Escolar Documentos
Profissional Documentos
Cultura Documentos
Amal
. Both
. Both the statement and the reason are correct but NOT related
. The staternent is correct, but the reason is NOT
. The statement is NOT correct, but the reason is correct
'|
Cop!riglr
c 20ll-l0l I
- Denhl Dccks
A lingual approach is made when preparing a Class III dental amalgam preparation for the
distal ofa canine because a lingual approach preserves the esthetic value ofthe facial surface.
Remember:
. A bite-wing radiograph is the best method to diagnose incipient carious lesions on
the distal surface ofcanine teeth.
. A diagnostic aid to be used as a last resort to confirm the presence ofa carious lesion
on the proximal surface of an anterior tooth is mechanical separation (usually w,ith a
weage).
Rule ofthumb: When two teeth adjacent to each other have Class III lesions, you should
prepare the larger one lirst and fill the smaller one first. Access to the preps and shade
matching are easier when you do both at the same appointment.
.0.5 mm
.l.0mm
. 2.0 mm
. 3.0 mm
'
A prtlent comes in claiming that thir holistic doctor told hlm that h has rn
allergy to mercury and needs only white fillings. Your best response is:
'
fillings
. You might have mercury allergy, but that is very rare. Plus, there is no mercury in
amrloam fi llinoc
. There is no such thing as a mercury allergy; plus, with proper isolation and technique
your exposure will be minirnal
. You might have a mercury allergy, but that is very rare. Plus, with proper isolation and
technique your exposure will be minimal
Copright O
**x Amalgam
is a poor thermal
a base
ide or zinc oxide eugenol is placed under most amalgam restorations 60plovide thermal
nrolectiotl).
Comparison of Restorative Msteri!ls
Chancteristic
Direct Gold
Amrlgem
Composite
Vcry good
Good
Verv good
Cood
Very good
Cood
Very good
Good
Very good
Very good
Fair
N/A
Ixcel]cnt
Excellent
Cood
Clinical loflge\'ify
Verv good
Good
Fair
Cood
Cood
Cood
Fair
Cood
Very good
Fair
\\'irh
sla nds
masticatory forces
\jersatility in
use
F-air
Cood
Iair
Cood
Fair
Poor
very good
Good
Very good
Very good
Cood
Thc amount of mercury rcmaining in a set amalgam rcstoration is rclated to how much of
thc rnercury-rich matdx is lel-i in thc amalgam after condcnsation. The key is to minimize
the amount of matrix which forms during the reaction. By condensing the amalgam
nri\turc in the cavity preparation, the mercury-rich matrix will comc to the surface and bc
r!'mo\ cd bv subscqucnt condensing and carving. The final amalgam restoration will be
.Lrnrposed of mostly residual alloy and vcry little ofthe mercury-rich matrix.
TlIc amount ofmercury remaining in dental amalgam after condensation directly affects:
i 1 t th,-. porosity ofthe restoration (2) thc compressive strength ofthc rcstoration (3) the corrt sir,-- rcsistancc ofthc rcstoration and (4) tbe surfacc finish ofthc rcstoration.
\Iercurr is used to initiate the reaction ryith the alloy. Although an amalgam restoration
i: non-toric. mercury is poisonous. Free mercury, in thc form of vapor or liquid droplets.
r.prcscnts a significant health hazard in the dcntal office. The greatest potential hazard of
chronic nrcrcury toxicity comes from inhalation ofmcrcury vapor. The vaporization is most
lrkell to occur during condensation ofthe amalgam (alu,ct1.s use high speed suction).
\ote: Nlercury hypersensitivity (allergl') isvery rare (l irt 100 million).
Important point concerning corldensation pressure: The area ofthe condenser point and
thc forcc cxcrtcd on it by thc opcrator govcrn the condensation pressurc. The smaller the
condenser point. thc greater is thc pressure exerted on the amalgam. By doubling the diameter of the condenser point and doubling the hand pressure applied to the instrument,
the operator actually exens lcss condensation pressure.
. Both
Co$n-shr <
:0ll l0ll
- Denral Decks
The longer the trituration time, the smaller the setting expansion. Ifthe trituration is carried to the extent that the amalgam appears shiny and wet. the strength will be maximal
and the smooth, can'ed surface will retain its Iuster long after polishing. A properly tdturated amalgam appears shiny, wet, smooth and homogenous.
Inadequate trituration results in an amalgam mix that has a low strength and a rough surface that will accelerate corrosion. An undertriturated amalgam mixture will appear dry
and grainy. Condensing this mixture will result in poor adaptation to the walls of the
preparation, lacrimation between condensed increments, and reduced strength.
Remember: An overtriturated
nix
Iotei'
likely
of
sulfide.
***
The gingival n.rargin should clear the contact area to allow lor adequate finishing
the enamel marsins and olacement ofa matrix band.
Form
a reverse
bevel at th axial
of
Cop,righr O
201
and condensation
***
The rtention form for a Class V amalgar.n preparation is provided by the gingival retention groove placed along the gingivoaxial Iine angle and the incisal retention groove
placed along the incisoaxial line angle.
The outline form for the classical Class V amalgam preparation is a deformed trapezoid
(sometimescollecl'kidney-shaped").Theoutlineformisdeterminedbythelocationand
size
The non-parallel mesial and distal walls ofthe preparation are straight and parallel to,
but never extending beyond, the transitional line angles. The direction olthese walls is
determined by the direction ofthe enamel walls (as is the decay pattern).
The occlusal and gingival walls ofthe preparation should be gently curved arcs as deterrrlined by the contour ofth free margin ofthe gingival tissue. Note: These arcs should
be as parallel to each other as possible.
lmportant points:
L The occlusal arc will normally be the longer of the two.
i. The gingival margin will normally be at, or slightly below, the rrargin ofthe free ginsir
a.
-l. For incipient lesions, the axial wall should be uniformly deep into dentin.
limorsture is incorporatcd into an alloy that contains zinc, thc watcr reacts with the zjnc to produce hydrogcn gas. The resulting pressure from the liberated gas produces severe expansion ofthe amalgam. This
clinical manifestations:
. lhc amalgam protrudes from the cavity preparation
. PosI operative parn
. Erccssivc corrosion
Important points to remcmbcr rcgarding amalgam:
L The compressive sftength js greatly reduced when amalgam is contaminated with moisture. The
comp.essr!e strength ofhigh-coppcr amalgam is similar to tooth structure.
LThc most imponant problem for amalgam restorations is that they have different cofficients of
thermaf erpansion/contr^ction (amalgam: 25 ppnr/"C) compared to tooth structure (10 ppm/'C).
During reductions in intraoral temperatllre. there is a strong tendency at thc margins for amalgam
rcsroralions to contract away from the margins and allow marginal leakage ol intraoral fluids (petro
1dhir, that arc latcr expelled when the temperature retums to non-nal.
i. Thc tensile strength ofamalgam is about one-fifth to one-eighth ofits compressive strcngth. that
is \\ht enamel is needed to support amalgam at the margins ofrestomtions. Nole: It is more abrasionresistant than composite resin or unfilled resin.
.1. Amalgam is brittle and has a low edge strength.
5. Amalgam is a high thermal conductor.
6. High-copper amalgams exhibit no clinically relevant crccp or flow
7. You need a minimum thickness of0.75 fin axial areds) to |.5-2 mm (in areas ofocclusal conldct)
lbr adequate cornpressivc strength.
. Both the statement and the reason are correct ard related
. Both the statement and the reason are correct but NOT related
. The statement is correct, but the reason is NOT
reason is correct
Coplright
e 20ll-2012
- Dental Decks
. Gamma
. Garrma-one
. Gamma-fwo
. Gamma-three
CopFghtO 20ll-2012
- Dental Decls
The most important consideration in the strength ofthe amalgam is the mercury content.
lfthe mercury content exceeds 5570, a dramatic loss in strength results. Amalgam restorations that contain mercury levels ofabout 55% exhibit a high incidence ofmarginal breakdown, fracture, corrosion, and the surface finish olthe restoration is not good.
. Amount of trituration
. Condensation
Very important: Removing the mercury-rich matrix by proper condensation and carving produces a stronger and more corrosion-resistant amalgam because it minimizes the
forration of the matrix phases of ar.nalgam, which are the least desirable parts of the set
matenal.
The reaction that occLrrs between the allov Darticles and thc mcrcurv can be sunrmarized as lollows:
Silrcr-tin alloy
,\g:Sn
(gamma)
+ Mercury -)
Hg
Silvcr-tin alloy
AglSn
(gamma)
Silver-mcrcury
Ag:Hg:
Tin-mercury
SngHg
(gamma-one) (gamma-two)
Camma is the unreacted alloy. lt is the strongest and corrodes the least. l'onrs 307n ofvolume of
sct anialsan. Gamma-one is thc matrix lbr unrcactcd alloy and is thc sccond strongesl phasc. It
Frrnni 609'0 ofvolume ofset a)nalgam. Gamma-two is thc wcakcst and softest phase. It is also the
most susceptible to corrosion in the mouth and fonns l0olu ofthe volume ofthe sct amalgam. The
r olunre of lhe Ganrma-two phase decreases with tirne due to corrosion.
Thc kcy drttcrcncc bctwcen the low coppcr and thc high copper amalganls is thal thc low copper
amalgarns contain the gamma-two phase, which is not present in the high copper amalgams. lnstead,
the high copper anralgams contain the Cu6Sn5 phase. Since the gamma-two phasc conodcs t'aster
rhan the Cu,,Sn5 phase. thc gamma-two phasc containing low copper amalgams develop microporositics duc to corrosion fastcr than thc high coppcr amalgams. Thesc porcsities wcaken the
anralcam rnarcins and explain why rnarginal delbcts (chipped riargllr) are more oftcn seen around
lo* copper amalgans. This explains why high-copper amalgams should be used rather than the lowcerpper amalgams.
\ot*s
""
l. Smaller particle size results in higher strength, lower tlow, and bctter car'"ability.
2 Spherical amalgams high in copper usually have the bcst tcnsilc and con'rprcssivc
charactcristics.
3. Copper contents over 6yo ("high-copper" alloy,i/ climinate the gamma-two phase
by forming a copper-tin fCr6SrJ-, phase resulting in superior propcrties.
,1. Amalgam has a coellicient ofthcrmal cxpansion approrimately tuice that ofloolh
structure.
5.The tensile strength ofamalgam is about one-fifth to one-eighth ofits compressive
strcngth.
10
CopyriShr O 201l-2012, Dental Decks
Is contraindicated because
11
12
- De'tal
Deck
lI
amalgam preparations:
. All walls should meet the surlace of the tooth at a 90'angle (butt joint).
. Occlusal dovetail; provides resistance to proximal displacement.
. Pulpal floor should be flat same as Class l.
. The buccal and lingual walls ofthe proximal section should converge occlusally the extension ofthese walls is determined primarily by the position ofthe adjacent teeth in relation to the tooth being restored.
. The buccal, lingual, and gingival walls should be extended into the embrasures enough
to allow easy cleaning
areas of lessened caries
- is beveled to reduce susceptibility.
. The axiopulpal line angle
concentration of stresses resistance
fonn.
. Retention
grooves are placed in the axiobuccal and axiolingual line angles and extendresistance to dislodgement.
ofthe axial wall
- create a reverse cuNe in the outline. A revelse curve
. Lingually, it is often necessary to
is a cun'e put into the buccal or lingual wall so the wall meets the extemal surface of the
tooth at a 90" angle.
ed to the height
\ote: Class ll amalgam preps have independent retention and resistance form fbr both the
proximal box and occlusal portion ofthe prcparation.
Important: When caries is extensive, reduction ofone or more ofthe cusps for capping rnay
be indicated. When the facial (or lingtnl) extension is two-thirds from the primar) groove torvard the cusp tip, reduction ofthe cusp(s) for amalgam capping is mandatory fbr the developn]ent ofadequate resistance form. Note: The final restomtion has to have restored cusps with
a minimal thickness of2 mm of amalgam for functional cusps and l 5 mm of amalgam for
nonfunctional cusps.
""* The gingival cavosurface margin is bevered onry ifit is in the enamer. Beveling is not
necessary if the gingival margin is within cementum.
The,singir.,al cavosurface margin should be beveled to remove
any unsupported enamel.
The ber el is usually placed with a gingival margin trimmer. This gingival
margin must be
be1o* an'existing contact with the adjacent tooth in order to alori pioper
finishing ofthe
-rrnerlal margin.
\oa
L The bevel is no steeper than necessary to ensure lullJength enamel rods fonn_
ing the gingival margin and is no wider than the enamel.
12
Coprighr O
All four wa[s ofa Class I amalgam preparation should diverge slighfly
because divetgence prevents undermining ofthe marginal ridges.
. Both the statement and the reason are correct ard related
. Both the statement and the reason are correct but NOT related
. The statement is conect, but the reason is NOT
. The statement is NOT correct, but the reason is correct
. NEITHER the statement NOR the reason is correct
13
Cop)right O 201l-2012 - Denial Decks
The key to this question is the angulation ofthe preparation. The bur should be tilted lingually to prevent encroachment on the facial pulp horn and also to maintain dentinal
support ofthe lingual cusp. The pulpal floor should be parallel to the occlusal plane ofthe
tooth faciolinsuallv.
\ote:
Pulpal floor slopes to coincide with the slope (height) of the c\sps.
Remember: The area olthe tooth that is most sensitive durins cavitv nreparation is DEJ.
Important:
. Only nvo walls of a Class I amalgam preparation should diverge, the mesial and distal
Thc. reason is
still true because there are only two marginal ridges per tooth, mesial
and distal
DIVERGING
(Correct)
CONVERGING
(Incorrect)
***
This slight occlusal divergence prevents undermining the marginal ridges of their
dentin support.
, 1. This divergence of the mesial and distal walls holds true for Class I prepat\i..otci'. rations for direct filling gold and gold inlays as well.
.,.;:,:,,;,:, 2. For premolars the distance from the margin of the mesial and distal wall to
the proximal surface must not be less than 1.6 mm. For molars this minimal
distance is 2 mm.
The matrix band should be removed after condensation ofthe amalgam, but
prior to the linal carving ofthe restor|tion. This is because the wedge
compensstes for the thickness ofthe matrix band.
. Both the statement and the reason are correct but NOT related
. The statement is correct, but the reason is NOT
. The statement is NOT correct, but the reason is corect
. NEITHER the statement NOR the reason is conect
14
Cop) iehr O
201
The diagonal slot opening on the Tomemire matrix ret ner (also called the
Univercal matrix systeml is always placed facing the gingiva. This:
. Permits
easy separation
. Allou's for
15
Coplright O 20ll-2012 - Dental Decks
Although the wcdge is uscd to cornpensatc for the thickncss ofthe mat x band. the true reason for
carving after the rcmoval ofthe band is to gain proper access to all margins ofthe amalgam rcstoration.
lmportant: The wedging action betwcen the teeth should providc enough separation to compensate for the thickness ofthe matrix band. This will cnsure a positive contact relationship after thc
nratrix is rcmovcd following thc condensation and initial carving oflhe anralgam.
Corrrrnon problems associated with amalgam restorations:
. Postoperative sensitivitl
. \Iarginal voids:
- \1ay be caused by inadequate condcnsation. or amalgarn breaking away from margins when
can ing
In addition. tlte larger circumference ofthe matrix band is alu,ays placed toward the occlusal surlace ofthe tooth. This acconnnodates for the larger tooth circumference at the
contact level.
The primary function ofthe matrix band is to restore anatomical contours and contact
areas. Other functions include providing a rigid wall to condense filling material against,
pre\ enling excess filling material from going subgingivally, and to some extent, limiting
moisture contamination during condensation. A properly placed wedge will also protect
the sinsiral tissue and help reduce moisture leakage into the cavity preparation.
\\ edses are inserted fron the facial or lingual embrasure, whichever is largeq slightly gingival to the gingival margin. The wedging action between the teeth should provide enough
separation to compensate for the thickness ofthe matrix band.
Important: When placing a matrix band for a Class II amalgam restoration, the gingivoocclusal \r'idth ofthe band should be trimmed to be at least I mm qreater than the expected marginal ridge height.
