direct posterior resin composites (ii) - جامعة الملك عبد العزيز ... · ·...

Direct Posterior Resin Composites (II)Direct Posterior Resin Composites (II)Direct Posterior Resin Composites (II)Direct Posterior Resin Composites (II)

Motaz A Ghulman BDS MSD CAGS DScDMotaz A Ghulman BDS MSD CAGS DScDMotaz A Ghulman BDS MSD CAGS DScDMotaz A Ghulman BDS MSD CAGS DScDMotaz A. Ghulman, BDS, MSD, CAGS, DScDMotaz A. Ghulman, BDS, MSD, CAGS, DScDAssistant Professor of Operative/Esthetic DentistryAssistant Professor of Operative/Esthetic Dentistry

Chairman, Conservative Dental Sciences DepartmentChairman, Conservative Dental Sciences Department

Motaz A. Ghulman, BDS, MSD, CAGS, DScDMotaz A. Ghulman, BDS, MSD, CAGS, DScDAssistant Professor of Operative/Esthetic DentistryAssistant Professor of Operative/Esthetic Dentistry

Chairman, Conservative Dental Sciences DepartmentChairman, Conservative Dental Sciences DepartmentFaculty of DentistryFaculty of Dentistry

King Abdulaziz UniversityKing Abdulaziz UniversityFaculty of DentistryFaculty of Dentistry

King Abdulaziz UniversityKing Abdulaziz University

Preventive Resin Restorations (PRR)Preventive Resin Restorations (PRR)Preventive Resin Restorations (PRR)Preventive Resin Restorations (PRR)

Once the lesion is eliminated, no further preparation is performedOnce the lesion is eliminated, no further preparation is performed

A restorationA restoration

, f p p p f, f p p p f

A restorationA restoration

that that

Maximizes the Maximizes the benefits of conservative, adhesive dentistrybenefits of conservative, adhesive dentistryDeveloped to overcome problems associated with Developed to overcome problems associated with traditional traditional “extension for prevention”“extension for prevention” in restorations in restorations f pf pnecessitated by minimal occlusal caries lesions necessitated by minimal occlusal caries lesions

Limits preparation to Limits preparation to pit & fissures that are cariouspit & fissures that are cariouss p p o os p p o o p f e h ep f e h e


IfIfIf If

restricted to restricted to narrow & shallow opening of the fissurenarrow & shallow opening of the fissure(a (a resin sealantresin sealant or or flowable resin compositeflowable resin composite)) is placedis placed

IfIfadditi al t th t t i dadditi al t th t t i dadditional tooth structure is removedadditional tooth structure is removed

(a (a posterior resin compositeposterior resin composite)) in that area & the remaining in that area & the remaining fissures & the surface of the resin composite restorationfissures & the surface of the resin composite restorationfissures & the surface of the resin composite restoration fissures & the surface of the resin composite restoration

are sealed with are sealed with ((resin sealant material or flowable compositeresin sealant material or flowable composite))


ConservationConservation of tooth of tooth structurestructurestructurestructure

Enhanced Enhanced estheticsestheticsI dI d ll f if i

IndicationsIndicationsMinimally or moderatelyMinimally or moderately

Improved Improved sealseal of restorative of restorative material to tooth structurematerial to tooth structure

Mi i lMi i l

y yy ycarious fissurescarious fissures

ContraindicationsContraindicationsMinimal Minimal wearwearNo No progressionprogression of sealed caries of sealed caries

l il i

Restorations that will Restorations that will occupy aoccupy a large area of thelarge area of thelesionslesions

Good Good longevitylongevity

occupy a occupy a large area of the large area of the occlusal surfaceocclusal surface


TechniqueTechnique The preparation should be The preparation should be TechniqueTechniqueThe The preoperative evaluationpreoperative evaluation, , marking the marking the

occlusionocclusion, , shade selectionshade selection, & , & rubber dam isolationrubber dam isolation

T e p epa at o s ou d beT e p epa at o s ou d beinitiated with the smallest initiated with the smallest

instrumentinstrument(that will accomplish this(that will accomplish this

•• should be accomplishedshould be accomplished(that will accomplish this (that will accomplish this limited preparation), such limited preparation), such

asasNN 11//1616 11//88 d bd ba a No. No. 11//1616 or or 11//88 round burround bur

The conservative adhesion preparationThe conservative adhesion preparation•• eliminates demeniralized dentin & eliminates demeniralized dentin & associated unsupported & demeniralizedassociated unsupported & demeniralized N b lN b l h ld b l dh ld b l dassociated unsupported & demeniralized associated unsupported & demeniralized

enamelenamelNo bevel No bevel should be placed should be placed on the occlusal marginon the occlusal margin

