Operative, 10/18/11

Front 1

What about incipient proximal lesions?

Back 1

Really hard to tell on xrays. Measurement of calcification and decalfication.
-can either be a cavitated hole for smooth surface lesion on its way to DEJ. Can also be diffuse calcification that occurs just below the contact.

If risk is low, treat with prevention (remineralization) - flossing, fluoride, diet.

If lesion is cavitated, there's no reverse. So you must treat this while its still small.

Front 2

Minimally invasive dentistry vs. extension for prevention

Back 2

When you make decision to not reestore, you must have a compliant patient and especially one that follows up in your office.

Front 3

Slot preparation

Back 3

Preferred treatment when there is not pit and fissure caries. Even for amalgam, occurs in coalesced fissure. Goes throuh the marginal ridge instead of doing the occlusal grooves - simply a function of being a minimally invasive dentist.

Front 4

When to not break contact..?

Back 4

If the caries doesn't go near the contact, you don't have to break it. Just remove small lip of unsupported enamel and place posterior composite.

Front 5

Preferred matrix system for Class 2 posteriors?

Back 5

Separator ring. No need to use it when you don't break contact. If its still touching the adjacent tooth, or there's no adajcent tooth, you dont need tooth separation.
-You do need a matrix but no toot separator. Any size tofflemire, make a curl, and slide it through one surface. Place wedge to hold the metal band.

Front 6

When do you stop excavating?
Difference between affected and infected dentin

Back 6

Use infected dentin dye to permanently stain denatured collagen.

Affected dentin can remineralize and reverse. Infected dentin can arrest but cannot reverse = very soft. No minerals, no collagen or denatured collagen, and has various amounts of cariogenic bacteria.
Could arrest given ideal conditions.

Front 7

What is a good source of Ca and Phosphates?

Back 7

Good, healthy pulp. Need a good barrier to prevent leakage, bacteria and outside fluids from getting in. This is one reason to leave affected dentin.

Will not stain with dye because the collagen is healhty. Its almost unrecognizable. Only thing to detect it is to use your explorer and to feel the difference.

Front 8

How will affected dentin etch and seal?

Back 8

Actually double etching it since its already deminerlizing it, you're over etching. Its okay to leave affected dentin, only when you're extremely deep and close to pulp exposure. In all other cases, leave nothing but healthy normal dentin.

Front 9

Will it flex and trigger pain ?

Back 9

Yes, affected dentin causes movement in the fluid tubules and causes pain.

Front 10

Sub-gingival margins?

Back 10

This have the most potential for leakage, especially true for composite.
-Switch to amalgam? Incidence of caries is low. Amalgam (well done) on root surface margin is logical.
-Dont ignore a perio problem.
-Glass ionomer first layer? First thing after you etch prime and seal. Shrinks with very little stress. Easy to get into tight spaces.
Glass ionomer forms a chemical bond to dentin that is more durable than mechanical bond. Better long term seal for glass ionomer vs. flowable. Can be rechared with fluoride.

Glass ionomer gets confusing, but use the filler material since its the strongest. When its fully set, then place composite.

When you use glass ionomer and composite in the same restoration, never etch before you apply glass ionomer. Glass ionomer needs the minerals to get a chemical bond.
-Customized matrices - most of them do make extended flaps that go gingival.
-Prevention, prevention!

Front 11

What did the older palodent matrices have?

Back 11

Has a transparent layer that allows you to cure the composite, on the gingival first. But the plastic was too thick, and hard to establish a contact point.
-Use light tip to try to push down and establish contact.

Front 12

The key difference between sectional matrices and rings and those that were older?

Back 12

Predictability! It is possible to get a contact with a tofflemire band but not all the time. Best chance is using sectional matrix.

Bad - can't use it between premolar and canine. Or when proximal is very wide. this caves in.

Front 13

If proximal is wide?

Back 13

Use full size wedge and stretch the ring so that the ends are engaging the ends of the wedge. Don't need to cut off the top part of the wedge.

Front 14

Clone of Palodent?

Back 14

Garrison system. has a small nail head or flange at the end of the ring. Comes in a few different lengths.
Has its own prongs to engage the ring.

Front 15

Triodent's V ring?

Back 15

Came up with a wave wedge that is skinner in the middle and wider at the ends. Good seal on both sides.
-easier to slide in rather than the palodent system. Easier to place than less possibility of getting a wrinkled band.
-Has holes to place it and remove it.
-V shaped is 3 dimensionally contoured so it adapts.
1. makes it easier to prevent pop off
2. nicely adapts to buccal and lingual better than a single tine
3. allows you to play with wedge after ring is in place.

V3 ring - newest one.
ring is smaller, adapts very well to buccal and lingual and never pops off. significant price difference.

Front 16

Garrison's 3d ring

Back 16

very similar to triodent ring. maintains openness.