3 Placing Composite Restorations

Chapter 3:

3.1 Fill the Box Using a Tofflemire Band

3.2 Shaping the Occlusion Using a Tofflemire Band #14 MO

3.3 Shaping the Occlusion Using a Tofflemire Band #30 DO

3.4 Polishing and Contouring Composite Restorations

3.5 Transcripts


3.1 Fill the Box Using a Tofflemire Band

This video demonstrates filling the box with composite for a shallow class two typodont prep using a tofflemire band as retention. No flowable or layering are used but a short description and rationale for different techniques are described. Here a first molar is used but the same technique is applicable for any shallow tooth prep.

See transcript below.

3.2 Shaping the Occlusion Using a Tofflemire Band #14 MO

This video demonstrates filling the remainder of a class two typodont prep.  Anatomy is placed on a maxillary first molar primarily using a tofflemire band, tinbrdilly, shoshan, mini-greg and discoid cleoid. It includes techniques for clearing flash, shaping embrasures, and marginal ridge height. Also there are additional explanations of common anatomy terms and tools used plus a demonstration of relieving a tight contact.

See transcript below.

3.3 Shaping the Occlusion Using a Tofflemire Band #30 DO

This video demonstrates filling the remainder of a class two typodont prep.  Anatomy is placed on a mandibular first molar primarily using a tofflemire band, tinbrdilly, shoshan, mini-greg and discoid cleoid. It includes techniques for clearing flash, shaping embrasures, and marginal ridge height. Also there are additional explanations of common anatomy terms and tools used.

See transcript below.

3.4 Polishing and Contouring Composite Restorations

Brief description of common tools used for finishing and polishing composite restorations followed by a demonstration using the Enhance system to polish and recontour a typodont tooth.

See transcript below.

3.5 Transcripts

Video Transcript: 3.1 Fill the box using a tofflemire band

There are many techniques for placing composite restorations. The one a clinician uses is determined by tooth location, size and depth of the prep as well as personal preference.  Large preps may require a steeped technique or base liner like flowable or glass ionomer. This is done to reduce shrinkage, cusp deflection, microleakage, and post-operative sensitivity.

This video will demonstrate a 2 step application for small preps, using a toflimer

First examine the prep.

When placing composite on real teeth etch, prime, bond, and cure the tooth according to product instructions first

Place the composite applicator tip in the deepest part of the prep and dispense approximately 2mm of material.

Wipe up the side of the prep so not to pull the material out

Here’s another view

Compress composite with a light touch making sure to fill all corners of the box

Failure to adapt the material to all surfaces of the tooth will create voids which can cause post-operative sensitivity and recurrent decay

Do not use your amalgam plugger. It has serrations that will catch and pull the composite.

Instead, use a tmbrdilly or composite plugger and wipe often with alcohol to prevent sticking, another common cause of voids.

Laying the timbrdilly flat, level the composite with the floor of the prep.  Push it toward the matrix band to begin creating a contact.

Remove excess material aiming to fill the box to the contact and not above as you will want to control the occlusal embrasure when shaping the occlusal surface in steep 2.

Once the desired height is achieved light cure and your ready to fill and shape the occlusal surface.

Video Transcript: 3.2 Shaping the occlusion using a tofflemire band #14 MO

Begin by placing the tip at the base of the prep, Fill from the bottom up and wipe against the enamel to prevent material lifting and creating voids.

Because this is a shallow prep, no layering is needed.

Before shaping anatomy, pause and imagine the finished product. Begin with the end in mind.

Condense composite, filling voids, and pressing material against the prep margins. Using a walking bouncing motion. Like kneading bread. This will move excess material toward the marginal ridge

Work one side of the central grove at a time and what is done on one side should be done to the other.

Remove excess material or add more if needed, and wipe instruments often to prevent composite from sticking.

Check for and remove flash from the prep margin often.

A timbrdilly or shoshan can be used to mark the buccal and lingual groves.

Notice the rotating motion used here

Once the major landmarks are mapped out it’s time to shape the marginal ridge. Using a plastic instrument or greg remove excess composite to create the arched shape of the occlusal embrasure.

