Alex Chen

Composite Class III preparation & restoration

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Composite Class III Preparation & Restoration

Alex Chen
Dent 430 ePortfolio
Faculty of Dentistry
University of British Columbia

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Composite Class III Preparation critical requirements
Critical Rationale of requirements and supporting
requirement literature
s of this
procedure
90 degrees to 1. This requirement ensures all the unsupported
the enamel is removed since enamel rods orient
cavosurface perpendicular to cavosurface (Schwartz et al., 2006).
2. This is also important for the resistance form of the
composite restoration as it improves structural integrity
to prevent fracture (O’Brien, 2006).
Incisal 1. By preserving some natural contact, it becomes
extension to easier to for the restoration to have a closed contact
the mid- since the contact does not need to be made entirely by
contact composite (Roberson et al., 2006).
2. Just gingival to the contact point is a common
location for caries to occur, hence, we need to extend
our preparation there for caries removal (Schwartz et
al., 2006).
Gingival 1. The disease dictates the outline form of the
extension just preparation. The preparation need to extend just
beyond caries beyond the caries to ensure proper caries removal
(Gardner, 2009).
2. Also extending preparation just beyond caries
preserves the maximum amount of health enamel and
dentin (Schwartz et al., 2006).
Alex Chen
Composite Class III preparation & restoration
New skills accomplished in this excercise, Did my
problems encountered, and breakthrough product meet
moments these
requirement
For me, the key to meeting this requirement is Yes
to always make sure the bur is 90o to surface
before drilling. I ensure this by checking the
bur angulation is 90o in my mirror both mesial-
distally and facial-lingually before starting.
To meet this requirement, I would mark the Yes
end-points of the preparation on the tooth with
pencil before I start. This way, my preparation
would always have the correct extension. As
my skills improve, I can now match my actual
preparation to my pre-operatory drawing
without any visual aids.
I made sure my preparation is as conservative Yes
as possible by taking off carious tooth structure
in small increments.
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 Alex Chen
Composite Class III preparation & restoration
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Does not Extending the preparation past the marginal ridge This is the hardest requirement to meet for me, Yes
cross the significantly weakens the tooth structure (Qualtrough especially on the lateral incisors where the
marginal et al., 2005). marginal ridges are so thin. The width of the
ridge marginal ridge is sometimes smaller than the
diameter of my bur. My breakthrough moment
came when I realized I should start the
preparation gingivally where there’s more
space from the adjacent tooth. Also, I should
start with a portion of the bur in the gingival
embrasure space for the teeth that have
marginal ridges with width equal to or smaller
than the diameter of my bur.
Axial lingual 1. The parallelism contributes to resistance form of the I achieved this by frequently checking my No
wall parallel restoration by minimizing the displacement forces preparation lingually in my hand-mirror.
to the under functional stress (Roberson et al. 2006). Finally, the parallelism can be made even more
proximal accurate by hand-instrumenting.
cavosurface 2. The parallelism ensures the preparation has even
distance to the pulp, and hence decrease the chance of
pulp exposure (Robertson et al., 2006).
Incisal and The parallelism contributes to resistance form by Same as above. Yes
gingival minimizing displacement forces (Schwartz et al. 2006).
floors are
parallel
Rounded 1. A rounded internal form eliminates any stress points This requirement is achieved by modifying the Yes
internal form for the restoration, which may fracture under stress preparation with hand-instruments as the final
(Feilzer et al., 1998). step.

2. A sharp internal form may be hard for composite to

flow in and fill all spaces, and a void may result
(Schwartz et al. 2006).

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Composite Class III preparation & restoration
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Composite Class III Preparation pictures

90 degrees to cavosurface. Rounded internal form Does not cross the Incisal and
Incisal extension to mid- marginal ridge gingival floors are
Axial lingual wall parallel contact. parallel
to the proximal
cavosurface (requirement
not met)

Composite Class III Preparation discussion

In achieving this break-throughs, how will this help you in defining yourself as a dentist?

