1

Operative Dentistry Laboratory Exercise Date: 13/03/2913

CLASS II Complex AMALGAM PREPARATION: MODL on #19 or #30
Retentive facets: proximal retentive locks, slot/grooves, amalgapins,
convergent axial walls
Armamentarium
Basic: mirror, explorer, perio probe, cotton pliers, periodontal probe
Rubber dam kit: frame, dam, clamp, punch, forceps, floss
Operative kit: burs - # 330, 245, !, 2, 169/169L, 57/58, 956/957; hand instruments Spoon
excavators, Hatchets (10-8-14 Sm.), Chisels, Margin Trimmers (Sm. & Lrg)
Matrix kit: toffelmire band holder and band, wedges, crown and collar scissors
Amalgam Condensers: carrier, well, pluggers (serrated sm. - 0/1 and med./lrg.- 1/2 or 3/4),
Burnishers: ball - #1, ball-football - #26/29, acorn 321/21B, duckhead contouring
Carvers: Cleoid-discoid (sm. & med/lrg.), Hollenback 3S/3/IPC, Ward 1/2, 3 Tanner
Hand pieces: fast, slow (contra-angle attachments)

Procedure:

1. Check the occlusion: Use articulating ribbon and tap the jaws of the manikin. Remember
the location of the marks and use them as an aid in carving the restoration.
Get Occlusion Check-Off By Instructor Before Proceeding
2. Reduce the mesiolingual cusp 2.5 3.0 mm. and have it approved by your instructor
3. Outline Form: The outline form should be identical to that of the conventional Class II
MOD amalgam preparation with a widening distally to cover the ML cusp to the lingual
groove where it extends gingivally to a lingual box preparation.






















Classic Cl II MOD amalgam preparation:
Isthmus width is 1.5 mm.
2.0 mm depth of pulpal floor and should be parallel
to an imaginary line connecting the buccal and
lingual cusp tips.
0.5 mm. clearance of gingival cavosurface margin
O.2 0.5 mm. clearance of facial and lingual
proximal walls
Smooth, flat pulpal and gingival floors, perpendicular
to plane of occlusion
Bevelled axio-pulpal line angle and gingival
cavosurface margin planed apically
Convergent (occlusally) facial and lingual axial walls
90
0
cavosurface margins of facial and lingual
proximal walls
Axial wall depth (of both proximal boxes) is a
minimum of 1.0 mm and duplicates the convexity of
the proximal outer surface of the tooth.

Cl II MODL amalgam preparation with
ML Cusp Coverage and Lingual Groove Box:
Amalgapin will be utilized instead of slot at ML cusp
Three box preparations: two proximal (M & D) boxes and
a lingual groove box (Cl I) preparation extending gingivally.
Axial wall depth (of both proximal boxes) is a minimum of
1.0 mm and duplicates the convexity of the proximal outer
surface of the tooth; and the on the lingual a minimum of 1.0
mm. apical to the level of the ML cusp reduction
roxlmal reLenLlve locks ln axlo-faclal and axlo-llngual llne
angles of proxlmal boxes
Bevelled axio-pulpal line angles and gingival cavosurface
margins planed apically in all three boxes
Convergent (occlusally) facial and lingual axial walls
90
0
cavosurface marglns of faclal and llngual walls of
proxlmal boxes as well as M and u walls of llngual groove
box
SloL
!"#$%#&'(
'(*+,#- ./ 0$.+
Llngual Croove
reparaLlon/8ox
roxlmal
8eLenLlve Locks
roxlmal
8eLenLlve Locks
8everse Curves
90
0

Cavosurface
Margln
lsLhmus x (Lo
1/3) ulsLance
8eLween Cusps
2

4. Proximal box preparation:
Prepare the buccal portion of the mesial/distal dovetail as you normally would, using care
not to extend the dovetail buccally farther than the contact area.
Prepare the lingual of the prep by extending it from the isthmus slightly lingual to the
mesial/distal pit.
Using the #169 bur, connect the two sides of the preparation, while moving the bur
mesially/distally and gradually thinning the marginal ridge, leaving only a thin shell of
material between the bur and the adjacent tooth.
Using a slight pendulum motion, move the bur from side to side, gradually deepening the
prep to approximately 3.5 mm.
With the small hatchet, break away the final pieces of material protecting the adjacent
tooth.
With the #169 bur expand the box to the proper dimensions (the small hatchet and
gingival margin trimmer can aid you in this task).
Do not try to remove too large a piece of tooth structure with the hand instruments
or use a dull instrument for this task. This will cause the manikin tooth to chip and
ruin your preparation.
The axial wall height of the box should be 1.0 mm measured from the pulpal floor, with a
convexity reflecting that of the unprepared proximal wall.
Use care not to break any of the proximal contacts (buccal, lingual, gingival) by more
than 0.5 mm (this can be measured by passing the first 1.0 mm of the #23 explorer
through the contact, if any more of the explorer passes through, the contact is too wide).



















