TBU: #045 Composite Fillings Are Breaking DentistryApr 15, 2023
New Issue of The Biomimetic Uprising
Read Time: 3.5 min
Composite restorations are one of the most common things we do in dentistry, yet is often one that has the most issues associated with it. Most of the time, they are pretty cheap to do, will have low reimbursement rates, and will have a set of post op complications associated with them.
Dental insurances in America will often cover them to be redone about every 2-5 years. That essentially is them admitting the time length that they expect them to last.
In some ways that really is a poor business model. Most practitioners will do a 'filling' in about 30 minutes. Start to finish, including the injection. This same filling will often come back with post operative pain and sensitivity, recurrent decay, chipping and fracturing, or possibly even fall out. No wonder most dentists hate doing these restorations. There's so much baggage that comes along with them for virtually no reward!
Just yesterday I was treating a patient That had an existing MOD restoration on tooth #3. The filling was cracked in four different places. The distal box was completely broken off and was wedged and being held by the next tooth. Here I am working to remove this filling, and to no surprise of my own, the thing starts popping out in chunks. The distal portion came out first, then a portion off the occlusal, then the mesial, then the rest on the pulpal floor. Its actually kind of surprising that the patient didn't have more sensitivity on this tooth.
But the real question is, Why is this allowed to be the standard of care of dentistry? How is this allowed to pass as quality work? This happens daily and almost always when there is a deep prep. There's no way everyone is seeing the same person to do all of these fillings. There's not one person to blame for all of this. That means the entire industry is to blame.
I have so many questions about this.
Do dentists really not care and are pushing for the next bigger treatment? Do dentist really not have the time to do it right? Do they not know how to bond a tooth? Are they ok with their work falling apart after a few years? Or are they blaming their failures on the patients and saying they have poor hygiene habits, poor bite, they clench and grind, they never come in for hygiene checks, etc. There's so many 'reasons' I've heard like this. Its like what is happening? How are we cool with this?
Honestly it kind of gets to me. It makes sad/angry/sympathetic/ etc for the patient. They are going in there for a reason they've been told they needed to do. They can't verify to see if its in fact correct. Then they're given a poor restoration that is going to give them bigger complications later in the future. They've given us their trust and money to fix something and yet most of the time we create bigger issues for the.
So lets change it.
Of course I am biased and believe that biomimetic dentistry is the way and will give the answers to all of these issues. But I'm also not naïve to think that there is quality dentistry being done outside of biomimetic dentistry.
So how do we fix it?
First I'd say, slow down! Proper dentistry takes time to do it right. It takes time to establish a workable floor that can be bonded predictably. It takes time to form a lasting hybrid layer, create the needed layers, and then to finish it off and get it workable.
If you can't slow down due to the style of the office, I'd highly suggest dropping insurances, changing the schedule, not including so many teeth in one appointment, or whatever it might be to give you more time and ability to do it right. Even an extra 15 minutes to the procedure can make a dramatic change and make your life easier after these are done.
I'd also suggest to focus on what were are bonding to. This is another topic all together, but the point of our preps isn't always caries removal. It's about creating a space that we can predictably bond with the highest bond strengths.
And then, of course I'd recommend advanced training. Maybe a few less Continuing Education Courses on higher production and speed and more on clinical improvements and techniques.
And then lastly, just care. Care enough to want to change and grow from prior experiences.
We all have an area or two that we could learn from and become better. Just find that extra effort to make it happen!
Whenever you're ready, here are the ways I can help you:
- If you're looking for better application in your practice, take a look at our online courses
- The Foundations Of Biomimetic Dentistry
- How To Do Biomimetic Posterior Direct Composites.
- Get our 53 page biomimetic protocols guide for posterior direct restorations.
- Join our ever growing community and get instant access to our group chat, shared resources, on-demand help, along with networking with the leaders in biomimetics.
- Work with me 1:1 to grow your biomimetic dental practice.
Biomimetic dentistry is a revolutionary approach to dental care that is quickly becoming the standard of care for many dental practices. This approach to dentistry focuses on preserving as much of the natural tooth structure as possible while still providing effective treatment. By utilizing the latest in advanced materials and techniques, biomimetic dentistry can provide patients with a stronger, longer-lasting restoration that looks and feels more natural.