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252 Cards in this Set

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  • Back
identify and name major parts of hand instument
explain the reasons for vaiations in major parts of dental hand instrument
variation occurs in the shank angulation control the relationship of the blade to the central axis of the handle. The angle of the shank expedites access of cutting blade for various operative cutting procedures
explain the significance of each number in 3 and four numbered instruments
1.width of blade in tenths of millimeter
2.length of blade in millimeters
3.angle of blade to long axis of handle measured in Centigrade

1.blade width in tenths of millimeter
2.angle of cutting edge to long axis of the handle
3.blade length in mm
4.angle of blade to handle
explain how instrument may be id by characteristics of its bevel, shank, and classification
1. number of bevels on cutting edge
-single bevel
-Bi bevel

2.Angulation of shank
-Triple Angle

3.Class of instrument
-Gingival margin trimr
-Angle formers
-Spoon excavators
3 ways a hand cutting instrument can be identified
1.number of bevels on cutting edge

2.angulation of shank

3.Class of instrument
name 5 major types of cutting burs
2.inverted cone
3.straight fissure
4.tapered fissure
round burs
range in # from 1/16 to 10

useful for initial entry into lesion, excavation of caries, and placement of retentive features
Inverted Cone burs
30 series
numbered from small size of #33 1/2 to large size #39

useful for refining internal features of cavity preparations, creating line angles, and flattening internal walls and floor
Straight fissure burs
in 50 series. #55-61

burs are cylindrical in shape and have angled cutting flutes. primarily used for bulk of cavity prep, extension to final ouline form and smoothing of internal cavity walls
Tapered Fissure burs
these burs are just like straight fissure burs except for slight taper to cutting surface. They are numbered from #168-173.

they are used just like straight fissures

the smaller of these burs is used for placement of retentive grooves
Pear burs
like inverted cone but gives you undercut

characterized by rounded corners and sides that are slightly tapered toward the bur shank. they are numbered from #229-333 and are used to give conservative cavity prep w/rounded internal line angles
ID and explain differences in burs which are designated as LA,RA, or FG
Burs for use in slow speed are Latch Type that are either RA (rt angle) or LA (latch attachment).Slow speed also has FG (friction grip)

Hi speed are FG
Cross cut fissure burs
500-700 series and are analogous to plain fissure burs.
straight burs are in 500 series

Tapered burs are in 700 series

some fissure burs have L at end of number to designate long
purpose for cutting cavity nomenclature
so we understand one another in coversing about treatment of pt.

cavites can occur on one or up to five surfaces of tooth.
difference between simple and complex cavities
a simple cavity is one which involves only one surface

a complex cavity is one which, either from decay or extension in preparation, involves more than one surface
How are complex cavities classified?
by using first letter of words naming surfaces of tooth involved and writing them in capitol letters

Ex:MOD (mesio-occluso-distal)
disccuss characteric of pit and fissure caries
caries most often appear here bc they are protected areas. Pits and fissures are deeper than surrounding tooth substance and proper cleansing is hard. these conditions are v. favorable for bacterial growth
where are pit and fissure cavities found?
1.oclusal surface of PM and M
2.Linglal pit of max incisors
3.facial grove & pit of max M
4.lingul grove & pit of max M
5.pits ocur in atypical areas
characteristics of smooth surface cavities
they accompany unclean conditions on areas of tooth that are difficult to clean
where are smooth surface cavities found?
1.proximal surfaces of all teeth

2.gingival one third of areas on facial and lingual of all teeth
How are smooth surface cavities most likely detected?
by bitewing xrays w/exception of gingival 1/3 lesions
Class I caries
all pit and fissure cavities

most commonly, occlusal surfaces of posterior teeth,buccal and lingual surfaces of molars, and lingula surfaces of anterior teeth
Class II
proximal surface cavities on premolars and molars

usually occlusal surface is involved along w/one or more proximal surfaces of any posterior teeth(MOD)
Class III
all proximal surface cavities on anterior teeth which do NOT involve removal and restoration of incisal angle
Class IV
all proximal surface cavities on incisors and canines which involve removal and restoration of incisal angle
Class V
all gingival caries located wi gingival 1/3 of tooth. May be within either facial or lingual gingival 1/3 of tooth
Class VI
all cavities on incisal edge of occlusal surface where attritional wear has removed enamel to expose dentin
axial wall
inside wall of an axial surface cavity which covers pulp and is in plane parallel to long axis of tooth
gingival wall
is inside wall of axial surface cavity placed toward and running in same plane as gingiva
proximal surface
refers to surface of tooth or portion of cavity thats nearest to adjacent tooth.

mesial/distal of tooth
represents extension of prep desined to create an interlock for resotrative material
cavosurface margin
line formed by junction of cavity wall and external surface of tooth
bottom or deepest part of cavity prep. axial or pulpal wall
geometric configuration in compound cavity preparation composed of pulpal axial and gingival walls
pulpal wall
inside wall of cavity which covers the pulp and is in plane at right angles to long axis of tooth
line angle
formed where 2 walls of cavity meet along a line and is named by joining names of walls so meeting
narrowest part of dovetail
line representing union of enamel and dentin. used to judge depth of internal prep
difference between Universal and Federation Dentaire Internationale systems for tooth numbering
Universal-numbering begins w/maxillary R 3 molar proceeds around to max L 3 molar then drops down to man L 3 molar and around to man R 3 molar(#1-32)

FDI-first digit of tooth number represent a quad (1-max R, 2-max L, 3-man L, 4-man R) second digit represents the tooth
Ex: max L 1st PM= 24
what is advantage of stainless steel hand instruments over carbon steel hand instruments?
stainless are preferred over carbon stell bc all instruments must be sterilized with steam or dry heat between pts.

