Restorative - Final Exam

English	Chemistry
What is the hardest tissue in the body?	Enamel
Cementum is very _____ near the ______	thin; CEJ
Odontoblasts	Responsible for secondary dentin
Dental Pulp is responisible for _____	Sensation Odontoblasts and nerves
Anatomic	crown is covered with enamel
Anatomic	root is covered with cementum
CEJ	Junction between anatomic crown and root
Universal Numbering System	#1-32 #1 max. rt. 3rd molar- #16 max. left. 3rd molar #32 mand. rt. 3rd molar
Federation Dentaire International	first digit (1-4)- quad number second digit (1-8) position from the midline #24 is max. left 1st premolar
Four continuous embrasures	Facial, lingual, occlusal/incisal, gingival
Posterior teeth	Occlusal view; proximal contacts are buccal to the center of the tooth so the lingual embrasure is larger than the buccal embrasure
Anterior teeth	viewed from the facial; proximal contact in the incisal 1/3
Central groove	groove running m<--->d, seperating buccal and lingual cusps
Triangular Ridge	runs buccolingually from cusp tip to central groove
Mandibular 1st Molar	5 cusps, distofacial cusp
#19	30 (MB, ML, DB, DL, D)
2 buccal grooves- mesiobuccal	distobuccal
Oblique Ridge	ML and DB triangular ridge
Transverse Ridge Max. Molar	formed by MB and ML cusps
Dental Caries	Caused by: 1. Bacteria (strep mutans) 2. Food (carbs sugar) 3. Suceptible tooth surface Prevented by- oral hygiene, diet, fluoride
Class II, III, IV, V	smooth surfaces
Pits	defects where grooves join
Cavosurface	surfaces of uncut tooth adjacent to the walls
4 line angles of a Class I (walls and pulpal floor)	mesiopulpal, distopulpal, buccopulpal, linguopulpal
Cavosurface margin	junction of walls with uncut cavosurface
Class II	found on smooth, proximal surfaces of posterior teeth bitewings are used to diagnose this decay not found at proximal contact but slightly gingival, adjacent to the papilla
Class III	smooth, interprox. of anterior teeth use transillumination gingival to proximal contact box shaped, rounded corners
Class V	ginigval 1/3 of facial or lingual surfaces can be max. ant. linguals floor is axially-vertically along long axis of tooth
Food impaction	can contribute to both caries and periodontal disease
Improper positioning or manipulation of instruments can contribute to	muscle pain, circulatory problems, muscle aches, and lower back pain
Stool supports	the lumbar, sacral region of the back
Patient should be reclined so...	the mouth is approximately at elbow level, elbows should be roughly parallel to the floor
Maxillary Arch	supine arch is perpendicular to the floor
Mandibular Arch	head at 10-30 degrees forward arch is parallel to the floor
Parts of instrument	shank, working end, handle
Condensors	used to compact or condense filling material into preperations
Carvers	to remoce excess material from beyond prep margins to blend restoration contour with adjacent tooth structure to refine anatomical features
Cleiod-Discoid Carver	Discoid-disc shaped Cleoid-claw shape
Burnishers	to lightly rub a recently placed amalgam to smooth the urfaces or to form anatomy
Modified Pen Grasp	offers greatest control
Four Points of support	ball or forefinger, ball of middle finger, ball of thumb, and third joint of forefinger
Fulcrum	ring finger is used and should rest on the teeth in the arch of the tooth being restored
Basic definitions of EFDA's in Ohio Law	Chapter 4715 of Ohio Revised Code and Ohio Administrative Code
Remediable tasks	tasks or procedure that do not cause irreparable change within the oral cavity and or adjacent structures
Irremediable tasks	may cause irrepareable changes within the oral cavity or adjacent structures and are non-delagable
Non-delagable	must be preformed by a dentist
Advanced Remediable tasks	can be preformed by an EFDA
limited to sealants	amalgam, composite, direct bonding restorative
EFDA Responsibility	may perform under the direct supervision and full responsibility of a liscensed dentist advanced remediable intraoral dental taks and/ or procedures as defined by state laws
