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CLASS III, IV and V
DIRECT COMPOSITE
  RESTORATIONS
Indications:
Indications:

    restorations in esthetic prominent
    areas
Indications:

  restorations in esthetic prominent
  areas

  areas can be adequately isolated
Indications:

  restorations in esthetic prominent
  areas

  areas can be adequately isolated

  tooth preparations that have an all
  enamel margins
Contraindications:
Contraindications:

    an operating area that cannot be
    adequately isolated
Contraindications:

  an operating area that cannot be
  adequately isolated

  class v restorations that are not
  esthetically critical
Contraindications:

  an operating area that cannot be
  adequately isolated

  class v restorations that are not
  esthetically critical

  restorations that extends into the
  root surface (contraction gap)
Advantages
Advantages

    esthetics
Advantages

  esthetics

  conservative of tooth structure
  removal
Advantages

  esthetics

  conservative of tooth structure
  removal

  less complex when preparing the
  tooth
Advantages

  esthetics

  conservative of tooth structure
  removal

  less complex when preparing the
  tooth

  low thermal conductivity (insulative)
Advantages

  esthetics

  conservative of tooth structure
  removal

  less complex when preparing the
  tooth

  low thermal conductivity (insulative)

  Used almost universally
Advantages (continued)

    bonded to tooth structure
Advantages (continued)

  bonded to tooth structure

  Repairable
Disadvantages
Disadvantages

    may result to gap formation
Disadvantages

  may result to gap formation

  restoration is more difficult, time-
  consuming, costly
Disadvantages

  may result to gap formation

  restoration is more difficult, time-
  consuming, costly

  more technique sensitive
Disadvantages

  may result to gap formation

  restoration is more difficult, time-
  consuming, costly

  more technique sensitive

  may exhibit more wear in areas of
  high occlusion
Disadvantages

  may result to gap formation

  restoration is more difficult, time-
  consuming, costly

  more technique sensitive

  may exhibit more wear in areas of
  high occlusion

  have a higher linear coefficient of
  thermal expansion
COMPOSITE
COMPOSITE

    introduced commercially in 1962 by
    Bowen of the National Bureau of
    Standards
COMPOSITE

  introduced commercially in 1962 by
  Bowen of the National Bureau of
  Standards

  most popular tooth colored material
COMPOSITE

  introduced commercially in 1962 by
  Bowen of the National Bureau of
  Standards

  most popular tooth colored material

  consist of a continuous polymeric or
  resin matrix in which an inorganic
  filler is dispersed
Classification
Classification
1. Conventional
Classification
1. Conventional
2. Microfilled
Classification
1. Conventional
2. Microfilled
3. Hybrid
Classification
1. Conventional
2. Microfilled
3. Hybrid
  .1 Flowable
Classification
1. Conventional
2. Microfilled
3. Hybrid
  .1 Flowable
  .2 Packable
Classification
1. Conventional
2. Microfilled
3. Hybrid
  .1 Flowable
  .2 Packable
4. Nanofilled
Composition
Composition
1. Organic Resin
Composition
1. Organic Resin – forms the matrix
Composition
1. Organic Resin – forms the matrix
-dimethacrylate monomer (BIS-GMA)
Composition
1. Organic Resin – forms the matrix
-dimethacrylate monomer (BIS-GMA)
2. Inorganic filler
Composition
1. Organic Resin – forms the matrix
-dimethacrylate monomer (BIS-GMA)
2. Inorganic filler
- inhibits deformation of the matrix
Composition
1. Organic Resin – forms the matrix
-dimethacrylate monomer (BIS-GMA)
2. Inorganic filler
- inhibits deformation of the matrix
-reduce the coefficient of thermal
  expansion of the resin matrix
Composition
A. Organic Resin – forms the matrix
-dimethacrylate monomer (BIS-GMA)
B. Inorganic filler
- inhibits deformation of the matrix
-reduce the coefficient of thermal
  expansion of the resin matrix
e.g. fused silica, crystalline quartz,
  lithium aluminum silicate,
  borosilicate glass
C. Coupling Agent
C. Coupling Agent
– unite the resin with the filler
C. Coupling Agent
– unite the resin with the filler
-stress absorber of the filler and
  resin
3. Coupling Agent
– unite the resin with the filler
-stress absorber of the filler and
  resin
4. Initiator System
3. Coupling Agent
– unite the resin with the filler
-stress absorber of the filler and
  resin
4. Initiator System – activate the
  setting mechanism
3. Coupling Agent
– unite the resin with the filler
-stress absorber of the filler and
  resin
4. Initiator System – activate the
  setting mechanism
5. Stabilizers
C. Coupling Agent
– unite the resin with the filler
-stress absorber of the filler and
  resin
D. Initiator System – activate the
  setting mechanism
E. Stabilizers
F. Pigments
Conventional Composites
Conventional Composites

    contains 75-80% inorganic filler by
    weight
Conventional Composites

  contains 75-80% inorganic filler by
  weight

  average particle size 8µm
l
Conventional Composites

  contains 75-80% inorganic filler by
  weight

  average particle size 8µm

  large size particle and
  extremely hard filler
Conventional Composites

  contains 75-80% inorganic filler by
  weight

  average particle size 8µm

  large size particle and
  extremely hard filler

  rough surface structure
   strontium and barium glass
    (radiopaque)
Microfilled Composites
Microfilled Composites

    introduced in the late 1970
Microfilled Composites

  introduced in the late 1970

  polishable
Microfilled Composites

  introduced in the late 1970

  polishable

  smooth lustrous surface similar to
  tooth enamel
Microfilled Composites

  introduced in the late 1970

  polishable

  smooth lustrous surface similar to
  tooth enamel

  particle size is 0.01 – 0.04µm
Microfilled Composites

  introduced in the late 1970

  polishable

  smooth lustrous surface similar to
  tooth enamel

  particle size is 0.01 – 0.04µm

  contains 35-60% inorganic filler
  by weight

    some of physical and mechanical
    properties are inferior

  some of physical and mechanical
  properties are inferior

  wear resistant

  some of physical and mechanical
  properties are inferior

  wear resistant

  low modulus of elasticity (allow
  restoration to flex)

  some of physical and mechanical
  properties are inferior

  wear resistant

  low modulus of elasticity (allow
  restoration to flex)

  high resin content results in an
  increased coefficient of thermal
  expansion and lower strength
Use of Microfilled Composites
Use of Microfilled Composites

    used for low stress restorations
Use of Microfilled Composites

  used for low stress restorations

  buccal and lingual surfaces of class
  III and class V
Hybrid Composites
Hybrid Composites

    combines the properties of
    conventional and microfilled
Hybrid Composites

  combines the properties of
  conventional and microfilled

  contains 75-85% inorganic filler by
  weight
Hybrid Composites

  combines the properties of
  conventional and microfilled

  contains 75-85% inorganic filler by
  weight

  particle size is 0.4 – 1µm
Hybrid Composites

  combines the properties of
  conventional and microfilled

  contains 75-85% inorganic filler by
  weight

  particle size is 0.4 – 1µm

  physical properties is superior
  to conventional

    predominant direct esthetic resin

  predominant direct esthetic resin

  have universal clinical applicability
Use of Hybrid Composites
Use of Hybrid Composites

    used in moderate stress
    restorations where strength and
    wear resistance are more important
    than surface luster
Use of Hybrid Composites

  used in moderate stress
  restorations where strength and
  wear resistance are more important
  than surface luster

