Ch.48

Front 1

General Dentistry also referred to as a creative Dentistry Remains the primary responsibility of the dental dentist. Just wrap your presents background knowledge and describe the skills needed for the clinical dental assistant to get knowledge of restorative and aesthetic procedures such as amalgam restorations in composite resin restoration intermediate restoration resin veneers, and tooth whitening procedures restorative Dentistry is indicated when teeth are to be restored to their original from warm and safe through the use of direct and indirect restorative materials specific conditions that determine the need for restorative Dentistry include the following in your soul or recurring became cavity replacement of a failed restoration abrasion or wearing away of the tooth structure erosion of tooth structure esthetic Dentistry is devoted primarily to improving the appearance of teeth by repairing imperfections with direct and indirect restorative material or by using whitening techniques specific conditions that result in the need for a treatment include the following discoloration caused by interested or interesting staining and normally caused by developmental disturbances normal spacing between teeth trauma

Back 1

Cavity preparation to restore a 2 to its normal function while still maintaining its aesthetic appearance, the dentist must Master a technique that involves following. specific steps to complete the process of restorative Dentistry. When preparing a tooth for a permanent restoration, the dentist has acquired knowledge about the direction of the enamel rods, the thickness of the enamel, the body of the Dentin, the size and position of the pulp, in the crown of the tooth as it relates to the gingival tissues.

Terminology

An understanding of the terminology of a cavity preparation will help you to know which Dental instrument, Dental accessories, and dental materials to have ready at the appropriate times throughout a procedure. The Pacific terminology refers to the anatomic structures as they relate to the cavity preparation, which is especially helpful for expanded function dental assistant efda in the application of the dental materials in the intermediate Restorations. See box for the 814 to preparation terms cavity preparation is the process of removing diseased tooth structure while leaving a limited amount of healthy tooth structure for the two to remain in a restoration the principles of the cavity preparation are divided into two stages each with several steps the dentist for all of these steps in the exact order so the ideal results are achieved.

The initial preparation cavity preparation involves the initial design an extension of the preparations external walls to a limited depth the factors listed below or an intended to help the dentist gain access to the Decay or defect and reach sound to structure the objectives for initial cavity preparation are as follows outline form the dentist decide on the design and initial depth of sound to structure resistant form the dentist determines the primary shape and placement of the cavity walls retention form the dentist knows where to place retention in the preparation to help in securing the restoration and place convenient for the dentist has excess ability in preparing and restoring the tooth.

Final preparation after the initial cavity preparation, the dentist will continue the procedure with the final cavity preparation. This includes the following removing any remaining animal with it then the preparation, disease Denton or old restoration material or a combination inserting the additional resistance and retention launches rules and coves to provide strength and maintenance of the restoration placing protective Dental material, which may include lining agents, bases and desensitizing or bonding agents, for pulpal protection and better retention

Front 2

Standardized plan for restorative procedure:

Communicate with the patient about the procedure about what to expect during a treatment. Position the patient correctly for the dentist and the type of procedure the dentist will evaluate the tooth to be restored the dentist will administer local anesthesia prepared the type of moisture control to be used for the procedure cotton roll, triangle, dental dam the dentist will prepare the teeth for the restoration this includes the use of the Dental Hand instruments in Dental handpieces with rotary instruments the dentist will determine the type of dental materials to be used applied the dental materials burnish, carb or if the Finish Dental material check the occlusion of the restoration finish and polish the restoration.

Dental assistant role in the restorative procedure:

Be familiar with the procedure, and anticipate the dentist needs prepare the setup for the restorative procedure. Provide moisture control and better visualization for the dentist by using high-velocity section in the airway water syringe transfer Dental instruments and accessories. Provided proper mix and transfer a dental materials. Perform any required legal expanded functions. Maintain patient Comfort throughout the procedure. Maintain appropriate infection control precautions.

Permanent restoration:

A permanent restoration can be anything from a small class 1 restoration to an extensive Class 2 multi surface foundation. With the exception of steps added to the process by using supplementary accessories in Dental materials, and restorative procedure will follow a standardized format.

Class 1restoration:

The class 1 cavity, or Legion, is one of the four surface lesions involving the pits and fissures of the 18th. Because of this anatomic feature, black and debris will accumulate within these areas, making it difficult for a patient to keep areas clean. Therefore, the pits and fissures are highly susceptible to Decay. Class 1 Decay involves the following areas of concern;

Occlusal pits and fissures of premolar and molars. Buckle pits and fissures in mandibular molars. Lingual pits and fissures of maxillary molars. Lingual pits of maxillary incisors, most frequently mirror the cingulum.

