contentsGeneral consideration for composite restoration• Indication• Contraindication• Advantages• DisadvantagesClinical technique• Initial clinical procedure• Tooth preperation for restoration• Adhesion technique• Restorative technique for composite restoration

INDICATIONS-:

.1. Class I,II,III,IV,V,VI restorations

2. Foundation or core buildup.

3. Esthetic enhancement procedures- Partial veneers and Full veneers.

Tooth contour modifications. Diastema closure.

4. For periodontal splinting.

CONTRAINDICATIONS:-

1.High caries incidence and poor oral hygiene. 2.Teeth with heavy or abnormal Occlusal stress.

3.If access & isolation difficulties.

4.Subgingival difficulties

5.Patient allergic or sensitive to resin composite.

1.Esthetic.

2.Conservation of tooth structure.

3.Insulative.

4.Bonded to tooth structure.

5.”Command set”

6.Repairable.

7.Can be polished at the same appointment

ADVANTAGES:-

DISADVANTAGES:-

1.polymerization shrinkage.

2.time consuming and expensive.

3. More technique sensitive.

4. difficult to finish and polish.

5. increased coefficient of thermal expansion.

Clinical technique of composite restoration

A. Initial clinical procedures,B. Tooth preparation for compositeC. Restorative technique for composite

A-Initial clinical procedures,-Local anesthesia-Local anesthesia - patient is more relaxed - patient is more relaxed - reduced salivation- reduced salivation

-Preparation of operating site –-Preparation of operating site – clean the operating site with slurry of pumice to clean the operating site with slurry of pumice to remove any debris, plaqueremove any debris, plaque , pellicle, and superficial stains .Calculus removal

Prophylaxis pastes containing flavoring agents, or fluorides act as contaminants and should be avoided to prevent a possible conflict with the acid-etch technique.

ClinicalClinical techniquetechnique

Color varies with translucency, Color varies with translucency, thickness of enamel and dentin, age of thickness of enamel and dentin, age of the patient, presence of any external or the patient, presence of any external or internal stains internal stains

Different color zones are present - Different color zones are present - incisal third is lighter and translucent incisal third is lighter and translucent than cervical third. Middle third is blend than cervical third. Middle third is blend of two of two

Shade selectionShade selection

1. 1. Determine shade Determine shade at the startat the start of an appointment of an appointment (before the tooth is subjected to dehydration)(before the tooth is subjected to dehydration)

2. Use either 2. Use either natural lightnatural light (not direct sunlight) or a (not direct sunlight) or a colour corrected artificial light source.colour corrected artificial light source.

3. Drape the patient with a neutral colored cover if 3. Drape the patient with a neutral colored cover if clothing is bright clothing is bright

4. Make 4. Make rapid comparisonsrapid comparisons with shade tabs (no more with shade tabs (no more than 5 seconds each viewing) than 5 seconds each viewing) Make the selection Make the selection rapidly to avoid eye fatiguerapidly to avoid eye fatigue

Automated Shade Automated Shade SelectionSelection

Isolation of operating Isolation of operating sitesite

- Rubber dam- Rubber dam - cotton rolls- cotton rolls - retraction cord- retraction cord

1.1. Conventional Conventional

2.2. Beveled conventionalBeveled conventional

3.3. ModifiedModified

4.4. Box shapeBox shape

5.5. Facial/lingual slotFacial/lingual slot

B- Cavity designs for composite cavity B- Cavity designs for composite cavity preparationpreparation

similar to that of cavity preparation for amalgam similar to that of cavity preparation for amalgam restoration.restoration.

