COMPLEX MULTI-SURFACE COMPLEX MULTI-SURFACE COMPOSITE RESTORATIONSCOMPOSITE RESTORATIONS

DR. PETER WALFORD

COMMON PROBLEMSCOMMON PROBLEMS EXCESSIVE TIMEEXCESSIVE TIME OPEN/BROKEN CONTACTOPEN/BROKEN CONTACT MATRIX ISSUESMATRIX ISSUES GINGIVAL RE-DECAYGINGIVAL RE-DECAY

MORE PROBLEMS….MORE PROBLEMS…. PULP - SENSITIVITY OR PULP - SENSITIVITY OR

DEATHDEATH PITS,VOIDS,BUBBLESPITS,VOIDS,BUBBLES UNATTRACTIVE ESTHETICSUNATTRACTIVE ESTHETICS

ISOLATION CHALLENGESISOLATION CHALLENGES INSTRUMENTATION FOR INSTRUMENTATION FOR

LONG CROWNSLONG CROWNS PREPARATION DESIGN?PREPARATION DESIGN?

WWW.PETERWALFORDDENTISTRY.COM

USERNAME cardp2012

PASSWORD halifax

LINKS ON WEBSITELINKS ON WEBSITE FOLLOW ((CARDP)) ON HOME PAGE TO FIND FOLLOW ((CARDP)) ON HOME PAGE TO FIND

APPROPRIATE LINKS WITHIN WEBSITEAPPROPRIATE LINKS WITHIN WEBSITE

TIME SAVERSTIME SAVERS HEATED RESINSHEATED RESINS FAST CURE LIGHTSFAST CURE LIGHTS DELEGATION-the future ofDELEGATION-the future of

the restorative hygienistthe restorative hygienist positionposition BULK FILL?- a flawed conceptBULK FILL?- a flawed concept

CALSET COMPOSITE HEATERCALSET COMPOSITE HEATER BEST SETTING: 54 DEGREESBEST SETTING: 54 DEGREES MULTIPLE DESIGNS FOR COMPULES OR SYRINGES; SYRINGE IS MOST MULTIPLE DESIGNS FOR COMPULES OR SYRINGES; SYRINGE IS MOST

VERSATILE MODELVERSATILE MODEL DECREASES CURE TIME BY UP TO 75%DECREASES CURE TIME BY UP TO 75% INCREASES PHOTOCONVERSION, HARDNESSINCREASES PHOTOCONVERSION, HARDNESS THINS OXYGEN-INHIBITED LAYERTHINS OXYGEN-INHIBITED LAYER FOR EVIDENCE SEE WWW.ADDENT.COMFOR EVIDENCE SEE WWW.ADDENT.COM

DETERMINING CURE TIME FOR HEATED DETERMINING CURE TIME FOR HEATED RESINSRESINS

CHAIRSIDE CURE TESTINGCHAIRSIDE CURE TESTING 2MM DISC (DENMAT)2MM DISC (DENMAT) 3.5 MM DISC (HARDWARE TAP WASHER)3.5 MM DISC (HARDWARE TAP WASHER) DETERMINE CURE BY SCRATCH TESTDETERMINE CURE BY SCRATCH TEST CRUDE BUT ONE STEP UP FROM BLIND FAITHCRUDE BUT ONE STEP UP FROM BLIND FAITH HAVE CDA COMPILE A TABLE- A FEW SURPRISES WILL BE FOUNDHAVE CDA COMPILE A TABLE- A FEW SURPRISES WILL BE FOUND DARK SHADES AND FLOWABLES!! TAKE LONGERDARK SHADES AND FLOWABLES!! TAKE LONGER SOME VERY LIGHT SHADES MAY ALSO TAKE LONGER DUE TO MISMATCH BETWEEN LIGHT SOME VERY LIGHT SHADES MAY ALSO TAKE LONGER DUE TO MISMATCH BETWEEN LIGHT