16
Coprighr 20ll-2012
- Dental Dects
. The outline form is determined primarily by the location ofthe free gingival margin
. The mesial, distal, gingival and incisal walls of the cavity preparation diverge outward
. The retention form is provided by the gingival retention groove along the gingivoaxial
line angle and an incisal retention groove along the incisoaxial line angle
17
Cop),right C 20ll-2012 - Dntal Decks
The final finish of the amalgam restoration should not be done until after the amalgam
is fully set. It should be delayed for at least 24 hours after condensation and preferably
longer (21-48 hours). By waiting you can be assured that the reactions between the alloy
and mercury will have been completed and a more corrosion-resistant surface will be created.
Amalgam restorations should be tlnished and polished fbr tlrree major reasons: (1) to reduce marginal discrepancies and to create a more hygienic restoration. (2) to reduce marginal breakdown which will reduce the chance of recurrent decay, and (3) to prevent
tarnishing and to improve the appearance ofthe restoration.
Heat generation must be avoided. The use of dry polishing porvders and discs can
easily raise the surface temperature above the 6VC (14ff F) danger point. Thus, a wet
abrasive powder in a paste form is the agent ofchoice. Not: I{eat will not only damage
rhe pulp but also draws mercury to the surlace ofthe restoration and an inferior restoration rvill result.
Flnai polishing may be accomplished using a rubber cup with flour of pumice followed
b1 a high-luster agent, such as tin oxide.
***
This is false; the outline lbrm is determined primarily by the location and size ofthe
carious lesion.
\otes
l. Care must be taken to distinguish the active root surface carious lesion from
the root-sudace lesion that was active but has become inactive (arrested).The
anested lesion shows ebumated dentin (sclerotic dentin) lhat has darkened from
extrinsic staining and is firm to the touch of an explorer.
2. Thc Class V an.ralgam restoration is used to restore lesions from caries, erosion and abrasion.
3. Care should be taken not to "ditch" the cementum when finishing and polishing.
,1. Occasionally you will notice that the gingival tissue has receded apically
from the gingival margin ofa Class V restoration that was previously polished.
This may be related to ineversible tissue changes caused by inadvertently traumatizing the tissue when the restoration was being polished.
Key point: Be careful.
Remember: Incipient carious lesions are contained entirely within enamel and have not
spread to the underlying dentin. The two options for treatment are:
l. Promote remineralization: with fluoride vamish and self-administered fluoride.
followed by regular monitoring. Note: Incipient carious lesions usually do not progress
rapidly.
2. Place a restoration: be as conservative as nossible.
will
expanslon
will
. Increased condensation pressure will increase compressive strength and decrease setting
exDansron
18
Coplaight O
201
. Both the statement and the reason are correct ard related
19
Coplrjghr O 20ll-2012 - Dental Deck!
***
Dimensional change
Setting Expansion:
- Most amalgam restorations show slight setting expansion, but not ofclinical significance.
- The more free mercury, the more setting expansion (and vice versa).
. The greater the time oftrituration, the less the expansion
. The greater the pressure used in condensation, the less the expansion
. The smaller the particle size, the less the expansion
Strength:
- Amalgam is brittle, but possesses good compressive strength. The most impor-
tant consideration in the strength of the amalgam is the mercury content. Mercury
content above 550% will cause a marked decrease in stren stb. khould be within 455 3?6 b1'u,eight).
. Higher condensation
20
Coptriglr
. Both
21
Cop),right () 2011,20t? - Dertat Decks
Constituents in Amalgam:
Basic constituents:
. Tin (Sn)
25-270/.
. Copper /C , 6% or less:
Note: New alloys called "high copper" conrain 9- ties up tin: rcducing gamma-2 fbnnation 30% copper. These alloys have less marginal break- incrcascs
dorvn and are lcss likcly to corrode.
- reduces tamish irnd corrosion
- rcducc. crccl: rcdrrccs marginal deterromtron
Nlercury d18l 3% max.:
- activates reaction
- only pure metalthat is liquid
strength
- spherical allo]s
. requrre less mercury
- smalier surface area easier to wet
- -10 Io,15% Hg
- admixed alloys
. require more mercury
- lathe-cut particles more difficult to wet
- 45 ro 50% Hg
Other constitunts:
. Zi.c (Zn) l9i, or less: used in manufacturing. decreases oxidation of other elements (sacrificial
- Prolides better clinical perfomance: less marginal breakdown
- Causes delayed expansion with low Cu alloys ifcontaminated with moisture during condensation
vapor
Creep (ti re-dependent deJbrmation or strqin relaxation) is the deformation with time in
response to a constant stress. It has been implicated as one of the main causes for mar-
\otes
L The higher the creepJ the greater the degree ofmarginal deterioration.
2. Creep is time-dependent.
High copper and low mercury content of an amalgam restoration will tend to decrease
creep..{ltering the trituration time and condensation pressure can change the creep rate
Lri an
amalgam restoration:
al.so
decrease
The marginal leakage ofan amalgam restoration decreases as the restoration ages. Corrosion products are helpiul in reducing marginal leakage around amalgam restorations.
These corrosion products, such as tin oxide and tin sulfide, accumulate in the gap betrveen
the restoration and the tooth, thus providing an excellent seal.
. Both
. Both the statement ard the reason are correct but NOT related
. The statement is correctt but the reason is NOT
22
Coplright C 20ll-2012 - Dental Deks
. Release fluoride
. Good chemical adhesion
. Good biocompatibility
Cop)righr
23
20ll'2012 - Denral Decks
***
There is no free mercury in tdtumted amalgam because trituration coats the alloy particles with mercury.
The object oftrituration is to bring about an amalgamation ofthe mercury and alloy. Each individual alloy particle is coated with a slight film ofoxide that prevents penetmtion by the mercury. During trituration this film is rubbed offand the clean metal is then readily attacked by
the mercury
. Spherical particles
9-30%o most
Spherical: sets faster and attains final mechanical properties more rapidly
. Comminuted can haye zinc or be zinc free and also can be fine cut ur microcut
. Combination (admix) mixture of spherical and comminuted particles
Dispersed phase allov was the original admix alloy, mixture of comminuted traditional silr er alloy and spherical particles of silver-copper eutectic alloy. Most commonly used alloy
toda1.
Eutectic alloy is an alloy in which the elements are completely soluble in liquid solution but
separate into distinct areas upon solidification.
\ote:
Once amalgamation occurs, no free (unreacted) mercury is associated with the amalgam
restomrion. The restoration has no toxic properties. However, if the amalgam is heated be) ond 80'C, liquid mercury can fom on the surface ofthe amalgam and its vapor presents a
health hazard.
***
This is false; glass ionomer cements have low solubility, lower than zinc phosphates
as a cement is that
it has
phosphate cements.
Rmember: No lab test ofcement has correlated solubility with clinical retention.
. Both
21
Coptrighr () 20l l-2012, Denlal Decks
. Both the statement and the reason are correct and related
. Both the statement and the reason are correct but NOT related
. The statement is conect, but the reason is NOT
25
Cop)righr O
201
Glass ionomer ccmcnts arc mixcd powdcr-liquid componcnt systcms. Thc polvdcr is a fluoro alumino-silicrte glass
that .cacts with a liquid u,hich is polyacrylic acid to tbrm a ccmcnr ofglass particlcs sunoundcd by a matrix of tlu-
oridc clcments.
Luaing agcnts /{{ rrerrrl:
. Zinc phosphate cement: onc ofthc oldcsl and nrosl widcly uscd ccmcnts, zinc phosphalc ccmcnt is lhc standard against which ncw ccmcnls arc mcasurcd. Advantages: Iong record ofclinical acccpiabilily, high comprcssivc strcnglh, acccptably fiin film thickncss. Disadvantagcsr lo\r initial pH lvhrch ml]y lcad to postccmcntalion
scnsitivily, lack ofan abilily 10 bond chcmically to toolh structurc and lack ofan anticariogcnic cUcct. Important:
Zjnc phosphatc cemcnl is mixcd using thc "frozen slabrr lcchnique rlhich grcatl,v cxrcnds thc working timc abr'
$nuchas300%). Note:ThcpHofncwlymixcdzincphosphatecsmcnlisundcr2/.'foldr.rtol\dnishm
sl
bc applied i or.ler to proled thc pulp) brl iscs lo 5.9 $ithin 2,1hours aDd is rcarly n!'utralat 48 hours.Thc film
' R!sin-modified
glass ionomer luting agents: havc propcrtics sinrilar to glass ionomcr ccmcnls, bul havc higher
rtrenglh end lo*er solubilit). Note: Thcy should not bc used with all-ccramic resloralions ducs to rcporls ofcc.3rnic iiacturc. nrost likcly Ihc rcsult ofexpansion liom walcr absorplion.
Resin luting agcnts: arc unfillcd rcsins that bond to dcntin, which is achicvcd \rith organophosphatcs, l2-,tr.
lrotterht l nu'rhacn'late IHE]|{AI/, or,1-mcthacryloyloxycthyl rrimcllitatc anhydridc (4-llE rA).
,\d\antages: higb comprcssivc strcngth. low solubility. Disadrantages: irrilaling cffccls on thc pulp. high liln
rhickncss a. lJ !rr. Note: As a gene.al rulc, resin cements arc thc bcst choicc fbr luling ceramrc restoratrons.
***
ZOE cen.rents make good temporary sedative restorations because their pH is about
Zinc oxide-eugenol cement is a soft, sedative - type cement. It is used as a sedatiYe or temporar\'filling material, as an insulative base, and in interim caries treatment. The powder is zinc oride and the liquid is eugenol. Eugenol has a palliative effct upon the dental
pulp. and this is one of the main advantages ofusing this type ofcement.
-\ con|entional mixture ofzinc oxide and eugenol is relatively weak. In recent years "reintorced" or "irnproved" zinc oxide-eugenol cements have been introduced (called rainIorced ZOE or ZOE-EBA).ln reinforced ZOE (4,pe I ZOE) the powder is composed
of zinc oxide and finely divided polymer particles (poll,nethyl-metlncD'late) in the
arrount of 20 to 40% by weight. In addition, the zinc oxide powder is surfac treated
br an aliphatic monocarboxylic acid. such as propionic acid. Note: This combination of
sLrriace treatment and polymer reinforcement results in a material that has good strength
and toughness rvhich markedly improves abrasion resistance. Reinforced ZOE is fine for
basing large and complex cavities. This material is able to withstand the pressure of amalsam condensation and it has minimal effect on the pulp.
BILIC
. Both the staternent and the reason are correct but NOT related
. The statement is correct, but the reason is NOT
OPERATI\rE
BIL/C
. Both the statement and the reason are correct and related
. Both the statement and the reason are correct but NOT related
. The statement is correct, but the reason is NOT
. The statement is NOT correct, but the reason is correct
. NEITHER the statement NOR the reason is comect
. As
. As
. Restorative emergencies
-tr
dvantages:
Important: Because of its zinc-oxide eugenol composition, IRM rvill interfere rvith subsequent placement ofa resin filling.
lmportant: The initial nixture ofthis cement is very acidic (pH oJ 3.5) ancl
can cause
irrerersible pulpal damage ifa cavity varnish (2 coits) is not;lac;d
on rhe tooth prior
to cementation ofthe crown.
\ote: Zinc phosphate cements shrink more when they are in contact with air; thus,
the
.'ement should not be alJowed to dry our.
zinc phosphate cement is the oldest ofthe luting cements and thus is
the one that has the
Lrrnsest "track record" and serves as the standard to which
newer systems can be com_
pared. It is
needed.
It
In.":luni:ul interfocking
\otes,
l.Zinc phosphate cement riquid that has lost some of its water content wi
ofthe mix to be lengthened.
. Stronger final
set
. Lower solubility
. Greater viscosity
2A
Cop).right C
20ll-2012
Dental
Deks
. Glass ionomer is often the ideal material of choice for restorins root surface caries in
patients with high caries activity
. The best
surface finish for a glass ionomer restoralion is that obtained against a surface matrix
CopFiShr O
201
29
l'2012 - Dntal Decks
***
This is a disadvantage; it will create a material with lower viscosity and thus allowing it to flow throughout the metal crown.
. Mixing should be started with the addition of a small amount of powder to the liquid. This procedure, along with the cool slab, increases the working time.
. Small increments of powder are added approximately every 20 seconds with vigorous mixing until a creamy consistency is achieved. This will promote a high powder
liquid ratio and a superior cementation medium by providing the following:
- a lower viscosity ofthe mix
- a stronger final set
- a lower solubility ofthe set cement
The advantages of using the cool slab method are a substantial increase in the working time of the mix on the slab and a shorter setting
time of the mix after olacement in the mouth.
*** It is tru that glass ionomers are somewhat esthetic. however, they do not polish as
u ell as composites.
Both self-cured and light-cured versions ofglass ionomers are available. Light-cured glass
ronomers are preferred because of both the extended working tirne and their improved
phvsical properties. Because of their limited strength and wear resistance, glass
ionomers are indicated generally for the restoration of low stress aras where caries ac-
rilin
mrred
\ote: \\iith
of
***
Sometimes called the "sandwich technique". This technique achieves all the benefits ofthe glass ionomer cements plus the high polishability, surface hardness, and
. Glass Ionomer
. Zinc oxide-eugenol
. Zinc polycarboxylate
. Zinc phosphate
30
CopyriShr O 201 I'2012 - Denral Decks
. Both
31
Remember: It is important to note that fhe main f'unction ol'a luting cement is 10 provide a nonpenreable seal at the margins around the restoration. Thc rnarginal cementiilled gaps around inlals. cro\\'ns and bridgc abutments can rangc from 25 to 15Opm. Research has shown that thc wider
rhe cenrenl gap at the nargin, the greater thc ccmcnt loss i'li1.'rirrgl. A rough cement surfacc is an
rd.'al site fbr plaque accumulation. ln such a situation, slow rclcase of fluoridc can be a very distrnct ad\ anlage.
lmportant: In general, glass ionomer cements tend to have the least erosion. and polycarboxylate
.enrents the most. However, solubility, crosion and strength are signiljcantly affccted by the powder liqurd ratio uscd.
ZOE. rcinforced ZOE, ZOE-EBA, silicate, and zinc silicophosphate ccmcnts are no longcr rouuscd to permancntly cement restorations. Zinc photphate cement has been cxtcnsivcly reolacr'd b1 polycarboxylate or glass ionomcr cements. These cemcnts are based on ion cross linked
polr acrl lic acid natriccs that have the potcntial to rcact chenically with residual po\\'dcr panicles
.iild the suriace ol tooth struclurc.
\ote:
iircly
a potential for adhesion to tooth structure via chelation. The polycarboxylate cements are powder/liquid systems. The liquid is an aqueous solution ofpolyacrylic acid and copolymers. The powder
is zinc oride and magnesium oxid,
Zinc pollcarboaylate cements have a compressive strength slightly lower than that of
zrnc phosphate while the tensile strength is highr. Its final strength is dependent on the
pos der liquid ratio, with n.rore powder giving greater strength. The strength of the set
material is sufficient for amalgam condensation and its effect on the pulp is mild enough
ro eliminate the need for sublining. Thermal conductivity is low and thus the material
gi\ es sood protection against thermal stimuli applied to metallic restorations.
-\n ad\ antage ofzinc polycarboxylate cement is that it can bond to tooth structure. This
is attributed to the ability of the carboxylate groups in the polymer molecule to chelate
to calcium in the tooth. The most commonly noted disadvantages of polycarboxylate
cen]ent js its marked thickness and short working time. Currently marketed brands include Durelon lJM ESPE).Liy Carbo (GC Amerita),Shofu Polycarboxylate /.t o/ir. and
Trlok Plus (Dentspl.v/Cqulk). The most recent innovation in these cements has been the
development of Durelon Maxicap. an encapsulated version of Durelon. Because it is
mixed and expressed lrom a capsule, the traditional difficulties ofshort working time and
excessive thickness are overcome.
Remember: When cementing a cast restoration, always apply cement to both restoration and the tooth.
When uslng a zlnc phosphate cement you place the varnish lirst
This is because zinc phosphate cements are not biocompatible.
. Both the statement and the reason are correct and related
32
Cop).rightO 20ll-2012 - Denial Dects
It should be emphasized that the use ofa base in conjunction with amalgam or gold foil does
not alleviate the need for a vamish as an aid in sealing the cavity margins against leakage.
