Steps

1. Seat patient confirm completing filling on tooth listed today.
2. Place bid
3. Dry mucosa at site of injection and place topical with cotton gauze or roll over top
4. If anterior filling check shade with mock composite
5. Doctor deliver first step anesthetic
6. Doctor deliver second step anesthetic
7. ASK patient feels numb
8. Remove decay and bevel all enamel edges
9. Use Viscostat, cords, or traxodent as needed.

 Anterior filling Total etch technique

1. Place mylar strip and wave wedge
2. Etch enamel 15 seconds and dentin 10 seconds then wash and dry (with bac etch)
3. 2% CHX unknown duration 30-60 sec suggested (only beneficial on areas etched) air dry
4. Gluma 10-20 seconds with scrubbing in dentin and air dry
5. If deep, line dentin with RMGI (but etch and CHX steps get moved to right after this step)
6. Step 1 Optibond Fl Prime 15 seconds scrubbing then air dry 5 sec
7. Step 2 1 tooth?=same brush Optibond Fl Adhesive 15 seconds scrubbing then air thin 3 sec
8. Cure
9. Layer composite curing as needed
10. Peel mylar strip back place flowable comp IP and pull mylar through and cure

Buccal filling Total etch technique

1. Place #0 cord soaked in hemodent
2. Etch enamel 15 seconds and dentin 10 seconds then wash and dry (with bac etch)
3. 2% CHX unknown duration 30-60 sec suggested (only beneficial on areas etched) air dry
4. Gluma 10-20 seconds with scrubbing in dentin and air dry
5. If deep, line dentin with RMGI (but etch and CHX steps get moved to right after this step)
6. Step 1 Optibond Fl Prime 15 seconds scrubbing then air dry 5 sec
7. Step 2 1 tooth?=same brush Optibond Fl Adhesive 15 seconds scrubbing then air thin 3 sec
8. Cure
9. Layer composite curing as needed
10. Remove cord

Posterior filling Selective etch technique

1. Place V-ring if IP
2. Etch enamel 15 seconds then wash and dry (with bac etch)
3. 2% CHX unknown duration 30-60 sec suggested (only beneficial on areas etched) air dry
4. Gluma 10-20 seconds with scrubbing in dentin and air dry
5. If deep, line dentin with RMGI (but etch and CHX steps get moved to right after this step)
6. Step 1 Clearfil SE Protect prime and etch 20 seconds with scrubbing then air dry
7. Step 2 Clearfil SE Protect bond, air thin then cure 5-10 seconds
8. Burnish metal matrix if needed
9. Layer composite curing as needed
10. Removal V-ring, wedge, and peel back matrx to cure IP

 Finish and polish

1. Bulk reduction excess composite
2. Check occlusion and excursion with Troll foil
3. Check contacts with floss
4. Fine tune with finishing burs
5. Polish

Total etch article is good
6 month test showing total etch maintains bond strength best
Kanca article on moist bonding with total etch technique
Kanca article on HEMA.

Kanca says HEMA is acting as the wetting agent, most glutaraldehyde products also contain that.

Bryan Bauer, DDS, FAGD                                                                
630-665-5550                                                                  

Wheaton General and Cosmetic Dentists

Armatarium

1. Anesthetic: lower 27 gauge long (yellow tip) with 2 carps of 4% articaine (Septocaine) for block, upper or lower infiltration 30 gauge short (blue tip) with 1 carp 4% articaine (Septocaine).  Always use the color of tip instead of having to say the word long needle in front of the patient.  Also we never say “shot”, we say injection.
2. Topical anesthtic
3. Restorative tray
4. Dr. Bauer bur block
5. 2% CHX
6. Gluma
7. Etch bac
8. 3 microbruses for multiple teeth only 2 or 1 for single tooth
9. Vitrebond Plus
10. Clearfil SE Bond or Optiobond Fl
11. Composite =
12. Clearfil SE A2 APX if posterior and some anterior
13. Filtek Supreme Ultra if anterior
14. Buccal requires #0 cord soaked in hemodent?
15. IP need V-Ring system
16. Anterior need mylar strip and white wave wedge
17. Troll Foil
18. IP polishing strip for some anteriors

Bryan Bauer, DDS, FAGD                                                                
630-665-5550                                                                  

Wheaton General and Cosmetic Dentists