Alex Chen

Complex amalgam preparation & restoration

_________________________________________________________________________________________________________________________________
Complex Amalgam Preparation & Restoration
Alex Chen
Dent 430 ePortfolio
Faculty of Dentistry
University of British Columbia
Page 1 of 15
Alex Chen
Complex amalgam preparation & restoration
_________________________________________________________________________________________________________________________________
Complex Amalgam Preparation critical reuirements
Tooth: 46 MODB
Critical
requirements of
this procedure
Rationale of requirements and supporting literature New skills accomplished in this excercise,
problems encountered, and breakthrough
moments
id m! product
meet these
requirements"
Class ##
Amalgam$
Reerse !
1" The reerse ! shape# is nee#e# #$e to the
%i#ening of the preparation of the proximal &ox"
The ! shape allo%s the proximal &ox to maintain
'(
o
)aos$rfa)e an# opening &$))al*ling$al )onta)ts
%hile presering so$n# tooth str$)t$re at the same
time +!)h%art, et al- .((6/"
." 0t sho$l# &e note# that the 1reerse !2 is not
al%a3s nee#e# an# sometimes een &e)omes a 1!2
shape #epen#ing on the lo)ation of the )onta)t %ith
the a#4a)ent tooth"
To a)hiee a reerse 1!2 +%hen nee#e#/-
0 learne# to )$t the proximal &ox part
an# o))l$sal part of the preparation
separatel3 an# finall3 4oin them
together" This ens$re a #istin)t 1!2
shape# preparation is forme#"
5es
%pen
interproximal
contact
1" Allo%s is$al erifi)ation that all )aos$rfa)e
margins are pla)e# in so$n# tooth str$)t$re
+Ro&ertson et al"- .((6/"
." Conenien)e of a))ess for finishing an#
polishing"
6" Allo% self7)leansing of the )aos$rfa)e margin
to #e)rease ris8 of pla9$e a))$m$lation an#
se)on#ar3 )aries +:athi an# Morta,ai- .((4/"
;The a#antage of not &rea8ing the )onta)t is the
The proximal )onta)t %as #iffi)$lt to
open as it $s$all3 en# $p too %i#e" M3
sol$tion %as opening the )onta)t
slightl3 %ith a fine nee#le nose# &$r"
5es
Page . of 15
Alex Chen
Complex amalgam preparation & restoration
_________________________________________________________________________________________________________________________________
)onseration of tooth str$)t$re an# &etter ens$re of
proximal )onta)t" <en)e- %e m$st &e )aref$l not to
ex)essiel3 an# $nne)essaril3 remoe ex)ess so$n#
tooth str$)t$re %hen &rea8ing the )onta)t
+A8er&oom et al"- .((6/"
&'( to ca)osurface The '(= to )aos$rfa)e ma8es s$re that there>s no
$n#ermine# enamel ro#s" Also- it ma8es s$re the
amalgam is of s$ffi)ient &$l8 than if the angle is
too a)$te" This #e)reases the )han)e of the enamel
or amalgam fra)t$res +Ro&erson- .((6/"
This %as fairl3 eas3 to a)hiee &3
)he)8ing the preparation from o))l$sal
ie%"
5es
*alls con)ergent
occlusall!
