contents

General consideration for composite restoration

Indication
Contraindication
Advantages
Disadvantages
Clinical technique
Initial clinical procedure
Tooth preperation for restoration
Adhesion technique
Restorative technique for composite restoration
 INDICATIONS-:
.
1. Class I,II,III,IV,V,VI restorations

2. Foundation or core buildup.

3. Esthetic enhancement procedures-

Partial veneers and Full veneers.
Tooth contour modifications.
Diastema closure.

4. For periodontal splinting.

 CONTRAINDICATIONS:-

1.High caries incidence and poor oral hygiene.

2.Teeth with heavy or abnormal Occlusal stress.

3.If access & isolation difficulties.

4.Subgingival difficulties

5.Patient allergic or sensitive to

resin composite.
 ADVANTAGES:-

1.Esthetic.

2.Conservation of tooth structure.

3.Insulative.

4.Bonded to tooth structure.

5.Command set

6.Repairable.

7.Can be polished at the same appointment

 DISADVANTAGES:-

1.polymerization shrinkage.
2.time consuming and expensive.
3. More technique sensitive.
4. difficult to finish and polish.
5. increased coefficient of thermal
expansion.
Clinical technique of composite restoration

A. Initial clinical procedures,

B. Tooth preparation for composite
C. Restorative technique for composite
 Clinical technique

A-Initial clinical procedures,

-Local anesthesia - patient is more relaxed
- reduced salivation

-Preparation of operating site

clean the operating site with slurry of pumice to remove any
debris, plaque , pellicle, and superficial stains .Calculus removal

Prophylaxis pastes containing flavoring agents, or fluorides act

as contaminants and should be avoided to prevent a possible
conflict with the acid-etch technique.
 Shade selection

Color varies with translucency,

thickness of enamel and dentin, age of
the patient, presence of any external or
internal stains

Different color zones are present -

incisal third is lighter and translucent
than cervical third. Middle third is blend
of two
1. Determine shade at the start of an appointment (before the tooth is
subjected to dehydration)
2. Use either natural light (not direct sunlight) or a colour corrected artificial
light source.
3. Drape the patient with a neutral colored cover if clothing is bright
4. Make rapid comparisons with shade tabs (no more than 5 seconds each
viewing) Make the selection rapidly to avoid eye fatigue
Automated Shade
Selection
 Isolation of operating site

- Rubber dam
- cotton rolls
- retraction cord
 B- Cavity designs for composite cavity preparation

1. Conventional
2. Beveled conventional
3. Modified
4. Box shape
5. Facial/lingual slot
 CONVENTIONAL
similar to that of cavity preparation for amalgam restoration.
A uniform depth of the cavity with 90 cavosurface margin is
required

INDICATIONS
1. Moderate to large class I and class II restorations
2. Preparation is located on root surfaces.
3. Old amalgam restoration being replaced
 BEVELED CONVENTIONAL
1. Similar to conventional cavity
design
2. Have some beveled enamel
margins.

INDICATIONS
1. Composite is used to replace
existing restoration.
(class III, IV, V)
2. Restore large area

Rarely used for posterior composite

restorations
 Advantage of enamel bevel-ends of enamel rods are
more effectively etched producing deeper
microundercuts than when only the sides of enamel
rods are etched.
 MODIFIED

1. No specified wall configuration.

2. No Specified pulpal or axial depth.
3. All parameters determined by extent of caries.
4. Conserve tooth and obtain retention (MICRO MECHANICAL).
5. Scooped out appearance

INDICATIONS
small, cavitated, carious lesion surrounded by enamel
correcting enamel defects.
 BOX ONLY PREPARATION
Indicated when only the proximal surface is faulty with no
lesion present on the occlusal surface

Prepared with either an inverted cone or diamond stone held

parallel to the long axis of tooth crown.
Initial proximal axial depth - 0.2mm inside DEJ.
Neither bevel nor secondary retention required.
 FACIAL OR LINGUAL SLOT
1. Lesion is proximal but access is possible through facial or
lingual surface
2. Cavosurface is 90 or greater.
3. Direct access for removal of caries.
 Pulp protection
In deep cavities pulp protection may be necessary prior to acid
etching and bonding.

- Calcium hydroxide, GIC , RMGI

- ZnOE is contraindicated
 Adhesion
ETCHING
30-40% conc. Of phosphoric used(ideally 37%)
For enamel & dentin for 15 sec and then rinsed off.
Available as liquid and gel.

Syringe for dispensing gel etchant

Applicator tip for liquid etchant
Etching Procedure
 ETCHING ENAMEL-
affects both prism core and prism periphery.
transforms smooth enamel into very irregular surface.

