Operative Dentistry II Final Exam Review
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Questions and Answers

What is the opacity of the dentin in composite resins?

  • Low opacity
  • High opacity (correct)
  • Opacity between dentin and enamel
  • Translucent

    • When should shade selection be done for a Class II composite restoration?

  • After isolation
  • After the restoration is completed
  • Before isolation (correct)
  • During the bonding procedure

    • What is an advantage of resin as a posterior restorative material?

  • High thermal conductivity
  • Elimination of galvanic currents (correct)
  • Increased wear resistance
  • High bonding technique sensitivity

    • What is the ideal radiograph for Class II caries detection?

    <p>Bitewing radiograph</p> Signup and view all the answers

    What is the first step in the matrix system for a Three Surface Class II Composite Restoration?

    <p>Sectional matrix is first choice when possible</p> Signup and view all the answers

    What is the component of dental bonding that removes inorganic material?

    <p>Conditioner</p> Signup and view all the answers

    How long should the acid etch be applied on enamel in dental bonding?

    <p>No more than 15 seconds</p> Signup and view all the answers

    What is the characteristic of flowable resin in terms of its thickness?

    <p>0.5 mm or less</p> Signup and view all the answers

    What is the primary purpose of removing the rubber dam in the clinical setting during occlusal evaluation?

    <p>To enable gentle closure to occlusion</p> Signup and view all the answers

    What is a key characteristic of a complex amalgam restoration?

    <p>Replaces one or more cusps</p> Signup and view all the answers

    What is the recommended depth for an amalgapin placement?

    <p>1.5-2 mm</p> Signup and view all the answers

    What is the primary reason for cusp capping in complex amalgam restorations?

    <p>To reduce the risk of fracture due to weak cusps</p> Signup and view all the answers

    What is the recommended reduction for a non-functional cusp in complex amalgam restorations?

    <p>1.5 mm</p> Signup and view all the answers

    What is the primary advantage of slot-retained amalgam restorations?

    <p>More tooth structure is removed, reducing the risk of perforation</p> Signup and view all the answers

    What is the recommended convergence of opposing vertical walls in complex amalgam restorations?

    <p>Occlusally converging</p> Signup and view all the answers

    What is the primary purpose of using a perio probe in pin-retained amalgam restorations?

    <p>To assess contour and identify potential perforation risks</p> Signup and view all the answers

    What is the recommended location for placement of an amalgapin in relation to the margin?

    <p>At least 1 mm from the margin</p> Signup and view all the answers

    What is the purpose of the plowing flowable technique in composite restorations?

    <p>To push flowable resin to the sides to seal the margins</p> Signup and view all the answers

    What type of composite shade is preferred for MODL foundation restorations?

    <p>Lighter composite for better depth of cure and visualization</p> Signup and view all the answers

    What is the primary advantage of using bulk fill composites?

    <p>Reduced chair time and improved ease of use</p> Signup and view all the answers

    What is the purpose of pre-wedging in three surface Class II amalgam preparations?

    <p>All of the above</p> Signup and view all the answers

    What is the minimum depth required for an amalgam restoration?

    <p>1.5 mm</p> Signup and view all the answers

    What is the significance of the tilted planes of maxillary molars?

    <p>Needs to be considered when preparing a Class II amalgam restoration</p> Signup and view all the answers

    What is the purpose of using an ultra thin Tofflemire matrix in composite restorations?

    <p>To ensure contact between the composite and the tooth structure</p> Signup and view all the answers

    What is the significance of internal line angles in MODL preparation?

    <p>They help to reduce stress concentration and improve adaptation</p> Signup and view all the answers

    What is the purpose of the initial increment in composite restorative steps?

    <p>To provide a thin layer of composite material on the gingival floor</p> Signup and view all the answers

    What is the significance of viscosity in composite restorations?

    <p>It affects the risk of porosities in the final restoration</p> Signup and view all the answers

    What is the primary concern related to crazing of dentin in pin-retained amalgam restorations?

    <p>Decreased physical strength of amalgam</p> Signup and view all the answers

    What is the purpose of a conditioner in the amalgam bonding system?

    <p>To attach resin to dentin and enamel</p> Signup and view all the answers

    What is the primary advantage of amalgapin over traditional pin preparations?

    <p>Easier placement</p> Signup and view all the answers

    What is the recommended distance between the pin and the preparation walls?

    <p>0.5 mm</p> Signup and view all the answers

    What is the primary difference between slots and coves in amalgam foundation preparations?

    <p>Direction of the groove</p> Signup and view all the answers

    What is the recommended minimum amount of amalgam over the pin?

    <p>1.5 mm</p> Signup and view all the answers

    What is the primary consideration when determining the number of pins to use in a pin-retained amalgam restoration?

    <p>Amount of retention desired</p> Signup and view all the answers

    Which type of material is best suited for high-stress situations in which most of the coronal portion of the crown needs to be replaced?

    <p>Amalgam</p> Signup and view all the answers

    What is the primary purpose of polishing an amalgam restoration?

