Clinical technique of composite restoration

presented by: Faisal Alanazi

Clinical technique of composite restoration

A. B. C. D. Initial clinical procedures, Tooth preparation for composite Restorative technique for composite Repairing composite restorations

Fahad will complete C and D

Clinical technique
A. Initial clinical procedures, 1. Local anesthesia - patient is more relaxed - reduced salivation 2. Preparation of operating site clean the operating site with slurry of pumice to remove any debris, plaque , pellicle, and superficial stains . Calculus removal
Prophy pastes containing flavoring agents, or fluorides act as contaminants and should be avoided to prevent a possible conflict with the acid-etch technique.

3.Shade selection
Color varies with translucency, thickness of enamel and dentin, age of the patient, presence of any external or internal stains
Different color zones are present - incisal third is lighter and translucent than cervical third. Middle third is blend of two

Vita Lumin: A= reddish brown B = reddish yellowB1 A1 B2 D2 A2 C1 C2 D4 A3 D3 B3 A3.5 B4 C3 A4 C4 C = grey shades D = reddish grey

3D Master

1. Determine shade at the start of an appointment (before the tooth is subjected to dehydration) 2. Use either natural light (not direct sunlight) or a colour corrected artificial light source. 3. Drape the patient with a neutral colored cover if clothing is bright 4. Assess value by squinting. The reduced amount of light entering the eye allows the retinal rods to better distinguish degrees of lightness and darkness. (Vita Lumin shade tabs set in order of value ) 5. Make rapid comparisons with shade tabs (no more than 5 seconds each viewing) Make the selection rapidly to avoid eye fatigue

 If more time (more than 30) required then look at complimentary colors (blue/violet) this revitalizes and resensititze the color receptors in the eye

6. Choose the dominant hue and chroma within the value range chosen. The canines - useful guide to assessing hue. 7. Compare selected tabs under different conditions eg wet vs dry, different lip positions, artificial and natural light from different angles. 8. Look carefully for colour characterisation such as stained imbrication lines, white spots, neck colouration, incisal edge translucency

Automated Shade Selection

B.Tooth preparation for composite

4.Cavity preparation

Tooth preparation principles and criteria

External Outline form
Extent is determined by size, shape, and location of defect . should include all Caries, any fault, defective, old friable tooth structure. Removal of discolored tooth structure as required for esthetics. Create prepared enamel margin of 90 or greater by giving bevel wherever required. Create 90 cavosurface on root surfaces Pulpally, no uniform depth is needed Depth should be sufficient to identify and remove caries or existing restoration.

RETENTION
1. 2. Micromechanical retention by etching of enamel and dentin. Mechanical undercuts when margins terminate in cementum.

Advantages of beveling.
1. Increase in surface area because stronger enamel to resin bond

2. Ends of enamel rods are etched. 3. Esthetic blending due to cavosurface bevel.

Cavity designs for composite cavity preparation

Conventional Beveled conventional Modified Box shape Facial/lingual slot

CONVENTIONAL
similar to that of cavity preparation for amalgam restoration. A uniform depth of the cavity with 90 cavosurface margin is required INDICATIONS 1. Moderate to large class I and class II restorations 2. Preparation is located on root surfaces. 3. Old amalgam restoration being replaced

BEVELED CONVENTIONAL
1. 2. Similar to conventional cavity design Have some beveled enamel margins.

INDICATIONS 1. Composite is used to replace existing restoration. (class III, IV, V) 2. Restore large area

Rarely used for posterior composite restorations

Combined design

MODIFIED
1. 2. 3. 4. 5.

No specified wall configuration. No Specified pulpal or axial depth. All parameters determined by extent of caries. Conserve tooth and obtain retention (MICRO MECHANICAL). Scooped out appearance

INDICATIONS small, cavitated, carious lesion surrounded by enamel correcting enamel defects.

BOX ONLY
When only Proximal surface is faulty and no lesion on occlusal surface

FACIAL OR LINGUAL SLOT

1. 2. 3. Lesion is proximal but access is possible through facial or lingual surface Cavosurface is 90 or greater. Direct access for removal of caries.

5. -

Isolation of operating site Rubber dam cotton rolls retraction cord

6 . Pulp protection - Calcium hydroxide, GIC , RMGI - ZnOE is contraindicated

7. Matrix placement
Two types of matrices are available - Polyester matrix - metal matrix
Various matrix retainer which can be used are - Tofflemire retainer - Compound supported metal matrix - Sectional matrix system- palodent contact matrix

 Polyester matrix

used especially CLASS III, CLASSIV ,CLASS V cavities Advantage - they allow the light to pass Disadvantage - they are not rigid and get deform during placement of rigid material and contact cannot be properly restored

Metal matrix

Ultrathin metal matrices 001- .002 inch are used

- Band should be precontoured outside the mouth

Reference
Theodore.M.Roberson,Harald.O.Heymann,Edward.J.SwiftJR.Sturdevant's Art and Science of Operative Dentistry.Mosby publications;2002; 483-492

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