Dental Composite Restorations Quiz
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Questions and Answers

Which of the following is a potential disadvantage of composite restorations?

  • Less moisture sensitivity compared to other materials
  • High aesthetic appeal
  • Lower wear resistance than amalgam (correct)
  • Ability to bond chemically to tooth structure

    • What is the recommended time to wait after bleaching before evaluating tooth color stabilization?

  • Immediately after bleaching
  • 1-2 days
  • 1-2 weeks (correct)
  • 3-4 weeks

    • What is an essential factor influencing the success of composite restorations?

  • Quality of the tooth isolation during placement (correct)
  • Choice of dental floss
  • Patient's diet after restoration
  • Type of anesthesia used

    • Which technique is commonly used to enhance the bonding of composite materials to enamel and dentin?

    <p>Etching (C)</p> Signup and view all the answers

    Which shade categories represent natural to typical tooth colors?

    <p>A1-A4 (B)</p> Signup and view all the answers

    When should shade selection be conducted for optimal results?

    <p>As soon as the patient is seated (B)</p> Signup and view all the answers

    Why is light curing important in the application of composite restorations?

    <p>It initiates the polymerization process for hardening (B)</p> Signup and view all the answers

    What is the primary reason composite materials are called composite?

    <p>They combine different materials together. (C)</p> Signup and view all the answers

    What tool can be used for confirmation of shade matching?

    <p>Spectrophotometer (B)</p> Signup and view all the answers

    Which of the following is a necessary step in the finishing and polishing process of composite restorations?

    <p>Progressively decreasing the grit of polishing disks (A)</p> Signup and view all the answers

    What is the role of color mapping in cosmetic dental cases?

    <p>To map the tooth's various colors (D)</p> Signup and view all the answers

    What is a notable advantage of composite materials compared to amalgam?

    <p>Better esthetics. (B)</p> Signup and view all the answers

    Which of the following is a disadvantage of using composite materials?

    <p>Limited wear resistance. (A)</p> Signup and view all the answers

    Which indication of composite materials involves sealing cavities?

    <p>Sealants. (D)</p> Signup and view all the answers

    What is one technique sensitivity issue related to composite materials?

    <p>Incremental layering during application. (D)</p> Signup and view all the answers

    What does a higher C-Factor value indicate about a dental restoration?

    <p>Increased likelihood of adhesive failure. (C), Fewer bonded walls relative to unbonded walls. (D)</p> Signup and view all the answers

    Which class of preparation demonstrates the highest C-Factor ratio?

    <p>Class IV (B)</p> Signup and view all the answers

    Why is the incremental/layering technique recommended during composite placement?

    <p>It helps in managing polymerization shrinkage stress effectively. (A)</p> Signup and view all the answers

    What is the C-Factor for Class I preparation based on the provided information?

    <p>5:1 (B)</p> Signup and view all the answers

    What does the configuration factor (C-Factor) primarily assess in dental restorations?

    <p>The ratio of bonded to unbonded surfaces. (B)</p> Signup and view all the answers

    What is the minimum isthmus width required for convenience form to accommodate the smallest condenser?

    <p>1 mm (C)</p> Signup and view all the answers

    Which etching technique is used for posterior composites at CDMI?

    <p>Selective Enamel Etch Technique (A)</p> Signup and view all the answers

    In which scenario is the Self-Etch Bonding Steps indicated?

    <p>When restoring shallow preparations (A)</p> Signup and view all the answers

    What bonding steps should be taken for a deep class II cavity involving both enamel and dentin?

    <p>Total Etch Bonding Steps (A)</p> Signup and view all the answers

    Why are additional retention features like grooves unnecessary in posterior composites?

    <p>Retention is provided by bonding (D)</p> Signup and view all the answers

    In which case would Total Etch Bonding Steps be most appropriate?

    <p>Deep class II cavity preparation (A)</p> Signup and view all the answers

    What is a characteristic of the Selective Enamel Etch Technique?

    <p>It etches only the enamel (B)</p> Signup and view all the answers

    Which statement best defines the main aim of convenience form in cavity preparations?

    <p>To ensure easier access and observation of the cavity (B)</p> Signup and view all the answers

    What is the primary function of a primer in dental bonding?

    <p>To increase the strength of the bond (C)</p> Signup and view all the answers

    What does a higher configuration factor (C-Factor) indicate?

