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By Ronald D. Jackson, DDS, FACD, FAGD, FAACD n In 1990, 94 percent of dentists in the United States chose amalgam as their primary intracoronal poste- rior restorative material.1 By 2010, composite resin restorations had exceeded amalgam by a ratio of 2:1.2 In fact, it is estimated that one- third of U.S. dentists no longer use amalgam and those who do report a steady decline. This is not an indict- ment of amalgam, a material that has served dentistry well for more than 100 years. There are many reasons for this relatively rapid and signifi- cant change in restorative dentistry. In this author’s opinion, the leading reasons are: • individual patient desires for non-metal, natural looking restora- tions. • the less invasive nature of com- posite restorations. 3 • the significant improvement in composite resin material physical properties, leading to increased dura- bilityandlongevity,which,according to recent clinical studies, can rival amalgam.4,5 Nevertheless, many dentists still complain that placing posterior com- posites is exacting, tedious, time con- suming and not always predictable. Speeding up the process Current composite resins now yield high physical properties of hard- ness, flexural strength and fracture toughness, as well as low shrinkage and low wear. However, these highly filled, highly viscous materials can make it more difficult to achieve intimate adaptation to cavity walls and, because of low depth of cure, require multiple, separately adapted and cured layers. Manufacturers have begun to address this concern by introducing new composite resins and technolo- gies specifically for posterior use, which allow dentists to place restora- tions faster and easier. Indeed, one such product/technology, SonicFill, by Kerr, eliminates the need for a low viscosity liner altogether and, with a depth of cure of 5 mm, allows rapid restoration placement in the major- ity of posterior cavities in one, single bulk-fill increment.6,7 This is accomplished because SonicFill is a highly filled (84 percent by weight), shaded composite resin (B1, A1, A2, A3) that contains spe- cial rheological modifiers sensitive to the specific high frequency vibration provided by the sonic handpiece. The handpiece fits most quick-disconnect air line couplers, but universal adapt- ers are available if needed. Upon activation, the viscosity of the composite drops 87 percent and is rapidly extruded from the unit dosed tip.Thecompositeisliterallyvibrated into the cavity and adapts intimately to all cavity walls in the same manner that mixed stone is vibrated into an impression. Most cavities are totally filled in less than five seconds. Upon deactivation of the hand- piece, recovery is not immediate, so viscosity returns at a slower rate. This intermediate viscosity makes the material non-sticky and non- slump, so it can be easily and quickly sculpted to accurate anatomy. This author finds that from the time the adhesive is cured, poste- rior composites (even relatively large Class IIs) can be placed, cured, fin- ished and polished in less than three minutes (Figs. 1a–1d). Placing posterior composite resto- rations is a significant bread-and-but- ter service in most general practices. With SonicFill, less time is needed to place these restorations, thereby improving practice profitability and, at the same time, less tedious effort is expended, improving practice satis- faction for the dentist. For the second year in a row, SonicFill(Kerr)hasreceivedthe“Best of Class” Technology Award by the Pride Institute at the Greater New York Dental Meeting. Disclosure: Dr. Ron Jackson dis- closes that he acted as a consultant in the development of SonicFill and retains a financial interest in the product. References 1. In your dental practice, is dental amalgamstilltherestorativemate- rial of choice? J Am Dent Assoc. 1997;128(11):1502. 2. JacksonRD.PlacingPosteriorCom- posites:IncreasingEfficiency.Dent Today. 2011;30(4):126–131. 3. Lynch CD, Frazier KB, McConnell RJ, et al. Minimally invasive man- agementofdentalcaries.JAmDent Assoc. 2011;142(6):612–620. 4. OpdamNJ,BronkhorstEM,Roeters JM, Loomans BA. A restrospective clinicalstudyonlongevityofposte- rior composite and amalgam resto- rations.DentMater.2007;23(1):2–8. 5. OpdamNJ,BronkhorstEM,Roeters JM, Loomans BA. 12-year survival of composite vs. amalgam restora- tions. J Dent Res. 2010;89(10):1063– 1067. 6. Dental Adviser Research Report #33; February 2011. 7. Christensen,GJ,Clinician’sReport; Volume 5, Issue 1, January 2012. speakers6 Greater New York Dental Meeting — Nov. 27, 2012 New posterior composite technology improves placement efficiency Attend today’s session TODAY from 11:15 a.m. to 12:15 p.m. in aisle 5000, room 3, Dr. Ron Jackson will present “Direct Posterior Compos- ites: A Rapid Simplified Placement Technique” as part of the DTSC Sym- posia. In his session, he will discuss how a greatly simplified and efficient procedure for placing Class II compos- ite restorations using new technology could benefit your practice. The pre- dictable, standardized system of place- ment achieves a significant reduction in both time and effort when placing these restorations. About the speaker RonJackson,DDS,haspublishedmany articles on esthetic and adhesive den- tistry and has lectured extensively acrosstheUnitedStatesandabroad.He has presented at all the major U.S. sci- entific conferences. Jackson is a fellow in the Academy of General Dentistry, an accredited fellow in the Ameri- can Academy of Cosmetic Dentistry, a diplomate in the American Board of Aesthetic Dentistry and is director of the Mastering Dynamic Adhesion program at the Las Vegas Institute for Advanced Dental Studies. Jackson practices in Middleburg, Va., empha- sizing comprehensive restorative and cosmetic dentistry. 5 Figs. 1c, 1d: Twenty-six month postoperative view of SonicFill (Kerr) restoration. Note adaptation to cavity walls without the need for a low viscosity liner. ▲ ▲ 5 Figs. 1a, 1b: Before photo and preoperative X-ray showing Class II amalgam needing replacement. (Photos/ Provided by Dr. Ronald Jackson)5 Fig. 1a 5 Fig. 1d 5 Fig. 1b 5 Fig. 1c