This document provides an overview of esthetic biomaterials and principles for clinical steps in restorative dentistry. It lists materials used, cavity preparation techniques, and factors affecting polymerization. It then discusses direct resin composites indications and contraindications, basic instruments used, clinical procedures for class III, IV and V cavities. These include preparation details, matrix and wedge use, adhesive placement, composite insertion and curing techniques. Finishing and polishing of restorations is also covered. The document concludes by mentioning pre-heating of composite to lower viscosity for improved adaptation.

1. Esthetic Biomaterials &
Principles of Clinical Steps - 1
Muhammad Amber Fareed
BDS (Lahore), MSc (London), PhD (Birmingham),
FRACDS (Sydney), FDSRCPS (Glasgow), DipMedEdu (Cardiff)
Professor of Restorative Dentistry
College of Dentistry, Gulf Medical University
Ajman, United Arab Emirates
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2. Learning Content
• List of esthetic restorative materials
• Cavity preparation
• Oral environment
• Selection of the esthetic restorative material and its properties
• Material application or placement
• Polymerization technique
• Factors affecting polymerization
• Light polymerization unit
• Finishing and polishing of restoration
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3. Learning Outcomes
• Discuss the different esthetic restorative materials
• Determine the different features for cavity preparations in the
esthetic zone
• Define polymerization reaction of composite and its sequelae
• Illustrate different strategies used to reduce polymerization shrinkage
stress
• Discuss the interaction between the restorative materials and the oral
environment
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4. Cavity Preparation Principles
Esthetic restoration procedure either involves the cavity preparation:
• Class III cavity preparation
• Class IV cavity preparation
• Class V cavity preparation
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5. Direct Resin Composites Restoration
Indications Contraindications
• Class I, II, III, IV, V, and VI restorations
• Foundations and core buildups
• Sealants and preventive resin restorations
(conservative composite restorations)
• Esthetic enhancement procedures: Partial
veneers, Full veneers, Tooth contour
modifications, Diastema closures
• Temporary or provisional restorations
• Periodontal splinting
• Luting of indirect esthetic restorations
(when used in flowable form, or when
heated to increase low)
• Inability to obtain adequate
isolation
• Occlusal considerations related
to wear and fracture of the
composite material
• Extension of the restoration on
root surface
• Operator factor
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6. Basic Restorative Insturments
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7. Class-III Composite – Initial Clinical Procedures
Initial Clinial Procedure involves the following steps:
• Anesthesia  For patient comfort and to decrease salivary low
• Occlusal assessments to determine the tooth preparation design
• Composite shade must be selected before the tooth dehydrates
• Rubber dam isolation  facilitate access and effective bonding
• Wedge placement  should be placed beforehand as it may assist in
the reestablishment of the proximal contact with composite
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8. Class-III Composite – Tooth Preparation
• The tooth preparation for Class III direct composites involves
1. Creating access to the faulty structure (caries, defective restoration, non-
carious tooth surface lesion)
2. Removal of faulty structures (the caries lesion, defective restoration, and
base material, if present)
3. Creating the convenience form for the restoration.
4. Retention, primarily obtained by bonding, so it is not necessary to use
mechanical retention features in the tooth preparation
5. Obtaining access to the defect may include removal of sound enamel to
access the caries lesion.
6. The extension of the preparation is therefore ultimately dictated by the
extension of the fault or defect
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9. Class-III Composite Cavity Preparation – Bavel
• In class-II composite  No bevels are placed as beveled composite
margins may be more difficult to finish.
• In class-III composite  Enamel bevel is used on the facial cavo-
surface margin to provide a gradual color transition from the
restoration to the tooth structure
• Additional retention form if needed  is achieved either by
increasing the surface area with a wider enamel bevel or by adding
retentive features in the preparation internal dentin walls.
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10. Class-III Composite – Lingual Preparation
• A choice between facial or lingual entry for class-III cavity preparation
• Lingual approach  always preferred due to following advantages
1. Facial enamel is conserved to enhance esthetics
2. Shade matching is less crucial in lingual approach
3. Discolored lingual restoration is less visible
• Facial approach  sometime preferred if
1. Caries is position facially and caries removal is necessary
2. Faulty composite restoration replacement which was placed facially
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11. Class-III Composite – Lingual Preparation
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12. Class-III Composite – Final Preparation Stage
• Selective removal of carious dentin by round carbide bur or
excavator
• Pulp protection
• Bevel placement on accessible enamel margins
• Outline form of the final preparation should NOT…
1. Include the entire proximal contact area
2. Extend onto the facial surface
3. Extend too much sub-gingivally
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13. Class-III Composite – Facial Approach
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14. Class-III Composite – Key Points
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• In approximating caries lesions or faulty
restorations on adjacent teeth:
• If one of the lesions is larger than the other, then
the larger outline form is developed first.
