1. Numb the tooth.
2. Drill an optimal slot for a white composite filling.
3. Remove remaining decay.
4. Ensure no decay remains.
5. Place matrix band.
6. Place wedge.
7. Place glass ionomer liner.
8. Etch the surface of the enamel.
9. Bond with a universal bond.
10. Set composite filling in layers.
11. Check the bite.
12. Check the contacts.
13. Remove excess composite.
14. Repeat steps 10 to 12 until the filling feels natural.
15. Polish filling.

Once the slot has been optimally drilled, I have great visualization of the decay unless I removed most of the decay while drilling the slot. With the decay exposed, I then use a slow-speed drill to remove the decay. A round drill bit will remove the decay without removing much of the healthy and solid tooth. This is one way to tell if you have removed all the decay because removing the decayed tooth will come out with a mushy consistency. If I drill on a partially decayed tooth, I will see a flakey texture. Or, if it is a healthy tooth structure, it will look dusty as you drill, indicating you no longer need to remove decay.

There are many types of matrix bands. I use a traditional matrix band that fits tightly around the circumference of the tooth. The matrix band helps isolate the filling from blood or saliva. It prevents liquid and doughy filling materials from flowing out of the tooth slot. Lastly, the matrix band helps shape the filling.

A glass ionomer liner is a layer of filling material that sits over the part of the filling closest to the dental pulp. The primary function of the glass ionomer liner is that it reduces sensitivity after a filling. A second function of the Glass Ionomer is that it releases fluoride to strengthen the tooth from any possible decay. Lastly, it provides an initial layer since you should place fillings in layers. We will cover this in a moment. Placing glass ionomer under every filling is a crucial difference that sets us apart from other dental practices, so our patients rarely experience sensitivity after a filling.

Watch this video if you want all the ways a filling could cause sensitivity.

There is research that shows GI liners don’t reduce sensitivity. However, in my practice, I went from having a couple of patients a year with sensitivity to almost never having patients with sensitivity. The difference was that I started using a glass ionomer liner on every filling. Initially, the research convinced me I didn’t need to use a liner, but the results have been very apparent to me. Glass ionomer liners reduce sensitivity after a filling. I believe we need more research on why there is a discrepancy in Glass Ionomer anti-sensitivity results.

After etching, we scrub a resin bond onto the tooth. I use the Peak Universal bond because it is the strongest bond that I have tested. The bond attaches the filling to the tooth and is the weakest point of the filling, which is why it is vital to use the strongest bond. I also make sure to “scrub” the bond in because that is the second most important factor for a strong bond.

If a filling is over-filled, it can completely throw off the bite. If the bite cannot settle correctly into place for long enough, it can cause permanent damage and pain in the jaw. However, the problems don’t end there. If the filling is too high, it can take the brunt of the biting force, putting too much pressure on the ligaments holding the tooth in place. The bruised ligaments can be painful and make it difficult to eat.

To avoid overfilling a tooth, we use a combination of checkpoints. First, we have a patient bite on blue carbon paper. If it leaves a mark on the filling without any spots on the natural teeth, most likely the filling is too high. However, that test sometimes gives false negatives, meaning no blue dots appear on the filling even though the bite is too high. Asking the patient if the bite feels off is another test. That is not a 100 percent accurate test because it is hard to judge a bite when numb. Lastly, we test the bite by the sound an even bite makes. Dentists can hear a chomping sound when a patient bites down on all their teeth evenly. We use a combination of these three tests to check for an even filling.

If there is a high spot on the filling, we simply use a finishing bur in the high-speed drill to remove the high spots. Then we repeat this step until the filling is even with the rest of the bite. During this step of the composite dental filling procedure, we also smooth off sharp edges that irritate the patient.

The last step of the filling is to polish it off. Polishing is the least important of the steps, as the filling will polish over time the more it grinds against the other teeth. However, polishing off the tooth is essential for the patient's satisfaction, so we always take this step.