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Terms in this set (134)
Pear carbide, 0.6 mm diameter, 1.2 length, high speed
Pear carbide, 0.8 mm diameter, 1.6 length, high speed
Pear carbide, 0.8mm diameter, 2.8 length, high speed
Bur 801 010
Round diamond, 1mm diameter, high speed,
Diamond dip, 0.7 mm diameter and 2.5 mm length, highspeed.
Diamond bur (big), 1.6 mm diameter and 2.5 mm length. Shapes restoration surface, high speed.
Bur 2 010
Round carbide, slowspeed, use at 8000rpm, 1.0 diameter
Diamond bur grit sizes
The finer the grit, the lower the number in micron. 150 micron is super coarse and 15 micron is extra fine.
Carbide Bur Grit Sizes
The finer the grit, the higher the number of blades.
- Tip: 5,000-10,000 w water
- Wheel: 5,000-8,000
- Tip: 5,000-10,000 w water
- Wheel: 5,000-8,000
- Brush: 5,00-7,000 rpm
CP6419- 90 degree square blade, cutting edge on the same plane as the long axis.
1.3 mm width, other side is 1 mm
*smooth margins and clean floors
CP4008- cutting edge 90 degrees to long axis, also its just smaller looking. Tapered blade
1 mm width or 0.65 mm on other side
*smooth floors and walls
Blade is either aligned with handle, slightly angled, or curved from the long axis. Cutting edge is 90 deg to the long axis. Tapered blade
Pointed instruments used to feel tooth surface
Used for invagination for rubber dams- rounded flat blade.
one side is 1 mm and the other is 1.3 - circles
1.5 and 2 mm- circles
PFIDD 5/58 (red)
PFIDD 3/48 (yellow)
PFIDD 7/88 (blue)
PFIDD 1/28 (green)
3 and 4 Numbering Systems
3) width or cutting edge length (microm) - blade length (mm) - blade angle
4) cutting edge length (microm)- cutting edge angle- blade length (mm)- blade angle
rubber dam thickness
Think- 0.006 in
Medium- 0.008 in
Heavy- 0.008 in
Extra Heavy- 0.012 in
Special Heavy- 0.014 in
What materials do we use for rubber dams?
Ainsworth hole puncher
Plastic Nygaard otsby frame
Clamps: 0(large PMs), 00(PMs, canines), 26N (molars- mand), 27N (large PMs, small molars)- 26N IS BIGGEST
Friction Grip (FG) Shank
1.6 mm, used in high speeds
Right Angle (RA) Shank
2.35 mm, used in slow speeds
High speed hand-piece
1:5 ratio, 500-200,000 rpm speed range
Slow speed hand-piece
1:1 ratio, 60-40,000 rpm speed range
if your motor is at 1:5 (highspeed) and its spinning at 20k rpm, its 100k speed. if its 40k, its 200k speed (mult by 5!).
so the speed at gear ratio 1:5 is always 5x the speed at gear ratio 1:1
1) patient protection/risk management
2) increased access/ visibility
3) improved time efficiency
4)moisture control/improved quality
5) infection control
hygoformic saliva ejector
high vol suction
rubber dam (natural latex or non latex rubber made of petroleum products (isoprene))
Rubber dam punch
1) mand incisors
2) Max incisors
3) canines and premolars
Salivary Flow Rate
DAILY FLOW- .5-1.5 L
Unstimulated- normal is 0.3 and abnormal is less than .1-.2 ml/min
Stimulated- normal is 1-2 and abnormal is .5 ml/min
Multifactoral, transmissible, infectious, oral disease caused primarily by the complex interaction of cariogenic oral flora (biofilm) with fermentable dietary carbohydrates on the tooth surface over time
Vertical vs Horizontal Trasmission
Vertical- from mother and environment as a baby, exchanging saliva from parents
Horizontal- Exchange bacteria to peers, partner, same age range
Initiated by exposure of cariogenic bacteria to fermentable carbs such as monosaccharides, glucose, fructose or disaccharides sucrose and lactose. Main pathway is conversion of sugar by glycolysis to pyruvic acid and then to lactic acid.
