CLASS V RESTORATIONS 11

CLASS V RESTORATIONS 11.21.07

Important to differentiate carious and non carious

Non-Carious Class V lesion

abrasion

Erosion

Abfraction (maybe)

A combination of these entities

Non- Carious treatment options

maybe non restorative

eliminating the causative factors of the lesions

regularly monitoring their progression

periodontal treatment

surgically cover the lesion with a connective tissue graft

may result in a more natural gingival architecture

Only connective tissue graft

If there is no attached gingiva

No enamel defect is present on the root

??

Papilla length and fullness are adequate

Esthetics is crucial restoring a more natural gingival contour

Restorative treatment

Lesion is active and no success in stopping its progression

Integriy of the tooth structure is jeopardized

A pulpal exposure becomes imminent

Hypersensitivity does not subside with nonrestorative tx

Lesion location compromises the planning of a removable prothesthesis

Only restorative

There is an adequate attached gingiva

Defect is mainly I nenamel

Lesion is deeper than 2mm horizontally

Class III recession; there is some loss of interdental bone

Esthetics is not of primary importance

Tooth may still be taller than adjacent teeth after restorative treatment

Combination treatment

Flap

Gingivectomy

Gain access

Maintaining biologic width

3mm biologic width from gingival margin of direct restoration

To gingival crest of bone

Tx may involve??

Factors influencing choice of restorative material for class V or root caries

caries risk

field control

strength requirements

accessibility to lesion for placement, finishing, polishing

longevity requirements

How retentive does the lesion present? If not very retentive, and you dont want to prep, use GI.

Can you get a curing light to the spot?

Behavior problems?

Esthetic requirements?

Class V Clinic materials

1. GI fuji II light cured resin modified GI

2. Fuji IX not light cured GI resin only

a. Requires a fuji coat to prevent water movement

3. amalgam

4. composite

Caries risk high, use

1. GI fluoride release

2. Amalgam cariostatic less plaque

3. composite no inhibition most plaque

Field control not excellent, use

1. amalgam

2. glass ionomer

3. composite

Esthetics important, use1. composite

2. glass ionomer

a. our clinic does not give us very many shades to choose from

3. amalgam

To groove or not to groove (retention groove)

When class V composite gingival prep margin is on root structure no gingival retention grove placed unless there is evidence of occlusal dysfunction.

If there is posterior interferences or mobility, wear facets, or parafunction (bruxism), you may need the retention groove.

Restoring materials and sequencing of placement

Flowable composite as the first increment in a THIN layer gingivally (we dont want it to be on the enamel.

For a better esthetic result with class V composite, etch and bond past your occlusal bevel. Also, allow the occlusal composite increment to go past your bevel (maybe just like 1mm). Thin out or feather edge the occlusal composite with a gloved finger or other instrument and wetting resin. ?? another sentence ??

Strength is important

1. amalgam

2. composite

3. glass ionomer

Amalgam

requires minimum 1mm depth in a non-stressed area.

90 degrees exit angles.

Sharp internal line angles and gingival retention grooves

Accessibility to place, finish posterior resin

1. amalgam

2. composite

Lingevity is critical

1. amalgam

2. composite

Lesion doesnt require much tooth preparation

1. glass ionomer

2. ?

3. ? didnt get it see slide ?

Glass ionmer cements

cement implies luting material

any substance which sets to a hard mass on being mixed with water or another material

only dental cement that is also a direct restorative material

Early glass ionomers

poor esthetics

prolonged setting rxns

poor wear resistances

vulnerable to hydration extremes

handling difficulties

Glass ionomers

inherent chemical adhesion to tooth structure

fluoride release

but sensitive to moisture and dessication

low fracture toughness

low flexure strength

low wear resistance

relatively poor esthetics

One way to classify glass ionomers:

how the material sets up

conventional GI is a powder and liquid

powder: glass

liquid: acid

Vitrebond is a resin modified glass ionomer.

dds091/4C. Nelson