Operative - Anterior Prep

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3 Types of tooth colored materials (for esthetics)

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1) Dental resin, 2) Glass ionomer, 3) Ceramic

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3 Types of Dental resin

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1) Composite resin, 2) Sealants, 3) PMMA (polymethylmethacrylate)

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What can be used for Direct placement?

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dental resin or glass ionomer

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3 types of restoration in mouth

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1) Amalgam (metal), 2) Polymer (composite-material), 3) Ceramic : tooth-color/not direct placement usually

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4 components of Composite resin

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1) Resin matrix, 2) Filler particles, 3) Coupling agent, 4) Initiators; *Unreactive part is present and surrounded by matrix

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5 Types of Composite Resins

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1) Microfill, 2) Hybrid, 3) Micromatrix hybrid, 4) Flowable, 5) Packable

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Use of Microfill

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small particle and very easy to polish. Use in anterior restoration – Class 5 and direct veneers

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Use of Hybrid

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All classes; direct veneers

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Use of Micromatrix hybrid

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All classes; direct veneers

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Use of Flowable

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PRRs and other uses

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Use of Packable

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Posterior restorations

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4 Classifications of Restorations that can involve anterior teeth

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1) Class I (can be anterior or posterior), 2) Class III (proximal of anteriors), 3) Class IV (incisal edge), 4) Class V (smooth surface legion, caries or notched lesion at gingival third of anterior and posterior teeth (facial or lingual))

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When should you select the shade for the tooth?

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Before numbing and before application of rubber or tooth preparation because tooth gets whiter with dehydration; *Select shade based upon color of area being restored and use natural light; Shade of gingival/body of tooth preferred to incisal color

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Instrument for preparing Class V

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330 bur to create round internal angle rather than sharp angles of amalgam prep; *Can use Flowable for the starter to better adopt to round internal line angle

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Retention

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We do not have to consider same retention form as amalgam preparation; Retention can come from the material itself.

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How to isolate site

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use a rubber dam with gingival retraction clamp (#212 retainer); use of gingival retraction cord to control and retract soft tissue

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Outline form

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defined by extent of caries; bevel the walls (0.5-1mm bevel of ½ the thickness of enamel); *Outline form is NOT how deep into the tooth it is

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2 Reasons for beveling

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1) Exposes more reactive ends pf enamel rods for better bodning, 2) Helps establish esthetic blend of composite;

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What part of the tooth should you NOT bevel? (3)

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Chewing surfaces (load-bearing), root surfaces, and any part that goes into dentin (below DEJ)

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Axial wall

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Wall created when you drill down into proximal box (up against pulp of tooth)

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Gingival wall

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the floor of your proximal box (similar to pulpal wall)

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Retention grooves

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placed into gingival wall/margins with ¼ round bur

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Outline form of non-carious lesions (ex: fraction or abrasion)

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Tooth preparation is defined by extent of notching; Gingival retention with ¼ round bur

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Clinical diagnosis of Class 5 caries (3 criteria)

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1) Determined by tactile sense (tacky), 2) Color, 3) Consistency

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Procedure for Restoring Class V caries

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1) Rubber dam placed with Gingival retraction 212 clamp, 2) Outline form: extent of the decay, 2) Caries removed with #2 round bur and slow speed hand piece (Don’t go too far; dentin has ivory color; it is hard and resists explorer tip penetration, 3) Enamel margins beveled along the cavosurface margin (ABOVE THE DEJ), 4) Etch enamel and dentin with phosphoric acid (15 sec., then rinse 15 sec), 5) Adhesive: total-etch system (etchant and primer + adhesive – SINGLE COMPONENT SYSTEM; Cure 10 sec.), 6) Restore with microhybrid composite resin

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Adhesive we use

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Optibond Solo Plus

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What 3 other types of etchant systems are out there

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1) Multi-bottle (Etch, primer, and adhesive all separate), 2) Self-etching (self-etching primer + adhesive), 3) All-in-one

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Etchant

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Phosphoric acid with 10-37% conc.; Gel, semi-gel, or liquid applied with brush or needle tip

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Why do we want to gently blow air after adding primer/adhesive?

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Get rid of solvent layer and make sure adhesive is an evenly thin layer

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5 Reasons for Etching

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1) Clean tooth surface, 2) Increase surface area, 3) Increase surface energy allowing for resin penetration of microscopically roughened surface (Depth of microporous layer is approximately 5-50 microns), 4) ENAMEL: To have the honeycomb effect. Good surface to bond and increase the surface energy, 5) DENTIN: To totally remove the smear layer to access the tubules and collagen fibers of the tooth.

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Dentin smear layer

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Layer on tooth surfaces created by rotary cutting instruments; Made of loosely bound debris, collagen, and hydroxyapatite crystals

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Appearance of enamel after etching

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frosty white appearance after dried

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Why should dentin be kept slightly moist?

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If over dried, it will collapse the collagen fibers. If the collagen fibers are collapsed, the ‘hybrid layer’(inorganic and organic mixture of two interphases) will not be created.

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Purpose of primer

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chases the water and to create the hybrid layer.

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Application of composite resin

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Composite resin placed in increments no greater than 2 mm for complete polymerization and to control shrinkage; *Sometimes you can syringe composite resin into tooth preparation to minimize excess

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Shaping the composite

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Shape composite with plastic filling instrument (PFI) that is lightly wetted with adhesive resin so that the instrument will not stick; Light cure 20-30seconds

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Finish of composite resin

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finishing burs and disks on facial/lingual; Then Rubber abrasives for composite resin – 1) Rubber Disks, 2) Rubber adhesive Cups, 3) Rubber adhesive Bullet

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Polish of composite resin

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Final polish with Finest grit disk (superfine Soflex disk) and Composite resin polishing paste

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Using soflex discs

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Go from coarsest to finest (dark to light color); Use with composite NOT glass ionomer; Coars good for shaping incisal and embrasures; Always wipe grit between using Medium, fine and superfine always wipe grit from composite surface between grits

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Polishing paste

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For final polish, especially for posterior occlusal and anterior lingual surfaces)

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What are the 5 walls in a Class V prep?

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five walls: mesial, distal, gingival, incisal, axial walls

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Shade selection for Class V

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Cervical restorations usually use darker shades of composite resin

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Retention for Class V

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Preparation will have occlusal Bevel and gingival retention groove