Composites Handout

Report
Superior Aesthetics
Composite Layering vs Composite
Veneers
Munther Sulieman
Aesthetic Treatments
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Smile analysis
Recontouring
Whitening
Micro/macro-abrasion
Composite bonding
Veneers
Crowns
Factors affecting tooth shade
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Degree of polish
Thickness of enamel
Enamel morphology
Fluorescence and translucency
Dehydration
Recession and dentinal exposure
Intrinsic, extrinsic or internalised stain
Causes of Tooth Discolouration
• Intrinsic Discolouration
• Extrinsic Discolouration
• Internalised Discolouration
Intrinsic tooth staining causes
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METABOLIC
Alkaptonuria
Congenital erythropoietic porphyria
Congenital hyperbilirubinaemia
Rickets, Ehlers- Danlos syndrome
etc.
Intrinsic tooth staining causes
• INHERITED
• Amelogenesis
imperfecta
• Dentinogenesis
imperfecta
• Dentinal dysplasias
Intrinsic tooth staining causes
• IATROGENIC
• Tetracycline stains
• Fluorosis
Fluorosis Staining
 Caused by an interference with the calcification
process of the enamel matrix which results in
incomplete maturation accompanied with opacity
and or porosity
 Wide range of severity: mottled teeth- minor
(intermittent white flecking or spots) to severe
manifestation that involves pitting and brownish
surface stains
 Only affects superficial enamel thickness usually
Intrinsic tooth staining causes
• TRAUMATIC
• Enamel hypoplasia
• Pulpal haemorrhage
products
• Root resorption
• AGEING
• Teeth become darker,
more yellow and slightly
more red
Haemorrhagic discoloration
 Rupture of blood vessels and extravasation of
erythrocytes into the dentinal tubules which gives
the tooth a pink hue but the tooth may still remain
vital
 Majority of post endo discoloration is caused by
failure to completely remove blood or other organic
material from the pulp chamber.
 Pastes/ restorations: corrosion products from silver
amalgam in dentinal tubules, silver in sealing pastes
or zinc oxide eugenol- blue grey discoloration at
cervical area
Enamel Hypomineralisation
Developmental disturbance in the formation
of the inorganic component of enamel during
amelogenesis- results in brown enamel, white
opacities or enamel coloration defects of
various hues.
Defects can be localised to one section or an
entire surface of the tooth with coloured
streaks, multiple spots or other patterns
Intrinsic tooth staining causes
• Idiopathic
• MIH: Molar Incisor
Hypomineralisation
Root Resorption
Extrinsic tooth staining-direct
• Tobacco products
• Tea, coffee and red
wine
• Spices
• Vegetables
• Medicines
• Plaque
Extrinsic tooth staining-indirect
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CATIONIC ANTISEPTICS
Chlorhexidine
CPC
Hexetidine
OTHERS eg. Listerine
Internalised stains
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TRAUMA
cracks
loss of enamel
recession
• CARIES
• RESTORATIONS
Enamel Decalcification
 Lesions are acquired: occur when dental plaque
persists undisturbed on enamel surface producing
organic acids that etch the mineral content out of
the enamel surface
 Left undisturbed further leads to dental decay
 If intercepted early, there is no need for restorations
 Common sites for these lesions are cervical margins
of teeth or around orthodontic brackets with poor
OH.
Tooth discolouration
• Regardless of the nature of the discolouration
Must decide whether the discolouration is
confined to the superficial enamel thickness
or in the deep dentine layers
This determines the complexity and extent of
treatment as well as the absolute choice of
treatment
Tooth discolouration
Treatment Options
1. Bleaching: Vital and Non-vital
2. Enamel microabrasion
3. Direct composite veneers
4. Indirect veneers (Porcelain/ Composite)
5. Bleaching with indirect or direct veneers
Bleaching Options
• Vital
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Home
CP / HP -trays
In-surgery
15-50% HP± heat / light
activation
35% CP waiting room
OTC
Strips / Paint-on
Other
Toothpaste Mouthrinse Chewing
gum
• Non-Vital
 Walking
 HP,Perborate/HP, CP
 Inside / Outside
 CP
 In-surgery
 35% HP
Bleaching Indications
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Generalised staining
Ageing
Smoking and dietary stains
Fluorosis
Tetracycline staining
Traumatic pulpal changes
Aesthetics pre or post restorative
Bleaching Contraindications
 Patients high expectations
 Decay and periapical
lesions
 Patient can’t tolerate taste
 Pre existing Conditions
 Crowns
 Extensive restorative
dentistry: Composite and
porcelain restorations
 Major cracks
 Exposed dentine
 Pre existing problem
sensitivity
 Highly translucent tooth
 Pregnancy
 No scientific evidence
against bleaching but there
may be a psychological
effect on mother
 Bleaching may exacerbate
pregnancy gingivitis
Treatment of White Fluorosis
 Intensity, Location and Depth of lesion will
determine Tx
Bleaching of background (reduce contrast
between white spot and rest of tooth)
Micro-abrasion of foreground with or without
bleaching
Bleaching/abrasion and composites
Composite Veneers
Where Why and When Does
Composite Work?
