Composite Bonding of a Class 4 Fracture – Dental Minute with Steven T. Cutbirth, DDS

 

Composite Bonding of a Class 4 Fracture – Dental Minute with Steven T. Cutbirth, DDS

Let’s discuss composite bonding of a class 4 fracture of a maxillary, lateral incisor. You can see I’ve prepared the central incisors for porcelain veneers. You see there was an old composite class iv composite on this lateral, and so I removed that composite re-prepared the area and then have rebonded and polished the restoration. We begin. You can see.

I’ve prepared the centrals for veneers and that’s in another video. This one is just on the composite placement in preparation, i’m using a coarse barrel diamond and extending past the line angle of the fracture.

That’s one of the very important parts. You don’t want to end it on a straight line. You want to blend the composite onto the tooth, so it tapers and finishes with the flame shaped finish or extends past the fracture line.

So, I’m creating that situation with this coarse barrel diamond. It’s not deep. Just light preparation, I’m going to extend the restoration down to here then I’m going to etch with 38 phosphoric acids.

Since the preparation is completely in enamel, we can etch for a minute with no problem. If it was in part of the preparation was indented, then you’d etch, the enamel for 45 seconds to a minute and the dentin for 15 seconds.

How do you do that? You place it on the enamel first and leave it for 45 seconds and then come back and place it on the dentin for 15 seconds. Then I’m going to rinse it thoroughly for about 15-20 seconds. Then I’m gonna isolate with a two by two. Some of you will say: well, why don’t you use a rubber dam?

The key is not a rubber dam or some other means of isolation. It’s isolation, and this is a lot simpler in the anterior because I’m not anesthetizing the teeth, so I don’t want the rubber dam.

Clamp to pinch the gingival tissue around the tooth, that’s being clamped I’m just isolating with a number of two by twos in the mouth, then I’m wiping the primer adhesive on the prepared area, and then this is very important once you do that place, a copious amount On the preparation then blow the excess off onto a two by two blows it until nothing, wiggles, there’s acetone carrier in the primer adhesive, and if you leave the acetone carrier in the primer adhesive, it can affect the bond strength so blow it all off until nothing.

Wiggles onto a two by two and place a two by two around the tooth, so you don’t blow it all onto the tissue and the adjacent teeth. Then, if it’s a direct composite always cure the primer adhesive before you place the filled resin if it’s a class, 1 2 3, whatever it is, if it’s a direct composite, always blow off the primer, adhesive and cure it before you place the filled resin.

If you’ll do that, you will virtually eliminate sensitivity now, don’t do it if you’re placing veneers, but if it’s a direct composite, always cure the primer adhesive after you’ve blown it off before you place the filled resin, and you only have to cure it for about five seconds now I’ve decided to use filtec supreme flowable because it adapts so well to the tooth preparation, keep the tip of the syringe in the material don’t come in and out, or you’ll incorporate air bubbles, and even if you do it perfectly, you may incorporate some air Bubbles which I did in this composite, and I’ll show you what to do.

If that happens, and I’m just going to contour it a little bit with this plastic instrument, and then I’m going to cure it, and I generally cure direct composite 40 seconds.

You probably don’t have to cure it that long, but you can’t over cure. Then this is a chauffeur polishing disc, and it’s excellent for polishing composite and I like to have my assistant, squirt water, on the area that I’m polishing with the disc or, if I’m polishing, with a rubber wheel. Squirt water is a luber, just a light touch, and you want the disc to spin from the composite to the tooth.

So in this case, you want it to spin in this direction, see I had a little tiny void right, a rough spot, so I’m just using the tip of some burr to open that up just a little bit. In this case, I happen to have a flame shape, burr on the hand, piece and that’s fine, just open it. Just a little bit. You don’t have to reapply the primer adhesive see I open these two areas, get it good and dry. Aspirate, isolate, keep the tip of the syringe in the void, fill up that defect smooth it.

This is a very good plastic instrument because the material doesn’t stick to this. Whatever this is made of, then I’m going to cure this for about 20 seconds, and I’m going to use either a 12 fluted or 30 fluted carbide burr to initially contour the composite and move the burr in the polishing direction.

You know there’s one direction, you move a hand piece or a burr, and it cuts, and you move the other way, and it polishes. So, you want to move it in the polishing direction. Smooth it very light touch, a lot of water.

Then I’m going to contour again with the polishing disc and there are two different grits one’s a medium and one’s a fine, so begin with the medium and then finish with the fine. And you want it again to move in the form of the composite to the tooth okay, so I had another little void. So, I open that just a bit and place some more composite.

You don’t have to place primer adhesive if you’re repairing a void or adding to existing composite or polishing once you’ve polished it dip this in the primer adhesive this pledge it and then dab it on the patient’s bib or two by two to make it almost Dry and then wipe that on the surface you don’t want a thickness. You just wanna barely wet it as a glaze.

So, I’ve just barely dipped this in the primer adhesive, and then I touch it to the bib of the patient, so it all, but just the tiniest little bit soaks up and rub that on the composite, and you get a nice sheen. That’s a gentle minute. These techniques work and they work every time you

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