Restoring Primary Molars Quiz
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What is a recommended method for achieving a tight contact point between two back-to-back Class II resin-based restorations?

  • Filling both restorations at once before polymerization.
  • Applying etchant after both restorations are placed.
  • Using a small ball burnisher on the matrix band against the first restoration. (correct)
  • Contouring and polymerizing both restorations simultaneously.

    • Which step should be performed before applying etchant if using RMGI liner in a slot preparation?

  • Curing the liner. (correct)
  • Burnishing the matrix band.
  • Applying the dentin bonding agent.
  • Rinsing the cavity thoroughly.

    • Which condition presents the most challenge when performing Class III adhesive restorations?

  • Difficulty in detecting the caries extent.
  • Presence of developmental defects in enamel.
  • Small pulp size that limits preparation.
  • Isolation problems and control of hemorrhage. (correct)

    • What is a characteristic feature of a simple slot preparation for Class III restorations?

    <p>It has a short cavosurface bevel.</p> Signup and view all the answers

    What is the maximum depth of composite that should be polymerized at one time during restoration procedures?

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

    What is a consequence of placing deep anatomy in primary teeth during restoration?

    <p>It can lead to fracture due to a thin shelf of amalgam.</p> Signup and view all the answers

    When should burnishing of amalgam be initiated during restoration?

    <p>When the amalgam has begun its initial set.</p> Signup and view all the answers

    Which of the following actions should be taken just after etching a tooth?

    <p>Rinse and dry the tooth.</p> Signup and view all the answers

    What may be a consideration when preparing Class III restorations in primary canines compared to incisors?

    <p>The proximal box angle is adjusted.</p> Signup and view all the answers

    Which of the following is NOT a common error made in class I amalgam restorations?

    <p>Preparing the cavity too shallow.</p> Signup and view all the answers

    What is the purpose of using a wet cotton pellet on burnished amalgam?

    <p>For a final smoothing effect.</p> Signup and view all the answers

    What technique can increase retention in Class III adhesive restorations?

    <p>Acid etching the enamel surface.</p> Signup and view all the answers

    What should be ensured about the buccal and lingual walls in a class II amalgam restoration?

    <p>They should break contact with the adjacent tooth.</p> Signup and view all the answers

    What incorrect practice can lead to subsequent fracture of amalgam due to hyperocclusion?

    <p>Undercarving the restoration.</p> Signup and view all the answers

    What is an alternative to including all susceptible fissures in an amalgam preparation?

    <p>Filling only the area of decay and sealing the rest.</p> Signup and view all the answers

    In the construction of the proximal box for class II amalgam restorations, how should the cervical portion compare to the occlusal portion?

    <p>It should be broader.</p> Signup and view all the answers

    What is the ideal depth for the axial wall of the proximal box in Class II amalgam restorations?

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

    What is the recommended MD width of the gingival seat in a Class II amalgam restoration?

    <p>1 mm</p> Signup and view all the answers

    What is an important feature of the axiopulpal line angle in Class II amalgam restorations?

    <p>It should be beveled or rounded.</p> Signup and view all the answers

    Which restoration type is preferred in preschool children with large proximal carious lesions?

    <p>Stainless steel crowns</p> Signup and view all the answers

    What is a notable finding regarding the success rate of stainless steel crowns compared to Class II amalgams?

    <p>SSCs have a lower failure rate after 5 years.</p> Signup and view all the answers

    What should be done first when preparing for a Class II amalgam restoration?

    <p>Administer local anesthesia and place rubber dam.</p> Signup and view all the answers

    Why is a wooden wedge placed interproximally during the preparation of a Class II amalgam restoration?

    <p>To retract the gingival papilla.</p> Signup and view all the answers

    Which motion is recommended when preparing the proximal box starting from the marginal ridge?

    <p>A pendulum motion in a buccal-lingual direction.</p> Signup and view all the answers

    What is the consequence of making the gingival wall too deep during preparation?

    <p>It leads to a very narrow gingival seat.</p> Signup and view all the answers

    Which step is crucial for ensuring a tight proximal contact after amalgam placement?

    <p>Condensing amalgam into the corners of the proximal box.</p> Signup and view all the answers

    Which matrix type is specifically mentioned for use in proximal restorations?

    <p>T-band.</p> Signup and view all the answers

    What is the purpose of using a wedge during the placement of a matrix band?

    <p>To hold the matrix band in place tightly.</p> Signup and view all the answers

    What should be done after carving the occlusal portion of the amalgam?

    <p>Check the occlusion.</p> Signup and view all the answers

    Which instrument can be used to shape the marginal ridge during amalgam restoration?

    <p>Hollenback carver.</p> Signup and view all the answers

    What is the primary reason for placing matrices during proximal restorations?

    <p>To restore the normal contour and contact.</p> Signup and view all the answers

    What action should be taken to check the tightness of the contact after restoration?

