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OPERATIVE DENTISTRY Part 1: Dental Caries Dental Caries -infectious bacterial disease caused b cario!

enic "la#ue for$ation on toot% t%at results in de$inerali&ation of ena$el at "' ()( or less* so$eti$es re#uirin! restorati+e t, or e+en e,traction -for caries to occur* t%ree t%in!s $ust be "resent at sa$e ti$e: 1- cario!enic bacteria .- susce"tible toot% surface /- foodstuffs to su""ort bacterial !ro0t% Specific Plaque Hypothesis -not all of bacterial s"ecies in oral ca+it cause caries1 onl t%e bacteria t%at !enerate "la#ue for$ation resultin! in caries are considered cario!enic 2not all "la#ue is cario!enic-e,) Viridans stre"tococci cause "la#ue but $uc% less +irulent for caries for$ation Streptococcus Mutans -non$otile* !ra$3 bacteria t%at is cario!enic 2"ri$ar causati+e a!ent of initial caries for$ation-ad%eres to ena$el t%rou!% !lucos ltransferase en& $e* 0%ic% causes for$ation of e,tracellular "ol sacc%aride t%at allo0s it to stic4 to s$oot% toot% surfaces -con+erts sucrose into fructans and !lucans* 0%ic% e,trude fro$ bacteria and stic4 to toot% -"roduces and tolerates acid 2$etaboli&es sucrose to lactic acid-t%ri+es in sucrose-ric% en+iron$ent -"roduces bacteriocins* 0%ic% 4ill off co$"etin! or!anis$s Enamel Caries -ion transfer continuousl occurs at "la#ue-ena$el surface -initial decalcification occurs at subsurface -$a be 1-. ears before enou!% decalcification occurs to cause surface inte!rit loss a- Inci"ient caries: caries t%at %a+e not "ro!ressed fart%er t%an ena$el and are re+ersible5able to re$inerali&e b- 6ran4 caries: caries t%at %a+e "ro!ress 7ust into DE8 and not re+ersible Zones of Carious Enamel 1- Surface &one: outer$ost &one 0%ic% see$s unaffected b caries .- 9od &one: lar!est &one 0%ic% re"resents de$inerali&in! "%ase /- Dar4 &one: re"resents re$inerali&ation1 na$ed b5c it can:t trans$it "olari&ed li!%t ;- Translucent &one: dee"est &one1 na$ed b5c of its absent a""earance under "olari&ed li!%t -re"resents ad+ancin! front of ena$el lesion Dentinal Caries -once ena$el decalcification occurs* t%e underl in! dentin %as alread been affected b "ro!ression of t%e destruction -<actobacillus or!anis$ beco$es a "ri$ar a!ent for furt%er destruction of t%e dentin -<actobacillus "roduces le,an instead of de,tran -dentin is less resistant to caries and can "ro!ress ra"idl t%rou!% "roteol sis of dentin -dentin is less $inerali&ed t%an ena$el and %as tubular structures allo0in! for s"read of acid destruction -caries a""ears V-s%a"ed 05 base at DE8 and a"e, to0ard "ul" -necrotic dentin a""ears soft* 0et* and $us% 1- Infected dentin: tubules infected 05 cario!enic bacteria and "roteol tic acti+it causes de!radation .- Affected dentin: bacteria "resent but in s$aller a$ounts1 de$inerali&ation occurs but can be re+ersed if infected la er re$o+ed and en+iron$ent fa+orable

Zones of Carious Dentin (from innermost to outermost) 1- Nor$al dentin: dee"est area1 no bacteria or b "roducts "resent .- Subtrans"arent dentin: de$inerali&ation fro$ acido!enesis but no bacteria found in tubules -ca"able of re$inerali&ation /- Trans"arent dentin: softer t%an nor$al and %as furt%er de$inerali&ation1 no bacteria %ere --ca"able of re$inerali&ation ;- Turbid dentin: &one of first encountered bacterial in+asion 05 tubules filled 05 bacteria1 &one $ust be re$o+ed (- Infected dentin: outer$ost &one1 consists of deco$"osed dentin and $an bacteria found in t%is &one and $ust be re$o+ed -&ones 1-/ are ca"able of re$inerali&ation -&ones . and / 2subtrans"arent and trans"arent- ter$ed affected dentin and &ones ; and ( 2turbid* infectedare ter$ed infected dentin Tertiary/ eparati!e Dentin -"roduced b secondar odontoblasts in res"onse to irritants -if insult is stron! enou!%* it 0ill 4ill odontoblasts and for$ dead tracts* 0%ic% calcif to for$ s clerotic dentin -ot%er t "es of dentin: 1- Pri$ar dentin: dentin for$in! initial s%a"e of toot% and de"osited before co$"letion of a"ical fora$en .- Secondar dentin: dentin for$ed after co$"letion of a"ical fora$en "ther #acteria $n!ol!ed in Caries 1- Actino$ ces +iscus: $ost co$$on cario!enic bacteria in root surface caries and s$oot% surface caries .- Stre"tococcus san!uis: earliest bacteria in dental "la#ue /- Ot%er cario!enic bacteria: Actino$ ces naeslundi* Veillonella* Stre"tococcus sali+arious Cyclic Process of Caries -as "la#ue is e,"osed to sucrose* t%e "la#ue $etabolis$ "roduces acid 0%ic% 0%en less t%an "' ()(* causes de$inerali&ation of toot% structure -as sucrose or "la#ue is re$o+ed* ions fro$ sali+a 2Na* =* Ca- cause re$inerali&ation to occur* 0%ic% atte$"t to restore ionic co$"onent of toot% structure -0%en fluoride is "resent* it is "ic4ed u" b toot% and for$s fluoroa"atite in ena$el* 0%ic% is e+en $ore resistant to future de$inerali&ation t%an nor$al ena$el Hydrodynamic Theory of Pain from Caries -0%en toot% is sub7ected to insult* fluid $o+e$ent t%rou!% tubules increases and !reater flo0 defor$s t%e ner+e endin!s in "ul" leadin! to "ain res"onse -cold conducti+it increases bot% +olu$e and flo0 in tubules resultin! in "ain sti$ulus Sali!a -sali+a is a $a7or bloc4 barrin! t%e cario!enic bacteria -"rotecti+e $ec%anis$s: 1- 9acterial clearance: lar!e carbo% drate-"rotein $olecules in sali+a cause so$e bacteria to a!!lutinate and t%en be re$o+ed b s0allo0in! .- 9ufferin! action: sali+a contains urea and ot%er buffers to %el" dilute "la#ue acid /- Anti$icrobial actions: a +ariet of "roteins and Ab in sali+a discoura!e54ill bacterial !ro0t% a- < so& $e: destro s bacterial cell 0alls and causes $e$brane "er$eabilit b- <actoferrin: acti+el binds iron* 0%ic% is i$"ortant for bacterial en& $e "roduction and f,n 2$a also destro S) $utansc- <acto"ero,idase: inacti+ates bacterial en& $es d- T "e A secretor i$$uno!lobulin: Ab in sali+a 0%ic% fi!%ts S) $utans attac4s ;- Re$inerali&ation: Ca* =* PO;* and 6 ions in sali+a assist 05 re$inerali&ation of ena$el -so$e sali+ar "roteins "ro$ote re$inerali&ation 2stat%erin* c statin* %istatin* "roline-

