Quiz on Complex Amalgam Flashcards by Austin Shackelford

Indications for complex amalgams: for a “_______” restoration of a tooth has questionable pulp or periodontium.(EXT or RCT might be needed)

“control”

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Indications for complex amalgams: patient cannot ______ a crown

afford

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CONTRAindications for complex amalgams: Severe _______ problems

occlusal

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CONTRAindications for complex amalgams: ________ important area

esthetically

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CONTRAindications for complex amalgams: Cannot be restored properly due to _________ or functional considerations (contour, contacts, occlusion, inability to place a matrix)

anatomical

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Complex Amalgam Restorations ADVANTAGES!– ________ tooth structure!

Conserves

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Complex Amalgam Restorations ADVANTAGES!– One ________ instead of two as in a cast restoration

appointment

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Complex Amalgam Restorations ADVANTAGES!– Less ________ than indirect restorations

EXPENSIVE

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Complex Amalgam Restorations ADVANTAGES!– success rate at 5 years ___%-____% for amalgam vs. ____% for cast restorations

65%-72% for amalagam vs 84% for cast…so a viable alternative

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Complex Amalgam Restorations disADVANTAGES :( Its not very structurally _______

durable

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Complex Amalgam Restorations disADVANTAGES :( theres not much ______ so it can fall off

retention

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Complex Amalgam Restorations disADVANTAGES :( Difficult to develop natural ______ and function

contours (pssshh, whatev’s)

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Complex Amalgam Restorations disADVANTAGES :( Potential for pulp and root _______ and dentin ________ when placing pins for retention

perforation, microfracture

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Complex amal-PREP DESIGNS! When the isthmus exceeds ____ the distance between the facial and lingual cusp tips

2/3

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Complex amal-PREP DESIGNS! When you had to remove a _____ :(

cusp

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Complex amal-PREP DESIGNS! Plus, (tip, or cap) a cusp when the facial or lingual extension exceeds _____ the distance from a primary _______ toward the cusp tip

2/3….primary groove (so when you remove 2/3 of a cusp on the interproximal extension, the cusp has to go)

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Complex amal-PREP DESIGNS! You NEED ____ retention feature PER missing cusp!

1 retention feature per missing cusp!

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Complex amal-PREP DESIGNS! How much of a NON-Fxn cusp needs to be removed to support the amalgam?

greater or equal to 1.5mm

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Complex amal-PREP DESIGNS! How much of a FUNCTIONAL cusp needs to be reduced to support the amalgam?

greater than 2mm (2-3mm)…shit needs to be THICK yo

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If you get this wrong, I will kill you. ON the mandibular arch, the ______ cusps are the functional cusps.

buccal

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If you get this wrong, I will kill you. ON the maxillary arch, the ______ cusps are the functional cusps.

lingual

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Complex amal-PREP DESIGNS! Cusp reduction should be extended just below the extension of the ______ or ______ _______.

facial or lingual groove

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Complex amal-PREP DESIGNS! DO NOT end the prep cavo-surface in a __________. End either BEFORE or AFTER it.

facial or lingual groove (i think i made this mistake in lab)

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Complex amal-PREP DESIGNS! Opposing vertical walls should ________ slightly to the occlusal.

converge

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Complex amal-PREP DESIGNS! Pulpal and gingival floors and tipped cusps should be _____ and ________ to the long axis of the tooth.

flat and perpendicular

Complex amal-PREP DESIGNS! All _______ margins are SHARP and well defined

Cavo-surface

Complex amal-PREP DESIGNS! Axial and occlusal- gingival "____" should be developed where possible

steps (like our "shoulder" that we put into it)

Complex amal-PREP DESIGNS! All internal line angles are _______

rounded

Complex amal-PREP DESIGNS! Angle of departure is ___ degrees (no _______ enamel)

90 degrees.....undermined

Complex amal-PREP DESIGNS! Auxiliary retention is provided by using ______, ______, or ____..... or a combination.

slots, troughs, or pins

Complex amal-PREP DESIGNS! Slot/trough placement--May be continuous or segmented, (_____ slots resist horizontal force as well as longer ones)...DEPTH of the slot is _____

shorter..the depth of the 34D (0.8mm)

Complex amal-PREP DESIGNS! All retention features are placed in ______...more specifically placed ____mm past the ____. (following the contour of the _____)

dentin...0.5mm...DEJ....DEJ

Complex amal-PREP DESIGNS! the slot you put in should have _______ walls, thank you 34D

convergent

Complex amal-PREP DESIGNS! Putting pins in _____ treated teeth is actually CONTRAINDICATED & AGAINST the Standard of Care!

endodontically

The most frequently used pin is the ________ type. They are the MOST _______!

self-threading...retentive

SLOTS VS PINS- There is ________ in the retention provided by slots and pins in vitro and in vivo

NO SIGNIFICANT DIFFERENCE

SLOTS VS PINS-_______ retention is used in preparations lacking vertical walls for steps or boxes

PINS

SLOTS VS PINS- _____ are used in preparations with short clinical crowns and in cusps that have been reduced 3-4 mm for amalgam

SLOTS

SLOTS VS PINS- ____ are less likely to create micro-fractures than are _____.

