Restorative Ii

Front 1

1. What is enamel made of?

Back 1

95% - 98% inorganic

**brittle w/ high elastic modulus and low tensile strength

**requires base of dentin for support

Front 2

2. How is amalgam?

Back 2

1. Brittle

**require bulk for strength (1.5-2.0 mm)

2. Requires 90 degree margins fro strength

3. Requires undercuts for retention

Front 3

3. What is composite?

Back 3

Filler particle embedded in a matrix

**polymerization shrinkage

Bonds to enamel and dentin using acid etch

**cavosurface margins can be butt joint or beveled

Front 4

4. What is the initial stage of cavity prep?

Back 4

1. Outline form and initial depth

2. Primary resistance form

3. Primary retention form

4. Convenience form

Front 5

5. What is the final stage of cavity prep?

Back 5

1. Removal of remaining enamel pit/fissure and/or infected dentin and/or old restorative material

2. Pulp protection

3. Secondary resistance and retention form

4. Finishing the external walls

5. Final procedures: cleaning, inspecting, varnishing, conditioning

Front 6

6. What is primary resistance form?

Back 6

Cavity features that prevent fracture of tooth and/or restorative material

1. Depth
2. Unsupported enamel
3. Residual decay
4. Sharp angles

Front 7

7. What is primary retention form?

Back 7

Mechanical undercuts required for amalgam

Mechanical and micro-mechanical for composite (acid etch)

Front 8

8. What is convenience form?

Back 8

Cavity features that provide for adequate observation, accessibility, and ease of operation

Cavity designs changes based on tooth location, patient compliance

Front 9

9. What is secondary resistance and retention form?

Back 9

Mechanical
-grooves, slots, boxes, pins

**grooves/locks length is in a longitudinal plane

**slot located in dentin on transverse plane

Cavity wall conditioning features
-enamel and dentin conditioning (micro-mechanical retention using acid etch)

Front 10

10. What occurs when finishing the external walls?

Back 10

Development of cavosurface design that produces the max effectiveness of the restorative material

Amalgam: butt joint margins

Composite: butt joint or beveled

Cast restorations: bevels

Front 11

11. What is primary caries?

What are the morphological types of primary caries?

Back 11

Original carious lesion of the tooth (never been drilled on before)

1. Pit and fissure
2. Smooth surface
3. Root surface

Front 12

12. What are pit and fissure caries?

Back 12

Areas of imperfect coalescence of the developmental enamel lobes on the occlusal of posterior teeth and maxillary incisors

Difficult to cleanse and therefore susceptible to decay if oral conditions are conducive

Front 13

12. What are smooth surface caries?

Back 13

Caries in a smooth area of enamel that is habitually unclean and covered w/ plaque

Proximal surface of posterior teeth

Ideally disrupt bacterial mass w/ daily flossing

Front 14

13. What are root surface (senile) caries?

Back 14

Rapidly progressing caries on root surface

Root surface is softer and more difficult to keep clean

**important anatomic features: CEJ
DEJ (0.5 mm into dentin when doing prep)

Front 15

14. What are residual caries?

What are secondary or recurrent caries?

Back 15

Caries that remains in a completed cavity preparation

**on pulpal floor or DEJ

Caries occurring at the borders of a restoration and then progressing under it

Front 16

15. What are incipient (reversible) caries?

What are white spot lesions?

What are brown spot lesions?

Back 16

First evidence of caries activity in the enamel

**Hasn't reached DEJ (not into dentin)

Only in enamel, opaque white when dry, normal when wet

Remineralized white spot lesion (restoration not indicated)

Front 17

16. What are cavitated (non-reversible) caries?

What are acute or rampant caries?

What are chronic (slow or arrested) caries?

Back 17

Decay advanced into dentin

**Enamel is no longer intact and remineralization is not possible

Rapid in progression

Alternating periods of demineralization and remineralization

**lesions could be dark in color w/ sclerotic dentin present

Front 18

17. What is enameloplasty?

Back 18

Grinding away a shallow enamel developmental fissure/pit to create a smooth saucer-shaped surface which is self or easily cleaned

Can also be used to enhance proper finishing of a restoration whose margins cross it

Can be used to remove caries prone geometry w/o over-extending outline

**not more than 1/3 enamel thickness should be removed

Front 19

18. What is infected dentin (outer zone of dentin decay)?

Back 19

Zone of dentin decay where bacteria is present

**collagen is irreversibly denatured, cannot remineralize, and must be removed

Front 20

19. What is affected (inner) dentin?

Back 20

Collagen is reversibly denatured, not infected and remineralization is possible

This dentin should be preserved and can be differentiated clinically by...

