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Operative Dentistry BDS2 > Clinical Amalgam > Flashcards

Clinical Amalgam Flashcards

1
Q

what are the direct restorative materials

A

amalgam, composite resin, glass ionomer and RMGI

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2
Q

what are the indirect restorative materials

A

gold, other metals, ceramic

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3
Q

what are the contra-indications for amalgam

A

aesthetics, sensitivity to mercury, loss of tooth substance does not allow for retentive cavity, excessive removal of tooth substance would be required

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4
Q

what are the indications for amalgam use

A

direct restoration in moderate and large sized cavities in posterior teeth

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5
Q

what are the advantages of amalgam

A

durable, good long-term clinical performance, long lasting, resistance to surface corrosion, shorter placement time, radiopaque, economical

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6
Q

what are the disadvantages of amalgam?

A

poor aesthetic qualities, does not bond easily to tooth substance, thermal diffusivity, cavity preparation requires destruction of sound tissue, marginal breakdown, local sensitivity, lichenoid lesions, galvanic response, tooth discolouration, amalgam tattoo, mercury toxicity

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7
Q

what is the retention form of the cavity design

A

features that prevent the loss of the restoration in any direction

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8
Q

what is the resistance form of the cavity design?

A

features that prevent the loss of the material due to distortion or fracture by masticatory forces

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9
Q

how is a resistance form made?

A

cavity floor parallel to occlusal surface with sufficient depth of the cavity to give adequate mechanical strength

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10
Q

in what type of cavity would amalgam be acceptable for?

A

moderate to large occlusal cavities

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11
Q

what are the cavity designs for interproximal caries

A

self-retentive box preparation, proximo-occlusal preparation

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12
Q

what is a self-retentive box preparation

A

small undercuts made on buccal and lingual walls

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13
Q

what are the advantages of self-retentive box preparations

A

less tooth tissue removed, reduced amount of amalgam, sound tissue retained between proximal box and occlusal cavity

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14
Q

what are the disadvantages of self-retentive box preparation

A

more technically demanding than proximo-occlusal preparation, further treatment of any pit and fissure caries may be required

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15
Q

what is a proximo-occlusal preparation

A

take out the fissure as well as interproximal caries

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16
Q

what are the advantages of proximo-occlusal preparation

A

retentive, also treats pit and fissure caries, less or no opportunities for future caries in pits and fissures

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17
Q

what are the disadvantages of proximo-occlusal preparation

A

destruction of tooth tissue, increased risk of weakening the tooth

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18
Q

what sort of initial retention factors can you include?

A

grooves or dimples within cavity design, pin placement

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19
Q

how do you place a retentive pin?

A

self-tapping screws, place into dentine, avoid pulp enamel and ADJ, pack amalgam around pin

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20
Q

what are the initial problems with pins?

A

stress in tooth, cracking dentine, sensitivity of tooth due to temperature transference

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21
Q

what are the long-term problems with pins?

A

filling can leak but will not fall out due to pin so secondary caries caused which can go deeper into tooth

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22
Q

how do you finish an amalgam cavity?

A

ensure all caries is removed, smooth and round internal line angles, check and finish cavo-surface angles, smooth cavity margins

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23
Q

what is the effect of moisture contamination

A

reduces strength, increases creep, increases corrosion, increases porosity, critical but not as bad as composite restorations

24
Q

what do you seal dentine with?

A

cavity varnishes, RMGIC, use DBA sometimes

25
Q

what is microleakage

A

passage of fluid and bacteria in micro gaps between restoration and tooth

26
Q

what does microleakage cause?

A

pulpal irritation, discolouration, secondary caries

27
Q

how can microleakage occur?

A

due to mechanical loading and thermal stresses

28
Q

what is the purpose of a matrix?

A

recreate cavity walls, allows creation of proximal form, allows adequate condensation, confines amalgam to the cavity, should be less than 0.5mm thick, smooth and strong, allow close adaption at cervical margin, allow good contact with adjacent tooth

29
Q

what do wedges do?

A

produce adaptation of matrix at cervical margin, prevents excess amalgam gingivally, aids proximal wall contour, prevents movement of matrix band

30
Q

what does mixing time affect?

A

handling characteristics, working time, amalgam microstructure, restoration longevity

31
Q

what does condensation do?

A

expels excess mercury bringing it to the surface, adapts material to cavity walls, reduces layering, eliminates voids

32
Q

what does using a large plugger allow?

A

controlling initial increment

33
Q

what does inadequate condensation do?

A

lack of adaption to cavity, poor bonding between layers, inadequate mercury expression and removal, inferior mechanical properties

34
Q

how do you remove mercury from surface amalgam

A

carving, burnishing, using high volume aspiration

35
Q

what does carving do?

A

recreates anatomical contour

36
Q

what does finishing do?

A

adjust anatomical contour after amalgam set

37
Q

what can corrosion cause?

A

marginal breakdown with creep and ditching

38
Q

what is creep?

A

slow internal stressing and deformation of amalgam under stress

39
Q

which type of alloys do not exhibit as much creeo?

A

high copper

40
Q

what do you need to remove amalgam restorations

A

dental dam, high volume aspiration, minimal cutting, selective cutting, hand instruments

41
Q

when is the greatest amount of mercury released?

A

during insertion and removal of amalgam restorations

42
Q

during insertions what is the amount of amalgam proportional to?

A

the restorations free surface area

43
Q

where can mercury absorption occur?

A

vapour into lungs, contact with skin, GI tract, gingiva and mucosa

44
Q

what can mercury toxicity cause?

A

neuro-toxicity, kidney dysfunction, reduced immunocompetence, effect on oral and intestinal bacterial flora, effects on general health, foetal and birth effects

45
Q

what does the Minimata convention aim to do?

A

phase down dental amalgam

46
Q

what is the consequence of the Minimata convention

A

aim for prevention, minimise amalgam use, promote mercury-free alternatives, promote research of mercury-free materials, encourage education of mercury-free alternatives, discouraging insurance policies favouring amalgam, encourage insurance policies favouring amalgam alternatives, only encapsulated amalgam, promote good environmental practices

47
Q

which groups of people should amalgam not be used on?

A

children under 15, pregnant women, breastfeeding women

48
Q

what is the SDCEP guidance regarding amalgam use?

A

no justification for removal of sound amalgam restorations except in patients with allergies

49
Q

what are the main limitations for alternative amalgam placement

A

lack of cooperation, inadequate moisture control

50
Q

what is Class 1 Caries?

A

pit and fissure

51
Q

what is Class 2 Caries?

A

approximal caries for posterior teeth

52
Q

what is Class 3 caries?

A

approximal caries for anterior teeth

53
Q

what is Class IV caries?

A

approximal caries involving incisal angle

54
Q

what is Class V caries?

A

cervical surfaces

55
Q

what is class VI caries?

A

affecting cusp tips

Operative Dentistry BDS2 (3 decks)

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