O))l$sal )onergen)e resists restoration
#islo#gement o))l$sall3 &3 me)hani)al retention
+!$mmit et al"- .((6/"
0 ha# no tro$&le %ith this re9$irement" 5es
+ shelf$
1" Parallel to
o))l$sal plane
." ?$st into #entin
6" :lat an# e9$al
%i#th thro$gho$t
1" The parallelism of &$))al shelf to o))l$sal plane
gies it the most resistan)e to%ar#s o))l$sal loa#
&3 eliminating the ramp effe)t that %o$l# o))$r if
the shelf an# o))l$sal plane are not parallel" The
parallelism also ens$res that the res$lting amalgam
restoration %ill &e e9$al in thi)8ness tho$gho$t the
o))l$sal plane- %hi)h helps resist fra)t$re"
." The shelf is 4$st into #entin to ens$re s$ffi)ient
&$l8 for the amalgam restoration to resist fra)t$re"

6" The shelf is flat to ens$re that the res$lting
amalgam restoration %ill &e e9$al in thi)8ness
#is)$sse# in point 1"
0 learne# to $se the 66( &$r length as a
g$i#e for #epth" Also- 0 smoothen an#
flatten the shelf &3 r$nning a &$r a)ross
it at @.(A spee#"
5es
Page 6 of 15
Alex Chen
Complex amalgam preparation & restoration
_________________________________________________________________________________________________________________________________
Pulpal slot$
1" 0n area of
)entral grooe
." At least 1mm in
#epth
6" A))ommo#ates
smallest )on#enser
1" P$lpal slot is pla)e# in the area of )entral grooe
&e)a$se that>s %here the p$lp is f$rtherst a%a3
from the o))l$sal plane" <en)e- a p$lpal slot at this
lo)ation has the least )han)e of p$lpal expos$re
+M4or et al"- .((6/"
." The 1mm #epth is to gie the amalgam
restoration s$ffi)ient &$l8 to resist #islo#gement"
+M)Daniel et al"- .(((/
6" The a))ommo#ation of the smallest )on#enser is
for proper )on#ensation of amalgam #$ring
restoration"
0 $se 66( &$r +.mm length/ as a g$i#e
for length an# al%a3s )he)8 to see if the
a small )on#enser )an fit in m3
preparation"
B*A
Proximal trough:
1" B$tts $p against
axial %all
." At least 1mm in
#epth
6" A))epts smallest
)on#enser
4" ("5mm into
#entin
1" The proximal tro$gh )onta)ts the axial %all
." At least 1mm in #epth proi#es the amalgam
restoration %ith &$l8 to proi#e resistan)e to
#islo#gement an# fra)t$re" +M)Daniel et al"- .(((/
6" The a))ommo#ation of the smallest )on#enser is
for proper )on#ensation of amalgam #$ring
restoration"
4" The tro$gh nee#s to &e at least ("5mm into #entin
to preent the o$ter %all of the tro$gh from
fra)t$ring #$e to thin remaining tooth str$)t$re"
0 learne# to ma8e s$re m3 tro$gh &$tts
$p against the axial %all &3 onl3 lightl3
mar8 the position of m3 tro$gh an#
)he)8 to see if 0>m satisfie# %ith the
positioning &efore 0 start )$tting #o%n
more aggressiel3"
5es
Pin$
1" Parallel to
)aos$rfa)e
." ?$st into #entin
6" Clearan)e of
1" The pin parallels the )aos$rfa)e to preent
perforating the tooth as the tooth tapers to%ar#s
)eri)al"
." The pin is 4$st into #entin to #e)rease the ris8 of
0 #i# not hae pro&lem %ith pla)ing the
pin"
B*A
Page 4 of 15
Alex Chen
Complex amalgam preparation & restoration
_________________________________________________________________________________________________________________________________
smallest )on#enser perforation an# stress pla)e# on the tooth that ma3
)a$se mi)rofra)t$re of #entin or gross fra)t$re of
the )ro%n" +B$rgess et al"- 1''C/
6" The a))ommo#ation of the smallest )on#enser is
for proper )on#ensation of amalgam #$ring
restoration"
Retention
groo)es$
1" a))ommo#ates
smallest )on#enser
1" The a))ommo#ation of the smallest )on#enser is
for proper )on#ensation of amalgam #$ring
restoration"
The retention grooes are fairl3 eas3 to
pla)e" 0 $se the 66( &$r to ens$re the
%all )onergen)e is maintaine#"
B*A
Page 5 of 15
Alex Chen
Complex amalgam preparation & restoration
_________________________________________________________________________________________________________________________________
Complex Amalgam Preparation pictures
Complex Amalgam Preparation
!iscussion
0n a)hieing this &rea87thro$ghs- ho% %ill this help 3o$ in #efining 3o$rself as a #entistD
The &iggest pro&lem 0 ha# %ith the )omplex amalgam preparation is the proximal tro$gh retentie feat$re"
Preparing this feat$re is har# for me &e)a$se 0 )annot is$ali,e the area as 0 )$t as m3 ision +&oth #ire)t an#
in#ire)t/ is &lo)8e# &3 m3 han#pie)e" This )a$se# me to hae less )ontrol oer m3 preparation an# m3 tro$ghs
%o$l# t$rn o$t either too #eep or too %i#e" 0 trie# to sole the pro&lem &3 tr3ing to fin# the optimal pla)ement of
m3 mirror an# the mani8in hea# position to is$ali,e the area 0>m )$tting- &$t ha# no s$))ess" Eent$all3- 0 learne#
to #epen# on m3 ta)tile sense to estimate the #epth of m3 &$r an# )$t slo%l3" 0 %o$l# also )he)8 m3 #epth
fre9$entl3 %ith in#ire)t ision $ntil the re9$ire# #epth an# %i#th is met" This &rea87thro$gh ta$ght me that
Page 6 of 15
aaa
%pen
interproximal
contact
Re)erse , &'( to ca)osurface +uccal shelf$
1" Parallel to
o))l$sal plane
." ?$st into #entin
6" :lat an# e9$al
%i#th thro$gho$t
Proximal trough:
1" B$tts $p against
axial %all
." At least 1mm in
#epth
6" ("5mm into #entin
*alls con)ergent
occlusall!
