Class III, IV, and Class V Composite Restoration

Question 1

Select shade first
◦ before tooth is

Answer 1

dehydrated, excessively dried, or isolated with rubber dam.

Question 2

Don’t — when taking the shade.

Answer 2

Don’t shine overhead light on tooth

Question 3

Can cure some composite on the tooth to check the shade
◦ Do not

Answer 3

etch nor bond prior to this step

Question 4

Steps in composite resin restoration

Answer 4

Acid Etch
◦ Rinse/dry
Prime (often included in bond step)
Bond/Adhesive
◦ Light cure
Place Composite
◦ Light cure

Question 5

Acid Etch increases

Answer 5

surface area

Question 6

Adhesive penetrates etched enamel
◦ creating

Answer 6

micromechanical bond

Question 7

Etch
◦ enamel for — seconds
◦ dentin for — seconds.
◦ order

Answer 7

20-30
15
Apply etchant to enamel first; 15 seconds later apply it to the dentin then wash
off the enamel and dentin at the same time.

Question 8

Rinse thoroughly — seconds.

Answer 8

15

Question 9

Dry enamel with an

Answer 9

air syringe.

Question 10

May selective etch ENAMEL ONLY

Answer 10

20-30 seconds, rinse, dry
◦ When using appropriate bond agent (e.g. Adhese, but any Universal)

Question 11

Consideration when etching and
bonding Do not etch the adjacent tooth
(2)

Answer 11

◦ Teeth can be bonded together.
◦ May have to use a saw to open the contact

Question 12

if the tooth gets contaminated with saliva re-etch for — seconds and then rinse
again and dry until frosted enamel appearance is present.

Answer 12

10

Question 13

Consideration with fluoridated teeth Teeth rich in fluoride require longer etching times because

Answer 13

fluoridated teeth are more
resistant to acid
◦ That is why they have less tooth decay
◦ fluoridated teeth are resistant to the lactic acid produced by bacteria

Question 14

Primer
(3)

Answer 14

◦ Hydrophilic monomers in solvent
◦ Draws adhesive in
◦ This step is included with adhesive in our clinic

Question 15

Bond
(2)

Answer 15

◦ Resin bonding agent
◦ Also referred to as “adhesive”

Question 16

The thin bonding agent engages the etched enamel through a

Answer 16

micro-mechanical bond.

Question 17

The self-curing or light-cured resin then — bonds to the bonding agent.

Answer 17

chemically

Question 18

Primer/adhesive penetrate the intertubular dentin forming

Answer 18

hybrid layer

Question 19

Bonding Agent
(4)

Answer 19

Thin adhesive with a brush
Thin the solvent by blowing air gently
Don’t overly air-thin adhesive
◦ can result in uneven distribution and introduce air (oxygen) in mixture which retards polymerization

Question 20

What we use in the clinic:

Answer 20

Peak Universal

Question 21

Do not dispense the bonding agent before use
◦ why

Answer 21

alcohol will evaporate and not wet the dentin well enough.

Question 22

Adhese Universal
Vivapen-

Answer 22

one-click dispense

Question 23

Placing the composite resin Insert composite into preparation

Answer 23

◦ May insert with composite gun directly or use instrument
◦ Composite instrument, plastic instrument, small condenser, or ball burnisher may be appropriate
Contour with the plastic instrument or OptraSculpt pad

Question 24

COMPOSITE STICKING TO INSTRUMENT:
(4)

Answer 24

◦ Dip instrument into small amount of adhesive to work with the composite
◦ Keeps composite from sticking to instrument
◦ May use Wetting Resin in practice
◦ If composite sticks to instrument and “pulls back”-> VOIDS

Question 25

Opaque shades require --- curing times

Answer 25

longer

Question 26

Large class III restorations require --- shades especially when the preparation can be seen through from the facial to the lingual.

Answer 26

opaque

Question 27

Light will pass through --- shades in large restorations thus making the restoration stand out in a patients mouth but the light will not as readily pass through in --- shades.

Answer 27

translucent opaque

Question 28

Placing composite resin No etching or bonding agent is required between

Answer 28

layers ◦ if the surface you are bonding to is clean and dry.

Question 29

HOWEVER, if the surface gets contaminated between layers

Answer 29

RE-ETCH the contaminated composite surface ◦ re-apply bonding agent, thin, cure ◦ apply composite resin

Question 30

After placement of composite restoration, an

Answer 30

Oxygen-inhibited layer of resin will remain on the surface for a time ◦ Additional composite can be added directly to this layer ◦ No need to re-etch and bond

Question 31

Repairing old composites: ◦ The same process EXCEPT: (2)

Answer 31

◦ roughen the old composite with a diamond bur ◦ then etch, wash, dry, bonding agent, thin, cure and apply new composite resin

Question 32

When restoring two adjacent preparations (4)

Answer 32

Prepare the larger restoration first Restore the one with the least access first (the smallest preparation) and finish it first before restoring the larger one Only etch one preparation at a time. Gingival bleeding will usually occur when removing the wedge. Must reinsert the wedge and apply the matrix to the second tooth before etching and restoring.

Question 33

PREPARE --- FIRST RESTORE --- FIRST

Answer 33

LARGEST SMALLEST

Question 34

What we presently use in the clinic (2)

Answer 34

3M Filtek Supreme Peak® Universal Adhesive ◦ Ethanol solvent based ◦ 7% filled Adhese® Universal Adhesive ◦ Ethanol solvent based ◦ Clicking dispenser penMaterials

Question 35

Bulk method causes an increase in

Answer 35

polymerization stress.

Question 36

--- layering technique causes less polymerization stress ◦ Thus less post op sensitivity.

Answer 36

Incremental

Question 37

Once the resin hardens, the stresses are moved to the

Answer 37

bond between the material and the cavity wall ◦ can pull away from the cavity wall leaving a void

Question 38

The more walls the resin is not bonded to helps to

Answer 38

relieve the stress in the resin- adhesive interface

Question 39

Class IV Restoration (4)

Answer 39

Similar to Class III MUST RE-ESTABLISH INCISAL EDGE Bevel 2-3 mm on buccal Bevel on lingual 1-2 mm

Question 40

Class V restoration Field should be clean and dry Use appropriate retraction and matrix (2)

Answer 40

◦ Retraction cord may be necessary ◦ May use Cure-Thru matrix

Question 41

Finished Class V margin (4)

Answer 41

Bond to the end of the bevel and finish to the end of the bevel Avoid finishing on cementum when possible ◦ This exposes dentin tubules ◦ Leads to sensitivity

Question 42

Restore with Resin Composite Use nanofill or microfill (3)

Answer 42

◦lower modulus of elasticity (less stiff) than hybrids ◦won't flex as readily ◦less likely to debond