Chromium imparts ocrrosion resistance and brightness to metal; cabon imparts hardness
what is meant when a hand instrument is "balanced"?
shanks of instruments have multiple angles to keep working end of insturment wi 2-3 mm of long axis of handle

angulation of shank gives balance so force is exerted on instrument is not as likely to rotate (which would decrease effectiveness of blade and cause tooth damage)
What are 2 strokes identified in use of hand cutting instrumens?
a cutting instrument can be used w/horizontal strokes is which long axis of blade is directed 45-90 to surface of plane being scraped

vertical or chopping strokes is when blade is parallel to wall or margin being planed
for horizontal or vertical strokes what angle of cutting edge is intended for use?
acute angle
what does term contra-angle mean?
contra angle handpieces indicated that the head of the handpiece is angled first away from and then back toward long axis of handle
what is hi speed usually used for?
cutting enamel and dentin
what is lo speed handpeice used for?
lo speed contra angle handpieces w/round burs rotating slowly are used to remove carious dentin.

lo speed contra angle are also used for various finishing and polishing procedures that use abrasive disks,points, or cups
What is difference between trimmin/finishing bur and regular cutting bur?
trimming and finishing burs are great for making v. smooth cuts in tooth preps, for adjusting occlusion in enamel of restoration, and for contouring and finishing restorations

trimming and finishing burs havve more blades than tooth prep burs and the more blades, the smoother the cut surface that can be attained
ID diff basic shapes of cutting and finishing burs available

inverted cone

straight fissure

straight fissure, round/strat

straight fissure,crosscut

straight fissure,round end/crosscut

tapered fissure

tapered fissure,round end

tapered fissure, crosscut


long inverted cone,round corners

end cutting







long pear

straight fissure

how can use of magnification afect oucome of an operative prodecure?
quality,serviceabilty, and longevity of dental restoration depends on ability of operator to see what she is doing
what methods may be used to assess the sharpness of hand cutting instrument?
look at cutting edge in bright light; presence of glint indicated that the edge is dull

dentist can pull instrument across hard plastic. dull blade will slide across plastic; sharp blade will cut into surface, stopping movement

A specially made, sterilizable, sharpness testing stick is also available
what special techique must be used to sharpen round bladed cutting instrument like cleoid-discoid carver?
when blade w/rounded edge is being sharpened,the handle cannot simply be twirled to achieve desired rotation but must actrally be swung in an arc to keep cutting edge of blade perpendicular to direction of stroke, and bevel parallel w/ and against surface of stone
What is correct angle of bevel on a hand-cutting instrument?
45 degrees
what are main used of mouth mirror during dental prodedures
indirect visualization

reflector of light


indirect illumination
how does grasp describe for dental instrumentation differ from that used to hold a pen?
handle of instrument is engaged by end of the middle finger, this allows more finger power. pen grasp is initiated by placement of instrument handle between thumb and index finger; the middle fingler engages the handle near the shank. The ring finger is braced against the teeth to stablize instrument
advantages of using rubber dam
1.adequate access and visibility bc it keep the tongue and cheek out of the way

2.better pt management and protection. It prevents aspiration of foreign objects

3.control of moisture. It allow uncontamination

4.Decreased operating time

5.infection control-acts as a barrier between oral cavity and operative field
what type of rubber dam is recommended for operative dentistry?
dark, extra heavy precut 6x6 squres bc provides better seal to teeth and better to retract soft tissue
Id armamentaria for rubber dam placement and removal
1.basic 3
explorer (cowhorn/hook)
Cotton pliers

2.Rubber Dam
3.Rubber Dam clamps
-W2 premolar
-W3 molars
4.Rubber dam punch
5.rubber dam forceps
6.Rubber dam holder
7.Burnisher (OU 37) 3
-dental floss
-cotton pellets
-Dappen Dish
most commonly used rubber dam clamps and use in dental arch
W2-max/man premolars
W3-small erupted molars
W7-for nomal man molars
W8-for norm. max molars
W14A-parital erupted molars
W8A-for molars<W14A clamp
general guidelines for selection of number of teeth included in field of isolation for operative procedure
for working on anterior teeth, isolation should include all anterior teeth and first premolars on both sides of dental arch. this gives more room lingually

For working on posterior teeth, isolation should include appropriate quadrant from opposite central incisor to at least one tooth distal to tooth being treated
general guidelines for positioning holes properly for rubber dam isolation in max and man arch
for max arech holes for central incisors should be punched one inch from superior border of rubber dam

for man arch holdes for central incisors should be punched on to two inches from inferior border of rubber dam depending on which molar is being treated
3rd-1 inch from dam
2nd-1.5 in from dam
1st-2 in from dam
what are unique situations which might require modification of rubber dam application procedure?
larger teeth require greater spacing between holes

ovoid/tapered teeth require greater spacing between holes than square teeth

hi/large interspetal papillae require greater spacing between holes to provide more rubber dam for proper inversion around necks of teeth

no holes punched for missing teeth

holes for malaligned teeth should be punched in same relationship as positions of such teeth
basic criteria that should be met by clinically acceptable rubber dam isolation
rubber covers upper lip but does not cover nose

clamp is ligated and securely fastened to anchor

rubber dam is anchored both posteriorly and anteriorly

napkin is between face and rubber dam

no voids around necks of isolated teeth

no excess bunching of dam between teeth

no rips/tearns in rubber dam

dam is invaginated around neck of tooth

dam is centered on pts face

adequate number of teeth isolated
what commonly can cause rubber dam punch to be damaged so that it will no longer cut a clean hole?
bc rotating cutting table was not snapped completely into position before punching hole.

