Inside My Practice with Bob Margeas
I recently returned from the annual meeting of the AACD, which I have attended for 20 years. Even after decades of attending conferences, I still look forward to expanding my knowledge, brushing up on a technique, or trying something new based on a recommendation.
In this spirit, I have selected three products this month that I use in my practice for temporization, air abrasion, and finishing and polishing. Certainly there are other worthwhile products in these categories, but these are the ones with which I have the most experience and clinical success.
For questions or comments, or if you want to share your own preferences for products and techniques, please contact me at firstname.lastname@example.org.
Bob Margeas, DDS
Figure 1 | Instead of making a putty matrix, I use Template for fabricating my lingual matrices for anterior direct composites. Template is a fast-setting polyvinyl—it sets in just 30 seconds. Compared with a regular bite registration material, the difference is that this material just flows into all the crevices, so you get really high accuracy.
A case where Template is really useful is in a fractured Class IV anterior restoration. You mock-up the fracture with composite, and then you squirt Template on the lingual side. After 30 seconds, you have your matrix. Then you break off the fractured piece of the mock-up and use the Template matrix to help condense and shape your composite resin. In addition, Template can be used for temporization of crowns and bridges. If a patient loses their temporary, you can keep the Template matrix and use it to fabricate a new one.
Enamelize™ & FlexiBuffs®
Figure 2 and Figure 3 | For my final polish, no matter that the composite is, I always use Enamelize and FlexiBuffs in the anterior. Enamelize is an aluminum oxide paste and the FlexiBuff is a felt-backed disc that will give you the highest shine possible on your composites, whether it’s a nano- or a micro-fill. Instead of a disc with abrasive, FlexiBuffs are felt—almost like a shammy you use when you wax your car. I put a small amount of Enamelize on the tooth and rub it around in a circular motion. After I get it on the buff, then I just flex it. The disc flexes until it’s almost at a 45° angle, so it works really great and just hones the polish.
When you polish with a prophy paste that has fluoride, its abrasiveness can dull your composite restorations. If I have a patient who has a lot of composite veneers or restorations, my hygienist will use Enamelize on a prophy cup to refurbish composite restorations.
Figure 4 | PrepStart H2O is a really great product that I use it to clean all of my preparations and restorations prior to bonding. My main reason for using the PrepStart is that it gives you the cleanest surface possible. It’s a self-contained, small unit, and it works extremely well.
If I have a crown prep, I’ll use PrepStart to clean the tooth prior to bonding or cementing the restoration. Etch cannot penetrate plaque, so if you want to have a good, clean surface, you just sandblast it. Any time I do bonding, before I etch the teeth, I use the PrepStart to clean that tooth really well.
The other advantage of the PrepStart is that if you have small areas of decay, it can actually remove tooth structure and you can do small fillings with it. It’s powerful enough that you can drill with it. Sometimes patients come in and they have a small occlusal cavity, I can just use the PrepStart to remove the decay. A lot of times you won’t have to use anesthetic.