COMPOSITE RESTORATIONS

www.caapidsimplified.com

• Introduction
• Composite classification
• Composition and types
• Class II, III, IV, and V restoration procedures
• Stamp technique
• Criteria for evaluation of preparation Tips and tricks

Agenda

• They generally have two steps:

• A solid formed from two or more distinct phases that have been combined to produce properties superior to or intermediate to those of individual constituents

• Matrix phase: encloses the composite and gives its bulk form.
• Dispersion phase: determines the internal structure of composite, and it is bonded to the matrix phase

Introduction

• Class I, II, III, IV, V, VI
• Core buildups & Inlays
• Sealants and preventive resin

restorations

• Esthetic enhancements procedures
• Cement, & Temporary restorations
• Veneering metal crowns/bridges
• Periodontal splinting
• Enamel hypoplasia
• Repair of old composite restoration
• Patients allergic to metals

• Where isolation is impossible Traumatic occlusion
• Subgingival area/root surface Poor oral hygiene
• High caries index
• Habits (Bruxism)
• Compromised Operator abilities

Indications

Contraindications

Conservative

Less complex

Used almost universally Strength

Bonded to tooth structure Repairable

No corrosion

No health hazard

Cheaper than porcelain

• Polymerization shrinkage
• Technique sensitive
• Higher coefficient of thermal expansion Difficult, time-consuming
• Increased occlusal wear
• Low modulus of elasticity
• Lack of anticarcinogenic property Staining
• Costly

Advantages

Disadvantages

Sturdevant: Based on filler particle size

• Megafill (0.5 - 2mm)
• Macrofill (10 -100micron)
• Midifill (1 - 10micron)
• Minifill (0.1 - 1micron)
• Microfill (0.01 - 0.1micron)
• Nanofill (0.05 - 0.01micron)

Skinners (10th ed):

• Traditional composites (Macrofilled) 8 - 12um
• Small particle-filled composite (1 - 1um)
• Microfilled composite (0.04 - 0.4um)
• Hybrid composite (0.6 - 1um)

Classification

Based on the method of curing:

• Chemical
• Light cure
• Uv
• Visible
• Dual cure

Based on consistency:

• Light body - flowable
• Medium body - Homogenous microfills,
• macro fills, midifills
• Heavy body - a packable hybrid, mini fills

• Based on the matrix:
• Composites based on BisGMA
• Composites based on UDMA

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• Based on their area of application:
• Anterior
• posterior

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• Based on inorganic loading:
• Heavy filler material - 75%
• Lightly filler material - 66%

Mode of presentation

Two paste system

Single paste system

Major components:

• Resin matrix: BIS GMA, UDMA, TEGDMA, EGDMA, HEMA
• Coupling agents: Organosilanes
• Inorganic fillers: Quartz, Silica, Glasses

Other components:

• Inhibitors
• Activator-initiator system: Benzoyl peroxide +

tertiary amine

• Optical modifiers: Camphoroquinone
• Color stabilizers
• Pigments

Composition

Composite Restoration

ARMAMENTARIUM:

• Teflon coated instruments
• Composite material
• Carvers - Hollenback, discoid cleoid, IP
• Curing light
• Polishing kit -
• Finishing carbide burs,
• Stone burs,
• Soflex disks,
• Finishing cups/discs/points (green - yellow-white)
• Retainer and matrix system: Tofflemire, Compound, Sectional matrix:
• Palodent contact matrix
• Wedges

• Color varies with translucency, the thickness of enamel and dentin, age of the patient, presence of any external/internal stains.
• Different color zones are present - the incisal third is lighter and translucent than a cervical third. The Middle third is a blend of two.
• Determine shade at the start
• Use either natural light/color corrected artificial light source
• Make quick comparisons with shade tabs (make selection rapidly to avoid eye fatigue.

Shade selection

Anatomy/ Contour

Margin Deficiency

Margin Excess

Interproximal Contact

Centric/ Excursive Contacts

Gingival Overhang

Surface Finish

Contiguous Tooth Structure

Centric/ Excursive Contacts

There is no marginal deficiency. There is no evidence of voids or open margins.

There is no detectable marginal excess at the cavosurface margin either visually or with the tine of an explorer.

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The restoration exhibits no gingival overhang.

The surface of the restoration is uniformly smooth and free of pits and voids.

There is no evidence of unwarranted or unnecessary removal or recontouring of tooth structure

contiguous to the restoration. (Enameloplasty)

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Interproximal contact is present; the contact is visually closed. It is appropriately shaped and

positioned, and there is definite, but not excessive, resistance to dental floss when passed through the

interproximal contact area.

All centric and excursive contacts on the restoration are consistent in size, shape, and intensity with

such contacts on other teeth in that quadrant when checked with articulating ribbon or paper.

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The restoration reproduces the normal physiological proximal contours of the tooth, occlusal and

marginal ridge anatomy.

