Transcript complex multi-surface composite restorations

COMPLEX MULTI-SURFACE
COMPOSITE RESTORATIONS
DR. PETER WALFORD
COMMON PROBLEMS
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EXCESSIVE TIME
OPEN/BROKEN CONTACT
MATRIX ISSUES
GINGIVAL RE-DECAY
MORE PROBLEMS….
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PULP - SENSITIVITY OR
DEATH
PITS,VOIDS,BUBBLES
UNATTRACTIVE ESTHETICS
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ISOLATION CHALLENGES
INSTRUMENTATION FOR LONG
CROWNS
PREPARATION DESIGN?
WWW.PETERWALFORDDENTISTRY.COM
USERNAME cardp2012
PASSWORD halifax
LINKS ON WEBSITE
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FOLLOW ((CARDP)) ON HOME PAGE TO FIND
APPROPRIATE LINKS WITHIN WEBSITE
TIME SAVERS
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HEATED RESINS
FAST CURE LIGHTS
DELEGATION-the future of
the restorative hygienist
position
BULK FILL?- a flawed concept
CALSET COMPOSITE HEATER
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BEST SETTING: 54 DEGREES
MULTIPLE DESIGNS FOR COMPULES OR SYRINGES; SYRINGE IS MOST
VERSATILE MODEL
DECREASES CURE TIME BY UP TO 75%
INCREASES PHOTOCONVERSION, HARDNESS
THINS OXYGEN-INHIBITED LAYER
FOR EVIDENCE SEE WWW.ADDENT.COM
DETERMINING CURE TIME FOR HEATED RESINS
CHAIRSIDE CURE TESTING
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2MM DISC (DENMAT)
3.5 MM DISC (HARDWARE TAP WASHER)
DETERMINE CURE BY SCRATCH TEST
CRUDE BUT ONE STEP UP FROM BLIND FAITH
HAVE CDA COMPILE A TABLE- A FEW SURPRISES WILL BE FOUND
DARK SHADES AND FLOWABLES!! TAKE LONGER
SOME VERY LIGHT SHADES MAY ALSO TAKE LONGER DUE TO MISMATCH BETWEEN LIGHT
SPECTRUM AND PHOTOINITIATOR
PREVENTING OPEN/BROKEN CONTACT
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ANATOMICALLLY CONTOURED CIRCUMFERENTIAL MATRIX
CONTACT FORMERS
CUSTOM WEDGING
RESIN WITH SUITABLE FLEXURAL STRENGTH
ADEQUATE CURING
FLEXURAL
STRENGTH
THE IMPORTANCE OF FLEXURAL STRENGTH
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THOSE PORTIONS OF THE RESTORATION EXTENDING BEYOND THE ROOT BASE MUST
TRANSFER LOADS ON A DIAGONAL PATH TO THE RETORATION
THIS CREATES A TWISTING SHEAR FORCE WITHIN THE RESIN; A “ FLEXURAL LOAD”
BEST PARAMETER TO INDICATE THIS QUALITY IS FLEXURAL STRENGTH
INADEQUATE FLEXURAL STRENGTH WILL LEAD TO BREAKAGE OF MARGINAL RIDGES
EVEN IF EVERYTHING ELSE IN THE RESTOATIVE SUITE IS PERFECT
SEE WEBSITE FOR TABLE “COMPOSITE PARAMETER SPREADSHEET”
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BEST RESINS FOR LARGE RESTORATIONS:
TOP QUARTILE
GRANDIOSO (VOCO) 181 MPa
VENUS DIAMOND (HEREAUS KULZER)169MPa
FILTEK SUPREME ULTRA (3M Espe) 162MPa
VENUS
DIAMOND
ENSURING ADEQUATE CURE
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UNDERCURED RESIN IS A PREVALENT CAUSE FOR FRACTURED
RESTORATIONS
SEE WEBSITE ((CURING COMPOSITES))
WIDE-SPECTRUM HIGH INTENSITY LIGHTS ARE BEST
BEST RECOMMENDATION: SAPPHIRE PLASMA ARC 5 SEC CURE
VALO LED SEE CLINICIAN’S REPORT OCTOBER 2010
ref
CRA
OCTOBER 2010
CURING DEEP BOXES
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STUDY CLUB RULE; BEYOND 6MM DEPTH, USE A DUAL
CURE SYSTEM UNTIL BOX DEPTH RESTORED TO 6MM
DUAL-CURE ADHESIVE PHOTOBOND OR ALL BOND 3
DUAL CURE FLOWABLE, STARFILL 2B
STARFILL 2B
DANVILLE DENTAL
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141MPa
HYBRID
S/C IN 2.5 MINS
SEVERAL CONVENIENT
AUTOMIX TIPS
RECOMMENDED JOURNALS FOR
COMPOSITE INFORMATION
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REALITY
CLINICIAN’S REPORT
THE DENTAL ADVISOR
ref
RESIDUAL CARIES, BIOFILM CONTAMINATION
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CARIES IS A NON-STRUCTURAL SUBSTRATE; DOESN’T BOND, HAS NO
RESISTANCE FORM
BIOFILM IS AN INVISIBLE ANDUNIVERALLY PRESENT CONTAMINANT TO
ADHESION
BOTH CONTRIBUTE TO PREMATURE FAILURE OF RESINS
CAN BE CONTROLLED WITH THE ROUTINE USE OF CARIES DETECTOR
BENEFITS OF CARIES DETECTOR
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CONFIRMS COMPLETE REMOVAL (CARIES IS NOT
STRUCTURAL!!)
