L8 Class Ii Amalgams 2015Pt1

Front 1

What is a Class II?
• Class II decay is defined as a cavity involving the ____ surface(s) of a ____ tooth. Historically, these restorations have been prepared to include the ____ and ____ surface(s) due to rules of extension for prevention.

Back 1

What is a Class II?
• Class II decay is defined as a cavity involving the interproximal surface(s) of a posterior tooth. Historically, these restorations have been prepared to include the occlusal and proximal surface(s) due to rules of extension for prevention.

Front 2

Class II: Pathogenesis
• Class I’s and II’s share the same pathogenesis.
– Bacteria + Shelter + Food
– Acid Production
– More Demineralization than Remineralization
– Involvement of Decay to the ___
– ____ of the Process.
• Primarily responsible organisms:
– superficially _____ ________ Group.
– deeper areas, _____.
• Due to differences in ____ and ____ Preference.

Back 2

Class II: Pathogenesis
• Class I’s and II’s share the same pathogenesis.
– Bacteria + Shelter + Food
– Acid Production
– More Demineralization than Remineralization
– Involvement of Decay to the DEJ
– Irreversibility of the Process.
• Primarily responsible organisms:
– superficially Mutans Streptococci Group.
– deeper areas, Lactobacilli.
• Due to differences in Environment and Bacterial Preference.

Front 3

Class II: Defense and Prevention
•Patient Homecare. Nothing will beat ___ and using an ADA accepted toothpaste with a suitable concentration of ___.
•Adjunctively, fluoride rinses, prescribed trays with gels, etc. can be helpful.
•Decreased refined sugar intake
•Alteration of Oral Microflora.

Back 3

Class II: Defense and Prevention
•Patient Homecare. Nothing will beat flossing and using an ADA accepted toothpaste with a suitable concentration of fluoride.
•Adjunctively, fluoride rinses, prescribed trays with gels, etc. can be helpful.
•Decreased refined sugar intake
•Alteration of Oral Microflora.

Front 4

Class II: Patient Symptomology
• Patient’s with Class II Decay may report a combination of any, all, or some of the following:
– No change, no reported problems.
– Sensitivity to cold and/or sweet items.
– Problem during _____
• Floss Shreds in specific areas
• Different Sensations with Flossing specific areas.
– Altered sensation upon ___/______.

Back 4

Class II: Patient Symptomology
• Patient’s with Class II Decay may report a combination of any, all, or some of the following:
– No change, no reported problems.
– Sensitivity to cold and/or sweet items.
– Problem during flossing
• Floss Shreds in specific areas
• Different Sensations with Flossing specific areas.
– Altered sensation upon biting/percussion.

Front 5

Class II: Diagnosis
•Clinical Findings:
–Tactile Observations:
•Soft tooth structure under the ____ area
•Flossing Abnormality.
–Visual Observations:
•______ interproximally
•Dentin _____ indicative of decay through _____ or _____.
•Radiographic Findings:
–Definite change in radiographic _____ at the area located just underneath the contact with ____ or ____ shape.
–_______ involvement adjacent to the affected enamel areas

Back 5

Class II: Diagnosis
•Clinical Findings:
–Tactile Observations:
•Soft tooth structure under the contact area
•Flossing Abnormality.
–Visual Observations:
•Decalcification interproximally
•Dentin shadowing indicative of decay through occlusal or interproximally.
•Radiographic Findings:
–Definite change in radiographic density at the area located just underneath the contact with triangular or trapezoidal shape.
–Dentinal involvement adjacent to the affected enamel areas

Front 6

Class II: Definitive Diagnosis
•Definitive diagnosis of Class II Decay can be made from the combination of patient symptomology, clinical findings, and radiographic findings.
•Remember that you shouldn’t rely too heavily on symptomology. Both clinical and radiographic findings are more reliable.

Back 6

Class II: Definitive Diagnosis
•Definitive diagnosis of Class II Decay can be made from the combination of patient symptomology, clinical findings, and radiographic findings.
•Remember that you shouldn’t rely too heavily on symptomology. Both clinical and radiographic findings are more reliable.

Front 7

Class II Visual Examination
• Distal Decay may appear as:
- Decalcification: “Chalky” White
* and/or *
- Caries: ____ stain seen at the ___ from the _____ or through decalcification on the ___ View

Back 7

Class II Visual Examination
•Distal Decay may appear as:
- Decalcification: “Chalky” White
* and/or *
- Caries: brown stain seen at the DEJ from the Occlusal or through decalcification on the Proximal

Front 8

Class II: Treatment
•Class II Decay can be restored in any of the following fashions successfully:
–Direct or Indirect _____
–____ Inlays or Onlays
–____ Inlays or Onlays
–_____
•_____ Was heavily used due to ease of placement, cost effectiveness, long term clinical track record/seal.

