A Predictable Resin Composite Injection Technique, Part 2 line angles, pulpectomized primary teeth with a signi-ﬁcant loss of tooth structure, patients with special needs,4-13

Opinions expressed by CE authors are their own and may not reflect those of Dentistry Today. Mention of

specific product names does not infer endorsement by Dentistry Today. Information contained in CE articles and

courses is not a substitute for sound clinical judgment and accepted standards of care. Participants are urged to

contact their state dental boards for continuing education requirements.

Continuing Education

A Predictable ResinComposite Injection

Technique, Part 2Authored by Douglas A. Terry, DDS; John M. Powers, PhD; Deepak Mehta, BDS, MDS; Venkatesh Babu, BDS, MDS; Usha H. L., BDS, MDS; Ashwini Santosh, BDS, MDS;

Yoshihiro Kida, DDS, PhD; and Hiroyuki Wakatsuki, DDS

Upon successful completion of this CE activity 1 CE credit hour will be awarded

Volume 33 No. 6 Page 80

ABOUT THE AUTHORSDr. Terry is a graduate of University ofTexas (UT) Health School of Dentistry. Hepresently holds positions as an adjunctprofessor in the department of restorativesciences at the University of Alabama atBirmingham, assistant professor in the

department of general practice and dental public health at UTHealth School of Dentistry at Houston, and professor emeritusin the department of conservative dentistry and endodontics atthe V. S. Dental College and Hospital, Rajiv Gandhi Universityof Health Sciences, Bangalore, India. He is an accreditedmember of the American Academy of Cosmetic Dentistry, anactive member of the European Academy of Esthetic Dentistry,and an honorary member of the Indian Academy ofRestorative Dentistry. He has authored textbooks in numerouslanguages including Natural Aesthetics With Composite Resin(Montage Media, 2004), Aesthetic and Restorative Dentistry:Material Selection and Technique (Everest Publishing Media,2009), Esthetic and Restorative Dentistry: Material Selectionand Technique, Second Edition (Quintessence Publishing,2013), What’s in Your Mouth?/What’s in Your Child’s Mouth?(Quintessence Publishing, 2013), Smile! Your Guide toEsthetic Dental Treatment (Quintessence Publishing, 2014),and What’s in Your Mouth? Your Guide to a Lifelong Smile(Quintessence Publishing, 2014). He has lecturedinternationally on restorative and aesthetic dentistry and is adental materials clinical research consultant for industrymanufacturers. He is the founder and CEO of designTechnique In ternational and the Institute of Esthetic andRestorative Dentistry, and he maintains a private practice inHouston. He can be reached at (281) 481-3483 or via e-mailat [email protected].

Disclosure: Dr. Terry reports no disclosures.

Dr. Powers graduated from the University of Michigan with a

BS in chemistry in 1967 and a PhD in dental materials andmechanical engineering in 1972. He received an honoraryPhD from the Nippon Dental University in 2011. He is thesenior editor of THE DENTAL ADVISOR and clinical professorof oral biomaterials, department of restorative dentistry andprosthodontics, at the Uni versity of Texas School of Dentistryat Houston. He can be contacted via e-mail at the followingaddress: [email protected].

Disclosure: Dr. Powers is senior vice president of DentalConsultants, Inc. (publisher of THE DENTAL ADVISOR)and is senior editor of THE DENTAL ADVISOR.

Dr. Mehta is a professor in the department of conservativedentistry and endodontics at the V. S. Dental College andHospital in Banga lore, India. He can be reached via the e-mail address [email protected].

Disclosure: Dr. Mehta reports no disclsoures.

Dr. Babu is a professor and chair of the department ofpedodontics at the V. S. Dental College and Hospital inBangalore, India. He can be reached at [email protected].

Disclosure: Dr. Babu reports no disclosures.

Dr. H. L. is dean, professor, and chair of the department ofconservative dentistry and endodontics at the V. S. DentalCollege and Hospital in Bangalore, India. She can bereached via e-mail at [email protected].

