Troy Schmedding, DDS, is a 1993 honors graduate of the Arthur A. Dugoni School of Dentistry in San Francisco, California. He maintains a private practice in Walnut Creek, California, where he focuses on esthetic and functional dentistry. An accredited member of the American Academy of Cosmetic Dentistry, he lectures both nationally and internationally on esthetics and restorative materials. Schmedding also serves as a key opinion leader for numerous manufacturers, helping develop and bring new products to market. Contact him at troyschmeddingdds@gmail.com.

Troy Schmedding, DDS

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Technique Touch-Ups 2022

Tokuyama made a big splash in our industry a few years ago with the introduction of OMNICHROMA. It was a unique product in an otherwise well established, and somewhat boring, space. The company itself has been around for a while and this by far is not its first innovation. When I first used their hard REBASE material for denture relining, it was as good as anything I got back from the lab. Accurate, chairside, no lab fee. It was a push against the norm with a simple but elegant solution. For me, OMNICHROMA was equally innovative, as well as impressive.

The whole idea of “one shade for every tooth” was obviously a compelling story. I am always looking for a way to simplify our armamentarium and streamline our product supply. OMNICHROMA’s success stems from a basic optical property of the composite. Most composites are shaded by having a particular color of the filler. A1 shaded composite has particles that are A1, for example. A light source hits the surface of the composite and reflects light to your eye for your brain to perceive color. In the case of OMNICHROMA products, the filler actually regenerates light from the surrounding tooth against the filler particles. This essentially creates the illusion that the composite itself is the same color as the structure around it. If you could isolate that composite, you would see it hasn’t actually changed color at all.

One technicality of using the product is that you do need actual structure to reflect that color. If you have an incisal extension that extends out, it would have less to reflect back and potentially look a bit too translucent or gray. In this case, Tokuyama recommends using their OMNICHROMA BLOCKER or OMNICHROMA BLOCKER Flow. It has similar regenerative properties but also creates a base layer of color to avoid that grayed-out look. Because of its ability to block color, it is only recommended to use a 0.5 mm layer of OMNICHROMA BLOCKER Flow. I find this is also useful when I have a darker base shade, such as a tooth with amalgam staining or a dark root surface. The opaque layer nicely blocks out the undesirable shades for a more esthetic color match in the final result.

The introduction of OMNICHROMA Flow BULK further redefines this category with simplicity and greater efficiency. Like other bulk composites, you don’t have to place the material in small incremental layers. The reason we used to place composites small layer by small layer is because large layers would exhibit greater shrinkage affecting marginal integrity and deeper layers could remain uncured if light could not get to the material in the deepest parts of the prep for proper curing. In the case of OMNICHROMA Flow BULK, this is no longer an issue. Its flowability and self-leveling help to not only layer evenly but the supra-nano fillers allow reflection of red to yellow structural color. It also enables the material to have a high level of polishability. Considering extensive studies that show great compressive strength, flexural strength, and lack of polymerization shrinkage, the company has definitely backed their claims with good science. 

When I first got a chance to use OMNICHROMA Flow BULK, I was most surprised by the simplicity of the packaging. A syringe and some tips were all that was in there, again reinforcing the value of OMNICHROMA products when it comes to helping declutter our storage. According to their recommendations, I can use the material on any posterior or anterior application. The instruction card had just a few steps that basically consisted of apply your bond of choice, fill it up, cure, and polish. The viscosity of the material is noticeable and flowed well into crevices, especially the floor of a Class II prep. I used the OMNICHROMA BLOCKER Flow in all cases of amalgam stain and it definitely helps keep the restoration at the brighter shade of the surrounding teeth. I did not have a single case that developed that “little white line” from poor bonding. If anything, it feathered well across any bevel.