Back 8

Class II: Treatment
•Class II Decay can be restored in any of the following fashions successfully:
–Direct or Indirect Composite
–Gold Inlays or Onlays
–Porcelain Inlays or Onlays
–Amalgam
•Amalgam Was heavily used due to ease of placement, cost effectiveness, long term clinical track record/seal.

Front 9

Class II Amalgam Armamentarium
•High Speed Handpiece
•____ and ___ L Burs
•Hand Instruments
–6½-2½-9 / 10-4-8
–Periodontal Probe
–Mirror
–____
–______
–Small ____
•___
•Operative Manual
•Cotton Disposables
•Rubber Dam Supplies
•0.5 mm Lead Pencil

Back 9

Class II Amalgam Armamentarium
•High Speed Handpiece
•256 and 699L Burs
•Hand Instruments
–6½-2½-9 / 10-4-8
–Periodontal Probe
–Mirror
–GMTs
–Hatchet
–Small Condenser
•PPE
•Operative Manual
•Cotton Disposables
•Rubber Dam Supplies
•0.5 mm Lead Pencil

Front 10

Class II Buccal/Lingual View
•Buccal/Lingual View
–Notice
1) Minimal pulpal & axial depth,
2) Tapered enamel portion of the ____ & ____ floors,
3) ____ wall tapers to allow dentin on the proximal wall for retention.

Back 10

Class II Buccal/Lingual View
•Buccal/Lingual View
–Notice
1) Minimal pulpal & axial depth,
2) Tapered enamel portion of the occlusal & gingival floors,
3) axial wall tapers to allow dentin on the proximal wall for retention.

Front 11

Class II Occlusal View
Occlusal View
•___ mm of proximal extension from the adjacent tooth observed evenly from ~ ___ degree angle view past the adjacent tooth.
•Notice the axial wall is easily seen from the occlusal view. Notice the even axial depth into dentin which follows the curvature of the tooth.

Back 11

Class II Occlusal View
Occlusal View
•0.5 mm of proximal extension from the adjacent tooth observed evenly from ~ 45 degree angle view past the adjacent tooth.
•Notice the axial wall is easily seen from the occlusal view. Notice the even axial depth into dentin which follows the curvature of the tooth.

Front 12

Class II Proximal Extension
•The direction of the ___ and ____ proximal walls is determined by the ____ and _____ of the adjacent tooth.
•They should be ____ and have even access from the adjacent tooth.

Back 12

Class II Proximal Extension
•The direction of the buccal and lingual proximal walls is determined by the contour and alignment of the adjacent tooth.
•They should be straight and have even access from the adjacent tooth.

Front 13

Class II Boxform Occlusal-Gingival Shape
-When the teeth are in proper alignment, the ____ wall of the mandibular teeth will follow the contour of the buccal surface of the adjacent tooth, usually meeting the ____ wall forming an ____ angle. Due to the more ____ contour of the _____ axial surface of the mandibular posterior teeth, the ____ wall will usually meet the gingival wall forming a ____ angle.

Back 13

Class II Boxform Occlusal-Gingival Shape
-When the teeth are in proper alignment, the buccal wall of the mandibular teeth will follow the contour of the buccal surface of the adjacent tooth, usually meeting the gingival wall forming an acute angle. Due to the more vertical contour of the lingual axial surface of the mandibular posterior teeth, the lingual wall will usually meet the gingival wall forming a right angle.

Front 14

Class II Proximal Wall Angulation and Length
•The buccal and lingual walls, as they approach the proximal, should be straight for approximately ___mm and meet the proximal surface of the tooth at ___ angles to a ____ at that point on the tooth

Back 14

Class II Proximal Wall Angulation and Length
•The buccal and lingual walls, as they approach the proximal, should be straight for approximately 2mm and meet the proximal surface of the tooth at right angles to a tangent at that point on the tooth

Front 15

Class II to Class I Outline Blending
•They are directed in a ____ line for approximately __mm before gently curving to connect with the class I portion of the occlusal preparation.

Back 15

Class II to Class I Outline Blending
•They are directed in a straight line for approximately 2mm before gently curving to connect with the class I portion of the occlusal preparation.

Front 16

Class II Axial Depth
•The ___ depth of the preparation should be a minimum of __ mm when measured at the ___ wall AND
•The axial wall should be at least ___ mm into ___.

Back 16

Class II Axial Depth
•The axial depth of the preparation should be a minimum of 1mm when measured at the gingival wall AND
•The axial wall should be at least .5mm into dentin.

Front 17

Axial Wall Curvature
•The axial wall should be _____ to follow the ____ surface of the tooth in a ___-____ direction. This is done to maintain a uniform axial wall depth.

Back 17

Axial Wall Curvature
•The axial wall should be curved to follow the external surface of the tooth in a buccal-lingual direction. This is done to maintain a uniform axial wall depth.

