Questions and Answers
What is a Class 1 restoration?
Pits, fissures, and occlusal surfaces of posterior teeth.
What is essential for all margins when preparing a Class I prep?
Make sure all margins are caries-free.
What are indications for a Class 1 restoration?
Caries on the occlusal, pits, or fissures of posterior teeth and defective restoration.
What are four advantages of resin-based composites (RBC)?
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What are the two options for materials for restorations? What is the difference?
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What factors affect the long-term success of RBC restorations?
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Since our parents' time, how have posterior resin composite restorations improved?
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What should be kept in mind when considering RBC?
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What are limitations of RBC restorations?
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What is important regarding shape for RBC restorations?
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What are three considerations a clinician should keep in mind for clinical circumstances?
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What is the step-by-step operative technique for Class 1 RBC preparation?
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What should the wall orientation have in a Class 1 didactic preparation?
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What is the shape of a didactic Class 1 upper premolar?
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What is the shape of a didactic Class 1 lower first premolar?
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What is the shape of a didactic Class 1 lower second premolar?
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What is the shape of a didactic Class 1 lower first molar?
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What is the shape of a didactic Class 1 lower second molar?
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What is the shape of a didactic Class 1 upper first molar?
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What is the shape of a didactic Class 1 upper incisor?
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What is the difference in the outline form between amalgam and composite restorations?
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What is the difference in the pulpal depth between amalgam and composite restorations?
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What is the difference in the primary retention form between amalgam and composite restorations?
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What is the difference in the secondary retention form between amalgam and composite restorations?
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What is the difference in the resistance form between amalgam and composite restorations?
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What is the difference in the base indications form between amalgam and composite restorations?
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What is the difference in the linear indications form between amalgam and composite restorations?
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What is the difference in the sealer form between amalgam and composite restorations?
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What are the indicating lines on the perio probe used when measuring out didactic preps?
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What instrument should be used to create the isthmus?
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Study Notes
Class 1 Cavity Preparation Overview
- Class 1 preparations involve treating pits, fissures, and occlusal surfaces of posterior teeth.
- Treatment may reveal deeper decay than initially visible.
Margin Preparation
- Ensure all margins are free of caries, which can be either active or inactive.
Indications for Class 1 Restoration
- Caries found on occlusal surfaces, pits, and fissures of posterior teeth necessitate restoration.
- Restoration should also be considered if the existing one is defective.
Advantages of Resin-Based Composites (RBC)
- Aesthetic appeal with no mercury in composition.
- Thermally non-conductive, reducing sensitivity.
- Encourages conservation of tooth structure due to adherence properties.
Restoration Material Options
- Two main materials: Resin-Based Composites (RBC) and Amalgam.
- RBC provides better aesthetic results and should only be replaced if truly necessary to preserve tooth structure.
Long-Term Success Factors for RBC
- Success is influenced by cavity size, tooth type, occlusal contact location, commitment from both patient and dentist, and patient's caries risk.
- High caries risk and clenching leads to lower restoration survival rates.
Success Rates of Composite Restorations
- Posterior RBC restorations have improved significantly; with failure rates of 1.8% at 5 years and 2.4% at 10 years.
Considerations for RBC Application
- Technique sensitivity: Follow proper protocols and timing for material application.
- Durability varies between RBCs; overly hard materials may wear opposing teeth.
- Proper isolation from saliva and blood is critical to bond quality.
- Polymerization shrinkage must be managed properly during application.
- Post-operative sensitivity may arise from improper etching or heating.
- Marginal discoloration can occur; quality adhesive application is essential to minimize this issue.
- Microleakage can result in discoloration linked to shrinkage of the material.
- Selection of materials affects the likelihood of fractures in restorations.
Limitations of RBC Restorations
- High caries risk patients may not benefit as much from RBC.
- Difficulties in achieving adequate field isolation affect bonding success.
- Significant wear on cusps due to parafunctional habits limits effectiveness.
- Large restorations may compromise structural integrity.
Importance of Proper Anatomy Restoration
- Aim to restore proper occlusal and proximal anatomy for functional success.
Clinical Considerations for Treatment
- Effective isolation techniques are mandatory for composite restorations.
- Preserve sound tooth structure as much as possible through minimally invasive techniques.
- Information on etiological factors such as caries and periodontal disease should be addressed before treatment begins.
Step-by-Step Technique for Class 1 RBC Preparation
- Begin with case selection and identification of techniques.
- Evaluate the patient's occlusion.
- Clean the area by removing biofilm, caries, and debris.
- Choose the appropriate composite system and shade pre-isolation.
- Implement rubber dam isolation for optimal conditions.
- Proceed with cavity preparation.
Characteristics in Didactic Class 1 Preparations
- Wall orientation should feature smooth, slightly converging occlusal walls, slightly diverging mesial/distal walls, and rounded internal angles.
- Cavosurface must be smooth and free from irregularities.
- Ensure no unsupported enamel is present in walls.
Shapes of Didactic Class 1 Preparations
- Upper premolar resembles a "bow."
- Lower first premolar characterized as "snake eyes."
- Lower second premolar takes the shape of a "glass slipper."
- Lower first molar presents with an identifiable occlusal surface, buccal pits, and lingual grooves.
- Shapes for other molars and incisors depend on caries and anatomical variations.
Differences Between Amalgam and Composite Restorations
- Pulpal depth for amalgam restorations requires a flat floor of 1.5-2mm; composite allows for rough, non-uniform surfaces.
- Primary retention form: amalgam requires occlusal convergence; RBC relies on surface roughness for bonding.
- Secondary retention for amalgam includes grooves and pins; RBC uses adhesive bonding primarily.
- Resistance forms for amalgam have flat floors and rounded angles; composites have less stringent requirements.
- Base indications for amalgam suggest 2mm clearance from pulp; RBC has no specific requirements.
- Both use calcium hydroxide for pulp capping, but RBC may include RMGI liners for specific procedures.
- Sealing differences: amalgam uses GLUMA desensitizer when not bonding, while RBC relies on the bonding system.
Additional Tools and Methods
- Use hatchets for isthmus creation when preparing cavities; excess removal can be achieved with brendall instruments.
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