week 4- CII composites

when should you decide the shade of composite

before you place the rubber dam, bc the teeth can desiccate teeth

what type of questions should be answered before placing restorative material

• is all the infected dentin removed

• is the DEJ caries-free

• it there poorly supported enamel

• any pulp cap needed

• how to maximize bonding

• how to minimize stress; shrinking factors

• other considerations like biomechanics, durability, esthetics, bevels, etc

what is a matrix

a device that sequesters, supports, controls, and forms the restorative material in its unset form to facilitate placement of a clinically appropriate restoration 

goals of matrices

• provide good proximal contact 

• create good interproximal contours 

• provide good gingival margin seal 

• help for, accurate occlusal table 

• minimize finishing time 

how to get a good proximal contact

the matrix must be in contact w the adjacent tooth

how to get a good interproximal contour

B, L, G, O embrasures are formed by the matrix → the better the matrix → the less finishing is needed

first arrow on the top

head 

2nd arrow on the top

locking vise

3rd arrow on top

large knurled nut

first bottom arrow

pointed spindle 

2nd bottom arrow 

small knurrled nut 

what is a wedge

a device employed to stabilize the matrix, seperate the teeth, and shape the gingival embrasure, and secure the gingival prep margin

wedging separates the teeth by stretching the…

periodontal ligament

wedging is nearly always mandatory for what types of restorations

C II and III

what do the numbers represent in wedges

length in mm

wedging goals 

• separate the teeth 

• stabilize the matrix 

• close the gingival margin 

• prevent an overhang of the restoration 

• shape the gingival margin embrasure 

steps to prepping and restoring a CII

• evaluate tooth size and position

• pre-wedge 

• cut prep, remove pre-wedge

• place the wedge 

• place the ring 

• wedge check 

• burnish the proximal contact 

• evaluation → if not okay → DO OVER

matrix dimensions to provide adequate coverage

must be at least 1 mm gingivally from gingival margin, 1 mm above the adjacent marginal ridge

composite addition to CII 

• add composite to proximal contact area 

• start to form interproximal anatomy

• photocure

• don’t contaminate the polymerized surface

bulk-filling options

• flowable bulk-fill + capping layer 

• high viscosity single increment bulk-flling 

• injection over molding w heated composites 

composite layering techniques

• horizontal layering

• vertical layering

• oblique layering

• anatomical layering

increment placement handeling techniques

• direct

• pre-shaped increment

• resin coating 

• snowplowing 

what is the direct technique

the hybrid composite is directly extruded from the nozzle into the preparation and manipulation by an instrument 

what is the pre-shaped increment 

balls or sausage of hybrid composite are formed on the instrument and then placed into the prep 

what is the resin-coating technique

a thin (.5) coat of flowable is placed over the preparation as a first increment sealing the gingival margin and/or the entire dentin

what is the slow plowing technique

a small amount of uncured flowable is placed followed by direct or pre-shaped increments of hybrid composite 

how to remove the matrix

• remove the ring 

• remove the wedge 

• remove the sectional matrix 

• final photo-polymerization from B and L 

steps to finishing

1. course contour

2. final contour 

3. final polish 

what areas should be addresses first in finishing

interproximal area: gingival margin, embrasures, marginal ridge

what you can use to coarse contour the gingival margin

• #12 scalpel 

• #7901 bur 

• strips

then chekc w an explorer or floss → should not shred 

what can you use to coarse contour the interproximal contour

use strips or sof-lex discs

what are interproximal strip saws

interproximal reduction system that makes interproximal enamel stripping safe and accurate without creating sharp corners or subgingival ledges. are flexible, diamond strips curve and conform along the natural contours of the teeth to maximize pt comfort and safety 

what to check after the rubber dam removal

• occlusion

• proximal contact

• gingival debris

• shade → note ti will not be apparent until ~24 hours

• any final re-polishing

what can polishing pastes made of

• aluminum oxide

• polymer, pumice

• or other abrasive FINE particles

when are polishing pastes recommended

anterior and esthetic cases 

how to use polishing pastes 

apply w rubber cup or rotary brush on slow sleep w water use