Dentistry has high standards of quality and efficiency. Being efficient and effective is important to having a successful and well run business. The way we fill cavity preps is determined by scientific evidence that says how much material to add, where, when and how–all concerned with providing the strongest yet most flexible and long lasting composite filling. Many schools of thought teach the layering method. Adding composite in increments, towards one side of the prep and then the other. They teach their students to study and memorize occlusal anatomy–the cusps, slopes, margins, grooves, pits and ridges. However, other methods of filling composite preps require less nitpicking with your plastic instrument, and possibly more accurate topography.
In my sim lab days, we never learned about the “occlusal stamp” technique. A flexible and accurate material is first applied generously to the tooth to make a mini impression of the occlusal surface prior to prepping the tooth. The index is connected to a microbrush for easy handling. After your prep is ready to fill, composite is pushed into the prep by pressing the occlusal stamp against the tooth. This recreates the original anatomy of the tooth! I tried this out in the sim lab with some friends to see how we liked it. As with any new technique, it is a really smart idea to try it out on a fake tooth before you try it in the clinic on a patient!
As many theories in technical dentistry, there are pros and cons to both types. There are some scenarios when one way may be better than the other. Either way it is good to be aware of your options and therefore treat your patients and future patients with the best dentistry possible. For example, a variation that may impact whether you chose to use an index or custom fill of the prep may be when there is a previous restoration in place. If it failed due to imperfections or cracks the occlusal stamp may not be appropriate. Check out an awesome invivo example of the occlusal stamp technique here!
Pros of occlusal stamp technique using index to form occlusal topography:
Faster-No more trying to recreate occlusal anatomy by hand! Less layers of composite are used toward the occlusal surface. Less time spent on making it look fancy.
More accurate topography-Literally capturing the anatomy with a custom stamp doesn’t get more custom.
Less adjusting-If it started in occlusion, keep it in occlusion. The height remains constant like the original. Imagine having to make less post-fill adjustments. Save articulating paper…and TIME.
No special instruments-Less need for XTS anti-stick plastic instruments. Less tweaking your wrist and trying to get your instrument flush with the margin of the prep.
Consistency-What you see is what you get. If you get a good index, you can expect the stamp to be a replica and therefore there is less guessing on how it would look, if you design it yourself.
Pros of traditional layered custom occlusal anatomy technique:
More flexibility– When you aren’t constrained to an index, you have more opportunity to design the fill on how you like.
Works for any situation– For preps that are getting refilled due to failure, an index may not be the best option. You may want to consider why the fill failed and see if you can customize the fill to be more effective.
Doesn’t recreate imperfections– Even if you don’t see it, imperfections may be embedded in the tooth and therefore mimicked in the occlusal stamp. Deep pits and fissures of an original tooth may not be desired for a fill.
Shrinkage– While practicing the technique, I realized I had to add more composite at once to get a consistent fill. We are taught that placing composite in increments reducing shrinking and therefore reducing leaking and stress. Adding larger increments may not be favorable for larger preps when concerned with shrinkage.
Stick falling off stamp– I noticed that you have to completely embed the micro brush into the index material. Otherwise a couple times it fell off the stick and posed a threat for aspiration or choking.
Wasting disposable material– This technique does use more disposable material than the traditional fill way (index material, microbrush), so cost of supplies should be considered.
Do you use this method? Do you have other techniques that allow you to get great occlusal topography? Share in the comment box below!!
Neek LaMantia, San Francisco ’16, electronic editor