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How many universal material options can you rely on and how small a material set you can use today?
Companies market these materials as universal. Touted as one-size-fits-most materials addressing numerous indications, universal materials provide the reliable outcomes clinicians depend on in their fast-paced daily work.
We discuss universal materials options you can rely on, how small a material set you can keep on hand in your armamentarium, and how to sort through the options to find the universal solution that works best for most patients.
One significant category for these materials is universal cement. Jennifer Sanders, DMD, a private practice dentist in Frenchtown, Montana, is a user. After its performance, the most crucial reason she uses it is to reduce her inventory, which is essential to her practice management philosophy.
“I don’t want thousands of dollars worth of stuff sitting in my lab. The more stuff I have, the more it gets lost, or my assistants don’t know where it is or what to do with it. So if I can simplify, that makes everybody’s life a little bit easier,” Dr Sanders says.
Although she doesn’t use a one-shade universal composite, she does use a brand where the shades transition very well. The universal composite she uses isn’t as streamlined as the one-shade composite, but it gives her more control, a critical feature to many dentists.
Ease of use is essential to Dr Sanders too. Different systems have different workflows, which the dental team needs to remember. This process can leave a lot more room for user error when you aren’t as familiar with the workflow, she says. Therefore, using a universal cement often makes it easier to remember the manufacturer’s directions and simplifies the assistants’ setup.
International speaker and presenter Troy A. Schmedding, DDS, AAACD, says he likes Kuraray’s CLEARFIL Majesty™ ES-2 Universal in terms of a universal composite material that can handle most situations. He estimates that he uses it in 80% of his restorative cases in the posterior.
“I don’t think there’s a material out there today that covers 100% of your restorations,” Dr Schmedding says. “Materials that cover the broad spectrum of cases you do daily help you minimize your inventory because they are very reliable products.”
However, Dr Schmedding likes having more materials for anterior work, where he wants to do more mimicking. When working in the anterior, you must have a product line with opacities and translucency, he says. These materials allow clinicians to mimic nature and blend more consistently than they could with a universal.
“But overall, the universal composite is a great outlet for most of your cases,” he adds.
Todd Snyder, DDS, FAACD, FIADFE, ASDA, ABAD, uses BISCO’s All-Bond Universal bonding agent. He says he uses it for every case where a bonding agent is necessary and appreciates how he can use 1 bottle everywhere without sacrificing anything for convenience.
“To me, universal is 1 bottle that I can use without making sacrifices to the patient outcome,” Dr Snyder says. “I can use All-Bond for my direct restorations. I can use it for my indirect restorations. I can use it for my light-cured or my dual-cured. I don’t need any additional bottles ever. And it works with every manufacturer’s product and gets high bond strength."
Speaker and trainer Tim Bizga, DDS, FAGD, practices general dentistry in Cleveland, Ohio. He likes how universal products are great for inventory streamlining and how they provide efficiency and simplicity to the workflow. Like Dr Snyder, he uses BISCO’s All-Bond, and he also likes Prime&Bond elect® Universal Dental Adhesive from Dentsply Sirona. Universal primers have been efficient in his practice because he can use 1 primer with all the substrates, he says.
“Now you don’t have to stock 5 different bottles that expire fast because of their chemistry,” Dr Bizga says. “When they went universal, you got more shelf life and streamlined your inventory.”
Paring Down the Inventory
Dentists can go relatively small with inventory in some product types, depending on their preferences, Dr Sanders says. For example, she feels some clinicians might only need 1 cement, with the caveat that what clinicians do will drive those decisions.
Dr Sanders is not on board with using 1 composite everywhere in the mouth. However, she believes a composite with fewer shades that can be more versatile allows dentists to simplify their inventory significantly, reducing waste.
“I used to have all these different shades of composite, and they used to expire. I don’t have those anymore. So I’ve pared it down,” Dr Sanders says. “Some of that is me learning and growing in my practice and learning about inventory management, and some of it is the currently available materials.”