Non-delagable Dental Tasks and or Procedures	Definitive diagnosis final placement of any fixed or removable appliance final removal of any fixed or removable appliance cutting preperations placement of the final root canal filling Final impressions of any tissue upon which prostheses is placed (except mouthguards) Occlusal registration for prostheses final placement of prefabricated crowns retraction of ginigval sulus prior to direct or indirect impression Procedures involving LASERS
Who can become an EFDA	Unlicensed dentists who have graduated from an acredited school Dental students Graduates of unacredited dental college out of the U.S. Certified Dental Assitants Liscensed Dental Hygientists Unlicensed Dental Hygientists after acredited EFDA program
Limit of EFDA's working with a dentist	No more than 2 EFDA's and 3 Hygientists shall be performing EFDA and dental hygiene tasks respectively under the supervision of one dentist at one time
Functional occlusion	Teeth contacting during normal functions like chewing or wallowing
Maxiumum intercuspal postion	Ideallywhen people bring their upper and lower teeth togeter the tightest fit is... AKA centric occlusion touch uniformly and with equal pressure
Protrusive	when the mandible juts forward
Excursive of eccentric occlusion	when moved out of maximum intercuspal position
Heavy (Premature contacts)/ Supra-occlusion	if a few teeth touch heavier than the rest
Heavy pressure placed on PDL during functional or parafunctional occlusion	could irritate nerves of PDL, causing sore tooth that is made worse upon chewing over time, widening of PDL and loosening of tooth if in presence of perio disease, disease process progesses more quickly
Goal of EFDA	reproduce anatmoy in a maximum intercuspal postion that permits all teeth that were touching prior to the placement of the restoration to touch with equal force afterwards leave it like you found it
Heavy occlusion	confirmed with articulating paper when marks are heavier, denser, and larger
Donut shaped mark	heavy mark ring that is rubbed clean in the center
Order of occlusion	Dry tooth mark centric cusps reduce centric cusps until equal density mark excursive with paper wipe andy marks with a 2X2 gauze and dismiss patient
checking maximum intercuspal position on a patient	blue paper used for centric occlusion red paper used for eccentric movements
Ideal occlusal relationship	facial surfaces of all max teeth are positioned facially to the facial surfaces of all mand. teeth
While sitting up	acting as if chewing,check occlusion on a patient...
Class IV and temporary filling (ZOE)	two types of restorations that should leave no occlusion marks either in centric or excursive more suceptible to fracture
R	nearly perfect
S	slight problems
T	debating whether clinically acceptable
V	failure
Occlusion for #29 MOD amalgam	in centric marks should be even in size and shape as the other marks in the quad. all excursive marks should be removed
Excellent isolations characteristics	Protection of soft tissue Moisture control Visibility Protection from aspiration Patient comfort Reduced aresol Dental material properties are better
Dri-angles	most effective for blocking stenson's/parotid duct protects the cheek
Disadvantages of cotton roll isolation	become saturated and need to be changed minimal retraction of soft tissue and ginigva no protection from aspiration
Svedopter	mandibular posterior teeth contoured metal salival ejector that can be connected to the saliva ejector hose and has a varying size of metal plates that can be used to keep the tongue out of the field of vision as well as a sliding lock that fits under the chin to keep the devise relatively stable
Rubber Dam	meets the most criteria for excellent isolation of teeth
Armamentarium	mirror cotton pliers dam punch frame clamps clamp forceps T-ball burnisher scissors waxed dental floss rubber dam rubber dam template lubricant lubricant for lips rubber dam napkin saliva ejector
Rubber Dam clamp parts
Winged picture	pg 60
Wingless picture	pg 60
Four points of the clamp	Ideally should engage the tooth below the height of contour
W	wingless
crest of curvature is visible	flat jawed clamps are used when the...
