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Operative I > Week 8 Class II Restorations > Flashcards

Week 8 Class II Restorations Flashcards

1
Q

what does caries on the axial wall indicate

A

only remove caries

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2
Q

what does caries on the pulpal floor indicate

A

widening of the prep but dont deepen. use a round bur or spoon excavator to remove caries and accept an irregular pulpal floor

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3
Q

what do you do if recurrent caries extends gingivally in the box area

A

you can make a box within the box rather than deepening the entire box

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4
Q

how should liner be placed

A

only to the deepest part of the prep closest to the pulp and keep it away from the margins

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5
Q

what are the liner materials, when do you use them and what are the names

A

-calcium hydroxide: Life, Dycal, use on deepest preps- pulp capping material
- resin modified glass ionomer: vitrebond, light cured, releases fluoride over time

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6
Q

restoration should be supported by at least ___

A

a tripod of structure

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7
Q

why should the entire floor not be covered by calcium hydroxide

A

CaOH is too soft to support the restoration

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8
Q

when can the entire pulpal floor be covered with the material

A

if the material is hard when set like a glass ionomer but the material must rest on a tripod of dentin

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9
Q

what are the functions of a good matrix band

A
  1. enough rigidity to resist too much deformation by packing forces or wedging but is slightly burnishable and displacable
  2. assists in establishing proper anatomical contour
  3. must prevent excess amalgam from being expressed at the gingival margin as much as possible so you dont get gingival overhand that will trap plaque and irritate the gingiva
  4. must be convenient to install
  5. must be easy to remove and allow for removal without breaking a partially set amalgam
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10
Q

what are the 3 choices for putting the tofflemire on

A

-retainer on buccal side and band emerges from one side of guide channels (more common)
- retainer on lingual side, requires use of a contra angle retainer, useful with missing buccal tooth structure
- band emerges through the middle channel. the retainer is on the lingual. useful when there is missing buccal structure and used more in maxilla than mandible because of tongue

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11
Q

what are the steps of inserting band into tofflemire

A
  1. turn the inner nut counterclockwise until slot vice is about 1/4inch from guide channels
  2. hold inner nut and turn the outer nut counterclockwise until the pointed end of the spindle is free of the slot in the slot vice
  3. double the band back on itself forming a loop
  4. insert into the slot vice and direct it through one of the three guide channels. tighten spindle
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12
Q

what do you do if gingival tissue gets caught between the matrix band and the gingival margin

A

move the matrix band in an occlusal direction, place a hollenback carver between the matrix band and the tissue, deflecting the tissue and reset the band

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13
Q

where should the wedge be placed

A

through the more open of embrasures- usually lingual

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14
Q

what are the special considerations when wedging

A
  • choose right size
  • dont allow the wedge to force the band into the box or areas that should be filled with amalgam
  • if prep is deep gingivally and band wants to jump up on the box, ue a hollenback carver to support the band and allow it to seat far enough gingivally for wedging
  • if wide interproximal and deep box you can double wedge
  • if gingival recession you can double wedge vertically
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15
Q

what do you do if no standard wedge will close the gingival margin without distorting the band

A

use a bur or sharp blade to reshape the wedge

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16
Q

how should you obtain a good contact with the band

A
  • loosen the band a quarter turn after wedging
  • burnish the band against the proximal surface of the adjacent tooth
  • scrape with an explorer along the tooth metal interface at the gingival margin to remove tissue or debris in this area. flush and dry
  • if band is still not against tooth, loosen retainer more and burnish again
  • pack amalgam hard against matrix band
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17
Q

what are the steps to placing the amalgam

A
  • burnish the matrix band against the adjacent tooth and reconfirm tightness of the wedge
  • loosen the inner nut 1/4 turn to assist in getting good contact. mix amalgam, dispense well and pick up with amalgam carrier
  • unload only one carrier full into the box at a time, then one load in the occlusal but condense box first
  • use hollenback to pack firmly into all internal line angles
  • pack until overfill of 1 mm
  • pre carve/burnish
  • use explorer at 45 degree angle to define the occlusal embrasure by trimming away the amalgam that runs up onto the matrix band
  • form anatomy on occlusal
  • form marginal ridge
  • redefine the occlusal embrasure once more and remove wedge
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18
Q

describe the technique that amalgam should be condensed in the box

A
  • pack firmly at an angle into the buccal gingival and lingual gingival line angles and all other margin areas especially. use press and wiggel technique
  • be aware of the corners of the box where its easy to get voids
  • condense against the contact area on the band
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19
Q

what are voids often the result of

A

placing too much amalgam in the box without condensing it the first time

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20
Q

how long do you have to condense

A

3-4 mins

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21
Q

what instruments should be used for pre carve burnishing

A

side ofhollenback condenser or large ball burnisher

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22
Q

how should the marginal ridge be formed

A

carved at the same height as the adjacent marginal ridge
- have a straight section perpendicular to the long axis of the tooth with a triangular inclined plane descending from the ridge crest into the pit

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23
Q

how should the matrix band be removed on a two surface amalgam

A

first on the non-restored surface then next to the new amalgam by sliding the band horizontally and then in an oblique oclussal direction