Simplicity Goes Even Deeper with OMNICHROMA Flow BULK case images by Jeff Rohde, DDS

The only tricky part for me was for Class V applications. Due to the viscosity of the material, if I overfilled the preparation at all it would pool across onto the gingiva and make finishing a little more laborious. In this case, I found that it was best to initially wet the preparation right up to the margins, but not totally filled. After an initial cure, I would then layer the regular OMNICHROMA material over that due to its thicker handling. Sandwiching like this gave a great optical result, I still got a good seal, and simplified finishing. If this were a Class IV fracture, I would only use the original OMNICHROMA to ensure you can build out that body of the material to the intended incisal edge. One nice thing about OMNICHROMA Flow BULK is you don’t have to have that topper layer to protect it. In the Class V case switching materials to cap the restoration with the original OMNICHROMA viscosity was to be able to shape and sculpt the material.

Because of the viscosity of OMNICHROMA Flow BULK, I would recommend confirming you have nice four wall preparation to get the best results with the material. This would include a Class I, a Class II with a matrix band, a Class III with a matrix band, etc. You can also very easily adapt this for use with the Bioclear technique, especially in the posterior.

In a Class II situation, the material flowed nicely in the bevel areas of the buccal and lingual walls. Once placed in those areas, I filled the bulk of the rest with no issues. I still did another round of curing after I removed the matrix band but that was more out of habit than necessity. For anterior restorations with Bioclear matrix bands, I would place OMNICHROMA BLOCKER Flow into the deeper areas of the black triangle to block off the dark background and then fill with the regular OMNICHROMA Flow BULK material over the top of that.

OMNICHROMA Flow BULK definitely delivers on the simplicity of the system, as well as its broad range of use. It’s an excellent addition to Tokuyama’s line-up and continues to push the boundaries of what can be accomplished when solid science and research are applied to developing innovative and effective dental materials.

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Dental Products Report's Technique Touch-Ups 2022

, Class II resin composite restorations were 10 times more likely to be replaced at no cost to the patient than Class II dental amalgam restorations.1 That said, Class II procedural efficiency and a streamlined workflow should be a priority for every dental practice. The case featured in this article utilizes a universal single-shade composite that saves time by eliminating the need to determine and select the right composite shade for posterior restorations. Having to stock only 1 shade reduces inventory and accomplishes most everyday direct restorative needs.

Utilizes light diffusion technology to match natural tooth structure.

Wide blending effect reduces or eliminates the need for an opaquer or blocker resin.

Its filler content and spherical formulation allow for a polish in fewer steps.

A 61-year-old healthy man presented with an existing occlusal amalgam and a mesial marginal ridge fracture with recurrent decay on tooth #18. Additionally, tooth #19 had lost a prior occlusal restoration with decay present 

Because of the minimal amount of tooth structure involved, it was decided to remove the existing amalgam on tooth #18 and incorporate the mesial fracture and decay. Tooth #19 was treatment-planned on the same principle of being as conservative as possible and simply restoring with a direct resin composite.

DryShield® from DryShield LLC was placed as we began to remove the existing occlusal amalgam on tooth #18 as well as fractured marginal ridge decay in both teeth.

CARIES DETECTOR from Kuraray Noritake was applied to ensure decay removal was properly achieved 

The remaining decalcified portions shown in pink were removed utilizing air abrasion with a Prep Start H20 from Zest Dental Solutions. This is a less aggressive approach compared with using a slow-speed handpiece, but also effective in increasing the surface area for bonding protocols 

A sectional matrix band was placed and sealed at the gingival margin with a plastic wedge followed by the placement of a nickel titanium ring from Garrison Dental Solutions. A ball burnisher was then used in a buccal lingual motion midcontact to help ensure contact with the adjacent tooth. Selective etch using K-ETCHANT, a 35% phosphoric acid from Kuraray Noritake, was placed on the cavosurface margins for 20 seconds and then rinsed off with copious amounts of water, followed by air-drying the entire restoration 

The Technique

CLEARFIL Universal Bond Quick from Kuraray Noritake was administered to both preparations and agitated for 5 seconds, then air-thinned vigorously until the bonding agent could no longer be seen moving across the preparations 

. Next, the preparations were light-cured for 20 seconds using the PinkWave from Vista Apex.

