Lets growtooth

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<ul><li> 1. Efficiency in tooth restorationLets Grow ToothBioactive/regenerative materials to increase comfort and decrease failure2014-2015Jack D Griffin, Jr DMDDiplomat American Board of Aesthetic DentistryAccredited American Academy of Cosmetic DentistryMaster Academy of General DentistryThank you for choosing to spend your time with us. We know that there are many choices in continuing education and we sincerely want this to be one of the best experiences in dental CE today. Our goal is to help you gain greater understanding, confidence, and skill that will allow you to take your restorative practice to the next level in dentistrymaking your practice more efficient.Please let us know if there is anything we can do to help you as we take a journey down the road of long term restoration success together.If you dont know where you are going, any road will take you there.All materials in this manual are protectedplease dont copy without permission </li></ul><p> 2. 2Lets grow some toothBioactivityRegenerativeObviously we arent growing tooth from scratch. Perhaps a better term for what we are describing is regenerative in that we are creating an environment to promote secondary dentin formation and bacterial inhibition.With regenerative materials we are trying to stimulate dentin repair, healing, and formation using materials that are bio-friendly.ourse outline:1. Liners and bases that insulate, protect, and seal2. Giomers: the class of restorative materials that inhibit bacteria but perform like composite3. Cements that are biofriendly, easy to clean up, and sensitivity free4. Universal bonding agentsthe new GOTTA HAVE materials5. Bulk fill materials for posterior restorationsmore predictable, more efficient6. Putting it all together with direct and indirect restorationsC[bio-aktiv] having an effect on or eliciting a response from living tissue. bioactiveSome regenerative materials:TheraCal LC (Bisco) a linerBiodentine (Septodont) a baseCeramir (Doxa) a cementGiomers (Shofu) a class of restorative materials 3. 3a liner that promotes dentin regeneration TheraCal LC (Bisco)What it isA Resin Modified Calcium Silicate (RMCS)Stimulates apatite formation and dentin repairMTA (Mineral Trioxide Aggregate) chemistryEarly high alkalinity (high pH = 11)Neutralizes over weeksSelf-sealing minor bond to dentinAnti-microbialClinical useLiner to protect pulpPlace on moist dentin prior to DBAKeep 1mm deep or lessOpacity prevents deep cureDirect pulp cap possibleKeep 1mm from enamelMay show through less opaque compositeComparisonsis alkaline but not stable DycalWashes outMay interfere with DBAsimilar dentin/pulp response BiodentineCumbersome to mixEasy to placeDentin replacement baseNeed 2nd appt to restore overGiomersa class of (Shofu)restorative materials that inhibitsbacterial growth while stimulatingdentin repair. Probably has clinicalcharacteristics similar to any materialyou currently use within in the samerestorative category WITH the benefit of fluoride release, recharge, and re-release.A restorative material with the following:Surface Pre-Reacted Glass (S-PRG)Unique release of 6 bioactive, regeneration inducing ionsHigh ability for acid neutralizationInhibition of plaque formationGreat clinical characteristicsHow does it work?A source of reparative ionsAlkaline environment required for dentin healingStimulant of hydroxy-apaptiteBacteriostaticDentin tubule protectant/sealantThermal insulationNotes: ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ 4. 4Giomer ion release by S-PRG:NA+ water soluble, induces function of the other 5 ions - Sodium:BO3- bacteriocidal, promotes dentin formation, decrease bacteria adhesion, anti-plaque - Borate:Al3+ blocks dentin tubules, decreases hypersensitivity - Aluminum:SiO2- Calcification of dentin - Silicate:Sr2+ Buffer, acid resistance, stimulate dentin regeneration - Strontium:F- Formation of fluoroapatite, anti-caries, anti-bacterial, remineralization of decalcified lesions - Fluoride:Giomer restorativesFlowableUniversal hybridPackable posteriorBulk fill flowableSealantAll with same giomer benefits.Distinguishing characteristics.A glass ionomer type core, protected from the negative effects of moisture, in a resin matrix. The result is glass ionomer benefits with physical properties of composite.Notes: ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ 5. 