incompletely punched holes cause tearing of dam during application or will affect ability of dam to seal
3 basic types of rubber dam clamps mentioned
winged rubber dam clamp

wingless ruber dam clamp

butterfly rubber dam clamp
what does W marked on rubber dam clamp signify
wingless no wing extension
what special purpose does 212SA clamp serve
gingival retraction clamp desgned mainly for max and man anteriors and premolars

this clamp must be stabilized w/dental cmpd
why is it important to get 4 pint contact between clamp and tooth?
provides stabilty ,or resistance to rotation and dislodgement
how does authors philosophy toward ligation of rubberdam clamp during operative procedure differ from that followed in our clinics?
we recommend that dental floss be attached to clamp used in mouth to allow retrival if clamp gets dislodged, the author disagrees bc she says floss causes leakage
alternative techniques for rubber dam retention used to anchor anterior segment of rubber dam floss placed doubly through contact

2.short strip of rubber dam stretched through contact

3. floss is tied to rubber plunger from an anesthetic cartridge and tied around most distal tooth

4.elastic cord is placed interproximally to retain dam
what is advantage of using waxed dental floss to help pass rubber dam through proximal contacts?
carries more of septum throuch contact in single pass
can a rubber dam be placed wo administration of anesthesia?
yeah it can but the pts might feel discomfort for a sec but it will disappear due to pressure anesthesia

usually local anesthetic agen has been administered to give pulpal anesthesia for tooth/teeth
how should stability of rubber dam clamp be checked?
engage bow w/ instrument and attempt to pull occlusally
what are four different approaches to dental dam application discussed?
1. dam over clamp

2.winged clamp in dam

3.wingless clamp in dam

4.clamp after dam
how does inversion of dam around tooth imporove isolation of operating field?
when dam is iverted postitive pressure under dam serves to push valve more tightly against tooth so no flooding of field occurs
what percentage of pts are allergic to latex?
3-4% so use synthetic rubber dam on these pts
what are 3 other methods of isolatin that can be used if rubber dam is not feasible?
Svedopter-most commonly used tongue retractor

hygoformic saliva ejector-more comfy and less traumatic then svedopter

vac ejector-has bite block and tongure retractor for man area w/hi speed suction.
explain the importance of a strong bond between the tooth surface and a restorative material
to prevent microleakage bc microleakage causes recurrent decay, post op sensitivity, and staining of cavosurface margins
criteria for a good adhesion
1.close contact between adhesive and substrate(tooth)
2.surface tension of adhesive must be lower than the surface energy of enamel and dentin to allow good wetting of substrate by adhesive
3.adhesive must provide strong initial bond to resist stresses of resin polymerization shrikage
define the term microleakage and explain how it may lead to early failure of dental restorations
microleakage is the percolation or oral fluids and bacteria between the tooth and restoration. microleakage causes recurrent decay, post op sensitivity, and staining
explain how polymerization shrinkage can affect the margins of a resin composite restoration
the material pulls away from the tooth margins when it cures causing formation of gaps between the tooth and the restoration, this leads to...MICROLEAKAGE which then causes staind margins, post op sensitivity, and recurrent decay
List and describe the various types of bonding that may be utilized in dentistry
resin-glass ionmer
list the typical indication for resin to enamel bonding
incisal fracture
peg laterals
reshaping malformed teeth
hypoplastic defects
white spot lesions
direct compostie veneers
describe steps involved in the acid etch and enamel bonding procedure
etch enhances mechanical bonding of resin to surface. Acid etching of enamel surface converts the smooth enamel surface into an irregular. etch causes small porosities. etching also increases surface free energy of enamel to allow for better wetting and contact with the tooth by the adhesive
explain effects of the differences in the structural composition of enamel and dentin on the bonding process
dentin is higher in organic and water content with a lower inorganic content than enamel. dentin also differs in structure so bond stregths to dentin are less in deep dentin because there is less dentin and more tubules.Also the moisture on dentin is an obstacle

to get a strong bond with dentin, remove dentinal smaear layer and expose the intertubular and peritubular dentin. the resin penetrates the dentin causing a mechanical bond
obstacles to successful dentin bonding
1.hi organic material in dentin
2.smear layer dentin tubules release fluid
3 characteristic of smear layer on dentin
1.occluds dentin tubules
2.prevents strong bond
3.must be removed with acid it cant be scrubbed off
how adhesive bonding agents were modified to allow better bonding to dentin
use ethch to remove smear layer and open dentin tubules

GLUMA wets the dentin for the primer

primer allows resin to penetrate collagen fibers and wet the dentin. solvent in primer pushes the moisture out of the way so that the resin can coat the dentin

primer makes hybrid layer that is hydrophobic that will bind to resin. the outer surface has an oxygen inhibited layer that is chemically active that can be bound to more resin
what is one step
dentin bonding system used in our clinic it has resin primer and adhesive bonding resin combined into one agen
LED curing light
used for polymerization of all photoinitiiated dental materials
bonding resin
tooth colored restorative material
3 phases to prep tooth for resin bond
Gluma desensitizer
rewets the tooth after etch and before primer

provides wet surface

no negative effect on bond

applied 20-30s
what does one step plus contain
low viscosity hydrophilic monomer that wets the dentin and penetrates the tubules

acetone to help resins penetrate into dentinal tubules and through moist collagen fibers and contact dentin

filled bonding resin to create strong bond
what provides most effective bonding?
penetration of primers into intertubular and peritubular dentin
bond strenth
aka adhesive strength is the measure of the load bearing capability of the adhesive
deiffence between cohesive and an adhesive type of bond failure
adhesive failure is failure that occurs at the interface bc the interface is subjected to tensile or shear force

cohesive failure is failure at one of the substrates, not the chemical interface
how does surface free energy affect our ability to bond to enamel and dentin?
suffient wetting of adhesive occurs only if surface tension is less than the surface energy of the adhered. adhesion to enamel is easier than dentin bc enamel has hydroxyappetite where as dentin has hydroxyappetite and collagen. tooth should be cleaned and pretreated to increase surface energy so better bonding
primary mechanism that allows resin bonding agen to bond to tooth structure
micromechanical interlocking w/surface irregularities of the etched substrate
smear layer
any debris, produced by reduction or instrumentation of dentin,enamel, or cementum that precluedes interaction w/ underlying pure tooth tissue

