ASDOH Class V Amal, Comps & GI 2015 Flashcards
What is a Class V restoration?
-Restorations involving the cervical 1/3 of the facial or lingual aspect of any tooth
- -on dentin & enamel
- -can occur in groups
- -can be sensitive
- -under crowns
Class V is an ______________
epidemic
What are other causes of class V decay?
1) Toothbrush abrasion
2) Abraction
3) Erosion (Bio corrosion)
Since multiple Class V lesions signal system issues what should we look at?
1) Systemic protective mechanisms
2) bacterial load
3) habits
What are systemic protective mechanisms to look at?
1) Immune system- immune compromised, drugs, irradiation
2) Salivary flow- Xerostomia, Sjogren’s, medications
When considering bacterial load what should we loo at?
1) Nutrition
2) Diet
3) hidden sugars
4) Compliance
- attitude
- depression
- ability to care
When considering habits what should we look at?
1) grinding
2) clenching
3) mal-occlusion
4) special diets
What are the advantages of Class V amalgam restorations?
1) Strong
2) wear resistance
3) insoluble
4) corrosion products
5) lower cost
6) less moisture sensitive
What are the advantages of Class V amalgam restorations?
1) Strong
2) wear resistance
3) insoluble
4) corrosion products
5) lower cost
6) less moisture sensitive
What are the DIS-advantages of Class V amalgam restorations?
1) Poor aesthetics
2) non-retentive
3) temperature conductive
4) inability to detect recurrent decay
What are the advantages of Class V composite restorations?
1) excellent aesthetics
2) thermally insulating
3) more elastic material
What are the DIS-advantages of Class V composite restorations?
1) Requires isolated field
2) technique sensitive
3) bond not reliable long term (~5 yrs?)
What are the advantages of Class V Glass Ionomer restorations?
1) Bond is best thermally insulating
2) fluoride release
3) similar expansion to dentin
What are the DIS-advantages of Class V Glass Ionomer restorations?
1) High acid solubility
2) poor wear resistance
3) more opaque
4) difficult to handle (limited working time and very sticky)
GI can be combined with __________?
This is useful when restorations are constantly falling out.
“Sandwich technique”
What are the advantages of Class V Glass Ionomer restorations?
1) Bond is best thermally insulating (less chance of developing micro leakage)
2) fluoride release
3) similar expansion to dentin
4) Great for high caries risk
What are the DIS-advantages of Class V Glass Ionomer restorations?
1) High acid solubility
2) poor wear resistance
3) more opaque
4) difficult to handle (limited working time and very sticky)
Which restoration should be used if…decay is mostly on dentin, very sensitive and pt concerned about aesthetics?
- Amalgam No, (b/c temperature conductive)
- Glass Ionomer? Maybe but may wear away if pt brushes too hard.
- Composite? Yes would work b/c of adequate isolation
Which restoration should be used If..pt has decay under crown and difficult to isolate, cost is an issue?
- Repair and drill out decay
- Use amalgam
Which restoration should be used if.. repairing aesthetic zone?
-Composite or GI (GI can be better) give fluoride to RECHARGE
Which restoration should be used if.. pt just had braces taken off and has decalcification and decayed areas ??
- This is considered a PHASING TX
- Remove de-mineralized area or remineralize w/ varnish or fluoride
Which restoration should be used if.. 75 yr old pat who’s filling keep WEARING and FALLING out ?
- Lateral loading causes it to FAIL
- Not enough retention so use, SANDWICH TECHNIQUE (GI + composite) !
- Amalgam not as good
Which restoration should be used if.. decayed area that’s impossible to place a rubber dam?
Use AMALGAM
In what way are the preparation designs (Amalgam, composite, GI) the same?
Outline is determined by DECAY
How do the prep designs differ for Amalgam?
Undercuts, retention & internal angles w/ a butt joint (More aggressive prep)
How do the prep designs differ for Composite?
BEVELS on enamel for retention, GROOVES in dentin w/ a butt joint
How do the prep designs differ for GI?
No prep, light smoothing of the tooth sturecutres ONLY
How do the prep designs differ for GI?
No prep, light smoothing of the tooth structures ONLY
How do the prep designs differ for Amalgam?
Undercuts
- Retention & internal angles w/ a butt joint
- (More aggressive prep)
How do the prep designs differ for Composite?
- BEVELS on enamel for retention
- GROOVES in dentin w/ a butt joint
How do the prep designs differ for GI?
- No prep
- light smoothing of the tooth structures ONLY
What is the Amalgam prep outline form?
- Occlusal is “Kidney Bean” shaped
- Gingiva flows curvature of gingiva
What is the Amalgam prep outline form?
1) Occlusal is “Kidney Bean” shaped
2) Gingiva flows curvature of gingiva
3) PROXIMAL walls end within the line angles
4) Typodont Prep should be
What is the Amalgam prep for the Internal Walls?
1) Internal line angles are well defined but ROUNDED
2) Occlusal & gingival wall are SLIGHTLY “CONVERGING” or EXIT at 90 degrees
3) Occlusal Depth = 1.25- 1.5 mm
4) Gingival Depth = 1.0- 1.25 mm
What is the Amalgam prep for the Proximal walls?
1) Exit angle TOO straight RESULTS in undermined enamel
2) Walls DIVERGE near the line angles & exit 90 degrees relative to the surface of the tooth
What is the Amalgam prep for the Retention grooves?
