Class Five (Gingival Facial) Composite - Dental Minute with Steven T. Cutbirth, DDS

[@ronakonina]

your videos are golden for dental students, i learn more from you than from my dental practice teacher. You explain everything beautifully. Thank you so much for all your videos, i appreciate them a lot!

[@centerforard]

Terrific. My teaching center in Dallas began at Baylor Dental School in 2020. We closed it this year after 20 years and I have gone exclusively to online teaching with Dental Minute videos and DentistryMasterClasses.com for those interested in really elevating their practices. I would like to be more involved with dental schools, but we have not been able to get dental schools interested. If you students could figure out how to get dental schools interested in my work and teaching, let me know. I presented seminars would wide for 30+ years before going online.

[@Nitiwire]

2nd year student. Doing my first Class V tomorrow. Thanks for the review, very helpful!

[@centerforard]

Glad it was helpful! Take your practice to the Top Tier. Subscribe to DentistryMasterClasses.com for an organized library of all the Dental Minute videos plus many complete comprehensive cases and many very important articles. New cases are added weekly. Only $20/month.

[@dr.sanket]

You are an amazing doctor and teacher

[@centerforard]

Thank you.

[@FL-gg4dq]

Another great video. I explain the same way you do to my patients .

[@centerforard]

Terrific. Glad you like the video. I hope you are subscribed to DentistryMasterClasses.com. An organized library of all the DM videos plus many, many complete comprehensive cases.

[@nutellaluis683]

thank you for sharing your knowledge dr..may your tribe increase

[@centerforard]

You are welcome. Subscribe to DentistryMasterClasses.com for the best videos.

[@ThePm0]

Great stuff! I love all your videos; so clear and to the point. I wanted to ask: are the Dental Mastery series videos accredited that I could count them for CE?

[@centerforard]

Not yet. We are working on it. My teaching center (CARD) in Dallas was CE accredited, but we have not done it with DMC videos yet. DMC has been so popular we have been focused on the teaching cases.

[@nadayounis132]

Thank you Steven , another amazing video and I like how you repeat tips in each video so they remain memorable . If the patient returned with some sensitivity after a nice filling was placed ina. cervical defect ,using flowable composite , any advise ? also if the defect is subgingival would you recommend using a retraction cord ? if yes , what size ? Thank you .

[@centerforard]

Yes. Be sure you cure the primer adhesive after blowing off the excess to remove the acetone carrier. If the composite is deep, place and cure it in 1mm layers. If the tooth is hypersensitive prior to treatment, it may need endo. If it is not sensitive prior to composite placement, the tooth should not be sensitive post op if you use this technique exactly as explained. Do not over prepare the surface when freshening the sclerotic/secondary dentin. I have placed direct composites this way for 40 years without any post op sensitivity I am aware of.

[@nadayounis132]

@@centerforard Thank you Steven , I do appreciate your reply . Could you kindly show us how to use the retraction cord when doing class v with a defect extending to subgingival level .Have a lovely holiday .

[@centerforard]

Just use a small (length) retraction cord, probably a size 0 or 1, placed only on the facial surface of the tooth. I have never used retraction cord for Class 5 restorations because I do not want gingival bleeding if I can avoid it. If the gingival tissue is inflamed, you might want to clean the teeth and show the patient proper home care prior to the bonding procedure.

[@chandishrijibesh175]

It's so good of you Sir for sharing tit bits of dentistry. Such class v are much neglected!!! Etiology can be varied from clenching to erosion, abfraction etc

[@centerforard]

Glad you like the videos. I hope you are subscribed to DentistryMasterClasses.com if you want the very best videos and an organized library of all the videos.

[@max9677]

A doctor worth of thousands of dental school! I don't bother checking other channels anymore.. here is enough and more

[@centerforard]

Fantastic! So glad you like the videos. Hope you are subscribed to DentistryMasterClasses.com. There is a library of all the DM videos plus many complete comprehensive cases. New cases and technical videos added weekly.

[@HanzGoodman]

Hello Dr. Cutbirth. I'm a student and I was told by all of my professors that Flowabale, while it seals the restoration it does not provide adequate strength when compared to a conventional composite. In your clinical experience why do you believe that the Flowabale will hold up to the forces of clenching? Thank you for your videos!

