Transcript AMALGAM AND COMPOSITE RESTORATIONS

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