SPECTRUM AND PHOTOINITIATORSPECTRUM AND PHOTOINITIATOR

PREVENTING OPEN/BROKEN PREVENTING OPEN/BROKEN CONTACTCONTACT

1.1. ANATOMICALLLY CONTOURED CIRCUMFERENTIAL MATRIXANATOMICALLLY CONTOURED CIRCUMFERENTIAL MATRIX2.2. CONTACT FORMERSCONTACT FORMERS3.3. CUSTOM WEDGINGCUSTOM WEDGING4.4. RESIN WITH SUITABLE FLEXURAL STRENGTHRESIN WITH SUITABLE FLEXURAL STRENGTH5.5. ADEQUATE CURINGADEQUATE CURING

FLEXURAL STRENGTH

THE IMPORTANCE OF FLEXURAL STRENGTHTHE IMPORTANCE OF FLEXURAL STRENGTH THOSE PORTIONS OF THE RESTORATION EXTENDING BEYOND THE ROOT BASE THOSE PORTIONS OF THE RESTORATION EXTENDING BEYOND THE ROOT BASE

MUST TRANSFER LOADS ON A DIAGONAL PATH TO THE RETORATIONMUST TRANSFER LOADS ON A DIAGONAL PATH TO THE RETORATION THIS CREATES A TWISTING SHEAR FORCE WITHIN THE RESIN; A “ FLEXURAL THIS CREATES A TWISTING SHEAR FORCE WITHIN THE RESIN; A “ FLEXURAL

LOAD”LOAD” BEST PARAMETER TO INDICATE THIS QUALITY IS FLEXURAL STRENGTHBEST PARAMETER TO INDICATE THIS QUALITY IS FLEXURAL STRENGTH INADEQUATE FLEXURAL STRENGTH WILL LEAD TO BREAKAGE OF MARGINAL INADEQUATE FLEXURAL STRENGTH WILL LEAD TO BREAKAGE OF MARGINAL

RIDGES EVEN IF EVERYTHING ELSE IN THE RESTOATIVE SUITE IS PERFECTRIDGES EVEN IF EVERYTHING ELSE IN THE RESTOATIVE SUITE IS PERFECT SEE WEBSITE FOR TABLE “COMPOSITE PARAMETER SPREADSHEET”SEE WEBSITE FOR TABLE “COMPOSITE PARAMETER SPREADSHEET”

BEST RESINS FOR LARGE RESTORATIONS: BEST RESINS FOR LARGE RESTORATIONS: TOP QUARTILETOP QUARTILE

GRANDIOSO (VOCO) 181 MPaGRANDIOSO (VOCO) 181 MPa VENUS DIAMOND (HEREAUS KULZER)169MPaVENUS DIAMOND (HEREAUS KULZER)169MPa FILTEK SUPREME ULTRA (3M Espe) 162MPaFILTEK SUPREME ULTRA (3M Espe) 162MPa

VENUSVENUSDIAMONDDIAMOND

ENSURING ADEQUATE CUREENSURING ADEQUATE CURE UNDERCURED RESIN IS A PREVALENT CAUSE FOR UNDERCURED RESIN IS A PREVALENT CAUSE FOR

FRACTURED RESTORATIONSFRACTURED RESTORATIONS SEE WEBSITE ((CURING COMPOSITES))SEE WEBSITE ((CURING COMPOSITES)) WIDE-SPECTRUM HIGH INTENSITY LIGHTS ARE BESTWIDE-SPECTRUM HIGH INTENSITY LIGHTS ARE BEST BEST RECOMMENDATION: SAPPHIRE PLASMA ARC 5 SEC CUREBEST RECOMMENDATION: SAPPHIRE PLASMA ARC 5 SEC CURE VALO LED SEE CLINICIAN’S REPORT OCTOBER 2010VALO LED SEE CLINICIAN’S REPORT OCTOBER 2010

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CRACRAOCTOBER 2010OCTOBER 2010

CURING DEEP BOXESCURING DEEP BOXES STUDY CLUB RULESTUDY CLUB RULE; BEYOND 6MM DEPTH, USE A DUAL ; BEYOND 6MM DEPTH, USE A DUAL