Smooth all walls of the preparation with the appropriate burs and hand instruments. The
walls of both proximal boxes and lingual box should have smooth cavosurface margins.
Use the gingival margin trimmer to bevel all three axio-pulpal line angles and plane
gingival cavosurface margins

0.5 mm. clearance of gingival
cavosurface margin
O.2 0.5 mm. clearance of facial
and lingual proximal walls

The buccal and lingual walls
should converge slightly (3
0
)


3































5. Retentive facets:
Primary retention form is provided by the occlusal convergence of facial and lingual
walls and by the dovetail design of the occlusal step, if present. Proximal retention locks may
also increase the fracture resistance of the amalgam restoration. The use of retention locks in
proximal boxes is controversial. However, the use of retention locks is recommended in
tooth preparation with extensive proximal boxes.
Retentive locks, slots, grooves, amalgapins, pins, etc. provide secondary retention form.
Ideally secondary retention form for the occlusal and proximal portions of the preparation should
be independent of each other. The occlusal convergence of the facial and lingual walls and the
dovetail design (if needed) provide sufficient retention form to the occlusal portion of the tooth
preparation. The occlusal convergence of the mesiofacial and mesiolingual walls offers retention
8evelled axlo-pulpal llne angle and planed glnglval
cavosurface angle
8everse curve evldenL ln faclal proxlmal wall,
conservlng sound LooLh sLrucLure and aLLalnlng
90
0
cavosurface angle
Llngual Croove 8ox reparaLlon
CuLllne lorm
Slmllar
ouLllne
form wlLh
llngual
box
4

in the proximal portion of the preparation against displacement occlusally. To enhance retention
form of the proximal portion, proximal locks may be indicated to counter proximal
displacement. Many operators use proximal locks routinely to ensure that each portion of the
tooth preparation is independently retentive. However, evidence suggests that retentive locks
may not be needed in conservative, narrow proximal boxes.



































8eLenLlve Locks aL axlo-faclal and axlo-llngual llne angles of proxlmal boxes
Preparation of a retention lock: use a No. 169L bur with air coolant (to improve vision) and
reduced speed (to improve tactile "feel" and control). The bur is placed in the properly positioned
axiolingual line angle and directed (i.e., translated) to bisect the angle approximately parallel to the
DEJ. This positions the retention lock 0.2 mm inside the DEJ, thus maintaining the enamel support.
The bur is tilted to allow cutting to the depth of the diameter of the end of the bur at the point
angle and permit the lock to diminish in depth occlusally, terminating at the axiolinguopulpal
point angle. In a similar manner prepare the facial lock in the axiofacial line angle. When the
axiofacial and axiolingual line angles are less than 2 mm in length, reduce the tilt the bur slightly
so that the proximal locks are extended occlusally to disappear midway between the DEJ and
the enamel margin.
There are four characteristics or determinants of proximal locks: (1) position, (2)
translation, (3) depth, and (4) occlusogingival orientation. Position refers to the axiofacial and
axiolingual line angles of initial tooth preparation (0.2 mm axial to DEJ). It is important to note
that the retention locks should be placed 0.2 mm inside the DEJ, regardless of the depth of the axial
walls and axial line angles. Translation refers to the direction of movement of the axis of the bur.
Depth refers to the extent of translation (i.e., 0.5 mm at gingival floor level). Occlusogingival
orientation refers to the tilt of the No. 169L bur, which dictates the occlusal height of the lock,
given a constant depth.
Some operators prefer using the No. 1/4 bur to cut the proximal locks. The rotating bur
is carried into the axiolinguogingival (or axiofaciogingival) point angle, and then moved
parallel to the DEJ to the depth of the diameter of the bur. It is then drawn occlusally along
the axiolingual (or axiofacial) line angle, allowing the lock to become shallower and to
terminate at the axiolinguopulpal (or axiofaciopulpal) point angle (or more occlusally if the
line angles are less than 2 mm in length). Regardless of the method used in placing the locks,
extreme care is necessary to prevent the removal of dentin that immediately supports the proximal
enamel. In addition, it is essential not to prepare the locks entirely in the axial wall (i.e.,
incorrect translation [moving the bur only in a pulpal direction]), because no effective
retention is obtained and there is a risk of pulpal involvement. An improperly positioned
axiofacial or axiolingual line angle must not be used as a positional guide for the proximal lock. If
the axial line angle is too shallow, the lock may undermine the enamel of dentinal support. If the
line angle is too deep, preparation of the lock may result in exposure of the pulp. Retention
locks should always be placed in the facial and lingual proximal walls (0.2 mm inside the DEJ),
regardless of the depth of the axial wall.
3


