Complex multi surface composite restorations
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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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COMPLEX MULTI-SURFACE COMPOSITE RESTORATIONS

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Complex multi surface composite restorations

COMPLEX MULTI-SURFACE COMPOSITE RESTORATIONS

DR. PETER WALFORD


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….


Complex multi surface composite restorations

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


Determining cure time for heated resins

DETERMINING CURE TIME FOR HEATED RESINS


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


Complex multi surface composite restorations

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


Venus diamond

VENUSDIAMOND


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


Complex multi surface composite restorations

ref


Cra october 2010

CRAOCTOBER 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


Complex multi surface composite restorations

ref


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


Complex multi surface composite restorations

PRACTICON


Complex multi surface composite restorations

ref


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


Complex multi surface composite restorations

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


If you can isolate it and matrix it you can restore it

IF YOU CAN ISOLATE IT AND MATRIX IT, YOU CAN RESTORE IT


The end

THE END


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