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 Alex Chen
Composite Class III preparation & restoration
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While learning about the class III preparations, we were asked if we should bevel the proximal cavosurface similar to a class II
preparation. I looked at literatures for this and found papers supporting both methods. It seems beveling was supported in older sources
and teachings while the standard now is not to bevel. I think not beveling makes a lot of sense because due to extension into buccal
enamel, the class III preparation exposes much more enamel surface areas than class II. Exposing a little bit more enamel rods with
beveling in class III preparation will not significantly improve retention, but it will create an area of thin resin that’s susceptible to
fracturing. Realizing this was my biggest breakthrough in class III preparation.

In achieving this break-through, I find that there are many ways of accomplishing a task. As dentists, we should not blindly follow a
single method we were taught as we need to be able to justify everything we do. With advances in research, I have no doubt that a lot of
things we learned in dental school will be out-dated by the time we retire. The beveling of class III preparation is a good example of this.
It would therefore be very important for dentists to be open to changes and not practice the same way throughout his or her career.

Composite Class III Restoration critical requirements

Critical Purpose of critical requirements and supporting New skills accomplished in this excercise, Did my
requirements literature problems encountered, and breakthrough product
of this moments meet

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 Alex Chen
Composite Class III preparation & restoration
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procedure requirement
Properly cured The degree of polymerization of the composite I achieve this by adding the composite in small Yes
- hard to the monomers is related to its mechanical properties. A increments, which ensures that each layer
touch compromised composite due to lack of curing results would be properly cured.
in a less polymerized and weaker restoration that
would likely fracture under minimal force (Sakaguchi
et al., 1992).

Buccal and Does not apply to this restoration Does not apply to this restoration N/A
Lingual Cusps
in proper
alignment

Homogeneous The restoration needs to match the color of natural
and teeth to give the patient a pleasing look and improve
translucent patient satisfaction. Esthetics also has great impact on
esthetic a person’s self-esteem and self-image. This is the
appearance main reason why composite the most commonly used
for the anterior teeth where esthetics is important
(Okuda, 2005).
After finishing the restoration, I would polish Yes
the surface with enhance kit. My breakthrough
is to run the enhance kit at very low speeds
(usually 20-30% power). This makes the
surface homogeneous and smooth while not
flattening the surface at the same time.

Smooth, no 1. Scratches on restoration may feel unpleasant to the I achieved this by slightly overfilling my Yes
visible patient. preparation and contouring it with composite
scratches finishing burs. Finally, I would polish it as
2. It also provides a place for bacteria accumulation described above.
and growth. (Roberson et al., 2006).

3. Lastly, scratches may act as centers for corrosion

(Akerboom et al., 2006).

Original 1. Improper contouring in the form of overhangs leads My breakthrough in achieving this requirement Yes
Contour is to increased chance of plaque accumulation and may is learning to adapt the correctly shaped

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 Alex Chen
Composite Class III preparation & restoration
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restored lead to recurrent caries or periodontal diseases. finishing bur to the surface to be contoured. No
(Thomas et al., 2007) one bur will work on all surfaces. For example,
I would use the football bur on lingual surfaces
2. Proper contouring gives the restoration an esthetic of anterior teeth because it follows the natural
appearance. (Okuda, 2005) concavity of the lingual fossa.

No iatrogenic 1. Unnecessary removal of sound tooth structure
flaws should always be avoided (Gardner, 2009).
2. Iatrogenic flaws increase chances of caries
developing (Qvist et al., 1991).
This is the most difficult requirement for me. Yes
Trying to avoid the adjacent tooth may make
me remove too much of the marginal ridge.
Meeting this criteria requires a very steady
hand and stable fulcrum so I can comfortably
get as close as possible to the adjacent tooth
without accidentally cutting it with my bur.

Positive 1. Prevent food impaction. My breakthrough for this requirement is to fill Yes
contact the composite in small increments and not
2. Maintaining health of interproximal soft tissue pulling the matrix too tight while curing the
(Roberson et al., 2006). composite. By not pulling the matrix too tight,
there would be more composite bulk
3. Prevent tooth migration (Mamoun and Ahmed, interproximally to close the contact. The
2006). negative side of holding the matrix loosely is
composite may not adapt to the contour of the
tooth. This problem is avoid by loading the
composite in very small increments so that
there’s only minimal flash and contour
irregularites that can be easily fixed with
finishing burs and proximal strips.

