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COMPOSITE

RESTORATIONS
Prepared and presented
by
GROUP D
TOPICS
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Finishing and polishing of composite
restorations
instruments
procedures
Rebonding
Prewedging
Snow-plow technique
Centripetal build-up technique
FINISHING &
POLISHING
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Finishing includes the shaping, contouring and
smoothing of the restoration

Polishing imparts the shine or luster to the
surface
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Finishing a restoration is as important as adequate
shade matching

If the finishing process doesnot simulate the adjacent
tooth contours, the restoration will not appropriately
blend with its surroundings, even if a good shade
match has been obtained

The smoothest possible surface obtained when the
resin composite polymerizes against a clear plastic
strip

This may yield a very smooth superficial layer but one
that is less resistant to wear due to its reduced amount
of reinforcing fillers

INSTRUMEN
TS
(for finishing and polishing)
DIAMOND AND CARBIDE
BURS

Resin composite require minimum finishing and
this can be easily achieved if smoothing is
performed before polymerization

May be used to develop the proper macro and
microanatomy for restoration

12 fluted carbide bur is used for gross finishing





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A finishing bur or fine diamond is
used for gross finishing
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Fine finishing diamond impart less surface
damage

These may be used to develop the proper macro
and micro anatomy for the restoration

They are always used with light pressure to
avoid overheating and possibly damaging the
restoration

SCAPEL BLADES AND RESIN
CARVING INSTRUMENTS
Used to refine gingival margins and
interproximal area

Burs and disks can cause damage to soft tissue
and cementum in gingival area

No.12 or 12B scalpel is used to safely remove
the excess material at gingival margin

They can also be used to refine embrasures

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Gingival margins of the restoration are
shaped with a no.12 scalpel blade
DISKS

Flexible disks have now become the standard
in finishing and polishing

Have soft flexible backing and series of grit
that can provide smooth,even finish.


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The resin composite is contoured
with a coarse-grit disk
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Some disks also have thin plastic or polymeric
backings that allow access of the abrasive side
into embrasures and interproximal areas

Have tendency to leave flat surfaces, unlike,
the rounded contour of natural teeth

Dry finishing with disks is superior to wet
finishing in terms of smoothness hardness and
color stability

IMPREGNATED RUBBER
POINTS AND CUPS
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Rubber finishing and polishing points and cups
impregnated with abrasive materials are
available
Used sequentially from coarse to fine grit
Coarse grits are effective for gross reduction
and finishing
Fine grits create a smooth shiny surface
The primary advantage of rubber points and
cups over disks is that they provide access to
grooves and surface irregularities thus
providing better resemblance to natural teeth

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Surfaces of the restoration are polished
using rubber cups and aluminium oxide
pastes
FINISHING STRIPS
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Used to contour the proximal surface and margins
to the interproximal contact

Available with metal or plastic backings

Metal-backed strips are used for gross reduction
but the restoration shouldnot be over reduced
(these strips can also reduce enamel, dentin and
cementum)

Plastic strips can be used for both finishing and
polishing

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The proximal surfaces are finished
and polished using finer-grit finishing
strips
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Finishing and polishing can affect many
aspects of the final restoration including:
Surface shine
Surface staining
Plaque accumulation
Composition of the composite material
Polishing system used


PROCEDURES
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Contouring:
Contouring has the purpose of simulating the
natural contours and anatomy of a tooth

It should be carried out in a sequence

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Step 1
Evaluate the length of the restoration in relation
with adjacent teeth and the establishment of
the facio-incisal line angle. A medium grit disk
is used to reduce and contour the incisal edge

Step 2
Check the occlusion in maximum intercuspation
and in excursive movements and adjust
accordingly
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Step 3
Locate and contour the mesiofacial and distofacial
transitional line angles. This is accomplished by
using fine carbide or diamond burs or
impregnated rubber cups

Step 4
Contour tooth embrasures. Incisal embrasures are
contoured with medium grit disks and the
gingival embrasures with a no. 12 or 12B
scalpel blade

FINISHING AND
CHARACTERIZATION
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Finishing should be done carefuly to avoid
damaging the surface and margins of the
restoration

Medium and fine grit cups are used to smooth the
facial and lingual surfaces

Finishing strips can be used on the proximal
surfaces

Surface characterization is obtained by observing
and copying details of the adjacent dentition onto
the restoration
POLISHING
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Final surface polish can be obtained by using a
diamond or silicon carbide impregnated disk

Aluminium oxide or diamond polishing pastes can
also be used

The development of a white line has been
observed at the margins of composite restorations
while finishing
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The exact cause of this is unknown but there are
several explanations

One explanation implicated traumatic finishing
leading to microfractures in the resin composite
or tooth structure at the interface

Other proposed causes include:
Improperly rotating abrasive disks
Inadequate polymerization of composite
Polymerizaion shrinkage causing microfracture
of unsupported or fragile enamel at the margins
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When the white line presents as an
esthetic problem and procedures such
as rebonding donot resolve it , the white
area must be removed with a bur and
additional composite must be bonded
and finished.
RE-BONDING
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RE-BONDING
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Also called surface sealing or glazing

