posterior composite.pptx about copmosire

posterior composite.pptx about copmosire

1. Posterior composite Amira mahmoud

2. Outline 01. Introduction 02. Materials 03. Approaches 04. Techniques 05. Class II 06. How to obtain proper contact 07. Tools 08. Finishing & polishing 0.9 Failures 2

3. Introduction 3 Post composite is used to restore posterior teeth in different classes: I,II, V, VI

4. Anatomy: Posterior teeth have different anatomy ex: L6 has DB cusp as a third cusp while L7 has 2 B cusps only Upper molars oblique ridge connects the DB cusp with MP cusp 4

5. Function: Proper occlusion should be obtained as posterior teeth are under huge forces. High spots need to be eliminated to withstand occlusal forces Proper materials need to be used 5

6. Posterior composite approaches Indirect Semi-indirect Every day dental practice and can be done with different techniques Composite applied into the cavity w ith the use of separating medium Initial curing inside pt mouth and final cure outside by heat tempering or light Eliminate the use of impression and done in single visit Direct Cases that needs cuspal coverage Fast with low cost Direct build up to block the undercuts then preparation impression indirect restoration Spreafico R. et al. Clinical performance and marginal adaptation of class II direct and semidirect composite restorations over 3,5 years in vivo. Journal of Dentistry. 2005; 33: 499-507 Nandini S. Indirect resin composites. J Conserv Dent. 2010 Oct;13(4):184-94. doi : 10.4103/0972-0707.73377. PMID: 21217945; PMCID: PMC3010022. Done on a die using separating medium Can be done by usual composite or cad cam blocks The advantage of this technique is that the proximal contours can be achieved appropriately

7. Techniques: stamp tech International Journal of Dentistry Research 2017; 2(1): 3-7

8. Cusp by cusp tech   time-consuming reduce finishing time precise attention to progressive reconstruction of natural morphology . Chandrasekhar V, Rudrapati L, Badami V, Tummala M. Incremental techniques in direct composite restoration. J Conserv Dent. 2017 Nov-Dec;20(6):386-391. doi : 10.4103/JCD.JCD_157_16. PMID: 29430088; PMCID: PMC5799982. 9

9. Incremental packing tech Horizontal tech Increase c factor Increase shrinking stresses Vertical tech Polymerization shrinkage= Gap at gingival wall= post op sensitivity & recurrent caries Oblique tech  reduces the C-factor prevents the distortion of cavity walls Chandrasekhar V, Rudrapati L, Badami V, Tummala M. Incremental techniques in direct composite restoration. J Conserv Dent. 2017 Nov-Dec;20(6):386-391. doi : 10.4103/JCD.JCD_157_16. PMID: 29430088; PMCID: PMC5799982.

10. Bulk fil tech Less clinical time Less risk of contamination increased translucency of these resins due to their incorporation of more photoinitiator reagents allows for deeper photopolymerization and permits insertion of the material into thick 4–5 mm increments, with uniform polymerization and degree of conversion. Tech: two-step bulk technique (using flowable bulk-fill covered with conventional resin material) the bulk technique with sonic activation (using flowable bulk-fill with sonic activation) the bulk technique (using paste-like or regular bulk-fill) Arbildo -Vega HI, Lapinska B, Panda S, Lamas-Lara C, Khan AS, Lukomska-Szymanska M. Clinical Effectiveness of Bulk-Fill and Conventional Resin Composite Restorations: Systematic Review and Meta-Analysis. Polymers (Basel). 2020 Aug 10;12(8):1786. doi : 10.3390/polym12081786. PMID: 32785019; PMCID: PMC7464794.

11. Preheated composite I mprove handling and marginal adaptation It will decrease its viscosity and thickness, increasing its flow and adaptation with the cavity walls. preheating increases the polymerization rate and microhardness of composite resin, improving its physico mechanical properties Used for cementation o f indirect restorations Bhopatkar J, Ikhar A, Chandak M, Mankar N, Sedani S. Composite Pre-heating: A Novel Approach in Restorative Dentistry. Cureus . 2022 Jul 22;14(7):e27151. doi : 10.7759/cureus.27151. PMID: 36004030; PMCID: PMC9392864. 12

12. Class II: split-increment horizontal placement tech placing composite resins in increments reduces shrinkage stresses. Several incremental techniques have been proposed and used to restore Class II cavities, building up the proximal wall (thus converting the Class II cavities into Class I) and restoring both the remaining proximal portion and the occlusal portion in increments. Hassan K, Mante F, List G, Dhuru V. A modified incremental filling technique for Class II composite restorations. J Prosthet Dent 1987;58:153-156.

