CLASS II COMPOSITE

CAVITY PREPARATION
INDICATIONS

– Small and moderate restorations

– When esthetics is critical
– Some may serve as foundations for crowns
– To strengthen remaining weakened tooth structure (for
economic or interim use reasons)
CONTRAINDICATIONS

– When the operating site cannot be appropriately isolated

– With heavy occlusal stresses
– When all the occlusal contacts are only on composite
– Restorations that extend onto the root surface
ADVANTAGES

– Esthetics
– Conservative tooth structure removal
– Easier, less complex tooth preparation
– Economics (compared to crowns and indirect restorations)
– Insulation(Low thermal conductivity)
– Increased retention
– Increased strength of remaining tooth structure
– Alternative to Amalgam
DISADVANTAGES

1. Material related
– Greater localized wear
– Polymerization shrinkage effects
– Postoperative sensitivity
– Secondary caries lesion
– Marginal leakage
DISADVANTAGES

2. Require more time to place

3. More technique sensitive
• Etching, priming, adhesive placement
• Inserting composite
• Developing proximal contacts
• Finishing and polishing
4. More expensive than amalgam restorations
Tooth preparation principles and
criteria
External Outline form

– Extent is determined by size, shape, and location of defect .

– should include all Caries, any fault, defective, old friable tooth
structure.
– Removal of discolored tooth structure as required for esthetics.
– Create prepared enamel margin of 90° or greater by giving bevel
wherever required.
– Create 90° cavosurface on root surfaces
– Pulpally, no uniform depth is needed
– Depth should be sufficient to identify and remove caries or existing
restoration.
 RETENTION

1. Micromechanical retention by etching of enamel and

dentin.
2. Mechanical undercuts when margins terminate in
cementum.
BEVEL

– Gingival margin should be beveled only

– If the margin is in enamel
– Well away from cementoenamel junction
– Adequate band of enamel remains
FACIAL AND LINGUAL WALLS
FORM RIGHT ANGLE (900 CSA)

– Conservative bevel (0.5 mm) at 45 degree angle on the

facial and lingual cavo surface margins
FACIAL AND LINGUAL WALLS
FORM OBTUSE ANGLE (>900
CSA)
– No further bevelling is necessary
REVERSE BEVEL

– Gingival margin should not be beveled

– If the margin is approaching within 1 to 1.5 mm of the
cementoenamel junction
– Weak band of enamel remains
 Advantages of beveling.

1. Increase in surface area because stronger enamel

to resin bond

2. Ends of enamel rods are etched.

3. Esthetic blending due to cavosurface bevel.

Cavity designs for composite cavity
preparation

– Conventional
– Beveled conventional
– Modified
– Box shape
– Facial/lingual slot
CONVENTIONAL
similar to that of cavity preparation for amalgam restoration.
A uniform depth of the cavity with 90° cavosurface margin is
required

INDICATIONS
1. Moderate to large class I and class II restorations
2. Preparation is located on root surfaces.
3. Old amalgam restoration being replaced
Conventional Class II composite
tooth preparation.
Occlusal view.
MODIFIED
1. No specified wall configuration.
2. No Specified pulpal or axial depth.
3. All parameters determined by extent of caries.
4. Conserve tooth and obtain retention (MICRO
MECHANICAL).
5. Scooped out appearance

INDICATIONS
– small, cavitated, carious lesion surrounded by enamel
– correcting enamel defects.
 BOX ONLY
– When only Proximal
surface is faulty and no
lesion on occlusal surface
 FACIAL OR LINGUAL SLOT
1. Lesion is proximal but access is possible through facial
or lingual surface
2. Cavosurface is 90 or greater.
3. Direct access for removal of caries.
Isolation of operating site
- Rubber dam
- cotton rolls
- retraction cord

Pulp protection
- Calcium hydroxide, GIC , RMGI
- ZnOE is contraindicated
COMPOSITE
RESTORATION
PREWEDGING

– It’s the placement of interproximal wedge at the start of

procedure(cavity preparation) in order to open the contact
with the adjacent tooth and to compensate for the
thickness of matrix band
Advantages

– Tight interproximal contacts.

– Wedge can protect the rubber dam from damage and
gingival tissues from laceration,so reducing leakage into
the operative side.
– Tooth separation promotes more conservative preparation
and protect adjacent teeth from damage during
preparation
PLACING THE MATRIX BAND
– Thin metal or clear Mylar or pre-contoured metal or plastic is selected

– Metal has the advantage that it can be firmly burnished against the
adjacent tooth

– Mylar strip has advantage that curing light can pass through it & a
better curing of composite is possible
Precontoured metal matrix

– Most matrix bands are flat occluso-gingivally.

– Flat interproximal contours, where the contact point is

translocated high occlusally.

– This contact is often broken  under normal occlusal forces.

Sectional matrix system

– Sectional matrix system are helpful in developing tight

interproximal contacts.
– This system consist of thinner, dead-soft, stainless-steel
matrix bands and specialized metal rings with springlike
properties.
Sectional Matrix System

– Palodent and palodent plus Sectional Matrix System

– Composi-Tight Matrix System
– Composi-Tight 3D Matrix System
– Optramatrix
– Supermat Matrix System
– Triodent V Ring System
– Triodent V3 Ring System
– Omni Matrix
Composi-Tight 3D Matrix System
Optramatrix
Triodent V Ring System
Omni Matrix
PLACING THE MATRIX
BAND AND WEDGE
ETCH WITH PHOSPHORIC
ACID GEL
THE ACID GEL IS WASHED
AWAY
EXCESS WATER IS BLOWN WITH
AN AIR SYRINGE.
THE BONDING AGENT IS APPLIED
(FOLLOW MANUFACTURER’S
DIRECTIONS).
THE BONDING AGENT IS
LIGHT-CURED
THE FIRST COMPOSITE IS
PLACED
INCREMENTAL LAYERING
TECHNIQUE
2mm layer
– Oblique layering technique
– Horizontal layering technique
THE COMPOSITE IS DIRECTED
TO THE FLOOR AND ONE WALL
OF THE PROXIMAL CAVITY.
THE RESTORATION IS CURED
THROUGH THE TOOTH FROM THE
SAME SIDE..
CURING UNITS

– HALOGEN UNITS
– LED UNITS
– PLASMA ARC
– LASERS
– TWO STEP, SOFT START, RAMPED CURING
THE MATRIX IS REMOVED AT
THE END AND FINISHING
DONE.
FINISHING TOOLS
 Rebonding

– Rebonding is performed after the restoration is finished

and polished.
– The enamel margins are re-etched and coat of low-
viscosity resin is placed over the restoration surface and
polymerized
 Significance

– Improve marginal integrity

– Color stability
– Improve wear resistance
– Reduce staining of the restoration
BONDED BASE
TECHNIQUE

– If the margin is approaching within 1 to 1.5 mm of the

cementoenamel junction
– No band of enamel remains
– Margins in dentin
– Resin modified GIC(RMGIC) should be placed as first layer
at margin
– Also called Sandwich Technique
BONDED BASE
TECHNIQUE
SNOW PLOW TECHNIQUE

– Thin increment of flowable composite is placed at the

gingival margin
– This layer is not cured
– Initial increment of normal composite is syringed or push
into the unset flowable resin composite
– Then light cured
TIGHT INTERPROXIMAL
CONTACTS

– Prewedging
– Sectional matrix system
– Contact forming instruments
– Conical light tip
– Precured composite ball
– Class transition technique