mastering tips and ticks for composite restorations

1. Mastering Tips and tricks
for Direct Aesthetic
Restorations

4. OBJECTIVE
Clinical tips before and after treatment.
composite material ,composition and types.
Dental histology and anatomy.
Adhesive tricks.
Case analysis and shade selection,
Methods to make the anterior and posterior restoration
mimic the natural dentition.
Affection of the light curing system on the appearance
of the restoration.
Finishing ,polishing and repair of the composite
restoration

5. What do I do if……..
With the OptraGate®
in place, the mouth
stays open.
1.my patient does not open
wide enough?
A lip and cheek retractor made of soft,
flexible material such as OptraGate® is
handy for establishing full access
to the oral cavity.
1. Before and after treatment
2. have only one hand
free whilst I am treating
my patient?
 A flexible lip and cheek retractor, e.g.
Optra-Gate,
 is the ideal auxiliary for impression-
taking, bleaching, cleaning and
polishing procedures.
 It considerably facilitates relative
isolation with cotton rolls, parotid pads
and saliva ejectors..

6. Why do we
prefer Composite
restoration?
Because of advancement and
innovation in the composite
restoration .

7. Material
Structure
Types
Brands in marketing

8. Basic components of
C.R
•Filler
•Matrix
•Coupling agent

9. Nanohybrid
is the best

10. Types
Mono shade
Enamel
Dentine
Body shade
Translucent
Opaque
Colored composite

11. Brands

13. Tooth
Anatomy
• Tooth histology

14. Tooth
histolog

15. Tooth
Anatomy

16. Incisal
Middle
Cervical
M & D line angle

17. Cervical
Middel
Incisal

35. I am not sure if the dentin is wet enough for bonding?
After the etching procedure, the exposed collagen
fibers on the dentin surface should be encapsulated by
a homogeneous and thin layer of adhesive to achieve a
stable bond to the tooth.
For this to happen, the tooth surface must not be
overly dry. Otherwise, the collagen fibres may
collapse.
It is therefore difficult to evaluate if or when the
dentin surface has become too dry.
What do I do if……..
2. Adhesive

36. Some adhesives fail to infiltrate over dried collagen
fibers properly and this may lead to a significant
reduction in bond strength.
Against this background, adhesives such as Adhese®
Universal are based on a combination of water and
ethanol as the solvent to restore moisture to collagen
fibers that have collapsed because of desiccation.
This type of adhesives is suitable for both wet and dry
bonding techniques.
What do I do if……..
2. Adhesive

37. What do I do if……..
2. Adhesive

38. I want to prevent postoperative sensitivities?
Postoperative sensitivities can have any of a number
of causes. They often occur if the dentin tubules and
collagen network are exposed because they are not
properly covered with adhesive.
What do I do if……..
2. Adhesive

39. One way of preventing it is to use an adhesive (e.g.
Adhese Universal) that comprises hydrophilic solvents
and methacrylate monomers that can wet and
infiltrate the dentin tubules in moist and dry
conditions.
In addition, the acidic compounds in the dentin
precipitate as insoluble calcium salts, facilitating the
mechanical blocking and sealing of the dentin tubules.
This integrated "desensitizing effect" prevents the
fluid flow within the dentin tubules and reduces the
risk for micro-leakage and postoperative sensitivities
What do I do if……..
2. Adhesive

40. Using the adhesive in conjunction with the self-etch
technique may be an additional measure to prevent
hypersensitivity.
What do I do if……..
2. Adhesive

41. I am not sure which etching technique is best suited for the
case at hand?
Etch-and-rinse systems which etch both the enamel
and dentin (total-etch technique) usually achieve a
better bond strength because the phosphoric acid
contained in the etchant results in a deeper and more
pronounced retention pattern on the enamel.
What do I do if……..
2. Adhesive

42. I am not sure which etching technique is best suited for the
case at hand?
Self etching system result in a favorable and predictable shear
bond strength on dentin. As genuine self-etch systems do not
normally involve a separate application of phosphoric acid, the
bond to the enamel may be reduced in comparison with etch &
rinse systems.
The more recently introduced universal adhesive systems, e.g.
Adhese Universal, have the advantage that they allow you to
freely select your etching technique.
What do I do if……..
2. Adhesive

44. Case analysis
 HISTORY
 Clinicalexamination
 X . Ray
 Occlusion
Missdiagnosis increase p.o.s

45. Proper clinical
examination
Extra oral
• Lips
• Check
Intra oral
• Softtissuemainly the gum
• Hardtissue bone andtooth

46. Analysis of the tooth
Shape
Shade
Function

47. Isolation
 Decreasestress
 Increasethe result success
 NO COMPOSITE WTIHOUT R.D

50. Caries management
Infected dentin
Affected dentine

51. Managementof deepcarieslegion
2 schools
Remove of all the caries Partially removed of the caries

52. 5 points for directpulp
capping
1. No history ofpain
2. Pin pointexposure
3. Isolation
4. Stopbleeding
5. Immediate seal

53. Shade selection

54. Method of shade selection
 Shade guide
 Ball technique

56. Dry polishing
cause
 discoloration
 Heat generation

57. Building up
 Layering technique ( E & D )
 Mono block technique ( Monoshade )

58. Technique
•Indirect ( lab )
•Direct ( free hand )
Finger technique
Strip technique
Palatal index
Composite mock up

59. When you use finger technique
( should be use powder free glove

60. Class IV restorations
 Free hands composite restoration.
 Putty index.
 Sectional bands build up.
What do I do if……..
3. Methods to make the anterior restoration mimic the natural dentition.