Disclosure: Dr. H. L. reports no disclosures.

Dr. Santosh is a clinical assistant professor of thedepartment of conservative dentistry and endodontics atthe V. S. Dental College and Hospital in Bangalore, India.He can be reached at [email protected].

Disclosure: Dr. Santosh reports no disclsoures.

Dr. Kida is in private practice specializing in periodontics inHonj, Saitama Prefecture, Japan. He can be reached via e-mail at the address [email protected].

Disclosure: Dr. Kida reports no disclsoures.

Dr. Wakatsuki is in private practice specializing in pediatricdentistry in Tokyo, Japan. He can be reached [email protected].

Disclosure: Dr. Wakatsuki reports no disclosures.


1

A Predictable Resin CompositeInjection Technique, Part 2Effective Date: 6/1/2014 Expiration Date: 6/1/2017

INTRODUCTIONThe first part of this series on the injectable resin compositetechnique provided an overview of its clinical applicationsand described the procedure and its predictability fordeveloping transitional resin composite restorations in theadult dentition. As presented in part one, compositeprototyping can be used to establish aesthetic and occlusalparameters such as restoration shape, physiologic contour,phonetics, and occlusion.1 The second part of this serieswill describe and illustrate another revolutionary applicationof the injectable resin composite technique for use with theprimary dentition described as the Terry Injectable PrimaryComposite Crown (TIPCC).

Extensive caries and trauma represent the major reasonsfor the restoration of primary teeth with full coronalcoverage.2,3 Clinical indications for the use of full-coveragecrowns include primary teeth with multiple carious surfaces,fractured primary teeth with a significant loss of tooth structure,primary teeth with developmental defects and discoloration,Class II lesions in which the caries has extended beyond theanatomic line angles, pulpectomized primary teeth with a signi-ficant loss of tooth structure, patients with special needs,4-13

and hypoplastic deciduous teeth.8 There are a myriad ofmethods and materials for restoring primary teeth with fullcoronal coverage (crowns).14 These include polycarbonatecrowns, traditional stainless steel crowns, open-faced stainlesssteel crowns, stainless steel crowns veneered with toothcolored materials (ie, composite, ceramic), the acid-etchedresin strip crown, and zirconium crowns.10,14-27 The treatmentchallenges associated with these various types of crowns inthe past have included improper anatomical contours, gingivalinflammation, fractured facings, microleakage, poor retention,and an unnatural appearance (Figure 1).15,16,21,25,28-30

In pediatric dentistry, manufacturers, researchers, andclinicians continue to search for an ideal material andtechnique that will allow duplication similar to natural toothstructure and morphology. This biomaterial should beresistant to masticatory forces and possess an appearanceakin to natural dentin and enamel.31 In addition, it shouldhave similar physical and mechanical properties to that ofthe natural tooth, because as the mechanical properties of arestorative material approximate the enamel and dentin, therestoration’s longevity increases.32 Also in pediatric

dentistry, the material should have the ability to be easilyand efficiently placed and repaired, and the techniqueshould require minimal chair time.3,33 While no restorativematerial and technique currently fulfill all theseprerequisites, one treatment modality and material mayprovide some of these attributes.

The TIPCC technique, a novel and minimally invasiveapproach, has now been introduced and used for primarycrown placement. This injectable resin composite technique isa unique and novel indirect/direct process of predictablytranslating a diagnostic wax-up into composite restorationsusing a highly filled flowable resin composite.1 As described inpart one, this is a transitional technique. Thus, its applicationwould be favorable for a transitional dentition such as theprimary teeth. When selecting this procedure for children,several factors should be considered prior to selecting theinjectable composite material. These include caries riskassessment, age and behavior, periodontal health, adequateremaining tooth structure, moisture-controlled field, thelongevity of the tooth, and treatment conditions for thepatient.16,28

