General consideration for composite restoration Indication Contraindication Advantages Disadvantages Clinical technique Initial clinical procedure Tooth preperation for restoration Adhesion technique Restorative technique for composite restoration

3. contents
 General consideration for composite restoration
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Indication
Contraindication
Advantages
Disadvantages
Clinical technique
Initial clinical procedure
Tooth preperation for restoration
Adhesion technique
Restorative technique for composite restoration

4. INDICATIONS-:
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1. Class I,II,III,IV,V,VI restorations
2. Foundation or core buildup.
3. Esthetic enhancement proceduresPartial veneers and Full veneers.
Tooth contour modifications.
Diastema closure.
4. For periodontal splinting.

5. CONTRAINDICATIONS:-
1.High caries incidence and poor oral hygiene.
2.Teeth with heavy or abnormal Occlusal stress.
3.If access & isolation difficulties.
4.Subgingival difficulties
5.Patient allergic or sensitive to
resin composite.

6. ADVANTAGES:1.Esthetic.
2.Conservation of tooth structure.
3.Insulative.
4.Bonded to tooth structure.
5.”Command set”
6.Repairable.
7.Can be polished at the same appointment

7. DISADVANTAGES:-
1.polymerization shrinkage.
2.time consuming and expensive.
3. More technique sensitive.
4. difficult to finish and polish.
5. increased coefficient of thermal
expansion.

8. Clinical technique of composite restoration
A. Initial clinical procedures,
B. Tooth preparation for composite
C. Restorative technique for composite

9. Clinical technique
A-Initial clinical procedures,
-Local anesthesia - patient is more relaxed
- reduced salivation
-Preparation of operating site –
clean the operating site with slurry of pumice to remove any
debris, plaque , pellicle, and superficial stains .Calculus removal
Prophylaxis pastes containing flavoring agents, or fluorides act
as contaminants and should be avoided to prevent a possible
conflict with the acid-etch technique.

10. Shade selection
Color varies with translucency,
thickness of enamel and dentin, age of
the patient, presence of any external or
internal stains
Different color zones are present incisal third is lighter and translucent
than cervical third. Middle third is blend
of two

11. 1. Determine shade at the start of an appointment (before the tooth is
subjected to dehydration)
2. Use either natural light (not direct sunlight) or a colour corrected artificial
light source.
3. Drape the patient with a neutral colored cover if clothing is bright
4. Make rapid comparisons with shade tabs (no more than 5 seconds each
viewing) Make the selection rapidly to avoid eye fatigue

12. Automated Shade
Selection

13. Isolation of operating site
- Rubber dam
- cotton rolls
- retraction cord

14. B- Cavity designs for composite cavity preparation
1.
Conventional
2.
Beveled conventional
3.
Modified
4.
Box shape
5.
Facial/lingual slot

15. CONVENTIONAL
similar to that of cavity preparation for amalgam restoration.
A uniform depth of the cavity with 90° cavosurface margin is
required
INDICATIONS
1. Moderate to large class I and class II restorations
2. Preparation is located on root surfaces.
3. Old amalgam restoration being replaced

16. BEVELED CONVENTIONAL
1.
2.
Similar to conventional cavity
design
Have some beveled enamel
margins.
INDICATIONS
1. Composite is used to replace
existing restoration.
(class III, IV, V)
2. Restore large area
Rarely used for posterior composite
restorations

17. • Advantage of enamel bevel-ends of enamel rods are
more effectively etched producing deeper
microundercuts than when only the sides of enamel
rods are etched.

18. MODIFIED
1.
2.
3.
4.
5.
No specified wall configuration.
No Specified pulpal or axial depth.
All parameters determined by extent of caries.
Conserve tooth and obtain retention (MICRO MECHANICAL).
Scooped out appearance
INDICATIONS
small, cavitated, carious lesion surrounded by enamel
correcting enamel defects.

20. BOX ONLY PREPARATION
• Indicated when only the proximal surface is faulty with no
lesion present on the occlusal surface
• Prepared with either an inverted cone or diamond stone held
parallel to the long axis of tooth crown.
• Initial proximal axial depth - 0.2mm inside DEJ.
• Neither bevel nor secondary retention required.

21. FACIAL OR LINGUAL SLOT
1.
2.
3.
Lesion is proximal but access is possible through facial or
lingual surface
Cavosurface is 90 or greater.
Direct access for removal of caries.

