When positioning always check
Me, my patient, my light
Eye level for dental assistant
4-6 inches above operators head
Supine position
Patient head same level as their knees
Distance between patients face and operator
12-14 inches
Light position maxillary
On an angle towards maxilla 45 degrees
Light position mandibular
Directly above mandible 90 degrees
Which body motions are not ideal
Class IV and V
Body motions class I
Movement of fingers only
Motions class II
Fingers and wrist motion only
Motions class III
Fingers wrist and elbow (reaching for hand piece)
Motion class IV
The entire arm and shoulder
Motion class V
Entire upper torso
Patients head is towards which clock position
12 o’clock
Operators zone
Where person completing procedure is seated: right handed 7-12 left 12-5
Transfer zone
Where instruments and materials are exchanged over patients chest: right handed 4-7 left 5-8
Assistants zone
Right handed 2-4 left handed 8-10
Static zone
Directly behind patient. Countertop space, or portable equipment: right hand 12-2 left 10-12
Two handed transfer
Bulky instruments, rubber dam forceps, surgical instruments, hinged. (Mouth mirror right hand, explorer left hand)
Single handed exchange
Two last finger on left hand to retrieve instruments. Hand instruments, A/W syringe and hand pieces
If fogging occurs on the mouth mirror
Rub the reflecting surface against the patients buccal mucosa, blow a gentle stream of air across it or wipe it with a sterile gauze
Intra oral fulcrum
Tip of ring finger rests on a stable structure, is unbent, supporting the weight of the hand and instrument inside patients mouth
Extra oral fulcrum
Tip or side of finger rests against structure finger may be bent or straight outside the patients mouth
Saliva ejector
Fluoride treatment, sealants, under dental dam, cementation of crown or bridge, during orthodontic bonding
HVE
Keeps mouth free of saliva, blood, water and debris, retracts tongue and cheek away from the field of operation, reduces aerosol cause by high speed
Isolation techniques
Cotton rolls, dry angles, dental dam
Indications for dental dam
Controls moisture, improves visibility, improves client management
Dental dam lubricant
Water soluble lubricant placed on the underside of the dental dam to help material slide over teeth
Dental dam frames
Plastic u frame places under dam, young frame stainless steel placed on outside of dam, ostby frame round and plastic places outside dam
Sublingual clamps used for
Partial erupted/ class V
Cervical clamps used for
Class v
Universal clamps
Placed on same tooth in the opposing quadrant as the jaws are same size on both sides
Dental dam placement
Make sure teeth are free of plaque and debris and check chart for latex sensitivity
Dental dam placement techniques one step method
Dam and clamp placed at the same time
Dental dam placement techniques two step method
Clamp placed first then dam material is stretched over it
Punching dam: how far are holes punched away from eachother
3-3.5mm
Punching dam to flat or wide results in
Folds or bunching and stretching on lingual
Punching the dam to curved or narrow results in
Folds and stretching on the facial
Hand instruments design
Handle shank and working end
Working end can have a
Point blade or nib
There number formula 1st number
Width of blade in tenths of mm
3 # formula second number
Length of blade in mm
3 # formula third number
Angle of blade in degrees to the long axis of handle
Four # formula first number
Width of blade
4 # formula second number
Degree of the angle of cutting edge
4 # formula third number
Length of blade
4 # formula fourth number
Angle of blade to long axis of handle
Allow operator to examine health of oral cavity
Examination instruments
Assist in design of the cavity prep, refines and defines the walls (6 total)
Hand cutting
Allow operator to place, condense and carve dental materials to the original anatomy
Restorative instruments
Miscellaneous instruments and items used to complete a procedure
Accessory instruments
Mouth mirror used for
Indirect vision, light reflection, retraction, transillumination (anterior)
Allows operator to use tactile sense to distinguish areas of calculus, decay or other irregularities
Explorer
Used to carry, place, and retrieve small objects such as cotton products to and from the mouth
Cotton pliers
Excavators (spoon)
Used primarily to remove carious material and debris from teeth can also be used for removing excess cement, inverting rubber dam
Use in a downward pushing motion to form and define point angles and sharpen line angles (4 numbered instrument)
Angle former
Used to shape and plane enamel and dentin walls of cavity preparation
Chisels
Clean and smooth the walls in a cavity prep, to remove enamel not supported by dentin
Hatchet
Used to bevel the gingival margin wall of the cavity prep
Gingival margin trimmers
Mesial gingival margin trimmer numbers
Angle 85 degrees or less
Distal gingival margin trimmer number
Angle 90 degrees or more
Used to clean and smooth the floor of the cavity prep (blade is perpendicular with handle)
Hoe
Designed to carry and dispense amalgam (smallest end used to start the filling process)
Amalgam carrier
Used to pack filling material into cavity preparation
Condensers (pluggers)
Used to smooth rough margins of the restoration and shape metal matrix bands once placed.