Tooth preparation:

The occlusal or lingual class 1 cavity preparation is a simple preparation for the dentist. The outline of the cavity preparation involves the pit, the groove , or fissures that is decayed. The dentist will use a bur to open the enamel, taking care not to create any sharp angles or Corners within the preparation. The preparation should be a smooth throughout the internal structure. The location of the restoration and they didn't even will determine the type of permanent restorative material to be used. Because the class 1 lesions are small Restorations and most likely do not interfere with occlusal forces, the dentist will often select a composite resin material for the permanent restoration.

Special consideration:

Because class 1 restoration can occur on the occlusal surface, the dentist must evaluate the patient's occlusion after replacing tooth structure. An easy way for the dentist to review how the tooth occludes with an opposing tooth is to Mark the occlusion with articulating paper after restorative process.

Class 2 restoration:

The cost to Legion is an extension of the class 1 cavity into the proximal surfaces of the premolars and molars. The proximal Services of the truth can be more difficult to keep Decay free, expecially if a patient is not disciplined with the routine flossing regimen. Class 2 Decay involves of the following areas to surface restoration of a posterior tooth, three surface restoration of a posterior tooth, multi surface restoration four or more surfaces of a posterior tooth.

Tooth preparation:

Because of the difficulties involved in reaching the proximal surface of what the handpiece or hand instrument, the dentist will involve the occlusal surface in the preparation and restoration of the tooth. A Class 2 restoration can be term conservative, or it involves two surfaces of a tooth, or a comprehensive or it involves four or more surfaces in the removal of a cusp. The Decay me extend from the enamel into the Denton this could require placement of additional retention in the cavity preparation and the use of bonding material. Amalgam or composite resin can be selected as a direct restorative material for Class 2 restoration the dentist often will select amalgam if strength is required and composite resin if esthetic is a factor.

Special consideration:

The outline of Class 2 preparation involves removal of one or both of the proximal surfaces. Because the mesial or distal or both walls are missing, little to no support is available to hold the material in place, so a matrix system must be used for this procedure. See chapter 49 on the description and placement of posterior Matrix.

Back 2

Class 3 and 4 restoration:

A class 3 lesion affect the interproximal surfaces mesial or distal of incisors and canines. A class 4 lesion involves a larger surface area or distal, which includes the incisal edge in the interproximal surfaces of the incisors and canines.

Tooth preparation:

The anatomy of the anterior teeth is such that the dentist is able to access the interproximal surface without affecting other surfaces of the teeth. If possible, the dentist will enter the tooth from the lingual surface to reduce the size of restoration from the facial aspect. If the Decay has moved subgingivally, special precautions are used to keep the area isolated and dry during restorative process.

Because incisors and canines are still visible, Esthetics is a concern. The dentist will select a composite resin when restraining the class three or four cavity. It is important to pay attention to the shade selection to the composite resin material use natural lightening, and involve the patient in this selection.

Special considerations:

It is advisable to use a dental dam during preparation and restoration of class 3 and 4 lesions. This type of isolation provides better retraction of gingival tissue and maintains a dryer environment. The dental pay attention to the contouring of the class 3 or 4 restoration, making sure to reproduce the correct Contours and contact. To help and the contouring process, and Myler Matrix system is used in the restoration process. See chapter 49 on the description and placement of anterior Matrix.

:

The crossfire restoration is classified as a smooth surface restoration. These Decay lesions occur on the gingival third of the facial or lingual surfaces of any tooth. In the older population, classify lesions are also tend to occur on the root of the tooth, near the cementoenamel Junction.

Tooth preparation: as was a class-one restoration, The Quest V lesion is prepared by having a smooth outline with no angles. The location of a class 5 lesion determines the type of material selected. The dentist would prefer to use a composite resin material for esthetic purposes, but the moisture control factor in this area May prohibit its use.