22. Pulp protection
In deep cavities pulp protection may be necessary prior to acid
etching and bonding.
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Calcium hydroxide, GIC , RMGI
ZnOE is contraindicated

23. Adhesion
ETCHING
• 30-40% conc. Of phosphoric used(ideally 37%)
• For enamel & dentin for 15 sec and then rinsed off.
• Available as –liquid and gel.
Syringe for dispensing gel etchant
Applicator tip for liquid etchant

24. Etching Procedure

25. ETCHING ENAMEL-
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affects both prism core and prism periphery.
transforms smooth enamel into very irregular surface.
• When fluid resin is applied
to etched surface
Resin penetrates etched surface
Forms resin tags
Basis for adhesion of resin to enamel

26. ETCHING DENTIN•
Affects intertubular and peritubular dentin.
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Removes the smear layer and exposes collagen network to
achieve optimal adhesion to the dentinal surface.
• After rinsing the surface is kept slightly moistened when
dentin is also involved because it allows the primer and
adhesive material to more effectively penetrate the collagen
fibre to form a hybrid layer which is the basis for mechanical
bond to dentin.

27. PRIMER or CONDITIONERS
• Primers condition the dentin surface, & improve
bonding.
• Acidic in nature
• eg. EDTA,nitricacid, Maleic acid
Functions:• Removes smear layer & provides subtle opening of
dentinal tubules.
• Provides modest etching of the inter-tubular dentine.

28. Bonding agents
 Classified : First generation(1980) – used glycerophosphoric acid
dimethacrylate
provide a bifunctional molecule.
disadvantage – low bond strength.
Eg-NPG-GMA
 second generation (1983)-adhesive agents for composite
resin.
bond strength three times more than before.
disadvantage-adhesion was short term the bond
eventually hydrolysed.
Eg.prisma , universal bond,clearfil,scotch bond

29. Third generation – coupling agent had bond strength to that
of resin to etched enamel.
Disadvantages-use is more complex & require 2-3 application
steps
eg-tenure , scotch bond2,universal bond
Fourth generation-all bond-2 system consists of 2
primers(NPG-GMA and bisphenol dimethacrylate (BPDM) &
an unfilled resin adhesive (40% BISGMA,30%UDMA,30%HEMA)
Fifth generation-single bond adhesive.
advantage- single step application
eg.3M single bond , one step (BISCO)

30. Application of Bonding Agent:
Application of the bonding agent and then
cured for 10 seconds.

31. Uses of bond Agents
 For bonding composite to tooth structure.
 Bonding composite to porcelain and various metals like
amalgam, base metal and noble metal alloys.
 Desensitization of exposed dentin or root surface.
 Bonding of porcelain veneers.

32. CURING
• Two types:- 1.Self curing
2.Light curing.
SELF CURING: not used extensively .
Disadvantages1.Mixing of two pastes required and it is almost
impossible to avoid incorporation of air bubbles.
Air bubble contain oxygen that causes oxygen
inhibition during polymerization.
2.No control of working time.

33. LIGHT CURING• Material inserted in tooth preparation in 1-2mm
thickness. This allows the light to properly polymerize
the composite and may render the effect of
polymerization shrinkage appear along the gingival
floor.
• ADVANTAGES1.Sufficient working time.
2.Not sensitive to oxygen inhibition.
3.Easy placement.
LIMITATION
1.Time consuming
2.Shrink towards the light source.

34. Curing Of the Composite:
The material is cured using the
light curing machine for 20
seconds for every increment of
composite that was placed.

35. Matrix placement
• Two types of matrices are available
- Polyester matrix
- metal matrix
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Various matrix retainer which can be used are
Tofflemire retainer
Compound supported metal matrix
Sectional matrix system- palodent contact matrix

38. • Polyester matrix
- used especially CLASS III, CLASS IV ,CLASS V cavities
Advantage - they allow the light to pass
Disadvantage - they are not rigid and get deform during
placement of rigid material and contact cannot be properly
restored
• Metal matrix
- Ultrathin metal matrices .001- .002 inch are used
- Band should be precontoured outside the mouth

39. CONTOURINGCan be initiated immediately after light cured
composite have been placed or 3 minutes after the
initial hardening of self cured material.POLISINGDone with fine polishing discs, fine rubber points or
cups.

40. Finishing and Polishing:
The use of polishers with
enhancers and polishing paste
were done after the trimming of
the excess composites.

41. Finish & polish
Tungsten carbide finishing bur is used
to contour the marginal ridge (note the
water spray).
Rugby ball’-shaped fine diamond is used
to contour the occlusal anatomy. All
high-speed instruments must be used
with water spray.
A flexible, abrasive, impregnated disc is
used to polish and smooth the occlusal
contours.

42. Finishing & Polishing

43. After restoring with Composite Resin Material
Before the restoration procedure.

44. Composite restorations are very technique sensitive so
utmost care is necessary before, During and after manipulation.
The Visible Modes Of Failures
1) Discoloration-Especially At Margins
2) Marginal Fracture
3)Recurrent Caries
4) Post Operative Sensitivity
5) Cross Fracture Of Restoration
6) Lack Of Maintaining Contact
7) Accumulation Of Plaque Around The Restoration

45. Prepared by :
Hazhar Ahmed Xidr
Hemn Muhammed Xidr
Stage 4 , group D2