Preventive Resin Restorations (PRR)Preventive Resin Restorations (PRR)Preventive Resin Restorations (PRR)Preventive Resin Restorations (PRR)No pulpal protection is neededNo pulpal protection is needed

(these restorations are limited (these restorations are limited in size & depth)in size & depth) Areas that have extended into dentinAreas that have extended into dentin

•• (are filled with (are filled with post resin compositespost resin composites))

Prior to curing thePrior to curing the final incrementfinal increment,, occlusal occlusal anatomyanatomyanatomy anatomy

•• (is developed with a (is developed with a hand instrumenthand instrument))

Etching & application of Etching & application of g pp fg pp fdentin bonding agentdentin bonding agent

(are the same as with other (are the same as with other adhesive restorativeadhesive restorativeadhesive restorative adhesive restorative

procedures)procedures)


If If adj t t adj t t i i If If adj t tadj t t i i Aft pl ti f thAft pl ti f thIf If no adjustmentno adjustment is is requiredrequired

((sealantsealant is placed over the is placed over the

If If adjustmentadjustment is is requiredrequired

(the entire fissure (the entire fissure

After completion of the After completion of the restorationrestoration

(the RD is removed(the RD is removed(( ppresin composites, resin composites,

through remaining through remaining prepared or prepared or

((system, including the system, including the resin composite & its resin composite & its margins, should be margins, should be rere--

((& correct occlusion & correct occlusion verified or obtained)verified or obtained)

p pp punprepared etched unprepared etched

fissures, & cured)fissures, & cured)

g ,g ,etched & adhesive resin etched & adhesive resin reapplied prior to sealant reapplied prior to sealant

placementplacement))pp ))

Other class Other class 1 1 resin resin Other class Other class 2 2 resin resin composite restorationscomposite restorations

WhWh ClCl 11 ii

composite restorationscomposite restorations

When a When a Class Class 11 restorationrestoration

is is

A ith ti i t tiA ith ti i t tiBeing placed due to Being placed due to

initial carious lesioninitial carious lesionTheThe PRRPRR is s all the techniq e of choiceis s all the techniq e of choice

As with preventive resin restorationsAs with preventive resin restorationsClass Class 2 2 restorationsrestorations

Sh ld b li it d tSh ld b li it d tThe The PRRPRR is usually the technique of choiceis usually the technique of choice

If If ThTh

obtaining access to the obtaining access to the carious dentincarious dentin its removalits removal

Should be limited toShould be limited to

There was There was a previous restorationa previous restoration

The outline form & depth of the The outline form & depth of the

carious dentincarious dentin, its removal, , its removal, & the removal of any overlying & the removal of any overlying fragile & fragile &

demeniralized enameldemeniralized enamelpreparation will be determined by te preparation will be determined by te preveous restoration & any new pathosispreveous restoration & any new pathosis

Margins of occlusal preparations Margins of occlusal preparations Margins of occlusal preparations Margins of occlusal preparations should not be beveledshould not be beveled

Class II resin composite restorationsClass II resin composite restorationsClass II resin composite restorationsClass II resin composite restorations

P d iP d iPrewedging Prewedging PreparationPreparation

Use of cavity linersUse of cavity linersAcid etchingAcid etchinggg

Application of bonding resinApplication of bonding resinMatrix applicationMatrix applicationpp cpp c

Resin composite placementResin composite placementFinishingFinishingFinishingFinishing

Rebonding & final cureRebonding & final cure

Class II resin composite restorationsClass II resin composite restorationsClass II resin composite restorationsClass II resin composite restorationsPrewedgingPrewedgingg gg g

Placement of an interproximal wedgePlacement of an interproximal wedge((at the start of the procedureat the start of the procedure))((at the start of the procedureat the start of the procedure))

is recommended tois recommended to

open the open the contact with the adjacent toothcontact with the adjacent toothcompensate for the compensate for the thickness of the matrix bandthickness of the matrix band

protect the protect the RD RD from damage from damage & gingival tissue& gingival tissue from from lacerationlaceration

r dr d l k i t th p tiv itl k i t th p tiv itreduce reduce leakage into the operative siteleakage into the operative sitepromotes promotes more conservative preparationmore conservative preparation

helps protecthelps protect adjacent teeth from damaging during preparationadjacent teeth from damaging during preparationhelps protect helps protect adjacent teeth from damaging during preparationadjacent teeth from damaging during preparation


P tiP tiPreparationPreparation

PreparationPreparationpp

should be limited toshould be limited to

Eliminating Eliminating carious tooth structurecarious tooth structure& providing & providing access for restoration access for restoration

placement & finishingplacement & finishing(areas of fissure caries lesions in the tooth, in (areas of fissure caries lesions in the tooth, in addition to the proximal, should be treated addition to the proximal, should be treated

p t l )p t l )separately)separately)


