Adobe Systems Restorative dentistry I. 4th lecture Preparation and making fillings Class V., III., IV. Adobe Systems Class V. Fillings od cervical defects- In cervical area can be found: Dental caries Non carious lesions: Non carious lesions are defects of hard dental tissues caused by various reasons, no microbs are involved. ̶ Dental caries cahlík V Adobe Systems Types of defects ̶Caries ̶Erosion ̶Abrasion ̶V shaped defects ̶Erosion Adobe Systems Erosion ̶ ̶Irreversible loss of hard dental tissue as a consequency of demineralization without participation of microbs. Repeated contact with chemicals of low pH (1-3) is necessary. Acidic food and beverages, gastric acid (gastrooesophageal rephlux). 6 kanova3 eroze-abraze eroze Erosion + abrasion Adobe Systems Abrasion ̶Abrasion is a lost of hard dental tissues caused mechanically with some substance or objects. Abrasion is often combined with erosion. Typical location – cervical area of canines and premolars. Typical reason: hard toothbrush, abrasive toothpaste. Adobe Systems ̶ klinovedef Adobe Systems 9 V shape defect Typical shape, smooth bottom, the border is subgingivally. No pain. kliny Adobe Systems Aethiology of V shaped defects - abfraction st_6_2013-56.jpg Hard enamel Elastic dentin During the occlusal loading – elastic deformation of dentin -enamel looses the support -fracture of small pieces -abfraction Adobe Systems Filling therapy of cental caries and non carious lesions is the same ̶ Definujte zápatí – název prezentace nebo pracoviště 11 Adobe Systems Choice of material ØAmalgam (posterior area) Ø ØComposite (mainly in anterior teeth where the defect is situated in enamel) ØGlassionomer: caries defects, esp deeper, situated out of enamel, higher caries risk ̶ ̶ Adobe Systems V.Class Amalgam ̶ Posterior area DSC_0169 Adobe Systems 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) Adobe Systems 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 5 5trida3 Adobe Systems Retention ̶Box 0,75 – 1,25 mm deep, undercuts, V V Adobe Systems Depht Gingivally: axial depht of 0,5 mm inside the DEJ.(Subgingivally) Total dephth: 1 – 1.25 mm. If on root surface -0,75 mm Adobe Systems Resistance No occlusal forces V V Gingival margin Mesial and distal margin Occlusal margin The bottom of the cavity follows the convexity of the crown. Adobe Systems Filling Base – pulpal wall ̶ Amalgam – portion by portion, condensor with straight front, burnisher (spatula). Adobe Systems Class V. composit Ø Aesthetic area ̶ Margin in enamel DSC_0231 DSC_0229 Adobe Systems Preparation for composite, making filling Cavity is limited on caries lesion only Enamel must be beveled Etching, priming + bonding Placement of composite schema18a schema18b Adobe Systems Matrices Transparent cervical matrices Matrix band acc. to Belvedere DSC_0218 pasky Adobe Systems Class V. glassionomer ̶Cavities with margins in cementum ̶Or also in enamel or partly in enamel (in patients with worse level of oral hygiene) cahlík Adobe Systems Glassionomer ̶ Bonds chemically to hard dental tissues ØRealease fluoride ions ØThermal expansion similar to dentin ØAcceptable aesthetics Ø Ø Adobe Systems Preparation for glassionomer ̶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 – cervical foil) ̶ ̶ Adobe Systems ̶ V DSC_0444 DSC_0450 DSC_0522 Adobe Systems Matrices for glassionomers ̶Cervical foils Hawe adaptable metal cervical matrices have a specially treated aluminium surface and are suitable for all self-curing composites and glass ionomers. Adobe Systems Combination of materials ̶Glassionomer – replaces lost dentin ̶Composite – replaces lost enamel Base of glassionomer Composite Connection - bonding Glassionomer – tooth: chemical Composite – tooth: micromechanical Composite – glassionomer Micromechanical. 