5. Posterior Composite Preparation Flashcards
Clinical Decision Making
• The American Dental Association (ADA) indicates the appropriateness of composites for ____ and ____-sized Class I and II restorations, using modified ____ tooth preparations
small
moderate
conservative
Clinical Decision Making
• The longevity of posterior composite restorations, however, is directly related to factors such as the ____ of the restoration, the patient’s ____ risk, and operator ____
* Amalgam longer life - \_\_\_\_ * Composite plastic - \_\_\_\_
size caries technique corrosion wear
Clinical Decision Making • Guidelines for ideal lesion selection • Carefully selected Class I or Class II: -Minimal \_\_\_\_ -Minimal MIC/MIP \_\_\_\_ contact -No excessive \_\_\_\_ -Margins IDEALLY should be entirely on \_\_\_\_ -Should be able to be \_\_\_\_ well -Non involvement of \_\_\_\_
* Don't want a lot of occlusal contact bc it will \_\_\_\_ * Don't want a MODL in composite - if someone broke a cusp of it off, you'd place an \_\_\_\_ instead
isthmus width occlusal wear/bruxism enamel isolated cusps
wear
onlay
Clinical Decision Making
• Advantages
- ____
- Micromechanical bond to tooth structure
- ____ tooth structure removal
- Easier, less complex tooth preparation
- Increased ____
- Increased strength of remaining ____ structure
- Increased retention bc ____ (tendrels?) are going into etched enamel/dentin
- If enamel fracture, take out the restoration, take out fracture and put in composite resin - no more ____ on biting
esthetic
conservative
retention
tooth
resin tags
flexion
Clinical Decision Making
• Disadvantages
Material Related:
- Greater ____ of restoration material
- Improving with ____ materials and good case selection
- Prone to fracture in ____ areas
- ____ effects
- ____ sensitive
- Do not bevel in ____ areas - fracture
- Material shrinks towards the ____ and pulls on the walls
wear newer thin polymerization shrinkage technique
mastication
center
Clinical Decision Making
In Order To Do This Procedure Successfully, you must understand:
- Tooth Preparation -____
- Composite Material -____
- Proper Placement ____
differences
choices
technique
Clinical Decision Making Careful Consideration must be given to: • \_\_\_\_ Location • Type of \_\_\_\_ • Which \_\_\_\_ to use
tooth
preparation
bonding system
Tooth Preparation
Preparation Design
• Amalgam - “____”
• Composite - “____”
– “____ adhesive dentistry”
– Because composite is bonded to enamel and dentin, tooth preparations for composite can be very ____
• "Restrict how much to cut, but we know why"
extension for prevention
restriction with conviction
minimum
conservative
Tooth Preparation
Preparation Design:
• A composite restoration not only is retained well in the tooth, but also can strengthen the remaining ____ tooth structure
* Composite doesn't have to be as large * [NOTES]
unprepared
Tooth Preparation Preparation Design -Posterior Composite Class I vs -Traditional Amalgam Class I
[NOTES]
YA
Preparation Design
-Conservative Composite Class II
vs
-Traditional Class II
* No \_\_\_\_ enamel, the class II can be \_\_\_\_-shaped * No \_\_\_\_
unsupported
Y
s curve
Tooth Preparation Preparation Design -Slot Preparation vs -Composite Resin Class II
* Slot - not cutting any occlusal surface * Slot can have a number of \_\_\_\_, as long as enamel rods are \_\_\_\_ and no \_\_\_\_ enamel
shapes
parallel
unsupported
Tooth Preparation
Tooth Preparation Procedure Involves:
- Creating access to the ____ and faulty structures (defective restoration, base material, if present)
- Removal of ____ structures
- Creating ____ form for the restoration
- Removal of any ____ enamel (resistance form)
- Retention form is obtained by ____ and most times not ____• Remove unsupported enamel due to ____
caries faulty convenience faulty unsupported bonding necessary
polymerization shrinkage
Tooth Preparation
Preparation Procedure Guidelines
– Use preparation diamonds – \_\_\_\_ internal line angles – Include \_\_\_\_ lesion(s) – Remove any \_\_\_\_ enamel – Remove any \_\_\_\_ enamel