P tiP tiPreparation Preparation ((following are recommendations regarding bevel following are recommendations regarding bevel

placement in Class placement in Class 22 preparations for posterior resin preparations for posterior resin pp p p pp p pcomposite restorationscomposite restorations

Facial &Facial & lingual proximal marginslingual proximal marginsFacial &Facial & lingual proximal marginslingual proximal margins

Conservative bevels (Conservative bevels (00..55mm) at approx. a mm) at approx. a 4545--degree angledegree angle((on the facial & lingual cavosurface marginson the facial & lingual cavosurface margins)) of the proximal of the proximal (( f g f gf g f g )) pp

box preparationbox preparationthis willthis will

achieve the achieve the benefits of beveling (provides more area for acid etching & benefits of beveling (provides more area for acid etching & bonding)bonding)

aid in placing the aid in placing the margin in a more accessible location for finishing & margin in a more accessible location for finishing & polishingpolishing

Class II resin composite restorationsClass II resin composite restorationsClass II resin composite restorationsClass II resin composite restorationsPreparationPreparationPreparationPreparation

Gingival marginsGingival margins

Th i i l iTh i i l iThe gingival marginThe gingival marginshould be should be beveledbeveled

only ifonly if

•• the margin is the margin is well above the well above the CEJCEJCEJCEJ

•• & an adequate & an adequate band of band of enamel remainsenamel remains


When the enamel is well above the CEJWhen the enamel is well above the CEJWhen the enamel is well above the CEJWhen the enamel is well above the CEJAppropriate proximalAppropriate proximalf i b b l df i b b l dcavosurface margin can be beveled cavosurface margin can be beveled

(gingival as well as facial & lingual vertical (gingival as well as facial & lingual vertical cavosurface margins are beveled)cavosurface margins are beveled)cavosurface margins are beveled) cavosurface margins are beveled)


As the preparation nears the CEJAs the preparation nears the CEJAs the preparation nears the CEJAs the preparation nears the CEJthe the enamel layer is thinnerenamel layer is thinner than in the other regions of the crownthan in the other regions of the crown& & beveling the preparation increases the beveling the preparation increases the potential for removing the potential for removing the

little enamel that remainslittle enamel that remainsBecause of the presence of prismless enamel in this region, acid etching is often less effective Because of the presence of prismless enamel in this region, acid etching is often less effective When cavity preparation approaches within approx. When cavity preparation approaches within approx. 11mm of CEJ, adhesion is essentially mm of CEJ, adhesion is essentially

no better than bonding to dentinno better than bonding to dentin

Class II resin composite restorationsClass II resin composite restorationsClass II resin composite restorationsClass II resin composite restorationsPreparationPreparationPreparationPreparation

Gingival marginsGingival margins

Use of anUse of an inverse bevelinverse bevel or soor so calledcalled internal bevelinternal bevelUse of an Use of an inverse bevelinverse bevel, or so, or so--called called internal bevelinternal bevel((leaving enamel that is not supported by dentin at leaving enamel that is not supported by dentin at

h i i l f ih i i l f i ))the gingival cavosurface marginthe gingival cavosurface margin))

has been shown tohas been shown to

significantly reduce significantly reduce microleakagemicroleakage compared to a compared to a butt regionbutt regionbutt regionbutt region

•• & would be preferable to & would be preferable to placing the gingival placing the gingival margin on, or near, the CEJmargin on, or near, the CEJg , , Jg , , J

Class II resin composite restorationsClass II resin composite restorationsClass II resin composite restorationsClass II resin composite restorationsPreparationPreparationP epa at oP epa at o

Occlusal marginsOcclusal margins

The use of occlusal cavosurface margin bevelsThe use of occlusal cavosurface margin bevels is not indicatedis not indicated

A normal preparation in the occlusal surface will result in endA normal preparation in the occlusal surface will result in end--cut enamelcut enamelA normal preparation in the occlusal surface will result in endA normal preparation in the occlusal surface will result in end cut enamel cut enamel rods because of the orientation of the enamel rods in cuspal inclinesrods because of the orientation of the enamel rods in cuspal inclines


Avoidance of bevel onAvoidance of bevel onthe occlusal surfacethe occlusal surfacethe occlusal surfacethe occlusal surface

Prevents the loss of sound tooth structurePrevents the loss of sound tooth structureDecreases the surface area of the final restorationDecreases the surface area of the final restoration

Lessens the chance of occlusal contact on the restorationLessens the chance of occlusal contact on the restorationEliminates a thin area of composite that would be more Eliminates a thin area of composite that would be more

susceptible to fracturesusceptible to fracturePresents a well demarcated marginal periphery to which Presents a well demarcated marginal periphery to which

resin composite can more precisely finished resin composite can more precisely finished