The criteria for tooth replacement, de fects, trauma, andcaries, as well as the basic definition of cavity preparation,have remained unchanged throughout the last 100 years.However, the physical preparation design for the replacementof natural tooth structure and/or existing restorations has been continuously altered as advances in materials occur.The newer formulations of syringeable universal composites have improved physical, mechanical, and opticalcharacteristics.34,35 Thus, the adhesive application of thesehighly filled flowable resin composite systems permits a moreconservative tooth preparation. Furthermore, restoring thenatural dentition with bonded resin composite reinforces thetooth and restoration, which results in an increased structural


2

A Predictable Resin Composite Injection Technique, Part 2

Figure 1. Theresin strip crownson the maxillaryprimary centralincisors revealimproperanatomicalcontours withgingival inflam-mation. Notice the unnaturalappearance.

integrity while reducing anddissipating functional forces alongthe entire restorative interface.36

Although many of the basicpreparation principles are similar forall adhesive preparations, there isconsideration in the preparationdesign that is different for vital andpulpectomized primary teeth. Vitalteeth require only removal of pre-existing defective re storativematerial and/or caries, while thepulpectomized teeth should have a resin-modified glass ionomer placed intracoronally toim prove marginal seal of the pulpotomy.28,37

The general design guidelines for the adhesivepreparation for vital and pulpecto mizedanterior and posterior primary teeth includethe following:

l Any pre-existing defective restoration(composite or alloy) and/or caries should beremoved.

l To allow for a better resin adaptation, allinternal or external line angles should berounded and cavity walls smooth.Unsupported enamel walls should beremoved to improve the path of flow ofmaterial.

l A circumferential chamfer is placed 0.3mm in depth to increase the enamel-adhesive surface and to allow for a sufficientbulk of material at the margins.38

l Occlusal reduction 1.5 to 2 mm shouldbe achieved.

Vertical proximal, facial/buccal, and lingual walls with slightconvergence toward the occlusal will break proximal contacts.The preparation can be completed with a finishing disk, butwith no silicone points or cups because these contaminate thebond. A mixture of plain pumice and aqueous 2% chlor -hexidine solution (Consepsis [Ultra dent Products]) can beused to remove potential contaminants.

This article presents a case report involving the use ofthe TIPCC technique to restore the primary maxillaryanterior dentition.

CASE REPORTDiagnosis and Treatment PlanningA 6-year-old male was referred to the department ofpedodontics at the V. S. Dental College and Hospital inBang alore Karanataka, India. The child was healthy andhad no history of systemic disease. Upon examination,extensive interproximal caries was present on the maxillaryprimary central incisors and maxillary right primary lateralincisor from extensive sugar intake and inadequate plaquecontrol (Figure 2). After clinical and radiographicevaluations were performed, a treatment plan was


3


Figures 2a and 2b. Preoperative facial view of the maxillary anterior primary incisors. Patient presented atage 6 with extensive interproximal caries on the maxillary primary incisors from excessive sugar intakeand inadequate plaque control.

a b

Figures 3a and 3b. (a) A diagnostic wax-up was created to develop the original contours ofthe incisors, and (b) a clear vinyl polysiloxane matrix (ExaClear [GC America]) wasfabricated to replicate the diagnostic wax-up intraorally.

a b

Figures 4a and 4b. (a) Initial caries removal was performed and (b) shade determinationwas completed before final preparation to reduce the potential of an improper shade fromtooth dehydration.

a b

established. The restorative technique wasexplained to the parents and patient, andthey accepted the suggested treatment andsigned an informed consent form before thetreatment was initiated.

Clinical ProtocolA full-mouth alginate impression was taken ofthe patient’s maxillary arch and poured withtype IV stone (GC FUJIROCK EP [GCAmerica]). The stone model was removedfrom the impression one hour later andshaped on the model trimmer. This processcan be expedited by using a fast set dentaldie stone (NEW FUJI ROCK FAST SET [GCAmerica]). The maxillary incisors were waxedto an ideal contour and a clear vinylpolysiloxane (Exa Clear [GC America]) matrixwas fabricated to replicate the diagnosticwax-up (Figure 3). The impression was takenin a nonperforated plastic tray. Other methodsfor restoring ideal contour include the use of block-out resin,resin composite, or utility wax.

