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Operative II > Based on Exam 1 Review Doc > Flashcards

Based on Exam 1 Review Doc Flashcards

1
Q

Why should you place composite incrementally vs bulk filling?

A

-Incrementally placing composite minimizes stresses placed on the material and on the tooth due to polymerization shrinkage (this may be a factor in postoperative sensitivity)
-Resin is bonded to LESS walls → relieves stress in the resin-adhesive surface
incrementally placed has a lower C factor

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2
Q

Basic components of Tofflemire matrix system

A
  • Retainer: slot faces gingiva
    placed on BUCCAL side
    band comes out of SIDE channel
    slit down so it is easier to remove
  • Matrix band: burnish adjacent tooth IN CONTACT AREA
  • Wooden wedges: wedge properly- through the more open of the embrasures (typically the lingual)
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3
Q

Basic components of sectional matrix system (Palodent)

A
  • Use provided tweezers to place wedge
  • place sectional matrix band using provided tweezers
  • place ring on top of wedge
    can use on MOD
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4
Q

What are the advantages to using a rubber dam?

A
  • better visualization
  • better access
  • prep walls dry and clean
  • materials work better
  • improved properties- direct contacts of varnish/liner/base with cavity walls
  • moisture affects bond as well as materials ability to set up
  • prevents injury to patient soft tissues
  • prevents aspiration and swallowing of debris
  • fewer aerosols
    -shiny part of rubber dam on tongue side, matte side faces operator
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5
Q

Basic order of operations for preparing Class II

A
  • establish initial outline form and depth
  • extend proximal box
  • once ideal outline form is achieved, remove caries (spoon excavator or round bur on slow speed handpiece)
  • refine prep (with steps below)
  • plane axiopulpal line angle (reduces stress)
  • plane gingival margin (removes loose enamel rods)
  • bevel gingival margin (ONLY with ideal preps)
    *do not place gingival bevel on dentin or cementum
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6
Q

Basic order of operations for composite restoration

A
  • place matrix
  • etch, bond
  • begin by placing material in box
  • place composite incrementally
  • cure each increment for 20 seconds
  • form final anatomy BEFORE final cure
  • finishing carbides for minor adjustments after curing
  • polishing
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7
Q

Basic order of operations for amalgam restoration

A
  • Tofflemire matrix in place
  • fill box first, then occlusal
  • begin carving
  • marginal ridge- use explorer
  • try a pre-carve burnish to remind you of your outline
  • begin with HOLLENBACK carver to recreate anatomy (before set)
  • remove band (from side)
  • carve interproximal before sets up fully
  • refine anatomy
  • smooth restoration with wet cotton pellet
  • dull, matte finish
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8
Q

Why bevel?

A

to reduce microleakage at cervical and ascending walls in class II preps

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9
Q

Where should you bevel in Class IIs?

A

Bevel gingival floor of prep
only if on enamel

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10
Q

When to bevel?

A

-NECESSARY when in enamel
-DO NOT bevel in deep preps (So little enamel remains that a bevel would remove it all OR Gingival floor is on cementum or dentin)

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11
Q

How to bevel?

A

Enamel prepared with a bur (beveled) etches better; exposes ends of enamel rods; reveals prismatic enamel

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12
Q

What walls in a class II are a flare recommended?

A

slight flare occlusal of prep

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13
Q

Type I enamel etching

A
  • “honeycomb”; from dissolution of prism (enamel rod) CORES
  • found in occlusal and middle thirds of teeth
  • best bonds achieved to type I (and II)
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14
Q

Type II enamel etching

A
  • “cobblestone”; from dissolution of prism (enamel rod) PERIPHERIES
  • found in occlusal and middle thirds of teeth
  • best bonds achieved to type II (and I)
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15
Q

Type III enamel etching

A
  • combination of I and II
  • not stuck very deep
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16
Q

Type IV enamel etching

A
  • “pitted”
  • not stuck very deep
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17
Q

Type V enamel etching

A
  • “aprismatic”
  • flat and smooth
  • not stuck very deep
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18
Q

Acid etching enamel

A
  • Chemical “drilling”
  • Removes about 10 microns enamel
  • Place for 15 seconds prior to rinsing
  • Creates porous layer 5-50 microns deep
  • RINSE with water 10 seconds after etching
  • To remove acid and leave enamel surface clean for bonding
  • 25mL minimum water is necessary
  • Visualize a FROSTY surface after gentle air dry
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19
Q

Which acid is used to etch enamel?

