Dental Restorative Materials & Techniques PDF

Dr. Nesrine Elsahn 10/6/2024 Selection of restorative material Gold foil Direct...

Dr. Nesrine Elsahn 10/6/2024 Selection of restorative material Gold foil Direct Modified GI Caries control Inaccessible areas Fissure sealant or PRR Flowable Packable Amalgam Fissure sealant or PRR Liner Selection of restorative material Indirect Cast gold Cast metal Ceramic Dr.Nesrine Elsahn 1 Dr. Nesrine Elsahn 10/6/2024 Closed sandwich technique Open sandwich technique  Adding GI will: 1. Provide chemical adhesion and fluoride  The open technique can be used for release marginal elevation in cases with deep 2. Decrease the volume of composite used subgingival margins (Difficult isolation and ( Decrease polymerization shrinkage) uncontrollable polymerization). 3. Decrease C-Factor ( Decrease polymerization  GIC is more biocompatible than Composite stress)  Resin modified glass ionomer is preferred Coupling Resin Matrix agent Inorganic fillers Dr. Nesrine Elsahn Dental Composites 2 Dr. Nesrine Elsahn 10/6/2024 Inorganic fillers Filler size Dr. Nesrine Elsahn Inorganic fillers Filler size  Ideal composite should be highly filled with very small particles But this will increase the viscosity ›Up to 75% wt ›Up to 35-50% wt  ( The Larger, the stronger)  ( The smaller, the smoother) Dr. Nesrine Elsahn 3 Dr. Nesrine Elsahn 10/6/2024 Organic Filler  50% microfiller added to matrix  Heat polymerized  Ground to particle size of 1-20 microns  Filler added to matrix which also contain more microfillers Dr. Nesrine Elsahn Organic Filler Dr. Nesrine Elsahn 4 Dr. Nesrine Elsahn 10/6/2024 Organic fillers  Enhance the mechanical properties  Better viscosity  Better polishability  Less polymerization shrinkage (pre- polymerized) Watch video! Dr. Nesrine Elsahn Nanofilled composite  Nano-spherical fillers Zirconia/Silica Nanocluster 100,000X magnification  Replacement of the large particles with zirconia/silica spherical nanoclusters of 1 to 4 μm 200nm  Similar or better properties compared to nanohybrid Dr. Nesrine Elsahn 5 Dr. Nesrine Elsahn 10/6/2024 Nanofilled composite Dr. Nesrine Elsahn Amalgam Incremental , Forceful, Multidirectional condensation. Direct gold Incremental , Forceful, Multidirectional compaction. 6 Dr. Nesrine Elsahn 10/6/2024  Limited depth of cure Dr. Nesrine Elsahn  Limited depth of cure Dr. Nesrine Elsahn 7 Dr. Nesrine Elsahn 10/6/2024 Optimal Curing  the correspondence between the light emission spectrum and photoinitiator absorption is very important. Wavelengths outside those necessary to activate these photo- initiators do not improve the cure of the resin, but do increase the overall risk to pulp from secondary generation of heat. Dr. Nesrine Elsahn Dr. Nesrine Elsahn 8 Dr. Nesrine Elsahn 10/6/2024 Optimal Curing Differences in spectral absorption profiles and absolute LED 3rd generation absorption values among the dental photoinitiators. Dr. Nesrine Elsahn  Questionable adaptation High polymerization shrinkage, which causes the Poor wettability to tooth material to pull away from structure because of its high the underlying enamel and viscosity and high surface dentin. tension. Moreover, the material is hydrophobic. Dr. Nesrine Elsahn 9 Dr. Nesrine Elsahn 10/6/2024 Shrinkage stress Coupling Resin Matrix agent Inorganic fillers stresses Leakage Effect of composite volume Effect of bonded surface area Dr. Nesrine Elsahn Dr. Nesrine Elsahn 10 Dr. Nesrine Elsahn 10/6/2024 As a result of shrinkage and cuspal deflection Dr. Nesrine Elsahn Composite Elastic bonding