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Direct and Indirect Esthetic Restorative Materials
Direct and Indirect Esthetic Restorative Materials
Midterm exam
15/11/2011 Tuesday 12.15 pm Location: 10H3,4, N2
Replacement of amalgam
Uses
Out of necessity
Composite resin
Components
Resin matrix:
bis-GMA
(bisphenol A-glycidyl methacrylate). UDMA (Urethane dimethacrylate) These resins are made of oligomers (organic molecules) and low molecular weight monomers
Fillers: silica, quartz, glasses composed of barium, strontium etc. Why add fillers:
Add strength Increase wear resistance Reduce polymerization shrinkage
of filler? Ratio or weight of filler to resin matrix? Coupling agent: silane, binds filler to matrix and reduces wear. Pigments: to produce different colors and shades.
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Size
Polymerization
Monomers join polymers Initiators and activators cause the reaction to begin. Side chains on polymers cross-link to form stronger material
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Polymerization
1.
Base: composite and benzoyl peroxide as initiator Catalyst: composite and tertiary amine activator Require manual mixing which may lead to air bubbles incorporation.
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Polymerization
2. 3.
Light cure: blue light (400-500 nm) is used to harden the composite. Depth of cure? Depends on:
1. 2. 3. 4.
color and location of restoration Thickness of the layer Light intensity Distance between light source and restoration
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Polymerization
3.
Dual cure: 2-paste system containing both types of initiators and activators. Advantage: light starts the polymerization rxn and the chemical reaction continues in areas were light cant reach them.
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Classification of composites
1. 2. 3. 4. 5. 6. 7. 8. 9.
Macrofilled Microfilled Small-particle composite Hybrid Flowable Pit and fissure sealant Packable composite Smart composite Core build up composite
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Macrofilled composites
First generation Filler particle size 10-100 m Difficult to polish Stronger than composites with smaller particles
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Microfilled composites
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Hybrid composite
Mixture of macro and microfillers (75-80% by weight) Microhybrid composite: contains 2 particle sizes, small 0.5-3 m and microfine fillers 0.04 m Hybrids have high polishability and strength so they can be used for anterior and posterior restorations
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Flowable composites
Low-viscosity, light cured Can be lightly filled (40%), or more heavily filled (70%) Particle size 0.07-1 m Delivered into cavity using a syringe
Used for PRR Pit and fissure sealing Liners (cushion stress
caused by polymerization shrinkage of overlying composite)
Class V
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Packable composites
Highly viscous Heavily filled Stiff and strong Posterior restorations (as a substitute for amalgam) Shrink less due to higher filler content
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Smart composites
Combat caries by having the ability to release fluoride, calcium, hydroxyl ions when acidity increases Effectiveness has not yet been proven
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Physical properties
Biocompatibility
Polished composites are tolerated by soft tissue. Bonding agents protect pulp by sealing tubules Larger filler composites are stronger in tension and compression Lower filler content increases wear. Composites wear more than amalgams shrink away from cavity walls Minimized by incremental placement. Can cause postoperative sensitivity, & pressure on tooth 27
Composite
Shrinkage outcomes
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Thermal conductivity
Coefficient of thermal Greater than tooth structure, causes expansion (CTE) debonding & leakage. Filler content CTE Elastic modulus Determined by amount of filler. Filler increases stiffness. Water sorption Radiopacity resin content water sorption
Barium, strontium radiopacity. Quartz (radiolucent) used as filler in anterior composites to improve shade
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Esthetic
demands: Microfills and microhybrids are suited Strength demands: in posterior teeth and stress bearing areas, hybrids are more suited
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Shade
portion of composite on tooth surface and cure it to observe the appropriate shade. The tabs in the shade guide should be moist and held adjacent to the tooth and observed under different lights Shelf life: follow manufacturer instructions but as a general rule, avoid heat and light. Average shelf life 2-3 years.
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Isolation
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Single paste, light activated composite Instruments for placing composite Syringe for injecting composite
minimize polymerization shrinkage Allow curing light to properly penetrate and cure
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Etching
Etching
and bonding:
is achieved using phosphoric acid ( 34-37%). After etching, tooth surface is washed and gently dried, etched enamel will appear frosty white. Bonding agent is applied in a thin layer and light-cured according to manufacturer instructions. (remember micromechanical retention).
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Etching
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Resin to resin bonding: proper isolation, no contamination is necessary for proper bonding of successive composite layers. The surface layer is a thin layer of unpolymerized composite (airinhibited), is removed by polishing
Enamel etching
Bonding agent Composite (bonds chemically to bonding agent) 2nd layer of composite, etc.
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Light-curing:
Should
be held as closely as possible to composite 20-40 seconds for thin layers Thicker layers, darker shades, deeper locations require more time
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Finishing and polishing: sandpaper discs, fine, ultra-fine diamonds.Abrasive strips and needle-shaped diamond burs are used. Polishing pasts can also be used. Surface sealers: unfilled resin maybe added after cleaning and etching the surface. It is thought to be useful to reseal margins opened by polymerization shrinkage, or surface porosities.
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Halogen light bulbs are used as a light source. Light delivery probe or tip is glass or glass encased in metal or plastic casing. Should be covered in a disposable cover
Cordless
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2.
3.
4.
Eye protection: light-shielding protective device, glasses for patient. Heat generation: may cause pulp irritation in deep
cavities (1 mm or less of dentine).
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Compomers
Composites modified with polyacid (polyacid-modified resin). The resin contains MMA and polycarboxylic acid. Light activation chemicals are included and also fluoride containing glasses. Fluoride release is small compared to conventional GIC due to resin binding the glass fillers after light activation. Setting rxn occurs in 2 stages Same as light-cured composite Acid-base rxn Bonding to tooth structure occurs as in composites
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Veneers: can be porcelain or composite. Veneers are used to treat staining, close diastemas, lighten teeth color, reshape crooked teeth.
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Indirect composites:
inlays, onlays, veneers. Preparation is done in the clinic, followed by an impression and construction of the restoration on a die, then cementation in the preparation. With resin cements and bonding agent.
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Procedure:
Preparation
Shrinkage occurs outside the cavity, therefore less stress is created as opposed to direct restorations
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composite Fiber reinforced composite. Fiber source is carbon Kevlar, glass fiber, polyethylene ( to improve strength). Particle-reinforced composite: heavily filled (70-80% by weight) with ceramic particles to improve wear resistance.
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Shade taking
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effort Should be taken before preparation Taken before rubber dam placement Teeth should be clean, free of stains and moist Two different lights should be used (Metamerism): dental offices usually have fluorescent light (blue), or incandescent light (yellow). Natural light is a good source except in morning or late afternoon (more yellow and orange, and less green and blue)
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Continue,
A
neutral background should be used (e.g. blue apron) Female patients should be asked to remove lipstick, and colorful clothes should be covered Several tabs are held close to patients teeth and kept moist. Separate shades for cervical part of the tooth might be necessary.
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Continue,
Any surface characteristics should be replicated if the patient demands that the restoration matches existing teeth. A photograph of the patients teeth and adjacent shade guide tab maybe helpful.
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Reference
Dental materials, clinical applications for dental assistants and dental hygienists Chapter 6
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