Front 18

Axial Wall Taper/Tilt
•The axial wall should be ____ in an ____-____ dimension to maintain the proper axial wall depth into dentin.
•This taper is necessary because the enamel becomes ____ as the axial wall extends occlusally

Back 18

Axial Wall Taper/Tilt
•The axial wall should be tapered in an occlusal-gingival dimension to maintain the proper axial wall depth into dentin.
•This taper is necessary because the enamel becomes thicker as the axial wall extends occlusally

Front 19

Pulpal-Axial Bevel
•The pulpal axial line angle should be beveled to decrease the _____ forces in the amalgam restoration.
•The bevel should be approximately __ mm in width and extend from the buccal to the lingual walls.with an angulation of___ degrees to the pulpal wall

Back 19

Pulpal-Axial Bevel
•The pulpal axial line angle should be beveled to decrease the stress forces in the amalgam restoration.
•The bevel should be approximately .5mm in width and extend from the buccal to the lingual walls.with an angulation of 45 degrees to the pulpal wall

Front 20

Class II to Class I Internal Blending
•The only consideration is that the occlusal line angles should flow harmoniously into the proximal line angels. To achieve this blending of the line angles frequently requires an _____ of the ______ or _____ occlusal wall as it approaches the proximal. The amount of undercut should correspond to the undercut of the _____ wall. The ____ line angles are connected with the proximal line angles to increase the bulk of amalgam internally without over-extending the occlusal outline.

Back 20

Class II to Class I Internal Blending
•The only consideration is that the occlusal line angles should flow harmoniously into the proximal line angels. To achieve this blending of the line angles frequently requires an undercutting of the buccal or lingual occlusal wall as it approaches the proximal. The amount of undercut should correspond to the undercut of the proximal wall. The occlusal line angles are connected with the proximal line angles to increase the bulk of amalgam internally without over-extending the occlusal outline.

Front 21

Proximal Retention Placement
•The proximal retentive features starts slightly occlusal (___-___mm) to the pulpal wall and becomes more accentuated as it goes _____, terminating in an accentuated ___-___-___ point angle
•This design of the retentive feature will provide sufficient bulk of amalgam to prevent fracture without undermining the proximal walls

Back 21

Proximal Retention Placement
•The proximal retentive features starts slightly occlusal (.25-.5mm) to the pulpal wall and becomes more accentuated as it goes gingivally, terminating in an accentuated proximal-axial-gingival point angle
•This design of the retentive feature will provide sufficient bulk of amalgam to prevent fracture without undermining the proximal walls

Front 22

Proximal Retention
•Proximal retention placed at a ___ degree angle to the axial wall creating space for a sufficient bulk of amalgam to be placed into the retention to resist fracture of the amalgam.

Back 22

Proximal Retention
•Proximal retention placed at a 45 degree angle to the axial wall creating space for a sufficient bulk of amalgam to be placed into the retention to resist fracture of the amalgam.

Front 23

Dovetails
•Additional retention is created to prevent proximal displacement by the formation of a ____. The dovetail is any occlusal extension that is min. ___mm wider than the ____. This feature usually occurs automatically when the occlusal outline is developed.
•Dovetails are placed towards the _____ part of the tooth.

Back 23

Dovetails
•Additional retention is created to prevent proximal displacement by the formation of a dovetail. The dovetail is any occlusal extension that is min. 0.5mm wider than the isthmus. This feature usually occurs automatically when the occlusal outline is developed.
•Dovetails are placed towards the bulkiest part of the tooth.

Front 24

Caries Removal
•If the caries or existing restoration extends deeper ____ or ____ than minimal, they are removed as conservatively as possible and based as necessary. The ___ ____ ___ should always be maintained at the minimal depth; don’t move the whole wall!

Back 24

Caries Removal
•If the caries or existing restoration extends deeper pulpally or axially than minimal, they are removed as conservatively as possible and based as necessary. The internal line angles should always be maintained at the minimal depth; don’t move the whole wall!

Front 25

The Class II Amalgam Preparation
•Finish Class __ Form completely.
•Extend to Proximal at minimal pulpal depth.
•Define Proximal Extensions w/ Hatchet
•Drop Box form using __/__ Enamel:_/_ Dentin for __ mm for practice with a ___, or reverse ratio for a ___ bur.
•Define Proximal Walls to satisfy Cavosurface Requirements
•Refine Box form with ___L Bur
•Taper ___ Wall Enamel and Create __-___ Bevel with GMT

Back 25

The Class II Amalgam Preparation
•Finish Class I Form completely.
•Extend to Proximal at minimal pulpal depth.
•Define Proximal Extensions w/ Hatchet
•Drop Box form using 1/3 Enamel:2/3 Dentin for 2 mm for practice with a 256, or reverse ratio for a 701 bur.
•Define Proximal Walls to satisfy Cavosurface Requirements
•Refine Box form with 699L Bur
•Taper Gingival Wall Enamel and Create Axial-Pulpal Bevel with GMT