Common Dru%s Causin% &erostomia 1- Antic%oliner!ics 2atro"ine.- Diuretics 2% droc%lorot%ia&ide/- <ocal anest%etics ;- Anti"s c%otics (- 9eta bloc4ers 2atenolol>- 9en&odia&e"ines 2al"ra&ola$?- Anti%ista$ines $dentification of Hi%h' is( Caries Patients -no e,act $ec%anis$ for deter$ination* but so$e factors t%at "redis"ose to caries: 1- %i!% S) $utans count (- lar!e nu$ber of restorations @- oral a""liances .- . or $ore acti+e lesions >- "oor oral % !iene 1A- dee" "its5fissures /- "oor diet ?- subo"ti$al fluoride 11- e,"osed roots ;- lo0 sali+ar flo0 B- unusual toot% $or"%olo! 1.- dru! use )luoride -is bactericidal and "ro+ides fluoride ion for re$inerali&ation -sources: 1- 0ater fluoridation s ste$s ;- +arnis%es .- rinses (- toot%"aste /- !els Pre!ention of Dental Caries 1- Decrease S) $utans acti+it and educate "t t%at re"airin! carious lesion doesn:t cure caries "roble$ .- Intense anti$icrobial a""lication on s%ort-ter$ basis /- 6luoride ;- Sali+a -alter sali+ar -reducin! $eds if "ossible -use sali+a sti$ulants 2!u$* "araffin 0a,* sali+a substitutes* diet %i!% in "rotein and +e!etables(- Decrease sucrose in diet 2better to decrease 6RECDENCY t%an CDANTITY-sin!le e,"osure to sucrose for caries-acti+e $out% can result in "' reduction belo0 ()( for sustained "eriod of ti$e b5c of ra"id $etabolis$ b S) $utans >- E litol 2natural su!ar fro$ birc% trees t%at 4ee"s sucrose fro$ bindin! 05 S) $utans-S) $utans can:t fer$ent , litol ?- Enforce !ood oral % !iene 2disru"ts "la#ue for$ationB- Sealants 2re$o+es %abitat for S) $utans@- Restorations Treatment of Carious *esions 1- Restorations: 0%en ca+itated lesions "resent* t%e $ust be restored 2Ca+itated lesions F Restore-use of anti$icrobials $ust 0ait until after ca+itated lesion is restored* or t%e anti$icrobial 0ill disru"t t%e nor$al flora and allo0 +irulent or!anis$s in "rotected* ca+itated area to flouris% on no0-un"rotected surfaces -restorations re$o+e lar!e nidi of infectious or!anis$s as 0ell as re$o+e %abitats for $ore bacterial ad%erence -restorations alone don:t cure caries "roble$s* need better "re+enti+e strate!ies .- Sealants -sealants s%ould be a""lied si$ultaneousl to at-ris4 $olars and "re$olars as 0ell as ditc%ed restoration $ar!ins 2etc% ena$el and $icroabrade a$al!a$/- Intense* s%ort-ter$ use of a!ents -C%lor%e,idine -6luoride +arnis%es ;- E litol "roducts (- 6luoride rinses 2OTC-use after C%lor%e,idine is finis%ed and use at difft) ti$es t%an for brus%in! .,5da >- /-$ont% recalls after C%lor%e,idine5fluoride +arnis% a""lication

