5. Class I Amalgam Restoration Flashcards
Dental Amalgam :
A metal alloy consisting of a combination of ____ with a mixture of ____
Mercury is mixed with the powder and produces a plastic-like material that can be pressed into a prepared cavity prior to hardening
Dental Amalgam has a metallic silver appearance
It is primarily used for restorations where esthetics are not a major concern
Typically used in ____, ____, and ____ restorations in posterior teeth
mercury silver-tin-and-copper I II V
Dental Amalgam
Dental Amalgam has been the subject of intense research concerning mercury toxicity and environmental concerns.
Is the most thoroughly ____ and researched dental material
Most lay people (and even many dentists) are unfamiliar with the scientific dental literature
Are more easily convinced that amalgam is dangerous based on allegations from anti-amalgam activists
tested
The FDA, CDC, and WHO ALL have found ____ evidence of harm directly related to dental amalgam
Research has demonstrated:
the safety of dental amalgam
the success of amalgam restoration
Use of high volume evacuation (suction) and rubber dam should be used to isolate the patient and reduce intraoral mercury vapor present during amalgam insertion
After initial setting, the material has hardened to a solid and the released ____ drops
Proper amalgam handling and disposal procedures should be used
no
vapor pressure
Use of mask and gloves during all amalgam procedures required
Collect and dispose of all unused amalgam and capsules in designated sealed containers
Rubber dam will be used on designated procedures in the preclinical laboratory
Cannot place rubber dam(s) on the ____ and ____ arches at the same time
Rubber Dam should be used on ____ operative procedures in the Clinic
maxilliary
mandibular
all
Indications:
Amalgam is a predominantly used restorative material The material of choice for:
moderate to large Class I and Class II preparations (especially those with heavy occlusion, hard to isolate, or with margins on the root surface)
Used to overlay ____
Used for ____ restorations
Used for patients with moderate to severe caries susceptibility
cusps
core build up
Advantages: Strong and durable material Relatively easy to use Wears at a rate similar to \_\_\_\_ structure Slight amount of corrosion occurs decreases \_\_\_\_ at cavosurface margin Not time consuming to place Low Cost
Disadvantages: Not tooth colored Does not bond to tooth structure \_\_\_\_ ---Needs \_\_\_\_ component ---- Bond strength not \_\_\_\_ Could be allergenic Contains mercury Must be handled properly Mercury vapor can be hazardous to practitioner and staff
tooth
microleakge
independently
adhesive
signficiant
Amalgam Restoration
Smear Layer
Unoccluded dentinal tubules– open to the environment
Smear layer – plugs the ____
tubules
Conventional Amalgam Restoration
1. cleanse cavity preparation
2. USED to: place cavity varnish to seal dentinal tubules temporarily while restoration margins seal by corrosoion( not done at SDM anymore)
3. place amalgam
____ – plug material into preparation
____ – remove excess and refine anatomy
____ – make shiny and smooth with a rubbing motion
____ – after the amalgam has hardened (at least 24 hours)
condense
carve
burnish
polish
Bonded Amalgam Restoration
1. Cleanse and ____ the cavity prep
Conditioning: Alters the internal surface layer (removes the ____ completely)
2. Place ____ to seal the dentinal tubules
3. Place amalgam as in the conventional method
____
Carve
____
Polish
condition smear layer dentin bonding agents condense burnish
Bonded Amalgam Restoration
Conditioning done with the use of an acidic solution 1. Removes \_\_\_\_ in enamel 2. Removes \_\_\_\_ components in dentin 3. Removes the \_\_\_\_ \_\_\_\_ the dentinal tubules
Bonding Agent placement accomplishes:
- Infiltration of resin monomers into demineralized ____ and ____
- Replacement of the smear layer –
- the dentinal tubules are occluded with the ____
hydroxyapatite
organic
smear layer
opens
enamel
dentin
adhesive resin
Bonded Amalgam Restoration
The Adhesive layer:
Has shown to be successful in providing a ____ seal
Significantly reduces marginal ____ Decreases post operative ____
dentinal tubule
microleakage
sensitivity
Bonded Amalgam Restoration
Bonded amalgam technique ____ show significant “bonding strength” of amalgam to preparation (3-6 megapascals)
Long term clinical studies are needed to further support the bonded amalgam restoration as a superior procedure over the traditional amalgam restoration.
CONTRAINDICATED FOR ANY INDIVIDUALS WITH SENSITIVITY TO ____
does not
methacrylates
Prime & Bond NT Dual Cure
To be left up in the front of each group
____ use ONE DROP of each component only
conservatively
Cleansing /Conditioning Cavity
Place syringe tip onto Phosphoric Acid Tooth Conditioning Gel syringe
Gently syringe the tooth conditioner into cavity preparation – WAIT ____ SECONDS
Rinse with ____ vigorously for ____ SECONDS
Air dry slightly, leaving moist
Blot dry with cotton pellet
Bonded Amalgam Restoration
Prime & Bond NT Dual Cure Adhesive
Use 1 drop of Prime and Bond NT and one drop of Self Cure Activator into small end of glass dappen dish. Replace caps tightly.
