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140 Cards in this Set

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Causes/factors of caries
host resistance(teeth), diet(sucrose), time
Caries causing bacteria
Mutans bacillus(initiator), lactobacillus (progression)
Progression of caries
acids from bac plaque demineralization, bac invasion, demin leads to capitation which then leads to root softening.
G.V. Black
considered to be the father of dentistry. came up with the system of classifying caries.
"simple" caries
Involving one surface of the tooth.
"compound" caries
Involving 2 surfaces of the tooth.
"complex" caries
involving 3 or more surfaces of the tooth.
Location of caries on tooth:
O,MO,DO,MOD, F,DL,MID, DF
O-occlusal, MO-mesiooclusal, DO-distalocclusal, MOD- mesio-occlusodistal, F-facial, MID-mesio-incisodistal, DF- distofacial.
Class 1 caries
pit and fissure caries to include posterior occlusal surfaces, facial and lingual surfaces; buccal pits of molars; lingual pits of anterior teeth.
Progression of c1
It will be 2 cones base to base.
Caries management paradigm
Way of classifying lesions by its appropriate care. detectable lesions into dentin and pulp->preventative n operative care. caries limited to enamel, intact surfaces-->preventative care advised.
Caries extension
requires preparation of composite resin or amalgam.
Class 2 caries
smooth surface caries on the proximal surfaces of posterior teeth
C2 progression of caries
2 cones tip to base
Class 3 caries
Class III: smooth surface caries on the proximal surfaces of anterior teeth
Class 4 caries(or defective restoration)
(usually due to traumatic fracture)
lesions on the proximal surface of anterior teeth. that include the incisal edge. Note: Whenever restoring Class IV fractures, occlusal considerations will provide important information regarding tooth preparation before restoration.
Class 5
smooth surface caries on the facial or lingual surfaces of both anterior and posterior teeth at the gingival third; may involve cementum or dentin as well as enamel surfaces. It alaso describes non-carious smooth surface loss of tooth substance lesions on facial and lingual surfaces.
Root surface caries morphology
Carious lesion is a softening of the root surface that progresses following the paths of the dentinal tubules
Noncarious class 5 lesions
Erosion, abfraction, abrasion.
Class 6 caries
lesions are pit or wear defects on the incisal edges of anterior teeth or cusp tips of posterior teeth; lesions can be caries but don’t have to be.
Cutting instruments
Chisels(a)hoes, b)angle forming chisels), hatchets (gingival margin trimmers)
Chisels vs Hatchets
the cutting edge is parallel to the handle in hatchets.
while the cutting edge is perpendicular to the handle in chisels.
Instrument design
3 parts:
-shank(can be: curved, straight, angled->mono,binagled,ternangle)
-handle
-blade(body, cutting edge)
3 number formula on blade
1. First number = width of blade in tenths of mm
2. Second number = length of blade in mm
3. Third number = angle of blade relative to handle in degrees Centigrade
4 number formula on blade
the difference:
1. First number = width of blade in tenths of mm
2. Second number = angle of the cutting edge (in degrees C) relative to the handle when the cutting edge is NOT 90 degrees to the handle
3. length of blade
4.angle of blade realtive to handle.
Noncutting instruments
-mirror
-periodontal probe
-explorer
Historical landmarks (pertaining to rotary instruments)
1846 – Hand drill replaces hand instruments for removal of tooth structure.
1910 – Motorized belt driven handpiece introduced. Still used by lab technicians because of high torque (engine will not stall under a heavy load or resistance).
1945 – Introduction of air abrasive using aluminum oxide driven by carbon dioxide.
1954 – Modern air turbine handpiece introduced.
Low speed
up to 20,000 rpm
High speed
10,000 to 150,000 rpm
Ultra high speed
upto 150,000 rpm
General indication for slow speed
Excavating Decay
Polishing Restorations and/or Teeth
Smoothing and Finishing Preparations
Laboratory procedures for cutting, smoothing and polishing metals and acrylics and other lab materials.
Slow speed rot inst.
has 3 peiece:
-contra angle head (screw,latch, friction grip)
-motor angle
-motor base
High speed rot intrum.
2 pieces:
-straight head ( can have fiberoptics, air/water spray)
-motor base
Bur
a steel or tungsten carbide rotary instrument that customarily has flutes or blades on the head. has 3 parts: head, neck, shaft(friction grip, latch ,handpeice) .
