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COMPLEX MULTI-SURFACE COMPOSITE RESTORATIONS. DR. PETER WALFORD. EXCESSIVE TIME OPEN/BROKEN CONTACT MATRIX ISSUES GINGIVAL RE-DECAY. COMMON PROBLEMS. PULP - SENSITIVITY OR DEATH PITS,VOIDS,BUBBLES UNATTRACTIVE ESTHETICS. ISOLATION CHALLENGES INSTRUMENTATION FOR LONG CROWNS

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common problems
EXCESSIVE TIME

OPEN/BROKEN CONTACT

MATRIX ISSUES

GINGIVAL RE-DECAY

COMMON PROBLEMS
more problems
PULP - SENSITIVITY OR DEATH

PITS,VOIDS,BUBBLES

UNATTRACTIVE ESTHETICS

ISOLATION CHALLENGES

INSTRUMENTATION FOR LONG CROWNS

PREPARATION DESIGN?

MORE PROBLEMS….
slide5

WWW.PETERWALFORDDENTISTRY.COM

USERNAME cardp2012

PASSWORD halifax

links on website
LINKS ON WEBSITE
  • FOLLOW ((CARDP)) ON HOME PAGE TO FIND APPROPRIATE LINKS WITHIN WEBSITE
time savers
HEATED RESINS

FAST CURE LIGHTS

DELEGATION-the future of

the restorative hygienist

position

BULK FILL?- a flawed concept

TIME SAVERS
calset composite heater
CALSET COMPOSITE HEATER
  • BEST SETTING: 54 DEGREES
  • MULTIPLE DESIGNS FOR COMPULES OR SYRINGES; SYRINGE IS MOST VERSATILE MODEL
  • DECREASES CURE TIME BY UP TO 75%
  • INCREASES PHOTOCONVERSION, HARDNESS
  • THINS OXYGEN-INHIBITED LAYER
  • FOR EVIDENCE SEE WWW.ADDENT.COM
chairside cure testing
CHAIRSIDE CURE TESTING
  • 2MM DISC (DENMAT)
  • 3.5 MM DISC (HARDWARE TAP WASHER)
  • DETERMINE CURE BY SCRATCH TEST
  • CRUDE BUT ONE STEP UP FROM BLIND FAITH
  • HAVE CDA COMPILE A TABLE- A FEW SURPRISES WILL BE FOUND
  • DARK SHADES AND FLOWABLES!! TAKE LONGER
  • SOME VERY LIGHT SHADES MAY ALSO TAKE LONGER DUE TO MISMATCH BETWEEN LIGHT SPECTRUM AND PHOTOINITIATOR
preventing open broken contact
PREVENTING OPEN/BROKEN CONTACT
  • ANATOMICALLLY CONTOURED CIRCUMFERENTIAL MATRIX
  • CONTACT FORMERS
  • CUSTOM WEDGING
  • RESIN WITH SUITABLE FLEXURAL STRENGTH
  • ADEQUATE CURING
slide26

