Clinical Success with Direct and Indirect Restorations

G. Franklin Shull Jr., DMD
Author: G. Franklin Shull Jr., DMD
Date: 10/10/2013 11:47am
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In his presentation on acheiving excellence in crown and bridge, Dr. Shull gave an overview of newer materials (high-strength ceramics and zirconia) as well as preparation techniqes and cementation options.


Dr. Shull outlined and detailed the chairside steps involved in indirect restorative cases: diagnosis (including risk factors), preparation (including impression taking and prep design), delivery (including cementation protocol), and maintenance (including hygiene practices and protective appliances).

"What I use"

To enhance diagnostic capabilities, Dr. Shull always uses magnification, specifically loupes and illumination from Orascoptic.

For impressions, Dr. Shull covered available digital options as well as DENTSPLY Caulk's new offering Aquasil Ultra Cordless.

For cementation, Dr. Shull introduced the audience to Doxa's Ceramir, an innovative natural, biocompatible dental luting cement. He also demonstrated the use of Ivoclar Vivadent's Ivoclean cleaning agent to for significantly improving bond strength.

Dr. Shull is a huge proponent of offering protective appliances along with restorative dentistry. He recommended the Drufomat system from DENTSPLY Raintree Essix as a convenient alternative for practices interested in fabricating protective guards in-house. He stessed that protective appliances protect valuable dentistry from damage caused by parafunction and dramatically prolong the life of restorations.


“Composite resin is one of the most used materials in restorative dentistry.” G. Franklin Shull, Jr., DMD, addressing more than 200 clinicians in attendance, shared his technique and experience with direct composite restorations. From material selection to adhesives to the procedure itself, Dr. Shull asked, “How can we do better?”

Research Before You Buy

Dr. Shull stressed the importance of conducting research before buying a product. “For all of the products I buy, I’ve researched them and I’ve heard speakers talk about them.” He went on to say that it’s incredibly easy to research products in this day and age, with the wealth of information available on the Internet. Dr. Shull advised that “newer is not always better” and to look for products with a proven track record.

Step 1: Diagnose

“If you’re not digital, it’s time.” Dr. Shull spoke on the importance of using both digital radiography and photography in diagnosing patients. These tools give the clinician a much more complete picture of the situation and allow for better planning (and therefore better outcomes).

In an interview, Dr. Shull said he uses Schick 33 digital intraoral sensors in his practice and likes that their replaceable cables offer an easy and inexpensive solution that reduces downtime.

From Preparation to Restoration

There is an often-overwhelming number of adhesives and composites on the market. The key is choosing the right tool for the right situation. There are many different generations of adhesives, from single bottle to multi-bottle, and self-etch to total-etch. The key is knowing which products offer the properties you need. Again, research proves important, as using the incorrect material or using a material incorrectly can lead to failures down the road.

In an interview, Dr. Shull recommended the KaVo COMFORTdrive handpiece because it provides quiet operation and high power in an ergonomic package.

Dr. Shull said that he uses VOCO’s Futurabond adhesive system in his practice because of the versatility it affords in being able to be used for both direct and indirect restorations. For the restoration itself, Dr. Shull also said that VOCO’s GrandioSO heavy flow makes for a great flowable composite. He likes the polishability of the product and the ability to use it in the anterior and posterior regions.

Throughout his lecture, Dr. Shull constantly reinforced the importance of knowing your material properties. As he put it, “All composites are not created equal. We need to know which composites to use in different situations.”

Attendees left both sessions with copious notes and practical product suggestions to take back to their practices.

Category TagsCAD/CAM, Dental Materials and Biomaterials, Esthetic Dentistry, Cements, Ceramics, Composites, Crown and Bridge, Magnification/ Lights/ Loupes, Restorative Materials