A

30-40% phosphoric acid

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20
Q

What are the other types of acid used to etch different materials?

A

Nitric –> metal
Hydrofluoric –> feldspathic porcelain

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21
Q

What is the purpose of etching?

A
  • Etching transforms smooth enamel into an IRREGULAR surface
  • Etching increases wettability and surface area of the enamel
  • Etching raises the surface free energy to EXCEED the surface tension of bonding material
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22
Q

What is surface wetting?

A

the ability of a liquid to maintain intermolecular contact with a solid surface

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23
Q

What type of bond are we trying to achieve with etch/bond?

A

MICROMECHANICAL BOND

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24
Q

What is etchant?

A

interacts with superficial dentin and there is no pulpal damage

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25
Q

After etching, what does bond agent resin do?

A
  • low viscosity
  • flows into mircoporosities
  • polymerizes to MICROMECHANICAL BOND
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26
Q

What does resin interlock with in enamel?

A

enamel rods

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27
Q

What does resin interlock with in dentin?

A

dentin collagen

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28
Q

What are the types of bonding systems?

A
  • Etch-and-Rinse (FKA Total etch)
  • Self-etch
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29
Q

What are the basic elements of the Etch-and-Rinse (FKA Total etch) system?

A
  • Etch separately
  • Prime (3-step)
  • Bond (3-step)
  • or Prime + Bond combined (2-step)
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30
Q

What are the advantages to Etch-and-Rinse system?

A
  • More predictable, stronger bond
  • Enamel adequately prepared
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31
Q

What are the disadvantages to Etch-and-Rinse system?

A
  • Collagen collapse is possible (result of user error)
  • Etched zone is often deeper than hybrid layer (exposed demineralized, collagen fibrils; post-operative sensitivity)
  • Too many steps (more chances for operator error)
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32
Q

What are the basic elements of the self-etch system?

A
  • No phosphoric acid-etch step
  • Acid part of the primer or primer/bond agent (acidic primer partially dissolves smear layer, allows penetration of bond resin)
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33
Q

What are the types of self-etch systems?

A
  • 2 step: acidic primer & bonding agent
  • 1-step: most variable/least predictable (acidic primer and bond resin, one solution)
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34
Q

What are the advantages of the self-etch system?

A
  • No separate etch: overdried, collapsed demineralized collagen not a problem
  • Etched zone and hybrid layer comparable width; however, some exposed collagen
  • Low postoperative sensitivity
  • Time efficiency
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35
Q

What are the disadvantages of the self-etch system?

A
  • Not compatible with self-cure, dual-cure composite (acidic monomers, low pH, “kills” the basic amine activator)
  • Will not etch unprepared enamel
  • Self-etch primer systems have long-term bond strength?
  • Self-etch adhesives (all-in-one) have lower bond strength, long-term breakdown (collagen degradation over time)
  • Insufficient penetration of smear layer
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36
Q

What effects longevity in bonds?

A
  • Bond to dentin collagen is influenced by Matrix metalloproteinases (MMPs)
  • MMPs are present on collagen fibrils and can be seen at 100,000X on SEM
  • Chlorhexidine inhibits MMP activation –> leading to longer lasting bonds
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37
Q

What are MMPs?

A

collagen enzymes that metabolize unhybridized collagen

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38
Q

What is Consepsis?

A

2% Chlorhexidine Antibacterial solution applied after etching —> leads to longer lasting bonds

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39
Q

What are the clinical success requirements of bonding?

A
  • Knowledge of substrate
  • Good cavity preparation and margins
  • Rubber dam and matrix/wedge
  • Correct use of the bonding agent (follow directions; Wet/Moist bonding, total etch, self-etch)
  • Bond agent compatible with resin composite
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40
Q

What are the bond system components?