Special considerations:

Class 5 restoration:The crossfire restoration is classified as a smooth surface restoration. These Decay lesions occur on the gingival third of the facial or lingual surfaces of any tooth. In the older population, classify lesions are also tend to occur on the root of the tooth, near the cementoenamel Junction.Tooth preparation: as was a class-one restoration, The Quest V lesion is prepared by having a smooth outline with no angles. The location of a class 5 lesion determines the type of material selected. The dentist would prefer to use a composite resin material for esthetic purposes, but the moisture control factor in this area May prohibit its use.Special considerations:One of the most important considerations for the dentist when restoring this area of the tooth is proximately of the gingiva to the legion. It is of utmost importance to be able to retract the gingival away from the legion during the preparation and restoration stages and keep the area is clean and dry as possible. The application of the dental dam provides this added gingival retraction period is cervical clamp should be used in this procedure to move the dental dam subgingivally. If a dental dam is not place, the dentist me select the placement of the gingival retraction cord for better visibility and for a reduction in moisture and Hemorrhage from that area.

One of the most important considerations for the dentist when restoring this area of the tooth is proximately of the gingiva to the legion. It is of utmost importance to be able to retract the gingival away from the legion during the preparation and restoration stages and keep the area is clean and dry as possible. The application of the dental dam provides this added gingival retraction period is cervical clamp should be used in this procedure to move the dental dam subgingivally. If a dental dam is not place, the dentist me select the placement of the gingival retraction cord for better visibility and for a reduction in moisture and Hemorrhage from that area.

Front 3

Complex restoration:

In a certain situation during tooth preparation, to structure loss will become greater than what it is remaining of the natural tooth. And these cases, the dentist must decide whether to number one move ahead and restore the truth with their direct restoration, or to change the treatment plan and advise the patient that an indirect restoration would be more suitable. It's the dentist and the patient agreed to move ahead with their direct restoration, additional techniques can be used to help retain or hold the restoration and place.

Retention pins:

If Decay has extended beyond the normal size or shape, it may be necessary for the dentist to be use a stronger system to retain and support the restoration other than retentive grooves or bonding materials. Retention pins can provide this additional means. For example, a pen may be required when the tooth decay has extended in the distal lingual cusp comma undermining the enamel and Dentin. In general, when the retention pins are used, one pin is placed for each missing cusp. Pins are available in several diameters within Styles. The retention pins have deep threads that group but they did dentyne when screwed into the tooth structure. The other end of the pen grips the restorative material. Because all pins are very small and are easily misplaced or dropped, it is essential that the dental dam be placed during the process of preparing and placing the pins.

Intermediate restoration:

An intermediate restoration is a temporary restoration that can be placed on any tooth or Surface for a short. Of time. The use of this type of respiration is primary step toward providing a patient with permanent restoration. The dentist would recommend placement of an intermediate restoration for three primary reasons number one to wait and determine the health of a tooth, number two while waiting to receive permanent restoration, or number three for financial reasons. Chapter 43 discuss the type of dental material commonly used when a temporary restoration is required immediate restorative material irm is the type of material most commonly used for procedure when tooth structure is replaced because this is a short-term rather than a permanent restoration, many states have approved this procedure as an expanded function for a certified dental assistant.

Veneers:

Veneer is a thin layer of tooth colored material that is applied to the facial surface of a prepared tooth. Veneers may be placed on one or more anterior teeth to improve their appearance. Veneers are used to improve the appearance of the teeth that are slightly abraded, eroded, discolored with intrinsic , or darkened after endodontic treatment. Veneers can be used to improve the alignment of teeth or to close a diastema. Two or more techniques may be used in the placement of veneers. The direct technique uses a composite resin to create a veneer that is bonded directly to the tooth surface. A porcelain veneer prepared in the Dental Laboratory and then cemented to the tooth surface is known as the indirect technique. See chapter 54 the indirect technique. Regardless of the type of veneer that is applied, the patient is advised of the following: veneers have limited life span and must be watch for anywhere, shipping, or discoloration that may occur and required replacement. Good oral hygiene is important to keep the surfaces in margins for a plaque and food debris. Biting on hard substances such as ice and hard candy could fracture the veneer.

Back 3

Tooth whitening:

Teeth whitening, also referred to as vital bleaching, is a non-invasive method of lightning the color of dark or discolored teeth. Tooth whitening has become a routine procedure that includes both in office option and professionally supervised at home options. The three primary indications for having a tooth whitening procedure are number one extrinsic stains from food, cigarettes smoking, coffee, or tea.2. aged teeth, and number three intrinsic stains, such as mild tetracycline stains and Mild fluorosis.

Tooth whitening is a type of treatment that is often requested by the patient. The patient must be aware that the results are not guaranteed and not permanent. Most whitening systems last for three to five years. Chapter 43 describes the composite of whitening products.

