2ND SEMESTER / S.Y. 2024-2025 / DR.

ANDRES SRBE / DMD6C

FINAL PERIOD
Use unilateral tray
INDIRECT ONLAY RESTORATION 2 method impression (put clingwrap before
light body)
→ Cannot be fabricated inside the mouth POUR DIE STONE
→ Fabricated outside of the mouth MOUNT IN ARTICULATOR
MASTER CAST
BURS TO USE: Apply separating medium – use Colorgard
Tapered Use tofflemire or sectional matrix (do not use
Straight celluloid / mylar strip)
Do not use: round and inverted because it creates
undercuts. MARGINAL BUILD-UP
Cusp buildup technique – first composite
INDICATIONS: increment is applied to a single dentin surface
Class I without contacting the opposing cavity walls,
Class II and the restoration is built up by placing a
Modified Class II series of wedge-shaped composite increments.
Large restorations Each cusp is then built up separately.
Endodontically treated tooth
Stamp technique – creating an occlusal matrix
Preparation should have short beveling and round-
before removing the carious tissue in order to
off cavosurface margin
imprint the occlusal anatomy of the posterior
teeth.
ETCH
Poor indirect composite material – lower flexural
Etchant / Tooth conditioner
strength
15 seconds
37% Phosphoric acid PROCESSING OF INDIRECT COMPOSITE
Etch base using resin type Helium technique – 10 mins single; 20 mins
Types of Etching: multiple
• Selected etching technique – applied only to Boiling technique – Immerse in 100-degree
the enamel surface / selected area Celsius water for 30 minutes and let it cool
• Total etching technique – applied to both down for 30 minutes
the enamel and dentin surfaces (ex. Light box – 20 minutes
Diastema closure case)
CHECK OCCLUSION / TRIAL FITTING
• Self-etch technique – does not etch
APPLY 6.9% HYDROFLUORIC ACID ETCHANT
Stay for 2 minutes then wash with water
WASH, DRY, BOND
SILANE COUPLING AGENT APPLICATION
Bonding Agent / Adhesive
CEMENTATION
Light-curing is 10 seconds
Glass Ionomer Type I – wait for it to set, need
PLACEMENT OF INTERMEDIARY BASE
etch
LIGHT-CURING
Luting cement: resin type – cure
20 seconds composite polymerization
FINISHING AND POLISHING
PVS IMPRESSION MATERIAL Use light hand to avoid microfracture
Polyvinyl Siloxane

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Anterior lingual surface of the teeth.
AMALGAM
Distal surface of canine (considered as
→ Alloy which has MERCURY as one of its posterior tooth)
components, SILVER-BASED ALLOY w/
variant types and combination. CONTRAINDICATIONS AMALGAM
Anterior teeth restorations (III,IV,V) -
COMPONENTS OF AMALGAM unacceptable aesthetic
Silver - 65% increase setting time, & strength
Zinc - 2% scavengers for oxides ADVANTAGES OF AMALGAM
Tin - 30% the weakest phase of Am. For Convenience on manipulation & insertion of
plasticity (allow amalgam to be carved) restorative material.
Copper - 6% increase compressive strength Insoluble to oral fluids

COPPER CONTENT DISADVANTAGES OF AMALGAM

Low Copper - containing 4% or less copper Susceptible to Tarnish & Corrosion (because it’s
• Must wait 24 hours before carving / metal, but can be polished)
polishing Galvanic Action or Galvanic Shock - meeting of
High Copper - containing more than 10% of two dissimilar metals
copper
• Can be carved / polished after 20 mins TECHNIQUES FOR AMALGAM RESTORATION
1. CHOICE OF ALLOY AND MERCURY
SHAPES OF ALLOY PARTICLES Zinc Containing - decrease brittleness,
Spherical Shape - smooth surface deoxidizers or scavengers (most common)
Irregular Shape - lathe-cut Zine Free - eliminates moisture, less plastic
In between shape - spherical with irregular and less workable
surface, spheroidal • Rubber dam isolation to eliminate
moisture
FLOW AND CREEP
Flow - measured during the setting of an 2. PROPORTIONING OF ALLOY AND MERCURY
amalgam & reflects the change in dimension of High Mercury Technique - amalgam mix
an amalgam containing more mercury than needed for
Creep - measured after amalgam setting, powder. (52%-53% mercury)
reflects the constant change in dimension. Minimum Mercury or Eames Technique - 1:1
amalgam mix. Contains equal amount of
SIZES OF POWDER PARTICLES mercury & powder alloy. (capsule)
Micro cut
Fine cut
Coarse cut

ROLE OF MERCURY IN DENTAL AMALGAM

INDICATIONS AMALGAM 1. Reactant w/ the alloy particles.
Restoration of posterior teeth. Class I, II, V. 2. Base of trituration or wetting of alloy particles.