A
  • Etchant (Phosphoric acid gel (30-40%))
  • Primer
  • Adhesive Bonding Resin/Agent
  • Filler (Mostly unfilled resins, some 0.5-40% by weight)
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41
Q

What does the primer do in bonding systems?

A
  • HYDROPHILIC (draws the bond agent in) monomers in HEMA solvent
  • Acetone, ethanol/water, water
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42
Q

What does the adhesive bonding resin/agent do in bonding system?

A
  • HYDROPHOBIC dimethacrylate monomers (BisGMA)
  • Initiators and Activators (Camphorquinone in light activated systems
    Benzoyl Peroxide (BPO) tertiary amine in chemical and dual cure systems)
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43
Q

When can Universal adhesives be used?

A

Can be used in total etch, self-etch or selective-etch mode (etch enamel only with phosphoric acid)

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44
Q

What adhesive do we use at UMKC?

A

Universal adhesive

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45
Q

What is the chemistry game changer of universal adhesives?

A

10-MDP
Mechanism of action: a monomer that chemically interacts via ionic bonding to calcium in hydroxyapatite

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46
Q

Would you ever directly etch the pulp?

A

NO

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47
Q

What is dentin adhesive?

A
  • Well tolerated by dentin
  • Do NOT want to apply it directly to the pulp
  • Adverse pulp reaction comes primarily from bacteria remaining in or penetrating the preparation
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48
Q

What location for adhesive is predictable and strong?

A

Incisal ⅓ and middle ⅓ enamel

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49
Q

What is makes cervical enamel less favorable for adhesive?

A
  • Shorter and fewer enamel tags (compared to middle ⅓ and incisal ⅓)
  • Less prism delineation (due to presence of prismless enamel)
  • Bad news: this is where deep class II preps usually end
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50
Q

What is the Makeup of enamel?

A

95-98% inorganic matter by weight
90-92% hydroxyapatite by volume
1-2% organic matter by weight
4% water weight

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51
Q

What is the bond strength to perpendicular enamel (ENDS of rods)?

A

25MPa

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52
Q

What is the bond strength to parallel enamel (SIDES of rods)?

A

7-10MPa

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53
Q

Examples of perpendicular oriented enamel

A
  • Cavosurface margins of class I preps
  • Bevels of class II preps
  • ENDS of enamel rods
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54
Q

Examples of parallel enamel

A
  • Internal walls of occlusal preps
  • Gingival floor of box of class II preps (see beveling)
  • SIDES of enamel rods
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55
Q

Summary of enamel bonding

A
  • Etch surface
  • Resin tags interlock (macro and micro tags into surface irregularities)
  • Micromechanical bonding
  • Enamel-adhesive-composite bond
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56
Q

What is the makeup
of dentin?

A

55% mineral by volume
30% collagen
15% water

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57
Q

Basic dentin anatomy

A
  • Tubules (fluid filled)
  • Peritubular dentin (very INorganic)
  • Intertubular dentin (very ORGANIC, collagen rich, where you want to bond)
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58
Q

What is the top arrow pointing to?

A

peritubular dentin

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59
Q

What is the bottom arrow pointing to?

A

intertubular dentin

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60
Q

How does the diameter of the dentin tubules change as they get closer to the pulp?

A

larger
- 0.5 micrometers near DEJ
- 2.5 micrometers near pulp

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61
Q

How does the distribution of the dentin tubules change as they get closer to the pulp?

A

more near pulp
- 20,000/mm2 near DEJ
- 45,000/mm2 near pulp

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62
Q

How does deeper dentin differ from less deep dentin?

A
  • more & wider tubules (=more fluid)
  • less tubular dentin
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63
Q

What is the basic dentin bonding mechanism?

A
  • Acid-etched, demineralized collagen fibrils (2-5 micrometers deep)
  • Water supports collagen network
  • Dentin bond agent applied, polymerized
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64
Q

What factors can affect bonding to dentin?

