Seminars 1 - Hawaii Dental | American Dental Association
Transcript of Seminars 1 - Hawaii Dental | American Dental Association
HDA Posterior Composites 1 2017 11/14/2016
JAMSTAN PC dba Stan Presley, D.D.S., Jaimee Morgan, D.D.S., & Prestige Seminars 1
PA
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PA
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POSTERIOR COMPOSITE
RESIN RESTORATIONS 2 Biggest Complaints:
• Post-op sensitivity
• Unpredictability in establishing
interproximal contact
Stay in
Control!!!!!!
Use a rubber
dam and
tissue
management
The wonders of a rubber dam
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Tissue Management
It’s a dry subject but ……
it’s not just about getting
perfect impressions anymore
Tissue Management
3 catagores:
Mecanical Chemical Surgical
Retraction cord Ferric Sulfate Laser
Retraction foam Al Chloride Radiosurgery
Hemostatic Agents
• Viscostat: 20% Ferric Sulfate
• Viscostat Clear: 25% Aluminum Chloride
• Astringedent: 15.5% Ferric Sulfate
• Astringedent X: 12.7% Iron Soloution
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Don’t let your curing light be the weak link!
Valo and Elipar LED curing
lights are worth looking into
Check out the Valo
LED Curing light
• Corded or cordless
• Multiple modes
• Easy clean up
• Slender design allow
easy access even on
posterior teeth
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VAL LED Curing light Ultra high energy broadband cures
all dental materials
• 385 – 480nm
Capable of curing all light-cured
dental materials
Elipar (430-480nm)
VAL LED Curing light
3 Different settings
• Standard: 1000cm2
• High Power: 1600cm2
• Xtra Power: 3200cm2
– Capable of curing all light-cured dental
VAL LED Curing light
• Colluminated beam results in
complete curing
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Check out the Valo
LED Curing light
• Cordless operates on environmentally
responsible, safe, inexpensive
rechargeable batteries
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Dentin Bonding Agents (Blessed be the tie that binds)
AD
HE
SIO
N
The b
ondin
g o
f dis
sim
ilar
mate
rials
at th
e a
tom
ic level
Enamel Bonding
Phosphoric acid etching
achieves exposure of
enamel rod anatomy.
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DENTIN BONDING
• Acid etching removes protein in dentinal tubules,
exposing clean tubules ready for bonding.
• HEMA has a hydrophilic end that creates tags
into the dentinal tubules.
• The other end of the molecule is resin friendly
(hydrophobic), and thus bonds to the resin.
• The resin and the tooth are then united as one.
Etching “opens” the surface to receive resin
Dentin
Enam
el
• 35% phosphoric acid gel
• Used for all total-etch bonding
• Contains a surfactant; rinses easily
Ultra-Etch
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Peak Universal Bond Light Cure Resin Adhesive
Peak Universal Bond
• Peak Universal Bond is an adhesive resin ideal for all
bonding procedures
• Can be used with a self-etch or total-etch technique
• 7.5% filled and can be thinned to 2µm
• Ethyl alcohol solvent carrier
• Cures with most high intensity lights including LEDs
• Contains chlorhexidine (0.2%), which may ensure long-
term bond strength.
In the SEM image shown, the tooth structure has been dissolved away, revealing precisely where Peak had flowed into the dentinal tubules. Peak Universal Bond’s unique formula allows for optimal penetration
into the tooth structure, resulting in exceptional bond strengths.
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An even closer look reveals that Peak will fill even the most minute spaces within the tooth’s
anatomy, reducing the potential for air voids that create hydraulic pressure and cause post-op
sensitivity.
Clearfill SE
• Clearfil SE bond is a 6th generation light curing bonding
system.
• Can be used with a self-etch or total-etch technique
• Cures with most high intensity lights including LEDs
Optibond XTR
• Optibond XTR is a 6th generation light cure bonding
system
• Can be used with a self-etch or total-etch technique
• The adhesive is 15% filled.
• Cures with most high intensity lights including LEDs
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Bonding Strategies • Etch and rinse
• Self Etch
Obtaining a High Bond Strength
….a listing of quality products
• Peak SE or TE
• Optibond XTR
• Clearfill SE
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Clinical Observation of Three Self-Etching Adhesives for Bonding Orthodontic Brackets to Enamel Jaimeé Morgan, D.D.S., Stanley K. Presley, D.D.S.