    <p>To produce a smoother surface that may be less plaque retentive</p> Signup and view all the answers

    Which type of post is used in endodontically treated teeth depending on the remaining tooth structure and ferrule?

    <p>Prefabricated posts</p> Signup and view all the answers

    What is the primary advantage of using RMGIC in dental restorations?

    <p>Simple technique and exceptional retention</p> Signup and view all the answers

    What is the primary purpose of using a pulp chamber retention in foundation restorations?

    <p>To retain the amalgam in the canal space</p> Signup and view all the answers

    What is the primary disadvantage of using RMGIC in dental restorations?

    <p>Low strength and durability</p> Signup and view all the answers

    What is the primary purpose of using a Gates Glidden drill in foundation restorations?

    <p>To prepare the pulp chamber for retention</p> Signup and view all the answers

    Which type of material is best suited for use in CL V/Root Caries restorations?

    <p>Glass Ionomers</p> Signup and view all the answers

    What is the primary purpose of using a heated instrument in pulp chamber retention?

    <p>To prepare the pulp chamber for retention</p> Signup and view all the answers

    What is the primary advantage of using Cosmecore in core buildups?

    <p>Dual-cured material</p> Signup and view all the answers

    What is the primary purpose of the resistance form in tooth preparation?

    <p>To increase the strength of the tooth structure</p> Signup and view all the answers

    What is the purpose of the convenience form in tooth preparation?

    <p>To allow for access with instrumentation during tooth preparation</p> Signup and view all the answers

    What is the purpose of retention grooves in tooth preparation?

    <p>To provide additional retention for large boxes</p> Signup and view all the answers

    What is the purpose of desensitizer placement in restorative technique?

    <p>To occlude dentinal tubules</p> Signup and view all the answers

    What is the purpose of pulp protection in restorative technique?

    <p>To protect the pulp depending on the depth of preparation</p> Signup and view all the answers

    What is the purpose of post-carve burnishing in amalgam restoration?

    <p>To improve marginal integrity and smoothness of the restoration</p> Signup and view all the answers

    Study Notes

    Three Surface Class II Preps

    • Composite resins have different opacities:
      • Dentin: high opacity
      • Body: opacity between dentin and enamel
      • Enamel: low opacity
      • Incisal: translucent
    • Shade selection:
      • Timing: before isolation
      • Location: middle third of the tooth
    • Instruments for composite resin placement:
      • Plastic instruments
      • Metal instruments
      • Lightly dampened alcohol gauze
      • Adhesive with no primer
      • Finishing and polishing burs

    Advantages and Disadvantages of Resin as a Posterior Restorative Material

    • Advantages:
      • Esthetics
      • Conservation of tooth structure
      • Adhesion to tooth structure
      • Low thermal conductivity
      • Elimination of galvanic currents
    • Disadvantages:
      • Polymerization shrinkage (C-Factor)
      • Secondary carious lesions
      • Postoperative sensitivity
      • Decreased wear resistance
      • Bonding technique sensitivity

    Ideal Radiograph and Cavity Preparation

    • Ideal radiograph for Class II caries detection:
      • Bitewing radiograph
    • Class II cavity preparation general elements:
      • Preservation of tooth structure
      • Access for adequate caries removal
      • Round internal line angles
      • Clear cavosurface without beveling

    Composite Restorations

    • Best isolation for posterior resins:
      • Rubber dam
    • Matrix system:
      • Sectional matrix is the first choice when possible
      • Seal gingival margin
      • Wedge from lingual, open embrasure
      • MOD composite technique
    • Dental bonding components:
      • Conditioner (acid: 35-42% phosphoric acid)
      • Primer (hydrophilic monomers when bonding dentin)
      • Adhesive (low viscosity filled or unfilled resin)
    • Dental bond in CU clinics:
      • Opti Bond FL (three-step etch, rinse, and bonding system)
    • Dental bonding procedures:
      • Acid etch on enamel first and then dentin (no more than 15 seconds)
      • Rinse for 15 seconds, removing excess moisture from the operating field
      • Apply primer with a micro brush for 30 seconds
      • Air dry primer from a distance, do not desiccate
      • Apply an even coat of adhesive, remove excess with a micro brush, and use an air syringe to disperse
      • Light cure for 20 seconds
      • Apply resin
      • DIFFERENCE FOR ENAMEL: NO PRIMING
    • Incremental placement:
      • 1st increment always at the gingival floor
      • Equals the area of highest contamination potential
    • Flowable resin characteristics:
      • Micro hybrids and nano fills
      • 0.5 mm or less
      • Very careful with voids (as viscosity goes down, the risk of porosities increases)
      • Higher polymerization shrinkage
    • Plowing flowable technique:
      • Pushing flowable resin to the sides to seal the margins

