This is the second part of my presentation on composite resins, this PPT deals with the Clinical aspects involving composite resins

1. Presented by
Mettina

2.  Introduction
 History
 Definition
 Composition
 Classification
 Activation systems
 Photocuring units
 Properties of Resin based composites
 Recent Advancements

3.  A Highly Cross linked polymeric material reinforced by a dispersion of amorphous
silica, glass,crystalline or organic resin filler particles & /or short fibers bonded to
the matrix by a coupling agent.
Skinner’s 10th edition
 A 3 dimensional combination of atleast two chemically different materials with a
distinct interface separating the components.
DCNA

4. Cross linked
polymeric
matrix
Coupling
agents
Glass
/Resin
fillers

5. Activator/
Initiator
system
Color
stabilizers
Inhibitors
Optical
modifiers
Pigments

6.  Indications /Contraindications
 Advantages/ Disadvantages
 Armamentarium
 Initial clinical technique
 Isolation
 Shade selection
 Cavity designs for composite restoration
 Etching
 Priming
 Bonding
 Curing
 Matrix placement
 Finishing & polishing
 Modes of Failure
 Repair of composites

7.  Class I, II, III,IV,V,VI
 Core build ups
 Sealants & preventive resin restorations
 Esthetic enhancement procedures
 Cements
 Veneering metal crowns/bridges
 Temporary restorations
 Periodontal Splinting
 Non- carious lesions
 Enamel Hypoplasia
 Composite inlays
 Repair of old composite restoration
 Patients allergic to metals

8.  Isolation
 Occlusion
 Subgingival area/ Root surface
 Poor oral hygiene
 High caries index
 Habits- ( Bruxism)

9.  Esthetic
 Conservative
 Less complex
 Used almost universally
 Strengthening
 Bonded to tooth structure
 Repairable
 Corrosion resistant
 Biocompatible
 Cheaper than porcelain

10.  Polymerization shrinkage
 Technique sensitive
 Higher coefficient of thermal expansion
 Difficult, time consuming
 Increased occlusal wear
 Low modulus of elasticity
 Lack of anticariogenic property
 Stains easily
 Expensive

15.  https://www.youtube.com/watch?v=g6ugHUgoDBY
VIDEO CLIP

16. CLINICAL TECHNIQUE

17. Administration of Local anaesthetic injection

19. • Shade selection should be done at the start of
an appointment ( Before tooth is dehydrated)
• Either a natural light source or a color
corrected artificial light source should be used.
• Neutral color drape
• Rapid comparisons with shade tabs( no more
than 5 secs each)
• Rapid selection- avoids eye fatigue

20. Vita classic
Vitapan 3D master
Extended range shade
guides

23.  Class III direct composite restorations
Lingual
approach Facial
approach
Tooth
preparation

24. •Facial enamel is conserved for
enhanced esthetics
•Shade matching- less crucial
•Discoloration- less visible
Irregular alignment of teeth
Facial positioning of lesion
Caries lesion- positioned facially
Irregular tooth alignment
Lingual vs
Facial

25.  Outline form
 Initial tooth preparation- Class 3 preparation , initial axial wall depth of 0.2 mm
into dentin
 Final tooth preparation
1. Removal of infected dentin
2. Pulp protection
3. Bevel placement on accessible enamel margins
4. Final procedures of cleansing & inspecting.

26. Initial tooth preparation
• Creating access to the defective structure
• Removal of faulty structures
• Creating the convenience form
Final tooth preparation
• Removal of infected dentin
• Pulp protection
• Bevel placement
• Cleaning & inspecting.

27.  Bevel is prepared at 45 degree angle to external tooth surface with flame shape
diamond instrument.
 ADDITIONAL MECHANICAL RETENTION-
 Gingival retention groove
 Dovetail

29.  Primary caries lesion
 Esthetics
 Interim restorations
 Foundations for crowns
 Operating area with inadequate
isolation
 Heavy occlusal stresses
 Proximal box extending onto root
surface,
Indications Contraindications

30. Esthetics
Conservative tooth
structure removal
Insulation
Decreased
microleakage
Disadvantages
Polymerization
shrinkage
Technique
sensitive
Lower fracture
toughness
Advantages
Disadvantages

31. Conservative cavity
Box only preparation
Facial or lingual slot preparation.

32. Anatomic
layering

33. Creating access to faulty structure
Removal of faulty structures (caries, defective restorations)
Creating convenience form for the restoration

34. Indication
Most common indication- small faulty
developmental pit.
Clinical procedure
Preparation should be as small in diameter as
possible
Faulty pit entered with appropriate round bur.
Fault limited to enamel.
Stains should be removed.