  Class I, class II, class IV
Flowable
Flowable

    flows into cavity due to lower
    viscosity
Flowable

  flows into cavity due to lower
  viscosity

  have lower filler content
Flowable

  flows into cavity due to lower
  viscosity

  have lower filler content

  inferior physical properties (lower
  wear resistance, lower strength)
Flowable

  flows into cavity due to lower
  viscosity

  have lower filler content

  inferior physical properties (lower
  wear resistance, lower strength)

  used in small class I, pit and fissure
  sealant,marginal repair, liner

    easy to use

  easy to use

  good wettability

  easy to use

  good wettability

  favorable handling properties
Packable (Condensable)
Packable (Condensable)

    more viscous, “thicker, stiffer feel”
Packable (Condensable)

  more viscous, “thicker, stiffer feel”

  have filler particle feature that
  prevents sliding of the filler particle
  by one another
Packable (Condensable)

  more viscous, “thicker, stiffer feel”

  have filler particle feature that
  prevents sliding of the filler particle
  by one another

  easier restoration of proximal
  contact
Packable (Condensable)

  more viscous, “thicker, stiffer feel”

  have filler particle feature that
  prevents sliding of the filler particle
  by one another

  easier restoration of proximal
  contact

  similar to the handling of amalgam
Nanocomposites

    Nanotechnology or, for short, nanotech,
    refers to a field of applied science whose
    theme is the control of matter on an atomic
    or molecular scale.

    Generally nanotechnology deals with
    structures 100 nanometers or smaller, and
    involves developing materials or devices
    within that size.

    Nanocomposites are materials that are
    created by introducing nanoparticulates
    (often referred to as filler) into a
    macroscopic sample material (often referred
    to as the matrix).

    After adding nanoparticulates to the matrix
    material, the resulting nanocomposite may
    exhibit drastically enhanced properties. For
    example, adding carbon nanotubes tends to
    drastically add to the electrical and thermal
    conductivity.

    Other kinds of nanoparticulates may result
    in enhanced optical properties, dielectric or
    mechanical properties such as stiffness and
    strenght.
CLINICAL TECHNIQUE
FOR DIRECT CLASS III,

   CLASS IV AND
      CLASS V
   RESTORATIONS
Class III Tooth Preparation
Class III Tooth Preparation
Class III Tooth Preparation

    there is a choice between facial or
    lingual entry into the tooth
Indications for Lingual Approach
Indications for Lingual Approach
1. to conserve facial enamel for
  enhanced esthetics
Indications for Lingual Approach
1. to conserve facial enamel for
  enhanced esthetics
2. carious lesion is positioned
  lingually
Indications for Lingual Approach
1. to conserve facial enamel for
  enhanced esthetics
2. carious lesion is positioned
  lingually
3. lesion is accessible from the
  lingual
Indications for Facial Approach
Indications for Facial Approach
1. The carious lesion is positioned
  facially
Indications for Facial Approach
1. The carious lesion is positioned
  facially
2. Teeth is irregularly aligned,
  making lingual access undesirable.
Indications for Facial Approach
1. The carious lesion is positioned
  facially
2. Teeth is irregularly aligned,
  making lingual access undesirable.
3. Extensive caries extent into the
  facial surface.
Indications for Facial Approach
1. The carious lesion is positioned
  facially
2. Teeth is irregularly aligned,
  making lingual access undesirable.
3. Extensive caries extent into the
  facial surface.
4. Faulty restoration that was
  originally placed at the facial.
Conventional Class III
Conventional Class III

    indicated for restorations involving
    the root surface
Conventional Class III

 indicated for restorations involving
 the root surface
1. using a No. ½, 1, 2 round bur
 prepare the outline form on the root
 surface
Conventional Class III

 indicated for restorations involving
 the root surface
1. using a No. ½, 1, 2 round bur
 prepare the outline form on the root
 surface
2. extend the preparation into sound
 walls
Conventional Class III

 indicated for restorations involving
 the root surface
1. using a No. ½, 1, 2 round bur
 prepare the outline form on the root
 surface
2. extend the preparation into sound
 walls
3. extend pulpally 0.75mm in depth
4. The gingival/cervical and incisal
 wall is perpendicular to the root
 surface (box like design)
4. The gingival/cervical and incisal
 wall is perpendicular to the root
 surface (box like design)
5. A continuous groove retention can
 be prepared 0.25 mm (½ of
 diameter of bur) into dentin of the
 gingival and incisal walls with a ¼
 round bur.
6. The groove is placed at the
 junction of the axial and the external
 walls.
6. The groove is placed at the
 junction of the axial and the external
 walls.
7. Clean preparation and inspect the
 final preparation.
Beveled Conventional Class III
Beveled Conventional Class III

    Indicated for replacing an existing
    defective restoration in the crown
    portion of the tooth
Beveled Conventional Class III

  Indicated for replacing an existing
  defective restoration in the crown
  portion of the tooth

  when restoring a large carious
  lesion for which the need for
  increased retention and/or
  resistance form is anticipated.
Lingual Access
Lingual Access
1. Use a round bur No. 1/2, 1. 2
 depending on the size of the caries
 to enlarge the opening sufficiently to
 allow for caries removal.
Lingual Access
1. Use a round bur No. 1/2, 1. 2
 depending on the size of the caries
 to enlarge the opening sufficiently to
 allow for caries removal.
2. Extend external walls to sound
 tooth structure using a straight bur
3. Extend the gingival and incisal
 walls up to extent of caries or
 location of old restoration.
3. Extend the gingival and incisal
 walls up to extent of caries or
 location of old restoration.
Unless necessary, DO NOT:
3. Extend the gingival and incisal
  walls up to extent of caries or
  location of old restoration.
Unless necessary, DO NOT:

  include the proximal contact.
3. Extend the gingival and incisal
  walls up to extent of caries or
  location of old restoration.
Unless necessary, DO NOT:

  include the proximal contact.

  extend into the facial surface.
3. Extend the gingival and incisal
  walls up to extent of caries or
  location of old restoration.
Unless necessary, DO NOT:

  include the proximal contact.

  extend into the facial surface.

  extend subgingivally
4. Create an axial wall depth of
 0.2mm into the dentin/DEJ
 (approximately 0.75 – 1.25mm in
 depth)
4. Create an axial wall depth of
 0.2mm into the dentin/DEJ
 (approximately 0.75 – 1.25mm in
 depth)
5. Axial wall is convex, following the
 external contour of the tooth.
4. Create an axial wall depth of
 0.2mm into the dentin/DEJ
 (approximately 0.75 – 1.25mm in
 depth)
5. Axial wall is convex, following the
 external contour of the tooth.
6. Remove all remaining infected
 dentin, using a round bur or small
 spoon excavator.
7. Remove friable enamel at the
 margins.
7. Remove friable enamel at the
 margins.
8. If necessary, prepare retention
 (grooves or coves)
7. Remove friable enamel at the
  margins.
8. If necessary, prepare retention
  (grooves or coves)

  prepare it along the gingivoxial line
  angle, and sometimes at the
  incisoaxial line angle .25 mm with a
  ¼ round bur.
9. Place cavosurface bevel or flare at
 the enamel except at the gingival
 margin area.
9. Place cavosurface bevel or flare at
 the enamel except at the gingival
 margin area.
10. Use a flame shape or round bur
 resulting in a 45 degrees angle to
 the external tooth surface.
9. Place cavosurface bevel or flare at
 the enamel except at the gingival
 margin area.
10. Use a flame shape or round bur
 resulting in a 45 degrees angle to
 the external tooth surface.
11. Bevel width should be 0.25 to
 0.5mm.
12. Clean the preparation of any
 debris and inspect final preparation.
Facial Access
Facial Access

  same stages and steps are followed
Facial Access

  same stages and steps are followed

  procedure is simplified because of
  easy access
Modified Class III
Modified Class III

  most used type of cavity
  preparation.
Modified Class III

  most used type of cavity
  preparation.

