Direct Composite Restoration PDF

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Reviewer in restorative dentistry...

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RESTO 2 LECTURE

[DIRECT COMPOSITE RESTORATION]

DIRECT COMPOSITE RESTORATION  placing composite on the tooth of the patient (inside the patient's mouth) CLASS I AND II Indications of Class I and II: 1. Small and moderate restorations preferable with enamel margins 2. Most PM and 1M restorations when esthetics are considered 3. A restoration that does not provide all of the occlusal contacts 4. A restoration that does not have a heavy occlusal contact 5. A restoration that can be isolated during procedure 6. Some restoration that may serve as foundation for crowns 7. Some very large restorations that are used to strengthen remaining weakened tooth structure Contraindications of Class I and II: 1. When the operating site can't be appropriately isolated 2. With heavy occlusal stresses 3. With all the occlusal contacts only on composite 4. In restorations that extend onto the root surface  Extension of composite to the root surface cause a CONTRACTION GAP  v-shaped contraction gap is formed between the root and the composite  cause:  force initial polymerization of composite shrinkage is > initial bond strength of the composite to the dentin of the root  meticulous effort of the operator is required

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(comp. amalgam) increment of composite > diagonal insertion > better attachment

Advantages of Class I and II: COSTA

Esthetics Conservative tooth structure removal Easier, less complex tooth preparation Economics - compared to crowns and indirect tooth colored restoration 5. Insulation 6. Bonding benefits  decrease microleakage  decrease recurrent caries  decreased post operative sensitivity 1. 2. 3. 4.

Disadvantages of Class I and II: 1. Material related:  greater localized wear  polymerization shrinkage effect  LCTE (linear coefficient of thermal expansion)  biocompatibility of some components unknown 2. Require more time to place 3. More technique sensitivity  etching, priming, adhesive placements  inserting composites  developing proximal contacts  finishing and polishing 4. More expensive than amalgam restorations Pits and Fissure Sealants:  diagnosis  x-ray or clinical examination  chalkiness  softening  discoloration  radiolucency under the ??  px risk to caries  sealant is used a prevention of caries rather than treatment of carious lesions  bitewing radiographs is used to make sure that dentinal caries is not present  sealants are indicated as preventive or therapeutic use depending on the patient  caries risk, tooth morphology, or presence of incipient enamel caries  clinical techniques:  isolation of the area concerned is critical for the success of the sealant  etchant/rinsing  light cure/self-cured sealant

RESTO 2 LECTURE 

[DIRECT COMPOSITE RESTORATION]

finishing bur to remove excess

Conservative Composite (Preventive Resin):  minimal removal of tooth structure to seal radiating non -carious fissures or pits  isolation is not possible so composites are contraindicated  exploratory preparation

Class VI Composites Indications:  small and shallow depth Preparation:  class VI preparation on the facial cusp tip of the max. PM  entry with a small round bur or diamond  preparation roughened with diamond bur if necessary Initial Clinical Procedures: 1. Anesthesia and shade selection 2. Assess preoperative occlusal relationship and its indications 3. Isolation of the operating area 3 Typical Composite Tooth Preparation: 1. Conventional tooth prep - amalgam-like C.T.P 2. Beveled conventional tooth prep - rarely used 3. Modified tooth prep - conservative tooth removal Conventional Class I Tooth Preparation:  increase resistance form; fractures of the tooth  large preparation or restoration  subject to high occlusal forces COSTA

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used in combination with other preparations such as box type, flat walls perpendicular to outline wall, strong t? and restoration m? amalgam: 1.5mm from central fossa and 2mm from cavosurface margin class I mesiodistal width/marginal ridge:  molar area: 2mm because larger tooth structure  PM: 1.6mm  faciolingual extension: 1.5mm  groove extension: 1.5mm (occlusal) and 2.0mm (DEJ)

RESTO 2 LECTURE

[DIRECT COMPOSITE RESTORATION]

Modified Class I Tooth Preparation:  small to moderate restorations  flare cavosurface form without uniform nor flat pulpal or axial walls Restorative Technique: Inserting and Curing the Composites  variation in materials depends upon the manufacturer instructions  enamel and dentin must be etched and bonded  composite are placed and cured by small increment (1-2mm, 20-40s)  contouring is done by #12 bladed, round or oblong finishing bur  carbide tipped carvers used for composites excess along occlusal margins  finishing is accomplished by using polishing cups and points COSTA...