Factors that can influence caries
- amount of saliva
- saliva or plaque ph
- chewing gum, sugar
- antibacterial rinses
- social demographic (insurance coverage)
- knowledge and attitude to take care of teeth
Enamel and dentin critical pH
When lactic acid is made from sugar, the pH falls which causes demineralization of the enamel and dentin when pH goes below critical pH.
Once we stop eating our saliva rinses out the remaining food and he see a slow rise back to pH 7 (remineralization)
Enamel and Dentin Compositions
Enamel- more minerals, takes longer to decay... 10% water, 88% inorganic, 2% organic (made mostly of hydroxappetite crystals)
Dentin- less minerals more water, decays quick... 30% organic, 50% inorganic, 20% water
Enamel Organic Components
Proteins- amelogenin, ameloblastin, enamelin, tuflelin
Enzymes- mettaloproteinases (MMP), proteinase, phosphatase
You masticatory surfaces have more enamel, bc you need stronger tooth to bite
Striae of Retzius
incremental growth lines seen in enamel. represent incremental pattern of enamel, enamel grows in layers and layers
- external manifestation of the stria of retizus
Enamel Cross Striations
diagonal lines, show the amount of enamel deposited by ameloblasts in 1 day. secondary enamel (primary is what were born with).
Avg rate is 4 micro meters a day in humans.
Hunter Schreger Bands
10 or more layers of enamel rods. Seen more in areas that have more stress, like the canines bc they chew hard. Also molars.
Rod positioning in enamel
In outer enamel the rods are paraelll to support chewing and stress.
Your enamel starts to deviate into an S curve called
when you go towards the inner enamel so that the dentin and pulp are protected from force- prevents cracking.
Rods are perpendicular to DEJ. HORIZANTAL
Outermost layer of enamel has this, it has the highest elasticity. Secrete a lot of hydroxappetitin.
Its a dense area of hydroxappetitin on the most outer surface of enamel- YOU DO NOT HAVE THE ROD INTERACTION.
Close to the DEJ, acts as a cushion when you chew.
Brush like structures extending outward from DEJ- hypomineralized regions containing increased residual enamel matrix proteins. May assist in the resilience of enamel.
Fissure like linear enamel defects, vertical lines.
Increased in enamel porosity along the stria of retzius.
Hypomineralized (too much fluoride causes less mineralization) lesions that extend throughout the enamel- white spots.
Your enamel is more weak so youre likely to see pits bands attrition, abrasion, loss of extensive areas.
AMELX, ENAM, MMP20, FAM83H genes.
Defect in growth of enamel- hypocalicfication. Causes hypoplastic teeth (lots of pits).
Enamel is not formed. Treatable.
Dentin enamel junction. Transition from hard enamel to softer dentin. Prevents cracks. Flexible, cushion, absorbs all the stress
Dentin Organic Components
Made of type 1 collagen- 90%.
10%- non collagen like proteins lipids and growth factors.
Proteins- amelogenin, osteonectin, osteoclacin.
Enzymes- MMP-1, -2, -3, -9, TIMPS, phosphates
Dentin Inorganic Components
Intertubular crystallites have needle like appearance
House odontoblast cells, living part of tooth.
It goes around the dentinal tubules and it contains most hydroxapetite, most calcified, protects the tubules.
96% inorganic component.
Amount of tubules along dentin
closer we get to DEJ, the less tubules we have. as you approach teh pulp, theres way more dentinal tubules and tehyre really wide. effects bonding
rest of the surface of the tooth, between the tubules - collagen fibers and hydroxappetitin
Types of Dentin
Primary Dentin- formed in the beginning.
Secondary Dentin-formed normally
Tertiary Dentin- reactionary, formed in presence of aggression
Tertiary dentin. Response of odntoblasts and hoels cells to carious decay. Keeps aggression from getting to the pulp
formed in the response of a pulp exposure. made super fast.