1. Degree of discoloration
2. Degree of hardness as evaluated w/ an explorer or excavator

Front 21

21. What are different types of abnormal tooth surface loss?

four types...

Back 21

1. Abrasion
-tooth to foreign object w/ or w/o an abrasive present
**gingival 1/3

2. Erosion
-chemical mechanical action

3. Attrition
-toot to tooth contact (parafunctional habits)

4. Idiopathic erosion
-cervical wedge shaped defects resulting from microfractures due to heavy eccentric occlusion (parafunction habit - grinding)

Front 22

22. How is the strongest enamel margin?

What is a line angle?

What is an internal line angle?

What is an external line angle?

What is a point angle?

Back 22

Buttressed by progressively shorter rods whose inner ends rest on sound dentin

Junction of 2 planal surface of different orientation along a line

Lina angle whose apex points into the tooth

Line angle whose apex points away from the tooth

Junction of three line angles

Front 23

23. What is the cavosurface angle?

What should it be?

Back 23

Angle formed by the junction of a preparaed cavity wall and the external tooth surface

Should be bwt 80 - 100 degrees for amalgam

Front 24

24. What are the classifications of cavities?

Back 24

Class I
-occlusal surface of molars / premolars
-occlusal 2/3 of F. and L. of molars
-L. surface of max incisors

Class II
-proximal surface of posterior teeth

Class III
-proximal surface of anterior teeth

Class IV
-proximal of anterior w/ incisal edge

Class V
-gingival 1/3 of F. and L. of all teeth

Class VI
-incisal edge of anterior teeth
-cusp tips of posterior teeth

Front 25

25. What is the length of the #330 bur?

What is the length of the #245 bur?

Back 25

330: 1.3 - 1.5 mm

245: 3.0 mm
(width is 0.8 mm)

Front 26

26. How is the outline form determined?

Back 26

1. Clinically by decay

2. Classical conservative class I lesion follows primary anatomy of pits and fissures

**produce marginal outline form free of sharp angles

Front 27

27. What should the isthmus width be?

What should the depth be?

Back 27

1. Width is not more that 1.5 times the width of the bur

2. Width is not more than 1/4 the inter-cuspal distance

1.5 - 2.0 mm (0.5 mm into dentin)

Front 28

28. What is resistance form or cavosurface geometry?

Back 28

1. Isthmus width

2. Depth

3. Flat floors

4. Butt joints (90 degree cavosurface margins)

5. Rounded axio-pulpal line angles

Front 29

29. What is retention form?

What is refinement and internal definition?

Back 29

Occlusally converging walls

1. Smooth walls
2. Well-defined line angles
3. Gingival wall width and contour

Front 30

30. How should the handpiece be angulated?

Where should you be during operative procedures?

Where should you be during oral examinations?

Back 30

Top of hand piece parallel to occlusal surface (or surface you are working on)

Work from behind the patient

Work from behind or beside the patient

Front 31

31. What is the criteria used to identify decay?

Back 31

1. Visual
-chalkiness radiating from occlusal fissures

2. Radiographic
-decalcified tooth structure appears darker (less dense b/c demineralized so radiolucent and darker)

3. Tackiness/physical stick w/ explorer
-aggressive probing can damage fragile enamel causing cavitation

Front 32

32. How are the cones of decay in a pit and fissure decay?

Back 32

Cones of decay at DEJ are base to base

Example: class I lesions

**decay spreads out at DEJ

Front 33

33. How can you distinguish enamel from dentin?

Back 33

1. Color
-dentin is yellower and slightly darker

2. Reflectance
-dentin is less reflective (opaque and dull)

3. Hardness

4. Sound
-enamel produces higher pitched sound

Front 34

34. What other colors can dentin be?

How are enamel rods oriented?

How are accessory grooves in cavity prep outline form?

Back 34

Brown or black when it's been exposed to oral fluids, old restorative materials, or slowly advancing decay

Perpendicular to external surface of tooth

Extend half-way bwt central fossa and cusp tip

Front 35

35. When is it necessary to flare (diverge) the marginal ridges?

Back 35

If less than 1.5 mm from contact point make 10 degree flare into marginal ridges

Front 36

36. What are the rules of rubber dam application?

Back 36

1. Minimum of five teeth isolated
2. Never end on canine
3. Stable clamp, four pt contact
(just prongs touch tooth)
4. Safety floss attached
5. Punch correct size/distance apart
6. Accommodate for crowding and missing teeth

Front 37

37. When is an anterior clamp used?

What is W56 used for?