Boxes and Walls
Proximal
Retention Lock
Vertical Plane
(169L or ! round)
Convergent Walls
Boxes
W A L L W A L L
B O X B O X
Missing Cusp?
Groove or Cove
Horizontal Plane

Amalgapins
Shavell, H. J Ca Dent Assoc 1980; 8: 48-55
Amalgapin
Advantages
Quick
Standard armamentarium
Stress-free
Minimal weakening of tooth
Additional occlusal
reduction unnecessary
Disadvantages
Vulnerable to early fracture
Tensile strength poor initially
Need abundant dentin (but
so do pins)
Proper condensation
essential
Indications:
Loss of coronal tooth structure
Minimal occlusal-gingival height short clinical crowns,
minimal room for pins

6

Amalgapin Technique
Prepare hole-SLOW SPEED
choice of burs
330 = .8 mm, 1157 = 1 mm
located in dentin
1 mm diameter
1.5 - 2 mm deep
bevel at cavosurface margin
#2 round bur
follow tooth anatomy not LA


6. Matrix Placement: Adaptation Problems













Purpose
Band confines amalgam/composite
Supports amalgam during condensation
Restores anatomical contour
Restores contact area(s)

Adaptation
Extends 1 mm below gingival margin
Doesnt impinge on gingiva
Doesnt entrap gingiva or rubber dam
Extends > 1 mm occlusal to marginal ridge
Extends < 2 mm occlusal to marginal ridge

Lower wedge Llp Lrlmmed Lo ellmlnaLe
lnLerference wlLh Loffelmlre holder off-seL
Lo lmprove conLour
AdapLaLlon problems when proxlmal box ls exLenslve
and exLend onLo faclal and llngual surfaces
CounLerslnk occlusal porLlon of
channel wlLh #2 bur
> 1 mm
lnLo denLln
> 0.3 mm
lnLo denLln
Ideal Properties
Rigid:
Confine - - prevent gingival
excess
Supports amalgam during
condensation
Restore anatomical contour - -
where contour of band is a match
Flexible:
Establish contour - - proximal
contact
Convenient application / removal
Restores anatomical contour

7

Adaptation Problems



7. Amalgam Filling Steps:

Mixing
Insertion
Condensation:
Compaction for dense restoration (reduce voids in restoration); overstep condenser nib;
Adaptation of increments toward line and point angles
o bisecting line angles
o trisecting point angles
Reduce residual Hg
o compaction of amalgam ensures excess mercury moves to next increment
o allows for final amalgam structure to be composed of reinforcing residual alloy with a
minimum of reaction product matrix
Precarve burnishing
Carving:
Define anatomy
Remove excess amalgam
Return restoration to occlusal function
Perfect physiologic form and function
Choose shape and size for area being carved
o cleoid-discoid for occlusal
o Hollenback carver for occlusal, facial, lingual and interproximal
o Interproximal carver for interproximal (can be used for facial and lingual)
Loss of convexity
and proper
embrasure form
8and shorL of deep"
glnglval margln
Cap when
proxlmal box
ls exLenslve
8

Whenever possible use cavosurface margin to guide carving instrument to avoid
submarginal areas.
Steps in carving:
1) Pre-op evaluation
2) Contour overfill during condensation
3) 3) Burnish - - Form basic occlusal anatomy
4) Establish marginal ridge height
5) Establish occlusal embrasure
6) Remove matrix & wedge
7) Finalize gingival margin
8) Finalize proximal contours
9) Finalize facial/lingual embrasures
10) Finalize occlusal anatomy
Postcarve burnishing;
After carving is complete, use the burnisher
to lightly rub on the surface of the
restoration.
o Makes the surface smoother
o Adapts amalgam to cavosurface
margins
o Do not use to hard a force that will
make grooves in the restoration
o Stop at point amalgam becomes
shiny
Checking occlusion
Finishing and polishing
Adaptation to cavity walls

















Lven marglnal rldges and proper
llngual helghL of conLour"
1'('*2,- #(- 3.$'*2,- - 24 48 hrs posL-placemenL
Coarse flnlshlng- choose shape of roLary
lnsLrumenL Lo flL Lhe surface of Lhe resLoraLlon- Lo
shape, marglnaLe resLoraLlon (dlscs, cups, and
polnLs)
! flnlshlng sLones
! flnlshlng burs
llne flnlshlng- smooLh and pollsh Lo lusLer
! 8ubber abraslves from coarse Lo smooLh
pollshers, e.g. Shofu - 8rownle, Creenle, &
Super Creenle
! ZnC (slurry)
! umlce and Clycerol (aL placemenL??)