36. The application of an acid to a tooth surface so
that the enamel is roughened in order to allow for
improved adhesion of bonding material (such as
resin)Acid etching of enamel should be carried out
using a 30-40% solution of phosphoric acid in gel
form …
— Stewart Barclay, in Master Dentistry, Volume
2, 2003

38. Enamel
• Selective demineralization
• Increases surface area
• Increases lifespan of composite
• Decreases marginal staining
• Decreases secondary caries
• Decreases post operative sensitivity
• Permits efficient wetting by
hydrophobic resin
• Tag formation
Dentine
• Demineralizes dentin surface
• Opens dentinal tubules
• Exposes collagen
• Conditions dentine for better wetting
of primer

39.  Primer is used to displace residual moisture, thus creating a surface upon which the
hydrophobic bonding resin can adhere.
 The primer assists the adhesive to flow into and penetrate the etched tooth surface.
 The primer contains a hydrophilic portion that interacts with the moisture present in the
tooth structure, as well as a hydrophobic end that provides bonding sites for the
methacrylate monomers in the bonding resin.
For example, 2-HEMA and HEMA dissolved in acetone or alcohol.

41. (micromechanical attachment between resin and conditioned primed dentin).
 Bond strength is mainly due to micro mechanical bonding of intertubular dentin.
 Clinical longevity of dentin bonding system is not as long as enamel bonding system
1st generation:
 Uses glycerol-phosphoric acid dimethacrylate.
2nd generation:
 Uses chloral substituted phosphate esters of various monomers.
3rd generation:
 Three step procedure of conditioning, priming, bonding.
4th generation:
 Relies on formation of hybrid layer.
 self-etching primers
 conditioning and priming-combined.
5th generation:
 Steps two and three are combined.
6th generation:
 One step procedure as all three solutions is in one bottle.
7th generation:
 Fluoride releasing bonding agents.

42. Classification of Dentinal
adhesives
1. Historical strategies:
i. First generation (1965)
ii. Second generation (1978)
iii. Third generation (1984)
2. Current strategies:
i. Etch and rinse adhesives
a. Three step—etch and rinse adhesive (fourth
generation)
b. Two step—etch and rinse adhesive (fifth
generation)
ii. Self-etch adhesives
a. Two component—self-etch adhesive (sixth
generation)
— Two step—two component—self-etch
adhesive
— One step—two component—self-etch
adhesive
b. Single component—one step—self-etch
adhesive (seventh generation)

44. Convexi T- Convex
tofflemire matrix Palodent matrix system
Palodent plus matricing system

45. Bioclear matrix system
Fender matrix
Composi-tight gold
system
Composi-tight silver
system

46. Orange soft face 3D ring &
gray thin tine G ring
Stick bands
3D Clear sectional
matrix system
V Ring matrix system
V 3 matrix system

47. • The composite material bonds directly to the
polymerized adhesive.
• The application of adhesive & composite
should occur in timely manner.
• The composite is inserted by hand instrument
or syringe.
Composites are available in two forms-
• A threaded syringe for dispensing
• A self contained compule that is placed into an
injection syringe for dispensing,
• From a threaded syringe composite is
dispensed using a hand instrument.
• For large restorations several 2mm
increments are placed & cured.

50. • Poor isolation of the operating area.
• White line or Halo adjacent to enamel margin
• Voids
• Weak or missing proximal contacts ( Class II, III OR IV)
• Inaccurate shade.
• Poor retention.
• Contouring & Finishing problems.

54. Core build up

56. CORE BUILD UP TECHNIQUE - VIDEO
https://www.youtube.com/watch?v=myT-Gm0ItxA

57. Pit & fissure sealants
Pits & fissures result from incomplete coalescence of enamel & are particularly prone
to caries.
These areas can be sealed with low viscosity fluid resin after acid etching.
Light activated
activated
UDMA
Light activated
activated BIS-
BIS-GMA

59. Sealants & preventive resin restorations

62. Esthetic procedures

64. Composite
laminates

65. Enamel Hypoplasia

66.  Composite resins are a versatile dental restorative material which
provide excellent Biomimetic effects to emulate and restore lost
tooth structure.
 Proper technique can ensure success of this restorative material.

67.  Sturdevant’s art & science of operative dentistry
 Google.co.in
 Pubmed.nic.in