complex multi-surface composite restorations

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COMPLEX MULTI-SURFACE

COMPOSITE RESTORATIONS

DR. PETER WALFORD

COMMON PROBLEMS

EXCESSIVE TIME

OPEN/BROKEN CONTACT

MATRIX ISSUES

GINGIVAL RE-DECAY

MORE PROBLEMS….

PULP - SENSITIVITY OR

DEATH

PITS,VOIDS,BUBBLES

UNATTRACTIVE ESTHETICS

ISOLATION CHALLENGES

INSTRUMENTATION FOR LONG

CROWNS

PREPARATION DESIGN?

WWW.PETERWALFORDDENTISTRY.COM

USERNAME cardp2012

PASSWORD halifax

LINKS ON WEBSITE

FOLLOW ((CARDP)) ON HOME PAGE TO FIND

APPROPRIATE LINKS WITHIN WEBSITE

TIME SAVERS

HEATED RESINS

FAST CURE LIGHTS

DELEGATION-the future of the restorative hygienist position

BULK FILL?- a flawed concept

CALSET COMPOSITE HEATER

BEST SETTING: 54 DEGREES

MULTIPLE DESIGNS FOR COMPULES OR SYRINGES; SYRINGE IS MOST

VERSATILE MODEL

DECREASES CURE TIME BY UP TO 75%

INCREASES PHOTOCONVERSION, HARDNESS

THINS OXYGEN-INHIBITED LAYER

FOR EVIDENCE SEE WWW.ADDENT.COM

DETERMINING CURE TIME FOR HEATED RESINS

CHAIRSIDE CURE TESTING

2MM DISC (DENMAT)

3.5 MM DISC (HARDWARE TAP WASHER)

DETERMINE CURE BY SCRATCH TEST

CRUDE BUT ONE STEP UP FROM BLIND FAITH

HAVE CDA COMPILE A TABLE- A FEW SURPRISES WILL BE FOUND

DARK SHADES AND FLOWABLES!! TAKE LONGER

SOME VERY LIGHT SHADES MAY ALSO TAKE LONGER DUE TO MISMATCH BETWEEN LIGHT

SPECTRUM AND PHOTOINITIATOR

1.

2.

3.

4.

5.

PREVENTING OPEN/BROKEN CONTACT

ANATOMICALLLY CONTOURED CIRCUMFERENTIAL MATRIX

CONTACT FORMERS

CUSTOM WEDGING

RESIN WITH SUITABLE FLEXURAL STRENGTH

ADEQUATE CURING

FLEXURAL

STRENGTH

THE IMPORTANCE OF FLEXURAL STRENGTH

THOSE PORTIONS OF THE RESTORATION EXTENDING BEYOND THE ROOT BASE MUST

TRANSFER LOADS ON A DIAGONAL PATH TO THE RETORATION

THIS CREATES A TWISTING SHEAR FORCE WITHIN THE RESIN; A “ FLEXURAL LOAD”

BEST PARAMETER TO INDICATE THIS QUALITY IS FLEXURAL STRENGTH

INADEQUATE FLEXURAL STRENGTH WILL LEAD TO BREAKAGE OF MARGINAL RIDGES

EVEN IF EVERYTHING ELSE IN THE RESTOATIVE SUITE IS PERFECT

SEE WEBSITE FOR TABLE “COMPOSITE PARAMETER SPREADSHEET”

BEST RESINS FOR LARGE RESTORATIONS:

TOP QUARTILE

GRANDIOSO (VOCO) 181 MPa

VENUS DIAMOND (HEREAUS KULZER)169MPa

FILTEK SUPREME ULTRA (3M Espe) 162MPa

VENUS

DIAMOND

ENSURING ADEQUATE CURE

UNDERCURED RESIN IS A PREVALENT CAUSE FOR FRACTURED

RESTORATIONS

SEE WEBSITE ((CURING COMPOSITES))

WIDE-SPECTRUM HIGH INTENSITY LIGHTS ARE BEST

BEST RECOMMENDATION: SAPPHIRE PLASMA ARC 5 SEC CURE

VALO LED SEE CLINICIAN’S REPORT OCTOBER 2010

ref

CRA

OCTOBER 2010

CURING DEEP BOXES

STUDY CLUB RULE; BEYOND 6MM DEPTH, USE A DUAL

CURE SYSTEM UNTIL BOX DEPTH RESTORED TO 6MM

DUAL-CURE ADHESIVE PHOTOBOND OR ALL BOND 3

DUAL CURE FLOWABLE, STARFILL 2B

STARFILL 2B

DANVILLE DENTAL

141MPa

HYBRID

S/C IN 2.5 MINS

SEVERAL CONVENIENT

AUTOMIX TIPS

RECOMMENDED JOURNALS FOR

COMPOSITE INFORMATION

REALITY

CLINICIAN’S REPORT

THE DENTAL ADVISOR

ref

RESIDUAL CARIES, BIOFILM CONTAMINATION

CARIES IS A NON-STRUCTURAL SUBSTRATE; DOESN’T BOND, HAS NO

RESISTANCE FORM

BIOFILM IS AN INVISIBLE ANDUNIVERALLY PRESENT CONTAMINANT TO

ADHESION

BOTH CONTRIBUTE TO PREMATURE FAILURE OF RESINS

CAN BE CONTROLLED WITH THE ROUTINE USE OF CARIES DETECTOR

BENEFITS OF CARIES DETECTOR

CONFIRMS COMPLETE REMOVAL (CARIES IS NOT

STRUCTURAL!!)