this iatrogenic layer of debris influcnes adhesive bond between tooth and restoration
why does contamination w/saliva decrease the boding effectiveness?
bc saliva contains proteins that blocks infiltration of resin into the microporosities created on acid atched enamel and dentin
what is meant by the term wet bonding?
when bonding to dentin you want to keep the dentin wet so that the collagon does not collapse. It also allows the primer to wet the dentin of the dentin is wet
how does excessive moisture on dentin surface prior to applying resin primers effect resin-dentin bond?
excessive moisture do to GLUMA pooling dilutes the primer so it is less effective
Why is it important to leave primers on for at least 15 sec?
to allow collapsed collagon to reexpand
what is effect of over thinning the thickness of adhesive resin layer?
decreases the elastic buffer
what is advantage of having small filler particles in the adhesive resin?
allows less polymerization contraction
why should a light cured adhesive bonding agent be light cured prior to the application of a resin composite restorative material?
so the adhesive resin is not displaced when the restroative resin composite is applied
describe the causes of degeneration of the bond between resin and tooth structure
temp causing contraction/expansion
why factors affect the effectiveness of a curing light?
wavelength of ligth (450-500)

intensity of light

light exposure time

distance from lt to surface

shade of resin composite
describe the effects of treating the dentin surface with acid
treating dentin w/acid removes the smear layer, and exposes the intertubular and peritubular therefore opening up the dentin tubules. it creates dentin w/microporosities so the resin can penetrate into it. the acid removes calcium and phos from outside surface of the dentin to depth of about 10microns leaving a demineralized collagon layer
define hybrid layer and describe its significance in dentin bonding process
betwen the collagon rick layer and the unaltered dentin lies a zone of demineralized dentin. the collagon fibers and the cured nond resin result in a zone of resin reinforced dentin; it lies between the overlying cured resin composite and the underlying dentin
describe hydrodynamic theory of dentin sensitivty and explain how dentin bonding relates to it
states that various stimuli such as heat,cold, or osmotic pressure affect fluid movement in dentin tubules. many tubules have mechanoreceptro nerve endings near pulp and movement of fluid int tubules stimulates these cells so you feel pain.

the hybrid layer results in resin penetration of dentin surface which seals the tubules preventing fluid movement and reducing sensitivity
what is meant by total etch procedure?
establishes bond to both dentin and enamel. it involves conditioning enamel and dentin w/acid
what is meant by bonding wet dentin? and its significance to establishment of strong dentin bond?
wet dentin is natural. it does not mean wet w/saliva or blood. dentin must be moistened by water or GLUMA after ethching.

one reason moist dentin has higher bond strength that the dry dentin is bc it allows the acetone based primer to spread along the dentinal surface. also when exposed to drying, fibrous outermost demineralized zone is compromised so collagon collapses and this interferes w/ primer penetration.

maintain collagon w/ moist state!!!
describe smear layer and what relationship it has w/4th and 5th generation bonding agents
4th gen is first that involves complete removal of smear layer. so the 4th and 5th generation dentin bonding agents involve using the total etch tecnique to remove the smear layer in its entirety. this oopens the dentinal tubules and a layer of unsupported collagen fibers covering the dentin. if using the 4th gen this then primed and a hydrophobic bonding agent is applied.

if using 5th gen, then the resin primer and bonding agent are combined (one step) so it only takes one step to prime and apply resin
describe 2 step systems of classifying resin dentin bonding agents
one system involves classification according to which generation the material originated from in the evolutionary process. the 2nd involves basing the classification on the bonding strategy of todays bonding agents (ex: etch and rinse adhesives, or self etch)
ID classification of resin bonding we use by both systems
5th generation

2 step etch and rinse adhesive
describe instruments avaibable for finishing and polishing resin restorations
carbide finishing burs

flexible abrasive finishing disks

rubber polishing abrasives

finishing strips
explain why the contour of the finished restoration is important to the esthetics and health of restoration
the contour of a composite restoration is critical for esthetics and hlth. a flat surface will reflect lt differently from rest of tooth and not look natural even is shade is correct. an over or under contoured restoration may also irritate the adjacent givgival tissue
difference between 2 classification systems for resin dentin bonding agents in text
1.chronological classification

2.scientifically based adhesives
-ethc/rinse adhesive
-self etch adhesive
-glass ionomer adhesivies
what is defference between n etch and rinse adhesive and a self ethc adhesive?
etch and rinse is 3 steps: etch, primer, bonding agent. it is moste effective

self etch is pretty new. for dentin bonding only so enamel ethching is seperate step. omission of etch and rinse step bc everthing all together so less for you to mess up
most critical step in etch and rinse adhesive approach?
application of the primer. when an acetone based adhesive is used the highly technique sensitive wet bonding technique is mandatory.
effect of acid etching on enamel
smooths surface
increase surface nrg
makes porosities for mech ad.
parameters that can afffect the effectiveness of acid ethching?
type of acid
acid conc
etch time
form of etch
rinse time
method of activation
if enamel has been instrument
primary or permanent teeth
enamel prism or prism less
enamel is demin,Fl,stained
how does acid condition of dentin affect its surface free energy?
hi protein content exposed after conditioning w/ acid is responsible for lo surface free energy of ethced dentin this differentiates it from etched enamel
why are lo viscosity resins such as HEMA essential to promote adhesion to conditioned dentin?
bc it wets the dentin
major role of adhesive bonding resin
to stabilize the hybrid layer and to form resin extensions into the dentinal tubules called resin tags
what is implication of O2 inhibited layer on surface of adhesive resin?
to allow chem bond
big difference between bonding systems used in first 2 generation and those that followed?
1st and 2nd use chem bonds where the others use chem and mechanical bonds
major diff in 4th and 5th generation bond system
4th gen has 3 seperate steps etch,primer,resin

