Class V composite preparation and restoration

Class V composite preparation and restoration on

Human tooth #22

Faranak zaeimdar

DMD 2014

UBC dental school

 Class V composite preparation and restoration

Abstract
Gingival recession associated with aging and periodontal therapy exposes root

surfaces, which are then susceptible to root caries. Resin composites, compomers,

glass ionomers and resin-modified glass ionomers are increasing in popularity

because they are aesthetic and bond to tooth structure. (Burgess J.Gallo J, 2002).

This project present information about class V aetiology, indication for treatment,

cavity preparation and restoration by considering the aetiology of the lesion. I

decided to work on the human tooth to have a better understanding of the procedure.
 Class V composite preparation and restoration

Class V composite preparation and restoration

Class V lesions are those carious and non carious defects found in the gingival

third of facial and lingual tooth surfaces. A class V lesion resulting from factors

other than dental caries is known as noncarious cervical lesion and appears is

unique to modern man. (Summit, J. B. Robbins, J. W. Hilton, T. J. Schwarz, R. S.

2006).

Approximately 18 percent of all permanent teeth have class V lesions. In

addition, the prolonged retention of teeth in an increasingly older population is

expected to increase the prevalence of class V lesions. (Vandewalle, KS. Vigil

G,1997). Therefore, the challenge for the dentist is rather substantial, since it has

been shown that the longevity of these cervical restorations is not as great as that

of other restorations. (Blunck U, 2001)

Aetiology

The triad of susceptible root surface, bacteria, and a fermentable carbohydrate

provides the necessary ingredients for root caries. The entire aetiology of

noncarious cervical lesions have not been determined (Tyas MJ, 1995), there is a

lot of evidence that the cause is multifacterial. Before any treatment is performed

for a patient, a careful examination and determination of possible causes for the

lesion should be made. In fact the first goal of any treatment should be to remove

the primary cause or causes of the lesion. The decision to place a restoration for a

class v non carious lesion is not easily made and considering some factors in this
 Class V composite preparation and restoration

area for example gingival health, aesthetics, sensitivity, pulp protection, and

tooth strength is crucial.(Dr Gardner, 2009; Summit et al, 2006)

General considerations

Material

Once the decision to place a restoration is made, the practitioner should select a

restorative material and design the cavity preparation .In this project because of

aesthetic considerations and since the cavity is on the gingival one third of the

tooth (the incisal wall would be on the enamel), I decided to choose composite as

the filling material. .Microfilled composite resins often are advocated for restoring

class v defects because they have lower modulus than hybrid composite resin. The

argument for this type of composite resin restoration is that because the tooth

flexes during mastication, flexible restoration materials flex with the teeth also

the highest smooth surface may be achieved with microfilled material. (Burgess, J

et al, 2002; Roberson et al, 2006; Summit et al, 2006)

Shade selection

It is very important that we select the colour before the isolation with rubber

dam and starting the preparation because after preparation, the tooth may be

dehydrated and looks whiter. For this project I chose Aesthetics A3.
 Class V composite preparation and restoration

Tooth preparation considerations

Figure 1

The extend and depth of the lesion should be determine the outline and depth of

the preparation for resin composite. This project addresses on Bevelled

conventional class V tooth preparation.

A) Mesiodistal extension: just to the mesial and distal line angles (Dr Gardner, 2009);

for tooth preservation and resistance form. Gingival and incisal extension of the

preparation is dictated by the extent of the caries but in this project the gingival wall is near

the CEJ and the incisal one is 1.5 mm far from that toward incisal edge and the both walls

follow the CEJ contour.

 Class V composite preparation and restoration

Figure 2 Figures 1 &2(A&B) show the cavity meet these specifications

B) Axial wall depth should be at least 0.75 mm to provide adequate external wall width
for 1) strength of the preparation wall; 2) strength of the composite. (Roberson et al, 2006)

Figure 3

Yes the cavity meets this requirement

 Class V composite preparation and restoration

C) The axial wall should follow the original contour of the facial surface so it should be

convex and uniform. (Robeson et al, 2006) To prevent pulpal exposure and preservation of

the tooth material.

