After placement and occlusal adjustment of the restorative material, the operator
should place a layer of sealant on the finished surface to fill any micro-cracks within
the surface of the resin, followed by curing the resin to ensure maximal
polymerization.
Key Point
Composite resin restorations are extremely technique sensitive. They should only be
placed when isolation is guaranteed.
Before making decisions concerning the most appropriate restorative material in the
treatment of children, the clinician should consider:
- Moisture exclusion. Is it realistic for this patient?
- Patient compliance. Will the patient sit still through the restoration?
- The size of the cavity. Lesion extent determines operative duration.
- Patient compliance after the procedure. Will he or she return for monitoring and
review?
As long as the clinician allows due consideration in relation to these provisos
concerning use of the material, it will be appropriate to employ it restoratively, since
its inherent properties make it an excellent choice in the treatment of children for
occlusal cavities. As long as the responses to questions 1, 2, and 4 are affirmative and
the restoration is relatively small, the composite can be used with confidence.
The advent of dentine bonding systems has enabled clinicians to achieve bonding of
materials, to the dentine as well as to the enamel, thereby improving the strength of
the restoration. Dentine bonding is very technique sensitive. Adherence to
manufacturer instructions is axiomatic at all times. Initially the technique consisted of
etching and rinsing followed by application of primer containing a solvent resin
monomer to wet and penetrate the collagen meshwork. Finally the operator applied a
bonding agent, which penetrates into the primed dentine.
One-bottle systems in which the primer and the bonding agent are combined within
one solution are now on the market. When combined, they require a moist surface to
facilitate etching and bonding. With such agents there is some evidence to suggest
that patients may suffer a high incidence of postoperative sensitivity.
There are also a few systems in the market, where the manufacturer has combined
etch, prime, and bond solutions into a single solution. There is little independent
research as yet to support these systems in relation to long-term performance, but
initial results appear to indicate that there is very low postoperative sensitivity. The
potential time-saving advantage would, of course, be welcome if researchers prove in
the future that these systems provide high bond strength between the polymerized
material and the dentine.
Key Point