AMALGAM AND COMPOSITE RESTORATIONS class I, II, V posterior class III, IV anterior amalgam or...
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Transcript of AMALGAM AND COMPOSITE RESTORATIONS class I, II, V posterior class III, IV anterior amalgam or...
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AMALGAM AND COMPOSITE RESTORATIONS
class I, II, V posterior class III, IV anterior amalgam or composite
in posterior gold and porcelain anterior - composite or
porcelain
basic procedures– anesthetic, dental dam,
remove decay– place matrix band, if
needed, wedges if needed
– place restorative material
– finish restoration
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Classification of Cavities
Class I – Pit and Fissure– No tofflemire or matrix required– Amalgam or composite
Class II – Posterior interproximal and occlusal– Tofflemire or Mylar matrix required– Amalgam or composite
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Classification of Cavities
Class III – anterior interproximal (no incisal edge)– Mylar strip– Composite
Class IV – anterior interproximal with incisal edge– Mylar strip– Composite
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Classification of Cavities
Class V – cervical 1/3– Composite– Glass ionomer (type II)
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CAVITY PREPARATION
It is a surgical operation basic principles
– outline form– resistance form– retention form
mechanical vs chemical
– convenience form– removal of caries
– Finishing of enamel walls– extension for prevention– cavity debridement– line angles – point angles
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CAVITY PREPARATION
Formed by the junction of 2 walls in the cavity prepLine Angles
Point angles
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AMALGAM MATERIAL
Advantages– used in posterior only– strong to with stand
compressive pressures(160 lbs. pressure)
– Malleable (soft and easily shaped when freshly mixed)
– durable– inexpensive
Disadvantages– mechanical retention
only– not esthetically pleasing– contains mercury
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AMALGAM MATERIAL
Can be used for:– posterior restorations– core buildups– delivered in capsules or
bulk– today most offices use
high copper amalgam, less mercury
Composition– mercury– silver– tin– copper– zinc
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AMALGAM MATERIAL
Combination of two or more metals mercury liquid at room temperature Once mixed, amalgam cannot be reused Ratio – one to one Controversial
– health hazard– environmental hazard
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Amalgamator
Amalgamation Tritturation
– quality of mix is determined by mixing time
– too long - soupy, sets quickly
– too short - dull, crumbles
Preparation– class II requires
tofflemire and band– anatomy placed in
material with carvers T-3 Hollenback Discoid/Cleoid
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Retention Pins
Used for additional retention Vital or non-vital teeth Can be drilled into tooth with a self-threaded
hand driver or cemented Used for large restoration Titanium
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Composite Restorations
Also called resins Advantages:
– Tooth colored– Esthetically pleasing– Bonded directly to the tooth– Reduced microleakage
Disadvantages– Strength – occlusal wear resistance is improving– Discoloration around borders after time
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COMPOSITE MATERIAL
Advantages:– esthetically pleasing– wear resistance is
improving– resist fracture– mechanical and
chemical retention– expansion/contraction
similar to tooth structure
Disadvantage:– is not as durable as
amalgam for posterior use (but improving)
– Has to be placed in dry environment
– Technique sensitive – can discolor at margins
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COMPOSITE MATERIAL
Sometimes fails
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COMPOSITE MATERIAL
Sometimes Work Well
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COMPOSITE MATERIAL
Types– light cure – self cure– dual cure
Components– resin material– polymer - powder– monomer - liquid– polymerization - to set
Uses:– class I,II, III,IV, V– core build ups– veneers
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Composite make up
Composite is a combination of polymers and monomers
– resins– fillers– coloring
Filler:– originally quartz - good
translucent appearance, strong and hard, difficult to polish to high shine
– silica particles, chemically produced
– macrofills– microfills– hybrid
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Composite make up
Macrofils:– large particle– durable– low shine
Microfils:– small particle– low strength– high shine
Hybrid:– combination of macro
and micro– durable and higher shine
than macro
Laminating:– layering of composite
material– Macrofil for durability– Micro for high shine
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COMPOSITE PLACEMENT
Mechanical and chemical retention
tooth preparation differs from amalgam
acid etch, primer, bond materials
Basic process– anesthesia, shade
selection, isolation, prep– placement of matrix,
mylar or stainless steel and wedges
– place composite– finish with finishing disc
or burs
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Shade Selection
Must be selected in natural light Done before isolation Done while teeth are naturally wet with saliva Best to check right after anesthetic is given
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Etching systems
Removes smear layer Phosphoric acid, maleic acid, or hydrochloric
acid Critical step in bonding enamel and dentin
surfaces to resin/composite materials
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Enamel Bonding
Includes:– Sealants– Bonded orthodontic brackets– Resin bonded bridges– Bonded veneers
Usually bonded directly to enamel surface Dentin Bonding - involves removing the
smear layer
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Smear Layer
Very thin layer of debris composed of fluids and tooth components
1000’s of dentinal tubules are cut during preparation of tooth
Open ends can transmit fluids and micro-organisms to the pulp of the tooth
May result in PO sensitivity, pain, or even damage to the pulp
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Smear Layer
Described as nature’s bandage Protects the tooth by closing off the openings
of the dentinal tubules Must be removed and tubules re-opened as
part of the bonding process where they are sealed with primer and bonding agents
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Laminating Technique
Layers or thin stacking of composite Light cure between layers to reduce
shrinkage
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Many Different Materials
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GLASS IONOMERS
Type I, II, III, IV and Type II restorative
– used as esthetic restoration
– non stress bearing areas
Powder and Liquid– dispensed and mix– capsule form– fluoride release
Class V restorative– root repair
Pediatric restorative Light cure Self cure
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Many Choices
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Core Buildups
Materials used:– Amalgam– Composite– Glass Ionomer
Replaces missing tooth structure
Give support to remaining tooth structure
Matrices– Stainless Steel– Mylar strips– Crown Formers
Additionally– Titanium pins can be
added for strength
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Core Buildups
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BLEACHING
Extrinsic– tobacco– coffee– tea
Intrinsic– tetracycline– dental fluorosis– non-vital
Considerations– amount of stain– origin– cost– difficulty
Methods– home bleaching– in office
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Bleach or Not to Bleach????
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Bleaching Techniques
Non-vital bleaching (walking bleach)– Thick paste of hydrogen peroxide and sodium perborate
placed in the tooth and covered– Patient can leave and return to remove and finish treatment
Vital bleaching (in office)– All teeth are isolated with a dental dam and cleaned with
pumice– Apply liquid or gel bleach on teeth and light cure– Sometimes called power bleaching
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Bleaching Techniques
Take home bleaching (mouth guard bleaching)– Most common– Used with dental trays– Dental assistant does majority of these visits– Patient takes bleach home and uses in dental tray
for 1 to 2 hours daily until goal shade is reached
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WALKING BLEACH TECHNIQUE
Used for endodontically treated teeth
sodium hyperborate, hydrogen peroxide
Bleach placed, patient dismissed, returns one to two days for color check
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Many Choices