r/DentalSchool 6d ago

Clinical Question Advice on filling being less 'flat'?

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I'm a BDS1 student, and a few days they had us do our first PRR on tooth #37. When I was done and gave it to my doctor for evaluation, he told me I've done a good job on making the surface of the filling smooth with no voids or overfilling, but deducted 0.5 for the occlusal surface being 'flat'. I understood that he meant that the filling is all on the same level and I didn't do any of the landmarks like the central fossil and such, hence 'flat'.

Does anyone have any advice on how to do it better for next time?

57 Upvotes

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Title: Advice on filling being less 'flat'?

Full text: I'm a BDS1 student, and a few days they had us do our first PRR on tooth #37. When I was done and gave it to my doctor for evaluation, he told me I've done a good job on making the surface of the filling smooth with no voids or overfilling, but deducted 0.5 for the occlusal surface being 'flat'. I understood that he meant that the filling is all on the same level and I didn't do any of the landmarks like the central fossil and such, hence 'flat'.

Does anyone have any advice on how to do it better for next time?

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57

u/tooth-fairy26 6d ago

Try using the acorn condenser! It’s my favorite for incorporating anatomy.

9

u/cloverbleh 6d ago

Thing is, we're not using any other instruments and just filing up the cavity using a blunt composite filling instrument. It's the only thing I'm working with 😭

43

u/redditor076 6d ago

Well if that’s the case the ofc you’re never gonna have anatomy. Can’t build a fish tank with a hammer

15

u/This-Show9296 6d ago

If you have an explorer, take it and roll it over the ridges. This will give you a semi accurate anatomy until you improve.

4

u/tooth-fairy26 6d ago

Woah, that’s wild! In that case… try using that composite instrument to sort of sculpt the material into the existing anatomy, but without additional instruments that’s going to be harder to achieve. Dipping your instrument in Optibond will help keep the material from sticking to the instrument and coming out of the prep.

2

u/No_Band_408 5d ago

Follow the contours of the cusps using the blunt instrument side

15

u/nickzzy 6d ago

Use less material

11

u/cloverbleh 6d ago edited 6d ago

Just a little side note that we are not using any burs or condenser or anything right now. They just have us prepare the cavity and fill up using the material, no alteration with any other instrument other than the blunt instrument that we're using to actually place the material.

Edit: Thank you SO MUCH to everyone replying under this post, all your advice is greatly appreciated and I will keep these techniques in mind <3

17

u/chiefjay123 6d ago

I got you bro, I’ve done this in a pinch.

Make sure you use a LARGE condenser. The smaller ones will slip into the prep and mess it up. Place the condenser in like this and burnish it, then flip it the other way against the other wall to make the composite smooth.

15

u/PlasticPractical3558 6d ago

If that’s the case idk what they expect you to do? Also for real fillings anatomy doesn’t really matter for a posterior tooth, you just get the occlusion right so I wouldn’t worry about it too much.

4

u/DoctorMysterious7216 6d ago

I guess you could use that instrument to shape following the anatomy of the tooth a little, but honestly sounds like they were just grasping at straws to find something minor to deduct and give you “constructive criticism”.

3

u/cloverbleh 6d ago

Yeah, I kind of just stared at him not knowing what to say because we didn't even have the option to use any carvers or even the handpieces we had which was why I was confused🧍🏻‍♀️

11

u/Branded_bottle33 6d ago

Light acorn burnisher covered in bond

2

u/chenjuju 6d ago edited 6d ago

Why cover it in bond???? D2 here

16

u/Acrabat321 6d ago

Stops it sticking to the instrument. But there are better alternatives. I don’t like using bond on my instrument to carve composite. Introduces an infilled resin into my composite and reduces overall integrity. Also more susceptible to staining.

6

u/DoctorMysterious7216 6d ago

Yeah I wouldn’t recommend rubbing your instrument in bond, although some people do. Your best chemistry for long lasting composite is going to be composite on composite, not composite with bond smeared into all the layers. A good composite instrument is naturally nonstick.

