Class V Composite Restorations

So far I have done about 12 Class V restorations, and a few of them have been more complicated than I expected, so I just wanted to type up a post on this in hopes that it may give someone a heads up on what to expect.

The hardest part about a Class V is if the lesion extends to the gingival margin. Using a rubber dam will probably be difficult with this type of lesion, so ask if its okay to do without a dam.

Anesthesia

 If it is only a couple of Class V's on the mandibular anterior, you can still do infiltration. Faculty have told me to use 4% Septocaine several times now when working on mandibular anteriors, so I figure that's pretty normal. 1 carpule should be plenty. Only give a lingual infiltration if the prep will extend to the lingual. Sometimes, you may not need anesthesia at all. It all depends on the patient and how deep the prep will be.

The Prep

There are two types of Class V lesions that I have encountered so far:

1. Abfraction lesion -  
1. for this type of lesion, there typically isnt any decay. That means that all you should need to do is bevel the enamel on the most incisal portion of the prep. Bevels need to be at least 1-2mm wide to allow the composite to blend in with tooth structure. Use a diamond bur for this.
2. Classic Class V lesions
1. these are the ones that have caries in them. You want to prep these until all of the caries has been removed. 
2. How do you tell when caries is removed? - air dry the prep and then take either a slow speed round bur or the spoon excavator. If the prep is still soft and you can scrape a decent amount of white tooth structure out of it, then decay is still present. This has been the hardest thing for me to visualize.

Packing Cord

It's necessary to pack cord with preps at the gingival margin. It doesn't really matter whether you pack the cord before or after you prep. Faculty have told me both ways, but it may be easier to go ahead and pack cord before you begin prepping.

I typically get 00 cord and dip it in hemodent. We have a bottle for hemodent in our cart, and you take it to supply for them to fill it up.

When Your prep gets close to the pulp

Several times now, my prep has gotten close to the pulp. You can tell you are getting close because the center of the prep will start to become a different color white. I would not prep too much more after noticing this color change. Go get your faculty and see what they say.

Once you are done prepping, faculty will probably want you to use Fuji glass ionomer liner on the prep. We should have this in our kit somewhere. You need the gun and the paste capsule, both of which we already have.

After mixing the Fuji, apply it to the prep and then light cure for 15-20 seconds. Afterwards, you can proceed with etchant, prime, and bond.

Finishing your restoration

I recommend using your finishing burs or the Enhance system. If you have a lot of excess, start with finishing burs and then switch to Enhance. Whether you use finishing burs on slow speed or high speed depends on how comfortable you are with it.

Don't be afraid to take the finishing burs subgingivally. It may damage the gingiva slightly, but it will heal. It's important that you get the composite margins flush with the rest of the tooth.You may want to warn the patient that their gums may be sore later on, and that they can take an Advil if needed.

When using Enhance to finish the buccal surface, use the cup. This allows for better contour. Also, use enhance finishing system on a dry field. Be careful not to leave the cup on the tooth for a long time though, because it will start to overheat the tooth.


Let me know if you have any more questions!
- Joe