2. Adhesive Dentistry, I Flashcards by J L

Q

Adhesion:

nA material, usually a ____ fluid, that joins two substrates together and solidifies

A

viscous

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Q

Prerequisites for Effective Adhesive Dentistry

wEtch/Prime: ____ dissolution of the enamel or dentin to enhance intimate contact of adhesives with substrate

wBond : infiltration of ____ resin into demineralized enamel and dentin which enables bonding of resins to the surface -
-____ RETENTION

A

acidic
unfilled
micromechanical

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Q

Principles of Adhesion Dentistry

Bonding Agent/Adhesive:
w____ that penetrates and establishes intimate contact with the conditioned tooth, polymerizes, and forms a strong bond between substrate and the restorative material.

A

monomer

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Q

Principles of Adhesion Dentistry

wBonding agent needs ____ contact between it and the conditioned substrate (enamel, dentin, and/or cementum)
l____ action
l____ the surface well

A

close
scrubbing
wet

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Q

Principles of Adhesion Dentistry

wEnamel Adhesion:
n Bonding agent is the ____ into treated enamel
n ____ penetrates into etched surface
n Formation of ____ into porosities

A

scrubbed
resin
resin microtags

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Q

Principles of Adhesion Dentistry

wDentin Adhesion:
n Resin tags infiltrate
demineralized ____
n Adhesion to ____ is less strong than adhesion to ____

A

dentin
dentin
enamel

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Q

Principles of Adhesion Dentistry

uDentin Adhesion:
nBonding resin penetrate and polymerize in the etched, open ____, forming resin tags

nBonding resins also penetrates the ____

A

dentinal tubules

intertubular dentin

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Q

Dentin Adhesion
wAdhesive strength to dentin is less than enamel
w Why?

[???]

A

ANSWER ME

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Q

Challenges in Dentin Adhesion

MUST remove the ____ -Requires a procedure to
etch or prime the dentin
Deeper preparation into dentin = less ____ substrate = less ____
-Therefore: Deeper preparation into dentin = less ____

A

smear layer
mineralized
retention
bond strength

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Q

Challenges in Dentin Adhesion

Gap Formation at the Resin-Dentin Interface
Dentin bond strengths ____ than enamel bond strengths
Composite resins ____ as they polymerize, creating stresses within the composite material
Pulls away from substrate = ____ discrepancy = “____”

A

less
shrink
marginal
gap formation

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Q

Different Adhesive System Clasifications
n “____” - Etch and Rinse procedure
n “____” - Adhesives that have etching capacity built into the material but NO rinse step
n “____” – Combination of both above

A

total etch
self etch
selective self etch

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Q

Different Bonding Systems

wTotal Etch technique:
n Developed in the 1990’s 
n Still used effectively
n \_\_\_\_ etching of the entire preparation (\_\_\_\_) with \_\_\_\_ Acid
n \_\_\_\_

A

simulataneous
dentin and enamel
phosphoric
rinse and dry

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Q

Total Etch Technique
w\_\_\_\_ phosphoric acid 
n \_\_\_\_ second etch on enamel
n \_\_\_\_ second etch on dentin
n Rinse time \_\_\_\_ seconds

w____ Step System and ____ Step System

A

30-40%
15
10
5-10

3
2

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Q

Total Etch Technique - 3 Step System

w 3-steps:
1st : \_\_\_\_(conditioning)
l\_\_\_\_ off
lDemineralizes \_\_\_\_
lRemoves the \_\_\_\_ layer in dentin 
lOpens the \_\_\_\_ 
lIncreases enamel/dentin \_\_\_\_

A

acid etching
rinsed
enamel
smear
dentinal tubules
permeability

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Q

Total Etch Technique - 3 Step System

2nd : ____
lWets and penetrates porosities
lPrimer molecules contain two functional
groups:
w____ group: has affinity for the tooth substrate
w____ group: has an affinity for unfilled resin that follows

A

primer
hydrophilic
hydrophobic

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Q

Total Etch Technique - 3 Step System

3rd : ____ (unfilled resin)
l____ onto the treated surfaces
lTogether with the Primer penetrates the treated enamel and opened dentinal tubules
Then: ____ to set bonding agent

A

bonding
scrubbed
light cure

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Q

Total Etch Technique - 2 Step System

wSimplified 3 Step Systems
wStill use “____” technique
wCombined Steps 2 and 3: ____ are combined

A

total etch

primer and bonding agents

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Q

Total Etch Technique - 2 Step System

w Advantages:
n ____ to use
n Bond strengths sometimes were ____

w Disadvantages:
n Greater post operative ____ in some
2 Step products
n Some adhesives NOT ____ certain kinds of composite materials

