Unit 2 Composite Restoration PDF

WELCOME TO WEEK 2 Of CLINIC THEORY  WEEK 1 REVIEW A filling placed at the Gingival margin is: a) Class I b) Class II c) Class IV d) Class V  WEEK 1 REVIEW A filling placed at the Gingival margin is: a) Class I b) Class II c) Class IV d) Class V A cavity that extends betw...

WELCOME TO WEEK 2 Of CLINIC THEORY  WEEK 1 REVIEW A filling placed at the Gingival margin is: a) Class I b) Class II c) Class IV d) Class V  WEEK 1 REVIEW A filling placed at the Gingival margin is: a) Class I b) Class II c) Class IV d) Class V A cavity that extends between 2 molars is: a) Class I b) Class II c) Class III d) Class IV A cavity that extends between 2 molars is: a) Class I b) Class II c) Class III d) Class IV When placing a matrix band, the edge of the band placed at the occlusal surface will be: a) Smaller in circumference b) Larger in circumference  When placing a matrix band, the edge of the band placed at the occlusal surface will be: a) Smaller in circumference b) Larger in circumference What matrix system is designed for a restoration of a primary molar a) Toffelmire b) Automatrix c) T Band d) Sectional What matrix system is designed for a restoration of a primary molar a) Toffelmire b) Automatrix c) T Band d) Sectional Post Op Instructions after an amalgam resto should include: a) How long the anesthetic will last b) You can chew on the restoration right away c) Do not drink anything hot right away d) Wait 24 hours before chewing on anything hard e) a, b and c f) a, c and d g) All of the above Post Op Instructions after an amalgam resto should include: a) How long the anesthetic will last b) You can chew on the restoration right away c) Do not drink anything hot right away d) Wait 24 hours before chewing on anything hard e) a, b and c f) a, c and d g) All of the above Composite Restoration Unit 2 Composite Resins Becoming the most widely accepted material of choice by dentists and patients because of their esthetic qualities and new advances in their strength.  Composite Resins 1. What is meant by esthetics? 2. What classifications of restorations would always be done in Composite? Why? Both Class III and IV carious lesions would be restored with composite. ⚫ A class IV lesion involves both the proximal surface and the incisal edge of anterior teeth. Tooth Preparation for Class III and IV Restorations: ⚫ If possible the operator will open through the Lingual surface to reduce the size of the restoration from the facial aspect. ⚫ If decay is subgingival a tissue retraction R.D clamp may be used to access the caries under the gingiva Class V Restorations ⚫ Classified as a smooth surface restoration ⚫ Occur in gingival 1/3 of the facial or lingual surface of any tooth ⚫ Can also occur on root surfaces near the cemento-enamel junction, CEJ Tooth Preparation for Class V Restorations ⚫ Prepared with smooth outline with no angles ⚫ Location of lesion dictates what material will be used. ⚫ If moisture is an issue and it is a posterior tooth the operator may choose to use amalgam Special Considerations with Class V restorations: ⚫ Proximity of the gingiva may result in retraction in order to keep the area dry and clean ⚫ A cervical R.D. clamp may be used to retract the gingival Application of Composite Resins ⚫ Polymerization is the process by which a material is changed from a pliable state into a hardened restoration ⚫ Polymerization can be accomplished 2 ways: ⚫ self cured (auto cured) ⚫ light cured  Anterior Matrix Systems ⚫ A clear plastic strip (matrix) is used with anterior composite resin or glass ionomer restorations ⚫ CR have inorganic filler particles that would be scratched or marked by stainless steel. ⚫ Newer bonding materials can also interfere with stainless steel bands affecting polymerization ⚫ A clear matrix is also referred to as a celluloid strip or mylar strip ⚫ No retainer is necessary Liners/Bases ⚫ Dycal and Glass Ionomer liners are commonly used under Composite resins ⚫ Both dycal and GI are available in self and light cured ⚫ Varnish and ZOE are never placed under a CR ⚫ Why? ⚫ Both interfere with bonding & setting of the resin ⚫ Polymerization The use of varnish is contraindicated with these materials. The eugenol in the liquid will affect the setting of the resin material Etching ⚫ The use of etchant is critical on both enamel and dentin surfaces for a better chemical bond between the tooth and resin material. Types of acid etch: ⚫ maleic acid ⚫ phosphoric acid Purpose of Etch ⚫ Creates micropores in enamel and dentin ⚫ Removes smear layer from dentin in preparation for bonding. ⚫ Major factor in success of bonding is removal of the smear layer with the etch, so the bond can adhere to the tags created in the dentin.  