FLEXURAL

STRENGTH

the importance of flexural strength
THE IMPORTANCE OF FLEXURAL STRENGTH
  • THOSE PORTIONS OF THE RESTORATION EXTENDING BEYOND THE ROOT BASE MUST TRANSFER LOADS ON A DIAGONAL PATH TO THE RETORATION
  • THIS CREATES A TWISTING SHEAR FORCE WITHIN THE RESIN; A “ FLEXURAL LOAD”
  • BEST PARAMETER TO INDICATE THIS QUALITY IS FLEXURAL STRENGTH
  • INADEQUATE FLEXURAL STRENGTH WILL LEAD TO BREAKAGE OF MARGINAL RIDGES EVEN IF EVERYTHING ELSE IN THE RESTOATIVE SUITE IS PERFECT
  • SEE WEBSITE FOR TABLE “COMPOSITE PARAMETER SPREADSHEET”
best resins for large restorations top quartile
BEST RESINS FOR LARGE RESTORATIONS: TOP QUARTILE
  • GRANDIOSO (VOCO) 181 MPa
  • VENUS DIAMOND (HEREAUS KULZER)169MPa
  • FILTEK SUPREME ULTRA (3M Espe) 162MPa
ensuring adequate cure
ENSURING ADEQUATE CURE
  • UNDERCURED RESIN IS A PREVALENT CAUSE FOR FRACTURED RESTORATIONS
  • SEE WEBSITE ((CURING COMPOSITES))
  • WIDE-SPECTRUM HIGH INTENSITY LIGHTS ARE BEST
  • BEST RECOMMENDATION: SAPPHIRE PLASMA ARC 5 SEC CURE
  • VALO LED SEE CLINICIAN’S REPORT OCTOBER 2010
curing deep boxes
CURING DEEP BOXES
  • STUDY CLUB RULE; BEYOND 6MM DEPTH, USE A DUAL CURE SYSTEM UNTIL BOX DEPTH RESTORED TO 6MM
  • DUAL-CURE ADHESIVE PHOTOBOND OR ALL BOND 3
  • DUAL CURE FLOWABLE, STARFILL 2B
starfill 2b danville dental
STARFILL 2BDANVILLE DENTAL
  • 141MPa
  • HYBRID
  • S/C IN 2.5 MINS
  • SEVERAL CONVENIENT AUTOMIX TIPS
recommended journals for composite information
RECOMMENDED JOURNALS FOR COMPOSITE INFORMATION
  • REALITY
  • CLINICIAN’S REPORT
  • THE DENTAL ADVISOR
residual caries biofilm contamination
RESIDUAL CARIES, BIOFILM CONTAMINATION
  • CARIES IS A NON-STRUCTURAL SUBSTRATE; DOESN’T BOND, HAS NO RESISTANCE FORM
  • BIOFILM IS AN INVISIBLE ANDUNIVERALLY PRESENT CONTAMINANT TO ADHESION
  • BOTH CONTRIBUTE TO PREMATURE FAILURE OF RESINS
  • CAN BE CONTROLLED WITH THE ROUTINE USE OF CARIES DETECTOR
benefits of caries detector
BENEFITS OF CARIES DETECTOR
  • CONFIRMS COMPLETE REMOVAL (CARIES IS NOT STRUCTURAL!!)
  • DISCLOSES PLAQUE
  • REVEALS FLASH IN FINISHING
deep caries
DEEP CARIES
  • ANGELUS MTA 10 MINUTE SET
  • DOVGAN PLACEMENT INSTRUMENT
  • FO FULL PROTOCOL SEE CHAPTER IN MODXYZ
eliminating and repairing placement flaws
ELIMINATING AND REPAIRING PLACEMENT FLAWS
  • ALCOHOL AS AN INSTRUMENT LUBRICANT IN PLACEMENT
  • AVOIDS WEAKENING INCREMENT INTERFACES WITH ”PLACEMENT RESIN”
  • LIGHT SHIELD TO PERMIT UNHURRIED COHESIVE PLACEMENT-NO PREMATURE CURE
  • Z-PRIME PLUS (BISCO) AS AN EFFECTIVE PRIMER FOR REPAIRS –BONDS TO SILICA 18MPa, ZIRCONIM 22MPa, AND RESIN
  • HF ETCH OPTIMIZES ADHESION TO SILICA
  • USE CONVENTIONAL THIN (5-7 MICRON) GEN IV OR V ADHESIVE AFTER Z-PRIME, CURE BOND, RESTORE