However, the type ofbase govems the respective order ofapplication ofthe vamish and the
base. lf a zinc phosphate cement base is to be used, then the cavity vamish should be applied to the cavity walls prior to placement of the base. On the other hand, if a biocompatible agent (e.g., a calcittm h.vdroxide, zinc oxide-eugenol, or polvc arboxl'late cenent
base.,l is employed. then these should be placed against the dentin. and the vamish should
not be applied until the base material has hardened. Important: lf vamish is added before a biocompatible base it may prohibit positive qualities such as eugenol's soothing effect or polycarboxylate's chelation and adhesion-
Zinc phosphate cements provide good pulpal protection frorr thermal. electrical, and
pressure stimuli, but may damage the pulp as a result ofan initial low pH. This, however,
can be ofbenefit as it provides an antibacterial effect which reduces the number ofviable
microorganisms in the cavity floor and thus decreases pulpal irritation.
Important: Cements used for bases should be mechanically stronger than u'hen used as
Iuting agents and are mixed with the maximum powder content that is possible. A lou'
pol der-toJiquid ratio produces a Iow viscosity cement that is needed for luting agents.
\ote:
The varnisb
The most important consideration for pulp protection in restorativc techniques is thc thickness
of
In gencral. cements that are thickcr than 2 mm are termed bases and as such function to replace
lost dentin structure beneath restorations. A base may be used to providc thcnnal protection under
:nctallic restorations. to increasc the resistance to thc forccs of conclcnsation of amalgam, or to
block out undercuts g'hen taking irnpressions for cast restorations.
The only drstinction bctwcen a base, a cen,leni, and a cavity lincr is thcir final application thicknesS:
L Cements for luting havc a dcsircd linal film thickness ofapproximatcly l5 to 25 microns.
.?
desied./inal
/iln
Important: A
base should
Remember: Calcium hydroxide is very eileclive in promoting the fbrmation ofsccondary dcntin.
which is an important aid in the repair ofthc pulp.
Note: Thc sclcction of appropriate bascs and liners to restore the axial wall ol'a Class ll restorations is dependent r,rpon the biological eff'ect requircd and thc thickness of th remaining
dentin.
. Primary base
Secondary base
. Direct base
. Indirect
base
34
Coplrighr O 20l l-2012 - Denral Decks
. Primary
primary or secondary:
bases are placed on the dcntin in closc proximity to thc pulp primarily to pro-
vide protection from toxic and thermal irrilants. Undcr amalgam and tooth-colored
restorations, the primary base is usually calcium hydroxide. whereas, under gold restorations, the primary base is usually zinc phosphate cement or zinc polycarboxylate cemenl.
Glass ionomcrs arc commonly uscd today as wcll.
. Thc most common use of a secondary base is thc placcmcnt of zinc phosphate cement
ovcr a calcium hydroxide base which has been placed over a pulpal cxposve (direcl pulp
. ap).
***
Bases in essence serye as a replacement or substitute lor the protective dentin that has
Important:The thickness ofthcrmal insulation
required for pulpal protection is 1000-2000 gm ( L000-2.000 mrn).
been destroyed by caries an<lor cavity preparation.
.
.
.
.
.
to application
Zinc phosphatc cement: remember
Zinc polycarboxyJate cement: provides adhesion
ZOE
Glass ionomer cemcnt:providcs lluoridc rclcase and adhesion
"Hard setting" calcium hydroxidc matcrials: thickcr than rvhcn used as a liner
Remember: All of the above are suitable as a base under amalgam restorations, however, lor
composites, ZOE cannot be used becausc thc cugcnol will inhibit the compositc sctting rcaction.
Important: (l) pulpal sensitivity is causcd prirnarily by lluid l1ow in dentinal tubulcs (2) lluid
flo\\ is detected by mcchanoreceplors on the edge ofthe pulp (3) the reduction in tooth sensitivity
* ith decreased fluid flow in tubules is rclated to the fourth power ofthc tubulc radius.
will inhibit
poll merization ofthe resin. Suspcnsion lincrs should be uscd for pulpal protection in this
the
casc.
it\ liners are matenals that are placed as thin coatings over exposed dentin. Their ma'n purposc js to
protect thc pulp by crcating a barrier between the dentin and pulpally jrrilating agents i.e., ocids.liom
;::it,tItt or centents. restordlive nalerials, elc../ by sealing thc dentinal tubules.
Ca\
Ca\
iI
L Solution Lircr ( LArnish)t thin film; typical thickncss rangc is 2-5 pm (0.002-0.005 mm)
Suspension Liner: relatively thin film; typicalthickness rangc is 20-25 pm (0.020-0.025 mm)
:.
to seal offrubules
- \'arnish:
. Organic solvent based: water insoluble
. l-: llm filmi used to line cavity up over cavosufacc margins
. Sets bl ph.vsical rcaction fd,),1,79/ iust like finger nail polish
Commercial examples: Copalite. Hydroxyline. Chembat and Tubilitcc
?. Suspension Liner:
. \\ater solvent bascd: water soluble
. l0-:5 Lrnr fllm; uscd to line only the denhn
. Sets b] physical reactton (dt)ing)
Commercial examples: Pulpdcnt and Hypooal
are now being substitutcd with the new dentin bonding systems or
dentin sealcrs 1'e.g., Gluma or HurriSeal). Thc dcntin bonding systcms and dentin sealers arc classificd
5olution liners.
-loles
':t;;ii:..t
A 509. rubule co\crcgc is produccd by onc thin coating ofvamish. Hence. thc reason
varnish.! lhuulJ bc anp'iietl rn ru' rhrn c.ats.
3. Thc chemical composition ofcopalite contains organic resin, chloroform solvcnt, acc2.
36
Coplrighr O
201
. Turbid dentin
. Infected dentin
. Transparent dentin
. Normal dentin
Sub-transpaxent dentin
37
Coplright O 201 l-201? - Dental Decks
Dental materials that are designed as pulpal mcdicaments contain caicium hydroxide or eugenol.
Need depends oo extent ofcavity preparationl
. Shallow : 0.5 mm into dentin (Rcmaining dentin > 2 mm, not necessary)
. Moderate: 1.0 mm into dentin (Remaining dentin : 0.5-2 mm, possibly)
. Deep < 0.5 mm from pulp (Rcmaining dcntin < 0.5 mm, ycs)
. Eliminate
senses
Delivery:
. Relcased from cement liner or ccmcnt basc into dentinal tubules
. Short term effect
N{anagement of Chronic Infl ammation:
Calcium hydroxide:
Delivery:
. Released from susDension liner, cement liner, or cement base
Aqueous pastes are viscous and do not wet dry dentin well
l.Translucent zone: the deepest zone, represents the advancing front ofthe enamel
lesion.
2. The dark zone: does not transmit polarized light. Areas of demineralization and remineralization.
3. The body ofthe Iesion: the largest portion ofthe incipient lesion. Area ofdemineraltzauon.
4. The surface zone: relatively unaffected by the caries attack.
. Both lhe statement and the reason are correct and related
38
CopFiShr O 201l-2012 - Dental Decks
39
Cop}'ighr O 20ll-2012 - Dntal Dtrks
The rising incidence ofroot surlace cales (sometime,s relbrretl to as senile cqrle.s/ can be
attributed to the aging ofpopulations and the fact that most adults are retaining more teeth.
ln this population, there is increased gingival recession with exposure ofroot surfaces.
leading to the development ofroot surface caries. Root surface caries usually appears as
a well-defined discolored area adjacent to the gingival margin, typically near the CEJ. It
is found to be softer than the adjacent cementum or dentin. Root surface caries generally
spread more on the surface laterally around the CEJ, rather than in depth. In older patients, rampant caries can be caused by poor oral hygiene, decreased salivary flow, and
side effects of medications. On a dntal radiograph, root surface caries appears as a
cupped-out or crater-shaped radiolucencyjust below the cemento-enamel junctron (CE.I).
Early lesions may be difficult to detect on a dental radiograph
Remember: Glass ionomer is a desirable restorative material for root surface caries
u here esthetics is not a major lactor.
\otes
*** \\'ith
Chronic caries is somelimes rcfcncd to as slow or arrested caries and is also characterized by the
:ollorr ing:
. Rapidly
progressing
Note: Changes ofthc pulp and dentin depend on the rate ofthe carious progression. The response
ofthe pulp to carious attack or thc trauma ofoperative procedures dcpcnds on the blood supply of
thc pulp and its cellular activitv.
Defense mechanisms ofthe pulp (loprolect
it
fiom irrit.ition)i
. Sclcrotic dcntin /peritxhular dentin fbrmalioir: inilial delense. Whcn it occurs due to thc aging
process it is called physiologic sclerotic dentin and when by initants it is known as reactive scle-
rotic dcntin.
. Rcparativc dcntin liD'ildtion dentitl Jbmralio,r: sccond line ofdefense
. lls vascularily (inllammation)
and
tberefore causing caries initiation and progression.
. Glucose,
40
Copyighr C 20ll'2011- Dental Decks
. Host
. Bacteria
. Carbohydrates
Saliva
. Time
41
Coplright
@ 201
***
Sucrose is degraded by Streptococcrls mutans into glucans and lactic acid therefore causing caries initiation and progression.
Pit and fissure caries has the highest prevalence ofall dental caries. Smooth surface areas, especially the proximal enamel surfaces immediately gingival to the contact area are the second most sr"rsceptible areas to caries. Streptococci and lactobacilli species are common in this
area. The facial and lingual root surfacs may have plaque containing filamentous actinomyces species which can cause root surface caries. Remember: Lactobacillus species do not
produce the dextranlike, extracellular long-chain polysaccharides (fi'uctaus and glucans) as
do Streptococci species but produces a different extra-polysaccharide called lexan. The way
that the lactobacillus species cause dental caries in the pit and fissure areas is that it gets packed
into those pit and fissure areas thereby exerting its effect.
Fluoride treatments will dramatically reduce smooth surface caries though they are not as
effective in preventing pit and fissure caries. Sealing the pits and fissures just after tooth eruption :nay be the single most impoftant procedure to help protect these areas from caries destruction.
Remember:The metabolic acids produced by mutans streptococci demineralize the tooth surl'ace and lead to dental caries. The enzyme glucosyltransferase lGlFl produced by mutans
srreptococci is the key factor in this process. Sucrose is a natural source ofenergy for this enz\rre. and GTF is the key enzyme that catalyzes the conversion ofsucrose to dextranlike, extracellular long-chain polysacchaddes (fructqns and g/llcar.t/, which extrude from the
bacterium and stick to the tooth.
and Fusobacterium
Dental caries is an irfectioos microbiological disease that results in the localized dissolution oftooth structurc. For caries to occur, a suscepiible host /d tootrl, microflora $ith cariogenic potential apldqrer, and a suit
ahle subsrate /dieldr'r . urhohv.lnues), all inli'ract to promote the severiq ofthe disease. \ot: A cc(ain period
c'i tinle is also required fbr caries to develop.
The grealest percentage ofiooth loss in the first two decades oflifc lcrcept /),on the nutrral loss ofdeeicluou.r
is due ro untrated dental caries. The rate at which the carious desiruction ofdentin progrcsses tends
r,r be slower in older adults than in young persons due to genralized dentinal sclerosis *'hich occurs with
i!(r,
3g'rs.
J/ drscourage or
crprcit): ofsaliva
'
BufTering
\ote3
'
L Fluoride and occlusal scalants modili the susceplible host /Ioor[r.Remember: Fluoride providcs lluoride ion lor remirleralization forming fluorapalitc. $'hich is more rcsistant to acid aF
rack than intdcl hydroxyapatitc crystals in enamel.
2. Enamel demineralization occurs at pll 5-5 or belo$'. Reminralizrtion ofthe damaged tooth
srructurc occurs as the pH rises above 5.5.
L The prevalence of caries has bcen declining in children. A decline in adult caries is not
as evident. Fluoridation has received thc most crcdit for thc decline in the devclopment olcaries.
4. Pregnant patienfs, compared with similar non-pregnant paticnts, are likely to have the
same degrcc ofdcn{al caries, but more inflamed gingival tissues.
5. In ordcr to create smooth surface caries, a microorganism musl be able to produce dextran-like.
42
Coplright
201
. Acidogenic, cariogenic
. Aciduric, cariostatic
. Acidogenic, cariostatic
. Aciduric, cariogenic
43
CopI
of
Thc first event in thc development ofcarics is the deposit ofplaque on the teeth. Dental plaque
is a highly organized gelalinous mass ofbacte a that adhcrcs to the tooth surfacc. Streptococcus
mutans produce great anrounts of lactic acid fucidogenic), arc tolcmnt of acidic cnvironlncnts
(ot'iduric.l, arc vigorously stimulatcd by sucrose, and appear to be the primar) orga nisms nssrrciated with dcntal carics, howcvcr, thcy arc not the only organisms required for caries initiation.
Olher mutans strcptococci species in humans can do this as well (for exanrple, S. sobrirtus).
T!,rre of bacteria
Jr\
$ irh low pH
***
Streptococcus mutans are acidogenic and therefbre cariogenic.'Ihis means that these
species produce acid and therefore cause the initiation and rrrosression ofcaries.
Cariogenic bacteria:
.
St
\ote: \losl
current research suggests that the microbial etiology ofroot caries is very sim_
rlar to coronal caries. In the past it \\,as thought that Actinomyces species (.tis(,osu.\ and
tl,tciIundii) were most commonly associated with root surface caries.
Essential properties of cariogenic bacteria:
. -\cidogenic Qtoduce acid) and acidluric (being able to tolerate qn a..id enyitonment)
**x \ote: Lactic acid is tbrmed in large quantities following the degradation
ofsucrose
b\ mutans streptococci,
. The abilit]'to attach to the tooth surlace. Note: Streptococci species have special receptors ibr adhesion to the surl'ace and also produce a sticky mat x that allows them to cohere
Io eilch other
. The abilitr to lbrm a protective matrix. Note: Streptococci species produce dextran-like.
ertracellular long-chain polysaccharides (lructans and glutar.rJ, which extrude fiom the
bacterium and stick to the tooth, which protects it fiom being removed from the tooth by
salir a, liquids. foods, and masticatory forces.
Dental plaque describes the soft white film of organized bacterial colonies (nain L,onpo cTit,salivary glycoproteins, and inorganic material that readily forms on the surt'ace of teeth.
\ote: The strong correlation between the presence of dental plaque and the appearance
dental caries and periodontal disease has been recognized for many years.
of
Comp
. Both the statement and the reason are corect and related
44
Coplright ,e
20ll-2012
Dental Decks
OPERATIVE
Comp
. Posterior composite
(
bruri.tnt)
may be indicated for the restoration of Class II cavities in premolar teeth where the appearance is very important, the cavity margins are
in the enamel, and the occlusal contacts are on tbe enamel
. Posterior composites
field is
maintained
4s
Coplright
c 20ll-2012
- Dental Decks
Light curing of compositc formulations arose dudng the late 1960s with the adoption of ulftavtolet (UV) light polymerized systems. In just a few years, it became obvious that visible-
light cured (VLC) had many advantages over UVJight cured composites, and practitioners
made the shif't. Dentistry has been wed to VLC systems ever since.
Msible light cr.rring systems have totally displaced the UV light systems. Also, visible light
curjng systems are much more widely used than the chemically activated ones /selfcured). An
advantage oflight cudng systems as a whole is that the dentist has complete control over the
working time and is not conlined to the built-in curing cycle ofthe self-cure. This is particularly beneficial when large restorations are placed.
Note: To deal with problems ofincomplete curing with VLC due to the thickness ofrestorations and filler particles scattering light, manufacturers have developed composite resins that
are dual-curd which combines self-curing and visible light-curing. Another polymerization
method is staged curing which is a two-staged cure. Howeyer, VLC composites are still the
most popular today.
Remember: Visible light cured composites are single component pastes, and the polymerization process is activated by an extemal energy source. The alpha-diketone initiator (gelF
etu ll.t canphor quirorel absorbs energy from a visible 14 2.1 r n-blue light) llght source. The
ketone absorbs energy and reacts with an amitl.e (added to the s)'sten lo enlut ce the affect of
rhe light-sensitive c..r/alrs, to produce ftee radicals.
\ores
L For large restorations (those that are u,ider than the diqmeter of tlte light tip),
cure each area for the full required time. Do not back off light tip until it lights up
entire sud'ace of restoration.