Performed after the restoration is finished and
polished

The margins are re-etched and a coat of
unfilled or lightly filled low viscosity resin is
placed over the restoration surface and
polymerized
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REBONDING:
Improves marginal integrity
Aid color stability
Improves early wear resistance
Helps reduce staining of the restoration

The long-term effect of rebonding is questionable
because this surface layer of low viscosity resin is
likely to wear quickly
It is rarely needed for anterior restorations when a
proper placement and finishing protocol has been
followed
PRE-WEDGING
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PRE-WEDGING
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The procedure of inserting
a wedge between the interproximal
surfaces of two adjacent teeth prior to
cavity preparation involving a
proximal wall.
PURPOSE
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The purpose is to achieve some tooth
separation such that, after
restoration, the teeth will return to
their original position and a more
positive tooth contact area will be
achieved.
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Placement of an interproximal wedge at the
start of the procedure is recommended to
open the contact with the adjacent tooth

MULTIPLE WEDGING: inserting a wedge
initially and then reapplying seating pressure
several times during the course of the
procedure.

This is more effective in opening the contact
then is a single placement of a wedge
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BENEFITS OF PRE-
WEDGING
Seperation of teeth in order to:

Achieve functional contacts , contours &
occlusion during restorations.

Promotes a more conservative preparation

Improve convenience form of dentist

Prevent damage to teeth & supporting
tissues

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SNOW-PLOW
TECHNIQUE
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SNOW-PLOW TECHNIQUE
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The use of flowable composites in conjunction
with posterior resin composite restorations has
been called the snow-plow technique

This technique has demonstrated significantly
reduced void formation compared with
placement of restorative composite alone




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In this technique an initial increment of flowable
composite is placed over the gingival and pulpal
floors of the cavity preparation.

This layer is not cured at this stage, but rather an
initial increment of heavily filled restorative resin
composite is syringed or pushed into the unset
flowable resin composite

Most of the flowable resin composite is displaced by
the restorative and is subsequently removed from
the cavity preparation with a hand instrument,
microbrush or bristle brush

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As a result, most of the flowable composite and
therefore its disadvantageous characteristics
isnot present in the cavity preparation

Instead there is only a small amount of flowable
composite remaining in those areas of cavity in
which the high viscosity resin did not adapt and
may have been void of restorative material

The combined increment of flowable resin
composite and restorative resin composite is
then cured
CENTRIPETAL
BUILD-UP
TECHNIQUE
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CENTRIPETAL BULID-UP
TECHNIQUE
It replaces lost tooth
structure from periphery
towards the center of the
cavity.

It is done in Class II
posterior composite
restorations.

Also known as Class
Transition Technique.

THE
PROCEDURE
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Preoperative radiograph. A centripetal
posterior composite Class II restoration is
planned for the Mandibular second molar.
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After local anesthesia, a rubber dam is
placed to isolate the mandibular second
molar.

Conservative cavity preparation is
performed with a water-cooled high-
speed carbide bur.
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If no undercuts have been performed
during caries removal, intentional gingival
and axial grooves are created.

A GIC lining is
placed upon the
pulpal walls.
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A thin metal matrix band is placed.
Wooden wedge is inserted to tilt the molar
distally.

A conditioner of universal bonding system is
used to condition enamel and dentine walls
of the cavity
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A proximal composite semi-transparent
layer is placed towards the matrix band
using a composite condenser.

A thin proximal semi-transparent layer
of composite is created (Step 1 of
centripetal technique).
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A proximal composite layer is cured using
an intra-cavitary extension tip.

Different types of light tips
available.
A schemtaic drawing illustrates the
use of the curing light
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A semi-transparent layer of composite is
laid down and forms a thin occlusal ring.
(Step 2 of the centripetal buildup)

A schemtaic drawing of transvese section
of the molar shows the semi-transparent
composite envelop.
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Filling of the cavity with small increments
of the dentin shade composite. (Step 3 of
the centripetal buildup)

The actual size of the composite
increment, held by the tip of a dental
explorer.
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A schematic drawing of the incremental
filling, performed during step 3 of
centripetal build-up.

Last increment of the dentin shade
composite is laid. Extension of central
fossa is achieved by piercing soft
composite.
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Staining of the central fossa with
composite tints, if necessary to achieve
optimal aesthetic results
Placement of last occlusal semi-
transparent layer (step 4).
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Various layers of Centripetal build-up
Technique.
The completed centripetal build-up.
The use of burs was not required in
finishing of the restoration.
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Postoperative bitewing radiograph after
restoration of second molar.

ADVANTAGES
Better marginal adaptation
Rotary finishing is minimal
Reduces cervical gap
Preserves sound tooth structure
Not time consuming
Easy to apply
Long-term esthetic posterior
restoration


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