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Description
Restorations in this category will often represent replacement dentistry based upon the GV Black cavity designs. Amalgam is still a useful material particularly as the cavity gets larger in molar teeth where aesthetics is of less significance. If composite resin is to be used for aesthetic reasons then pay attention to the occlusal load and the ability to restore occlusal function.
Also the lamination technique (Ref #4, Chapt. 11, P193) is the best way to minimise microleakage.
Amalgam
Having overcome the disease the cavity design can be limited in extent but the normal retention designs will still be required.
Composite resin Lab
The series is included to offer a deeper understanding of the lamination technique.
Composite resin clinical
This series demonstrates the possible longevity of the technique in the absence of disease.
Composite Resin Anterior
This series suggests that glass-ionomer can be used successfully alone for anterior restorations although lamination is always available.”
Click on an image to view full size.
AMALGAM
Click on the image to see a larger version A bitewing radiograph taken many years ago showing a lesion at the distal of the upper molar. At that time there was no alternative so a standard GV Black Class II cavity was prescribed to be restored with amalgam.
Click on the image to see a larger version The completed cavity that would now be classed as a Site 2, Size 2. Note the limited extension to both buccal and lingual because it was assumed at that time that the disease had been controlled.
Click on the image to see a larger version The completed amalgam restoration photographed 12 years later. Although not aesthetic it has been effective and remains in place still.
COMPOSITE RESIN - LABORATORY
This is the first of a laboratory series showing the stages in placement of a laminated composite resin in a Site 2, Size 2 lesion replacing an old failed amalgam. The cavity has just been completed and is being conditioned with 10% polyacrylic acid for 10 seconds.
A resin modified glass-ionomer is being syringed to place. This was the choice for a base because of the aesthetic demands of the restoration. A short length of mylar strip has been lightly wedged into place to act as a matrix.
Following light activation of the glass-ionomer the cavity has been prepared again this time for a composite resin. Note that the GIC still covers the floor of the proximal box.
The enamel margin is being etched with 37 % orthophosphoric acid for 15 seconds only. Note that there is no need to etch the glass-ionomer because it is resin modified although it does not matter if it is etched. It will do no harm.
A small section of mylar strip has been contoured, placed as a matrix and wedged firmly to place to create some separation between the teeth to assist in obtaining a good contact.
The completed composite resin restoration.
A view of the proximal surface of the restored tooth showing that the glass-ionomer remains exposed at the floor of the proximal box. This will ensure an ion exchange with the GIC as well as a sound margin with the dentine free of micro-leakage.
The tooth has been sectioned to show the relationship between the glass-ionomer, the tooth structure and the composite resin.
COMPOSITE RESIN – CLINICAL
A clinical case showing replacement dentistry on both the lower first molar and the second bicuspid. The old MOD amalgam in the bicuspid had broken down and there was a small Site 2 lesion on the mesial of the molar as well as a Site 1.2 amalgam on the occlusal. All old restorations were removed and the mesial lesion on the molar was opened very conservatively.
Both lesions have now been restored with a resin modified glass-ionomer which was fully light activated and then re-prepared to make room for the composite resin laminate.
The molar has now been restored and the bicuspid is being etched in preparation for the incremental build-up of the composite resin.
The restorations are complete in both teeth and there has been some attempt at simulation of the fissures on the bicuspid. This is temporary artistry at best.
A bitewing radiograph taken 8 years after placement of the restorations. Note that there appears to be no loss of glass-ionomer interproximally but this is not surprising in a patient where the disease is under control. Note that, in view of the limited occlusal load on the molar, there is a very limited amount of composite resin laminated over the GIC.
COMPOSITE RESIN –ANTERIOR
As is often the case this is replacement dentistry. An old composite resin restoration has changed colour and shows minor marginal leakage so it will be replaced.
The same restoration viewed from the labial. Note the poor aesthetics and need for replacement.
The old restoration has been removed and the extent of the lesion revealed. The cavity is now being conditioned with 10% polyacrylic acid for 10 seconds before being washed and dried lightly.
The lesion has been restored with a Type II.1 restorative aesthetic glass-ionomer that had to be sealed immediately it was set with a resin bond to maintain the water balance for the first few hours.
The completed restoration photographed several days later when the patient returned for a routine polishing appointment. Note the satisfactory aesthetic result using only a glass-ionomer.

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Copyright © 2003 Graham J Mount