[@kvgolfa]

I think that's the idea tho. You want something more flexible. The patients own enamel couldn't hold up to the forces

[@YOu-jl2bn]

F

[@HanzGoodman]

@@kvgolfa yeah but Flowabale is so much weaker compared to a regular composite it would fail a lot earlier. In terms of flexibility if your composite moves around your marginal seal would break and you will get secondary caries

[@kvgolfa]

@@HanzGoodman www.aegisdentalnetwork.com/id/2011/06/esthetic-and-predictable-treatment-of-abfraction-lesions

[@kvgolfa]

@@HanzGoodman www.aegisdentalnetwork.com/id/2011/06/esthetic-and-predictable-treatment-of-abfraction-lesions

[@saddamzeynalov3812]

I just love ur southern accent. They work every time ;)

[@centerforard]

Interesting! Some feel I have a distinctive British accent.

[@wewereads]

@@centerforardhow come with that beautiful american R sound

[@nataliemalekkfuri7339]

You are a Great teacher and a wonderful Dentist , God bless you always

[@centerforard]

Thank you.

[@amirmo6615]

Thank you Doctor for this fantastic video. I have one question on using flowable and would love to hear your thoughts about it. How do you factor in the polymerization shrinkage of these materials in class v where there is the highest number of C-factors? Numerous studies confirmed the low filler composition of flowables make them prone to shrinkage after light curing and hence stress on bonded walls of the cavity and therefore post ope discoloration and sensitivity Many thanks

[@centerforard]

There is no problem so long as the patient does not drink much strong coffee or red wine or other things that stain the composite. As with all direct composite restorations, they normally do not stand up for years and years. Patients who drink/eat very cold and very hot things are more prone to issues because the coefficient of thermal expansion of a tooth is 11 and a composite is 75, so the temperature affects the composite more than the tooth, especially cold things which cause the composite to contract and pull away from the tooth. T Take your practice to the Top Tier. Subscribe to DentistryMasterClasses.com for an organized library of all the Dental Minute videos plus many complete comprehensive cases and many very important articles. New cases are added weekly. Only $20/month. Click here to subscribe: membership.dentistrymasterclasses.com/purchase/?plan=513

[@rybka995]

Thanks a lot, Doctor Steven! if the bleeding occurs during preparation or bonding, how do you manage with it?

[@centerforard]

Watch my video on hemostasis. By accident, years ago I discovered placing 38% phosphoric acid (composite etch) on a bleeding site for 45 seconds, stops the bleeding (it causes the blood to scab). Try it!

[@ypherrist2792]

Indebted to you Sir. Respect and love from Pakistan.

[@centerforard]

Subscribe to DentistryMasterClasses.com. There is an organized library of all the DM videos plus many complete comprehensive cases.

[@hassnabbas4136]

معلومة قيمة شكرا لك دكتور

[@FL-gg4dq]

Pray

[@wooeinjung]

Thank you for sharing your tips! I wonder if you use flowable resin only. In my case, I also use flowable resin and then condensable resin on top of it.

[@centerforard]

Terrific. I do the same thing with occlusal composites. I feel like flowable composite adheres to the surface better in class 5 restorations. Plus there is no compressive stress on class 5 restorations.

[@kriyanshjain2451]

Very nicely explained doc .. how about using self etch bond ? Instead of etching and priming separately,can we do both the steps together

[@centerforard]

Self etch is probably fine, I just do not use it in my practice. Take your practice to the Top Tier. Subscribe to DentistryMasterClasses.com for an organized library of all the Dental Minute videos plus many complete comprehensive cases and many very important articles. New cases are added weekly. Only $39.95/month. Click here to subscribe: membership.dentistrymasterclasses.com/purchase/?plan=513

[@Okellobrian12]

This a great video with good Explanation

[@centerforard]

Thank you. Glad the video was helpful. Take your practice to the Top Tier. Subscribe to DentistryMasterClasses.com for an organized library of all the Dental Minute videos plus many complete comprehensive cases and many very important articles. New cases are added weekly. Only $39.95/month. Click here to subscribe: membership.dentistrymasterclasses.com/purchase/?plan=513

[@bpastr]

hi, did u use retraction cord on this video or u just put the flowable composite right away? Any tips how to get the beautiful margin though if you didn't use retraction cord? thank you

[@centerforard]

