Dr. Sam Simos

"The resulting translucencies, opacities and subtle chroma value of 

 were excellent and, best of all, the patient loved the result and could not believe how little time the entire procedure took to complete.”

In most practices, composite is commonly used as a restorative material in both anterior and posterior restorations. In a recent survey by the 

, more than 75% of dentists polled use three or more different composite systems to satisfy different challenges posed when placing these restorations. Currently, different composite shades have been necessary to provide a lifelike optical appearance of natural tooth structure to create a structurally sound restoration for functional stability and a pleasing esthetic result. This article will introduce Dentsply Caulk’s new TPH Spectra Universal composite through Catapult Group’s evaluation and a photographed case study.

Techniques for composite placement differ when trying to create a lifelike appearance. The goal of any technique is to enhance the composite’s optics so the operator can create opacities, translucencies, or subtle chroma and value differences within the enamel. 

The layering technique is the most commonly used technique to achieve this result. While many have mastered this technique, it remains a difficult, time consuming, and complex technique that requires both an artistic eye, a large amount of composite inventory, and a knowledge of the shades used to create a lifelike result. Ironically, the advancements and sophistication in composite technology, designed to give better/easier results, have instead made it more difficult, in many instances, for the clinician to make the correct shade decisions. This leads to operators giving up on the layering technique, opting instead for materials that are “simpler” or more “chameleon-like."

Dentsply Caulk’s new TPH Spectra™ universal composite builds on the trusted TPH brand that has been the gold standard in composites for the last 20 years. TPH Spectra™  is the only composite offered in two viscosities: high viscosity and low viscosity, depending on your preference for handling. TPH Spectra™  also incorporates a unique optic system that allows for simplified shading by providing seven of the most essential tooth shades that cover the entire 

. TPH Spectra™  also offers a unique shade guide that leads the clinician to the correct composite shade. All of this helps save time when placing restorations. 

Putting this new composite to the test, a 35-year-old male presented with spaces between tooth Nos. 7, 8 and 9 (Fig. 1).

He wanted the spaces closed. Because he speaks in front of large audiences, a natural cosmetic result was important to him. A factor to consider when selecting a shade and technique is the varying degree of translucency and opacity within his teeth. When taking the shade with the TPH Spectra™  shade guide (Fig. 4), we noted both shades B1 and A1 were very close to the shade of the tooth (Figs. 2 and 3). The simplicity of the system allows the clinician to pick one of the shades from the supplied shade matching guide (Fig 5). In this case, shade A1 was selected because the overall appearance of the tooth matched the A1 tab better.

It should be noted that either of the shades (according to the shade matching guide) could be used. To test the system, I chose to use A1 on the central incisors and B1 on the lateral incisor using a non-layering technique (Fig. 6). After placing and shaping the material, polishing with an 

Enhance® finishing (DENTSPLY Caulk) disc

 was performed (Fig. 7). Immediate post placement results were captured with photos and evaluated (Fig. 8). 

The resulting translucencies, opacities, and subtle chroma and value of the TPH Spectra composite were excellent and, best of all, the patient loved the result and could not believe how little time the entire procedure took to complete (about 40 minutes).

Overall, TPH Spectra™  was very well received by Catapult’s evaluators. They seem to be very discriminating in that they use a wide variety of systems (more than 75% use three or more systems) to meet their personal preferences and patient needs.

Eighty-six percent rated this product in the excellent/good category, while 77% would incorporate TPH Spectra™  into their posterior composite practice and 71% into their anterior composite practice. An overwhelming 90% of evaluators would recommend TPH Spectra™  to their colleagues.  
	The top three reasons evaluators liked this material over their current system were:

1. Chameleon effect
	2. Simplified shade system
	3. Overall handling and less stickiness to instruments

Results drive our material decisions. Control over the entire restorative process is crucial. Employing a material that gives you command over shade selection to account for a wide range of varying opacities and translucencies, as well as high polishabilitiy and sculptability, are essential for a great result every time. 

Articles

"The resulting translucencies, opacities and subtle chroma value of TPH Spectra composite were excellent and, best of all, the patient loved the result and could not believe how little time the entire procedure took to complete.”

Review: TPH Spectra universal composite offers excellent opacities in less procedure time

If a vertex, as defined by Webster, is the intersection of two lines that form an angle, 

 is the intersection of composite and bonding agent where speed and convenience collide without sacrificing performance.

It’s rare, these days, that a dental manufacturer introduces a material that is truly unique. Admittedly, there are “new” products touting different chemistries, improved bond strength and better elasticity, but these “improved” materials often are basically the same products slightly modified.

, however, is a new class of composite material: self-adhering flowable composite. This is an advanced approach to composite technology that I believe is the next logical development in restorative materials. However, the concept is so novel it has many dentists wondering if it is too good to be true.

The purpose of this article is to demystify this exciting new technology so more clinicians will decide to incorporate it into their armamentarium of restorative solutions.

 has incorporated its proven, proprietary 

 adhesive technology into Vertise Flow as well as an optimized resin matrix and filler system with an average particle size of 1 micron. This particle size ensures optimal wear resistance, comparable with the leading flowables on the market today.

Equally impressive is Vertise Flow’s shear bond strength, with its 22.4 MPa in enamel and 26 MPa in dentin.

 This should allay any fears that this technology does not work.

Microleakage is another concern clinicians have with any bonded restoration. In a University of Siena study

 that compared the microleakage of various flowable composites and dental adhesives in Class I composites, Vertise Flow outperformed many of the systems.

Clinicians know viscosity is important when using a flowable. Vertise Flow has a viscosity that is well suited for both anterior and posterior restorations. In a recent North American hands-on in-vitro field test,3 clinicians favored Vertise Flow’s physical characteristics over the flowables they currently used. All-in-all Vertise Flow is a pretty remarkable product that deserves a spot on your shelf of restoratives.

The following is a step-by-step pictorial showing the ease of use of Vertise Flow. I’ve chosen to show a direct Class I restoration, however this material can be used in Class I, II or even as the restorative of choice when doing a sealant.

 Isolate the tooth you’re working on from the adjacent teeth before you start the procedure (

 Prepare the cavity, wash thoroughly with water, and dry with air. Research has shown that with Vertise Flow, dry dentin surfaces enhance bond strength. Vertise Flow composite is self-adhering and therefore does not require an etching or bonding protocol prior to placement.

 Select the desired shade. Dispense Vertise Flow into the preparation with the provided dispensing tip. Place the tip into the deepest area of the preparation and begin dispensing (

 Use the provided brush to apply Vertise Flow to the entire cavity wall. Brush with moderate pressure for 15-20 seconds to obtain a thin layer. The initial layer should be no more than 0.5 mm (

 for 20 seconds. After lining the cavity wall with Vertise Flow, you can either build the restoration with more composite in increments of 2 mm or less, or you can build the restoration with a traditional universal composite resin such as Kerr’s Premise or Herculite Ultra. The thickness of each increment of the traditional universal composite should be no more than 2 mm.

Light cure each increment for 20 seconds. Now the final restoration (

Dr. Sam Simos is nationally recognized as a leader in cosmetic and restorative dentistry. He teaches post-graduate courses to dentists through Allstar Smiles’ state-of-the-art Learning Center and client facility in Bolingbrook, Ill. and throughout the country. Dr. Simos can be contacted through 

If a vertex, as defined by Webster, is the intersection of two lines that form an angle, Vertise Flow is the intersection of composite and bonding agent where speed and convenience collide without sacrificing performance.