9

Grading Criteria
The outline form should conform to that described above.
The occlusal depth should be 2.0 mm (measured at the mesial/distal pit area).
The isthmus width must be 1.5 mm.
Slightly convergent (3
0
) axial walls (facial and lingual)
The axial wall height should be a minimum of 1.0 mm.
All proximal contacts should be open: gingival - a minimum of 0.5 mm; facial & lingual
0.2 to 0.3 mm.
The pulpal floor should be smooth and parallel to an imaginary line connecting the buccal
and lingual cusp tips.
The gingival floor should be smooth and perpendicular to the occlusal plane of the tooth; all
walls should be smooth
Proximal and lingual boxes: axiopulpal line angle is bevelled; gingival cavosurface planed
apically; 90
0
cavosurface margins
Retentive locks and amalgapin placement
Amalgam filling: contour, marginal adaptation, surface finish






























10

EVALUATION FORM INSTRUCTIONS: CLASS II MODL MOLAR PREPARATION

Evaluator: _____________________________ Date:__________________
ID Number: ____________________________ Tooth No.: ______________
Circle One: Faculty Student Prep: __________________
Class II Amalgam Preparation (MODL) Grade Sheet (#19 or #30)
Points
Awarded
3+ 2+ 1+ 0

1. Occlusal
Depth

1.5 - 2mm 2 -
2.5mm


2.5
3.0mm

1.0
1.5mm
>3.0mm

<1.0mm

2. Isthmus
Width

1.5mm 1.0 -
1.5mm
<1mm

1.5
2.0mm
>2.0mm

3. Axial Wall
(Depth)
Convex
(1.0mm)
Convex
(0.5
1.0mm)
Flat,
Concav
e
(0.5
1.0mm)
1.0
1.5mm
Flat,
Concave
(<0.5mm)
>1.5mm


4. Proximal
Contacts
All contacts
open
(.5mm)

(Min. Axial
Wall Ht. =
0.5 or score
0)
" 2
contacts
ideal
open
(0.5
1.0)
(mb,
ml, db,
dl, dg)
"1
contact
ideal
open
(0.5
1.0)
(mb,
ml, db,
dl, dg)
Closed
Contact/
Contact
Open
(>1mm)
(mb, ml,
db, dl, dg)

5. Pulpal Floor
Gingival
Floor

Smooth,
Perpendicul
ar
Slight
Deviati
on
Modera
te
Deviati
on
Unaccepta
ble

6. Outline Form
(Other
Consideration
Proper
Form
Slight
Deviati
on
Modera
te
Deviati
Unaccepta
ble
11

s)

on
7. Secondary
Retention:
proximal
locks and
amalgapins


Total: ________
A score 0 on items 1, 2 or 4 is an automatic failure.
A= 16-18 points B= 12-15 points
C= 09-11 points F= <09 points

Class II Amalgam Restoration (MOD) Grade Sheet (#28/#21 or #19/#30)
Points 3+ 2+ 1+ 0
1. Margin
Integrit
y
No marginal
excess or
deficiency
detectable
(visually or
with tine of
explorer) at
the
cavosurface
Detectabl
e
marginal
excess or
deficienc
y <0.2
Marginal
excess or
deficiency
>0.2-0.5
which can
include pits
and voids at
the
cavosurface
margins
Marginal
excess or
deficienc
y >0.5
mm
which
include
pits and
voids and
have
open
margins
2. Surface
Finish
Uniformly
smooth and
free of pits
and voids
Slightly
grainy
rough but
free of
pits and
voids
Rough,
exhibits
significant
irregularities
, pits and
voids
Grossly
rough and
uneven
and/or
fractured
3. Contou
r
Reproduces
the normal
physiologica
l contour of
the tooth
Slight
variation
in the
normal
contour,
not
expected
to
adversely
affect
tissue
health
Does not
reproduce
the normal
contour and
expected to
severely
affect the
tissue health
Grossly
over-
contoured
or under-
contoured
and
severely
affect the
tissue
surface

12

Total: ________
A= 8-9 points B= 6-7 points
C=4-5 points F= <3 points