Gingival retracting clamp picture	pg 62
Steps of placement of rubber dam	1. explain procedure to patient 2. Determine area to be isolated (one tooth distal and two teeth mesial) 3. Check proximal contacts (may need wedges of finishing strips) 4. Select appropriate clamp and ATTACH FLOSS 5. Check stability of clamp before dam placement 6. Mark dam with hole locations (may need modification) (class V hole 2-3 mm facial for ginigval retraction) 7. *Punch holes of the best size for each tooth 8. Attach the frame (outside) (droop) 9. Water soluble lubricant 10. Stretch hole over clamp (bow distal to clamped tooth) (all 4 points visible) 11. Place clamp with attached rubber dam and frame 12. Confirm comfort of patient 13. Interseptal seating (tooth farthest from clamp first) 14. Place a wedge in most mesial tooth 15. Adapt rubber dam around clamp with blunt instrument 16. Invert rubber dam with blunt instrument 17. 2x2 gauze between dam and lips 18. Saliva ejector under dam 19. Floss ligature around prep
Picture of clamp and floss	pg 63
Punch sizes	1. smallest incisors 2. Incisors and cuspids 3. Cuspids and premolars 4. Premolars and molars 5. Molars and CLAMPS May be smaller for non-latex dams as they stretch more for better adaptation
Rubber Dam Removal Steps	1. Evacuate debris 2. Advise to close eyes 3. Remove rubber dam ligature 4. Cut rubber dam interproximally 5. Use clamp spreader to remove clamp, dam, and frame 6. See to patient comfort (wipe lips, chin, rinse, evacuate, massage gingiva) 7. Examine dam for all present interseptal
Untoward events of dam removal	laceration of gums with scissors retention of interseptal dam rubber pieces of material fall into mouth if not evacuated properly
Amalgam Advantages	inexpensive, stong enough to withstand chewing forces, and resists abrasion, better than composites
Trituration	the mixing together of the alloy with mercury using a mechanical device (amalgamator)
Gamma 2 phase	reaction of dental amalgam when mercury combines with tin most suceptible to corrosion,weakest part
Alloy powder	Silver (Ag) 40-70%* Tin (Sn) 22-30% Copper (Cu) 13-30% Zinc (Zn) 1% Silver is the highest percentage in alloy powder*
High copper alloys	10-30% gamma 2 phase has been reduced/eliminated less corrosion and better marginal stability
Zinc	Prevents oxidation during manufactuering and when present is a very small percentage (1-2%) of metal composition for amalgam in the precense of moisture may cause delayed expansion, can cause pain
Characteristics of amalgam are influenced by:	size and shape of particles ratio of mercury to alloy triturating condensation
3 basic types of alloy powder	Conventional lathe cut Spherical Admix (combination)
Spherical	greatest one hour compressile strength lesser mercury content than lathe larger condensers, less force set quickly
Admix/ combination/ dispersion	most common spherical and lathe cut stability moderate pressure and condenser size
Mercury vapors	greatest danger of mercury in the dental office
Dental office personnel	greatest danger of mercury
Mercury access	ingestion, absorption, through skin, inhalation
Mercury has a....	high vapor pressure and readily evaporates at room temp.
vapor is breathed into the lungs	metallic mercury is absorbed most readily when...
Studies	amalgam is not a significant health hazard to humans
Mercury safety guidelines	train office personnel on mercury hygiene practices work in well ventilated areas check mercury levels periodically use precapsulated office condusive to cleaning spills (no capret) clean spills with trap bottles, other amalgam, not a vaccum, increases surface area and vapor use water and HVE to keep vapor down when finishing and polishing Manage waste (traps for recycling, no sink, air tight containers)
Factors that affect handling and performance of amalgam	manufacteurer-particle shape and size dentist-condensation assistant-triturating
Strength	excellent compressive strength tensile strength
Tensile strength	strength of amalgam to resist being pulled apart, such as proximal box broken off the occlusal at the thinnest areat (isthmus) 1/8 of compressive strength
Galvanism	transfer of electrons between dissimilar metals in an acidic environment nerve irritation
Under-triturated	dry, grainy, not cohesive, porosity, corrosion, less strength
Effects of condensation	decrease voids, improve properties, decrease corrosion lathe cut and admix
Too much mercury	amalgam will not have strength slower set
increased setting expansion	corrosion, and creep
Mercury rich	55%
Moisture contamination	delayed expansion of amalgam due to H2 gas zinc free reduces delayed expansion caused by zinc*
