What do you use to fill the seemingly simplistic Class V fillings? They are so easily accessible in the anterior, but can be elusive to fill due to close proximity to the gingiva, bloody field, rotation and crowding, and sticky composite materials.
I have been utilizing Reflectys nano-hybrid composite by Itena. I love the ease and beautiful finish of Reflectys and the variety of shades that it comes in. The placement is effortless, the color matching and translucency are artful, and the results beautiful and cleansable.
I had a patient with extensive dental work and low salivary flow that presented for a filling on #22 and a crown on #21 due to recurrent decay. I first worked to remove the decay and carefully tried to avoid the delicate gingiva.
As you can see the field hemorrhaged and it was difficult to staunch the flow. I did two things to create a dry field. First I used hemostatic agent, Viscostat, to see if that alone would stop the flow. It worked for a short time, but bleeding resumed. Then I soaked a retraction cord in Viscostat and applied it to the buccal margin of my preparation. This ensured the clear view of the margins and allowed the hemostatic agent more exposure to the deeper tissues in the sulcus that were continuously “weeping”. I achieved excellent hemostasis with this double duty technique.
After the field was dry and free of debris, I chose my shade.
Placing the composite in a dry field, with retraction cord in place to allow for easy access to the margins, and the use of a doctor-friendly material –there’s nothing better! I loved the final result. The patient should be able to keep this clean and free of debris for years to come.
Do you have any great techniques for placement of fillings, especially in challenging situations where the gingiva bleed, there’s an awkward angle to fill, or you can’t access the preparation well due to rotation?
I’d love to hear any pearls!
Keep saving the world one tooth at a time!