Restorative Final (A5-A10) PDF

> Isolation isusedisfor having an adequate control over the operating field > Specifically moisture control ( saliva ,...

> Isolation isusedisfor having an adequate control over the operating field > Specifically moisture control ( saliva , blood ) & alsoforaccessibilityandvisibililysotrelract the soft tissues → + lips gingiva > cheeks Types of the isolation r s Relative Absolute protection of the THIS IS THE RUBBER operating fieldonlyfrom DAM ISOLATION SALIVA t we can't protect from blood , ceruicularfluid , water vapour 1 of expiration protection ofoperahngfeldfromsalivaonly  1. must be moistened them > before removing from the mouth DAB cotton rolls → posih.cn/placementofthecotlonro1ls: UPPER ARCH LOWER ARCH next to prepared next to prepared tooth bothlingualQ-buccal-inbuccalveslib.am tooth - side - nearpardidduct & - oneintheupperbuccal veslibulumneartheparolid duct BB Parolisrolls (for isolation of maxillary OR mandibular anterior area) MAXILLARY ANTERIOR MANDIBULAR ANTERIOR - Small sized rolls - Small sized rolls - either side of - either side of labial frenulum MANDIBULAR labial frenulum + next to the Boa Cotton roll holders tongue thecottonrollhddersareusedtplacethe cotton rolls into position and stabilize them ( they can be from metal OR plastic) > it provides slightly more retraction → better accessibility and visibility  ! Cotton rolls must be moistened before removing them from the mouth to prevent the removal of epithelium from cheeks lips etc ,. - BB High volume evacuate / exhausts canbemetallicorplaslic - evacuates fluids tdebrisfromtheoral cavity - toxic material is readily removed Doa Lowvolumeevacuatorcsalivaejectrlip) dlsocanbemetallicorplaslic - evacuates smaller volumes of fluid fomtheoralcavily-canbebentztplaceintnguefothe.ir areas of mouth 0 tpshouldbeplacedonthefloorofmouth Slight upward - directed backwards curvature - notincontactwiththesoftlissues MBLip& cheek retractors REMINDER > offers excellent accessibility loan enlarged indications of relative field isolation temporary fillings ( softly flexible placement amalgam , , GIC material) filling , scaling , bleaching etc.  2 Absolute isolation } Rubber Dam Isolation }to Absolute isolation isolate completely theplaceweare = completely working on ' - control euerytypeofbodilyfluidinthemouthcavily ( bleeding > saliva gingival cervicularfluid) , - - - - equipment : upper front scanbe 1) Rubber sheet + clamp metalorplaslic 2) frame ← lower front - champ 3) Rubberdamdamp > molar clamp > pre molar clamp - i. frontal / front clamp 4) ctampforceps.to/oenupthec1amps&maKe the inner diameter bigger) 5) Hole maker/ puncher there are different types of hole put the rubber damontp this hole on puncher ofitwitha pencil draw the circles of the teeth you want to isolate (shows you where tpunch) Heidemann (dental spatula dental Cflaggs) L floss  ydamps clamp the second holeisfraverage sized molars or bigger premolars " "" "" """" """ " orlargersize first incisors big molars average sized first incisors or lateral incisors ( UPPER) Clamps the smallest holeisforthe lower incisors there are several types of clamps Upper Lower Connector ( should always front front clamp parts : face the distal surface ofalooth) → itis always distal from the here several working field ,!° hdescanbeseen whydoweneedthewings ? wecanplacethedampinto forthedampforceps the rubber sheet with the help ☐ ftp.egewing, thesehddersareloretractto makes it possible to place the makeplaceforusctorelractthe rubber sheet & wings rubbersheetsoitdoesnltcoverthe thedampatthe sametmeonthe working field) working field wealsohavedampswithoutwings ( wingless clamps) important for : - When making cervical fillings Conthetoothneck) - wherethecrownissodestructedbythecariesthataflercleaningthearea , wehaveverysmallamountofhealthyloothmalen.at remaining we also have Root clamps which meanstheseholderpartsofthe.gg#ampsarefacingthi- sway on both sides ¥ wecanalsomakegroupsaccordingtthemalerialofthe clampasw.eu metal clamps > I plastic clamps s so clamps are classified based on cifthepalienthasanactvehepat-t.sc → 1) material infection } soafterthatyoucanthrowitaway > 2) type > 3) > Clinical