When fluid resin is applied

to etched surface

Resin penetrates etched surface

Forms resin tags

Basis for adhesion of resin to enamel

 ETCHING DENTIN-
Affects intertubular and peritubular dentin.
Removes the smear layer and exposes collagen network to
achieve optimal adhesion to the dentinal surface.
After rinsing the surface is kept slightly moistened when
dentin is also involved because it allows the primer and
adhesive material to more effectively penetrate the collagen
fibre to form a hybrid layer which is the basis for mechanical
bond to dentin.
 PRIMER or CONDITIONERS
Primers condition the dentin surface, & improve
bonding.
Acidic in nature
eg. EDTA,nitricacid, Maleic acid

Functions:-
Removes smear layer & provides subtle opening of
dentinal tubules.
Provides modest etching of the inter-tubular dentine.
 Bonding agents
Classified :-
First generation(1980) used glycerophosphoric acid
dimethacrylate
provide a bifunctional molecule.
disadvantage low bond strength.
Eg-NPG-GMA
second generation (1983)-adhesive agents for composite
resin.
bond strength three times more than before.
disadvantage-adhesion was short term the bond
eventually hydrolysed.
Eg.prisma , universal bond,clearfil,scotch bond
Third generation coupling agent had bond strength to that
of resin to etched enamel.
Disadvantages-use is more complex & require 2-3 application
steps
eg-tenure , scotch bond2,universal bond

Fourth generation-all bond-2 system consists of 2

primers(NPG-GMA and bisphenol dimethacrylate (BPDM) &
an unfilled resin adhesive (40% BIS-
GMA,30%UDMA,30%HEMA)

Fifth generation-single bond adhesive.

advantage- single step application
eg.3M single bond , one step (BISCO)
 Application of Bonding Agent:
Application of the bonding agent and then
cured for 10 seconds.
 Uses of bond Agents
For bonding composite to tooth structure.

Bonding composite to porcelain and various metals like

amalgam, base metal and noble metal alloys.

Desensitization of exposed dentin or root surface.

Bonding of porcelain veneers.

 CURING
Two types:- 1.Self curing 2.Light curing.

SELF CURING: not used extensively .

Disadvantages-
1.Mixing of two pastes required and it is almost
impossible to avoid incorporation of air bubbles.
Air bubble contain oxygen that causes oxygen
inhibition during polymerization.
2.No control of working time.
 LIGHT CURING-
Material inserted in tooth preparation in 1-2mm
thickness. This allows the light to properly polymerize
the composite and may render the effect of
polymerization shrinkage appear along the gingival
floor.
ADVANTAGES-
1.Sufficient working time.
2.Not sensitive to oxygen inhibition.
3.Easy placement.
LIMITATION
1.Time consuming
2.Shrink towards the light source.
Curing Of the Composite:
The material is cured using the
light curing machine for 20
seconds for every increment of
composite that was placed.
 Matrix placement

Two types of matrices are available

- Polyester matrix
- metal matrix

Various matrix retainer which can be used are

- Tofflemire retainer
- Compound supported metal matrix
- Sectional matrix system- palodent contact matrix
 Polyester matrix
- used especially CLASS III, CLASS IV ,CLASS V cavities
Advantage - they allow the light to pass
Disadvantage - they are not rigid and get deform during
placement of rigid material and contact cannot be properly
restored

Metal matrix
- Ultrathin metal matrices .001- .002 inch are used
- Band should be precontoured outside the mouth
CONTOURING-
Can be initiated immediately after light cured
composite have been placed or 3 minutes after the
initial hardening of self cured material.POLISING-
Done with fine polishing discs, fine rubber points or
cups.
 Finishing and Polishing:
The use of polishers with
enhancers and polishing paste
were done after the trimming of
the excess composites.
 Finish & polish

Tungsten carbide finishing bur is used

to contour the marginal ridge (note the
water spray).

Rugby ball-shaped fine diamond is used

to contour the occlusal anatomy. All
high-speed instruments must be used
with water spray.

A flexible, abrasive, impregnated disc is

used to polish and smooth the occlusal
contours.
Finishing & Polishing
 After restoring with Composite Resin Material
Before the restoration procedure.
Composite restorations are very technique sensitive so
utmost care is necessary before, During and after manipulation.

The Visible Modes Of Failures

1) Discoloration-Especially At Margins
2) Marginal Fracture
3)Recurrent Caries
4) Post Operative Sensitivity
5) Cross Fracture Of Restoration
6) Lack Of Maintaining Contact
7) Accumulation Of Plaque Around The Restoration
Prepared by :
Hazhar Ahmed Xidr
Hemn Muhammed Xidr

Stage 4 , group D2