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Operative 2 > Class III, IV, and V Composite Preparations > Flashcards

Class III, IV, and V Composite Preparations Flashcards

1
Q

Select shade before

A

placing rubber dam
◦ Dehydrating tooth affects shade

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2
Q

Avoid — on tooth

A

shining overhead light/loupes light directly

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3
Q

Unsure?

A

Cure small blob of composite on tooth to check shade
◦ Do not etch nor bond- composite will flick off easily

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4
Q

Class III Preparation: Shade
selection Be mindful
(2)

A

◦ At least three color esthetic zones on a tooth
◦ TAKE SHADE FROM PORTION OF SHADE GUIDE MOST SIMILAR TO THICKNESS OF RESTORATION

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5
Q

MARK — PRIOR TO APPLYING DAM
◦ Avoid margins ending in occlusal contact areas

A

OCCLUSION

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6
Q

Class III Preparation
Approach from the — when possible

A

lingual

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7
Q

Class III Preparation
Approach from the — when possible

A

lingual

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8
Q

Class III Preparation
Approach from the lingual when possible
◦ Acceptable to leave unsupported enamel on facial wall of preparation
(5)

A

◦ Esthetics improved
◦ Discoloration and deterioration is less visible
◦ Color match is easier
◦ Facial enamel is conserved
◦ WEDGE SHAPED PREPARATION

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9
Q

Class III Preparation Minimal extension
Protect adjacent tooth
Where is caries?
(2)

A

◦ Usually more lingual than facial
◦ Gingival to contact area

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10
Q

Preserve — contact
◦ It may be acceptable to leave sound undermined enamel here

A

incisal

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11
Q

Remove — from margins
◦ You can’t see these- must visualize based on rod location

A

loose enamel rods

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12
Q

Begin outline form
◦ Prepare — to long axis

A

PERPENDICULAR

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13
Q

Inciso-gingival length
◦ — on maxillary lateral
◦ — on maxillary central

A

1.5
2.0

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14
Q

Mesial distal width
◦ — on maxillary lateral
◦ — on maxillary central

A

1.0
1.5

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15
Q

— contact is broken
— contact is intact

A

Gingival
Incisal

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16
Q

Inciso-gingival height=

A

2.0mm

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17
Q

Mesio-distal width=

A

1.5

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18
Q

— not always required
Place in dentin!
◦ Do not undermine enamel
Incisal Point
◦ Place with
Gingival groove
◦ Place with

A

Retention

½ or ¼ round bur
½ or ¼ round bur

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19
Q

Class III Preparation Retention
(2)

A

◦ Deeper than normal prep= avoid placing retention to avoid pulp exposure
◦ Place point and groove where they would be in an ideal prep

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20
Q

Class III Preparation
BEVEL
(4)

A

◦ Place 1mm bevel lingual and facial
◦ 45-60 degrees
◦ Smooth, even
◦ Flame-shaped diamond bur

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21
Q

Class III Preparation
Break — contact
◦ MINIMALLY

A

facial

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22
Q

Class III Preparation
Variations
◦ Root surface caries
◦ Same prep but

A

◦ DO NOT BEVEL on dentin or cementum

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23
Q

Class III Preparation
Variations
DO NOT BEVEL
◦ If there would be

A

heavy centric contact on margin
◦ Enamel wears better than composite
◦ Enamel is stronger than composite

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24
Q

Class III Preparations
Variations
◦ Facial approach
(4)

A

◦ When lingual access may involve only centric contact of tooth
◦ Irregular tooth alignment or rotation
◦ Extensive caries on the facial
◦ Existing defective restoration on the facial

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25
Q

Class III Restoration
— usually not necessary

A

Pulp Protection (Liner)

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26
Q

Do not use —
why?

A

eugenol
◦ Found in IRM
◦ interferes with polymerization reaction.

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27
Q

Do not use eugenol
◦ Found in IRM
◦ interferes with polymerization reaction.
If needed, line — wall ONLY
(6)

A

dentin axial

◦ Use appropriate material
◦ CaOH, Glass Ionomer
◦ Avoid liner on enamel
◦ Take care to avoid liner in retention points, grooves
◦ More likely to need liner in younger patients
◦ Larger pulp

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28
Q

Matrix and Wedge Application
(5)

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!!!