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3. Pre-condense mercury influence the degree of Butt-joint relationship - relationship of the
plasticity of the amalgam mass. amalgam and cavosurface margin

3. TRITURATION
8. CARVING
Duration is 2 ½ minutes
Anatomical sculpturing of amalgam material
OBJECTIVES OF TRITURATION PROCESS
OBJECTIVES OF CARVING
1. Achieve workable mass within min. time.
Produce restorations with:
2. Remove oxides from powder particle surface.
no overhangs (use wedge)
3. Pulverized pellet particles that can easily
proper physiological contour (convex)
attached to mercury.
functional non interfering occlusal anatomy
4. Reduce particle size to increase surf, area of
(use articulating paper)
alloy particles.
adequate compatible marginal ridge (same
5. Dissolve part of particles in mercury.
height with adjacent)
4. MULLING minimal flash
Continuation of trituration, this step is used to proper size, location, extent & inter-
improved the homogeneity of the mass & relationship of contact area
assure consistent mix (2-5 secs in squeeze physiological compatible embrasure
cloth).
Produce restorations without:
5. MATRICING (involves more than 1 surf.) interfering with periodontium
Tofflemire and matrix band • Gold is the only material that is
biocompatible with periodontium
‘

6. CONDENSATION / PLUGGING
squeezes unreacted mercury out of the
9. FINISHING AND POLISHING
increments building up the restoration.
Amalgam flash that was left after carving was
(3mins)
removed.
7. BURNISHING OR SURFACING Major overhangs are removed – using finishing
After condensation the next procedure is and polishing burs
burnishing using a light stroke proceeding from Minor enamel underhangs are corrected.
the amalgam surface to the tooth surface on Remove superficial scratches and
the occlusal & other conspicuous portions of the irregularities.
restorations.
POLISHING
OBJECTIVES OF BURNISHING pumice dentrifice (toothpaste), tin oxide
1. Reduce the size and no. of voids on critical & rubbercup, brush, finishing disks, stones &
marginal areas of the amalgam. finishing burs
2. Bring excess mercury to be discarded during
carving.
3. Adapt amalgam to cavosurface margin.
INSTRUMENTS

4. Conditions the surface before carving. → refers to a wide variety of implements held in
the hand & applied during a treatment
Initial instrument before carving is Hollenback procedure.
then Anatomical burnisher

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CLASSIFICATION OF INSTRUMENTS

1. CUTTING INSTRUMENTS 6. MISCELLANEOUS INSTRUMENTS

• Hand Mouth Mirror
• Chisel • Light reflection
• Hatchet • Indirect vision
• Hoe • Retraction
• Excavators • Tissue protection
• Gingival Marginal Trimmer Explorer
• Rotary Scissors
• Burs Pliers
• Stones
PARTS OF AN INSTRUMENT
• Disks
1. Shaft – handle, small, medium or large diameter.
Straight w/ various size. Smooth or Serrated
2. CONDESING INSTRUMENTS / PLUGGING
• Pluggers 2. Shank – connects the shaft w/ the blade or
• Hand working end.
• Mechanical
3. Blade or Nib – point or head. Functional end of
an instrument. (use term blade if dealing with cutting
3. PLASTIC INSTRUMENTS
instrument, nib if non-cutting)
• Spatulas
• Carvers FORMULA OF AN INSTRUMENT
• Burnishers 1. First Unit - width of a blade
2. Second Unit - length of a blade
4. FINISHING AND POLISHING INSTRUMENTS 3. Third Unit - angle of the blade
• Rotary Additional Unit - second unit indicates the
• Finishing Burs blade width angle
• Mounted Brush Examples:
• Rubber Cap 12 10 8 12 92 10 8
• Impregnated Disk & Wheels 12 – width of blade 12 – width of blade
10 – length of 92- additional unit

• Hand blade 10 – length of blade

8 – angle of blade 8 – angle of blade
• Finishing Strips

ROTARY AND HAND INSTRUMENTS

Rotary Instruments - refers to a tool / device
5. ISOLATION INSTRUMENTS designed to carry out a specific function. (e.g.
• Rubber dam frame micromotor, handpiece)
• Clamp
• Forceps CHARACTERISTICS OF A ROTARY INSTRUMENT
• Punch A. Speed - refers not only to the rpm
• Saliva Ejector (revolutions per minute), but also the
• Evacuating Tips & Equipment surface feet unit time to contact that the
• Cotton roll holder tool has w/ the work to be cut.

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Lack of patient cooperation
Classification of Speed
• Ultra-low Speed - 300-3000 rpm G. Sources of Power - air (turbine as power source
• Low Speed - 3000-6000 rpm (micromotor) change the shape of dental practice)
• Medium High Speed - 20,000-40,000 rpm
• High Speed - 45,000-100,000 INSTRUMENT DESIGN
• Ultra -High Speed - 100,000 rpm & above Evaluated in two parameters:
1. Handpiece – hold & provide power for cutting tool.
B. Pressure - resultant effect of force & area. Variation of Handpiece
Force - gripping of handpiece, its positioning • Straight
& application • Contra-angled
Area - amount of surface area of the cutting • Right-angled
tool in contact w/ the tooth surface during Criteria in Evaluating Handpieces
operation. Less:
P =F/A • Friction
• Torque
C. Heat Production - directly proportional to • Vibration
pressure, rpm, area of tooth in contact w/ the tooth.
• Too much pressure produces heat which 2. Cutting Tool - rotary tool used for removal of tooth
causes sensitivity. structure
Types of Rotary Tool
D. Vibration - product of equipment used & speed of • Burs
rotation • Stones
Classification of Dental Burs
E. Patient Reaction - factors that cause patient • Steel
apprehension: • Tungsten Carbide
Consist primarily of heat production • Diamond
(sensitivity) ▪ Round bur - 1/4→10
Vibrational sensation ▪ Inverted bur - 33 1/4→39 (series of 30s)
Length of operating time & no. of visits ▪ Straight bur - 500 / 900 series
▪ Tapered bur 600 / 700 series