2. Visible lighrcuring involves light energy in the range of,ll0-500 nm with a peak
intensity ofabout 470 nm.
3. The minimum acceptable level for visible curing light outputs is 300 mwcmr.
Allhough Ihe ADA does not endorse composite resins as a substifutc for a[ralgam in postcrior teeth,
cLrtuposite restorations can be excellcnt if stricl guidelines are follotved for tooth selcction and if the
re\rorations are done properly. But remember. composite resin restorations arc infcrior k) amalgam in
iarms of compressive strength and abrasion rcsistancc foaclr!a/ )rc4rl. Also, curent composite resins
rrr
e no
capabilirv to providc an anticarjogcnic cffect as do freshly placed glass ionomer or resin modiionomers, for example.
i:l.l gla\\
lhc
nrLrst scrious limitation of the visiblc light-cured posterior cornposite restoration is the polymerization shrinkage, \\'hich can cause intemal stresses and gap formations at butt-joint interfaccs. which
r:a ieen rt the gingi\al lloor ofClass II and V resiorations. Important: Stress from polvmcrization
.irinkase is influenced by rcstorativc technique, modLllus ofresin elasticity, polymerization rate, and ca\.
:5 .onlisuration or "C-factor." Thc C-t'acIor is the ratio between bonded and unbonded surfaces; an in.r.iic in this ratio rcsults in incrcascd polymcrization stress. Three-dimensional cavity preparations
,C/,r-rr 1r have the highcst (nost unJbtorable.) C-factor because only outer unbonded surfaces absorb
.irer\ To rninimize the sttess fiom polymerization shrinkagc, efforts have been directed torvard imp:.ir ine placement techniques, material and composite formulation. and curing methods. Incremental
cunnq rc-duces the C-factor und, therefore, reduces the residual stress ofthe resulting composite restora-
tion.
\ote:
Thc major indication for the use ofpostcrior composjtcs is the dcmand for csthetics by thc dcnand paticnt. Othcr criteria are non-involvement of cusps, minimai occlusal contact, no cxce\si\,c
\\car. and the isthmus nrust be no uidcr than onc-thjrd ofthe intercuspal distancc.
Remember: Compositc is thc material ofchoice if the patient has a documented allergy to mcrcury.
ril
Important: In thc past, postcrior compositc restorations were contraindicatcd in a patient with
a carics
aclivc mouth. Ncw conccpts strcss that you should manage the disease (i.e., dental carie.rl bcforc or at
the same time as you are treating the consequence ofthe discasc (i.e., hr placing restorutions). Therctbrc, the currert literature does not see a special probJem for these restorations in caric\'active pctienrs.
They havc as bad a prognosis as any othcr rcstorative trcatment ifthe diseasc is not managed simultaneouslY. Note: However. for the National Boards jt js still a contraindication.
46
Coprdgft t C 201
l':012
- Dental Decks
. Microfills
. Hybrids
. \{icrohybrids
Packables
. Flowables
17
CoDright O 20l l-2012 - Dental Decks
Ideally, composite resins should be used only to restore n.rinimal cavities in posterior teeth.
Its use should be restricted to those instances where it will not be subjected to excessive
occlusal forces and \,!,here, when teeth are in occlusion. there is cusp-to-cusp contact and
not cusp to restoratron.
For Class III preparations using resins, the rule ol extension for prevention into embrasures is disregarded for Class III esthetic restorations. This compromise is for esthetic reasons, as well as the unnecessary removal oftooth structure which will often involve the
incisal edge. Ifpossible, the outline form should place the gingival margin incisally from
thc crest ofthe gingiva.
When placing the composite resin in a Class III preparation, the wooden wedge is placed
in order to provide some separation of the teeth (for contac t), to stabilize the mylar strip.
and to avoid creation ofexcess gingival flash. Important: Restoring the contact area must
be done properly and diIgently.
III
the gingivoaxiaf and incisoaxial line angles (entirely in dentin). These grooves will pror ide tbr mechanical lock in the preparation. Small, rounded retentive areas are preferred,
as contrasted to sharp angles. since it is difficult to insert viscous composite material into
the sharp angles.
\ote: Once proper finishing has been completed, a thin layer ofunfilled resin can be applied as a glaze (this seal.s the nrargiu.s and snroothes the sujitce). The difficulty in finishing cornposite resin restorations is due primarily to the softness ofthe resin matrix and
hardness of the filler particles. The most desirable finished surl'ace for composites is oblained rvith aluminum oxide disks.
The iirst composite resins that were developed contained large filler p^rticles (10-100 mictons in did,rrcrcr'r and became known as macrofill materials. In the past 20
I'ears. rcsin-based composites havc been
imFrlrled b,v reducing particle sizc. increasing filler quantity, improving adhcsion betrvccn filler and or!anic miltrix. and using low-molecular-u'cight monomers to improve handling and polymcrization. By
a\l!'imcntinq rvirh particle size, shape and volume, nanufacftrrers have introduced resin-based
.oinpL)sites \\ ith diffcring physical and handling properties. Microfill. hybrid, microhybrid. packable
r.J il!r\\ able composites now are available to be used for varying clinical situations.
. \[icrofills: are 35 to 50 percent fillcd by volume and havc an average particle size ranging from 0.04
t!, lr I n)icromctcr (lrm). They havc lo*,modulus ofelasticiry and high polishability; howcvcr, they
a\hibit Io$ t'racturc toughness and increascd marginal breakdown.
. Hl bridsi are 70 to 77 percent fil1cd by volumc and an avcrage particlc size ranging from I to 3
Am.
Th.) do nor maintain a high polish but do have improved physical properties when compared with
tr:cro lls.
. \licroh] brids: are 56 to 66 percent filled by volume and have an average particle size ranging from
I t.) 0. E !m. They have particlc sizes small enough to polish to a shinc similar to microfills but Iargc
.nough ro be highly filled, thus achieving higher strcngth. The results are resin-bascd composites with
good ph\sical properties, high polishability and improved wear resistancc.
. Packable compositsi are ,18 to 65 percent filled by volume and have an average particlc size rangrnc iroor 0.7 to 20 pm. Thcir improved handling properties arlj obtaincd by adding a higher percentage of irregular or porous filler, fibrous filler and resin natrix. They arc indicatcd for stress-bearing
arcas and allorv easicr cstablishmcnt ofphysiological contact points in Class II rcsrorations. Research
has sho\\ n that thc physical properties ofpackablc composites are not superior to conventional hl,brids.
. Flonable composites: are 44 to 54 percent fi11cd by volLrme and havc an avcragc particle size ranging frorn 0.04 to 1 pm. Thcir decreased viscosity is achieved by reducing the filler volumc so they are
lass rigid. yet they arc pronc to morc polymerization shrinkage and $,ear than convcntional composites. Flowable composites have becn said to improve marginal adaptation ofposierior composites by
acting as an clastic. stress-absorbing laycr ofsubsequently applicd rcsin-bascd composite incremcnts.
ar
. Improve
48
Cop!.rjghlO 201l-2012 - Dfrral Decls
a higher coefficient
ofthermal expansion
a lower modulus
ofelasticity
49
Coprighr O 20l l-?012 - Dentat Decks
***
Fillers are placed in dcntal compositcs to reduce shrinkage Llpon curing- Physical propenies ofcomposite are improvcd by fillers, howcver. composite characteristics change based on tiller material, surface, sizc, )oad, shapc, surfacc modifiers, optical index.
acts as an adhcsivc betwccn thc inen filler and the organic matrix.
Recentl!,. ions have been added to the filler to produce desirable physical changes. Lithium and
alunlrnum ions makc thc glass casicr to crush to gcncratc small panicles. Barium, zinc. boron, zirconrum. and vttrium ions producc radiopacity in thc fillcr particlc.
t**
\ote*
***
L The normai wear mechanism ofthc compositc resins is best explained by the following
eventsr abrasion ofthe matrix, followcd by cxposure offillcrparticles and subsequent dislodgencnt of thcse fillcr particles.
2. With any ofthe restorative resins, cavity vamish or zinc oxide eugenol should not be used
as they might inhibit polymerization. The use ofa cavity vamish might prcvcnt dircct contact between the composite and the tooth structure, preventing bonding.
The most common classification :nethod for composite resins is based on filler content. filler
particle size, and the method of filler addition. AImost all important properties of conposite resins are improved by using higher filler levels. However, as the filler level is increased,
the iluidity decreases.
Highlr' filled resins typically contain large filler particles but this composition results in
roush finished surface. Smaller
liller
a resin
*** Hl brid resins contain a mixture ofparticles with different diarneters which allows higher
tiller levels and still permits good finishing. The principal particle size is in the I to 3 pm
Charjsma. Herculite XRV, Prodigy, Tetric ,TPH (Total Perforuqnce Hlbrid). and Z- 100 are examples.
\ote: Hybrid
and microfill resins utilize colloidal silica fillers which are useful for in-
creasing the hardness and wear resistance ofthe base rcsin matedal while maintaining high polr.h.rbility rrnd or erall estheric qualities.
. UV light
50
Coplri8ht O 201 l-2012 - Dental Decks
. bis-GMA
. P\{MA
. UEDMA
. TEGDMA
51
a shield betwccn thc lighl tip and thc opcrator's cycs. Paticnrs who havc had rcccnt cataract rcmoval should
havc protcction also. Note: Studics havc shown that thc visiblc light uscd in polymcrization ofphoto-activated mai,
crials can ciusc rctinal damagc always usc a shicld and cycglasscs for pfotcclion.
. For deep restorations, you have to cure thc composilc in incrcncnts ifyou don t, thc dccpcr arcas will not
bc curcd. lmportanti No morc than 1.5-2 mm incrcmcnts should bc Iight curcd at onc limc.
. \'lake sure the bulb in the light is sdll powcrful cnough thcy havc commcrcially availablc p.oducts to tcsl
thc bulb.
litdc longcr.
Unifoft
Creare 9o-desree
unifdfr
Rmolc cdicsi
u.ifom
nol usually
narsin
For csthct'cs, do nor berel Mgins
tnat re on furdion:l pElhs
Prim.n
rctcntion
fom
Secondrry rclcntion
forn
Groorc\. n!tr.
tla'
l!ct\.
nooF, roundcd
in,cmil
P.ovrdc .pproxrndely
Ca
prn\. bonJrn!
Inc
Bond,ngr
gr6vs
&
fdchs lll&v
an!hs
: nnbcls.cn
(,lumr Dc\Ln\iLizcr
tr hcn nnr
hondinq
Dcntal resin composites typically contain a mixture ofsoft, organic resin rntri x (pol-vmer)
and hard. inorganic filler particles (ceramic). Other components are included to improve
the efTicacy ofthe combination and initiate polymerization. The resin matrix consists of
monomers. an initiator system, stabilizers and pigments. The inorganic filler consists of
particles such as glass, quartz and colloidal silica. The matrix and filler are bonded together rr ith a coupling agent. The peformance ofresin composites is dependent upon these
basrc components. The recent improvement in these materials has prirnarily focused on
trller technologv. but the resin monomers have remained largely unmodified.
The orsanic resin matrix is a high molecular weight monomer such as bisphenol A glyjdr I methacrvlate (bis-GMA) or urethanc dimethacrylate (UEDMA). bis-GMA, rvhich
itr. manufacturers add low-molecular-weight f/olr-vrsco.!iry, monomers like triethyleneslrcol dimethacrylate (TECDMA) and ethyleneglycol dimethacrylate (EGDMA);
thcse reduce the bis-GMA's viscosity, increase crosslinking, and increase hardness. Another monomer frequently used as the matrix for resin composites is urethane dimethacrylate. This monomer was introduced in 1974 and is a brittle material with low viscosity.
Important: The high filler content and the bis-GMA resin matrix drastically reduce the
(as co mpared to the unfilled acrylic resins).The filler also
. Ethyl Methacrylate
. IsobuWl Methacrylate
. bis-GMA
. Ethylene Imine
. Methyl Methacrylate
52
CoD,riglit O 201 I -20 l2 - Denral Deck
. Amalgam
. Gold
. Unfilled resin
. Filled resin
For both inlays and onlays, plastic r'acry,1ic) provisional restorations are fabricated prior to the
final restoration being cemented. Their physical properties enable them to withstand occlusal
ibrces and the adverse oral environment for short pedods of time. These temporaries must:
restore and maintain proxilnal contacts, restore and maintain the occlusion, restore and maintain tooth contours and the margins should be closed and flush with the tooth.
Methyl methacrylate, ethyl methacrylate, and ethylene imine resins have been employed to
produce provisional restorations. However, methyl methacrylate /MM.4/ is by l'ar the most
common. lt is the liquid monomer that is mixed with the polymer polymethyl methacrylate
(the powler). The monomer partially dissolves the polymer to form a plastic dough.
Note: The monomer is polymerized by the action of an initiator (benzoyl peroxide).
Important: Methyl methacrylate maintains the occlusal and interproximal contact relationships.
Remember: Polyme zation should not go to completion in the mouth for fear of overheating the pulp and that the provisional will not be able to be removed from the tooth.
These provisionals are usually cemented in with a ZOE cement.
\ote:
- Intracoronal Restorations:
. ZOE-based and/or ZOF-ba.ed temporaries
- Preformed Provisional Shell Crowns:
. Polycarbonate Crowns
. \letal Alloy Crowns
- Custom-Fabricated Proyisional Crowns:
. \{N{A-like
compensate for
This characteristic probably offsets to some degree the undesirable effects of the relatively high coe{ficient ofthermal expansion, which is 7 to 8 times that ofthe tooth. Due
to this low thermal conductivity and diffusivity, the unfilled resin restoration changes temperature quite slowly. Therefore, it takes considerably longer for the unfilled resin restoration to become hot or cold, as compared to metallic restorations, which have a high
\ot*
.
The compressive strength of the unfilled resin is low; the yield strngth
and tensile strength are even lower
2. Unfilled resins are the softest of all restorative materials //ou, vlear resist1.
ance
-no Jiller)
with amalgam, filled resin, direct gold and silicates; unfilled
3. Compared
resins show the greatest extent of marginal leakage related to temperature
change (percol ation)
54
Copright O
201
3 79,'o
Hydrochloric acid
+** This is false; acid etching does not increase the esthetics ofthe enamel margin. Do
not be confused by the fact that you acid etch the bevel, which itself functions for retention and esthetics.
One olthe most effective ways ofimproving the marginal seal and mechanical bonding
ofcomposite resins to tooth structure is to condition or pretleat the enamel with acid prior
to insertion ofthe resin. This procedure is referred to as "acid-etch" t"hni'"'
Purposes of acid etching:
Important: Acid etching paves the rvay for resin "microtags" ivhich produces a much
inrproved bond of the resin to the tooth. The effective tag length as a result of etching
on adult anterior teeth has been demonstrated to be approximately 7 to 25 mm.
This "acid-etch technique" consen'es tooth structure, reduces microleakage, improves
estlletics. and provides micro-mechanical retention.
\()1e3
Standard acid etching ofenamel involves the application ol37% phosphoric acid for l5
seconds with a l5-second rinse and a l5-second drying to roughen the surface of the
enarrel. This lonns little tags approximately 7-25 micrometers in length, providing mechanical retention. When using the acid etch technique all enamel cavosurface margins
should be chamfered or beveled (this process fonns obtuse angles).
Be\ eling the enamel margins of anterior resin composite preparations is recommended
prilrr lo etching to:
. Reduce microleakage
. Irnpror e eslhetics: by gradually blending the resin composite into the enamel
Remember: Once you etch the tooth, it cannot be contaminated with saliva.
Ifit
does, you
I0te3
. more, easler
less, harder
. more, harder
less, easier
56
Coplright O 201l-2012 - Dent.l Decks
. Intemrbular dentin
decalcifi cation
***
When restoring teeth with composite resin, it is much easier to compress the material into rounded line angles.
The outline form ofa Class V restoration is not always uniform, as it will vary depending on the location and amount of caries or decalcification
size and location of the
-the When the carious tiscarious lesion determines the outline fonn ofthe cavity preparation.
sue has been removed and the margins are on reliable enamel or dentin, the outline will
usually be rectangular with the comers round, ovoid, or kidney-shaped, very much resembling the amalgam Class V preparation except that the intemal line angles are much
more rounded.
