finals lecture directcompositehistory 120317054329 phpapp02
TRANSCRIPT
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Introduction
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I. Class 1 DirectComposite Restoration
Preparation design:
Conventional (class I,II,V)in amalgam/90or buttjoint
Modified (classV)
Bevealed conventional(rarely used)
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I. Class 1 Direct
Composite RestorationB. Inverted cone with rounded
caries
Provide flat floorsProduces a more stronger margin on the
occlusal cavosurface
Creates preparation walls that converge
occlusallyOcclusally more conservative facial
lingual preparation width
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Class II Conventional
direct compositeB. Proximal Box:
Facial, lingual and gingival extensions
dictated by extend of caries or oldrestoration; may not be extended beyondthe contact with the adjacent tooth.
Walls at 90, axial wall to 0.2mm in
dentinGingival floor flat with minimal extension
Retained by micromechanical retention,no secondary retention necessary.
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Indirect tooth colored
RestorationIndications:
Esthetic
Large defects or previous restorationsEconomic factors
Contraindications:
Heavy occlusal forcesInability to maintain a dry field
Deep subgingival preparation
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Definition of terms
Indirect:Inlay
- restoration of metal, porcelain/ceramic orcomposite made to fit a tapered cavitypreparation and luted into it by a cementingmedium.
Onlay (overlay)
- an inlay that includes the restoration of allof the cusp of a tooth.
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Definition of terms
Taper-permits an unobstructed removal of the wax
pattern and subsequent seating of the
material. The wax pattern should be removedfrom the tooth without distortion.
TaperIntracoronal
-divergence from the floor of thepreparation outwards.
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Definition of terms
Extracoronal- converge from the cervical to the
occlusal or incisal surface.shallow cavities (vertical walls unusually short)Requires minimal taper of 2 occlusal divergenceto enhance resistance and retention.
deep cavities (increased gingivo-occlusal height ofvertical walls)
As much as 5 taper to facilitate:
Pattern withdrawal, trail seating and cementingof restoration
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Types of restorative
materialsLaboratory-processed inlays and
onlays
Ceramic inlays and onlaysMachinable ceramics or CAD/CAM
Feldspathic porcelain
Hot-pressed ceramic
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Laboratory-processed
inlays and onlaysPolymerized under pressure, vacuum, inert gas,intense light, heat, or a combination of thesedevices to optimize physical properties of
composite resins.More resistant to occlusal wear vs directcomposites but less wear resistance thanceramics.
Easily adjusted, low wear of opposing teethgood esthetics and has potential for repair.
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Laboratory-processed
inlays and onlaysIndications:
If maximum resistance is desired from
composite restoration.Achievement of proper contour and
contacts would be difficult with directcomposite.
If ceramic restoration iscontraindicated because of wear ofopposing dentition.
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Advantages of heat curedcomposite inlay/onlay restoration
Improved physical properties/durability andwear resistance compared to direct compositesystems.
Depth of cure not a problem unlike with directcomposite where there is limited depth of cure.
Excellent marginal adaptation since the lutingcomposite fills any marginal contraction gap
present.Non-extent polymerization shrinkage except inluting resin cement.
Post-operative sensitivity seldom encounetered
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Ceramic inlays and onlays
Esthetics, durable, improvedmaterials, fabrication techniques,
adhesives and non based lutingagents.
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Fabrication steps for
ceramic inlays and onlaysAfter tooth preparation, an impression
is made and a master working cast is
poured of die stone.The die is duplicated and poured with a
refractory investment capable ofwithstanding porcelain firing
temperatures. The duplication methodmust result in the master die and therefractory die being accuratelyinterchangable.
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Fabrication steps for
ceramic inlays and onlaysPorcelain is added into the preparation
area of the refractory die and fired in
an oven. Multiple increments and firingsare necessary to compensate forsintering shrinkage.
The ceramic restoration is recovered
from the refractory die, cleaned of allinvestment, and seated on the masterdie and working cast for finaladjustments and finishing.
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Feldspathic porcelain
Partially crystalline minerals (feldspar,silica, alumina) dispersed in a glass
matrix.Porcelain restorations are made from
finely ground ceramic powders that aremixed with distilled water or a special
liquid, shaped into the desired form,then fired and fused together to form atranslucent material that looks liketooth structure.
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Feldspathic porcelain
Some ceramic inlays and onlays arefabricated in the dental laboratory by
firing dental porcelains on refractorydies.