Part .: Clinical E,a$ Clinical E+am for Caries 1- Visual c%an!es in toot% surface te,ture or color (- DIAGNOdent .- Tactile sensation 05 e,"lorer >- DI6OTI 2di!ital i$a!in! fibero"tic transillu$)/- Radio!ra"%s ?- Cuantitati+e li!%t-induced fluorescence 2C<6;- Transillu$ination B- Electronic caries $onitor -no sin!le test is co$"letel accurate* so can:t rel solel on one test Caries $ndicatin% Solution -colored d e in or!anic base ad%eres to denatured colla!en* 0%ic% distin!uis%es bt0 infected and affected dentin "cclusal Pits and )issures -caries is $ost "re+alent in fault "its and fissures on occlusal surfaces 0%ere de+elo"$ental lobes %a+e failed to coalesce -occlusal !roo+es5fossae are s$oot%* +alle s indicatin! re!ion of co$"lete coalescence of de+elo"$ental !roo+es 2not susce"tible to caries nor$all b5c not "rone to "la#ue for$ation-occlusal fissures and "its are dee"* ti!%t cre+ices in ena$el 0%ere lobes fail to coalesce -use of an e,"lorer in dia!nosin! caries is stron!l discoura!ed b5c in7udicious use of e,"lorer $a actuall cause fracture of surface ena$el t%at 0as 0ea4ened b carious destruction beneat% it -occlusal surface s%ould be e,a$ined +isuall and radio!ra"%icall -+isual e,a$ done b dr in! toot% and usin! illu$ination to loo4 for c%al4iness* bro0n-!ra coloration or softenin!5ca+itation in fissure5"it -radio!ra"%ic dia!nosis $ade b 9H radio!ra"%s* loo4in! for radiolucenc beneat% ena$el surface at DE8 2narro0 at ena$el surface and s"reads 0ide at DE8 2in+erted V-actual lesion $uc% lar!er t%an clinicall "resentable -lesion "ro!resses "arallel to ena$el rods -carious "its and fissures also occur on occlusal .5/ of facial and lin!ual surfaces of "osterior teet% and on lin!ual surface of $a,) incisors -"it5fissure caries $ostl caused b Stre") San!uis and ot%er Stre" s"ecies -"re+ented b fissuroto$ or sealants Cusp Tip Caries -"re-carious or carious "its are occasionall found on cus" ti"s -t%ese are result of de+elo"$ental ena$el defects Pro+imal Surface Caries -for$ of s$oot% surface caries located bt0 teet% -dia!nosed radio!ra"%icall $ost often* but $a be detected +isuall 05 toot% se"aration or fibero"tic transillu$ination -starts 0ide at surface and con+er!es to0ard DE8 2V-s%a"e-DE8 "ro+ides least resistance to caries and allo0s re"aid s"read once reac%ed -"ro,i$al caries in anterior teet% $a also be detected b e,"lorer "robin! -located 7ust !in!i+al to IP contact -"ro!resses $uc% slo0er t%an "it5fissure caries #ro,n Spots -bro0n s"ots on intact* %ard "ro,i$al surfaces ad7acent to and !in!i+al to contact area often seen in older "ts 0%o %a+e lo0 caries acti+it -are result of e,trinsic stainin! durin! earlier caries de$inerali&in! e"isodes t%at 0ere re$inerali&ed -s"ots are no lon!er carious and usuall $ore resistant to caries* so restorati+e t, not indicated

Smooth Surface Caries on )acial/*in%ual Surfaces -$ostl in !in!i+al areas t%at are less accessible for cleanin! -earliest e+idence is inci"ient caries 0%ic% s%o0s as 0%ite s"ot t%at is +isuall difft) fro$ ad7acent translucent ena$el and disa""ears 0%en 0etted 2dr in! 0ill cause it to rea""ear-s%ould "ro$ote re$inerali&ation of t%ese inci"ient lesions -ena$el % "ocalcification does not disa""ear 0%en 0et -"resence of se+eral facial5lin!ual s$oot% surface lesions indicated %i!% caries rate* so s%ould al0a s c%ec4 facial5lin!ual areas of "osterior teet% b5c t%ese areas are at e+en $ore ris4 -ad+anced s$oot% surface caries 0ill feel soft to e,"lorer "enetration and discolored 20%ite to dar4 bro0n-05 slo0l "ro!ressin! caries* dar4enin! occurs due to de$inerali&ation-re$inerali&ation c cle* resultin! in %ardened* arrested lesion -restoration not indicated* e,ce"t for est%etics -dentin in an arrested lesion is ter$ed eburnated or sclerotic oot Surface Caries (Senile Caries) -earl on* root caries a""ears as 0ell-defined discolored area ad7acent to !in!i+al $ar!in near CE8 -softer t%an ad7acent tissue and s"reads laterall around CE8 -t%in ce$entu$ la er "ro+ides little resistance to attac4 and results in ra"id "ro!ression 2"ro!resses $ore ra"idl t%an ena$el and dentin caries-"ro!resses $ore laterall alon! surface t%an in de"t% -"at%0a of initial de$inerali&ation is alon! S%ar"e :s fibers -no clinical criteria uni+ersall acce"ted for dia!nosin! root caries* it is a!reed t%ou!% t%at softened toot% structure co$"ared to surroundin! structure is c%aracteristic -acti+e root caries detected b softenin! and ca+itation -$a be detected radio!ra"%icall * but careful clinical e,a$ is crucial b5c root caries and cer+ical burnout are si$ilar in a""earance -+ertical 9H best for dia!nosin! root caries -a""ears as cu""ed-out5crater-s%a"ed radiolucenc 7ust belo0 CE8 -often occurs in elderl due to !in!i+al recession 2,erosto$ia and lac4 of % !iene "la role also-ce$entu$ is rou!%er t%an ena$el and $ore li4el to ac#uire "la#ue -often re$inerali&e due to s%allo0 nature -often as $"to$atic and difficult to restore -best restored 05 !lass iono$er "ther )orms of Caries 1- Residual caries: infected toot% structure re$ainin! after atte$"ted re$o+al in a co$"lete ca+it "re" .- Recurrent caries 2secondar caries-: deca t%at re$ains in co$"leted ca+it or for$s around e,istin! restoration -radiolucent bases5liners $a be $ista4en for recurrent deca on radio!ra"% /- Ra$"ant caries 2acute caries-: ra"idl "ro!ressin! 0ide-s"read caries1 usuall acute onset and "ainful -assoc) 05 "oor % !iene* dru! use* radiation* %i!% su!ar diet* ,erosto$ia ;- Arrested caries 2c%ronic caries-: lesions t%at %a+e re$inerali&ed -%ard* blac4* and as $"to$atic -s%ould be co$"letel re$o+ed if found in ena$el or close to DE8

