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Operative > Class I and Class V Restoration Fundamentals > Flashcards

Class I and Class V Restoration Fundamentals Flashcards

1
Q

Placing an Occlusal Restoration

Step 1:

A

Place Liner and/or Base if needed (Deep caries)

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2
Q

Materials: (2)

A
  1. Calcium Hydroxide (Ex: Dycal)

2. Glass Ionomer (Ex: Vitrebond)

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3
Q

Calcium Hydroxide (Ex: Dycal)

A

2 paste system, dispenses from separate tubes, mix Stimulates reparative dentin formation

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4
Q

Glass Ionomer (Ex: Vitrebond) (3)

A

2 paste system, dispenses from “clicker,” mix
Light cure
Releases fluoride over time

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5
Q

Place in — areas only. Keep away from margins.

A

deeper

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6
Q

Placed with — instrument (small ball shape)

A

Dycal

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7
Q

Calcium Hydroxide Liners (2)

A

LIFE OR DYCAL

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8
Q

Liner

A

placed in a thin layer over dentin

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9
Q

Base

A

placed in thicker layer on floor of prepared cavity

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10
Q

Placing an Occlusal Restoration

Step 2:

A

Seal Dentinal Tubules

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11
Q

Step 2: Seal Dentinal Tubules (2)

A

A. Not generally necessary

B. Types of desensitizers

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12
Q

A. Not generally necessary

A

Most preps do not require it, but some that would be especially prone to sensitivity may (ex. very young teeth- large pulp)

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13
Q

B. Types of desensitizers (3)

A
  1. Copal resin (Ex.: Copalite)
  2. Bonding Agents
  3. Gluteraldehyde & (2-hydroxyethyl)methylacrylate [HEMA] desensitizer (Ex.: Glumma)
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14
Q

Desensitizers (3)

A

Copal Resin (Ex: copalite)
Unfilled dentin bond agent (Ex: PQ-1, Peak)
Gluma

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15
Q

Copal Resin (Ex: copalite)

a. Advantage:
b. Disadvantage:

A

inexpensive , quick to use

leaves a film thickness (could wash out, causing
microleakage)

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16
Q

Unfilled dentin bond agent (Ex: PQ-1, Peak)

a. Advantage:
b. Disadvantage:

A

intermediate in cost

some require more than one step; involves some
form of etching with an acid, which researchers suggest may leave
teeth more vulnerable to recurrent caries; leave a film thickness.

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17
Q

Gluma

a. Advantages:
b. Disadvantages:

A

no film thickness, one step to apply

EXPENSIVE, somewhat caustic to soft tissues & possibly
to the pulp in deep preparations.

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18
Q

Application of desensitizer (3)

A
  1. Copal resin
    -wipe cavity walls with cotton pellet soaked in resin,
    then gently air dry
  2. Dentin-bonded resins
    -press resin into dentin using brush, gently air dry, light
    cure
  3. Gluma
    -apply to walls for 30 seconds , dry, rinse, dry again.
    -material is caustic; minimize contact with gingivae
    and protect pulp with liner/base in deep preparations
    prior to applying.
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19
Q

The Current Policy at UMKC

Regarding Dentin Desensitizer

A

We do not teach the standard use of dentin desensitizers under
amalgam. Studies suggest they make negligible difference in tooth
sensitivity on routine cases. The smear layer will seal most dentinal
tubules, and, after a few weeks, the amalgam will seal itself with an
oxide layer. Occasionally, after consultation with faculty, one might use
Gluma on an especially sensitive tooth, but place a liner or base first in
deep preparations.

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20
Q

Placing an Occlusal Restoration: Amalgam

Step 3:

A

Mix amalgam

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21
Q

Step 3: Mix amalgam

A

-adjust triturator mixing time according to manufacturer’s directions.

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22
Q

Placing an Occlusal Restoration: Amalgam

Step 4:

A

Dispense into Amalgam Well and Pick up

With Amalgam Carrier

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23
Q

Placing an Occlusal Restoration: Amalgam

Step 5:

A

Deposit amalgam into preparation using

amalgam carrier.

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24
Q

Step 5: Deposit amalgam into preparation using

amalgam carrier. (2)

A

Dispense a small amount

Allows for proper condensation

25
Q

Placing an Occlusal Restoration: Amalgam

Step. 6:

A

Condense Amalgam using the small

Hollenback condenser.

26
Q

Step. 6: Condense Amalgam using the small

Hollenback condenser. (2)

A

a. Tamp into the preparation to fix the amalgam in
place, perhaps using the larger condenser nib.
b. Use the small condenser nib to pack the material
FIRMLY into all line angles at a 45 ◦angle, using a
pressing, wiggling motion in a step-wise fashion.

27
Q

Placing an Occlusal Restoration: Amalgam

Step 7:

A

Overfill the Preparation

~ 1.0 mm beyond the margins

28
Q

Placing an Occlusal Restoration: Amalgam

Step 8:

A

Pre-carve burnishing
Using the side of the nib of the condenser or a large ball burnisher. Burnish
towards the margins to eliminate voids and to bring excess mercury to the
surface, where it can be carved away. Begin to define grooves.

29
Q

Placing an Occlusal Restoration: Amalgam

Step 9:

A

Carve the Amalgam

30
Q

Step 9: Carve the Amalgam (5)

A

a. Keep correct groove anatomy in mind.
b. Use the Hollenback carver held perpendicular to the margins.
c. Use the tip of the carver to recreate groove anatomy.
d. Carve exactly to the margins.
e. Remove all flash beyond the margins.

