AMALGAM AND COMPOSITE RESTORATIONS

class I, II, V posterior class III, IV anterior amalgam or composite

in posterior gold and porcelain anterior - composite or

porcelain

basic procedures– anesthetic, dental dam,

remove decay– place matrix band, if

needed, wedges if needed

– place restorative material

– finish restoration

Classification of Cavities

Class I – Pit and Fissure– No tofflemire or matrix required– Amalgam or composite

Class II – Posterior interproximal and occlusal– Tofflemire or Mylar matrix required– Amalgam or composite

Classification of Cavities

Class III – anterior interproximal (no incisal edge)– Mylar strip– Composite

Class IV – anterior interproximal with incisal edge– Mylar strip– Composite

Classification of Cavities

Class V – cervical 1/3– Composite– Glass ionomer (type II)

CAVITY PREPARATION

It is a surgical operation basic principles

– outline form– resistance form– retention form

mechanical vs chemical

– convenience form– removal of caries

– Finishing of enamel walls– extension for prevention– cavity debridement– line angles – point angles

CAVITY PREPARATION

Formed by the junction of 2 walls in the cavity prepLine Angles

Point angles

AMALGAM MATERIAL

Advantages– used in posterior only– strong to with stand

compressive pressures(160 lbs. pressure)

– Malleable (soft and easily shaped when freshly mixed)

– durable– inexpensive

Disadvantages– mechanical retention

only– not esthetically pleasing– contains mercury

AMALGAM MATERIAL

Can be used for:– posterior restorations– core buildups– delivered in capsules or

bulk– today most offices use

high copper amalgam, less mercury

Composition– mercury– silver– tin– copper– zinc

AMALGAM MATERIAL

Combination of two or more metals mercury liquid at room temperature Once mixed, amalgam cannot be reused Ratio – one to one Controversial

– health hazard– environmental hazard

Amalgamator

Amalgamation Tritturation

– quality of mix is determined by mixing time

– too long - soupy, sets quickly

– too short - dull, crumbles

Preparation– class II requires

tofflemire and band– anatomy placed in

material with carvers T-3 Hollenback Discoid/Cleoid

Retention Pins

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

Also called resins Advantages:

– Tooth colored– Esthetically pleasing– Bonded directly to the tooth– Reduced microleakage

Disadvantages– Strength – occlusal wear resistance is improving– Discoloration around borders after time

COMPOSITE MATERIAL

Advantages:– esthetically pleasing– wear resistance is

improving– resist fracture– mechanical and

chemical retention– expansion/contraction

similar to tooth structure

Disadvantage:– 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

Sometimes fails

COMPOSITE MATERIAL

Sometimes Work Well

COMPOSITE MATERIAL

Types– light cure – self cure– dual cure

Components– resin material– polymer - powder– monomer - liquid– polymerization - to set

Uses:– class I,II, III,IV, V– core build ups– veneers

Composite make up

Composite is a combination of polymers and monomers

– resins– fillers– coloring

Filler:– originally quartz - good

translucent appearance, strong and hard, difficult to polish to high shine

– silica particles, chemically produced

– macrofills– microfills– hybrid

Composite make up

Macrofils:– large particle– durable– low shine

Microfils:– small particle– low strength– high shine

Hybrid:– combination of macro

and micro– durable and higher shine

than macro

Laminating:– layering of composite

material– Macrofil for durability– Micro for high shine

COMPOSITE PLACEMENT

Mechanical and chemical retention

tooth preparation differs from amalgam

acid etch, primer, bond materials

Basic process– anesthesia, shade

selection, isolation, prep– placement of matrix,

mylar or stainless steel and wedges

– place composite– finish with finishing disc

or burs

Shade Selection

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

Removes smear layer Phosphoric acid, maleic acid, or hydrochloric

acid Critical step in bonding enamel and dentin

surfaces to resin/composite materials

Enamel Bonding

Includes:– Sealants– Bonded orthodontic brackets– Resin bonded bridges– Bonded veneers

Usually bonded directly to enamel surface Dentin Bonding - involves removing the

smear layer

Smear Layer

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 micro-organisms to the pulp of the tooth

May result in PO sensitivity, pain, or even damage to the pulp

Smear Layer

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

Layers or thin stacking of composite Light cure between layers to reduce

shrinkage

Many Different Materials

GLASS IONOMERS

Type I, II, III, IV and Type II restorative

– used as esthetic restoration

– non stress bearing areas

Powder and Liquid– dispensed and mix– capsule form– fluoride release

Class V restorative– root repair

Pediatric restorative Light cure Self cure

Many Choices

Core Buildups

Materials used:– Amalgam– Composite– Glass Ionomer

Replaces missing tooth structure

Give support to remaining tooth structure

Matrices– Stainless Steel– Mylar strips– Crown Formers

Additionally– Titanium pins can be

added for strength

Core Buildups

BLEACHING

Extrinsic– tobacco– coffee– tea

Intrinsic– tetracycline– dental fluorosis– non-vital

Considerations– amount of stain– origin– cost– difficulty

Methods– home bleaching– in office

Bleach or Not to Bleach????

Bleaching Techniques

Non-vital bleaching (walking bleach)– 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)– 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

Take home bleaching (mouth guard bleaching)– 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

Used for endodontically treated teeth

sodium hyperborate, hydrogen peroxide

Bleach placed, patient dismissed, returns one to two days for color check

Many Choices