Clinical E+am of -mal%am estorations -in+ol+es +isual obser+ation* tactile sense 05 e,"lorer* dental floss* radio!ra"%s* and 4no0led!e of "robabilities t%at !i+en toot% or restoration is at ris4 for furt%er brea4do0n -"roble$s t%at can arise 05 a$al!a$ restorations include: 1- A$al!a$ IbluesJ: discolored ena$el resultin! fro$ leac%in! of corrosion "roducts of a$al!a$ into dentinal tubules or fro$ color of underl in! a$al!a$ seen t%rou!% t%in* translucent ena$el 2unsu""orted-does not indicate failin! restoration5caries and no re-t, needed* unless for est%etics .- Pro,i$al o+er%an!s: dia!nosed +isuall * tactilel * and radio!ra"%icall /- Kar!inal !a"5ditc%in!: s%allo0 ditc%in! of a$al!a$ $ar!in less t%an A)($$ usuall not reason for ret,t b5c it loo4s 0orse t%an it reall is -e+entual seal-sealin! "ro"ert of a$al!a$ allo0s restoration to sur+i+e as lon! as it can be cleaned -if ditc% is too dee" to be cleaned or 7eo"ardi&es restoration5toot% structure* it s%ould be re"laced ;- Voids: accessible s$all +oids in areas 0%ere ena$el is t%ic4 $a be corrected b recontourin! or re"airin! 05 s$all restoration (- 6racture lines: detected b clinical e,a$ >- <ine indicatin! interface bt0 abutted restorations: acce"table and better t%an a s$all inter+enin! stri" of ena$el ?- I$"ro"er anato$ic contours: a$al!a$s s%ould $i$ic nor$al anato$ic contours of teet% -restorations t%at i$"in!e on soft tissue* %a+e inade#uate e$brasure for$* bad contact* or "re+ent use of floss s%ould be re"laced or recontoured B- Kar!inal rid!e inco$"atibilit : $ar!inal rid!e of a$al!a$ s%ould be co$"atible 05 ad7acent $ar!inal rid!e of toot% or restoration -s%ould bot% be at about sa$e le+el and dis"la correct occlusal e$brasure for "assa!e of food to facial5lin!ual surfaces and "ro"er contact area -if rid!es aren:t co$"atible* %a+e "oor tissue %ealt%* food i$"action* or can:t floss* s%ould be re"laced or recontoured @- I$"ro"er "ro,i$al contacts: t%ere s%ould be closed and "ro"er contact bt0 restoration and ad7acent toot% -c%ec4ed 05 floss or t%rou!% illu$ination and $irror ins"ection 2$ust be dr L1A- Recurrent caries: detected +isuall * tactilel * and radio!ra"%icall 11- Inade#uate occlusal contacts: can cause i$"ro"er occlusal f,nin!* and toot% $o+e$ent Part /: Treat$ent Plannin! Treatment Plan Sequencin% 1- Dr!ent5E$er!enc "%ase .- Disease control "%ase /- Re-e+aluation "%ase ;- Definiti+e "%ase (- Kaintenance "%ase estoration of $ncipient *esions -inci"ient lesions are contained entirel 0it%in ena$el and %a+en:t et s"read to dentin -t0o o"tions to treat: 1- Tar!eted re$inerali&ation and $onitorin!: first and "referred a""roac% for inci"ient lesions -inci"ient lesions do not "ro!ress ra"idl -c%an!in! oral en+iron$ent co$bined 05 fluoride +arnis% and %o$e fluoride can re$inerali&e t%ese lesions .- Restorati+e t,t: last resort for inci"ient lesions -be as conser+ati+e as "ossible Criteria for estorin% 1- Poor oral % !iene .- <o0 fre#uenc of routine dental care /- ', of caries or nu$erous restorations ;- Ca+itation or defect "resent (- <esion e,tends to DE8 >- 'i!% de!ree of caries susce"tibilit ?- Patient a!e B- Est%etic t,t

Treatment of -.rasion/ Erosion/ and -ttrition -areas of si!nificant attrition t%at are 0orn into dentin and are sensiti+e or anno in! s%ould be restored -before cast restorations are used* a co$"lete occlusal anal sis and in-de"t% inter+ie0 05 "t re!ardin! etiolo! s%ould be done to reduce contributin! factors -bite!uard t%era" s%ould be considered also -abrasion or erosion s%ould be considered for restoration if: 1- area is carious .- defect s dee" enou!% to co$"ro$ise structural inte!rit of toot% /- intolerable sensiti+it e,ists and is unres"onsi+e to desensiti&in! $easures ;- defect contributes to "erio "roble$ (- area to be in+ol+ed in RPD >- de"t% of defect close to "ul" ?- "t 0ants est%etic i$"ro+e$ent Treatment of oot Surface Caries -$ust use caution to onl correct acti+e root carious lesions* not areas t%at are arrested 2discolored* but %ard to e,"lorerTreatment of oot Surface Sensiti!ity -t%eor for cause of sensiti+it is hydrodynamic theory 0%ic% states t%e "ain results fro$ indirect inner+ation caused b dentinal fluid $o+e$ent in tubules t%at sti$ulates $ec%anorece"tors near "redentin -cause of fluid s%ift includes te$") c%an!e* air dr in!* and os$otic "ressure -an t, t%at can reduce fluid s%ifts b occludin! tubules $a %el" reduce sensiti+it -dentin % "ersensiti+it is "roble$ in "ts follo0in! "erio sur!er t%at e,"oses root surface -t, used to "ro+ide relief include to"ical fluoride* fluoride rinses* o,alate solutions* dentin bondin! a!ents* sealants* ionto"%oresis* and desensiti&in! toot%"astes -dentin bondin! a!ents 0or4 best -0%en t%ese $et%ods don:t "ro+ide relief* restorati+e t, is indicated $ndications for $ndirect Tooth'Colored estorations -$a be indicated for class I and II restorations due to est%etics* stren!t%* and ot%er bondin! benefits -b5c of "otential for bonded restorations to stren!t%en re$ainin! toot% structure* indirect restorations $a be indicated for conser+ati+e restoration of 0ea4ened "osterior teet% in est%etic areas -indirect toot%-colored restorations include: 1- Processed co$"osite: %a+e better 0ear resistance o+er direct co$"osites -used $ainl in conser+ati+e class I and II restorations in lo0-$oderate stress areas .- 6elds"at%ic "orcelain: used for inla s and onla s for class I and II restorations b5c %i!%l est%etic -suffer fro$ %i!% incidence of fracture* es"eciall under %ea+ occlusal forces -"orcelain can also 0ear o""osin! toot% structure /- Cast cera$ic: inla s and onla s for class I and II "re"s %a+e !reat $ar!inal fit* lo0 abrasion to o""osin! toot% structure* and su"erior stren!t% co$"ared to "rocessed co$"osite or 6elds"at%ic -are e,cellent est%etic alternati+e to cast $etal restorations ;- Co$"uter-!enerated 2CAD5CAK-: better "% sical c%aracteristics t%an "rocessed co$"osite* are also $ore e,"ensi+e due to e,"ense of e#ui"$ent needed -ad+anta!e is t%e are fabricated c%airside* so onl one a""t needed -do %a+e %i!% stren!t%* lo0 abrasi+eness* and %i!%l est%etic Part ;: 'and Instru$ents Hand $nstrument Materials -%and instru$ents are $ade fro$ t0o $aterials: carbon steel and stainless steel -so$e $ade 05 carbide inserts to "ro+ide $ore durable cuttin! ed!es 2is $ore brittle t%ou!%-carbon steel is %arder t%an stainless steel but 0ill corrode easier -stainless steel 0ill lose its 4een ed!e #uic4er t%an carbon steel