A uniform depth of the cavity with 90° cavosurface A uniform depth of the cavity with 90° cavosurface margin is required margin is required

INDICATIONSINDICATIONS1.1. Moderate to large class I and class II restorations Moderate to large class I and class II restorations 2.2. Preparation is located on root surfaces.Preparation is located on root surfaces.3.3. Old amalgam restoration being replacedOld amalgam restoration being replaced

CONVENTIONALCONVENTIONAL

1.1. Similar to conventional Similar to conventional cavity designcavity design

2.2. Have some beveled enamel Have some beveled enamel margins. margins.

INDICATIONSINDICATIONS1.1. Composite is used to replace Composite is used to replace

existing restoration.existing restoration.(class III, IV, V)(class III, IV, V)

2.2. Restore large areaRestore large area

Rarely used for posterior Rarely used for posterior composite restorationscomposite restorations

BEVELED CONVENTIONALBEVELED CONVENTIONAL

• Advantage of enamel bevel-ends of enamel rods are more effectively etched producing deeper microundercuts than when only the sides of enamel rods are etched.

1.1. No specified wall configuration.No specified wall configuration.2.2. No Specified pulpal or axial depth.No Specified pulpal or axial depth.3.3. All parameters determined by extent of caries.All parameters determined by extent of caries.4.4. Conserve tooth and obtain retention Conserve tooth and obtain retention (MICRO (MICRO

MECHANICAL). MECHANICAL). 5.5. Scooped out appearanceScooped out appearance

INDICATIONSINDICATIONS small, cavitated, carious lesion surrounded by small, cavitated, carious lesion surrounded by

enamel correcting enamel defects.enamel correcting enamel defects.

MODIFIEDMODIFIED

BOX ONLY PREPARATION• Indicated when only the proximal surface is faulty

with no lesion present on the occlusal surface

• Prepared with either an inverted cone or diamond stone held parallel to the long axis of tooth crown.

• Initial proximal axial depth - 0.2mm inside DEJ.

• Neither bevel nor secondary retention required.

FACIAL OR LINGUAL SLOTFACIAL OR LINGUAL SLOT1.1. Lesion is proximal but access is possible through Lesion is proximal but access is possible through

facial or lingual surfacefacial or lingual surface

2.2. Cavosurface is 90 or greater.Cavosurface is 90 or greater.

3.3. Direct access for removal of caries.Direct access for removal of caries.

- Calcium hydroxide, GIC , RMGICalcium hydroxide, GIC , RMGI- ZnOE is contraindicatedZnOE is contraindicated

Pulp protectionPulp protection

In deep cavities pulp protection may be necessary prior to acid etching and bonding.

ETCHING

Syringe for dispensing gel etchant

Applicator tip for liquid etchant

• 30-40% conc. Of phosphoric used(ideally 37%)• For enamel & dentin for 15 sec and then rinsed off.• Available as –liquid and gel.

Adhesion

Etching Procedure

ETCHING ENAMEL-• affects both prism core and prism periphery.• transforms smooth enamel into very irregular

surface.

• When fluid resin is applied to etched surface

Resin penetrates etched surface

Forms resin tags

Basis for adhesion of resin to enamel

ETCHING DENTIN-• Affects intertubular and peritubular dentin.• Removes the smear layer and exposes collagen

network to achieve optimal adhesion to the dentinal surface.

• After rinsing the surface is kept slightly moistened when dentin is also involved because it allows the primer and adhesive material to more effectively penetrate the collagen fibre to form a hybrid layer which is the basis for mechanical bond to dentin.

PRIMER or CONDITIONERS• Primers condition the dentin surface, &

improve bonding.• Acidic in nature• eg. EDTA,nitricacid, Maleic acid

Functions:-• Removes smear layer & provides subtle

opening of dentinal tubules.• Provides modest etching of the inter-tubular

dentine.