    <p>Floss the interproximal contact.</p> Signup and view all the answers

    Where should a dovetail be placed when amalgam is selected for a maxillary canine?

    <p>Palatal surface</p> Signup and view all the answers

    What is the maximum extent a dovetail on the labial surface should reach?

    <p>Halfway across the labial surface</p> Signup and view all the answers

    What is the recommended depth for the axial wall ideally placed into dentin?

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

    Which type of bur is recommended for removing caries in a Class III restoration?

    <p>No. 330 bur or no. 2 round bur</p> Signup and view all the answers

    What is the purpose of placing a wooden wedge interproximally during the clinical steps?

    <p>To provide stability to the rubber dam</p> Signup and view all the answers

    How long should the etching process be applied during cavity preparation?

    <p>15-20 seconds</p> Signup and view all the answers

    What should be done after etching the preparation?

    <p>Rinse and dry the preparation</p> Signup and view all the answers

    What is the function of placing a short bevel at the cavosurface margin?

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

    Study Notes

    Restoring Primary Molars

    • Placing deep anatomy in primary teeth (like grooves) can weaken the restoration, leading to fracture.
    • Steps of Preparation and Restoration
      • Begin burnishing after the amalgam has started to set.
      • Use a small, round burnisher to create a satin-like appearance.
      • Smoothing the surface reduces finishing time and creates a substructure with fewer voids.
      • Use a wet cotton pellet to smooth the burnished amalgam (optional).
      • Remove the rubber dam and check occlusion.
      • Rinse the oral cavity and massage the soft tissue around the previously clamped tooth.

    Common Errors in Class I Amalgam Restorations

    • Preparing the cavity too deep.
    • Undercutting the marginal ridges.
    • Carving the anatomy of the amalgam too deep.
    • Not removing amalgam flash from cavosurface margins.
    • Undercarving, which leads to subsequent fracture of amalgam from hyperocclusion.
    • Not including all susceptible fissures.

    Class II Amalgam Restorations

    • Guidelines for the occlusal portion of the preparation are the same as for Class I restorations.
    • Proximal Box:
      • Should be wider at the cervical portion than at the occlusal portion.
      • The buccal, lingual, and gingival walls should all break contact with the adjacent tooth, allowing for explorer tip passage.
      • Buccal and lingual walls should form a 90-degree angle with the enamel
      • The gingival wall should be flat and not beveled. All unsupported enamel should be removed.
      • Ideally, the axial wall should extend 0.5 mm into dentin and follow the outer proximal contour of the tooth.
      • The axiopulpal line angle is routinely beveled or rounded.
      • No buccal or lingual retentive grooves should be placed in the proximal box.
      • The mesiodistal width of the ging seat should be 1 mm.

    Class II vs. SSCs

    • Many practitioners limit Class II amalgam restorations to relatively small two-surface restorations in primary teeth.
    • Three-surface (MOD) restorations may be done, but studies show SSCs (stainless steel crowns) are more durable and predictable.
    • Messer and Leveringl's study shows that SSCs placed in children 4 years old and younger had a success rate twice that of Class II amalgams for up to 10 years of service.
    • Roberts and Sherriff's study reported that after 5 years, one-third of Class II amalgams placed in primary teeth had failed or required replacement, whereas only 8% of SSCs required retreatment.
    • SSCs are preferred for large proximal carious lesions in preschool children due to their durability.
    • Amalgam may be suitable for similar lesions in teeth within 2 or 3 years of exfoliation, considering the shorter anticipated lifespan.

    Steps of Preparation and Restoration (Class II)

    • Administer appropriate local anesthesia and place a rubber dam.
    • Place a wooden wedge interproximally, retracting the gingival papilla during instrumentation, preventing cutting of the interseptal rubber dam material and underlying gingiva, and creating prewedging for a tight proximal contact of the final restoration.
    • Prepare the occlusal outline form at an ideal depth using a No. 330 bur (high-speed).
    • Prepare the proximal box, starting at the marginal ridge by brushing the bur (bucco-lingually) in a pendulum motion and in a gingival direction at the dentinoenamel junction.
    • Continue until contact is broken between the adjacent tooth and the gingival wall, and the wedge is visible.
    • The widest bucco-lingual width of the box will be at the gingival margin.
    • If the gingival wall is made too deep, the cervical constriction of the primary molar will create a very narrow gingival seat.
    • Remove any remaining caries.
    • Round the axiopulpal line angle slightly.
    • Remove the wedge and place a matrix band.
    • Reinsert the wedge between the matrix band and the adjacent tooth, beneath the gingival seat of the preparation, while holding the matrix band in place.
    • Triturate the amalgam. Add the amalgam to the preparation in single increments, beginning in the proximal box, using an amalgam carrier.
    • Condense the amalgam into the corners of the proximal box and against the matrix band to ensure a reestablishment of a tight proximal contact, using a small condenser. Continue filling and condensing until the entire cavity is overfilled.
    • Use a small round burnisher to begin the initial contouring of the amalgam. Carve the occlusal portion with a small cleoid-discoid carver, as in Class I restorations.
    • The marginal ridge can be carved with the tip of an explorer or with a Hollenback carver.
    • Remove the wedge and the matrix band by drawing the band in a bucco-lingual direction.
    • Remove excess amalgam at the buccal, lingual, and gingival margins using an explorer or Hollenback carver.
    • Gently floss the interproximal contact to check the tightness of the contact, check for gingival overhang, and remove any loose amalgam particles from the interproximal region.
    • Perform a final burnish and apply a wet cotton pellet for final smoothing (if necessary).
    • Remove the rubber dam.
    • Check the occlusion.

