Moving away from an 'all-metal mouth'

(This is the third part of a CDA Presents Speaker Spotlight series highlighting the various topics that will be covered at CDA Presents in Anaheim.)

CDA Presents The Art and Science of Dentistry in Anaheim is expected to attract more than 25,000 attendees April 30-May 2, and one of the biggest draws is the unique lineup of lectures and workshops.

CDA Update staff spoke with John O. Burgess, DDS, MS, an active clinical trial investigator who evaluates posterior composites, adhesives, digital impression systems and biomimetic materials. Burgess is the assistant dean for clinical research at the University of Alabama at Birmingham.

As a speaker, Burgess describes himself with these three words: “informative, stimulating and funny.” He will lead a lecture titled “Adhesive and Restorative Dentistry Update 2015” on May 1 at the Anaheim Convention Center.

Below are excerpts from the interview.

Can you explain what you do as a clinical trial investigator at the University of Alabama?

We look at cutting-edge materials, which in many cases are materials that are not yet on the market. For example, we are evaluating bulk filling materials, new ceramic materials, universal adhesives and digital impressions. In short, any new material or technique is fair game for what we do. We recruit patients for studies, obtain consent and then evaluate materials over the duration of the study. Typically these studies last two to three years and we follow up to evaluate the materials’ clinical performance over this period. Currently, we have nine or 10 studies in progress.

Talk about how the area of restorative dentistry has changed over the last 10 years.

We are using fewer and fewer amalgam materials, which are still a good option in many cases. But the clinical performance of tooth-colored restorative materials equals amalgam now. Calcium silicate materials have significantly improved and now should be a part of your vital pulp treatment approach. Resin materials use preparations, which allow more conservation of tooth structure. Newly developed universal adhesives are increasing our ability to restore teeth with a single bottle material. The long-term approach will be a metal-free mouth with all esthetic materials.

What changes/advancements should dentists expect in the area of restorative dentistry this year?

With adhesives, the profession is moving toward universal material that will bond to zirconium and to the tooth structure and base metals like titanium. The application procedure has been simplified to work with multiple techniques. With vital pulp therapy and posterior composites, we are looking at bulk-fill materials, which have been simplified. Ceramic materials have changed. There is a tremendous shift to all-ceramic versus all-metal restorations. These materials are extremely wear-resistant. There are advantages to using esthetic ceramic materials.

What is one of the main things dentists can do to improve their adhesive performance?

We are conducting clinical and in-vitro studies on universal bonding agents to determine if they are truly universal. We have compared bond strengths, mechanical and physical properties and the performance of adhesives in the laboratory and have discovered significant differences between some of the adhesives. Although it seems that these single-bottle materials are easier to apply, the application of these adhesives is probably just as important as the selection. Application techniques are critical to clinical performance, such as agitating the etching and bonding agent and etching sclerotic dentin before adhesive placement. The new universal adhesives can be applied using a total-etch, selective-etch and self-etch technique. In addition to bonding the teeth, these materials will bond to metal and ceramic.

How much of an art is bonding ceramic material in place?

Both the art and science of dentistry is important, and while there’s a bit of a science to material selection, the art determines in large part the patient’s satisfaction with their new restoration. But it is also an art to determine the proper shade, translucency and form of the final restoration to produce an invisible restoration.   The art of dentistry does sometimes supersede the science of dentistry and is essential when you are dealing with a patient. In cases where the patient wants an invisible restoration, it can be 70 percent of your procedure. Other times, when you are looking at technical procedures, it can be 50-50.

How does one go about determining which dental materials are clinically successful?

Attend lectures where the presenter shows objective data in laboratory and clinical studies to evaluate and compare materials. Learn which materials demonstrate excellent clinical performance and then make a selection. Listen to some excellent speakers who are knowledgeable in this area who recommend which materials to select. From there, you can manipulate different materials at any of the manufacturers’ booths to determine if you like the handling, curing and finishing of different composites and adhesives. Finally, read articles for long-term general evaluations where the clinical performance of the restorative materials is compared.  These steps will prepare practitioners for the limits and useful applications where composites and adhesives perform well.  

Do you think a lot of dentists are still stuck in the ways they have been doing things or are most dentists transitioning into these new materials and techniques?

Of late, if you look at the numbers, most dentists use posterior composites and many are converting from metal ceramic to monolithic ceramic restorations. These materials are here to stay and have displaced metal in large part in the mouth. Most dentists are embracing those new materials and techniques. When you see good clinical performance, it’s probably time to make a shift.  

What is the main thing you want attendees of your course to take away?

I want them to know how to put in an adhesive-based restoration either ceramic or composite that will produce little or no cold sensitivity and have a durable predictable clinical performance. Ceramic materials, combined with CAD/CAM systems, are really excellent materials. Lithium disilicate and zirconia restorations can be very esthetic and provide a 20- to 30-year lifetime. People may be skeptical about bulk-placed and cured posterior composite resins, but we have clinical data that demonstrate they are successful and reduce chair time. We want to demonstrate successful techniques to validate how materials work and provide guidelines for the limits of these materials so they can be used successfully. This course is an evidence-based, procedural-driven, scientific presentation. You will learn how to increase your ability to perform excellent dentistry in an imperfect world.

For more information, visit cdapresents.com, or register for the convention here.