Bond ing 007 th generation and beyond



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BONDing 007th generation and beyond

Todd C. Snyder, DDS

25500 Rancho Niguel Road, Suite 230

Laguna Niguel, CA. 92677

(949) 643-6733

doc@tcsdental.com

www.drtoddsnyder.com

www.facebook.com/aesthetic.dental.designs

www.twitter.com/tcsaesthetics

Posterior Composites:



  • Anesthetize

  • Start off by selecting color & marking occlusion

  • Preparation

  • Caries indicator

  • Antibacterial

  • Resin modified glass ionomer material

  • Bonding agent of choice

  • Composite Restorative Material of choice

  • Mark occlusion again at end with different color

OR-
Posterior Composites:



  • Anesthetize

  • Start off by selecting color & marking occlusion

  • Preparation

  • Caries indicator

  • Antibacterial

  • Bonding agent of choice

  • Flowable material

  • Composite Restorative Material of choice

  • Mark occlusion again at end with different color

OR-
Posterior Restoration:



  • Anesthetize

  • Start off by selecting color & marking occlusion

  • Preparation

  • Caries indicator

  • Antibacterial

  • Glass ionomer material

  • Mark occlusion again at end with different color

MMP inhibitors:



  • Benzalkonium chloride (BAC) in Bisco’s etchants, Tublicid Red (BAC from Global Dental)

  • 2% Chlorhexidine DiGluoconate: Consepsis (Ultradent), Cavity Cleanser (Bisco) {emollient free}

  • Bonding agent with MDPB (Clearfil SE Protect)

SE adhesives and bur selection and lubrication

Composite Preparations


  • Class I (II) - occlusal preparations limited to less than or half of the occlusal isthmus width

  • Rounded internal line angles

  • Limited extension for prevention

  • No finish lines on occlusal stops

  • No occlusal (or interproximal) bevels

  • Class III, IV, V bevel

Composite Material Treatment Planning



  • Based on Material Strength Properties

    • Size of pathology and preparation

    • Access

    • Occlusion (loading)

  • MECHANICAL & Adhesive Retention

  • Supragingival margins

Composite Incremental Layering Options

  • 1 increment used

    • <2mm

    • Dentin or Enamel shade?

  • 2 increments >2mm

    • Dentin or Enamel for both increments

    • Dentin first then Enamel

    • Flowable then Dentin or Enamel

    • RMGI then Dentin or Enamel or Both

    • Open & Closed Sandwiches


Abfraction Lesions (literature)

Microleakage of Class V resin-modified glass ionomer and compomer restorations. Toledano, M; et al. J Prosthet Dent 1999;81:610-5.

Microleakage in Class II Resin Composite Restorations with Various Adhesive/ Liner Combinations: An In Vitro Study. Neme, et al. Oral Health Journal. April 2003.

Simulated oral environment and microleakage of Class II resin-based composite and sandwich restorations. Besnault C, Attal JP. Am J Dent. 2003 Jun;16(3):186-90.


The Use of Resin-Modified Glass Ionomer Liners Under Composite Resins: Should They be Used to Help Control Microleakage? Alex,G. Dec 2005 — Vol. 1, Iss. 2

The effect of flowable resin composites as gingival incfrements on the microleakage of posterior resin composites. Attar N, Turgut MD, Gungor HC. Oper Dent 2004;29:162-167.

Dietschi D, Herzfeld D. In vitro evaluation of marginal and internal adaptation of class II resin composite restorations after thermal and occlusal stressing. Eur J Oral Sci. 1998;106:1033-42.

The microleakage in open-sandwich class II restorations. Florita, Z. et al. European Cells and Materials Vol 11. Suppl.2.2006(page 23)









“The major shortcoming of contemporary

adhesive restoratives is their limited durability in vivo.”



Intact hybrid layers created by a simplified etch-and-rinse adhesive in caries-affected primary dentin partially disappeared after 6 months of intraoral function



Demineralizing dentin is like opening the Pandora’s box, releasing endogenous enzymes

(Matrix Metalloproteinases - MMPs) that were trapped within the mineralized dentin matrix.

In the presence of water (such as that derived from water sorption or from adhesives, MMPs can breakdown collagen fibrils that are not protected by intrafibrillar minerals



Direct Composite Matrices



  • Composi Tight - Garrison Dental

  • Composi Tight 3D- Garrison Dental

  • Palodent Plus - Dentsply

  • SuperMat - Kerr Hawe

  • Toffelmier Bands

  • Greater Curvature Bands

  • V3 Ring- TrioDent

  • Polydentia SA-Quickmat Delux

  • Walser Matrix

  • Danville ABC Wedge



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