During the next visit, local anesthesia was administeredand initial caries removal accomplished (Figure 4a). Shadeselection was performed prior to the restorative procedureand confirmed during the procedure (Fig ure 4b). It isimportant to perform a shade analysis before the restorativetreatment to prevent an improper color matching that mayresult from dehydration and elevated values.39,40 Theadhesive preparation was completed according to theaforementioned design guidelines for the vital primaryanterior incisor. It is important that the unsupported enamelwalls of the Class III be removed to allow the material anunrestricted path of flow.

After the preparations were completed, each tooth wasseparated by applying Teflon tape (DuPont) (Fig ure 5a) or asmall amount of glycerin to the adjacent teeth. Thisproximal adaptation technique allows for optimal integrationof flowable resin composite in the interproximal re gion whilepreventing adhesion of the material to the adjacent toothsurfaces.38,41-43 A 37.5% phosphoric acid semi-gel (GelEtchant [Kerr]) was ap plied to the enamel and dentin


4


Figurs 5a to 5d. (a) Before initiating the adhesive protocol, the preparation design was completed and each tooth was separated by applying Teflon tape (DuPont) on the adjacentteeth; (b) a 37.5% phosphoric acid semi-gel (Gel Etchant [Kerr]) was applied to the enameland dentin surfaces for 15 seconds, rinsed for 5 seconds, and gently air dried; (c) a single-component adhesive (OptiBond Solo Plus [Kerr]) was applied with an applicator to the toothsurfaces, using a light brushing motion for 15 seconds, and air-thinned for 5 seconds; and(d) light cured for 10 seconds using a halogen LED curing light.

a b

c d

Figures 6a to 6c. (a) Theclear silicone matrix wasplaced over the anteriorsegment of the maxillaryarch and an opacious A-1shaded flowable resincomposite (G-ænialUniversal Flo [GCAmerica]) was initiallyinjected through a smallopening above eachtooth, followed by a B-1shaded flowable resincomposite; and (b and c)the resin composite wascured through the clearmatrix on the incisal,facial, and lingual aspectfor 40 seconds.

a

b c

Figure 7. The primarycomposite crown on themaxillary left primarycentral incisor aftercomposite sprueremoval prior to the finishing and polishingprocedure.


5


Figures 11a to 11c. (a) The gingival tissue was retracted with a gingival protector while the tooth-composite resin interface was finishedusing a tapered finishing bur. After finishing each primary composite crown with interproximal finishing strips and disks, silicone polishingpoints and cups, (b) a goat-hair wheel and diamond polishing paste were used to further enhance the surface luster of the composite resin.(c) The final surface gloss was achieved with a dry cotton buff using an intermittent staccato motion applied at conventional speed.

a b c

Figures 9a to 9d. (a) Before the adhesiveprocedure, the Teflon tape was applied tothe teeth adjacent to the maxillary rightprimary lateral to ensure an optimal andsmooth integration of the flowablecomposite in the interproximal region. Thisalso prevents adhesion of the material to the adjacent tooth surfaces. The tape can be adapted to the tooth surfaces and tucked into the gingival sulcus, using aninterproximal instrument (IPC-L (TN)[American Eagle]). (b) The etchant wasapplied to the enamel and dentin surfacesfor 15 seconds, rinsed for 5 seconds, andgently air dried; (c) an adhesive was appliedto the enamel and dentin surfaces with aNo. 2 sable brush, using a light brushingmotion for 15 seconds, air-thinned for 5seconds, and light cured. (d) After the sameshade combination of flowable compositematerial was injected into the clear matrixand allowed to cover the entire toothsurface, the material was cured through thematrix from all aspects for 40 seconds.

a b

c d

Figures 10a and 10b. After the incisalcomposite sprue was removed, theexcess polymerized composite resin wasremoved with the No. 12 scalpel blade.