concept Incremental packing technique Guided polymerization technique Dr. Nesrine Elsahn 11 Dr. Nesrine Elsahn 10/6/2024 1-Flowable composite The selected adhesive system has to be applied before placing the flowable composite liner. Dr. Nesrine Elsahn 2- GIC liner  Ionosit Baseliner ( Compomer) Dr. Nesrine Elsahn 12 Dr. Nesrine Elsahn 10/6/2024 Dr. Nesrine Elsahn FULL POWER 600 SOFT - START 500 Light Intensity (mW/cm2) 400 RAMPED 300 PULSED OR OSCILLATING 200 100 0 0 10 20 30 40 50 Time (sec) Dr. Nesrine Elsahn 13 Dr. Nesrine Elsahn 10/6/2024 Dr. Nesrine Elsahn  Conventional composite:  Limited depth of cure  High shrinkage stress after bulk placement  Packable composite needs an incremental packing technique Dr. Nesrine Elsahn 14 Dr. Nesrine Elsahn 10/6/2024 Dr. Nesrine Elsahn  Bulk flowable  Bulk Restorative (full body) (Low viscosity) (High viscosity) Dr. Nesrine Elsahn 15 Dr. Nesrine Elsahn 10/6/2024 Dr. Nesrine Elsahn  Bulk flowable  Bulk Restorative Dr. Nesrine Elsahn 16 Dr. Nesrine Elsahn 10/6/2024 Dr. Nesrine Elsahn Dr. Nesrine Elsahn 17 Dr. Nesrine Elsahn 10/6/2024  1.Use of flowable materials, with lower filler content ( decrease light scattering). Translucent and weak materials.  2.Modifications to the filler type (refractive index) to improve light transmission in depth (sonic fill material)  3.Use of more efficient initiators with higher quantum yield: are able to generate several active radicals per molecule (Tetric EvoCeram) Bulk Fill)  4.Modifications to the monomer system to allow for stress relief during curing. Capable of undergoing free-radical addition fragmentation. This is a mechanism that allows the forming crosslinked network to adapt to stress development during polymerization, significantly decreasing its final value( Filtek Bulk Fill). Dr. Nesrine Elsahn  https://youtu.be/sBrwzAx60gg?si=VTepZF7_1Lx6cnTd  https://youtube.com/shorts/fGf9Nno_d1Y?si=XiZiLyLHRDuM ng24 Dr. Nesrine Elsahn 18 Dr. Nesrine Elsahn 10/6/2024 Dr. Nesrine Elsahn https://in.dental-tribune.com/news/layering-technique-to- produce-aesthetic-posterior-composite-restorations-a-case- report/ Dr. Nesrine Elsahn 19 Dr. Nesrine Elsahn 10/6/2024 Dr. Nesrine Elsahn Dr. Nesrine Elsahn 20 Dr. Nesrine Elsahn 10/6/2024 https://dentistry.co.uk/2022/10/26/go-with-the-flow-a-cuspby- cusp-additive-technique-with-injectable-composite/ Dr. Nesrine Elsahn The application of the matrix before or after the adhesive system depends on the clinical situation. Some dentists prefer to apply the matrix and wedge before 1. To obtain good isolation and prevent any contamination of the preparation walls. 2. It also allows evaluating if any fractures occur on the cavosurface enamel margins, due to the matrix and wedge placement, before performing the adhesive application. However, in this case, care should be taken to avoid adhesive pooling along the preparation margins, which would create a radiolucent area on the interface between the composite and the wall, that may be misdiagnosed as secondary caries. The excess of adhesive must be removed with the airstream, dry disposable applicator before light-curing. Dr. Nesrine Elsahn 21 Dr. Nesrine Elsahn 10/6/2024 The wedge has the purpose of  separating the teeth to compensate for the thickness of the matrix strip  stabilize the matrix band  prevent the overhangs at the gingival margin Dr. Nesrine Elsahn Light transmitting Light-reflecting Dr. Nesrine Elsahn Plastic 22 Dr. Nesrine Elsahn 10/6/2024 Dr. Nesrine Elsahn Dr. Nesrine Elsahn 23 Dr. Nesrine Elsahn 10/6/2024 Dr. Nesrine Elsahn  When there are two proximal boxes to be restored, a wedge is first inserted in only one interproximal space and this proximal surface is restored.  