QUIZ 1: Composite and Bonding

What are the restorative classifications?

Class 1: pits and fissures (we can do this)

Class 2: interprox of posterior teeth (we can do this)

Class 3: interprox of anterior teeth

Class 4: interprox and incisal edge of anterior teeth

Class 5: gingival third (gingival margin) (we can do this)

Class 6: cusp tips

Define adhesive

material that can "stick" flat surfaces together

Define micromechanical adhesion

using small irregularities to bond or stick surfaces together

Define macromechanical adhesion

using large irregularities to bond large surfaces together

What are the benefits of adhesion?

aids for a better bond

Why does composite need a clean work area?

it will not adhere if the area is unclean

debris free, smear layer, remove saliva, and use rubber dam

What is the purpose of acid etch?

remove parts of enamel rods at core and open dental tubules to make the composite adhere best

15 - 30 sec, 37% Phosphoric Acid Etchant

Is acid etch micro or macromechanical adhesion?

micro

What does over etching past the recommended time cause?

post op sensitivity

What appearance is ideal once etching is applied?

chalky white, don't over dry

Where is acid etch used?

Pit and fissure sealants

Composite restorations

Orthodontic brackets

What do you apply after acid etch?

remove it with water and dry

place bonding agent with microbrush

dry the tooth lightly

light cure it (minimum of 30 sec)

What does too much bond application result in?

thicker layer

solvent needs to be air thinned, so if it is too thick then it decrease the quality

Where is sealant composite used?

pits and fissures

What is flowable composite used for?

preventative restoration or sealer for orthodontics

Where is nanofilled composite used?

anteriors

Where is bulk-fill composite used?

large posterior

Where is macro composite used?

posterior (may be anterior)

Where is micro composite used?

anterior

What are the steps to a proper composite and bonding application?

1. Gather supplies

2. Acid etch --> apply for 15-20 seconds, rinse well with water and lightly dry, aim for chalky white appearance

3. Bond placement --> apply to enamel and dentin, air thin bond to remove solvent, and light sure for 15-40 seconds

4. Place composite --> layering may be necessary (2 mm per layer), use isolation, multiple light cures, and create anatomy and contacts

What type of isolations do we use when placing composite?

tofflemire bands

mylar strips

V-Ring system

Garrison

etc

What instruments do we use for composite placement?

Anodized instruments

Teflon coated instruments

Helps increase composite surface finish and reduce damage to composite micro particles

If you are doing a composite on multiple classes, which one should you fill first?

Class II

What is axial wall condensation?

ensure composite is condensed into preparation

Why should you avoid hard pressure or folding composites?

leads to voids

How do you layer when placing composite?

2 mm layering

light cure after each layer

How do you select a shade for composite?

dentin vs enamel shade

use natural lighting to select

Does the time you light cure matter?

yes, ensure you are curing for enough time

can over-cure with no consequences

What do we use for finish and polishing for composite? What are the goals?

LUSTER

use finishing burs, polishing discs, and enhancing polishing points/cups/discs

reduce flash, smooth finish, correct occlusal contacts and anatomy

What are the common issues with composite and bonding?

It is a technique sensitive material

Shrinkage

Sensitivity

Longevity

Shade

How do we avoid shrinkage?

Incremental filling technique

Curing time

Depth of cure

How do we avoid sensitivity?

Placement of liner

Placement of desensitizing medication

How do we increase longevity?

use proper technique to increase longevity