Round burs
Come in six common sizes: # ¼ , ½, 2, 4, 6 and 8.
The small sizes # ¼ and ½ are used for retention in tooth preparation.
Larger round burs are used with the slow speed handpiece for caries excavation
Inverted cone bur
Used for retention and cavity definition
Sizes range from #33 ½ to #39
Used to make smooth pulpal walls, convergent vertical walls and create sharp internal line angles
Short head with broad flat end and narrower at neck
Used in both high and low speed
Straight fissures
Bur comes with both plain and crosscut blades. Crosscuts are little notches perpendicular to the length of the blade designed for cutting efficiency.
Burs are either “plain straight fissure” or “crosscut straight fissure.
The bur has a long parallel sided head.
Sizes run from #555 to #558 (Crosscut) and from #55-#58 (Plain).
The numbers #1155-#1158 denote a plain straight fissure bur with a rounded end and #1555-#1558 are crosscut straight fissure bur with rounded end.
Tapered fissure bur
Used to create divergent walls in cavity preparations
Bur has tapering head that is wider at the neck than the end
Can be plain or crosscut. #699-#703 are crosscut; #169-#172 are plain
#271 or #272 are round nose tapered fissure burs
Tapered fissure burs are used mainly for inlays
Pear shaped bur
Similar to inverted cone burs, but much rounder and without crosscuts. What is the difference in internal line angles created by an inverted cone vs. a pear shaped bur?
The shorter head style comes with a length of 1.5mm. These are #330 and #331.
The elongated head style comes with a length of 3.0mm. The primary bur used is a #245.
Pear shaped burs can be used for all tooth preparations that receive direct filling materials (amalgam, composite or glass ionomer). They can be used for the initial penetration of enamel and for all other aspects of the cavity preparation.
Multifluted burs
The heads of these burs have from 12 to 40 flutes vs. 6, 8 or 10 for those burs used to cut or excavate tooth structure. All burs have an even number of blades or flutes.
Multi-fluted burs are used for finishing restorative materials, beveling tooth structure and finishing cavity walls – all tasks that require smoother surfaces.
Burs and abrasives with red stripes usually denote fine or smooth cutting.
Diamond abrassives
They are made of three parts: a metal blank (that is shaped similar to a bur); the powdered diamond abrasive; and a metallic bonding material.
The diamonds are attached to the blank by electroplating them with the metallic bonding material.
they come in various coarseness but no numbering system.
Care of hard tissue
Air and water must always be used with high speed to counter act the generation of heat.
Always use either a hand instrument (spoon excavator) or slow speed to conserve tooth structure and protect the pulp.
Metal matrix bands can be placed between teeth during cavity preparation to protect the adjacent tooth.
Care of soft tissue
Air and water must always be used with high speed to counter act the generation of heat.
Always use either a hand instrument (spoon excavator) or slow speed to conserve tooth structure and protect the pulp.
The rubber dam helps protect soft tissues while using rotary instruments.
Wedges placed in the interdental space protect the tissues and the rubber dam.
Fiber products such as cotton rolls, gauze and Driangles keep the field dry and help protect soft tissues.
Metal matrix bands can be placed between teeth during cavity preparation to protect the adjacent tooth.
Abrasive disks
Abrasive disks come in a variety of sizes, materials and coarsenesses.
The two main groups are made of Aluminum Oxide and “Sandpaper.” The Sandpaper disks commonly come in Garnet, Emory and Sandpaper. All abrasive disks come in color coded backings in dark to light colors (reflecting coarse to fine abrasiveness).
Snap on abrasive disks
Garnet(square hole), Emory(diamond shaped hole), Sand
carbide burs for trimming acrylic
Fine Trimming for use with Provisional Restorations. Coarse trimming is used for denture bases etc.
control of instruments, 4 grasps
the 4 grasps are:
-pen grasp
-modified pen
-inverted pen grasp
-pen and thumb modified grasp
Cutting/Trimming Devices Used Extra-Orally in Straight Handpieces
Safe-sided Diamond Discs Most Commonly Used for Laboratory Trimming of Interproximal Areas of Provisional Fixed Partial Dentures. There is the diamond impregnated side and the safe side.
Abrasives in a hand piece
These abrasives are either one piece (like the diamond disk) or are attached by means of a mandrel.
