clinical composite resin

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Slide 1: 

Is that was a end???... or just a beginning …

Composite resin : 

Composite resin

contents : 

contents General consideration for composite restoration Indication Contraindication Advantages Disadvantages Clinical technique Initial clinical procedure Tooth preperation for restoration Restorative technique for composite restoration Recent advances of composite resin

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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.

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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.

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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 ADVANTAGES:-

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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.

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Clinical technique of composite restoration Initial clinical procedures, Tooth preparation for composite Restorative technique for composite

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Initial clinical procedures, 1. Local anesthesia - patient is more relaxed - reduced salivation 2. 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. Clinical technique

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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 Shade selection

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Vita Lumin: A= reddish brown B = reddish yellow C = grey shades D = reddish grey B1 A1 B2 D2 A2 C1 C2 D4 A3 D3 B3 A3.5 B4 C3 A4 C4

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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. Assess value by squinting. The reduced amount of light entering the eye allows the retinal rods to better distinguish degrees of lightness and darkness. (Vita Lumin shade tabs set in order of value ) 5. Make rapid comparisons with shade tabs (no more than 5 seconds each viewing) Make the selection rapidly to avoid eye fatigue

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6. Choose the dominant hue and chroma within the value range chosen. The canines - useful guide to assessing hue. 7. Compare selected tabs under different conditions eg wet vs dry, different lip positions, artificial and natural light from different angles. 8. Look carefully for colour characterisation such as stained imbrication lines, white spots, neck colouration, incisal edge translucency

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Automated Shade Selection

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Isolation of operating site - Rubber dam - cotton rolls - retraction cord Isolation of the Teeth: Rubber dam isolation technique was used to keep the prepared teeth from saliva, blood, debris and other fluids.

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TOOTH PREPARATION:- Basically this includes- 1.Minimal extension. 2.Pulpal and axial walls of varying depth. 3.Enamel bevel. 4.Butt joint on root surface. 5.Tooth preparation walls must be rough.

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Conventional Beveled conventional Modified Box shape Facial/lingual slot Cavity designs for composite cavity preparation

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similar to that of cavity preparation for amalgam restoration. A uniform depth of the cavity with 90° cavosurface margin is required INDICATIONS Moderate to large class I and class II restorations Preparation is located on root surfaces. Old amalgam restoration being replaced CONVENTIONAL

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Similar to conventional cavity design Have some beveled enamel margins. INDICATIONS Composite is used to replace existing restoration. (class III, IV, V) Restore large area Rarely used for posterior composite restorations BEVELED CONVENTIONAL

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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.

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No specified wall configuration. No Specified pulpal or axial depth. All parameters determined by extent of caries. Conserve tooth and obtain retention (MICRO MECHANICAL). Scooped out appearance INDICATIONS small, cavitated, carious lesion surrounded by enamel correcting enamel defects. MODIFIED

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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.

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FACIAL OR LINGUAL SLOT Lesion is proximal but access is possible through facial or lingual surface Cavosurface is 90 or greater. Direct access for removal of caries.

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Calcium hydroxide, GIC , RMGI ZnOE is contraindicated Pulp protection In deep cavities pulp protection may be necessary prior to acid etching and bonding.

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ETCHING Syringe for dispensing gel etchant Applicator tip for liquid etchant 30-40% conc. Of phosphoric used(ideally 37%) For enamel & dentin for 15 sec and then rinsed off. Available as –liquid and gel.

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Etching Procedure

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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

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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.

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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 : 

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

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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)

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Application of Bonding Agent: Application of the bonding agent and then cured for 10 seconds.

Uses of bond Agents : 

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.

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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. CURING

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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.

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Curing Of the Composite: The material is cured using the light curing machine for 20 seconds for every increment of composite that was placed.

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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

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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

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CONTOURING- Can be initiated immediately after light cured composite have been placed or 3 minutes after the initial hardening of self cured material. POLISHING- Done with fine polishing discs, fine rubber points or cups.

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Finishing and Polishing: The use of polishers with enhancers and polishing paste were done after the trimming of the excess composites.

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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.

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Finishing & Polishing

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Before the restoration procedure. After restoring with Composite Resin Material

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Recent advances in composite resin 1.Flowable composite resins. 2.Packable or condensable composites. 3.ALERT 4.Solitaire 5.Surefill

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1.Flowable composites- a.New standard for convenience in anterior and posterior restorations. b. Offers smart handling. c. Flows under pressure but holds its shape in place prior to light cure. d. No oozing,slumping or running. e. Ideal viscocity and flow suitable for small classI,III,IV and shallow classV restoration and as pit and fissure sealant.

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2.Packable composites- promoted as amalgam alternative or conventional universal composite. Distinguishing feature- a.Less stickiness or stiffer viscosity than conventional composite which allows them to be placed in a manner that somewhat resembles amalgam placement. b.Likely to offer better clinical performance than non packable composite. But it is not recommended in deep cavities. Polymerization shrinkage similar or higher than non packable composite.

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Packable/ condensable composites: Based on PRIMM (polymer rigid inorganic matrixmaterial). Consist of resin and ceramic component. Fillers instead of being incorporated into composites as glass particles are present as a continuous/scaffold of ceramic particles. Diameter -< 2 µm.

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Highly filled polyceramic material, combination of conventional fillers & chopped glass fillers. Low wear rate& polymerization shrinkage, high strength, good proximal contacts In addition to hybrid composite filler.(crushed barium aluminosilicate glass & colloidal silica) 3.ALERT(Amalgam Like Esthetic Restorative Treatment)

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First commercially available packable composite material contains barium alumino silicate glass particles fused at elevated temp creating large particles with coarse texture. Porosity & geometry of fillers allows packability of composites Greater the forces applied during condensation better is packing ability 4.SOLTAIRE: (1997)

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Contain Urethane modified BisGMA High packing density by incorporation of 3 types of fillers-midfiller, minifiller & microfiller. Good clinical wear Tight proximal contacts Curing depth-5mm 5.SUREFILL

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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

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Thank you……………….. THANK YOU