DR RAJESH GADEKAR
BDS 1982 GDC NGPPG CERT COSMETIC DENTISTRY USA CERT COSMETIC DENTISTRY SWISCERT DENTAL IMPLANTS GERMANYCERT FIXED ORTHODONTICSCERT MICRO DENTISTRYCERT PERIO AESTHETIC SURGERYCERT METAL FREE DENTISTRY
INTERNATIONAL LECTURESJAPAN,TURKEY,SINGAPORE,SRILANKA,ISRAEL,ITALY
T V INTERVIEWS SURABHI –DD1,SUBAH –SAVERE-DD1,ZEE NEWS MAHARASHTRA STATE NEWS,ETV
Private practice As GP since 25 yrs As smile designer since 15yrs
SHRI GANESHJI
LORD RAMDEOJI
LORD MAHAVIRJI
Invisible trouble free & durable composite restorations
BASICS & LATESTS IN AESTHETIC ADHESIVE DENTISTRY
composites
*Require different approach in cutting principles*G V BLACK’S principles not useful*No extenssion for prevention,, extenssion is consideredAs distruction,,extenssion is ONLY FOR CONVENIENCE*Rounded thick margins or thick BEVELS,,NO KNIFE EDGES*No bulk fillings
WHY & HOW
*Attention to technique sensitivity as per manufacurers intructions*Use of un expired materials,,good storage*Strict isolation,prevention from infection*Efficient light cure machines*regular periodic maintenance of restoration & gingival pdl tissues
composites
composites
*use of round burs & tapered fissure burs with rounded ends*minimum cutting,, minimum dentin cementum exposure*updating knowledge & armamentarium
Composites for Direct Composites for Direct RestorationRestoration
Conventional Conventional 8 to 12 8 to 12 m m Small Particle Small Particle 1 to 5 1 to 5 m m
HybridHybrid 0.6 to 1 0.6 to 1 m m Microfill Microfill 0.04 to 0.4 0.04 to 0.4 m m Micro/Nano-hybridMicro/Nano-hybrid 0.6 0.6 mm
Particle size Particle size 0.04 0.04 m to 1 m to 1 mm equivalent to equivalent to
40 nanometers40 nanometersto 100 nm. to 100 nm.
Ideal Composite for Direct Ideal Composite for Direct Composite Restorations Composite Restorations outermost layeroutermost layerMicrofillsMicrofills - Less cure time 4 to 10 sec. - Less cure time 4 to 10 sec.
- High luster & Polish- High luster & Polish- Slow wear- Slow wear- - High Polymerization shrinkageHigh Polymerization shrinkage- Less strength- Less strength- Lower Flexural strength- Lower Flexural strength- Stickiness- Stickiness- Translucency- Translucency
Microfill sizeMicrofill size - 0.04 to 0.4 - 0.04 to 0.4 m m - - HeliomolarHeliomolar Invoclar Invoclar -Vivadent -Vivadent - - Clearfil STClearfil ST - Kuraray - Kuraray - - Durafil VSDurafil VS - Heraeus - Heraeus Kulzer Kulzer
Latest New Composites
NanofillsAre Nanofills different & Better from Microfills?
Spherical Particles of controlled size as filler in microfills.Same or some what better than Microfills- less curingtime, Long Term Clinical data awaited?
Filtek 3M supreme - 20-75 nmEquivalent to (0.04 to 1 m ) i.e. Microfill
Simile - Pentron Clinical.
Ceram x nano ceramic Composite with organically modified ceramic particles 2-3 nano meter in size
High lusterLess curing timeLow voidsNon stickyLow polymerisarion shrinkageBetter cureMore durableReuced fluid absorptionLow wearLow maintenance Most economical
MicroHybrids – 0.4 to 0.6 mFor Posterior Stress Bearing Situations
NANO HYBRIDSFiltek I 250 - 3 M Ceram X - DentsplyTetric Evo-Ceram - Ivoclar - Vivadent
All these are Nano Ceramic Hybrid composites
Contain Nanofill/microfill fillers in Hybrid Composite matrix.
