Week 5 PP Flashcards
What should the DA explain to patient before Amalgam restoration?
- The procedure’s location in the mouth
- What type of restorative material will be used
- Approx. how long the procedure will be
- What to expect through the procedure
- Post Op Instructions
What are Post Op instructions for Amalgam?
-Explain how long the anesthetic will last, depending on whether it was infiltration
-The patient should be careful not to bite or chew on the soft tissue in that area
-Soft foods for at least 24hrs while the amalgam is setting
-There may be some sensitivity to hot and cold for a couple days but it should gradually subside
-Optional - show the patient where the filling was done
Instruments needed for Amalgam restoration?
-Disposable brushes or applicators: to apply materials
- Matrix System: tofflemire retainer (amalgams), band and wedges
- Amalgam well
-Amalgam carrier
-Amalgam condensers: Large nib & small nib
-Amalgam Carvers: Discoid/Cleoid, Hollenback carver
What is non-bonded amalgam?
varnish (Copalite) is used to seal the dentinal tubules BEFORE the amalgam is placed (amalgam is held through MECHANICAL retention)
What is bonded amalgam?
a bonding system is used to chemically bond the amalgam into the restoration (amalgam is held through CHEMICAL retention)
What type of matrix is used with Amalgam??
Tofflemeiere!!
(Sectional is composite)
Non-Bonded vs Bonded Amalgam??
Non-Bonded = Mechanical retention (handcutting instruments, burs)
Bonded = Chemical retention (bonding system)
What is Acid Etch?
Acid etch is used in dental procedures and usually occurs in either liquid or gel forum. The concentration is 30-40% phosphoric acid.
the concentration produces the most evenly distribured etch over the entire enamel surface. At a greater concentration, less depth is etch.
Gel forum is preferred as it is the most controllable during placement
Opens up the tubules & Creates microtags in dentin & enamel
Amalgam Bonding System Used at Sait - 2 steps
Primer (with an activator)
Adhesive (has a catalyst)
No curing required!
What does Acid Etch Do?
-Opens up the tubules
-Primer flows into the tubules
-Bonding resin attaches to the primer - chemical reaction
-Amalgam and bonding resin create a hybrid layer
Precautions for Acid Etch
-Avoid direct contact with patient’s soft tissues
-When removing etch from the tooth always use HVE and water stream to avoid dispersing onto adjacent teeth and tissues
-If contact with tissues occurs throughly rinse area with lots of running water
-Eye protection is essential for patient and dental personnel - if eye exposure occurs immediately flush with water and seek medical attention
What is Primer - when is it used?
-Primer is applied after the tooth has been etched (flows into open tubules)
-retained with mechanical retention
-flows into defects and tags created by the etchant
-can be light cured, self fured, or dual cured
-make sure to re-cap containers immediately as the primer will evaporate
What is Adhesive - when is it used?
-Adhesive is applied on the primar layer
-Resin will chemicall bond to the bonding agent
-the bond is then light cured
-Amalgam is placed directly over top
-Called a bonded amalgam restoration
Why do you think an activator and catalyst are added to our primer and adhesive?
During an amalgam procedure a curing light is typically not used, therefore an activator and catalyst must be added into the primer and adhesive, creating the chemical reaction required to make the materials set
What is condensing?
- Amalgam is compacted into the cavity preparation
-it is done in small increments
-The longer the time between trituration and condensation, the weaker the amalgam restoration will be (5 mins of time can decrease the strength by up to 40%)
-restoration is always overfilled then the excess is removed with carving instruments
What are burnishers?
- Burnishers have no sharp edges and are ideal for smoothing dental amalgam
- There are several burnisher designs to chose from based on
- Size
- location of restoration
- DDS preference
When is a burnisher used for amalgam restoration?
-Typically the surface of the amalgam is burnished prior to the removal of the matrix system
What are carvers?
- There are several carvers to choose from based on
- Size
- location of restoration
- DDS preference
- Some common examples are:
- Discoid/Cleoid
- Hollenback Carvers
When are carvers used in amalgam restorations?
- After condensing the amalgam, amalgam carvers are passed to the DDS to create anatomy in the restoration.
It is important that the patient bite is even in order to…
- avoid fracturing the restoration(s)
-avoid injuring/traumatizing opposing teeth
-ensure optimum chewing
-avoid potential TMJ injury/trauma
How to check occlusion?
- Dry the patient’s teeth with gauze 2X2
- Ask the patient to bite in centric occlusion (natural bite) on the carbon paper
- Adjustments are made
- Patient is asked to slide their jaw side to side (lateral) and front to back
- Adjustments are made
- To adjust use a slow speed and round bur (carver can be used if filling is not set yet)
- Repeat steps if necessary
Checking Occlusion Ideal Outcome
Light blue or red marks will be visible from carbon paper on cusps - marks are not heavy and not on the filling just placed
Polishing & Finishing
- some dentists may choose to polish and amalgam restoration
-final polishing of amalgam can reduce surface roughness and make the amalgam more resistant to corrosion
-it cannot be performed until at least 24 hours after initial placement
-when polishing amalgams, avoid generating excess heat, as heat can release mercury vapors from the restoration
-slow speed greenie and/or brownie points are typically used for this process
What are Post op Instructions for Bonded Amalgam?
- It takes approximately 24 hours for the amalgam to obtain initial strength and 3-7 days for it to fully set
- avoid direct biting pressure for that time period
- Soft food diet – chicken , rice, potatoes, yogurt bananas
- You may have some sensitivity to hot and cold for several days
- Be careful not to chew as the anesthetic will last for…….(based on anesthetic used)
- A brisk walk or moderate exercise will metabolize the anesthetic
- Call the office if the bite feels incorrect [high] or if the sensitivity increases rather than decreases
Difference between bondend & non-bonded procedure set up
Bonded:
-hand cutting instruments not required (chemical retention)
-varnish not used
-etch and bonding agent used
Non-bonded amalgam:
-hand-cutting instruments required (mechanical retention)
-Copalite Varnish used
