6. Posterior Composite Restoration Flashcards
Posterior Composite Restoration
REMEMBER:
• Composite resin materials have a ____ depth of cure
– they must be placed in increments, usually not exceeding ____ mm; preferably 1mm
• \_\_\_\_ has a limited curing range
limited
2
light
REMEMBER:
• Composite resin materials experience polymerization shrinkage upon curing
– they must be placed in increments, to reduce the amount of ____
– Reduction in polymerization shrinkage reduces microscopic gap formation, and possibly reduce ____
• Cusp deflection - polymerization shrinkage pulling on the \_\_\_\_ creating discomfort ○ Reason why you don't bulk fill
polymerization shrinkage
cusp deflection
cusps
REMEMBER:
• Since recurrent caries is one of the main reasons for failure:
– it is important to make every effort to minimize ____ at the tooth- resin interface by implementing the incremental placement technique
gap formation
Bonding System Choice Is Critical
Want:
• Strong ____
• Good ____
enamel bond
dentinal seal
Bonding System Choice
- Total etch
- Self etch
- Selective self etch
YAY
Bonding System Choice
Bonding System Decision Making:
-Class III, IV, V
____ dentin involved > ____ etch
-Diastema
____ dentin involved > ____ etch
-Larger/Deeper Class III, IV and V
____ dentin involved > ____ etch or *____ etch
- Research supports this method provides the best marginal seal. Use ____ etch on external cavosurface enamel for best bond strength there.• A little bit of dentin and a lot of enamel
little total no total more self selective self phosphoric acid
Bonding System Choice
Bonding System Decision Making:
-Class I and II
____ dentin involved > Small box > ____ etch
____ dentin involved > Large box or deep preparation > *____ etch
- Research supports this method provides the best marginal seal. Use Phosphoric acid etch on external cavosurface enamel for best bond strength there.
little
total
more
selective self
Bonding System Choice
• Studies show for Posterior teeth:
-____ box preparations (little dentin) show less enamel marginal microleakage with ____ etch bonding systems vs plain self etch bonding systems
-Example: ____ slot; small pit, etc
smaller
total
premolar
Bonding System Choice
• Studies show for Posterior teeth:
-More predicatable dentin bond strength is found with the ____ etch bonding system when the preparation is larger and deeper (more dentin exposed).
-Example: Conservative Class I and Class II
self
Bonding System Choice
• Studies show for Posterior teeth:
-The ____ etch bonding system shows a better enamel marginal seal than the conventional Self etch bonding systems
selective self
Posterior Composite Resin Placement Technique
Palodent Plus Sectional Matrix System
* Not \_\_\_\_ * Convex * No \_\_\_\_ * Separate teeth > compensate for the \_\_\_\_ of the band > for when you take matrix out so there isn't an open contact beccause you didn't use a wedge * Ring doesn't obstruct view of occlusal * Little band rests along adjacent \_\_\_\_ * Should have \_\_\_\_ on the palodent
circumferential
thickness
marginal ridge
floss
Posterior Composite Resin Placement Technique
Polymerization Shrinkage:
• Curing contraction in a bonded restoration generate stress on the walls of the tooth
• “____” is a term that relates the ratio of ____ walls of the tooth to ____ walls
• Bulk fill indications - recovering after endodontics - using a \_\_\_\_ composite during a build up (internal structure of the tooth)
configuration factor/c-factor
bonded
unbonded
dual cure
Posterior Composite Resin Placement Technique
Polymerization Shrinkage:
“C” Factor:
-The Ratio of Bonded/Restored walls/surfaces to Non Restored walls/surfaces
-Every restoration is like a cube, with ____ sides
-The higher “C” factor, the ____ stress the cavity will be under when restored unless special accommadations
are met during restoration placement phase
6
more
Posterior Composite Resin Placement Technique
“C” Factor:
• Presence of ____ and fracture lines beyond the restoration - resulting from the shrinkage of the material (____)
craze
instantaneous
Posterior Composite Resin Placement Technique
“C” Factor Examples:
• Class I: ____ walls bonded (M,D,B,L,P) /1 surface not (O) = ratio of 5/1
-“C” Factor of ____
• Class II (1 proximal surface): ____ surfaces bonded (M or D, P, B,L)/ 2 not (M or D,O)
- “C” Factor of ____
• C Factor of 5 - high polymerization shrinkage
5
5
4
2
Posterior Composite Resin Placement Technique
“C” Factor (continued)
• What about the Class V?