31
Q

Placing an Occlusal Restoration: Amalgam

Step 10:

A

Check and Refine Occlusion

32
Q

Step 10: Check and Refine Occlusion (5)

A

a. Remove rubber dam
b. Use articulating paper to mark occlusion(have patient close in
maximum intercuspation first and then move into lateral excursions).
c. Use the discoid carver to remove high occlusion marks and inclined
plane contacts.
d. Try to preserve cusp seats in the bottoms of fossae (long axis forces
on the teeth)
e. Other occluding areas should touch as usual (indicating no high
spots on the restoration which open the bite)

33
Q

Placing an Occlusal Restoration: Amalgam

Step 11:

A

Smoothing the surface

34
Q

Step 11: Smoothing the surface (2)

A

a. Use a beavertail burnisher to smooth surface, define
grooves, and eliminate voids (Avoid heavy burnishing on amalgam that is well along in its set. This could bring excess mercury to the
surface)
b. Wipe with a cotton pellet to smooth surface and to
leave a matte finish.

35
Q

— is not always strictly necessary

36
Q

It is needed when something needs to be corrected: (6)

A

• Occlusion, overhang, anatomy, marginal plaque trap, contour
improvement

37
Q

Research suggests that a well condensed, well carved amalgam
does not gain — from the finishing process

38
Q

If you do need to finish/polish an amalgam
restoration, you must wait — after
placement for amalgam crystallization to be
complete

39
Q 
Finishing and Polishing Amalgam
INSTRUMENT SEQUENCE (3)
A

•Green stone (coarse)
•White stone (medium)
•12 bladed polishing bur
(medium-fine)

40
Q

Finishing Burs -

A 
12 bladed flutes
Needle Point    
Flame              7902
Round              7006
Bullet                7404
Small round      7002
Bullet pointed   7104
41
Q

Placement of the bur: (3)

A

•Put the tip of the bur in the central groove and lay the bur across the
enamel margin.
•Sequence is to go from the most abrasive to the finest polishing
instrument. This sequentially produces smaller and finer scratches.
•Refine, don’t destroy, the groove anatomy.

42
Q

Criteria for finished amalgam: (5)

A
  • Scratches and major surface irregularities should be eliminated.
  • High polish is not necessary, can be done for esthetic reasons.
  • The most important area is the cavosurface margin.
  • Grooves should be definite but not deep. Contours should be maintained and not flattened.
  • No occlusal prematurities. Natural occlusal marks on the tooth should be present.
43
Q

•The most important area is the cavosurfacemargin. (2)

A
  • All flash and overhangs should be eliminated.
  • The tip of an explorer should pass from the tooth surface to the restoration surface and vice versa without jumping or catching
44
Q

Finishing older restorations (5)

A
  • Amalgam margins that have expanded beyond the cavosurface
  • Margins that were originally undercarved
  • 1/3 of the enamel thickness in a localized area can be removed to extend the life of a restoration without replacing it
  • Margins with minimal ditching may be refined
  • Rough surfaces can be smoothed
45
Q

Polishing may be done for — reasons only

◦ No longer considered necessary for a well-done amalgam

A

esthetic

◦ No longer considered necessary for a well-done amalgam

46
Q

We decide polishing is —

47
Q

POLISH AT SLOW SPEED bc

A

◦ Rubber points may fall apart at high speeds
◦ Tooth may overheat at high temp (May result in pulpal damage
◦ Amalgam may overheat) (Bringing mercury to the surface and increasing likelihood of future amalgam breakdown)
◦ Should obtain smooth surface after only a few seconds of polishing (If not, surface was too rough to polish. Restart finishing procedure from
beginning.)

48
Q

Placing an Occlusal Restoration: Composite

Technical aspects are very similar (2)

A

◦ Condense material well into preparation

◦ Restore occlusion

49
Q

Additional steps:

IN CLINIC:

A

Acid etch prepared tooth structure

50
Q

Additional steps:

IN CLINIC AND LAB: (3)

A

Place bond agent into enamel and dentin
Gently air dry
Light cure

51
Q

Composite is inserted via — in —

A 
syringe
small increments (~2mm or less)
52
Q

Each increment should be condensed well and then

A

light cured before adding the next increment.

◦ While condensing composite, “pull back” may occur

53
Q

After restoring the preparation, the occlusal surface should be shaped using

A

hand instruments

54
Q

Placing an Occlusal Restoration: CompositeOperator has control over

A

composite set up time
◦ Light cure
◦ Composite is completely polymerized (set up)
◦ Ability to polish at the same appointmen

55
Q

Advantages of composite: (5)

A 
◦ Preparation can be more forgiving
◦ Esthetic 
◦ Operator control of set up time
◦ Preserve tooth structure
◦ Don’t need to remove as much for retention (bonds) or bulk of restorative material
56
Q

Disadvantages of composite: (5)

A 
◦ Technique sensitive restoration
◦ Additional steps
◦ May not last as long
◦ Not as strong
◦ No moisture tolerance
57
Q

Placing a Class V Restoration Very similar to Class I (3)

A

◦ Not worried about occlusal anatomy
◦ Focus on making sure restoration is contoured to match original tooth
structure
◦ Overcontoured restoration will be more traumatic to gingiva than
undercontoured restoration

58
Q

Placing a Class V Restoration ◦ Steps: (3)

A

◦ 1. Follow same guidelines as occlusal (triturate, use carrier to place, condense well, over fill 1mm)
◦ With this restoration, forces will be going from the buccal surface to the axial wall
◦ 2. Use Hollenback carver to remove excess amalgam
◦ Keeping ends of carver on sound tooth structure, move instrument from distal to mesial
◦ Careful not to gouge restoration, resulting in voids
◦ 3. No need to check occlusion
◦ Polishing usually not necessary, but look how lovely this is!

Operative (11 decks)

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