a b

Figures 8a to 8c. (a) The composite crown was completed on the maxillary right primary central incisor using the same restorative procedure. (b) The excess polymerized composite resin was removed with a scalpel blade (No. 12 Bard-Parker [BD Medical]). (c) The incisalcomposite sprue was removed with a 30-fluted tapered finishing bur.

a b c

surfaces for 15 seconds (Figure 5b), rinsed for 5 seconds,and gently air dried. A single-component adhesive (Opti -Bond Solo Plus [Kerr]) was ap plied with an applicator to theenamel surface using a light brushing motion for 15seconds (Figure 5c), air-thinned for 5 seconds, and lightcured for 10 seconds using an LED curing light (Figure 5d).For difficult-to-manage children, a self-etch adhesive (G-ænial Bond [GC America], Scotch bond Uni versalAdhesive [3M ESPE], ALL-BOND UNIVERSAL [BISCODen tal Products]) may be used to expedite the adhesiveprocedure. In addition, preparing the enamel with adiamond bur may improve bond strengths.

The clear silicone matrix was placed over the maxillaryarch, and a highly filled flowable resin composite (G-ænialUniversal Flo [GC Ameri ca]) was injected through a smallopening above each tooth. An opacious A-1 shadedflowable resin composite (G-ænial Universal Flo) wasinitially injected followed by a B-1 shaded flowable resincomposite (Figure 6a). The resin composite was curedthrough the clear silicone matrix on the incisal, facial, andlingual aspects for 40 seconds (Figures 6b and 6c). Afterthe incisal composite sprue was removed, the excesspolymerized resin composite was removed with a scalpel(No. 12 Bard-Parker [BD Medical]) for each restoration(Figures 7 and 8). This restorative procedure wascompleted for each tooth prior to initiation of the next tooth(Figures 9 and 10).

The same simplified finishing and polishing protocol asdescribed in part one of this series was utilized (Figure 11).

An optimally finished restoration should provide a smoothsurface that will prevent plaque accumulation1,43-46 and resiststaining.1,43,47 In addition, the presence of microfine particles,composed of mineral filler and strongly bound to the organicmatrix, has been proven to produce the appearance of anaesthetically polished and smooth surface.48,49 Furthermore,finishing and polishing directly affects the aesthetic qualities ofcolor and gloss of the composite restoration.36 Thus, finishingand polishing techniques for composite primary crownsrequire a simplified, methodical, and efficient protocol toachieve a pleasing outcome and may provide the benefit ofincreased longevity of the restoration36,47 while promotingimproved gingival health.

IN SUMMARYAesthetic restoration of primary teeth in children has beenan ongoing challenge for the pediatric and general dentist,while the most effective aesthetic materials and techniquesfor restoring deciduous teeth are still in question.6 With theadvancement of dental materials and techniques inconservative dentistry, a multitude of aesthetic treatmentmodalities have been introduced for the management ofdental caries and trauma in the primary dentition.

The TIPCC is a technique that can be used to restorecaries and fractured anterior and posterior primary teeth toan ideal anatomical form. The described technique issimple and can be used to predictably replicate anatomicalmorphology, re-establish function, and restore naturalaesthetics in young children (Figures 12 and 13). Althoughnot a panacea to all pediatric restorative challenges, thistechnique offers an alternative restor ative solution for


6


Figures 12 and 13. Thecompleted maxillaryprimary incisors. Thisresin composite injection technique forprimary compositecrowns (Terry InjectablePrimary CompositeCrown) providesclinicians a simplified and predictable methodfor restoring aestheticand anatomicalmorphologicalparameters of theprimary dentition for anatural smile.

various clinical situations and is provided to complement—not to replace—our existing clinical repertoire. However,there is need for long-term clinical studies to further assessthe success and potential clinical benefits of this techniquewith these alternative biomaterials.