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29
Q

Removing Excess Material

A

Let the excess restorative material extrude toward the incisal
◦ easier to finish incisally vs. gingivally

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30
Q

The Mylar Strip Finish Tighten mylar strip around restoration and cure
(3)

A

◦ Results in smooth finish
◦ Eliminates oxygen interference
◦ Not necessary to polish this surface if it does not need contouring

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31
Q

Metal Plastic InstrumentThe instrument is metal
BUT it works with

A

plastic material
* Composite resin is plastic

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32
Q

Steps of placement
(6)

A

Cover pulpal (axial) wall first, get in retention points/grooves
Cure between increments
Second layer
Cure between increments
Third layer
Final cure (Larger preps require additional layers and vice versa)

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33
Q

Shaping and Finishing Should be shaped as much as possible prior to curing
◦ Plastic instrument, matrix band
Use
(3)

A

finishing burs
Brasseler finishing discs - (coarse, then medium, then fine, then superfine)
Finishing strips (strip from the gingival to the contact if necessary, do not strip and remove the
contact).

34
Q

Shaping and Finishing
— preferable when finishing lingual surface

A

12 bladed finishing burs (round or bullet shape)

35
Q

— blades smoother than — blades
(like sandpaper- higher grit= smoother)

A

12
6

36
Q

Lingual excess of material
Check occlusion
(2)
Remove composite back to the —
◦ Remember your preparation

A

◦ Remove all occlusal prematurities in centric and excursions
◦ Occlusion should be on the tooth, not the restoration.

cavosurface bevel

37
Q

Flash on gingival
(4)

A

check that there is no overhangs in this area with the
explorer. If there is use a sharp gold knife to remove.
Avoid by better wedge and clear matrix band
placement
Remove with finishing strip (if small enough)
Remove with bur (if large)- Be careful not to gouge composite

38
Q

Finishing Strips
(4)

A

Thread below contact
Use above contact
Non-abrasive area in center- can “floss” through contact without removing material
AVOID STRIPPING AWAY CONTACT

39
Q

Class IV Preparation – classic “chipped
tooth”
Same principles as Class III BUT

A

the incisal angle is missing
◦ Increase in restorability difficulty level!

Increase the bevel and extend beyond the bevel with the resin for
more retention and a better esthetic appearance.

40
Q

Resin Extension for large fracture
A labial veneer or full coverage crown may be necessary on a

A

large fracture for extra retention.

41
Q

Class V Preparation

A

-Carious lesion in gingival third of tooth
◦ Can be buccal or lingual

42
Q

Curing Light

A

Light must have sufficient output
◦ > 550mW/cm2

43
Q

Class V Preparations
Axial Wall is —
Mesial and Distal Walls —
Incisal gingival height= —
Axial depth —

A

convex
diverged
1.5mm
1.0mm

44
Q

Class V Preparation
Beveled
(4)

A

◦ USE DIAMONDS
◦ Increases surface area
◦ Increases retention
◦ Reduces microleakage

45
Q

◦ Reduces microleakage
(2)

A

◦ Reduces margin discoloration
◦ Eliminates white “halo” effect= better esthetics

46
Q

Bevel ENDS of

A

enamel rods

47
Q

Add

A

Retention grooves

48
Q

Class V Preparation When do we NOT bevel?

A

◦ Below CEJ
◦ We’re in cementum then- no need to expose enamel rods for better bonding

49
Q

Class V Preparation
Modification for shallow caries or decalcified enamel adjacent to

A

Class V caries
◦ Basically an extended bevel

50
Q

Class V restorations may extend onto the

A

root surface
◦ Polymerization shrinkage is greater than bond to cementum/dentin
◦ Causes contraction gap

51
Q

Retention groove
◦ can minimize —

A

gap

52
Q

Consider other restorative materials
(2)

A

◦ RMGI
- May reduce microleakage
◦ Amalgam

53
Q

Class V Considerations
Non Carious Cervical Lesions
(3)

A

◦ Abrasion- wear
◦ Erosion- caused by acid
◦ Abfraction- mechanical loss of tooth structure

54
Q

◦ Abrasion- wear

A

◦ Toothbrush, pen chewing, occlusal wear from grinding

55
Q

◦ Erosion- caused by acid

A

◦ Bulimia, GERD, alcoholics, extreme diet

56
Q

◦ Abfraction- mechanical loss of tooth structure
(2)

A

◦ Loading forces aren’t where they’re supposed to be
◦ = flexure of tooth and failure of enamel and dentin

57
Q

Dentin wears — times easier than enamel

A

25-125

58
Q

Abrasion
◦ Discuss

A

habits with patient, including brushing

59
Q

Bond strength to natural sclerotic dentin is —% lower than to sound cervical dentin
- REMOVE with bur

