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Preclinical dentistry III.
Class III.
Proximal surface of frontal teeth (incisors and
canines) without loss of incisal edge. It originates usually below the
contact point.
Diagnosis and clinical symptoms
̶ Visual diagnosis – good illumination or transillumination. Dark spot
can be seen.
̶ Early diagnosis is quite easy.
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Materials
̶ Composite filling material is a materiál of the first choice
̶ Glassionomer when oral hygiene or control of dry field is not
optimal.
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Access to the cavity
̶ Through the enamel from the oral side
̶ If the carious lesion is spreading towards
vestibular side, vestibular access is
acceptable
̶ 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
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Cavosurface margin
̶ Cavity is limited on carious lesion only
̶ Margins must be beveled
bevel
Retention
̶ Margins must be beveled – micromechanical retention
̶ Within the bevel (retentive border – shallow groove around the
lesion) the aprismatic enamel is removed, the prismatic structure
is exposed. Depth 0,5 mm. Angel appr. 45°.
lroubalikova@gmail.com
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Prismatic structure
after the removalof aprismatic enamel
and acid etching – retentive pattern
periprismatic intraprismatic
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Aprismatic enamel Aprismatic enamel after acid etching
Good isolation with the rubberdam
Acid etching of enamel and dentin:
Enamel 20 – 30 s
Dentin 10 s
Bonding
Sequence of operation – after choosing the colour – the enamel is
cleaning
Preparation
Acid etching – protection of the other tooth
tooth
Matrix (transparent polyester strip) and
wedge, priming and bonding
Application of the composite – palatal
layer first
Incremental technique
Before finishing, the wedge can remain in
situ – separation of teeth
Layering of the composite
̶ Palatal wall (matrix in situ) – enamel shade
̶ Dentin shade
̶ Enamel shade
Matrix has been removed
Finishing: final shape with fine and
extrafine diamond bur, flexible discs
Polishing – rubber
instruments, fine discs
Rubber cups,
brushes
Finished filling
3 rd class restoration – 20 years ago
Layering depends on size and location of the
defect – dentin and enamel shades
Class IV.
Defects on proximal surfaces premolars
and molars with loss of part or complete
incisal edge
Dental caries
Trauma
Cavosurface margin
Preparation is limited on the defect
The enamel must be beveled
Principle of the layering
of the composite material
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The matrix is necessary:
Transparent polyester strip + wooden
wedge
For location od the palatal wall silicone
matrix can be used
Silicone matrix
̶ Is a simple impression of silicone impression materiál after
building of the shape of the future restoration on the model or in
oral cavity
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Now the transparent strip
and wedge is necessary again
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Finishing and polishing