5th generation you etch then do combined primer,adhesive
what has been the success of adhesives using 6th and 7th generatiio bonding agents?
lower bond strengths
describe the most effective method of diagnosing pit and fissure caries
pit and fissure caries is most effectively diagnosed in its earliest stages by visually inspecting a dry tooth surface using optical magnification
Tx decisions for pit and fissure caries must be used on what 3 main factors?
1.extent of caries observed

2.age of tooth

3.pts risk for future caries
(caries risk assessment)
describe the main factors that influence the selection of a restroative material for pit and fissure restorations
the 2 types of direct restorative materials that are used to restore pit and fissure caries are silver amalgam alloy and resin composite. the decision regarding which to use is based on the following facotrs: esthetic concern
extent of caries
ability to isolate
what are the 2 main types of resin restorative materials used in our clinics to restore pit and fissure caries?
1.flowable resin composite (ultraseal XT) this has 50-60%filled resin composite it is less viscous and flows easily, but it is not as strong or wear resistant as hybrid composite

2.Hybrid resin composite (TPH3 or esthet-X) has 70-80% filled resin composite stiffer handling than the flowable, but stronger and better wear resistance. Less polymerization shrinkage than the flowable
how does pts risk of future caries influence the decision made for treating pit and fissure caries?
lo caries risk-get no tx for mild staining or some opacity in enamel; if there is a distinct opacity and discoloration seen w/air drying, get preventive tx

moderate caries risk-mild staining gets preventive tx (OH;F) distinct opacity get preventive tx

hi risk-staining or slight opacity in enamel gets preventive tx; distinct opacity or discoloration after air drying get preventive tx or sealant

for all risk categories, if there is a distinct opacity and discoloration wo air drying,remove caries and assess cavity to determine tx plan
procedure for placing sealant
isolate teeth w/rubber dam

clean pitsfissure 1/8 rd bur

etch w/phos acid for 15 s

rinse and dry

apply prime and dry or adhesive resin

apply ultra seal XT sealant material in pits and fissures

check occlusion w/ribbon
explain difference between preventative sealant and preventative resin restoration
preventative sealant are not really restorations but are a t intended to prevent future caries in pts that are at hi risk for futrue caries; they consist of a moderately filled resin that is adhesively bonded over deep pits and fissures; thsi filles the pits and fissures and creates a smooth easy to clean surface

preventative resin provides most conservative form of restoration for v.mod carious lesions in pits and fissures; the caries are removed and either a flowable or a hybrid resin composite material is used to restore the small often shallow cavity prep
describe the cavity prep fro preventive resin restoration
the pred for preventative resin restroation is meant to be super conservative in width. once caries is removed any deep pits and fissure should be cleaned w/ 1/8 rd bur and sealed
describe procedure for placing preventative resin restoration in our clinic
isolate teeth w/rubber dam

remove caries from pits and fissures


rinse and dry

if prep in dentin use gluma

apply 2 coats of one step

dry till shiny

light cure 20 s


light cure

check occlusion
tell when the procedure for dentin resin bonding would be indicated in tx of pits and fissure caries
studies suggest that sealant seal better and last longer when a dentin bonding agent is used. this is left up to dr. if time,pt managmetn, and field of isolation permit, a dentin bonding resi may be used during placement of sealants
describe the restorative materials that are currently used in our clinic for preventative sealants and preventative resin restorations
ultraseal XT used for sealants; this is flowable composite material it is radioopaque, 58% fillerd, thixotropic and comes in 4 shades (opaque white, A1,A2, and clear)

esthet-x used for preventative rsin composites light cure

TPH3 used for preventative resin composites visible light activated
can you over ethch enamel? Dentin?
you cannot over etch enamel you can however over etch dentin. the longer the acid remains on the dentin the deeper will be the zone of demineralization and the harder it will be for the primers to penetrate through the collagen layer. if acid is left too long on dentin, the dentin will denature

4 components of one step
biphenyl dimethlacrlyte (BPDM)



which is more likely to develop caries, a coalesced pit or fissure or a non coalesced pit or fissure?
usually in incomplete enamel coalescence. usually on occlusal surfaces of posterior teeth, lingual of max anteriors and molars,, and bucal pits of molars
what has been found to be reliable method of detecting pit and fissure caries?
visual observation w/magnification of a clean dry tooth is reliable and nondestructive way to detect pit and fissure caries
does author recommend placy sealants over known carious dentin lesions?
placement of sealants in fissures or known carious dentin cannot be recommended bc the risk of losing the sealant makes the practice injusts
why is it important to dry a tooth off while attempting to detect caries?
1.remove saliva which can obscure lesion

2.dry a white spot lesion
how does the presence of a cavitation on the tooth surface relate to the depth of caries in relation to the dentin?
any sign of cavitation in the occlusal surface corresponds to progression of lesion into the dentin
how are BWX utilized to support the visual inspection of the teeth for pit and fissure caries?
acts as a safety net for occlusal lesions. Only see lesions that go into dentin
does author recomment the use of sharp dental explorer to detect caries in pits and fissures of teeth?
no it is inaccurate and explorer can damage white spot lesion by breaking through the intact surface zone and cause a cavity that will trap plaque and encourage lesion progression
how can caries activity be assessed and why is it important to know if a caries lesion is active?
look at immediate past caries experience

progression of lesion

appearance of lesion/cavities

location of lesions cavities

presence of plaque
how can a decision tree, be help ful in forming a TX plan
has different features that lead to different options bc caries is a multifactorial process.
what are preventive measures suggested for use in preventive caries?
how does the fact that a caries lesion has become cavitated effect the possibilty of healing the lesion by remineralization?
if lesion is cavitated, dentin is involved.easily reachable areas should be cleaned. keep area free of plaque. cavietis can be arrested and converted into leathery or hard lesions. when caries is arrested they still contain few bacteria that can be cultivated
name 3 main problems associated w.use of resin composite in posterior restoration
polymerizatin shrinkage