W7?

W8?

W4?

Back 37

Retract the gingiva for class V lesion

**W means it's wingless

W56: most molar anchor teeth

W7: mand. molar anchor teeth

W8: max molar anchor teeth

W4: most premolar anchor teeth

Front 38

38. What is a W2 used for?

W27?

How is a W14 or 14a?

Back 38

W2: small premolar anchor teeth

W27: terminal mand. molar anchor teeth requiring preparations involving distal surface

Prongs are pointed gingivally

Front 39

39. What should you lubricate the dam with?

How should the dam be in relation to the sulcus?

How is the dam removed?

Back 39

Lubricate w/ water based solvent (no vasoline)

Inverted into sulculs

1. Stretch and cut septa
2. Remove clamp and frame
3. Check for missing pieces

Front 40

40. What is the distance between two holes on the rubber dam?

What happens if the distance is excessive?

What happens if the distance is too little?

Back 40

Distance from center of one tooth to center of adjacent tooth measures at gingival 1/3

Wrinkles bwt teeth

Stretching causes leakage

Front 41

41. Where should the hole be punched for maxilla?

For mandibular?

Back 41

Punch central incisor hole first (1 inch from superior dam border)

First punch posterior anchor tooth receiving retainer

1st molar - halfway from superior edge to inferior at junction of right and middle thirds

2nd or 3rd molar - towards inferior border and center of dam

1st premolar - towards superior border and center of rubber dam

Front 42

42. What is the purpose of the "s" curve?

Back 42

Preserve tooth structure around cusp and pulp horn

Also provides for proper proximal cavosurface angle

Front 43

43. What are cutting and non-cutting handpieces?

Back 43

Cutting
-excavators
-hatchets
-hoes
-chisels
-angle formers
-spoons

Non-cutting
-condensers
-mirrors
-explores
-probes

Front 44

44. What is the design of the instrument?

Back 44

1. Handle

2. Shank

3. Blade (or nib on non-cutting)

Front 45

45. How can the handle be?

Back 45

1. Eight sided or knurled

**knurled so don't slip

2. Long handled or cone socket

**cone socket allows you to but just mirror

Front 46

46. How can the shank be?

What does bending of the shank do?

Back 46

Straight or bent

1. Optimizes balance
(eliminate hand fatigue)

2. Brings cutting edge w/in 1-2 mm of the long axis of the handle

Front 47

47. What are the components of the blade?

Back 47

1. Primary cutting edge

2. Secondary cutting edge

**cutting edges can be beveled and bevel always faces away from the surface being cut

Front 48

48. What is the identification formulas of operative instruments?

Back 48

First number - width of blade
(tenth of millimeter)

Second number - angle of cutting edge from long axis of the shaft
**always greater than 50
(if have four numbers)

Third number - length of blade (mm)

Fourth number - angle of the blade from the long axis of the shaft
**always less than 50
(centigrades or hundreth of circle)

Front 49

49. What does it mean if the identification formula only has three numbers?

Back 49

Cutting edge is 90 degrees
(leave out second number)

Front 50

50. How can a chisel be designed?

How is the cutting edge of a chisel?

How is it used?

What is the difference between a regular bevel and reverse bevel?

Back 50

Straight, curved, or angled

Cutting edge is perpendicular to long axis of handle

Regular - bevel faces away from operator

Reverse - bevel faces the operator

Front 51

51. How is a hoe designed?

How is it used?

What is it used for?

Back 51

Single ended and regular bevel

Used in a pull motion

Used to smooth floors and form line angles
**esp in direct filling gold

Front 52

52. How is the cutting edge in the hatchet?

How is the hatchet designed?

How is it used?

What is it used for?

Back 52

Cutting edge is parallel to long axis of the handle

Doubled ended w/ left or right side cutting edge
(has primary and secondary cutting edges)

Used in chopping motion

Used on gingival, axial and lateral walls of proximal box (refinement)

Front 53

53. What is bibeveled ordinary hatchet used for?

What is an angle former?

What is it used for?

Back 53

Used for retentive areas and sharpening internal line angles

Combination chisel and gingival margin trimmer

Used to place dentin retention features, bevels and sharpen line angles

Front 54

54. How is the cutting edge in a gingival margin trimmer?

What is the design of the gingival margin trimmer?

