1. AMALGAM AND COMPOSITE RESTORATIONS
class I, II, V posterior
class III, IV anterior
amalgam or composite in posterior
gold and porcelain
anterior - composite or porcelain
basic procedures
anesthetic, dental dam, remove decay
place matrix band, if needed, wedges if needed
place restorative material
finish restoration

2. Classification of Cavities
Class I – Pit and Fissure
No tofflemire or matrix required
Amalgam or composite
Class II – Posterior interproximal and occlusal
Tofflemire or Mylar matrix required

3. Classification of Cavities
Class III – anterior interproximal (no incisal edge)
Mylar strip
Composite
Class IV – anterior interproximal with incisal edge

4. Classification of Cavities
Class V – cervical 1/3
Composite
Glass ionomer (type II)

5. CAVITY PREPARATION It is a surgical operation basic principles
outline form
resistance form
retention form
mechanical vs chemical
convenience form
removal of caries
Finishing of enamel walls
extension for prevention
cavity debridement
line angles
point angles

6. CAVITY PREPARATION
Formed by the junction of 2 walls in the cavity prep
Line Angles
Point angles

7. AMALGAM MATERIAL Advantages used in posterior only
strong to with stand compressive pressures(160 lbs. pressure)
Malleable (soft and easily shaped when freshly mixed)
durable
inexpensive
Disadvantages
mechanical retention only
not esthetically pleasing
contains mercury

8. AMALGAM MATERIAL Can be used for: Composition posterior restorations
core buildups
delivered in capsules or bulk
today most offices use high copper amalgam, less mercury
Composition
mercury
silver
tin
copper
zinc

9. AMALGAM MATERIAL Combination of two or more metals
mercury liquid at room temperature
Once mixed, amalgam cannot be reused
Ratio – one to one
Controversial
health hazard
environmental hazard

10. Amalgamator Amalgamation Tritturation Preparation
quality of mix is determined by mixing time
too long - soupy, sets quickly
too short - dull, crumbles
Preparation
class II requires tofflemire and band
anatomy placed in material with carvers
T-3
Hollenback
Discoid/Cleoid

11. Retention Pins Used for additional retention Vital or non-vital teeth
Can be drilled into tooth with a self-threaded hand driver or cemented
Used for large restoration
Titanium

12. Composite Restorations
Also called resins
Advantages:
Tooth colored
Esthetically pleasing
Bonded directly to the tooth
Reduced microleakage
Disadvantages
Strength – occlusal wear resistance is improving
Discoloration around borders after time

13. COMPOSITE MATERIAL Advantages: Disadvantage: esthetically pleasing
wear resistance is improving
resist fracture
mechanical and chemical retention
expansion/contraction similar to tooth structure
Disadvantage:
is not as durable as amalgam for posterior use (but improving)
Has to be placed in dry environment
Technique sensitive
can discolor at margins

14. COMPOSITE MATERIAL
Sometimes fails

15. COMPOSITE MATERIAL
Sometimes Work Well

16. COMPOSITE MATERIAL Types Components Uses: light cure self cure
dual cure
Components
resin material
polymer - powder
monomer - liquid
polymerization - to set
Uses:
class I,II, III,IV, V
core build ups
veneers

17. Composite make up Composite is a combination of polymers and monomers
resins
fillers
coloring
Filler:
originally quartz - good translucent appearance, strong and hard, difficult to polish to high shine
silica particles, chemically produced
macrofills
microfills
hybrid

18. Composite make up Macrofils: Microfils: Hybrid: Laminating:
large particle
durable
low shine
Microfils:
small particle
low strength
high shine
Hybrid:
combination of macro and micro
durable and higher shine than macro
Laminating:
layering of composite material
Macrofil for durability
Micro for high shine

19. COMPOSITE PLACEMENT Mechanical and chemical retention
tooth preparation differs from amalgam
acid etch, primer, bond materials
Basic process
anesthesia, shade selection, isolation, prep
placement of matrix, mylar or stainless steel and wedges
place composite
finish with finishing disc or burs

20. Shade Selection Must be selected in natural light
Done before isolation
Done while teeth are naturally wet with saliva
Best to check right after anesthetic is given

21. Etching systems Removes smear layer
Phosphoric acid, maleic acid, or hydrochloric acid
Critical step in bonding enamel and dentin surfaces to resin/composite materials

22. Enamel Bonding Includes: Usually bonded directly to enamel surface
Sealants
Bonded orthodontic brackets
Resin bonded bridges
Bonded veneers
Usually bonded directly to enamel surface
Dentin Bonding - involves removing the smear layer

23. Smear Layer
Very thin layer of debris composed of fluids and tooth components
1000’s of dentinal tubules are cut during preparation of tooth
Open ends can transmit fluids and micro-organisms to the pulp of the tooth
May result in PO sensitivity, pain, or even damage to the pulp

24. Smear Layer Described as nature’s bandage
Protects the tooth by closing off the openings of the dentinal tubules
Must be removed and tubules re-opened as part of the bonding process where they are sealed with primer and bonding agents

25. Laminating Technique Layers or thin stacking of composite
Light cure between layers to reduce shrinkage

26. Many Different Materials

27. GLASS IONOMERS Type I, II, III, IV and Type II restorative
used as esthetic restoration
non stress bearing areas
Powder and Liquid
dispensed and mix
capsule form
fluoride release
Class V restorative
root repair
Pediatric restorative
Light cure
Self cure

28. Many Choices

29. Core Buildups Materials used: Replaces missing tooth structure
Amalgam
Composite
Glass Ionomer
Replaces missing tooth structure
Give support to remaining tooth structure
Matrices
Stainless Steel
Mylar strips
Crown Formers
Additionally
Titanium pins can be added for strength

30. Core Buildups

31. BLEACHING Extrinsic Intrinsic Considerations Methods tobacco coffee
tea
Intrinsic
tetracycline
dental fluorosis
non-vital
Considerations
amount of stain
origin
cost
difficulty
Methods
home bleaching
in office

33. Bleach or Not to Bleach????

34. Bleaching Techniques Non-vital bleaching (walking bleach)
Thick paste of hydrogen peroxide and sodium perborate placed in the tooth and covered
Patient can leave and return to remove and finish treatment
Vital bleaching (in office)
All teeth are isolated with a dental dam and cleaned with pumice
Apply liquid or gel bleach on teeth and light cure
Sometimes called power bleaching

35. Bleaching Techniques Take home bleaching (mouth guard bleaching)
Most common
Used with dental trays
Dental assistant does majority of these visits
Patient takes bleach home and uses in dental tray for 1 to 2 hours daily until goal shade is reached

36. WALKING BLEACH TECHNIQUE
Used for endodontically treated teeth
sodium hyperborate, hydrogen peroxide
Bleach placed, patient dismissed, returns one to two days for color check

37. Many Choices