Professional Documents
Culture Documents
EPORTFOLIO:
CLASS II COMPOSITE PREPARATION AND RESTORATION
Paul Pang
University of British Columbia
CLASS II COMPOSITE PREPARATION & RESTORATION 2
CLASS II COMPOSITE PREPARATION — 16 MO
Bevel on
proximal box
Gingival and
proximal
contacts broken Divergent
walls
in this case
Narrow
outline
form
Figure 1: Occlusal view of preparation.
Occlusal depth
of 1.5 mm
Figure 2: Occlusal depth of preparation, shown with PQW
CLASS II COMPOSITE PREPARATION & RESTORATION 3
Figure 3: Other views of preparation.
CLASS II COMPOSITE PREPARATION & RESTORATION 4
CRITICAL REQUIREMENTS FOR CLASS II COMPOSITE PREPARATION
Critical Evidence–Based Rationale Self Evaluation
Requirements
(As presented in
Operative 430)
Metzger, & Gontar, 1987; Summitt et. al, 2006;
Söderholm, Tyas, & Jokstad, 1998).
Gingival Ultimately, the carious lesion will determine The gingival depth of my
contact just how far the proximal box should extend preparation could be more
broken gingivally. However, since most carious lesions conservative.
are found just gingival to the contact point, we
have made this a requirement for our
preparations.
Walls slightly Since composite chemically bonds to tooth Requirement is met. This was
divergent structure, mechanical retention is not required. achieved by using the tapered
Moreover, because marginal leakage with diamond bur, and also by running
composite is a much more prominent problem, along the walls with angled feather
it is desirable to have the restoration fall out strokes in the end.
once it fails. If not, detection of secondary
carious under a failed, but mechanically
retained restoration, will be very difficult.
CLASS II COMPOSITE PREPARATION & RESTORATION 6
REFLECTIONS ON CLASS II COMPOSITE PREPARATION
Where did you have the most problems? What did you do to solve these problems?
In general, I am having trouble staying conservative, both in terms of width and depth. More
practice with fine motor control since completing the photographed preparation has resulted in great
improvements in my occlusal preparation. However, I am still struggling to consistently produce a
conservative proximal box. My biggest problem lies with the beveling. In trying to produce a dramatic
bevel, I often nick the entire corner of the box, resulting in flared out proximal walls. This is clearly seen
in the buccal wall of my preparation (Fig. 1). In the future, I must learn to stop when a sufficient bevel
has been produced.
What constituted you major break–through (your aha moment) in completing this restorative
procedure?
My break–through came when I tried using the thin needle nose bur to bevel instead of hand
instruments. Previously, I was had little success obtaining a sufficient bevel on the plastic teeth with
hand instruments. The thin needle nose produced a nice clean bevel in seconds. Of course, as
mentioned above, I am now on the other end of the spectrum, beveling excessively such that I flare out
the proximal walls. Nevertheless, with improve motor control, the needle nose should prove to be an
invaluable part of my armamentarium.
In achieving this break–through, how will this help you in defining yourself as a dentist?
I now realize that there are at least two parts to a successful preparation. Fine motor control is
definitely required, but so is the knowledge of knowing what instrument to use. The first comes with
practice and time. The second comes not only with experimentation, but also in discussions with
colleagues. This last point underlines the importance of continuing education and study clubs.
What new skill did you accomplish in this exercise?
I learned to recognize the usefulness of the thin needle nose bur, and the importance of fine
motor control.
CLASS II COMPOSITE PREPARATION & RESTORATION 7
CLASS II COMPOSITE RESTORATION — 16 MO
Figure 4: Occlusal view of restoration.
True anatomy
Figure 5
CLASS II COMPOSITE PREPARATION & RESTORATION 8
Closed
contact
Figure 6: Buccal view of restoration
Central
groove
aligned
with arch
Properly
shaped
marginal
ridge
Figure 7
CLASS II COMPOSITE PREPARATION & RESTORATION 9
CRITICAL REQUIREMENTS FOR CLASS II COMPOSITE RESTORATION
Critical Evidence–Based Rationale Self Evaluation
Requirements
(As presented in
Operative 430)
Opdama, & Kuijs, 2008; Roberson et. al, 2006). nose.
In occlusion This is essential for proper occlusion. High Requirement is met.
cusps and fossa will promote force
concentration and restoration fracture. On the
other hand, anatomy that is too short will put
the tooth out of occlusion.