A 0.5-mm layer of CLEARFIL MAJESTY™ FLOW A-3 from Kuraray Noritake was placed horizontally along the entire floor of both preparations and light-cured for 20 seconds to help aid in the development of the hybrid layer 

CLEARFIL MAJESTY™ ES-2 Universal composite from Kuraray Noritake was then placed into the box form of tooth #18 only, to begin developing the interproximal wall and marginal ridge. The restoration was then light-cured for 20 seconds to ensure polymerization of the 1-mm increment of composite that was placed 

. Thin increments help control the C-factor stresses of a Class II restoration.

With the inner proximal wall established, the matrix system was removed to provide easier access for composite application. Then, 2-mm layers of CLEARFIL MAJESTY™ ES-2 Universal composite were applied to both restorations with a Roetzer Posterior Packer Sculptor composite placing instrument from Practicon in an incremental fashion until an appropriate level was achieved (

The restorations were then contoured and shaped utilizing Meisinger fine diamond burs in various points and shapes to achieve a near-ideal occlusion. Mark Rite articulating paper was then utilized to fine-tune the final adjustments and create an ideal cuspal contact (

Polishing was achieved with a single-use 2-step polishing system from Meisinger. The filler content and spherical formulation of CLEARFIL MAJESTY ES-2 Universal composite makes for a very good polish in fewer steps and decreases the need for multiple polishers results in a more efficient polish (

1. Overton JD, Sullivan DJ. Early failure of Class II resin composite versus Class II amalgam restorations placed by dental students. 

https://pubmed.ncbi.nlm.nih.gov/22383602/

CLEARFIL MAJESTY™ ES-2 Universal composite utilizes light diffusion technology to integrate into the preparation.

How to Use a Universal Single Shade Composite for a Class II Restoration

 we learned to create primary and secondary anatomy of the posterior teeth by carving wax blocks according to diagrams in a flip chart. It was very straightforward.

By the time I actually started placing restorations in patients’ posterior teeth, things were less clear. It seems every professor we asked had their own protocol for the placement and postcure finishing and polishing of direct esthetic restorations.

In essence, they left us to find our own way of finishing polish restorations to our own satisfaction. Now, 25 years later, I have found a system that I wish I’d had in school.

The Occlusinator from Strauss Diamond and its corresponding Posterior Packer Sculptor (PPS) instrument simplify the technique and save time, materials, and steps. Efficiency is more crucial than ever.

Creating Restorations with the Occlusinator

Using the Occlusinator from Strauss Diamonds, along with its various features has made posterior restorations more efficient and simple. 

How To Efficiently Create Great Restorations

Dentists see all types of direct restorative cases throughout their days, weeks, and years, but the most common is a Class II. With the demand for esthetic composite restorations, clinicians find that complexity in restoring a posterior tooth to its natural appearance and function has only increased.

Study results have shown that dental resin composites have an average life of 5.7 years, with the main causes of failure being secondary decay and fracture of the restoration.1 The factors that contribute to failure are mostly poor adhesion protocols, inadequate interproximal contacts, improper polymerization, and poor placement of materials.

The challenges that dentists must overcome to achieve a desired patient outcome are immense but achievable if we avoid the pitfalls of restorative failure. Here is an outline of some of the most common pitfalls with tips to help practices.

In the days of placing amalgam, isolation was not as critical. As we use advanced materials that are more technique-sensitive and don’t work well in a moist or wet field, we must control moisture and bleeding.

Dentists will see more failures if they do not have good isolation in place. Investing in a refresher course on rubber dams or in a device such as DryShield® from DryShield or Isolite from Zyris® will provide benefits that far outweigh any costs. Depending on the procedure and patient, I will use either rubber dam isolation (Figure 1) or DryShield (Figure 2).

There is an abundance of matrix options, both circumferential (Figure 3) and sectional (Figure 4), to help handle situations with composites, but these options do have their limitations. The components of matrix systems are matrices, wedges, and bands. I use 3 or 4 different sectional systems in my office for different situations.

I typically avoid circumferential matrices because they will drive my contact point to the occlusal surface, taking away the ability to manipulate that circumferential band when packing composite. When I place composite into a very unfavorable physical characteristic, it will fail time and time again regardless of the composite used.