PARTS OF A BUR
E.1 Ways to minimize Irritation 1. Head - carrying the cutting blade
• Duration of operation 2. Shank / Neck - connecting the head &
• Intermittent application of tool to a tooth attachment
• Use sharp instruments 3. Attachment - engaged in the handpiece

F. Operator Fatigue
F.1 Causes:
Duration of operation
Vibration produced by handpiece
Forces that control the rotating instrument
Apprehension on the part of the dentist

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CLASSIFICATION OF GLASS IONOMER

GLASS IONOMER

→ A material that is classified under tooth 1. Anhydrous - Polyacrylic acid is frozen or vacuum
colored restoration dried & added to the powder. Mixing done by adding
→ Known for its fluoride release distilled water
Longer shelf life
Aluminosilicate Glass – (powder) primary Less viscous
Calcium Fluoride Higher powder-liquid ratio
Sodium Fluoride Very acidic (double powder component)
Aluminum Phosphate Slower initial set
Silicon Dioxide *Anhydrous means no liquid
Aluminum Oxide
2. Hydrous
Copolymer of Polyacrylic Acid - (liquid)
Polyacrylic acid in liquid
Tartaric Acid
Highly viscous
Maleic Acid
Initially less acidic (less powder ratio)
Itaconic Acid
Reduced shelf life
*Primary component is the polyacrylic acid

3. Semi-Hydrous
PROPERTIES OF GLASS IONOMER
Polyacrylic is in both liquid & powder
Long term chemical adhesion to tooth
Viscosity - between hydrous & anhydrous
structure (it will not adhere to unetched
Acidity - low to moderate
enamel or exposed cementum and dentin)
Shelf life - between hydrous & anhydrous
Minimal shrinkage (because it is not resin)
Low thermal expansion (not resin/amalgam)
ADVANTAGES OF GLASS IONOMER
Fluoride release (arrest rampant caries)
Fluoride release
Greater adhesion to enamel
TYPES OF GLASS IONOMER
Virtually insoluble in water (as compared to
Type I - luting cement, cementation of crowns,
IRM and Calcium Hydroxide – used in
bridge, inlay & ortho appliance
sandwich technique: CH then GI)
Type Il - restorative aesthetics, requiring
aesthetic consideration (e.g. Class V, incipient
DISADVANTAGES OF GLASS IONOMER
carious lesion, base)
Do not adhere well on dentin, cementum or
Type ll 2 - restorative re-inforced. Used where
unetched enamel
aesthetic consideration are not important, but
Film thickness is excessively high
rapid set & good physical properties are
Removal of excess cement is extremely difficult
required
Type III - lining, base & fissure sealant. Physical
properties improve as powder increases
• Pit & fissure sealant also known as
prophylactic odontotomy

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Microfilled
COMPOSITE RESIN
• 35%-50% inorganic fillers
→ Direct tooth-colored restorative materials • submicron sized particles
that is commonly or most universally used to • low in strength, easily abraded after few
restore anterior teeth. months
→ Consist of continuously polymeric or resin • well polishable
matrix in which an inorganic filler is
dispersed composed of GLICYDIL Hybrid
METHACRYLATE & inorganic compound • 70%-80% inorganic fillers
called BISPHENOL which together yield a • submicron sized particles
polymer commonly known as BIS-GMA. • high strength, well polishable

All resin materials contain methacrylate / POLYMERIZATION METHOD

Bisphenol Glycidyl Methacrylate Acid (Bis-
GMA) being a primary component used in Self-Curing Composite (autopolymerized)
various types of resin materials (luting, • activated by chemical means, catalyst &
flowable, packable). base.
Bisphenol is one component that • Base + Catalyst
contributes to the toxicity of composite • Addition of more catalyst in the mixture
resins, but toxicity only occurs in trace does not affect the strength, only the
amounts if unpolymerized resin is present. polymerization (more catalyst, faster
polymerization, and vice versa)
Inorganic filler – good mechanical properties epoxy
silane coupling agent Light Activated Composite
Increase strength • polymerized by ultraviolet light, halogen
Reduces solubility of water absorption of the light
composite resin • Avoid buying a light-curing machine with
an intensity below or less than
TYPES OF COMPOSITE RESIN 400 mW/cm². Insufficient intensity leads
to unpolymerized resin, causing spaces,
Conventional air bubbles, and will result to sensitivity.
• 75%-80% inorganic fillers • Follow the 16 Joules rule for proper
• particle size 5-25 micron polymerization: the total energy
• also known as self-cure composite resin (intensity x time) needed for well-
(with base + catalyst) polymerized resin.
• High filler content, high strength
• Particle size is large making it not To achieve 16 Joules/cm², you need a combination
polishable, not esthetically acceptable of light intensity and curing time. For example:
• Metal instruments cannot be used as it
If a curing light has an intensity of 400 mW/cm², you
abrades the fillers
would need to expose the resin for 40 seconds (400
mW/cm × 40 seconds = 16 Joules/cm).