Non Carious Cervical Lesion
Area of that dentin is exposed due to lack of enamel... too much pressure during tooth bushing or clenching due to stress.. painful.
Your bodys attemt to seal the holes when dentin is exposed. Hypermineralized, all the tubules calsify to protect odontoblasts. Very common on non caries cervical lesions
DSPP gene mutation. Abnormally soft dentin, tooth is likely to break and decay.
Type 1 is most common, you have osteogenesis imperfecta and but have brittle bones.
covers root surface
acellular- thin and covers cerical root
thick- apical root towards the cej top
Biofilm Formation Steps
- protein film that forms on surface of enamel by selective binding of glycoproteins from saliva that prevents continuous deposition of salivary calcium phosphate
Attachment of early bacterial colonisers
(0-24 hrs)- Pellicle has special ligands that certain bacteria can bind to.
Co-adhesion and growth of attached bacteria
(4-24 hrs)- grow and form microcolonies, teeth feel rough
(1-7 days)- increased species diversity with continued co-adhesion and growth of microcolonies. new bacteria attaches to old bacteria, not the pellicle.
Climax community/mature biofilm
(1 week+)- form on top of first colony. hierarchy in biofilm layers: bacteria on bottom are anaerobic bc get less oxygen
1) Specific Plaque Hypothesis- There are specific pathogenic bacteria among the biome that were solely responsible for the disease. (in the absence of the disease causing bacteria, were healthy) - WRONG
2) Non-Specific Plaque Hypothesis- Accumulation of activity of all types of dental plaque is responsible for oral disease, regardless of virulence of the specific pathogens involved. Ecological shift and pH levels changing cause diff bacteria to flourish - NOT THE BEST
3) Ecological Plaque Hypothesis: Caries is a result of changes in the environment due to acid production from the fermentation of dietary carbohydrates, which selects for acidogenic and aciduric (acid tolerating) species such as strep mutans and lactobacilli. THis results in imbalance and high numbers of certain keystone pathogens - TRUE
Bacteria found in diff types of caries
White spots, initial incipient caries:
- S. mutans
Cavitated lesion, caries:
- lactobacilli is the most prevalent
- actinomyces most prevelent
1) White Spot- demineralized enamel, light scatters on tooth surface, not cavitated
3) Subsurface Lesion (pseudo intact layer)
4) Dentin Tubules- Dentin has microscopic long tubule pores (red)- starts at pulp chamber and goes all the way to DEJ
Micro Cavitation Progression
Pores act as a scaffold so that minerals can attach and fill it back in, but if you start demineralization the pores are not the same anymore (not hydroxyapitite) so theres no way to regrow the enamel.
ZD (Zone of Destruction) INFECTED
- the dentin is breaking down completely, penetrated by bacteria and denaturalized organic matter. Enzymes eat away at collagen fibers in dentin so it breaks down and gets soft.
Sclerotic Dentin (SD) AFFECTED DENTIN
- Calcified dentin tubules. Caries manipulating and causing block of tubules, the dentin thus changes into sclerotic dentin. The roots are exposed the the dentin is hypersensitive...
Tertiary Dentin AFFECTED DENTIN
- Now its receded more into dental chamber, at the pulp and it happens in response to odontoblastic activity from the sclerotic dentin (minerals from dentin are being dissolved)
(refer to chart)
What do we need to do before a restoration
we need to use oil free pummace to clean to tooth so we dont bond to microorangisms
When you drill tooth, powder that comes out.
Carbide burs make thinner smear layer, diamond makes thicker smear layer
Smear layers obstructs the dentinal tubules
must be removed to allow permeablilty of adhesive to surface.
Three Step Etch and Rinse
Multi Bottles: 35=37.5% phosphoric acid (H3PO4), primer, and bonding resin (adhesive)
Hydrophillic- high enamel and dental bond strength.