    Complex Composite Restorations

    • Foundation definition:
      • Initial restoration of a severely involved tooth
      • Serving in place of tooth structure to provide retention and resistance forms during the development of the final indirect restoration
      • Type of restoration: Direct complex restoration
    • MODL preparation:
      • MOD preparation first
      • DL depth cut parallel to cusp incline (1.5-2 mm deep)
      • Several depth cuts
      • Join the depth cuts
      • Internal line angles must be round
      • Clear cavosurface without beveling
    • MODL foundation composite shade choice:
      • Lighter composite = better depth of cure and better visualization
    • Tofflemire matrix for composites:
      • Must be ultra-thin matrix, burnished between increments in order to ensure contact
    • Composite restorative steps:
      • Dental bonding
      • First increment placed on the gingival floor (1mm thick max, light shade)
      • All other increments no more than 2 mm
    • Finishing:
      • #12 scalpel clean excess at the gingival margin
      • Finishing burs
      • Shofu snap disks/Shofu Strips
      • Rinse between grits
      • Dicomp polishing points
      • Green – slow with water
      • Grey – fast and dry
    • Bulk fill composites:
      • Flowable base bulk-fill composites
      • Majority of bulk fills require a conventional composite as the occlusal increment
      • Full bulk fill composites (Filtek One Bulk Fill)
      • Replace both dentin and enamel
    • Core composite materials at CU:
      • Filtek Supreme Ultra
      • Nanofill/Nanohybrid
      • Radiopaque
      • High strength
      • Choose opaque shade
      • Incremental technique
      • Cosmecore
      • Dual-cure composite core build-up material
      • Radiopaque
      • High strength and depth of cure
      • 3 shades
      • Bulk fill – cures 7mm depth

    Three Surface Class II Amalgam Prep/Restoration

    • Situation where amalgam might be better:
      • Very deep Class II lesions
      • Ability to condense amalgam to seal amalgam
      • Fewer concerns with depth of cure
    • Planes of maxillary molars:
      • Two planes: Distal is tilted in comparison to the mesial portion
      • Significance: Need to tilt the bur more towards the distal to prevent undermining of adjacent ridges
    • Initial clinical procedures:
      • Anesthesia
      • Occlusal relationship
      • Isolation
    • Preparation instruments:
      • 329, 330, 245 for initial access and prep
      • Round 1, 2, 3, 8 for caries removal (Largest that fits)
      • Straight fissure 56, 57 on slow speed to flatten pulpal floor and gingival wall only
      • Hatchets and margin trimmers
    • Pre-wedging purpose:
      • Helps to protect adjacent tooth
      • Creates tighter contact
      • Protects rubber dam
      • Prevents gingival overextension
      • NOTE: Remove to evaluate if proximal contact is broken
    • Preparation elements:
      • Establish outline
      • Cut around triangular ridge
      • Lean more towards oblique ridge vs. distal incline
      • Pulpal floor is tilted towards the lingual surface
      • Provides strength for amalgam
      • Lingual extension; prep vertical with long axis or perpendicular
      • Create access to and remove faulty structure
      • Create resistance, convenience, and retention forms
      • Pulpal floor smooth and uniform depth parallel with occlusal surface
      • Gingival wall smooth, leveled, and parallel to occlusal
      • Pulpal floor depth into dentin in all areas minimum of 1.5 mm
      • Internal line angles well-defined, slightly rounded
      • Axiopulpal line angle rounded/beveled
      • Undermined enamel included in prep
    • Restorative technique:
      • Assessment of prepared tooth
      • Isolation maintained
      • Cleanliness and dryness of prepared tooth
      • Pretest condensers fit all areas of the preparation
      • Desensitizer placement
      • Pulp protection
      • Prepare instruments
      • Matrix placement
      • Select amalgam
      • Trituration
      • Insertion
      • Condensation
      • Pre-carve burnishing
      • Carving
      • Post-carve burnishing
      • Evaluation of occlusal

    Foundations Part I

    • Complex amalgam restoration:
      • Amalgam restoration that replaces one or more cusps
    • Essential elements of a foundation/buildup restoration:
      • Caries removed
      • Pulp status determined
      • Adequate retention established
      • No excess restorative material beyond tooth margins
      • Proximal contact established
      • Occlusion not high
      • Restoration comfortable to the patient
    • MOD to MODL transition:
      • Cusp reduction = 1.5-2 mm
      • Level pulpal floor up to lingual groove
      • Gingival floor 1.25-1.5 mm to axial wall
      • Cove 1.75-2 mm from cavosurface
      • Axiopulpal line angle beveled
      • DL wall flat
    • Amalgapin placement:
      • Pilot hole – ¼ round bur
      • Place w/ 330 bur
      • 1.5-2 mm deep
      • At least 1 mm from the margin
      • Keeps margin from fracturing
      • Bevel entrance to amalgapin channel
      • 2 or 4 round bur on slow speed
    • Retention grooves:
      • Distoaxial and buccoaxial line angles
      • Use ¼ round bur
      • Only the height of the axial wall
    • Placement of amalgam for restoration:
      • Begin at amalgapin channel
      • Second at retention grooves
      • Fill mesiolingual box to pulpal floor

    Foundations II

    • Success of complex amalgam restorations:
      • Long-lasting (50% at 11.5 years, as high as 73% at 15 years)
    • Factors for consideration before complex

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    Review of Three Surface Class II Preps, including composite resin opacities, shade selection, and instrument usage for placement and finishing.

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