  indicated for small and moderate
  lesions or faults.
Modified Class III

  most used type of cavity
  preparation.

  indicated for small and moderate
  lesions or faults.

  designed to be as conservative as
  possible.
Modified Class III

  most used type of cavity
  preparation.

  indicated for small and moderate
  lesions or faults.

  designed to be as conservative as
  possible.

  preparation walls have no specific
  shapes or forms other than an
  external angle of 90 or more
  degrees

    preparation design appears to be
    scooped or concave

 preparation design appears to be
 scooped or concave
1. Use a 1/2, 1, 2 round bur, point of
 entry is within the incisogingival
 dimension of the lesion,
 perpendicular to the enamel
 surface.

 preparation design appears to be
 scooped or concave
1. Use a 1/2, 1, 2 round bur, point of
 entry is within the incisogingival
 dimension of the lesion,
 perpendicular to the enamel
 surface.
2. Remove all remaining caries or
 defect.
3. No attempt is made to create a
 uniform axial wall.
3. No attempt is made to create a
 uniform axial wall.
4. Place cavosurface bevel or flare at
 the enamel except at the gingival
 margin area.
3. No attempt is made to create a
 uniform axial wall.
4. Place cavosurface bevel or flare at
 the enamel except at the gingival
 margin area.
5. Use a flame shape or round bur
 resulting in a 45 degrees angle to
 the external tooth surface.
3. No attempt is made to create a
 uniform axial wall.
4. Place cavosurface bevel or flare at
 the enamel except at the gingival
 margin area.
5. Use a flame shape or round bur
 resulting in a 45 degrees angle to
 the external tooth surface.
6. Bevel width should be 0.25 to
 0.5mm.
7. Clean the preparation of any
 debris and inspect final preparation.
Class IV Tooth Preparation
Class IV Tooth Preparation

    preoperative assessment of
    occlusion is very important
    (placement of margin in noncontact
    areas)
Class IV Tooth Preparation

  preoperative assessment of
  occlusion is very important
  (placement of margin in noncontact
  areas)

  shade selection is more difficult
Class IV Tooth Preparation

  preoperative assessment of
  occlusion is very important
  (placement of margin in noncontact
  areas)

  shade selection is more difficult

  preparation is similar to Class III
  except that the preparation for class
  IV is extended to the incisal angles
Class V Tooth Preparation
Conventional
Class V Tooth Preparation
    Conventional


    the feature of the preparation
    include a 90 degree cavosurface
    angle, uniform depth of the axial line
    angle, and sometimes, groove
    retention from.
Class V Tooth Preparation
    Conventional


  the feature of the preparation
  include a 90 degree cavosurface
  angle, uniform depth of the axial line
  angle, and sometimes, groove
  retention from.

  conventional design is indicated
  only for portion of the lesion
  extended onto the root surface
1. Use a tapered fissure (No. 700,
 701,or 271) or No.1 or 2 round bur.
1. Use a tapered fissure (No. 700,
 701,or 271) or No.1 or 2 round bur.
2. Make entry at 45 degrees angle to
 tooth surface, this should result to a
 90 degree cavosurface.
1. Use a tapered fissure (No. 700,
 701,or 271) or No.1 or 2 round bur.
2. Make entry at 45 degrees angle to
 tooth surface, this should result to a
 90 degree cavosurface.
3. Axial depth is 0.75 mm
1. Use a tapered fissure (No. 700,
  701,or 271) or No.1 or 2 round bur.
2. Make entry at 45 degrees angle to
  tooth surface, this should result to a
  90 degree cavosurface.
3. Axial depth is 0.75 mm
-strength of preparation wall
1. Use a tapered fissure (No. 700,
  701,or 271) or No.1 or 2 round bur.
2. Make entry at 45 degrees angle to
  tooth surface, this should result to a
  90 degree cavosurface.
3. Axial depth is 0.75 mm
-strength of preparation wall
-strength of composite
1. Use a tapered fissure (No. 700,
  701,or 271) or No.1 or 2 round bur.
2. Make entry at 45 degrees angle to
  tooth surface, this should result to a
  90 degree cavosurface.
3. Axial depth is 0.75 mm
-strength of preparation wall
-strength of composite
-placement of retention groove
4. Axial should follow contour of the
 tooth.
4. Axial should follow contour of the
 tooth.
5. Extent of outline form is dictated
 by the carious lesion extent.
4. Axial should follow contour of the
 tooth.
5. Extent of outline form is dictated
 by the carious lesion extent.
6. Remove remaining carious lesion
4. Axial should follow contour of the
 tooth.
5. Extent of outline form is dictated
 by the carious lesion extent.
6. Remove remaining carious lesion
7. Prepare retention groove (similar
 to Class III preparation)
4. Axial should follow contour of the
 tooth.
5. Extent of outline form is dictated
 by the carious lesion extent.
6. Remove remaining carious lesion
7. Prepare retention groove (similar
 to Class III preparation)
8. Clean preparation
Beveled Conventional Class V
Beveled Conventional Class V

    Indications
Beveled Conventional Class V

 Indications
1. replacement of defective class V
 restorations
Beveled Conventional Class V

 Indications
1. replacement of defective class V
 restorations
2. large carious lesion
Beveled Conventional Class V

  Indications
1. replacement of defective class V
  restorations
2. large carious lesion

  exhibits 90 degrees of cavosurface
Beveled Conventional Class V

  Indications
1. replacement of defective class V
  restorations
2. large carious lesion

  exhibits 90 degrees of cavosurface

  axial wall depth is uniform (0.2mm
  or 0.5 when retention groove is to
  placed)

    groove is not indicated when
    periphery of tooth preparation is
    located in enamel.

  groove is not indicated when
  periphery of tooth preparation is
  located in enamel.

  remove all infected dentin

  groove is not indicated when
  periphery of tooth preparation is
  located in enamel.

  remove all infected dentin

  clean preparation
Modified Class V
Modified Class V

    indicated for small and moderate
    lesion and lesion entirely in the
    enamel
Modified Class V

  indicated for small and moderate
  lesion and lesion entirely in the
  enamel

  no effort to prepare a butt-joint
Modified Class V

  indicated for small and moderate
  lesion and lesion entirely in the
  enamel

  no effort to prepare a butt-joint

  no retention groove
Modified Class V

  indicated for small and moderate
  lesion and lesion entirely in the
  enamel

  no effort to prepare a butt-joint

  no retention groove

  lesion is scooped out
Modified Class V

  indicated for small and moderate
  lesion and lesion entirely in the
  enamel

  no effort to prepare a butt-joint

  no retention groove

  lesion is scooped out

  preparation has divergent wall
Modified Class V

  indicated for small and moderate
  lesion and lesion entirely in the
  enamel

  no effort to prepare a butt-joint

  no retention groove

  lesion is scooped out

  preparation has divergent wall

  axial wall does not have uniform
  depth

    prepare tooth with round or elliptical
    instrument

  prepare tooth with round or elliptical
  instrument

  preparation is extended no deeper
  than 0.2 mm

  prepare tooth with round or elliptical
  instrument

  preparation is extended no deeper
  than 0.2 mm

  no effort is made to prepare a 90
  degree cavosurface margins.

  prepare tooth with round or elliptical
  instrument

  preparation is extended no deeper
  than 0.2 mm

  no effort is made to prepare a 90
  degree cavosurface margins.

  infected enamel is removed with a
  round bur or excavator.
Class V Tooth Preparation for
Abrasion/Erosion
Class V Tooth Preparation for
Abrasion/Erosion

  Abrasion – often V-shaped is a loss
  or wearing away due to mechanical
  forces.
Class V Tooth Preparation for
Abrasion/Erosion

  Abrasion – often V-shaped is a loss
  or wearing away due to mechanical
  forces.

