Operative Dentistry 3

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Slide 1 :

CHEN Zhi Wuhan University School of Stomatology Operative Dentistry 3

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

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Tooth-colored restoration For Class ?,? and ?, Esthetic Dentistry For Class ?and ?,

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

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

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Tooth-Colored Materials Composite resin Glass ionomer cement Compomer

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

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Glass Ionomer Chemical adhesion to dentin Release Fluoride

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Compomer Compomer = Composite + Ionomer

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

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

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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.

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

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

Slide 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.

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

Slide 17 :

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

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

Slide 19 :

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

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

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Beveled enamel margin

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Beveled conventional cavity designs for Class ?, ? and ? preparations

Slide 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

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

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Modified cavity preparation

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

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Rubber dam

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

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Matrix application

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Final procedures

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Cases

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Slide 43 :

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

Slide 44 :

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

Slide 45 :

“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

Slide 46 :

University Minnisota School of Dentistry

Slide 47 :

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

Slide 48 :

Thanks

Minimal Intervention...

The Right Hand of th...

Introduction to Oper...

DENTISTRY AND ORAL S...

History and Present ...

Restorative and Esth...

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Operative Dentistry 3. Indication of Operative Dentistry. Caries;; Malformed, discolored,practicing more Operative Dentistry 3. Indication of Operative Dentistry. Caries;; Malformed, discolored,practicing preventive, rather than reparative, dentistry. ” ... less
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