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PROPERTIES OF COMPOSITE RESIN INDICATIONS OF COMPOSITE RESIN

Anterior teeth (class III, IV, V)
Porosity - presence of void, space, bubbles, & Closure of diastema
presence of air Chipped teeth (Class IV cases)
Peg-shaped laterals
HOW TO AVOID POROSITY Veneers
Use of celluloid strip / mylar strip
Use of syringe (over self-cure type) to carry CONTRAINDICATION OF COMPOSITE RESIN
mixed mass Proximal-occlusal restoration (Class II)
Use folding & pressing technique during mixing
(use of glass slab, put composite, then do press SHELF LIFE OF COMPOSITE RESIN
and fold technique to remove all air, space, Can be prolonged by limiting exposure of
bubbles) monomer & catalyst to both UV light & heat
Cool room temperature
CONSEQUENCES OF THERMAL EXPANSION
Micro-leakage
Marginal breakdown
Pain due to micro-leakage
Dimensional change
Discoloration (known as secondary carious
lesion)
Radio-opacity - radiograph color/appearance
(dull white, not bright white – amalgam)

PHYSICAL PROPERTIES & MECHANISM OF

COMPOSITE RESIN
Less soluble (as compared to GI)
Decrease in fluid exchange promote both
chemical & color stability (more color stable as
compared to GI)
Greater capacity to resist masticatory stress
(used in posterior teeth)
Thermal conductivity is low (as compared to
amalgam)

DISADVANTAGE OF COMPOSITE RESIN

Low resistance to abrasion

ADVANTAGE OF COMPOSITE RESIN

Aesthetically acceptable (anterior & posterior)

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POSTERIOR RESTORATION
→ To overcome stress build-up:
Cumbersome Layering Techniques – by
FLOWABLE or LOW VISCOSITY, LOW MODULUS increments / incremental technique
INTERMEDIARY BASE Cumbersome Light-Curing Techniques
→ SDR is a brand with good characteristic that Use of Low Viscosity, Low Modulus
can help us prevent stress and contraction Intermediary Base or Flowable
for posterior tooth. (ppt: low viscosity, low modulous
→ Stress and Contraction – primary intermediate resin)
disadvantage of composite resin
→ Shrinkage of composite materials during COMPOSITION OF SDR
polymerization is one of the prime factors
that adversely affected the success of direct CONSTITUENT FUNCTION
composite restorations. • EBPADMA Urethane resin → structure
→ Shrinkage occurs if you have more than 2mm • di-functional diluent → crosslinking
composite resin and you cure it. • barium and strontium alumino- → filler
→ Significant research efforts have been made fluoro-silicate glass
to provide relief of the contraction stresses (in • initiator curing → visible light
terms of composite) caused by the • iron oxide → colorant
shrinkage, which cause • SDR (urethane dimethacrylate) → reduces stress
Microcracking in the bulk
Weakening of interfaces SDR MONOMER - POLYMERIZATION

Debonding of local areas between bonded Refer to pic below: The packable type of composite

surfaces resin contains conventional monomers, making it

These 3 will only be resultant effects of stress and unable to resist stress and contraction when applied

contraction if you exceeded more than 3mm or in layers exceeding 2 mm. In contrast, the flowable

more. type contains a modulator that acts as a stress

→ If no adhesive is used, and the resin is light- breaker for the resin. It is responsible for reduction of

cured, then there is shrinkage and gap stress and contraction during polymerization.

formation.
Summary: Unconstrained composite shrinks

Results to stress and contraction or gap formation

which will lead to debonding.

→ If adhesive is used, and the composite tries to

shrink - the adhesive tries to hold, stress
builds-up.
SDR can be applied in bulk because it
Summary: Bonded composite builds-up stress
provides 60% reduced shrinkage stress
compared to compo used for posterior
→ If the stress is too high on the ADHESIVE:
restorations. This is achieved by using a
Fracture of the adhesive
patented modulator in the formulation that
Fracture of tooth restoration or tooth
results in reduced shrinkage stress (force)
surface
at the tooth interface.

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Best benefit of using SDR is you can place it SDR APPLICATION PROCEDURE
by bulk (4-6mm), and reduces chair side 1. Application of Adhesive
time. 2. Application of SDR in bulk (up to 4 mm
increment)
INDICATIONS 3. Application of a cap with composite (2 mm)
Small Class I & II Cavities (Base /Liner) *capping – occlusal third of the restoration
Pit and Fissure Sealant (prophylactic
odontotomy) SDR POSTERIOR BULK FILL FLOWABLE BASE
Filling defects or undercuts in tooth preparation APPLICATION
(crowns, inlays, onlays) 1. Apply acid conditioner followed by adhesive or
Core Build up self-etching adhesive. Light cure.
2. Increments up to 4mm. 2mm short of the
SDR BENEFITS cavosurface margin.
simple and efficient procedure! 3. Light cure 4mm increments. *light output ≥
Replaces the liner 550 mW/cm^2
Bulk application of up to 4 mm increments 4. Final 2mm layer with composito restorative.
Aesthetic and durable
Reduction of procedure steps IMPORTANCE
Exact placement with Compula® Tip new SDR Monomer reduces stress
Compatible with conventional adhesives and flowable, self-leveling consistency which can
composites prevent sensitivity
One universal shade increments up to 4mm
Low consistency supports self-leveling in the
cavity (Thixotropic characteristic – changes SECTIONAL MATRIX
from very flowable consistency to hard when
cured) → Gives better proximal contour and contact
→ Less flash, excess, and overhangs
SELF-LEVELING / FLOW-LIKE CONSISTENCY
Benefits:
It prevents air, space, and bubbles
*air, space, and bubbles will build up pressure
which will lead to post operative sensitivity
Perfect adaptation - no air bubbles underneath
restoration
Increased application convenience