Use of cavity linersUse of cavity linersUse of cavity linersUse of cavity liners

calcium hydroxide liner calcium hydroxide liner Placement of a calcium Placement of a calcium hydroxide liner hydroxide liner over an over an

If used,If used, should be limited to should be limited to •• those areas of the those areas of the

extensive area of dentinextensive area of dentinProvides no benefit to the Provides no benefit to the

preparation that are preparation that are believed to be believed to be very close very close to the pulpto the pulp where therewhere there

pulppulpDecreases the surface area Decreases the surface area f dh if dh ito the pulpto the pulp, , where there where there

is the possibility of a is the possibility of a minute pulp exposureminute pulp exposure

for adhesionfor adhesionDissolution of the liner Dissolution of the liner during acid etching canduring acid etching canp p pp p p

If the preservation is conservative in size, no If the preservation is conservative in size, no liner is required in addition to adhesive liner is required in addition to adhesive

during acid etching can during acid etching can interfere with a sound interfere with a sound bond to enamel & dentinbond to enamel & dentinqq

agentagent

Class II resin composite Class II resin composite restorationsrestorations

Use of cavity linersUse of cavity liners

ll

WWhen used under posterior resin compositeshen used under posterior resin compositesBondBond to both tooth structure & to both tooth structure &

glassglass--ionomer ionomer may be beneficialmay be beneficial

overlying resin compositesoverlying resin compositesIntroduce Introduce less polymerization stressless polymerization stress into into yy

•• in deeper in deeper preparations & preparations &

tooth structure than does resin tooth structure than does resin compositecompositeR l fl dR l fl d i dj hi dj hthose in which the those in which the

gingival margin gingival margin hh

Release fluorideRelease fluoride into adjacent tooth into adjacent tooth structurestructureII i l i t iti l i t itapproaches or approaches or

extends beyond extends beyond the CEJthe CEJ

Improve Improve marginal integritymarginal integrityDecrease Decrease marginal leakagemarginal leakage

the CEJthe CEJ


Acid etchingAcid etching•• 3737% phosphoric acid % phosphoric acid •• for for 15 15 secondsseconds•• The enamel is examined for The enamel is examined for

a frosted matte appearance a frosted matte appearance to confirm proper enamel to confirm proper enamel conditioningconditioning

Class II resin composite restorationsClass II resin composite restorationsClass II resin composite restorationsClass II resin composite restorationsApplication of bonding resinApplication of bonding resin

PrimerPrimerHydrophilic resin Hydrophilic resin

•• contained in a volatile liquid carriercontained in a volatile liquid carrier

Aft li tiAft li tiAfter applicationAfter application•• the carrier evaporates, leaving behind a very thin the carrier evaporates, leaving behind a very thin

layer of resinlayer of resin

AdhesiveAdhesiveAdhesiveAdhesiveApplied in a very thin layer & thinned Applied in a very thin layer & thinned further with a blotted brushfurther with a blotted brushfurther with a blotted brushfurther with a blotted brush


Application of bonding resinApplication of bonding resin

fifthfifth--generation, or “single bottle,” adhesive systems,generation, or “single bottle,” adhesive systems,fifthfifth generation, or single bottle, adhesive systems,generation, or single bottle, adhesive systems,in which the primer & adhesive components have been combined,in which the primer & adhesive components have been combined,

A different placement technique is requiredA different placement technique is requiredp q qp q q•• Air thinningAir thinning (needed to ensure adequate evaporation of the (needed to ensure adequate evaporation of the

solvent)solvent)solvent)solvent)•• Additional applicationsAdditional applications (recommended to maximize the bond to (recommended to maximize the bond to

dentin)dentin)dentin)dentin)


Matrix applicationMatrix application

Several useful matrices areSeveral useful matrices areSeveral useful matrices are Several useful matrices are availableavailable

l pl ti t il pl ti t i

includingincluding

•• clear plastic matrixclear plastic matrix•• ultrathin (ultrathin (00..001001--inch) Toflemire metal matrixinch) Toflemire metal matrix

hi (hi (00 00150015 i h) i l ii h) i l i•• thin (thin (00..00150015--inch) sectional matrixinch) sectional matrix•• & & Toflemire metal matrix with photoetchedToflemire metal matrix with photoetched--

thinned (thinned (00 00050005 inch) cont ct reinch) cont ct rethinned (thinned (00..00050005--inch) contact areainch) contact area

