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Operative Dentistry 3

Operative Dentistry 3. CHEN Zhi Wuhan University School of Stomatology. Indication of Operative Dentistry. Caries ; Malformed, discolored, or fractured teeth; Restoration replacement. Tooth-colored restoration. For Class Ⅲ ， Ⅳ and Ⅴ ， Esthetic Dentistry For Class Ⅰand Ⅱ ， .

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Operative Dentistry 3

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  1. Operative Dentistry 3 CHEN Zhi Wuhan University School of Stomatology

  2. Indication of Operative Dentistry • Caries; • Malformed, discolored, or fractured teeth; • Restoration replacement.

  3. Tooth-colored restoration For Class Ⅲ，Ⅳ and Ⅴ， • Esthetic Dentistry For Class Ⅰand Ⅱ，

  4. What are Tooth-colored materials? What is their working mechanism? What are the cavity preparation futures for tooth-colored restoration?

  5. What are steps for tooth-colored restoration? What are the advantage & disadvantage of tooth-colored restoration?

  6. Tooth-Colored Materials • Composite resin • Glass ionomer cement • Compomer

  7. Composite Resin Traditional composites Hybird composites Flowable composites Condensable composites Packable Universal composites

  8. Glass Ionomer • Chemical adhesion to dentin • Release Fluoride

  9. Compomer Compomer = Composite + Ionomer

  10. Dental Adhesionor Dental Bonding Adhesion is a process of solid and/or liquid interaction of one material with another at a single interface.

  11. Enamel bonding system Enamel bongding depends on resin tags becoming interlocked with the surface irregularities created by etching.

  12. Macrotags: form between enamel rod peripheries. Microtags: smaller tags form across the end of each rod. Macrotags and microtags are the basis for micro-mechanical bonding.

  13. Dentin bonding system The difficulties of dentin bonding: More water---wet bonding Lower calcification Richer organic---collagen network Smear layer

  14. The bond strength is primarily related to micro-mechanical bonding to the intertubular dentin which occures between tubules along the cut dentin surface.

  15. Dentin Bonding Agent, DBA Early DBA were hydrophobic, bonded directly to the dentin smear layer. Bond strengths＜6MPa. Later DBA removed the smear layer but tended to over-etch dentin. Bond strengths≈10~12MPa.

  16. DBA were chemically modified to be more hydrophilic. Bond Strengths≈18~20MPa. Careful dentin conditioning, Coupled with hydrophilic primer, Bond Strength≈22~35MPa.

  17. The Development of DBA Enamel etch (1955) Dentine etch (1960) Treatment of smear layer (1980) Wet Bonding technique(1990)

  18. First generation Second generation Third generation Fourth generation: Total etch technique Fifth generation: One bottle system Sixth generation: All in one,2000 Seventh generation

  19. Cavity Preparation Three designs of cavity preparation: 1.Conventional 2.Beveled conventional 3.Modified

  20. Beveled conventional cavity preparations are similar to conventional preparation, in that the outline form has external, “box-like” walls, but with beveled enamel margin.

  21. Beveled enamel margin

  22. Beveled conventional cavity designs for Class Ⅲ, Ⅳ and Ⅴ preparations

  23. The advantages : The ends of enamel rods are more etched The increase in etched surface results in a stronger bond Increase the retention and reduce marginal leakage and discoloration. More esthtically

  24. Modified cavity preparation Have neither specified cavity wall structure nor specified pulpal depth, and have enamel margins. Conserve more tooth structure.

  25. Modified cavity preparation

  26. Initial Clinical Procedure Local anesthesia Preparation of the operating site Shade selection Isolation of the operating site with rubber dam or cotton rolls

  27. Rubber dam

  28. Clinical Procedure Cavity preparation Acid etching enamel & conditioning dentin Matrix application Application of bonding agent Insertion of composite Finishing procedures

  29. Matrix application

  30. Final procedures

  31. Cases

  32. Conservative Operative Dentistry Minimal intervention dentistry is regards as a main stream in caries treatment in the 21st century.

  33. Principles of Minimal Intervention dentistry • Remineralization of early lesions • Reduction in cariogenic bacteria, to elminate the risk of further demi-neralization and cavitation • Minimum surgical intervention of ca-vitated lesions • Repair rather than replacement of defective restorations

  34. “The day is surely coming, and perhaps within the lifetime of you young men before me, when we will be engaged in practicing preventive, rather than reparative, dentistry. ” • GV Black in 1896

  35. University Minnisota School of Dentistry

  36. http://202.114.104.243/jpkc/ysysbx/index.html

  37. Thanks

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