PROCEDURE APPLICATION BEFORE

1. Application of Adhesive
2. Application of a flowable as liner
3. Application of increment 1 with composite
4. Application of increment 2 with composite
5. Application of increment 3 with composite

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BITINE MATRIX SYSTEM RING
In all of bonding techniques, resin tag should
be formed/created
The advantage of total-etch over self-etch is
that total-etch uses an etchant (tooth
conditioner & primer), whereas in self-etch, the
etchant is contained within the bottle.
A single application of bonding agent achieves
only 65-70% effectiveness; therefore, a second
application is recommended to achieve 100%.
The proper consistency of a good bonding
agent is watery, indicating that the solvent
(ethanol or acetone) is still present.
After application of bonding agent, air-dry for
5-10 seconds to make sure the solvent present
has evaporated already.

FIBER REINFORCED COMPOSITE RESTORATIONS

Wedge-guard – used to protect the adjacent
tooth during the restoration Shivanna and Gopeshetti (2012) concluded in
their study that composite restorations
reinforced with polyethylene fibers showed
increased fracture resistance or root filled teeth
and had favorable fracture lines.

*** The last 3 steps after Layering technique are:

Wedge – used to prevent overhangs of the Contouring
restoration Finishing
Polishing
Avoid applying excessive pressure with the rotary
instrument, as it can generate heat, potentially
causing microfractures due to excessive finishing
and polishing.
Composite Sealant – to preserve the
3 BONDING SYSTEM TECHNIQUES restoration from early abrasion
Types of Etching: Apply 37% phosphoric acid to composite resin for 15
• Selected etching technique – applied only to seconds, the wash and dry, apply composite sealant.
the enamel surface / selected area
• Total etching technique – applied to both
the enamel and dentin surfaces (ex.
Diastema closure case)
• Self-etch technique – does not etch

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BLEACHING
4. RETRACTION
→ Cosmetic procedure for lightening the tooth Cheek retractor – isolates the lips, cheek,
color. Primary component is 25% hydrogen tongue
peroxide. Put face gauze after retractor
→ Whitening during bleaching is achieved
through hydrogen peroxide + accelerator 5. ISOLATION
light Use cotton roll on vestibular area (convex
→ The accelerator light causes sensitivity contour)
→ Hydrogen peroxide does not weaken teeth Fold the gauze into 2, triangular shape then put
nor causes sensitivity on vestibular area

INDICATIONS: 6. APPLICATION OF BARRIER

Generalized staining Barrier – liquid, another form of isolation,
Extrinsic stains isolates the soft tissues from the teeth, needs
Tetracycline stains curing
Traumatic pulpal changes Liquid barrier should be applied in a thick layer
White spots – indicate enamel
demineralization, progression stops with the 7. REMOVE EXCESS OF BARRIER
use of fluoride and calcium phosphate Remove excess using cotton
LIMITATIONS:
Patient with high unrealistic expectations 8. CURING
Decay and active periapical pathology
Sensitivity / crack / exposed dentin 9. APPLICATION OF BLEACHING AGENT
Existing crowns / large restoration Apply thickly, more than 3mm
Patients can’t afford changing existing Premolar to premolar or canine to canine
restoration post-bleaching High intensity rate, longer cycle, more material

STEPS IN BLEACHING PROCEDURE 10. USE WHITENING ACCELERATOR (LIGHT)

*30 minutes prior to procedure, ask px to take ibuprofen or Use whitening accelerator directly
mefenamic acid to help with sensitivity
Has low and high option
Use high option first
1. DEBRIDEMENT
4 cycles, 15 minutes per cycle = 1 hour
Oral Prophylaxis
Intensity rates can vary from 60, 90, or 120
TRAY SET-UP:
mW/cm²
Cotton plier
Buy small square gauze 2x2 6 pieces with cotton ball
10. REMOVAL OF BLEACHING AGENT
Use gauze or cotton roll to wipe the bleaching
2. SHADE SELECTION
agent
Re-apply the bleaching agent for next cycle
3. VITAMIN E
If the patient experiences sensitivity during the
Apply on lips to protect from light heat / less
third cycle, reduce the intensity and shorten
friction
light exposure.
Myra Vitamin E (colorless)

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If the patient feels pain, stop the procedure;
otherwise proceed to the fourth cycle.
Carefully remove everything including
retractor
Ask patient to rinse

11. SHADE ASSESSMENT

12. APPLY CALCIUM PHOSPHATE

1 per class
Get bleaching tray made of silicon rubber
Place calcium phosphate to labial up to buccal
surfaces of premolar to premolar then insert
Instruct px take pain reliever for the first 24 hrs
and no colored food or drinks