Clear matrixClear matrixClear matrixClear matrix

Can be used in conjunction with a lightCan be used in conjunction with a light reflecting wedgereflecting wedgeCan be used in conjunction with a lightCan be used in conjunction with a light--reflecting wedgereflecting wedgeAllows Allows penetration of the curing penetration of the curing

lightlight from multiple directionsfrom multiple directions The clear matrix isThe clear matrix is thickerthicker thanthanlightlight from multiple directionsfrom multiple directionsAllows the clinician to Allows the clinician to cure the cure the

increments of composites from the increments of composites from the i li l & i i l di i& i i l di i

The clear matrix is The clear matrix is thickerthicker than than the thinnest metal matricesthe thinnest metal matricesIts Its lack of rigiditylack of rigidity makes makes

proximalproximal & gingival directions& gingival directions, , rather than from the occlusal aspect rather than from the occlusal aspect

onlyonly

placement through tight placement through tight interproximal contacts difficultinterproximal contacts difficultTheThe rigidity & smoothness of rigidity & smoothness of

To ensure To ensure adequate polymerizationadequate polymerizationof each incrementof each increment

AllowsAllows more favorable directionmore favorable direction ofof

The The rigidity & smoothness of rigidity & smoothness of the lightthe light--reflecting wedgereflecting wedge

makes it less effective in gaining makes it less effective in gaining the slight tooth separationthe slight tooth separationAllows Allows more favorable directionmore favorable direction of of

the polymerization shrinkagethe polymerization shrinkagethe slight tooth separationthe slight tooth separation

Ultrathin metal matricesUltrathin metal matricesUltrathin metal matricesUltrathin metal matrices

Tight interproximal Tight interproximal contacts are more easily developedcontacts are more easily developed with itwith itEasierEasier to placeto placepp

Maintain their shapeMaintain their shape betterbetterCan beCan be burnished against the adjacent toothburnished against the adjacent tooth (to a oid flat(to a oid flatCan be Can be burnished against the adjacent toothburnished against the adjacent tooth (to avoid flat (to avoid flat

proximal surfacet contours) proximal surfacet contours) II b i i i ll d f h l l b i i i ll d f h l l Increments Increments must be initially cured from the occlusal aspectmust be initially cured from the occlusal aspect

Sectional matrixSectional matrixSectional matrix Sectional matrix used with metal rings with used with metal rings with

springlike propertiesspringlike propertiesAfter the sectional matrix & wedgeAfter the sectional matrix & wedgeAfter the sectional matrix & wedge After the sectional matrix & wedge are placed, are placed, the ringthe ring is placed using is placed using RD clamp forcepsRD clamp forceps, ,

•• so that the so that the vertical pointsvertical points are are positioned in the facial & lingual positioned in the facial & lingual

Provide wedgingProvide wedging to ensure to ensure good interproximal contactgood interproximal contact

embrasures adjacent to the box embrasures adjacent to the box preparationpreparation

Th iTh i h ld h d f h i lh ld h d f h i l

Provide better proximal Provide better proximal contourcontour than traditional matricesthan traditional matrices

The ringThe ring holds the end of the sectional holds the end of the sectional matrixmatrix tightly against the tooth & tightly against the tooth & exerts a continuous separation forceexerts a continuous separation force

Simplify matrix placementSimplify matrix placement for for single proximal surface single proximal surface

i di dexerts a continuous separation forceexerts a continuous separation forcebetween the teethbetween the teeth

restorations, compared to restorations, compared to circumferential bandcircumferential band

Sectional matrixSectional matrixSectional matrix Sectional matrix

Another typeAnother typeAnother type Another type involves a short piece of thin, involves a short piece of thin,

stainless steel matrixstainless steel matrixstainless steel matrix stainless steel matrix materialmaterial

That is contoured only occlusogingivally & does not surround the tooth at allThat is contoured only occlusogingivally & does not surround the tooth at allThe contoured matrix is secured with a wooden wedge & lies passivelyThe contoured matrix is secured with a wooden wedge & lies passivelyThe contoured matrix is secured with a wooden wedge & lies passively The contoured matrix is secured with a wooden wedge & lies passively

against the adjacent tooth surface or it held there with an instrument during against the adjacent tooth surface or it held there with an instrument during curing of the first incrementcuring of the first incrementgg

Allows someAllows some light curing from facial & lingual aspectslight curing from facial & lingual aspectsAllows some Allows some light curing from facial & lingual aspectslight curing from facial & lingual aspects


R i i lR i i lResin composite placement:Resin composite placement:incremental techniqueincremental technique

S i l i d iS i l i d iSuccessive , laminated increments, to Successive , laminated increments, to ensure curingensure curingdecreases the effect of polymerizationdecreases the effect of polymerizationdecreases the effect of polymerization decreases the effect of polymerization shrinkageshrinkageenhances marginal adaptationenhances marginal adaptationg pg pdecreases gap formationdecreases gap formationreduces marginal leakagereduces marginal leakageg gg gdecreases cuspal deformationdecreases cuspal deformationmakes the cusps more resistant to fracturemakes the cusps more resistant to fracture& decreases postoperative sensitivity & decreases postoperative sensitivity


