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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 Gingival and proximal contacts broken in this case Figure 1: Occlusal view of preparation. shown with PQW Bevel on proximal box Divergent walls Narrow outline form .5 mm Figure 2: Occlusal depth of preparation. Occlusal depth of 1.
.CLASS II COMPOSITE PREPARATION & RESTORATION 3 Figure 3: Other views of preparation.
2003. Furthermore. B. Metzger. Thus. Narrow outline form Minimal proximal box Bevel on proximal walls Requirement is met. a narrower prep minimizes this deleterious effect (Summitt et. Summitt et. & Gontar. conservative buccolingually. controversies surround this issue (Isenberg & Leinfelder. since polymerization shrinkage occurs toward the bulk of the material.. 1990). The buccal wall especially flares out. 2006). 1987). Roeters.5 mm deep from the occlusal can be designed to be more conservative aspect (Fig. thus minimizing the risk of restoration can probably be a tad more failure (Ben‐Amar. 2006). Rounded internal line angles This serves two purposes. adhesive systems allow for stronger bonding to enamel than dentin. Thus. Thus. (Anusavice. This minimizes the risk voids and microspace leakage. Unlike amalgam. al. the extent of the carious lesion will determine the buccolingual dimensions of the proximal box (Summitt J. Beveling exposes more enamel rods for bonding. their elimination is essential (Ben‐Amar. al. Ben‐Amar. to the preparation walls. resulting in a stronger bond. 2). & Burgersdijk. Kuijs. and minimizes marginal leakage (Opdam. My preparation is acceptable. sharp angles will serve as points of stress concentration. contacts do not need to be opened to allow entry of a carver. 2006. Metzger. 1987). resulting in restoration fracture.CLASS II COMPOSITE PREPARATION & RESTORATION 4 CRITICAL REQUIREMENTS FOR CLASS II COMPOSITE PREPARATION Critical Requirements (As presented in Operative 430) Evidence–Based Rationale Self Evaluation Shallow (1 mm) Composite does not require bulk to withstand My preparation is approximately occlusal forces. & Gontar. A thin needle nose was used to achieve this. Thus. Instead. composite preparations 1. Also. Rounded line angles Axiopulpal line angle could be allow the composite to bead and adapt closely smoothed out a bit more. Proximal box is fairly large. al. In addition. This aids in retention. & Gontar. Contact was broken inadvertently. However. but it A narrow outline form allows for less occlusal contact. 1987). 1998. it is desirable to stay within the enamel layer if the carious lesion allows for this (Summitt et. Metzger. . composite restorations cannot be carved after curing. 2002). Ben‐Amar.
However. This was achieved by using the tapered diamond bur. .CLASS II COMPOSITE PREPARATION & RESTORATION 5 Metzger. Söderholm. it is desirable to have the restoration fall out once it fails. If not. al. Gingival contact just broken Ultimately. detection of secondary carious under a failed. since most carious lesions are found just gingival to the contact point. & Jokstad. 1998). The gingival depth of my preparation could be more conservative. Since composite chemically bonds to tooth structure. the carious lesion will determine how far the proximal box should extend gingivally. will be very difficult. Moreover. Tyas. Summitt et. 1987. because marginal leakage with composite is a much more prominent problem. but mechanically retained restoration. and also by running along the walls with angled feather strokes in the end. 2006. we have made this a requirement for our preparations. mechanical retention is not required. Walls slightly divergent Requirement is met. & Gontar.
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. Of course. both in terms of width and depth. beveling excessively such that I flare out the proximal walls. Previously. In achieving this break–through. and the importance of fine motor control. More practice with fine motor control since completing the photographed preparation has resulted in great improvements in my occlusal preparation. the needle nose should prove to be an invaluable part of my armamentarium. However. I must learn to stop when a sufficient bevel has been produced. I was had little success obtaining a sufficient bevel on the plastic teeth with hand instruments. 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. The thin needle nose produced a nice clean bevel in seconds. The first comes with practice and time. I am still struggling to consistently produce a conservative proximal box. Nevertheless. with improve motor control. but also in discussions with colleagues. 1). I often nick the entire corner of the box. resulting in flared out proximal walls. The second comes not only with experimentation. This is clearly seen in the buccal wall of my preparation (Fig. What new skill did you accomplish in this exercise? I learned to recognize the usefulness of the thin needle nose bur. In trying to produce a dramatic bevel. .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. My biggest problem lies with the beveling. as mentioned above. Fine motor control is definitely required. I am now on the other end of the spectrum. In the future. but so is the knowledge of knowing what instrument to use. This last point underlines the importance of continuing education and study clubs.
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 .