Note that this is a requirement that would lead

to an automatic re-do if not met. I completely
agree with this. I have an open-contact
restoration in my own mouth and it bothers me

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 Alex Chen
Composite Class III preparation & restoration
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greatly having to floss out food debris every

time I eat.
No marginal Same as above, marginal voids or overhangs My breakthrough is realizing my marginal Yes
voids accumulates food debris and plaque. This may lead to voids are the result of loading the composite in
recurrent caries. Depending on location, marginal void increments that are too large. I tend to do this
could also make the restoration susceptible to fracture. when I’m rushed to finish a restoration in
(Gardner, 2009) limited time. However, the plan often backfires
since it is harder to flow the larger composite
increment to fill all voids and I would end up
with marginal voids that takes a long time to
fix.

Another breakthrough moment I had is

realizing a dirty composite PPI can also cause
marginal voids because the composite would
stick to the PPI and be pulled away from the
preparation when I withdraw the PPI before
curing. So now, I virtually eliminated any
marginal voids by loading my composite in
small increments and making sure my
composite PPI is always clean.

Composite Class III Preparation pictures

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 Alex Chen
Composite Class III preparation & restoration
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Positive contact Homogeneous and Smooth, no visible No marginal voids Original Contour is
translucent esthetic scratches restored
appearance
No iatrogenic flaws

Composite Class III Restoration discussion

In achieving this break-through, how will this help you in defining yourself as a dentist?

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 Alex Chen
Composite Class III preparation & restoration
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My biggest problem with class III restoration is closing the contact. My breakthrough was realizing that the contact can be closed by
not holding the matrix band too tight. This would close the contact but it also lead to excess resin in the interproximal area. The key in
solving this is to load the composite in small increments so that the last increment only leaves minimal composite that’s very easy to clean
off.

With this break-through, I find it is very important for dentists to be patient. For example, cutting corners by loading composite in
large chunks would leave too much excess composite at the interproximal area which will take huge effort and time to clean up. Hence,
being patient and not taking short-cuts will not only produce higher quality work, it will save the dentist time as well.

References:
Feilzer, J., DeGee, J., Davidson, L. (1998). Setting stress in composite resin in relation to configuration of the restoration. Journal of
Dental Research, 66(11): 1636-1639.

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 Alex Chen
Composite Class III preparation & restoration
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Gardner, K. (2009). Dent 430 Operative Dentistry 2009–2010 Module Manual. Vancouver: UBC.

Gardner, K., Class III Composite Preparation and Restoration PowerPoint. Vancouver BC. Retrieved October 26, 2009, from
https://www.vista.ubc.ca/webct/urw/lc5116011.tp0/cobaltMainFrame.dowebct

Mamoun, J., Ahmed, M. (2006). Matrix for Class III and Class V preparations connected at the proximal box. Journal of
American Dental Association, 137(2): 186-189

O’Brien, W. J. (2002). Dental materials and their selection. Chicago, Illinois: Quintessence Publishing Co.

Okuda, W. (2005). Achieving optimal aesthetics for direct and indirect restorations with microhybrid composite resins. Journal of
Practical Procedures & Aesthetic Dentistry,17(3): 177-184.

Qualtrough, A., Satterthwaite, J., Morrow, L. (2005). Principles of operative dentistry. Ames, Iowa: Blackwell Pub.

Qvist, V., Johanessen, L., & Bruun, M. (1991). Progression of approximal caries in relation to iatragenic preparation damage. Journal
of Dental Research, 71(3): 1370-1373.

Roberson, T., Heymann, O., Swift, J. (2006). Studevant’s Art and Science of Operative Dentistry. St. Louis, Missouri: Mosby
Pub.

Sakaguchi, R., Peters, C., Nelson, R., Douglas, H., Poort, W. (1992). Effects of polymerization contraction in composite restorations.
Journal of Dentistry, 20(3): 178-182.
Schwartz, R., Summitt, J., Robbins, W. (2006) Fundamentals of operative dentistry : a contemporary approach (3rd ed.) Chicago :
Quintessence Pub.

Thomas, R., Ruben, J., Ten-Bosch, J., Fidler, V., Huysmans, M. (2007). Approximal Secondary Caries Lesion Progression. Journal of
Caries Research, 41(5): 399-405.

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