Recent research indicates that preparations with bevels are more resistant to microleakage as compared with those without bevels when an acid tch technique is used. The
bevel permits the acid to attack the enamel rods at the appropriate angle for maximum effect. The cavosurface nargin is beveled wherever it is placed on enamel -- this is a major
diii-erence betrveen composite and amalgam preps. When possible an enamel bevel 0.2 to
0.5 mm uide is advocated as the final stage ofpreparation. This bevel is etched and pror ides retention for the restorative material as well as improving the marginal seal and
mainraining the strength of the resin with su{ficient bulk. Retentive grooves supplement
the etched enamel retention (these grooves are placed in both inci,sal ond girtgival axial
line andes).
\ote:
Whenever possible, use a composite syringe to place the composite resin in the
resroration, this will minimize the possibility of trapping air in the final restoration.
(Kuraray)
l-component s]'stems (E + P+ B)
. S..rchbond \luhipurposc Plus (lM)
. Prr--:r3quick (Lltradcnt)
. B.nd-lt {Jcncnc Pcntron)
. \:l-Bond I (BISCO)
Grr.yrtionr oiDcntin Bonding Systctrs /rAS).
I Firjt Gencralion DBS's (bonded to smcar laycr)
(EPB)
. Bond-l (Jcncric'/Pcniron)
:
I
(r.
7. S.\'enth Ccncration DBS's: adhesivcs rcquirc no mixing and arc simply placed in onc stcp.
L Dentin and cnamel bonding strcngths arc simllar tbr currcnt total-ctch products.
.,,--_..
-\ore3
.
atlAAr;,.
Must lotrl clch dcntin bonding systems bond bcltcr lo moist dcnlin. usc Aqua Prcp orCluma Dcscn\rLrzcr to kccp ocnrrn mor\r.
3.lnamcl bonding is fhst, strong, and long-lasting; dcn(in bonding is slower, may bc strong, bu1 may
.2.
not bc longlasting.
A gold onlay you placd last week fails, which ofthe following
reasons is most likely responsible for the failure?
58
Cop)'right C 201l-2012 - Dental Decks
. Annealing
. Quenching
. None of the above
59
Coplright e 20ll-2012 - Dental Decks
*** Important:
Onlay preparations:
. Resistance form: two types of cuspal protection:
l. "Capping": refe6 to the complete coverage of functional cusp with 1.5 mm ofgold.
2. "Shoeing": refers to veneering of non-functional cusp by means ofa slight finishing
bevel.
Note: Except in situations demanding a minimal display of gold (primarill, the ./hcial
naxillary molars and premolars), capping is always preferred over shoeing.
cusps oJ
r----al
IH
Shoeing
L The noble metal alloy is left in an annealed condition for burnishing, polishing, and
procedures it maintains its malleability and ductility.
:. \\hen the water contacts tlle hot investment. a violent reaction ensues. The investnent becomes soft and granular, and the casting is more easily cleaned.
similar
Remember: The set of processes, annealing, hardening and tempering are collectively
krorr n as "heat treating."
. -{nnealing is the softening ol a metal by controlled heating and cooling to make its
manipulation easier. It makes the metal tougher and less brittle.
. Tempering is hardening something by heat treatment.
CopltiShr O
Z\
'
201
60
l'2012 - Dental Deks
Gold Ntloys
upon solidification in the investment This needs
to be compens*ted for by an equal amount of_
ofthe mold.
. Shrink, expansion
. Expand, shrinkage
. Shnnk, shrinkage
. Expand, expansion
61
Cop)'righr O 20ll-2012 - Dnral Decks
. In patients with
. Young patients
periodontal health
. Strngth
.ln
Gvpsum bonded investments are used with Type I. II, and III gold alloys. Gold alloys
used for cast gold restorations shrink upon solidification. Therefore, it is necessary to
compensate for the solidification shrinkage of the specific alloy used by expanding the
mold enoueh to equal the shrinkage.
The dimensional compensation necessary is accomplished by tu'o methods ofexpansion:
1. Setting expansion: occurs as a result ofnormal crystal growth but can be enhanced
by'' alJo$ ing the investment to set in the presence ofwatel producing hygroscopic ex-
pansion.
2. Thermal xpansion: is achieved through the normal expansion that occurs upon
heating the silica (quartz or cristobali/e). Note: The amount of expansion depends on
the particular refractory material used (cristobalite produces greater expansion than
does quartz).
Important: Thermal expansion is the principal cause for mold expansion.
less
it will
expand
Note: During solidification ofan alloy, the number ofgrains forming depends on the rate
. Knife edge
. Beveled shoulder
. Chamfer
Shoulder
. Undercut on mesial
. Undercut on buccal and lingual walls
. Occlusal lock (dovetail)
Deks
a hollow ground bevel. lnstead ofa flat diagonal cut across the
cavosurface margin, the chamfer is "scooped out" creating rr.rore bulk ofrestorative material near the margin and providing a greater cavosurface angle.
A chamfer is essentially
Cavosurface angle configurations that are used when preparing a tooth for a cast gold
restoration:
. A bevel is a diagonal cut across the cavosurface margin which is flat in one dimension only and curved in its other dimensions. It involves the extemal ends of enamel
prisms and follows a continuous cuwed outline. It can be either a short bevel which
cuts only the external one-third of the enamel prisms, a full bevel involving the entire thickness of enamel. or a wide bevel involving not only enamel but some dentin
as well.
. A plane is a diagonal cut across the cavosurface margin which is flat in all dimensions. A plane may involve the entire thickness ol enamel (u,hich it usually does) or
most of it but cannot be curved in anv direction.
When designing a Class II preparation for an inlay, an occlusal lock or dovetail should
be established to prevent proximal dislodgement. Also, the marginal ridges ofposterior
teeth that are restored with cast gold should be rounded to help form the occlusal embrasures and be in contact with the cusps ofthe opposing teeth. Marginal ridges should
be the same height as the adjacent tooth's marginal rtdge (or else you can create an inturlArence in retrusive movemenl).
The cement does provide some retention; however, the preparation design
does as well. The cement's main function is for marginal seal, not retention.
2. When rernoving a Class ll inlay, the method of choic is to cut through the
isthmus to remove the occlusal and proximal pieces one at a time.
3. The restoration will not seat ifthere are undercuts. Actually this holds true
for all cast metal restorations. See picture above ofa Class II inlay prepara-
tion.
A patient arrivs at your oflice with their full gold crown in hand,
They explain to you thlt anothr dentist delivered itjust last welc
You then examine the crovm and the preparation.What is the
most likely reason the the crown fell olf?
l5'
64
CopFightO 20ll-2012 - Denbl Decks
The lab calls your o{fice and asks ifyou want a prrticular
casting done in N base or a nolrle metal. Which of the
Copright C
201
65
l-:012 - Dental Decks
Taper provides the optinal friction between the walls and the casting, which is the main retention. The f'enule (or height) of the preparation also provides the friction and thus retention,
but 4mm is enough /3 nn is minimarl.
lmportant: For maxjmum retention ofcast gold restorations. the axial walls should be as parallel as possible and as long as possible. Retention is directly proportional to the area ofthe
axial walls and their parallelism. The axial walls should converge slightly frorr the gingival
walls to the pulpal wall.
b\t
also to provide for an appropdate small angle of divergence (2 to 5 defrorn the line ofdraw which will enhance retention form.
per t'all)
Ke\ point: More parallel - more rerenlion
grees
. Circumference
-{di antages of
. The.v are very strong and able to withstand the forces ofmastication
. Thel
. Cost
.
.
.
.
Time-consuming
Difllculty of technique
The need to use cement, which is the weakest point in the cast gold restoration
tri temperature.
Base metal alloys i/also called non-precious netols) arebased on active metallic elements
lhat conode. but which develop corrosion resistance via surface oxidation that produces a
rhin. righrl) adherent film, which inhibits further corrosion. Exarnple: Cobaltchromium alIt l : ibrm a Cr.O3 oxide film, which passivates the surface. Base metals are less resistant
i(-' corlosion. Base metal alloy advantages are principally found only in their strength and
lo$ densit\',
T1pes of
t
allol systemsi
olid it.\')
the metals freeze without segregation of the individual constituents. )iote: Are generally used in dentistry because they have a very homogenous
stmcture an provide maximum strength.
. Eutectic alloys: separatc into individual grains of the respective constituents. Exhibit complete liquid solubility but limited solid solubility. Example is the silver-copper system.
Remember: Nobfe metals /a/so called precious melalt are very resistant to corrosion
and do not oxidize on casting. Noble systems for dental use are based on the noble or precious metal elements gold! silver, palladium, and platinum.
. Copper
30%o
. Greater than
50o%
. Greater than
75o%
***
Gold actually increases ductility and malleability. It also increases resistance to tar-
Compound
Gold (Au)
Coppe. (Cu)
Increascs hardness
Sil,ver (Ae)
Main purposc is to modify the orange color ofcoppert reduccs melting tmperalure;
increases duciility and malleability
Platinum (Pt)
Raises melting temperaturet increases tcnsilc slrength; decreases the coelfiient oflhermal
exDansion: reduces tamish and corrosion
Palladium (Pd)
Raises melting temperature; increases hardness: acls to absorb bydrogen gas which can
cause porosities in lhc casling; prevents tamish and corrosion; has a very strong whilening
eflecl on gold alloys even when used at a low concenlralion (i.e., 5 wt%)
Ztnc (Zn)
Acts
as an
oxygen scavenger and prevenls oxidation oflhe olher melals during the manufac-
luring process; increases fluidity and decreases surface lensions, which increases castability
be bumished.
l.
ADA
Ipe lll:
greater than 750lo noble mctals. Inlcnded for onlays and crowns. Capable
of
being heat-trcatcd.
-\D-{ t}pe lv: greater than 75% noble metals. Intended for bridges and removablc partial
dentures. ,,\lso capable ofbeing heat-treated. Hardest ofhigh-gold alloys.
-+.
T! pe
Hardness
Soft
<140
l8
II
Medium
140-200
l8
It
Hard
201-_t40
t2
IV
Extra-Hard
>340
t0
The following statements describe an MOD gold cast onlay preparation. Which
would you have to change in order to ensure the onlay will be successful?
has an ariopulpal line angle that is longer from facial to lingual than
the distal axiopulpal line angle is longer than the mesial axiop-
has an axiopulpal line angle that is shofier from facial to lingual than
68
Copyighr 20ll
20ll
DentalDecks
OPERATIVE
Gold
. Small retentive undercuts placed in the axio-occlusal and axio-gingival line angles
. \Iesial
and distal walls that flare and meet the cavosurface at a 90o angle
. An axial wall that is convex and follows the extemal contour of the tooth .5mm into
dentin
69
Copynghr L.l 201l'201: - Dental Decks
Remember:
. When preparing teeth with short clinical crowns, the facial and lingual walls should
have a minimal gingival to occlusal divergence angle for maximum retention.
. From facial to lingual, the axiopulpal line angle of an onlay preparation is longer
than the axiogingival line angle (l ll \rere not, the pt?paration would be undercut and
tlrc onlay would not.seaf. For an MOD onlay prep, the axial walls must converge from
the gingival walls to the pulpal wall (fbr the same reason, tlte onlqrvrould not seat iJ
they diverged).
\ot*'
L The bevel (0.5 mm vidth) on the cavosurface margin permits closer adaptation of the gold margin because the thinner margin of gold overlying the
bevel is more ductile and is able to be bumished. The desirable metal angle at
the margins ofonlays is 40 degrees, except gingivally, where the metal angle
should be 30 degrees. Note: You can bumish a 30- to 40-degree gold margin,
less than 30 degrees rnay be too thin and break, greater than 40 degrees may
be too thick and will not bumish.
2. During cementation, the finishing /burnishing) ofthe margins ofa cast gold
restoration should be starled as soon as the restoration is well-seated into the
preparation.
3. While preparing a tooth to receive an inlay or onlay. a gingival bevel is used
to remov unsupported enamel and to compensate for casting inaccuracies. Gingival margin trimmers. carbide finishing burs, or fine, tapered diarronds are used to place this bevel.
4. This gingival margin is always placed gingival to the contact area.
filling gold:
The outline form is usually either trapezoidal (most popalay' or kidney-shaped. The
axiai wall is placed .5 mm into dentin (this u'ill make the occlusal u'all slightl,- deeper
tha the gingiral wqll because there is a thicker la.,-er ofenamel nnking up the occlu'
-sc/ rla//,). The mesial and distal walls are placed at the line angles ofthe tooth.
The retention form is attained by shalp intemal line and point angles (a-rio-gingival
und utio-occlusal).
. The resistance form is provided by flat mesial and distal walls and a convex axial
s all rvhich parallels the external surface of the tooth.
\ote:
The axial rvall is convex in a mesiodistal direction in order to conserve tooth strucrure and minimize pulpal initation.
Important: The rubber dam is essential to prevent contamination of the gold with salila. A cervical clamp usually is necessary to retract the gingiva (#2 | 2 ivory clamp). The
hole that is to be punched in the rubber dam lor the tooth that is being restored should
be located facial to the nomal alignment with the adjacent teeth.
. Both
. Both
70
Cop)'right O 20ll-2012 - Denhl Decks
. Reduced flow
stress
71
The purpose of the sprue former or sprue pin, as it is usually called, is to provide an
ingate or sprue in the investment through which the molten alloy can reach the mold
after the wax has been eliminated.
The size of the sprue former depends to a considerable extent on the type and size ofthe
paftem, the type ofthe casting machine to be used and the dimensions ofthe flask or ring
in which the casting is to be made. Generally, however, for the average size pattem, sprue
formers smaller in diameter than approximately 1.5 mm are contraindicated. tla sprue is
too small, the molten metal freezes completely in this area first, and localized shrinkage
porosity results. The general rule for sprue pin diameter when using a centrifugal type ol
casting machine is that the diameter ofthe sprue pin should be equal to or greater than
the thickest portion of the pattem.
..Ls a general rule, it is desirable to attach the sprxe at the point of greatest bulk in the
pattem. There is less chance ofdistortion upon attaching the sprue, and the molten metal
is more apt to remain liquid in this area until the entire mold is filled. The direction ofthe
sprue former is also impoftant. It should never be attached at a right angle to a broad flat
surface of the mold. The entering hot metal impinges the mold surface at this point to
cause turbulenc ofthe metal, which, in tum, creates a shrinlage void or suck-back porosir). \\'hen the same pattern is sprued at an angle of 45o to the proximal wall, a satisfactory casting is obtained.
The three types ofinlay waxes differ in terms of melting point and flow:
1. Type A: hard or low-flow wax that is rarely used except in some indirect technique
2. Tvpe B: medium-flow wax that is used in some direct techniques.
3. Type C: soft or high-flow wax that is used in indirect techniques for the construction of inlays, onlays, and full crowns.
fhe essential ingredients ofa successlul inlay wa"r are paraffin wax, gum dammar and carl ax with some coloring material. Paraffin wax is generally the main ingredient,
usualll in a concentration of40-60%. Gum dammar is added to the paraffin to improve
rhe smoothness in the molding. It also increases the toughness of the wax. Carnauba
war is quite hard and tends to decrease the flow ofa wax.
nauba
\ote:
Ho\r'ever the pattern is prepared, it should be an accurate reproduction ofthe missing tooth structure. The casting can be no more accurate than the wax pattem. The wax
pattem should be invested as soon as possible after fabrication in order to minimize
changes in shaped caused by relaxation ofthe intemal stresses in the war.
. Both
72
Coplri8hr C
201
cases
etc.
tooth with minimal femrle, where a full coverage crown would not have
enough retention
73
a
porosity ofthe set material, and ultimately weaken the set material.
,l. \lodifiers are added to modify various physical properties ofthe investment. These
rrodifiers include magnesium oxide, sodium chloride, boric acid, graphite, or potasssiurn sulfate.
A fenule effect is defined as the envclopmcnt ofthc tooth stmcture by a crown. According to recent studies. L 5 mm oftooth structure is sufficient to ensure the tmnsmission of the forces of mastication to both
rhe post and the tooth. A tooth that is fractured at the gumljne offcrs no form olresistance to transversal
torces. The post must take on the entire load and it is inevitablc that ccmentation fails.