A
  • Cavity depth (better bond strength in superficial dentin)
  • Caries (lower bond strength in carious dentin)
  • Moist vs Dry dentin (Moist is better!; Overwet resin does not penetrate well –> decreased bond strength)
  • Collagen fibers collapse in dry dentin (resin cannot penetrate; poor hybrid layer; decreased bond strength)
65
Q

What can you do to improve bond to dentin?

A
  • Use extreme caution when using air/water syringe to dry dentin
  • Use rubber dam
66
Q

What is the smear layer?

A

Mixture of tooth debris, often contaminated with saliva, blood cells, and bacteria
- DO NOT bond to smear layer
- removed with acid etch

67
Q

What is the hybrid layer?

A
  • Intermingled layer of collagen and resin
  • What we WANT to form when bonding to dentin
  • Forms upon light curing, the unfilled resin sets within the collagen fibril network
68
Q

What should you avoid when forming the hybrid layer?

A
  • Avoid OVERetching
  • Avoid OVERdrying
  • Avoid UNDERdrying
69
Q

What are methods to ensure you restore a patient’s occlusion properly?

A
  • evaluate occlusion BEFORE preparing and then try to recreate that
  • visually evaluate CONTRALATERAL side
  • check occlusion again with patient sitting up
  • Use articulating paper
  • Evaluate in MIP
  • Evaluate in excursions, protrusives
70
Q

What are potential outcomes if occlusion is not considered when placing a restoration?

A
  • Pain on biting
  • Fractured cusp
  • Fractured restoration
  • Premature wear on tooth
  • Trauma to periodontal ligament
  • Trauma to temporomandibular joint
  • Angry patient
  • Frustrated dentist
71
Q

Challenges in trying to restore occlusion?

A
  • Many patients do not have ideal occlusion
  • Patient often numb when asked to bite down and feel restoration
  • Fatigue
72
Q

What is occlusion?

A

the way the maxillary teeth contact the mandibular teeth
- or vice versa
- static

73
Q

What is articulation?

A

the static dynamic relationship b/w occlusal surfaces during function

74
Q

Ideal occlusion =

A

teeth occlude with each other along their LONG AXES

75
Q

Nonfunctional cusps:

A
  • Buccal on maxillary
  • Lingual on mandibular
76
Q

Functional cusps:

A
  • Lingual on maxillary
  • Buccal on mandibular
77
Q

What is Cusp-Fossa occlusion?

A
  • Each functional cusp occludes in fossa of opposing tooth
  • One to One tooth arrangement
78
Q

What is Cusp-Marginal Ridge occlusion?

A
  • Each functional cusp contacts the MR or fossa of the opposing pair of teeth
  • One to Two teeth arrangement
  • Most natural dentitions
79
Q

How are maxillary teeth inclined?

80
Q

How are mandibular teeth inlcined?

81
Q

What are the components of dental composite resins?

A
  • Silane coupling agent
  • Resin matrix (organic phase)
  • Fillers (inorganic phase)
  • Activators & Initiators
82
Q

What does the silane coupling agent do?

A
  • Interfacial bridge
  • Strongly binds the filler to the resin matrix
83
Q

What are the benefits of the silane coupling agent?

A
  • Better stress distribution b/w resin matrix and filler particles
  • Improves the mechanical properties
  • Decreased water sorption along filler-resin interface
84
Q

What does the resin matrix do?

A

organic phase
- 2 reactive ends to allow cross-linking

85
Q

What are the benefits of fillers?

A

inorganic phase
- Reinforcement of resin matrix (increase the mechanical and physical properties)
- DECREASED polymerization shrinkage (proportional to the filler volume)
- DECREASED thermal expansion and contraction (higher filler amount reduces the thermal expansion and contraction coefficients )
- Viscosity control (improved workability, handling)
- DECREASED water sorption
- INCREASED radiopacity (Barium, Strontium, Zirconium)

86
Q

What is the chemical or self-cure activator?

A

tertiary amine

87
Q

What is the chemical or self-cure initiator?

A

Benzoyl peroxide

88
Q

What is the light-cured activator?

A

blue light (465nm)

89
Q

What is the light-cured initiator?

