Class V Scenarios & Technique

Question 1

If a pt has recurrent decay around existing composite what prep design & restorative material do you use?

Answer 1

• GI + composite (sandwich technique)

- Add fluoride to recharge GI

Question 2

Which restorative material has relatively poor wear ?

Answer 2

GI > Resin Ionomer > Composite > Amalgam

Question 3

What are the steps for GI placement?

Answer 3

1) Cut defect at the CEJ (1 mm)
2) Use tooth dentin conditioner (REMOVES biofilm & smear layer) for 20 SEC
3) Rinse & dry, DON’T DESICCATE DENTIN (surface moist)

4)

Question 4

When is GI used?

Answer 4

1) As an intermediate restorative material (as it is NOT as strong as composite, but LESS technique sensitive than composite)
2) Used in TX of non-cavitiated lesions, such as abrasions & abfractions

Question 5

What are the steps for GI placement?

Answer 5

1) Cut defect at the CEJ (1 mm)
2) Use tooth dentin conditioner (REMOVES biofilm & smear layer) for 20 SEC
3) Rinse & dry, DON’T DESICCATE DENTIN (surface moist)
4) Shake capsule and tap 3 times
5) Titrate the GIC capsule for 10 seconds
6) Place capsule in applicator clicking 2X to begin dispensing.
7) Wipe istrument w/ alcohol
8) Work quickly b/c work time = 1 min form start of mix
9) You can cover w/ matrix to shape restoration
10) Light cure for 20 SEC (if CHEMICAL cured material, set time = 6 min)
11) GIC is SOFT when it is SET. Therefore use finishing fur on SLOW SPEED to avoid under-contouring
12) CLEAR RESIN may be applied over GI for polish & seal!

Question 6

Before applying GI to tooth, make sure you squeeze out a little first to make sure _______________

Answer 6

it is not too wet (PA acid)

Question 7

Place the tip the ____________ part of the prep and over full the prep by about _________.

Answer 7

• Deepest

- 20%

Question 8

What are the steps for GI placement?

Answer 8

1) Cut defect at the CEJ (1 mm)
2) Use tooth dentin conditioner (REMOVES biofilm & smear layer) for 20 SEC
3) Rinse & dry, DON’T DESICCATE DENTIN (surface moist)
4) Shake capsule and tap 3 times
5) Titrate the GIC capsule for 10 seconds
6) Place capsule in applicator clicking 2X to begin dispensing.
7) Wipe PLASTIC instrument w/ alcohol
8) Work quickly b/c work time = 1 min form start of mix
9) You can cover w/ matrix to shape restoration
10) Light cure for 20 SEC (if CHEMICAL cured material, set time = 6 min)
11) GIC is SOFT when it is SET. Therefore use finishing fur on SLOW SPEED to avoid under-contouring
12) CLEAR RESIN may be applied over GI for polish & seal!

Question 9

Swipe the excess Resin Ionomer __________ from the tooth

Answer 9

-away

Question 10

Moisture contamination must be __________

Answer 10

-controlled

Question 11

Limited working time depending on _______ & ___________.
Once gel state reached, DO NOT ___________.

Answer 11

• Temperature
• Mix rate (3-5 min) see manufacturer details
• Manipulate

Question 12

What can you use to trim set Resin Ionomer ?

Making sure you do not what?

Answer 12

• 135 F diamond w/ water spray and ALWAYS end w/ 135 EF diamond.
• Cut into the root or cementum

Question 13

Get your explorer to make sure there are no _______ or _________ Resin ionomer

Answer 13

• VOIDS

- EXCESS

Question 14

What do you use to start and end polishing?

Answer 14

-Start w/ a FINE softflex disc and end with SUPERFINE

Question 15

What are patient home care instructions?

Answer 15

1) Wait till anesthesia gone before eating

2) Apply neural NAF rinse every night to recharge the Resin Ionomer

Question 16

A 45 yr old complains of severe gum recession. He brushes his teeth properly and has no contributing medical history. He grinds his teeth. What would you look for in his dental exam and what would you recommend?

Answer 16

• Diagnossis? Abfraction pt brushing too hard
• Tx Plan: First graft & then composite & occlusal adjustment or mouthguard(if all teeth involved)
• Preparation Design: Class V Composite w/ gingival retention grooves
• Materials used: Restore w/ internal layer of flowable composite & exterior w/ paste composite

Question 17

What are the steps to filling tooth w/ composite?

Answer 17

1) FIRST: flowable composite layer placed in retention groove & gingival margin first
2) SECOND: Fills the axial wall w/ dentin colored paste composite
3) THIRD: Final layer is enamel colored paste composite that covers entire surface

Question 18

What is the filling technique?

Answer 18

1) Use colored gel etchant
2) apply to enamel first then dentin for 20 SEC
3) Immediately rinse w/ water & air spray for 30 sec–leave barely moist
4) Apply bonding resin and blow thin w/ dry air
5) Light cure for 20 seconds using eye filter
6) Apply your 1st layer of flowable composite and cure for 20 SEC
7) Apply remaining paste composite in increments and cure for 20 sec

Question 19

Always direct the instrument from _______ to _______ when filling

Answer 19

• Composite

- Tooth

Question 20

What is the filling technique?

Answer 20

1) Use colored gel etchant
2) apply to enamel first then dentin for 20 SEC
3) Immediately rinse w/ water & air spray for 30 sec–leave barely moist
4) Apply bonding resin and blow thin w/ dry air
5) Light cure for 20 seconds using eye filter
6) Apply your 1st layer of flowable composite and cure for 20 SEC
7) Apply remaining paste composite in increments and cure for 20 sec
8) Lastly light cure for 60 SEC

Question 21

When using 135 EF (15 micron grit size) diamond, ALWAYS go from ________ towards ____________, using a feathering action.

Answer 21

• Tooth

- Composite

Question 22

What are other alternatives used for polishing?

Answer 22

-Impregnated rubber tips or composipro

Question 23

What are the steps to applying the final glaze?

Answer 23

• Reapply etchant over the composite for 20 seconds
• Apply Opti-guard w/ applicator, blow thin and light cure for 20 sec
• DONT forget to floss :)

Question 24

28 yr old has large carious lesion and multiple lesions throughout his mouth. CRA is high and he is very concerned about aesthetics. When he smile, his lips lift over 3 mm above the crest of his gingivae.

-What materials and prep design should be used?

Answer 24

• Not amalgam.
• GI & composite
• In aesthetic areas, you may bevel to the line angles

Question 25

Describe the step in the sandwich technique ?

-Is there a special technique for deep vs normal depth ?

Answer 25

1) Inner layer is filled w/ GI (Fuji IX) if DEEP OR Resin Ionomer (Fuji II LC) if NORMAL depth
2) 2nd later fills axial wall w/ dentin colored paste composite
3) Final layer is enamel colored paste composite that covers entire surface

Question 26

The glass or resin ionomer layer is placed on _______ with normal GI technique but only filled as a _________ on the _______ wall and or gingival margin.

Answer 26

• first

- liner