Etching Times ⚫ Vary from one product to another ⚫ Read manufacturer’s instructions ⚫ Anywhere from 15 to 20 seconds ⚫ Etch must be thoroughly rinsed from tooth surface and dried Bonding Process 1. Enamel bonding ⚫ occurs with PFS, ortho brackets and resin-bonded bridges ⚫ Most of these are attached directly to the intact enamel surface ⚫ When a sealant, resin cement or restorative material is placed on the etched surface, it flows in and around the enamel tags ⚫ The material hardens in this location to form a mechanical bond with enamel 2. Dentin bonding ⚫ Different from enamel, dentin consists of a range of organic substances and bonding of these dental materials can be difficult. ⚫ A major factor in the success of bonding to dentin is the removal of the smear layer (a very thin layer 5-10mm of debris composed of fluids and tooth components that remain on the dentin after cavity preparation. ⚫ Unlike enamel, a slight amount of moisture must be maintained on the dentin so as not to desiccate or dry out the tooth ⚫ *Bond may or may not be light cured Placement of Composite Restoration ⚫ Placed in increments no larger than 2 mm with first increment placed in proximal box (deepest interproximal area of the prep) ⚫ The plastic matrix strip is held tight against the cavity prep to hold the CR material in place  The plastic strip and wedge serve the following 4 purposes : 1. matrix is placed before etching and bonding to protect adjacent teeth from these materials 2. after placement of the CR (before light curing) the matrix is pulled tightly around the tooth to help in reconstructing its natural contour 3. the clear plastic allows penetration of light from the curing light 4. the wedge prevents overhang and holds the matrix in place Mylar strip for composite Plastic/Teflon vs Metal PFI ⚫ PFI – ____________________________ ⚫ Advantages to using plastic or teflon types of instruments are that they won't discolour or contaminate the composite restoration, and composite resin material will not cling to the instrument Steps in Finishing a Composite Restoration 1. Reduction of the material is completed by the use of a white stone or a finishing diamond. 2. Fine finishing is completed with carbide finishing burs and diamond burs. 3.The CR is polished with medium discs and finish with the superfine discs. 4. Finishing strips assist in the polishing of the interproximal surfaces. 5. Use polishing paste with a rubber cup. Finishing Stones and Burs  Procedural Steps ✔ Examine the CONTOUR of the prepped site ✔ Attention to the OUTLINE of the prep ✔ Contour the MYLAR STRIP ✔ Slide the MYLAR INTERPROXIMALLY – ensure gingival edge of matrix extends beyond the prep ✔ Using THUMB & INDEX FINGER pull the band over the prepped tooth on the facial and lingual ✔ POSITION WEDGE within the gingival embrasure ✔ After filled – LIGHT CURE, then matrix is removed Check articulation and contact, Give post op instructions ⚫ Inform client how long anesthetic will remain ⚫ Tooth color will improve as the tooth hydrates ⚫ The material is set so they don’t need to avoid chewing in that area. ⚫ Procedural Steps for CR. -As per clinic study guide- 1. Review day sheet 9:00 Mrs. Ida Wanna Tooth 11- Class III Composite Resin Dental Teams Role in a Composite Procedure ⚫ Retrieve chart ⚫ Explain procedure ⚫ Update MH 3. Examine treatment site ⚫ Position Bracket Tray ⚫ Pass Explorer & Mirror ⚫ Adjust lighting 4. Determine occlusal relationship ⚫ Dry teeth ⚫ Have Client bite on articulating paper 5. Polish the tooth with pumice ⚫ Pass slurry of pumice and water-have rubber cup on slow speed prophy angle  Shade selection ⚫ Pass shade guide. Assist in selection. ⚫ Use natural light when possible and involve the client. Administer anesthesia ⚫ Pass Gauze ⚫ Pass Topical anesthetic on Q-tip ⚫ Pass Assembled anesthetic syringe Punch and place rubber dam ⚫ Open cavity prep ⚫ Outline/resistance form of cavity prep. ⚫ Remove caries ⚫ Place retention form Place cavity medication ⚫ Mix GI liner ⚫ Transfer applicator to dentist ⚫ Have gauze ready to wipe applicator  Place matrix strip & wedge assess isolation ⚫ Pass or place matrix strip interproximally ( about 1 mm below cervical wall) ⚫ Select size of wedge ⚫ Secure wedge in holder or cotton pliers ⚫ Pass wedge (keeps material flush with tooth and forces teeth apart for a tighter contact) ⚫ Dry & assess isolation Wedge holds mylar  Acid etch ⚫ Prepare and pass etching agent (gel or liquid) ⚫ Acid etch is left on for 10 to 30 sec and thoroughly rinsed for at least 30 seconds ⚫ Evacuate and blot dry ⚫ Replace with new mylar strip and wedge if needed. Place bonding material ⚫ Maintain clear field ⚫ Pass composite bonding agent and applicator ⚫ Pass curing light or activate for 20 –30 seconds ⚫ not all operators will cure the bonding agent. Bonding Material  Insertion of filling material Fill in increments of not more than 2mm. ⚫ Dispense just before using ⚫ Retrieve curing light ⚫ Pass filling material and PFI-have gauze handy to wipe PFI ⚫ Pass Matrix strip holder if using ⚫ Pass cure light or activate Remove Matrix strip holder, strip & wedge ⚫ Pass explorer (to test for hardness) and receive cure light. ⚫ Pass cotton pliers for removal of wedge and strip. Remove isolation Remove rubber dam Finishing and Polishing ⚫ Pass a sharp , pointed instrument such as a sickle scaler to remove excess flash ⚫ Receive scaler ⚫ Place diamond finishing bur in high speed handpiece (not available in clinic) ⚫ Ready HVE for removal of excess material ⚫ Prepare required cups, stones or disks on mandrels and place in slow handpiece. ⚫ Pass and retrieve handpiece ⚫ Pass finishing strips as required. ⚫ Prepare composite polishing paste and cups as needed ⚫ Keep area moist with fine spray when using finishing devices Finishing Stones and Burs Put in correct order ⚫ Etch ⚫ Shade selection ⚫ Sickle scaler ⚫ Highspeed with round bur ⚫ Explorer to ck for hardness ⚫ Slow speed with pumice ⚫ Finishing strip ⚫ Anesthetic ⚫ Curing light  Correct order: 1. Slow speed with pumice 2. Shade selection 3. Anesthetic 4. Highspeed with round bur 5. Etch (rinse and dry) (then bond is placed) 6. Curing light 7. Explorer to ck for hardness 8. Sickle scaler (removes any excess called “flash”) 9. Finishing strip - smooth interproximal –want to be able to floss Examples of Bonded Tooth-Coloured Restorations