$nstrument Cate%ories 1- Cuttin!: e,ca+ators* c%isels* $ar!in tri$$ers .- Noncuttin!: condensers* $irrors* e,"lorers* "robes $nstrument Desi%n -$ost %and instru$ent %a+e / "arts: 1- 'andle: "art o"erator %olds .- S%an4: connects %andle to blade /- 9lade: 0or4in! end of instru$ent -noncuttin! instru$ents %a+e a nib instead of a blade -t%e end of t%e nib 20or4in! surface- is call t%e face Cuttin% $nstrument )ormulas 1- 6irst nu$ber: 0idt% of blade in tent%s of $$ .- Second nu$ber: "ri$ar cuttin! ed!e an!le 2al0a s e,ceeds (A-if ed!e is "er"endicular to blade* t%is nu$ber o$itted* resultin! in / nu$ber for$ula /- T%ird nu$ber 2.nd nu$ber of /-nu$ber code-: blade len!t% in $$ ;- 6ourt% nu$ber 2/rd nu$ber in /-nu$ber code-: blade an!le 2al0a s (A or lessClassification of Hand $nstruments 1- Order: describes "ur"ose of instru$ent .- Suborder: describes "osition and tec%ni#ue /- Class: describes for$ and s%a"e 2c%isel or %atc%et;- Subclass: describes an!le of s%an4 2strai!%t* $ono* bin* tri"le an!lesCuttin% $nstrument -pplications 1- E,ca+ators: used for re$o+al of caries and refine$ent of "re" .- C%isels: used for cuttin! ena$el E+ca!ators -four subdi+isions: 1- 'atc%ets: %as cuttin! ed!e of blade in sa$e "lane as lon! a,is of %andle -is bi-be+eled -used "ri$aril on anterior teet% for "re"arin! retenti+e areas and s%ar"enin! internal line an!les .- 'oes: %as cuttin! ed!e of blade "er"endicular to a,is of %andle -used for "lanin! toot% "re" 0alls and for$in! line an!les -co$$onl used in class III and V "re"s for !old /- An!le-for$ers: is a $ono-an!le instru$ent 05 cuttin! ed!e at an!le ot%er t%an @A de!rees to blade -used "ri$aril for s%ar"enin! line an!les and creatin! retenti+e features in dentin -can also be used to "lace be+el in ena$el $ar!ins -li4e a co$bo of c%isel and !in!i+al $ar!in tri$$er ;- S"oons: blades are sli!%tl cur+ed and cuttin! ed!es are circular 2discoid- or cla0-li4e 2cleoid-used for re$o+in! caries and car+in! a$al!a$ and 0a, "atterns Chisels 1- Strai!%t c%isel: cuttin! ed!e "er"endicular to a,is of %andle and %as bevel on only one side -force used is $ainl strai!%t t%rust -used to "lane5clea+e ena$el .- Ena$el %atc%et: used for cuttin! and "lanin! ena$el surfaces /- Gin!i+al $ar!in tri$$er: desi!ned to "roduce a "ro"er be+el on !in!i+al $ar!ins of "ro,i$o-occlusal "re"s and be+els on a,io"ul"al line an!le in class II "re"s -blade is curved and cuttin! ed!e at an!le ot%er t%an "er"endicular to a,is of blade