Thin layer of cavity varnish	< or equal to .5 mm
Copalite is placed because	prevent discoloration reduce initial cavosurface marginal leakage block chemical irritants from dentinal tubules
Class V retentive grooves	axiogingival and axio-incisal line angles
Memorize....	the shape of the preperation
Rubber dam hole	may be placed 2-3 mm to the buccal for use of a gingival retracting clamp
Ginigval retractor clamp	used when a class V prep is apical to margin not used on molars
Minimum number of increments	no matter how small 2 are used
Condensing	process of compressing the amalgam into the cavity prep so that the cavity is completely filled with a uniform mass of amalgam
Overfill	amalgam should be beyond cavosurface margins, then switch to a larger condenser. one margin at a time amalgam prep should be slightly... creates convexitiy
Carving	should remove the merecury rich layer (plash) from the overfilled amalgam and leave a compact mass on the surface at cavosurface margins used to contour restorations
Carving blade	should rest half on the tooth and half on fresh amalgam to prevent submargination parallel to cavosurface push or pull
overfilled/overcontoured
overcarved/undercontoured
Undercontoured perio issues	permits food, upon chewing, to impact into the ginigval sulcus
Overcontoured perio issues	permits plaque accumulation between filling and ginigva resulting in decay or perio
Issues caused by poor contour	displace ginigva ginigval irritation inhibit proper hygiene increase plaque retention lead to secondary caries lead to perio breakdown
Margin RSTV criteria	R-not detectable or scarcely detectable, flush S- slight excess of deficiency < 1 mm T- significant marginal deificiency >or equal to 1 mm V- severe excess of deficiencies
Unacceptable submargination	.2 mm
Submarginal area	explorer tip catches from restoration to tooth can be corrected with white stone if no greater than .2 mm
Armamentarium for class I	basic set up amalgam carrier* small condenser* large condenser* anatomical burnisher* cleiod-discoid carver miller forceps articulation paper amalgam capsules amalgamator dappen dish *=additional instruments for class I
Anatomical burnisher	mesial and distal pits that are centered within the mesial and distal "dog-bone" shapes of the prep. this must be accomplished when amalgam is soft
too deep of amalgam thin-->brittleness
DO NOT..	carve from filling to tooth submargination
Secondary matrix band	condensation may be difficult without because occlusal condensation will remove extension and extension condensation will remove occlusal
Condensing pattern for Class I with buccal extension	occlusal extension (nib pointed cervically) isthmus
Class II retention in proximal box	axiobuccal line angle
Condensing technique	used to prevent voids at the buccoginigval and linguoginigval corners for excellent proximal contact
Class II armamentarium	matrix retainer, bands, and wedges floss carriers condensers hollenback carver anatomical burnisher cleoid-discoid carver articulating paper amalgam capsules amalgamator
Matrix band	temporary wall for proximal boxes of class II amalagam preperations so that the amalgam can be condensed into the box and confined to form a good proximal contour and a good proximal contact with the adjacent tooth
Band shape and size	smaller diameter at gingival larger diameter at occlusal
Slotted head	three outer guide channels
Sliding body or locking vice	one diagonal guide slot
Outer short knob	turns the screw to tighten the matrix band into the locking vice of sliding body of the retainer
Inner Long knob	used to adapt loop of band tighter around the tooth
#2 universal matrix bands
toffelmire retainer
properly assembled matrix band
Wedges	adapt the ginigval edge of the matrix band against the gingival cavosurface of the preparation in order to prevent flash from squeezing out gingivally and to seperate adjacent teeth slightly to permit an excellent proximal contact when the wedge and matrix band are removed
Assembly of retainer for each dental quad	ex. head down, looped on right side of the retainer head tooth #28-32
Amalgam placement	first layer into the most inaccessible area first
Condensing pattern	when the amalgam increment is at the level where the proximal contact should be located, be sure to condense out toward the matrix band only in the area of contact in order to establish an excellent proximal contact. However do not condense outward against the entire band or you will only be filling in the buccal and lingual embrasure spaces that must be later carved away.