The role of the wedge (Figure 5) in adhesive dentistry is to maintain a gingival seal and allow proper band contour to achieve ideal anatomic contact. The wedge should not negatively impact the shape of the sectional matrix and should not create separation. I prefer plastic wedges, which tend to have a truly anatomic form, protect papilla, and are easy to place under contacts. That said, they are more costly. But what is a smooth operator’s time worth?

Bands come in various options. What is most important is that there is an array of sizes in the office. There should always be 0.5 to 1 mm above the adjacent tooth structure. If it is elevated more than that, it pushes the concavity that creates that ideal contact from mid contact point up to the occlusal embrasure space, much like circumferential matrices.

Clinicians should look for a system that is flexible and allows them to stack. In Figure 6, clinicians can see the Palodent® Plus system from Dentsply Sirona with a nice built-in angulation to its rings, so they go on and stack easily.

The final critical component of being successful with a matrix system is Teflon tape. Clinicians can buy this at any hardware store and should have a roll in every operatory.

Pictured is a mesial-occlusal-distal on the premolar (Figure 7) and a distal occlusal on another premolar (Figure 8). The matrixes are all in place and packed with Teflon tape in the contact point to create a rigid surface, so when I go to the mesial of the second premolar, I can burnish that against something of rigidity.

Another great use of Teflon tape is to minimize buccal and lingual flash, by packing the tape into the buccal lingual gaps that the rings provide (Figure 9). When it’s done, the buccal, lingual polishing and finishing are much easier (Figure 10).

Regardless of the adhesive material used, the best advice I can give is always to read the instructions. Clinicians are amazed at the instructional nuances that can cause restorative failures. I am a self-proclaimed self-etcher, and I don’t total-etch unless I am 100% into the enamel.

Although a total-etch technique absolutely works, I prefer self-etch, which I find to be less technique sensitive. Total-etch obliterates the smear layer with a strong acid. This creates an opportunity to fill all those tubules that create a potential for problems. Research has shown that utilizing the smear layer in self-etch mode can provide superior dentin bond strength to a total-etch technique in relation to length of time in service.

At A Glace

Although I always leave my smear layer intact, I do clean it. I use Clean & Boost® Dentin and Enamel Cleanser from Vista Apex (Figure 11). Nitric acid, combined with disinfectants and HEMA, allows the cleanser to interface through the smear layer and remove any contaminants that may inhibit adhesion. The pH level encourages roughening of enamel and dentin but is less aggressive than phosphoric acid. Clean & Boost also reportedly increases bond strength up to 33% by cleaning but not obliterating the smear layer.

I always use a selective-etch on the enamel margin using Best-Etch™ Phosphoric Acid from Vista Apex (Figure 12). I believe any time dentists can etch enamel, they should take advantage of it. It is still the most tried-and-true bond in dentistry.

Half of all dental income (and clinicians’ success and reputation) relies on the successful use of light-cured dental materials.2,3 The consequences of improper light curing are:

When choosing a curing light, dentists should understand its power output, spectral output, collimation, and surface area footprint.

The power output of the curing light should be a minimum of 1000 mW/cm2 of light energy. At that output for 10 seconds, clinicians should be able to cure most products today. So, how do clinicians know the exact power output? I highly recommend investing in a radiometer. I really like CheckUp 2.7 from Bluelight Analytics because it not only measures the light but also gives specific recommendations based on the materials used. With any radiometer, though, clinicians can check the consistency of the light.

Spectral output is interesting because the materials used today have different types and amounts of photoinitiators. For example, the Ivocerin photoinitiator falls under a different spectrum, requiring a broader spectral output range. Many lights are built for camphorquinone curing only, so clinicians should check the light’s spectral output.

Collimation is a critical factor. Light that isn’t collimated will not give the full benefit of a broad spectrum to the entire restoration. Collimation can be checked by shining a light on a table to see where the energy is going.

