Preparation and making fillings
Class V., III., IV.
Class V.
 Cervical defects
- Dental caries
- Non carious lesions (erosion, abrasion,
V shaped defects)
Types of defects
 Caries
 Erosion
 Abrasion
 V shaped defects
 Erosion
Choice of material
 Amalgam (posterior area)
 Composite (mainly in anterior teeth where
the defect is situated in enamel)
 Glassionomer: caries defects, esp deeper,
situated out of enamel, higher caries risk
V.Class Amalgam
 Posterior area
Access
 Elimination od the undermined enamel
- Burs or diamonds (pear), tapered fissure bur
 Separation of the gingiva– temporary filling
guttapercha, fermit, clip, zinkoxidsulfate
cement, cavit, provimat).
 Ablation of ingrown gingiva – surgical
(scalpel, laser, high frequency current)
Cavosurface margins
Gingival: axial dephth of 0,5 mm inside the
DEJ.
Extention of the preparation incisally,
Gingivally: 0,5 mm subgingivally
mesially and distally: to axial walls
Or: untill the cavosurface margins are positioned in
sound dental structure. (small cavities, good oral
hygiene)
Total dephth: 1 – 1.25 mm. If on root
surface -0,75 mm
Retention
 Box 0,75 – 1,25 mm deep, undercuts,
Depht
Gingivally: axial dephth of 0,5 mm inside the
DEJ.
Total dephth: 1 – 1.25 mm. If on root
surface -0,75 mm
Resistance
No occlusal forces
Gingival margin
Mesial and
distal margin
Occlusal margin
The bottom of the cavity follows the convexity of the crown.
Filling
Base – pulpal wall
Amalgam – portion by portion, condensor
with straight front, burnisher (spatula).
Class V. composit
 Aesthetic area
 Margin in enamel
Preparation for composite,
making filling
Cavity is limited on caries lesion only
Enamel must be beveled
Etching, priming + bonding
Placement of composite
Matrices
Transparent cervical matrices
Matrix band acc. to Belvedere
Laser
Rotační nástroj
Class V. glassionomer
 Cavities with margins in cementum
 Or also in enamel or partly in enamel (in
patients with worse level of oral hygiene)
Glassionomer
 Bonds chemically
 Realease fluoride ions
 Thermal expansion similar to dentin
 Acceptable aesthetics
Preparation for glassionomer
making filling
 Cavity is limited on carious lesion only
 Margins sholud be smoothen (no bevel)
 Conditioner (polyacrylic acid) -20 s
 Washing
 Placement of glassionomer (one bulk)
 Matrix (transparent or aluminium cervical
 matrix)
Combination of materials
 Glassionomer – replaces lost dentin
 Composite – replaces lost enamel
base of glassionomer
Composite
Connection
Glassionomer – tooth:
chemical
Composite – tooth:
micromechanical
Composite – glassionomer
Micromechanical.
Choice of materials
Glassionomer Combination Composite
Or amalgam in posterior area
Class III.
Proximal surface of frontal teeth (incisors and
canines) without loss of incisal edge
Access to the cavity
 Through the enamel from the oral side
 Removal of old filling
 Separation of teeth - wedges
 Removal od hyperplastic gingiva
Round bur or diamond,
from oral side,
the caries lesion
on proximal wall must be reached
Access
Cavosurface margin
 Cavity is limited on carious lesion only
 Margins must be beveled
Retention
 Margins must be beveled –
micromechanical retention
bevel
Dry field!!!!
Etching of enamel and dentin
Bonding
Surface Morphology
for Adhesion Enamel
- regular surface with opened
inter/intraprismatic
spaces
 Dentin
- no smear layer
- opened dentinal tubules
- collagen with microscopic
spaces (after etching)
Preparation
Preparace kavity
Acid etching – protection of the
tooth
Matrix and wedge, bonding
Palcement of the composite
Layering of the composite
 Palatal wall (matrix in situ) – enamel shade
 Dentin shade
 Enamel shade
Matrix has been removed
Finishing
Ultrafine diamonds.
Flexible discs
Polishing
Rubber cups,
brushes
Finished filling
Class IV.
Defects on proximal surfaces
premolars and molars with loss of
part or complete incisal edge
Dental caries
Trauma
Access
Cavosurface margin
Preparation is limited on the defect
Compoiste is plastic material
of only choice
Primer and
bond
Micromechanical connection
The enamel must be beveled
Silicone matrix
Oral surface
Incisal edge