rounded contour
Removal of the matrix band	when the amalgam is still carvable if removing an MO or DO remove the side that does not have the restoration first push or pull the band first facially or lingually before occlusally
1st step after removing the matrix band	carving interproximal space for overhangs
Interproximal contour RSTV criteria	R-definite but not excessive resistance to floss, proper location S- slight variation from normal, excessive resitance T- visually open with resitance V- open, no resistance, will not pass, too broad
Matrix and wedge criteria	facial to teeth and slots and smaller loop towards gingiva occlusal .5-1.5 mm and gingival .5-1.0 mm secure and stable wedge adapts snugly without tissue damage proximal contact visual
Pins	The dentist may place only the retention pin, nothing else* help retain the amalgam into the prep when one or more cusps have been lost. are placed in holes that have been drilled entirely within dentin, not enamel one pin/ cusp missing*
pg 117 pic	contoured #2 matrix band
Polishing	relatively low speed with intermittant strokes under moist conditions to achieve luster
Finishing bur characteristics	made from steel, prone to rust smaller flutes than prep bur have fine mulitflutes have more flutes per bur than a cavity prep bur
Brownie cup and point	brown coarse grit used first
Temperature	>140 can cause pulpitis bring Hg to surface-->suceptibility to corrosion and dull cloudy surface
Polishing	process of removing minute scratches and producing a shiny surface with no visible surface pits
Ideal properties of a restorative material	protect dentinal tubules from irritation caused by: the invasion of bacteria drying out pressure- especially if dentin is thin
Bases and liners	used for pulpal protection
Irritation of the pulp is caused by:	trauma from occlusion excess heat from tooth prep pressure from condensing expansion of dental materials conduction of hot or cold leakage of oral fluids at the margin
Metallic fillings	high coefficient of thermal conductivity and readily conduct termal to the pulp causing pain (only response) gold and amalgam
Coefficient of thermal expansion	the relative extent that a material expands when when exposed to heat
Functions of restorative materials	Protect dentinal tubules from irritation non-irritating to dentinal tubules compatible with other dental materials strong to withstand functional occlusion
ZOE	best for termporary restorative material soothing when applied directly to dentinal tubules pallative of obtundent
Dentinal liners	used as pulp stimulators since thin layers can do the job
Obtundents	calm and soothe the irritated tooth liner or base
Thick bases	thermal insulators reinforcers sealers
Calcium hydroxide	pulp stimulator stimulates secondary dentin liner not sufficient strength to function as a reinforcer no thermal insulation often covered with a thicker base protects from irritating bases such as zinc phosphate
Zinc phosphate	strong reinforcer and thermal insulator very irritating so must protect tubules before use base and cement (thin) oldest cement inexpensive
Zinc oxide eugenol	an OBTUNDENT, thermal insulator, and reinforcer, best fo temporary filling material not with composite resin base and temporary
Glass ionomer	reinforcer and thermal insulator, as well as a final restorative material prevents caries with fluoride liner, base, cement, final filling
Cavity copal varnish	used to seal dentin tubules not with composite resin liner
Cavity liners	ndont insulate and not strong enough to support te restorations on the pulpal floor
Components of a cavity varnish	natural resins and organic volatile solvent
Uses of bases and liners	sealers insulators obtundent reinforcers
Direct Pulp Cap	procedure of placing calcium hydroxide over the actual pulp (pinpoint bleeding) and surrounding dentin not all patients are candidates. Dentist must asses the patients symptoms and character of pulp and how it will respond. Dead pulp will not respond
Pulp stimulation	< or equal to .5 mm
Order of placement	calcium hydroxide copal varnish zinc phosphate
Desirable material criteria for temporary restorations	easy to manipulate sets quickly therapeutic to pulp seal margins strong and durable for 6-8 weeks
Temporary restorations	filling an enitre cavity preparation for a month or two may be used by a dentist to determine if the tooth will respond favorably prior to placing a more permanent and costly restoration or when there is insufficent time to place the permanent restoration (as during an emergency appointment) questionable pulp vitality, acute pulpitis, emergency or permanent one being made
Eugenol	AKA oil of cloves is soothing over an irritated pulp and has a unique smell often associated with the dental office inhibits setting of resins, never used iwth resins
Glass Ionomer reaction	chemical bonding to enamel, dentin, and stainless steel polyacrylic acid dentin conditioner to remove debris
Polycarboxylate cement	AKA zinc polyacrylic bonds chemically to the tooth polyacrylic acid and zinc oxide less irritating, but not as strong
Placement order under amalgam	Dycal glass ionomer copal varnish
Ideal depth of amalgam preperation	slightly deeper than the DEJ .5 mm into dentin
Prior to Dr. Bowen's resin materials...	silicate cement 1900's
Unfilled acrylic resin	mid 1900's easy to place excellent esthetics high coefficient of thermal expansion, greater than the tooth high percolation poor abrasion resistance poor color stability