Light-curing areas save time and help when it comes to human error. I cure all my own restorations (I’m a control freak), but if dentists are looking away from the light or shifting positions, that is likely moving the head away from the target.

I use the PinkWave™ curing light from Vista Apex for its expanded wavelength, providing broad spectral coverage(Figure 13). The light also has a red and near-infrared diode that has shown to cause a decrease in composite shrinkage and increased polymerization. The PinkWave is also said to have the largest curing area on the market at 12.1 mm, helping to navigate larger restorations.

Whether layering incrementally, 2-step, bulk fill, or any other type of strategy, dentists always have to manipulate their composite. According to results from an American Dental Association Clinical Evaluator Panel report, 70% of dentists are doing some form of incremental layering approach.

When it comes to incremental layering, I find that heated composite improves my results. Research has shown that heated composite has multiple benefits, including increased durability and better wear rates, fewer voids and microleakage, and lower viscosity.

There are several options out there for composite warming. For compules, I like the Phasor™ from Vista Apex, which heats within 20 seconds and keeps a constant heat and flow to continually heat and reheat composite material.

Every clinician should have a wetting resin, which allows for the manipulation of material without causing any residual pull back. I mostly use SeamFree from Vista Apex because it is unfilled (Figure 14). Once cured, an unfilled resin will become incorporated into the composite, leaving clinicians with no lines or stains.

At the end of the day, everyone wants a tightly packed composite that is highly filled and anatomically beautiful, with ideal contact points. Some of the tips and tricks mentioned here will help achieve this goal with fewer headaches.

Overton JD, Sullivan DJ. Early failure of Class II resin composite versus Class II amalgam restorations placed by dental students. 

2005-06 Survey of Dental Services Rendered. American Dental Association; 2007.

Revenue of dentists (NAICS) in the United States from 2009 to 2014. Statista. April 15, 2014. Accessed February 28, 2021. http://www.statista.com/statistics/296642/revenue-dentists-in-the-us

Class II posterior direct restorations often present as complex cases. But Clean & Boost® Dentin and Enamel Cleanser from Vista Apex can increase bond strength while leaving the smear layer intact. 

How to Become a Class II Smooth Operator

KATANA Zirconia STML has flexural strength of 750 MPa

KATANA Zirconia allows for well-balanced translucency

CLEARFIL CERAMIC PRIMER PLUS is designed to enhance the bond of resin or metal materials

CLEARFIL PRIMER PLUS contains a silane coupling agent to allow for strong adhesion to all SiO2-based ceramic materials

PANAVIA V5 Cement offers a wide indication, automix application, and the easy removal of excess

PANAVIA V5 contains the LCSi monomer that reportedly adheres to every material, including glass ceramics, without the need for a separate primer

Kuraray Noritake
800-879-1676|kuraraydental.com

work” rings true in all aspects of life, including dentistry. A typical dental team may consist of a dentist, a hygienist, an assistant, an office manager, and front desk staff. In this case study, however, the team refers to the ideal set of restorative materials and instrumentation required to achieve the desired clinical outcome as efficiently, productively, and predictably as possible.

When assembling the ultimate team of restorative essentials, ask the right questions. Is the 

preparation retentive or nonretentive? Is the restoration posterior or anterior? Is the amount of sound, healthy tooth structure retained after preparation adequate to support a functional restoration over the long term?

After addressing the clinical, functional, and esthetic considerations, assemble the best team of materials for the case. For this case study, it made sense to stick with a proven trio of restorative products from a single manufacturer—Kuraray Noritake Dental—because each product in the company’s portfolio is formulated to work together for optimal efficacy and efficiency.

A 32-year-old healthy man presented with an existing large mesio-occluso-disto-lingual amalgam and fractured mesiobuccal cusp on tooth No. 14. Prior to this appointment, the tooth was conservatively prepared with minimal reduction of about 1.5 mm on the occlusal surface. Because the tooth was fundamentally sound, an overlay, rather than a crown, was indicated.