Fi iFi iFirst incrementFirst incrementAn incrementAn increment no more than no more than 11..0 0 mmmm is placed againstis placed againstAn increment An increment no more than no more than 11..0 0 mmmm is placed against is placed against

the gingival floorthe gingival floorto ensure proper light irradiation throughout the incrementto ensure proper light irradiation throughout the increment•• to ensure proper light irradiation throughout the incrementto ensure proper light irradiation throughout the increment

A light, translucent shadeA light, translucent shade should be used in the box should be used in the box •• to maximize polymerizationto maximize polymerization


If If a clear matrix & lighta clear matrix & light--reflecting wedgereflecting wedgeare being used, are being used,

•• the initial curing should be directed the initial curing should be directed through the flat end of the wedgethrough the flat end of the wedge

If If a metal matrix that surrounds the tootha metal matrix that surrounds the tooth has been chosenhas been chosen•• All increment must be cured from the occlusal directionAll increment must be cured from the occlusal direction•• After the metal matrix is removedAfter the metal matrix is removed

All proximal area of the restoration should receive additional All proximal area of the restoration should receive additional light curinglight curing

Class II resin composite restorationsClass II resin composite restorationsClass II resin composite restorationsClass II resin composite restorationsSubsequent incrementsSubsequent increments

should be placed in should be placed in thickness no greater than thickness no greater than 22..0 0 mmmm

If If a surrounding metal matrixa surrounding metal matrix is empolyedis empolyed•• An oblique layering techniqueAn oblique layering technique should be should be

used, & the restoration should be cured used, & the restoration should be cured f h f i l li l ff h f i l li l ffrom the facial & lingual aspects after from the facial & lingual aspects after removal of the matrixremoval of the matrix


If If a clear matrixa clear matrix is used is used •• The oblique technique or a virtical The oblique technique or a virtical q qq q

techniquetechnique should be usedshould be used


Resin composite placement: Resin composite placement:

A lt ti t l i t h iA lt ti t l i t h iAn alternative to layering techniqueAn alternative to layering techniqueConical light curing tipConical light curing tip

Prepolymerized resin composite “balls”Prepolymerized resin composite “balls”


Resin composite placement: An alternative to Resin composite placement: An alternative to layering techniquelayering techniquey g qy g q

(The use of a conical light curing tip)(The use of a conical light curing tip)::•• Conical tip is wedged into the resin compositeConical tip is wedged into the resin composite•• Used to apply pressure to the matrix band & push it Used to apply pressure to the matrix band & push it

against the adjacent tooth during curingagainst the adjacent tooth during curingSubsequent increments restore the coneSubsequent increments restore the cone shaped gapshaped gap•• Subsequent increments restore the coneSubsequent increments restore the cone--shaped gap shaped gap formed by the tipformed by the tipEnsure Ensure adequate interproximal contactadequate interproximal contactMinimize the thickness of resin compositeMinimize the thickness of resin composite that that the light must penetratethe light must penetrate


R i it l t A lt ti tR i it l t A lt ti tResin composite placement: An alternative to Resin composite placement: An alternative to layering techniquelayering technique

(the use of prepolymerized resin composite (the use of prepolymerized resin composite ( p p y p( p p y p“balls”)“balls”)::

•• A small, slightly flattened ball of composite A small, slightly flattened ball of composite is precured on the tip of an instrumentis precured on the tip of an instrumentis precured on the tip of an instrument.is precured on the tip of an instrument.

•• An additional increment of uncured resin An additional increment of uncured resin composite is placed into the proximal boxcomposite is placed into the proximal box

•• The precured ball is pushed into this The precured ball is pushed into this increment to wedge the matrix tightly increment to wedge the matrix tightly against the adjacent tooth, then the resin against the adjacent tooth, then the resin g jg jcomposite is curedcomposite is curedAid in Aid in establishing interproximal contactestablishing interproximal contact


Resin composite placement: incremental Resin composite placement: incremental techniquetechniqueqq

Final incrementFinal increment•• Careful control of the final incrementCareful control of the final increment•• Careful control of the final increment Careful control of the final increment

minimize the amount of finishingminimize the amount of finishingAfter removal of the wedge & matrix:After removal of the wedge & matrix:•• After removal of the wedge & matrix:After removal of the wedge & matrix:

The resin composite is cured from the facial The resin composite is cured from the facial & lingual aspects& lingual aspects& lingual aspects& lingual aspects

To help ensure adequate polymerization To help ensure adequate polymerization throughout the entire restorationthroughout the entire restorationthroughout the entire restorationthroughout the entire restoration