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RINSING
BONDING AGENT
→ After etching, the enamel surface should be
→ Bonding agents are resin materials used to thoroughly rinsed with a continuous stream
make dental composite filling adhere to both of water spray for 5-10 seconds completely
enamel & dentin. washed off.
→ Bonding agents are often methacrylates with
some volatile carrier & solvent like acetone & DRYING
ethanol. → Remove excess water, contamination of the
etched and dried enamel surface by saliva,
REQUIREMENTS OF GOOD AHESION: blood or moisture can prevent proper
Surface should be clean bonding.
There should be intimate adaptation between
the adhesive and adherent ENAMEL BONDING AGENT
The adhesive should be well-cured → Bis-GMA (bisphenol A-glycidyl methacrylate) or
The bond strength between the adhesive & UDMa (urethane dimethacrylate) resins, these
adherent should be strong enough to resist agents flow easily into the microporosities of the
bonding enamel surface & when polymerized by the light
activation, from resin tags which lock them into the
ENAMEL BONDING: enamel surface.
Acid etching transforms the smooth enamel → Bond strength of composite to etched enamel
into an irregular surface & increases its surface. 15-25 MPa (megapascal)
When a fluid resin-based material is applied to ▪ If below 15 MPa, it will be removed
the irregular etched surface, the resin ▪ Cure it for 10 seconds
penetrates into the surface.
Monomers undergo polymerization & the DENTIN BONDING
material becomes interlocked with the enamel → More difficult & less reliable than enamel
surface. bonding, primarily relies on the penetration of
The formation of resin microtags within the adhesive monomers into the filigree of
enamel surface is the fundamental mechanism collagen fibers left exposed by acid etching.
of resin-enamel adhesion.
▪ Much difficult because you cannot etch on
▪ Resin-enamel adhesion / Resin microtags – a wet dentin
when bonding agent is locked on the surface of ▪ Can cause porosity which leads to post-
the tooth through curing. operative sensitivity
▪ Establish good resin tag formation to lock
EFFECTS OF ETCHING: dentin
Removes 10 micrometers of surface enamel & ▪ Key to success for more retentive
creates a microporous layer composite into the prepared cavity - more,
Increase wettability longer resin tags / lateral tags
Increase surface area
Increase surface energy

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2ND SEMESTER / S.Y. 2024-2025 / DR. ANDRES SRBE / DMD6C

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THIRD GENERATION
GENERATIONS OF BONDING AGENT
Attempted to deal with smear layer in 2 layers
FIRST GENERATION • Modification of the smear layer to improve
(1950-1970's) its properties or
Use of glycerophosphoric acid dimethacrylate • Removal of the smear layer by keeping the
containing resin would bond to acid-etched smear plugs intact
enamel. Phenyl-P or PENTA was used to achieve smear
Bond was due to interaction of bio functional layer modification by penetration of acidic
resin molecule with the calcium ions of monomers
hydroxyapatite (enamel) Examples:
Hydrophobic monomers • Clearfil New bond
Very low bond strengths - 2 to 3 MPa • Scotchbond 2
First commercial dentinal adhesive • Gluma system
• Cervident - SS White (1965)
→ claimed chemical bond to calcium FOURTH GENERATION
retention only 50% at 6 months Three-step, total etch adhesive system
• Class 5 This method is commonly known as the "Total
Etch Technique or Rinse Technique"
SECOND GENERATION ▪ Gold standard of bonding
Phosphate ester material (Phenyl-P and Consist of 3 essential components:
hydroxyethyl methacrylate in ethanol) • 37% Phosphoric acid etching gel that is
Mechanism of action is based on polar rinsed off / tooth conditioner / acid etchant
interaction between phosphate group & • Primer containing reactive hydrophilic
calcium in the smear layer monomers in ethanol, acetone, or water
▪ Smear layer – debris / residue of the organic & ▪ Can be hydrophobic or hydrophilic,
inorganic structure of the tooth (hydroxyapatite made up of water-based solvent,
crystals, phosphate, fluoride) improves adhesion of bonding
The smear layer was the weakest link in the • Unfilled or filled resin bonding agent /
system because of its loose attachment with adhesive
dentin When primer & bonding resins are applied to
Show less wettability & penetration into the etch dentin, they penetrate the intertubular
dentin crossing smear layer dentin, forming a resin-dentin interdiffusion
Bond strength was also poor <10 MPa zone or hybrid layer.
Examples: Examples:
• Clearfil Bond • scotch bond multi purpose
• Scotchbond • All bond2
• Bondlite • Panavia21

▪ Composite resins are technique sensitive – any form of

contamination from saliva, blood, or tooth debris can
lead to early removal of the composite out of the
preparation.

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2ND SEMESTER / S.Y. 2024-2025 / DR. ANDRES SRBE / DMD6C

