DIRECT ESTHETIC

TOOTH-COLORED
RESTORATIONS

DR. MAI Mahmoud YOUSRY

Professor
Operative Dentistry Department
Faculty of Oral and Dental Medicine
Cairo University
 Overview
 Definition
Composition, types and Classification
 Advantages and Disadvantages
 Indications and Contraindications
 Cavity preparation
 Clinical Steps of application
Disadvantages of resin composite
1. Questionable adaptation
 Polymerization shrinkage
 Poor wettability
 High Coefficient of
thermal expansion
This will cause:
– marginal leakage
– secondary caries
– postoperative sensitivity
 Thus
Proper adaptation must be achieved by
proper bonding through the use of:
Adhesive system

High bond strength

To resist debonding

Immediate by time
 Adhesive bond strength versus
composite polymerization shrinkage
High Adhesive bond strength and
high polymerization shrinkage

Enamel

Composite

Cuspal deflection Enamel microfractures

 Polymerization Shrinkage
• Significant role in restoration failure
• Counteract through:
A. decrease shrinkage volume
– lower shrinkage composites
– incremental placement
– Sandwich technique
use of base (GIC or RMGI)
B. Control shrinkage stresses
- Composites with stress-relief
technology
- Use of flowable composite
• Flowable composite:
Used under packable and
highly filled composites
- increase adaptation
• BUT have Increased
shrinkage

- elastic bonding concept

 Elastic bonding concept
• flow capacity during pre-gel stage of
polymerization
• Absorb stresses
 during polymerization
 during function
 Factors affecting polymerization
shrinkage Stress
• Amount of polymerization shrinkage
- filler content
- type of resin (MMA vs. Silorane)
• Rate of polymerization
- flow capacity (pre-gel stage) during
polymerization
- Viscoelasticity – elastic modulus
• Degree of conversion
 Overview
 Definition
Composition, types and Classification
 Advantages and Disadvantages
 Indications and Contraindications
 Cavity preparation
 Clinical Steps of application
 Steps of application of resin
composite
1. Selection of resin composite type
2. Shade selection
3. Isolation of the operatory field
4. Application of liner/base (if needed)
5. Matricing and wedging
6. Application of adhesive system
7. Packing and curing of composite
8. Finishing and polishing
 1. Selection of Composite type
Filler size and loading
Class of Size of
Anterior or
cavity cavity
posterior
preparation preparation
Esthetic/
Surface
finish Form,
Modulus of contact
elasticity and
contour
Mechanical
support
 Selection of Composite type
• Anterior/non-stress (Class 3)
– Microfill
– nanofill
– Micro- or nanohybrid

• Anterior/non-stress (Class 5)
– Microfill
– flowable
 Selection of Composite type
• Anterior/stress (Class 4)
– hybrid
– hybrid/microfill veneer

• Posterior
– hybrid
– packable
– bulk-fill
 Steps of application of resin
composite
1. Selection of resin composite type
2. Shade selection
3. Isolation of the operatory field
4. Application of liner/base (if needed)
5. Matricing and wedging
6. Application of adhesive system
7. Packing and curing of composite
8. Finishing and polishing
 Shade Selection
Anatomic shade guide
Enamel and dentin shades
- Enamel shade selected
from incisal third of tooth
- Dentin shade selected
from cervical third of tooth
Anatomic shade guide
Vita Tooth-guide 3D Master

Value
Chroma
Hue
After curing, will the resin composite
be lighter or darker in color??

Before curing Post curing

Lighter color when cured, because:

Camphorquinone initiator (yellow-brown)
is consumed in the setting reaction and
becomes part of the polymer (clear)
 Shade selection

When in doubt, choose the darker shade

Posterior restorations
Sectional matrix
Posterior restorations
Sectional matrix personalization
6. Application of adhesive system
• Self-etch adhesive
- one-step or 2-step
• Glass ionomer based adhesive
- Conditioning 10-20% polyacrylic acid for
10 seconds, then apply bond
• Universal adhesive system
- One bottle multimode adhesive; used
as etch-and-rinse, self-etch or selective
enamel etching
7. Packing techniques:
Incremental packing technique
Anterior teeth

Natural layering concept

 Packing techniques:
Incremental packing technique
Anterior teeth – Natural layering technique
 Packing techniques:
Incremental packing technique
Anterior teeth – Natural layering technique
• Incisal index technique
 How to achieve an invisible
highly esthetic restoration?
• Simulate tooth structure in:
 Shade and translucency
 Shape and size
 Form and contour
 Surface morphology, texture and lustre
 How to achieve an invisible
highly esthetic restoration?

• Choose a highly esthetic composite material

• Proper shade selection
• Use Enamel/Dentin shades
• Use Natural layering concept and technique
• Use Incisal index technique
• Proper finishing and polishing
 Packing techniques:
Incremental packing technique
Posterior teeth

Horizontal Vertical

Oblique Centripetal
Packing techniques:
Incremental packing technique
Centripetal packing technique
 Packing techniques:
Incremental packing technique
Posterior teeth – Pyramidal packing
(Successive cusp build up technique)
 Packing techniques:
Incremental packing techniques for
Posterior teeth:
x Horizontal (not preferable)
 Vertical
 Oblique
 Centripetal
 Pyramidal packing
(Successive cusp build up)
 Is Guided polymerization
technique still used?
NO Because:
• It was not proven that Composite
shrinks towards the light
• Does not improve marginal
integrity of restorations
• Metallic matrices are far better than plastic
ones in contact and contour/ overhangs
• Trans-dentinal curing attenuates the light
intensity and decreases depth of cure
• Advances in materials and techniques
 Packing techniques:
Bulk-fill resin composites
Features:
• Up to 4-5 mm increment thickness
How?
Degree of conversion
• Transparent fillers
• Using new photoinitiators
Shrinkage stresses
• Low shrinkage volume
• Stress-relief technology
 Packing techniques:
Bulk-fill resin composites
 Bulk-fill resin composites

Types:
Flowable bulk-fill
Conventional bulk-fill
Sonic-fill (kerr)
 Bulk-fill resin composites
Uses of Flowable bulk fill:
• Base material in Posterior class I and II
restorations in Deep preparations
• Endodontically treated teeth (core buildup)
 Bulk-fill resin composites
Uses of Conventional Bulk-fill:
• Posterior class I and II restorations
especially in:
 Deep preparations
 Endodontically treated teeth
Bulk-fill composites
Sonic-fill composite
Conventional versus Bulk-fill
resin composites

Conventional Flowable Bulk-fill

incremental Bulk-fill + composite/
placement conventional Sonic-fill
composite
 Finishing and polishing
How to simulate morphological surface
characteristics
How to simulate morphological
surface characteristics
Checking occlusion