may seem like the simplest part of a Class II restoration, it’s not as straightforward as you might think. Traditionally, clinicians have been led to believe that as long as the blue light is near the restoration for long enough, the restorative material will cure.

It’s not as simple as that, which is why more than 37% of composite restorations are being insufficiently light cured7. The amount of energy delivered by the curing light is what leads to a successful procedure. The more energy delivered to the Class II restoration, the stronger the material will be. An insufficient cure can lead to adverse effects on physical properties, reduced bond strengths, breakdown at the margins, increased potential for microleakage, and ultimately secondary caries and Class II restoration failure.8

To be sure you’re curing effectively, make sure to consider the following when using your light:

  • Performance over distance: The #1 reason for Class II failure is recurrent caries, and the floor of the proximal box (often 8mm away from the tip of the light) is the most vulnerable interface. Be sure your curing light is effective over distance to avoid this.
  • Beam uniformity: Hot and cold spots within the light beam may lead to a non-uniform cure across the restoration, which is why you want a uniform beam profile.
  • Angle: Be careful with the angle of your curing light. The guide tip should be as close as possible and parallel to the occlusal surface of a Class II to have the best chance at allowing light to fill up the proximal box. Pen-style lights make it easier to maintain the proper curing angle when space is an issue – such as the back of mouth, and in geriatric and pediatric cases.
  • Ergonomics and operation: A lightweight, ergonomic curing light design with simple controls may help reduce the opportunity for technique variability.
  • Curing Cycle length: While you can’t overcure the composite itself, you CAN, in fact, deliver too much radiant energy to the tooth, causing an excessive increase in temperature which can cause sensitivity, and damage the pulp and oral tissues. The safest and most reliable approach is to deliver a lower intensity over a longer exposure time.

With the tooth prepped, matrix placed, and adhesive applied and light cured, it’s now time to place the restorative material.  The main challenge faced in this step is cavity adaptation at the floor of the proximal box.  

Our Standard Class II Total Practice Solution

Common vs. Challenging Class II Cases

The Streamlined Class II Total Practice Solution

Now that’ we’ve covered the basics of the procedure, you should understand that not all Class II restorations are alike and the complexity can vary between a common and a challenging case. The profitability of your restoration depends on being able to efficiently overcome challenging situations, which an estimated 25% of all cases are considered to have challenging situations.11 We consider a Class II procedure to be “challenging” if the patient is not tolerant of the procedure time, enamel margins are not present, isolation is difficult to control or the patient is not overly compliant.

For example, in a common clinical scenario, the prepared tooth can be effectively isolated throughout the procedure and enamel margins are present and clearly visible. Additionally, the patient should have good oral hygiene and be tolerant of the procedure time, meaning they are able to stay open, breathe through their nose and control their tongue.

By contrast, challenging clinical scenarios are situations where the ability to isolate the tooth is compromised due to the location in the mouth, the margin is substantially in dentin or cementum and the margin is subgingival.

While standard solutions and products work great for the most common cases, in challenging situations you may need specialized products. For example, our Streamlined Class II Total Practice Solution was designed for situations where saliva or blood contamination is a risk, allowing you to fill in one quick step to minimize the window of contamination risk.

Our Streamlined Class II Total Practice Solution

1. 2010 Survey of Dental Practice – Income from the Private Practice of Dentistry. http://www.ada.org/1444.aspx, Centers for Disease Control and Prevention http://www.cdc.gov/chronicdisease/resources/publications/AAG/doh.htm, Oral and Dental Health, United States: 2011, table 98

2. American Dental Association Procedure Recap Report (2006).

3. 2013 Levin Group Annual Practice Research Report. Dental Economics November 2013.

4. 2013 Levin Group Annual Practice Research Report. Dental Economics November 2013.

5. DentalTown (2012). Restorative Dentistry. Monthly Poll: What is the most challenging part of a Class II Restoration?

6. Rosenburg, Jeffrey M (2013). Dentistry Today. Making Contact: A Method for Restoring Adjacent Posterior Direct Resin.

7. El-Mowafy OM, El-Badrawy WA, Lewis DW, et al. Intensity of quartz-tungsten-halogen light-curing units used in private practice in Toronto. J Am Dent Assoc. 2005;136:766-773

8. Boksman, L., Santos GC., (2012). Principles of Light Curing. Inside Dentistry, Volume 8, Issue 3.
30. Strassler H., Price R. (2014). Understanding Light Curing Part 1. Dentistry Today Continuing Education Course 173.

9. Jackson RD. Placing posterior composites: increasing efficiency. Dent Today 2011; 30(4):126,128,130-1.

10. Joiner A. Tooth colour: a review of the literature. J Dent. 2004;32(Suppl. 1):3–12

11. Key Group International Survey, 2019, n=300 (Brazil, France, Italy, Germany, USA)