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• Restorative dentistry is also known as operative dentistry.
• Restorative dentistry focuses on the overall dental needs of a client.
• Restorative dentistry is indicated when teeth need restoration to their original form and shape.
• Restorative dentistry uses direct and indirect restorative materials.

Specific Conditions Requiring Restorative Dentistry

• Initial or recurrent decay
• Replacement of broken or fractured restorations
• Abrasion or wearing away of tooth structure
• Erosion of tooth structure

Black's Cavity Classification

• Teeth are restored with a method developed by G.V. Black in the early 1900s.
• Classification based on the location of the decay.
• This is a universal system.

Class I

• Class I lesions affect the pits and fissures of teeth.
• Surfaces involved include occlusal pits and fissures of premolars and molars.
• Buccal or lingual pits and fissures of molars can be involved.
• Lingual pits of maxillary incisors, frequently near the cingulum, can be involved.
• Class I tooth preparation is typical for amalgam on a maxillary premolar.

Class II

• Class II lesions extend from a Class I lesion into the proximal surfaces of premolars and molars.
• Surfaces involved can include two-surface, three-surface, or multi-surface restorations of posterior teeth.
• Radiographs can assist with diagnosing class II decay.
• Oral hygiene regimes can assist with prevention.

Class III

• Class III affects the interproximal surface of incisors and canines.

Class IV

• Class IV involves a larger surface area.
• It includes the incisal edges and interproximal surface of incisors and canines

Class V

• Class V restoration is classified as a smooth surface restoration.
• Decayed lesions occur at the gingival 1/3 of the facial or lingual surfaces of any tooth.
• Decayed lesions occur at the root of a tooth, near the cementoenamel junction (CEJ).
• Class V lesions tend to occur in older clients, but not always.
• Composite resin is often used for this type of restoration unless isolation is not possible.

Class VI

• Class VI lesions involve the incisal edge of anterior dentition, excluding proximal surfaces.
• Class VI lesions involve the cusp tips of posterior dentition.

Cavity Preparation Process and Principles

• When preparing a tooth for permanent restoration, the dentist requires knowledge of tooth anatomy.
• They require knowledge of the direction of enamel rods.
• They require knwoledge iof the thickness of the enamel.
• They also require knowledgge of the body of the dentin, the pulp size and position, and the crown of the tooth as it relates to the gingival tissues.
• Cavity preparation removes diseased tooth structure, leaving a limited amount of healthy tooth structure.
• Conservation of tooth structure is key.

Cavity Preparation Steps

• The dentist uses the following to achieve an ideal cavity preparation
• Initial Preparation:
  • Involves the initial design and extension of the prep's external walls to a limited depth
  • Aims to help the dentist gain access to the decay or defect
  • Aims to reach sound tooth structure

Client Preparation For Restorative Procedures

• Informing the client of what to expect is optimal
• Position the client correctly in relation to the dentist and type of procedure
• Explaining each step to the client as procedure progresses is key

Dental Assistant Responsibilities

• Preparing the setup for procedures
• Knowing and anticipating the dentist's needs
• Providing moisture control
• Transferring dental instruments and accessories
• Mixing and transferring dental materials
• Maintaining client comfort

Steps in Initial Preparation

• Outline Form: Design and initial depth of sound tooth structure
• Resistance Form: Shape and placement of cavity walls
• Retention Form: Help in securing the restoration in place
• Convenience Form: Accessibility in preparing and restoring tooth

Cavity Preparation Terminology

• Axial Wall: Internal wall/surface of the prepared tooth running parallel to the long axis of the tooth
• Pulpal Wall: Also known as the pulpal floor; internal wall/surface of the prepared tooth that is perpendicular to the long axis of the tooth
• Line Angle: Angle formed by the junction of 2 walls/surfaces in a cavity preparation (e.g., mesiolingual line angle)
• Point Angle: Junction of 3 walls/surfaces

Retentive Pins for Extensive Restoration

• For decay extended beyond the normal size or shape.
• Retentive grooves or bonding material offers added strength to support the restoration
• These pins are used to aid in the retention of restorations when extensive tooth structure is missing.
• 1 pin is placed for each missing cusp to aid in retaining and supporting restoration.
• Pins grip to the dentin when screwed into the tooth structure due to the deep threads.
• The opposing end grips to the restorative material.
• The use of a dental dam is a must as the pins can cause gagging or choking.

Matrix System

• Used when a tooth has been prepared for a class II, III, or IV restoration where at least one interproximal wall has been removed.
• Provides a temporary wall for the restoration process of class II, III, and IV preparations.
• A class I or V restoration would not require a matrix band.

Posterior Matrix Systems for Amalgam Restorations

• Universal Retainer:
• It's aka Tofflemire retainer
• It holds the matrix band in position.
• Positioned most commonly from buccal surface of tooth being restored

Matrix Bands

• Universal band:
  • Used for a class II where the proximal box is prepared to a minimal depth
• Extension band:
  • Used for a class II preparation with gingival extensions
  • Height of contour of the band cannot exceed the height of the tooth

Tofflemire Retainer Components

• Outer knob
• Inner knob
• Spindle pin (stabilizes band in holder)
• Slot to hold position of band
• Slot to receive the ends of the band

Matrix Band and Tofflemire Retainer Assembly

• Hold the retainer with the diagonal slot facing the operator.
• Hold the frame and turn the inner knob until the vise moves next to the guide channels.
• Loop the matrix band ends together when placing the assembly.
• The gingival edge will be on the top (smaller)
• The occlusal edge will be on the bottom (larger)
• Place band in the guide channel
• Assembly depends on which tooth is being restored
• Turn the outer knob until the tip of the spindle is tight against the band in the vise slot.
• If the band becomes bent, smooth and insert a mirror handle into the loop, running it around the inside of the band

Tofflemire Matrix Placement

• Position and seat loop of the band over the occlusal surface
• Retainer should be parallel to the buccal surface.
• Slot should be towards the gingiva.
• Band remains 1-1 ½ mm beyond occlusal edge.
• Hold the band securely by applying pressure.
• Turn the inner knob slowly to tighten the band around the tooth.
• Contour with a ball burnisher, if needed.
• Place a wedge.

Wedges

• Wedges hold the band tight against the tooth.
• They allow for good contours
• Wedges can eliminate overhangs.
• There is a variety of sizes and colors.
• Usually wooden, some are plastic.
• Triangular, pointed, and usually tapered.
• Placed against missing wall side.
• The base of triangle faces the gingiva.
• Placed with cotton pliers
• Wedges are positioned into the lingual embrasure of Class II preparation after band placement.
• They help position the matrix band firmly against the gingival margin of the preparation.

Matrix Systems

• AutoMatrix:

• No retainer is necessary.

• Bands are ready to be placed.

• Have coil like locking loops

• tightening wrench is inserted to coil and turned clockwise

• T Bands: Used for primary molars. They're T shaped copper band with no retainer needed. The T is bent to conform the shape of the band.

Sectional Matrices

• Small, oval, polished stainless steel matrices.
• Used with a tension ring for tight contact.
• Ideal for posterior composite resin restorations .
• Includes Matrix, Wedge, and a Tension Ring

Amalgam Post-Op Instructions

• Provide instructions on how long anesthesia will remain
• Provide instructions on how long until client can eat or drink hot items
• Provide instructions not to bite anything hard
• Instruct client to call if any problems