and then meticulously ran over all the margins of the restoration with the football bur (occlusal) and needle nose (proximally). composite flash easily cracks under occlusal pressure. This was done by careful placement and contouring of composite prior to curing. an unnatural bulge had to be created proximally (Fig. No flash Flash by itself is an uneven surface between tooth and composite. food impaction is highly uncomfortable for the patient. resulting in fracture. Roetersa. misalignment could result in greater alignment occlusal loading on the restoration. True anatomy This is essential for proper occlusion. An under–carved restoration could easily fracture due to concentration of occlusal forces. and result in restoration failure. Conversely. Note that in order to close the contact on my dentoform. Requirement is met. gingivitis. Opdama. 2009). This was done by proper placement of the bytine matrix. Contouring prior to curing was the key. and use of the coarse gapped finishing strips. An overly Requirement is met. Bronkhorsta. Properly This is essential for proper occlusion. in proper arch Moreover. The shaped bulky ridge will be subjected to concentrated ridge was built up just slightly marginal ridge occlusal forces. resulting in marginal leakage. al.CLASS II COMPOSITE PREPARATION & RESTORATION 9 CRITICAL REQUIREMENTS FOR CLASS II COMPOSITE RESTORATION Critical Requirements (As presented in Operative 430) Evidence–Based Rationale Self Evaluation Closed contact Closure of contact prevents food impaction. which could increase the risk of caries. true occlusal anatomy helps with food clearance during mastication (Roberson et. and promote food impaction (Loomans. Requirement is met. and can result in secondary caries and periodontal diseases (Loomans. I placed the composite very carefully. Moreover. 6) Requirement is met. Moreover. This was done by using a bytine matrix. & Huysmans. This rough ledge serves as an attachment site for cariogenic bacteria. Requirement is met. over–carving could put the tooth out of occlusion. and periodontal disease (Roberson et. A ridge that is shorter than the adjacent tooth may higher than the adjacent ridge. Central groove This is essential for proper occlusion. Overhangs act as plaque traps. Smooth interproximal Requirement is met. It is also uncomfortable for the patient. 2006). This further increase the risk of secondary caries. 2006). al. then burred down with the needle . and lightly pushing composite towards the adjacent tooth before curing. In addition.
& Kuijs. Any rough surface can serve as attachment sites for cariogenic bacteria. Smooth. shiny finish. Roberson et. al. thus promoting secondary caries (Ben‐Amar. nose.CLASS II COMPOSITE PREPARATION & RESTORATION 10 Opdama. Marginal voids act as plaque traps. No marginal voids Requirement is met. 1987). 2008. & Gontar. . Requirement is met. a rough surface may be esthetically undesirable. Using the enhancing kit with Vaseline on the tooth surface gives the restoration a smooth. promoting the formation of secondary caries. Also. no scratches Requirement is met. High cusps and fossa will promote force concentration and restoration fracture. anatomy that is too short will put the tooth out of occlusion. Metzger. In occlusion This is essential for proper occlusion. 1976). voids compromise the structural integrity of the restoration. Also. On the other hand. resulting in restoration failure (Brannstrom & Vojinovic. 2006).
In achieving this break–through. I solved this problem by slowing down the composite placement process. To treat all materials the same would be a gross negligence on my part.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. I would place just a minute amount on my instrument. With composite. It is important to realize that different materials behave differently. Albeit. and contour it before curing. 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. composite behaves much differently. Extreme care was taken to not get any composite outside of the preparation. What new skill did you accomplish in this exercise? I learned how to carefully place composite. A subsequent pass of the football bur around the cavosurface margin is usually sufficient to remove any flash. I will undoubtedly be working with many different restorative materials. After filling the preparation to the top. . how will this help you in defining yourself as a dentist? As a future dentist. careful placement of composite will undoubtedly be important. and carefully roll the composite into the preparation. often time it is impossible to remove excessive flash without also removing plastic. Even then. 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. I had essentially no way of removing all the flash without also performing an enameloplasty. Instead of taking large clumps of composite. not only is the use to burs time consuming. This skill is transferable to the Class V GI restorations that we have been doing in the clinic. and that the football bur will rarely take off any enamel. and thus deserve distinct methods of handling. Whereas amalgam restorations are overfilled and subsequently carved down. I have been told by upper year colleagues that real enamel is much harder than the plastic. After curing.
K. J. Dent Clin N Am . (1987). Cavity Design for Class II Composite Restorations.. Söderholm. Crit Rev Oral Biol Med .. 2 (3). 46. N. Hilton. B.. N. (2003). Robbins... (2009). (2006). 70‐73. R. T. Opdama. 828‐832. M. O. Conservative cavity preparations. R. Fundamentals of Operative Dentistry: A Contemporary Approach (3 ed.. J.). B.. (2002). E. 712‐ 717. A. K. C. 36 (10). . Sturdevant's Art & Science of Operative Dentistry (5 ed. Journal of Dentistry . (2006). Isenberg. Determinanats of Quality in Operative Dentistry. M. & Vojinovic. Tyas. E. J. Ben‐Amar. Response of the Dental Pulp to Invasion of Bacteria Around Three Filling Materials. Summitt. Bronkhorsta.. Restoration Techniques and Marginal Overhang in Class II Composite Resin Restorations. 171‐184. 464.). Quintessence Publishing. R. G. 58 (1). & Gontar. R. Journal of Esthetic and Restorative Dentistry . Loomans. & Leinfelder. J. (1990). (2008). P. Opdama..).. 274‐9. & Schwartz. R. & Swift. W. M.. J. 43. Z. Summitt.. Loomans.. N. J.. Roberson. B. 83‐9. F. (1976). (1998). 37 (9). Mosby. S. 80. F.CLASS II COMPOSITE PREPARATION & RESTORATION 12 REFERENCES Anusavice. & Kuijs. Roetersa. & Huysmans. Metzger. The Effect of Proximal Contour on Marginal Ridge Fracture of Class II Composite Resin Restorations. J Prosthet Dent . Saunders. H.. A.‐J. & Jokstad... Heymann. (1998). Kuijs. B.. & Burgersdijk. Efficacy of Beveling Posterior Composite Resin Preparations. 5‐8. Phillips' Science of Dental Materials (11 ed. 9. Roeters. The Journal of Prosthetic Dentistry . Opdam.. K. T. ASDC J Dent Child . Brannstrom. Journal of Dentistry . J. Necessity of Bevels for Box Only Class II Composite Restorations. J..
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