CURE SYSTEM UNTIL BOX DEPTH RESTORED TO 6MMCURE SYSTEM UNTIL BOX DEPTH RESTORED TO 6MM DUAL-CURE ADHESIVE PHOTOBOND OR ALL BOND 3DUAL-CURE ADHESIVE PHOTOBOND OR ALL BOND 3 DUAL CURE FLOWABLE, STARFILL 2BDUAL CURE FLOWABLE, STARFILL 2B

STARFILL 2BSTARFILL 2BDANVILLE DENTALDANVILLE DENTAL

141MPa141MPa HYBRIDHYBRID S/C IN 2.5 MINSS/C IN 2.5 MINS SEVERAL SEVERAL

CONVENIENT CONVENIENT AUTOMIX TIPSAUTOMIX TIPS

RECOMMENDED JOURNALS FOR RECOMMENDED JOURNALS FOR COMPOSITE INFORMATIONCOMPOSITE INFORMATION

REALITYREALITY CLINICIAN’S REPORTCLINICIAN’S REPORT THE DENTAL ADVISORTHE DENTAL ADVISOR

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RESIDUAL CARIES, BIOFILM CONTAMINATIONRESIDUAL CARIES, BIOFILM CONTAMINATION CARIES IS A NON-STRUCTURAL SUBSTRATE; DOESN’T BOND, HAS NO CARIES IS A NON-STRUCTURAL SUBSTRATE; DOESN’T BOND, HAS NO

RESISTANCE FORMRESISTANCE FORM BIOFILM IS AN INVISIBLE ANDUNIVERALLY PRESENT CONTAMINANT TO BIOFILM IS AN INVISIBLE ANDUNIVERALLY PRESENT CONTAMINANT TO

ADHESIONADHESION BOTH CONTRIBUTE TO PREMATURE FAILURE OF RESINSBOTH CONTRIBUTE TO PREMATURE FAILURE OF RESINS CAN BE CONTROLLED WITH THE ROUTINE USE OF CARIES DETECTORCAN BE CONTROLLED WITH THE ROUTINE USE OF CARIES DETECTOR

BENEFITS OF CARIES DETECTORBENEFITS OF CARIES DETECTOR CONFIRMS COMPLETE REMOVAL (CARIES IS CONFIRMS COMPLETE REMOVAL (CARIES IS

NOT STRUCTURAL!!)NOT STRUCTURAL!!) DISCLOSES PLAQUEDISCLOSES PLAQUE REVEALS FLASH IN FINISHINGREVEALS FLASH IN FINISHING

DEEP CARIESDEEP CARIES ANGELUS MTA 10 MINUTE ANGELUS MTA 10 MINUTE

SETSET DOVGAN PLACEMENT DOVGAN PLACEMENT

INSTRUMENTINSTRUMENT FO FULL PROTOCOL SEE FO FULL PROTOCOL SEE

CHAPTER IN MODXYZ CHAPTER IN MODXYZ

ELIMINATING AND REPAIRING PLACEMENT FLAWSELIMINATING AND REPAIRING PLACEMENT FLAWS ALCOHOLALCOHOL AS AN INSTRUMENT LUBRICANT IN PLACEMENT AS AN INSTRUMENT LUBRICANT IN PLACEMENT AVOIDS WEAKENING INCREMENT INTERFACES WITH ”PLACEMENT RESIN”AVOIDS WEAKENING INCREMENT INTERFACES WITH ”PLACEMENT RESIN” LIGHT SHIELDLIGHT SHIELD TO PERMIT UNHURRIED COHESIVE PLACEMENT-NO PREMATURE CURE TO PERMIT UNHURRIED COHESIVE PLACEMENT-NO PREMATURE CURE Z-PRIME PLUS (BISCO)Z-PRIME PLUS (BISCO) AS AN EFFECTIVE PRIMER FOR REPAIRS –BONDS TO SILICA AS AN EFFECTIVE PRIMER FOR REPAIRS –BONDS TO SILICA