    <p>Greater risk of bond failure (C)</p> Signup and view all the answers

    What should be done immediately if GLUMA comes into contact with skin?

    <p>Flush the area with water (A)</p> Signup and view all the answers

    Which of the following correctly describes the application method for the Clearfil SE Protect Primer?

    <p>Apply and leave undisturbed for 20 seconds (B)</p> Signup and view all the answers

    What does a lower C-Factor improve in dental restorations?

    <p>Polymerization shrinkage stress management (B)</p> Signup and view all the answers

    Which of the following is a consequence of high polymerization shrinkage stress in dental restorations?

    <p>Increased postoperative sensitivity (A)</p> Signup and view all the answers

    What is the C-Factor for a Class I preparation that has 5 bonded walls and 1 unbonded wall?

    <p>$5.0$ (D)</p> Signup and view all the answers

    What is a key goal when placing a composite restoration?

    <p>Restore occlusion and anatomy (B)</p> Signup and view all the answers

    Flashcards

    Tooth Shade Groups

    The natural color of the tooth can vary depending on the underlying shade. This classification categorizes tooth shades into groups based on their basic color characteristics.

    Spectrophotometer

    A tool used to confirm tooth shade selection by measuring the reflected light from the tooth surface. This provides an objective measure of the color.

    Occlusion Check

    This assessment focuses on how the patient's teeth fit together during different biting movements. This information is vital for restorative procedures.

    Color Mapping

    This technique involves recognizing the variations in color across a tooth. It helps identify subtle shade differences and creates a more natural-looking restoration.

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    Shade Selection

    The process of selecting a tooth-colored material that matches the existing color of the tooth. It's essential for aesthetic and natural restoration of teeth.

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    Composite Material

    A dental material made by combining different materials, like resin and tiny glass or quartz particles, to create a strong, durable, tooth-like material. It is the first material that can bond to tooth structure.

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    Polymerization

    A process where a composite resin is hardened using a special light, often a blue light, to set the material. The process is typically quick and relatively painless.

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    Conservative Tooth Preparation

    Composite restorations are typically less bulky than traditional fillings. They are designed to bond directly to the tooth, reducing the need for extensive tooth preparation and mechanical retention.

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    Great Esthetics

    Composite fillings, due to their ability to bond to the tooth, may be considered more aesthetically pleasing than traditional silver fillings.

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    Incremental Layering

    A process that involves carefully applying layers of composite material to the tooth surface, allowing each layer to cure before adding the next. This technique is crucial for achieving a strong, durable final restoration.

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    What are composite restorations?

    Composite restorations are tooth fillings made from a tooth-colored resin material. They are widely used to restore teeth affected by cavities or for cosmetic enhancements.

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    When are composite restorations indicated?

    Factors like tooth location, size of the cavity, and patient needs influence the decision to use composite restorations. For example, they are ideal for smaller cavities and in areas visible to the eye but not suitable for large cavities or high-stress areas.

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    How is shade selection for composite restorations done?

    Shade selection involves matching the color of the composite to the surrounding tooth structure. This process ensures a natural appearance and aesthetic appeal of the restoration.

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    Why is light curing essential in composite restorations?

    Proper light curing plays a crucial role in composite restorations. It uses a special light to harden the composite material, ensuring its strength and durability.

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    What is the purpose of finishing and polishing composite restorations?

    Proper finishing and polishing techniques are essential for achieving a smooth and natural surface for composite restorations. This helps prevent plaque accumulation and ensures long-term durability.

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    Convenience Form

    A design feature of a dental preparation that allows for easy access and observation of the cavity, simplifying preparation and restoration.

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    Minimum Isthmus Width

    A design feature ensuring that the smallest dental instrument, such as a condenser, can fit into the tooth preparation.

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    Bonding

    The process of bonding composite material to tooth structure, relying on adhesive chemicals to create a strong bond.

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    Selective Enamel Etch Technique

    An etching technique used for posterior composites that focuses on etching only the enamel, minimizing dentin sensitivity.

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    Self-Etch Bonding

    An adhesive bonding system that involves both etching and bonding in a single step, simplifying the process.

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    Total Etch Bonding

    An adhesive bonding system that requires separate etching and bonding steps, providing a reliable bond for various situations.

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    Deep Class II Cavity

    A dental preparation that involves both enamel and dentin, often encountered in deep cavities.

