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Clinical technique of composite restoration

presented by: abdulmageed alhusaniy

Clinical technique of composite restoration

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

Mohannad will complete C and D

Clinical technique Clinical technique A. Initial clinical procedures,1. Local anesthesia1. Local anesthesia - patient is more relaxed - patient is more relaxed

- reduced salivation- reduced salivation

2. Preparation of operating site –2. Preparation of operating site –• clean the operating site with slurry of pumice to clean the operating site with slurry of pumice to

remove any remove any debris, plaquedebris, 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 selection3.Shade selection

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

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

Vita Lumin:Vita Lumin:• A= reddish brownA= reddish brown• B = reddish yellowB = reddish yellow• C = grey shadesC = grey shades• D = reddish greyD = reddish grey

B1 A1 B2 D2 A2 C1 C2 D4 A3 D3 B3 A3.5 B4 C3 A4 C4

3D Master3D Master

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

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

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

4. 4. Assess value by squintingAssess value by squinting. The reduced . The reduced amount of light entering the eye allows the amount of light entering the eye allows the retinal rods to better distinguish degrees of retinal rods to better distinguish degrees of lightness and darkness. (Vita Lumin shade lightness and darkness. (Vita Lumin shade tabs set in order of value )tabs set in order of value )

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

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

6. Choose the dominant hue and chroma within 6. Choose the dominant hue and chroma within the value range chosen. The canines - useful the value range chosen. The canines - useful guide to assessing hue.guide to assessing hue.

7. Compare selected tabs under different 7. Compare selected tabs under different conditions eg wet vs dry, different lip conditions eg wet vs dry, different lip positions, artificial and natural light from positions, artificial and natural light from different angles.different angles.

8. Look carefully for colour characterisation 8. Look carefully for colour characterisation such as stained imbrication lines, white such as stained imbrication lines, white spots, neck colouration, incisal edge spots, neck colouration, incisal edge translucency translucency

Automated Automated Shade SelectionShade Selection

B.Tooth preparation for composite

4.Cavity preparation4.Cavity preparation

Tooth preparation Tooth preparation principles and criteriaprinciples and criteria

External Outline formExternal Outline form

• Extent is determined by size, shape, and location of Extent is determined by size, shape, and location of defect .defect .

• should include all Caries, any fault, defective, old should include all Caries, any fault, defective, old friable tooth structure.friable tooth structure.

• Removal of discolored tooth structure as required for Removal of discolored tooth structure as required for esthetics.esthetics.

External Outline formExternal Outline form

• Create prepared enamel margin of 90° or Create prepared enamel margin of 90° or greater by giving bevel wherever required.greater by giving bevel wherever required.

• Create 90° cavosurface on root surfaces Create 90° cavosurface on root surfaces Pulpally, no uniform depth is needed.Pulpally, no uniform depth is needed.

• Depth should be sufficient to identify and Depth should be sufficient to identify and remove caries or existing restoration.remove caries or existing restoration.

RETENTIONRETENTION

1.1. Micromechanical retention by etching of enamel Micromechanical retention by etching of enamel and dentin.and dentin.

2.2. Mechanical undercuts when margins terminate Mechanical undercuts when margins terminate in cementum.in cementum.

Advantages of beveling.Advantages of beveling.

1.1. Increase in surface area because Increase in surface area because stronger enamel to resin bond stronger enamel to resin bond

2.2. Ends of enamel rods are etched.Ends of enamel rods are etched.

3.3. Esthetic blending due to cavosurface Esthetic blending due to cavosurface bevel. bevel.

Cavity designs for composite Cavity designs for composite cavity preparationcavity preparation

• Conventional Conventional • Beveled conventionalBeveled conventional• ModifiedModified• Box shapeBox shape• Facial/lingual slotFacial/lingual slot

CONVENTIONALCONVENTIONALsimilar 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

INDICATIONSINDICATIONS

1.1. Moderate to large class I and class II Moderate to large class I and class II restorations 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

BEVELED CONVENTIONALBEVELED CONVENTIONAL1.1. Similar to conventional cavity designSimilar to conventional cavity design

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

INDICATIONSINDICATIONS

1.1. Composite is used to replace existing Composite is used to replace existing restoration.restoration.

(class III, IV, V)(class III, IV, V)

2.2. Restore large areaRestore large area

Rarely used for posterior composite restorationsRarely used for posterior composite restorations

Combined designCombined design

MODIFIEDMODIFIED1.1. 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 (MICRO Conserve tooth and obtain retention (MICRO

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

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

enamel enamel • correcting enamel defects.correcting enamel defects.

BOX ONLYBOX ONLY• When only Proximal When only Proximal

surface is faulty and surface is faulty and no lesion on occlusal no lesion on occlusal surfacesurface

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

through facial or lingual surfacethrough facial 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.

5. Isolation of operating site5. Isolation of operating site - Rubber dam- Rubber dam - cotton rolls- cotton rolls - retraction cord- retraction cord

6 . Pulp protection6 . Pulp protection- Calcium hydroxide, GIC , RMGICalcium hydroxide, GIC , RMGI- ZnOE is contraindicatedZnOE is contraindicated

7. Matrix placement7. Matrix placement

• Two types of matrices are availableTwo types of matrices are available

- - Polyester matrixPolyester matrix

- metal matrix - metal matrix

• Various matrix retainer which can be used are

- 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, CLASSIV ,CLASS V used especially CLASS III, CLASSIV ,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

Thank you

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

Reference