LARGE ADHESIVE RESTORATIONS, MARGIN
RELOCATION
CONVENTIONAL WAY
Large caries lesion endodontic treatment root
canal inlay, crown
CONTEMPORARY TRENDS
• Adhesive materials
- Smaller loss of hard dental tissues
- Connection without any gap
- Hihger resistancy of treated teeth
ADHESIVE TECHNOLOGIES - RISKS
• Preparation of cavosurface margin with regard to
orientation of enamel rods and retention of the filling
• Subgingival defects – is possible to make a composite
filling?
IF THE BORDER IS NEXT TO CUSP – IT IS
BETTER TO REPLACE THE CUSP WITH INDIRECT
FILLING
1,5 mm
30 - 40°
?
CERVICAL BORDER
In enamel
Bevel
no bevel
CERVICAL BORDER
In dentin
SUBGINGIVAL DEFECTS
• Main problems
- Substantial loss of hard dental tissues
- Subgingival cervical borders
- Adhesive procedures in region without enamel –
selfetching adhesive systems are better
CLASSIFICATION OF SUBGINGIVAL DEFECTS -
CRITERIA
Technical parameters: Possibilioty to keep the operating
field dry
Biological parameters: measurement of distance between
clean gingival border and insertion of periodontal ligament
or crest of alveolar bone using periodontal probe and xray.
Consider biological width.
CLASSIFICATION OF SUBGINGIVAL DEFECTS
1. Ruberdam is possible to use, gingival border can be seen
isolation can be insufficient.
2. Rubberdam does not allow complete isolation of operating field
biological width is ok (distance between gingival border and
insertion of periodontal ligament is 2mm and more and distance
between gingival border and crest of alveolar bone is 3 mm and.
3. Subgingival defect, biological width is insufficient.
SOLUTION
1. Margin elevation (relocation using flowable material 1 – 1,5
mm.
2. Gingivectomy + gingivoplasty
3. Elongation of clinical crown (gingivectomy, ostectomy)
Reconstruction: direct or indirect
lroubalikova@gmail.com 12
cca 3 mm
Biological width
Gargiulo AW, Wentz
FM, Orban B
(J Perio 1961)
Vacek JS, Gher ME,
Assad DA,
Richardson AC,
Gambaressi LI
(Int J Perio & Rest
Dent 1994)
2 mm
Principle of margin relocation
lroubalikova@gmail.com 14
SEQUENCE OF OPERATION – MARGIN
RELOCATION
• Consider possibility of effect of rubberdam and biological width
• Margin elevation - matrix wedge
• Selfetching adhesive system
• Flow 1 – 1,5 mm
• BW post op
• Making filling and impression
lenka.roubalikova@tiscal
i.cz
20
Gingivektomie
Gingivoplastika
GINGIVECTOMY + GINGIVOPLASTY
• Cut gingiva and form id anatomically
- Scalpel
- Laser
- Cauter
Elongation of clinical crown
Ostectomy, gingivectomy
Scalpel
Laser
Ultrasound
LARGE DEFECTS - AMALGAM
• In vital teeth if the cusp has been undermined due to
dental caries
• Large defects in non vital teeth – amalgam overlays
• Combination with the cavity on vestibular/oral surface
Cusp has been removed
The thickness of the filling
3 – 4 mm (at the cusp)
Retention
Grooves, pins, slots
Parapulpal pins (today obsolete)
Intrapulpal posts (root canal posts)
Retention in the endodontic
cavity
LARGE AMALGAM RESTORATION -
OVERLAYS
•