Put the 35-37.5% phosphoric acid on enamel and dentin after we drill.
-30 sec on enamel
- 15 sec on dentin
GETS RID OF SMEAR LAYER.... NOW DENTINAL TUBULES WILL BE EXPOSED AND YOUR COLLAGEN NETWORK WILL SHOW AND THE ADHESIVE CAN PENETRATE NOW
RINSE but dont make it too dry or too wet. Dont air dry. 30 s
Patterns of Etched Enamel
Type 1: youve kept the periphery of enamel and got rid of middle. strongest bonding one can have.
Type 2: you got rid of periphery rods and you kept the middle prism cores
Type 3: aprismatic... much less distinctive, between 1 and 2 its jUst not distinctive.
1) Bifunctional Monomer- hydrophillic (to bind enamel and dentin) and hydrophobic (binds adhsive)
Possible: HEMA, 10MDP, bis-GMA, TEGDMA, GDMA, UDMA
*i think we use bis- gma
2) Solvent- removes excess water.
Possible: WATER, ETHANOL, ACETONE
**allow primer to air dry... should get shiny. the collagen network wont collapse bc its resin protected
We bond with adhesive.
Made of bifunctional monomer (bis-GMA), photoinitiator (CQ), and fillers (SiO2- sillicone).
(theres resin in it- bis gma is the resin i guess)
composed of resin and decalcified dentin - you want the resin in the intertubunil, not in the dentinal layers
in the enamel, you want it intra and inter the prisms, between and inside, makes it super strong.
the type is important- nanofillers are able to penetrate between two collagen fibers so it gives the best results.
Best Nonofiller is SiO2 it goes into the nonofiller
Two Step Etch and RInse
the primer and bonding resin adhesive are in the same bottle. but you still need to put 2 layers.
degrades more quickly
has higher concentration of solvent (up to 50%) so its more succeptable to water and tooth has water, so it degrades
Two Step Self Etch
You dont use phorphoric acid for this one but the primer and bonding resin adhesive is acidic, so it removes some smear layer but NOT ALL SMEAR LAYER.
*one bottle is self etching primer (no acid, etches itself) and second bottle is the resin adhesive
*hybrid layer for this one has smear layer in it bc you couldnt get rid of all of it
One step self etch
contains complex mix of hydrophilic and hydrophobic resin blends, acid, and water to activate etching
contains highest hydrophilic monomer content available.
it acts as a semipermeable membrane on the dentin surface, allowing fluids to cross the interface and increase water which promotes swelling
low bond strength and BAD... really porous so it will create bad hybrid layer ... the etching just doesnt work for this
Multi-Mode Universal Adhesive
can be applied as etch and rinse or self etch adhesives.
high water content, presence of
makes it more resistant to biodegradation.
Self- Adhesive Cement
Its more of a composite... its acidic and goes on tooth then bonds to calcium which neutralizes its ph again. good for bonding of crowns and its very reliable.
Has phospohric acid and is hydrophillic, but then the acid becomes neutralized by the alkaline fillers (ph back to 7) and after neutralization the cement becomes hydrophobic and stable.
**while this is good for dentin, you still need to modify the surface for enamel.
**low bonding strength, smear layer is still an issue. GI is better.
Hybrid Layer Degradation
1) Enzymatic Degradation- MMP degrades collagen so we use MMP inhibitor
2) hydrolytic degredation
3) polymerization shrinkage
2% chlorohexidine solution applied before or after acid etching of dentin/ to prevent your adhesive or hybrid layer from degredation we add MMP increases longevity of restoration if added etching
INHIBITS MMP FROM EATING YOUR COLLAGEN (mmp causes matrix degredation in teeth)
intrinsic moisture seeping from pulp chamber during adhesive application prevents formation of sealed interfaces regardless of bonding strategy used.