1) Occur @ BOTH the occlusal & gingival walls
2) Occlusal & gingival may be CONVERGING
3) Enter the occlusal & gingival floor
4) ALWAY in DENTIN
5) Extension of the axial wall
6) Extend along the ENTIRE floor (Occl & Ging)
7) Depth of a 1/4 round bur
What is the Amalgam prep for the Axial Walls?
1) Axial wall is PARALLEL to the DEJ
2) If the Axial wall is STRAIGHT it results in a pulp exposure
3) Axial wall is curved
What are the Step-by-step instructions for Class V amalgam prep?
1) Follow curvature of tooth from mesial to distal, keeping bur perpendicular to surface
2) Use correct angulations
3) Start from one side using #34 D
4) Cut to depth of the bur at least 1mm
5) Move bur across center at same angle, this keeps axial wall shallower at the center!
6) Do other side
7) This technique will allow you to keep axial wall rounded & parallel to DEJ
8) Use a hoe to plane the walls and outline form OR a #34 D to smooth walls and keep Occl & Ging wall converging
9) Make sure PROXIMAL walls DIVERGE
10) Place retention grooves along the ENTIRE GINGIVAL FLOOR & OCCL awl w/ 1/4 R bur (DONT CUT INTO AXIAL WALL)
What is the Amalgam prep for the Internal Walls?
1) Internal line angles are well defined but ROUNDED
2) Occlusal & gingival wall are SLIGHTLY “CONVERGING” or EXIT at 90 degrees
3) Occlusal Depth = 1.25- 1.5 mm
4) Gingival Depth = 1.0- 1.25 mm
What is the COMPOSITE prep for the Internal Walls?
1) Internal line angles are ROUNDED
2) Occl & Ging walls CONVERGE
3) Occlusal depth = 1.0-1.25mm
4) Gingival depth=
What is the COMPOSITE prep for the Outline Form?
1) Enamel is BEVELED
2) Outline determined by decay
3) If on dentin gingival floor is completed like an amalgam
What is the COMPOSITE prep for the Outline Form?
1) Enamel is BEVELED (may be LARGER on OCCLUSAL)
2) Outline determined by decay
3) If on dentin gingival floor is completed like an amalgam
4) Bevel NEVER placed on dentin if BELOW the DEJ
5) Bevels DON’T EXTEND beyond line angle ( M&D)
What is the purpose for enamel bevels in composite preps?
For Retention, good seal & color blending (makes translucency match)
What is the COMPOSITE prep for the Outline Form?
1) Enamel is BEVELED 1 mm @ 45 DEGREE ANGLE
(may be LARGER on OCCLUSAL)
2) Outline determined by decay
3) If on dentin gingival floor is completed like an amalgam
4) Bevel NEVER placed on dentin if BELOW the DEJ
5) Bevels DON’T EXTEND beyond line angle ( M&D)
There is no bevel on the gingival floor when ____________ is exposed. There is a retention groove.
-Dentin
All walls in a composite prep may be beveled when on enamel __________, _______ and _______
- Occlusal
- Mesial
- Distal
Axial wall follows the _________
Proximal walls may ____________
- DEJ
- Diverge
Describe the GI “Prepless” Design
1) Lesion is NOT prepared w/ specific design
2) May lightly polish w/ pumice on a brush OR roughen w/ diamond bur
3) Design may include enamel and/or dentin ONLY @ margins
4) Useful w/ shallow defects in enamel
Before you start the GI what should you do?
1) Select shade if placing composite or GI
2) Give pt anesthesia
3) apply rubber dam or retraction cord (can soak in epi) & cotton rolls
4) Apply place 212 clamp
What are the Step-by-step instructions for Class V Amalgam prep?
1) Follow curvature of tooth from mesial to distal, keeping bur perpendicular to surface
2) Use correct angulations
3) Start from one side using #34 D
4) Cut to depth of the bur at least 1mm
5) Move bur across center at same angle, this keeps axial wall shallower at the center!
6) Do other side
7) This technique will allow you to keep axial wall rounded & parallel to DEJ
8) Use a hoe to plane the walls and outline form OR a #34 D to smooth walls and keep Occl & Ging wall converging
9) Make sure PROXIMAL walls DIVERGE
10) Place retention grooves along the ENTIRE GINGIVAL FLOOR & OCCL awl w/ 1/4 R bur (DONT CUT INTO AXIAL WALL)
Before you start the prep, what should you do?
1) Select shade if placing composite or GI
2) Give pt anesthesia
3) apply rubber dam or retraction cord (can soak in epi) & cotton rolls
4) Apply place 212 clamp
What is the armamentarium for burs used
1) #34 D -initial cut
2) 330 D -refined cut
3) 132 F Diamond -bevels
4) 1/4 R -retention grooves
What are the Step-by-step instructions for Class V COMPOSITE prep?
1) Use pencil to scribe outline
2) Use correct angulations
3) Follow curvature of tooth from mesial to distal, keeping bur perpendicular to surface
4) Start from one side making a cut at ~ 1 mm into tooth to reach decay/dentin
5) Move bur across center at same angle, this prevents you from removing axial tooth structure at center of tooth
6) Do other side
7) This technique will allow you to keep axial wall rounded & parallel to DEJ
8) Use a hoe to plane the walls and outline form
9) Axial walls should be rounded, internal line angles smooth & gingival floor @ 90 degrees
10) Use 132 F D to DRY cut enamel BEVELS ONLY (Occl & Prox walls) Perpendicularly to surface to keep it even in width
Do you place a retention groove onto he occlusal wall of the composite prep?
No, because of the enamel bevel
Do you cut into the axial wall when making retention grooves for a composite prep?
No! Retention groove is along the ENTIRE floor w/ a 1/4 R carbide bur
