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