repairing flaws in restorations with z prime plus
REPAIRING FLAWS IN RESTORATIONS WITH Z-PRIME PLUS
  • OPEN DEFECT UP INTO A SMALL SAUCER
  • ETCH WITH PHOSPHORIC ACID IF ENAMEL MARGINS ARE INVOLVED
  • HF ETCH IF IS A SILICA-BASED FILLER PARTICLE (MOST RESINS ARE)
  • RINSE, DRY, Z-PRIME (BISCO),BLOW OFF SOLVENT, ADD PHOTOBOND, BLOW OFF EXCESS, CURE
  • FILL SMALL DEFECTS WITIH MATCHING FLOWABLE WITH AN EXPLORER TIP, CURE
  • FILL LARGE DEFECTS WITH RESTORING RESIN, CURE
  • FINISH WITH 7902,POLISH WITH WET SHOFU FG BROWNIE POINT, SLOW RPMS.
website link on repairs
WEBSITE LINK ON REPAIRS
  • http://www.peterwalforddentistry.com/tiki/tiki-index.php?page=Repairing%20Bubbles%2CVoids%2C%20and%20Flaws
optimum isolation isolate or die
OPTIMUM ISOLATION ”ISOLATE OR DIE”
  • SUPRAGINGIVAL PREPS- ISOLATE NON-LATEX DAM
  • SUBGIINGIVAL- HYGOFORMIC SALIVA EJECTOR
  • SILVERED DRI-ANGLES (THETA)
  • SURGICAL SUCTION REDUCED IN LENGTH TO IMPROVE ACCESS IN LIMITED ACCESS SITUATIONS
  • SALIVA EJECTOR BENT TO LIE UNDER THE TONGUE BENEATH A RUBBER DAM
qualities of an ideal restorative retraction cord
QUALITIES OF AN IDEAL RESTORATIVE RETRACTION CORD
  • BRAIDED NOT SPIRAL-WOUND OR LOOPED
  • MINIMAL EXPANSION WHEN WETTED
  • EPINEPHRINE-IMPREGNATED
  • ALUMINUM SALT-IMPREGNATED, NOT FERROUS SALTS
  • ONLY TWO PRODUCTS MEET THIS CRITERIA: GINGIBRAID E (VAN R) AND SILTRAX (PASCAL)
qualities of an ideal cord placement instrument
QUALITIES OF AN IDEAL CORD PLACEMENT INSTRUMENT
  • MOST CORD PACKERS ARE SERRATED, OVERLY BULKY, AND UN-ERGONOMIC
  • OFF-ANGLE ; ERGONOMICALLY REACHES INTERPROXIMALLY
  • SLIM
  • NON-SERRATED TIP
  • RECOMMENDED: PFIG 4/5- CAN ALSO BE USED TO PLACE RESIN BEYOND THE LINE ANGLES
hemostatic etch a game changer
HEMOSTATIC ETCH; A GAME-CHANGER
  • REQUIRES USE OF A LIQUID ETCH
  • LEAVES NO RESIDUE
  • ATRAUMATIC
  • VIRTUALLY 100% EFFECTIVE
inexpensive liquid etch
INEXPENSIVE LIQUID ETCH
  • Henry Schein 100-0572 (210cc) diluted 3:1 by volume with distilled water
  • About $50
  • Makes up to 840 cc of etchant
slide64

DEPTH OF

DEMINERALIZATION

the study club adhesive system see bonding bonding protocol
THE STUDY CLUB ADHESIVE SYSTEMSEE ((Bonding|Bonding Protocol))
  • MICROPRIME B
    • EFFECTIVE CROWN PREP DESENSITIZATION, HYPERSENSITIVE DENTIN
    • LESS TISSUE-TOXIC THAN GLUTERALDEHYE FORMULATIONS SEE CRA AUGUST 2002
    • STABILIZES THE COLLAGEN NETWORK TO IMPROVE LONG TERM BOND DURABILITY
    • COMPATIBILE WITH ALL GEN IV AND V ADHESIVES (TOTAL ETCH)
  • DUAL-CURE ADHESIVES:
    • PHOTOBOND (KURARY) 20MPa OR ALL-BOND 3 (BISCO)35MPa
    • BOTH ARE:
      • ALCOHOL BASED
      • THIN ( 5-7 MICRONS THICK,)
      • DURABLE
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