PREVENT THIS BY PRESERVING TOOTH STRUCTURE - USE LOCAL ANESTHESIA AND VASOCONSTRICTORS
bacteria is problematic, you want enamel all over the resotration... the restoration will shrink if its not bound to more enamel
Temporary direct restorative materials (types) AKA Protective Restorations
if you dont have a lot of time left and seeing the patient again soon.
2) Calcium Sulphate
3) Zinc-Oxide Eugenol
Calcium Sulphate Based
Cavit brand, paste that you smear into cavity and it hardens with saliva.
High expansion so wedges in
Its weak, used to small cavities and endo access.
Zinc Oxide Eugenol (ZOE)
IRM Brand. Added PMMA to make it stronger.
Solid zinc oxide mixes with liquid eugenol, and its self curing.
Protects pulp or nerve so its good for protective restoration
Eugenol inhibits bonding process polymerization, so think ahead.
Glass Ionomer Cements (GIC)
Calcium-aluminosilicate (powder) with polyacrylic acid. ACID BASE REACTION.
This is the only material that chemically bonds to the tooth via ionic bonds. The others are just wedged in.
Good for protective restorations, endo access, and class V.
**What we use in lab.
What is GIC Composed Of?
Powder: calcium aluminum fluorosilicate glass, zinc oxide, silver
Liquid: polyacrylic acid, polycarboxylic acid, tartaric acid.
ACID BASE REACTION
GIC Setting Reaction
acid from liquid component attacks the glass, surface of glass releases Ca, Al, F ions, cations cross link polyacid molecules forming a salt matrix. So the poly acrylic acid has the calcium and aluminum ions that will bond to the calcified tooth surface via ionic bonds.
Types of GIC (FUJIS)
Fuji 2 LC
: Green, hybrid of glass ionomer cement and resin composite material. - RMGIC
Two setting processes, acid base reaction and polymerization so its dual cured and takes longer.
Good for protective restoration class 3 and 5, base. SUPER STRONG.
: Yellow. self cured, good for protective restorations, endo access, base-buildup RIC... i think this is the one we used in class
: Pink. acid base reaction, protective restoration or sealant
cleaning the tooth cavity surface before you put the GIC.
20% polyacrylic acid
apply for 10 s, rinse, dry but dont desiccate.
Application of GIC
Pierce so liquid and powder meet and then mix via Trituration (7 sec),
6 Components of Posture
1) Base of support
2) Pelvis alignment
3) Hip hinge
4) trunk position
5) shoulder/scapular position
6) head and neck
Base of Support
- feet flat on floor, dont extend legts
- wide base of support, hip hinge
- slight tilt forward of chair
hip hinge strategy
wide base of support, bend from hips not back
pelvic position drives neck position... allows for better alignment up kinetic chain.
pelvic tilts to find neutral position
minimize round trunk, hip hinge strategy, avoid static prolonged positions
stay as close to neutral as possible, elbows by side is best
head and neck position
neutral head and neck.
capital flexion vs cervical flexion
patient sitting position
Trendelenburg- perfusion of blood to head and organs (all the way back ?)
Right handed patients sit...
between 8-1 and 7-12
*7 (you) and 12 (them)
direct/indirect restorations, cements, base up buid up, repair restorations, sealants, provisional restorations
***WE USE FILTREX SUPREME ULTRA SYRINGE
Resin Matrix- glue that keeps everything together
initiators (blue light) and accelerators (makes materials harden instantly)
Resin is organic material made of long carbohydrate chains (carbon and hydrogen)
Most common is Bis-GMA, theres also UDMA and TEGDMA
Polymerization of Resin
Chemical process where monomers react with each other to make polymers.
Acrylate is the group that participates in the polymerization reaction and this.
CROSSLINKING IS MADE POSSIBLE VIA POLYMERIZATION
1) Initiation: benzoyl peroxide breaks down into free radical
2) Propagation: radical on both sides of arrow
3) Termination: Gives us final product
*Conversion rate is 50-70%
*polymerization is inhibited by eugenol in ZOE or peroxide (bleaching)
Oxygen Inhibited Layer
oxygen reacts with free radicals and this causes inhibition of chain propagation (in polymerization).
if you leave this layer fillings will stain very easily, BUT you also need this layer if you add a new layer of composite...