Slots....pins

SLOTS VS PINS-____ remove more tooth structure

Slots

SLOTS VS PINS- Failure of slot in ______ retained amalgam will be IMMEDIATE LOSS of the amalgam!

DENTIN

SLOTS VS PINS-_______ elicited an inflammatory pulpal response if placed within ___mm of the pulp; ____ placed in the same location did not!

Self-threading pins....0.5mm..slots

SLOTS VS PINS-_____ are more likely to result in perforations of the pulp or side of the tooth

pins

SLOTS VS PINS-Failure of a pin retained amalgam can be slip or fracture at first (but not fall out) and later very catastrophic due to ______ beneath it!

PINS=Recurrent Caries!

SLOTS VS PINS- Amalgam TENSILE and HORIZONTAL strength is weakened by ____

pins

SLOTS VS PINS-Believe it or not: _____ are NOT analogous to steel rebar reinforced concrete

PINS

SLOTS VS PINS- ______ of the restoration increases as the number of pins increases, but an excessive number of pins can ______ the tooth and significantly weaken the amalgam (more is not necessarily better)

retention...fracture

Pin Placement Technique: The pin hole goes ___mm past the DEJ.

0.5mm

Pin Placement Technique: Pin hole prepared on a _____ surface

flat!

Pin Placement Technique: Provide a minimum ____ mm CLEARANCE around the circumference of the pin for adequate amalgam condensation

0.5

Pin Placement Technique: 1 pin per missing _______

AXIAL LINE ANGLE, place it at the line angle!

Anatomical Features to AVOID when placing pinholes!!! The PROMINENT M concavity of the _______ (tooth perforation)

max 1st PM

Anatomical Features to AVOID when placing pinholes!!! Midfacial and midlingual BIFURCATIONS of _______ (tooth perforation)

mandibular molars

Anatomical Features to AVOID when placing pinholes!!! Mid facial, midmesial, and middistal FURCAITONS of _______ (tooth perforation)

maxillary molars

Anatomical Features to AVOID when placing pinholes!!! MF CORNERS of _____ AND ______ (possible pulpal penentration)

maxillary and mandibular molars

MORE Pin Placement Technique! Start with a _____ bur PILOT hole where you want the pin to start

1/4 round bur

MORE Pin Placement Technique! Use a ______ to align drill before placement

perio probe

MORE Pin Placement Technique! _______ placement of pins enhances the retention of the amalgam...interesting!

Non-parallel

MORE Pin Placement Technique! Rotate at _______ speed (300-500 rpm) and apply pressure preparing the pinhole in one or two insertions until the depth- limiting portion is reached (____mm)..oh and USE ______

low speed...(2.0mm)...USE WATER!

MORE Pin Placement Technique! NEVER _____ the drill in the pinhole...Never _______ the drill unless only used to half the depth the first time

stop....reinsert

Can you bend pins?

yes, with a "special instrument"

Pin placement ERRORS :O Sudden loss of RESISTANCE to the pin twist drill and the evidence of _____ IN the pinhole means you _______!

blood....perforated

Pin placement ERRORS :O When do I inform the patient?

At the end of the appointment

Pin placement ERRORS :O Whats next? Ideally ______ treatment should be done on compromised teeth if the pulp is exposed.

endodontic

Pin placement ERRORS :O Whats next? ________ may be placed over the pinhole and another hole prepared ___-__ _ mm away.

CaOH ( Dycal or Life)....1.5-2.0mm away

Pin placement ERRORS :O Perforations occlusal to the gingival attachment: 1. _____ the pin off FLUSH with the tooth surface. 2. Same as in 1 and extend a ____ restoration beyond the perforation 3. Remove the pin, ENLARGE the hole and restore with ______

cut...cast...amalgam

Pin placement ERRORS :O Perforations APICAL to the attachment: 1.Surgical ____, remove bone, enlarge hole and place amalgam or ____ 2. _________ surgery and extend a cast restoration below the perforation

flap...MTA(portland cement!)...Crown lengthening

You can use amalgam for a endo treated tooth for a crown build up when the pulp chamber height is ___-___mm. Do you need a post?