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    Diastema Closure with Composite

    A non-invasive procedure that closes a diastema (gap) between teeth using composite material, involving only enamel bonding.

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    C-Factor

    A ratio representing the amount of bonded tooth surface to unbonded (free) surface in a restoration.

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    High C-Factor

    The higher the C-Factor, the greater the potential for polymerization shrinkage stress.

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    Low C-Factor

    The lower the C-Factor, the less polymerization shrinkage stress is likely to occur because of more free surfaces.

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    Incremental/Layering Technique

    A technique that uses unbonded surfaces in each layer to relieve polymerization shrinkage stress, minimizing the risk of stress at the bonding interface.

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    Primer

    A chemical used to enhance the bond strength between a restorative material and the tooth surface by creating a chemical link.

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    Bonding Agent

    A bonding agent is a liquid that adheres to both tooth structure and restorative material, creating a strong bond between them.

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    Composite Placement Goals

    The process of restoring a tooth to its original shape, function and aesthetics.

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    Polymerization Shrinkage Stress

    This stress occurs due to the shrinking of composite material as it hardens. More bonded walls result in this stress being concentrated, potentially causing problems.

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    Lower C-Factor benefits

    A lower C-Factor is preferable due to less polymerization shrinkage stress.

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    C-Factor in Class I Prep

    A Class I cavity preparation has a C-Factor of 5:1 (bonded walls : unbonded walls).

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    Polymerization Shrinkage Stress Consequences

    This is a concern because it can lead to issues like cracks, leakage and sensitivity.

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    Study Notes

    Composite Restorations

    • Composite restorations were introduced in the 1960s
    • They are made by combining resin and tiny glass or quartz particles.
    • These materials create a strong, durable, and tooth-like material, excellent for dental restorations
    • Composite is the first material that bonds to tooth structure.
    • Most direct dental restorations have transitioned to this material.

    Learning Objectives

    • Discuss indications, contraindication, advantages, and disadvantages of composite restorations.
    • Evaluate the predictors of composite success.
    • Appraise the process of shade selection for composite restorations.
    • Justify the importance of occlusion checks in composite restorations.
    • Discuss the rationale for tooth isolation when using composites.
    • Assess the steps involved in tooth preparation for composite restorations.
    • Discuss the etching technique used in composite restorations.
    • Explain the role and use of desensitizers in composite restorations.
    • Analyze the C-Factor and its impact on composite restorations.
    • Discuss the process and importance of light curing in composite restorations.
    • Apply the steps involved in finishing and polishing composite restorations.
    • Provide post-operative instructions for patients following composite restoration procedures.
    • Apply CDMI composite restoration protocol.

    Advantages and Disadvantages (Compared to Amalgam)

    • Advantages
      • Conservative tooth preparation: no bulk or mechanical retention needed.
      • Easier, less complex tooth preparation, using adhesive bonding.
      • Decreased microleaked stronger seal.
      • Provides insulation with non-metallic materials.
      • Disadvantages
      • Polymerization shrinkage
      • Technique sensitivity (isolation, bonding, incremental layering)
      • Limited wear resistance, leading to limited longevity.
      • Possible marginal stain, and bond failure
      • High occlusal forces
      • More costly

    Indications

    • Sealants
    • Preventive Resin Restorations (PRR)
    • Direct restorations (Class I, II, III, IV, V cavities; esthetic dentistry, diastema closure)
    • Bonding other materials (orthodontic attachments, periodontal splints)

    Other Indications

    • Large restorations as foundations for crowns.
    • Core build-up to restore lost tooth structure.
    • Interim restorations (when final treatment is delayed or due to cost or patient ability to come to appointments, for example, trauma or young patients)

    Contraindications

    • Areas that cannot be properly isolated(dry field is essential to prevent saliva, blood, or moisture contamination).
    • Large restorations with heavy occlusal stress (prone to material fatigue or fracture)
    • Proximal boxes (Class II) that extend onto the root surface.
    • Deep gingival margins where light cannot penetrate easily

    Clinical Indications and Prognosis

    • Clinical indications and prognosis are always case-specific.
    • More predictable prognosis associated with:
      • Primary caries
      • Smaller preparations
      • Margins on enamel (strong bond)
      • Well-isolated field
    • Less predictable prognosis associated with:
      • Secondary caries
      • Larger preparations
      • Margins on cementum (weak bond)
      • Contaminated field

    Manufacturer's Instructions (IPS Empress® Direct)

    • Limitations of use: If a dry working field cannot be established, or if the stipulated working technique cannot be applied.