A

easier
improved
sensitivity
compatible

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Q

Total Etch Technique - 2 Step System

w2 Step Systems Used in PreClinic:
n ____

A

prime & bond NT

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Q

Different Bonding Systems

wSelf Etch technique:
n Developed recently
n ____ etching of the entire preparation (____) with ____ Primer – but NOT ____ Acid
n Do Not rinse/just ____ dry

A

simultaneous
dentin and enamel
acidic
phosphoric
air

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Q

Self Etch Adhesive System

w Uses an \_\_\_\_ primer to etch enamel and dentin simultaneously
n Not \_\_\_\_ acid
n NOT \_\_\_\_ OFF
n Less acidic than phosphoric acid
lWhy does this matter?* 
n Only \_\_\_\_ dried

A

acidic
phosphoric
rinsed
air

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Q

Self Etch Adhesive System

wSelf-etching adhesive systems:
n ____ motion is required
lWhy is this important?*
-Self-etching bonding agents dissolve the smear layer without ever exposing ____

n Minimizes post-operative sensitivity lHow?
-No ____ of the primer; never opening the ____ to the environment

A

scrubbing
dentinal tubules
rinsing/drying
dentinal tubules

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Q

Self Etch Adhesive System

wAdvantage of eliminating the rinsing and drying step:
n Reduces the possibility of ____ the dentinal tubules - “____” (that can happen in total etch procedures).
n Desiccaiton = collapsing of dentinal tubules that occur with overdrying = less ____
n Eliminates guessing “how ____” for the dentin with Total Etch

A

overdrying
desiccation
penetration
dry is dry enough

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Q

Self Etch Adhesive System

wPrime and Bond Elect Steps:
Scrub primer around the ____ and into the entire ____ thoroughly, do not rinse; air dry

Then ____cure

A

margins
prep
light

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Self Etch Adhesive System The Self Etch material used in preclinic: n ____

prime and bond elect

Different Bonding Systems wShortcoming of Pure Self Etch Systems: Enamel demineralization /marginal seal ____ than with Phosphoric acid* **Research has shown: The use of Phosphoric Acid to etch the enamel ____/and or enamel ____ of the preparaion as an initial and additional step has increased the overall bond ____ of the restoration This is the why the newer “____” Technique came to be developed

``` weaker cavosurface bevel strength selective-etch ```

Different Bonding Systems wSelective-Etch technique: n Phosphoric Acid etching of only the ____ margins of the preparation n ____ Follow with n ____ etching of the entire ____ preparation with Self Etch Primer - NOT ____ Acid n Do Not rinse/just ____ dry

enamel rinse and dry simultaneous internal phosphoric air

Selective-Self Etch Adhesive System wExtra Step – Based on Research: 1st: Etch enamel ____ and/or ____ areas first with Phosphoric acid to increase marginal bond strength lDo not get etchant into the ____ itself lThen proceed with the Self Etch System according to manufacturers instructions

cavosurface bevel preparation

Composite Resin Composition n Primary components l____ Phase – liquid resin liquid l____ Phase – reinforcing particles or fibers within the matrix l____ to promote adhesion between the filler and the matrix Complex composition – covered in Dental Materials

matrix filler bonding agent

Composite Resin Composition n Compositions vary by ____ lEach material is a proprietary mix of ____ forming the matrix, as well as engineered filler ____ and glass ____.

manufacturer resins glasses ceramics

Composite Resin Composition ``` wComposite Resins are divided into types: 1. Unfilled Resins no ____ particles 2. Filled Resins a variety ____ materials ```

filler | filled

Composite Resin Composition wTypes of Unfilled Resins: n ____ - adhesive layer n ____ sealer/____ glaze Thin, ____ top coat, but not used as a ____ material

``` bonding agent restoration clear viscous restorative ```

Composite Resin Composition wFilled composite resins: = unfilled resin + inorganic ____ or ____ filler wMakes a stronger and ____ resin wUsed for ____

silica glass stiffer restorations

Composite Resin Composition ``` wFiller Contributions: n ____ n Hardness n ____ n Color n ____ n Lowers setting shrinkage n Lowers the coefficient of ____ ```

strength abrasion resistance opacity thermal expansion

Composite Resin Composition wFilled composite resins: n Larger sized filler particles = ____ finished surface - ____ material n Smaller sized filler particles = better ____ surface (less filler spacing between particles) - less ____ material

rough stronger finished strong

Composite Resin Composition wTypes of Filled Composite Resins: ``` n Flowable wLess ____ content wMore ____ consistency wInferior ____ properties - Lower ____ resistance - Lower ____ ```

``` filler liquid physical wear strength ```

Flowable Composite Resin Clinical indications very ____! w____ sealants w____ repair wClass ____ Gingival Box – ____ layer