Bis-GMA	resin matirx bisphenol A-glycidyl methacrylate
Dr. R. Bowen	developed composite resins in the mid 1900's
Composite material substances	filler particles and surrounding matrix
Matrix	"glue" that binds the filler particles together and is a resin like Bis-GMA
Filler particles	various sizes of glass particles (quartz, lithium aluminum silicate, silica, or boro-silicate glass) strengthen the material reduced shrinking upon setting provide better esthetics reduce thermal conductivity
Dimensional change of composites	similar to the tooth due to filler particles
Radiopaque filler particles	barium fluoride and strontium glass
Coupling agent	vinyl or epoxy silane filler paritcles are coated, that causes the Bis-GMA to stick to the filler particles
Macrofill	conventional have roughest surface texture contains larger filler particles strong and abrasion resistant, but cannot be polished 10-100 um 75-80% filler strong poor polish
Types of composities	Macrofill Microfill (minifill) nanofill hybrid
Microfill	smaller filler particles such as silica polish easily poor abrasion resistance less than 1 um 35-50% filler less strong more abrasion good polish
Nanofill	extremely small particles size
Hybrid	combination of micro and macrofill can be polished and are strong and abrasion resistant 70-80% filler strong less abrasion viscous good polish
Advatages of composite resins	Less solubility, resist dehydration less dimensional change better marginal strength excellent marginal adaption
Etching	when enamel in the permanent dentition is exposed to acid the outer layer of enamel is selectively dissolved leaving a rough surface of micropores
Shrinkage	composite shrinks towards the center when cured with light
Calcium hydroxide or glass ionomer	if remaining dentin thickness covering the pulp is less than .5 mm thick can protect dentinal tubules stimulates secondary dentin
Oxygen	inhibits
Conditioning	tooth must be clean and dry (without saliva contamination) clean with pumice and water with no oil or fluoride which could reduce effects of acid
Dentin bonding system	seperate etch, primer, and bond 3 step system
Dentin bonding	adherence of composite resin to dentin and enamel
Dentin etch	37% phosphoric acid 15 seconds rinse for 10 and remove excess water removes a layer of tooth debris left by preperation mechanical retention to layer of flowable bonding agent
Smear layer	dentinal tooth debris left by preperation
Dentin bonding systems	micromechanical bonds and secondary chemical bonds
Composites	subject to polymerization shrinkage
Light cure	AKA VLC 470-480 nm long working time reduced porosity
Setting times	the bonding agent or the filled resin should not be dispensed until use or they will begin to set may slowly set with daylight or operatory light
Curing light	be sure to use orange protective sheilds may cause retinal damage formerly UV light, but now is visible light-->more hardened restoration
Depth of cure	light only penetrates through minimal thickness, about 2 mm at one time dark shades do not absorb as well so less layers may be used thick takes longer to cure
Stage curing	able to cure more than 2 mm or in stages from less bright to more bright
Incremental addition	helps with depth of cure air inhibited layer allows this to be employed
Armamentarium	Basic set up Shade guide Etchant Bonding agent or primer and bond Composite material
Bevel for composite	45 degree bevels vs. 90 degree bevel for amalgam
Composite margins	should taper near the cavosurface margin to a very thin layer if amalgam were thin it would fracture
Advantages of bevel	composite blends from thick to thin at the cavosurface resulting in improved blending of the shade of composite to tooth and placing a bevel removes the fluorids rich outer layre of enamel that would be more resistant to acid etching
Lightest shade of tooth	incisal 1/3
Shade selection	match prior to isolation without dental light on after external stain is removed
Isolated teeth and shade matching	teeth that have been isolated by rubber dam or cotton rolls for a period ot time tends to dry out and get lighter
Value	most important color component relative brightness of color
Metamerism	two sample which match when illuminated by a particular light source and then do not match when illuminated by another light source happens when two people view the same object and the angle of light influences the color perception
Background color	behind the tooth effects the shade selected
Applicator Tip	Keep in the composite while extruding to prevent avoid air entrapment
Guidelines for manipulation	A general guideline for composite placement and manipulation is to gently part and wipe the material with your blade-shaped instrumetn towards each cavosurface margin
Blade instrument	moving the instrument from filling to tooth in order to prevent pulling the somewhat sticky composite from the margins which leads to open margins
Composite adaptation	using blade instrument over adjacent tooth while sliding the instrument toward the tooth cavosurfaces to avoid open margins
do not move tooth to filling	this may also cause an open margin
Cure light	keep the light very close to the restoration since the lights ability to harden the composite decreases greatly when it is even just an inch away from the material do not touch the material
