Indication of Operative

Dentistry
Caries;
Malformed, discolored,
or fractured teeth;
Restoration replacement.
 Tooth-colored
restoration
For Class and
Esthetic Dentistry

For Class and

 What are Tooth-colored materials?

What is their working mechanism?

What are the cavity preparation futures for tooth-colored restoration?

What are steps for tooth-colored
restoration?

What are the advantage & disadvantage

of tooth-colored restoration?
Tooth-Colored Materials

Composite resin

Glass ionomer cement

Compomer
 Composite Resin

Traditional composites

Hybird composites

Flowable composites

Condensable composites Packable

Universal composites
Glass Ionomer

Chemical adhesion to dentin

Release Fluoride
 Compomer

Compomer =

Composite + Ionomer
Dental Adhesion
or
Dental Bonding

Adhesion is a process of solid and/or

liquid interaction of one material with
another at a single interface.
Enamel bonding system

Enamel bongding depends on resin tags

becoming interlocked with the surface
irregularities created by etching.
Macrotags: form between enamel rod
peripheries.

Microtags: smaller tags form across

the end of each rod.

Macrotags and microtags are the basis

for micro-mechanical bonding.
 Dentin bonding system

The difficulties of dentin bonding:

More water---wet bonding

Lower calcification

Richer organic---collagen network

Smear layer
The bond strength is primarily related
to micro-mechanical bonding to the
intertubular dentin which occures
between tubules along the cut dentin
surface.
Dentin Bonding Agent,
DBA
Early DBA were hydrophobic, bonded
directly to the dentin smear layer.
Bond strengths 6MPa.

Later DBA removed the smear layer but

tended to over-etch dentin.
Bond strengths10~12MPa.
 DBA were chemically modified to be
more hydrophilic.
Bond Strengths18~20MPa.

Careful dentin conditioning,

Coupled with hydrophilic primer,
Bond Strength22~35MPa.
The Development of DBA
Enamel etch (1955)

Dentine etch (1960)

Treatment of smear layer (1980)

Wet Bonding technique(1990)

First generation

Second generation

Third generation

Fourth generation: Total etch technique

Fifth generation: One bottle system

Sixth generation: All in one,2000

Seventh generation
Cavity Preparation

Three designs of cavity preparation:

1.Conventional

2.Beveled conventional

3.Modified
Beveled conventional cavity preparations
are similar to conventional preparation,
in that the outline form has external,
box-like walls, but with beveled
enamel margin.
Beveled enamel margin
Beveled conventional cavity designs for
Class , and preparations
 The advantages :

The ends of enamel rods are more etched

The increase in etched surface results in

a stronger bond

Increase the retention and reduce marginal

leakage and discoloration.

More esthtically
Modified cavity preparation

Have neither specified cavity wall structure

nor specified pulpal depth, and have enamel
margins.

Conserve more tooth structure.

Modified cavity preparation
Initial Clinical Procedure

Local anesthesia

Preparation of the operating site

Shade selection

Isolation of the operating site

with rubber dam or cotton rolls
Rubber dam
 Clinical Procedure

Cavity preparation

Acid etching enamel & conditioning dentin

Matrix application

Application of bonding agent

Insertion of composite

Finishing procedures
Matrix application
Final procedures
Cases
Conservative Operative
Dentistry
Minimal intervention dentistry

is regards as a main stream

in caries treatment in the 21st
century.
Principles of Minimal Intervention
dentistry
Remineralization of early lesions
Reduction in cariogenic bacteria, to
elminate the risk of further demi-
neralization and cavitation
Minimum surgical intervention of ca-
vitated lesions
Repair rather than replacement of
defective restorations
The day is surely coming, and perhaps
within the lifetime of you young men
before me, when we will be engaged in
practicing preventive, rather than reparative, dentistry.

GV Black in 1896
Thanks
Technique of composite resin

By
Amin Abusallamah
Steps of restoration

1. Isolation
2. Etching /Conditioning
3. Washing /Drying
4. Bonding
5. Curing
6. Determine shade
7. Incremental buildup &
curing of composite
8. Finish/polish
 Isolation

Composite is a highly technique

sensitive material

Slight contamination or procedural

error spoils the durability of the
restoration

Perfect isolation of operating area

is mandatory
 Etching
/Conditioning

Both the tissues are etched

Enamel with Phosphoric acid.
Dentin
 Enamel Etching

To cut into the enamel surface through

the action of acid

After
washing
 Etchant

32- 37 %
phosphoric acid

liquid gel
 Dentin
conditionin
g

Chemical alteration of dentinal

surface by acids to remove the
smear layer and demineralize
the dentin
 Cont

Various acid are supplied with

various adhesive systems

Citirc acid
Maleic acid
Nitric acid
Phospshoric acid

Etching time:
 Applying
Etchant

roughens the surface by removing

calcium from enamel .
 Washing and
Drying

Washing is performed
with triple syringe for
5-10 seconds and
then drying.
Etched enamel
surface
 Bondin
g
Bonding agents are unfilled resins
that flow into the micro channels and
form an interlocking system.

It is available in liquid form

 Application of
bond

Apply bonding
agent with help
of a small
brush.
 curing

20
seconds
Determine
shade
 Matrix band
application

Apply matrix band & wedge for class II

Build proximal walls with composite
 Incremental buildup &
curing of composite

Fill the cavity in increments and

adjust
Cure it.
each increment for 40-45 sec.
 Finish & polish

Tungsten carbide finishing bur is

used to contour the marginal
ridge (note the water spray).

Rugby ball-shaped fine diamond

is used to contour the occlusal
anatomy. All high-speed
instruments must be used with
water spray.

A flexible, abrasive, impregnated

disc is used to polish and smooth
the occlusal contours.
 Thank
Reference:
you
Pickards Manual of
Operative Dentistry,
Eighth edition
Chapter 6. P 111,112