The document discusses tooth-colored restorative materials and procedures for their use. It describes different types of tooth-colored materials including composite resins, glass ionomer cements, and compomers. It also discusses dental adhesion/bonding systems and the development of dentin bonding agents. Cavity preparation designs for tooth-colored restorations include conventional, beveled conventional, and modified preparations. The clinical procedure for placing a tooth-colored restoration involves local anesthesia, isolation, cavity preparation, acid etching, bonding agent application, composite insertion, and finishing procedures.

1. CHEN Zhi Wuhan University School of Stomatology Operative Dentistry 3

2. Indication of Operative Dentistry Caries ; Malformed, discolored, or fractured teeth; Restoration replacement.

3. Tooth-colored restoration For Class Ⅲ ，Ⅳ and Ⅴ ， Esthetic Dentistry For Class Ⅰand Ⅱ ，

4. What are Tooth-colored materials? What is their working mechanism? What are the cavity preparation futures for tooth-colored restoration?

5. What are steps for tooth-colored restoration? What are the advantage & disadvantage of tooth-colored restoration?

6. Tooth-Colored Materials Composite resin Glass ionomer cement Compomer

7. Composite Resin Traditional composites Hybird composites Flowable composites Condensable composites Packable Universal composites

8. Glass Ionomer Chemical adhesion to dentin Release Fluoride

9. Compomer Compomer = Compo site + Ion omer

10. Dental Adhesion or Dental Bonding Adhesion is a process of solid and/or liquid interaction of one material with another at a single interface.

11. Enamel bonding system Enamel bongding depends on resin tags becoming interlocked with the surface irregularities created by etching.

12. Macrotags: form between enamel rod peripheries. Microtags: smaller tags form across the end of each rod. Macrotags and microtags are the basis for micro-mechanical bonding.

13. Dentin bonding system The difficulties of dentin bonding: More water---wet bonding Lower calcification Richer organic---collagen network Smear layer

14. The bond strength is primarily related to micro-mechanical bonding to the intertubular dentin which occures between tubules along the cut dentin surface.

15. Dentin Bonding Agent, DBA Early DBA were hydrophobic, bonded directly to the dentin smear layer. Bond strengths ＜ 6MPa. Later DBA removed the smear layer but tended to over-etch dentin. Bond strengths≈10~12MPa.

16. DBA were chemically modified to be more hydrophilic. Bond Strengths≈18~20MPa. Careful dentin conditioning, Coupled with hydrophilic primer, Bond Strength≈22~35MPa.

17. The Development of DBA Enamel etch (1955) Dentine etch (1960) Treatment of smear layer (1980) Wet Bonding technique(1990)

18. First generation Second generation Third generation Fourth generation: Total etch technique Fifth generation: One bottle system Sixth generation: All in one,2000 Seventh generation

19. Cavity Preparation Three designs of cavity preparation: 1.Conventional 2.Beveled conventional 3.Modified

20. Beveled conventional cavity preparations are similar to conventional preparation, in that the outline form has external, “ box-like” walls, but with beveled enamel margin.

21. Beveled enamel margin

22. Beveled conventional cavity designs for Class Ⅲ, Ⅳ and Ⅴ preparations

23. The advantages : The ends of enamel rods are more etched The increase in etched surface results in a stronger bond Increase the retention and reduce marginal leakage and discoloration. More esthtically

24. Modified cavity preparation Have neither specified cavity wall structure nor specified pulpal depth, and have enamel margins. Conserve more tooth structure.

25. Modified cavity preparation

26. Initial Clinical Procedure Local anesthesia Preparation of the operating site Shade selection Isolation of the operating site with rubber dam or cotton rolls

28. Rubber dam

29. Clinical Procedure Cavity preparation Acid etching enamel & conditioning dentin Matrix application Application of bonding agent Insertion of composite Finishing procedures

31. Matrix application

38. Final procedures

40. Cases

43. Conservative Operative Dentistry Minimal intervention dentistry is regards as a main stream in caries treatment in the 21 st century.

44. Principles of Minimal Intervention dentistry Remineralization of early lesions Reduction in cariogenic bacteria, to elminate the risk of further demi-neralization and cavitation Minimum surgical intervention of ca-vitated lesions Repair rather than replacement of defective restorations

45. “ The day is surely coming, and perhaps within the lifetime of you young men before me, when we will be engaged in practicing preventive, rather than reparative, dentistry. ” GV Black in 1896

46. University Minnisota School of Dentistry

47. http://202.114.104.243/jpkc/ysysbx/index.html

48. Thanks