Posterior Handout

8/6/2019 Posterior Handout

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PosteriorRestora+ons


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TakeintoConsidera+ontheFollowing

RiskassessmentExtentofdecayLoca+onofthelesions:brokenmarginalridge?Surfacesinvolved:noMODs(anatomyof

primarytoothandcariesrate)

Pulpalinvolvement?Permanentorprimaryden++onBehaviourofpa+entAgeofpa+ent/stageofdentaldevelopmentParentalpreference


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Decisions,DecisionsCAVITY

SMALL

NEAREXFOLIATION

NO

COOPERATIVE

RESTORE

UNCOOPERATIVE

WAIT36MONTHS

OR

GLASSIONOMER

YES

GLASSIONOMEROR

ALLOWTOEXFOLIATE

LARGE

NEAREXFOLIATION

YES

EXTRACTOR

GLASSIONOMEROR

ALLOWTOEXFOLIATE

NO

COOPERATIVE

VITAL

RESTORE

NONVITAL

EXTRACTION

UNCOOPERATIVE

VITAL

GLASSIONOMER

NONVITAL

EXTRACTION


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ART

Atrauma+corAlterna+veRestora+veTreatment

1) Techniqueofrestoringcariesinpopula+onswithli\leornoaccesstodentalcare.

2) Techniqueofrestoringcariesinpa+entswhoareuncoopera+veorpre-coopera+ve

InvolvestheremovalofdecaywithahandinstrumentoraslowspeedrotaryinstrumentandplacementofamaterialsuchasGI


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Con+nuumofMaterials

Resinbasedcomposite Compomers Resinmodifiedglassionomers GlassionomersRangefrommosttoleasttechniquesensi+ve


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ResinBasedComposites

Mostesthe+c Mosttechniquesensi+ve


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Compomers

PrimarilyaresinbasedcompositewithaddedGI

Ini+allydevelopedtoactlikeaGI,withouttheneedtoetchandbond,howeverthisproveduntrueandtheywereinfactsimplyweaker

lessesthe+cresincomposites


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GlassIonomers

Chemicalbond Noneedtoetchandbond Fluoriderelease Thermalexpansionissimilartoenamel/

den+n

Lastgenera+onofGIwerenotesthe+c,newgenera+onareprovingtobemoreesthe+c ExamplesareRivaSelfCure,FujiIX


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RMGI

PrimarilyaGIbutwithaddedresinmaterialsandchemistrytoincreasestrengthand

esthe+cs Noneedforetchandbond Dualcure Fluoriderelease Examples:RivaLightCureandKetacNano


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UseofGlassIonomer(AAPD)

Lu+ngcements Cavitybase/liner ClassI,II,III,andVrestora+onsinprimaryteeth ClassIIIorVrestora+onsinyoungpermanent

teeththatcannotbeisolated

Cariescontrol Highriskpa+ents Restora+onrepair Atrauma+crestora+ontechnique


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RivaSCInstruc+ons

Isolatetooth,preparecavity.ApplyRivaConditionerfor10

secondsorSuperEtch37%PhosphoricAcidfor5seconds.

2.Washthoroughly.

3.Removeexcesswater.Keepmoist.

4.Activatethecapsuleandimmediatelymixinanamalgamator.

5.Immediatelyplaceintocapsuleapplicatorandclicktrigger

untilpasteisseenthroughthenozzle.

6.ExtrudeRivaSelfCureintocavityandcontour.

7.ApplyRivaCoatandlightcure.8.CommenceNinalNinishingunderwaterspray.

9.ApplyRivaCoatandlightcure.


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1.Isolatetooth,preparecavity.ApplyRivaConditionerfor

10secondsorSuperEtch37%PhosphoricAcidfor5

seconds.

2.Washthoroughly.

3.Removeexcesswater.Keepmoist.4.Activatethecapsuleandimmediatelymixinan

amalgamator.

5.Immediatelyplaceintocapsuleapplicatorandclicktrigger

until pasteisseenthroughthenozzle..

6.ExtrudeRivaLightCureinincrementsofnomorethan2mminto cavityandcontour.

7.Lightcureeachincrementfor20seconds.

8.FinalNinishingunderwaterspraycanbeginimmediately

afterlightcuring.

RivaLCInstruc+ons


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CompositeVs.GlassIonomer

Composite GlassIonomer

MoistureControl Polymeriza+onshrinkage Techniquesensi+ve Esthe+c HighlyPolishable Mechanicalbond

Moisturecontrolisnotcri+cal Expansion/contrac+onis

similartothatofthetooth Lesstechniquesensi+ve Bulkplacement Fluoriderelease ChemicalBond(acid/base

reac+on) Bioac+ve(ac+vitybetweenthe

saliva,restora+onandthetooth)


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CavityPrepara+oninPrimaryTeeth

THINNERENAMELANDDENTINTHANINPERMANENTTEETH

PULPSARELARGERINRELATIONTOTHECROWN PULPHORNSARECLOSERTOTHEDEJ SOMUSTRESTOREEARLY!!!!


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ProximalContacts

Wider,broader,fla\er Lessneedtocontourmatrixband Donotflarethatbox!


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CommonErrors

Failuretofollowtheoutlineofthecusps Isthmusistoowide Flareofproximalboxistoowide Gingivalcontactwithadjacenttoothisnot

broken


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Intracoronalrestora+onsvs.StainlessSteelCrowns

SSChada1.59+meshighersuccessrate

ascomparedtoclassIIrestora+ons.(Thisis

fromaliteraturereviewof10separatestudies)

MainreasonsoffailureofclIIrestora+ons

werefractureandsecondarycaries.AveragelifespanofaclIIrestora+onos2

years.


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IntraCoronalRestora+onSuccessRatesRetrospec+vestudyofdurabilityofamalgamsinprimaryteeth:

Braff1975:11%successover33.5monthsHolandetal1986:3yearsurvivalrate:Ds:38%Es48%Ovistetal1986:50%failedwithin2years

RobertsandSheriff1990:5yearsurvivalrateof67%


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StainlessSteelCrownSuccessRates

Overallsuccessrateof88%,meansurvival+meifplacedin


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StainlessSteelCrownTechnique

Occlusalreduc+onof12mm(straightfissurebur)

Interproximalreduc+on,mesialanddistal,mustbesubgingival,noledges Buccalandlingualbevel DONE!


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MixingofGICements

When mixing the cement it is important to usethe recommended powder to liquid ratio.

Too much powder dispensed= Increased viscosity and decreased workingtime

Too much liquid dispensed= Decreased physical properties of the setmaterial


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GICementAdvantages

Easier to mix Good Seal Fluoride release Fluoride recharging Ions exchange between the tooth and cement Good resistance to acid dissolution Remineralization Bonds to tooth structure

Bonds to metal substrate Snap Set Radiopaque


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Main features for Conventional GlassIonomer Cements are:

1.Adhesion to tooth structure2.Adhesion to metals3.Slow & sustained fluoride release


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LaminatedStainlessSteelCrowns

Compositefacing,bonded,oenwithmesh Limitedcrimpability Widermesiodeistally Bulky Easytoplace Suscep+bletolossoffacing

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Posterior Handout