• The second preparation can be more conservative
because of the improved access provided by the
larger preparation.
• The reverse order would be followed when the
restorative material is inserted.

15. Class-IV Composite Restoration – Principles
• Preparation is similar to class III except that the
preparation for class IV is extended to the incisal angles
• Preoperative assessment of occlusion is very important
• Placement of margin in noncontact areas
• Shade selection is more challenging
• An enamel bevel  On the facial cavo-surface margin
to provide a gradual color transition
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16. Class-IV Composite – Marix Application
• A commercially available preformed plastic or
celluloid crown form may be used but usually too
thick as a matrix.
• A custom lingual matrix may be used for large
Class IV preparations
• Lingual matrix is prepared with polyvinyl siloxane
or fabricated from a quickly inserted mockup
restoration or waxed study model for more
complex cases
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17. Class-V Composite Restoratins
• Occlusal evaluation is not required for Class V restorations
unless there are concerns about occlusal factors as an
etiology for non-carious cervical lesions
• Abfraction may also cause cervical non-carious cavities
• Shade selection  tooth is more darker and opaque in
cervical 1/3
• Isolation  with rubber dam/cotton roll / retraction cord
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18. Class-V Composite – Cavity Prepartion
• The lesion or defect is conservatively
prepared resulting in a form that may have
a divergent wall configuration and an axial
surface that usually is not uniform in depth
• Small or moderate lesions  extend onto
the root surface
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19. Class V – Non-carious Cervical Lesions (NCCL)
• It requires only surface debridement of any exposed dentin and
roughening/beveling all enamel margins with a diamond instrument
because of the inherent form of an abraded or eroded lesion, further
preparation of root surface cavosurface margins is not needed.
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20. Common Restorative Procedures
• Outline form  assessment of expected cavity preparation
• Keep as much as possible sound tooth structure, especially at the
gingival margin
• Peripheral enamel presence strengthen the composite restoration
• Enamel bonding is more predictable than dentine bonding
• Isolation problem and potentional problem to achieve adhesion if
gingival margin of Class-II extend onto the root surface
• Contraindication  Deep sub-gingival margin of Class-II cavity to the
root surface site due to problems with composite adhesion
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21. Esthetic Composite – Matrix  Wedge
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22. Anterior Composite – Adhesive Placement
• Acid-etching is done before the total-etch adhesive application
• For self-etch adhesive  no etching is required (follow instruction)
• The dental adhesive is applied to the entire preparation with a micro-
brush, in accordance with the manufacturer’s instructions.
• After application, the adhesive is polymerized with a light-curing unit,
as recommended by the manufacturer.
• Necessary pulp protection is done before etching and bonding
• Remaining dentin thickness is clinically judged to to be less than 0.5
mm, a calcium hydroxide liner should be used in the deepest cavity
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23. Anterior Composite Insertion and Light Curing
• First, the proximal box portion of the preparation is restored
• Place composite incrementally to maximize the curing potential
• Oblique incremental build-up reduce the polymerization shrinkage
• First increment should be placed along the gingival floor (<2 mm)
• Second increment (2 mm)  lingual (or facial) wall to restore box
• Final increment is to develop the marginal ridge
• After proximal box, occlusal restoration by anatomic layering technique
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24. Anterior Composite – Finishing and Polishing
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25. Resin Composite – Pre-heating
• Composite resin placement may be stiffness and stickiness
• Heating the composite material prior to insertion may help
• Commercial “composite warmers” are available (e.g., Calset,
AdDent) to pre-heat the composite resin up to 68°C (155°F)
• The increased temperature lowers the viscosity of composite,
resulting in better marginal adaptation and reduced microleakage
• When a stiffer or “packable” high-viscosity composite, a very small
increment of a flowable composite may be first placed in the
proximal box to improve marginal adaptation of the restoration.
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26. Thank you!
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