post op senitivity

less than ideal resistance wear
lis 2 factors that autor say are prerequisites for resin composites to be able to serve as good restorations
meticuolous operative technique

appropriate case selection
lis the advantages of resin composite as posterior restorative material
conserve tooth structure
adhesion to tooth
low thermal conductivity
eleminate gavanic currents
list disadvantage of resin composite as posterior restorative material
polymerization shrinkage
2ary carious lesion
postop sensivity
decreased wear resistance
describe ideal circumstances for use of resin compostie for posterior restoration
pt has no allergies

pt has good OH

centric occclusal stops located primarily on tooth structure

pt does not clench or grind

tooth should be isolated w/rubber dam

esthetics should be prime consideration

faciolingual width of carity should be less than one third of intercuspal distance to decrease occlusal force

all cavosurace margins should be on enamel
why is it important to provide pt w/appropriate info concerning advantage and disadvantages of resin vs amalgum as posterior restroation
100% of pts want dr to tell them about aspects of alternative restroative materials
in authors opinion what is most reliable method of establishing field isolation that will allow successful placement of esin composite restoration?
rubber dam to prevent moisture contamination and protect gigival tissues from laceration
what is key to sealant success?
tolatal retention of sealnt.
list factors that can affect retention and effectiveness of sealant
man teeth better retention; premolars better that molars

annual recall

use bonding agens before sealant placed

slight mechanical prep

flowable resin

hi risk for caries pt
name advantage of using preventive resin to restore pit and fissure caries
do PRR
when is preventive resin restroation indicated?
PRR is indicated when some areas of fissure system of tooth are associated w/carious dentin and others are not.
how does width and depth of prep affect selection of type of resin restorative material used?
if narrow and shallow use flowable

areas tht are deep and into dentin should be filled w/ highly filled restorative resin composite
list four main types of resin composite restorative materials
large particle macrofilled microfilled
small particle macrofilled
describe polishing characteristices of the 4 main types of resin composite restorative materials
large particle macrofilled are hard to polish

microfilled are highly polishable but not v.strong

small particle macrofilled are easy to polish

hybrids are combined properties of microfilled and macrofilled in terms of polishability and stregth
what differentiates a hybrid composite from other types of resin composite?
hybrids were devedloped in an attempt to combine the beneficial properties of microfilled and macrofilled materials. It has some microfiller particles and some macrofiller particles so it has a hi degree of fx resistance in stress bearing
what are main advantages associated w/flowable hybrid composite?
flowables have lo viscosity and can be syringed directly into cavity prp. thay are reistant to slumping, but can not be scupted like most highly filled hybrids. they have versatile delivery system, and lo modulus of elasticity
list advantages of resin composite
esthetic, mercury free, lo in thermal conductivity, bondable
what are 2 most important criteria that must be met for a successful posterior resin composite restoration
proper case selection and use of appropriate materials and techniques
describe basic physical characteristics of resin composite restorative material
polymerization shrinkage causes stress at restoration margins

hi coeffieint of thermal expansion may lead to loss of adhesive bond as stress is placed on it by great reange of temps in oral environment

wear resistance, poor wear rates in past but now rivaling amalgum
list indications for use of resin composite in posterior
when estetics are of primary importance.

if pt has known mercury sensitivty

in conservative Class I and II lesions where conservative preps can be made

in Class I and II lesions of deciduous teeth
list contraindications for use of resin composite in posterior
large restoration where forces of occlusion would be great

pts w/hi caries rate and poor OH

signs of excessive wear

when buccolingual width of prep can be kept to minimum

when cusp replaement is involved

when moisture control is not possible
define the term C factor and explain its importance in resin composite restoration
C factor is number of bonded walls divided by number of undbonded walls. A hi C factor value indicates a greater amound to stress within restoration bc more bonded walls means more stress due to polymerization shrinkage
describe proper technique for prep and insertion of Class I occlusal cavity using resin composite
select shade
mark centric stop
apply adhesive
restore w/esthetX or TPH3
remove rubber dam
check occlusion
seal w/fortify
list 3 main components of resin composite
filler particle
coupling agen to bind filler
composite surface sealant
what are four structural compnents of a resin compostie?
polymer matrix(Bis GMA)
glass filler particles
coupling agent (silane)
what benefits fo filler impart on resin?
improves translucenty

reduces coeffient of thermal expansion

reduces polymerization shrinkage of composite

makes material harder,denser, and more resistant to wear
what is coupling agen used to bind filler to matrix?
silane to promote adhesion of filler to matrix. W/O it strength of cohesive mass is reduced and filler particles ten to be lost for surface
what are some undesirable characteristics of resin composites?
polymerization shrikage

marginal gaps which cause microleakage

hi thermal expansion coeffienct so they expant and contract
what are some things that are recomended to help offset effects of polymerization shrkage in resin composite?
incremental curing techniques

enamel bevels

flexible resin liners

slowsetting resin modified glass ionomer liners
how does viscosity of resin composite affect its handling characteristics?
viscosity has an influence on adaptation of material to cavity wall or previous layer of composite
describe difference between opaque, dentin, and incisal shades of composite resin
dentin and opaque denote highly opaque resins that resemble dentin

body shades represent enamel in opacity/translucency and shade

translucent or incisal has more translucenty for purpose of simulation highly translucent areas
what are 2 major types of resin composites descibed?
microfilled resin and hybrid resin
explain differences in strength and polishablilty between hybrid and microfilled resin composite
microfilled in highly polishable but not v. strong

hybrid can be polished to a fairly hi luster but not as much as microfilled but hybrids resist internal discolaration and are stronger
describe ideal circumstance for using resin composite in posterior restroation
pt not allergic to resin

