Techniques of direct composite restoration

Techniques of the direct composite restoration. Includes different instruments, matrix system, wedges, bevel, etching, bonding, and placement of composite along with finishing and polishing and clinical management

1. TECHNIQUES FOR
DIRECT COMPOSITE
RESTORATION

2. 2
FLOWCHART
Armamentarium
Instruments
Matrix system
Bevelling
Etching and Bonding
Techniques for direct composite restoration
Bulk fill
Incremental techniques
Conventional technique: Modifications
Putty index technique: Modifications
Injection molding technique
Stamp/Bite technique
Custom tray technique
Anatomic replication
Finishing and Polishing
Clinical management

3. 3
INSTRUMENTS
27/29 Burnisher:
Blend material for final
contouring, to achieve
sculpting of areas like
grooves, fissures or pits.
Can also be used to form
occlusalanatomy.

4. 1 Goldstein Flexi-Thin
Composite Instrument
Small universal style with
rounded pluggertip and a
narrow paddle for initial
placement and contouring of
Class I, II, and III restorations

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5
MODIFICATIONS
Mini 1 Goldstein Flexi-Thin
Composite Instrument
CIGFTMIN16
Mini version of the CIGFT1 for
small pits and fissures, tunnel
preparations or minor tooth
defects on lower anteriors.

6. 6
Flexible, reversed, flared paddle
design for shaping and placement
of Class III and IV and V
restorations.The thinness of the
paddles allow for easier
subgingival margin finishing.

7. ▸Medium Placing/Condensing
XTS
®
Composite Instrument
For small pits and fissures, as well
as placement and condensing
with limited access.

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COMPOROLLER
OPTASCULPT PAD/Next
generation(IVOCLAR)

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Application of opaques and tints, bonding adhesive, and for cement removal prior to
polymerization.
Fine brush (#1) for fine detailing, (#2) and (#3) brushes for the rest of the restorative
dental needs.

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SECTIONAL VS CIRCUMFERENTIAL
MATRIX SYSTEM

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FenderMate matrix system

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Luciwedges(Light reflecting Kerr
Interdental wedges)

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MATRIX SYSTEM FOR ANTERIOR
TEETH
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BURTON BANDS UNICA ANTERIORS
BLUE VIEW VARISTRIP
CONTOUR
BLUE VIEW CERVICAL
MATRIX
SECTIONAL TRANSPARENT
MATRIX(KERR)

16. BEVELLING
▸STARBURST BEVEL
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Initial 45°bevel, marked in
blue and then feather the
finish line out in an irregular
pattern to help blend in final
restoration

17. CONDITIONING AND ETCHING
Etching:
demineralisati
on of
superficial
calcium ions
Conditioning:
removal of
organic layer
making the
surface more
reactive
Less
concentration,
less time:
conditioning
More conc.
More time:
etching
17

18. BONDING
▸5
TH
GENERATION(Mid
1990s)
▸Two step
▸Etching
▸Priming+Bonding
▸Eg. Opti Bond Solo(Kerr),
Single Bond(3M)
▸Disadvantages: Solution must
be refreshed continuously,
Post operative sensitivity
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▸6
TH
GENERATION(Early
2000s)
▸“self-etching primers
▸Two step: Acidic primer followed
by adhesive
▸One step: One drop from each
bottle mixed outside and applied
▸Disadvantage: Bond to enamel
is less as pH of acidic primer not
enough to properly etch enamel
▸Eg.Nano Bond, Optibond, Xeno
III

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21. HORIZONTAL LAYERING TECHNIQUE :
•Layer: Less than 2mm thickness
•Increases C factor, thereby increases shrinkage stress on opposing
wall
INCREMENTAL TECHNIQUES

22. OBLIQUE LAYERING TECHNIQUE
•Series of wedge-shaped composite increments.
•Each increment: photocuredtwice, first through the cavity walls &
from the occlusalsurface.
•Reduces the C-factor and prevents the distortion of cavity walls.

23. VERTICAL LAYERING TECHNIQUE
•Small increments in vertical pattern starting from one wall, i.e.,
buccalor lingual and carried to another wall.
•Start polymerization from behind the wall, i.e., if buccalincrement is
placed on the lingual wall, it is cured from outside of the lingual wall.
•Reduces gap at gingival wall which is formed due to polymerization
shrinkage, hence postoperative sensitivity and secondary caries

24. CENTRIPETAL BUILDUP TECHNIQUE
•Employs thin metal matrix bands and wooden wedges which
provide firm contact areas and anatomical proximal contours .
•Recent studies do not indicate any detriment of metal matrix bands
in cervical gap formation.

25. ▸If gap develops, the next consecutive layer which is condensed
toward the gingival floor is likely to fill gap since the
continuity of space created is not occluded.
▸Not time-consuming and easy to implement.
▸Once peripheral composite envelope is created, the cavity is
managed as a simple Class I cavity.
▸The systemic use of enamel and dentin shades achieves
predictable and pleasing estheticresults.
▸Indication: small to medium posterior restoration.

26. SUCCESSIVE CUSP BUILDUP
TECHNIQUE

27. ▸Individual cusps are restored one at a time up to the level of
the occlusalenamel.
▸Small sloping increments are applied to each corner of the
cavity.
▸Manipulation is kept to a minimum, to avoid folding voids
into the material.
▸Initially time-consuming but greatly reduce finishing time by
precise attention to progressive reconstruction of natural
morphology

28. THREE SITE TECHNIQUE

29. ▸Use of a clear matrix and reflective wedges.
▸First, the curing light is directed through the matrix and wedges
in the attempt to guide the polymerization vectors toward the
gingival margin thus preventing any gap formation.
▸Then, wedge-shaped composite increments are placed to
further inhibit distortion of cavity walls and reduce the C-
factor.
▸This technique is associated with polymerization first through
the cavity walls and then from the occlusalsurface in order to
direct the vectors of polymerization toward the adhesive
surface.