  Erosion- often a saucer shaped
  notch as a result of chemical
  dissolutions

    Abfraction/Idiopathic Erosion- may
    occur as a result of flexure of
    cervical area under heavy occlusal
    stress. This occurs as a notched
    defect.

  Abfraction/Idiopathic Erosion- may
  occur as a result of flexure of
  cervical area under heavy occlusal
  stress. This occurs as a notched
  defect.

  Modified tooth preparation is used
  for this types of defects.
Acid Etching
Acid Etching

    A physical process that creates a
    microscopically rough enamel
    surface (enamel tags)
Acid Etching

  A physical process that creates a
  microscopically rough enamel
  surface (enamel tags)

  first successful technique developed
  to bond dental materials to tooth
  structure
Acid Etching

  A physical process that creates a
  microscopically rough enamel
  surface (enamel tags)

  first successful technique developed
  to bond dental materials to tooth
  structure

  acid used id 37% ortho-phosphoric
  acid

    sometimes referred to as
    conditioner
Enamel Etching
Enamel Etching
Acid
Enamel Etching
Acid

  37% ortho-phosphoric acid
Enamel Etching
Acid

  37% ortho-phosphoric acid

  dissolves the periphery of enamel
  rod, or the core of the rods or both

    over-etching results to formation of
    crystals (precipitates) that inhibits
    bonding

  over-etching results to formation of
  crystals (precipitates) that inhibits
  bonding

  built-in quality control check – if
  properly etched it appears frosty or
  chalky white.

  over-etching results to formation of
  crystals (precipitates) that inhibits
  bonding

  built-in quality control check – if
  properly etched it appears frosty or
  chalky white.
Time

  over-etching results to formation of
  crystals (precipitates) that inhibits
  bonding

  built-in quality control check – if
  properly etched it appears frosty or
  chalky white.
Time

  15-30 seconds permanent tooth

  over-etching results to formation of
  crystals (precipitates) that inhibits
  bonding

  built-in quality control check – if
  properly etched it appears frosty or
  chalky white.
Time

  15-30 seconds permanent tooth

  twice as long for deciduous
Dentin Etching
Dentin Etching
Acid
Dentin Etching
Acid

  37% ortho-phosphoric acid
Dentin Etching
Acid

  37% ortho-phosphoric acid

  removes the smear layer from the
  surface of the of the dentin as well
  as the plugs of material forces into
  dentinal tubules during cavity
  preparation.

    decalcifies a layer of dentin several
    microns thick

 decalcifies a layer of dentin several
 microns thick
Time

 decalcifies a layer of dentin several
 microns thick
Time
10-15 seconds
Primer
Primer

    similar to the low viscosity resin
    used in enamel bonding.
Primer

  similar to the low viscosity resin
  used in enamel bonding.

  primers are hydrophilic (tolerant of
  moisture)
Primer

  similar to the low viscosity resin
  used in enamel bonding.

  primers are hydrophilic (tolerant of
  moisture)

  contains a volatile solutions
  (acetone) to thin the organic
  chemicals and improves the wetting
  of the etched surface

    primer flows into:

  primer flows into:
-surface irregularities of etched
  enamel

  primer flows into:
-surface irregularities of etched
  enamel
-open tubules and around collagen
  fibers of etched dentin

  primer flows into:
-surface irregularities of etched
  enamel
-open tubules and around collagen
  fibers of etched dentin

  primers do not set on their own, et
  when adhesive is applied
Adhesives
Adhesives

    a low viscosity resin
Adhesives

  a low viscosity resin

  dentin adhesives contain hydrophilic
  chemicals, but less than in primers
Adhesives

  a low viscosity resin

  dentin adhesives contain hydrophilic
  chemicals, but less than in primers

  adhesive sets
Adhesives

  a low viscosity resin

  dentin adhesives contain hydrophilic
  chemicals, but less than in primers

  adhesive sets

  renders the tooth surface glossy
Two-step Bonding System
Two-step Bonding System

  the primer and the adhesive have
  been combined
Two-step Bonding System

  the primer and the adhesive have
  been combined

One-step/Self Etching System
Two-step Bonding System

  the primer and the adhesive have
  been combined

One-step/Self Etching System

  etches, primes and bonds (has
  adhesives) the tooth structure all at
  once
Two-step Bonding System

  the primer and the adhesive have
  been combined

One-step/Self Etching System

  etches, primes and bonds (has
  adhesives) the tooth structure all at
  once

  sometimes does not effectively etch
  the enamel.
Restorative Technique
Restorative Technique
1. Determine shade of tooth
Shade Selection:
After caries removal
and cavity preparation
shade selection was
done using shade
guide
Restorative Technique
1. Determine shade of tooth
2. Clean the tooth preparation using
 a slurry of pumice, polishing cup.
Restorative Technique
1. Determine shade of tooth
2. Clean the tooth preparation using
 a slurry of pumice, polishing cup.
3. Isolate the tooth, preferably with a
 rubber dam or cotton rolls.
Isolation of the Teeth:
Rubber dam isolation
technique was used to
keep the prepared teeth
from saliva, blood,
debris and other fluids.
Restorative Technique
1. Determine shade of tooth
2. Clean the tooth preparation using
 a slurry of pumice, polishing cup.
3. Isolate the tooth, preferably with a
 rubber dam or cotton rolls.
4. Protect adjacent unprepared tooth
 from the acid etchant with a
 polyester strip apply the wedge.
5. Apply the gel etchant 0.5 beyond
 the prepared margins onto the
 adjacent unprepared tooth.
5. Apply the gel etchant 0.5 beyond
 the prepared margins onto the
 adjacent unprepared tooth.
6. Etchant is left undisturbed for
 15-30 seconds.
Etching Procedure
5. Apply the gel etchant 0.5 beyond
 the prepared margins onto the
 adjacent unprepared tooth.
6. Etchant is left undisturbed for
 15-30 seconds.
7. The area is washed to remove the
 etchant. Same amount of time as
 etching time.
8. Dry the tooth structure, if dentin is
 exposed, do not air dry. Use cotton
 pellet, disposable brush or tissue
 paper to remove excess water.
8. Dry the tooth structure, if dentin is
 exposed, do not air dry. Use cotton
 pellet, disposable brush or tissue
 paper to remove excess water.
9. Bonding system is applied on all
 tooth structure that has been etched
 with a microbrush or other suitable
 applicators
10. Air bonding system to thin out
 coating.
10. Air bonding system to thin out
 coating.
11. Cure, follow manufacturer's
 direction.
Application of
Bonding Agent:
Application of
the bonding
agent and then
cured for 10
seconds.
10. Air bonding system to thin out
 coating.
11. Cure, follow manufacturer's
 direction.
12. Incrementally place composite
 material and cure.
Filling
Filling & Packing
Curing Of the
    Composite:
The material is cured
using the light curing
machine for 20
seconds for every
increment of
composite that was
placed.
10. Air bonding system to thin out
 coating.
11. Cure, follow manufacturer's
 direction.
12. Incrementally place composite
 material and cure.
13. Finish and Polish
Finishing and
     Polishing:
The use of polishers
with enhancers and
polishing paste were
done after the
trimming of the
excess composites.
Finishing & Polishing
BEFORE                   AFTER