"ther Cuttin% $nstruments 1- =ni+es 2finis%in! 4ni+es* a$al!a$ 4ni+es* !old 4ni+es-: %a+e t%in* 4nife-li4e blade used to tri$ e,cess restorati+e $aterial on !in!i+al* facial* or lin!ual $ar!ins on "ro,i$al or class V "re"s .- 6iles: also used to tri$ e,cess $aterial* "articularl at !in!i+al $ar!ins /- Discoid-Cleoid: used $ainl to car+e occlusal anato$ in unset a$al!a$ -$a be used to tri$ or burnis% inla -onla $ar!ins -0or4in! ends lar!er t%an s"oon e,ca+ator 0sin% Hand $nstruments -modified pen grasp %as !reatest intricac of touc% and is $ost co$$on -palm and thumb grasp is $ost "o0erful !ras" Part (: Po0er Cuttin! Instru$ents otary Speed an%es -rotational s"eed of "o0er instru$ents $easured in re+olutions "er $inute 2r"$-/ s"eeds: 1- <o05Slo0 s"eed: M 1.*AAA r"$ .- Kediu$ s"eed: 1.*AAA to .AA*AAA r"$ /- 'i!% s"eed: F .AA*AAA r"$ -crucial factor is +elocit at 0%ic% ed!es of cuttin! instru$ent "ass across surface bein! cut* 0%ic% is "ro"ortional to: 1- rotational s"eed .- dia$eter of instru$ent 2lar!e instru$ents %a+e %i!%er surface s"eeds*aser Equipment -"ri$aril used for soft tissue a""lications or %ard tissue $odifications -not used !enerall for toot% "re"aration b5c it is difficult to !et a defined $ar!in Car.ide Dental #urs -rotar cuttin! burs t%at %a+e bladed cuttin! %eads -!reater nu$ber of cuttin! blades* less efficient but s$oot%er surface 0ill result 2"olis%in! burs-lesser nu$ber of cuttin! blades* $ore efficient but rou!%er surface 0ill be 2fissure burs-includes burs for finis%in! $etal restorations and sur!ical re$o+al of bone* as 0ell as toot% "re"s -t%ere are also steel .urs* 0%ic% are used for finis%in! "rocedures Parts of #ur 1- S%an4: "art t%at fits into %and"iece -strai!%t* latc%-t "e* and friction-!ri" .- Nec4: inter$ediate "ortion t%at connect %ead and s%an4 -trans$its rotational and translational forces to %ead /- 'ead: 0or4in! "art of bur Sides of #ur #lade 1- Ra4e face: surface of blade 0%ic% $a4es contact 05 toot% surface and daces in direction of bur rotation .- Clearance face: surface of blade t%at faces a0a fro$ direction of bur rotation -n%les of #ur #lade 1- Ra4e an!le: an!le bt0 line connectin! ed!e of blade to a,is of bur and ra4e face -$ost i$"t "art of bur blade -carbide burs for cuttin! toot%5a$al!a$ %a+e ne!ati+e ra4e an!le -burs used to cut acr lic5soft $aterials %a+e "ositi+e ra4e an!le .- Ed!e an!le: an!le for$ed bt0 ra4e face and clearance face /- Clearance an!le: an!le for$ed bt0 clearance face and tan!ent to "at% of rotation -eli$inates friction 2%i!%er clearance an!le* less frictionound #urs -used for initial entr into toot%* "re"aration e,tension* "re"arin! retenti+e features* and caries re$o+al

$n!erted Cone #ur 2N/;-ra"idl ta"ered cone 0ider at a"e, and ta"ers to0ard nec4 of bur -!ood for "re"arin! undercuts into "re"arations Pear'Shaped #ur 2N//A-$ore sli!%tl ta"ered bur 0idest at a"e, and ta"ers to0ard nec4 of bur -end of bur is eit%er continuousl rounded or flat 05 rounded corners -used es"eciall in Class I "re"s for !old foil as 0ell as a$al!a$ "re"s Strai%ht )issure #ur 2N(>-elon!ated c linder used for a$al!a$ "re"s Tapered )issure #ur 2N1>@-sli!%tl ta"ered bur 05 narro0est "art at a"e, and 0idest "art at nec4 of bur -used for "re"s for indirect restorations t%at can:t %a+e undercuts Diamond -.rasi!e $nstruments -in+ol+es abrasi+e cuttin! instead of blade cuttin! -based on s$all* an!ular "articles of a %ard substance %eld in a $atri, of softer $aterial -cuttin! occurs at a lar!e nu$ber of "oints 0%ere indi+idual %ard "articles "rotrude fro$ t%e $atri, rat%er t%an alon! a continuous blade ed!e -dia$ond burs consist of a $etal blan4* t%e "o0dered dia$ond abrasi+e* and a $etallic bondin! $aterial t%at %olds dia$ond "o0der onto t%e blan4 Diamond Particle )actors -"erfor$ance de"ends on si&e* s"acin!* unifor$it * e,"osure* and bondin! of dia$ond "articles -increased "ressure causes "articles to di! into surface $ore dee"l * lea+in! dee"er scratc%es and re$o+in! $ore toot% structure -"articles si&e cate!ori&ed as coarse* $ediu$* fine* and +er fine* 0%ic% corres"onds to standard sie+e si&es 0%ic% se"arate dia$ond "articles -lar!er "articles $eans nu$ber of "articles is decreased* so $ore force is a""lied to eac% "article -dia$ond finis%in! burs use e+en finer dia$onds to "roduce s$oot% surfaces for final "olis%in! Cuttin% Mechanisms -re#uire$ents for effecti+e cuttin! include %and"iece* air-0ater s"ra for coolin!* %i!% o"eratin! s"eed 2F.AA*AAA r"$-* li!%t "ressure* and bur -carbide burs are better for end-cuttin!* "roduce lo0er %eat* and %a+e $ore blade ed!es "er dia$eter -used for "unc% cuts to enter toot% structure* intracoronal toot% "re"* a$al!a$ re$o+al* s$all "re"s* and secondar retenti+e features -dia$ond instru$ents %a+e !reater %ardness and +er %i!% cuttin! effecti+eness -$ore effecti+e t%an burs for bot% intracoronal and e,tracoronal toot% "re"s* be+elin! ena$el $ar!ins* and ena$elo"last Ha1ards ,ith Cuttin% $nstruments 1- Pul"al "recautions: cuttin! instru$ents can %ar$ "ul" b $ec%anical +ibration* %eat !eneration* dessication and loss of dentinal tubule fluid* and transection of odontoblastic "rocesses -as t%ic4ness of dentin decreases* "ul"al insult increases .- Soft-tissue "recautions: s%ould isolate o"eratin! field fro$ soft tissue b rubber da$* suction5assistant* cotton roll* $irror* etc) /- E e "recautions: 0ear !lasses 05 e e s%ields 2dentist $ore li4el to %a+e e e in7ur t%an assistant-if e e is in7ured* it s%ould be co+ered 05 !au&e until $edical attention recei+ed ;- Ear "recautions: %i!%-"itc% fro$ %i!% s"eed %and"iece $a cause %earin! loss (- In%alation "recautions: aerosols of toot% structure* restoration debris* $icroor!anis$s* etc) s%ould be a+oided b usin! intraoral e+acuation 0%en cuttin! -rubber da$s can "re+ent in%alation b "atient* but o"erators s%ould use face $as4s 2filter out bacteria and fine "articulate $atter* but not $ercur or $ono$er +a"ors fro$ restorations-