____ walls bonded (M,D,O,G,A) /1 surface not (O) = ratio of 5/1
-“C” Factor of ____
• What about the Class III?
____ walls restored (F,A,I,G)/ 2 non restored
(M or D,L)
-“C” Factor of ____
• Surface that's not is the B and L for CV
5
5
4
2
Posterior Composite Resin Placement Technique
Lower the “C” Factor - Lower the Polymerization Shrinkage….
• Do this by:
____ Placement of Composite
– Minimizes the amount of light cured composite in contact with the tooth surface at any one given time
– Rule of thumb: try to limit material to ____ walls at a time
incremental
2
Posterior Composite Resin Placement Technique
Class I
*with ____ Etch Bonding System
selective self
Class I Order
\_\_\_\_ Control Refine Preparation \_\_\_\_ Cavosurface Apply Self Etch Bonding System \_\_\_\_ Placement Contour Finish/Polish Restoration
caries
acid etch
incremental
Posterior Composite Resin Placement Technique
Class II
*with ____ Etch
Bonding System
selective self
Class II Order
____ Control/Refine Preparation
____ Placement/Re-wedge
____ Cavosurface
Apply Self Etch Bonding System
Place ____ on the Gingival floor
Incrementally Place Composite (Box first, then occlusal portion)
Finish/Polish Restoration Completed Restoration
caries
matrix
etch
flowable composite
Laboratory Procedure
1. Place the ____
- Condition tooth: Phosphoric Acid Etch Cavosurface for ____ seconds - Rinse thoroughly
- Application of Self Etch Prime and Bond Elect® Bonding Agent Same steps as with Class III and IV restorations
- Application of Shurfil SDR Flowable ® in Box (layer #1 above) New “Low stress bulk fill” Flowable composite
Only use for first increment in the ____ area first
____ Floor only – 1mm
Light cure for ____ seconds - Application of TPH Spectra HV® in Box (layers #2, #3, and #4 above)
Place incrementally to build up the remaining ____ area first
Try to keep material on only ____ walls at each time
Light cure each increment for ____ seconds
This will create a ____
matrix/wedge
15
box
gingival
30
nox
2
30
marginal ridge
Laboratory Procedure
- Application of TPH Spectra HV® in the Occlusal portion Place incrementally along entire ____ wall
Light cure for 30 seconds
Place incrementally along entire ____ wall
Light cure for 30 seconds
Sculpt final ____ increment, leaving the preparation slightly overfilled
Light cure for 30 seconds - Polish and contour with Composite Finishing Burs
-or Green and White stones (if much excess), then Finishing Carbides and Diamonds
____ Discs can be used in the embrasure areas – carefully
Enhance points, cups, and discs can be used as well - Polish with Prisma Gloss Polishing Paste in a prophy cup
Verify contact
-____
-With ____ - Remove Rubber Dam
lingual
buccal
occlusal
soflex
visually
floss
Posterior Composite Clinical Failures
Early Failures
- ____ formation
- Contamination/Voids
- Post operative ____
- Poor adhesion
- ____ halo
- Missing contact
DUE TO:
Poor ____/placement of materials
Poor ____
Poor ____ selection
gap
sensitivity
white
handling
isolation
case
Posterior Composite Clinical Failures
Late Failures
- ____
- Wear
- ____ caries
DUE TO:
Poor ____/placement of materials
Poor ____
Poor ____ selection
fracture
microleakage/recurrent
handling
isolation
case
