2. Adhesive Dentistry, I Flashcards
Adhesion:
nA material, usually a ____ fluid, that joins two substrates together and solidifies
viscous
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
acidic
unfilled
micromechanical
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.
monomer
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
close
scrubbing
wet
Principles of Adhesion Dentistry
wEnamel Adhesion:
n Bonding agent is the ____ into treated enamel
n ____ penetrates into etched surface
n Formation of ____ into porosities
scrubbed
resin
resin microtags
Principles of Adhesion Dentistry
wDentin Adhesion:
n Resin tags infiltrate
demineralized ____
n Adhesion to ____ is less strong than adhesion to ____
dentin
dentin
enamel
Principles of Adhesion Dentistry
uDentin Adhesion:
nBonding resin penetrate and polymerize in the etched, open ____, forming resin tags
nBonding resins also penetrates the ____
dentinal tubules
intertubular dentin
Dentin Adhesion
wAdhesive strength to dentin is less than enamel
w Why?
[???]
ANSWER ME
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 ____
smear layer
mineralized
retention
bond strength
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 = “____”
less
shrink
marginal
gap formation
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
total etch
self etch
selective self etch
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 \_\_\_\_
simulataneous
dentin and enamel
phosphoric
rinse and dry
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
30-40%
15
10
5-10
3
2
Total Etch Technique - 3 Step System
w 3-steps: 1st : \_\_\_\_(conditioning) l\_\_\_\_ off lDemineralizes \_\_\_\_ lRemoves the \_\_\_\_ layer in dentin lOpens the \_\_\_\_ lIncreases enamel/dentin \_\_\_\_
acid etching rinsed enamel smear dentinal tubules permeability
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
primer
hydrophilic
hydrophobic
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
bonding
scrubbed
light cure
Total Etch Technique - 2 Step System
wSimplified 3 Step Systems
wStill use “____” technique
wCombined Steps 2 and 3: ____ are combined
total etch
primer and bonding agents
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
easier
improved
sensitivity
compatible
Total Etch Technique - 2 Step System
w2 Step Systems Used in PreClinic:
n ____
prime & bond NT
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
simultaneous dentin and enamel acidic phosphoric air
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
acidic
phosphoric
rinsed
air
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
scrubbing
dentinal tubules
rinsing/drying
dentinal tubules
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
overdrying
desiccation
penetration
dry is dry enough
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
margins
prep
light
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:
- A restoration that will serve as a ____ under a ____
- A very ____ restoration that is used to strengthen remaining weakened tooth structure
foundation
crown
large
Indications for Composite Resin Restorations
Continued:
- Provide ____ for metallic crowns or PFM crowns
- Bond ____ restorations
- Bond ____ resin based restorations
- Seal ____ of posterior teeth
- Bond ____ brackets
retention all-ceramic indirect pits and fissures orthodontic
Indications for Composite Resin Restorations
Continued:
- Bond periodontal ____ and conservative tooth-replacement restorations
- Repair existing restorations (composite resin, amalgam, ceramic)
- Provide ____ for crowns
- Desensitize exposed ____ surfaces
- 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