18MPa, ZIRCONIM 22MPa, AND RESIN 18MPa, ZIRCONIM 22MPa, AND RESIN HF ETCH OPTIMIZES ADHESION TO SILICAHF ETCH OPTIMIZES ADHESION TO SILICA USE CONVENTIONAL THIN (5-7 MICRON) GEN IV OR V ADHESIVE AFTER Z-PRIME, USE CONVENTIONAL THIN (5-7 MICRON) GEN IV OR V ADHESIVE AFTER Z-PRIME,

CURE BOND, RESTORECURE BOND, RESTORE

PRACTICONPRACTICON

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REPAIRING FLAWS IN RESTORATIONS WITH Z-PRIME REPAIRING FLAWS IN RESTORATIONS WITH Z-PRIME PLUSPLUS

1.1. OPEN DEFECT UP INTO A SMALL SAUCEROPEN DEFECT UP INTO A SMALL SAUCER2.2. ETCH WITH PHOSPHORIC ACID IF ENAMEL MARGINS ARE INVOLVEDETCH WITH PHOSPHORIC ACID IF ENAMEL MARGINS ARE INVOLVED3.3. HF ETCH IF IS A SILICA-BASED FILLER PARTICLE (MOST RESINS ARE)HF ETCH IF IS A SILICA-BASED FILLER PARTICLE (MOST RESINS ARE)4.4. RINSE, DRY, Z-PRIME (BISCO),BLOW OFF SOLVENT, ADD PHOTOBOND, BLOW OFF RINSE, DRY, Z-PRIME (BISCO),BLOW OFF SOLVENT, ADD PHOTOBOND, BLOW OFF

EXCESS, CUREEXCESS, CURE5.5. FILL SMALL DEFECTS WITIH MATCHING FLOWABLE WITH AN EXPLORER TIP, CUREFILL SMALL DEFECTS WITIH MATCHING FLOWABLE WITH AN EXPLORER TIP, CURE6.6. FILL LARGE DEFECTS WITH RESTORING RESIN, CUREFILL LARGE DEFECTS WITH RESTORING RESIN, CURE7.7. FINISH WITH 7902,POLISH WITH WET SHOFU FG BROWNIE POINT, SLOW RPMS.FINISH WITH 7902,POLISH WITH WET SHOFU FG BROWNIE POINT, SLOW RPMS.

WEBSITE LINK ON REPAIRSWEBSITE LINK ON REPAIRS http://www.peterwalforddentistry.com/tiki/http://www.peterwalforddentistry.com/tiki/

tiki-index.php?page=Repairing%20Bubblestiki-index.php?page=Repairing%20Bubbles%2CVoids%2C%20and%20Flaws%2CVoids%2C%20and%20Flaws

OPTIMUM ISOLATION OPTIMUM ISOLATION ”ISOLATE OR DIE””ISOLATE OR DIE”

SUPRAGINGIVAL PREPS- SUPRAGINGIVAL PREPS- ISOLATE NON-LATEX DAMISOLATE NON-LATEX DAM SUBGIINGIVAL- SUBGIINGIVAL- HYGOFORMIC SALIVA EJECTORHYGOFORMIC SALIVA EJECTOR SILVERED DRI-ANGLES (THETA)SILVERED DRI-ANGLES (THETA) SURGICAL SUCTION REDUCEDSURGICAL SUCTION REDUCED IN LENGTH TO IMPROVE ACCESS IN IN LENGTH TO IMPROVE ACCESS IN

LIMITED ACCESS SITUATIONSLIMITED ACCESS SITUATIONS SALIVA EJECTOR BENTSALIVA EJECTOR BENT TO LIE UNDER THE TONGUE BENEATH A RUBBER TO LIE UNDER THE TONGUE BENEATH A RUBBER

DAMDAM

QUALITIES OF AN IDEAL RESTORATIVE QUALITIES OF AN IDEAL RESTORATIVE RETRACTION CORDRETRACTION CORD

BRAIDED NOT SPIRAL-WOUND OR LOOPEDBRAIDED NOT SPIRAL-WOUND OR LOOPED MINIMAL EXPANSION WHEN WETTEDMINIMAL EXPANSION WHEN WETTED EPINEPHRINE-IMPREGNATEDEPINEPHRINE-IMPREGNATED ALUMINUM SALT-IMPREGNATED, NOT FERROUS SALTSALUMINUM SALT-IMPREGNATED, NOT FERROUS SALTS ONLY TWO PRODUCTS MEET THIS CRITERIA: GINGIBRAID E ONLY TWO PRODUCTS MEET THIS CRITERIA: GINGIBRAID E