good OH

centricl occlusal stops located on tooth structure

pt should not have excessive wear on posteriors

tooth should be easy to isolate

esthetic concern

faciolingual width of cavity prep should be no more than one thrid of intercuspal distance

all cavosurface margins should be on enamel
explain what informed consent is and how it relates to tx planning for posterior restorations
tell pts proposed procedures and risks associated w/it and other options.
what does amout of filler particle in resin affect?
it increases physical, chemical, and mechnaical properties of resin

it also improves translucenty, reduces coeffieint of thermal expansion, reduces polymeriazation shrikage, and makes material stronger, harder, denser, and more resistnat to wear
what must you inform pt when doing a posterior resin restoration
that it takes longer to complete

costs more

less durable than amalgum
what enamel do you NOT bevel?
do not bevel occlusal enamel cavosuraface margin
retention form
ability of restoration to avoid dislodgement
convenience form
ability to access and see all caries and cavity walls
resistance form
abilty of restoration and tooth to resist fx
GV blakcs 7 steps of cavity prep
1.outline form
2.resistance form
3.retention form
4.convenience form
5.caries removal
6.finish walls/margins
7.prepare toilet of cavity
descibe ouline form of GV blacks cavity prep
smooth flowing no sharp angles

proper extension including all carious pit and fissures

remove all caries on all enamel walls to .5 into dentin

prefer cavosureface margin on smooth surface and not in an area of occlusal contanct

do minimum width needed to conserve tooth structure
descibe resistance form of GV blacks cavity prep
resists fx

smooth gingival wall at rt angle to Long axis of tooth

walls are rounded

no undermined enamel

no bevels at occlusal cavosurface margin
minimum depth of pulpal wall in natural tooth
1.5 mm
descibe retention form of GV blacks cavity prep
holds restoration in tooth

need adequate enamel at all cavosurface margins

adequate isolation to assure good retention

dove tails placed
descibe convenience form of GV blacks cavity prep
adequate access for instrumentaion

make sure all caries in prep can be visualized and removed
describe caries removal step of GV blacks outlin form
all remaining careis removed from pulpal wall beyond DEJ (deep caries toward pulp removed)
describe toilet prep of cavity prep outline
all debris is remoed

pumic and chorhexidine w/ICB brush
list 3 basic prerequisties for dental careis
bacterial dental plaque

suitable substrate (sugar)

tooth in oral environment
define and contrast primary and secondary types of careior processes
primary process-decalcification of inorganic portion of tooth/bacterial enzymatic action on concentrated slns of readily fermentable carbs produces the metaboite (acid) responsible for decalcification; this acid production is localized to tooth surface by organic plaques

secondary process is proteolysis and disintegration of organic tooth structure
list major factos that influence carious process
chemistry of salivary environment


prenatal conditions of tooth dev

systemic conditions

inherent resistance or immunity to caries
distinguish between enamel and entin on natural tooth
during cavity prep dentin is seen as more yellowish,dull, and unglaxed when compared to ename. It also has greater yield than enamel when scratched w/explorer
discuss physical make up and appearance of dentin and enamel tooth structure
enamel is made up of enamel rods that are perpendicular to tooth surface; therefore it nees underlying dentin to support it

dentin is relatively orgain ans separates the pulp from the enamel or cementum. It is softer that enamel, therefore caries progresses more quickly through denin than enamel
describe and ID various classification of caries
-smooth surface
-cemental (rooth) of severity
-acute caries involving
many teeth
-chronic caries (long
standing w/less # teeth
why does caries progress through dentin more rapidly?
bc softer than enamel
what do invagination like pits and fissures do to enamel?
decrease enamel thickness in areas and act as food traps so these areas are prime caries susceptible areas
dentin formed in response to caries
reparative dentin

its formation is a protective barrier to shild pulp from stimulus
describe 6 stages of caries process
1.incipient caries (slight penetration into the enamel)
2.dentin involvement (undermining of enamel)
3.moderate enamel destruction (loss of portions of enamel)
4.beginning pulpal involvement (extreme loss of enamel and dentin)
5.pulpal degeneration (invasion of pulpal tissue)
6.gross loss of tooth (pulpal necrosis)
explain how a caries risk assessment relates to tx planning process
caries risk assessment analyzes several factors that serve as predictors for increased incidence of carious lesions; oncle the pts caries risk has been assessed the pt is placed into one 3 categories for caries risk (hi,moderate,low) this categorization will inflence decisions made during the tx planning procedure in regular to preventatve care and restorative care
list major factors used in caries risk assessment process
1.presence of active caries

2.hx of dental restorations (tells past risk but not present)

3.plaque control

4.flouride use

6.saliva (buffer,cleans teeth)
understand and explain use of form for caries risk assessment in our clinic
the caries risk assessment can provide help in creating a tx plan that will most benefit each individual pt. it can help make decisions involving the need for additional preventative care and how aggressive the restorative tx plan should be
describe various options available for preventative tx dental caries
fluoride tx
antimicrobial rinse
preventative resin sealants
chronic caries
long standing lesion less number of teeth involved

bron in color w/leather appearance
is routine use of test for salivary count for mutans streptococcos recommeneded?
no bc low counts predict lo risk but hi counts does not necessarily mean hi risk
what is relationship between hi salivary count of mutans strptococcus and dental caries?
hi salivary counts of mutans streptococci will have multiple carious lesions
how are BWX utilized to support visual inspection of teeth for pit and fissure careis
to show carious dentin w/large lesions
according to autor what is most important careis risk factor that can be ID in pts medical records?
dry mouth
how can caries activity be assessed and why is ti important to know if a caries lesion is active?
occlusal lesion-white spot, cavitated, visible in dentin in BWX

proximal-BWX, inflam

smooth surface-clinially visible, white spot by gingival margin, cavitated
what indicates that lesion is in arrest?
shiny white or brown lesions often well exposed due to recession

