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PosteriorRestora+ons
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TakeintoConsidera+ontheFollowing
RiskassessmentExtentofdecayLoca+onofthelesions:brokenmarginalridge?Surfacesinvolved:noMODs(anatomyof
primarytoothandcariesrate)
Pulpalinvolvement?Permanentorprimaryden++onBehaviourofpa+entAgeofpa+ent/stageofdentaldevelopmentParentalpreference
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Decisions,DecisionsCAVITY
SMALL
NEAREXFOLIATION
NO
COOPERATIVE
RESTORE
UNCOOPERATIVE
WAIT36MONTHS
OR
GLASSIONOMER
YES
GLASSIONOMEROR
ALLOWTOEXFOLIATE
LARGE
NEAREXFOLIATION
YES
EXTRACTOR
GLASSIONOMEROR
ALLOWTOEXFOLIATE
NO
COOPERATIVE
VITAL
RESTORE
NONVITAL
EXTRACTION
UNCOOPERATIVE
VITAL
GLASSIONOMER
NONVITAL
EXTRACTION
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ART
Atrauma+corAlterna+veRestora+veTreatment
1) Techniqueofrestoringcariesinpopula+onswithli\leornoaccesstodentalcare.
2) Techniqueofrestoringcariesinpa+entswhoareuncoopera+veorpre-coopera+ve
InvolvestheremovalofdecaywithahandinstrumentoraslowspeedrotaryinstrumentandplacementofamaterialsuchasGI
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Con+nuumofMaterials
Resinbasedcomposite Compomers Resinmodifiedglassionomers GlassionomersRangefrommosttoleasttechniquesensi+ve
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ResinBasedComposites
Mostesthe+c Mosttechniquesensi+ve
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Compomers
PrimarilyaresinbasedcompositewithaddedGI
Ini+allydevelopedtoactlikeaGI,withouttheneedtoetchandbond,howeverthisproveduntrueandtheywereinfactsimplyweaker
lessesthe+cresincomposites
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GlassIonomers
Chemicalbond Noneedtoetchandbond Fluoriderelease Thermalexpansionissimilartoenamel/
den+n
Lastgenera+onofGIwerenotesthe+c,newgenera+onareprovingtobemoreesthe+c ExamplesareRivaSelfCure,FujiIX
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RMGI
PrimarilyaGIbutwithaddedresinmaterialsandchemistrytoincreasestrengthand
esthe+cs Noneedforetchandbond Dualcure Fluoriderelease Examples:RivaLightCureandKetacNano
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UseofGlassIonomer(AAPD)
Lu+ngcements Cavitybase/liner ClassI,II,III,andVrestora+onsinprimaryteeth ClassIIIorVrestora+onsinyoungpermanent
teeththatcannotbeisolated
Cariescontrol Highriskpa+ents Restora+onrepair Atrauma+crestora+ontechnique
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RivaSCInstruc+ons
Isolatetooth,preparecavity.ApplyRivaConditionerfor10
secondsorSuperEtch37%PhosphoricAcidfor5seconds.
2.Washthoroughly.
3.Removeexcesswater.Keepmoist.
4.Activatethecapsuleandimmediatelymixinanamalgamator.
5.Immediatelyplaceintocapsuleapplicatorandclicktrigger
untilpasteisseenthroughthenozzle.
6.ExtrudeRivaSelfCureintocavityandcontour.
7.ApplyRivaCoatandlightcure.8.CommenceNinalNinishingunderwaterspray.
9.ApplyRivaCoatandlightcure.
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1.Isolatetooth,preparecavity.ApplyRivaConditionerfor
10secondsorSuperEtch37%PhosphoricAcidfor5
seconds.
2.Washthoroughly.
3.Removeexcesswater.Keepmoist.4.Activatethecapsuleandimmediatelymixinan
amalgamator.
5.Immediatelyplaceintocapsuleapplicatorandclicktrigger
until pasteisseenthroughthenozzle..
6.ExtrudeRivaLightCureinincrementsofnomorethan2mminto cavityandcontour.
7.Lightcureeachincrementfor20seconds.
8.FinalNinishingunderwaterspraycanbeginimmediately
afterlightcuring.
RivaLCInstruc+ons
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CompositeVs.GlassIonomer
Composite GlassIonomer
MoistureControl Polymeriza+onshrinkage Techniquesensi+ve Esthe+c HighlyPolishable Mechanicalbond
Moisturecontrolisnotcri+cal Expansion/contrac+onis
similartothatofthetooth Lesstechniquesensi+ve Bulkplacement Fluoriderelease ChemicalBond(acid/base
reac+on) Bioac+ve(ac+vitybetweenthe
saliva,restora+onandthetooth)
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CavityPrepara+oninPrimaryTeeth
THINNERENAMELANDDENTINTHANINPERMANENTTEETH
PULPSARELARGERINRELATIONTOTHECROWN PULPHORNSARECLOSERTOTHEDEJ SOMUSTRESTOREEARLY!!!!
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ProximalContacts
Wider,broader,fla\er Lessneedtocontourmatrixband Donotflarethatbox!
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CommonErrors
Failuretofollowtheoutlineofthecusps Isthmusistoowide Flareofproximalboxistoowide Gingivalcontactwithadjacenttoothisnot
broken
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Intracoronalrestora+onsvs.StainlessSteelCrowns
SSChada1.59+meshighersuccessrate
ascomparedtoclassIIrestora+ons.(Thisis
fromaliteraturereviewof10separatestudies)
MainreasonsoffailureofclIIrestora+ons
werefractureandsecondarycaries.AveragelifespanofaclIIrestora+onos2
years.
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IntraCoronalRestora+onSuccessRatesRetrospec+vestudyofdurabilityofamalgamsinprimaryteeth:
Braff1975:11%successover33.5monthsHolandetal1986:3yearsurvivalrate:Ds:38%Es48%Ovistetal1986:50%failedwithin2years
RobertsandSheriff1990:5yearsurvivalrateof67%
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StainlessSteelCrownSuccessRates
Overallsuccessrateof88%,meansurvival+meifplacedin
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StainlessSteelCrownTechnique
Occlusalreduc+onof12mm(straightfissurebur)
Interproximalreduc+on,mesialanddistal,mustbesubgingival,noledges Buccalandlingualbevel DONE!
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MixingofGICements
When mixing the cement it is important to usethe recommended powder to liquid ratio.
Too much powder dispensed= Increased viscosity and decreased workingtime
Too much liquid dispensed= Decreased physical properties of the setmaterial
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GICementAdvantages
Easier to mix Good Seal Fluoride release Fluoride recharging Ions exchange between the tooth and cement Good resistance to acid dissolution Remineralization Bonds to tooth structure
Bonds to metal substrate Snap Set Radiopaque
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Main features for Conventional GlassIonomer Cements are:
1.Adhesion to tooth structure2.Adhesion to metals3.Slow & sustained fluoride release
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LaminatedStainlessSteelCrowns
Compositefacing,bonded,oenwithmesh Limitedcrimpability Widermesiodeistally Bulky Easytoplace Suscep+bletolossoffacing
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