Requiremcnts for a good ferrule efLct:
. Lr I mm ofbuccal and lingual subgingival tooth srucftre
. . nm uf r.\){h lhrckne:. after aJequ:rtc preparatiun
. J mm ofsuprabony tooth structure
is that it can permanently restore and reinforce a tooth by a consen ati\ e technique. r\lthough conscrvation oftooth structure is desirable, such action is oliset by a lack
oi rcrcnrion. It has been shown that conservative onlays have inferior retcntion comparcd to full crowns.
Thii is duc to the cro$n's greater axial surface area.
561js
l. Retentive features: parallelism ofvertical surface /lr,r:idl 11411t is the primary retentive
feature ofan onlay preparation. Sharp point and line angles add to retention.
2. Auxiliary retentive fcatures include a box or a groove. Thcse features may bc indicated
where inadequate surface atea ofvertical walls is present. A box olfers a greater increase
in surface area, thus greater retention than a groove, but is also more costly in terms of
lost tooth sfructure.
3. Thc location ofthe gingivalrnargin in the preparation ofproximal surfaces is influenced
by the amount of retention required, the need to ertend gingivally to clear the contact
area and convenience form.
On delivery ofyour lirst ever crown, you notice that the margins are
open when you rttempt to seat the crown in the mouth. Which of
the following should you check ffrst?
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Ifa
casting lails to completely seat on a prepared tooth, one should first check for residual temporary cement or other debris on the prepared tooth. Once all the temporary cement and other debris are removed, the first stp in fitting the casting in the mouth is to
adjust the proximal contact areas.
These defects. or nodules, are caused by the collection of air bubbles during the investing The best way to help eliminate these defects is to subject the water-tnvestment mtx-
rure to a vacuum during the investing procedure in order to remove the air bubbles.
The porosity ofthe investment is definitely reduced by vacuum investing, presumably beofthe increased density obtained. As a result, the texture ofthe suface ofthe cast-
cause
ins js somewhat smoother, with better reproduction ol fine detail. The compressive
strength ofthe investment is increased slightly by the vacuum investment (the investnient \t Ill not /iacture as eas!-).
\ot
all of the air is removed by the vacuum treatment. The amount removed depends
of the mix. The more yiscous the mix, the more air
bubbles remain in the investment. However, a thick mix is usually necessary because of
the desired shrinkage compensation and because of the poor surface texture that is obtarned Nith a thin tlix.
jLrme\\ ltat upon the consistency
You are preparing tooth #19 for a MODB gold onlay and tooth #18 for a MODB
amalgam restoration. Which of the followlng TWO statements correctly
describe the dilference in your preparations ofthe functional cusp?
. You will
The modifred pen gnsp is the most common instrumnt grasp in dentistry;
this is because it allows for the greatest intricacy tnd delicacy oftouch.
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Remember:
Working
Amalgam
2.5-3.0 mm
Non-working 2.0 mm
\otes
..
Cast Gold
Metal-Ceramic
1.5 mm
1.5-2.0 mm
1.0 mm
1.5-2.0 mm
decrease 1ml
Important: The most effective means for verifuing adequate occlusal clearance is a wax
bite chew-in.
With this grasp the middle finger, index finger, and thumb all rest on the handle close to
the junction of the handle and the shank. The middle finger rests on the shank and the
rhumb and index finger are opposite each other on the handle. (See photo below)
The inlerted pen grasp is very seldom used, however, sometimes it is used lor cavity
preps utilizing the lingual approach on anterior teeth.
The palrn and thumb grasp is the most powerful grasp and is most effectively used on
the maxillary arch. It is similar to the grasp used for holding a knife while paring the skin
from an apple.
The modified palm and thumb grasp allows much ofthe power of the palm and thumb
grasp but also permits more delicate control. It works best when you can rest the thumb
on the tooth being restored or on the adjacent tooth. It also works best on the maxillary
arch.
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OPERATTVE
Th
the
the
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be positive or ncgativc.
Generally speakrng, soft materials such as acrylics are cut mosl effectively with positive rake angie burs;
whereas cxtrcmcly hard and brittle materials /suth as analgan) ate best cul with ng|tive rake angle burs.
A rakc anllc is said to bc ncgativc whcn the rakc facc is ahead olthc radi$ (/ionl the (:utitlg edge to the atis
ofthebut).A^egllverakeanglcminimizesfi?cturesofthecuttingedgethathelps!oincreasetheburlife.lncreasing the edge angle reinforces the cutting edge ofthe bur and reduccs the likelihood ofrhe blade to fiacture.
Carbide burs used for cuiting looth structure gcnerally havc slight negativ rakc anglcs and edge angles of
approximately 90 . To be most effective, these burs should be rotating rapidly befor contircting the tooth.
The clesrance angle is also anothcr importanr factor in bllrde design. The clearancc anglc senes io climinatc
friction ben'een the clearance face and the new tooth structure exposed by lhe curting edgc. The gresfer the
clearance angle, the less friction.
srlrdclrnl C\ . Rob.F
in T\l.lieynran. HO.
\11
'
cross sec-
culting procedurc:
. The clearanc angle is the angle formed between the clearance face and
to the path of rotation.
tangent
.10mm
1.0 mm
. 0.85 mm
. 0.80 mm
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,PERATfVE
. Both
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Cutting instruments have formulas describing the dimensions and angles olthe working end:
. The first number indicates the width of th blade in tenths of a millimeter I 0 mm
(t 0 x . l) for the example on the front of the card.
. The second number indicates the primary cutting edge angle in centigrades 85 for
the example on the front ofthe card.
. The third number indicates the blade length in millimeters 8 mm for the example on
the front ofthe card.
. The fourth number indicates the blad angl in centigrades l4 for the example on the
front ofthe card.
***
l.
3. Gingival margin trimmers: are similar in design to the enamel hatchet except
it has a curved blade and an angled cutting edge. They are primarily used for beveling gingival margins. Among other uses for these instruments is the rounding or
beveling ofthe axiopulpal line angle of Class II preparations (very important).
. Hoes
Sharpening line angles and convenience points for gold foil preps
. Angle formers
. Ordinary hatchet
. Spoons
Class
a2
Coplright C 201l'?012 DentalDecks
You set down the hrnd piece after preparing a Chss II rmalgam
on tooth ti4. Your assistant hands vou a
so you
can remove the last bit of caries. and then the
so
you can plane the facial and lingual wllls ofthe prep.
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l. The hoe excavator: has the cutting edge ofthe blade perpendicular to the axis
the handle. It is commonly used in Class III and V preps for direct gold.
of
2. The angfe former: has the cutting edge at an angle (other than 90") to the blade.
It is used for sharpening line angles and is especially useful to form convenience
points for gold foil preps.
3. An ordinary hatchet excavator: has the cutting edge of the blade directed in the
same plane of the handle and is bibeveled. Used primarily on anterior teeth for
preparing retentiv areas.
A spoon excavator: has a curved blade with a rounded cutting edge. It is used to remove carious dentin and sometimes to carve amalgam,
.1.
\ote:
***
The enamel hatchet is the only instrument that will allow the dentist to have proper
access to the margins and that will impart the proper cavosurface angle to the margins.
Spoon excavators are used for removing caries and cawing amalgam or direct wax pattems. The blades are slightly cuwed and the cutting edges are either circular or claw-like.
The circular edge is known as a discoid, whereas the clawlike blade is temed a cleoid.
The number of bevels that make up the cutting edge can classify hand cutting instruments. For xample, enamel hatchets and chisels have single bevels, whereas ordinary
hatchets (fbr exqmple excavators) have two bevels and are called bibeveled.
Dental hand cutting instruments are angled to:
. Provide better manipulative control
. Produce a better distribution of force
. Increa-se elficiency
. Lsl3blish proper balance u hen in
use
Instruments used to
To polish a restoration you wlll likely use a bur with less cutting blades.
This is because less cutting blad$ cut more efficiently.
. Both the statement and the reason are correct and related
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There are several tlpes ofbleaching products tvailable for use at home'
which can either be dispensed by a dentist or purchased over-the-counter.
tray-applied
Curren$, only dentist-dispensed home-us
gels carry the ADA Sal.
159.'6
hydrogen peroxide
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*** Important:
Thc greater lhc numbcr ofculting bladcs on a bur rcsults in less efficint cutting but a smoother
suft^ce lpolishing hrs arc ol lhi\ l|pe). Alcsser numbcr of bladcs on a bur rcsulrs in more efficient cuitine but a
rougher sur{ace. Crosscut t'issurc burs al high spccd or low spccd arc ofthis r}pc.
Parts
ofburs:
I. Shank: thc part lhat fits into handpiccc. Thc thrcc most common tlpcs arc straight. latch-r]"pc anglc and tiictron-gflp anglc.
2. Ncck: {hc irtcnncdiatc portion ofa bur that connccls thc hcad to thc shank. lrs main lunction is to transmit ro!
tational and translational forccs to thc hcad.
3. Head: thc $'orking pan of $c bur the cutting edges ofwhich pcrfonn thc dcsircd shaping of tootb structure.
Types of burs:
. Sttel hts&t Dtostlr /t)t linishing prorcdure\)
. C^rbidc (used /ot, Larit| prepardtio : pe|orn best at high speeh)
Shapes of burs: rcfcrs to thc contour ofthc hcad. Thc basic hcad shapcs arc round, inveried conc, pcar straight fisiurc and lapcrcd fissurc. Note: Within a givcn scrics ofburs, thc smaller numbers rcprcscnt small burs; thc largcr
. Raduced
.(
-r
Th. rotational speed ofan instrumcnt is mcasurcd in rcvolutions pcr minutc /?rr. Thcrc arc 3 spccd rangcs: slow
\.:t,. i:na)1tpDt) intcnnctliarc (1:.000 to 200,000 rpnr, andhigh (ahore 200,A00 ryn, spcc.J.Tbc most uscfulin::r.r:..nti i.c rotatcd at either low o. high speed. Thc crucial lactor fbr somc purporcs is thc surfacc spccd ofthc in:rrl1r.rr- rhc \clocit) a1 which ihc cdgcs oflhc cultilg inslrumcnt pass across lhe surlhcc bcing ut. This is
.rr.rnion.rl Io borh thc rolalional speed and Ihc diamctcr oflhc inslrumcnl, with largc instrumcnts having highcr sur:=.J .:.Jds
3t
Di.mond abrasile instrumentsi involvc abrirsivc rathcr thar bladc cutting. Thcsc instrumcnts arc bascd on small.
.:r:.:u :r prnrclcs ofhard substanccs hcld in a matrix ofsoficr nratcrial. Diamonds consist ofthrcc parts: a mctal blank,
::::1Lr\\dcrcd diamond abrasive, and a mctallic bonding matcrial fiat holds thc diamond powdcronto thc blank. Thc
:::rnk in many $ays rcscmblcs a bur \r,ithoul bladcs. Il has $c samc csscnlial parts: hc!d, ncck. and shank. Thc clinr.:: p.rlbnnancc ofdiamonds depends on thc sizc. spacing. unifonnit!, cxposurc. and bonding ofthc diamond par-
t:.1.i
Di.rmond particlc sizc is commonly catcgorizcd as coarsc. mcdium. llnc. and vcry linc.
:. *-\t
home": the active ingredient contained in all of the at home tooth whiteners
* hich have eamed the ADA's seal, and the compound which has been evaluated in
rhc \ ast majority of at home bleaching studies, is carbamide peroxide at a concentration of 109/o. The active ingredient found in most over-the-counter at home bleachins products is not carbamide peroxide but instead hydrogen peroxide.
\ote: Bleachins
can affect the color ofdentin and enamel. Extrinsic stains respond best
:o r ital beaching. Response is best with yellow stain followed by brown and orange. The
\\ orsl response is from gray starns (tetracycline staining).
. Operator zone
. Assistant zone
. Transfer zone
. Patient zone
Static zone
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The operator and the assistant should concentrate on positioning themselves in work circles. The dentist's work circle should allow easy and unobstructed access to the patient's
mouth. The assistant's work circle should include all instruments and supplies needed for
the intended operation. also allowing access to the transfer zone to bring the necessary
items to the dentist. When viewed from above with the patient's head in the l2:00 o'clock
posrtion, the right handed dentist will operate in an area from 8:00 to I l:00 o'clock. This
area is the operator's zone. Nothing should be in this area that would interfere with the
free movement ofthe dentist. The area from I l:00 to 2:00 o'clock is called the static zone.
This area is reserved for the mobile cabinet and nitrous oxide apparatus. The area fronl
2:00 to 5:00 o'clock is the assistant's zone. Although the assistant will not move as much
as the dentist, nothing should be positioned in this area that would hamper the assistant's
free access to the oral cavity, mobile cabinet and dental unit. The area form 5:00 to 8:00
o'clock is the transfer zone. This area is reserved for the transfer of instruments, medicaments. and supplies to the dentist. Also, the dental unit should be positioned within this
arc.
***
. Fluoride Supplementation
. Scrupulous dental care is essential
Antichofinergic drugs (u,iici block receptor sites./or acery*lcholine) decrease salivary
tlos and respiratory secretions during surgery Examples include: atropine, scopolamine,
methantheline, and propantheline bromide.
Don't forget: Local anesthetics aid in reducing the flow ofsaliva during operative procedures by reducing sensitivity and anxiety during tooth preparation.
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OPERATIVE
Atooth was restored 3 months ago by a new associate of yours. The patient
complaining of mobility and thermal sensitivity, You trke a periapicrl
radiograph. You could see all ofthe following in that radiograph to
your suspicions, EXCEPI one. Which one is the EXCEPTION'!
conlirm
.
. H)?ercementosis
. Root resorption
. Periodontal pockets
. Alteration ofthe lamina dura
space
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is
***
will
Buccal
brfitcial)
Functions of embrasures:
I . N4ake a spillway lor food during mastication
Protect the gingival tissue from undue frictional trauma, but at the same time pro-
The height ofcontour refers to the thickest portion or point ofgreatest circumference
of
rhe tooth when viewed form the incisal or occlusal surface. Its functions include forming
the contact area on the mesial and distal surfaces and protecting the gingiva surrounding
rhe tooth.
*"*
YoLr should have suspected that the restoration was high, based n.rainly on the mobility
l'actor. Occlusal trauma can still cause periodontal pocketing; however, that cannot be
seen on a radiograph.
of
the toodr
\ote:
The radiograph ofchoice for evaluating root surfaces, suppofiing bone and the pe-
Z\
When restoring the embrasures of posterior teeth th contect
should be formed stightly buccal from center.
This will create a wider facial embrasure.
. Both
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. Percussion sensitivity
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***
This will create a wider lingual embrasure and a nanow facial embrasure.
primary purpose ofthe proximal contact relationships between adjacent teeth in the
dental arches is twofold. This relationship serves both to stabilize the dental arches by the
combined support of the individual teeth and to prvent the impingen.rent offood material on interseptal tissues between the teeth
The
Form embrasures
The loss of proxirnal contact between teeth nray result in periodontal disease, malocclusion. food impaction, or drifting ofteeth.
Remember: When viewed from the facial, all premolars have their contacts at the iunction of the occlusal and middle third. From this same view. molars have a proximal
contact located in the middle third. Fron.r the occlusal view, all posterior teeth have contacrs. r hich are located slightly buccal of the middle third (mesial and distql). This creates a rvide lingual and a nanow facial embrasure.
***
A tooth with percussion sensitivity could need caries control with a sedative temporary filling. lt could also need occlusal adjustment (vhich can cause reversible pulpitis os
Pulpal necrosis is the death of the pulp. A tooth aff'ected with a necrotic pulp may have
no painful symptoms. It may appear discolored. The EPT /electric pulp tester) will be of
r alue because there will be no response at any current level. The tooth sometimes respexds to heat, but will not respond to cold. Treahnent is root canal or extraction.
is characterized by pain, which is commonly triggered
(acate
apical periodontitis) alone is not indicative ofan
br chen ing or percussion. AAP
irrer ersible pulpitis. It is indicative that the apical tissues are irritated, which may be associated \\ ith an othenvise vital pulp rvith a potentially reversible pulpitis. In the absence
oircue pain. a negative EPT test or a frank apical radiolucency. a carious tooth with sensirir itr to percussion may respond to caries control (tentporary flling). If it doesn't re-
-.pond to a sedative
Treatment
Pulpal Diagnosis
Cold Response
Normal
Reversible pulpltis
RCT or extractlon
Necrotic pulp
RCT or extraction
No response
On the lirst d|y in your solo privNte practice you have r pulp exposure.