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▪ The right bonding agent should have a watery 2. Self-etching adhesives

consistency when you drop it. Viscous consistency
→ Etchant, primer, & adhesive are all in one
means that the solvent already evaporated /
package, but require mixing before
deteriorated.
application on the tooth surface
▪ CEB Technique – Cutting, Etching, Bonding
→ Example: Prompt-L-Pop
▪ Inferior compared to 4th generation
FIFTH GENERATION
▪ Self-etch primer – get a rough brush and apply it on
Simplified version of the fourth generation
the surface, agitate it to remove acidity (acidic ->
adhesives basic) then get another brush and air dry to make
▪ Termed as Prime & Bond Nanotechnology (NT) sure it is uniformly applied, cure for 10 seconds
Also known as "One Bottle System" ▪ Wait 2-5 seconds / air dry before curing to allow
Primer & Adhesive are combined in one bottle. solvent to evaporate
Separate etching step is still required
SEVENTH GENERATION
Though they require fewer steps to achieve
Also known as All-in-one adhesive system
dentin bonding, these agents are inferior to the
Combine etchant, primer, & adhesive in one
fourth generation bonding agents in terms of
bottle, no mixing
bond strength
Primarily these agents are intricate mixes of
Examples:
hydrophilic & hydrophobic components in one
• Single bond 3M
bottle
• one step
Their bond strength is less than that of the
• Gluma comfort bond
fourth & fifth generation adhesives
▪ 5th gen is very effective for enamel – use this Examples:
technique for Class IV, peg-shaped laterals, veneers • Clearfil S3 bond
limited to enamel surface, diastema closure (but use • G-Bond
6th gen for extensive cases where there is no enamel • Xeno IV
left)
EIGHT GENERATION
SIXTH GENERATION Single Dose System containing nanofillers
This generation of bonding system try to further (20nm) to increase bond strength.
simplify the process of dentin adhesion by Advantages:
minimizing clinical steps • User-friendly (Fewer steps are required)
Acids of lower concentration are generally • No rinsing required
used: Disadvantages:
• 10% phosphoric acid • Resin tag formed are smaller and
• 2.5% nitric acid inconsistent
• 10% citric acid • Hybrid layer formed is thinner and less
• 10% maleic acid uniform and discontinuous with lots of
Also known "SEP" Self-etching Primers debris.
Commercially available in 2 forms:
1. Self-etching primers
→ Etchant & primer are in one bottle, while
adhesive is in a separate bottle

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B. RESISTANCE & RETENTION FORM –

A. CLASS I AMALGAM PREPARATION
resistance refers to depth
Pulpo-occlusal convergence of the buccal
DIFFERENT DESIGNS OF A CLASS I PREPARATION: and lingual walls – slightly acute and slightly
Maxillary Posterior Teeth converging for support
• 1st and 2nd premolar – butterfly shape Parallel mesial or distal walls – and
st nd
• 1 & 2 molar – crossing or not crossing the perpendicular on the long axis of the tooth
oblique ridge (flatten the pulpal floor using inverted bur)
Mandibular Posterior Teeth Smooth and flat pulpal floor of the occlusal
• 1st and 2nd premolar – dumbbell shape; but table
if prominent lingual groove: H or Y Rounded line and point angles
preparation • Line angle – junction where two surfaces of
st
• 1 molar – need to extend preparation due a tooth meet; should be rounded (inverted
to the presence of distal cusp; fishtail is not bur) and definite (straight bur)
recommended; produce 3 cusp • Point angle – junction where three surfaces
preparation on buccal surface of tooth meet
nd
• 2 molar – cross-type preparation Occlusal cavity depth (1.5-2mm from the
cavosurface margin)

C. COVENIENCE FORM – the ease of removal

and insertion of the plugger or condenser

D. FINISHING OF WALLS – removal of the

unsupported enamel or minor enamel
overhangs or underhangs
Use finishing burs or hand cutting instruments
(hatchet / hoe / chisel for cleaving)

CRITERIA FOR CAVITY PREPARATION

A. OUTLINE FORM – refers to the shape of the
preparation
Butt joint margin – relationship of the
cavosurface margin or the external periphery
of the preparation to the filling material or the
preparation; right angle / 90-degree
angulation
Properly prepared dovetail
Isthmus width (1/4 intercuspal distance) or
• 1-1.5 mm for premolar
• 1.5 – 2 mm for molar
*dovetail slightly pointed + isthmus little bit rounded
= graceful curve

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2ND SEMESTER / S.Y. 2024-2025 / DR. ANDRES SRBE / DMD6C

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B. CLASS II AMALGAM PREPARATION

A. PROXIMAL DESIGN
Inverted truncated cone / slightly
converging towards the occlusal
Buccal and lingual walls are diverging
towards the proximal surface
Reverse curve at the mesiobuccal or
distobuccal cusp area (S-curve to
conserve tooth structure and for good
finishing)
Gingival margin should be extended
1-1.5mm below the contact area (to have
proper finishing of margins)
Gingival floor has a width of 1 mm for
premolars and 1.2-1.5 mm for molars
Gingival floor is horizontal (or straight/flat)
when viewed from the buccal (end cutting
bur is recommended)
Axial wall is not vertical when viewed
from the occlusal but convergent
occlusally by 2-3 degrees (a little convex)
Axio-pulpal line angle is beveled
0.5 mm out of contact

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2ND SEMESTER / S.Y. 2024-2025 / DR. ANDRES SRBE / DMD6C

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STEPS IN DOING ANTERIOR RESTORATION • Place resin buttons on the tooth surface,
(peg-shaped laterals, diastema closure, Class IV then take a photo. The resin button that
labial veneers, etc.) disappears in the photo indicates the

Example Case:
correct shade.