Although the philosophy for the modern restorativedentist has re mained the same, the mindset of the clinicianmust be transformed to continue to explore and developideas, techniques, and protocol. The knowledge and desireto create are limited by the materials that clinicians are ableto utilize in restorations. Con tinuing technological break -throughs allow the clinician to not only comprehend the“building blocks” of the ideal restoration, but also toimplement and maximize new materials in attaining morepredictable and aesthetic results.50 This knowledge mustbe integrated with the proper technique for each clinicalsituation and requires the clinical experience and judgmentof the operator. While the past may have given us greatminds with great discoveries, continuing to strive forexcellence will produce an even greater number ofadvances for future generations to write about.

REFERENCES1. Terry DA, Powers JM. A predictable resin composite

injection technique, Part I. Dent Today. 2014;33:96-101.2. Motisuki C, Santos-Pinto L, Giro EM. Restoration of

severely decayed primary incisors using indirectcomposite resin restoration technique. Int J PaediatrDent. 2005;15:282-286.

3. Metha D, Gulati A, Basappa N, et al. Estheticrehabilitation of severely decayed primary incisorsusing glass fiber reinforced composite: a case report.J Dent Child (Chic). 2012;79:22-25.

4. Troutman KC. Chrome steel crowns: a simplified self-assessment technique. Gen Dent. 1976;24:28-34.

5. Salama FS, Myers DR. Stainless steel crown inclinical pedodontics: a review. Saudi Dent J.1992;4:70-74.

6. Waggoner WF. Restoring primary anterior teeth.Pediatr Dent. 2002;24:511-516.

7. Waggoner WF. Restorative dentistry for the primarydentition. In: Casamassimo PS, Fields HW Jr,McTigue DJ, et al, eds. Pediatric Dentistry: InfancyThrough Adolescence. 5th ed. St. Louis, MO:Saunders; 2013.

8. Mahoney E, Kilpatrick N, Johnston T. Restorative

paediatric dentistry. In: Cameron AC, Widmer RP, eds.Handbook of Pediatric Dentistry. 4th ed. St. Louis,MO: Mosby Elsevier; 2013:71-93.

9. Kindelan SA, Day P, Nichol R, et al. UK NationalClinical Guidelines in Paediatric Dentistry: stainlesssteel preformed crowns for primary molars. Int JPaediatr Dent. 2008;18(suppl 1):20-28.

10. American Association of Pediatric Dentistry. Clinicalguidelines: pediatric restorative dentistry. ReferenceManual. 2013;35(6):226-234.aapd.org/media/Policies_Guidelines/G_Restorative.pdf.Accessed on April 21, 2014.

11. Gilchrist F, Morgan AG, Farman M, et al. Impact of theHall technique for preformed metal crown placementon undergraduate paediatric dentistry experience. EurJ Dent Educ. 2013;17:e10-e15.

12. Christensen GJ. Pediatric crowns are growing up.Clinicians Report. 2012;5:1, 3-4.

13. Schwartz S. Full coverage aesthetic restoration ofanterior primary teeth. media.dental care.com/ media/en-US/educa tion/ce379/ce379.pdf. Accessed April 8, 2014.

14. Webber DL, Epstein NB, Wong JW, et al. A method ofrestoring primary anterior teeth with the aid of acelluloid crown form and composite resins. PediatrDent. 1979;1:244-246.

15. Kupietzky A, Waggoner WE, Galea J. Long-termphotographic and radiographic assessment of bondedresin composite strip crowns for primary incisors:results after 3 years. Pediatr Dent. 2005;27:221-225.

16. Roberts C, Lee JY, Wright JT. Clinical evaluation ofand parental satisfaction with resin-faced stainlesssteel crowns. Pediatr Dent. 2001;23:28-31.

17. Croll TP, Helpin ML. Preformed resin-veneeredstainless steel crowns for restoration of primaryincisors. Quintessence Int. 1996;27:309-313.

18. Helpin ML. The open-face steel crown restoration inchildren. ASDC J Dent Child. 1983;50:34-38.

19. Pollard MA, Curzon JA, Fenlon WL. Restoration ofdecayed primary incisors using strip crowns. DentUpdate. 1991;18:150-152.