Burnishers (beaver tail, acorn, football, t ball, and ball shape)
Used to remove excess restorative material and carve anatomy in restoration before it hardens
Carvers
Carver used on occlusal surface
Discoid-Cleoid
Carver used interproximal
Hollenback carver
Discoid end is shaped
Disc shaped
Cleoid end is shaped
Pointed
Designed to carry, place, condense and carve composite material in cavity prep
Plastic filling instruments (PFI)
Trim excess filling material, working end has sharp knife like blade often used inter proximal along the margin
Finishing knife
Accessory instruments: used to mix dental materials
Spatula
Accessory instruments: used for cutting dental dam, retraction cord and stainless steel crowns
Brown and bridge scissors
Accessory instruments: hold dental materials/ liquids
Dappen dish
Accessory instruments: newly mixed amalgam is placed in here then picked up in the amalgam carrier for transfer
Amalgam well
Accessory instruments: carry cotton products to and from oral cavity, removing matrix band, placing and removing wedges
Howe pliers/ 110
Straight and short, speed ranges from 10,000 to 40,000 rotations per minute, operates the rotary instrument in either forward or back ward movement
Low speed
Operates at speeds up to 450,000 rpm, maintains a water coolant system, operate with a friction grip device, some have a light
High speed hand piece
High speed use
Rotary instruments used to remove decay and old or faulty restorations
Small version of sandblaster, produces a high pressure delivery of aluminum oxide particles through a small probe
Air abrasion
Operates at speeds up to 20,000 rpm, provides greater torque than hand pieces that are used intraorally
Laboratory hand piece
3 basic parts to rotary instruments
Shank, neck, head (working end)
Portion that fits into hand piece
Shank (latch type: low speed. straight shank: laboratory. Friction grip: high speed.
Used for tooth prep, excavations decay, finishing cavity walls, finishing surfaces , drilling out old fillings, finishing crown prep, separating crowns and bridges, adjusting acrylic temporary crowns
Dental burs
What are cutting burs made of
Tungsten carbide
Burs: Used as initial entry into lesions, excavation of caries and placement of retentive features
Round bur (low speed) latch
Burs: Used for refining internal features of cavity prep, creating line angles and retention/ undercuts, flattening internal walls and removing decay (low speed)
Inverted cone (latch)
Plain cut initial entry into tooth and helps in forming the internal walls of prep
Straight fissure plain
Cross cut helps in forming internal walls of preparation
Straight fissure cross cut
Burs: used for the bulk of cavity prep extension to final outline form and smoothing of internal cavity walls
Straight fissure burs
Plain and cross cut help in providing angles to the walls of the prepared tooth
Tapered fissure burs
Burs: used in providing initial entry into tooth and a conservative cavity prep with rounded internal line angles
Pear burs
Burs: creates a shoulder for the margin of a crown prep
End cutting burs
Similar to cutting bur, except the number of blades or flutes are increased, the greater the number of flutes the greater it’s polishing capability
Finishing rotary instruments
Brownie finishing instrument for amalgam does what
Smooths
Greenie finishing instrument in amalgam does what
Polishes (slow speed)
Used for final finishing and polishing of composite
Cuttlebone adhered to discs and points
Used to attach the abrasive disc to the hand piece
Mandrel
Cavity wall that does not extend to the external tooth surface
Internal wall
Surface of the tooth prep that extends to the external tooth surface, named according to the tooth surface involved: distal mesial facial lingual and gingival
External wall
Type of internal wall/ surface of the prepared tooth that runs parallel to the long axis of the tooth
Axial wall
Internal wall of a prepared tooth that is perpendicular to the long axis of the tooth (wall that overlies the pulp)
Pulpal wall
Angle formed by the junction of 2 walls / surfaces in a cavity prep
Line angle
Initial cavity prep resistance form:
Dentist determines the primary shape and placement of cavity walls
Initial cavity prep: retention form
Dentist knows where to place retention to prevent displacement (vertical forces)
Initial cavity prep: convenience form
Accessibility in preparing and restoring (opens tooth to have enough visibility to decay)
Removal of decayed dentin or old restorative material, insert retention notches needed, placing materials such as liners, bases or binding agents
Final cavity prep
Where decay has extended beyond normal size or shape
Complex restorations
Retention pins placed
When decay has extended into the cusp of tooth (1 pin per cusp affected)
Matrix system must be used when
A wall of a tooth is affected (mesial or distal)
Thin layer of tooth coloured material that is placed chairside to the facial surface of a tooth
Direct veneers (composite)
Porcelain fabricated in the dental lab (2 appointments)
Indirect veneers
If restoration extends onto buccal what type of tofflemire is placed with a slight bend to accommodate to positioning from lingual
Contra angle tofflemire
Diagonal slot on tofflemire always faces towards the
Gingiva
Matrix band is
Properly contoured piece of stainless steel material to give support and form to the restorative material
Extension matrix bands are used for
Class II with more extensive preparation and requires extensions to compensate for loss of cusp
Matrix band loop placed towards the flat side for which quadrants
2 and 4
Matrix band loop placed towards the screw when used with what quadrants
1 and 3
The wedge is placed
Lingual side where the interproximal wall is missing