Then, the wedge is removed and inserted into the other interproximal space, and then this area is restored.  This promotes a greater dental separation than if both wedges were inserted simultaneously Dr. Nesrine Elsahn 24 Dr. Nesrine Elsahn 10/6/2024  If both wedges are placed at the same time, they will work one against the other, reducing the total teeth separation  After each wedge placement, the gingival seal of the matrix is evaluated with an exploratory probe, followed by the band burnishing toward the adjacent tooth using the backside of a spoon excavator blade.  This ensures that adequate contact and contour of the band will be obtained. Dr. Nesrine Elsahn Dr. Nesrine Elsahn 25 Dr. Nesrine Elsahn 10/6/2024  The matrix band height must be enough to place the gingival edge of the band 1 mm below the cavosurface angle of the gingival wall and the occlusal edge 1 mm beyond the marginal ridge of the adjacent tooth.  The wedge is inserted from the larger embrasure. Dr. Nesrine Elsahn lack of adaptation small cotton “ball” or Teflon tape oblique wedge technique Dr. Nesrine Elsahn 26 Dr. Nesrine Elsahn 10/6/2024  In general, the circumferential matrices are not the first choice to restore posterior teeth with composite, even on MOD preparations When restoring a single proximal surface, on MO or OD preparations, the double thickness of band, due to the presence of the strip on the intact contact, reduces the teeth separation and makes contact harder to achieve. Therefore, the sectional matrices have advantages. Dr. Nesrine Elsahn However, when properly applied, thin circumferential matrices can also be used with great success. Dr. Nesrine Elsahn 27 Dr. Nesrine Elsahn 10/6/2024 Dr. Nesrine Elsahn  On MOD preparations, following the wedge alternation technique  The restoration should preferably be started in the distal box, reconstructing the distal surface in contact with the adjacent tooth.  After that, the wedge and matrix should be removed and a new band and wedge placed on the mesial box. Dr. Nesrine Elsahn 28 Dr. Nesrine Elsahn 10/6/2024 Dr. Nesrine Elsahn Dr. Nesrine Elsahn 29 Dr. Nesrine Elsahn 10/6/2024 Dr. Nesrine Elsahn Dr. Nesrine Elsahn 30 Dr. Nesrine Elsahn 10/6/2024 Dr. Nesrine Elsahn When a matrix doesn’t fit well around a severely compromised tooth, use OpalDam or OpalDam Green resin barriers to hold the matrix in place. Dr. Nesrine Elsahn 31 Dr. Nesrine Elsahn 10/6/2024 The matrix is placed and wedged, being Application of the low fusion compound in burnished in position to improve the contact the embrasures to improve the adaptation with the proximal surface of the adjacent and prevent flash formation C. R. Pucci et al. tooth Dr. Nesrine Elsahn Indicated when the proximal contour is not defective: a. Non cavitated proximal lesions which require restorative treatment. b. Defective restorations that require replacement but their proximal contour is accepted Dr. Nesrine Elsahn 32 Dr. Nesrine Elsahn 10/6/2024 1. Place a wedge 2. Lubricate the proximal parts of the adjacent teeth and the wedge. 