Dentistry has evolved to the point that we are dependent on adhesive and bonded restorations. That's a great thing. However, composite restorations can be challenging and anything that can improve your efficiency and give you a better restoration should be something we all consider. To that end, today let's look at a way to make composite placement easier on doctor and team while also giving the patient a better restoration. The solution is to use warm composite.
The margin is the critical area for any dental restoration. In the simplest terms, restorations alone don't get decay. It's where the restoration meets the tooth where almost all of the problems occur. On a microscopic level the margin is trench warfare where bacteria try to work their way into tiny voids and colonize. That makes it critical that the margin be as closely adapted as possible.
To help with marginal adaptation, there is a very good body of research that has been done on the benefits of warming composite prior to placement. You'll also find that in addition to improving your margins, warm composite offers several benefits during placement as well. I've always told manufacturers that my personal preference for composite consistency is 'cake icing' or 'cookie dough'. It's fairly obvious from those terms that I love sweets. However, I also think that using those terms helps give the chemists a better idea of how I like composite to feel.
By warming composite... and this applies to every composite I've worked with over the years, the warming process causes them to be easier to place, easier to adapt, and easier to sculpt. The warm material isn't sticky and it 'glides' where I want it to go with less effort. I feel the hardest thing we do frequently in dentistry is controlling the field. Every time we perform any procedure that requires bonding, contamination needs to be avoided and that means controlling the field. Warm composite makes me more efficient and that means restorations take less time. It also translates to less time controlling the field, which yields better results.
My history of using warm composites goes back over 20 years. I was at a major industry meeting and I was discussing trends with Dr. Josh Friedman, the owner of AdDent. The company had recently released a product called 'Calset' and he wanted to tell me about it. The product has had updates through the years, but the concept is a simple one. The Calset is an AC powered device that holds composite compules or syringes and gently warms them and keeps them at a constant temperature. It is basically 2 components. The first is the base which gets warm and on top of the base is a tray that holds the material. You simply put your composite into the Calset and leave it there until you use it.
Over the years, the company has created several different types of trays that allow the end user to pick the setup that is best for the way they work. The trays are interchangeable and some even hold composite dispensing guns and/or instruments.
In addition to making placement easier, warming composite also provides multiple benefits to curing. As I mentioned above, marginal adaptation is better. Heated composite has also been proven to have higher conversion rates of polymerization, lower shrinkage stress, and less micro-leakage. The effects on the pulp have also been studied and warming composite has no adverse effects on pulpal health.
To sum things up, not only does warming your composite make it handle better, it makes the material better across the board. To really drive this point home, 3M has publicly stated that, even though the company does NOT make a warming system, they have a blog post on 5 Reasons Why You Should Warm Your Composite. That's a pretty good indication of the benefits.
For more information on AdDent's Calset system, follow this link. I've been warming my composite for over 20 years and I can see the clinical benefits every day. Shortly after returning from the meeting where I discussed warm composite with Dr. Friedman, I started using Calset in my office. I've been using them ever since.
