Questions from Dr. Marc Alber

Dr. Clark,

I took one of your classes at PDA laboratory in Colorado about a month ago and am having awesome results using the techniques I learned. My issues with post op sensitivity are almost completely gone. One question though.

I have had a few patients back for bite adjustments after placing fills using your technique and have notices a yellow tint on parts of the fills that polish away if you apply enough pressure. What is this? Is it bonding agent or flowable? The fillings feel smooth when they come in but they just have a yellowish tint and it is always close to a margin. Any ideas are greatly appreciated.

Thank you for your awesome class. My composites have never looked better.

Sincerely,

Dr. Marc Alber
Boulder Dental Group

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DR. CLARK'S RESPONSE:


Dear Marc

Nice to hear from you,

I am always happy to hear about the decrease in sensitivity from the techniques that we have been sharing at the lectures. That's great!

Occlusion: One of the things that we forget is that composite swells when it absorbs water, and all composites absorb water. That means that all of our composite restorations will benefit from being left slightly out of occlusion. Remember that a restoration that is or becomes 1mm "high" on a second molar creates a 3mm open bite on the central incisor because of the way that the mandible rotates. Keep that in mind when restoring molars with composite.

That is especially crucial with modern restorations like that Clark Class II or Cala Lilly Class 1 that covers more of the occlusal table than the old fashioned G.V. Black preps. Take it from me, I learned this lesson after several patients returning for occlusal adjustments in the beginning of my change in prep design.

The yellow tint could be several things. If you could snap a photo and email it to me, that would be very helpful.

1. My first guess is that you have some resin, either bonding agent or flowable composite, that extended to an area just past the margin where the enamel was not etched. The microleakge will discolor.
2. Another possibility is that that resin is on part of the infinity edge margin just past where the bur cut the enamel and there was plaque on the uncut enamel. Most teeth are covered with a nearly invisible layer of biofilm (plaque) that DOES NOT remove easily. Phosphoric acid won't touch it. I or my assistant routinely place disclosing solution on the teeth to be restored so that the dental assistant can see the plaque and remove as much as she can before I get started. Invariably I will go in again with coarse pumice on a rubber cup and also sodium bicarbonate spray (The Bioclear/Vector unit-do you have one or access to a prophy jet?). The bicarb spray is very effective for hard to reach areas. Or if you use air abrasion, same thing, very effective at plaque removal. A lightning strip in the interproximal is often the only way to break through the biofilm along the gingival margin. These steps, once they become part of the routine, really don't take much time.

I know that scrubbing plaque doesn't seem as sexy as veneers or implants, but it is a huge problem with composite dentistry and does not get the attention it deserves. Trust me, if everyone who lectured used a microscope, there would be a lot more attention to this issue. I battle it all day, every day.

These are guesses on the "yellow" problem. It could be something else. Let me know how the trouble shooting goes. If it's ok with you I would like to put your questions and my answers on the Bioclear "blog" so that others can benefit.

We have new developments that I would love to share with you, I'll be back at PDA in 08 and 09. Hopefully I will see you then.

Sincerely, David