Restorative dentistry III. solution of defects in posterior teeth addition Alternative to amalgam Subgingival defects Alternative to the amalgam filling does not exist Fast application Excellent mechanical properties No sensitivity to moisture Social filling Comparison of permanent filling materials – mechanical properties Compressive strength MPa • Composite 150 • Glassionomer 80 • Amalgam 500 Flexural strength MPa 100 25 30 Bulk fill - materials that can be cured in the thicker layer • Aplikace a vytvrzení kompozitního materiálu v j1. 1. Higher translucency • 2. More fotoinitiators • 3. Some of the are dual cured • 4. Some of them have short fiber filler Application can be faster: Thicker layer – no more than 3 mm ! Polymerization shrinkage and stress are lower but silll exist! Review Bulk-Fill Resins versus Conventional Resins: An Umbrella Review Gonçalo Silva 1, Carlos Miguel Marto 1,2,3,4,5,6 , Inês Amaro 1,2,3,5,6, Ana Coelho 1,2,3,5,6 , José Sousa 1,2, Manuel Marques Ferreira 2,3,5,6,7 , Inês Francisco 2,3,5,6,8 , Francisco Vale 2,3,5,6,8 , Bárbara Oliveiros 2,3,5,6,9 , Eunice Carrilho 1,2,3,5,6 and Anabela Baptista Paula 1,2,3,5,6,8,* • They present greater translucency and, consequently, better light dissipation in the composite resin, with photo initiators allowing a greater polymerisation depth and polymerisation modulatorsallowing for less polymerisation shrinkage. Bulk-fill resins can be categorised into two groups, base with low viscosity and fullbodywith high viscosity, depending on the purpose for which they are used, namely the restoration type and its mechanical requirements.The first group, having a low viscosity, is easy to sculpt and can be sonically activatedbto become more fluid and more easily adaptable to the cavity walls. Normally, the application of flowable bulk-fill resins can be carried out using a syringe,since they are characterised by their high fluidity. Thus, the application is simpler, allowing use of the composite resin in cavities that are more difficult to access. However, this type of composite resin is often associated with low strength, and it is necessary to cover it using conventional composite resins, thus hiding the more transparent aspect of the restoration by bulk-fill composite resins. Comparison: Overall, although without statistical significance, the confidence interval for the OR (odds ratio) is most favourable to the use of conventional resin, as it is about five times more likely to obtain a good result with conventional resin than with bulk-fill resin. • Overall, although without statistical significance, the confidence interval for the OR • (odds ratio) is most favourable to the use of conventional resin, as it is about five times • more likely to obtain a good result with conventional resin than with bulk-fill resin. Bulk fill - materials that can be cured in the thicker layer • Aplikace a vytvrzení kompozitního materiálu v je 1. Flowable materials – • Good marginal adaptation, usually necessary to use the conventional composite material on the top • 2. Condensable composit materials – in combination with flowable • 3. Sonic materials (Sonic Fill) – thixotropy, the viscosity is decreased by vibrations. Sonic Fill Možnost plnění kavity v jednom bloku (do 5 mm) Sonická „aktivace“ – změna viskozity Vnitřní rozptyl světla – dobrá estetika Chybí dlouhodobé zkušenosti Dosavadní srovnání s jinými materiály je +- lenka.roubalikova@tiscali.cz 13lenka.roubalikova@tiscali.cz Problems of bulk fill materials 14 • Lower aesthetics • Polymerization stress lower • Adhesion procedure must be kept • The depth of the cavity must be measured New materials on the base of composite • Chemically cured with the possibility of light curing • Realeasing ions F, Ca, OH (Alkasit) • Self curing primer Technology One bulk The molecule of the monomer is splitting – lower polymerization stress Long monomer AUDMA lower polymerization shrinkage Main problems • Substantial loss of hard dental tissues • • Subgingival cervical borders – difficulties with dry operative field • (bleeding, sulcular liquid) • Adhesive procedures in region without enamel • – consider selfetching adhesive SUBGINGIVAL DEFECTS • Technical parameters: • Possibility 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/or xray. • Biological width lroubalikova@gmail.com 19 Dentogingival complex DGC = biological width 2-4mm + sulcular depth 1-3mm = 3-7 mm Biological width Epithelium junction 1-2 mm+ Connective tissue junction - supraalveolar fibers 1 -2 mm = 2 - 4 mm 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) 1 - 2 mm 1- 2 mm Lesion type 1 • Lesion does not reach cemento enamel junction • No pulp exposure • Gingival wall is located supragingivally: • Rubberdam and composite filling Lesion type 2 • Lesion does not reach the cementoenamel junction • Pulp is involved • The gingival wall is located supragingivally • Pre - endo, endo, postendo Lesion type 3 • Lesion does not reach the cementoenamel junction • Dental pulp is involved • The gingival wall is located subgingivally • Gingivectomy, preendo, endo, postendo Lesion type 4 • The lesion is on cemento enamel junction • Dental pulp involved • The gingival wall is located intrasulculary • Osteoplasty, gingivectomy, rubberdam, preendo, endo, DME, postendo Lesion type 5 • The lesion is below cemento-enamel junction • Dental pulp is involved • The gingival wall is located in the bone Ostectomy, preendo, endo DME, postendo Classification of subgingival defects • 1. Ruberdam is possible to use, gingival border can be seen. • 2. Rubberdam does not allow complete isolation of operating field, biological width is ok. • 3. Subgingival defect, biological width is affected. • 4. Ingtraosseal defect Solution • 1. Margin elevation – cervical margin relocation using flowable material or composite filling materiál • 2. Gingivectomy + gingivoplasty • 3. Elongation of clinical crown – crown lenghtening (gingivectomy + ostectomy) • Reconstruction: direct or indirect Cervical margin relocation • SEQUENCE OF OPERATION – MARGIN ELEVATION • • Consider possibility of effect of rubberdam and biological width • Cervical margin relocation • Matrix band – can be cut (appr.3 - 5 mm) • Tihgtening of the matrix with the retainer • No wooden wedge • Adhesive procedure consider selfetching adhesive system • Flowable • Composite New margin Gingivectomy and gingivoplasty • Cutting gingiva and shaping it anatomically : • Scalpel - Laser - Cauter lenka.roubalikova@tiscali.cz 35 Gingivectomy Gingivoplasty GIC as a temporary Crown lenghtening • Surgical procedure based on gingivectomy, gingivoplasty and ostectomy. • Closed and open lroubalikova@gmail.com 39 Extrusion • Extrusion orthodontic • Fast • Surgical Definujte zápatí – název prezentace nebo pracoviště40