Class III, IV, and Class V Composite Restoration Flashcards
Select shade first
◦ before tooth is
dehydrated, excessively dried, or isolated with rubber dam.
Don’t — when taking the shade.
Don’t shine overhead light on tooth
Can cure some composite on the tooth to check the shade
◦ Do not
etch nor bond prior to this step
Steps in composite resin restoration
Acid Etch
◦ Rinse/dry
Prime (often included in bond step)
Bond/Adhesive
◦ Light cure
Place Composite
◦ Light cure
Acid Etch increases
surface area
Adhesive penetrates etched enamel
◦ creating
micromechanical bond
Etch
◦ enamel for — seconds
◦ dentin for — seconds.
◦ order
20-30
15
Apply etchant to enamel first; 15 seconds later apply it to the dentin then wash
off the enamel and dentin at the same time.
Rinse thoroughly — seconds.
15
Dry enamel with an
air syringe.
May selective etch ENAMEL ONLY
20-30 seconds, rinse, dry
◦ When using appropriate bond agent (e.g. Adhese, but any Universal)
Consideration when etching and
bonding Do not etch the adjacent tooth
(2)
◦ Teeth can be bonded together.
◦ May have to use a saw to open the contact
if the tooth gets contaminated with saliva re-etch for — seconds and then rinse
again and dry until frosted enamel appearance is present.
10
Consideration with fluoridated teeth Teeth rich in fluoride require longer etching times because
fluoridated teeth are more
resistant to acid
◦ That is why they have less tooth decay
◦ fluoridated teeth are resistant to the lactic acid produced by bacteria
Primer
(3)
◦ Hydrophilic monomers in solvent
◦ Draws adhesive in
◦ This step is included with adhesive in our clinic
Bond
(2)
◦ Resin bonding agent
◦ Also referred to as “adhesive”
The thin bonding agent engages the etched enamel through a
micro-mechanical bond.
The self-curing or light-cured resin then — bonds to the bonding agent.
chemically
Primer/adhesive penetrate the intertubular dentin forming
hybrid layer
Bonding Agent
(4)
Thin adhesive with a brush
Thin the solvent by blowing air gently
Don’t overly air-thin adhesive
◦ can result in uneven distribution and introduce air (oxygen) in mixture which retards polymerization
What we use in the clinic:
Peak Universal
Do not dispense the bonding agent before use
◦ why
alcohol will evaporate and not wet the dentin well enough.
Adhese Universal
Vivapen-
one-click dispense
Placing the composite resin Insert composite into preparation
◦ May insert with composite gun directly or use instrument
◦ Composite instrument, plastic instrument, small condenser, or ball burnisher may be appropriate
Contour with the plastic instrument or OptraSculpt pad
COMPOSITE STICKING TO INSTRUMENT:
(4)
◦ Dip instrument into small amount of adhesive to work with the composite
◦ Keeps composite from sticking to instrument
◦ May use Wetting Resin in practice
◦ If composite sticks to instrument and “pulls back”-> VOIDS
Opaque shades require — curing times
longer
Large class III restorations require — shades especially when the preparation can be seen through from the facial to the lingual.
opaque
Light will pass through — shades in large restorations thus making the restoration stand out in a patients mouth but the light will not as readily pass through in — shades.
translucent
opaque
Placing composite resin
No etching or bonding agent is required between
layers
◦ if the surface you are bonding to is clean and dry.
HOWEVER, if the surface gets contaminated between layers
RE-ETCH the contaminated
composite surface
◦ re-apply bonding agent, thin, cure
◦ apply composite resin
After placement of composite restoration, an
Oxygen-inhibited layer of resin will remain on the
surface for a time
◦ Additional composite can be added directly to this layer
◦ No need to re-etch and bond
Repairing old composites:
◦ The same process EXCEPT:
(2)
◦ roughen the old composite with a diamond bur
◦ then etch, wash, dry, bonding agent, thin, cure and apply new composite resin
When restoring two adjacent preparations
(4)
Prepare the larger restoration first
Restore the one with the least access first (the smallest preparation) and finish it first before
restoring the larger one
Only etch one preparation at a time.
Gingival bleeding will usually occur when removing the wedge. Must reinsert the wedge and
apply the matrix to the second tooth before etching and restoring.
PREPARE — FIRST
RESTORE — FIRST
LARGEST
SMALLEST
What we presently use in the clinic
(2)
3M Filtek Supreme
Peak® Universal Adhesive
◦ Ethanol solvent based
◦ 7% filled
Adhese® Universal Adhesive
◦ Ethanol solvent based
◦ Clicking dispenser penMaterials
Bulk method causes an increase in
polymerization stress.
— layering technique causes less polymerization stress
◦ Thus less post op sensitivity.
Incremental
Once the resin hardens, the stresses are moved to the
bond between the material
and the cavity wall
◦ can pull away from the cavity wall leaving a void
The more walls the resin is not bonded to helps to
relieve the stress in the resin-
adhesive interface
Class IV Restoration
(4)
Similar to Class III
MUST RE-ESTABLISH INCISAL EDGE
Bevel 2-3 mm on buccal
Bevel on lingual 1-2 mm
Class V restoration
Field should be clean and dry
Use appropriate retraction and matrix
(2)
◦ Retraction cord may be necessary
◦ May use Cure-Thru matrix
Finished Class V margin
(4)
Bond to the end of the bevel and finish to the end of the bevel
Avoid finishing on cementum when
possible
◦ This exposes dentin tubules
◦ Leads to sensitivity
Restore with Resin Composite
Use nanofill or microfill
(3)
◦lower modulus of elasticity (less stiff) than hybrids
◦won’t flex as readily
◦less likely to debond