**Remove if the surface is exposed to air but keep if you want to add another layer!!
composite resins shrink during polymerization... this is determined by the C factor
C factor= bonded/ unbonded surfaces
*you want lower C factor, so you want more unbonded surfaces
How to reduce polymerization shrinkage?
- more and smaller fillers
- special resin monomers
- use soft start curing lights
- layer composite in incriments with low c factor
Composite Layering Techniques
d) cusp build up
Filler particles of the composite
these are the inorganic particles (the matrix is organic- resin is organic its made of carb chains).
can be quartz, lithium aluminum silicate, zirconia, and barium, strontium, zinc, or ytterbium glasses
*improves physical and mechanical properties of matrix by reducing polymerization shrinkage and water absorption and coefficient of thermal expansion
****NANO HYBRID PARTICLES MAKE RESTORATIONS STRONGER... SMALLER
not used anymore, good polishability
32-50% vol filler
Used in clinic, 60-70% filler and its a combination of micro and micro fine filler particles. strength and used for all classes.
* We use Herculite XR in clinic!!! Comes in different colors
very good polish-ability, high strength, 78.5% filler particle.
**WE USE THIS IN LAB... Filtrex Supreme Ultra.
Coupling agent in composite
puts the matrix and filler particles together!!!
SILANES- bifunctional molecule that provides bonding of inorganic filler to organic resin matrix
Shade of teeth, pigments... inorganic oxides to match shades of dentin or enamel
- energy absorbed and emitted at longer wavelength
- scattering of shorter wavelengths of light
- measure of impenetrability to visible light (enamel is translucent (70%) and dentin is more opaque)
The more enamel you have, dentin doesnt shine through as much.
For young patient you want more enamel so dentin doesnt show through.... elder patient has less enamel, dentin strikes through
colorblind people to choose the shade
Initiators and Accelerators in composite
heat, light, and chemicals.
Chemical initiator- benzoyl peroxide
Chemical Accelerator- organic amine
Light (photo) initiator- diketone: camphorquinone 468nm, lucirin TPO 370 nm, phenypropanedione (PPD)
Light accelerator- organic amine
****** 450 nm is blue light so we use comphoriquinone
DUAL CURED uses a combo of the chemical and photo initiators above.
Contraindications of posterior restorations (when you shouldnt do it)
- large resotrations
- when you cannot isolate with rubber dam
- tooth w heavy occlusal stress
Advantages and disadvantages of resin composite (v amalgam)
- conservative tooth removal
- decreased microleakage
- increased strength of remaining tooth
- polymerization shrinkage
- lower fracture toughness
- more technique sensitive
- possibel greater localized occlusal wear
- we dont know much about bisphenol A (mimics estrogen so can make boy more female)
Class 1 Restorations Clinical Protocol
- check occlusion
- prophylaxis (remove plaque)
- tooth color matching
- feild isolation (dam)
- cavity prep (drill)
- adhesive system
*WE USE OPTIBOND FL-3 STEPS:
- etch enamel (w phosphoric acid) for 15 sec then extend to dentin for another 15. rinse w water thoroughly, remove excess water but dont overdry
- composite placement
*WE USE FILTREX SUPREME, NANOFILLED
- final light cure
- put glycerine gel over the last layer to get rid of oxygen inhibited layer
- check occlusion
- finish and polishing (coarse to super fine)
Class I Prep
Class II Prep
Mesio occlusal or mesio occlusal distal (across teh middle of the tooth mesial to distal)
Class III Prep
Mesiolingual (top edge)
Class IV Prep
All down the mesial side
Class V Prep
Buccal cervical (all the way to bottom).
Erosion, abrasion, abfraction.
Class VI Prep
Incisal edge or occlusal cusp tips
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