``` limited pit and fissure marginal II initial ```

Composite Resin Composition wKinds of Filled composite resins: n Macrofill w ____ microns in diameter n Microfill u.____ microns in diameter

10-100 | 0.01-0.1

Composite Resin Composition ``` n Hybrid wMixture of particles with different ____ - allowing higher ____ levels - permits good ____ and polishing ``` wHybrid resins have ____ fillers that increase hardness and wear, yet maintaining high polishability and overall esthetic quality

diameters filler finishing silica

Composite Resin Composition n Microhybrid/Nanohybrid u.____ microns in diameter uallow very high ____ levels while still maintaining ____ consistencies

0.005-0.01 filler workable

Microfill Composite Resin w Esthetic, intended to be used in ____ bearing ____ restorations, high polish, esthetic - CL ____ - CL ____ (Note: Low ____ may allow flexure of microfill and therefore material of choice for CL V in ____ and ____ patients – remember abfraction areas?)

non-load anterior III V modulus of elasticity bruxism clenching

Hybrid Composite Resin wCombines physical and mechanical properties of ____ with smooth surface of ____ wHigh strength and wear resistance provide ____ restorations wUniversal clinical applicability but has been replaced by Microhybrid or Nanohybrid due to superior properiteis (better ____ and ____)

``` macrofill microfill long-lasting strength shine ```

Microhybrid/Nanohybrid wOptimal size particle n is small enough to ____ similar to a microfill, but large enough to be highly ____ for strength wRivals ____ for esthetics wHigh fill capability rivals ____ for strength wClinically stack different ____ and translucencies for esthetics

``` polish filled microfills hybrids shades ```

Composite Resin Materials Used wNano Hybrid/Microhybrid mix used in preclinic/clinic: n TPH Spectra ____/____ restorations n TPH Spectra ____/____ restorations

LV anterior HV posterior

Considerations when selecting a composite resin material ``` wType of ____ Required w____ of Restoration Required w Occlusion wMaterial Properties Required w____ properties of material wNumber of available ____ wEase of use wParticle size/polishability ```

restoration size physical shades

Indications for Composite Resin Restorations wReplace ____ tooth structure wReplace missing enamel or dentin in ____ areas of teeth wRestore ____ teeth wChange shape and color of anterior teeth (____)

carious cervical fractured peg laterals

Indications for Composite Resin Restorations wAnterior teeth n Class ____, III, ____, V, ____ restorations wPosterior teeth n Class ____, small Class VI, and selected Class ____ and II lesthetic areas (ex. ____) llow ____ bearing areas lAreas that would not compromise ____ relationship

I IV VI ``` V I first premolars stress occlusal ```

Indications for Composite Resin Restorations Many more indications: 1. A restoration that will serve as a ____ under a ____ 2. A very ____ restoration that is used to strengthen remaining weakened tooth structure

foundation crown large

Indications for Composite Resin Restorations Continued: 3. Provide ____ for metallic crowns or PFM crowns 4. Bond ____ restorations 5. Bond ____ resin based restorations 6. Seal ____ of posterior teeth 7. Bond ____ brackets

``` retention all-ceramic indirect pits and fissures orthodontic ```

Indications for Composite Resin Restorations Continued: 8. Bond periodontal ____ and conservative tooth-replacement restorations 9. Repair existing restorations (composite resin, amalgam, ceramic) 10. Provide ____ for crowns 11. Desensitize exposed ____ surfaces 12. Bond fractured fragments of anterior teeth

splints foundations root

Indications for Composite Resin Restorations Continued: 13. Bond prefabricated and ____ 14. Reinforce fragile roots ____ 15. Seal ____ restorations placed during ____ surgery

cast posts internally apical endodontic surgery

Contraindications Important: wWhen the site cannot be appropriately ____ wHeavy ____ stresses/supporting VDO wWhen all ____ contacts are only on composite resin wRestorations with most of the margins on the root surface – ____ (not ideal)

isolated occlusal occlusal cementum

Composite Resin Polymerization Options w ____-cured wVisible ____-cured n Curing time usually minimum of ____seconds w ____-cure

self light 20 dual

Composite Resin Polymerization Options Dual-Cured wCombines ____-curing and ____-curing to address the problems with light curing w Self-curing rate is ____ and designed to continue to chemically cure those portions not adequately light cured. wReduces ____

self light slower polymerization shrinkage

Advantages of Composite ResinTechniques wDirect Benefits from Adhesion/Bonding Procedure n Decreased ____ n Decreased ____ caries n Decreased postoperative ____ n Increased ____ n Increased ____ of remaining tooth structure