DISCLOSES PLAQUE
REVEALS FLASH IN FINISHING
DEEP CARIES
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ANGELUS MTA 10 MINUTE SET
DOVGAN PLACEMENT
INSTRUMENT
FO FULL PROTOCOL SEE
CHAPTER IN MODXYZ
ELIMINATING AND REPAIRING PLACEMENT FLAWS
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ALCOHOL AS AN INSTRUMENT LUBRICANT IN PLACEMENT
AVOIDS WEAKENING INCREMENT INTERFACES WITH ”PLACEMENT RESIN”
LIGHT SHIELD TO PERMIT UNHURRIED COHESIVE PLACEMENT-NO PREMATURE CURE
Z-PRIME PLUS (BISCO) AS AN EFFECTIVE PRIMER FOR REPAIRS –BONDS TO SILICA
18MPa, ZIRCONIM 22MPa, AND RESIN
HF ETCH OPTIMIZES ADHESION TO SILICA
USE CONVENTIONAL THIN (5-7 MICRON) GEN IV OR V ADHESIVE AFTER Z-PRIME, CURE
BOND, RESTORE
PRACTICON
ref
REPAIRING FLAWS IN RESTORATIONS WITH Z-PRIME PLUS
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OPEN DEFECT UP INTO A SMALL SAUCER
ETCH WITH PHOSPHORIC ACID IF ENAMEL MARGINS ARE INVOLVED
HF ETCH IF IS A SILICA-BASED FILLER PARTICLE (MOST RESINS ARE)
RINSE, DRY, Z-PRIME (BISCO),BLOW OFF SOLVENT, ADD PHOTOBOND, BLOW OFF EXCESS, CURE
FILL SMALL DEFECTS WITIH MATCHING FLOWABLE WITH AN EXPLORER TIP, CURE
FILL LARGE DEFECTS WITH RESTORING RESIN, CURE
FINISH WITH 7902,POLISH WITH WET SHOFU FG BROWNIE POINT, SLOW RPMS.
WEBSITE LINK ON REPAIRS
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http://www.peterwalforddentistry.com/tiki/tikiindex.php?page=Repairing%20Bubbles%2CVoids
%2C%20and%20Flaws
OPTIMUM ISOLATION
”ISOLATE OR DIE”
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SUPRAGINGIVAL PREPS- ISOLATE NON-LATEX DAM
SUBGIINGIVAL- HYGOFORMIC SALIVA EJECTOR
SILVERED DRI-ANGLES (THETA)
SURGICAL SUCTION REDUCED IN LENGTH TO IMPROVE ACCESS IN LIMITED
ACCESS SITUATIONS
SALIVA EJECTOR BENT TO LIE UNDER THE TONGUE BENEATH A RUBBER DAM
QUALITIES OF AN IDEAL RESTORATIVE
RETRACTION CORD
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BRAIDED NOT SPIRAL-WOUND OR LOOPED
MINIMAL EXPANSION WHEN WETTED
EPINEPHRINE-IMPREGNATED
ALUMINUM SALT-IMPREGNATED, NOT FERROUS SALTS
ONLY TWO PRODUCTS MEET THIS CRITERIA: GINGIBRAID E (VAN
R) AND SILTRAX (PASCAL)
QUALITIES OF AN IDEAL CORD PLACEMENT INSTRUMENT
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MOST CORD PACKERS ARE SERRATED, OVERLY BULKY, AND UN-ERGONOMIC
OFF-ANGLE ; ERGONOMICALLY REACHES INTERPROXIMALLY
SLIM
NON-SERRATED TIP
RECOMMENDED: PFIG 4/5- CAN ALSO BE USED TO PLACE RESIN BEYOND THE
LINE ANGLES
HEMOSTATIC ETCH; A GAME-CHANGER
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REQUIRES USE OF A LIQUID ETCH
LEAVES NO RESIDUE
ATRAUMATIC
VIRTUALLY 100% EFFECTIVE
INEXPENSIVE LIQUID ETCH
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Henry Schein 100-0572 (210cc) diluted 3:1 by
volume with distilled water
About $50
Makes up to 840 cc of etchant
DEPTH OF
DEMINERALIZATION
0
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THE STUDY CLUB ADHESIVE SYSTEM
SEE
((Bonding|Bonding
Protocol))
MICROPRIME B
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EFFECTIVE CROWN PREP DESENSITIZATION, HYPERSENSITIVE DENTIN
LESS TISSUE-TOXIC THAN GLUTERALDEHYE FORMULATIONS SEE CRA AUGUST 2002
STABILIZES THE COLLAGEN NETWORK TO IMPROVE LONG TERM BOND DURABILITY
COMPATIBILE WITH ALL GEN IV AND V ADHESIVES (TOTAL ETCH)
DUAL-CURE ADHESIVES:
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PHOTOBOND (KURARY) 20MPa OR ALL-BOND 3 (BISCO)35MPa
BOTH ARE:
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ALCOHOL BASED
THIN ( 5-7 MICRONS THICK,)
DURABLE
IF YOU CAN ISOLATE IT
AND MATRIX IT,
YOU CAN RESTORE IT
THE END