OmniChroma composite

What’s a great way to decrease your chair time and lower your overhead while still producing great aesthetic results? Switch to single shade dentistry! When you consider the difference that single shade dentistry can make in your practice, it’s no wonder so many dentists are moving away from the complex, multi-shade kits.

Dr. Stephanie Vondrak, a dentist who owns and operates a private practice in Elkhorn, Nebraska and is such a big believer in dental CE that she has personally pursued over 600 hours of post-doctorate education, is one of those who has embraced this change.

“I’m a health-centered dentist,” Dr. Vondrak shares. “In my practice, patients have the opportunity to become as healthy as they wish to be. Some patients come in and just need simple dentistry. Obviously composite is a big part of general dentistry – and when you can use single shade composites it makes life a whole lot easier.”

Even for those cases where patients want more than general dentistry – such as help treating sleep apnea or TMJ – Dr. Vondrak finds that there are many applications for the single-shade composites.

Single-shade composites can give you more time for patient education

“My goal,” Dr. Vondrak states, “is to have the tooth have biological tooth form and look as if I never even put a composite on it. OMNICHROMA [One-Shade Universal Composite by Tokuyama, available in 3 viscosities] is the brand I like and that works very well. If I have to go through three or four different shades, that takes a lot of time. And then if I don’t have the shade right, I have to take the pigment off.” Being able to put just one shade on, possibly after blocking out some dark color, can really simplify things.

“For example,” says Dr. Vondrak, “you have a child who comes in that breaks off a big chunk of number eight. You know that can be tricky to restore. When you’re looking at what to do, you want to make sure that child doesn’t grow up with a front tooth that they’re embarrassed about or that isn’t going to hold up for many years.

“You can go in and use some blocker shade to mask out where light is going to transmit. Cover it with the single-shade composite, and polish. That’s going to give you a lot more time to talk to the parent, to go over home care things.”

Single-shade composites are useful for changing a patient’s VDO

Another thing that Dr. Vondrak uses single-shade composites for is to open the vertical dimension of occlusion (VDO). She explains that in about an hour you can put composite on all of the cusp tips of the lower posterior teeth, increasing their height by one to one-and-a-half millimeters. Changing the VDO in this way can be helpful in a variety of circumstances.

For example, say you need to do a crown on a number 15 tooth that has a very short clinical crown height. By increasing the VDO you can avoid having to reduce the occlusal so much on that number 15 tooth, plus you’ll have better retention of your crown.

Using composite to open the VDO can also be a good option when you look at the bite and see that the upper teeth are kind of narrow and tipped in towards the lower teeth, and you don’t have much buccal overjet space in the posterior. When you see a situation like this while working on a treatment plan, you know that anything you do could chip more easily.

“It’s really simple to get out of that problem,” Dr. Vondrak declares. “Add a little composite to the buccal cusp tips of the lower molars (as long as they don’t have a crown on them). You isolate. You need no anesthetic. You add from let’s say 18 to 22, and you’re just kind of contouring back and getting that shape. Then I generally get the bite even on that side and use that as a guide when adding to the right side. But the reason I do it is so that there’s a little bit of freedom of movement of the mandible so that whatever work you’re doing on the top isn’t getting bumped and things aren’t getting broken.”

When you open up the VDO in this way, even a Class 4 composite will have a much longer life – as much as five to seven years.

Dr. Vondrak also uses this technique to open up the VDO for TMJ patients. If she has to reposition their jaw forward a little bit to take pressure off their joints, they just might need that little bit of height to keep those joints healthy.

When using this technique, be sure to warn your patients that because you are changing their bite, it may feel weird for about 48 hours. After that, they’ll get used to it. It’s also a good idea to have the patient come back for a check in about two weeks, just to be sure that they are not having any issues with the treatment.

High-end aesthetics can benefit from single-shade composites, too

What if you have a high-end aesthetic practice? Can you get away with using a single-shade system and achieve the same kind of aesthetics you’re accustomed to?

According to the Dr. Vondrak, the answer is yes… for the vast majority of cases. “Most of the time,” she relates, “once the value is correct in the teeth, that’s when single shade works very, very well. The only times I’ve really found an issue is if somebody wants to change their shade to be bright white. Because, if you think about this, we’re doing the single shade and structural color. The filler particle absorbs the light and then it shines back the shade of the natural tooth. So if they want to change the shade of their tooth to a super, super bright white, bleached look, that’s going to be difficult to do. I think it’s very challenging to do that well with composite, period. In a high-end aesthetic practice, my guess is if they want to change the shade that much, they’re probably looking at porcelain or zirconia or E-max or something like that.”

Conclusion

Single shade composites can reduce your inventory expense, simplify your “basic” restorations and also provide an excellent option for your more complex cases. If you have not yet given these products a try, now is a good time to get started!