20. Stewart RE, Luke LS, Pike AR. Preformedpolycarbonate crowns for the restoration of anteriorteeth. J Am Dent Assoc. 1974;88:103-107.

21. Lee JK. Restoration of primary anterior teeth: reviewof the literature. Pediatr Dent. 2002;24:506-510.

22. Randall RC. Preformed metal crowns for primary andpermanent molar teeth: review of the literature.Pediatr Dent. 2002;24:489-500.

23. MacLean JK, Champagne CE, Waggoner WF, et al.Clinical outcomes for primary anterior teeth treated


7


with preveneered stainless steel crowns. Pediatr Dent.2007;29:377-381.

24. Ram D, Peretz B. Composite crown-form crowns forseverely decayed primary molars: a technique forrestoring function and esthetics. J Clin Pediatr Dent.2000;24:257-260.

25. Romero M, Saez M, Cabrerizo C. Restoration of afractured primary incisor. J Clin Pediatr Dent.2001;25:255-258.

26. Hartmann CR. The open-face stainless steel crown:an esthetic technique. ASDC J Dent Child.1983;50:31-33.

27. Cohn C. Full-coverage esthetic restorations for earlychildhood caries. dentallearning.net/articles/full-coverage-esthetic-restorations-early-childhood-caries.Accessed April 11, 2014.

28. Guelmann M, Shapira J, Silva DR, et al. Estheticrestorative options for pulpotomized primary molars: areview of literature. J Clin Pediatr Dent. 2011;36:123-126.

29. Waggoner WF, Cohen H. Failure strength of fourveneered primary stainless steel crowns. PediatrDent. 1995;17:36-40.

30. Ram D, Fuks AB, Eidelman E. Long-term clinicalperformance of esthetic primary molar crowns.Pediatr Dent. 2003;25:582-584.

31. Terry DA. Direct applications of a nanocompositeresin system: Part 1—The evolution of contemporarycomposite materials. Pract Proced Aesthet Dent.2004;16:417-422.

32. Summitt JB, Robbins JW, Schwartz RS. Funda -mentals of Operative Dentistry: A ContemporaryApproach. 2nd ed. Chicago, IL: QuintessencePublishing; 2001.

33. Croll TP. Primary incisor restoration using resin-veneered stainless steel crowns. ASDC J Dent Child.1998;65:89-95.

34. Dixon SW, Moon PC. Flexure strength and chip forceof aged universal composites. Poster presented at:IADR General Session; March 18, 2011; San Diego,CA. Abstract 2018.

35. Illie N, Rencz A, Hickel R. Investigations towardsnano-hybrid resin-based composites. Clin OralInvestig. 2013;17:185-193.

36. Terry DA, Geller W. Esthetic and RestorativeDentistry: Material Selection and Technique. 2nd ed.Chicago, IL: Quintessence Publishing; 2013.

37. Berg JH, Donly KJ. Conservative technique forrestoring primary molars after pulpotomy treatment.ASDC J Dent Child. 1988;55:463-464.

38. Terry DA, Leinfelder KF. An integration of composite resinwith natural tooth structure: the Class IV restoration. PractProced Aesthet Dent. 2004;16:235-242.

39. Terry DA. Restoring the incisal edge. N Y State DentJ. 2005;71:30-35.

40. Fahl N Jr, Denehy GE, Jackson RD. Protocol forpredictable restoration of anterior teeth withcomposite resins. Pract Periodontics Aesthet Dent.1995;7:13-21.

41. Terry DA. Restoring the interproximal zone using theproximal adaptation technique—Part 1. CompendContin Educ Dent. 2004;25:965-973.

42. Terry DA. Restoring the interproximal zone using theproximal adaptation technique—Part 2. CompendContin Educ Dent. 2005;26:11-16.

43. Terry DA. Natural Aesthetics with Composite Resin.Mahwah, NJ: Montage Media; 2004.

44. Stewart GP, Bachman TA, Hatton JF. Temperature risedue to finishing of direct restorative materials. Am JDent. 1991;4:23-28.