Alex Chen
Complex amalgam preparation & restoration
_________________________________________________________________________________________________________________________________
sometimes a %e )annot al%a3s see %here %e are %or8ing an# some g$essing %or8 is inole#" 0n these )ases-
patien)e is extremel3 important" For8ing slo%ing an# )he)8ing o$r o%n %or8 )onstantl3 is the %a3 to pro#$)e the
optimal res$lt"
0 also felt that the )omplex amalgam preparation reall3 re9$ires $s to reall3 hae a #eep $n#erstan#ing of the
tooth str$)t$re an# retention me)hani)s" Compare# to the other )lasses of preparations %e learne# &efore %here the
shape an# feat$res of the preparations are 9$ite similar in the same )lass of lesions- there are great aria&ilit3 in the
#esign of the preparation in )omplex amalgam preparation as %e hae man3 #ifferent feat$re options %e )an
)hoose from" The operators nee# to hae a firm $n#erstan#ing of the anatom3 of the tooth an# the retention
me)hanism to &alan)e the remoal of so$n# tooth str$)t$re that %ea8ens the tooth an# the retention nee#e# for the
restoration" This is an ex)ellent example of ho% #entists nee# to )onstantl3 appl3 their 8no%le#ge an# 4$stif3 their
%or8 instea# of follo%ing a fixe# re)ipe"
Complex Amalgam "estoration critical reuirements
Tooth: 46 MODB
Critical
requirements
of this
procedure
Purpose of critical requirements and supporting literature New skills accomplished in this excercise,
problems encountered, and breakthrough
moments
id m! product
meet these
requirements"
Close
Contact
-. Pre)ent food impaction.
/. 0aintaining health of interproximal soft tissue
1Roberson et al., /''23.
# had a lot of trouble with this
requirement. 4he most important
step in ensuring a closed contact #
find is to laterall! condense the
amalgam )er! well towards the
5es
Page C of 15
Alex Chen
Complex amalgam preparation & restoration
_________________________________________________________________________________________________________________________________
6. Pre)ent tooth migration 10amoun and Ahmed,
/''23.
ad7acent tooth in the contact area to
close the contact.
+ height of
contour
-3 #n proper
alignment
/3 #n proper
arch contour
+ cups
-3 #n proper
alignment
Central
groo)e
-3 #n proper
arch
alignment
1" proper alignment an# )onto$r of )$sps proi#e
optim$m integrit3 of the )$sps"
." Properl3 repro#$)e# )entral grooe gies i#eal
o))l$sion %hen arti)$late# %ith the opposing )$sps as
o))l$sal relationship is repro#$)e# +Taernier an#
Colon- 1'G'/"
"
0 al%a3s follo% a s3stemi) se9$en)e
%hen )aring the in#ii#$al feat$res"
M3 pro)ess is #es)ri&e# in the follo%ing
#is)$ssions se)tion"
Another pro&lem 0 str$ggle# %ith is the
ten#en)3 to oer)are the )$spal ri#ges"
0 fin# that %hen 0 )are the ling$al
)$spal ri#ge- the tip of m3 <ollen&a)8
%o$l# exten# an# ta8e off parts of the
&$))al )$spal ri#ge- an# i)e ersa"
Eent$all3- 0 %o$l# en# $p %ith &oth
&$))al an# ling$al )$spal ri#ges
oer)are#" 0 sole# this pro&lem m3
pa3ing attention to the tip of m3
<ollen&a)8 an# ma8e s$re it #oes not
exten# past the )entral grooe"
5es
4rue
anatom!
-3 Not o)er8
or under8
car)ed
/3 4rue cusp
positioning
and contour
63 m9d pits in
proper
Properl3 #efine# pits gie the marginal ri#ge a
prominent in)line %hi)h %o$l# allo% foo# to es)ape
from interproximal area to preent impa)tion" +!)h%art,
et al- .((6/
Please see #is)$ssions se)tion" 5es
Page G of 15
Alex Chen
Complex amalgam preparation & restoration
_________________________________________________________________________________________________________________________________
position
Properl!
shaped
marginal
ridge
-3 Not o)erl!
bulk!