All of the following are favorable factors in avoiding root canal
treaturcnt EXCEPI one. Which one is the EXCEPUOM
. It is
a mechanical exposure
. The tooth
of lmm
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The ideal amount of time lrom placing an indirect pulp cap until
rcopening the tooth to remove the remaining decay is:
.7 - l0
days
.2-3weeks
. I month
.3-4months
.I
year
. Never,
r.rnless
Direct pulp capping involves the prompt application ofa setting calcium hy&oxide cement
to a "pinpoint" /ess thq l mm h diameref, well isoJated traumatic pulpal exposure. This procedure may be expected. in most instances, to stimulate the fbmation ofa reparative "dentin
bridge" over the exposure site and to preserye the underlying pulpal tissue in a healthy con-
dition.
Favorable factors for direct pulp capping include: the visual evidence of uninflamed /plnt)
pulp tissue, the absence ofcopious hemonhage through the exposure, no previous symptoms
ofpulpitis, a small non-carious exposure /a mechqnicol pulp exposure). and a clean cavity
uncontaminated with saliva.
The lollowing adverse responses may occur following direct pulp capping procedures:
Physical or microbial insult to the pulp may result in pemistent inflammatory changes,
rvhich may culminate in partial or complete pulpal necrosis.
. Regulation of the mineralization processes involved in dentin bridge fonnation may be
corne deranged, resulting in extensive calcification and obliteration ofthe pulp canal space
bl mineralized tissue.
. \'er) rarely, the differentiation ofodontoclasts may be induced u,ith the development ofintemal resorptive lesions.
\otr.
L Direct pulp capping is especially successful in immature teth. and is called apexfication
2.The failure of this direct pulp capping procedure u'ould be indicated by symploms of pulpitis at any tine or the lack of a vital response after several weeks or
months.
3. Direct pulp capping should not be attempted on teeth with a history of pain,
sensitivity to percussion or periapical radiolucencies (root canal therapl, may be indicated).
L Indirect pulp cap: a calcium hydroxide base is placed on a thin layer of question
able dentin remaining over the pulp. It is performed when a carious exposure is antic- expected
ipated. After a 3 - 4 month waiting period, the tooth is reopened and the remaining decay
is rerroved. During the waiting period, it is hoped that there rvill be secondary dentin
formation, allowing complete removal ofthe decay without pulp exposure.
Classic example: A radiograph ofa first molar shows gross decay that may involve
a hom of the dental pulp. The ideal treatment would be to do an indirect pulp cap and
place a sedative filling(IRM).If tooth remains asymptomatic, in 3 - 4 months you can
re-enter the toodr and remove all decay with subsequent placement ofa permanent fill
ing. \ote: Ifthis patient had pain in the tooth laggravated h.t'heat and tender to per(ussiotl). and excavation of the carious lesion revealed exposure of the pulp horn
\rithout evidence of vital tissue, the emergency treatment pending eventual root
canal therapy is to place a small cotton pellet dampened with eugenol over the exposure and seal the cavity with a temporary material (1R M).
Rationale for indirect pulp
capping
A patient walks into your ollice for an emrgency visit. He asks the
rceptionist for a cold glass ofwater and sesms to be tilting his
head sideways as to hold the watr on one side of his mouth.
Immediately, you suspect which reason for his visit?
. Pulpal necrosis
. Pulpal hyperernia
. Irreversible pulpitis
. Acute apical periodontitis
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A cold test reveals N lingedng pain. You ask the patient to raise their
hand until the pain subsides. The patient raises their hand for
about 8 seconds. What does this data suggest?
. Pulpal necrosis
. Ineversible pulpitis
. Pulpal hyperemia
. Acute apical periodontitis
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Irrevcrsibfe pufpitis honetimes called qcute pulpitis) rs an acute inflammation ofthe dental
pulp characterized by intemittent spasms of pain, which become continuous. In the early
stages, it may appear as a very severe hyperemia. As the condition continues, the pain may be
described as a gnawirg or dull throbbing. The pain is generally increased by heat and relieved
by cold. The treatment accepted by most clinicians is pulp removal (t'oot canal therapl).
Note: The tooth is usLrally percu.siun positive.
Important: Sometimes it
Remmber: Reversible pulpitis or pulpal hyperemia is mereJy the engorgement ofthe pul$,ith blood. Once the causative agent (i.e., ha.leria or a restoraliotl in h)perocc/r.rro7rl is removed or adjusted, the pulp will most likely retum to normal.
pa1 ressels
***
pulpitis"
ical. chemical or bacterial insult. Following restoration placement, teeth often become
hl peremic and are sensitive to cold for a few days. The pain is not spontaneous and
does not last longer than approxiraately 10 seconds after the stimulus is removed. It is
dris iict. its short duration and low intensity, which distinguishes it from the pain ofacute
pulpiris /"iiraerslble pulpitis"). Remember: Hyperemic teeth respond on a lower level
(rf curent on the EPT (electric pulp te,tter) than a nonnal tooth.
Treatnrent: If possible. the source (e.g., high restoretion) should be removed. lf indi.3red. a sedative restoration can be useful. If due to deep caries, an indirect pulp cap
should be used only in permanent teeth and when pulp pathology is believed to be rerersible/e.g.. noperiopicol patholopy, no lhgering sponlaneous pain lhqt might bevorse
orerniqht and stimulated pain ol short duratiotl onl,-).
pain that lasts long after the stimulus is removed (longer than l5 seconds), this suggests
"irreversible pulpitis." The pulp is unlikely to recover after removing the caries.
Remember: The most effective way to reduce injury to the pulp during tooth preparation
irrigation to avoid heating ofthe dentin.
is to use adequate
Pins
What was previously an MOD amalgarn in #20 now shows that the entire lower lt 5
lingual portion of the tooth has fractured off, You believe that the tooth
is restorable with a pin-rtained amalgam restoration/cor.
How many pins will you likely use and why?
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Pins
OPERATI\TE
The most retentive style of pin is the self-thraded pins because they are
cemented into pinholes that are smallr than the pin itself.
. Both
. Both
the statement and the reason are correct but NOT related
. The statement
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***
The largest pin that can safely be placed should be selected in any situation. The optimal placement is at the line angles or comers of the tooth, where the tooth./root mass is
greatest and the risks ofperforation into the pulp or furcation are minimal.
Advantages:
. More conservative and less time involved than castings
. Enhances retention form (adds n a//s) and is an economical alternative to castings
Disadvantages:
. Cemented
. Friction-lock
. Self-threading
***
Although the pinhole is smaller than the self-threaded pin, it is NOT cemented.
Self-threaded pin systems (fbr exantple, TMS. ll haleden 1) use holes sized just under the
scre\\' diameter The elasticity (resiliency) of the dentin functions to retain the screwed
pin. This systern comes with a selflimiting drill of optimal 2 mm depth and self-shearins pins that gunrd against overtightening. This type ofpin system is the most frequently
used olthe three tlpes ofpins.
(Thread-ntate .ttsler?) system has four sizes of pins (reg at minin, minikin
tt tl ntinLtta). They are available in titanium or stainless steel plated with gold.
Cemented pins are serrated stainless steel pins that are cemented into pinholes that are
larger thrn the diameter ofthe pin.
The
T\IS
Self-threading
Drill
Size
Pitr Diameter
Regular
0.027"
0.031"
Minim
0.021"
0.024'
Minikin
0.01?'
0.019'
Minuta
0.0135'
0.015"
are tapped into pinholes that are smaller than the diameter ofthe pin.
the
They are retained by
elasticity ofthe dentin.
FrictionJocked pins
Note: The increased strength of the latest dentin/enamel bonding agents, coupled with
the revived use ofretentive slots, pot-holes, grooves and channels, has led to a reduction
in the use ofpins. Examples ofdental adhesives include: Amalgambond Plus, All Bond
2, DenTastic and Easybond. These systems allow adhesion to preconditioned substrate
with the added benefits ofretention and sealing ofthe restoration and a stronger total cohesive mass to support all remaining cuspal segments ofthe tooth.
Pins
Regarding the use of pins, all of the following statements are true -gXCtPf one.
Which one is the.EXCBPTIOM
. Use one pin per missing axial line angle, cusp, or marginal ridge, up to a maximum offour
. Use large-diameter pins whenever possible
. Use the minimum number ofpins compatible with adequate retention (pins v,eqken amalgom)
. Keep at least
.5
. Pins should be placed away from furcation areas and parallel to the extemal tooth sudace
. Coating of pins with adhesion promoters such as Panavia and 4-META materials improves
liaclure resistance ofcomposite and amalgam cores
. Pins
20ll :012
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OPERATIVE
Pins
When preparing a pin channel you perforate into the vital pulp chamber.
What best describes your next step.
as to not enter
Allol
bleeding to stop, dry with paper point, place pin elsewhere and restore with amal-
_gam
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***
This is false; pins are not to be bent to make thetn parallel or to increase their retentiveness. Occasionally, bending a pin may be necessary to allow for condensation of amalgam occlusogingivally. When pins require bending, a bending tool must be used. A hand
instrunent fe.g., an amalgam condenser or spoon excavator) should not be used.
The main advantage of pins is to improve the retention of large restorations. Unfortunately, pin retention techniques are not without disadvantages. Pins are known to
weaken th restorativ matrial into which they intrude. Ifplaced by force, they can create stresses that cause crazing ofthe tooth structure. They may provide an additional deep
path for microleakage. Ilplaced in close proximity to the pulp, they may aggravate an existing pulp problem or create one. The use ofpins may be contraindicated in young teeth
rvith very large pulps and in teeth with reversible pulp pathology, which might be aggravated by instrumentation. Placement is always influenced by the limitations olaccess and
r ision.
\ote: After
restoring a tooth, make sure you check the occlusion very carefully. If a
restoration is left in supra-occlusion, the patient will retum complaining of discomfort
u hen biting, usually with no other symptoms.
Remember: If when attempting to drill a pin hole the drill enters a vital pulp chamber,
the proper treatment is to allow the bleeding to stop, dry with a sterile paper point and
place calcium hydroxide in the hole. Proceed with a better location for a pin hole. Ifa pin
channel perforates the extemal surface ofthe tooth and all factors are favorable, a pin can
be placed provided there is no extension beyond the surface ofthe tooth.
Idealty, pins should be placed I to 1.5 mm inside the cavosurface margin and at least .5
mm inside the dentinoenamel junction (DEJ), rf preserft. Placement ofthe pin channel at
least ,5 mm away from the DEJ helps prevent crazing or complete fracture of the rerraining enamel. Note: The optimal depth of the pinhole into the dentin is 2 mm.
The rule of thumb: Pins should be 2 mm into dentin,2 mm within amalgam, and I mm
tiom the DEJ (to be .salb)with no bends in the pins. Important: The twist drill used to
prepare the pin channels must be angled so that it remains in dentin only. The channel
should be prepared parallel to the extemal surface ofthe tooth.
\\'hen pins are placed nearer the occlusal surface, as in cuspal coverage areas. the pins
should project only minimally into the restorative material (2 mmfor amalganr); long pins
near an area ofocclusal loading will significantly weaken the amalgami additionally, the
purpose ofthe pin in cuspal coverage areas is to bind the cusp to the restoration and to resist lateral displacement with occlusal function.
Note: Maximal intemin distance results in lower levels of stress in dentin.
. Time consumption
. Patient objection
. Cost
. Staffallergies
to material
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00
The rubber dam can still be used effectively even if teeth are
crowded and overlapped because the hole punch pattern
does not alwavs have to be followed.
. Both
. Both the statement and the reason are correct but NOT related
is NOT
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***
However, ifyou become proficient in placing the rubber dam and explain to patients
will be eliminated.
.
.
Remember: The use of a rubber dam is the standard of care when performing endodontics.
In this case, you can punch the holes closer or in a similar pattem to the teeth, allowing
for the elimination ofwrinkles and avoid having papillae protruding through.
Five functions of rubber dam isolation:
Important: In order for a rubber dam clamp to be stable, all four points of the jaws of
the clamp must contact the tooth gingival to the height ofcontour They should not extend
beyond the line angles to prevent impingement ofthe interdental papilla and possible interference with placement ofa wedge.
l.A frequent cause of interdental papillae protruding from beneath the rubber
dam is holes that were punched too close together.
2. Wdnkling ofthe rubber dam between isolated teeth is the result ofholes that
were punched too far apart.
. Both the statement and the reason are correct but NOT related
. The statement is correct, but the reason is NOT
. The statement
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. Apply acid
etch 2
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the Young's rubber dam frame provides less soft tissue retraction than
the Woodbury. However, that is not why it is used, it is simply more convenient.
qnte).
. The rubber dam is inverted into the gingival sulcus using floss and/or
an instrument such as a plastic
instrument
Remolal of the rubber dam very important: Removal is the reverse of application,
ercept all ligat.lres (interdental septum of dam) must be cut and removed before the
dam is removed.
Sealants necd micro-mechanical retention. The surfaces should be cleaned rvith a prophr laxis brush or rubber cup and pumice with watcr. Whcn thc tccth arc cffectively isolated from saliva
.r.:rriminaiion. the surfaces are dried and acid-etched by ihe application ofa 30 to 50% phospho cacid
i.rhrrrlrn for one minute. Thc solution should bc gcntly agitatcd during thc application. This is then washed
3\fa\ and dried leaving a frosty-appearing /drlland chalky) etched surface.
Importanti
sealants,
i.
to thosc
offillcd rcsins
Sealants are weak compared to filled resins (composites). The strength of a sealant is sacrihced in
order to make it flou,into the pits and fissures (lhe viscosity needs lo be lo$'enough tofov'into the
.1.
pils andfssures).
5. The most likely result ofinadvertently sealing a small carious lesion in the occlusal surfacc ofa
tooth is that the caries rvould be arrested.
6. Research indicatcs that pit and lissure sealants are retained best on maxillary and mandibular bicuspids. Howevr, the first molars 1d4r. and mand.) bcncltt thc most from sealants.
7. Ifa topical fluoride is to bc used in conjunction with a pit and fissure sealant, the fluoride must bc
app)ied either beforc the conditioner /acld elcrdra/ or after the sealant.
is true
. Both
1(}4
. Both
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Remember: Light cure materials are all cured by visiblc light nowadays, not UV AIso. both light
cure and chcmical curc have indistinguishable rcsults.
Pit and fissure sealants were first devclopcd in the 1970s and 1980s, and thcir cltcctivcncss in prevcnting caries has now bccn rvcll cstablished. Two predominant typcs ofpit and fissurc sealant malerials are available: resin based sealants and glass ionomer cgments.
Availablc resin-based sealant materials can bc polynerized by autopolynrerization, photopolymerization using visible light or a combination ofthc two processes.
Glass ionomer ccmcnts arc available in two fonns. both of which contain fluoride: conventional
and resin-modified. Glass iononter ccmcnts, which do not require acid etching ol'the tooth surf'ace,
gcncrally are easier to place than are resin-based scalants. They also are not as moisture-sen:irivc
as their resin-bascd counlerparts. Glass ionomcr materials, which wcre developed for their ability
to relcase fluoride. can bond directly with enamel. It is hypothcsized that release of fluoride from
this nlaterial nlay conlribute to caries prevention. Howcvcr, the clinical cfl'cct of lluoridc release
liom glass ionorrer cenent is not well-eslablishcd.
\ote.
l. The succcss ofa sealant is highly dependent upon obtaining and maintaining an intimate adaptation ofthc scalant to the tooth surface and thereby hopefirlly sealing it.
f. Research has demonstrated that caries protcction is l00yo in pits and fissures that
re main completel] sealed,
3. Resin-based sealants are the firsl choice ofnraterial lor dental sealants. temporary= interim
Glass ionomer cement may be used as an intcrim prcvcntive agent when there are indications for placement of a resin-based sealant but concems about moisture control
nlay compromisc such placement.
5.Placement of pit-and-llssure sealants significanlly red|.|ces the perccntage of noncavitatcd carious lesions that progrcss in children, adolesccnts and young adults tbr as
long as live years after sealant placement. compared with unsealed tccth.
.1.
