Class II Composite Restoration Overview

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Questions and Answers

What is preparation?

Preparation

Why do Class II composite restorations often have to be replaced? (Select all that apply)

Material choice is poor

Tooth decay is inevitable

Difficult to isolate (correct)

Sealing the margins is difficult (correct)

What is essential for diagnosing Class II caries?

Bitewing radiographs showing cavitation to the dentin.

What are the treatment options for Class II?

Prevention and reversal methods, conservative restoration, conventional restoration. Signup and view all the answers

What does the ideal conventional Class II prep assume?

Assume pit and fissures have cavitation into dentin. Signup and view all the answers

What does the ideal conservative Class II prep include?

Only remove decay. Don't have to include pits and fissures if not into dentin. Signup and view all the answers

What type of prep do you use for a Class II that includes pit and fissure caries that is not into dentin?

Slot prep with sealants or preventative restoration. Signup and view all the answers

When is composite more indicated than amalgam?

When minimal surgical intervention is indicated, when bonding can conserve tooth structure, when good isolation can be achieved, and when aesthetics is required. Signup and view all the answers

What are the disadvantages of composite restoration?

Shrinkage effects, more technique sensitive, greater localized occlusal wear and lower fracture toughness, unknown biocompatibility of some components. Signup and view all the answers

What burs can be used for a Class II restoration?

Round No. 1, 2, No. 329, 330, Straight fissure No. 56. Signup and view all the answers

What hand instruments do you use to smooth the walls?

Hatchet, gingival marginal trimmer. Signup and view all the answers

What is the clinical technique for Class II tooth preparation?

<ol> <li>Create access to faulty structure, 2) Removal of faulty structure, 3) Create convenience form.</li> </ol> Signup and view all the answers

What are the purposes for pre-wedging in Class II preparations?

Additional separation, tighter contact, protects rubber dam. Signup and view all the answers

What are the general steps for a conventional prep?

<ol> <li>Pre-wedge, 2) Complete occlusal prep, 3) For proximal, cut along the DEJ to the depth of the lesion.</li> </ol> Signup and view all the answers

What is the purpose of the gingival marginal trimmer?

Round the pulpal-axial line angle. Signup and view all the answers

What is the minimum requirement for a Class II prep?

Must break all of the proximal contacts. Signup and view all the answers

Why do we break contact?

To remove all of the caries and make it possible to place matrixes for restoration. Signup and view all the answers

What is restoration?

Restoration Signup and view all the answers

What is the first choice for matrix systems?

Sectional matrix. Brand used by UCD is Composit-tight. Signup and view all the answers

What other sectional matrix system does UCD use that provides better contouring?

Triodent system, Palodent plus, Garrision Composit-Tight 3D. Signup and view all the answers

Can sectional matrix be used for amalgam?

False Signup and view all the answers

What is the second choice for a matrix system?

Tofflemire matrix, mostly used for amalgam restorations. Signup and view all the answers

If you have to place two rings for a MOD restoration, do you place the long or short ring first?

Short first. Signup and view all the answers

What are the advantages of sectional matrix?

Contouring band, ring provides additional tooth separation, easier to provide proximal contour and contact. Signup and view all the answers

What are the steps for setting up a sectional matrix for restoration?

<ol> <li>Place matrix band, 2) Place wedge, 3) Place retainer/ring, 4) Burnish contact with convex side of spoon.</li> </ol> Signup and view all the answers

How do you place a sectional matrix?

From the buccal or lingual side, concave portion towards the occlusal (smile up). Signup and view all the answers

How far should the matrix go beyond the marginal ridge and why?

0.5 - 1 mm to prevent bonding to the adjacent tooth. Signup and view all the answers

How do you place the retainer/ring?

Placed in between the wedge and matrix, prong must be gingival wedge. Signup and view all the answers

Do you etch and bond before or after placing a matrix system?

After the matrix system. Signup and view all the answers

How do you place the first increment of composite?

1 mm on the gingival floor on the proximal box first. Use condenser to push composite towards the wall. Signup and view all the answers

Study Notes

Class II Preparation and Restoration Overview

Class II composite restorations often need replacement due to isolation difficulties and challenges in sealing margins.
Essential for diagnosing Class II caries are bitewing radiographs that show dentin cavitation.

Treatment Options

Class II treatment includes prevention and reversal, conservative restoration, and conventional restoration approaches.
An ideal conventional Class II preparation assumes that pits and fissures have cavitation into dentin, while conservative preparations focus on removing only decay without affecting non-cavitated pits and fissures.

Restoration Types

Slot preparations with sealants or preventative restorations are used for Class II cases with pit and fissure caries not extending into dentin.
Composite is preferred over amalgam for minimal surgical intervention, bonding advantages, good isolation, and aesthetic necessities.

Disadvantages of Composite Restoration

Concerns include shrinkage effects, increased technique sensitivity, greater localized occlusal wear, lower fracture toughness, and unknown biocompatibility of some components.

Instruments for Class II Restoration

Common burs for Class II restoration: Round No. 1, No. 2, No. 329, No. 330, and Straight Fissure No. 56.
Hand instruments for smoothing walls include hatchets and gingival marginal trimmers.

Clinical Technique

Key steps in Class II preparation: create access to the faulty structure, remove the faulty structure, and establish a convenient form for restoration.
Pre-wedging assists with additional separation, tight contact, and rubber dam protection.

Conventional Preparation Steps

The process involves pre-wedging, completing occlusal prep, and cutting along the DEJ to the lesion's depth for proximal preparations.
The gingival marginal trimmer's purpose is to round the pulpal-axial line angle.

Requirements and Rationale

A minimum requirement for Class II prep is breaking all proximal contacts to remove caries and enable matrix placement for restoration.

Matrix Systems

The first choice for matrix systems is sectional matrices, specifically the Composit-tight brand used by UCD.
Triodent system, Palodent plus, and Garrision Composit-Tight 3D are alternate sectional matrix systems that offer better contouring.
Sectional matrices are exclusively for composites, while Tofflemire matrices are primarily used for amalgam restorations.

Ring Placement

For MOD restorations requiring two rings, place the short ring first for proper alignment.

Sectional Matrix Advantages

Benefits of sectional matrices include contouring bands, added tooth separation through rings, and easier proximal contour and contact creation.
Steps for setting up a sectional matrix involve placing the band, wedge, retainer/ring, and burnishing contact with the convex side of a spoon.

Matrix Placement Techniques

Sectional matrices are placed from the buccal or lingual side, ensuring the concave portion faces the occlusal (smile up).
The matrix should extend 0.5 - 1 mm beyond the marginal ridge to prevent bonding to adjacent teeth.
Retainers/rings are positioned between the wedge and the matrix with the prong gingivally oriented.

Composite Placement Guidelines

Etching and bonding should be performed after placing the matrix system.
The first increment of composite is applied to the gingival floor within the proximal box, using a condenser to push the composite towards the wall.

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Description

Explore the essential aspects of Class II composite restorations, their treatment options, and the various restoration types. This quiz emphasizes the challenges in sealing margins and the importance of using bitewing radiographs for diagnosis. Gain insights into conservative versus conventional approaches for effective dental restoration.