All What you Need to Know About Composites

November 6, 2019 - November 7, 2019

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Learning objectives

The participants will learn:

  1. The potential, advantages and disadvantages of direct composites
  2. To differentiate which cases are suitable or not for the injection technique
  3. How to prepare teeth previous to composites
  4. How to make correctly all kind of indications for direct restorations
  5. How to build a matrix, inject the composite and cure it
  6. The classic analog and the digital modification for posterior as well as for anterior teeth
  7. The simple way, the layering modification and the “Crystal Shell” technique

Course description

The course will cover the necessary knowledge to master anterior and posterior direct techniques. First, the participants will evaluate the model and plan how to prepare the anterior teeth. Afterwards they will prepare the teeth and then they will have to restore them with different techniques, depending from the indication. From classic wedge and mylar strips use, to more sophisticated techniques like the FEM technique, the pulling and reverse pulling to the injection technique. The complete range of indication for composites is going to be covered.

At the beginning all will start quickly with simple class III to IV, V as the foundation. Then, more modern indications like direct veneers, peg laterals and diastema closures will be done. The second day will start with complex cases that present stains or special optical challenges. Then the direct injection technique will be presented. How to build a proper translucent matrix will be shown. In the posterior region, severe worn dentition will be simulated and restored with the “Crystal Shell” technique. Simple monochromatic and multilayer polychromatic approaches are going to be shown. The advantages of the digital approach is going to be shown. How to finish and polish is going to be demonstrated in detail.
All the steps will be shown by the instructor with an HD camera with high magnification for explanation of all the details.

Agenda Day 1

9:00 - 10:30 Lecture

  • History of composites
  • Adhesion
  • New developments for the anterior region
  • Characteristics of modern composites, systems, properties, advantages and limitations
  • How to layer in a simple way
  • The value shade concept vs the A-D
  • How to get the best form
  • Proportions and shape
  • The FEM technique
  • The 3x5 concept

Questions and answers

10:30 - 10:45 Coffee Break
10:45 - 12:30 Hands-On

  • Colour, translucency and opacity
  • New techniques for optimizing the shape and contours, tight contact points, proper interproximal embrasures and emergence profile
  • Direct veneers, class III, IV, peg laterals, diastema closure
  • Case Presentation
  • Questions and answers
12:30 - 13:30 Lunch
13:30 - 15:00 Hands-On

  • Guides will be done, form and contour will be discussed and analyzed. The teeth prepared, considering differences in the basic shade of them and then the anterior teeth are going to be restored. All indications are going to be covered.
  • The participants will make a class III, IV, direct veneer, reconstruct a severe destroyed tooth.
  • Later a peg lateral and a diastema closure are going to be done.
15:00 - 15:15 Coffee Break
15:15 - 17:00 Practical demonstration

  • Final layering, finishing and polishing

Agenda Day 2

9:00 - 10:30 Lecture

  • The use of special stains
  • Advance techniques

Direct veneer and class IV in complex cases, how to stain and reproduce multiple effects

10:30 - 10:45 Coffee Break
10:45 - 12:30 Hands-On

  • The injection technique
  • Introduction of the technique. Advantages and disadvantages.
  • Differences between conventional and digital. Presentation of the models and the tools. Anterior and posterior modifications.
  • Ideal wax up, evaluation of how and when to prepare. Keeping the correct proportions How to create a good matrix. Tips and tricks. Anterior cases and posterior. Preparation of the teeth.
  • How to get the shape. Natural algorithms
  • The proper use of flowables
12:30 - 13:30 Lunch
13:30 - 15:00 Hands-On

  • Injection. Simple and advance forms. Single injection and layering modification. The “Crystal Shell” technique for posteriors.
  • Creation of the matrices, cutting and drilling the perforations.
  • Modifications for the anterior region.
15:00 - 15:15 Coffee Break
15:15 - 17:00 Practical demonstration
Excess removal, curing protocols. Finishing and polishing

About the course

Current and state of the art anterior oral rehabilitation techniques aim for both aesthetic and functional outcomes. During recent years, novel resin biomaterials and clinical techniques have appeared. Nevertheless, the process of making final restorations is still very tedious and time consuming; demanding highly specific skills and techniques from the clinician. On the other hand, matching the right shade, opacity and form is also challenging. Because of that is is of paramount importance that the clinician understand perfectly the layering concept, how to take the shade and how to mix the composite color and consistencies in order to get that shade.

Achieving the right opacity by mixing dentin, enamel and effect shades is crucial, since the mouth is dark, which means that our restorations need to achieve the correct value in order to block the darkness, but at the same time to be translucent enough to match the enamel.

On the other hand, the fabrication of the final restorations is often externalized to a dental technician if they are indirectly made, (ceramics or PFM) because the traditional process of placing multiple direct anterior restorations is usually not cost effective in terms of outcome and time invested to fulfill them. Furthermore, traditionally direct restorations are not made using pre established tooth shapes or contours, making them extremely difficult and single oriented. The development of materials has historically not contributed either, due to the fact, that according to the literature, only dense resin composites are recommended for direct anterior composite restorations. Filler amount, longevity and tooth looking shades for layering techniques are the main reason why those types of resin are the state of the art material chosen. However, since the 1990s, resin materials have improved vastly both in optical and mechanical properties, making them more versatile within their limitations. New strategies of applying resin composites have arisen, making new techniques possible. Mock ups using bis/acryl and injecting flowable composite using transparent matrixes have become more popular for provisionalising and restoring anterior teeth. Originally, the injection technique had the disadvantage of having only one matrix, which was taken from the wax up. This created a much more difficult excess removal than the modified version we are going to present. The course will help you understand the capabilities of these techniques, specially the newest version and will give you all the tools necessary to master them the classic direct techniques as well the newest version with mouldables and flowable composites.