Private Practice Midvale, Utah
The purpose of this clinical observation was to study and compare the
bonding efficacy of three self-etching (SE) and one etch and rinse (ER)
dentin adhesives for bonding orthodontic brackets to enamel.
Four young adult, orthodontic patients treatment planned for relatively
similar orthodontic procedures in four quadrants (both arches) were
recruited and subsequently selected for this 90 day clinical
observation. Patients with systemic and congenital enamel deficiencies
were excluded. Each quadrant extended from central incisor to 1st
molar. Self-etching dentin adhesives tested were: Peak SE (PSE,
Ultradent Products, Inc.), Clearfill SE (CSE, Kurary America), and
Optident XTR (OXTR, Kerr). The control group included etch and rinse
followed by Peak Universal Bond adhesive (PUB, Ultradent Products,
Inc.). A light activated luting resin was used for bonding the brackets.
The timing and method of illumination was controlled for all brackets.
For each patient, brackets on three quadrants were bonded with three
different SE adhesives. Etch and rinse (control) was used for the final
quadrant. The adhesives (SE and ER) were rotated through the
quadrants to allow equal functional loading to each adhesive. After
bracket placement, .014 nitanium wires were placed on the upper and
lower arches using elastomeric ligature ties. Presence and/or absence
of debonding were used as the criteria for comparison.
No brackets debonded during the 90 day clinical observation.
Results of this limited clinical observation suggest that the use of these
6th generation self-etch adhesives for bonding orthodontic brackets
provides similar clinical outcomes as the etch and rinse adhesive.
Strassler HE, Mann M. Dental adhesives for direct placement composite
restorations: an update. Dent CE Digest. 2011; Sept:2-14.
Christensen GJ. Bonding agents: Is convenience overriding strength? Clinicians
Report. 2010;3(6):1-3.
Christensen GJ. New universal adhesives (part II): Faster, easier, better?
Clinicians Report. 2012;5(8):1-2.
Alex G. Universal adhesives: The next evolution in adhesive dentistry? Compend
Contin Educ Dent. 2015;36(1):15-26.
Introduction
Materials and Methods
Results
Conclusion
References
AES 61st Annual Scientific Meeting February 24 -25, 2016
Control
PSE
CSE
OXTR
Peak SE Primer
Peak SE Primer is a self-etching primer mixed and
delivered in the unique JetMix syringe. JetMix
technology separates precise quantities of 1.2ph
acid and optimized priming resin to prevent the
hydrolytic breakdown and degradation that occurs
with other self-etching chemistries.
Obtaining a High Bond Strength: Proper Protocol is a REQUIRED
• Peak SE
20s 3s 10s 10s 10s
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In a World of Wedges,
What Should I Use?
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Getting Closer
To a Sensible
Segmental
Matrix System
Introduction to Segmental
Matrix System
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A sensible approach to a
segmental matrix system
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A sensible approach to a segmental matrix system
TRIODENT
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Speed it up!
Surefill SDR Flow Posterior Bulk Fill Flowable Base
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SDR: stress-decreasing resin
Polymerization stress is reduced by up to 60%
Apply up to 4mm increments
Use heavy body composite for occlusal 2mm
This flowable composite resin material, when compared to traditional flowable composite resins, demonstrated lower polymerization shrinkage and associated stress while possessing similar physical properties in terms of wear, surface roughness, gloss, color, stability, and stain resistance, as compared to traditional flowable composites resins Burgess J, Cakir D. Comparative properties of low-shrinkage
composite resins. Compend Contin Educ Dent. 2010;31 Spec No 2:10-
15.
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PF
Pearl Frost
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Remove the hardware
• Use your tapered bur to remove any
buccal or lingual flash
• Use egg shaped finishing bur to refine
occlusal anatomy
• Use 329 bur to add detail to grooves
• Use Green, Yellow, White Jiffy polishers
to put high shine.
• Finish with Jiffy Brush
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• Adjust occlusion
• Polish
• Finish with Jiffy Brush
The easiest, but the greatest
potential for post-op sensitivity
Class I’s
Jenny
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Class II’s
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Whitney
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•Omni matrix
•Segmental matrix
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