A

Camphoquorine

90
Q

What are the characteristics of bulk fill?

A
  • Developed to enable restoration in single increment built up to 4-5mm
  • Increased depth of cure (polymerization)
  • Reduced polymerization shrinkage stress
  • Improved adaptation to the surface of the cavity
  • Simplified placement technique compared to regular composites
91
Q

How does bulk fill relieve shrinkage stress?

A
  • Altered filler particles (low elastic modulus)
  • Presence of stress-relieving monomer
92
Q

How does bulk fill increase the depth of cure?

A
  • Reduced filler amount
  • Increased filler particle size
  • Alternative photoinitiators
93
Q

How does bulk fill improve adaptation to the surface cavity?

A
  • Rheology modifiers (some manufacturer’s)
94
Q

What is sonic activated bulk fill?

A
  • Rheology modifiers react to the sonic energy applied during placement
95
Q

What is phase 1 of sonic activated bulk fill?

A

Sonic application: to reduce viscosity = increase flowability to all cavity surfaces

96
Q

What is phase 2 of sonic activated bulk fill?

A

Sonic energy removed: the composite reverts to viscous, pliable state ideal for contouring and polishing

97
Q

What is the basic composition of bulk fill?

A
  • Filler Particles
  • Monomers
  • Alternative photoinitiator
  • Reinforcing fibers
98
Q

What are the characteristics of filler particles in bulk fill?

A
  • Lower amount of filler particles
  • Pre-polymerized filler particles (similarly to microparticules comp)
  • Low-elastic modulus = help to absorb stresses
  • Added larger filler size particles
99
Q

Which monomers are used in bulk fill?

A
  • UDMA
  • Modified UDMA
  • Fragmentation dimethacrylate monomers (less shrinkage than typical methacrylate)
100
Q

What are the two types of bulk fill?

A
  • Flowable bulk fill
  • Full body bulk fill
101
Q

What is flowable bulk fill?

A
  • Flowable consistency
  • Lower elastic modulus and reduced wear resistance (mechanical properties)
  • Base for regular composites as the occlusal increment
  • Dentin replacement only
  • Better adaptation on the surfaces of the cavity
102
Q

What is full body bulk fill?

A
  • Suitable wear resistance (better mechanical properties)
  • Replace dentin and enamel
  • Possibility of sculpture
  • Single increment (up to 4-5 mm)
103
Q

What are clinical applications of bulk fill?

A
  • Posterior restorations (Class I and II)
  • Some specific Class III’s
104
Q

What does this represent?

A

Incremental fill

105
Q

What does this represent?

A

Bulk-fill flow
(2mm of flowable bulk fill, then add layer of regular composite)

106
Q

What does this represent?

A

Bulk and body

107
Q

What is dual cure bulk fill?

A
  • Dual cure system: chemical (two pastes- automix) and light-cure
  • Single increment (class I and II)
108
Q

What does finishing and polishing do for bulk fill?

A
  • Esthetic appearance and functionality
  • Decrease the coefficient of friction = reduced rate of wear
  • Improve the clinical parameters and quality of the restoration
  • Less bacterial adhesion = less marginal leakage = less possibility of secondary caries
  • Color stability = reduce staining
109
Q

What are the advantages to bulk fill composites?

A
  • Simplification of the restorative technique
  • Reduced chair time (less stress for the dentist and patients)
  • Better flowability = cavity surface adaptation
  • Suitable mechanical properties
  • Reduced polymerization shrinkage stress
110
Q

What are the disadvantages to bulk fill composite?

A
  • More translucent than regular composites
  • Indicated for posterior restorations
  • Cannot mimic the natural layering of the tooth
  • Need high-output lights
  • Place in combination with properly performed bonding technique
111
Q

Would you do a sealant or PRR on teeth that have initial caries present?

A

PRR
caries cannot extend into dentin

112
Q

Would you do a sealant or PRR on teeth that are noncavitated?

113
Q

Which is meant to last longer? PRR or sealant?

114
Q

Who can place sealants?

A
  • hygienist
  • assistant
  • dentist
115
Q

Who can place PRRs?

