CLINICAL TECHNIQUE FOR

CLASS V COMPOSITE
RESTORATIONS

The clinical indications for using composite

for restoring Class V areas relate to all the
benefits of the bonded composite
restorations.

However, because isolation of the operating

site may be more appropriate for composite
use than nonesthetic areas .

INITIAL CLINICAL
PROCEDURES

Anesthesia is usually necessary when

restoring a Class V lesion.

Before the tooth preparation is initiated,

select the shade of the composite
material, as previously discussed, and
then isolated the operating area.

During shade selection remember that the

tooth is darker in the cervical third.

TOOTH PREPARATION

Class V tooth preparations, by definition,

are located in the gingival one third of the
facial and lingual tooth surfaces.

Because of esthetic consideration,

composite materials most frequently are
used for the restoration of Class V lesions
in anterior teeth.

Numerous factors must be taken into

consideration in material selection, including
esthetic, caries activity, access to the lesion,
moisture control, and patient age.

Because most of these restorative needs

will involve root surfaces, careful
consideration should be given to the
restorative material to be used.

Conventional Class V
Tooth Preparation

The conventional Class V tooth preparation

for composite is indicated for the portion of a
carious lesion or defect entirely or partially on
the facial or lingual root surface of a tooth.

The preparation form would be similar to

that described in (Class V amalgam).

The features of the preparation include a

90 degree cavosurface angle; uniform
depth of the axial line angles; and,
sometimes, grooves form.

A tapered fissure carbide bur (No. 700,

701, or 271) or similarly shaped diamond
is used at high speed with air - water spray.

If access interproximally or gingivally is

limited, a No. 1 or No. 2 round bur or
diamond may be used to prepare the
tooth.

When a tapered fissure bur or diamond is

used, make entry at a 45-degree angle to
the tooth surface by tilting the handpiece
distally.

At this initial tooth preparation stages, the

extensions in every direction are to sound
tooth structure, except the axial depth
should only be 0.75mm.

The 0.75 mm axial wall depth will provide

adequate external wall width for:

(1) strength of preparation wall;

(2) strength of the composite; and
(3) placement of a retention groove,
if necessary.

The outline form extension of the mesial,

distal, occlusal (incisal), and gingival
walls is dictated by the extent of the
caries, defect, or old restorative material
indicated for replacement (sometimes the
new material will abut a still satisfactory,
old restoration).

All of the external preparation walls of a

Class V conventional tooth preparation
are visible when viewed from facial
position (outwardly divergent walls).

Final tooth preparation for the conventional

preparation consists of the following steps:

(1) removing remaining infected dentin

or old restorative material (if indicated) on
the axial wall.

(2) applying a calcium hydroxide liner,

only if necessary.

(3) sometimes preparing groove retention

form.

If retention grooves are necessary, they are

prepared with a No. 1/4 bur along the full
length of the gingivoaxial and incisoaxial
(occlusoaxial) line angles.

These grooves are prepared 0.25 mm in

depth into the external walls and next to
the axial wall at an angle that bisects the
junction between the axial wall and the
gingival or occlusal (or incisal) wall.

This should leave, between the groove and

the margin, sufficient remaining wall
dimension (0.25 mm) to prevent fracture .

It is helpful while preparing the grooves to

observe that this remaining wall dimension is
equal to half the diameter of the bur head
(which is 0.5) .

Clean the preparation, if indicated, and

inspect for final approval.

Beveled Conventional Class V

Tooth Preparation

The beveled conventional Class V tooth

preparation has beveled enamel margins and is
indicated either for:

(1) the replacement of an existing,

defective Class V restoration that initially
used a conventional preparation or

(2) for large, new carious lesion.

The advantages of the beveled conventional

tooth preparation as compared to the
conventional tooth preparation are:

(1) increased retention due to the greater

surface area of etched enamel afforded by
the bevel.

(2) decreased microleakage due to the

enhanced bond between the composite and
the tooth.

(3) decreased need for groove retention

form (and consequently less removal of
tooth structure).

Complete the following steps of final

tooth preparation:

(1) remove any remaining infected dentin,

and, if indicated, remove any old
restorative material.

(2) apply a calcium hydroxide liner, but

only if necessary.

(3) usually prepare the gingival margin

retention groove if either the gingival
margin is located on the root surface or
the preparation is large to warrant groove
retention form.

(4) bevel the enamel margins. The bevel on

the enamel margin is accomplished with a
flame-shaped or round diamond instrument,
resulting in an angle approximately 45
degrees to the external tooth surface and
prepared to width of 0.25 to 0.5 mm.

When a large Class V carious lesion or

faulty restoration extends onto the root
surface, the gingival wall is prepared in the
same manner as a conventional Class V.

The depth of the initial preparation

on the root surface should be only 0.75 mm.
Only the enamel cavosurface margins are
beveled.

Modified Class V Tooth

Preparation

The modified Class V tooth preparation is

indicated for the restoration of small and
moderate Class V lesions or defects.

The objective is to restore the lesion or defect as

conservatively as possible. There is no effort to
prepare the walls as butt joints, and usually no
groove retention is incorporated. The lesion or
defect is "scooped" out, resulting in a preparation
form that may have a divergent wall configuration
and an axial surface that usually is not uniform in
depth.

RESTORATIVE TECHNIQUE

No matrix is needed for restoring

preparations for which the contour can be
controlled as the composite restorative
material is being inserted, such as in the
Class V restoration.

This is especially true when using a Light cured material that has an extended working
time which permits the operator to initiate
contouring of the restoration in
unpolymerized state.

Etching, Priming, and Placing

Adhesive

The etching, and priming, and placement of

adhesive techniques are the same as
previously described.

Inserting and Curing the

Composite

A self-cured or light-cured composite can be

inserted with a hand instrument or syringe.

A light-cured material is recommended for

most Class V preparations because of the
extended working time and control of contour
before polymerization.

Following etching and priming steps for

enamel and dentin (per manufacturers
instructions), place a thin layer of bonding
adhesive and cure.

Then insert the composite incrementally

with a hand instrument or syringe.

Fill deep preparations having retentive

undercuts in at least two increments.

First, insert a small amount of material in

retentive undercuts and cure.

Second, fill the outer portion of the

preparation and shape the material as
close to the final contour as possible.

An explorer or blade of a composite

instrument is useful in removing excess
material from the cervical margin and
obtaining the final contour.

Then apply light source for polymerization.

The restoration should require very little

finishing.

Contouring, and Polishing

the Composite

A flame-shaped carbide finishing bur or

polishing diamond is recommended for
removing excess composite on the facial
surface of a Class V composite .

Use medium speed with light intermittent

brush strokes and an air coolant for
contouring.

Final finishing and polishing are achieved

with a rubber polishing point or cup and,
sometimes, an aluminum oxide polishing
paste.