A mandrel is a shank that fits into either a straight or a contra-angle handpiece and has a tip that attaches to a center hole of the abrasive.
Care of soft and hard tissue
Air and water must always be used with high speed to counter act the generation of heat.
Always use either a hand instrument (spoon excavator) or slow speed to conserve tooth structure and protect the pulp.
The rubber dam helps protect soft tissues while using rotary instruments.
Wedges placed in the interdental space protect the tissues and the rubber dam.
Fiber products such as cotton rolls, gauze and Driangles keep the field dry and help protect soft tissues.
Metal matrix bands can be placed between teeth during cavity preparation to protect the adjacent tooth.
Purpose of isolation
-moisture control
-retraction and control.
-harm prevention
Advantages of rubber dams
Creates a dry, clean operating field
Access and visibility
Properties of Dental Materials
Patient protection
Operator protection
Operating efficiency
Fewer “patient pauses”
Disadvantages of rubber dams
"Time consumption”
Patient objections
Partially erupted teeth
Some third molars
Some subgingival restorations
materials needed for rubber dam isolation
Rubber dam
Rubber dam frame
Rubber dam retainers (clamps)
Rubber dam punch
Rubber dam forceps
Hole location (to be punched in rubber dam)
Tooth position
Distance between holes: ca. 5 mm
Maxillary teeth--incisors 1 inch from upper edge of dam (preclinical 1 ½ inches)
Mandibular teeth--incisors 1 1/2 inches from lower edge of dam (preclincal 1 inch)
Isolation- from where to where
in restorative you isolate one to two teeth distal to the midline.
Steps of placing a rubber dam
Hole location
Punching the rubber dam
Lubricating the rubber dam
Retainer placement
Anterior tooth isolation
Isolating remaining teeth
Inverting the rubber dam(cupping)
Anchoring the dam in the anterior
Steps of removing rubber dam
Cut the interdental septa
Remove retainer
Remove the frame and rubber dam
Check for missing septa
Walls of the (amalgam) prep
The walls are named after the surfaces they approximate.
Wall names: mesial, distal, pulpal, buccal and lingual. There are two additional walls: axial and gingival
The axial wall is parallel to the long axis of the tooth
The gingival wall is closest to the gingiva.
Angles of the preparation
Line angle : the intersection of two walls that form a line
Point angle: the intersection of three walls that form a point
GV Blacks principles of cavity preparation:
Outline form
Retention form
Resistance form
Convenience form
Removal of remaining carious dentin and undermined enamel
Finish of the enamel walls
Toilet of the cavity
Outline form
The placement of the cavity margins in the final positions they will occupy on the tooth
Ideal outline form
Preparation is centered over the grooves
Goes around the cusp ridges
Cavosurface margins on sound tooth structure
Isthmus width is as narrow as possible
Occlusal outline form
Maintain mesial and distal marginal ridge integrity. Smooth flow preparation.
Bur orientation
The bur should always be held perpendicular to the occlusal plane.
Maxillary teeth: Bur orientated parallel to the long axis of the tooth.
Mandibular teeth: bur will have a slight lingual tilt because of the orientation of the occlusal table to the root of the tooth
Retention form
The shape of the prepared cavity that resists displacement or removal of the restoration from lifting or tipping forces.Facial and lingual walls are parallel or slightly convergent.
Mesial and distal walls are divergent at the cavosurface margin to ensure there is dentin support
retention form(the walls)
Buccal and lingual walls of the preparation must be parallel or slightly convergent.Mesial and distal walls are slightly divergent to ensure enamel rods at the cavosurface margin are supported.
Resistance form
The ability of the restorative material and the tooth not to fracture once placed into function.
Resistance form rules
Box shape
Flat pulpal wall
Adequate bulk of amalgam
Defined internal line angles
Marginal ridge integrity.All enamel rods must be supported by dentin
convenience form
The ability of the operator to visualize all remaining caries and to also be able to use the appropriate instruments in the preparation.The outline form is extended in order that all the caries can be seen and excavated.
removal of carious dentin and undermined enamel
The elimination of any infected carious tooth or faulty restorative material in the tooth after the initial cavity preparation
removal of remaining carious lesion
This task may be accomplished in two different ways:
With a large round bur in the conventional speed handpiece.
