SAN FRANCISCO - Gordon Christensen, DDS, MSD, PhD, set the stage of his course on class II composites with questions for the ADA Annual Session audience.
"Who uses no amalgam whatsoever?" he asked. Dr. Christensen estimated that half of the full auditorium raised their hands. "And who does some amalgam? Statistics show that 68% of American dentists place some amalgam restorations. That would be zero in Europe."
The point was made: Questions about amalgam have reduced its usage, while composite usage has increased. However, Dr. Christensen added, "Class II composites only last about seven years. I think we can do better."
Typical revenue for class II composite is $200, he noted. "Maybe that's why they don't last so long -- we're in a hurry to get it over with and move onto something that will earn an income. Otherwise, we may have to drive a cab at night," he said.
Nevertheless, he emphasized, "This is 'bread and butter' dentistry!"
Live patient procedure
Dr. Christensen then proceeded to perform a restoration on one of his employees. During it, he outlined his product preferences based on the results of his team's research and product testing for his nonprofit Clinician's Report.
Before beginning, he took a moment to discuss the appearance of white-spot lesions. "We haven't been able to prevent them after orthodontics with any product after three years of testing," Dr. Christensen said. "Clinpro 5000 (3M ESPE) is slowing down caries as well as anything."
While beginning the procedure, he discussed the differences between popular anesthetics. "What's happened in anesthetics?" he asked. "We've all moved to lidocaine," even though research has shown that articaine consistently produced a numbing effect more swiftly than lidocaine.
"It's twice as toxic as lidocaine," Dr. Christensen noted. "My wife's philosophy is, 'Twice as toxic, give 'em half as much.' And I agree."
The importance of tooth desensitization received focus as well. Dr. Christensen characterized sensitivity as "one of the real problems with class II composites -- a sizable percentage have been sensitive."
"Recognize, very clearly, that you should have an effective method for desensitizing," he said. "Gluma is an excellent product by Heraeus."
After the patent expired on Gluma, other brands surfaced. "They're all the same but very different in price," Dr. Christensen stated. He displayed the differences in a slide: The cost of G5 (Clinician's Choice Dental Products) was $9.30, while Gluma desensitizer power gel was $35.
Other products to receive praise included several bonding agents, such as Peak SE (Ultradent), "which had the highest bonding of all the products we tested," Dr. Christensen said. "There was an odor the testers didn't like, but that doesn't turn me off. There is a shelf life when you open it, but my confidence in it is really high."
Optibond XTR (Kerr) "blew out every other bonding agent we tested two years ago." And his lab tested Scotchbond Universal (3M ESPE) and found "every one of those claims ... accurate," he stated.