45. Berastegui E, Canalda C, Brau E, et al. Surfaceroughness of finished composite resins. J ProsthetDent. 1992;68:742-749.

46. Yap AU, Sau CW, Lye KW. Effects offinishing/polishing time on surface characteristics oftooth-coloured restoratives. J Oral Rehabil.1998;25:456-461.

47. Goldstein RE. Finishing of composites and laminates.Dent Clin North Am. 1989;33:305-318, 210-219.

48. Joniot SB, Grégoire GL, Auther AM, et al. Three-dimensional optical profilometry analysis of surfacestates obtained after finishing sequences for threecomposite resins. Oper Dent. 2000;25:311-315.

49. Jefferies SR, Barkmeier WW, Gwinnett AJ. Threecomposite finishing systems: a multisite in vitroevaluation. J Esthet Dent. 1992;4:181-185.

50. Terry DA. Enhanced resilience and esthetics in aclass IV restoration. Compend Contin Educ DentSuppl. 2000;26:19-25.

SUGGESTED READINGTerry DA, Geller W. Esthetic and Restorative Den tistry:

Material Selec tion and Technique. 2nd ed. Chicago,IL: Quintessence Publish ing; 2013.

Terry DA. What’s In Your Mouth? Chicago, IL: Quin -tessence Publishing; 2013.

Terry DA. Smile! Your Guide to Esthetic Dental Treat ment.Chicago, IL: Quintessence Publishing; 2014.


8


POST EXAMINATION INFORMATION

To receive continuing education credit for participation inthis educational activity you must complete the programpost examination and answer 4 out of 5 questions correctly.

Traditional Completion Option:You may fax or mail your answers with payment to DentistryToday (see Traditional Completion Information on followingpage). All information requested must be provided in orderto process the program for credit. Be sure to complete your“Payment,” “Personal Certification Information,” “Answers,”and “Evaluation” forms. Your exam will be graded within 72hours of receipt. Upon successful completion of the post-exam (answer 4 out of 5 questions correctly), a letter ofcompletion will be mailed to the address provided.

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General Program Information:Online users may log in to dentalcetoday.com any time inthe future to access previously purchased programs andview or print letters of completion and results.

POST EXAMINATION QUESTIONS

1. Composite prototyping can be used to establishaesthetic and occlusal parameters such asrestoration shape, physiologic contour, phonetics,and occlusion.

a. True b. False

2. Extensive caries and trauma represent the majorreasons for the restoration of primary teeth with fullcoronal coverage.

a. True b. False

3. The Terry Injectable Primary Composite Crowntechnique is an injectable resin composite techniquethat predictably translates a diagnostic wax-up intocomposite restorations using a modern all-ceramicmaterial.

a. True b. False

4. A circumferential chamfer is placed at only 0.7 mm indepth to increase the enamel-adhesive surface andto allow for a sufficient bulk of material at themargins.

a. True b. False

5. Finishing and polishing directly affect the aestheticqualities of color and gloss of the compositerestoration.

a. True b. False


9


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Dentistry TodayDepartment of Continuing Education100 Passaic AvenueFairfield, NJ 07004

Fax: 973-882-3622

PAYMENT & CREDIT INFORMATION:

Examination Fee: $20.00 Credit Hours: 1

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PROGRAM EVAUATION FORMPlease complete the following activity evaluation questions.

Rating Scale: Excellent = 5 and Poor = 0

Course objectives were achieved.

Content was useful and benefited your clinical practice.

Review questions were clear and relevant to the editorial.

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ANSWER FORM: VOLUME 33 NO. 6 PAGE 80Please check the correct box for each question below.

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This CE activity was not developed in accordance withAGD PACE or ADA CERP standards.CEUs for this activity will not be accepted by the AGDfor MAGD/FAGD credit.

Documents

A Predictable Resin Composite Injection Technique, Part 2 line angles, pulpectomized primary teeth with a signi-ﬁcant loss of tooth structure, patients with special needs,4-13