Before the restoration   After restoring with Composite
procedure.               Resin Material

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J. class iii,iv, & v direct composite

  • 1. CLASS III, IV and V DIRECT COMPOSITE RESTORATIONS
  • 2.
  • 4. Indications:  restorations in esthetic prominent areas
  • 5. Indications:  restorations in esthetic prominent areas  areas can be adequately isolated
  • 6. Indications:  restorations in esthetic prominent areas  areas can be adequately isolated  tooth preparations that have an all enamel margins
  • 8. Contraindications:  an operating area that cannot be adequately isolated
  • 9. Contraindications:  an operating area that cannot be adequately isolated  class v restorations that are not esthetically critical
  • 10. Contraindications:  an operating area that cannot be adequately isolated  class v restorations that are not esthetically critical  restorations that extends into the root surface (contraction gap)
  • 12. Advantages  esthetics
  • 13. Advantages  esthetics  conservative of tooth structure removal
  • 14. Advantages  esthetics  conservative of tooth structure removal  less complex when preparing the tooth
  • 15. Advantages  esthetics  conservative of tooth structure removal  less complex when preparing the tooth  low thermal conductivity (insulative)
  • 16. Advantages  esthetics  conservative of tooth structure removal  less complex when preparing the tooth  low thermal conductivity (insulative)  Used almost universally
  • 17. Advantages (continued)  bonded to tooth structure
  • 18. Advantages (continued)  bonded to tooth structure  Repairable
  • 20. Disadvantages  may result to gap formation
  • 21. Disadvantages  may result to gap formation  restoration is more difficult, time- consuming, costly
  • 22. Disadvantages  may result to gap formation  restoration is more difficult, time- consuming, costly  more technique sensitive
  • 23. Disadvantages  may result to gap formation  restoration is more difficult, time- consuming, costly  more technique sensitive  may exhibit more wear in areas of high occlusion
  • 24. Disadvantages  may result to gap formation  restoration is more difficult, time- consuming, costly  more technique sensitive  may exhibit more wear in areas of high occlusion  have a higher linear coefficient of thermal expansion
  • 26. COMPOSITE  introduced commercially in 1962 by Bowen of the National Bureau of Standards
  • 27. COMPOSITE  introduced commercially in 1962 by Bowen of the National Bureau of Standards  most popular tooth colored material
  • 28. COMPOSITE  introduced commercially in 1962 by Bowen of the National Bureau of Standards  most popular tooth colored material  consist of a continuous polymeric or resin matrix in which an inorganic filler is dispersed
  • 34. Classification 1. Conventional 2. Microfilled 3. Hybrid .1 Flowable .2 Packable
  • 35. Classification 1. Conventional 2. Microfilled 3. Hybrid .1 Flowable .2 Packable 4. Nanofilled
  • 38. Composition 1. Organic Resin – forms the matrix
  • 39. Composition 1. Organic Resin – forms the matrix -dimethacrylate monomer (BIS-GMA)
  • 40. Composition 1. Organic Resin – forms the matrix -dimethacrylate monomer (BIS-GMA) 2. Inorganic filler
  • 41. Composition 1. Organic Resin – forms the matrix -dimethacrylate monomer (BIS-GMA) 2. Inorganic filler - inhibits deformation of the matrix
  • 42. Composition 1. Organic Resin – forms the matrix -dimethacrylate monomer (BIS-GMA) 2. Inorganic filler - inhibits deformation of the matrix -reduce the coefficient of thermal expansion of the resin matrix
  • 43. Composition A. Organic Resin – forms the matrix -dimethacrylate monomer (BIS-GMA) B. Inorganic filler - inhibits deformation of the matrix -reduce the coefficient of thermal expansion of the resin matrix e.g. fused silica, crystalline quartz, lithium aluminum silicate, borosilicate glass
  • 45. C. Coupling Agent – unite the resin with the filler
  • 46. C. Coupling Agent – unite the resin with the filler -stress absorber of the filler and resin
  • 47. 3. Coupling Agent – unite the resin with the filler -stress absorber of the filler and resin 4. Initiator System
  • 48. 3. Coupling Agent – unite the resin with the filler -stress absorber of the filler and resin 4. Initiator System – activate the setting mechanism
  • 49. 3. Coupling Agent – unite the resin with the filler -stress absorber of the filler and resin 4. Initiator System – activate the setting mechanism 5. Stabilizers
  • 50. C. Coupling Agent – unite the resin with the filler -stress absorber of the filler and resin D. Initiator System – activate the setting mechanism E. Stabilizers F. Pigments
  • 52. Conventional Composites  contains 75-80% inorganic filler by weight
  • 53. Conventional Composites  contains 75-80% inorganic filler by weight  average particle size 8µm l
  • 54. Conventional Composites  contains 75-80% inorganic filler by weight  average particle size 8µm  large size particle and extremely hard filler
  • 55. Conventional Composites  contains 75-80% inorganic filler by weight  average particle size 8µm  large size particle and extremely hard filler  rough surface structure strontium and barium glass (radiopaque)
  • 56.
  • 58. Microfilled Composites  introduced in the late 1970
  • 59. Microfilled Composites  introduced in the late 1970  polishable
  • 60. Microfilled Composites  introduced in the late 1970  polishable  smooth lustrous surface similar to tooth enamel
  • 61. Microfilled Composites  introduced in the late 1970  polishable  smooth lustrous surface similar to tooth enamel  particle size is 0.01 – 0.04µm
  • 62. Microfilled Composites  introduced in the late 1970  polishable  smooth lustrous surface similar to tooth enamel  particle size is 0.01 – 0.04µm  contains 35-60% inorganic filler by weight
  • 63. some of physical and mechanical properties are inferior
  • 64.  some of physical and mechanical properties are inferior  wear resistant
  • 65.  some of physical and mechanical properties are inferior  wear resistant  low modulus of elasticity (allow restoration to flex)
  • 66.  some of physical and mechanical properties are inferior  wear resistant  low modulus of elasticity (allow restoration to flex)  high resin content results in an increased coefficient of thermal expansion and lower strength
  • 67.
  • 68. Use of Microfilled Composites
  • 69. Use of Microfilled Composites  used for low stress restorations
  • 70. Use of Microfilled Composites  used for low stress restorations  buccal and lingual surfaces of class III and class V
  • 72. Hybrid Composites  combines the properties of conventional and microfilled
  • 73. Hybrid Composites  combines the properties of conventional and microfilled  contains 75-85% inorganic filler by weight
  • 74. Hybrid Composites  combines the properties of conventional and microfilled  contains 75-85% inorganic filler by weight  particle size is 0.4 – 1µm
  • 75. Hybrid Composites  combines the properties of conventional and microfilled  contains 75-85% inorganic filler by weight  particle size is 0.4 – 1µm  physical properties is superior to conventional
  • 76. predominant direct esthetic resin
  • 77.  predominant direct esthetic resin  have universal clinical applicability
  • 78.
  • 79. Use of Hybrid Composites
  • 80. Use of Hybrid Composites  used in moderate stress restorations where strength and wear resistance are more important than surface luster
  • 81. Use of Hybrid Composites  used in moderate stress restorations where strength and wear resistance are more important than surface luster  Class I, class II, class IV
  • 83. Flowable  flows into cavity due to lower viscosity
  • 84. Flowable  flows into cavity due to lower viscosity  have lower filler content
  • 85. Flowable  flows into cavity due to lower viscosity  have lower filler content  inferior physical properties (lower wear resistance, lower strength)