Part >: Toot% Pre"aration Emphasis on Conser!in% Tooth Structure in Tooth Preps 1- Su"ra!in!i+al $ar!ins .- Kini$al "ul"al de"t% /- Kini$al 9-< 0idt% ;- Rounded internal line an!les Principles of Tooth Preparation 1- All "re""ed 0alls and internal line an!les s%ould be "laced in dentin t%at is free of infection* %ard* and can:t be fla4ed a0a .- Pre""ed ca+it s%ould be e,tended to include all deca and "ro+ide con+enience for restorin! and finis%in! /- Enou!% de"t% and 0idt% s%ould be "re""ed to "re+ent fracture of toot% and restoration a- about 15( distance bt0 buccal and lin!ual cus"s b- at least A)($$ into dentin c- "ul"al floor s%ould be flat and "arallel to occlusal surface -s%ould ideall be at least .$$ of dentin bt0 a$al!a$ and "ul"al floor -"ul"al floor s%ould be tilted lin!uall in $and 1st PK due to %i!% buccal "ul" %orn d- line an!les s%ould be rounded and defined 2s%ar" line an!les increase ris4 of fractureCa!ity Classification .y 2um.er of Surfaces $n!ol!ed 1- Si$"le ca+it : lesion confined to one surface .- Co$"ound ca+it : lesion in+ol+es t0o surfaces /- Co$"le, ca+it : lesion in+ol+es t%ree or $ore surfaces 3454 #lac( Ca!ity Classification 1- Class I: in+ol+es "it5fissure caries -occlusal surface of "osterior teet% and lin!ual surface of anterior teet% -$esial5distal 0alls s%ould di+er!e occlusall 1 buccal5lin!ual 0alls "arallel -if 0idt% of $ar!inal rid!e less t%an 1)>$$* s%ould be con+erted to class II -difficult to see radio!ra"%icall .- Class II: in+ol+es "ro,i$al surfaces on "osterior teet% -occlusal outline at "ro,i$al se!$ent dictated b "osition of "ro,i$al contact and e,tent of caries -"ro,i$al 0alls are di+er!ent occluso-!in!i+all -!in!i+al floor s%ould "arallel t%e ena$el rods /- Class III: on "ro,i$al surfaces of anterior teet% t%at don:t include incisal an!le -for est%etic reasons* unsu""orted ena$el $a be left intact -co$"osite is "referred $aterial 2distal of canine $a be restored in a$al!a$;- Class IV: ca+ities of "ro,i$al surfaces of anterior teet% t%at in+ol+e incisal an!le (- Class V: cer+ical caries in !in!i+al 15/ of buccal or lin!ual surfaces -dictated b e,tent of caries -$esial and distal 0alls "arallel ena$el rods -occlusal 0all is lon!er t%an cer+ical5!in!i+al 0all in ideal "re"s* !i+in! tra"e&oidal s%a"e >- Class VI: on incisal ed!es of anterior teet% or on occlusal cus" %ei!%ts of "osterior teet% $nitial Tooth Preparation 1- Outline for$ .- Resistance for$ /- Retention for$ ;- Con+enience for$

"utline )orm -Def: E,tension of t%e "re" 0alls to sound toot% structure in all directions e,ce"t "ul"all ) -s%a"e or for$ of ca+it on surface of toot% -$ar!ins "laced in areas of lessened caries susce"tibilit 2e,tension for "re+ention-all under$ined ena$el $ust be re$o+ed -e,tension to sound* finis%able toot% structure at initial de"t% of A). to A)?( $$ into dentin 1- Princi"les: a- "lace $ar!ins 0%ere finis%able b- re$o+e unsu""orted* 0ea4ened toot% structure c- include all faults .- Dictated b : caries* old $aterial* defect si&e* occlusion* $ar!inal confi!uration* and ad7acent toot% contour /- 6eatures: a- Preser+e cus"al stren!t% d- Connect t0o close "re"s 20it%in A)($$b- Preser+e $ar!inal rid!e stren!t% e- Restrict de"t% to A).-A)?($$ into dentin c- =ee" 9-< 0idt% narro0 f- Dse ena$elo"last ;- Pit and fissure "re"s: e,tend to all of t%e fissure t%at is not eli$inated b ena$elo"last (- S$oot% surface "re"arations a- e,tend until no friable ena$el re$ains b- don:t sto" $ar!ins on cus" %ei!%ts or rid!e crests c- e,tend !in!i+al $ar!in5floor to !et A)($$ clearance d- e,tend facial and lin!ual "ro,i$al 0alls to clearance >- 6or class V "re"s* outline is !o+erned onl b e,tent of lesion* e,ce"t "ul"all ?- Ena$elo"last : re$o+al of defect b recontourin! ena$el 0%en defect is no dee"er t%an O t%ic4ness of ena$el -0%en defect is !reater t%an 15/ t%ic4ness of ena$el* t%e 0all $ust be e,tended esistance )orm -"re+ention of toot% OR restoration fracture fro$ occlusal forces alon! lon! a,is of toot% 1- 6actors: a- occlusal contacts b- a$ount of re$ainin! toot% structure c- t "e of restorati+e $aterial .- 6eatures: a- flat floors 2"ul"al and !in!i+al- e- re$o+e 0ea4ened toot% structure b- bo, s%a"e f- ca" cus"s if needed c- "reser+e $ar!inal rid!es !- round internal line an!les d- "reser+e cus"al stren!t% %- ade#uate t%ic4ness of $aterial Preser!in% Mar%inal id%es -$esial and distal 0alls in class I "re" s%ould be di+er!ent to "re+ent under$inin! of $ar!inal rid!es -for "re$olars* distance fro$ $ar!in of "re" to "ro,i$al surface s%ould be at least 1)>$$ -for $olars* distance fro$ $ar!in of "re" to "ro,i$al surface s%ould be at least .$$ ule for Cusp Cappin% 1- If e,tension fro$ a "ri$ar !roo+e to0ard t%e cus" ti" is no $ore t%an %alf t%e distance* no cus" ca""in! needed .- If e,tension is P to .5/ of t%e distance* consider cus" ca""in! /- If e,tension is $ore t%an .5/ t%e distance* usuall ca" t%e cus" etention )orm -"re+ention of dislod!e$ent of restoration -"re"aration s%ould %a+e so$e undercuts for retention* or ot%er retenti+e features if can:t use undercuts -s%ould %a+e sufficient %ei!%t to %a+e bul4 of $aterial Con!enience )orm -alterations $ade to "re" to i$"ro+e access and +isibilit for "re"arin! and restorin! t%e ca+it

