Expedited Excellence: Warmed Composite is a Game-changer

You're listening to The Dr. Phil Klein Dental Podcast from Viva Learning.com. Welcome to the show. I'm Dr. Phil Klein. Dental materials have certainly changed and evolved over the past few years. So the question is, how do those changes affect our restorative procedures and our practice? Today, we'll be discussing this and more with our guest, Dr. Joshua Austin. Dr. Austin maintains a full-time restorative private practice in San Antonio, Texas, which is not far from where we are now in Austin, Texas. He is an editorial director and monthly columnist for Dental Economics Magazine, focusing on products and technology. And he's doing this podcast outside. I see him outside in the back of his house. So if you hear birds chirping in the background, that's just nature. Don't worry about it. Dr. Austin, it's a pleasure to have you on Dental Talk. It's too beautiful today to not be outside. It's like 72 degrees and sunny. It looks like it's the same where you are. So got to enjoy this nature while we can. Yeah, you know what? I'm with you 100%. I'm in a studio here, but I'm looking at the video here, which our audience can't see, and it looks beautiful. But yeah, we've got the same beautiful sky here. So right after this podcast, I got to go take a walk. Okay. Good. Do it. Do it. We're really happy to have you. And we thank our sponsor, Voco, for sponsoring this podcast. And they sponsor a lot of continuing education with us. Great company, very strong in R&D. And again, we appreciate their sponsorship for this podcast. So what are some of the key evolutionary changes of resin composites that have taken place over the past few years? Yeah, you know, Phil, I think that the first thing is, is that we've all gotten comfortable with the idea of bulk filling composite, right? And so, you know, utilizing new monomer systems, utilizing different curing approaches. and different translucencies to try to cure as big of a piece of composite as we can while minimizing polymerization shrinkage. And we've gotten really good at that. I mean, when I was in dental school, the composite systems that I learned on were some of the classical, you know, composite systems that really dominated the market for a long time. But those polymerization shrinkages were around 7%. And you look at the materials that we have now, and we're now down under 2%, well under 2%. um around 1.5 1.1 in some cases so you know we've really taken polymerization shrinkage i don't want to say out of the equation but greatly greatly greatly reduced it so that we can be more efficient and not have to work in as as many increments as we used to have to before so that really starts sort of the the evolution and that evolution started six seven years ago um when some of the bulk fill materials came on the market We're now to the point where we're on second, third generations of those bulk fill materials. Now we're seeing really differentiators and improvements among those. And so, you know, every company kind of does things a little differently. And in the case of VOCO, they've really taking a stance and attempt to warm composite and warm a bulk fill composite. and now we're really doing a composite. And when we take a b and warm it, now we'r the benefits of bulk fill and the b and now you're really talking a have a really hard rest that really minimizes shrinkage that hopefully will Yeah, so these are great innovations for sure in direct restorative treatment. So what is the main effect or what are some of the effects of warming composite when applying it to a tooth? Yeah, it's interesting. You know, I learned about warming composite when I was in dental school. We used to warm old 3MZ100 when I was in dental school. And our restorative director was Jim Summit. And we would do a snowplow technique that was actually in. some previous editions of his textbook, Summits Fundamentals of Operative Dentistry. So the idea of warming composite is not new. It's always been sort of logistically an issue, but when you warm a composite, you reduce the polymerization shrinkage, you increase the surface hardness, and you get a sort of a monoblock type of restoration that is much easier to cure. And so all of the things that we want. out of a composite restar adaptability, sculptability, um, all that stuff get warm it up. And so, you know, what the temperature is that we need to warm that to. And now it's just a matter of, OK, like how do we unlock making this easy to do in the operatory? When I was in dental school, we used to use a denture bath. We would put composite compules in a denture bath and it was a mess and you'd have water everywhere and you're trying to find a Ziploc baggie and you're able to weigh the Ziploc baggie down with something so it stays submerged. It was just not easy to do. And I think one thing that we're doing now is figuring out the ways to make that more logistically easier in our practices. So I was under the impression that warming composite was so that it would adapt better. And then once it went back to its... normal state, it would be sculptable, but I didn't know that it had any effect on the actual hardness of the material. Absolutely, yeah. When you warm the composite, you get a greater percentage of the monomer that converts when it cures. And so when you get that, that's when you get that reduction in polymerization shrinkage. You get that increase in surface hardness, that decrease in or increase in fracture resistance in the restoration. And so by raising the heat or raising the temperature in the system, you are basically kind of providing a catalyst so that a greater percentage of those monomers convert into a full bond. Yeah, that's very interesting. So when you talked about when you were in dental school, how difficult it was to warm the composite, anything that becomes arduous in a task like that, obviously people aren't going to do it. So now there's a company that, and that's a sponsor of our podcast, Voco, who's come up with a system. that actually makes it extremely easy to to do this to warm the composite can you tell us about that whole process yeah voca with their viscalor bulk has got two different ways to do it and so you have options now and one option is a a comp fuel warmer that's a desktop comp fuel warmer that uh you know sets the temperature to the right amount of heat and then you you put your comp fuels on that it's kind of specially designed so the comp fuels fit into that particular desktop