    Success of Composite Restoration

    • Predicted on three main factors:
      • Remaining tooth structure
      • Patient's caries risk
      • Operator's technique

    Outline

    • Shade selection
    • Desensitizer
    • Bonding
    • Polish
    • Occlusion check (Pre)
    • Composite placement
    • Etch
    • Finish
    • Anesthetics
    • Isolation
    • Preparation
    • Light cure
    • Occlusion check (Post)

    Shade Selection

    • A1-A4: Natural, typical tooth colors
    • B1-B4: Warmer, yellower tones
    • C1-C3: More neutral or gray undertones
    • D2-D3: Red or brownish-gray undertones
    • BL-L, BL-XL: For bleached teeth (Light, Extra Light)
    • T: Translucent shade (mimics natural light interactions, e.g., on incisal edge)
    • The higher the number, the darker the color.

    Shade Selection (Additional Considerations)

    • Take shade as soon as possible (pre-dehydration)
    • Use natural light (avoiding operatory light);
    • Wait for 1-2 weeks after bleaching until stabilization.
    • Use spectrophotometer (color matching device) as confirmation

    Occlusion Check (Pre)

    • Assess centric and eccentric movements.
    • Determine if the patient has anterior or canine guidance.
    • Focus on the location and extension of the restorations, to preserve the patients' natural occlusion ensuring minimal changes or disruptions.

    Isolation

    • Technique for composite placement requires an isolated field (free of saliva or blood)
    • Longevity of composites is linked to placement conditions (under control of the operator)
    • Use dental dam to isolate the field effectively.
    • Minimum extension: 1 tooth posterior, 2 teeth anterior (for prep and restore access).

    Tooth Preparation

    • Principle for an ideal prep:
      • Large enough to allow access to damaged structure.
      • Prep includes removal of caries, existing restorations, liners, and bases.
      • Prep should leave little affected dentin to prevent pulpal exposure.
        • Apply liner (Theracal or Vitrebond) to protect the pulp, stimulate healing, and promote long-term tooth health.
    • Needs to have convenience form: shape of prep that allows easy access and observation of the cavity.
    • Additional retention features such as grooves are not necessary in posterior composites, as retention is provided by bonding.

    Etching Techniques

    • At CDMI, Selective Enamel Etch Technique (based on evidence) is used for posterior composites.

    Bonding Steps (Selective Enamel Etch Technique)

    • Etch enamel only.
    • Indication: Minimize dentin sensitivity when restoring deep preparations.
    • Example: Class I occlusal preparation.

    Bonding Steps (Total Etch Technique)

    • Etch both enamel and dentin.
    • Indication: Bonding restorations where preparations are primarily in enamel, with minimal dentin involvement.
    • Example: Composite restorations for anterior veneers.

    Knowledge Test 1 & 2

    • Cases presented with specific preparation and restoration requirements.
    • Questions and answers provided on necessary/appropriate bonding technique for various cases.

    Desensitizing Agent

    • Type: Dentin desensitizer
    • Primary Use: To manage dentin hypersensitivity by sealing exposed dentin tubules and preventing fluid flow in cases of post-restorative procedures.

    Why Use a Desensitizer

    • Reduce post-operative sensitivity.
    • Helps increase the longevity of the restoration.
    • Disinfect the medium/prepped tooth.

    C-Factor (Configuration Factor)

    • The ratio of bonded walls to unbonded (free) walls.
    • More bonded walls increase polymerization shrinkage stress.
    • A lower C-factor is more desirable because it is less likely to cause failure.

    C-Factor (Configuration Factor): How to Reduce

    • Use the incremental/layering technique when placing composite.
    • Unbonded surfaces in each increment allow relief of polymerization shrinkage stress.
    • This minimizes the risk of stress concentration at the adhesive interface.

    Composite Placement: Incremental/Layering Technique

    • Composite cures effectively up to a 6mm depth.
    • Layering is required to avoid incomplete polymerization
    • Bulk fill technique is not recommended due to a lack of enough clinical tests to support its success.
    • At CDMI, composites are layered (1.5-2.0mm increments) cusp by cusp at a time.

