Our latest DPR Survey covers a wide variety of topics associated with materials, including product choices and influences, bonding agents, amalgam use, and your satisfaction with the current state of esthetic direct restorative processes.

When we asked GPs to pick out a single aspect of today’s systems that they thought needed the most improvement, not a single category was selected by as many as one-third of the survey respondents (see “Room for improvement,” right). Longevity of the restoration was chosen by the largest single group (30%), while handling and bonding to dentin were the next two most popular choices, with 15% of our readers choosing those aspects as needing improvement. But 13% selected “None” and indicated they were satisfied with what is currently available from manufacturers.

Representatives from 3M ESPE, Ivoclar Vivadent and Septodont share their thoughts here on both the survey results and with the future of composites and direct restorative systems.

“There’s no end yet,” said Dr. Michael Gaglio, vice president of Marketing for Ivoclar Vivadent. “Although people keep saying, ‘Why do I need another composite?’, manufacturers continue to make improvements in small steps. And those small steps incrementally become important in the long-term stability and long-term usefulness of the restoration.”

“There are just so many composites out there. Every company has one or two or five composites, said Shofu Dental President and CEO Brian Melonakos. “And yet, the impression is that dentists rarely actually switch. Your survey shows a large group who have been using the same composites for 2 years to 4 years, but not necessarily more than 5 years. Furthermore, when asked why or what caused them to switch, Number one was peer or clinician guru, but then the next was clinical articles. With our new Beautifil II we have what we think is an excellent clinical study in JADA with the 8-year follow-up study. So we’re encouraged with that composite, based on some of those points.”

For those who have been using your current direct restorative system/materials for more than 5 years, your top responses when asked what would motivate you to try another system or material include lecturer/educator recommendation (75%) and published clinical testing results (62%), which Melonakos touched on. More than half indicated a colleague recommendation (55%) would motivate a switch, while published case studies (42%) and special vendor pricing (22%) also are influences.

Similarly, of those who have been using your direct restorative systems for less then 5 years, 62% said a lecturer/educator recommendation motivated you to make the switch, while 44% cited published clinical testing results.

“We went through a quiet period where composites weren’t changing,” Dr. Gaglio said. “It’s been in the last 2 years with some of the introductions of the nano-technology, the newer generations of composites, that we’ve seen dramatic shifts.”

DPR Survey Exclusive One-bottle, multi-bottles, or both? How often do you use... Single-bottle adhesive systems Always 48% Sometimes 37% Never 15% Multiple-bottle adhesive systems Always 33% Sometimes 47% Never 20% Source: March 2008 DPR Materials Survey

“New technology like bonded nanofillers is quickly embraced when it serves a useful clinical purpose,” said Jon Fundingsland, professional relations manager, 3M ESPE. “Our use of nanotechnology has allowed us to manipulate small particles creating improvements in the esthetics of composites; additionally, it is being used to improve adhesives, flowables and even RMGI (resin modified glass ionomer) restoratives.”

Benefits such as better esthetics, better wear and reduced shrinkage have helped these newer composites become quite popular.

“The smaller the particle technology, the better the wear,” said Dr. Gaglio. “Wear has always been one of the evil attributes of composite; it wears faster than tooth or amalgam. The second factor would be esthetics. The nano technologies tend to have better esthetic results—more translucency, more vitality. The third benefit would be shrinkage. With the more highly filled smaller particle composites, the shrinkage tends to be less.”

Melonakos said handling was a key component behind the release of Shofu’s Beautifil II nano-hybrid composite. “Handling is very important,” he said. “That was the heart when we looked at improving Beautifil and coming out with the new Beautifil II. We wanted to improve handling characteristics, to make it less sticky, and make it easier to pack.”

Forty-three percent of our readers do not currently place amalgam restorations (see “Amalgam use,” page 58)—two-thirds stopped placing amalgam more than 5 years ago, while another 24% stopped between 2-5 years ago. And of those still using amalgam, 81% report placing fewer than they did three years ago.

When it comes to simple Class I posteriors, one-quarter of our readers (see “Patient options,” page 120) always offer their patients a choice between amalgam and tooth-colored restorations. Thirty-one percent sometimes offer that choice, while 43% never give the patient that choice.

Nine percent of amalgam users always use an amalgam bonding agent, with 26% sometimes doing so, and 65% never using such.

“The significantly greater durability of posterior composites is something that you didn’t see reliably 10 years ago,” Melonakos said in explaining why some dentists don’t use amalgam as much as they did in the past. “They are using it (amalgam) less because of the greater durability of posterior composites and the simplification of steps on things like bonding agents.”

Dr. Gaglio added, “It’s still a robust market, but a declining market.”

CONTINUED ON NEXT PAGE

1 of 3