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Biocompatibility
Adhesion to Enamel and Dentine
Colour Perception Optical Effects
Harmonious Blending with Tooth structure
Multiple Uses
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Main problems in handling composite
• Stickiness
• Surface wetting
• Surface smoothness
• Homogeneity
• Adaptation
• Individualization of texture and shape
• Internal air bubbles and wetting defects
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Freehand technique - problems
• Aesthetic
impression/expression
• Anatomical form 2
• Modelling incisal edges3
• Surface texture4
• Mammelons 5
• Ridgeline contour
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• Control
thickness of enamel
layer
© Mario Besek
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Direct Composite Veneers
Primary indications
White spot lesions
Severe fluorosis
Severe hypoplasia
All these discolorations are usually confined
entirely to the enamel thickness and never
extend into the dentine
Heavily restored stained anterior teeth
Direct Composite Veneers
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Advantages
More conservative- no enamel removal!
One session no lab costs
Easier shade match compared to single
porcelain veneer involving a lab especially if
mock-up is used
Direct Composite Veneers
 Only cut tooth tissue if absolutely necessary and
then only into enamel
 Consider air abrasion and bonding composite to
reshape teeth
 Mock-up may be needed to check contour and
shade if patient agreement is deemed necessary
 Shade match prior to tooth dehydration
 Matching adjacent tooth roughness and texture
greatly enhances appearance
Restoration of anterior teeth
• For small class IV and III cavities- centripetal
approach (build up from inside to outside)
• For large class IV and incisal build up- buccolingual approach used in conjunction with
silicone index
Natural Layering Technique
“The Clinical Procedure”
• Finishing & Polishing- aim is to re-create
texture and gloss.
• Surface re-contouring with fine diamonds
while discs are best for plane and convex
surfaces.
• Smooth out concavities/uneven surfaces with
fine diamonds or silicone points
• Fine shine best with hard polishing brushes
Polishing
• PC- Proximal contact
• BLP- Bucco-lingual
profile
• TL- Transitional lines
• SM- Surface
morphology
• IE- Incisal edge
COMPONEER
● are polymerized, prefabricated enamel shaded composite laminates
● is a direct Composite-Veneering-System
● simplify the freehand technique
● increases the quality of front teeth restorations
● is an economical system
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Componeer thickness
● Minimal or no preparation due to the minimal
thickness of composit laminates of 0.3 mm.
● Ceramic veneers have a minimum
thickness of 0.5 – 0.8 mm
Contour guide
● Optimal form selection using the translucent,
high-contrast contour guide
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Properties & advantages
● High opalescence and natural blue effect of the enamel
● High flexure strength E-modulus similar to tooth
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Form - shape - texture - surface - gloss
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Properties & advantages
● Highest adhesion composite - composite, optimized
by the microretentive surface (2 µm)
©
Componeer erosion 2µm
© Mario Besek
Properties & advantages
• Soaked for 1 week in water at 37°C
• 240‘000 cycles, 49N
• 600 x 5° / 55°
• Cresylblue, 24h
• 80 specimen
• 74 showed no penetration
• 6 showed some slight discoloration
Prof.Dr. Ivo Krejci, University of Geneva
Simple individualization
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Properties & advantages
● Optimized marginal quality - less polymerization stress
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Advantages
• Extended indications
• Less objective & subjective limits
• Conservative Procedure
• Good Longevity /Repair
• Cost effectiveness
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Componeer Clinical Procedure
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Choose correct size
Choose correct shade
Isolation of teeth
Preparation small shallow
chamfer/interporoximal conditioning
• Re check size and adjust componeer with
possible try in
• Etch Bond Cure tooth
Componeer Clinical Procedure
• Place and adapt composite on tooth
• Bond but don’t cure Componeer, place
composite and adapt on Componeer
• Fit first Componeer on tooth and firmly push
into position
• Clean excess before curing
• Trim and polish
Indirect Porcelain or Composite Veneers
Indicated for conservative treatment of anterior
teeth that are;
• Relatively intact
• Worn
• Discoloured
• Misaligned
• Malformed
Indirect Porcelain or Composite Veneers
• Porcelain
• High aesthetics
• Excellent gingival tissue
response
• Relatively minimal labial
reduction
• Durable and fracture
resistant
• Shine through problem
(Blue grey)
• Composite
• High aesthetics
• Excellent gingival
response
• More conservative
• Can be repaired if
fractured
• Shine through problem
(Blue grey)
Porcelain Veneers
 Types of preparation: depends on shade of
discoloured tooth, its position and alignment and
presence of restorations
 Minimal: surface reduction just to bond to enamel
 Conventional: 0.3mm reduction cervically, 0.5mm
centrally within enamel and retain incisal edge or
reduce by 1mm. Keep contacts!
 Deep: 0.6mm reduction into dentine and removal of
contact points
© Munther Sulieman
University of Bristol
[email protected]
2014

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