  • 86. Flowable  flows into cavity due to lower viscosity  have lower filler content  inferior physical properties (lower wear resistance, lower strength)  used in small class I, pit and fissure sealant,marginal repair, liner
  • 87. easy to use
  • 88.  easy to use  good wettability
  • 89.  easy to use  good wettability  favorable handling properties
  • 91. Packable (Condensable)  more viscous, “thicker, stiffer feel”
  • 92. Packable (Condensable)  more viscous, “thicker, stiffer feel”  have filler particle feature that prevents sliding of the filler particle by one another
  • 93. Packable (Condensable)  more viscous, “thicker, stiffer feel”  have filler particle feature that prevents sliding of the filler particle by one another  easier restoration of proximal contact
  • 94. Packable (Condensable)  more viscous, “thicker, stiffer feel”  have filler particle feature that prevents sliding of the filler particle by one another  easier restoration of proximal contact  similar to the handling of amalgam
  • 95. Nanocomposites  Nanotechnology or, for short, nanotech, refers to a field of applied science whose theme is the control of matter on an atomic or molecular scale.
  • 96. Generally nanotechnology deals with structures 100 nanometers or smaller, and involves developing materials or devices within that size.
  • 97. Nanocomposites are materials that are created by introducing nanoparticulates (often referred to as filler) into a macroscopic sample material (often referred to as the matrix).
  • 98. After adding nanoparticulates to the matrix material, the resulting nanocomposite may exhibit drastically enhanced properties. For example, adding carbon nanotubes tends to drastically add to the electrical and thermal conductivity.
  • 99. Other kinds of nanoparticulates may result in enhanced optical properties, dielectric or mechanical properties such as stiffness and strenght.
  • 100. CLINICAL TECHNIQUE FOR DIRECT CLASS III, CLASS IV AND CLASS V RESTORATIONS
  • 101. Class III Tooth Preparation
  • 102. Class III Tooth Preparation
  • 103. Class III Tooth Preparation  there is a choice between facial or lingual entry into the tooth
  • 105. Indications for Lingual Approach 1. to conserve facial enamel for enhanced esthetics
  • 106. Indications for Lingual Approach 1. to conserve facial enamel for enhanced esthetics 2. carious lesion is positioned lingually
  • 107. Indications for Lingual Approach 1. to conserve facial enamel for enhanced esthetics 2. carious lesion is positioned lingually 3. lesion is accessible from the lingual
  • 109. Indications for Facial Approach 1. The carious lesion is positioned facially
  • 110. Indications for Facial Approach 1. The carious lesion is positioned facially 2. Teeth is irregularly aligned, making lingual access undesirable.
  • 111. Indications for Facial Approach 1. The carious lesion is positioned facially 2. Teeth is irregularly aligned, making lingual access undesirable. 3. Extensive caries extent into the facial surface.
  • 112. Indications for Facial Approach 1. The carious lesion is positioned facially 2. Teeth is irregularly aligned, making lingual access undesirable. 3. Extensive caries extent into the facial surface. 4. Faulty restoration that was originally placed at the facial.
  • 114. Conventional Class III  indicated for restorations involving the root surface
  • 115. Conventional Class III  indicated for restorations involving the root surface 1. using a No. ½, 1, 2 round bur prepare the outline form on the root surface
  • 116. Conventional Class III  indicated for restorations involving the root surface 1. using a No. ½, 1, 2 round bur prepare the outline form on the root surface 2. extend the preparation into sound walls
  • 117. Conventional Class III  indicated for restorations involving the root surface 1. using a No. ½, 1, 2 round bur prepare the outline form on the root surface 2. extend the preparation into sound walls 3. extend pulpally 0.75mm in depth
  • 118. 4. The gingival/cervical and incisal wall is perpendicular to the root surface (box like design)
  • 119. 4. The gingival/cervical and incisal wall is perpendicular to the root surface (box like design) 5. A continuous groove retention can be prepared 0.25 mm (½ of diameter of bur) into dentin of the gingival and incisal walls with a ¼ round bur.
  • 120. 6. The groove is placed at the junction of the axial and the external walls.
  • 121. 6. The groove is placed at the junction of the axial and the external walls. 7. Clean preparation and inspect the final preparation.
  • 122.
  • 123.
  • 125. Beveled Conventional Class III  Indicated for replacing an existing defective restoration in the crown portion of the tooth
  • 126. Beveled Conventional Class III  Indicated for replacing an existing defective restoration in the crown portion of the tooth  when restoring a large carious lesion for which the need for increased retention and/or resistance form is anticipated.
  • 128. Lingual Access 1. Use a round bur No. 1/2, 1. 2 depending on the size of the caries to enlarge the opening sufficiently to allow for caries removal.
  • 129. Lingual Access 1. Use a round bur No. 1/2, 1. 2 depending on the size of the caries to enlarge the opening sufficiently to allow for caries removal. 2. Extend external walls to sound tooth structure using a straight bur
  • 130. 3. Extend the gingival and incisal walls up to extent of caries or location of old restoration.
  • 131. 3. Extend the gingival and incisal walls up to extent of caries or location of old restoration. Unless necessary, DO NOT:
  • 132. 3. Extend the gingival and incisal walls up to extent of caries or location of old restoration. Unless necessary, DO NOT:  include the proximal contact.
  • 133. 3. Extend the gingival and incisal walls up to extent of caries or location of old restoration. Unless necessary, DO NOT:  include the proximal contact.  extend into the facial surface.
  • 134. 3. Extend the gingival and incisal walls up to extent of caries or location of old restoration. Unless necessary, DO NOT:  include the proximal contact.  extend into the facial surface.  extend subgingivally
  • 135. 4. Create an axial wall depth of 0.2mm into the dentin/DEJ (approximately 0.75 – 1.25mm in depth)
  • 136.
  • 137. 4. Create an axial wall depth of 0.2mm into the dentin/DEJ (approximately 0.75 – 1.25mm in depth) 5. Axial wall is convex, following the external contour of the tooth.
  • 138. 4. Create an axial wall depth of 0.2mm into the dentin/DEJ (approximately 0.75 – 1.25mm in depth) 5. Axial wall is convex, following the external contour of the tooth. 6. Remove all remaining infected dentin, using a round bur or small spoon excavator.
  • 139. 7. Remove friable enamel at the margins.
  • 140. 7. Remove friable enamel at the margins. 8. If necessary, prepare retention (grooves or coves)
  • 141. 7. Remove friable enamel at the margins. 8. If necessary, prepare retention (grooves or coves)  prepare it along the gingivoxial line angle, and sometimes at the incisoaxial line angle .25 mm with a ¼ round bur.
  • 142.
  • 143. 9. Place cavosurface bevel or flare at the enamel except at the gingival margin area.
  • 144. 9. Place cavosurface bevel or flare at the enamel except at the gingival margin area. 10. Use a flame shape or round bur resulting in a 45 degrees angle to the external tooth surface.
  • 145.
  • 146. 9. Place cavosurface bevel or flare at the enamel except at the gingival margin area. 10. Use a flame shape or round bur resulting in a 45 degrees angle to the external tooth surface. 11. Bevel width should be 0.25 to 0.5mm.
  • 147. 12. Clean the preparation of any debris and inspect final preparation.
  • 149. Facial Access  same stages and steps are followed
  • 150. Facial Access  same stages and steps are followed  procedure is simplified because of easy access
  • 152.
  • 153. Modified Class III  most used type of cavity preparation.
  • 154. Modified Class III  most used type of cavity preparation.  indicated for small and moderate lesions or faults.
