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Intra-Oral Repair of Direct and Indirect Esthetic Restorations
Nearly all restorative dentistry is done to repair a failure
Interesting Finding! n
Remember the golden rule of dentistry:
If it is your patient, repair it. If it is not your patient,
replace it.
n
Amalgam restorations are replaced by a newly chosen dentist seven times more often than if the patient continued to be seen by the dentist who placed the original restorations. The greatest independent risk factor for replacement of restorations is changing dentists!
Bogacki et al, Oper Dent, 2002
Not all failed esthetic should be repaired
Predictably repairable
Predictably repairable
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Predictably repairable
Loss of inter-dental papilla
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Introduction
Bonding to Enamel/dentin
Etched with
Phosphoric and Hydrofluoric Acids.
Enamel
Dentin
N. Barghi, K. Covington, D. Fischer and E. Herbold
Dentin surface treated with 10% HF
for 60 seconds (5000X).
Dentin surface first treated with
10% Hydrofluoric acid for 5 seconds, then etched
with 37% phosphoric acid for 10 seconds. (5000X)
Suggestion:
Cover the exposed tooth surface with OpalDam, etch
the porcelain with HF, remove the Opal Dam
and etch the exposed tooth surface with phosphoric acid
Make sure the adhesive fracture is localized
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Universal adhesive is applied on both porcelain and tooth structure and light cured
Effectiveness of Post-Etching Cleaning Regimens
on Porcelain-Composite Bond, IADR Abstract Id: 142916, 2011
L MCDONALD, T. MCALISTER and N. BARGHI
“Steam cleaning of etched porcelain surface is
more effective than H3P04 for removing etching
residues from porcelain surface.
Ultrasonic cleaning was the least effective method.”
IADR Abstract Id: 142914, 2011
Bonding Resin Composite to Glazed Porcelain
N. BARGHI, R. PARMA, H. R. Rawls, T. MCALISTER and L. MCDONALD
Removal of the glazed layer before etching
of porcelain should be considered.
Cohesive fracture of porcelain
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1999
Silanated and bonded with composite resin
HF is a weak acid with low tendency to +
dissociate into H and F Ions
-
•
•
Block out the exposed tooth structure
•
Place a 1mm. 45° bevel
•
Prepare the exposed tooth structure, remove the luting resin residue
Isolate the adjacent tooth and etch with HF gel for 90 sec.
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•
Remove the block out and apply H3P04 to tooth and etched porcelain
•
Thoroughly rinse, fully dry and apply silane
•
Apply bonding agent and restore
Establish a bevel and remove the glaze
Cover the tooth structure and the soft tissue, etch with HF
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• Removal of the glaze
• Retraction of soft tissue
• Isolation
Debonding at tooth interface:
RELIABILITY OF METHODS FOR BONDING DE-BONDED
CERAMIC VENEERS
N. BERNUY, J. OVERTON, H.R. RAWLS, and N. BARGHI, # 1319, 2010
“Conclusion: Etched ceramic restorations
de-bonded at the tooth interface may
be re-bonded without complete removal
of the remnants of luting resins”
Lightly sand and clean, then apply a thin coat of adhesive. Allow adhesive to penetrate
Remove resin residue before etching and bonding.
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Keep HF away from the tooth
structure if possible
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Mock-up of restorations
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Repairing a fractured PFM with exposed alloy
Establish an extended bevel
Roughen the exposed alloy
Etch with HF
If available, sanding is preferred
Apply alloy primer
Remove the salt with Phosphoric (agitate )
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Apply metal opaquer to exposed alloy
Apply porcelain bonding resin and light cure
In general, primers are most
effective when the exposed alloy
is surrounded by porcelain
Establish a bevel and remove the glaze
Block the exposed core
Restore with an appropriate shade of composite resin
Repairing fractured zirconia restorations
Etch the porcelain with HF
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Remove the salt with phosphoric
Silane before removing the block out
Remove the block out and
6 years later
Apply Primer on exposed core
Repairing direct composite resin restorations
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Good for another 6 years
Composite-to-composite bonding could be improved by sandbalsting Ozars& Bradakcy, Oper Dent F Papacchini et al. J Adhes Den u A Rathke, et al. Clinica Oral Inv u R Frankenberger, et al. u u
Composite-to-composite could be be improved by flowable composite
Composite-to-composite could be improved by roughening u
F Papacchini, et al. Euro Oral Sc 2007 u R Frankenberger, Am J Dent 2003 u F Papacchini, et al. Oper Dent 2007 u
u
JS Rodrigues, et al. Dent Mater EU Celic, et al. J Adhes Dent
TRF Costa, et al. Oper Dent 2010
2009 2010
By HF Pretreatment
JS Rodrigues, et al. Dent Mater u EU Celic, et al. J Adhes Dent u
Studies support that air abrasion with aluminum oxide followed by
application of a bonding agent results in an adhesive strength nearly identical to the cohesive strength of the original composite
2003 2007 2009 2003
2009 2010
“The composite resin bond strength after grinding the substrate with diamond bur is lower than that achieved with aluminum oxide
TRF Costa, et al. Oper Dent 2010
Composite-to-composite bonding could be improved by silanes
A Rathke, et al, Clinica Oral Inv 2009 R Frankenberger, et al. Am J dent 2003 u Brendake J O, J Adhes Dent 2007 u u
Composite-to-composite could be improved by dentinal adhesives Ozars& Bradakcy, Oper Dent 2003 F Papacchini et al. J Adhes Den 2007 u A Rathke, et al. Clinica Oral Inv 2009 u R Frankenberger, et al 2003 u JS Rodrigues, et al. Dent Mater 2009 u EU Celic, et al. J Adhes Dent 2010 u J Vival, et al. J Esthet Res 2009 u AN Cavalcanto, et al. J Esthet Re 2007 u F Staxrud, et al. . Uro Oral Sc 2001 u u
Application of an intermediate agent is considered essential for composite repair
Hydrophobic vs Hydrophilic ?
The contact time between the intermediate agent and the substrate is important for interpenetration of monomer
Staxrud & Dahl Euro J Oal 2011
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2 weeks post-op
Veneering PFM with composite resin
Sanded and etched
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Cleaned and primed
Restore with the composite of your choice
Stop removing,
consider repairing
Cracked Coreless veneers:! Firing a divest veneer
may result in total deformation or loss of marginal adaptation
#
Porcelain is polished with Dialite Composite is polished with Jeffy
Cracked Ceramic Restorations:
Fix or Remake?
Cracked Coreless veneers:!
Cracked Coreless veneers:!
Low temp glaze produces mixed results in fusing cracked veneers
Low temp glaze produces mixed results in fusing cracked veneers
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Examine the fused crack before bonding
Cracked Coreless veneers:!
Reinvesting and firing to a high temp under vacuum provides predictable results
A cracked veneer covered with low fusing glaze,is unlikely to be fully fused
Thank you
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