situations canalso L v > be classified molar premolar front topper. lower BB Incase of class Icavilyoparootcanal filling orarootcanal treatment CRCT ) sweisdatetsteethcenought isolate justtheteethweareworkingon) o.o incaseofclassvcavitylthe cervical fillings) } possible to make - absolute isolation butifthereisalsorootcan.es , we use special clamps designed for that purpose to isolate root surfaces exposed to mouth cavity BA In case of class It and IV cavity situations ( frontal areas) > we isolate atleast 3 recommended to isolate as much front teeth as > possible the more teeth you isolate the more > , place you have to work & instruments also need place R 23h ! Basic rule is isolate from 3 to 3 , 13 1211/21 22 ! if you put the clamp atleast one tooth distally so work on the 5, you place the clamp from the tooth you are working on ¥8B atleast on the 6 OR if you work on the 6 , you place the clamp on the 7 Doctor recommends to use a pre - molar clamp on the ' ' 3 on both sides so there is & a lot of space to place everything matrix , wedge etc. MO → DA Incase of class I cavities → OD / , MOD MO cavity } isolate mesial neighbour Eat so the distal neighbour of the tooth to place matrix & other tools because of clamp OD cavity } Isolate atleast 2 teeth s distally & the neighbouring tooth e. g. 25 → clamp goes to the£27 24 → clamp goes to the 26 so incase of an OD cavity we isolate 4 teeth totally the main rule ! } ! , this is 11 the actual tooth , 2 distally) mesial ly - , MOD cavity } we need anymore neighbouring teeth to be able to place everything 1×2 - neighbouring teeth distally , the actual tooth , ✗ 2- neighbouring teeth mesially)} so we isolate ( because of matrix , wedge & ring placement) 5 teeths  recommended shorter distance sodamp > putthedamponthedistat tooth loused Pre molar g. nailsarenotinthe neighbouring approximal areaso - Clamp matixzxwedgecanbe placed what if OD cavity in 6 ? Otcauityinthelasttoth ✗ Special clamplconnedorpartfddediabitlongersoretracts missing tooth the rubber> 2. ctheyhaveashortnail distance) > Rubberdamontoothandbringflossbeyondthe contact point and make it narrow and it would hold s s ourrubberdaminplace 1 ✗ most common placement strategies placement strategy incase of wingless 1 2 clamps most common 3 g. ( together they 2 areputlothe andthenthedamp mouth) 4 and then after that the frame 3 4 t and then put into the mouth together frame placement : 'the curvature of the frame follows the a. everything together curvature ofthefaceeverywhereQ.theopenpartisalways.fr outside of the mouth theupperfacepart cavity e. g. Mo cavity in the 25 s isolate mesial & distal neighbour to ( 24 , 25 , 267 1 punch the holes 2 clamp + rubber dam (together) into the mouth first > > Use a dental floss to bring > the rubber beyond the contact point ( to remove the floss , remove from the side of the tooth) s to bring rubber > beyond the contact to remove point the floss there is a gap between the rubber and the tooth neck because of > ✗ the clamp so we have to bring the rubber ① beyond the damp wings ( using Flagg's) 0 I 3 put the frame first holdin position only pull the borders in one corner oftherubberdamnotthe inner → parts , and it holds itself s OD cavity 2511 mesially , 2. distally) I > (24,25/26,27) ifthespacebetweenthehdesisverynarrowcthe approximal connector partsinthenbberarevery narrow) sthereisagapbecauseofthelensian > Useflaggstoputrubberintthe gingival groove ! ifitwouldbean MOD cavity 25 then 23 would be isolated aswell ( Zmesially , 2. distally) s( 23.24.25 26,27 ) ,  highfaces bracket of Marea orally clamp always faces distally Dr Melinda polyiak consultation - Absolute isolation anterior from thetooth > clamps > pre - molar → molar lower upper anterior ! onlytheanterioronesdifferbasedon anterior whether Weare isolating upperorlower 0 these are both 0 anterior clamps i. same size = : one big , one small t t so this is LOWER so this is UPPER ANTERIOR ANTERIOR for molars ⇐ premolars ✗ for front teeth for lower incisors Wh nyouwanttputrdclampstotherubberdam potthemostdistalone.in/othenbberdamlogether intothemouthfixateitandthenaddthemesialclamp while it's already in the mouth distakadded -outside