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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:
Avoiding Post-Op Sensitivity
Most dentists experienced in Class II restorations knows that postoperative sensitivity is a common problem, often caused by adhesive application technique mistakes. To minimize the chances of post-op sensitivity, avoid the following adhesive missteps:
- Over-etching dentin – Dentin exposure to etchant should not exceed 15 seconds.
- Over-drying dentin – Keep the dentin surface slightly moist prior to bonding.
- Solvents not removed during drying step – Keep in mind that each type of solvent (acetone vs. alcohol) requires a different amount of air thinning to completely volatize.
- Incomplete material coverage – Completely cover the entire internal surface of the cavity with the adhesive, ensuring it appears glossy rather than matte.
- Under curing – Choose a light that performs well at clinically relevant distances.
DS tunes: Dr. Alan Atlas on Class II restorations
Dr. Atlas is a Philadelphia dentist and Director of Restorative Microscopy at Technology Clinic at Penn Dental Medicine. In this DS tunes episode he talks about Class II restorations, the challenges associated with this procedure and different composite filling options.
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
Related Content
Discover more about Class II Restorations
Class II Clinical Cases
As part of its Class II approach, Dentsply Sirona provides the tools and techniques necessary for patient satisfaction and procedure success. See how dentists have had success with Class II.
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. Dental Market IQ 2022 Research Report - Calendar Year 2021. For more information, contact Consumables-Data-Requests@dentsplysirona.com
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)
