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Operative II > Week 1 - Operative Dentistry II > Flashcards

Week 1 - Operative Dentistry II Flashcards

1
Q

why is isolation important

A
  • better visualization
  • better access
  • prep walls dry and clean
  • materials will work better
  • prevents injury to patient soft tissues
  • prevents aspiration and swallowing of debris
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2
Q

how does isolation make your materials work better

A
  • improved properties- direct contact of varnish/liner/base with cavity walls
  • moisture affects bond as well as materials ability to set up
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3
Q

what are the components of dental dam set up

A
  • rubber sheet, clamp, frame, punch, forceps
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4
Q

what side of the rubber dam faces the operator

A

the dull side

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5
Q

what are the different sizes of rubber dams

A
  • 5x5 for pediatric patients
  • 6x6 for adults
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6
Q

what are the different thicknesses of dams

A
  • thin 0.006”- used for very tight contacts
  • medium 0.008”
  • heavy 0.010
  • extra heavy 0.012
  • special heavy 0.014
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7
Q

what can the frame be made of

A
  • metal
  • plastic - can be radiographed
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8
Q

which tooth gets the largest hole

A

the anchor tooth

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9
Q

what are the forceps used for

A

the place clamp

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10
Q

holes in clamp correspond to:

A

extension in forceps

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11
Q

what are the parts of retainers (clamps)

A
  • bow
  • jaws
  • forceps holes
  • points
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12
Q

what are the types of retainers (clamps)

A
  • winged or wingless
  • points can be rounded, can be bent to flatten
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13
Q

why is isolation so important in composite cases

A
  • bonding requires uncontaminated surface
  • technique sensitive
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14
Q

what does wet field result in in composite cases

A

recurrent caries or failed bond

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15
Q

when doing a class II what teeth should you isolate

A

one tooth posterior to the tooth youre working on and two teeth anterior

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16
Q

what should to isolate when working on anteriors

A

canine to canine or can clamp on one premolar

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17
Q

what do you isolate in peds cases

A

only isolate teeth necessary

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18
Q

what do you isolate in endo

A

single tooth

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19
Q

what is general isolation/FDP

A

may be acceptable to cut a slit between holes

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20
Q

what are the steps in placing the rubber dam

A
  • prep work: punch holes in rubber, check contacts for floss shredding, mark occlusion
  • place clamp in dam and tie with floss
  • place dam over tooth
  • stretch dam through contacts and floss contacts
  • invert dam
  • ligate anterior tooth
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21
Q

what does it mean to invert the dam

A

blow air around cervical area and push rubber into sulcus with plastic instrument

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22
Q

what should you used if rubber dam doesnt work

A
  • antisialogogue meds: atropine and banthine (rarely used)
  • absorbents: cotton rolls, dry shields, 2x2 gauze, cotton pellets
  • suction: high evacuation suction, saliva ejector, svedopter
  • isovac
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23
Q

what should you keep in mind when using cotton rolls

A
  • place them in vestibule
  • wet when removing to avoid cotton roll burn
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24
Q

what do dry shields do

A
  • blocks parotid gland, retracts and protects cheek
  • also wet when removing to avoid cotton roll burn
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25
Q

what does 2x2 gauze work well as

A

throat pack

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26
Q

which absorbent is least effective

A

2x2 gauze

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27
Q

when do you used cotton pellets

A
  • remove moisture from inside prep
  • remove moisture when patient is sensitive to air and water spray
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28
Q

what is high evacuation suction used for

A
  • 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
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29
Q

describe the saliva ejector

A
  • ineffective at removing debris
  • do NOT have patient close lips around suction because of backflow
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30
Q

what are some additional isolation tools

A
  • retraction cors
  • bite block
  • anterior lip retractors
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31
Q

once ideal outline form is achieved:

A

remove caries

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32
Q

what should you remove caries with

A

-spoon excavator
- round bur on slow speed hand piece

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33
Q

how should you refine your prep and what do each of these things do

A
  • plane axiopulpal line angle to reduce stress
  • plane gingival margin- use margin trimmer to remove loose enamel rods
34
Q

where should you place the wedge in an amalgam restoration

A

in the larger embrasure

35
Q

what are the steps to performing an amalgam restoration

A
  • fill box - 1.0mm above margins
  • begin carving- carve mesial incline of marginal ridge using explorer, pre carve burnish, carve with hollenback
  • remove tofflemire and wedge
  • remove band- hold condenser on marginal ridge as you do this
  • interproximal - carve before it sets up
36
Q

what should you do after amalgam restoration is complete

A
  • check contacts with floss and remove buccal/lingual
  • check occlusion with articulating paper
  • burnish groove anatomy
  • smooth with wet cotton pellet
37
Q

what should you clean the tooth with before a composite prep

A

pumice and water mixture

38
Q

describe the proximal outline form of a composite prep

A
  • must break gingival margin
  • caries must be removed
  • matrix band must fit passively
  • break lingual contact
  • break buccal contact…or not
39
Q

where do caries occur in class II

A

below the contact

40
Q

where should margins be kept in composite preps

A

in enamel

41
Q

what should only be removed in composite preps

A

carious tooth structure

42
Q

what should the buccal wall be in amalgams? composite?