I did not use retraction cord. I do not normally use retraction cord for facial composites because the cord can illicit gingival bleeding, which may be more difficult to control, especially if the gingival tissue is at all inflamed. It is important there is no bleeding onto the prep/margin when the resin is placed. 38% phosphoric acid placed on the gingival tissue for 45-60 seconds when the prep is etched is a terrific hemostatic agent. I always overfill the composite, then polish it back with the shown burrs, finishing with 12 or 30 fluted carbide burrs and a shofu polishing disc and sometimes a shofu rubber wheel. Watch my video on controlling gingival bleeding. Take your practice to the Top Tier. Subscribe to DentistryMasterClasses.com for an organized library of all the Dental Minute videos plus many complete comprehensive cases and many very important articles. New cases are added weekly. Only $39.95/month. Click here to subscribe: membership.dentistrymasterclasses.com/purchase/?plan=513

[@mimme864]

which is better to treat bruxism? mouth guard or botox?

[@centerforard]

In my opinion, a proper, CRO nightguard. You cannot stop a person from bruxing their teeth while sleeping, so the damage must be minimized.

[@jihoona1137]

Hello sir, great video, as always..how about placing liner under composite to prevent sensitivity ? Do you think it's necessary for class v restoration ?

[@centerforard]

Sometimes I will place 2 coats of primer/adhesive, blow off the excess primer/adhesive onto a 2x2 gauze and cure each coat for 5 seconds, then place flowable composite if it is a facial restoration. I feel primer/adhesive seals the dentinal tubules better than anything. Be sure the dentinal tubules and enamel have been wet, then just blot the surface dry, do not desiccate the surface. The primer/adhesive carrier is drawn to moisture, carrying the primer into the dentinal tubules forming the hybrid layer. Take your practice to the Top Tier. Subscribe to DentistryMasterClasses.com for an organized library of all the Dental Minute videos plus many complete comprehensive cases and many very important articles. New cases are added weekly. Only $39.95/month. Click here to subscribe: membership.dentistrymasterclasses.com/purchase/?plan=513

[@nirzannah]

In most practices, I have seen my fellow dentists using GIC for cervical abrasions. Which material is most preferred for cervical abrasions? Also, thank you for your excellent videos.👍

[@centerforard]

I prefer flowable composite. Watch the videos in DMC.com. Take your practice to the Top Tier. Subscribe to DentistryMasterClasses.com for an organized library of all the Dental Minute videos plus many complete comprehensive cases and many very important articles. New cases are added weekly. Only $20/month. Click here to subscribe: membership.dentistrymasterclasses.com/purchase/?plan=513

[@iddicted]

Doc since you mentioned i have been using that polishing bur. I just use the yellow one but its preference. Thank you

[@centerforard]

You are welcome.

[@SuperTyo10]

Hi doc, is it normal for the composite to touch the gingiva when placing increments ? Would this not contaminate the composite and affect bonding?

[@centerforard]

Keep the tip of the composite dispenser in the prep so the composite pushes the tissue out as it is placed. Gingival bleeding will definitely affect the bond strength of the final restoration, so you must control gingival bleeding and any crevicular fluid. Be sure the gingiva is healthy and not inflamed or bleeds with gingival probing prior to composite placement. If the gingiva is inflamed and bleeds upon probing, have the teeth cleaned and teach the patient proper home care prior to the facial composite placement. Take your practice to the Top Tier. Subscribe to DentistryMasterClasses.com for an organized library of all the Dental Minute videos plus many complete comprehensive cases and many very important articles. New cases are added weekly. Only $39.95/month. Click here to subscribe: membership.dentistrymasterclasses.com/purchase/?plan=513

[@Ahuromazda]

Every time I do these fillings afterwards one can see the border between then restoration and the tooth and I can't.make it look natural. There is always a thin line remaining. How can I get rid of that?

[@centerforard]

Bevel the tooth margin vs. a 90 degree margin between the tooth and the composite. Prep the tooth margin with a bevel before placing the composite so there is not a 90 degree interface between the composite and tooth. This will make the composite blend into the facial tooth surface. Take your practice to the Top Tier. Subscribe to DentistryMasterClasses.com for an organized library of all the Dental Minute videos plus many complete comprehensive cases and many very important articles. New cases are added weekly. Only $39.95/month. Click here to subscribe: membership.dentistrymasterclasses.com/purchase/?plan=513

[@SalahHaitham]

Always Good content *-* Thanks a lot Doctor!

[@centerforard]

Terrific. Subscribe to DentistryMasterClasses.com for the very best videos.

[@سامسام-ذ8ق]

Hi Doctor,Iam from Iraq and I have difficulte case with my tooth,How can I connect with you,please.

