ADVANCED TECHNIQUES IN GENERAL DENTISTRY JUNE 11, 2013 Dispensary Materials - Amalgam - not as good as amalgam performance.

Trituration time is 4 seconds. If you triturate for 12 seconds, you only have 1 and a half minute window to pack it. Increasing setting time more than twice or three times, in 10-15 minutes after packing amalgam, you can prep a crown on that tooth Excellent material and no other material can match it under a crown. Pack quickly because after 90 seconds, it will set on you. - Composite - Use Herculite and Z100 (3m ESPE) and Esthetics. - Z100 is probably one of the strongest composites and is great for posterior restorations; not recommended for anterior teeth. Gold standard of composites, included in a lot of research. - Herculite - another excellent composite for anteriors and posteriors. Has many shades. The shades look like porcelain Vita shade guide. For Herculite, just go with Vita shade guide. Esthet-X - Class 4, veneers, large restorations. Later there will be a lecture on differnt parts of the composite and different layers of the restoration. This composite comes with three different types enamel (shade guide and capsules), body, and opaque. Use the opaque when youwant to block shade on anterior teeth, then you need to layer it. Body is used as the dentin layer. Last 0.5 mm, place the enamel on top of it. You can then exactly match the shade with the existing patient's tooth shade. Again, he will give a lecture on the use of these materials later. DO NOT get the opaque for regular restorations. For anteriors, use enamel and body types. This shade guide shows any condition in the mouth - bleaching to dark staining. Tooth shade material includes which opaque, enamel, and body types that go with that particular shade. Example: shade C4 goes with C4-O (opaque), C4 (dentin), and GE (enamel) - all stands for three different tubes. When you get the shade guide, don't expect to match ONE SHADE for the entire tooth. **No course notes, only listen/watch Camtasias for this course. - Bonding materials: two options - Optibond Solo Plus and All Bond 2. - Optibond Solo Plus - etch the tooth 20 seconds, then rinse it, then dry but not overdry it. When applying Optibond Solo Plus, turn the light away and rub fresh material 3 TIMES to the entire preparation cavity for 20 seconds, otherwise you will not have bonding. Then, cure it. This is 5th generation bonding (will give lecture later). WE believe that generation 4 and 5 are the best for bonding. - All Bond 2 - 4th generation. This is the GOLD standard of bonding. Any research that comes out when they want to compare, they always compare with All Bond 2. As of yet, we don't have any agents that perform as well as this. First you etch, then prime (mix A and B - one drop of each) 8 times of the tip into the cavity preparation and make sure the operatory light is off. Then, light cure the primer in the prep. Then, place adhesive after mixing and then cure. MAKE SURE THAT THE CURING LIGHT IS NOT ON WHEN PRIMING!! Prime 8 times because it takes time to soak into the dentin. If you cure too soon, the patient will have sensitivity and not as great bonding of the restoration to the tooth. - ETCHANT - for etchants, we have 3 different materials: - Orthophosphoric acid (blue) used for enamel and dentin before using composite, etch for 20 seconds. - Yellow acid (hydroflouric acid) is used when we want to etch porcelain; we use it when we want to bond composite to porcelain. This is a very dangerous acid - MAKE SURE TO PUT RUBBER DAM AND COVER PATIENT'S EYES. This material needs to be placed for AT LEAST 2 minutes on the porcelain. After placing for one minute, rub the tip on the prep. When it is time to rinse it, gently rinse so that you don't have it splash everywhere on you and the patient. - Polyacrylic acid is used before placing glass ionomer to condition dentin and enamel. It partially removes the smear layer and prepares the glass ionomer to bond to the tooth. This is called a KELATING EFFECT, very weak bond involving calcium.

- Glass ionomer is an excellent material when used for the right patients - patient with a lot of caries in their mouths for any reasons. Control the caries and the disease and restore teeth with glass ionomers. Can be a temporary restoration for 2 -3 years or can be permanent. None of these glass ionomer materials are as strong as composite or amalgam. When used properly for the right application, they serve the patients well. Best solution for particular patients with rampant caries/individual problems. - Fuji 9 - comes in capsules. Trituration time is 8 seconds (even 10 is okay). Before using Fuji 9, use conditioning for glass ionomer or polyacrylic acid for 20 seconds. Fuji 9 will provide you with tremendous amount of Flouride and constantly pumps Fluoride into the patient's mouth. Excellent solution to stabilize carious mouth. - Fuji 2 - comes in liquid and powder form. Shows the ratio of the powder and liquid on the box as 1:1 ratio. Fuji 2 is basically like Fuji 9 but you manipulate it like you are mixing cement. Also like restorative material. - Fuji 2 LC - also a restorative material. The LC means "light cure"and is a glass ionomer that is like composite. You have a little more control on setting time. If you don't use light cure after 3-4 minutes, it will cure by itself. The amount of fluoride that this releases is less than Fuji II or Fuji 9. - GC Fuji PLUS - is a luting cement for VERY deep restorations that need direct or indirect capping. Ratio of powder to liquid is in the instructions and is 3 drops:1 powder. Make sure to look at the bottle and the conditioner is included as well. It is the same polyacrylic acid mentioned earlier. Lining cement is for liners and cementing crowns, DO NOTuse for indirect pulp caps or micro -exposures. - KETAC SILVER - comes in capsules and you use it like FUJI 9. NOT as strong as composite or amalgam. For a patient with rampant caries, it is not a bad idea to use this as a build -up material before prepping crown. If a tooth is endo treated you need a post. Make sure that there is enough tooth structure present before placing. - Vitrebond - light cure liner. Glass ionomer material which has composite reinforced because glass ionomer by itself cannot be light cured, so they added composite to it. Made by 3M company, you have more control with curing time etc. For micro -exposures, place dycal and liner. - Lining Cement by Fuji - releases more fluoride, for patient with rampant caries. - TI-CORE - another build-up material made of composite and needs to be treated like any other composite. The particles in it are titanum. Always use etchant, bonding agent, and then mix both Ti-core types together. Ti-core needs to be mixed together, load in centric syringe, and inject into the area you want. But you are NOT in control of the setting of the material. Some set faster than you can handle. Many cements - other lectures he will go over all of them. - Durelon cement - liquid and powders - used as temporary cement, especially for patients whose teeth are extremely sensitive, it has a neutral pH of 7 but it washes away faster than other cements. Carboxylate cement. Used over long breaks for patients. Bad thing about it: when removing the temporary, it will stick to the tooth and is a pain to remove it. You cannot easily scratch it off and have to use rotary instruments.