With a hand instrument such as a spoon excavator.
finish of enamel wall
The cavosurface must be smooth and distinct
The cavosurface must be between 90-110 degrees to produce maximum effectiveness for amalgam
Toilet of the caries
Ensuring that the preparation is free of debris before a base, liner, varnish and/or an adhesive or restorative material is placed (flush,flush).
Silver amalgam concerns
there are safety concerns, environmental concerns and also clinical efficacy. Research to date demonstrates safety of amalgam as restorative material
High Cu amalgams
Unique metal that has a complex setting reaction.
Alloy of mercury with other metals
~42-49% Hg
12-30% Cu
~60-72% Ag
~12-27% Sn
0% Zn
Other metals are added specific to different amalgams.These ratios between metals are determined by each
manufacturer to achieve good physical and handling properties.
Advantages of high Cu amalgams
High early physical properties
compressive strength
tensile strength
Low creep value
High corrosion resistance
Minimum Hg/alloy ratio (decreased residual Hg)
Variation in setting times (without affecting physical properties)
Creep value
dimention chnage over load on a fully set specimen.
Working time
from moment mix something together, that the rest mat is starting to hardern/change physical properties
Setting time
refers to how long it takes for a mat to reach its final physical properties. for amalgam that is 1hr tensile strength etc.
Amalgam packaging
Precapsulated amalgam
Mercury kept separate from alloy powder
Alloy powder
Spherical particles
Admix (mixed, blend or dispersed phase): spherical and lathe cut particles
Amalgam selection
Cu content >12%
Creep <1%
Compactibility- handling characteristics
Speed of set
Mercury hygiene
Barrier protection (dental dam) and high velocity suction when removing defective amalgam restorations
scrap amalgam stored in closed container
disposal of amalgam scraps with approved waste disposer
mercury spill cleanups-special precautions
Potential amalgam hazards
Hg sensitivity-allergy (very rare)
Hg toxicity: dentist and staff at greatest risk. Risk is minimized with proper handling of amalgam and disposal of scrap
galvanic effect (occurs infrequently but when a patient has this electrifying experience it is extremely painful)
Galvanic effects tht has to do with amalgams
Dissimilar metals have reactivity creating a battery effect- electrical shock, e.g. gold restorations touching a fresh amalgam restoration when occluding.
Chewing aluminum foil (by accident, candy wrapper is in your mouth): aluminum has a high negative standard reduction potential (ready to lose electrons). Saliva is slightly acidic helping the aluminum lose the electrons; silver (amalgam restorations) has a highly positive standard reduction potential (wants to grab electrons).
Aluminum foil + saliva + silver filling = weak electrical cell
Placement steps
Mixing
Insertion
Condensation
Precarve burnishing
Carving
Postcarve burnishing
Checking occlusion
Finishing and polishing
Trituration(mixing of amalgam)
Elliptical motion of mechanical mixer (capsule held in place by arms)
Medium/high speed minimum time
Mixing heat accelerates setting reaction
Process of mixing wets the silver alloy powder particles with the mercury to produce a homogenous mass of silver amalgam. Set the mixing time desired (specified by manufacturer).
The predose amalgam capsule is activated:
Place the capsule in the triturator arms
Close the top
Activate triturator
Amalgam removed from capsule is a shiny plastic mass.
It is placed in the cavity preparation using an amalgam carrier and amalgam well.
Insertion of amalgam into cavity.
Empty capsule in amalgam well
Pick up increments of amalgam with carrier
Dispense amalgam into cavity preparation in small increments.
Objectives of condensation
Adaptation to cavity walls
Compaction for dense restoration (reduce voids in restoration); overstep condenser nib
Reduce residual Hg
compaction of amalgam ensures excess mercury moves to next increment
allows for final amalgam structure to be composed of reinforcing residual alloy with a minimum of reaction product matrix.
Condensation- adaptation to cavity walls
Small increments placed
Adaptation of increments toward line and point angles
Condenser diameter determines force of condensation
Overfill to remove residual Hg.Adaptation of increments toward line and point angles.Adaptation of increments toward line and point angles.
Force of condensation
Force of condensation directly related to condenser diameter.