CLINAL MANAGEMENT OF PEG SHAPED

LATERALS USING COMPOSITE RESTORATION

5. Rubber Dam Isolation

1. Take pre-operative
best source of isolation
photos to see upper
free from all contamination
and lower dentition.
such as saliva, blood,
organic and inorganic debris
2. Take upper and lower
(smear layer)
impressions to create
a study cast, which
6. Retention Form
will serve as an
3 Forms:
educational tool for explaining the procedures
Mechanical Retention – use the smallest
to the patient.
round bur or inverted cone bur and place it at
the point angle of the preparation to create
3. Use Polyvinyl Siloxane Impression material /
mechanical retention.
putty to take an impression of the lingual
Accessory grooves or pins – added features
surface in order to create a lingual matrix.
to enhance retention.
Lingual matrix is used to build up the lost
Frictional Retention – used when there are no
lingual wall of the restoration
carious lesions.
Other terms for lingual matrix:
• To achieve proper
• palatal matrix
composite restoration,
• palatal silicone key
remember CEB – cut,
• palatal silicone guard
etch, bond.
• silicone index

7. Application of Acid Etchant

4. Shade Selection Guide
Apply 37% phosphoric acid purely on the
Use a classic shade guide (vita, bioform, etc.)
enamel surface for 15 seconds.
Choose shade based on:
Wash the etched surface with water
• Value – lightness or darkness of the
thoroughly.
shade (whitish, yellowish, brownish
Slightly dry the surface using cotton to avoid
tones)
desiccation of collagen fibers and
• Hue – actual color (A1, A2, B1, etc.)
dehydration of dentinal tubules.
• Chroma – intensity of the shade (the
What you need is a moist surface to achieve
cervical area has the darkest chroma,
good penetration of the bonding agent into
which lessens as you move toward the
the dentinal tubules and achieve resin tag
incisal edge).
formation – key to success for a more
retentive composite in the prepared cavity.
If shade is still unclear, use
Cross Polarization Technique

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2ND SEMESTER / S.Y. 2024-2025 / DR. ANDRES SRBE / DMD6C

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8. Bonding → To prevent stress and contraction:

Apply the bonding agent twice Do not use the bulk-fill technique (4 mm
The proper consistency of a good bonding or more). Instead, use the 2 mm
agent is watery, indicating that the solvent incremental technique.
(ethanol or acetone) is still present. Use a low-viscosity, low-modulus
If the bonding agent has a viscous intermediary base or flowable composite
consistency, it has already deteriorated. as a shock absorber.
9. Curing
Ensure that the light-curing machine has an 10. Layering Technique on Lingual Matrix
intensity rate of more than 400 mW/cm². Apply composite resin to the lingual matrix
Follow the 16 Joules rule for proper and build it up to form the lingual shell.
polymerization: Energy (Joules) = watts x Insert the matrix intraorally to shape the
time lingual wall of the restoration.
Example: If a curing light has an intensity of Continue layering in 2 mm increments until
400 mW/cm², you would need to expose the achieving:
resin for 40 seconds (400 mW/cm × 40 • Proper shape and form
seconds = 16 Joules). • Correct proportion and symmetry
• Accurate alignment and position of the
COMPOSITE restoration
When using duo shade:
→ Primary disadvantage: Shrinkage of • Use dentin shade for the cervical to
composite materials during polymerization is middle third of the tooth.
one of the prime factors that adversely • Use enamel shade for the incisal third.
affected the success of direct composite • This technique enhances translucency,
restorations. allowing light to pass through and giving
→ Stress and Contraction happen whenever the restoration a more natural
you click light cure machine. appearance.
→ Significant research efforts have been made If enamel shade is not available, you can do
to provide relief of the contraction stresses (in Polychromatic Layering Technique – use
terms of composite) caused by the shrinkage, multiple dentin shades
which cause Example:
Microcracking in the bulk • Cervical third → use A3.5 (darker, more
Weakening of interfaces saturated)
Debonding of local areas between bonded • Middle third → use A3
surfaces • Incisal third → use A2 (lighter shade)
→ If adhesive is used, and the composite tries to To avoid the formation of the oxygen-
shrink - the adhesive tries to hold, stress inhibited layer, use an air-block strip. This
builds-up. blocks oxygen so the surface cures
Summary: Bonded composite builds-up stress completely and hardens properly.
→ If the stress is too high on the adhesive:
Fracture of the adhesive
Fracture of tooth restoration or tooth
surface

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2ND SEMESTER / S.Y. 2024-2025 / DR. ANDRES SRBE / DMD6C

FINAL PERIOD

11. Characterization Digital Smile Design Application

Primary Anatomy (Shape) Analyzes a person's smile using photos and
• Ovoid, rounded, rectangular, square, scans, and suggests detailed ways to improve
triangular, tapering it.
Secondary Anatomy (Surface textures) In composite restoration, it can guide how
• Developmental grooves much material to use and help achieve the
• Lobes *basic anatomy in restoration.
• Mamelons
• Depressions
Tertiary Anatomy
• Perikymata – fine horizontal lines on the
enamel surface
• Imbrication line – slightly depressed
lines near the cervical third of the facial
surface.

12. Checking of Occlusion

Use articulating paper

13. Finishing & Polishing

Use a light stroke
Avoid excessive polishing as it can lead to
microfracture

14. Post-operative

Basic Anatomy (According to Importance)

Shape
Shade
Surface texture

*Basic Anatomy in Restoration

Having the right:
Shape and form
Proportionality and Symmetry
Alignment and position
…of the restoration
(^ito answer if question ni doc is basic anatomy lang, without acc. to importance)

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