Evaluation Criteria - Class III, IV, V Composite Restorations

Facial evaluation criteria

Symmetry

Transitional ling angles (width)

Embrasure

Contacts

Incisal height

lingual evaluation criteria

Marginal ridges

Lingual anatomy

Embrasures

symmetry

incisal evaluation criteria

Contours

Line angles

Embrasures

Incisal thickness

Arch alignment

Symmetry

lateral evaluation criteria

contours / height of contour

When should you shade match?

BEFORE placing rubber dam while the tooth is hydrated

Can you use prophy paste before shade matching?

no

overall steps for restoration

1. Preparation / restoration sequence

Decay present, outline form, and depth removes decay

2. Final prep (modified/small adhesive) - little internal form

3. Acid etch - note frosty appearance

4. Apply bonding agent (rub gently), air thin and cure

5. Apply composite shape and cure

What is important when using esthetic finishing burs?

Choose the proper shape for the surface

What is the general shape of esthetic finishing burs?

long and thin

which direction do you move carbide burs?

clockwise

if you go counterclockwise, the bur bounces

Enhance polishing point/tips/cups

Contains composite particles

Can finish and/or polish depending on pressure applied

Finishing bur

removes excess composite

Enhance bur - what pressure accomplishes what task?

use light pressure for polishing

hard pressure for removing composite

Coarser grit produces what?

deeper grooves which are more difficult to polish

What does the final restoration look like when dry?

chalky

What do you use polishing paste for?

to finish polish and luster

before doing a class 4, always check ____? Why?

check occlusion.

helps us determine whether the class 4 is there due to fracture or due to misocclusion.

if we do not correct reason for misocclusion our restoration can ultimately fail.

What type of matrix is used on the anterior part of mouth with composite?

Clear matrix strips

When do you place clear matrix strips? Why?

Before etching, so that we do not end up binding to adjacent tooth

Many practicioners like to pull the matrix band across in order to get a nice contour. What is the potential issue with this technique? How can we avoid this?

We can lose proximal contact.

first build up proximal wall, cure, then add rest of composite and then pull matrix across.

how far should you separate teeth when placing a matrix band?

must be separated atleast to the thickness of the matrix band.

What else can you use to prevent proximal bonding (boberick said we wouldn't really be doing this in clinic though)? when should we use this technique?

teflon tape over the adjacent tooth

good to use with lingual matrix

What is a lingual putty matrix?

impression material for a class IV

What can you use to create/ move line angles?

finishing bur, flexible disks

we can determine this by looking at the tooth from an incisal view

What surface do we tend to use a football finishing bur?

lingual

When moving line angles, do you adjust the lingual or facial first?

we check occlusion to determine if we should adjust the lingual first, then consider adjusting the facial

What bur can damage root surfaces easily?

finishing burs

what are finishing strips good for?

removing overhangs in gingival area

use firm pressure with finger against the surface requiring finishing and pull strip facially.

How can we avoid removing contact point when using a finishing strip?

cut it in half to reduce the length

Polishing tools

Enhance disks/points

Shofu discs - color coded

Finishing strips - cut lengthwise

Polishing paste (prisma gloss)

What do we use flexible disks for?

contour occlusal and proximal embrasure

external outline form is determined by?

your final geometry ( final cavosurface, final extent into sound tooth structure, etc)

should you polish dry or wet?

start dry, then add some water and end polishing wet

how should finishing burs be moved along the cavosurface?

Move parallel to cavosurface

Excess finishing disrupts _____

bonding

shape soft material (before/after) curing?

before

what step should we always take once we think we are done with our restoration?

check occlusion

rules for Class IV contact:

no contact in centric

no contact in protrusive

make the other teeth take up stress!