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COMPLEX MULTI-SURFACE COMPOSITE RESTORATIONS

COMPLEX MULTI-SURFACE COMPOSITE RESTORATIONS. DR. PETER WALFORD. EXCESSIVE TIME OPEN/BROKEN CONTACT MATRIX ISSUES GINGIVAL RE-DECAY. COMMON PROBLEMS. PULP - SENSITIVITY OR DEATH PITS,VOIDS,BUBBLES UNATTRACTIVE ESTHETICS. ISOLATION CHALLENGES INSTRUMENTATION FOR LONG CROWNS

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COMPLEX MULTI-SURFACE COMPOSITE RESTORATIONS

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  1. COMPLEX MULTI-SURFACE COMPOSITE RESTORATIONS DR. PETER WALFORD

  2. EXCESSIVE TIME OPEN/BROKEN CONTACT MATRIX ISSUES GINGIVAL RE-DECAY COMMON PROBLEMS

  3. PULP - SENSITIVITY OR DEATH PITS,VOIDS,BUBBLES UNATTRACTIVE ESTHETICS ISOLATION CHALLENGES INSTRUMENTATION FOR LONG CROWNS PREPARATION DESIGN? MORE PROBLEMS….

  4. WWW.PETERWALFORDDENTISTRY.COM USERNAME cardp2012 PASSWORD halifax

  5. LINKS ON WEBSITE • FOLLOW ((CARDP)) ON HOME PAGE TO FIND APPROPRIATE LINKS WITHIN WEBSITE

  6. HEATED RESINS FAST CURE LIGHTS DELEGATION-the future of the restorative hygienist position BULK FILL?- a flawed concept TIME SAVERS

  7. 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

  8. DETERMINING CURE TIME FOR HEATED RESINS

  9. 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

  10. PREVENTING OPEN/BROKEN CONTACT • ANATOMICALLLY CONTOURED CIRCUMFERENTIAL MATRIX • CONTACT FORMERS • CUSTOM WEDGING • RESIN WITH SUITABLE FLEXURAL STRENGTH • ADEQUATE CURING

  11. FLEXURAL STRENGTH

  12. 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”

  13. BEST RESINS FOR LARGE RESTORATIONS: TOP QUARTILE • GRANDIOSO (VOCO) 181 MPa • VENUS DIAMOND (HEREAUS KULZER)169MPa • FILTEK SUPREME ULTRA (3M Espe) 162MPa

  14. VENUSDIAMOND

  15. 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

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  17. CRAOCTOBER 2010

  18. 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

  19. STARFILL 2BDANVILLE DENTAL • 141MPa • HYBRID • S/C IN 2.5 MINS • SEVERAL CONVENIENT AUTOMIX TIPS

  20. RECOMMENDED JOURNALS FOR COMPOSITE INFORMATION • REALITY • CLINICIAN’S REPORT • THE DENTAL ADVISOR

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  22. 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

  23. BENEFITS OF CARIES DETECTOR • CONFIRMS COMPLETE REMOVAL (CARIES IS NOT STRUCTURAL!!) • DISCLOSES PLAQUE • REVEALS FLASH IN FINISHING

  24. DEEP CARIES • ANGELUS MTA 10 MINUTE SET • DOVGAN PLACEMENT INSTRUMENT • FO FULL PROTOCOL SEE CHAPTER IN MODXYZ

  25. 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

  26. PRACTICON

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  28. 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.

  29. WEBSITE LINK ON REPAIRS • http://www.peterwalforddentistry.com/tiki/tiki-index.php?page=Repairing%20Bubbles%2CVoids%2C%20and%20Flaws

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