Indications: Composite • Aesthetically prominent areas of posterior teeth • Small - moderate classes I. that can be well isolated • Good level of oral hygiene is necessary Contraindications: Composite • Moderate to large restorations • Restorations that have heavy occlusal contacts • Restorations that cannot be well isolated • Restorations that extend onto the root surface (subgingival – margin relocation or lenghtening of the crown is necessary) • Abutment teeth for removable partial dentures Composite - possibilities • Conventional cavity (oclusal and proximal cavity) • Adhesive slot • Tunnel preparation • Cusp replacement – direct, indirect. Definujte zápatí – název prezentace nebo pracoviště3 Interproximal borders Yes No Composite Amalgam Preparation 30 - 40° ? Cervical borders In enamel No bevel Cervical borders In dentin Preparation technique Oscillating instruments Class II. and contact point • Matrix band + matrix retainer - Metal band (in primary teeth) Without matrix retainer Plastic band (polyester – e.g. Lucifix matrix) Sectional matrices with separator Contact point Contact area Matrix band and matrix retainer Composite filling class II. Contact point Sectional matrices • Sectional matrices with separator Good adaptation Separation using wedge and separator 30 Sectional pre-contoured metal matrix system provided the highest contact tightness with the highest length of contact arc. Restorations with circumferential precontoured metal matrix system provided higher LCA than those with circumferential straight metal matrix with Tofflemire retainer and circumferential pre-contoured transparent matrix system“ Kampouropoulos D, Paximada C, Loukidis M, Kakaboura A. The influence of matrix type on the proximal contact in class II resin composite restorations. Oper Dent 2010; 35; 454-462 31 Use of the sectional matrix system in twosurface Class II cavities resulted in statistically significantly tighter proximal contacts than the use of the circumferential matrix system. For the three-surface no statistically significant differences in contact tightness were found between the different matrix systems.“ Wirsching E, LoomansB A, Klaiber B, Dörfer C E. Influence of matrix systems on proximal contact tightness of 2-and 3-surface posterior composite restorations in vivo. J Dent 2011; 39: 386–390 33 Step 1: Pre - wedging The wedge is inserted before preparation: Compression of gingiva Separation of teeth Together with the matrix protection of damage of neighbouring tooth Matrix for the filling can be inserted easier. Definujte zápatí – název prezentace nebo pracoviště34 Step 2: preparation • Preparation with the protection of neighbouring tooth using the metal strip or matrix. Definujte zápatí – název prezentace nebo pracoviště35 Step 3: adaptation of wedge, matrix and separator • The wedge can be new or the same as previous, inserted from oral or vestibular side • The matrix is 0,5 mm below the gingival wall • Separator separates teeth Definujte zápatí – název prezentace nebo pracoviště36 Step 4 Making filling Definujte zápatí – název prezentace nebo pracoviště37 Kompozitní výplň II. třídy Kompozitní výplň II. třídy Kompozitní výplň II. třídy Sedelmayer Adhezivní slotová preparace Approximal Caries Approximal Caries Tunnel preparation Success? Low caries risk Special smal instruments Magnification BW post op