Dense amalgam restoration with overstepping the nib of the condenser
The nib
The nib condenses a new area of amalgam and
some of the previously condensed area-
this allows for a denser condensation
and improved adaptation
reduction residual Hg
Condensation of each increment leads to the residual (not used in alloy reaction) Hg to move to the next layer.Always overfill the cavity preparation so that when carving the residual Hg is removed.The overfilled cavity preparation is carved removing the Hg rich layer
Preburnishing restoration.
Burnisher- rounded end instrument
Using pressure equal to that of condensation rub the amalgam
enhances density of amalgam
improves adaptation of amalgam to cavosurface margins
DO NOT over burnish and undercontour the restoration
Purpose of carving restoration
Define anatomy
Remove excess amalgam
Return restoration to occlusal function
Perfect physiologic form and function
Carving restoration
Carvers are sharp instruments
Choose shape and size for area being carved
cleoid-discoid for occlusal
Hollenback carver for occlusal, facial, lingual and interproximal
Interproximal carver for interproximal (can be used for facial and lingual)
Whenever possible use cavosurface margin to guide carving instrument to avoid submarginal areas.
postcarve burnishing
After carving is complete, use the burnisher to lightly rub on the surface of the restoration.
Makes the surface smoother
Adapts amalgam to cavosurface margins
Do not use to hard a force that will make grooves in the restoration
Stop at point amalgam becomes shiny.
Occlusion of restoration
After postcarve burnishing, remove all amalgam scrap, remove dental dam and for restorations that are on the occlusal surfaces of teeth, check occlusion with an articulating forceps with articulating ribbon. Further carving may be necessary to perfect the occlusion
Finishing and polishing
Not always necessary
If anatomy, margins and contours not perfected in original carve, finishing gives the operator the opportunity to improve the definitive restoration
accomplished at least 24 hr after placement (in most practices, polishing might be accomplished weeks later when the patient returns. A visit for just polishing would not be done.
Coarse finishing- choose shape of rotary instrument to fit the surface of the restoration
finishing stones
finishing burs
Fine finishing
Rubber abrasives.
Considerations for pulpal health-in the placement of restorative materials
Compromises to pulpal health (pulpal irritation)
Caries- bacterial infection causing pulpal inflammation
Rotary preparation- heat and trauma to odontoblastic processes
Goal- preservation of pulpal health
Goal-creation of barrier (seal of enamel and dentin with restoratives) to external irritation
Goal- seal any marginal gaps between tooth and restoration
Decision making in the use of sealers, liners and/or bases
Remaining dentin thickness in tooth preparation
Thermal conductivity of restorative material
Presence or absence of pulpal symptoms-pain to stimuli
Thermal
Sweets (osmotic changes)
Tactile touching of dentin
Duration of symptom
Spontaneous pain
Remaining dentin thickness
Shallow cavity depth
Preparation 0.5 mm into dentin (ideal depth)
Moderate cavity depth
Remaining dentin over pulp of at least 1-2 mm
Deep cavity depth
Depth of preparation with less than 1.0 mm of remaining dentin over pulp
causes of pulpal inflammation
Bacterial toxins penetrating the dentinal tubules
Bacterial can cause
Pulpal irritation
Pulpal necrosis
Recurrent caries


Leakage at the restoration-tooth interface due to gaps at that interface
Trauma of tooth preparation
Bacterial penetration- pulpal inflammation
Restorative material could be amalgam restoration
Bacteria invade the gap between restorative-tooth interface and get into the dentinal tubules and can cause pulpal inflammation
The pulpal inflammation could be reversible
Pulpal pain due to stimuli
Not an inflammatory response
Postulated to be due to the hydrodynamic theory
Stimulus causes rapid fluid flow through tubules, nerve endings deformed- interpreted as pain
Gap at tooth-restorative interface: the restoration is not well sealed
Explanation of root sensitivity
Avoiding marginal gaps
Marginal gaps at the restorative interface can lead to
Recurrent caries
Marginal staining (composite resin)
Tooth sensitivity
Microleakage
Why are teeth sensitive to thermal shock?
