Dental Tribune United Kingdom Edition

R4Practice Management Software GIVES YOU MORE For more information or to place an order please call 0800 169 9692 or visit www.carestreamdental.co.uk Carestream Dental © Carestream Dental Ltd., 2011. FeatuReS oF R4 R4 Mobile Direct link to PIN pad Patient Check-in Kiosk Care Pathways Communicator e-forms Patient Journey On-line Appointment Booking Text Message and Email reminders Clinical Notes Appointment Book Digital X-Ray Managed Service Practice Accounts Complete freedom from the burdens of I.T. system management Carestream Dental Managed Service is the simple and convenient on-line alternative to installing, running and managing software on your own computers. Using R4 through the Managed Service you’ll never have to install new software or updates, never have to remember to back up, never spend hours over the weekend working out how to get your software back up and running if it crashes, never suffer from a malicious virus attack and never have to buy the most up-to-date computers just so that you can operate the latest software. Simply log onto the web and use the system secure in the knowledge that Carestream Dental are managing everything for you. If you’re already using R4 or thinking of changing to it, don’t forget this software does a whole lot more than simply record your patient’s details. MANAGED SERVICE February 7-13, 201124 United Kingdom EditionClinical C omposite and ceramic tooth-like restorations are without doubt favoured by most patients. These restorations are also, increasingly, the choice of the clinician and a significant number of practices have now become amalgam-free. Posterior composite restorations offer a number of advantages over amal- gam, such as excellent aesthetics, minimal preparation of tooth tis- sue, and the potential reinforce- ment of tooth tissue. Amalgam has served the den- tal profession well for more than a century and is a fairly forgiving material in terms of placement and shaping. Composite on the other hand presents a number of difficulties in isolation, dentine bonding and material placement. In particular, when restoring in- terproximal lesions, technique and operator ability become of the utmost importance. Otherwise, numerous complications may re- sult. These include post-operative sensitivity, premature failure of the restoration due to microleak- age and recurrent caries. Of par- ticular difficultly are the produc- tion of good contact areas/points and the reproduction of good in- terproximal form. Clinical case to illustrate key aspects required for success (Fig- ures 1-6). When providing a poste- rior composite, there are several phases. At each phase, things can and do go wrong and each phase requires attention to detail. Of particular importance are: 1. Isolation 2. Tooth preparation 3. Bonding protocol 4. Matrix application 1. Isolation Whilst rubber dam use is taught and practiced routinely at dental school, many dentists quickly fall into a habit of only using such iso- lation for endodontic treatment. Lack of familiarity with rubber dam can lead to reluctance to use it for posterior composites. However, the reluctant clinician should practice the use of a “one- shot” technique where the barrier is stretched over the frame and a winged clamp is used. This tech- nique can be very fast and simple, often taking less than a minute to isolate one or two teeth and a couple of minutes for a quadrant. The advantages of rubber dam use outweigh the negatives of blood and saliva contamination which ruin bonding. The use of rubber dam should be practiced for the vast majority of cases. 2. Tooth preparation Tooth preparation should be limited to access and removal of any failed restoration and caries. The cavity preparation should be rounded in form with no sharp internal angles so as to prevent potential stress concentration and to make it easier to adapt the composite material to the cavity. Placement of bevels on the verti- cal walls of the box of a Class II restoration has been shown to improve adaptation and reduce microleakage. Bevels on the oc- clusal surface only seek to dis- guise margins and may have a detrimental effect in terms of thin sections of composite on the bit- ing surface, which may fracture with time. 3. Matrix application The use of conventional “pas- sive” type matrix bands, such as Toffelmire and Siqveland types (which are suited to amalgam restorations), are often found to be inadequate for posterior com- The beauty of modern materials Dr Ian Cline discusses how to achieve clinical success with posterior composites page 26DTà