/3 4rue
position le)el
with ad7acent
ridges
An ex)essiel3 high restoration %o$l# ta8e other teeth
o$t of o))l$sion" A))or#ing to !$mmitt et al" +.((6/-
)onta)ts #$ring o))l$sion sho$l# neer o))$r on
restoration alone" 0f this happens- the restoration sho$l#
&e ta8en o$t of o))l$sion an# ens$re )onta)t is on
restoration as %ell as tooth str$)t$re sim$ltaneo$sl3
+!$mmitt et al"- .((6/"
0 ma8e s$re the marginal ri#ges are leel
%ith a#4a)ent ri#ges &3 leeling it %ith
the flat en# of the &ea)h )arer"
N%
#n occlusion
-3 proper
cusp9fossae
relationship
An ex)essiel3 high restoration %o$l# ta8e other teeth
o$t of o))l$sion" A))or#ing to !$mmitt et al" +.((6/-
)onta)ts #$ring o))l$sion sho$l# neer o))$r on
restoration alone" 0f this happens- the restoration sho$l#
&e ta8en o$t of o))l$sion an# ens$re )onta)t is on
restoration as %ell as tooth str$)t$re sim$ltaneo$sl3"
0 %o$l# al%a3s )he)8 the o))l$sion %ith
an arti)$lating paper to ens$re none or
onl3 minimal )onta)t on m3 restoration"
5es
Proper cusp
height$
0+ cusp
higher than
+ cusp,
higher than
cusp
The )$sps nee# to &e in proper positions to o&tain
)orre)t o))l$sion" 0f )$sps are too high- hea3 o))l$sal
for)es )an lea# to fra)t$re of the restoration +!$mmitt et
al"- .((6/"
0 fin# it helps a lot to loo8 at a irgin 46
as a example %hile )aring to get a
is$al i#ea of the height relationships of
the )$sps"
5es
No marginal
)oids
0arginal )oids or o)erhangs accumulates food
debris and plaque. 4his ma! lead to recurrent caries.
epending on location, marginal )oid could also
make the restoration susceptible to fracture 10ahler
and 0arant:, -&;'3.
0arginal )oids are a)oided b!
condensing the amalgam with a lot of
force. <oading amalgam in small
increments is also essential in
remo)ing the )oids.
5es
Page ' of 15
Alex Chen
Complex amalgam preparation & restoration
_________________________________________________________________________________________________________________________________
,mooth no
scratches
1" !)rat)hes on restoration ma3 feel $npleasant to the
patient"
." !)rat)hes also proi#es a pla)e for &a)teria
a))$m$lation an# gro%th +Paarmann an# Be)8man-
.((5/"
6" !)rat)hes ma3 a)t as )enters for )orrosion"
+A8er&oom et al"- .((6/
0 smoothen m3 restoration %ith a )otton
roll at the en#"
5es
Complex Amalgam "estoration pictures
Page 1( of 15
Alex Chen
Complex amalgam preparation & restoration
_________________________________________________________________________________________________________________________________
Complex Amalgam "estoration !iscussion
Page 11 of 15
Close Contact Properl! shaped
marginal ridge
1/ Bot oerl3 &$l83
./ Tr$e position
leel %ith a#4a)ent
ri#ges Reerse !
;Distal ri#ge is too
&$l83
Proper cusp height
MB )$sp higher than
B )$sp- higher than
D )$sp Reerse !