Bonding agents Classified :- First generation(1980) – used glycerophosphoric

acid dimethacrylate provide a bifunctional molecule. disadvantage – low bond strength.Eg-NPG-GMAsecond generation (1983)-adhesive agents for

composite resin. bond strength three times more than before. disadvantage-adhesion was short term the

bond eventually hydrolysed.Eg.prisma , universal bond,clearfil,scotch bond

Third generation – coupling agent had bond strength to that of resin to etched enamel.Disadvantages-use is more complex & require 2-3 application stepseg-tenure , scotch bond2,universal bond

Fourth generation-all bond-2 system consists of 2 primers(NPG-GMA and bisphenol dimethacrylate (BPDM) & an unfilled resin adhesive (40% BIS-GMA,30%UDMA,30%HEMA)

Fifth generation-single bond adhesive. advantage- single step application eg.3M single bond , one step (BISCO)

Application of Bonding Agent:

Application of the bonding agent and then cured for 10 seconds.

Uses of bond AgentsFor bonding composite to tooth structure.

Bonding composite to porcelain and various metals like amalgam, base metal and noble metal alloys.

Desensitization of exposed dentin or root surface.

Bonding of porcelain veneers.

• Two types:- 1.Self curing 2.Light curing.

SELF CURING: not used extensively .Disadvantages-1.Mixing of two pastes required and it is

almost impossible to avoid incorporation of air bubbles.

Air bubble contain oxygen that causes oxygen inhibition during polymerization.

2.No control of working time.

CURING

LIGHT CURING-• Material inserted in tooth preparation in 1-

2mm thickness. This allows the light to properly polymerize the composite and may render the effect of polymerization shrinkage appear along the gingival floor.

• ADVANTAGES-1.Sufficient working time.2.Not sensitive to oxygen inhibition.3.Easy placement.LIMITATION1.Time consuming2.Shrink towards the light source.

Curing Of the Composite:

The material is cured using the light curing machine for 20 seconds for every increment of composite that was placed.

Matrix placementMatrix placement

• Two types of matrices are availableTwo types of matrices are available - Polyester matrix- Polyester matrix - metal matrix - metal matrix

• Various matrix retainer which can be used Various matrix retainer which can be used areare

- Tofflemire retainerTofflemire retainer- Compound supported metal matrixCompound supported metal matrix- Sectional matrix system- palodent contact Sectional matrix system- palodent contact

matrixmatrix

• Polyester matrixPolyester matrix

- - used especially CLASS III, CLASS IV ,CLASS V used especially CLASS III, CLASS IV ,CLASS V cavitiescavities

AdvantageAdvantage - they allow the light to pass - they allow the light to pass

DisadvantageDisadvantage - they are not rigid and get deform - they are not rigid and get deform during placement of rigid material and contact during placement of rigid material and contact cannot be properly restoredcannot be properly restored

• Metal matrixMetal matrix

- - Ultrathin metal matrices .001- .002 inch are usedUltrathin metal matrices .001- .002 inch are used

- Band should be precontoured outside the mouth- Band should be precontoured outside the mouth

CONTOURING-Can be initiated immediately after light cured

composite have been placed or 3 minutes after the initial hardening of self cured material.POLISING-

Done with fine polishing discs, fine rubber points or cups.

Finishing and Polishing:

The use of polishers with enhancers and polishing paste were done after the trimming of the excess composites.

Finish & polish

Tungsten carbide finishing bur is used to contour the marginal ridge (note the water spray).

Rugby ball’-shaped fine diamond is used to contour the occlusal anatomy. All high-speed instruments must be used with water spray.

A flexible, abrasive, impregnated disc is used to polish and smooth the occlusal contours.

Finishing & Polishing

Before the restoration procedure.After restoring with Composite Resin

Material

 

Composite restorations are very technique sensitive so utmost care is necessary before, During and after manipulation.

The Visible Modes Of Failures 1) Discoloration-Especially At Margins 2) Marginal Fracture 3)Recurrent Caries 4) Post Operative Sensitivity 5) Cross Fracture Of Restoration 6) Lack Of Maintaining Contact 7) Accumulation Of Plaque Around The Restoration

Prepared by :Hazhar Ahmed XidrHemn Muhammed Xidr

Stage 4 , group D2