4-6mm, no post needed!

For an amalgam core build up, get ___-___mm into the canal orifice below the CEJ

4-5mm

Which type of amalgam do I use when making a crown buildup? Why?

Megalloy-it is STRONGER and SETS FASTER than dispersalloy!

Which is higher, composite bonded to enamel or amalgam bonded to enamel?

Composite to enamel bond strength is 20-25 MPa, amalgam bonded to enamel is 3-10 MPa...BOOM

Bonding resin may interfere with the self ______ capability of amalgam

SEALING

complex amalgam-THE MATRIX: When using a Tofflemire placed from a facial approach, keep the slot in the _____ of the tooth, and the slot is going to be opposite of the ______.

middle...missing cusp

complex amalgam-THE MATRIX: When needing to place the Tofflemire Lingually, use an ______ Tofflemire and place wedges on _______ sides.

angled...opposite

complex amalgam-THE MATRIX: What do I use when my Tofflemire slot is exposed?!

Freak out! Life is over!! Jk. Cut a matrix band and place it over the slot

complex amalgam-THE MATRIX: What type of matrix can I use in lieu of the Tofflemire?

a Garrison PINCH matrix!

LETS DROP SOME KNOWLEDGE: Which amalgam is Spherical?

Megalloy

LETS DROP SOME KNOWLEDGE: Which amalgam is AD-Mixed?

Dispersalloy

LETS DROP SOME KNOWLEDGE: Which amalgam has LESS condensation pressure?

megalloy

LETS DROP SOME KNOWLEDGE: which amalgam has MORE condensation pressure?

dispersalloy

LETS DROP SOME KNOWLEDGE: Which amalgam has LESS mercury?

megalloy

LETS DROP SOME KNOWLEDGE: Which amalgam has MORE mercury?

dispersalloy :(

LETS DROP SOME KNOWLEDGE: Which amalgam sets faster?

megalloy

LETS DROP SOME KNOWLEDGE: which amalgam sets slower?

dispersalloy

LETS DROP SOME KNOWLEDGE: Which amalgam has NO ZINC? What does this mean?

Megalloy...no delayed expansion and no H2 Gas

LETS DROP SOME KNOWLEDGE: which amalgam has ZINC? what does this mean?

dispersalloy....NO WET environments!

LETS DROP SOME KNOWLEDGE:Which amalgam is stronger?

megalloy

Amalgam Selection: Unable to place RD and isolation is poor...

Megalloy---dispersalloy has ZINC and is therefore not comparable with WET invironments

Amalgam Selection: Strong Contacts are going to be difficult.

Dispersalloy-didnt give a good reason

Amalgam Selection: I need amalgam to fill in the intricate grooves and slots

megalloy

Amalgam Selection: I need to prepare the crown on the same build-up appointment

megalloy

Amalgam Selection: It’s my first time and I’m worried about the amalgam hardening on me before I complete the carving.....!

dispersalloy

What is the KEY move in forming the cusp in our bulk amalgam?

form the cusp with the DOUBLE ENDED PLASTIC INSTRUMENT

What instrument do I use to make the occulsal embrasures?

explorer

What instrument do I use to REBURNISH the amalgam where the missing cusp is?

double ended plastic instrument

OUR complex amalgam preps #14: Isthmus is ___mm wide and ____ mm deep

1.5mm...2.5mm

OUR complex amalgam preps #14: ___ to ___mm contact separation

0.5 to 1.0mm

OUR complex amalgam preps #14: ___mm on the ML cusp removal

3.0mm

OUR complex amalgam preps #14: Retention trough placed along mesial-lingual line angle ___ mm away from exterior surface of enamel and ____ mm deep.

1.0mm (which was 0.5mm in our lecture?!?!)...1.0 mm deep (depth of 34D)

OUR complex amalgam preps #14: Extend prep BEYOND the _____ groove

lingual

OUR complex amalgam prep #30: Pulpal floor at least ___ mm deep

2.5mm

OUR complex amalgam prep #30: Lingual cusps removed to level of _____ floor

pulpal

OUR complex amalgam prep #30: Lingual SHOULDER placed ___ mm below pulpal floor

1.0mm below

OUR complex amalgam prep #30: Small circular cut into lingual axial wall to make space for ____, and there is AT LEAST ____mm of space between pin and axial wall.

the PIN...0.5mm

OUR complex amalgam prep #30: The pin at least ___ mm away from external enamel, and it is placed at the _____ of the tooth.

1.0mm...line angle