[@benf2539]

Woud you say Glass Ionomer is better for Class 5 than Flowable composite?

[@centerforard]

No, I am not a fan of glass ionomer cement. Take your practice to the Top Tier. Subscribe to DentistryMasterClasses.com for an organized library of all the Dental Minute videos plus many complete comprehensive cases and many very important articles. New cases are added weekly. Only $39.95/month. Click here to subscribe: membership.dentistrymasterclasses.com/purchase/?plan=513

[@payaltrivedi6190]

Dr. what about lower lingual erosion lesions? Can we also add composite to that like a class V?

[@centerforard]

Probably. I would need to examine the patient to provide a definitive answer. Take your practice to the Top Tier. Subscribe to DentistryMasterClasses.com for an organized library of all the Dental Minute videos plus many complete comprehensive cases and many very important articles. New cases are added weekly. Only $39.95/month. Click here to subscribe: membership.dentistrymasterclasses.com/purchase/?plan=513

[@IggyCreates]

No need to pack cord to keep the fluids out?

[@centerforard]

Often not necessary if the gingival tissue is healthy.

[@IggyCreates]

@@centerforard thanks for the reply!

[@arikethbiswas5480]

We have a query about isolation Rubber dam isolation can assure us prevention of gingival fluid oozing Otherwise moisture may hamper composite bonding steps . Thnks .

[@ТемирРахым]

Nice video doc! What about tooth isolation? I mean rubber dam

[@centerforard]

The key is isolation. It does not always have to be with a rubber dam. If you can isolate the restorative site well with 2x2 cotton squares, as in a case like this, that is fine. If you have watched my videos, you know I use a rubber dam for most procedures, so I really like using a rubber dam. It makes most procedures better, easier and safer.

[@xevora9310]

How do you keep gingival crevicular fluid out of the cavity? There's some there even if the patient has healthy gums.

[@centerforard]

I try not to touch the gingival tissue with the burr when performing the preparation. Also, I would like the gingival tissue to be healthy so it does not bleed easily at the time of restoration, so most times the patient has had a recent dental cleaning and oral hygiene instruction.

[@mack0951]

love your videos sir

[@centerforard]

Thank you. Take your practice to the Top Tier. Subscribe to DentistryMasterClasses.com for an organized library of all the Dental Minute videos plus many complete comprehensive cases and many very important articles. New cases are added weekly. Only $20/month. Click here to subscribe: membership.dentistrymasterclasses.com/purchase/?plan=513

[@nikolacurcic4967]

Dear doc. when should we NOT use liner ? I found that whenever i dont use liner based on gjc ,i have sensitive tooth on cold. Does bond quality make dif. there ? I have tryed dentsply bond that prevents sens. but im scared to use it without gjc liner. What about some cheaper made in germany bonds ,are they making problem without liner ?

[@centerforard]

Use this technique and you should not have post op sensitivity. Only minimally roughen the abfracted area to freshen the surface of the prep. Do not remove but a tiny bit of tooth surface (probably sclerotic dentin) with a course barrel diamond burr. If the surface is soft, use a #6 round burr in a slow speed handpiece. Then, following etching for 15-30 seconds, apply the primer/adhesive and blow off the excess to remove the acetone carrier. Once nothing moves when you blow the prepared tooth surface with your air syringe, always cure the p/a for 5 seconds prior to placing the flowable filled resin in 1mm layers. Cure each layer for 20 seconds, with a final cure of 20-40 seconds.

[@nikolacurcic4967]

@@centerforard Thank you dear colleague. I will try it next time.

[@khaki714]

How about a gum graft instead of composite?

[@centerforard]

Read PD Miller's study on gingival grafting. The amount of coronal height you can gain from gingival grafting is dependent on the coronal height of the interproximal bone. It is much more complicated to gain gingival height predictably than periodontal crown lengthen.

[@Anwar-gu8rw]

what about isolation with rubber dam?

[@centerforard]

I love rubber dams, but in these cases I find it easier and effective to isolate with 2x2s. Take your practice to the Top Tier. Subscribe to DentistryMasterClasses.com for an organized library of all the Dental Minute videos plus many complete comprehensive cases and many very important articles. New cases are added weekly. Only $39.95/month. Click here to subscribe: membership.dentistrymasterclasses.com/purchase/?plan=513

[@carloslasarte2153]

Gracias...que buen profesor...

[@centerforard]

You are welcome.

