Class V. Characteristic ⚫ Cervical defects Anatomical x Clinical crown Anatomical x clinical crown ⚫ Anatomical crown - cemento- enamel junction ⚫ Clinical crown – gingival border Anatomical X Clinical crown Cervical area ⚫ Caries danger area ⚫ Gingiva - possibility of its injury, bleeding, inflammation ⚫ Flow of the sulcular liquid ⚫ Specific ordering of the hard dental tissues ⚫ Thin layer of hard dental tissues – risk of opening of the pulp chamber Difficulties with the maintenance of the dry field Types of defects ⚫ Caries ⚫ Erosion ⚫ Abrasion ⚫ V shaped ⚫ Erosion Non carious defects Class V. Amalgam ⚫ Posterior area Access ⚫ Directly from vestibular or oral side ⚫ Removal of undermined enamel ⚫ Gingivoplasty and gingivectomy ⚫ Temporary filling if necessary to push gingiva out Cavosurface margin and extention for prevention Gingival: 0,5 mm subgingivally Occlusally: below the maximum convexity Mesially, distally: to the axial walls Total dephth: 0,75 – 1.25 mm. Gingival border mesial and distal border Occlusal border Retention ⚫ Box 0,75 – 1,25 mm deep, undercuts, coves (larger cavities) Resistance Elastic deformation during the biting Excavation of carious dentin Round bur Excavator Finishing of the cavity border ⚫ Fine diamond bur of a chisel Filling ⚫ Portion of amalgam are condensed using a condensor with the straight front and finished using a spatula. Class V. composit ➢ Aesthetic area ⚫ Cavities situated in enamel (completely or partly) Class V. composit, contraindications ➢ Bad level of oral hygiene ➢ Dry operating field is not possible to keep ➢ Root surface caries Access ⚫ Directly from vestibular or oral side ⚫ Removal of undermined enamel ⚫ Gingivoplasty and gingivectomy ⚫ Temporary filling if necessary to push gingiva out Cavosurface margin and extention for prevention Gingival: supragingivally Occlusally: below the maximum convexity Mesially, distally: acc to size of the caries lesion Total dephth: appr. 1 mm. Excavation of carious dentin Round bur Excavator Retention (micromechnical) Enamel must be beveled (removal aprismatic enamel, good conditions for acid etching) Acid etching (35-37% phosphoric acid) 20-30 s in enamel, 10 s in dentin Washing Priming, bonding – disperse with air syringe, curing Placement of the composite material Matrices Anatomical form Good curing Class V. Glassionomer ⚫ Indication: - Cavity out of enamel (root rurface caries) - Not optimal level of oral hygiene Class V. Glassionomer ⚫ Contraindication: - Cavity out of enamel (root rurface caries) - Not optimal level of oral hygiene Glassionomer – benefits ➢ Chemical binding to hard dental tissues ➢ Realeasing fluoride ions ➢ Thermal expansion similar to dentin ➢ Acceptable aesthetics Glassionomer –disadvantages ➢ Vulnerable during setting ➢ Nor strong mechanically Access ⚫ Directly from vestibular or oral side ⚫ Removal of undermined enamel ⚫ Gingivoplasty and gingivectomy ⚫ Temporary filling if necessary to push gingiva out Cavosurface margin and extention for prevention Preparation limited on caries lesion Retention ➢ Box ➢ Chemical Resistance Elastic deformation during the biting No occlusal loading Excavation of carious dentin Round bur Excavator Filling ➢ Conditioner 20 s ➢ Washing off ➢ Wet cavity ➢ Filling material ➢ Matrix ➢ Varnish Finishing of the margin ⚫ Smoothening using red coded diamond Combination – GIC and Composite ⚫ Sandwich filling base of glassionomer Composite Connection Glassionomer – tooth: chemical Composite – tooth: micromechanical Composite – glassionomer Micromechanical. V.Class Amalgam ⚫ Posterior area Gingival border Mesial snd distal border Incisal border Gingival border mesial and distal border Occlusal border Retention ⚫ Box 0,75 – 1,25 mm deep, undercuts, coves (larger cavities) Resistance Elastic deformation during the biting Excavation of carious dentin Round bur Excavator Finishing of cavity borders ⚫ Fine diamond bur of a chisel Filling ⚫ Portion of amalgam are condensed using a condensor (stamen) and finished using a spatula or a carver. Class five - composïte ➢ Aesthetic reasons Contraindication of composites ➢ Bad hagiene ➢ Subgingival cavities ➢ Root caries (outside of enamel) Access Into The Cavity ⚫ 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) Composite must not be subgingival!!!! Determination of cavity borders Cavity is limited on the caries defect only – no extention!!!! The depth usually 1 mm Retention ➢ Micromechanical retention Enamel: Retentive border – 1 – 2 mm wide and the angle 45° Cementum: only finishing with the fine diamond bur. Retention Retentive border: - removing of the aprismatic enamel – better condition for micromechanical retention - better aesthetics Retention Acid etching (phosphoric acid): 30 s dentin, 30 s enamel Rinsing (washing off) 30s Priming, bonding, light curing. Filling Spatula Matrix - Polyester strip, wooden wedges - Special cervical matrix Matrix Anatomical form Class five - glasionomer ⚫ Cavity outside of enamel Properties ➢ Chemical fixation to tooth structure ➢ Fluoride release ➢ Favorable thermal expansion ➢ Aceptable aesthetics Determination of cavity borders Cavity is limited on the caries defect only – no extention!!!! The depth usually 1 mm Retention ➢ Box ➢ Chemical Finishing of cavity borders Fine diamond bur Filling ➢ Conditioner 20 s ➢ Washing off ➢ Wet cavity ➢ Filling material ➢ Matrix ➢ Varnish Class V. – Sandwich principle Base of galsionomer – replace of the lost dentin Thin layer of composite – replace of the lost enamel Base Composite Bond: GIC - Tooth Chemical Composite – Tooth Micromechanical Composite - GIC Micromechanical Sandwich filling