``` microleakage recurrent sensitivity retention strength ```

Advantages of Composite Resin Techniques w Esthetics wMore ____ tooth reduction wEasier, less complex tooth preparation w ____ wLess reliance on ____ retention (convergent walls, retention grooves)

conservative economical macromechanical

Advantages of Composite Resin Techniques wPotential to reinforce ____ tooth structure wReduces ____ at the restoration- tooth interface n Sealed ____ part of restoration process wDeteriorated restorations can be repaired (if NO ____ present)

weakened microleakage margins caries

Advantages of Composite ResinTechniques wCan esthetically restore and/or recontour teeth with little or no tooth ____ wCan improve facial esthetics simply and economically

preparation

Disadvantages Material Related n Greater localized ____ n ____ effects

wear | polymerization shrinkage

Disadvantages Polymerization Shrinkage w As the composite sets, shrinkage causes the composite resin to pull away from cavity margins, resulting in ____ ``` wCan result in: n Open ____ n Sensitivity n Marginal ____ n Recurrent decay n ____ ```

gap formation margins staining fractures

Disadvantages Variable Degree of Cure Factors influencing extent of polymerization n ____ shades cure more easily l____ shades need to be light cured for a longer time n Limit/increment material thickness l____ or less (____ mm increments preferred)

lighter darker 2mm 1

Disadvantages Technique Sensitive wProper ____ is the most important wMay account for the great ____ in clinical success wMore difficult – multiple steps

technique | variability

Class III Composite Resin Procedure | Select the ____ before placing the rubber dam

shade

Class III Composite Resin Procedure MYLAR Matrix strip in place ‘____ STRIPS ®’ Separate the teeth slightly to place mylar matrix strip, if necessary

stop

Class III Composite Resin Procedure 1st: Condition the cavosurface margins of the preparation: Application of gel acid etchant on ____ only

bevel

Class III Composite Resin Procedure wPlace etchant over enamel for ____ seconds wRinse etchant off for ____ seconds w____ tooth w Enamel will appear “____” from the etchant

15 10 dry frosty

Class III Composite Resin Procedure Self Etch Conditioning: Prime and Bond Elect® primer and bonding agent – SELF ETCH (____) bonding system

1 STEP

Primer/Conditioning Application wGreatest source of ____ of the restoration is this step wMust saturate the preparation with the ____ agent wThe primer conditioned dentin appears “____” or shiny when air dried w____ into the preparation wMultiple applications

failure primer/conditioning glossy scrubbed

Primer/Conditioning Application wApplication of Primer/Bonding Agent n Dip microbrush into the Prime and Bond Elect single dose container n Lightly scrub the primer on the internal surface of the preparation continuously for ____ seconds n Apply ____ applications

15-20 | 2

Dentin Bonding Agent Application wApplication of Primer/Bonding Agent n After several seconds, gently air dry for ____ seconds n Surface should be shiny (do not get ____) n Light cure for ____ seconds

5 wet 10-20

Class III Composite Resin Procedure Composite material placed on ____ and an instrument will placeit in the preparation with more precision DO NOT ____ DIRECTLY INTO THE PREP!!!!

mixing pad | syringe

Class III Composite Resin Procedure Composite resin is adapted to walls of preparation in ____ mm increments ____ strip pulled to to ensure good adaptation to preparation

1 | mylar

Class III Composite Resin Procedure Cure for ____ seconds * from facial (____ shades require longer cure times Cure for ____ seconds* from lingual

20 darker 20

Oxygen Inhibition Layer wResin cure is inhibited by ____ n Outermost layers touched by air do not ____ wThis CAN BE useful § Allows incremental layering of composite to minimize ____ § What about the Mylar Strip?

oxygen harden polymerization shrinkage

Class III Composite Resin Procedure Contour with finishing ____ bur Contour with finishing ____ bur

football | needle

Class III Composite Resin Procedure Refine incisal and lingual embrasures with finishing discs “____ ®” ____ speed Handpiece (Red dot – reduced to ____ rpm)

soflex system slow 20,000

Class III Composite Resin Procedure OR Smooth with rubber ____ ® finishing points, and discs ____ speed Handpiece (____ dot - ____ head - reduced to ____ rpm)

``` enhance slow blue latch 20,000 ```

Class III Composite Resin Procedure | Apply polishing paste (____ ®) in a prophy cup for final shine

prisma gloss

Class III Composite Resin Procedure wCheck margins visually, with explorer and with dental floss wIf floss “catches”, additional ____ is necessary

finishing

Class III Composite Resin Procedure Abrasive interproximal strips are used to remove ____. Do not remove contact!

excess