3. Inject a flowable resin based material at the buccal and lingual embrasure. Dr. Nesrine Elsahn 4. Immerse the sectional matrix ring in the uncured resin then add more resin around the ring 5. Light cure 6. Remove the wedge then the ring with the proximal stamp Dr. Nesrine Elsahn 33 Dr. Nesrine Elsahn 10/6/2024 7. Finish the cavity preparation 8. Place a sectional matrix and re-insert the same wedge. Dr. Nesrine Elsahn 9. Place the proximal stamp 10. Build the proximal wall Dr. Nesrine Elsahn 34 Dr. Nesrine Elsahn 10/6/2024 Dr. Nesrine Elsahn Dr. Nesrine Elsahn 35 Dr. Nesrine Elsahn 10/6/2024 Dr. Nesrine Elsahn Dr. Nesrine Elsahn 36 Dr. Nesrine Elsahn 10/6/2024 Dr. Nesrine Elsahn Dr. Nesrine Elsahn 37 Dr. Nesrine Elsahn 10/6/2024  Some accessory techniques can help to obtain a good proximal contact when making composite restorations, especially with circumferential matrices. 1- Contact forming instruments 2- Contact forming light conducting tips 3- The pre-polymerized ball technique Dr. Nesrine Elsahn  They are based on the use of some contact forming instrument, to keep the matrix pressed toward the adjacent tooth, at the same time that a small increment of composite is light-cured, stabilizing the band in contact with the adjacent tooth.  An in vitro study showed that a handheld contact forming instrument resulted on a significant increase of the contact tightness, even though its effect is smaller to the one obtained with the use of a separation ring. Dr. Nesrine Elsahn 38 Dr. Nesrine Elsahn 10/6/2024  OptraContact is available in two sizes: one for molars and one for premolars or for large and small cavities.  OptraContact features a forked working end with which a composite bridge is formed while the first layer is cured. Dr. Nesrine Elsahn  The forked working end can form a composite bridge while the first layer is cured. Dr. Nesrine Elsahn 39 Dr. Nesrine Elsahn 10/6/2024  The bridge, which is created in the contact region, stabilizes the matrix. Dr. Nesrine Elsahn  Tighter and larger proximal contacts  The stabilizing composite bridge makes the proximal contacts tighter and larger.  Selective positioning of contacts  Contacts can be selectively positioned in the upper third of the proximal surface. Consequently, the entire restoration is located much nearer to the original natural position. Dr. Nesrine Elsahn 40 Dr. Nesrine Elsahn 10/6/2024  This is a clear plastic, double-ended instrument that’s used to create really tight contacts with composite resins. Dr. Nesrine Elsahn  A transparent cone pressed into material before curing Dr. Nesrine Elsahn 41 Dr. Nesrine Elsahn 10/6/2024  This instrument is perfect when doing a large interproximal MO or DO.  The first layer is often a flowable resin around the margin. When that’s in place, push on the band, levering against the next tooth.  The next increment will be a compressible resin. Compress into place with whatever instrument. Then put the Contact Pro 2 into that resin and push against the adjacent tooth.  your assistant positions a light up against the instrument which spreads the light through the resin. Once the instrument is removed, there is a little hole that simply needs to be filled with a bit more resin. Dr. Nesrine Elsahn Contact Gold Fotoplus Dr. Nesrine Elsahn 42 Dr. Nesrine Elsahn 10/6/2024 Dr. Nesrine Elsahn prepolymerized ball Unpolymerized composite increment ball in position pushing the matrix strip toward the adjacent tooth; Dr. Nesrine Elsahn 43 Dr. Nesrine Elsahn 10/6/2024  Sturdevants Art & Science of Operative Dentistry, 7th Ed. Chapter 2, 8 and 13.  Modern Operative Dentistry: Principles for Clinical Practice (Textbooks in Contemporary dentistry) 1st ed. Chapter 3,8 and 15  A Practical Approach to Operative Dentistry 1st Ed. Chapter 5 and 6.  Restorative dentistry; treatment procedures and future prospects. 1st Ed. Chapter 9. Dr. Nesrine Elsahn Dr. Nesrine Elsahn 44