Figure 4: Shows the axial wall is convex

D) All of the walls of a class v should be divergent toward facial, so visible from facial view

and have 90-degree cavosurface angles. (Dr Gardner, 2009; Roberson et al, 2006)

Figure 5 The cavity meets this specification

 Class V composite preparation and restoration

E) The incisal enamel margin should be bevelled (Dr Gardner, 2009;Roberson et

al,2006)The bevel increases the surface area so the retention will be increased and

microleakage will be reduced(Bagheri M,Ghavamnasiri M,2008); on the other hand it

improves aesthetic blending of the resin with the tooth structure. Bevels of45 degrees and 1

to 2 mm wide are used in facial areas, whereas a smaller (0.5-mm) bevel is used in other

areas. (A wider bevel is placed on the facial surface to achieve better blending in the

aesthetic zone.) Bevelling the gingival margin that ends on or near cementum is not

recommended. (Summit et al, 2006; Aschheim kw, Dale BG; 2001)

Figure 6 yes the bevel is visible in this picture

 Class V composite preparation and restoration

Method of achievement
I used the bur #856 for preparation with high speed. Before starting the

preparation I focused on the figure that I was going to prep. I tried to keep in mind that

I must follow the CEJ curvature while I was moving the bur to create the 90-degree

cavousurface margin; so I put the bur perpendicular on the buccal surface of the tooth

and started from midline toward mesial and distal line angles. Since the buccal surface

of the tooth was convex and I wanted to follow that I tilted the handpiece when I was

going toward mesial and distal, for bevelling the incisal wall I used the chamfer bur.

Restoration consideration
The etching, priming, and placement of the adhesive should be done according to the

manufacture recommendations. I used Scotch bond multipurpose plus (3M company) as the

adhesive (third generation) and total etch as the etchant.

Clinical tip: the bonding should cover all etched enamel surfaces and MUST not be thick.

Figure 7: shows the etched enamel Figure8: the bonding applied

Brushing on only a thin layer of bonding agent maybe better than air drying,
 Class V composite preparation and restoration

this can incorporate air into the composite resin and inhibit curing. Air drying

from a triple syringe can also incorporate moisture into the preparation. (Aschheim et al, 2001)

Inserting and curing the composite

Resin composite should be placed in increments no thicker than 2 mm to ensure adequate

penetration of light for polymerization. Since microfill composites are more viscous for easier

manipulation of the material, the tip of the composite instrument may insert in the adhesive.

The first increment of resin composite should be placed from about the midpoint of the

gingival floor to the incisal cavosurface margin and light polymerized. The second increment

can then fill the reminder of the preparation. (Summit et al, 2006)
 Class V composite preparation and restoration

Clinical tip:
Adequate contouring of a restoration before polymerization is essential for minimizing

finishing time and reducing damage to the composite resin. (Finishing procedures can cause

microcracks.) Damage to the composite resin results in a higher wear rate, an increased

fracture rate, and a greater tendency for opening of margins. (Aschheim et al, 2001)

My reflection: For achieving that after insertion the material I shaped that as close to the final

contour as possible and for removing excess material from the cervical margin I used the tip of

the explorer; then I applied the light.

Contouring and finishing the composite restoration

Finishing involves margination, contouring, and polishing. The primary goals are good

contour, occlusion, smoothness, and appropriate embrasure form.'(Aschheim et al,

2001)Diamond burs, carbide finishing burs, or aluminum oxide disks may be used for

contouring the restoration (summit et al, 2006)

I divided the finishing procedure to 3 steps:

1) Grouse reduction

I used diamond burs (knife edge and flame shape) with high speed to remove excess material

from the restoration. I used a stable variable shift to create appropriate contour and prevent the

development of a flat surface. Because of the convexity that exists in this area I was curious not

to damage the unprepared root surface and cause damage the cementum.
 Class V composite preparation and restoration

2) Smooth reduction
I used abrasive discs (Softlex, 3M) mounted on an appropriate mandrel in an angle

handpiece at low speed .The disc is rotated at low speed. I found that I must use them in

different directions for having a good contour.