13. Class II: snow plow tech Utilizing the snowplow approach in high-stress areas can make restorations more fracture-resistant. Placement of non cured layer of flowable followed by denser filled composite Ölçer Us Y, Aydınoğlu A, Erşahan Ş, Erdem Hepşenoğlu Y, Sağır K, Üşümez A. A comparison of the effects of incremental and snowplow techniques on the mechanical properties of composite restorations. Aust Dent J. 2024 Mar;69(1):40-48. doi : 10.1111/adj.12982. Epub 2023 Oct 9. PMID: 37814190.

14. Class II: injection molding tech A redesigned cavity preparation, a translucent matrix system, and the proper combination of paste and flowable composites Reduces the potential for voids and fault lines while maintaining the structural integrity of the tooth Geštakovski D. The injectable composite resin technique: minimally invasive reconstruction of esthetics and function. Clinical case report with 2-year follow-up. Quintessence Int. 2019;50(9):712-719. doi : 10.3290/j.qi.a43089. PMID: 31482154.

15. Class II: DME working field should be completely isolated. the matrix should isolate margins accurately and ensure a perfect seal around them. the connective compartment of BW must not be violated by the matrix Materials to be used: microhybrid , nanohybrid, bulk-filled composites Universal etch better than total due to sensetivity Samartzi TK, Papalexopoulos D, Ntovas P, Rahiotis C, Blatz MB. Deep Margin Elevation: A Literature Review. Dent J (Basel). 2022 Mar 14;10(3):48. doi : 10.3390/dj10030048. PMID: 35323250; PMCID: PMC8947734.

16. How to obtain proper contact: matrecing

17. Bioclear matrix

18. How to obtain proper contact: wedging Pink line: 2 mm height from the bone crest. Purple line: cervical embrasure measurement in mesio -distal direction at 2 mm from the bone crest (width of the wedge). Green line: distance between the ideal contact area to 2 mm from the bone crest (height of the wedge). Gancedo-Gancedo T, Martín- Biedma B, Domínguez- Cachón J, Garrido-Parada S, Ababii V, Pereira- Lores P, García-Varela S, Castelo-Baz P. New Technique for Wedge Selection in Direct Class II Restorations: A Pilot Study.  Journal of Clinical Medicine . 2024; 13(5):1324. https://doi.org/10.3390/jcm13051324

19. Wedges Wooden wedge A+ wedge Coated with aluminium sulphate 3D fusion ultra adaptive wedge Diamond wedge 20

20. Tools

21. Posterior misura Measuring thickness of composite layers condensa Condensation to prevent voids Eccesso Excess residual removal Applica twist Proximal walls and marginal ridges Easier approach to inaccessible areas 22

22. Cusp misura Measuring cusp thickness and height Solo posterior Composite modeling Replica posterior Cusp modeling fissura Occlusal anatomy 23

23. Finishing & polishing Marigo , L., Nocca , G., Fiorenzano , G., Call&agrave ;, C., Castagnola , R., Cordaro , M., ... & Sauro , S. (2019). Influences of different air-inhibition coatings on monomer release, microhardness, and color stability of two composite materials.  BioMed research international ,  2019 . 24 Removal of oxygen-inhibited layer Gross finishing Final polishing

24. Failures & repair Discoloration Ttt : Resurfacing or replacement Wear Due to difference of load distribution Fracture Improper cavity design Hypersensitivity If due to cuspal deflection replace it with temp for 2weaks High spot 2020 IJRTI | Volume 5, Issue 2 | ISSN: 2456-3315 25

25. Failures & repair Dislodgement Improper bonding Cytotoxic pulp reaction Incomplete curing of the monomers Marginal overhang Improper matricing Recurrent caries Marginal leakage Incomplete caries removal 26

26. Thank you 27