(VAN R) AND SILTRAX (PASCAL)(VAN R) AND SILTRAX (PASCAL)

QUALITIES OF AN IDEAL CORD PLACEMENT QUALITIES OF AN IDEAL CORD PLACEMENT INSTRUMENTINSTRUMENT

MOST CORD PACKERS ARE SERRATED, OVERLY BULKY, AND UN-MOST CORD PACKERS ARE SERRATED, OVERLY BULKY, AND UN-ERGONOMICERGONOMIC

OFF-ANGLE ; ERGONOMICALLY REACHES INTERPROXIMALLYOFF-ANGLE ; ERGONOMICALLY REACHES INTERPROXIMALLY SLIMSLIM NON-SERRATED TIPNON-SERRATED TIP RECOMMENDED: PFIG 4/5- CAN ALSO BE USED TO PLACE RESIN RECOMMENDED: PFIG 4/5- CAN ALSO BE USED TO PLACE RESIN

BEYOND THE LINE ANGLESBEYOND THE LINE ANGLES

HEMOSTATIC ETCH; A GAME-HEMOSTATIC ETCH; A GAME-CHANGERCHANGER

REQUIRES USE OF A LIQUID ETCHREQUIRES USE OF A LIQUID ETCH LEAVES NO RESIDUELEAVES NO RESIDUE ATRAUMATICATRAUMATIC VIRTUALLY 100% EFFECTIVEVIRTUALLY 100% EFFECTIVE

INEXPENSIVE LIQUID ETCHINEXPENSIVE LIQUID ETCH

Henry Schein 100-0572 (210cc) diluted 3:1 Henry Schein 100-0572 (210cc) diluted 3:1 by volume with distilled waterby volume with distilled water

About $50About $50 Makes up to 840 cc of etchantMakes up to 840 cc of etchant

0 1 2 3 4 5 6

DEPTH OF DEMINERALIZATION

THE STUDY CLUB ADHESIVE SYSTEMTHE STUDY CLUB ADHESIVE SYSTEM

SEE SEE ((Bonding|Bonding Protocol))((Bonding|Bonding Protocol)) MICROPRIME BMICROPRIME B

EFFECTIVE CROWN PREP DESENSITIZATION, HYPERSENSITIVE DENTINEFFECTIVE CROWN PREP DESENSITIZATION, HYPERSENSITIVE DENTIN LESS TISSUE-TOXIC THAN GLUTERALDEHYE FORMULATIONS SEE CRA AUGUST 2002LESS TISSUE-TOXIC THAN GLUTERALDEHYE FORMULATIONS SEE CRA AUGUST 2002 STABILIZES THE COLLAGEN NETWORK TO IMPROVE LONG TERM BOND DURABILITYSTABILIZES THE COLLAGEN NETWORK TO IMPROVE LONG TERM BOND DURABILITY COMPATIBILE WITH ALL GEN IV AND V ADHESIVES (TOTAL ETCH)COMPATIBILE WITH ALL GEN IV AND V ADHESIVES (TOTAL ETCH)

DUAL-CURE ADHESIVES:DUAL-CURE ADHESIVES: PHOTOBOND (KURARY) 20MPa OR ALL-BOND 3 (BISCO)35MPaPHOTOBOND (KURARY) 20MPa OR ALL-BOND 3 (BISCO)35MPa BOTH ARE:BOTH ARE:

ALCOHOL BASEDALCOHOL BASED THIN ( 5-7 MICRONS THICK,)THIN ( 5-7 MICRONS THICK,) DURABLEDURABLE

IF YOU CAN ISOLATE ITIF YOU CAN ISOLATE IT AND MATRIX IT, AND MATRIX IT,

YOU CAN RESTORE ITYOU CAN RESTORE IT

THE ENDTHE END