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CLASS V RESTORATIONS 11.21.

07
Important to differentiate carious and non carious
Non-Carious Class V lesion
- abrasion
- Erosion
- Abfraction (maybe)
- A combination of these entities
Non- Carious treatment options
- maybe non restorative
- eliminating the causative factors of the lesions
- regularly monitoring their progression
- periodontal treatment
- surgically cover the lesion with a connective tissue graft
- may result in a more natural gingival architecture
- Only connective tissue graft
o If there is no attached gingiva
o No enamel defect is present on the root
o ??
o Papilla length and fullness are adequate
o Esthetics is crucial restoring a more natural gingival contour
- Restorative treatment
o Lesion is active and no success in stopping its progression
o Integriy of the tooth structure is jeopardized
o A pulpal exposure becomes imminent
o Hypersensitivity does not subside with nonrestorative tx
o Lesion location compromises the planning of a removable prothesthesis
- Only restorative
o There is an adequate attached gingiva
o Defect is mainly I nenamel
o Lesion is deeper than 2mm horizontally
o Class III recession; there is some loss of interdental bone
o Esthetics is not of primary importance
o Tooth may still be taller than adjacent teeth after restorative treatment
- Combination treatment
o Flap
o Gingivectomy
o Gain access
Maintaining biologic width
- 3mm biologic width from gingival margin of direct restoration
- To gingival crest of bone
- Tx may involve??

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C. Nelson

Factors influencing choice of restorative material for class V or root caries


- caries risk
o field control
- strength requirements
- accessibility to lesion for placement, finishing, polishing
- longevity requirements
How retentive does the lesion present? If not very retentive, and you dont want to prep,
use GI.
Can you get a curing light to the spot?
Behavior problems?
Esthetic requirements?
Class V Clinic materials
1. GI fuji II light cured resin modified GI
2. Fuji IX not light cured GI resin only
a. Requires a fuji coat to prevent water movement
3. amalgam
4. composite
Caries risk high, use
1. GI fluoride release
2. Amalgam cariostatic less plaque
3. composite no inhibition most plaque
Field control not excellent, use
1. amalgam
2. glass ionomer
3. composite
Esthetics important, use
1. composite
2. glass ionomer
a. our clinic does not give us very many shades to choose from
3. amalgam
To groove or not to groove (retention groove)
When class V composite gingival prep margin is on root structure no gingival retention
grove placed unless there is evidence of occlusal dysfunction.
If there is posterior interferences or mobility, wear facets, or parafunction (bruxism), you
may need the retention groove.

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C. Nelson

Restoring materials and sequencing of placement


Flowable composite as the first increment in a THIN layer gingivally (we dont want it to
be on the enamel.
For a better esthetic result with class V composite, etch and bond past your occlusal
bevel. Also, allow the occlusal composite increment to go past your bevel (maybe just
like 1mm). Thin out or feather edge the occlusal composite with a gloved finger or other
instrument and wetting resin. ?? another sentence ??
Strength is important
1. amalgam
2. composite
3. glass ionomer
Amalgam
- requires minimum 1mm depth in a non-stressed area.
- 90 degrees exit angles.
- Sharp internal line angles and gingival retention grooves
Accessibility to place, finish posterior resin
1. amalgam
2. composite
Lingevity is critical
1. amalgam
2. composite
Lesion doesnt require much tooth preparation
1. glass ionomer
2. ?
3. ? didnt get it see slide ?
Glass ionmer cements
- cement implies luting material
o any substance which sets to a hard mass on being mixed with water or
another material
- only dental cement that is also a direct restorative material
Early glass ionomers
- poor esthetics
- prolonged setting rxns
- poor wear resistances
o vulnerable to hydration extremes
- handling difficulties

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C. Nelson

Glass ionomers
- inherent chemical adhesion to tooth structure
- fluoride release
- but sensitive to moisture and dessication
- low fracture toughness
- low flexure strength
- low wear resistance
- relatively poor esthetics
One way to classify glass ionomers:
- how the material sets up
o conventional GI is a powder and liquid
powder: glass
liquid: acid
Vitrebond is a resin modified glass ionomer.

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C. Nelson