FinishingFinishing

Placement procedures that minimize the need for finishingPlacement procedures that minimize the need for finishing, should be , should be p z f f gp z f f gusedusedThe smoothest surface that can be obtainedThe smoothest surface that can be obtained is that of is that of he he f e h e edhe he f e h e ed ss

•• unfinished resin composite that has been cured against a smooth matrixunfinished resin composite that has been cured against a smooth matrix

Finishing & polishing procedures are inherentlyFinishing & polishing procedures are inherentlyFinishing & polishing procedures are inherentlyFinishing & polishing procedures are inherentlyDestructiveDestructive to the restoration surfaceto the restoration surface& may result in the formation of& may result in the formation of microcrackmicrocrackss below the surfacebelow the surface& may result in the formation of & may result in the formation of microcrackmicrocrackss below the surfacebelow the surface

Because cracks may also produced or exacerbated during Because cracks may also produced or exacerbated during mastication, the fracture toughness may be significantly mastication, the fracture toughness may be significantly ast cat o , t e actu e toug ess ay be s g ca t yast cat o , t e actu e toug ess ay be s g ca t yreduced by destructive finishing techniquesreduced by destructive finishing techniques


Finishing & polishingFinishing & polishingSimilar to that used with otherSimilar to that used with otherSimilar to that used with other Similar to that used with other compositescomposites

•• A No. A No. 12 12 or or 1212b b scalpel bladescalpel blade•• Sharp No. Sharp No. 1414L L carverscarvers•• Weldelstaedt Weldelstaedt chiselchisel or other thin, or other thin,

hh d d h d id d h d isharpsharp--edged hand instrumentedged hand instrumentRemoving flashRemoving flash from the from the proximal& gingival marginsproximal& gingival marginsproximal& gingival marginsproximal& gingival margins& for & for shaping proximal shaping proximal surfacessurfaces


Finishing & polishing Finishing & polishing

S i l fi it &S i l fi it & p li hip li hiSuccessively finer grits & Successively finer grits & polishing polishing points, cups or discspoints, cups or discs

Finish & blendFinish & blend the composite material to thethe composite material to theFinish & blendFinish & blend the composite material to the the composite material to the toothtooth

Aluminum oxide disksAluminum oxide disksRestoration Restoration contours that are relatively flat or contours that are relatively flat or convexconvex (e.g. facial & lingual proximal embrasure (e.g. facial & lingual proximal embrasure areas)areas)))

Multifluted carbide finishing burs or fine Multifluted carbide finishing burs or fine diamondsdiamonds

Shaping & finishing of Shaping & finishing of occlusal surfacesocclusal surfaces


Finishing & polishingFinishing & polishingRubber or silicone disks, points & cups, Rubber or silicone disks, points & cups, impregnated with aluminum oxideimpregnated with aluminum oxide

S h h i fS h h i fSmooth the composite surfaceSmooth the composite surface after initial after initial finishingfinishing

Finishing strips coated with aluminum oxideFinishing strips coated with aluminum oxideFinishing strips coated with aluminum oxideFinishing strips coated with aluminum oxideFinish Finish proximal surfaces proximal surfaces

Rubber prophylaxis cup with aluminum Rubber prophylaxis cup with aluminum p p y pp p y poxideoxide

The The final high polishfinal high polish


b di fi lb di fi lRebonding & final cureRebonding & final cureRebondingRebonding (the application of a low(the application of a low--viscosity viscosity resin to the finished surface & margins of a resin to the finished surface & margins of a restoration) restoration)

May be performed yearly for maximal May be performed yearly for maximal effectiveness effectiveness

llImprove the Improve the marginal integritymarginal integrity of resin of resin composite restorationscomposite restorations

l kl kReduce Reduce microleakagemicroleakageReduce Reduce marginal stainingmarginal stainingReduce Reduce wearwear & prolong & prolong marginal integritymarginal integrity


Rebonding & final cureRebonding & final cureRebonding & final cure Rebonding & final cure MethodMethod

•• Phosphric acid is usually applied to the Phosphric acid is usually applied to the P osp c ac d s usua y app ed to t eP osp c ac d s usua y app ed to t emarginal areas for marginal areas for 10 10 seconds, rinsed off, & seconds, rinsed off, & the area thoroughly dried.the area thoroughly dried.