A

-amalgam- S curve
- composite- flare

43
Q

what is the pulpal floor depth in composite preps

A

1.5mm, no greater than 2.5mm

44
Q

what are the bevels we would do in a composite prep

A
  • lingual wall bevel
  • gingival bevel
  • axial- pulpal line angle bevel
45
Q

when do you not bevel the gingival floor

A

if it is in dentin or cementum

46
Q

what instruments should you use for flare on facial

A

7902 bur and hatchet

47
Q

what walls should be converged and diverged in composite prep

A
  • dovetails diverged
  • slightly converged or parallel occlusal walls
48
Q

what instruments should you use to finish a composite prep

A
  • use flame shaped diamond bur
  • use hatchet on proximal walls
49
Q

what should the composite prep be free of before restoring

A

debris, moisture, blood and saliva

50
Q

what are the additional steps to prepare for tooth bonding in composite restorations

A
  • etch (and rinse), bond agent placement (gentle, dry, light cure), composite placed incrementally, light cure each increment
51
Q

why is it more challenging to establish contact with composite

A
  • composite does not displace the matrix band like amalgam
  • shrinkage occurs as you light cure
  • different type of matrix may help counteract this issue
52
Q

what is complete etch

A
  • place etch on enamel first followed by dentin
  • etch enamel 20-30 seconds
  • etch dentin 15-20 seconds
  • rinse and gently air dry
  • typically only done with total etch and universal bond agents
53
Q

what is selective etch

A
  • etch enamel only
  • 20-30 seconds
  • rinse and air dry
  • can only be done with certain bond agents
54
Q

what bond agents can be used with selective etch

A

universal (what we use in clinic and lab) and self etch types

55
Q

what would give you clear evidence of etched enamel

A

whitish etched enamel surface

56
Q

what do you do if the enamel or dentin is contaminate with saliva when etching

A

re etch for 10 seconds, wash, dry apply bonding/primer agent, cure and continue

57
Q

what happens if you dessicate the dentin

A

collapse of collagen layer and reduced bond strengths

58
Q

how do you apply bond agent

A
  • gently push bond into tooth
  • brush on thin layer
  • avoid letting it pool in prep
  • gently blow air to thin bond agent and evaporate solvent
  • cure 20 seconds
59
Q

what is usually the solvent in bond agent

A

acetone, ethanol or water

60
Q

where should composite be placed first

A
  • first layer of composite in the proximal box to a depth of 1 mm
  • some use flowable for first layer
  • adapt well into prep and against the matrix band with a small condenser
  • cure 20 seconds
61
Q

can you leave flowable uncured and place regular composite on top

A

yes

62
Q

what is the most important first increment

A

at gingival wall

63
Q

incremements of composite should not exceed:

A

2 mm

64
Q

why should increments of composite not exceed 2 mm

A

minimizes stresses placed on the material and tooth due to polymerization shrinkage
- could be a factor in post op sensitivity

65
Q

what instrument should yo use to form the final anatomy on a composite prep

A

plastic instrument

66
Q

marginal ridge in a composite restoration should be _____

A

rounded , not flat

67
Q

what happens if the marginal ridge is rounded in composite restoration

A

it shreds floss

68
Q

what do you do in the final cure for composite

A
  • remove the matrix band
  • cure the restoration from the buccal and lingual for 20 seconds
69
Q

how are voids created in composite restorations

A
  • composite can stick to an instrument and upon pulling back a void is created
  • when injecting material, lifting the syring may cause a tug back and create a void
  • consider using flowable composite in the box if you cant place composite without creating a void
70
Q

what are the light considerations when placing composite

A
  • be careful to avoid shining directly on resin while you work - overhead and loupes
  • make sure orange protective light is blocking your view of the cure
71
Q

what do finishing and polishing composite do

A
  • removes the oxygen inhibited layer
  • establish anatomy/ final shape
  • ensures a smooth surface
72
Q

what does a smooth surface prevent in composite restorations

A
  • staining
  • recurrent caries
73
Q

what are instruments used for finishing composite

A
  • plastic/composite instrument
  • optrasculpt
  • esthetic trimming carbides
74
Q

when are esthetic trimming carbides used

A

to finish and refine prior to polishing

75
Q

what instruments are used to finish proximal walls

A
  • discs
  • flame shaped carbide
76
Q

when can you polish composite and why

A

after finishing because if it is left scratchy the polishing paste will stick in irregularities and make it look worse

77
Q

what should you do after composite restoration is complete

A
  • remove rubber dam
  • compare occlusion to adjacent tooth
  • check occlusion with articulating paper
  • assess contact with floss
78
Q

when should polishing of composite be done

A

same day that it is placed

79
Q

what does proper finishing and polishing do

A
  • increases longevity of restorations
  • improved marginal integrity
  • plaque resistant surfaces
  • improves esthetics
  • improved contours
  • undetectable margins
  • healthier gingiva
80
Q
A

Operative II (10 decks)

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