  • 155. Modified Class III  most used type of cavity preparation.  indicated for small and moderate lesions or faults.  designed to be as conservative as possible.
  • 156. Modified Class III  most used type of cavity preparation.  indicated for small and moderate lesions or faults.  designed to be as conservative as possible.  preparation walls have no specific shapes or forms other than an external angle of 90 or more degrees
  • 157. preparation design appears to be scooped or concave
  • 158.
  • 159.  preparation design appears to be scooped or concave 1. Use a 1/2, 1, 2 round bur, point of entry is within the incisogingival dimension of the lesion, perpendicular to the enamel surface.
  • 160.  preparation design appears to be scooped or concave 1. Use a 1/2, 1, 2 round bur, point of entry is within the incisogingival dimension of the lesion, perpendicular to the enamel surface. 2. Remove all remaining caries or defect.
  • 161. 3. No attempt is made to create a uniform axial wall.
  • 162. 3. No attempt is made to create a uniform axial wall. 4. Place cavosurface bevel or flare at the enamel except at the gingival margin area.
  • 163. 3. No attempt is made to create a uniform axial wall. 4. Place cavosurface bevel or flare at the enamel except at the gingival margin area. 5. Use a flame shape or round bur resulting in a 45 degrees angle to the external tooth surface.
  • 164. 3. No attempt is made to create a uniform axial wall. 4. Place cavosurface bevel or flare at the enamel except at the gingival margin area. 5. Use a flame shape or round bur resulting in a 45 degrees angle to the external tooth surface. 6. Bevel width should be 0.25 to 0.5mm.
  • 165. 7. Clean the preparation of any debris and inspect final preparation.
  • 166.
  • 167. Class IV Tooth Preparation
  • 168.
  • 169. Class IV Tooth Preparation  preoperative assessment of occlusion is very important (placement of margin in noncontact areas)
  • 170. Class IV Tooth Preparation  preoperative assessment of occlusion is very important (placement of margin in noncontact areas)  shade selection is more difficult
  • 171. Class IV Tooth Preparation  preoperative assessment of occlusion is very important (placement of margin in noncontact areas)  shade selection is more difficult  preparation is similar to Class III except that the preparation for class IV is extended to the incisal angles
  • 172.
  • 173. Class V Tooth Preparation Conventional
  • 174. Class V Tooth Preparation Conventional  the feature of the preparation include a 90 degree cavosurface angle, uniform depth of the axial line angle, and sometimes, groove retention from.
  • 175. Class V Tooth Preparation Conventional  the feature of the preparation include a 90 degree cavosurface angle, uniform depth of the axial line angle, and sometimes, groove retention from.  conventional design is indicated only for portion of the lesion extended onto the root surface
  • 176. 1. Use a tapered fissure (No. 700, 701,or 271) or No.1 or 2 round bur.
  • 177. 1. Use a tapered fissure (No. 700, 701,or 271) or No.1 or 2 round bur. 2. Make entry at 45 degrees angle to tooth surface, this should result to a 90 degree cavosurface.
  • 178. 1. Use a tapered fissure (No. 700, 701,or 271) or No.1 or 2 round bur. 2. Make entry at 45 degrees angle to tooth surface, this should result to a 90 degree cavosurface. 3. Axial depth is 0.75 mm
  • 179. 1. Use a tapered fissure (No. 700, 701,or 271) or No.1 or 2 round bur. 2. Make entry at 45 degrees angle to tooth surface, this should result to a 90 degree cavosurface. 3. Axial depth is 0.75 mm -strength of preparation wall
  • 180. 1. Use a tapered fissure (No. 700, 701,or 271) or No.1 or 2 round bur. 2. Make entry at 45 degrees angle to tooth surface, this should result to a 90 degree cavosurface. 3. Axial depth is 0.75 mm -strength of preparation wall -strength of composite
  • 181. 1. Use a tapered fissure (No. 700, 701,or 271) or No.1 or 2 round bur. 2. Make entry at 45 degrees angle to tooth surface, this should result to a 90 degree cavosurface. 3. Axial depth is 0.75 mm -strength of preparation wall -strength of composite -placement of retention groove
  • 182. 4. Axial should follow contour of the tooth.
  • 183. 4. Axial should follow contour of the tooth. 5. Extent of outline form is dictated by the carious lesion extent.
  • 184. 4. Axial should follow contour of the tooth. 5. Extent of outline form is dictated by the carious lesion extent. 6. Remove remaining carious lesion
  • 185. 4. Axial should follow contour of the tooth. 5. Extent of outline form is dictated by the carious lesion extent. 6. Remove remaining carious lesion 7. Prepare retention groove (similar to Class III preparation)
  • 186. 4. Axial should follow contour of the tooth. 5. Extent of outline form is dictated by the carious lesion extent. 6. Remove remaining carious lesion 7. Prepare retention groove (similar to Class III preparation) 8. Clean preparation
  • 188. Beveled Conventional Class V  Indications
  • 189. Beveled Conventional Class V  Indications 1. replacement of defective class V restorations
  • 190. Beveled Conventional Class V  Indications 1. replacement of defective class V restorations 2. large carious lesion
  • 191. Beveled Conventional Class V  Indications 1. replacement of defective class V restorations 2. large carious lesion  exhibits 90 degrees of cavosurface
  • 192. Beveled Conventional Class V  Indications 1. replacement of defective class V restorations 2. large carious lesion  exhibits 90 degrees of cavosurface  axial wall depth is uniform (0.2mm or 0.5 when retention groove is to placed)
  • 193. groove is not indicated when periphery of tooth preparation is located in enamel.
  • 194.  groove is not indicated when periphery of tooth preparation is located in enamel.  remove all infected dentin
  • 195.  groove is not indicated when periphery of tooth preparation is located in enamel.  remove all infected dentin  clean preparation
  • 197. Modified Class V  indicated for small and moderate lesion and lesion entirely in the enamel
  • 198. Modified Class V  indicated for small and moderate lesion and lesion entirely in the enamel  no effort to prepare a butt-joint
  • 199. Modified Class V  indicated for small and moderate lesion and lesion entirely in the enamel  no effort to prepare a butt-joint  no retention groove
  • 200. Modified Class V  indicated for small and moderate lesion and lesion entirely in the enamel  no effort to prepare a butt-joint  no retention groove  lesion is scooped out
  • 201. Modified Class V  indicated for small and moderate lesion and lesion entirely in the enamel  no effort to prepare a butt-joint  no retention groove  lesion is scooped out  preparation has divergent wall
  • 202. Modified Class V  indicated for small and moderate lesion and lesion entirely in the enamel  no effort to prepare a butt-joint  no retention groove  lesion is scooped out  preparation has divergent wall  axial wall does not have uniform depth
  • 203. prepare tooth with round or elliptical instrument
  • 204.  prepare tooth with round or elliptical instrument  preparation is extended no deeper than 0.2 mm
  • 205.  prepare tooth with round or elliptical instrument  preparation is extended no deeper than 0.2 mm  no effort is made to prepare a 90 degree cavosurface margins.
  • 206.  prepare tooth with round or elliptical instrument  preparation is extended no deeper than 0.2 mm  no effort is made to prepare a 90 degree cavosurface margins.  infected enamel is removed with a round bur or excavator.
  • 207.
  • 208. Class V Tooth Preparation for Abrasion/Erosion
  • 209. Class V Tooth Preparation for Abrasion/Erosion  Abrasion – often V-shaped is a loss or wearing away due to mechanical forces.
  • 210. Class V Tooth Preparation for Abrasion/Erosion  Abrasion – often V-shaped is a loss or wearing away due to mechanical forces.  Erosion- often a saucer shaped notch as a result of chemical dissolutions