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24
Q

what do you do after you remove the matrix band

A
  • use hollenback to carve excess amalgam off the buccal and lingual walls of the box
25
Q

what are the different methods to carve away the gingival margins excess on the box

A

-the hollenback carver held obliquely and drawn laterally or occlusally
- the wiland carver or a 34-35 jaquette scaler, drawn laterally or occlusally

26
Q

how should you remove the rubber dam

A

snip the septa between the teeth

27
Q

how do you adjust occlusion in a live patient

A

mark occlusion with articulating paper, closing in MI and doing right and left lateral excursion

28
Q

how do you do the occlusal adjustment

A
  • eliminate inclined plane contacts first. try to preserve stops for the opposing cusps that will put long axis forces on the teeth such as marginal ridge crest, bottom of the fossa
29
Q

what is the most effective instrument for adjusting occlusion on a partially set amalgam

A

the discoid carver

30
Q

how do you smooth surfaces and bottoms of grooves in an amalgam restoration

A

-with a beavertail burnisher
- wipe with cotton pellet to leave a matte finish

31
Q

why does the amalgam shine when burnishing after

A

you have brought excess mercury to the surface which may weaken the amalgam

32
Q

how do you assess the interproximal contact in an amalgam after band is off

A

floss and dry the contact area and look through the facial and lingual to be sure the contact is closed

33
Q

what should you consider when carving amalgams

A
  • interproximal surface is neither more convex nor less convex than the original tooth structure- no overhang at margins
  • contact close to occlusal surface- slightly open occlusal embrasure
  • buccal and lingual embrasures are neither more open nor less open than original tooth anatomy. ovoid, not point, contact. occlusal edge of marginal ridge is slightly rounded, creating slightly open occlusal embrasures
34
Q

describe the ideal marginal ridge form

A
  • a triangular inclined plane descends from the ridge crest into the pit which is further apical than ridge crest. this deflects food towards the occlusal table of the tooth
  • marginal ridge has straight area that is perpendicular to the long axis of the tooth so a cusp striking there can put long axis forces on the tooth root in MI
  • the cusp can exit off the ridge crest without hitting an inclined plane in lateral excursions
35
Q

what are common errors in marginal ridge form

A

-central groove crosses marginal ridge and creates V-shape: forces in MI are not down long axis of tooth
- pit anatomy is indistinct and bottom of pit is not further apical than ridge crest: this creates inclined plane occlusal contact or may deflect food towards the interproximal

36
Q

what can happen if marginal ridge is higher or lower than adjacent tooth

A

food impaction, occlusal contacts that would deflect the mandible in MI

37
Q

what fossa form will put long axis forces on the teeth

A

occlusal stop is in bottom of fossa in MI

38
Q

what are the additional steps in class II composite restoration placement

A
  • etch and rinse, bond agent placement, composite placement incrementally, light cure each increment
39
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

40
Q

why should you not use clear matrix band with composite restoration

A

-too much flash
- poor contours
- resevoir for moisture

41
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

42
Q

what is selective etch

A

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

43
Q

how can you tell enamel has been etched

A

it has a whitish surface

44
Q

what does dentin dessication result in

A

collapse of collagen layer and reduced bond strengths

45
Q

how do you apply bond agent

A
  • gently push bond agent into tooth
    -brush on thin layer
  • avoid letting bonding agent pool in prep
  • gently blow air: this thins bond agent and evaporates solvent
  • cure 20 seconds
46
Q

what is the oxygen inhibited layer

A

the sticky uncured layer left on the surface
- O2 in the air interferes with polymerization on the surface of composite
- this facilitates bonding to the next layer added

47
Q

what can remove the oxygen inhibited layer

A

finishing

48
Q

how large of increments should composite be placed

A

1mm

49
Q

where should you use flowable composite and why

A

first increment at the gingival wall because most important increment

50
Q

what should increments of composite be no greater than

A

2 mm

51
Q

what does increment placement do

A

minimizes stresses placed on the material and on the tooth due to polymerization shrinkage

52
Q

why should marginal ridge be rounded and not flat

A

flat shreds floss

53
Q

how long should you light cure the final cure

A

20 sec from buccal and 20 sec from lingual

54
Q

what are the new things to consider with composite

A

-interproximal contacts
-voids
- light
-polymerization stress

55
Q

how can a void be created with composite

A
  • composite can stick to instrument and create a void upon pulling back
  • when injecting the material, lifting the syringe may cause tug back
56
Q

what are light considerations when placing composite

A
  • dont shine direct light on resin while you work
  • overhead light and loupes light can permanantly cure rein
  • make sure orange protective light is blocking view of cure
57
Q

what do finishing and polishing composite do for the restoration

A

-remove oxygen inhibited layer
- establish the anatomy/final shape
- ensure a smooth surface
- extremely important in composite

58
Q

when should you polish composite

A

same day that it is placed and after properly finishing composite

59
Q

what does proper finishing and polishing do for the restoration

A

-increases longevity of restorations: improved marginal integrity, plaque resistant surface
- improves esthetics: improved contours, undetectable margins, healthier gingiva

Operative I (12 decks)

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