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Fractured Restoration, Restoration is debonded/ movable in the preparation

Criteria for Evaluation

Good traits in Class II Composite Restoration

• Major grooves, pits, marginal ridges, cuspal planes of restoration are restored to meet anatomical and functional forms
• Marginal ridges are even with adjacent teeth/tooth
• No visible flash/excess
• Clinically acceptable contact
• Smooth surface, no voids

• Apply matrix band and retainer: Pre-contoured Ultra-thin metal matrices - 0.001, 0.002 inches used
• Place a wedge interproximally
• Adhesive - cure for 10 sec

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• Place small increments of composite with a vibratory motion - minimizing air bubbles.
• Start in the proximal box - cure - instrument from composite to enamel
• Add more composite layers in 1-1mm increments, and replicate occlusal anatomy cusps by cusps
• Before taking out the matrix band, final cure another few seconds in all directions.
• Take out the matrix band

Class II composite restoration

• Use #379F and #247 F burs the gross removal of composite, recreating anatomy, including accessory grooves and fissures

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• When pre-finishing, always move from course grade burs to fine grade burs to achieve optimal polishability.

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• Remove any remaining composite flash.

Pre-finishing and shaping

• Tungsten carbide finishing bur is used to contour the marginal ridge.

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• Rugby ball-shaped fine diamond is used to contour the occlusal anatomy.

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• A flexible, abrasive, impregnated soflex disc is used to polish and smooth the occlusal contours.

Finishing and Polishing

• Rinse and dry restoration and change to a super fine gradient disc.
• This should be done at a fast speed in a dry environment
• A jiffy brush can also be used for polishing
• Composite finishing strips can be used to polish

interproximal areas

• Check interproximal areas with explorer and floss to
• ensure good polishing.
• Do not polish the contact itself to minimize the
• probability of losing adequate contact.

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• It mimics the original tooth morphology by using the existing clinical condition before the necessary destruction of the tooth surface, reducing the time required for the removal of excess and polishing the restoration.

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• Consists in taking an impression of the tooth structure before cavity preparation for getting a stamp through the negative imprint of the anatomical shape of the occlusal surface

Stamp Technique

• Place a mylar strip interproximally (to facilitate strip placement, place an interproximal wedge before mylar strip placement)
• Instrument options: Plastic instrument, composite
• condenser, composite carrier, super plugger
• Place the composite in 1-1mm increments into the most
• facial portion of the preparation, beginning at the facial-axial line angle.
• Use the smallest composite plugger to pack the composite and ensure it is flush with the preparation walls: cure
• Incrementally fill, pack, and contour the preparation until the
• preparation is filled- Final cure

Class III Composite Restoration

• Bur options: dura white stone, fine and ultrafine diamond finishing burs, multi fluted carbide finishing burs, aluminum oxide polishing discs
• Perform fine finishing with rotary instruments or finishing strips
• Check the occlusion using articulating paper.
• Polish the restoration with rotary instruments (Slow speed)

• Using the index finger, hold down on the facial portion of the mylar strip and wrap the lingual portion over the lingual contour of the tooth to create the proximal anatomy- cure
• Remove the wedge and mylar strip.
• Inspect the restoration using the explorer

• Composite restoration must be flush to cavosurface margin with no pits, steps, and voids
• Smooth transition from restoration to tooth structure
• Correct marginal ridge height
• Closed interproximal contact
• Correct interproximal contour
• No overhang or underhang

Checklist

• Thin layer adhesive light-cured (Facial and lingual) Wrap a one-piece mylar strip around the adjacent tooth.
• Apply a thin layer of composite resin against the lingual surfaces of the tooth and light-cured for 20 seconds
• Add the second layer of the resin over the first cured
• composite. The second layer creates dentinal
• opacity.
• The third increment is somewhat opaque and
• creates lobes and hints of mamelons.

Class IV Restoration

Mylar’s “push/pull-through” technique

• Material is pushed toward the lingual using the flat instrument
• Final increment added
• Matrix is removed by gently pulling through lingually.
• Contour margin before curing- cure
• Finish with Diamond flame bur (low speed) / 30-fluted
• carbide finishing bur
• Interproximal polishing strips can also be used.
• Remember to separate teeth slightly before smoothing the
• contact area.

Final finished view

• Add the composite resin increments and light cure the material for 20 seconds.

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• The polishing and final finish (finishing of the external walls)of the restoration are done.

Final view

Class V Restoration

1.Margins

• Excess/Deficient

2.Morphology

• Height of Marginal Ridge (Proper, Excess, Deficient)
• Contour (Proper, Bulky, Flat)
• Incisal Embrasure (Proper, Insufficient)
• Anatomy (Proper, Lacking)

3.Occlusion

4.Contours

5.Contact

• Position (Proper, High, Low)
• Tightness (Proper, Light, Open)
• Area (Proper, Wide, Point)

6.Surface Finish

• Smooth/ Rough
• Voids/ Pits

Mnemonic

(MM)O(CC)S

• Roberson. T.(2006). Sturdevant’s Art and Science of operative dentistry (5th edn)
• Phillips’ Science of dental materials
• Marzouk - Operative dentistry- modern theory and practice
• Craig’s dental materials
• Principles and practice of operative dentistry- Charbeneau
• Occlusal stamp technique for direct resin composite restoration: A clinical case report - Jose Guilherme Ferror Pompeu

REFERENCES

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