    Matrix Application

    • Place matrices for proximal restorations to restore normal contour, maintain normal contact, and prevent the extrusion of restorative material into gingival tissue.

    Matrix Types

    • T-band
    • Sectional matrices (strip-T)
    • Automatrix
    • Tofflemiere matrix

    Class I & II Preparation

    • If a resin-modified glass ionomer (RMGI) liner is to be used, it should be placed and cured before the etchant.
    • Etch for 15-20 seconds using an acid gel.
    • Thoroughly rinse the etchant from the tooth, then apply and cure a dentin bonding agent.
    • Polymerize no more than 2 mm of composite at one time.

    Back-to-Back Class II Resin-Based Composite Restorations

    • Place two matrix bands, then etch and bond both preparations.
    • Completely fill, contour, and polymerize one of the restorations.
    • After the first restoration is polymerized, use a small ball burnisher to burnish the matrix band against the newly placed restoration in the area where you want to create the contact point, ensuring a tight contact between the two restorations.
    • Add, contour, and polymerize the resin-based composite material in the second preparation.
    • Remove the wedge and bands, and finishing and polishing procedures are identical to single restoration placement.

    Restoration of Primary Incisors and Canines

    • Indications:
      • Caries
      • Trauma
      • Developmental defects of the tooth’s hard tissue

    Class III Adhesive Restorations

    • Very challenging due to subgingival extension, which makes isolation and hemorrhage control difficult, and large pulp size, which requires small preparations.
    • A simple slot preparation removes decay and has a short cavosurface bevel.
    • Retention is gained through:
      • Acid etching.
      • Retentive locks on the facial or lingual surface, especially important in children with bruxism.
      • Beveling the cavosurface margin to increase the surface area of enamel etched.
      • Preparing the entire facial surface by 0.5 mm and veneering the surface.

    Class III Restorations in Primary Canines

    • Slightly different preparation from that for incisors.
    • Proximal box is directed at a different angle toward the gingiva.
    • Either amalgam or adhesive materials may be used.
    • The preparation (except for a short cavosurface bevel for resins) is identical regardless of the restorative material chosen.
    • A dovetail can be placed on the facial surface, except for amalgam in a maxillary canine, where it is placed on the palatal surface.

    Modified Class III Cavity Preparation

    • Uses a dovetail on the lingual or labial surfaces of the tooth.
    • Lingual lock is used for maxillary canines.
    • Labial lock is used for mandibular canines (aesthetic requirement is not as important).
    • Dovetails allow for additional retention and access to properly insert the restorative material.

    Clinical Steps (Class III)

    • Administer appropriate anesthesia.
    • Place the rubber dam. Ligation of individual teeth with dental floss provides the best stability.
    • Place a wooden wedge interproximally.
    • Create access and remove caries using a No. 330 bur or No. 2 round bur (high-speed), using a facial access.
    • Ideally, the axial wall should be placed 0.5 mm into dentin. Use a round bur (low-speed) to remove deep decay
    • The gingival and lingual walls should just break contact with the adjacent tooth.
    • It is not necessary to break contact with the incisal wall of the preparation to maintain adequate tooth structure.
    • To enhance retention, place a dovetail or lock on the labial or lingual surface. The dovetail should not extend more than halfway across the labial surface and should be in the middle horizontal third of the tooth. It may extend across the cervical area if decalcification is present.
    • Place a short bevel (0.5 mm) at the cavosurface margin using a fine, tapered diamond or a flame-shaped composite finishing bur.
    • Clean and dry the preparation with water and compressed air.
    • Place a plastic or sectional metal matrix, cut in half horizontally, interproximally.
    • Reinsert a wedge.
    • Etch for 15-20 seconds.
    • After etching, rinse and dry the preparation well. (This step is eliminated if using a self-etching bonding agent.)
    • Place a dentin-bonding agent. Gently blow compressed air into the preparation to disperse a thin layer of bonding agent evenly over dentin and enamel.
    • Polymerize the bonding agent.
    • Place the composite in the preparation using a plastic instrument or a pressure syringe. Pull the matrix tightly around the cavity preparation with finger pressure and hold until cured.
    • Hold the visible light as close as possible to the composite and polymerize according to the manufacturer's instructions.

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