Advancements in composite technology for fillers contribute to streamlining materials, Dr Schmedding says. In addition, the spherical shape enables a better balance between light and tooth structure.
“It allows the material to absorb and scatter light better than any materials we’ve had in the past,” he says. “So we’ve all noticed a smaller product line, meaning we have more shades crossing over in composite dentistry than we ever have had before. What that’s done for us is take that 32-shade guide that they used to have and minimized it down to 4 to 6 shades that seems to cover a broad range of what we’re doing in dentistry."
Having 4 to 6 shades from a universal composite is a vast improvement over buying 32 shades, using 4, and throwing away 28, Dr Schmedding adds.
“In that sense, the advancement across the lines has been great,” he says.
Critical Considerations With Universal Materials
According to Dr Snyder, the first question clinicians should ask when using universal materials should be about its limitations. Next, dentists should consider what they are giving up to enjoy a universal application. Although universal can work in some products, in others it can be too much of a sacrifice in performance that leads to inferior patient outcomes.
“As a dentist, you have to think for yourself,” Dr Snyder says. “If something sounds too good to be true, it usually is…not always, but usually.”
The material that will do the job best based on the restoration prep is the driving force behind every product he uses, Dr Snyder says. So if that’s universal, he will choose that. However, if it isn’t, he picks the material that will work best for the treatment in front of him.
For example, glass ionomer cement, cermet, calcium aluminate, or calcium silicates are universal because clinicians can use them for many indications. However, Dr Snyder says it would be unwise for clinicians to use them in every situation. The same goes for many of the modern dual-barrel cements. They can do a lot, he notes, but not everything.
“If there’s going to be some saliva moisture, I need to jump to a calcium aluminate or glass ionomer, something that is made partially of water, that likes water, and creates hydroxyapatite in the presence of phosphate and sulcular fluids or saliva,” Dr Snyder explains. “So there’s a time when one should be used over the other.”
As universals are not one-size-fits-all, Dr Snyder cautions against making the automatic choice to use one based on convenience and expediency. For example, relying on quick and easy materials because they finish the job faster and increase the profitability of an inadequate insurance reimbursement does not lead to the best choices for the patient. Instead, he encourages clinicians to consider the trade-offs for ease of use and what that might mean for the long-term outcome.
“It’s all about the patient integrity,” Dr Snyder says.
Dentists should also ask why they need the product to be universal, according to Dr Bizga. Is it storage, inventory, efficiency, or all of the above? In his practice, Dr Bizga needs a primer with versatility. His practice performs a variety of procedures, from endodontics to implants and orthodontics, crowns, and fillings. With this variety, he wants universals that work with the different materials he chooses based on the patient and given situation.
“You have to look at the problem you’re trying to solve and whether you even have a problem,” Dr Bizga says, adding that sometimes people chase the newer product just because it’s new. “You’ve got to ask yourself, ‘Is this something I need?’ And for me, bonding and primers are areas where universals simplify things and make it much easier.”
Dr Sanders encourages clinicians to try a material before rethinking their inventory. If clinicians like the workability of the material or the way it polishes, they will have more success with their one-size-fits-most strategy for inventory management. Dr Snyder thinks talking to clinicians that use the product can help, too.
In addition, she thinks looking at the studies about the material for how it will hold up in the long term and buying from reputable companies is essential, too. Plus, the cost should be in line with a clinician’s expectations.
“If it’s way more expensive to have this 1 composite rather than having 5 composites, it’s not worth it,” Dr Sanders says. “It still needs to be worth it.”
Perhaps most importantly, Dr Schmedding believes clinicians should choose a universal material from a reputable manufacturer. Part of his attraction to Kuraray’s product lines is their performance over the years in the dental industry. Also, he encourages understanding the research behind the materials and the track records before jumping into new product lines and new manufacturers.
“You need to go with someone that’s been around the block for several years [and] has product lines that stand the test of time over and over, especially when dealing with adhesion-based composite dentistry,” Dr Schmedding says. “Make sure you are dealing with a good manufacturer.”