Complex multi surface composite restorations
Sponsored Links
This presentation is the property of its rightful owner.
1 / 69

COMPLEX MULTI-SURFACE COMPOSITE RESTORATIONS PowerPoint PPT Presentation


  • 86 Views
  • Uploaded on
  • Presentation posted in: General

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

Download Presentation

COMPLEX MULTI-SURFACE COMPOSITE RESTORATIONS

An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -

Presentation Transcript


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

PREPARATION DESIGN?

MORE PROBLEMS….


WWW.PETERWALFORDDENTISTRY.COM

USERNAME cardp2012

PASSWORD halifax


LINKS ON WEBSITE

  • FOLLOW ((CARDP)) ON HOME PAGE TO FIND APPROPRIATE LINKS WITHIN WEBSITE


HEATED RESINS

FAST CURE LIGHTS

DELEGATION-the future of

the restorative hygienist

position

BULK FILL?- a flawed concept

TIME SAVERS


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


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

  • ANATOMICALLLY CONTOURED CIRCUMFERENTIAL MATRIX

  • CONTACT FORMERS

  • CUSTOM WEDGING

  • RESIN WITH SUITABLE FLEXURAL STRENGTH

  • ADEQUATE CURING


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

  • GRANDIOSO (VOCO) 181 MPa

  • VENUS DIAMOND (HEREAUS KULZER)169MPa

  • FILTEK SUPREME ULTRA (3M Espe) 162MPa


VENUSDIAMOND


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


ref


CRAOCTOBER 2010


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 2BDANVILLE DENTAL

  • 141MPa

  • HYBRID

  • S/C IN 2.5 MINS

  • SEVERAL CONVENIENT AUTOMIX TIPS


RECOMMENDED JOURNALS FOR COMPOSITE INFORMATION

  • REALITY

  • CLINICIAN’S REPORT

  • THE DENTAL ADVISOR


ref


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

  • CONFIRMS COMPLETE REMOVAL (CARIES IS NOT STRUCTURAL!!)

  • DISCLOSES PLAQUE

  • REVEALS FLASH IN FINISHING


DEEP CARIES

  • ANGELUS MTA 10 MINUTE SET

  • DOVGAN PLACEMENT INSTRUMENT

  • FO FULL PROTOCOL SEE CHAPTER IN MODXYZ


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


PRACTICON


ref


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

  • http://www.peterwalforddentistry.com/tiki/tiki-index.php?page=Repairing%20Bubbles%2CVoids%2C%20and%20Flaws


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

  • 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

  • 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

  • REQUIRES USE OF A LIQUID ETCH

  • LEAVES NO RESIDUE

  • ATRAUMATIC

  • VIRTUALLY 100% EFFECTIVE


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


DEPTH OF

DEMINERALIZATION


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


THE END


  • Login