8. Amalgam Polishing/Clinical Caries Flashcards
Amalgam Polishing
Done AFTER restoration has completely set – at least ____ hours later
24
Amalgam Polishing
Benefit
Improves oral hygiene - ____ surface
Inhibits recurrent decay - ____ polished
Inhibits gingival irritation - marginal ____ are removed that otherwise would irritate the surrounding tissue
smoothes
margins
overhangs
Amalgam Polishing
Occlusion and occlusal anatomy can be refined further
Life of restoration is ____
Esthetics better – much more shiny
extended
Amalgam Polishing Armamentarium \_\_\_\_ speed handpiece Burs to use (in this order): \_\_\_\_ stone \_\_\_\_ stone \_\_\_\_ burs \_\_\_\_, greenie, \_\_\_\_ rubber cups and points
slow green white finishing carbide brownie super-greenie
Amalgam Polishing 2 steps FIRST: Contour the restoration - use \_\_\_\_ and then \_\_\_\_ polishing burs Gross removal of \_\_\_\_ material Eliminate \_\_\_\_ Eliminate \_\_\_\_ and overhangs Redefine anatomy
stones carbide excessive roughness marginal flash
Amalgam Polishing
2 Steps
SECOND: Shining the restoration with ____, discs, and ____
____ restoration between changes in abrasive points to remove particles
rubber points
cups
rinse
Amalgam Polishing
Precautions
Avoid excessive ____/ rise in ____
Avoid loss of contour and ____ by over-polishing
Avoid damage to surrounding hard and soft tissues
pressure
temperature
contact
Caries: From a Clinical Perspective
Detection – Caries vs Stained Fossae and Grooves
dull, chalky, flakey, explorer is sticky - ____ carious lesion
would think big lesion but look how shiny it is - very deep fissures/grooves w/o explorer getting stuck
NOT A ____
re-mineralized de-calcification
____ is stronger! - better to leave
active
lesion
re-mineralized
Clinical Caries Excavation
! Caries excavation is the control of carious lesions by removing the infected area, then restoring the tooth to optimal form, and function
! The specific clinical treatment depends on the extent of carious ____
activity/destruction
Clinical Caries Excavation
! We need to clinically determine the different types of dentin as we work
! ____ – non infected/normal
! Infected – presence of ____; dentin is ____ demineralized; must be ____
! Affected – no ____ present; dentin is demineralized, but can be ____
**how to tell b/t infected/affected: if explorer ____ it’s infected; if ____ + ____ = affected (no bacteria)
healthy bacteria irreversibly removed bacteria remineralized
sticks
stained
hard
Caries: From a Clinical Perspective
class 3 from lingual can see \_\_\_\_ area of decay
Class 3 = inter proximal lesion
open up see ____ @ DEJ which is what gives you purple color
purple
brown
Clinical Caries Excavation
! Ways we clinically detect the different kinds
of dentin
! Visual: Degree of discoloration; shiny vs dull; careful: not all ____ is caries
these are freshly extracted teeth 1 day old
this is ideal outline - shiny dentin near explorer; ____ + ____ = infected dentin
discoloration
brown
flakey
Clinical Caries Excavation
! Ways we clinically detect the different kinds of dentin
! Tactile: Hardness – detected with ____ or explorer – tugback/____/leathery
- besides explorer + color of dentin can also tell when done with spoon excavator - scoop in ____
- dentin and it will come off in ____; do it in areas where you’re afraid t take your drill
spoon excavator
sticky
infected
flakes
Clinical Caries Excavation
! Ways we clinically detect the different kinds of dentin
! Audio: Sound of the instrument on healthy dentin sounds different than the ____, infected dentin
dull
Clinical Caries Excavation
! Clinical Strategy for Caries Removal:
! Remove any dentin that appears “____, peels off in ____, or can be ____ with an explorer or spoon excavator
! More aggressive removal of stained dentin at the ____
! Less aggressive removal of stained dentin over the ____
first get ideal outline - then continue to remove any caries left over
anything dark you check to see if soft enough that you can remove with spoon excavator
