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 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:
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:
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:
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.
Related Content
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)