Considerations for Operative Dentistry and Class II Review Flashcards
Why should you isolate the operating field with a rubber dam?
◦ Better visualization
◦ Better access
◦ Prep walls dry and clean
◦ Your materials work better
- Improved properties- direct contact 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
What are the componenets of a dental dam set up?
- rubber sheet
- clamp
- frame
- punch
- forceps
What side of the rubber sheet faces the operator and which side faces the patient?
- shiny side against patients tongue, palate
- dull side faces the operator
What are the parts of a rubber dam retainer (clamp)?
- bow
- jaws
- forceps holes
- points
What cases are more important to use a rubber dam: composite or amalgam?
Composite
- bonding requires uncontaminated surfaces
- wet field = recurrent caries or failed bond
What can a wet field cause during a composite restoration?
recurrent caries or failed bond
How do you isolate the teeth during a class II procedure?
one tooth posterior, two teeth anterior to tooth you’re working on
How do you isolate the anterior teeth during a procedure?
◦ Canine to canine
◦ Or can clamp on one premolar, ligate between incisors or incisor/canine
What teeth do you isolate in a pediatric case?
only isolate teeth necessary
What teeth do you isolate in an endo case?
a single tooth
What are the steps for placing a rubber dam?
- Prep work
◦ punch holes in rubber
◦ check contacts for floss shredding
◦ mark occlusion BEFORE placing dam - Place clamp on tooth
- Place dam over entire clamp
- Stretch dam through contacts (Floss)
- Invert dam
◦ Delicately blow air around cervical area and push rubber into sulcus with plastic instrument - Ligate anterior tooth
If the rubber dam does not work to isolate what are other options?
Antisialogogue medications (RARELY USED)
◦ Atropine and Banthine
Absorbents
◦ Cotton Rolls
◦ Dry Shields
◦ 2x2 gauze
◦ Cotton pellets
Suction
◦ High evacuation suction
◦ Saliva ejector
◦ Svedopter
◦ Isovac (bolded)
What are the different absorbents we can use?
- cotton rolls
- dry shield
- 2x2 gauze
- cotton pellets
What is the least effective absorbent?
2x2 gauze (works better as a throat pack
What can cotton pellets be used for?
◦ Remove moisture from inside preparation
◦ Remove moisture when patient is sensitive to air and water spray
What is a dry shield?
◦ Blocks parotid, retracts and protects cheek
◦ Wet when removing to avoid “cotton roll burn”
How do you place and remove a cotton roll?
◦ Placed in vestibule
◦ Wet when removing to avoid “cotton roll burn”
What are the different types of suction?
◦ High evacuation suction
◦ Saliva ejector
◦ Svedopter
◦ Isovac
What are the pros of the high evacuation suction?
◦ Very effective at picking up debris
◦ Can be used to retract tissue
◦ Vented is better- reduces sucking up of tongue and mucosa
What are the cons of the saliva ejector?
◦ Ineffective at removing debris
What is a svedopter?
old fahioned isovac
What are some additional tools that can be used to isolate the operating field?
- retraction cord
- bite block
- anterior lip retractors
If caries are in the E1/E2 layer what is the treatment?
- REMINERALIZE
If caries are in the D1 layer what is the treatment?
restore surgically or attempt
to remineralize
- caries extends only to first third of dentin
If caries are in the D2 layer what is the treatment?
restore surgically
- caries extends to middle third of dentin
If caries are in the D3 layer what is the treatment?
Restore surgically, prepare for
possible root canal or pulp capping
What are the very basic steps of a class II prep?
- establish initial outline form and depth
- extend proximal box
- composite or amalgam exit angles
- remove caries
- refine prep
What should the exit angles be for composite preps?
◦ Buccal flared >100o
◦ Lingual flared >90o
What should the exit angles be for amalgam preps?
◦ Reverse S curve to achieve 90o exit angle
◦ Buccal contact must be broken
How do you remove caries during a prep?
◦ Spoon excavator
◦ Round bur on slow speed handpiece
What steps do you need to do when refining a prep?
◦ Plane axiopulpal line angle
◦ Plane gingival margin
◦ Bevel gingival margin
Ideal pulpal depth in these premolar preparations is…
1.5mm
In Class II preparation, if extra retention is needed, retention grooves can be placed
in the…
buccal-axial line angles
How do you add retention grooves to a class II prep?
- Place flutes of the 169 bur right the buccal axial line angle of the box.
- Tip the bur mesially and lingually
- Only the tip of the bur touches the tooth in the buccal-gingival-axial point angle - Push the bur in a disto-buccal direction just inside the dentin
Are retention grooves in the dentin or enamel or a combo?
dentin!
What are the steps to put in a sectional matrix (palodent)?
Step 1:
Use provided tweezers to place
wedge or WedgeGuard PRIOR TO
PREPARATION
Step 2 (if applicable):
Remove guard using palodent tweezers
Step 3:
Place sectional matrix band using provided Palodent tweezers
Step 4:
Place ring on top of wedge.
The indentations on the ring allow for the wedge to fit in between them.
What are the parts of the tofflemire retainer?
Being placing composite material in ________ of preparation
box
Form final anatomy before or after final cure
before if possible
True/false: You may need to use the finishing carbides to make minor adjustments after light-curing
True
With amalgam restorations begin with ____________ ________ to recreate anatomy
HOLLENBACK carver
When doing an amalgam restoration you should fill _______ above margins
1.0 mm
How do you end an amalgam restoration?
*Carve interproximal before amalgam sets up fully
*Refine anatomy
*Smooth restoration with wet cotton pellet
*Prefer a DULL, MATTE finish for this class