116
Q

What is different about the PRR technique compared to sealants?

A

PRR technique similar to sealants but:
- Caries must be removed prior to placement
- Bonding agent and flowable resin composite are used

117
Q

What are resin-based sealants?

A
  • UDMA or bisGMA monomers polymerized by either chemical activator and initiator or light or specific wavelength and intensity
  • Can be unfilled, colorless, or tinted transparent materials, or opaque tooth-colored or white materials
118
Q

What are the pros of resin-based sealants?

A
  • Good retention
  • Can control working time (light-cured)
  • Wear-resistant
119
Q

What are the cons to resin-based sealants?

A
  • Moisture-sensitive
  • Require cleaning/etching of tooth surface prior to placement
120
Q

What is the most common type of sealant used?

A

Resin-based

121
Q

What are glass ionomer sealants?

A
  • Cements with an acid-base reaction b/w fluoroaluminosilicate glass powder and polyacrylic acid solution
  • Developed and used for fluoride releasing properties
122
Q

What are the pros to glass ionomer sealants?

A
  • Moisture-friendly
  • No need for pretreatment of tooth surface due to chemical bonding to tooth surface
  • Continuous release of fluoride
123
Q

What are the cons to glass ionomer sealants?

A
  • Poor retention
  • Cannot control working time (chemical reaction)
124
Q

What are polyacid-modified resin sealants?

A

Combine resin-based material with fluoride releasing and adhesive properties of glass ionomer

125
Q

What are the pros to polyacid-modified resin sealants?

A
  • Continuous release of fluoride
  • Controlled working time
126
Q

What are the cons to polyacid-modified resin sealants?

A
  • Lower amounts of fluoride release vs GI
  • Retention lower than resin
  • Moisture-sensitive
  • Require etching prior to placement
127
Q

What are resin-modified glass ionomer sealants?

A

Glass ionomer sealants with resin components

128
Q

What are the pros to resin-modified glass ionomer sealants?

A
  • Similar fluoride release properties as GI
  • Longer working time than GI
  • Less water sensitivity than GI
  • Does not require etching prior to placement
129
Q

What are the cons to to resin-modified glass ionomer sealants?

A
  • Lower retention than resin
  • Lower wear-resistance than resin
130
Q

What are the steps involved in placing sealants?

A
  • Always recommend dry environment (especially important for resin-based)
  • Clean pits & fissures with pumice and prophy brush, air abrasion, hydrogen peroxide, or enameloplasty (usually used for deeper grooves)
  • Place acid etch (35% phosphoric acid) for 15-20 seconds, rinse, and dry (enamel should appear “chalky” white (for resin-based sealants ONLY)
  • Place sealant material of choice and light cure if necessary (resin sealant materials)
  • Check occlusion and adjust if necessary
131
Q

Should you use prophy paste to clean a tooth prior to sealant placement?

A

DO NOT use prophy paste to clean a tooth b/c fluoride and oil interferes with etching process

132
Q

What does research show if you place bonding agent prior to sealant placement?

A

Research shows an increased bond strength if bonding agent placed prior to sealant placement

133
Q

What are the steps involved in placing PRRs?

A
  • Remove caries
  • Etch for 15-20 seconds, rinse, and dry
  • Place bonding agent, air dry, and light cure
  • Place flowable resin composite, and light cure
  • Check occlusion and adjust if necessary
134
Q

Do you need to numb the patient prior to placing a PRR?

A

NO- due to enamel layer caries only

135
Q

What are some examples of non-surgical caries management techniques?

A
  • Behavioral modification
  • Topical fluoride application
  • Pit & fissure sealants
136
Q

What is involved with behavior modification?

A
  • Limiting sugary foods and drinks
  • Chewing sugar-free gum with xylitol
  • Brushing with fluoride toothpaste 2x/day
  • Cleaning between teeth 1x/day
137
Q

What is involved with topical fluoride application?

A
  • Placement of fluoride varnish (2.26%)
  • Placement of fluoride gel (1.23% acidulated phosphate) (age 6 & up)
  • Daily use of 0.09% fluoride mouthrinse (age 6 & up)
  • Silver Diamine Fluoride (38%) for arrest of dental caries
138
Q

When is SDF used?