Central groo)e
0n proper ar)h
alignment
+uccal height of
contour
1/ 0n proper
alignment
./ 0n proper ar)h
)onto$r
+uccal cups
0n proper alignment
No marginal )oids
,mooth no
scratches
Alex Chen
Complex amalgam preparation & restoration
_________________________________________________________________________________________________________________________________
0n a)hieing this &rea87thro$gh- ho% %ill this help 3o$ in #efining 3o$rself as a #entistD
0 ha# a har# time )aring the anatom3 of the molar at first" Fith pra)ti)e- 0 got a lot faster an# m3 restoration
&e)ame more anatomi)all3 )orre)t" Fhat 0 fo$n# helpe# is haing a s3stemati) approa)h %hile )aring the tooth
feat$res" 0 learne# to %or8 in a fixe# or#er an# al%a3s $se the same instr$ment for a parti)$lar feat$re" :or
example- 0 %o$l# al%a3s start &3 #efining the o))l$sal ta&le %ith an explorer" Then 0 %o$l# )are a ro$gh o$tline
of the )$sps an# grooes %ith the same explorer" 0 %o$l# then moe on to #efine the )$sps %ith a hollen&a)8 an#
&ea)h )arer" This is follo%e# &3 #efining the pits an# marginal grooes %ith a #is)oi#7)leoi#" Hastl3- 0 %o$l#
finish off %ith shaping the &$))al or ling$al )onto$r %ith a hollen&a)8" 0 fo$n# this s3stemi) approa)h ma#e s$re
all the feat$res of the restoration is present an# nothing is misse#" Also- repeate# pra)ti)e %ith the same instr$ment
on the same anatomi)al feat$re greatl3 improes m3 spee# an# 9$alit3 of %or8 then if 0 )are# the str$)t$re %ith
#ifferent instr$ment ea)h time" This experien)e )learl3 signifie# the importan)e of a#opting a s3stemi) approa)h in
o$r #ail3 pro)e#$res" :rom a ro$tine patient exam to )ompli)ate# #ental pro)e#$res- haing a s3stemi) approa)h
%ill greatl3 improe the effi)ien)3 an# ma8e s$re eer3thing is )oere#"
Referen)es:
Page 1. of 15
Alex Chen
Complex amalgam preparation & restoration
_________________________________________________________________________________________________________________________________
A8er&oom- <"- A#o8aat" ?"- Amerongen I"- Borgmei4er- P" +.((6/" Hong7term eal$ation an# rerestoration of amalgam restorations-
Community Dentistry an! #ral $pi!emiology% .1+1/: 4574G
B$rgess- O"- Alare,- A"- !$mmitt B" +1''C/" :ra)t$re resistan)e of )omplex amalgam restorations" &ournal of #perative Dentistry-
..+6/:1.G716."
:athi M"- Morta,ai- I"- +.((4/" A Reie% on Dental Amalgam Corrosion an# 0ts Conse9$en)es- &ournal of "esearch in 'e!ical
(ciences- '+1/: 4.751
Mahler" B"- Marant,- H" +1'G(/" Marginal fra)t$re of amalgam: effe)t of t3pe of tooth an# restoration )lass an# si,e" &ournal of !ental
restorations) 5'+'/: 14'C715((
M)Daniel- R"- Dais- R"- M$r)hison- D"- Cohen- R" +.(((/" Ca$ses of fail$re among )$spal7)oerage amalgam restorations" &ournal of
American Dental Association% 161+./: 1C671CC" Retriee# ?an .6- .(1(- from http:**4a#a7pl$s")om*)gi*reprint*161*.*1C6"
M4or- 0"- Hars- B"- :errar- M"- <e3eraas- J" +.((6/" Pulp*!entin biology in restorative !entistry) Chi)ago: K$intessen)e P$&"
Paarmann- C"- Be)8man- T" +.((5/" Polishing amalgam restoration) Department of !ental hygiene% +!aho (tate University) Retriee#
?an .1- .(1(- from http:**%%%")si"e#$* %e&Tools*sites*Bo%)$t5G*)o$rses*6.(*DentalPolishingAmalgamRestorations"p#f
K$altro$gh- A"- !atterth%aite- ?"- Morro%- H" +.((5/" Principles of operative !entistry" Ames- 0o%a: Bla)8%ell P$&"
Kist- I"- ?ohanessen- H"- & Br$$n- M" +1''1/" Progression of approximal )aries in relation to iatrageni) preparation #amage" &ournal
of Dental "esearch% C1+6/: 16C(7C6"
Ro&erson- T" <e3mann- <" O"- !%ift- E" ? "+.((6/" (tu!evant,s Art an! (cience of #perative Dentistry" !t" Ho$is- Misso$ri: Mos&3
P$&"
Page 16 of 15
Alex Chen
Complex amalgam preparation & restoration
_________________________________________________________________________________________________________________________________
Rosenstiel- :"- A3a#- :"- Maghra&i- A" +.((5/" Assessment of Conergen)e angles of tooth preparations) &ournal of Dentistry-
66+G/: 6667G"
!)h%art,- R"- !$mmitt- ?"- Ro&&ins- F" +.((6/" Fun!amentals of operative !entistry - a contemporary approach +6
r#
e#"/ Chi)ago:
K$intessen)e P$&"
Taernier- B"- Colon- P" +1'G'/" :$n)tional #ental anatom3 an# amalgam- "ev #!ontostomatol .Paris/) 1G+1/: .17.'
Page 14 of 15
Alex Chen
Complex amalgam preparation & restoration
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Page 15 of 15