[@AstroShiraj]

Excellent experience man😢

[@centerforard]

Thank you.

[@dongdongdong8413]

thank you

[@centerforard]

You're welcome. Take your practice to the Top Tier. Subscribe to DentistryMasterClasses.com for an organized library of all the Dental Minute videos plus many complete comprehensive cases and many very important articles. New cases are added weekly. Only $20/month. Click here to subscribe: membership.dentistrymasterclasses.com/purchase/?plan=513

[@abanoubalexander4047]

why there is no isolation or gingival retraction ?

[@centerforard]

Isolation with 2x2 gauze pads while the restoration is being placed. No retraction cord because I do not want to cause bleeding. With composite bonding, blood is the enemy. The restoration is supra gingival, so don't stir up bleeding with retraction cord. You absolutely do not want to place a rubber dam clamp on the tooth you are placing the class 5 composite on. If you watch my other videos and are subscribed to DentistryMasterClasses.com, you know I use rubber dam for almost every procedure. This is a procedure I have to isolate with 2x2s.

[@nusratsharmin777]

Thanks Dr. for your kind reply ❤

[@drkauserfatima7354]

Hloo sir..most of the time I face problm of sensitivity in patient after composite restoration...patient. Complaining me sensitivity which last for around 4-5 days..after that it subsidede....wht is the reason ?

[@centerforard]

If there is no pulp exposure or close proximity to the nerve, be sure to blow off the excess primer/adhesive, then cure it for 5 seconds prior to placing the filled resin. This works beautifully to eliminate sensitivity. Also, sure the filled resin in 1-2mm layers as it is placed. I normally place flowable composite as the first layer, if the restoration is very large, then continue to fill with highly filled resin. In my opinion, the flowable "wets" the surface of the floor of the restoration better. Take your practice to the Top Tier. Subscribe to DentistryMasterClasses.com for an organized library of all the Dental Minute videos plus many complete comprehensive cases and many very important articles. New cases are added weekly. Only $20/month. Click here to subscribe: membership.dentistrymasterclasses.com/purchase/?plan=513

[@harshsingh_hs]

How much this filing life

[@centerforard]

The life of the composite filling depends on several factors, including if the patient clinches their teeth and does not wear a night guard, if they eat/drink a lot of hot and cold foods, home care, etc. If the patient follows proper protocol, the composite could last for many years. Take your practice to the Top Tier. Subscribe to DentistryMasterClasses.com for an organized library of all the Dental Minute videos plus many complete comprehensive cases and many very important articles. New cases are added weekly. Only $39.95/month. Click here to subscribe: membership.dentistrymasterclasses.com/purchase/?plan=513

[@gobeyondtheuniverse]

Beautiful.

[@centerforard]

Thank you! If you are a dentist, take your practice to the Top Tier. Subscribe to DentistryMasterClasses.com for an organized library of all the Dental Minute videos plus many complete comprehensive cases and many very important articles. New cases are added weekly. Only $20/month.

[@edz030]

Just the tip?

[@centerforard]

Just the tip of what?

[@avesta1021]

Lingual and palatal tori may have genetic factors involved.

[@centerforard]

Correct.

[@amirmoezz]

Thank you for your educative videos. Is it possible to do a video on how to approach the Heavily Eroded teeth where you can see the pulp through a thin layer of tertiary dentin (vital pulp)? Much appreciated.

[@centerforard]

The real issue in these cases is how to prevent further erosion. Is it abrasion or erosion. If abrasion, then a nightguard or dental sleep apnea/snoring device will help. If erosion, the cause must be addressed, i.e., bulumia, acid reflux.

[@amirmoezz]

@@centerforard The teeth are eroded as the patient has tendency to constant consumption of soft drinks with high acidity. It involves multiple anterior teeth which esthetically are problematic (the teeth are too brittle).

[@centerforard]

Veneers or full crowns may be the solution if there is considerable tooth structure missing. Large composite bonding does not hold up. Of course the patient must also change their bad habits.

[@amirmoezz]

@@centerforard Thank you, much appreciated.

[@centerforard]

Also, endodntics may be needed. Be sure to discuss that possibility/probability with the patient prior to restoration. You do not want to complete the restoration and the patient have sensitive teeth. Remember, if you discuss the probable need for endodontics prior to a restorative procedure, it is a reason and the patient will understand and accept it. If you do not discuss the probability of endodontics prior to the restorative procedure and the patient has a post op sensitive tooth, they will blame you.