Adhesive restoration: principle and technique
1-Introduction:
Over the last few decades, the means and materials available to practitioners have evolved rapidly, offering new possibilities, namely:
– Improving the mechanical and functional qualities of the obturation.
– Biological respect for the dental organ.
– The aesthetics of restoration.
Patients now want durable and aesthetic restorations even for posterior teeth. This has gradually led to an evolution of dental care towards care with a strong aesthetic component. This evolution has been made possible by the arrival of new materials but also by technical advances in the field of bonding. Adhesive restorations are directly part of cosmetic dentistry but are above all minimalist dentistry, the shape of the cavity being most often limited to the sole extension of the caries.
2-Definition:
Restoration: Repair. Reestablish. Put back into good condition
To restore a tooth: to put it back in good condition, to give it back the appearance of a healthy tooth.
There are partial coronal restorations (inlay, onlay, overlay, partial crown, endocrown, bridge on inlays) or total (crown, bridge). A partial restoration can be aesthetic (ceramic, composite) or not (amalgam), inserted in the plastic phase (direct technique) or made in the laboratory (indirect technique).
Adhesive restoration: A prosthetic part or conservative plastic filling that restores the form, function and aesthetics of the tooth by using coupling agents that chemically and mechanically bond the material to the dental tissues.
3- Materials:
1- The selection criteria:
-Patient-related criteria: hygiene, pathology, allergic conditions.
-Criteria related to the injury: in relation to:
The extent of the lesion will guide the choice of material.
-Criteria linked to clinical constraints in the presence of a tight occlusion for example.
-Criteria related to the practitioner; skills of the practitioner, their method of practice.
-Economic criteria: the cost of the techniques, the patient’s purchasing power.
2- Materials for adhesive techniques: composite, glass ionomer cement, compomer, ceramic
4-Techniques:
A- The different restoration techniques on anterior teeth:
1-Composite veneers (direct method ): the creation of composite veneers is a therapeutic option that should be considered as a “social” alternative to the partial fixed prosthesis (ceramic veneer). It should also be noted that, although composite veneers offer slightly lower aesthetics and longevity than ceramic veneers.
Operating protocol:
-Administration of local anesthesia, if necessary.
-Isolation of teeth using a dam.
-Choice of composite resin color.
-Enamel preparation
-Etching.
-Rinsing.
– Drying (follow manufacturer’s recommendations).
-Application of a layer of adhesive.
-Photopolymerization.
-Application of composite resin in thin layers.
-Photopolymerization of thin layers of composite.
– Finishing using finishing cutters and sandpaper discs.
-Occlusion control.
-Polishing the restoration.
1. Taking the “shade” 2- Placement of an operating field 3- Cavity preparation 4- Etching and adhesive
Adhesive restoration: principle and technique
5- Assembly of the composite in the anterior zone 6-Final result
4-Glued ceramic veneers (indirect method):
The indication for ceramic veneers has increased significantly due to their conservative nature, biocompatibility, esthetic quality and reliability. They should be considered as the first option when a treatment plan includes an indirect restoration in the esthetic zone.
Adhesive restoration: principle and technique
Adhesive restoration: principle and technique
5-Conventional restoration (layering technique):
Layering is a technique for restoring dental substance loss by applying successive layers of composite material. The key elements for the success of this technique are color and shape.
Layering. The goal of layering is to mimic the optical effects and properties of natural teeth in order to replace dental tissues.
Principles of implementation:
Production of a palatal guide
Setting up the operating field
Mordanting
Application of the adhesive
Creation of the palatal face and proximal faces
Production of the dentinal core
Realization of vestibular enamel
Adhesive restoration: principle and technique
Realization of macro and micro geography
Finishing and polishing
B- The different restoration techniques on posterior teeth:
1-Single-layer or bulk-fill technique:
When performing a posterior composite restoration , the dentist must address several material and technique-related issues such as adapting the composite to the cavity floor, managing constraints related to material polymerization shrinkage, achieving a good contact point, and adequate polymerization of the composite. Considering that the average depth of a posterior proximal cavity can be up to 7 mm, cavity filling can sometimes be a tedious task.
Operating principle:
Unlike conventional light-cured composite materials, which must be applied in individual layers of approximately 2 mm for sufficient curing, “Bulk Fill” composites can be light-cured in layers of 4–5 mm.
Adhesive restoration: principle and technique
2 The sandwich technique:
Is a mixed restoration technique combining the CVI MAR with the composite.
1- Closed sandwich:
The indications:
– Site 1: stage 2,3.
– Site 2: stage 2,3 (in the case where the cervical limits are supra-gingival).
2- Open sandwich:
The indications:
Site 2. Stage 3, 4 if the cervical limits are juxta or subgingival
Adhesive restoration: principle and technique
Causes of failure of adhesive restorations:
• lack of sealing
• inadequate marginal adaptation
• incorrect restoration of the contact point
• fracture of the tooth or material
• occlusal wear
• post-operative sensitivity
• occlusion not respected
• recurrence of caries
Sensitive teeth react to hot, cold or sweet.
Sensitive teeth react to hot, cold or sweet.
Ceramic crowns perfectly imitate the appearance of natural teeth.
Regular dental care reduces the risk of serious problems.
Impacted teeth can cause pain and require intervention.
Antiseptic mouthwashes help reduce plaque.
Fractured teeth can be repaired with modern techniques.
A balanced diet promotes healthy teeth and gums.