Treatment options:

In-office treatment professionally applied tooth whitening can be accomplished by the dentist in a little as 1 hour. The patient will see results, with the teeth becoming 5 Shades lighter. This appointment requires the dental team to follow Pacific criteria in the application comma complete isolation of teeth involved include use of the dental dam or light reflective resin barrier whitening agent at a higher concentration applied to facial surfaces of teeth light or Laser Source used to enhance the application.

At home treatment:

The decision to use whitening products at home under the care of a dentist as another option for a patient who wants this procedure. The patient will see results within a couple of weeks and can anticipate up to 6 Shades lighter from this process. The patient must follow specific criteria for application ,

having a custom-fitted trained me made in the dental office to hold the peroxide based gel. Have any supply of peroxide-based gel available for application for the suggested length of time period uses regimen very. Some products are used twice a day for two weeks and others are intended for overnight use for 1 to 2 weeks.

Over-the-counter options:

A variety of over-the-counter tooth whitening products are available today. Most of the products that are manufactured by the larger oral health companies are safe, reliable, and effective. However, these products will not achieve the dramatic changes that may be made with the dentist supervise product. The three types of the over counter tooth whitening systems that are most commonly used include the following ,

Brush on whitening. Brush on Whitening Gel can be purchased at most drug stores. The gel contains peroxide that, after it has been painted on the facial surfaces of the teeth, will whiten surface stains through and oxidation process. It is important to explain to your patients that they should expect a minimum amount of whitening from this technique. Other tooth whitening methods are much more effective. For this type of whitening, the brush-on gel must remain on the team for specific time, but saliva flow inhibits the effectiveness of this method. If they are not used properly, brush on whiteners can cause blotches on the teeth.

Whitening strips:

These then, flexible strips are coated with an adhesive hydrogen peroxide Whitening Gel. The patient peels off the backing like it bandaged and then presses the strip to the facial anterior teeth, ensuring that the upper edge of the strip is at the gingival margin. The remaining portion of the strip is folded onto the lingual surface. New Advanced bleaching components have been added to the strip and it and stronger adhesive qualities are available, making this choice of whitening techniques very popular, with visible results in 7 to 10 days.

Trays with bleaching gels.

Teeth whitening kits have become very popular because the process is Affordable, the patient receives good results, the results are long lasting with minimal adverse effects. Teeth Whitening Gel trays are very similar to what a patient would receive in the dental office, except that the bleaching process is completed at home. The type of kid most commonly used involves a tree that is bolted to the mouth by boiling it in water, the tray is allowed to cool slightly, and then it is placed in the mouth until it is mold to the teeth. Once the tree is completely cold, it is filled with peroxide gel and placed in the mouth for the prescribed time, which is typically around 30 minutes.

Hint 3

Abusive whitening products:

Without home and over-the-counter whitening products, the patient may have a greater potential for abuse. A patient will abuse it whitening product by not following directions or by over-using it to achieve whiter teeth. Most adverse effects are temporary, but on rare occasions, reversible tooth damage can occur.

Adverse effects of the tooth whitening:

Thermal hypersensitivity the patient may experience sensitivity to hot or cold after removal of the train and material. Recommend that the patient use sensitive teeth toothpaste when this process has been completed.

Tissue irritation:

Gingival tissue may be exposed to excessive because of improper fitting of the tree, allowing the material to use on to the gingiva. Advise the patient not to overfill the tray with material, and remind the patient to remove any excess when seating the tray.

Dental assistant role in tooth whitening:

The role of a dental assistant in the tooth whitening process involves the following functions and procedural steps assistant recording the medical and dental history. Make the shade selection. Take intraoral photographs before and after the whitening procedure. Take import up the preliminary impression for the custom tray. Fabricate and trim the tree. Provide preoperative instructions on use of the material. Assistant weekly or bi-weekly clinic visits.

Patient instructions for tooth whitening: patient instructions for the jail tooth whitening procedure includes the following brush and floss before the placement. Place gel in the tray and equal limited amounts less material is better than more. See the tree. Do not eat or drink when wearing the tray. Where the tray for the recommended time. Just continue using the tray if adverse effects occur. Discuss adverse effects or other problems with the dentist.

Legal and ethical implications one important reason a patient uses your dental practice is because of the type of dental work that is performed it is a dental steam responsibility and obligation to update their knowledge of procedures and materials. It is illegal in your state to perform expanded functions such as placement of liners and bonding agents, mattresses, and new material and techniques being used for restorative processes procedures. Remember that you are putting your patient, yourself and your dentist at liability by performing these procedures if you have not prepared and become certified in the application process.