3) Polishing
I used polishing cup and polishing paste to bring out the luster, but I found that care

should be taken not to destroy the created texture.

Clinical tips
Surface-penetrating sealants (e.g., Fortify, Bisco Corp.; Optiguard, Kerr Corp.) can be used

to repair wear of posterior composite resins and decreases microleakage around Class V

composite resins. In addition, the composite resin that is closest to the light is often the most

polymerized and therefore the hardest part of the restoration. Because this layer is removed

with occlusal adjustment et al, 2001)

It is impossible to overcure a composite resin. An additional 60-second cure isrecommended

if the tooth is dark or if a dark shade of composite resin isused. The additional cure is most

beneficial after the restoration is finished to its final form. (Aschheim et al, 2001)

Composite restoration considerations

A) The contour of the restoration should follow the contour of the tooth at that area; to

prevent plaque accumulation.

 Class V composite preparation and restoration

Figure 9: shows that the restoration meets this criterion

B) No overcontour or undercontour from mesial or distal view.

Figure 9 shows the mesial contour follows the tooth contour

 Class V composite preparation and restoration

Figure 10 shows the distal contour follows the tooth contour

c) Colour matching

I am happy with the colour.

C) No overcontour from incisal view

Figure 11 shows the restoration meets this consideration

D) No Flashes OR Voids
 Class V composite preparation and restoration

These are good area for plaque and stain resorption and leakage

Figure 12 shows the restoration meets these criteria

E) smooth surface, no scratches

To prevent plaque accumulation and patient comfort.
It seems the restoration has this specification.

What constituted my major break-through (my aha moment) in completing this restorative

procedure?

The biggest breakthrough I had with this procedure is improving my technique in removing

excess composite before curing. I have been getting better at doing that now after many

practices. The instruments I used in accomplishing this include the end of the explorer before

curing the material. I used the explorer to remove excess flash along the margins .Also I found

that for evaluating the restoration about the flashes it is better first dry the tooth completely in
 Class V composite preparation and restoration

this way the flashes will be appear and by moving the tip of the explorer from the tooth surface

toward the restoration I could diagnose them and also I found that for the tiny flashes the best

instrument might be the discoid excavator. I moved it on the margins while half of the blade

was on the tooth surface, this way helped me to avoid ditching and removing flashes

meanwhile.

In achieving this break-through, how will this help me in defining myself as a dentist?

Part of becoming a good dentist is learning to be efficient. If I can get better at

carving the composite before curing, this will greatly improve my efficiency because I would

not have to do much contouring with the burs after curing, this is more difficult to do. In fact

the more time I spend on insertion the material, the less time I need to spend on finishing. Also I

found that having enough information about the material we are using might help us to work

with those in the manner that we can get maximum benefit from them.
 Class V composite preparation and restoration

References
1) Burgess J, Gallo J. (2002) Treating root-surface caries. Dent Clinc N Am 46, 385-404

2) Summit, J. B. Robbins, J. W. Hilton, T. J. Schwarz, R. S. (2006) Fundamentals of Operative Dentistry:

A contemporary approach. Chicago: Quintessence Publishing Co.

3) Vandewalle KS, Vigil G. (2003) Guidelines for the restoration of class V lesions. Gen Dent.45 (3):254-60

4) Blunk U. (2001) Improving cervical restorations: a review of materials and techniques. Adhes Dent;
3(1):33-34
5) Tyas MJ. (1995) The Class V lesion-aetiology and restoration. Aus Dent J; 40(3):167-70

6) Gardner, K. (2008) Class V composite preparation and restoration. Power Point Presentation.

DENT 430, Faculty of Dentistry, University of British Columbia

7) Roberson, T. M., Heymann, H. O., & Swift, E. J (2006). Sturtevant’s Art and Science of

Operative Dentistry, St. Louis: Mosby.

8) Aschheim KW. Dale BG. (2001)Aesthetic Dentistry: A Clinical Approach to Techniques and Materials. Mosby

9) Kenneth J.Anusavice. (2009) Phillips’ Science of dental materials: A Sunders Title