Mix together with composite brush
Scrub into the preparation vigorously for ____ seconds, keeping surfaces moist
15
water
10
20
Bonded Amalgam Restoration
Prime & Bond NT Dual Cure Adhesive Remove excess with air syringe for \_\_\_\_ seconds. Surface should have a uniform \_\_\_\_ surface If not, repeat application of adhesive and air dry
Amalgam Bonding Accessory Kit
Place one drop of Amalgam Bonding Catalyst and one Drop of Amalgam Bonding Base into clean glass dappen dish
Mix well with NEW composite brush
Apply mixture in the cavity preparation
Air syringe excess
Begin amalgam trituration
5
glossy
Preparing the Amalgam
Tytin Double Spill
600mg alloy + 447mg mercury
Average \_\_\_\_-surface restorations
Working time \_\_\_\_ minutes
Setting time
\_\_\_\_ minutes
Trituration (Mixing)
Capsule is put in the amalgamator
Time and intensity of mixing is selected
Remove amalgam immediately from capsule following trituration
Should appear ____ and ____ immediately after mixing
two 3-3.5 4-4.5 shiny coherent
Placing amalgam
Keeping nozzle in contact with the tooth, a small increment is squeezed out against the pulpal wall by depressing lever
____mm –____mm thickness of amalgam
1 1/2
2
Condensation
Amalgam is thoroughly condensed into retentive areas buccally and lingually
Condense with firm pressure
Rocking, wiping and sweeping motion for ____ alloy (Tytin)
Condense into all B and L line angles
Add in increments from the original mix
Condense within the cavity
These procedures are repeated until preparation is overfilled
spherical
Carving and Contouring
Allow amalgam to set until sufficient crystallization has taken place to permit carving and contouring
Recontouring can be initiated with burnishers or carvers
Carving can be done with any sharp instrument ____
____
hollenback
discoid-cleoid
Carving and Contouring Goal: Restore natural contour of tooth
Remove excess amalgam beyond cavosurface margin
Restore primary anatomy
Deeply carved grooves and pits are avoided
Complete carving within time of complete setting of the amalgam
Carving and contouring Precarve with an \_\_\_\_ Burnisher: Burnishing with large burnisher is a form of \_\_\_\_ Acorn burnisher (21B) Use to obtain \_\_\_\_ anatomy
acorn
condensation
occlusal
Carving and contouring
Always carve amalgam from tooth ____ amalgam
Carve parallel to ____ margin
Use natural tooth as a rest for the instrument and guide
Will prevent creating divots
Overcarved amalgam deep occlusal grooves
toward
cavosurface
Burnishing
Burnish ____ times
First burnishing
Heavy pressure during condensation Example: ____ Burnisher 21B
Second burnishing**
Just after initial carving Example: ____ Burnisher 21B
Final burnishing**
After recarving
Example: ____ Burnisher, Ball Burnisher 26/27
acorn
acorn
Tball
Burnishing
Smoothes and polishes the carved surface of amalgam with amalgam burnisher
improves ____ adaptation
smoothes surface
Lessens need to recontour during finishing and polishing
**Be Careful not to change contour by burnishing too earl
When Burnishing Complete
Verify sealed margins when amalgam is set
Verify proper occlusal anatomy
Remove Rubber Dam
Verify occlusion with articulating paper
marginal
Matrix Band
Squeeze the ends of the band to form a loop
Smaller diameter
Towards ____
Larger diameter
Towards ____
Place ends of of the matrix band in the matrix holder
Maxillary Molar Amalgam Restoration
gingival
occlusal
Matrix Band
Position the matrix band in the matrix holder
____ circumference will be on the same side
of matrix holder as open ends of retaining mechanism
____ circumerence
toward the closed end of the retaining device
smaller
larger
Checking Occlusion
Check occlusion with articulating paper
Eliminate any high spots with a carver
Clinically: Check ____ occlusion (MAXIMUM INTERCUSPATION) and ____ movements
Clinically: Patient instructed not to chew on the side of the mouth until a few ____s later
centric
lateral
hours
3 rules of occlusion
- The functional cusps rest in marginal ridge areas except ____ cusps of maxillary molars and ____ cusps of mandibular molars which rest in their respective opposing ____.
The occlusal markings in an ideal tooth relationship
mesiolingual
distobuccal
central fossa
Why Check Occlusion?
Undercarving or leaving excess
May cause patient to touch prematurely
Feels “high” to patient
May result in occlusal trauma to tooth and
supporting structures
Frequently causes amalgam to fracture (pain)
If premature contacts are not removed
____ spot or ____ facet will appear on amalgam
shiny
wear