DISCLOSES PLAQUE

REVEALS FLASH IN FINISHING

DEEP CARIES

ANGELUS MTA 10 MINUTE SET

DOVGAN PLACEMENT

INSTRUMENT

FO FULL PROTOCOL SEE

CHAPTER IN MODXYZ

ELIMINATING AND REPAIRING PLACEMENT FLAWS

ALCOHOL AS AN INSTRUMENT LUBRICANT IN PLACEMENT

AVOIDS WEAKENING INCREMENT INTERFACES WITH ”PLACEMENT RESIN”

LIGHT SHIELD TO PERMIT UNHURRIED COHESIVE PLACEMENT-NO PREMATURE CURE

Z-PRIME PLUS (BISCO) AS AN EFFECTIVE PRIMER FOR REPAIRS –BONDS TO SILICA

18MPa, ZIRCONIM 22MPa, AND RESIN

HF ETCH OPTIMIZES ADHESION TO SILICA

USE CONVENTIONAL THIN (5-7 MICRON) GEN IV OR V ADHESIVE AFTER Z-PRIME, CURE

BOND, RESTORE

PRACTICON

ref

6.

7.

4.

5.

1.

2.

3.

REPAIRING FLAWS IN RESTORATIONS WITH Z-PRIME PLUS

OPEN DEFECT UP INTO A SMALL SAUCER

ETCH WITH PHOSPHORIC ACID IF ENAMEL MARGINS ARE INVOLVED

HF ETCH IF IS A SILICA-BASED FILLER PARTICLE (MOST RESINS ARE)

RINSE, DRY, Z-PRIME (BISCO),BLOW OFF SOLVENT, ADD PHOTOBOND, BLOW OFF EXCESS, CURE

FILL SMALL DEFECTS WITIH MATCHING FLOWABLE WITH AN EXPLORER TIP, CURE

FILL LARGE DEFECTS WITH RESTORING RESIN, CURE

FINISH WITH 7902,POLISH WITH WET SHOFU FG BROWNIE POINT, SLOW RPMS.

WEBSITE LINK ON REPAIRS

 http://www.peterwalforddentistry.com/tiki/tikiindex.php?page=Repairing%20Bubbles%2CVoids

%2C%20and%20Flaws

OPTIMUM ISOLATION

”ISOLATE OR DIE”

SUPRAGINGIVAL PREPS- ISOLATE NON-LATEX DAM

SUBGIINGIVAL- HYGOFORMIC SALIVA EJECTOR

SILVERED DRI-ANGLES (THETA)

SURGICAL SUCTION REDUCED IN LENGTH TO IMPROVE ACCESS IN LIMITED

ACCESS SITUATIONS

SALIVA EJECTOR BENT TO LIE UNDER THE TONGUE BENEATH A RUBBER DAM

QUALITIES OF AN IDEAL RESTORATIVE

RETRACTION CORD

BRAIDED NOT SPIRAL-WOUND OR LOOPED

MINIMAL EXPANSION WHEN WETTED

EPINEPHRINE-IMPREGNATED

ALUMINUM SALT-IMPREGNATED, NOT FERROUS SALTS

ONLY TWO PRODUCTS MEET THIS CRITERIA: GINGIBRAID E (VAN

R) AND SILTRAX (PASCAL)

QUALITIES OF AN IDEAL CORD PLACEMENT INSTRUMENT

MOST CORD PACKERS ARE SERRATED, OVERLY BULKY, AND UN-ERGONOMIC

OFF-ANGLE ; ERGONOMICALLY REACHES INTERPROXIMALLY

SLIM

NON-SERRATED TIP

RECOMMENDED: PFIG 4/5- CAN ALSO BE USED TO PLACE RESIN BEYOND THE

LINE ANGLES

HEMOSTATIC ETCH; A GAME-CHANGER

REQUIRES USE OF A LIQUID ETCH

LEAVES NO RESIDUE

ATRAUMATIC

VIRTUALLY 100% EFFECTIVE

INEXPENSIVE LIQUID ETCH

Henry Schein 100-0572 (210cc) diluted 3:1 by volume with distilled water

About $50

Makes up to 840 cc of etchant

0 1 2 3

DEPTH OF

DEMINERALIZATION

4 5 6

THE STUDY CLUB ADHESIVE SYSTEM

SEE

((Bonding|Bonding Protocol))

MICROPRIME B

EFFECTIVE CROWN PREP DESENSITIZATION, HYPERSENSITIVE DENTIN

LESS TISSUE-TOXIC THAN GLUTERALDEHYE FORMULATIONS SEE CRA AUGUST 2002

STABILIZES THE COLLAGEN NETWORK TO IMPROVE LONG TERM BOND DURABILITY

COMPATIBILE WITH ALL GEN IV AND V ADHESIVES (TOTAL ETCH)

DUAL-CURE ADHESIVES:

PHOTOBOND (KURARY) 20MPa OR ALL-BOND 3 (BISCO)35MPa

BOTH ARE:

ALCOHOL BASED

THIN ( 5-7 MICRONS THICK,)

DURABLE

IF YOU CAN ISOLATE IT

AND MATRIX IT,

YOU CAN RESTORE IT

THE END

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