Operative II Review Flashcards
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ISOLATION OF OPERATING FIELD
* But Why?
(6)
- Better visualization
- Better access
- Prep walls dry and clean
- Your materials work better https://www.researchgate.net/figure/Minimally-invasive-distal-slot-preparation_fig14_237388550
- 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
Components of Dental Dam set up
(4)
- Rubber sheet, clamp, frame, punch, forceps
- Rubber sheet
- Different sizes rubber material
- Different thickness (gauges)
- Rubber sheet
(2)
- Dull side faces operator
- Shiny side against patient tongue, palate
- Different sizes rubber material
(2)
- 5x5 pediatric patients
- 6x6 adults
- Different thickness (gauges)
(5)
- Thin 0.006” (used only for very tight contacts)
- Medium 0.008”
- Heavy 0.010”
- Extra Heavy 0.012”
- Special Heavy 0.014”
Frame
(2)
- Metal
- Plastic- can be radiographed
Punch
(2)
- Choose appropriate hole size based on tooth size
- Anchor tooth gets largest hole
Forceps
(2)
- Used to place clamp
- Holes in clamp correspond to extension in forceps
ISOLATION OF OPERATING FIELD
* Extremely important in composite cases
(4)
- USE RUBBER DAM
- Bonding requires uncontaminated surface
- Technique sensitive!
- Wet field= recurrent caries or failed bond
ISOLATION OF OPERATING FIELD
Class II=
one tooth posterior, two teeth anterior to tooth you’re working on
* ONE TOOTH BEHIND (anchor) and TWO TEETH IN FRONT
ISOLATION OF OPERATING FIELD
Anteriors
(2)
- Canine to canine
- Or can clamp on one premolar
ISOLATION OF OPERATING FIELD
* Pediatric-
only isolate teeth necessary
ISOLATION OF OPERATING FIELD
* Endo-
single tooth
ISOLATION OF OPERATING FIELD
General isolation/FDP-
general field isolation
* May be acceptable to cut a slit between holes
ISOLATION OF OPERATING FIELD
(6)
- Prep work
* punch holes in rubber
* check contacts for floss shredding
* Smooth contacts if necessary
* mark occlusion - Place clamp in dam
* Don’t forget to tie clamp with floss - Place dam over tooth
* Can do with or without frame in place - stretch dam through contacts
* Floss between contacts - Invert dam
* Delicately blow air around cervical area and push rubber into sulcus
with plastic instrument - Ligate anterior tooth /
* Ligate with ligatures or piece of rubber dam cut and placed
interproximally
Cotton rolls
(2)
- Placed in vestibule
- Wet when removing to avoid “cotton roll burn”
Dry Shield (parotid shield, cellulose wafer)
(2)
- Blocks parotid, retracts and protects cheek
- Wet when removing to avoid “cotton roll burn”
2x2 gauze
(2)
- Least effective
- Works well as throat pack
Cotton Pellets
(2)
- Remove moisture from inside preparation
- Remove moisture when patient is sensitive to air and water spray
High evacuation suction
(4)
- Vented is better- reduces sucking up of tongue and mucosa
- Very effective at picking up debris
- Can be used to retract tissue
- Leave room for water from handpiece to cool the tooth
Saliva Ejector
(3)
- Ineffective at removing debris
- Do NOT have patient close lips around suction
- Backflow, extra gross
Svedopter
- Old fashioned isovac
Additional tools:
(3)
- Retraction cord
- Bite Block
- Anterior lip retractors
— is the optimal method
* Get good at placing it!
* Fast and efficient
* Makes life easier
Rubber dam
D1 (Dentin-first layer):
caries extends only to first third of dentin
Treatment planning consideration: restore surgically or
attempt to remineralize
D2 (Dentin-second layer):
caries extends to middle third of
dentin
Treatment planning: restore surgically
Interproximal clearance= —
Facial, lingual, and gingival
0.5mm
Once ideal outline form is achieved, remove caries
(2)
- Spoon excavator
- Round bur on slow speed handpiece
Refine prep
(2)
- Plane axiopulpal line angle
- Reduces stress
- Plane gingival margin
- Use margin trimmer
- This removes loose enamel rods
amalgam
Good condensation is important!
* Fill — first
* Fill — above margins
Box
1.0mm
Begin carving
(3)
- Carve mesial incline of marginal ridge using explorer
- Pre-carve burnish
- Carve with Hollenback
CLASS II AMALGAM MODIFICATIONS
* Maxillary molars
(3)
Do not cross oblique ridge when possible
-if less than 0.5mm thick= cross ridge
-preserves resistance form
Clean tooth
* w/
Pumice and water mixture
Proximal outline form
(3)
- Must break gingival margin
- CARIES must be removed
- Occur just below contact
- Matrix band must fit passively
- Keep margins in enamel when possible
- Only remove carious tooth structure
BEVELS
- Lingual wall bevel
- Gingival bevel
- Careful- enamel is thin here
- If gingival floor is in dentin/cementum,
NO BEVEL - Axial-pulpal line angle bevel
- Flare on —
facial