Finishing and polishing	can be done immediately after placement and curing of the composite can uses discs or burs
Steps in composite placement	clean tooth with pumice and water pick shade isolate the tooth etch bonding resin applied
Disc application	any application that may touch tooth next to the cavosurface must move very lightly toward the tooth
"R" margins	tooth-restoratiion junction not detetable or scarely detectable with explorer there is not evidence of marginal excess (including overhangs) marginal deficiency, void (at the margin) or open margin
"S" surface	surface not uniformly smooth, free of pits and voids. No surface glaze/ sealer present
no evidence of modification	recontouring, removal or tooth structure; gloss not off enamel
Mylar matrix strip	clear plastic placed prior to etching to prevent etching of adjacent teeth prevent unwanted etching and bonding to adjacent tooth structure with a wedge to mimimize gingival flash
Surface under mylar strip	smoothest, hardest surface for composite becuase the mylar does not permit air to reach the surface of the composite so there is no softer air inhibited layer
blade instrument adaptation
pic of gapped finishing strip
Discs	more difficult to use when successfully contouring a composite on the lingual surface of an anterior tooth do not use on lingual surface without experience
Class III occlusion	DO NOT occlude
compare mylar strip pics
used to prevent open margins
1st is correct left is open contact middle is too thin right flash present
Composites in posterior teeth	composite resin can be successfully used in selected teeth
Composites	technique sensitive
Options for forming proximal on class II composites	clear mylar strip held by toffelmire metal matrix with toffelmire (similar to amalgam) sectional matrix system
Wedge and re-wedge	with PDL it is recommended that you wedge the teeth to compress the ligaments and seperate the teeth then after 30-60 seconds wedge even more
Proximal box	place composite first
Proximal contacts	harder to achieve with composite vs. amalgam
Compactable or condensable	can be compressed into the box preperation using amalgam condensing instruments
Used to fill proximal box	compactable/condensable (2) and (1) flowable
Bonding agent	may add to instruments to prevent composite from sticking, but dilutes composite and shoudl be avoided changes filler/martix ratio by incorporating more matrix
Condensing technique for composite	wedge helps seperate teeth, but composite cannot be condensed against matrix as much as amalgam
left-resonable contact middle-open contact, pin point right- correct
Factors that determine the success of a sealant	proper placement (cover all pits and fissures) retention strict adherence to the manufacteurs instructions
Sealants	used to prevent caries in pits and fissures, not smooth surface caries
Don't	scrub the surface with etchant
Filled sealant	glass or silica particles more viscous, more resistant to abrasion reinforce for greater strength and resistance to abrasion should be evaluated for high occlusion after curing and adjust if needed
Filled sealant	greater strength and abrasion resistance than unfilled sealant
Sealant placement	evaluated and treatment planned by the dentist (deep stained grooces, but shallow with no evidence of crevice) tooth is cleaned with plain pumice in water on a bristle brush to remove the pellicle, plaque, and surface stain prevent saliva contamination (cotton rolls, dri angles etc)
Brush	preferred over cup because the bristles can reach the deeper portions of the pits and grooves
Etching	may also be called roughening the tooth 37% phosphoric acid applied for 15-20 seconds removes extremelythin layer of enamel (10-20 microns) demineralization rinse then dry of debris avoid rubbing the surface
Proper etching appearance	"frosted, chalky white appearance on the tooth must continue to be isolated and kept dry
Auto cured/ self-cure sealants	mixed prior to application chemical reaction that begins hardening right away about 2 mins*
Air inhibited layer	thin outer surface that is exposed to air whie settin and appear wet and uncured, bitter to taste inhibited due to exposure to air should be wiped away once the sealant is set and the restoration is finished, before removal or rubber dam
Sealant placement steps	evaluate clean tooth apply etchant apply sealant check occlusion with articulating paper
Patient who benefit from sealants	kids with newly erupted teeth with deep pits and fissures children who use a fluoride toothpaste adults with a tooth that have pits and fissures that are suceptible to caries
Proper sealant placement pic
Advantages compared to composite	adheres to dentin and releases fluoride
Glass ionomer indications and advantages	primarily indicated for conservative restorations in primary teeth fro patients with a high caries rate of in areas of root caries and severe erosion or abrasion in the cervical areas of adult teeth where esthetics are not critical
Composite resin	still direct filling esthetic material of choice for stress bearing restorations (Class I and IV) since it is stronger than glass ionomer, and esthetics restorations (class III, IV, and V) when esthetics is critical some composites can be polished to a more tooth like finish
Compomers	glass ionomer and composite polyacid modified composite resins basically composite resins that have been modified with glass ionomer to release fluoride require adhesive