* Diamonds - rough internal finish on floor and walls that will enhance adhesiveness and bonding * rounded internal line angles - when blowing the bonding agent, it dissipates and goes into the whole prep better - you just want a thin layer of it everywhere (sharp angles would result in \_\_\_\_) * Bonding is not \_\_\_\_ to hypocalcified enamel - less mineral and bond strength
rounded
carious
decalcified (hypocalcified)
unsupported
pooling
strong
Tooth Preparation
Preparation Procedure
- SELECT SHADE ____ TO PREPARATION
- Evaluate occlusal markings in ____
- Place rubber dam
- Remove all of the caries or fault as ____ as possible
- Other less involved, or at-risk, pit and fissure areas can be ____ as part of the conservative preparation technique
- Take articulating paper before they get ____
- Want MIC markings all on tooth structure/composite, don’t want a ____ margin where you get a marking
prior
MIC
conservatively
sealed
numb
cavosurface
Tooth Preparation
Preparation procedure - Class I
* "\_\_\_\_" - if there's a higher part of enamel and the rest is in dentin - as long as it's \_\_\_\_mm thick so the composite doesn't break * [NOTES]
islands of enamel
1
Tooth Preparation
Preparation procedure - Class I
* Premolar: \_\_\_\_mm thickness for marginal ridge * Molar: \_\_\_\_mm of thickness for marginal ridge * Measuring from height of \_\_\_\_ to the \_\_\_\_
1.5-1.6
2
contour
mesial/distal pit
Tooth Preparation
Preparation Procedure – Class II
- ____ (allows a more conservative preparation)
- Place a wedge interproximally for Class II to achieve ____ orthodontic separation
- Prepare the box: break the contact to just the tip of the explorer clearing contact ____ the wedge in place (____)• Small hatchets for box width - convex axial wall
prewedge
subtle
with
0.25-0.5
Tooth Preparation
-PREWEDGE - allows very conservatively contact opening ____, ____, and ____
buccal
lingual
gingival
Tooth Preparation
Preparation Procedure – Class II
- NO ____ ON ANY ____ CAVOSURFACE
- Research has shown that bevels placed on the occlusal or proximal surfaces show no benefit and the ____ areas are prone to fracture
bevel
enamel
thin
Tooth Preparation
Preparation Procedure – Class II
Three Kinds:
• Class II Preparations (in order of invasiveness)
1. ____ Preparation:
- resembles the proximal portion of a conventional preparation without any involvement of the ____
• Least \_\_\_\_ prep
slot
central groove
invasive
Tooth Preparation
Preparation Procedure – Class II
• Class II Preparations (in order of invasiveness)
- Conservative Class II Preparation:
- The proximal caries lesion is eliminated with a ____ preparation
- The occlusal surface is prepared following lesions into ____ only as necessary
- The preparation preserves as much occlusal tooth structure as is practical
- The remaining ____ may be sealed- Occlusal slightly involved - ____mm depth, and isthmus is ____mm because groove was carious
- “Islands of enamel”
proximal slot
dentin
pits/fissures
1-1.5
1
Tooth Preparation
Preparation Procedure – Class II
• Class II Preparations (in order of invasiveness)
- Conventional Class II Preparation:
- Resembles a Class II preparation for ____ but much more conservative
- The occlusal fissures has caries involvement so they are minimally ____
- The isthmus dimension is as ____ as possible
- The box is prepared as the ____ and the conservative ____ preparation would be• No ____ needed for a premolar
amalgam prepared narrow slot preparation class II
dovetail
Procedure
• Conventional Composite Class II Preparation
#19 MO and #5 MO:
- ____ mm depth pulpally
- Small isthmus width (large end 1P condenser ____)
- Minor extentions into major grooves of molar #19 (large end 1P condenser ____)
- No ____ on premolar #5
- Minimal contact breakage .25 without the wedge in place;
or .5 with the ____ in place - ____ mm gingival floor width #19; ____ mm #5
- No ____ enamel
- No ____ needed
1.5 tight tight dovetail wedge 1.5 unsupported s curve
Procedure
• Class II Composite Slot Preparation #3 M:
- ____ mm depth
- Minimal contact breakage .25 without wedge in place; or ____ with the wedge in place
- ____ mm gingival floor width for molar #3, ____ mm for premolar
- No ____ enamel
1.5
0.5
1.5
1.0
unsupported