unit perfectly so that you'd an even distribution of heat around that comp fuel so that the composite heats up evenly so a desktop heater is one way to do it and then they have this other really cool system that is basically if you imagine your composite dispensing gun now put a infrared heater at the end of that and you can heat the composite comp fuel by comp fuel as you disp or right before you dispense it into the tooth so it takes about 30 seconds If you heat it up, it does mean you've got to charge this up. It is battery chargeable, so there's no cords or anything. So you charge it up, and one charge can get you through a few days of restorations. And you load the comp fuel into the gun, hit a button, a little IR light goes on inside the gun that heats up the composite evenly all the way around the comp fuel, and then you dispense it straight from that dispensing gun. Basically, now you don't have to have anything on your desktop. It's really just a updated 21st century composite dispensing gun that's doing the heating. So when you're using this warmed composite and you're putting it into the tooth, is this a game changer compared to the typical way we used to get composite down in there? Tell us about that. And also, do we need a flowable now? I mean, do we get that kind of adaptation that we're... about where we, in the box of a distal number 30 DO, we're going to get that kind of adaptation against the matrix band? Absolutely. And so that's really, really the advantage of this. And that's where this came from back when the snow pod technique was invented. It was when flowables were not very good. And flowables have gotten a lot better, but they're still not as good as the paste composite. So if you can eliminate them from the system, you have a monoblock of one restoration material. and and you don't have th the flowable and the pa heat up like viscal or bulk which is one of th FDA approved to be warm that up and dispense Yeah, it is almost like using a flowable. It's not quite as liquidy as a flowable, but it is much more flowable than a paste would be. So for like a buckle pit on a lower first molar, you don't really need that. You don't really need it to be super flowable. Paste works just fine. But like you said, that distal of number 30 or really any interproximal box, you want that flowability to really adapt well. Well, in the past, we're putting a flowable in there. It's kind of a weaker material. Now we've got a weaker material at the junction of the box. you know, that's the most and now we've got a weaker m about that. We've got o of our solid material as t to room temperature after you've d it and shaped it a li become much more like a traditio sculpt when you first dispen much more like a flowable. So you can't re to sort of the room temperature. Now you can sort of put some anatomy into it, sculpt it like you would a traditional paste composite right before you cure it. So it is pretty remarkable to use this material unheated versus heated to see the difference in how it handles. It really is night and day. How long does it take for the material to get to the point where you can sculpt it? To warm it in the capsule warmer, it's about 30 seconds. And from my experience, it's about 30 seconds to a minute before you can really sculpt it. and get good anatomy into it. I don't find myself sit it, you know, after I lo it into the rest it, making sure that I've got a sealed marg by the time I switch my instrument you're going to use by that point to stiffen up a little bit and now I can mold it how I want to mold It's a pretty quick process, but it all happens within, you know, the normal span of what you would find with placing a composite. Yeah. So is there any need to layer this type of material or do you always use it as a bulk fill? Most, the vast majority of the time, I'm going to use it as a bulk fill. Now, there are situations, you know, where you've got like a lower second molar on the distal where a wisdom tooth sort of erupted into it. and you've got a really l so now you've got an 8 or 9 m that's the case, I'm defini incrementally. I may do a 4 mm increment and the vast majority of class twos or so in depth from the occlusal margin. And so on all I'm doing those in a monobloc situations where I'll have a class one, like maybe replacing an old amalgam or something like that, where I have a very wide buccal-lingually and mesiodistally oriented restoration, where I may do that in a couple of increments just because of how wide everything is. But from a class two perspective, I'd say 95% of them are getting done and filling the box up in one single increment to maximize the benefits that we get out of the visco-worn bulks. Yeah, yeah, well said. So, and you did make a point that this material was actually developed to be warmed versus what you did in dental school and subsequent materials that come out on the market they'll say you can warm this but it wasn't actually developed off-label yeah so there's really only there's only three composites that are on fda on label approved to be warmed and so um like you said this was developed to be warmed and so you know we can get into the intricacies of that because how the companies get it into the comp fuel is by warming it up at the factory right But, you know, we all know how that is using something off-label. You know, if something were to happen and you had it in your chart note that you were warming another composite that wasn't designed to be warmed and something went wrong, we all know how that can go. With viscal or bulk, we don't have to worry about that because it's FDA on-label to be warmed. So it's a great aspect of that restorative material. Yeah, and if you want more information on this product, feel free to visit VOCO, V-O-C-O. There's plenty of information on their website. Well, Dr. Austin, I think that was great. Didn't know you were our neighbor down in San Antonio. I did go to some Spurs games back when Kawhi Leonard played for them when he left. He who shall not be named. We don't mention his name around here anymore. Exactly. Yeah, I know. We had 25 plus years of good times as Spurs fans. So I feel like even if we never won a championship the rest of my life. i never have the ability to complain about it i'm happy with the five rings and and we're good absolutely all right well listen you take care pleasure to have you on the show and we look forward to you doing more podcasts and webinars for viva learning thanks very much Dr. Austin, thanks, Dr. Klein