Usually cold stimulates response
Postulated that direct thermal shock transferred to pulp through thin dentin
Metallic restorations more thermoconductive
Base thickness to prevent thermal transfer should be no thicker than 0.5-0.75 mm (thicker bases may weaken restoration)
Postulated that thermal sensitivity may be due to pulpal hydrodynamics
Deeper preparations have more dentinal tubules open
Sealing dentinal tubules reduces sensitivity to thermal shock
Materials to seal the tooth for pulpal protection
-Cavity sealers: protective coating on the cavity walls creating a barrier to leakage
Varnish (Barrier)
Resin bonding systems (Scotchbond MP and OptiBond Solo)
-Cavity liners:cement or resin coating of minimal thickness (less than 0.5 mm) placed as a barrier to bacteria or to provide a therapeutic effect (pulpal sedative or antimicrobial effect). Applied to cavity walls adjacent to pulp calcium hydroxide =Dycal glass ionomer = VitreBond
-Cavity bases:placed to replace missing dentin, placed in thicknesses of 0.5-1 mm; used to block out undercuts in cavity preparations for indirect restorations (glass ionomers: VitreBond, Fuji IX)
Cavity sealers
Provide protective coating for freshly cut tooth structure in a cavity preparation
Cavity sealers provide a transition between cut tooth and restorative material
Two forms
Varnish- natural gum or resin dissolved in organic solvent (brand name: Barrier)
Adhesive sealer (bonding agent) (brand names used in BCDS- Scotchbond MP and Optibond Solo)
Cavity liner
Ca(OH) used to assist in formation of reparative dentin by its antibacterial effect
Best used for direct pulp cap
Use only small amount
Glass ionomer (Vitrebond)
Chemical bond- fluoride release
Chemically compatible with composite resins
Seals dentin
Glass Ionomer
Generally not used for pulpal protection
Primary use in the past as dentin replacement to decrease bulk of restorative material
Primary use to block out undercuts in cavity preparations for indirect restorations (crowns, inlays, onlays)
Glass ionomer material of choice (Vitrebond or Fuji IX)
Guide lines for basing, lining and sealing.
Do not remove healthy, sound tooth structure to provide space for base
Use base as build-up and block-out for cemented restorations
If using base for amalgam or composite restorations minimize extent of base. Always try to leave a dentin seat for the restorative material
Do not base a preparation to create an “ideal depth.” This is contraindicated and can lead to increased risk of restoration fracture.
Liners should be applied with a minimal thickness (less than 0.5 mm)
Use minimal amount of liner to achieve result
Calcium hydroxide should be placed only where needed adjacent to pulp
Currently no persuasive evidence for the routine use of adhesive (dentin/enamel bonding) sealers under metallic restorations.
Recommendation for amalgam (and composite resin)
shallow depth: sealer then amalgam.
Moderate cavity: glass ionomer, then sealer then amalgam.
Deep cavity: CaOH+glass ionomer+sealer + amalgam.
Materials for use with amalgam
Cavity sealer
Varnish (Barrier)
Resin adhesive (ScotchBond MP)
Cavity liner
Calcium hydroxide (Dycal)
Resin modified glass ionomer (Vitrebond)
Cavity base
Resin modified glass ionomer (Vitrebond; Fuji IILC)
Materials use for composite resin
Cavity sealer
Resin adhesive (ScotchBond MP or OptiBond Solo)
Cavity liner
Calcium hydroxide (Dycal)
Resin modified glass ionomer (Vitrebond)
Cavity base
Resin modified glass ionomer (Vitrebond; Fuji IILC)
Dispensing and mixing mat : CaOH
Dispense equal from each tube equal volume on a paper mixing pad
Mix the two pastes together thoroughly for 10 seconds
Using a base placement instrument- place in tooth preparation
To accelerate set of Dycal, place a moist cotton pellet in the cavity preparation for 15 seconds; remove; continue with next step
Dispensing and mixing: resin modified glass ionomer(vitrebond)
Dispense one drop of liquid and one scoop of powder on a paper mixing pad
Mix the liquid and powder together for 10 seconds
Using a base placement instrument- place in tooth preparation
Light cure for 20 seconds; continue with next step
Dispensing and application of cavity varnish (Barrier) for use with amalgam
Dispensed from bottle
Use of pipette
Pipette Barrier into tooth preparation
Or
Dip disposable brush into bottle
Apply to tooth preparation with brush (no double dipping)
Dry with air stream
Place amalgam
Dispensing and application of adhesive sealer (Scotchbond MP) for use with amalgam
