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7/28/2019 Class III, IV, V Direct Composite (2)
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Because Classes III and IV Restorations
involve only anterior teeth, an esthetic
material such as composite is indicated .
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Likewise, Class V Restorations on
anterior teeth usually require esthetic
restorations.
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Although esthetic considerations are valid
for posterior restorations, many patients are
not as concerned with esthetic in posterior
teeth as they are in anterior teeth .
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However, the use of composite for anyrestoration provides benefits rather than
improved esthetics.
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Pertinent Material Qualities and
Properties
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The specific material qualities or properties
that make composite the best material for
most Classes III, IV, and V Restorations
relate to esthetic.
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These include adequate strength and the
benefits of being able to bond thecomposite to tooth structure often resulting
in less tooth structure removal during tooth
preparation.
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Indications
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Almost all class III and Class IV restorations
are appropriately restored with composite.
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Most Class V restorations that are in estheticprominent areas are also appropriately
restored with composite or other tooth-
colored material.
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Contraindications
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The contraindications for use of composite for
these classes of restorations include:
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1- an operating area that cannot be
adequately isolated.
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2- some class V restorations in areasthat are not esthetically critical .
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3- some restorations that extend onto
the root surface.
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Clinical Technique for Direct Class III
Composite Restorations
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Initial Clinical Procedures
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Some information about procedures
necessary before beginning restoration:
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(1) Anesthesia may be necessary for patientcomfort, and if used, will help decrease the
salivary flow during the procedures.
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(2) Occlusal assessments should be made to
help in properly adjusting the restorations
function and in determining the tooth
design.
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(3) The shade must be selected before thetooth dehydrates and experiences
concomitant lightening .
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(4) The area must be isolated to permit
effective bonding.
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(5) If the restoration is large (including all ofthe proximal contact), inserting a wedge in
the area will assist in the re-establishment ofthe proximal contact with composite .
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Tooth Preparation
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Class III tooth preparations, bydefinition, are located on the proximal
surface of anterior teeth .
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Because the bond of composite to enameland dentin is so strong, most Class IIIcomposite restorations are retained only by
the micromechanical bond from acid
etching and resin bonding, so no additional
preparation retention form is usually
necessary.
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Using diamond stones for the toothpreparation leaves the prepared surfaces
rougher, increasing the surface area and
the micromechanical retention.
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Sometimes a groove or cove may benecessary for Class III restorations that
either extend onto the root surface or are
very large .
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The advantages of restoring theproximal lesion from the lingual
approach include:
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1- The facial enamel is conserved for
enhanced esthetics.
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2- Some unsupported, but not friable,enamel may be left on the facial wall of
Class III or Class IV preparation.
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3- Color matching of the composite is
not as critical.
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4- Discoloration or deterioration of the
restoration is less visible.
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Indications for a facial approach include
the following:
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1- The carious lesion is positioned faciallysuch that facial access would significantly
conserve tooth structure.
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2- The teeth are irregularly aligned, making
lingual access undesirable.
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3- An extensive carious lesion extends onto
the facial surface.
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When the facial and lingual surfaces areinvolved, the approach that provides the
best access for instrumentation should be
used.
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It is expeditious to prepared and restore
approximating carious lesions or faulty
restorations on adjacent teeth at the same
appointment.
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Conventional Class III ToothPreparation
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The primary indication for this type ofClass III preparation is for the restoration of
root surface.
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Beveled Conventional Class III
Tooth Preparation
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The beveled conventional tooth
preparation for composite restoration is
indicated primarily for replacing an
existing defective restoration in the crownportion of the tooth.
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The axial line angles may or may not beof uniform pulpal depth, varying as the
thickness of the enamel portion of the
external walls varies.
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Once the outline form and initial axial walldepth have been established, the initial
tooth preparation stage is completed and
the final stage of tooth preparation begins.
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Remove all remaining infected dentin usinground burs or small spoon excavators or
both.
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Some undermined enamel can be left innonstress areas, but very friable enamel
at the margins should be removed .
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Remaining old restorative material on theaxial wall should be removed if any of the
conditions presented earlier are present.
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Apply a calcium hydroxide liner only ifindicated .
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If restoration features (grooves or coves)
are indicated (and usually they are not),
Prepare them along the gingivoaxial line
angle and, sometimes, the incisoaxial lineangle with a No.1/4 bur .
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Occasionally retention may be provided
by undercuts left from caries removal.
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Particular care must be exercised not toweaken the walls or incisal angles that are
subject to masticatory force.
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Any necessary incisal retention cove is
prepared with the No.1/4 bur at theaxioincisal point angle with the bur
oriented in similar angle, 0.2mm inside the
DEJ, and 0.25mm deep.
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It is extended slightly into the facioaxial line
angle where it fades out.
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The placement of incisal retention is not
always as easy in mouth as illustratedbecause of handpiece size and angulation
problems caused by the anatomy of themaxilla and tooth positions.
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Modified Class III Tooth
Preparation
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A modified tooth preparation is the mostused type of Class III tooth preparation.
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It is indicated for small and moderatelesions or faults and is designed to be as
conservative as possible.
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The preparation design is dictated by the
extent of the fault or defect and is prepared
from a lingual approach when possible, with
an appropriate size round bur or diamondinstrument.
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No effort is made to produce preparationwalls that have specific shapes or forms
other than external angle of 90 degrees
or greater.
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Weakened, friable enamel is removed
while preparing the cavosurface margins in
a beveled or flared configuration with the
round diamond.
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Usually no groove (or cove) retention form
is indicated because the retention of the
material in the tooth will result from the
bond created between the compositematerial and the etched peripheral enamel.
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Begin the preparation from a lingual
approach (if possible) by making an opening
a round carbide bur or diamond instrument.
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Recommended