with Indications of absolute isolation : > 4 main ones trytmake rubber dam> 1 pocketswith therubberdam L endo → isolate 1tothfweusetsdamponthesa.me tooth frame mesial (added later inside 2 removal of amalgam filling > isolate Itoothxweusetsdamponthesametooth after insertion Ofnbberdarnt 3 Resin application ( Dual composite filling) for MOD distal clamp' cement , : → Sectional matrix classic pits , fissures , foramencoecum> → isolate Itothxweusetsdamponthesametooth classic proximal of posterior teeth)Mo,oD,MoD→iSda1e3 teeth ,2 Champs Ldistalandtmesial class # (anterior teeth, noincisaledge involved>→ isolates leethcfrom 4-47,2 Clamps class #Canteriorteethwithincisaledge involved) isolates leethcfrom 4-47,2 - Clamps classvcgingivalthird) isolate Itoothxweusetsdamponthesametooth > 4 Inlaylonlay cementation sisdale3t.ee/-h,2C1ampsLdistaland1mesial  Classification of caries by Black ( 19147 Base The predilection of caries : predilection area's are places that have no self cleaning pits & fissures - on on approximally under the contact point on in between the equator & the gingiva om root surface where are the foramen coecum ? Class I - pits & fissures 1) maxillary lateral incisor ↳ fissures of pre molars & molars - → Palatal surface ↳ foramen caecum's 2) maxillary molars → Palatal surface 3) mandibular molars → buccal surface class I - proximal surfaces of posterior teeth C molars &pre - molars ) surface caries T Smooth > Types : MO , OD MOD, class TI - on the proximal surface on anterior teeth and does not involve the ina-sat edge faces boxsmooth class IV - on the proximal surface on anterior teeth involving the ina-sat edge class V - on facial and oral surfaces in the gingival third of teeth → begin close to the gingiva ↳ may involve a cementum or dentinal surface aswell as enamel class V1 wear defects on - pits or - ina- sat edges of anterior teeth - cusp lips Cposterior teeth)  Preparation types / designs 1 Macroretentan C.Conventional form) - amalgam filling - metal inlay - root surface caries relies on medical retention + metal box shape inlay 2 Macroretention + Microretenlicn ( Beveled conventional) - exchanging an amalgam fillingto - composites - caries on root surface and anatomical crown together combines mechanical (macro) retention with chemical adhesion 15 45 fillingBeal composite ( micro) retention Conventional preparation + bevelingof 0 enamel margins 3 Microrelenhon ( Minimal Invasive / modified / adhesive) - Composite filling focuses on minimal removal of tooth structure retention is achieved primarily through adhesive bonding of composite materials tenamel & dentin DRAWINGS P I i a 0  388 here I 1) conventional ( macroretention) luring cement - extension for prevention (based on Black 's I - principle) box shape → extendingto self cleaning area's - 10 is - convergent / parallel walls (retention form) marginflat pulpal / gingival walls ( resistance form) - yagna w - Amalgam 900 margin - Amalgam minimal thickness 1,5 fntfarietrseignigaivestefhhe tl - MACRO MECHANICAL ADHERENCE IIIay amalgam → occlusal convergent walls metal inlay → almost parallel s 1-20 divergent walls 2) Bevelled conventional ( macro + micro retention) conventional preparation + 15mm bevetting of enamel margins 450 =- 015 1 230 10,5 1mm) - W Eee competige - - 3) Microretention (minimally invasive) composite fillings ie e it > - defect oriented EiEEEi - no special cavity design eachigtuir No special walls , line angles point angles , - No preventive extension Pfter - bevel in → approximally wide vestibular - oral box > enamel margin if there is no contact with the antagonist General ruiesandslepsofcavity preparation : - General ruleofcavily preparation (Extension for prevention) Nowadays this principle is not used > Taimiwastopreventthesecundercaries rooting ↳ itdescnbedthatthebordersofthecauilyshouldbe extended tareasthatare normally self-cleaning ordeansable therefore healthy toothslwctrescanbe removed Initial stage 1) initial depth & outlineform preserve strength of marginal - High speed , water cooling diamond bur , ridgerdstengthofthecusps principles nowadays ✓ Healthy tooth structure should be preserved ✓ Unsupported enamel should be