How can the mesial and distal pair be distinguished?

Back 54

Cutting edge at an angle to the long axis of the blade
(has angle so #4 instrument)

1. Modified hatchet
2. Double ended and left and right sided
3. Curved blade and angled cutting edge
4. Mesial and distal pair

Distal - 2nd # is 90 - 100

Mesial - 2nd # is 75 - 85

Front 55

55. What do 100 and 75 gingival margin trimmers do?

What do 90 and 85 gingival margin trimmers do?

In general what are gingival margin trimmers used for?

Back 55

Produce a steep angle for placing bevels on inlay and onlay preps

Angled for amalgam preps

Used in proximal box to round axiopulpal line angle and remove unsupported enamel

Front 56

56. What are some "miscellaneous" instruments?

Back 56

1. Knives
-trim excess "soft" interproximal material

2. Files
-trim excess "set" interproximal material

3. Discoid-cleoid (carving)

4. Spoon excavators (caries removal)

5. Non-cutting instruments
-explores, probes, mirrors

Front 57

57. What is the design of rotary cutting instrument?

Back 57

1. Head

2. Neck

3. Shank

Front 58

58. What are some characteristics of blades?

Back 58

1. Shorter blades are more efficient

2. Twisted to decrease vibration

3. Excavating burs have 6-10 blades (rough surface)

4. Finishing burs have 12-40 blades
**less efficient at cutting but produce a smoother surface

Front 59

59. What are flutes?

How are bigger flutes?

What is the clearance angle?

What is the rake angle?

Back 59

Space between blades

Bigger flutes are more efficient at debris removal and cleaning

Angle the back of the blade makes w/ the tooth
**smaller is better

Angle the face of the blade makes w/ the radial line
**positive is not acceptable

Front 60

60. How are round burs numbered?

What are they used for?

Back 60

1/4 to 10

1. Initial entry (class III)
2. Extension for prevention
3. Enameloplasty
4. Retention features (1/4)
5. Caries removal

Front 61

61. What are the numberings for inverted cone burs?

How are they designed?

What are they used for?

Back 61

33 1/3 - 39

Rapidly tapered cone w/ apex of the cone directed toward the bur shank

Length same as diameter

Used for preparing undercuts in dentin

Front 62

62. What are the numbers for straight fissure bur?

How are they designed?

What are they used for?

Back 62

55 - 61
*greater # = greater diameter

Elongated cylinder
Flat or curved tip

Large amalgam preps (4 mm)

**when that large prep does not need undercuts

Front 63

63. What are the numbers for tapers fissure bur?

How are they designed?

What are they used for?

Back 63

169 - 173

Slightly tapered cone w/ small end of the cone directed away from the bur shank

Won't create undercuts (top diameter is smallest)

Used from crown preps (diverging walls)

Front 64

64. What is flat or rounded tip bur used for?

Back 64

Preps requiring no undercuts (crowns, inlays/onlays)

Front 65

65. What are the numbers for pear shaped burs?

How are they designed?

What are they used for?

Back 65

329 - 333 and 245

Slightly tapered inverted cone w/ small end of the cone directed toward the shank

1. Flat or curved end
2. Normal or long length
normal - length is wider than width
long - length is 3x width

Used for amalgam preps b/c produced undercuts

Front 66

66. What are some variations of the basic bur types?

Back 66

1. End cutting (956 - 960)
-used in deep proximal boxes
-do not cut on side

2. Crosscut fissures (aggressive bur)
-straight (555 - 561)
-tapered (700 - 703)

Front 67

67. What does a "L" denote?

What does a "1" or "11" on a tapered or straight fissure bur mean?

Back 67

"L" denotes longer cutting head

Denotes a round cutting end

1156 - round end plain fissure
1556 - round end cross cut fissure

Front 68

68. What are the characteristics of diamond burs?

Back 68

1. Efficient at cutting brittle substances (i.e. enamel)
2. Long life if cleaned and used w/ water spray (prevent clogging)
3. Head, neck, shank
4. Metal blank layered w/ powered diamond
5. Many shapes possible (poor numbering system
6. Used for crown preps (remove almost all enamel)

Front 69

69. What are some precautions when using cutting instruments?

Back 69

1. Pulpal protection
-use water spray to prevent disiccation of tooth

2. Soft tissue protection

3. Eye protection

4. Ear protection

5. Inhalation protections