Page 64 - SURE DENTAL CATALOGUE 2023

Placing Direct Restorations Dr.Scott Parker
without Fear

By Scott Parker, DDS

Scott Parker, DDS, maintains an exclusive private practice in Redmond,
Washington and has published many articles on restorative dentistry and adhesion.
His fun and realistic approach to everyday dentistry has made him a highly sought-
after lecturing clinician. In addition to chairing an online learning center, he has
lectured extensively on aesthetic procedures and dental technology, and serves as a
consultant for several dental companies, and on the advisory boards of dental
journals and companies. Dr. Parker is committed to providing exceptional restorative
care in a progressive yet conservative manner.

Due to the current economic challenges of many of our patients, a greater number are choosing more
conservative means of restoring their compromised teeth. This decision is often made with only the financial
aspect being considered. The long-term consequence of restoring a tooth directly in the mouth is not
emphasized to our patients because it has been our standard of care for so many years. It is worth noting
that informal surveys of our peers show that these procedures can amount to an emotional roller coaster if
the results don't meet patient expectations—and our own.
Whether restoring a broken front tooth with resin or restoring an interproximal lesion, clinicians should have
a thorough understanding of how to provide such care in the best way possible, and to make the procedure
both easier and more profitable.
When reviewing our schedules, procedures that involve a root canal on a second molar, extracting a difficult
tooth or managing a challenging patient can often elicit a visceral response. While it can easily be argued
that indirect restorations are appropriate for class II or class III restorations, in most practices this is simply
not realistic or appropriate. Direct composites make most of us "sweat" due to the challenges inherent in
matching shades or achieving an ideal form and anatomical contact. And since direct restorations are
something that most of us do every day, it behooves us to master the necessary skill

Keys to Success
I love the feeling of joy I get when I place a direct restoration in the esthetic zone or in a posterior tooth,
knowing that I've conserved enamel and given the patient a durable and beautiful result. You too can feel
more relaxed and at ease by following a few simple steps that have made my life easier when performing
anterior restorations.
Something as simple as taking a shade as soon as a patient sits in the chair is a great start. While I agree
with this approach, I also place my chosen material directly on the tooth or adjacent teeth and then cure it to
see how it will interact with the existing teeth once it comes into contact with saliva. I always choose my
base (dentin) shade from the neck of the tooth and my overlaying (enamel) shade from the incisal third of
the tooth. Figure 1 is an example of a simple procedure using this technique. In the end, I used only one
shade; namely, Tokuyama's Estelite Sigma Quick (BW), as I was replacing only enamel.
When restoring posterior teeth, the following tips will facilitate the procedure while helping to ensure the
best possible outcome (Figure 2):
• Use a well-placed rubber dam to retract the lips and tongue and keep the teeth dry.
• Use a disinfecting scrub prior to placement of the filling.
• Be sure to choose an excellent matrix system.
• While placing the restorative material, use a thin liner of flowable composite prior to placing the final
layers, remembering not to splint any of the cusps together

A. Color matching was incorrect with dentin shaded A-2. B.
Color match was much more appropriate with BW.
C. Existing preoperative condition.
D. Postoperative result showing nice blend, even with just one
shade.

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