Oclusion

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A NONMECHANICAL ETIOLOGY:
THE ADHESIVE DESIGN CONCEPT
TERRY

Douglas A. Terry, DDS*
Karl F. Leinfelder, DDS, MS†
Alejandro James, DDS, FID‡

JULY

18
6

Advances in restorative material formulations and adhesive technology have
expanded and created new treatment possibilities for dental practitioners. Due to
this evolution, composite resinsare being used with increasing frequency in posterior restorations. In order to successfully place these restorations, the clinician
must understand the rationale for restorative material selection, preparation design,
adhesive protocol, and composite resin placement. This article illustrates these
considerations for placing a Class I posterior composite restoration.

Learning Objectives:
Thisarticle discusses a conservative design that is appropriate for the utilization
of modern microhybrid resins. Upon reading this article, the reader should:
• Have a thorough understanding of modern adhesive procedures to achieve
long-term success with composite resin restorations.
• Identify the factors that influence polymerization shrinkage, the effects of
shrinkage stress, and methods to overcomethese limitations.

Key Words: adhesive, composite resin, preparation, microhybrid
* Private practice, Houston, TX.
†Adjunct Professor, Biomaterials Clinical Research, University of North Carolina, Chapel Hill,
NC; Professor Emeritus, University of Alabama School of Dentistry, Birmingham, AL.
‡Private practice, Leon, Guanajuato, Mexico.
Douglas A. Terry, DDS, 12050 Beamer Road, Houston, TX 77089Tel: 281-481-3470 • E-mail: dterry@dentalinstitute.com

Pract Proced Aesthet Dent 2006;18(6):385-391

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Practical Procedures & AESTHETIC DENTISTRY

I

n recent years, there have been dramatic changes in
clinicians’ understanding and control of the caries
process, with a reduction in the incidence and severity
of caries and in the means ofdetecting decay with chemical agents. This has led the authors to reconsider traditional restorative principles, many of which have become
dated. Extension for prevention has yielded to an adhesive preparation design, a more conservative approach
to tooth preparation.1,2 Traditional methods for discerning decay from stained tooth structures have been supplemented with innovations such ascaries-detecting
agents, improved illumination, and optical aids, which
are used to enhance the clinician’s diagnostic skills.3
Unfortunately, many clinicians continue to perform
outdated procedures with modern restorative materials,
and then wonder why they continue to have microleakage, recurrent decay, and sensitivity. The effect of this
misdirection could be one of the reasons for the relatively
shortclinical service of composite restorations in the general dental practice.1 Advances in material science and
adhesive technology require the clinician to modify his
or her nonadhesive restorative techniques when placing
adhesive restorations. This is particularly true when one
is considering diagnosis, material selection, preparation
design, restorative placement techniques, pulp protection,finishing, and maintenance.2 The adhesive design
concept requires the selection of adhesive, bioactive
restorative materials, simplified modifications of preparation designs, and precise placement procedures and
techniques. This design concept has been instrumental
in the paradigm shift from the principles of extension for
prevention to prevention to eliminate extension.

Restorative MaterialSelection
When selecting a restorative composite resin, the average filler particle size, filler loading, and particle size
distribution provide information about the most appropriate use of the composite resins. In the past, the dilemma
in choosing either the hybrid or the microfill composite
resin often required the use of a combination of both to
achieve a restorative result with optimal physical and...