class IV prep and restore Flashcards
class IV
1) all proximal and incisal edge on anterior teeth
2) 4 or more surfaces
3) can be extension of old class III
4) trauma
prior to restoring this tooth
1) how much tooth is lost
2) pulp proximity, age?
3) vitality
- did they break any bones around it
4) fracture below or above gum
5) root fracture?
- radiograph
6) occlusion / incisal relationship
7) patient of record, pre-op record?
palpate gently
1) is tooth or bone moving when you palpate?
treatment options
1) reattachment
2) composite bonding
3) composite veneers
4) porcelain veneers
5) full coverage crown
reattachment
1) reverify fit
2) bond into place with bonding agent
3) fracture line visible
considerations for aesthetics
1) anatomy
2) shade/color
3) adhesive bonding
4) layering technique
5) finishing and polishing
biomimetic dentistry
1) mimicking biochemical process with inspiration from nature
2) repairing teeth with restorations that imitate the living tissue
- less aggressive and restore function and biomechanics
- emphasis on prevention rather than reactive approach
preparation goals
1) remove unsupported or vulnerable tooth
2) conservation of maximum tooth structure
3) bonding success-adhesive principles
4) no demarcation or lines
prep design
1) no need for chamfers
2) create irregular scalloping
- staburst
polychomatic teeth
1) multiple substrates
2) transparency and transopacity
3) shade selection is key
- BEFORE prep
- desiccation changes shade
shade matchin
1) dentin shade
- from gingival third
2) enamel
- middle third
4) incisal
- translucencytra
translucency
1) allows light to pass through
2) high translucency
- incisal edge
opacity
1) blocks lightb
benefits of incremental layering
1) shade and color
2) control volumetric shrinkage
criteria
1) polish
2) reduce shrinkage
3) handlining
4) stain resistance
5) nano particles
6) resistance to wear
7) layering
restoration technique
1) mylar
- good for small fractures
2) putty matrix
- better for bigger
mylar
1) small fracture with minimal incisal edge
2) readily available
- no stone model required
3) flexibility leads to improper contour and contact establishment
- hard to obtain exact correct contour in palatal aspect
putty
1) large fracture with incisal edge
2) exact palatal contour and from
- can restore multiple defects
3) mock build up of the defect has to be made
- second appointment
- UNLESS you have the stone model already
putty steps
1) wax up on stone model
- or use composite to wax up
2) fabricate putty
take putty matrix of typodont before prep
1) include the incisal area and extend onto the palate a little
2) must be cut right in the middle of the incisal area
set up your patient fracture
1) large fracture
2) break the contact
class IV prep steps
1) bevel the unsupported enamel 45 degrees on facial
- ONLY in enamel
3) lingual bevel in 45 degres
3) 2-4 starburst bevel
4) adapt teflon to adjacent teeth and palate
5) etch and bond
- dry and cure
6) apply a thin layer of wetting resin on putty to prevent sticking
shade layering
1) lingual shell with enamel color
- may not adapt all the way to the incisal if there is incisal translucency
2) create dental lobes with dental shade
3) fill in between lobes with enamel color
mylar steps
1) place a wedge
2) adapt mylar
- do not pull too hard
- hold at lingual very well with thumb
3) follow shade layering steps
finish and polish
1) less is more
2) minimize overbulk when placing composite
3) use composite polishing burs and optidiscs
- following the coarse => very fine
- DO NOT CUT PEOPLES LIPS
4) 012 scalpel
- SO SCARY
- do not cut people or ditch cementum
- gentle scraping
5) follow the contour of the original tooth, shape those mamelons!
what direction should the disc be moving
1) tooth => composite
- ditching
2) composite => tooth
- best!
finishing strips
1) insert through bald spot
2) do not wipe out contact
bristle brush
1) used at the end with the polishing paste
composite repair
1) good isolation
- oxygen inhibited layer present
- just add composite and light cure
2) poor isolation
- roughen restoration and re-etch
- can use 1/4 bur for small pits
white lines or halo
1) rotary instruments may make heat that cause enamel tags to tear
- as a result of tension of polymerization shrinkage
2) occurs when overaggressive use
