Need of Anesthesia: Generally anesthesia is not required for the placement of composite restoration but if badly decayed tooth is being restored by composite, patient may experience pain while preparing cavity and removing decayed tooth structure then anesthesia may be required to numb the tooth.
Cavity Preparation: If the tooth is decayed then decayed portion of tooth is removed and tooth is given proper shape by doing minimal reduction of tooth structure. If composite filling is being done for cosmetic improvement then also minimal amount of tooth structure has to be reduced to provide space for composite restoration.
Cleaning of Tooth: Composite does not bond to the tooth structure properly if any debris or plaque is present on its surface. So, tooth surface is cleaned properly and polished using pumice.
Shade Selection: Composite is available in various shades. So, a shade is selected matching the color of tooth to be restored.
Isolation of Tooth: Tooth to be restored is isolated using cotton rolls or rubber dam. Isolation of tooth is very important for composite restoration as any contact of the tooth with oral fluids while placement of filling will hinder the bonding mechanism and composite will not adhere to the tooth properly.
Etching the Tooth Surface: Both enamel and dentin of the tooth are etched using 30-40% phosphoric acid. Phosphoric acid is available in a syringe in the form of a gel. Etchant is applied on the tooth surface for 15 seconds then it is washed away using water spray and tooth is dried with air. Enamel will have a frosted appearance on drying and if frosted appearance of enamel is not observed then process of etching is repeated again.
Application of Bonding Agent: A liquid bonding agent is applied on the etched tooth surface using a brush or applicator. Bonding agent is then cured using a special light source for 10-20 seconds.
Placement of Composite: Composite material is placed and cured in increments because light source can cure material only up to the depth of 2mm. Each increment of composite is cured for about 40 seconds after shaping it properly. Composite is available in two varieties:
Putty like material available in tubes which is taken out and filled in the tooth using a hand instrument. It is then shaped according to the form of tooth and cured using a light source.
Flowable composite available in syringes is applied directly on the tooth surface by pushing it out of the syringe. Then it is shaped using a hand instrument and cured/hardened using curing light.
Curing the composite: Composite is cured with curing machine.
Shaping the Restoration: Composite is filled slightly in excess and then it is shaped using cutting instruments (such as burs or diamond points) to give the tooth a proper contour.
Checking Bite: After place of composite, cotton rolls or rubber dam placed for isolation of tooth are removed and patient is asked to bring the opposite teeth together to check the presence of any high point on the surface of filling. If high point is present a carbon paper like articulating paper is used to mark it and it is removed.
Finishing and Polishing: Completed composite restoration is finished and polished using fine burs to give it a smooth surface.
No precautions are required after the placement of composite filling since they set immediately. Composite restoration is ready to be used as soon as it is placed in the tooth.
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