Clinical techniques for composite placement

Step of clinical proceduring for composite restoration

1. Local anestesia
2. Oral prophylaxis
3. Preparation of operatingsite
4. Composite selection
5. shade selection
6. isolation
7. tooth preparation
8. bonding
9. composit placement
10. polumerization of composite resins
11. final contouring, finishing and polishing of composite restoration

local anastesia

as an when required, local anesthesia is given in many cases since it makes the procedure pleasant,
time saving and reduces the salivation.

Oral prophylaxis

operating site is cleaned using slurry of pumice in order to remove plaque, clculus and superficial
stains prior to the procedure. It is done before composite restoration to improve bonding.

Composite selection

Composite selection is dependent on:

1. position of tooth preparation : for restoration requiring high mechanical performance, like
class IV preparation, large class I, II, and class VI, choice of composite is that with the highest
inorganic load. For restorations of anterior teeth, esthetics is the main concern. So,
composits with submicronic fillers or nanoparticles are preferred in these cases. Composites
which are highly polishable are preferred for cervical lesions both in the posterior areas to
avoid plaque accumulation on them
2. esthetic requirements in special cases where esthetic is main concern like treatment of
devective shape, discolored teeth, diastemas, malpositioned teeth and for caries in anterior
teeth, opacity and the translucency of the composites are to be kept in mind for attaining
optimal result.
Shade selection

For posterior composite restorations, shade selectiob is not as critical as for anterior restorations.
Shade selection depends on the following factors:

1. complexity of restoration
2. plychromatic characteristics of the tooth to be restored
3. Relationship with adjacent teeth

In cases wehere the dentin is to be replaced, composites having dentin shade and opacity are
preferred. In cases where enamel is to be replaced, composites with enamel shades and
translucency are preferred

Guidelines for initial shade selection

1. Tooth are shade guide should be wet to stimulate oral environtment

2. Shade matching should be carrie in natural daylight
3. Dentin shade is selected from cervical third of tooth, and enamel shade is selected from its
incisal third
4. To confirm final shade, a small increment of selected composite is placed adjacent to the
area to be restored and then light cured for matching.

Isolation

To achive optimal results of composite restoration, moisture and salivary contamination must be
prevented, in other words isolation is a must. Contamination of etched enamel or dentin by saliva
results in a decreased bond strength and contamination of the composite material during insertion
result in degradation of its physical properties. Isolation is best done by using rubber dam, through it
can be done using cotton rolls, saliva ejector and retraction cord

Tooth preparation

General concepts for tooth preparation for composite restorations:

1. Conservation of tooth structure : tooth preparation is limited to extent ofthe defect. For
composite restorations, rule extention for prevention and proximal contactclereance, is not
necassary unles it is required to facililitate proximal matrix placement
2. Variable depth of pulpal and axial wall depth : pulpal and axial walls need not to beflat
3. Preparation of operating site : to facilitate bonding, tooth surface is made rough by using
diamond abrasives
4. Enamel bevel : enamel bevel is given in some cases to increase the surface area for etching
and bonding
 5. Butt join on root surface : cavosurface present on root surfaces has to be butt joined

Design of tooth preparation for composites

Following three types of designs or their combination are most commonly prepared for composites

1. Conventional : conventional design is similar to the tooth preparation for amalgam

restoration, except that there is less outline extension and in tooth preparation, walls are
made rough.

Indication for conventional tooth preparation

Preparations located on root surface
Moderate to large class I or class II restorations

Features
Prepared enamel margins should be 90 degree or greater
But join cavosurface margin is made on root surfaces
The prepared tooth surface is roughened to incrase the bonding

2. Beveled conventional tooth preparation

This design is almost similar to conventional design but some beveled enamel margins are
incorporated

Indication

When restoration is being used to replace an existing restoration exhibiting a conventional

design
To restore a large preparation and especially indicated for classes III, IV, V and VI
restorations.

3. Modified (conservative tooth preparation) it is more conservative in nature since retention is

achived by micromecanical bonding to the tooth
Indications : for initial or small carious lession
Features
1. Preparation has scooped out appearance
2. It does not have specified wall configuration or pulpal and axial wall depth
3. Extent and depth of the preparation dependent upon the extent and the depth of
carious lesion
4. In combination preparations, that is part of the preparation is on crown and part is on
root, the root surface is prepared as conventional preparation and enamel surface
portion is prepared as beveled conventional preparation where enamel margin is
beveled
Bonding
Adhesion of composites to tooth structure can be attained with any of the following methods.
1. Total etch involving 3 step adhesives that is etching, priming, and bonding
2. Total etch involving 2 step adhesives that is etchinf and bonding
3. Self-etch primers involving 2 step adhesives, that is priming and bonding
4. Self –etch adhesives involving single step of bonding

Composite placement
Instrument used for composite insertion
Hand instruments : Hand instruments used for placing composites are usually made up of coating
with teflon so asto avoid sticking of composite to the instrument. The instruments are simple anda
easy to use, but the problem of air trapping during inserton of composite can occurr.

Composite gun
Composite gun