A

25-40

60
Q

Erosion
Discuss (2)

A

◦ Discuss diet
◦ Chew/suck on lemons
◦ Frequent soda/energy drink intake

◦ Discuss medical history
◦ Acid reflux
◦ Bulimia
◦ Dry mouth from medications
◦ Lack saliva to buffer acid

61
Q

Class V Considerations
Abfraction
(5)

A

◦ Flexure and fatigue of enamel and dentin
◦ Caused by occlusal forces
◦ Microfractures
◦ Heavy occlusal force in lateral or eccentric occlusion
◦ Stress is concentrated at cervical area of tooth, causing fractures

62
Q

Class V Considerations
When to treat Non-carious Cervical Lesions?
(5)

A

◦ Lesion is deep enough to compromise tooth
◦ Sensitivity
◦ Involved in partial denture design
◦ Defect is approaching pulp
◦ Defect contributes to a periodontal problem

63
Q

◦ Sensitivity
(2)

A

◦ Attempt non-surgical treatment of sensitivity first
◦ Toothpaste, topical fluoride, etc

64
Q

Defect contributes to a periodontal problem

A

Overcontoured restorations more likely to produce perio problems

65
Q

Class V Preparation
For abrasion
(2)

A

◦ Conservative extension
◦ May need minimal to no preparation
- Patient already prepped tooth with toothbrush

66
Q

Hydrodynamic Theory of dentin sensitivity
(2)

A

◦ Pain caused by dentinal fluid movement

◦ From mechanical or chemical stimuli
- Temperature changes
- Air drying
- Osmotic pressure

67
Q

Causes of tooth sensitivity
(7)

A

Caries or leaky restoration
Void- fluid flows into void
Premature occlusion
Exposed dentin
Exposed cementum
Post- perio surgery
Abrasion and erosion

68
Q

Void- fluid flows into void
◦ Ex.

A

From CaOH liner having washed away

69
Q

Exposed dentin

A

◦ Recession or incomplete formation of CEJ

70
Q

Abrasion and erosion
◦ Includes

A

iatrogenic from polishing instruments

71
Q

Treatment options- sensitivity
Aim is to
— first

A

occlude tubules to stop fluid movement
NONINVASIVE

72
Q

NONINVASIVE first
(4)

A

◦ Topical fluoride
◦ Desensitizing dentifrices (toothpastes)
◦ Desensitizing agents
◦ Resin desensitizers

73
Q

If none of that works=

A

restoration

74
Q

Treatment:
Fluoride Varnish

A

5% NaF (Duraphat) varnish 22,600 ppm fluoride
◦ not approved for use by FDA as caries preventive but ok for desensitization. (Has been used in Europe for many years)
Fluoride varnish is a sticky, yellow, semi-liquid containing 5% NaF in a resin base mixed with alcohol to dry quickly after application.
Four manufacturers market the varnishes under the names. (Duraphat, Cavity Shield, Durafluor, and Fluor Protector)
Apply carefully – material sticks to lips and face.
◦ Use disposable application instruments because it bakes on instruments during sterilization and is difficult to remove.

75
Q

Treatments- fluoride toothpaste,
trays
(2)

A

Prescription toothpastes
Fluoride trays
- Wear overnight

76
Q

Treatments: Desensitizing Dentrifices
- Toothpaste

A

Toothpastes - may take 1-3 months for results to
be realized.
Sensodyne (Block Drug Company) Strontium
chloride 10% and Potassium Nitrate (KNO-
gunpowder)
Most brands make a Potassium Nitrate
sensitivity toothpaste

77
Q

Gluma
◦ Placed by dentist when preparing tooth
(5)

A

◦ place after etching (for composite restorations)
◦ Lightly dry
◦ Place bonding agent
◦ Place composite
◦ Can also be used with amalgam, but fewer steps

78
Q

When to restore vs. when to leave
(4)

A

Esthetic desire of patient
Lesion >1.0mm depth and progressing
Possible pulp exposure
Structural integrity of tooth is threatened

79
Q

Treatment- restoration Will block tubules
(3)

A

◦ Amalgam
◦ Composite
◦ Glass Ionomer

80
Q

Treatments- why they work
(6)

A

Protein coagulation
Enzyme interference, blocking nerve impulses
Induction of tertiary dentin
Various precipitates in dentinal tubules block fluid movement
Destruction of odontoblasts
Placebo effect (40% of patients respond to application of distilled water)

Operative 2 (12 decks)

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