removed ✓ all faults should be included in cavity ✓ outline of filling should be shortened 2) primary resistance form → boththetothz.rs/oralicncanwithstandwithoutfrachre the masticatory forces walls - parallel divergent or convergent , shape , flat floor rounded line angles , 3) primary retention form → preparation resists displacement orremovalofthe of the restoration from tipping / lifting forces influenced by the contact between restorative material Q-tothmacnmechic.at - composite → amalgam micnmechanical → chemical glass : ionomer 4) Convenience form  Final stage → secondary stages 5) Removal of infected dentine and/or old restorative material ↳ with a steel (soft bur dentine) old restoration should be removed if - caries under the filling - negatively affect the new one pulp symptomatic pre operatively - - 6) pulp protection pulp capping → 7) Secondary resistance Exretenlionform 8) external wall finishing - Acireale the best marginal seal - provide maximum strength of tooth 2.filling - Smooth marginal junction 9) Final procedures → Cleaning drying Einspeeling , cavity Nomenclature surface Line angle Junction of 2 walls unprepared part wall Point angle Junction of 3. walls prepared part cavosurfaceangle Junction of Walla surface  ✓ natural appearance Vabililyhbondhhothstvctre Aesthetic → Resincomposilecasopposedtmetal) ] Direct → chairsideintraorallycnoneedfrdental laboratory) MINIMALLY INVASIVE Thepreparat-anfrtheselypesof.fi/lingsinvdvesfonowingthe - ( MICRO RETENTION TECHNIQUE )orthe Bevelled conventional ( Microtmacroretenhon) → ifexchanginganamdlgamfllingh composite + - aesthetic - - polymerization - Conservative tooth shrinkage removal effect ! - microretenh.cn Principles ofcavilydesignsforaesthehcdirect restoration - preservetothstnctre → prioritize minimal intervention - noundercuts-smicromechani.cat bonding ↳ Uses adhesive techniques tretainthe restoration eliminating the need for mechanical , retention like undercuts no special cavity design nospecialwalls.lineanglesorpointang.es - - - no prevention for extension - onlycarioustothstnctseisremoved - itisa minimally invasive approach - aesthetic considerations - Smooth well finished marginsforagoodsealrdxminimalplaque retention - - Composite shade matching - includefaultsbutdonltexlendtadjacentpitsxfissures - depth 1- 2mm (usually) - cavosurfacemargin-sequaltandgrealerthangoo.at margin bevellingif No beveling : > approximately wide vestibular-0rad box - socclusally ↳ narrow vestibular -0rad approximal box > enamel margins ifthereisno contact with the antagonist ↳ enamel margins where there is contact with antagonist  AS AIZ } everything mentioned regarding composite - ↳ youcanment-onmicntetenh.cn intheprevioustwotpicswherearetheforamencoe.com minally invasive ! ? Class -1pitsEF-ssure.se - 1) maxillary lateral incisor ↳ fissures ofpremoiarsrdmoiars → Palatal surface ↳ foramen caecum's 2) maxillary molars → Palatal surface 3) mandibular molars - buccal surface e. g. tooth 36 1) withapencildrawouerthemajorfissuresofmolarleeth 2) burseledion → diamond fissure bur 3) Fingerrestonleethvery important 3mm long Coates 1mm ( diameter) Burangulalianis perpendicular lithe 4) Initial preparation occlusal surface  - burdepthhalfofthecoated surface - cavilyisexlendedlotheapproximalenameln-dg.es - Oro - vestibular widnessofcavityl -5 -2bar > Smooth outline I formcnoroughedges) check that the pulpalzverh-calcavi.ly ideal depth walls are smooth 1- 5- 2mm Potential mistakes during preparation : - wrong burangulah-oncshouldbeperpendiculartotheocdus.at surface) - weakening of the approximatename / ridges / notlessthanrdmmshouldbeleft) - oroveslibuidrwidthofthecavilyistomuch - weakening of cusps (should be 1.5-2 burst - depthofcavityistoomuch Riskofpulp exposure ! → - internal lineanglesarenotroundedQ-roughedg.es citshouldbe rounded internal lineanglesrxsmoothcavitywalls) tooth 36CFDDforamencoe.com : - headofburistmm from buccal view 1) labelitwithapencil 2) Burseledion → diamond round bur 3) fngerrestontheadjacenttothcvery important) 4) preparation Babur is perpendicular onthebuccaltoth surface Cdepthandwidthofpreparedcavilyis 1.5bar) 5) Enamel beveling ↳ flame shaped diamond bur s