***
Fluoride does not make the enamel hardel but reducs its rate of solubilitv.
i.
-l. Fluoride has antimicrobial activity. In low concentrations fluoride ion inhibits the
enzvmatic production of glucosvltransfrase. Glucosyltransferase prevents glucose
liom forming extracellular polysaccharides, and this reduces bacterial adhesion and
.lou s ecological succession. Intracellular polysaccharide formation is also inhibited,
pre\ enting storage of carbohydrates by limiting microbial metabolism between the
Itost's meals. Thus the duration ofcaries attack is limited to periods during and immediately after eating.
\otes
.t;::,,:.:.,,.:
l.The concentration offluoride in the body fluids is regulated by an equilibrium relationship between bone and urinary excretion.
2. Fluoride ion is easily exchanged lor hydroxyl ion in the lattice structure of
enamel because the fluoride ion is slightly smaller than the hydroxyl ion, and
has a greater affinity for the hydroxyapatite crystal than does the hydroxyl ion.
. sl0
. )lJ
. $38
. $58
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less than 0.8 ppm, 0.8-1.3 ppm, greater than 1.3 ppm
,0.7
0.9
L2 ppm
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. ,.
The optimal fluoride levels for public water supplies is about 1 part per million (PPM).
At 0.I PPM and below, the preventive effect is lost and the caries rate is higher for such
populations lacking sufficient fluoride exposure.
This knowledge is the basis for all individual and professional decisions regarding use ol
other fluoride modalrties (e.g.,fluoride toothpaste.for chikhen under 2 years ofage, mouth
rinse or supplemenlt. It is recomrnended that parents and caregivers of children, especialll children aged less than 6 years, know the fluoride concentration in their child's
drinking $ater. For example, in nonfluoridated areas where the natural fluoride concenrrarion is below optimal, fluoride supplements might be considered, whereas in areas
u here the natural fluoride concentration of more than 2 pprr.r, children should use alternati\ e sources of drinking water.
Fluoride is obtained in two forms: topical and systemic. Topical fluorides are found in
manl ty,pes oftoothpaste, mouth dnses and in special gels or pastes applied in the dental
ofllce.
Sy stemic fluorides are those that are ingested. They include fluoridated water and dietary
tluoride supplements in the form oftablets, drops or lozenges. Systemic fluorides are integrated into children's teeth as their tooth structures form.
The greatest reduction in tooth decay is achieved when fluoride is available both topically and systemically. Water fluoridation provides both types of contact.
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0.49./0
acid
fluoride
109
o/o
neutral sodium
The most accepted theory to explain the unusual sensitivity and response of exposed
root surfaces to various stimuli is the hydrodynamic theory. This theory postulates that
the pain results form indirect innervation caused by dentinal fluid movement in the
tubules, which stimulates mechanoreceptors near the predentin.
The rationale oldesensitization procedures is not fully understood. Some techniques may
Nunerous fonns of treatment have been used to provide relief, such as topical fluoride,
fluoride rinses, oxalate solutions, dentin bonding agents. sealants, iontophoresis, and desensitizing toothpastes. AII of these methods have met with varying degrees of success,
and none has been totally effective (although dentin bonding qgents provide the best rute
ol -.u(cess). When these conservative methods fail to provide relief, restorative treatment
is indicated.
\ote:
The application of sodium fluoride has been recommended as an effective treatment ior root sensitivity based upon the precipitation of calcium fluoride crystals in the
Lrpen dentinal tubules.
The gel contains either 1.07o sodium fluoride or 0.47o stannous fluoride, For maximum benefit, the gel must be in direct contact with the teeth. Fluorides are recommended
to protect these patients from post-irradiation caries.
Remember two important points:
l. The fluoride found in commercial toothpastes is not adequate for people who have
had head and neck radiation.
l. These patients must continue to use the fluoride gel as directed for the rest
lili to protect their teeth from rampant decay.
oftheir
Instructions for patient: The trays containing the fluoride are placed over the teeth for
a prescribed period of time (usually 10 minutes), and he/she may not eat or drink for at
least 30 minutes. Usually this is done at night after toothbrushing and just before going
to bed.
The daill use of fluoride gel in custom trays at home is indicated in the following situations:
. Rarnpant enamel or root caries in any age group
. Xerostomia
. Head and neck radiation therapy
an overdenture
lmportant: Fluorapatite is the most stable reaction product ofa topical application offluoride.
110
\-,
. Both
111
Coplriglr
Important:
l. Acidulated phosphate fluoride (lPF) is the most commonly applied in-office fluoride treatment.
2. The combination of 1.23% sodium fluoride and I M orthophosphoric acid results in
acidulated phosphate fluoride. It is very stable in solution.
3. The most common recommended over-the-counter fluoride is 0.05% sodium fluoride.
4. Stannous lluoride (80,6 F) has avery bitter, metallic taste, may bum the mucosa, and
has a short shell life.
5. The tin ion in stannous fluoride may be responsible for staining the teeth, but it may
be beneficial for anestinc root caries.
\NF
APF
SnF,
Concentmtion
2o/o
t.23%
8%'
Fluoride lon
0.91
1.23
1.95
ppm Fluoride
9.040 ppm
12.100 ppm
19,160 ppm
Mg FVml
9.04
12.0
19.16
Emc.cy
)9%
28yo
320/r
Taste
Bland
Nofle
BroM
Nonc
None
Occasional
7o
Tooth discolorrtlon
Gingivrl reectlon
Important:
. The pH ofAPF is approxrmately 3.5 (acidic)
. The pH of NaF is approximately 9.2 /ba.sicl
. The pH of SnFz is approximately 2.I to 2.3 (acidic)
lmportant: APF solutions and stannous fluoride /SNF2I should not be used on patients with
porcelain. glass ionomer, and composite restomtions. They have been shown to remove the
_claze trom the surlace of these rcstontions. Neutral sodium fluoride /NaF/ is best to r.rse if
:hese restorations are present. Also, APF should be avoided on implant patients, it may corr"Jc th< .urface oftit.rnium implants.
$ hen painting fluoride on, it is very important to isolate the teeth with cotton rolls. When
using ilLroride trays, cotton rolls may be placed in the premolar areas to increase patient comtbfi and help keep the fluoride in place. Patients are asked not to brush, rinse, eat or drink 30
mrnutes alier a fluoride treatment so that the fluoride is left undisturbed and is able to continue
reactjng \!jth the hydroxyapatite tbr some time after the initial application. Fluoride treatmenrs should be applied for four minutes. although there are now some one-minute products
rhar are beins marketed.
Ayoung child gets into the bathroom cabinet and ends up eating a full tube of
toothpaste. The mom calls you lirst, besides telling her to call poison control
you will ask all of the following questions TXCEPI one.
Which one is the.EXCXPZOIV?
w,ash)
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. Both the statement and the reason are correct and related
is NOT
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***
As with any toxin, the toxicity of fluoride is based on weight, not age.
Fluoride, administered in large doses can be fatal and should be kept with all other medication
ofthe reach ofchildren. This includes fluoridated toothpaste, gels and mouth
-out
generally excepted toxic amount of fluoride that needs to be consumed at one
rinse. The
time is 5 mg/kg of body weight. This means that a child who weighs 25lbs would need
to consume the equivalent of56 one mg tablets offluoride, not a difficult task to accomplish for most 2 year o1ds.
:{ote: Tlre most common forms of fluoride found in toothpastes are sodium fluoride and
sodium monofluorophosphate. Amine fluoride and stannous fluoride, are less common.
**"
Scalants can bc effective when placcd ovcr incipient caries lesions becausc caries is caused by
aerobic nricroorganisms.
Studies hare caret'ully demonstrated that once an incipient carious lesion is sealed, the caries is
{opped lbr most intcnsive purposes. Sincc carics is caused by acrobic microorganisms, once scalcd
Lr\ !-r \'ilh a sealant an anacrobic environment is created in which the microorganisms become static
t r die and there is no funhcr action because there is no melabolite 10 reach the orsanisms. there is
\otes
soon,
7. The most common reason lbr sealant failure is
to inadequate isolation.
. Creep
. Modulus olelasticity
. Resilience
. Brittleness
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limit.
***
Materials which are relatively weak or which are relatively close to their melting temperature are more susceptible to creep. Dental wax deforms (creeps) under its own weight
over short periods of time. Traditional dental amalgam restorations are involved in intraoral creep.
Resilience is the energy that a material can absorb bfore the onset of any plastic deformation.
***
Elastic deformation takes place prior to plastic deformation. The distinction between
these tivo is termed the elastic limit.
The elastic
limit
will
rerum to its original dimensions when the forces are released. Up to the elastic limit only
elastic deformation is involved, but beyond that, there is a combination ofelastic and plastic defonnation. with the plastic portion increasing and the elastic portion decreasing up
to rhe breaking point.
-\n erample rvould be if a snrall tensile stress is induced in a wire, the resulting strain
might be such that the wire will return to its original length when the load is removed. Il
the load is increased progressively in small increments and then released after each addition of stress, a stress value finally will be found at which the wire does not retum to its
original length after the load is removed. In such a case, the wire is said to have been
5tressed beyond its elastic limit.
The proportional limit is the greatest stress, which may be produced in a material such
that the stress is directly proportional to the strain. A material that has a high proportional
limit compared to one with a lower proportional limit also has more resistance to permanent deformation.
Although the two terms, elastic limit and proportional limit, are defined differently,
their magnitudes are so nearly the same that lor all practical pur?oses the terms can often
be used interchangeably.
Note: The yield strength represents
a stress
In general, ductility
whereas malleability
in temperature,
in temperature.
1t6
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. Both the statement and the reason are conect but NOT related
is NOT
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Ductility is the ability ofa metal to easily be worked into desired shapes (lbr example, the
dbili4, to ./brm a wire Ji'om a metal). '|tese materials undergo extensive plastic deformation prior to fracture (in tension). Ductility is dependent upon plasticity and tensil
strngth.
Not: Ductility is usually expressed in terms of the percent elongation; the higher the
value, the more ductile tlre alloy.
Arelated term is malleability, which describes a metal being able to be hammered (compression) into a thin sheet without rupture. It is also dependent on plasticity, but is not as
dependent upon tensile strength as is ductility.
Gold is the most ductile and malleable metal. and silver is second. Of the metals of interest to the dentist, platinum ranks third in ductility and copper ranks third in malleabil-
it\.
t**
-\n adhesiye joint is the result of interactions of a layer of intermediate material (adhesi\e ot adlrcrent) with two surfaces (adherends/ producing two adhesive interlaces.
Eramples include onhodontic bracket bonding resin, enamel bonding system for a composite resin. and a bonded porcelain veneer.
There are trvo principal types of adhesion:
1. Ph! sical forces: called van der Waals forces
l.
Adhesive potential can be predicted by measudng the spreading or wetting ofthe adhesive over the surface ofthe substrate. This is done by determining the contact angle ofthe
drop of adhesive as it spreads out. The smaller the angle, the greater the wetting and
thus the potential for adhesion.
*-D*
Shear
. Flexion
0--l
Y-
. Torsion
gl
. Compression
. Diametral compression/tension
. Tension
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Coplrighr O
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H
Y
,ixq
H
. Both
119
. Compression
. Tension
. Shear
. Torsion
trl
. Flexion
'H
H
. Diametral
compression/tension
*** Strain
ttitt
***
Tertiary dentin is formed in response to caries, operative procedures, or wear. Secondary odontobfasts secrete tertiary Qeparative) dentln.
Throughout life, the dentin will respond to environmental changes (iormal wear, caries,
operatire procedures, lc, These changes initiate the deposition oftrtiary dentin which
rs formed by repfacement odontoblzsts (termed secondary odontoblastr). This reparatile dentin will be limited to the site ofirritation. The composition ofreparative and secondarl dentin is basically the same /reparative dentin is more itegular) andthey differ
only in location of deposition.
If the environmental insult is strong enough, it will kill the odontoblast and its tubular
process. leaving the tubule empty. If there is a collection of empty tubules, they are refened to as dead tracts. In time, these ttbrles (dead tracLsl will calcify. The term used
to describe the tubules that become calcified is sclerotic dentin.
.
,&*.,
i\otcr:
1. Primary dentin is the dentin forming the initial shape ofthe tooth. It is deposited before completion ofthe apical foramen.
2. Secondary dentin is dentin that is formed after completion of the apical
foramen. It is formed at a slower rate than primary dentin as functional stresses
are placed on a tooth. Secondary dentin is a regular and somewhat uniform
layer ofdentin around the pulp cavity.
3. Thejunction between primary and secondary dentin is characterized by a
sharp change in the direction ofdentinal tubules.
for
. Both the statement and the reason are correct and related
. Both the statement and the reason are correct but NOT related
. The statement is correct, but the reason is NOT
. The statement
. NEITHER
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OPERATIVE
ofthe restoration"
. "The
shape
comoleted"
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***
Retention form is that form the cavity takes to resist dislodgement or displacment of
the restoration. For example, the buccal and lingual walls ofa Class I amalgam preparation converge occlusally; thus preventing dislodgement of the amalgam. For Class II
restorations, this resistance to dislodgement is provided by the occlusal dovetail and retention grooves in the proximoaxial line angles. axiobuccal &axiolingual line angles
Resistance form is that form the cavity walls take to resist the forces ofmastication. Resistance form prevents fracture ofth restoration and the tooth.
Remember: G.V Black, is known as the father of modem dentistry. He is known for his
principles oftooth preparations, in which he outlines the proper methods to prepare teeth
tbr fillings. The phrase, "extension for preventionrr is still famous in the dental community today and represents Black's idea that dentists should lollow preventive tneasures
to aid patients from developing tooth decay. Further, he organized a classification system
\\ ith 5 categories for different pattems oftooth decay which is still in use today. Since that
time, only one more category (Class Vl)has been added to his classification system.
***
b:i'-
sound dentin)
. Electromagnetic pulse
. Alternating current corrosion
. Electroly'te explosion
. Galvanic shock
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. Unfilled resins
l4.4
. Composite resins
11.4
81 -92
22-28
. Tooth
28-3s
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Galvanic shock is the briefbut sharp electrical sensation one can receive when two dissimilar metals come into contact in the mouth.
An example ofthis phenomenon: An amalgam restoration is placed on the occlusal surface of a lower tooth directly opposing a gold inlay in an upper tooth. Because both
restorations are wet with saliva, an electric couple exists, with a difference in potential between the dissimilar restorations. When the two fillings are brought into contact, the potential is short-circuited through the two alloys. The result is sharp pain, Such postoperative pain usually occurs immediately after insertion of a new restoration and
generally it gradually subsides and disappears in a few days.
Note: The amount of electricity involved in galvanic shock can range up to 1.0 microamneres and 500 millivolts.
Material
Tooth
11.4
Direct Gold
14.4
Amalgam
22-28
Composite
28-35
Unfilled Resins
8t-92
. Class
. Class tr
. Class III
.
Class
IV
Class
Class
VI
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Dnisl
I}ck
Cavity classification: standardized methods ofrecording the need for restoration exist to
facilitate communication among clinicians, researchers, and dental educators. The most
commonly accepted means ofclassiling cavities is by the names ofthe surfaces involved.
Cavity type is classified further based on the type of treatment and anatomical area involved. This classification, developed by Dr. G. V. Black in 1908, is designated by Roman
numerals as Class I, Class II, Class III, Class IY Class Y and Class Vl (this is the only
category that has been qdded to his original classificttion system). Note: It is important
lo remember that the classification relates to location and not size ofthe cavity.
Class I cavities: involve the pits and fissures, while all other classifications involve
smooth surfaces ofthe teeth.ling surfaces of incisors & canines have pits
. Class II cavities: involve the proximal surfaces and occlusal surfaces of premolars
and molars.
. Class III cavities: involve the proximal surfaces of incisors and canines that do not
involve the incisal angle.
. Class IV cavities: are located on the proximal surface of incisors and canines and do
involve the incisal angle.
. Class V cavities: are on the facial or lingual surface of all teeth and do not involve a
pit or fissure.
. Class VI cavities: are on the incisal edges of arterior teeth or on the occlusal cusp
heights of posterior teeth.
Remember: The best method for definitive detection of incipient carious lesions on the
interproximal surfaces ofposterior teeth (distal suryface of canines through molars) tsby
bite-wing radiographs.