extend outline of prep to make bigger
leathery flakes penetrated DEJ pulpal wall
Clinical Caries Excavation
! Clinical Strategy for Caries Removal:
! Procedure: (Small, Moderate, Large caries)
1. Obtain ideal ____/depth
2. Evaluate remaining caries
3. Remove carious dentin with a ____ bur (____ or ____) with a slow speed and ____ pressure
4. Continue with the ____ as you near the pulp chamber
putline round 4 6 light spoon excavator
Clinical Caries Excavation
! Clinical Strategy for Caries Removal: ! Procedure (continued):
5. Utilize ____ dye
6. Carefully evaluate with explorer or spoon
excavator for hard, ____ dentin
7. Remove any ____ enamel
8. Evaluation for ____ (____ layer to protect the pulp)
caries detection sound unsupported liner/base medicine
Caries: From a Clinical Perspective
• this is what it looks like when you use a slow speed
• soft caries
• when slow speed is in healthy prep, it ____ alot and healthy dentin doesn’t ____ off - you keep it on tooth until
nothing comes out
• bottom pic: this is finished -shiny, not wet
◦ not a flat floor (need flat for amalgam) - when you put a liner in to make floor flat
vibrates
flake
Caries: from a clinical perspective
caries detection dye - remove ____ enamel on external surface w/ slow speed
burr naturally just falls into ____ dentin
are there caries underneath ____?
• when u open up, see it’s brownish and how big it is
demineralized
infected
sealant
Clinical Caries Excavation ! Clinical Strategy for Caries Removal: Procedure: (Gross caries) 1. Carious lesion is so great, need to remove \_\_\_\_ first -Use slow speed with \_\_\_\_ round bur -Use spoon excavator 2. \_\_\_\_ remaining tooth structure 3. Evaluate \_\_\_\_ health 4. Remove all \_\_\_\_ enamel
caries 6 evaluate pulpal supported
Caries: From a Clinical Perspective
- don’t need ____ for this - can see it’s gross caries - see it, can’t do outline
- older peoples’ pulp horns ____ a little-don’t need endo b.c this person is old so ____ pulp chambers
radiograph
shrink
smaller
Caries: From a Clinical Perspective
pulpal blushing - throw ____ (contains ____), leave a little layer and refer to endo cuz you don’t wanna be the one who drills the nerve
◦ this will sedate it temporarily until endo (< ____weeks)
IRM
eugenol
3
Caries: From a Clinical Perspective
Pulpal blushing
see little red dot but not ____! = pulpal blushing
◦ ____ mm of dentin on top of pulp
◦ tooth tested ____ (sensitive to ____ but no toothache) - patient may start to feel more as u go deeper but not
that bad
◦ put ____ over + ____ then restore
◦ these are both boards patients’ lesions (right pic didn’t pass - started as slot prep and now…lol)
bleeding 0.5 vital cold CaOH liner
Caries: from a clinical perspective
Recurrent caries
• recurrent=under a ____
• left pic: MOD amalgam w/ a base (points to bottom of restoration) -can see caries underneath it
filling
Recurrent Caries
• can see borders are ____ and looks ____
• take off the amalgam and wow, lots of caries
• “pain on ____”
• x-ray showed recurrent caries
• black= ____ in left pic
• take amalgam out: if you see base is white it’s ____ but not important; HUGE mesial carious lesion
◦ Pt has been biting on that ____ - fracture in pulpal floor –> endo (fracture in pulp
chamber)
gray weak biting recurrent zinc phosphate marg ridge
Recurrent caries?
@ first glance one would think this is recurrent caries (i think she’s pointing here)
◦ however you’ll learn this after doing it once - what’s actually here is an old ____ that they didn’t make
____ - so you quietly restore the tooth but she felt bad about it
◦ how do you know it’s a liner? — see distinct outline of ____ area
liner
radioopaque
radiolucent
Caries: From a Clinical Perspective
! Caries detection during excavation is difficult to master
! #1 reason for ____ failure during the preparation
! Mastery of ____, Visual, and____ cues are important
! Training via Simodont System helpful
board exam
tactile
audio