No marginal Marginal voids act as plaque traps, promoting Requirement is met.
voids the formation of secondary caries. Also, voids
compromise the structural integrity of the
restoration, resulting in restoration failure
(Brannstrom & Vojinovic, 1976).
Smooth, no Any rough surface can serve as attachment Requirement is met. Using the
scratches sites for cariogenic bacteria, thus promoting enhancing kit with Vaseline on the
secondary caries (Ben‐Amar, Metzger, & tooth surface gives the restoration
Gontar, 1987). Also, a rough surface may be a smooth, shiny finish.
esthetically undesirable.
CLASS II COMPOSITE PREPARATION & RESTORATION 11
REFLECTIONS ON CLASS II COMPOSITE RESTORATION
Where did you have the most problems? What did you do to solve these problems?
My biggest problem was getting composite everywhere on the tooth during placement. After curing, I
had essentially no way of removing all the flash without also performing an enameloplasty. I solved this
problem by slowing down the composite placement process. Instead of taking large clumps of
composite, I would place just a minute amount on my instrument, and carefully roll the composite into
the preparation. Extreme care was taken to not get any composite outside of the preparation. After
filling the preparation to the top, I would take a tiny amount of composite and smear it across the
cavosurface (from cured composite towards tooth structure) in order to seal the margin. A subsequent
pass of the football bur around the cavosurface margin is usually sufficient to remove any flash.
What constituted you major break–through (your aha moment) in completing this restorative
procedure?
My epiphany from this procedure is that burs play a secondary role to careful placement and contouring
of composite prior to curing. With composite, not only is the use to burs time consuming, often time it
is impossible to remove excessive flash without also removing plastic. Albeit, I have been told by upper
year colleagues that real enamel is much harder than the plastic, and that the football bur will rarely
take off any enamel. Even then, careful placement of composite will undoubtedly be important.
In achieving this break–through, how will this help you in defining yourself as a dentist?
As a future dentist, I will undoubtedly be working with many different restorative materials. It is
important to realize that different materials behave differently, and thus deserve distinct methods of
handling. Whereas amalgam restorations are overfilled and subsequently carved down, composite
behaves much differently. To treat all materials the same would be a gross negligence on my part.
What new skill did you accomplish in this exercise?
I learned how to carefully place composite, and contour it before curing. This skill is transferable to the
Class V GI restorations that we have been doing in the clinic.
CLASS II COMPOSITE PREPARATION & RESTORATION 12
REFERENCES
Anusavice, K. J. (2003). Phillips' Science of Dental Materials (11 ed.). Saunders.
Ben‐Amar, A., Metzger, Z., & Gontar, G. (1987). Cavity Design for Class II Composite Restorations. The
Journal of Prosthetic Dentistry , 58 (1), 5‐8.
Brannstrom, M., & Vojinovic, O. (1976). Response of the Dental Pulp to Invasion of Bacteria Around
Three Filling Materials. ASDC J Dent Child , 43, 83‐9.
Isenberg, P., & Leinfelder, K. F. (1990). Efficacy of Beveling Posterior Composite Resin Preparations.
Journal of Esthetic and Restorative Dentistry , 2 (3), 70‐73.
Loomans, B., Opdama, N. R., Bronkhorsta, E., & Huysmans, M. (2009). Restoration Techniques and
Marginal Overhang in Class II Composite Resin Restorations. Journal of Dentistry , 37 (9), 712‐
717.
Loomans, B., Roetersa, F., Opdama, N., & Kuijs, R. (2008). The Effect of Proximal Contour on Marginal
Ridge Fracture of Class II Composite Resin Restorations. Journal of Dentistry , 36 (10), 828‐832.
Opdam, N. J., Roeters, J. J., Kuijs, R., & Burgersdijk, R. C. (1998). Necessity of Bevels for Box Only Class II
Composite Restorations. J Prosthet Dent , 80, 274‐9.
Roberson, T., Heymann, H., & Swift, E. (2006). Sturdevant's Art & Science of Operative Dentistry (5 ed.).
Mosby.
Söderholm, K.‐J., Tyas, M., & Jokstad, A. (1998). Determinanats of Quality in Operative Dentistry. Crit
Rev Oral Biol Med , 9, 464.
Summitt, J. B. (2002). Conservative cavity preparations. Dent Clin N Am , 46, 171‐184.
Summitt, J. B., Robbins, W. J., Hilton, T. J., & Schwartz, R. S. (2006). Fundamentals of Operative Dentistry:
A Contemporary Approach (3 ed.). Quintessence Publishing.