Kit contains components for amalgam sealing; used as a dual cure system
Indications for amalgam bonding
preparation with the need for additional retention beyond preparation form
Dispensing and technique for adhesive-composite resin procedure
Etch
Enamel
Dentin
Adhesive
Single component
Multi-bottle
Self-etching
Composite resin
Materials for adhesive procedure Adhesive (bonding agent)
Multibottle (Scotchbond MP)
Etch separate
Primer
Adhesive
Single component (Optibond Solo Plus)
Etch separate
Primer-adhesive
Purpose of adhesive
Seal tooth/restorative interface
Decrease leakage at tooth/restorative interface
Enhance restoration retention by mechanical locking of adhesive to roughened surface
Enamel-dentin smear layer created during tooth preparation
Layer on tooth surfaces created by rotary cutting instruments
Made of loosely bound debris, collagen, and hydroxapatite crystals
Direct and Indirect Pulp Capping
Endodontic treatment designed to maintain the vitality of the endodontium
Indirect pulpal capping
Tooth must be vital with no history of spontaneous pain
Pain elicited from cold test or EPT should not linger
Restoration must seal tooth from bacteria
Periapical radiograph demonstrates no periapical pathology
Tooth will not have casting as definitive restoration
Direct pulpal capping
Pulp tissue minimally exposed (usually less than 1 mm in diameter)
Tooth must be vital with no history of spontaneous pain
Pain elicited from cold test or EPT should not linger
Restoration must seal tooth from bacteria
Periapical radiograph demonstrates no periapical pathology
Tooth will not have casting as definitive restoration
Control bleeding with damp cotton pellet
Don’t use explorer tip to verify exposure.
Technique for indirect and direct pulp capping- same as deep cavity depth
CaOH->glass ionomer->sealer-> restorative material
Cavity bases
Materials to replace missing dentin, used for bulk build-up and/or blocking undercuts in preparations for indirect restorations (inlays, onlays, crowns)
Cavity liner
Cement or resin coating of minimal thickness (usually less than 0.5 mm) to achieve a physical barrier to bacteria and their excretion products and/or to provide a therapeutic effect, such as, antibacterial or pulpal anodyne (sedative) effect. Liners are usually applied only to dentin cavity walls that are near the pulp (pulpal and axial walls)
Finishing/polishing amalgam
FINISHING is essential.
POLISHING does not necessarily add longevity to the high copper restoration.
HOWEVER, a polished restoration “feels” better to the patient.
A polished restoration may lower plaque accumulation.
What materials need to be finished and polished?
Composite Resin, Cast restoration.
What is finishing
Initially accomplished at the placement appointment
Includes evaluation of the restoration for problems
Involves correcting those problems through carving
And involves post-carve burnishing.
remove flash w/ carving,adjusting margins with rotary instruments at least 24 hours after placement.
Finishing burs
#7002 – Small Round
#7004 – Large Round
#7303 – Long Pear
#7802 – Bullet
#7901 – Flame
Polishing
Taking large scratches and through an abrasive process, producing small, unnoticeable scratches which allow for an undistorted reflection of light.
Why polish?
Improves the “feeling” of the restoration to the patient.
May improve plaque control around the restoration.
Along with finishing, allows for correction of contours and anatomy missing from the carve of the restoration at the time of placement.
Knoop hardness
kg/mm2
Enamel (KHN 343)
Amalgam (KHN 80)
Gold foil (KHN 69)
Dentin (KHN 68)
Diamond (KHN 7000)
Silicon carbide [green stone] (KHN 2500)
Aluminum oxide [white stone – Sof-lex disc] (KHN 2100)
Emory (KHN 2100)
Garnet--mixture of mineral oxides [Al, Fe, Mn, Co & Mg] (KHN 1360)
Quartz (KHN 820)
Composite Resin (KHN 26)
Hardness
resistance to indentation or penetration , also a measure of scratch resistance.
Materials w/o KHN
Rubber abrasives
Powders
Finishing burs
Finishing
Perfect margins with finishing burs and stones

Bucco-occlusal and linguo-occlusal margins
Establish mesial and distal fossae and buccal and lingual grooves
7802 bur for mesial and distal fossae. Interproximal contouring with flame shaped finishing bur
Principles of polishing
Coarse to fine abrasive
Shape of polishing instrument
Finest that will do the task
USE SLOW SPEED
Move the abrasive from restoration to tooth to avoid “ditching” the margin.
Also: All margins are finished.
Margins not detectable by explorer tine
Polish with rubber abrasives
Brown-medium grit