    Composite Placement: Incremental/Layering Technique (Additional Considerations)

    • Avoid excessive hand manipulation (it can cause air entrapment and a grainy appearance leading to material weakening).
    • Clean instruments with alcohol gauze between applications to ensure smooth composite application.
    • Enamel layer consideration: Enamel layer is the final occlusal segment that should replicate natural anatomy, and should respect occlusal relationships.

    Composite Instruments

    • #18 Ball Burnisher: adapts composite to cavity walls
    • CVHL 1/26 or Hollenback: used to place, remove, and refine composite anatomy.
    • CIGFT 36 or Goldstein: used to place or remove composite.

    Composite Instruments (Ivoclar OptraSculpt)

    • Instrument handle with disposable tips in different shapes
    • Allows for composite condensing without pullback from previous layers or cavity walls
    • Tips do not stick or leave prints on composite.
    • No need to wipe with alcohol gauze between uses (saves time).

    Handling Composite Resin

    • Composite begins setting when exposed to light, so light protection is important to prevent premature setting.
    • Do not dispense composite until ready to use it
    • Bleed the composite using the dispensing gun to remove partially cured material.
    • Keep the composite compound covered, in its container, when not in use.

    Handling Composite Resin (additional considerations)

    • Change the overhead light setting to light cure mode in the clinic to control the light exposure.
    • Cover the headlight of your loupes with the orange shield when needed.

    Light Curing (Polymerization)

    • Light must reach the entirety of the material, at the right intensity, and curing time must be adequate to achieve total polymerization..
    • Proper light curing can reduce shrinkage and increase durability of the resultant composite resin restoration.
    • Recommended exposure times (20 seconds increments) should be maintained when adding to the restoration as required.

    Light Curing (Polymerization) (Additional considerations)

    • Controllable factors: Adequate light intensity (minimum 400 mW/cm²); sufficient exposure time (20 seconds per increment); proper positioning of the light tip (as closely to material as possible)
    • Difficult-to-control factors: Location and orientation (anterior vs. posterior); existing materials/structures, that block the light (e.g. adjacent teeth in class II preps); darker composites (opacity and pigmentation reduce light penetration); ability to maintain a 90° angle (subgingival restorations)

    Finishing Inspection - Check List

    • Proper contour, line angle, anatomy.
    • Is margin integrity good (excess or deficiency? Flash?)
    • Is surface texture smooth without irregularities?
    • Is bonding intact?

    Finishing

    • If there are deficiencies, add more composite after re-applying the dental dam.
    • Composite that has not been touched with a bur and water spray can be added to existing work
    • Oxygen-inhibiting layer helps improve the bond strength between composite layers without the need for etching or bonding.

    Finishing Instruments

    • Begin with hand instruments (e.g., scaler, scalpel), especially in interproximal areas.
    • Remove excess composite using multi-fluted carbide or super fine diamond burs at low speed with water.
    • Take enough time to care for any irregular surfaces before moving to finishing.

    Polishing - Benefits

    • Less roughness/scratches leads to improved:
      • Marginal integrity
      • Plaque accumulation
      • Gingival irritation
      • Secondary caries
      • Color stability
      • Easier for patient to clean
      • Esthetic appearance

    Polishing - Instruments and Materials

    • Use polishing instruments in the correct and appropriate sequence (e.g. fine > super fine).
    • Correct instruments should be used for the right tooth surface type (e.g. polishing strips for interproximal, polishing point for occlusal surfaces).
    • Constant, shifting motions when polishing.
    • Moderate to light pressure should be maintained during the polishing process to prevent flattening or acrylic wear.

    Polishing - Instruments and Materials (specific instruments)

    • Polishing strips (no abrasive grit area), Sof-lex discs (fine and superfine), Shofu discs (fine and superfine), polishing rubber wheels, polishing brushes, water-soluble aluminum oxide paste.

    Restoration Failure

    • Any steps in the composite restorative process can cause failure
    • Control the variables as much as possible to maximize success and ensure longevity in the resulting composite restoration

    Post-Operative Instructions

    • Provide instructions to the patients
    • Be able to explain instructions verbally to the patients

    Post-operative Instructions (Detail)

    • DIET:
      • Do not eat or drink anything for 2 hours after procedure.
      • Eat soft foods for the rest of the day.
      • Avoid extreme temperatures or crunchy foods.
    • ORAL HYGIENE
      • Continue regular home care (brushing twice daily, flossing).
      • Call dentist if experiencing moderate to severe pain/swelling/fever.

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