Class III Resin Composite Restoration

#8 ML

Overview

Anatomy
Marginal Integrity
 
 

Armamentarium

Instruments and Materials

 

Video Demonstration

Procedure

 

Evaluate the preparation for adequate dimensions  

  • Clinical note: Ensure complete caries removal

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Ensure appropriate isolation of the prepared tooth (e.g. rubber dam, isovac/isolite, etc.)

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Place the mylar strip interproximally 

  • Optional: To facilitate mylar strip placement, place an interproximal wedge prior to mylar strip placement

Instrument options: forceps

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Place a wedge interproximally, gingival to the contact area, from lingual to buccal to secure the mylar strip

Instrument options: forceps

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Optional: Clean the preparation with non-fluoride pumice on rotary instrument (slow speed)

Instrument options: prophy brush

Selectively etch the preparation

  • First apply etch to the enamel

  • After 5 seconds, apply etch to the dentin

  • Leave etch for a total etch time of 15-20 seconds (or according to manufacturer's instructions)

Use high speed suction to remove the majority of the etch

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Rinse the preparation with water for 30 seconds using the air-water syringe

          

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Lightly dry the preparation using the air-water syringe 

  • Clinical notes:

    • Do not desiccate or over-dry the preparation

    • Enamel should appear slightly frosty

    • Dentin should appear dry but slightly moist

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Clinical note: Apply disinfectant solution (e.g. 2% chlorhexidine) to the preparation and allow it to air-dry

Adjust the overhead light and loupe light to cure-safe mode

          

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Scrub the bonding agent into the preparation using a microbrush

          

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Apply a light stream of air from the air-water syringe to thin the bonding agent 

  • Test the air-water syringe prior to use to ensure there is no water contamination

  • Remove excess bond that has spread beyond the preparation using a clean microbrush 

          

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Optional: Apply a second coat of the bonding agent using the microbrush and air-thin using the air-water syringe

Light cure the bonding agent for 20 seconds 

          

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Extrude composite from the compule and composite dispenser onto a clean mixing pad sheet. Pick up a small amount of composite using a hand instrument

  • Optional: To prevent sticking of the composite, apply a coat of bonding agent to the hand instrument

 

Instrument options: plastic instrument, composite condenser, composite carrier, super plugger

          

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Place composite into the most facial portion of the preparation, beginning at the facial-axial line angle

  • Increments of composite should be no more than 2mm thick 

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Use the smallest composite plugger to pack the composite and ensure it is flush with the preparation walls

Light cure for 20-40 seconds 

  • The tip of the curing light should be close to but not touching the composite

          

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Incrementally fill, pack, and contour the preparation until the preparation is filled. Light cure between increments 

  • Composite should be applied and shaped using hand-instruments to recreate the desired tooth contours and anatomy 

Instrument options: plastic instrument, composite plugger, composite carrier, super plugger

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Using the index finger, hold down on the facial portion of the mylar strip and wrap the lingual portion over the lingual contour of the tooth to create the proximal anatomy

          

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Light cure for 20-40 seconds while holding the mylar strip over the composite

          

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Remove the wedge and mylar strip 

  • Optional: Separate the mylar strip from the restoration by breaking their contact with a probe before removing

Instrument options: forceps

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Light cure for 20-40 seconds from the facial, lingual, and incisal directions 

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Inspect the restoration for voids, flash, and inadequate marginal seal. Add composite as needed

 

Instrument options: explorer

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Assess the interproximal portion of the restoration

  • Identify excess material or overhang using the explorer

  • Floss will catch or fray if the restoration requires interproximal finishing

Instrument options: explorer, floss

Remove gross excess material or overhang as needed

  • Use the more abrasive side of the finishing strip to reduce interproximal excess 

    • Insert the finishing strip by the grit-free middle portion and move it buccally and lingually to contour and smooth

    • Do not use the finishing strip in the contact area

  • Use a No. 12 surgical blade or scaler to remove interproximal excess material in the gingival area 

    • Shave from the tooth onto the restoration using light strokes. Always maintain portion of the blade on enamel as a contour guide

Instrument options: finishing strip, No. 12 surgical blade, scaler

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Contour, remove excess composite, and perform coarse finishing with rotary instruments (high speed with water or slow speed) 

 

Bur options: dura white stone, fine and ultrafine diamond finishing burs, multifluted carbide finishing burs, aluminum oxide polishing disks

          

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Perform fine finishing with rotary instruments (high speed with water or slow speed) or finishing strips

  • Use the finer side of an appropriately sized finishing strip to finish interproximally

  • Use a round or oval shaped bur to remove excess on the lingual surface

Bur and material options: finishing strip, resin impregnated abrasive polishing burs, rubber finishing cups/points, felt polishing wheels 

          

Remove the isolation (e.g. rubber dam)

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Check the occlusion using articulating paper. Adjust the occlusion as needed using rotary instruments (high speed with water or slow speed) 

  • Clinical note: After checking with articulating paper, ask the patient if their bite feels “even” or their restoration feels “high”

Bur options: fine and ultra ultrafine diamond finishing burs, white stone

Floss up and down in the contact area 

  • An appropriately closed contact produces a "snap" sound when floss passes through 

  • An open contact will produce no resistance when floss passes through

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Polish the restoration with rotary instruments (slow speed) 

  • Optional: Use polishing paste (e.g. Prisma Gloss)

 

Bur options: sponge brush or goat brush, polishing discs, silicon carbide impregnated brush, paste impregnated brush 

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Clean and dry the restoration using the air-water syringe

Examine the restoration 

  • Use the explorer to check for a smooth transition between tooth structure and the restoration 

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  • Composite restoration must be flush to cavosurface margin with no pits, steps, and/or voids

  • Smooth transition from restoration to tooth structure

  • Correct marginal ridge height

  • Closed interproximal contact

  • Correct interproximal contour

  • No overhang or underhang

     

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Checklist