5Does your etch matter?TextureRinse-abilityColorLong term antimicrobial?Phosphoric acid kills NOWBezalkonium Chloride kills LATERDoes killing bugs matter?Matrix metalloproteinases = MMPsenzymes that may break down the hybrid layer between dentin and resin2% Chlorhexidine has been shown to decrease the MMP deterioration of our bonding to collagen.Notes: __________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Isolation is criticalDamIsoliteDentaPop/DriTipCotton rollsGauzeNotes: ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ 6. 6Indirect RestorationsPosterior CompositesStuff we gonna needCuring light _______________________________________________________Instruments ______________________________________________________Bonding agent ____________________________________________________Composite _______________________________________________________Flowable _________________________________________________________Matrix ___________________________________________________________Polishers __________________________________________________________WCERAMIR (Doxa)Regenerative cementGI plus calcium aluminateBioactive cement apatite formationEasiest clean up everLeast sensitivity of any cement testedNO RESINAlkaline pHHydrophilicNo silane, no primer, no bonding agentsAwesome for metal, zirconia, lithium disilicateNo bad taste! 7. 7Restoration cementation adhesive or non-adhesiveCementing is either adhesive or non-adhesive. A major clinical advantage of zirconia and lithium disilicate is that they can be cemented or bonded in place depending upon the resistance of the preparation and preference of the dentist. In those cases where preparation design is retentive in nature, cementation is a viable option with the amount of surface area and degree of divergence of the prepared walls can provide sufficient micromechanical retention. Resin reinforced glass ionomer cements like RelyX Luting (3M ESPE) or GC Fuji Plus (GC America) and newer bioactive cements like Ceramir (Doxa) have been popular choices because of lower reported sensitivity, ease of use, and long term clinical success on retentive preparations. These cements are often more opaque and less esthetic than the resins and so the more translucent the e.max the more this matters.The 2 critical junctions during definitive placement of any restoration is first the bond of the luting material to the internal surface of the restoration and secondly to the tooth. When preparations are short, overly tapered, or occlusal forces heavy, resin bonding is indicated and would provide maximum restoration retention, microleakage prevention, and increased fracture/fatigue resistance of the restorative material itself. Failure most often occurs at the cement/restoration interface and not at the cement/dentin interface.Important points: UNIVERSAL BONDING AGENTS: (i.e. All Bond Universal, Bisco;Scotchbond Universal, 3M) have changed our bondingprotocolsimpler and better. These are giving us the best all aroundbond strengths ever toa variety of surfaceswhether dry or wet,etched or not etched,metal or porcelain. SoUniversal Bond Agents simplify things no more total and self-etch bond agents, no zirconia or metal primers, no worry about too wet ortoo dry. CLEAN after try in: onpre-etched porcelainof any kind (and forzirconia) maximum bond strengths can only be achieved afterremoving salivary contaminants. Ivoclean (Ivoclar) does this better thananything and conditions the surface for better bonding (particularly(Shofu) Giomer, BeautiCem SA bonds highly to almost everything. High fluoride release, re-chargable, great properties. Similar to all others in Self Adhesive category with the benefits of the giomer. 8. 8zirconia). Must reapply silane Ivoclean use. If there is little or no enamel, we dont etch. The universal bonding agents are terrific non-etch adhesives on dentin or prepped enamel both Bisco and 3M have dual cure universal DBAs toinsure set under opaque restorations. If lots of enamel, selectively etchit first. Research is showing less long term breakdown of dentin bonds byprotease/enzymes if we use something to kill bacterial likechlorhexiding or benzalkonium chloride (BAC) prior to bonding. We usean etch (Etch 37 with BAC, Bisco) when we etch. Certainly anantimicrobial scrub (Concepsis, Ultradent: Cavity Cleanser, Bisco) makes sense as well. Self-adhesive dual-cure resin cements Like RelyX Unicem (3M),SpeedCem (Ivoclar), SmartCem (Dentsply) show very good retention,little sensitivity, and ease of use as long as the retention of the prep isgood. While these cements are popular, the retention andmicroleakage is not nearly