Advantage:Low start-up cost
Disadvantage:its technique sensitivity
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Hot Pressed Glass
ceramicsGlass could be modified with nucleating
agents and on heat treatment, be
changed into ceramics with organizedcrystalline forms.
Such glass ceramics were stronger,had a higher melting point than non
crystalline glass, and had variablecoefficients of thermal expansion.
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Hot Pressed Glass
ceramicsAdvantages:
Similarity to traditional wax-up processes
Excellent marginal fitRelatively high strength
The surface hardness and occlusal wear ofthese ceramics are similar to those of
enamel.Stronger than porcelain inlays made on
refractory dies, they are still quite fragileuntil cemented.
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Hot Pressed Glass
ceramicsDisadvantges:
its translucency, which necessitated
external application of all shading.Not significantly stronger than fired
feldspathic porcelains they do seemto provide better clinical service.
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Chronological Events of
Restorative MaterialsHistory
First recommended over 25 years ago
for posterior use.1907 cast gold
1908 silicate cement
First direct tooth colored restorativematerial.
Disadventage:Insoluble to oral fluid
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Chronological Events of
Restorative Materials1962 composite resin
According to the size of the filler:
Macrofill for class V(problem: abfraction)
Microfill anterior restoration
Hybrid
Microhybrid composite
Nanofilled composite
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Chronological Events of
Restorative Materials1962 composite resin
Two types of composite:
1. Packable compositealternative to amalgam
Supplied: unit dose, compules or insyringe
Higher filler loadingFibers
Porous filler particles
Irregular filler particles
Viscosity modifiers
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Chronological Events of
Restorative Materials1962 composite resin
Advantages:
Produce acceptable class II restorationHigh depth of cure possible
Bulk fill technique
Filler loading: 80%
Medium to high strengthHigh stiffness
Low wear rate: 3.5um/year
Molecules of elasticity :similar to amalgam
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Chronological Events of
Restorative Materials1962 composite resin
Disadvantages:
New techniqueLess polishable
Limited shades
Increased post-operative sensitivity
Increased sensitivity to ambient light
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Chronological Events of
Restorative Materials1962 composite resin
Recommended uses:Class I restoration
Class II restoration
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Chronological Events of
Restorative Materials1962 composite resin
2. Flowable composites
Low viscosity compositesLow filler content
Ideal for cervical lesion
Ideal for non stress bearing area
Ideal for first increment in Class Icomposite
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Chronological Events of
Restorative Materials1962 composite resin
Advantages:
SyringeableDispensed directly into cavity
Adequate strength
Disadvantages:Higher polymerization shrinkage
Greater potential for microleakage
Low wear resistance
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Chronological Events of
Restorative Materials1968 Glass ionomer cement
Different types:
Luting or cementing medium
Liner or base
Restorative material
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Chronological Events of
Restorative Materials1970microfill polishable
composite
1973 ultraviolet light1977 microfill composite
Advantages: polishability, wear and
resistance and color stabilityDisadvantages: low flexural/tensil
strength, localized wear and thus
limited uses posteriorly.
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Chronological Events of
Restorative Materials1978 visible light curing
composite
Mid 1980s hybrid:Hybrid 0.04-3um particle size
range
Examples: brands of hybridHerculite
Prisma APH
P-30
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Chronological Events of
Restorative MaterialsMid 1980s hybrid
Intended for universal use
Disadvantage of hybrid:Generalized wear
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Chronological Events of
Restorative MaterialsMid 1980s microhybrid:
Microhybrid 0.6-0.7um particle
size rangeExamples: brands of microhybrid
Prisma TPH
Herculite XRV
Charisma
Tetric ceram
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Chronological Events of
Restorative MaterialsMid 1980s microhybrid:
Advantages:
Excellent physical propertiesGood finishing and polishing
characteristics
Relatively non sticky materials
Disadvantage:Do not hold a high polish over time
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Chronological Events of
Restorative Materials1985 CEREC ceramic system
1991 CEREC 1 as modified by
siemens1994 CEREC 2 with an upgrade
dimensional camera
2000 CEREC 3 with splitacquisition/design
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CEREC
Chairside Economical Restoration ofEsthetic Ceramiics
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Chronological Events of
Restorative Materials1986 Heliomolar
The sole exception to the microfill
group of resins that were introducedfor posterior use.
70% filled anterior/posteriormicrofill resin.
very good wear characteristic
Less than perfect esthetics
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Thank you!