Clinical considerations

in
Composite Restoration
Presented by:
MUSKA GUL
Final Year BDS
CONTENTS
■ Factors to be considered for a successful composite restoration.
■ Advantages and disadvantages
■ Indications and contraindications
■ Shade selection
■ Initial clinical procedure
■ Tooth preparation
■ Adhesion techniques
■ Restorative technique
■ Finishing and polishing
AIMS
■ How to enhance binding to substrate
■ Requirements for effective bonding
■ How to minimize polymerization shrinkage
■ Polishing and finishing
Contraindications

■ Allergy (the only absolute contraindication)

■ Access and isolation difficulties
■ Heavy/abnormal occlusal forces
■ High caries index
■ Poor oral hygiene
■ Subgingival extension
 ADVANTAGES DISADVANTAGES
■ Esthetics ■ Polymerization shrinkage
■ Conservative tooth preparation ■ Marginal deterioration
■ Low thermal conductivity ■ Difficult and time consuming
■ Adhesion to tooth ■ Techniques sensitive
■ Repairability ■ Occlusal wear
 To enhance bonding to
substrate

■ Etching
■ Priming
■ Bonding agent
ENAMEL ADHESION
■ Agent: 37% phosphoric acids
■ Time: 15 seconds
■ Mechanism: resin micro tags formation, micromechanical
retention
DENTIN ADHESION
■ Great challenge:
Organic collagen
Hydrated tissue
Smear layer
■ Dentin bonding systems:
Etchant: Phosphoric acid
Primer: Hydrophilic agent
Bonding agent: Resin monomer
Requirements for effective bonding

■ Moisture control
■ Adequate isolation:
Rubber dam
cotton rolls
Retraction cord
■ Initial clinical technique
■ No residual caries
■ Margin should not be on areas of occlusal contact
■ Proper technique
■ Bevel the enamel
■ Proper curing
POLYMERIZATION SHRINKAGE

■ When composite monomer is converted into polymer, it shrinks an

creates considerable stresses on the tooth-restoration interface.
■ Unrelieved stresses contribute to:
1. Internal bond disruption
2. Marginal gaps
3. Microleakage
4. Post operative sensitivity
FACTORS
■ C-factor
■ Rate of polymerization
■ Nature and volume of inorganic fillers
■ Insertion technique
■ Degree of conversion
CAVITY CONFIGURATION
FACTOR
During curing, shrinkage leaves the bonded surfaces in a state of stress, while the free
surface release some of the stresses by contracting inwards towards the bulk of material.

Overcome by:
1. Incremental technique
2. Low modulus of elasticity
3. Light curing procedure
4. Preheating
5. Novel formulations with nanofillers
FINISHING

■ Trim the excess composite

■ Finishing:
1. Tungsten carbide finishing burs
2. Rugby ball shaped fine diamond bur
3. Flexible , abrasive disc

■ Polishing paste
MODES OF FAILURE

■ Discoloration
■ Marginal fractures
■ Recurrent caries
■ Post-operative sensitivity
■ Plaque accumulation
CONCLUSION
■ Composite have acquired a prominent place among direct filling
materials, giving rise to a variety of therapeutic indications, which
continue to grow.
■ Nonetheless, it should not be forgotten that it is highly technique
sensitive.
■ Hence the need to control certain factors:
1. Correct indication
2. Good isolation
3. Choice of right composite
4. Correct procedure
5. Proper curing
6. Proper finishing and polishing