5. Diagnosis and esthetic treatment of proximal caries

Translucency

Translucency

optical property in which varying degrees of light pass through or are absorbed by an object (SATURATION)

Chroma

color

Value

lightness or darkness

Organic components of composite

BISGMA, TegDMA, UDMA

Inorganic components of composite

zirconia, silica, barium silicate glass, ytterbium trifluoride

photo initiators of composite

comphorquinone, ucerin tpo

silane of composite

methacrylate functional silane

Composite colors

vita based
partially vita based
non vita
universal

Vita based composites

enamel: high translucent chromatic vita based
dentin: low translucent chromatic vita based
They follow the VITA shade guide
chromas based and follows the vita shade guide, chromaticity comes from the vita vue

Partially vita based composites

enamel: high translucent achromic NON vita
dentin: low translucent chromatic vita based
achromatic but don't follow the VITA shade guide, must use a very specific shade guide

non vita based composites

enamel: high translucent chromatic NON vita
dentin: low translucent chromatic NON vita
no chroma, essentially white. must test in the patients mouth first

universal composites

Medium translucent chromatic vita based or non-vita shade.
covers the color for dentin and enamel

dentin shades should have _______

chromaticity

Order of shades in increasing order of transluscency

dentin, chromatic enamel, achromatic enamel, translucent

dentin (essentially opaque), body/universal (medium translucency), chromatic enamel, achromatic enamel, opalescent enamel (most translucent, composite is called opalescent or efex)

________ enamel is more translucent than chromatic enamels

achromatic enamel

the _____ thickness the _____ chroma and the ______ value and _____ translucency for ENAMEL

more thickness = more chroma (color)= less value (darker) = less translucency

for the dentin shade, opacity increases _______ per mm

12%

The chromas changes significantly with increased thickness for the dentin shade? T/F

False, chromas does not change much with thickness for the dentin shade

for achromatic composite, opacity increases by ______ per mm

23%
thickness makes color look more gray for achromatic composite

for chromatic composite, opacity increases by ______ per mm

16%

achromatic is _____ where chromatic is ________

translucent; highly translucent

Class IV composites should always start from which surface of the tooth?

lingual

the closer you are to the ______ the more the opacity and chroma increases

pulp

when applying composite and working from the lingual to the enamel, how would you place the composite in order of shade?

lingual enamel is A1, A3 is deep dentin and A2 is superficial dentin.

when placing dentin, place composite chroma that is 2 shades higher (main shade= A1, superficial=A2, deep dentin= A3)

what is the maximum thickness of enamel composite?

1mm

teeth are highly translucent on which parts of the tooth

incisal edge and facial of the tooth

teeth are more chromatic towards

the pulp and gingiva

superficial dentin is usually _____ point higher than the main shade

1

what order do you apply the composite when rebuilding a tooth?

lingual enamel, artificial dentin (deep and superficial), facial enamel (opalescence, halo and enamel layer)

in which part/layer of the restoration do you create mamelons?

superficial dentin

at what step do you create contacts with the opposing tooth?

last step

what assisting tool do you use to rebuild a tooth?

silicone index. push putty from lingual side to facial and cut it at the incisal facial line angle to create a frame to work, remove part of the palatal

3 beginning steps before placing composite

cleaning
shade selection
rubber dam isolation (at least canine to canine)

creating the facial bevel

1-2mm
burs 8888 and 8274/016
soft-lex disc red or dark orange (creates the embrasure)
create a facial bevel ONLY, not on other surfaces. use the soflex to round the edges

bonding steps (1b)

dentin etching.
before etching, place wedge and teflon tape around opposing teeth

Restoration steps

1. place the first enamel layer on the silicone index and then place it tightly against the tooth, then remove the index
2. place A3 dentin in the center of the tooth to restore pulpal, cure
3. place the superficial layer over the deep dentin and close to the edges but not on the edges
4. create mamelons with the explorer on the superficial layer of dentin
5. place a highly translucent composite opalescent layer
6. place the incisal halo, but ensure the incisal edge is opaque. place highly translucent composite between the mamelons
7. place opaque enamel carefully at the remaining edge (use spatula)
8. enamel shade makes contacts, use matrix/spatula pull matrix lingually before curing
9. after contacts, place layer of composite on facial to connect the edges (make sure 1mm of space is available before)

composite layering in order

lingual enamel
deep dentin
superficial dentin
opalescent layer
incisal halo
facial enamel

finishing the restoration

polish the proximal surface with soflex polishing strip (fine or super fine)

• Excess: Blade #12 (from gingival area to interproximal contact)
• Lingual Contour (Fine diamond bur and Discs)
• Interproximal Finishing (Finishing Strips)
• Incisal Embrasures and Incisal Contour
• Mesial and Distal Transitional Line Angles
• V-Shaped Grooves and Developmental Lobe

polishing the restoration

initiate the polishing of the restoration using the median composite polishing point

• Fine (green) and Extra-Fine (Gray) Polishers
• Fine (Light Orange) and Extra fine (Yellow) Aluminum Oxide Discs
• Polishing Brush
• Luster Paste and Felt Disc
• Floss and Luster Paste Interproximally

when finishing, highlight the _________ and contour accordingly using the soflex discs

mesial and distal line angles (you want the same line angles between both teeth)

polishing the restoration part 2

Begin with the green polishing bur and finish with the gray always for all areas of the restoration (use gray once scratches are gone, and use brush to clear). Continue to polish with the fine and extra fine soflex disks and composite polishing points

Fine (green) and Extra-Fine (Gray) Pollishers • Fine (Light Orange) and Extra fine (Yellow) Aluminum Oxide Discs • Polishing Brush • Luster Paste and Felt Disc • Floss and Luster Paste Interproximally

polishing part 3

restoration finished and polished

Fine (green) and Extra-Fine (Gray) Pollishers • Fine (Light Orange) and Extra fine (Yellow) Aluminum Oxide Discs • Polishing Brush • Luster Paste and Felt Disc • Floss and Luster Paste Interproximally (SAME AS PART 2 TO GET HERE)