Heres another view,

Angle the instrument 45 degrees from the matrix band and sweep from the center toward each side and against the prep closing the margin

Notice how often the margins are checked

Use the shoshan to define the central grove working on one side at a time and careful to leave the marginal ridge high.

Let’s see a quick recap from another view

Notice how shaping the cusps or groves changes the marginal ridge and creates flash.  Also how the material is patted into shape or wiped against the prep margin when rounding the occlusal embrasure.

It can be difficult to see with the band on but estimate the marginal ridge height imagining the distal ridge height of #13.

Here a ball burnisher and timbrdilly are used to define the mesial occlusal pit and set the marginal ridge height. Both work well with a light touch.

When everything looks right light cure and remove the band,

Don’t worry there’s always a little clean up to do. But hopefully all you need is a montana jack because it’s much harder to fix the embrasure with burs and disks.

After checking the contact, occlusion, final ridge height, and for flash you can decide if polishing is needed.

Video Transcript: 3.3 Shaping the occlusion using a tofflemire band #30 DO

Begin by placing the composite applicator tip at the base of the pre., Fill from the bottom up. Because this is a shallow prep no layering is needed.

Condense the composite, filling voids, and pressing material against the prep margins.

Before shaping anatomy pause and imagine the finished product. Begin with the end in mind.

Remove excess material if needed and wipe instruments often to prevent composite from sticking.

Use the discoid to remove flash periodically, It’s easier to do it often. Rest the instrument on the edge of the prep so not to over carve.

Use the Shoshan in a rotating motion to mark the buccal lingual groves.

Continue to shape the top ⅓ of the cusps using a walking or kneading motion,

Work on one side of the central grove at a time pushing composite as you go.

Whatever you do to one side you must do to the other.

Clearing the margins is done often.

To deepen the groves use the tinberdilly or shoshan in a rotating motion angling more apical and wiping agents the prep margins.

Once the major landmarks are mapped out it’s time to shape the marginal ridge. Using a plastic instrument or greg remove excess composite to create the arched shape of the occlusal embrasure.

This will create flash so follow up with the discoid cleoid.

Notice the instrument walking with a bouncing motion. Like kneading bread.

The rounded end of the tinbrdilly is great for defining pits

The mini greg works well for the marginal ridge Use it to shape the occlusal embrasure

Composite responds best to a light touch.  Simply touching the material makes it soften.

The only time a pulling motion is used is when making the buccal and lingual groves.

All other times use the walking, bread kneading movement.

To clear flash in groves and depressions use a scooping motion.

Make sure to remove all flash before curing.

Once cured remove the band and cure from buccal and lingual again.

Using a cutting instrument like the T-3 or montana jack to clear flash from the embrasure.

Check the contact with floss.  Thankfully this composite is too tight not too loose.  An easy fix.

Wedge the contact open and use an interproximal reducer to slightly relieve the contact.

Perfect now.

Make a final check for occlusal flash and the occlusion. If no adjustments are needed, you’re done!

Video Transcript: 3.4 Polishing and contouring composite restorations

A well contoured composite restoration needs little polishing. If recontouring the embrasure or defining critical anatomy is needed it can be a tough grind.

Finishing burs and stones both recontour and polish.

Diamond burs are color-coded to distinguish aggressiveness while finishing carbide burs will have many, shallow, closely placed blades.

All polishing systems have the potential to remove tooth structure

Disks and wheels work like sandpaper moving from aggressive to fine polishing

While polishing systems like Shofu and Enhance use pressure to control abrasiveness.

Even polishing brushes, if used with excessive pressure or for a long time, will remove composite so use care when polishing.

Here an Enhance point is used to polish groves and cusp faces. Applying more pressure will define or recontour and light pressure will polish.

Use polishing instruments on the restoration only avoiding tooth structure whenever possible.

A cup works well for the occlusal embrasure.

Varying pressure from moderate to light slowly will smooth scratches and improve the finish.

License

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Restorative Mastery for the Dental Hygienist by Renee Alexandre and Rick Aronstein is licensed under a Creative Commons Attribution 4.0 International License, except where otherwise noted.

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