  • 211. Abfraction/Idiopathic Erosion- may occur as a result of flexure of cervical area under heavy occlusal stress. This occurs as a notched defect.
  • 212.  Abfraction/Idiopathic Erosion- may occur as a result of flexure of cervical area under heavy occlusal stress. This occurs as a notched defect.  Modified tooth preparation is used for this types of defects.
  • 214. Acid Etching  A physical process that creates a microscopically rough enamel surface (enamel tags)
  • 215. Acid Etching  A physical process that creates a microscopically rough enamel surface (enamel tags)  first successful technique developed to bond dental materials to tooth structure
  • 216. Acid Etching  A physical process that creates a microscopically rough enamel surface (enamel tags)  first successful technique developed to bond dental materials to tooth structure  acid used id 37% ortho-phosphoric acid
  • 217. sometimes referred to as conditioner
  • 220. Enamel Etching Acid  37% ortho-phosphoric acid
  • 221. Enamel Etching Acid  37% ortho-phosphoric acid  dissolves the periphery of enamel rod, or the core of the rods or both
  • 222.
  • 223. over-etching results to formation of crystals (precipitates) that inhibits bonding
  • 224.  over-etching results to formation of crystals (precipitates) that inhibits bonding  built-in quality control check – if properly etched it appears frosty or chalky white.
  • 225.  over-etching results to formation of crystals (precipitates) that inhibits bonding  built-in quality control check – if properly etched it appears frosty or chalky white. Time
  • 226.  over-etching results to formation of crystals (precipitates) that inhibits bonding  built-in quality control check – if properly etched it appears frosty or chalky white. Time  15-30 seconds permanent tooth
  • 227.  over-etching results to formation of crystals (precipitates) that inhibits bonding  built-in quality control check – if properly etched it appears frosty or chalky white. Time  15-30 seconds permanent tooth  twice as long for deciduous
  • 228.
  • 231. Dentin Etching Acid  37% ortho-phosphoric acid
  • 232. Dentin Etching Acid  37% ortho-phosphoric acid  removes the smear layer from the surface of the of the dentin as well as the plugs of material forces into dentinal tubules during cavity preparation.
  • 233.
  • 234. decalcifies a layer of dentin several microns thick
  • 235.  decalcifies a layer of dentin several microns thick Time
  • 236.  decalcifies a layer of dentin several microns thick Time 10-15 seconds
  • 237.
  • 238. Primer
  • 239. Primer  similar to the low viscosity resin used in enamel bonding.
  • 240. Primer  similar to the low viscosity resin used in enamel bonding.  primers are hydrophilic (tolerant of moisture)
  • 241. Primer  similar to the low viscosity resin used in enamel bonding.  primers are hydrophilic (tolerant of moisture)  contains a volatile solutions (acetone) to thin the organic chemicals and improves the wetting of the etched surface
  • 242. primer flows into:
  • 243.  primer flows into: -surface irregularities of etched enamel
  • 244.  primer flows into: -surface irregularities of etched enamel -open tubules and around collagen fibers of etched dentin
  • 245.  primer flows into: -surface irregularities of etched enamel -open tubules and around collagen fibers of etched dentin  primers do not set on their own, et when adhesive is applied
  • 247. Adhesives  a low viscosity resin
  • 248. Adhesives  a low viscosity resin  dentin adhesives contain hydrophilic chemicals, but less than in primers
  • 249. Adhesives  a low viscosity resin  dentin adhesives contain hydrophilic chemicals, but less than in primers  adhesive sets
  • 250. Adhesives  a low viscosity resin  dentin adhesives contain hydrophilic chemicals, but less than in primers  adhesive sets  renders the tooth surface glossy
  • 252. Two-step Bonding System  the primer and the adhesive have been combined
  • 253. Two-step Bonding System  the primer and the adhesive have been combined One-step/Self Etching System
  • 254. Two-step Bonding System  the primer and the adhesive have been combined One-step/Self Etching System  etches, primes and bonds (has adhesives) the tooth structure all at once
  • 255. Two-step Bonding System  the primer and the adhesive have been combined One-step/Self Etching System  etches, primes and bonds (has adhesives) the tooth structure all at once  sometimes does not effectively etch the enamel.
  • 256.
  • 259. Shade Selection: After caries removal and cavity preparation shade selection was done using shade guide
  • 260. Restorative Technique 1. Determine shade of tooth 2. Clean the tooth preparation using a slurry of pumice, polishing cup.
  • 261.
  • 262. Restorative Technique 1. Determine shade of tooth 2. Clean the tooth preparation using a slurry of pumice, polishing cup. 3. Isolate the tooth, preferably with a rubber dam or cotton rolls.
  • 263. Isolation of the Teeth: Rubber dam isolation technique was used to keep the prepared teeth from saliva, blood, debris and other fluids.
  • 264.
  • 265. Restorative Technique 1. Determine shade of tooth 2. Clean the tooth preparation using a slurry of pumice, polishing cup. 3. Isolate the tooth, preferably with a rubber dam or cotton rolls. 4. Protect adjacent unprepared tooth from the acid etchant with a polyester strip apply the wedge.
  • 266.
  • 267. 5. Apply the gel etchant 0.5 beyond the prepared margins onto the adjacent unprepared tooth.
  • 268. 5. Apply the gel etchant 0.5 beyond the prepared margins onto the adjacent unprepared tooth. 6. Etchant is left undisturbed for 15-30 seconds.
  • 270. 5. Apply the gel etchant 0.5 beyond the prepared margins onto the adjacent unprepared tooth. 6. Etchant is left undisturbed for 15-30 seconds. 7. The area is washed to remove the etchant. Same amount of time as etching time.
  • 271. 8. Dry the tooth structure, if dentin is exposed, do not air dry. Use cotton pellet, disposable brush or tissue paper to remove excess water.
  • 272.
  • 273. 8. Dry the tooth structure, if dentin is exposed, do not air dry. Use cotton pellet, disposable brush or tissue paper to remove excess water. 9. Bonding system is applied on all tooth structure that has been etched with a microbrush or other suitable applicators
  • 274. 10. Air bonding system to thin out coating.
  • 275. 10. Air bonding system to thin out coating. 11. Cure, follow manufacturer's direction.
  • 276. Application of Bonding Agent: Application of the bonding agent and then cured for 10 seconds.
  • 277. 10. Air bonding system to thin out coating. 11. Cure, follow manufacturer's direction. 12. Incrementally place composite material and cure.
  • 280. Curing Of the Composite: The material is cured using the light curing machine for 20 seconds for every increment of composite that was placed.
  • 281. 10. Air bonding system to thin out coating. 11. Cure, follow manufacturer's direction. 12. Incrementally place composite material and cure. 13. Finish and Polish
  • 282. Finishing and Polishing: The use of polishers with enhancers and polishing paste were done after the trimming of the excess composites.
  • 284. BEFORE AFTER Before the restoration After restoring with Composite procedure. Resin Material

Notas do Editor

  1. The beveled conventional Class IV tooth preparation was used.
  2. Tooth conditioner 36% is used to etch the enamel surface of the prepared teeth. It was left undisturbed for 15-30 secs then washed w/ water. The etched surface were then dried w/ cotton pellet.
  3. XP Bond is applied & spread evenly using an applicator tip. It was light-cured for 10-20 secs.
  4. The dentin is filled w/ ceram X dentin duo. Light cured for 20-30 secs.
  5. The unfilled region are filled & packed w/ ceram X enamel duo. The flat end of a hand instrument is used to flatten & contour the anatomy of the involved teeth. Light cured again for 20-30 secs. Celluloid strip should be placed interproximally tp avoid overhanging restoration before curing
  6. The teeth are now polished using POGO micro polisher.