as good as a separate bonding agent appliedto the tooth and restoration followed by a dual cure resin cement likeAll Bond Universal+DuoLink Universal (Bisco) or Scotchbond Universal+RelyX Ultimate (3M).Adhesive protocol for maximum lithium disilicate dependability (crowns, veneers, etc):1. Limit layering porcelain where not needed for esthetics2. Retentive preps 4-8 degree taper, minimum 3-4mm walls, strong core3. e.max press make sure the lab has etched and silanated4. e.max CAD in office 20 second 5% HF etch, rinse well, silane, resin depending on system used for luting5. Try in. Rinse. Clean with Ivoclean 20 seconds. Rinse well.6. Universal bonding agent applied to restoration. Air thinned. NO CURE.7. Isolate tooth. Clean dentinalcohol on microbrush or aluminum chloride scrub or chlorhexidine, or pumice8. Universal bonding agent applied to tooth. Air thinned. NO CURE.9. Luting materialdual cure resin for crowns or opaque anteriors, light cure only resin for thin veneers or translucent anteriors (to avoid shade shifting)Try in, clean.Universal DBA on porcelain and tooth...air thin both.place resin cementEsthetics of LiDi is at the limit of the ceramist. With proper cut back and addition of layered porcelain, esthetics can be as good as any material out there. Again, lab selection is the determining factor. Blocking dark color is not quite as dependable as more opaque materials like metal and zirconia. Remember, a monolithic piece of LiDi has much less chance of failure than one with layering porcelain, but for highly esthetic cases we use this material for almost all of them. The 9. 9combination of strength and esthetics with e.max is unsurpassed in esthetic dentistry today. The case above is e.max press, moderate translucency, cut back and customized.Important points of interest:1. Always show lab the color of the tooth so they can use the correct opacity. There are 5 different opacities of e.max press ingots.2. Sand blasting with AlO3 may cause tiny fractures which may grow and IS NOT RECOMMENDED by IvoclarIf you do with e.max CAD, use light pressure, far distance, glass beads, only to remove investment3. Cementation is allowed for retentive preps, but bonding improves retention and may strengthen porcelain by reducing crack propagation from inside and other iatrogenic problems4. Dont over etch slightly frosty, not chalky only 20 seconds with 5% HFl, rinse well, silanate5. Not strong enough for posterior or high stress anterior bridges6. Adjustments should be done with high speed finish diamonds, water, light pressure. Polish done with a porcelain polish system. Polish paste on chamy or felt wheel optional.7. For veneers a minimal prep is supported by Ivoclaras little as 0.3mmZirconiaThe quest for stronger, longer lasting esthetic restorations has continued since the practice of dentistry began. Today our goal is to combine ease in prep and placement, accepted esthetics, and predictable clinical longevity all at an in a manner that increases practice efficiency in a troubled economy. As we balance the functional performance of a material with the heightened esthetic standards of today, we sometimes have to think about taking a cosmetic step backward to gain more strength and durability. Along with these philosophical dilemmas there is often conflicting information on how best to use and handle newer materials and techniques: etch or no etch, sand blast or not, light or chemical cure, cement or bond?Advances with indirect esthetic materials the last few years have brought the profession higher levels of strength and esthetics than ever before with materials like lithium dislocate and zirconium oxide . Yttria- stabilized tetragonal zirconia polycrystal, Y-Tzp, has become very widely used the last few years because of its fracture resisting flexural strength over 1000MPa, non-metalic color, kind wear patterns on opposing teeth, easy intraoral polishability, tooth preparation similar to other all porcelain crowns, and excellent long term clinical success.Layering porcelain can be added to a zirconium coping to heighten esthetics but the weak adherence of the stacked or pressed layer has been a common area of clinical failure if the layering material is in function. Zirconia is a very strong monolithic restoration and an excellent substructure but the bond between layering porcelain and the zirconia is very clinically significant. Fracture or chipping of the veneering porcelain has been seen in a high percentage of cases and its use has been challeng...</p>