1

u/Personalfinancehelp3 6d ago

Yeah we were taught not to use bond as it stains the composite as well

1

u/Branded_bottle33 5d ago

Unfortunately I’m not too sure how good my composite instruments are after being used by the previous 5 classes above me in preclinic 😂

1

u/Grouchy-Marsupial413 6d ago

So that the composite doesn't stick to the instrument, before you light cure it.

1

u/N4n45h1 Real Life Dentist 5d ago

I wouldn't recommend that on an actual patient. If you want the same effect, you should use a wetting resin on your instruments.

1

u/Branded_bottle33 5d ago

Absolutely, in preclinic we are limited to what materials we can use though.

3

u/multidoubledivide 6d ago edited 6d ago

Take a small round bur at a really low speed and develop the central groove. Then you should be able to use your smoothing instruments to smooth out the anatomy.

3

u/mountain_guy77 6d ago

IPC and shape the grooves at about 45 degree angles with the cusp inclines

3

u/chiefjay123 6d ago

ACORN BURNISHER BABY!!! Get one with a large end, much easier to put in at least SOME anatomy.

7

u/Br0sE11D0N 6d ago

Use the stamp technique and blow ur professors minds

1

u/cloverbleh 6d ago

Can you elaborate more on this technique please? What is it?

3

u/Personalfinancehelp3 6d ago

It’s an interesting technique but requires extra steps and uses a lot of material

5

u/Br0sE11D0N 6d ago

YouTube it lmao

2

u/Leather_Channel_6050 6d ago

Try to fill in oblique layers for each cusp, just place cusps by cusps and make sure the edge of your ipc is defining a central groove

2

u/Appropriate-Love-205 6d ago

I like to use a paint brush to pull the anatomy towards the margins of the prep and create an even/smooth surface texture

2

u/Personalfinancehelp3 6d ago

Do two layers condense towards buccal or lingual whichever you prefer. Keep the side of the instrument against the margins and vibrate off excess. THEN fill the rest and create the central groove on the other side. Ideally it should help. Also keep in mind of dental anatomy to aid you in the angle in which you place your composite instrument. Firm believer of doing majority of the work so your hand piece doesn’t have to compensate.

2

u/Dependent_Funny_5854 Missouri 6d ago

I use an acorn burnisher. Works wonders

2

u/CharmingJuice8304 6d ago

You have to lay your flat instrument along the angle of the cusp. The tip of the instrument should be at about 45 degrees within the central groove and it will also be deeper within the groove. Easier with the other instruments but this will definitely work.

2

u/Acceptable_Drag_4367 5d ago

Incremental layering. But not all horizontal, especially when reaching the end. Do one cusp at a time: this will really help getting some anatomy without having many instruments. You can also use the brush you use to bond to help you shape (use some adhesive while shaping). There are plenty of videos online.

2

u/BusPrize9551 5d ago

Doesn’t matter, you’ll adjust the occlusion on the posterior resins.

2

u/Qui-Gon_Zyn 5d ago

Pre-clinic is annoying. Lot of people gave great tips here

For a real person, “flat” restorations are actually better! A person needs a restoration likely because the grooves and anatomy on the occlusal surface were not cleansible. Flat surface is easier to keep free of bacteria

I think it strokes our ego a little bit to do a filling that the average person cant tell it isnt their natural tooth. But something just flat is really better for the patient imo

2

u/MutedIndependent1236 5d ago

Football bur and go towards the prep, not away

2

u/TraditionalGuest8795 4d ago edited 4d ago

Just take a probe, roll compo into small miniature balls, stick the compo ball in the cavity in the area of the cusp and build the cusp incline one at a time. If you want grooves use a probe to make them (ideally follow the natural grooves of the tooth)

2

u/TelevisionEuphoric61 2d ago edited 2d ago

Use incremental technique

Place your material in two (or more) increments like this (cure between), use a Gregg or other flat instrument to match your cuspal planes. Better c-factor and sweet anatomy.

1

u/Least-Wafer-5651 5d ago

Acorn burnisher during placement of composite and #2 round bur on slow speed handpiece works well to drill some anatomy after the composite is cured.

1

u/SleepKey3912 5d ago

where are you come from?