Micro/Nano Hybrids - – 0.4 to Micro/Nano Hybrids - – 0.4 to 0.6 0.6 mm
ClinicalClinical Features Features
Good polishability & Luster. Good polishability & Luster. Low polymerization shrinkage due to less resin.Low polymerization shrinkage due to less resin. High strength.High strength. High Flexibility. High Flexibility. Virtually Non StickyVirtually Non Sticky Good Handling Less Slumping Good Handling Less Slumping Higher radioopacity. Higher radioopacity. Less Sensitivity to ambient & Operatory light.Less Sensitivity to ambient & Operatory light. Less curing time.Less curing time. Low wear. Low wear.
Flowable composites
Low filler contentThixotrophicLess stickyBetter intemate adaptation to tooth strucureLess voidsCan be placed evenly all over cavity in very thin layerMakes shading layering of paste composites very easyReducing pull back to instrument
Composites for Characterization-Durafil colour Vs – Heraeus kulzer
-Rambrant shade modifier - Denmat -Tetric colour – Ivoclar – Vivadent
1. Simulation of white spots,enamel cracks, masking discolouratins.
2. Bluish Gray- Simulation of Translucent enamel edges.3. Ochre4. Medium Brown – Enamel cracks, discoloured fissures,
worn surface, cervical area.5. Dark Brown.6. Black – Discoloured fissures.
Etching TechniquePartial Etch - Only Enamel 15 Sec.
- Sandwich Technique Total Etch - Enamel 15 sec. Followed
by dentin 5 sec. Spot Etch - For temporization of
ceramic veneers
Etching Solutions : Phosphoric acid H3PO4- 37% Nitric Acid Malaic Acid EDTA Hydrochloric Acid Salisylic acid Polyacrylic acid
Isolation Metal strips Capri Mouth prop
Optragate-Ivoclar
Cheek Retractor Rubber Dam
Retraction Cords Suction high-low
Effect of 37 % Phosphoric Acid
- Selective removal of hydroxyappalite from organic collagen matrix to a depth of 5 m to 10 m.
- Enter upto 50 m to 100 m.
- Lateral diffusion in peritubular dentine 5 m to 10 m.
Effect of 37 % Phosphoric AcidEffect of 37 % Phosphoric Acid
Rinsing SolutionWashing Solution Mean Tensile Bond
Strength Kg/Cm2
Distilled water 18.75Tap water 36.01Mineral water 43.09Saline 51.385
Ethanol Rinse increases Bond StrengthIons; Electrolytes contribute to the Bond
Strengths
Contamination of Etched Enamel &
Bond Strength
Tenacious surface coating cannot be removed by air
water spray. If etched enamel is contaminated by
saliva for 0.5 sec to 20 sec.
Enamel dried with Warm air increases Bond Strength
Beauty of Bonding & Beauty of Bonding &
Generation ConceptGeneration Concept
11stst GenerationGeneration Dentin Dentin BondingBonding 1965 – Bowen - Glycerophosphoric acid 1965 – Bowen - Glycerophosphoric acid
dimethacrylate dimethacrylate – – byfunctional molecule- byfunctional molecule-
hydrophilic phosphatehydrophilic phosphate group- calcium irons of group- calcium irons of
hydroxyapatite. hydroxyapatite.
- Surface active comonomer-NPG-GMA Surface active comonomer-NPG-GMA bonding by Chelationbonding by Chelation
- Bond strength to dentin Bond strength to dentin 3 MPA3 MPA
22ndnd Generation Generation Dentin Dentin BondingBonding
Polymerisable phosphates- Bis- GMA-Cloro substituted Polymerisable phosphates- Bis- GMA-Cloro substituted phoshate esters of various monomers phoshate esters of various monomers
Ionic bond to calcium by clorophosphate group Ionic bond to calcium by clorophosphate group
Drawback-Drawback- Eventual hydrolysis- Debonding- Long term Eventual hydrolysis- Debonding- Long term Success? Success?
Examples : Examples : Clearfil (Kuraray)-Clearfil (Kuraray)- 2-HEMA and Phenyl Phosphate 2-HEMA and Phenyl PhosphateScotch bond –Scotch bond – 3 M- Hallo Phosphorous Ester of Bis- 3 M- Hallo Phosphorous Ester of Bis-GMA GMA Bond Strength – Bond Strength – 2 to 7 MPA2 to 7 MPA