bur is in 450 on the surface ↳ beveiling is 1mm wide bevelled enamel at 450 ( 1mm Wide) Potential mistakes during preparation : - extension of cavity is too big (depth & width of prepared cavity should be 1.5 bur size) - depth of cavity is too big C Shouldn't be more than I -5mm) tooth 34 : special morphology 1) label the fissures with a pencil → crista transversa intact 2) Bur selection : diamond fissure bur 3) opening of fissures → bur perpendicular to occlusal surface depth of cavity half bur : approximal extension to the marginal enamel ridges potential mistakes during preparation : - Wrong bur angulation → leads to weakening of buccal cusp ( should be perpendicular to occlusal surface) - weakening of approximal enamel ridges ( leave atleast 2mm) - weakening of cristatransversa of Cavitt of of (depth - depth cavity is too much → Risk pulp exposure ! half a bur)  distal groove Tooth 26 Cocdusopalatalcavity) - 1) markthefissueswithapencil - extends mesial groove palatinateya endsinthe 2) Bur selection diamond fissure bur foramencoecum 3) Initial preparation : opening of mesial fissures - ↳ depthofcavity halfofthebur : ↳ wideness :S-5-2 burs smesialmarginaln-dgeQ-cn-statransvers.ae intact 4) Second stage of preparation opening distantpalatal fissures - ↳ depthofcavity : halfofthebur ↳ wideness :S-5-2 burs during the preparation of the palatal fissure : 5) secondary preparation beveltheenamel : palalinallywithared diamond flameshapebur → theburishlsotthepalatal surface > enamelbevellingistsmmin potential mistakes width - weakening ofcristatransversa - floorofcavilydoesnot follow convexity - widenessofpalatalcavitytomuchcshouldbel.rs - Zburs) oroveslibuidrwidthofthecavilyishomuch > weakening ofcuspscbuccal)  → microretention s minimally invasive class I - proximal surfaces of posterior teeth ( molars 2-pre - molars ) Smooth surface caries s Types : MO , OD MOD , e. g. tooth 35 ( FDI) - Mo cavity 1) Use a pencil 2-draw over the major fissures of the tooth 2) drawing the location of mesicapproximal caries 3) bur selection → diamond Assure bur 4) Initial preparation OCCLUSALCAVITY ↳ depth of cavity half of the bur : V 5) Next step of preparation APPROXIMAL CAVITY Cavity depth - extending cavity to mesial does not change - protective slither of enamel remains - mesial enamel margin is intact ( for now) option → put a metal matrix band to protect neighbouring / adjacent tooth 6) continue the bur is advanced down the long axis of the tooth preparation → - remaining enamel mesially is removed with care (Do not damage the adjacent tooth)  typical mistakes in preparation the : approximal cavilyiswiderthan - approximal cavity is narrow the occlusal - cavosurface undermined enamel Citshouldbeagoocavosurface margin) - wrongburangulahonweakensthe cusp - wide occlusal cavity → weakens cusp - damagingadjacent teeth - too deep approximal cavity → damages gingiva MOD-sbothmesiala-distalsides.ae involved csamestepsbutyoudoitmesiallyanddistally 1) drawwithdpencilandmarkthe fissures 2) drawthelocahonofcariouslesionscmesiallyrddistally) 3) bur selection - diamond fissure bur 4) preparing occlusal cavity iddasstcavily 5) enlarging thecavilymesiallyrdthemesialenamelmargin remains intact for now rgsoyouprepare 6) preparing an approximal cavity 7) preparing adistappnximalcavily approximal cavities bothmesiallyxdistally Typical mistakes in preparation : - approximal cauityisnarrowcopenitorally andbuccally) - cavosurface undermined enamel citshouldbeagoocavosurfacemarg.in)  microrelenhoninvasive g. > minimally class : ontheproximalsurfaceonanten-orteethanddoes.no/- involve the incisaledge ( central incisor / lateral incisor / canine) e. g. Tooth 21CFDDadistalcau.ly 1) Useapencibdrawthécariouslesiorifomthepalatal surface 2) Bur selection > diamond round bur 3) Initial preparation CFOMPALATALLY ) Burangulahonis perpendicular to the palatal surface - burdepttihalfofthecoaled surface - finger restontheleethisvery important potential mistakes during preparation : - reaching vestibular wallcdamagingit) - damaging adjacent tooth - residual undermined enamel approximating - harming the gingiva ( approximal enamel is removed) - wide cavity → riskofpulp exposure