CLASS V PREPARATION AND RESTORATION (open sandwich technique) TOOTH !

(inte"nationa# nu$%e"in& s'ste$) Mike Magnusson Preparation: The outline of the preparation is dictated by the extent of the lesion, the removal of unsupported enamel, and the requirements of the restorative material (McComb !!"#$ %ollo&ing these requirements &ill allo& the procedure to be minimally invasive$ Making sure that the &alls of the preparation form a '!(degree angle to the cavosurface &ill create a passive preparation$ This is an important feature for a preparation intended for a bonded restoration because it &ill result in dislodgement of a failed restoration$ )t &ill also result in a preparation that has removed all unsupported enamel since enamel rods run perpendicular to the cavosurface (*ummit !!+, pg ,#$ )t is important to remove all unsupported enamel rods as enamel unsupported by sound dentin has a &eakened fracture resistance (*ummit !!+, pg ,#$ -n incisal bevel can be placed to achieve a less abrupt esthetic change bet&een tooth structure and the resin composite material (*ummit !!+, pg . '#$ )t &ill also provide more surface area for bonding due to exposure of enamel rods$ The lack of a gingival bevel is due to the reduced amount of enamel closer to the cervical margin or root surface$ The placement of a bevel at the gingival cavosurface can be done if there is adequate distance from the cementoenamel /unction (*ummit !!+, pg 0!1#$ 2o&ever, no bevels are necessary or recommended for placement of resin modified glass ionomer cements (3M4)C# because 3M4)Cs are brittle in nature (*ummit !!+, pg .0 #$ 5eeping line angles smooth &ill help to relieve stress concentration on the restorative material (-nusavice !!0, pg 0,#$ This preparation should be achieved &ith no excess removal of tooth structure, as &ell as no iatrogenic damage to ad/acent teeth or gingivae (McComb !!"#$

('!(degrees (remove unsupported enamel (incisal bevel (smooth line angles

3estoration 3esin modified glass ionomer cement (3M4)C# is a favorable material to place on the gingival &all of the preparation$ 6ecause the preparation is placed close to the cervical margin, ideal moisture control may be hard to achieve$ 3M4)C is less moisture sensitive in comparison to 3esin composite (-nusavice !!0, pg .1.# and should be placed &hen field isolation is hard to achieve (Chalmers !!+#$ Paolantonio et al$ found that subgingivally placed composite restorations &ere associated &ith a significant local increase in total bacterial count, as &ell as gram negative anaerobic bacteria &hile 4)C sho&ed no change$ 3M4)C also releases fluoride, &hich can help to reduce the incidence of secondary caries formation &hen placed &ith composite (7ionysopoulos et al$ !!1#$ 3M4)C is also more opaque and less esthetically pleasing &hen compared to resin composite (*ummit !!+, pg .0 #$

(resin modified glass ionomer cement placed on gingival floor (ionic bond to tooth structure (opaque material

8tch, prime and bond is applied and resin composite is used to fill the remainder of the preparation$ )t is not necessary to etch the 3M4)C before composite placement because the t&o materials form a chemical bond, ho&ever, etching &ill do no harm if done (Chalmers !!+#$ %or large preparations, incremental filling of composite should be used in order to reduce the effects of polymeri9ation shrinkage (*arrett !!+#$ 3esin composite should be filled in increments no larger than mm due to reduced penetration of the light cure and increased effects of polymeri9ation shrinkage (*ummit !!+, pg .0:#$ The benefits of using composite arise because of its ability to form a strong bond to tooth structure and to create an esthetically pleasing result$ 2o&ever, the cons of using composite arise from its high coefficient of thermal expansion and polymeri9ation shrinkage, &hich can lead to marginal leakage (*ummit !!+, pg + #$

(follo&s contour of the tooth

%inishing can be carried out immediately after curing (Chalmers !!+#$ 8xcess material and flash can be removed using carbide burs and a scalpel blade$ %urthermore, the restoration can be polished &ith progressively finer(grit disks, rubber points or cups to make it smooth and reduce scratches (*ummit !!+, pg .0:#$ 2igh quality finishing and polishing improve the esthetics and longevity of direct tooth coloured restorations by limiting the amount of staining, plaque accumulation and gingival irritation that &ould other&ise form on rough surfaces (;ilder et al$, !!!#$ Care should be taken to ensure that no iatrogenic damage is caused to tooth structure or gingiva$ The final restoration should be free of flash and voids$

(*mooth (no voids (no flash (resin composite (3M4)C

3eferences -nusavice, 5$<$ ( !!0#$ Phillips Science of Dental Materials. Missouri: *aunders$ Chalmers, <$M$ ( !!+#$ Minimal intervention 7entistry: Part $ *trategies for -ddressing 3estorative Challenges in =lder Patients, JCDA >ol$ 1 , ?o$ ", pp$ .0"(..!$ 7ionysopoulos, P$, 5otsanos, ?$, Papadogianis$ @$ ( !!1#$ *econdary caries formation in vitro around glass ionomer lined amalgam and composite restorations, Journal of Oral Rehabilitation >ol 0 )ssue ,, pp$ "::(":'$ McComb, 7$ ( !!"#$ Conservative =perative Management *trategies, Dent Cln N Am .", pp$ ,.1(,+"$ Paolantonio, M$, 7Aercole, *$, Perinetti, 4$, Tripodi, 7$, Catamo, 4$, *erra, 8$, 6rue, C$, Piccolomini, 3$ ( !!.#$ Clinical and Microbiological 8ffects on 7ifferent 3estorative Materials on the Periodontal Tissues ad/acent to *ubgingival class > 3estorations, Journal of Clinical Periodontolog >ol$ 0: )ssue 0, pp$ !! ( !1$ *arrett, 7$C$ ( !!"#$ Clinical Challenges and the rele!ance of materials testing for posterior composite restorations. 7ental Materials >ol$ :, issue :, pp$ '( !$ *ummit <$6$, 3obbins <$M$, 2ilton T$<$, *ch&art9 3$*$ ( !!+#$ "undamentals of Operati!e Dentistr . )llinois: Buintessence$ ;ilder <r$, -$7$, *&ift <r$, 8$<$, May <r$, 5$?$ Thompson, <$@$, Mc7ougal, 3$-$ ( !!!#$ 8ffect of finishing technique on the microleakage and surface texture of resin(modified glass ionomer restorative materials$ Journal of Dentistr >ol , )ssue ", pp$ 0+1(010$