lesion not covered by plaque

cavitated lesions often dark brown w/hard dentin at their bases
explain purpose and general methods for condensation of class I amalgum resorations
condensation is forecful compaction of amalgam into any cavity prep. it accomplishes the following:
1.adapts amalgums to walls
and angles of cavity prep
2.increases compactness and
strength of amalgum
3.control amt of excess Hg
in restoration
how is excess Hg removed from amalgum restoration/
Hg is broght to surface of restoration during condensation and is removed during carving sothat the final alloy/Hg ratio is 50/50
explain purpose and general methods for carving of Class I amalgum restoration
objective of carving is to restore anatomical form and funciton to tooth. the anatomy should bereproduced as ideal as possible. the following are some basic carving priniples:
1.caring should commence
immediately after
2.carving instrucments
should always be sharp
3.carving should start
distal and come mesial to
maintain proper visibilty
4.edge of carving blade
should be rested half on
tooth and half on amalgum
5.amalgum should only be
carved in 2 directions;
from tooth to amalugum or
parallel w/margins
Id and describe use of each instrumen utilized in process of condensing and carving a class I amalgum restoration
amalum carrier-carries increments of freshly triturated amalgum to prep

condenser-begin w/largest round condenser that will fit in prep; condense in stepping motion,start from middle then walk to walls

carver-used to make tooth anatomy
Id and describe specific content, physical properites and manipulation times of amalgum alloy in preclinic
we use dispersealloy in preclinic. it is mix of 50% alloy and 50% mercury.

It allows for a total working time of 10.5 min from start of trituration to completion of carving. you should allow yourself 3.5 min to condense and 7 min to carve. If you carve for over 7 min you risk fracturing material and chipping away at margins
describe steps and explain need for proper handling of amalgam in relation to its mercury content
amalgum should never be toched w/ your fingers or it will become moisture contaminated. moisture can react w/Zinc in amalgum, hydrolyzing it and potentially causing excessive delayed expansion and corrosion of restoration
compre appearance and texture of properly mixed amalgum alloy w/ that of improperly mixed amalgum
if properly triturated, amalgum should be bright and have plastic consistency. If it is excessively wet looking or crumbly or grainy then trituration should be increased. A mix that is hot, or appears v dry and hard and sets fast requires a decrease in trituration time or amalgamator speed
what defines hi copper alloy and what is main advantage of their use?
hi copper amalgum alloys contian between 12-30% copper and at least 40% silver. this composition decreses corrosion by eliminating the weak gamma 2 phase which existed in lo copper dental amalgums
what does current research reveal concerning safety of amalgum restoration in relation to Hg content?
no confirmed evident to indicate that the Hg in dental amalgum is related to any disease. research reveals that no toxic effect has been linked to levl of mercury relesed from amalum even when amalgum restroations are removed
what is difference between lathe cut,spherical,and admixed amalgum?
lathe cut powder of alloy-made by milling an ingo of the alloy. spherical type alloy made by atomizing liquid allowy (spherical particles not true spheres but take on various round shapes) theree are lathe cut amalgum alloys,spherical alloys and those containing both called admixtures
is an allergic rxn to amalgum common?
of those w/allergy fewer than 1% show rxn to Hg in dental amalgum restorations
what are advantages and disadvantages of dental amalgum restoration?
advantages-strong,durable and easy to use. wears at rate similiar to tooth structure. corrosion products reduce microleakage at tooth interface, lo cost

disadvantages-not tooth colored. does not naturally bond to tooth. the vapor fro mthe mercury in dental amalgum can be harmful
what is relation between area of surface on face of conder and amt of force required for condensation?
larger condensers exert less condensation pressure than smaller. larger condensers should be used for spherical amalgum
what are different handling properties of spherical amalgum compared to lathe cut or admixed?
spherical alloys require lower mercury-alloy ration and less condensation force. direction of force is really important. it does not adapt to cavity walls as well as lathe cut or admixtures.
it is harder to get good interproximal contacts when doing class II amalgusms w/spherical

good thing about sphericals tho is the shorter working time and set faster than lathe cut or admixed. also spherical alloys are NOT sensitive to condensation pressures
what tecnique can be used to assure preoper lateral condensation of amlgum aginst walls of cavity prep?
1.alter face of condenser so face is pushed toward walls condenser in prep vertically then move it laterally toward walls so that the side of the condenser condenses amalgum against the walls.

tecniques are v. important for spherical amalgusms
how does residual mercury in an amalgum restoration affect its properties?
the lower the residual mercury in the carved restoratrion the greater its strenth and the beter the expected longevity of the restoration
when should precarve burnish take place?
immediately after condensation completion
why does text recommend sterilized sharpening stone be available whle carving?
bc amalgum rapidly dulls carvers
what methods can be used to aid in avoiding in getting flash when placin amalgum?
a jagged/rough appearance at margin=flash

id by tracing pt of explorer from enamel to amalum using tactile sense. parallel and perpendicular from enamel to amalgum using carver to remove flash
what 2 techniques aid in admustment of occlusal contacts on amalum restoration
checkin occlusion upon completion of restoraion is done using articulaing ribbon which marks pts of contact. dont have pt bit on ribbon or the amalgum will fx ask them to close near conatct and the manually manipulate mandible so that the two arches tap each other. an alternate method whould be to ask pt to gently tap teeth togther

can also use shimstock after restoration completion
function of putting fortify on completed resin restoration
it seals the microcracks that form on the occlusal surface of the composite during finishing and polishing
most common human disease
dental caries
most reliable indicator of caries risk
active caries
caries risk assessment
active caries

number of restorations




what to look at when looking at restoring teeth
tooth structure

age of tooth

caries risk
purposes of condensation of amalgum
1.adapt amalgum to walls and angles of prep

2.increase compactness and strength of amalgum

3.control amt of excess mercury to bring Hg to surface so it can be carved off(only want alloy/Hg ratio of 50/50