•• The rebonding resin is applied thinned with aThe rebonding resin is applied thinned with a•• The rebonding resin is applied, thinned with a The rebonding resin is applied, thinned with a blotted brush or applicator, & light cured for blotted brush or applicator, & light cured for 20 20 to to 40 40 secondssecondsT h b di i f j i iT h b di i f j i i•• To prevent the rebonding resin from joining To prevent the rebonding resin from joining the restored teeth to the adjacent teeththe restored teeth to the adjacent teeth

A piece of matrix may be placed interproximally A piece of matrix may be placed interproximally p y p p yp y p p yprior to the performing of the rebonding prior to the performing of the rebonding procedureprocedureAlternatively, floss is passed through the Alternatively, floss is passed through the i t i l t t b f i f thi t i l t t b f i f thinterproximal contacts before curing of the interproximal contacts before curing of the rebonding resin rebonding resin

The Tunnel RestorationThe Tunnel RestorationThe Tunnel RestorationThe Tunnel Restoration

An alternative to the traditional approach for An alternative to the traditional approach for gaining access to proximal carious dentingaining access to proximal carious dentin

First suggested by Jinks in First suggested by Jinks in 19631963, then modified , then modified later by Hunt (later by Hunt (19941994) & Knight () & Knight (19841984))

AdvantagesAdvantagesDisadvantagesDisadvantages

I di ti & t i di tiI di ti & t i di tiIndications & contraindicationsIndications & contraindicationsRestorationRestoration


Access is made in the Access is made in the A “tunnel”A “tunnel” is made under is made under the marginal ridge to the the marginal ridge to the

occlusal fossa adjacent to the occlusal fossa adjacent to the marginal ridgemarginal ridge

carious dentin (usually just carious dentin (usually just below the interproximal below the interproximal

contactcontact


Tunnel preparation (access Tunnel preparation (access opening)opening)

Tunnel restoration.Tunnel restoration. Occlusal Occlusal fissures have been sealedfissures have been sealedopening)opening) fissures have been sealed fissures have been sealed

The Tunnel RestorationThe Tunnel RestorationAdvantagesAdvantages

•• Less potential for a restorative Less potential for a restorative overhangeoverhange•• Destruction of tooth structureDestruction of tooth structure is minimizedis minimized

•• Less potential for Less potential for microleakagemicroleakage•• Reduced potential for Reduced potential for distaurbance for the adjacent toothdistaurbance for the adjacent tooth

DisadvantagesDisadvantages•• DifficultDifficult procedureprocedureffff pp

•• Demanding careful Demanding careful control of the preparation by the operatorcontrol of the preparation by the operator•• Decreased Decreased visibilityvisibility

•• More More uncertain removal of cariousuncertain removal of carious dentindentin•• The concern that the The concern that the marginal ridge is undermined & its strengthmarginal ridge is undermined & its strength

d d ( h f i f il f &d d ( h f i f il f &reduced (the most common causes of restoration failure are fracture & reduced (the most common causes of restoration failure are fracture & secondary caries)secondary caries)


IndicationsIndications•• Should beShould be limited tolimited to those patiens withthose patiens with high esthetic demandshigh esthetic demands•• Should be Should be limited tolimited to those patiens with those patiens with high esthetic demands high esthetic demands

& a low caries index& a low caries index, who exhibit small, noncavitated proximal , who exhibit small, noncavitated proximal caries lesionscaries lesions that can be removed without penetrating the proximal surfacethat can be removed without penetrating the proximal surfacecaries lesionscaries lesions that can be removed without penetrating the proximal surfacethat can be removed without penetrating the proximal surface

ContraindicationsContraindications•• Should be Should be avoided whenavoided when large carious lesionslarge carious lesions are diagnosed, are diagnosed, where where access is particularly difficultaccess is particularly difficult, or when the overlying marginal , or when the overlying marginal p y ffp y ff , y g g, y g g

ridge is subject to ridge is subject to heavy occlusal loads or demonstrates a crackheavy occlusal loads or demonstrates a crack


R iR i difi d ldifi d l R i iR i iGlass ionomerGlass ionomer•• was the material was the material

ResinResin--modified glass modified glass ionomerionomer

Resin compositesResin compositesMore More wear wear resistantresistant thanthanof choiceof choice

Because of their Because of their •• are the current material are the current material

of choice for this of choice for this restorationrestoration

resistantresistant than than glass ionomerglass ionomerMay help to May help to i h i h radiopacity radiopacity & &

fluoride releasefluoride releaserestorationrestoration

They are They are radiopaqueradiopaque& have been shown to& have been shown to

increase the increase the fracture fracture resistanceresistance of the of the & have been shown to & have been shown to

prevent microleakageprevent microleakageBut, have more But, have more probability toprobability to fail fail

restored teethrestored teeth

probability to probability to fail fail under occlusal stressunder occlusal stress

The occlusal The occlusal 11..5 5 to to 22..0 0 mm of the preparation should be filled with a VLC resin compositemm of the preparation should be filled with a VLC resin composite

THANKTHANK YOUYOUTHANKTHANK YOUYOU

direct posterior resin composites (ii) - جامعة الملك عبد العزيز ... · ·...

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