30. POLYCHROMATIC LAYERING TECHNIQUE
▸When estheticdemands are high, the widely accepted stratification
technique proposed by Lorenzo Vaniniis recommended.
▸Fundamental principle: use different composite shades to replicate
the layers seen in natural teeth which can be described in layers as
palatal enamel layer, dentine layer, special features, opalescent,
characterizations, and intensives.

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34. CONVENTIONAL COMPOSITE PLACEMENT
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PALATAL INDEX

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ANATOMIC REPLICATIONS

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49. FINISHING AND POLISHING
▸Finishing burs: Tungsten carbide burs
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ET BURS
(KOMET/BRASSLER)
{ET3, ET4, ET6, ET9)
SAFE ENDED FINISHING
BURS

50. OTHER PRODUCTS
50
BLUWHITE FINISHING BURS(KERR): Least
expensive
MIDWEST FINISHING BUR(DENSPLY)

51. ▸Finishing diamond burs have also been used for finishing
with light water spray
▸ET Diamonds
▸T & F Hybrid points(Shofu)
▸Two striper diamonds(Premier)
51

52. FINISHING DISCS
▸More precision and safety
▸Most discs uses abrasive agent like aluminium oxide or
silicon carbide
▸Refinement of incisal embrasure
▸Adjust incisal length
▸Smoothen the junction of composite and tooth
52
FLEXIDISC MINI AND
FLEXIDISC(COSMODENT)
SUPERSNAP(SHOFU)

53. FINISHING STRIPS
▸Sof-Flex finishing and polishing strips: 2mm and 4 mm widths.
▸Flexistrip(Cosmodent):Ultrathin version, more flexible,easily
pass through contacts
▸Epitex(GC): By far the thinnest strip(0.05mm)
▸Others: Super snap polystrip(shofu), Finishing strip(Bisco):
Least expensive
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54. POLISHING INSTRUMENTS
▸ASTROPOL(IVOCLAR VIVADENT): 4 shapes;
cup, small point, large point, discs
▸PoGo(Dentsply): cup,disc and a point,
very light pressure and polishing in one direction
▸D Fine diamond polishers for hybrid composites:SS
Semi flexible rubber instruments with
Diamond and D fine double diamond
produces highest shine comparable to
astropol
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55. BRUSHES
▸Jiffy brush(Ultradent): Lowest shine intraorally
▸ComposiPro brushes(Brassler): similar to jiffy brushes in
design but more effective
▸Groovy
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POLISHING PASTES
PRISMA GLOSS(DENTSPLY): Most effective
SPARKLE(PULPDENT): Remarkable gloss, tendency
to dry out
DIAMOND POLISH(ULTRADENT)
ENAMELISE(COSMODENT )

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STAINS IN COMPOSITE

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61. CLINICAL MANAGEMENT
1.DISCOLOURED/DARK TEETH:
▸Tooth preparation more, uniform thickness of
composite
▸Masking dentin shade at facial surface, cervical
margins and incisal edges
▸Selecting a more opaque material to mask
discoloration
▸Resin colour modifier(IVOCLAR, KERR)
▸Microabrasion /Bleaching prior to composite
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62. 2. GCF CONTAMINATION
▸Etched enamel: high surface energy, GCF
contamination prevent bonding agent penetration
.Therefore, repeat the etching process.
▸Use of retraction cord
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3. Loss of gingival embrasure

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66. REFERENCES
▸Spiller MS. Dental Composites: A Comprehensive Review. Albany,
NY. 2012 Oct;12212.
▸Ahmad MZ, Gaikwad RN, Arjumand B. Comparison of two different
matrix band systems in restoring two surface cavities in posterior
teeth done by senior undergraduate students at Qassim University,
Saudi Arabia: A randomized controlled clinical trial. Indian Journal
of Dental Research. 2018 Jul 1;29(4):459.
▸Loomans BA, Opdam NJ, Roeters FJ, Bronkhorst EM, Burgersdijk
RC. Comparison of proximal contacts of Class II resin composite
restorations in vitro. Operative dentistry. 2006 Nov;31(6):688-93.
▸LeSage BP. Aesthetic anterior composite restorations: a guide to
direct placement. Dental Clinics of North America. 2007 Apr
1;51(2):359-78.
▸Erickson RL, Barkmeier WW, Latta MA. The role of etching in
bonding to enamel: a comparison of self-etching and etch-and-rinse
adhesive systems. Dental materials. 2009 Nov 1;25(11):1459-67.
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67. ▸Benetti AR, Havndrup-Pedersen C, Honoré D, Pedersen MK,
Pallesen U. Bulk-fill resin composites: polymerization contraction,
depth of cure, and gap formation. Operative dentistry. 2015
Mar;40(2):190-200.
▸Chandrasekhar V, Rudrapati L, Badami V, Tummala M. Incremental
techniques in direct composite restoration. Journal of conservative
dentistry: JCD. 2017 Nov;20(6):386.
▸Ashok NG, Jayalakshmi S. Factors that influence the color stability of
composite restorations. International Journal of Orofacial Biology.
2017 Jan 1;1(1):1.
▸Türkün LS. New trends in polishing direct resin composites. Practical
procedures & aesthetic dentistry: PPAD. 2004 Sep;16(8):589.
▸Wahbi MA, Al Sharief HS, Tayeb H, Bokhari A. Minimally invasive
use of coloured composite resin in aesthetic restoration of
periodontially involved teeth: Case report. The Saudi dental journal.
2013 Apr 1;25(2):83-9.
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▸THANK YOU
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