CHEN Zhi Wuhan University School of Stomatology Operative Dentistry 3.
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Transcript of CHEN Zhi Wuhan University School of Stomatology Operative Dentistry 3.
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CHEN ZhiCHEN Zhi
Wuhan University School of StomatologyWuhan University School of Stomatology
Operative Dentistry 3Operative Dentistry 3
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Indication of Operative DentistryIndication of Operative Dentistry
Caries; Malformed, discolored,
or fractured teeth; Restoration replacement.
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Tooth-colored restoration
For Class Ⅲ ,Ⅳ and Ⅴ ,— Esthetic Dentistry
For Class and Ⅰ Ⅱ ,
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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 & disadvantageof 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 Adhesionor
Dental Bonding
Adhesion is a process of solid and/orliquid interaction of one material withanother at a single interface.
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Enamel bonding system
Enamel bongding depends on resin tagsbecoming interlocked with the surfaceirregularities 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 basisfor 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 relatedto micro-mechanical bonding to theintertubular dentin which occures between tubules along the cut dentinsurface.
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Dentin Bonding Agent, DBA
Early DBA were hydrophobic, bonded directly to the dentin smear layer. Bond strengths < 6MPa.
Later DBA removed the smear layer buttended 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.
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The Development of DBAEnamel 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
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Cavity Preparation
Three designs of cavity preparation:
1.Conventional
2.Beveled conventional
3.Modified
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Beveled conventional cavity preparationsare 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 preparationsⅢ Ⅳ Ⅴ
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The advantages :
The ends of enamel rods are more etched
The increase in etched surface results ina stronger bond
Increase the retention and reduce marginalleakage and discoloration.
More esthtically
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Modified cavity preparation
Have neither specified cavity wall structurenor specified pulpal depth, and have enamelmargins.
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 compositeFinishing procedures
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Matrix application
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Final proceduresFinal procedures
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Cases
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Conservative Operative Dentistry
Minimal intervention dentistry
is regards as a main stream in caries treatment in the 21st century.
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Principles of Minimal Intervention dentistry
Remineralization of early lesions Reduction in cariogenic bacteria, to el
minate the risk of further demi-neralization and cavitation
Minimum surgical intervention of ca-vitated lesions
Repair rather than replacement of defective restorations
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“The day is surely coming, and perhapswithin the lifetime of you young menbefore me, when we will be engaged inpracticing preventive, rather than reparative, dentistry. ”
— GV Black in 1896
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University Minnisota School of Dentistry
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http://202.114.104.243/jpkc/ysysbx/index.html
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