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  • 1. Efficiency in tooth restorationLets Grow ToothBioactive/regenerative materials to increase comfort and decrease failure2014-2015Jack D Griffin, Jr DMDDiplomat American Board of Aesthetic DentistryAccredited American Academy of Cosmetic DentistryMaster Academy of General DentistryThank you for choosing to spend your time with us. We know that there are many choices in continuing education and we sincerely want this to be one of the best experiences in dental CE today. Our goal is to help you gain greater understanding, confidence, and skill that will allow you to take your restorative practice to the next level in dentistrymaking your practice more efficient.Please let us know if there is anything we can do to help you as we take a journey down the road of long term restoration success together.If you dont know where you are going, any road will take you there.All materials in this manual are protectedplease dont copy without permission

2. 2Lets grow some toothBioactivityRegenerativeObviously we arent growing tooth from scratch. Perhaps a better term for what we are describing is regenerative in that we are creating an environment to promote secondary dentin formation and bacterial inhibition.With regenerative materials we are trying to stimulate dentin repair, healing, and formation using materials that are bio-friendly.ourse outline:1. Liners and bases that insulate, protect, and seal2. Giomers: the class of restorative materials that inhibit bacteria but perform like composite3. Cements that are biofriendly, easy to clean up, and sensitivity free4. Universal bonding agentsthe new GOTTA HAVE materials5. Bulk fill materials for posterior restorationsmore predictable, more efficient6. Putting it all together with direct and indirect restorationsC[bio-aktiv] having an effect on or eliciting a response from living tissue. bioactiveSome regenerative materials:TheraCal LC (Bisco) a linerBiodentine (Septodont) a baseCeramir (Doxa) a cementGiomers (Shofu) a class of restorative materials 3. 3a liner that promotes dentin regeneration TheraCal LC (Bisco)What it isA Resin Modified Calcium Silicate (RMCS)Stimulates apatite formation and dentin repairMTA (Mineral Trioxide Aggregate) chemistryEarly high alkalinity (high pH = 11)Neutralizes over weeksSelf-sealing minor bond to dentinAnti-microbialClinical useLiner to protect pulpPlace on moist dentin prior to DBAKeep 1mm deep or lessOpacity prevents deep cureDirect pulp cap possibleKeep 1mm from enamelMay show through less opaque compositeComparisonsis alkaline but not stable DycalWashes outMay interfere with DBAsimilar dentin/pulp response BiodentineCumbersome to mixEasy to placeDentin replacement baseNeed 2nd appt to restore overGiomersa class of (Shofu)restorative materials that inhibitsbacterial growth while stimulatingdentin repair. Probably has clinicalcharacteristics similar to any materialyou currently use within in the samerestorative category WITH the benefit of fluoride release, recharge, and re-release.A restorative material with the following:Surface Pre-Reacted Glass (S-PRG)Unique release of 6 bioactive, regeneration inducing ionsHigh ability for acid neutralizationInhibition of plaque formationGreat clinical characteristicsHow does it work?A source of reparative ionsAlkaline environment required for dentin healingStimulant of hydroxy-apaptiteBacteriostaticDentin tubule protectant/sealantThermal insulationNotes: ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ 4. 4Giomer ion release by S-PRG:NA+ water soluble, induces function of the other 5 ions - Sodium:BO3- bacteriocidal, promotes dentin formation, decrease bacteria adhesion, anti-plaque - Borate:Al3+ blocks dentin tubules, decreases hypersensitivity - Aluminum:SiO2- Calcification of dentin - Silicate:Sr2+ Buffer, acid resistance, stimulate dentin regeneration - Strontium:F- Formation of fluoroapatite, anti-caries, anti-bacterial, remineralization of decalcified lesions - Fluoride:Giomer restorativesFlowableUniversal hybridPackable posteriorBulk fill flowableSealantAll with same giomer benefits.Distinguishing characteristics.A glass ionomer type core, protected from the negative effects of moisture, in a resin matrix. The result is glass ionomer benefits with physical properties of composite.Notes: ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ 5. 5Does your etch matter?TextureRinse-abilityColorLong term antimicrobial?Phosphoric acid kills NOWBezalkonium Chloride kills LATERDoes killing bugs matter?Matrix metalloproteinases = MMPsenzymes that may break down the hybrid layer between dentin and resin2% Chlorhexidine has been shown to decrease the MMP deterioration of our bonding to collagen.Notes: __________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Isolation is criticalDamIsoliteDentaPop/DriTipCotton rollsGauzeNotes: ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ 6. 6Indirect RestorationsPosterior CompositesStuff we gonna needCuring light _______________________________________________________Instruments ______________________________________________________Bonding agent ____________________________________________________Composite _______________________________________________________Flowable _________________________________________________________Matrix ___________________________________________________________Polishers __________________________________________________________WCERAMIR (Doxa)Regenerative cementGI plus calcium aluminateBioactive cement apatite formationEasiest clean up everLeast sensitivity of any cement testedNO RESINAlkaline pHHydrophilicNo silane, no primer, no bonding agentsAwesome for metal, zirconia, lithium disilicateNo bad taste! 7. 7Restoration cementation adhesive or non-adhesiveCementing is either adhesive or non-adhesive. A major clinical advantage of zirconia and lithium disilicate is that they can be cemented or bonded in place depending upon the resistance of the preparation and preference of the dentist. In those cases where preparation design is retentive in nature, cementation is a viable option with the amount of surface area and degree of divergence of the prepared walls can provide sufficient micromechanical retention. Resin reinforced glass ionomer cements like RelyX Luting (3M ESPE) or GC Fuji Plus (GC America) and newer bioactive cements like Ceramir (Doxa) have been popular choices because of lower reported sensitivity, ease of use, and long term clinical success on retentive preparations. These cements are often more opaque and less esthetic than the resins and so the more translucent the e.max the more this matters.The 2 critical junctions during definitive placement of any restoration is first the bond of the luting material to the internal surface of the restoration and secondly to the tooth. When preparations are short, overly tapered, or occlusal forces heavy, resin bonding is indicated and would provide maximum restoration retention, microleakage prevention, and increased fracture/fatigue resistance of the restorative material itself. Failure most often occurs at the cement/restoration interface and not at the cement/dentin interface.Important points: UNIVERSAL BONDING AGENTS: (i.e. All Bond Universal, Bisco;Scotchbond Universal, 3M) have changed our bondingprotocolsimpler and better. These are giving us the best all aroundbond strengths ever toa variety of surfaceswhether dry or wet,etched or not etched,metal or porcelain. SoUniversal Bond Agents simplify things no more total and self-etch bond agents, no zirconia or metal primers, no worry about too wet ortoo dry. CLEAN after try in: onpre-etched porcelainof any kind (and forzirconia) maximum bond strengths can only be achieved afterremoving salivary contaminants. Ivoclean (Ivoclar) does this better thananything and conditions the surface for better bonding (particularly(Shofu) Giomer, BeautiCem SA bonds highly to almost everything. High fluoride release, re-chargable, great properties. Similar to all others in Self Adhesive category with the benefits of the giomer. 8. 8zirconia). Must reapply silane Ivoclean use. If there is little or no enamel, we dont etch. The universal bonding agents are terrific non-etch adhesives on dentin or prepped enamel both Bisco and 3M have dual cure universal DBAs toinsure set under opaque restorations. If lots of enamel, selectively etchit first. Research is showing less long term breakdown of dentin bonds byprotease/enzymes if we use something to kill bacterial likechlorhexiding or ben