A 3Shape TRIOS intraoral scanner was used to take a digital impression. The patient was sent home with a temporary restoration, and a second appointment 2 weeks later was made for placement of the lab-fabricated full-contour overlay. KATANA Zirconia STML™ from Kuraray Noritake was chosen for the overlay because it possesses an ideal balance of high flexural strength (748 MPa) with a lifelike translucency and vitality that mimic natural dentition with little or no characterization required 

Case Study

When the patient returned 2 weeks later, the temporary 

 was removed. To ensure an optimal surface for adhesion, air abrasion removed any remaining cement, biofilm, and debris from the preparation 

. Air abrasion was done with the PrepStart H2O Hydro Abrasion System from Zest Dental Solutions with 27-µm aluminum oxide.

After using air abrasion to remove the resin, the preparation was coated with a 35% phosphoric acid solution to clean any residual resin coating and aluminum oxide on the dentin. This also etched the exposed enamel 

Air abrasion was performed to clean up the internal substrate of the overlay and create a microscopically roughened surface to enhance retention of the bonding agent 

CLEARFIL CERAMIC PRIMER PLUS from Kuraray Noritake was applied to the internal surfaces of the overlay 

. A single-component silane and zirconia/metal primer containing a patented 10-methacryloyloxydecyl dihydrogen phosphate, CLEARFIL CERAMIC PRIMER PLUS is formulated to obtain a high degree of adhesion to tooth substrate via a chemical bonding.

PANAVIA™ V5 Tooth Primerfrom Kuraray Noritake was then applied to the preparation for 20 seconds and air thinned, with no need to light cure. This eliminated pooling on the margins that could result in an elevated margin. The primer’s touch-cure technology ensured that once the resin cement was introduced to the primer, polymerization began immediately on the preparation and the restoration interface 

) is the oxidized version of zirconium, a mineral that occurs naturally as zircon. Zircon is a soft, shiny metal that is common in the earth’s crust. In fact, in 2014, scientists estimated a zircon crystal to 4.4 billion years old.

 Specifically, dental zirconia was a new ceramic material in the late 20th century.

 Zirconia is a polymorphic ceramic, meaning that temperature and pressure can create different crystal structures. These structures are monoclinic, tetragonal, and cubic. Monoclinic zirconia, present at room temperature, is the most stable phase. The monoclinic phase transforms into the tetragonal phase at about 1,170o C, which then transforms into the cubic phase at about 2,370o C.

1. Valley J, Cavosie A, Ushikubo T. Hadean age for a post-magma-ocean zircon confirmed by atom-probe tomography. https://www.nature.com/articles/ngeo2075. Published 2014. Accessed July 16, 2020.

2. Madfa A, Al-Sanabani F, Al-Qudami N. Use of Zirconia in Dentistry: An overview. Benthamopen.com. https://benthamopen.com/contents/pdf/TOBIOMTJ/TOBIOMTJ-5-1.pdf. Published 2014. Accessed July 16, 2020.

PANAVIA V5 from Kuraray Noritake is a resin cement directly injected onto the bonding surface of the overlay 

The restoration is seated onto the prep and tack cured for 2 to 3 seconds. The overlay is held gently in place with a composite packing instrument while excess cement is peeled off with a curette and while flossing the interproximal spaces 

. After cleaning and flossing, a final light cure is performed: 20 seconds on the buccal, 20 seconds on the lingual, and 20 seconds on the occlusal.

Sit back and admire a job well done—buccal and occlusal views of the final restoration 

Whether presented with a fairly routine case that warrants a conventional restorative approach or faced with complex, multidisciplinary treatment challenges, the goal of any treatment plan is to restore the function and integrity of the tooth, maintain a natural appearance, and prevent future oral health issues. The restorative materials must support the patient’s overall dental health, and the material choices should complement the overall treatment plan.

Each restorative product manufactured by Kuraray Noritake offers individual, state-of-the-art benefits, and when used in combination, they deliver a seamless, predictable outcome. By eliminating the need for trial-and-error methodologies, Kuraray Noritake’s integrated system gives clinicians confidence in knowing that their products will perform on every patient, every time.

Your dental team consists of carefully chosen players—so should your restorative armamentarium.