5 Choice of materials Glassionomer Combination Composite Or amalgam in posterior area Adobe Systems Remember ! ̶The filling therapy is symptomatic therapy only! ̶ ̶It is always important to discover the ethiology of non carious lesions and eliminate it if possible. ̶ ̶ Definujte zápatí – název prezentace nebo pracoviště 34 Adobe Systems Class III. Proximal surface of frontal teeth (incisors and canines) without loss of incisal edge. It originates usually below the contact point. daniel9 Adobe Systems Diagnosis and clinical symptoms ̶Visual diagnosis – good illumination or transillumination. Dark spot can be seen. Also Diagnocal can be helpful. ̶Early diagnosis is quite easy. Definujte zápatí – název prezentace nebo pracoviště 36 Adobe Systems 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 klinek pristup3,trida Round bur or diamond, from oral side, the caries lesion on proximal wall must be reached Access Adobe Systems Cavosurface margin ̶ Cavity is limited on carious lesion only ̶ Margins must be beveled ̶ preparačni nastroje exkavator 3 brousky bevel Adobe Systems 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 42 enaperi Prismatic structure after the removalof aprismatic enamel and acid etching – retentive pattern periprismatic intraprismatic enaintra Adobe Systems 43 adhese1 ena Aprismatic enamel Aprismatic enamel after acid etching Adobe Systems Good isolation with the rubberdam ̶ daniel9 daniel11 Acid etching of enamel and dentin: Enamel 20 – 30 s Dentin 10 s daniel12 Bonding Adobe Systems Sequence of operation – after choosing the colour – the enamel is cleaning ̶ DSC_0125 Adobe Systems Preparation ̶ DSC_0126 Adobe Systems Acid etching – protection of the other tooth tooth ̶ DSC_0128 Adobe Systems Matrix (transparent polyester strip) and wedge, priming and bonding ̶ DSC_0129 Adobe Systems Application of the composite – palatal layer first ̶ DSC_0131 Adobe Systems Incremental technique ̶ DSC_0132 Adobe Systems Before finishing, the wedge can remain in situ – separation of teeth ̶ DSC_0138 Adobe Systems Layering of the composite ̶Palatal wall (matrix in situ) – enamel shade ̶Dentin shade ̶Enamel shade ̶ Adobe Systems Matrix has been removed ̶ DSC_0141 Adobe Systems Finishing: final shape with fine and extrafine diamond bur, flexible discs ̶ DSC_0143 Adobe Systems Polishing – rubber instruments, fine discs ̶ DSC_0145 Rubber cups, brushes Adobe Systems Finished filling ̶ III klusak1 klusak2 klusakmodelace klusak4 klusak3 3 rd class restoration – 20 years ago Layering depends on size and location of the defect – dentin and enamel shades obr obr obr-8e obr Adobe Systems Class IV. Defects on proximal surfaces premolars and molars with loss of part or complete incisal edge Dental caries Trauma Kopie vychstavmikulov Adobe Systems Cavosurface margin Preparation is limited on the defect Kopie vychstavmikulov sikmeni5 The enamel must be beveled vrstvenizas1 kovalikova3 mikulov2 Adobe Systems artemis3 artemis2 artemis1 Principle of the layering of the composite material Adobe Systems 67 The matrix is necessary: Transparent polyester strip + wooden wedge For location od the palatal wall silicone matrix can be used Adobe Systems 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 68 Adobe Systems Definujte zápatí – název prezentace nebo pracoviště 69 palkovamodel waxup2 palkmodelsilikon silik rozříznutá Adobe Systems ̶ IMG_1595 IMG_1596 klocprilozmatrice klocvrstvzacatek klocvrstvzacatek klocvrstveni7 Now the transparent strip and wedge is necessary again palkovavych palkovapo2letech Adobe Systems ̶ vych1 silikmatrice1 cep palkovalepptani Adobe Systems 77 ̶ vrstveni palkovavrstveni2d konec vych1 plstenykotouc