Posterior composite restorations my pres 222222.pptx

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1. Posterior composite restorations; tools, materials and techniques. Dr:Mena Rafat

2. Outline: Introuduction contraindication of posterior composites restoration Tools Materials Techniques

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

4. contraindications In patients with high caries risk and poor oral hygiene. High occlussal stresses as in patients with para-functional habits like clenching and bruxism. Patient allergic & sensitive to resin composite. Subgingival difficulties .

5. Tools

6. 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 6

7. Cusp misura Measuring cusp thickness and height Solo posterior Composite modeling Replica posterior Cusp modeling fissura Occlusal anatomy 7

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

9. 1)sectional matrix: achieve a strong contact point in Class II restorations with composite resin in the posterior 2) saddle matrix: it is useful for teeth without an adjacent tooth or distal caries on a last standing tooth. 3) compensating for the missing walls of the tooth and containing the filling material, and can be easily manipulated to match the natural contours of the treated tooth

10. TYPES OF COMPOSITE RESINS Composite resin can be divided into seven types based on the size, amount and composition of the inorganic filler Macro-filled filler. Micro-filled filler. Hybrid filler . Nano-filled filler. Bulk filler. fiber-reinforced composite Flowable composite Bonsor SJ (2013). A clinical guide to applied dental materials. Pearson, Gavin J. Amsterdam: Elsevier/Churchill Livingstone. pp. 73–75. ISBN 978-0-7020-3158-8. OCLC 824491168. 10

11. 11 Macrofilled Composite Resins Macrofilled :- fillers have a particle size ranging from 5 - 10 μm . They have good mechanical strength but poor wear resistance. Final restoration is difficult to polish adequately leaving rough surfaces, and therefore this type of resin is plaque retentive. Bonsor SJ (2013). A clinical guide to applied dental materials. Pearson, Gavin J. Amsterdam: Elsevier/Churchill Livingstone. pp. 73–75. ISBN 978-0-7020-3158-8. OCLC 824491168.

12. Microfilled Composites Resins Microfilled fillers are made of colloidal silica with a particle size of 0.4 μm . Resin with this type of filler is easier to polish compared to macrofilled . It has poor wear resistance. Bonsor SJ . A clinical guide to applied dental materials. Pearson, Gavin J. Amsterdam: Elsevier/Churchill Livingstone. pp. 73–75. ISBN 978-0-7020-3158-8. OCLC 824491168. 12

13. Hybrid Composite Resins Hybrid filler :_ contains particles of various sizes with filler load of 75-85% by weight. It was designed to get the benefits of both macrofilled and microfilled fillers. Resins with hybrid filler have reduced thermal expansion and higher mechanical strength. However, it has higher polymerisation shrinkage due to a larger volume of diluent monomer which controls viscosity of resin. Bonsor SJ (2013). A clinical guide to applied dental materials. Pearson, Gavin J. Amsterdam: Elsevier/Churchill Livingstone. pp. 73–75. ISBN 978-0-7020-3158-8. OCLC 824491168. 13

14. Nanofilled filler Nanofilled composite has a filler particle size of 20-70 nm Nanoparticles form nanocluster units and act as a single unit. They have high mechanical strength similar to hybrid material, high wear resistance, and are easily polished. However, nanofilled resins are difficult to adapt to the cavity margins due to high volume of filler. Sonal S, Kumar SR, Patnaik A, Meena A, Godara M (2022). "Effect of adding nanosilica particulate filler on the wear behavior of dental composite". Polymer Composites. 39 (S1): 332–341. 14

15. Bulk filler Bulk filler is composed of non-agglomerated silica and zirconia particles. It has nanohybrid particles and filler load of 77% by weight. Designed to decrease clinical steps with possibility of light curing through 4-5mm incremental depth, and reduce stress within remaining tooth tissue. Chesterman J, Jowett A, Gallacher A, Nixon P (2020). "Bulk-fill resin-based composite restorative materials: a review". BDJ. 222 (5): 337–344.

16. fibre -reinforced composite fibre reinforced composite:- designed for use as a replacement of dentin. contains silanated e-glass fibres which are optimised in size and length to provide the maximum reinforcing effect Composition of ever-x :_ organic resin matrix and inorganic glass fibres and filler particles. Indication: Dentin replacement material for all direct composite restorations including large posterior cavities, deep cavities and endo-treated teeth, cavities with missing cusps. Core build-up GC AUSTRALIA DENTAL 2024

17. bioactive ion releasing composite regenerate dental hard tissues after an acid attack by supplying calcium, phosphate and other ions, reduction of dentin hypersensitivity and postoperative sensitivity. BASED ON AMORPHOUS CALCIUM PHOSPHATE. Various calcium phosphates [monocalcium phosphate, dicalcium phosphate, tricalcium phosphate, hydroxyapatite (HA) and amorphous calcium phosphate (ACP)] can be used as ion-releasing fillers

18. Flowable composite Self adhesive composite use as a liner, porcelain repair and pit-and-fissure sealant. Bulk fill flowable composite for posterior restorations deeper and wider than 4 mm Flowable composite

19. Techniques Incremental techniques Stamp technique centripetal technique Cusp by cusp tech bulk fill technique snow plow technique

20. Horizontal layering technique The horizontal placement technique utilizes composite resin layers, each <2.0 mm thick . This technique has been reported to increase the C-factor, and thereupon increases the shrinkage stresses between the opposing cavity walls. Spreafico RC, Gagliani M. Composite resin restorations on posterior teeth. In: Roulet JF, Degrange M, editors. Adhesion: The Silent Revolution in Dentistry. Chicago: Quintessence Publishingpp . 253–76.

21. Oblique layering technique The oblique technique is accomplished by placing a series of wedge-shaped composite increments. Each increment is photocured twice, first through the cavity walls and then from the occlusal surface, to direct the vectors of polymerization toward the adhesive surface . This technique reduces the C-factor and prevents the distortion of cavity walls. Giachetti L, Scaminaci Russo D, Bambi C, Grandini R. A review of polymerization shrinkage stress: Current techniques for posterior direct resin restorations. J Contemp Dent Pract .

22. Vertical layering technique Place small increments in vertical pattern starting from one wall, i.e., buccal or lingual and carried to another wall. Start polymerization from behind the wall, i.e., if buccal increment is placed on the lingual wall, it is cured from outside of the lingual wall. This reduces gap at gingival wall which is formed due to polymerization shrinkage, hence postoperative sensitivity and secondary caries J Conserv Dent. 2017 Nov-Dec; 20(6): 386–391. doi : 10.4103/JCD.JCD_157_16

23. Stamp technique

24. centripetal technique replaces the lost tooth structure from the periphery towards the center of the cavity ‘ achieving better marginal adaptation to the gingival floor .

25. Cusp by cusp tech  time-consuming. reduce finishing time . precise attention to progressive reconstruction of natural morphology.

26. bulk fill technique terms of aesthetic and function in a relatively short time. it is performed placing one single layer of material up to the occlusal surface, without using the traditional layering technique. 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.

27. snow plow technique 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 to Reduce the shrinkage stress. 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.

28. Class II: DME working field should be completely isolated. the matrix should isolate margins accurately and ensure a perfect seal around them. Materials to be used: microhybrid , nanohybrid, bulk-filled composites Universal etch better than total due to sensitivity .

29. 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 . 29 For occlusal surfaces of posterior teeth, finishing diamonds, multi-grooved carbide burs or silicon carbide points of various sizes, shapes and grits are useful. Close-packed areas can be finished and polished with aluminium oxide finishing strips. Final polishing can be provided with a rubber cup with aluminium oxide pastes.