A

used mainly in pediatric dentistry for patients that would otherwise be difficult to work on

139
Q

What is involved with put & fissure sealants?

A
  • Anatomical grooves of teeth trap food particles and promote presence of bacterial biofilm, increasing the risk of caries
  • Effectively penetrating and sealing these surfaces with dental material (sealants) has been proven effective in preventing and arresting caries in permanent molars of children and adolescents
  • Placed on pit and fissure areas only on noncavitated teeth (caries risk assessment for patient should be taken into consideration)
140
Q

Should you prepare the smaller or larger lesion first?

141
Q

Should you restore the smaller or larger lesion first?

142
Q

Can you etch more than one prep at a time?

A

No- only etch one prep at a time

143
Q

What material was mined from Mammoth Cave in Mammoth Cave National Park in Kentucky/ the active ingredient in sensitivity toothpastes?

A

Potassium Nitrate (KNO- gunpowder)

144
Q

What is the ideal inciso-gingival height of class III preps?

A
  • 1.5mm on maxillary lateral
  • 2.0mm on maxillary central
145
Q

What is the ideal mesial distal height of class III preps?

A
  • 1.0mm on maxillary lateral
  • 1.5mm on maxillary central
146
Q

What is the state of the gingival contact in ideal class III preps?

147
Q

What is the state of the incisal contact in ideal class III preps?

148
Q

What is the state of the facial contact in ideal class III preps?

A

broken MINIMALLY

149
Q

What is the retention in class III preps?

A
  • Retention not always required (do not place in deeper than normal preps)
  • If placed, place in dentin
  • Incisal point (placed with ¼ or ½ round bur)
  • Gingival groove (placed with ¼ or ½ round bur)
150
Q

Where should you bevel in ideal class III?

A
  • Place 1mm bevel lingual
  • 45 degrees
    (all lingual Cavosurfaces)
151
Q

What are the different non-carious cases of Class V lesions?

A
  • Abrasion- wear
  • Erosion- caused by acid
  • Abfraction- mechanical loss of tooth structure
152
Q

What is abrasion?

A
  • Toothbrush, pen chewing, occlusal wear from grinding
  • Discuss habits with pt
153
Q

What is erosion?

A
  • Bulimia, GERD, alcoholics, extreme diet
  • Discuss diet & medical history
154
Q

What is abfraction?

A
  • Loading forces aren’t where they’re supposed to be
  • = flexure of tooth and failure of enamel and dentin
155
Q

Causes of dental sensitivity?

A
  • Caries or leaky restoration
    Void
  • Fluid flows into void (Ex: from CaOH liner having washed away)
  • Premature occlusion
  • Exposed dentin
  • Recession or incomplete formation of CEJ
  • Exposed cementum
  • Post-perio surgery
  • Abrasion and erosion (includes iatrogenic from polishing instruments)
156
Q

How to use clear mylar strip for class IIIs:

A
  • Wedge the matrix at the gingival to hold it against the tooth
  • Wedge aids in separating the tooth for good contact and control seepage and moisture contamination
  • Minimizes finishing time
  • Wedge is required to prevent gingival overhangs & to stop gingival bleeding or moisture seepage
  • SPEND TIME ON THIS STEP
  • Let excess material extrude toward the incisal (easier to finish incisally vs gingivally)
  • For FINAL INCREMENT: tighten mylar strip around restoration and cure
157
Q

Why do you tighten mylar strip around restoration and cure after final increment?

A
  • Results in smooth finish
  • Eliminates oxygen interference
  • Not necessary to polish this surface if it does not need contouring
158
Q

What is the Cure-Thru matrix?

A

Compresses the material with a matrix into the Class V prep while giving a great contour

159
Q

What biomaterials should you consider when restoring Class V lesions?

A

Use nanofill or microfill
- Lower modulus of elasticity (less stiff) than hybrids
- Won’t flex as readily
- Less likely to debond

Operative II (9 decks)

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