62. Puttyindexmethod

71. Abrar
4th yearsstudent

73. Silicone index:
What do I do if……..
3. Methods to make the anterior restoration mimic the natural dentition.

75. Diastema closure
What do I do if……..

76. Diastema closure
What do I do if……..
3. Methods to make the anterior restoration mimic the natural dentition.

79. Rowif
5th year

80. Sectional bandsbuildup.

90. What do I do if……..
3. Methods to make the anterior restoration mimic the natural dentition.

107. What do I do if……..
3. Methods to make the anterior restoration mimic the natural dentition.

108. Peg shaped lateral
What do I do if……..
3. Methods to make the anterior restoration mimic the natural dentition.

109. Peg shaped lateral

110. Composite veneers

111. Composite veneers

116. What do I do if……..
3. Methods to make the anterior restoration mimic the natural dentition.
I want to create correct
proximal contact on
posterior teeth?
Polyester band is
particularly suitable for
this indication .

122. What do I do if……..
3. Methods to make the anterior restoration mimic the natural dentition.
Stamp technique:
 Stamp” technique is a new method for placing large
composite restorations with accurate occlusal
topography.
 Was introduced mainly to restore Class I cavities.
 This technique is indicated when the preoperative
anatomy of the tooth is intact and not lost due to
the carious lesion.
 Using this technique to restore Class II cavities is
not established yet.

129. What do I do if……..
3. Methods to make the anterior restoration mimic the natural dentition.
I want to create mamelons and a correct proximal
contact on anterior teeth?
OptraSculpt Next Generation with the point
attachment is particularly suitable for this
indication .

130. What do I do if……..
3. Methods to make the anterior restoration mimic the natural dentition.
I want to create mamelons and a correct proximal
contact on anterior teeth?

131. What do I do if……..
3. Methods to make the anterior restoration mimic the natural dentition.
I want to create mamelons and a correct proximal
contact on anterior teeth?

136. Finishing
and

137. Finishing
and

139. Finishing
and

142. Finishing and polishing toles

147. What do I do if……..
5. Finishing and polishing

148. What do I do if……..
5. Finishing and polishing

150. What do I do if……..
3. Methods to make the anterior restoration mimic the natural dentition.
I want to add special effects and characterizations to my
Class IV restorations?
Characterizations or natural effects, e.g. hypo
calcifications, discolorations etc. can be replicated
using a composite resin system, such as IPS
Empress® Direct. The special effect materials are
applied in a very thin layer (approx. 0.1 – 0.5 mm)
under the enamel or incisal layer to prevent them
from fading out over time.
The shade selected depends on the indication

151. What do I do if……..
3. Methods to make the anterior restoration mimic the natural dentition.
I want to add special effects and characterizations to my
Class IV restorations?

152. What do I do if……..
3. Methods to make the anterior restoration mimic the natural dentition.

153. What do I do if……..
3. Methods to make the anterior restoration mimic the natural dentition.
1. Tooth fragment bonding is an excellent treatment
option in dealing with a traumatic injuries of the
anterior teeth. 1
2. an immediate attachment of the incisal edge is a
conservative, simple and aesthetic alternative.
Moreover also restores the function and provide a
positive psychological response. 2
1. F Shirani MR Malekipour V Sakhaei Manesh F Aghaei: Hydration and Dehydration Periods of Crown Fragments Prior to
Reattachment.
2. RICCARDO TONINI An Innovative Method for Fragment Reattachment after Complicated Crown Fracture
Crown reattachment technique:

154. What do I do if……..
3 Methods to make the anterior restoration mimic the natural dentition.

155. What do I do if……..
3. Methods to make the anterior restoration mimic the natural dentition.

156. What do I do if……..
3. Methods to make the anterior restoration mimic the natural dentition.
Fragments.
Rubber dam isolation—
frontal view.
Phosphoric acid-etching
of the tooth.

157. What do I do if……..
3. Methods to make the anterior restoration mimic the natural dentition.
Application of bonding
agent on the tooth

158. What do I do if……..
3. Methods to make the anterior restoration mimic the natural dentition.

159. What do I do if……..
3. Methods to make the anterior restoration mimic the natural dentition.
Crown reattachment technique:

160. What do I do if……..
4. Light curing system effecting the restoration .
.
I have my doubts that my curing light cures my fillings
completely?
 The light intensity emitted by the curing light is
inadequate (e.g. because of a technical defect).
Solution: Check the light intensity regularly using a reliable
measuring device (radiometer) such as a BluephaseMeter
II to be sure that you are getting the correct amount of
light

161. What do I do if……..
4. Light curing system effecting the restoration .
.
I have my doubts that my curing light cures my fillings
completely?

162. What do I do if……..
4. Light curing system effecting the restoration .
.
the composite in particularly bright fillings (e.g. bleach
shades) does not cure properly?
You should make sure that the emission spectrum of your
curing light matches the relevant wavelength range of the
product you are using.

163. What do I do if……..
4. Light curing system effecting the restoration .
.
Simple successful
Composite repair
When patients present
with esthetic
composite
restorations requiring
repair, a simple
technique for
repairing composite
defects is invaluable.