-aids o"erator in "re"arin!* "lacin!* and finis%in! restoration )inal Tooth Preparations 1- Re$o+e re$ainin! caries .- Secondar resistance5retention for$s /- 6inis%in! e,ternal 0alls emo!al of emainin% Caries -initial "re" $a re$o+e all of caries* but additional re$o+al $a be needed -if %a+e dee" e,ca+ation and #uestionable dentin near "ul"* can use indirect "ul" ca" 2lea+e dentin* CaO'* GI base* restorationPulp E+posure 1- Indirect "ul" ca" indicated if: a- s$all e,"osure 2M1$$b- as $"to$atic toot% c- isolated area d- %e$orr%a!e controlled -indirect "ul" ca""in! s%ould be reo"ened in 6'7 months to c%ec4 status and re$o+e re$ainin! deca .- Endo t,t indicated if: a- E,"osure lar!e 2F1$$b- s $"to$atic toot% c- area conta$inated 2sali+a* debrisd- "urulent e,udate Pulp Protection 1- Sealers: seal dentinal tubules -is desirable for A<< restorations .- <iners: used 0%en ca+it "re" is 0it%in A)($$ fro$ "ul" -e,) CaO' 2sti$ulates for$ation of re"arati+e dentina- "laced in A)($$ t%ic4ness b- Pro+ides $ini$al t%er$al and $ec%anical "rotection c- "ro+ides so$e c%e$ical "rotection /- 9ases: "ro+ide bul4 for t%er$al and $ec%anical "rotection 2need a""ro,i$atel .$$ bul4 bet0een "ul" and $etallic restorati+e $aterial-!lass iono$er is t "ical base c%oice -ot%er bases are &inc "%os"%ate and "ol carbo, late ce$ent Secondary esistance and etention )eatures 1- Kec%anical5Pre"aration 6eatures a- retenti+e loc4s* !roo+es* co+es 2$ainl for $etallic restorationsb- !roo+e e,tensions c- s4irts 2for cast restorationsd- be+eled ena$el $ar!ins 2cast and co$"osite restorationse- "ins* slots* ste"s* a$al!a$ "ins 2$ainl for a$al!a$s.- Surface treat$ent of "re"ared 0alls a- Ena$el 0all: etc%in! for bonded restorations b- Dentin 0all: etc%in! and "ri$in! for bonded restorations /- Ce$ent 2for cast restorations-

)inishin% of E+ternal 8alls -establis%in! t%e desi!n and s$oot%ness of ca+osurface $ar!in 1- Ob7ecti+es: a- !et best seal bt0 toot% and restoration b- %a+e s$oot% 7unction bt0 toot% and restoration c- $a,i$u$ stren!t% for toot% and restoration .- 6eatures a- be+els b- butt 7oints /- Considerations a- direction of ena$el rods b- su""ort of ena$el rods c- t "e of $aterial d- location of $ar!in e- de!ree of s$oot%ness re#uired Tooth Preparation )eatures9 -mal%am !s Composite Amalgam Includes adjacent suspicious Outline form areas Pulpal depth uniform 1.5mm Axial depth uniform .2-.5mm inside DEJ Cavosurface margin 9 de!ree amal!am mar!in Bevels only !in!ival Texture of prepped walls smoot" Cutting Instrument #urs Primary retention form conver!ence occlusally Secondary !rooves$ slots$ loc%s$ pins$ retention form #ondin! Resistance flat floors$ rounded an!les$ form #o&-s"aped floors Base need 2mm #t( pulp and indications amal!am iner indications )a*+ Sealer used ("en not #ondin! Composite Does not include adjacent suspicious areas remove fault (not usually uniform) remove fault (not usually uniform) 9 or !reater de!rees included for est"etic and seal rou!" diamonds none needed (#onded) #ondin! similar for lar!e preps' no special form for small restorations not needed )a*+ sealed #y #ondin! system

Part ?: Koisture Control 3oals of $solation 1- Koisture control .- Retraction and access /- 'ar$ "re+ention ;- <ocal Anest%esia u..er Dam -isolates 0or4in! field* "re+ents $oisture and conta$ination* retracts soft tissue* and sa+es ti$e 1- Ad+anta!es a- increased access and +isibilit d- "rotects "t and o"erator !- i$"r) $ater) "ro"erties b- isolates area e- retracts soft tissue c- 4ee"s area dr f- "reser+es and "rotects $aterials .- Disad+anta!es a- so$e "ts ob7ect c- "artiall eru"ted teet% e- ti$e consu$in! b- so$e situations don:t 0or4 d- e,tre$el $al"ositioned teet% f- ast%$a -alternati+es to rubber da$ for $oisture control include cotton roll isolation and cellulose 0afers 2dr an!le)i!e )+ns of u..er Dam 1- Retracts soft tissue .- Pro+ides clean* dr field /- Protects "t and dentist ;- Pro+ides for $a,i$u$ "% sical "ro"erties of $aterials (- Can sa+e ti$e for $ulti"le "re"s Pro.lems ,/ u..er Dam 1- Hrin4lin! of rubber da$ bt0 teet%: %oles "unc%ed too far a"art .- Pa"illae "rotrude fro$ beneat% da$: %oles "unc%ed too close to!et%er Clampin% -for cla$" to be stable* all four "oints of 7a0s of cla$" $ust contact toot% !in!i+al to 'OC -"oints of cla$" $ust not e,tend be ond line an!les to "re+ent i$"in!in! on "a"illae and interference 05 0ed!e u..er Dam )rames 1- Youn!:s fra$e: $ost "o"ular1 D-s%a"ed $etal fra$e .- Hoodbur :s fra$e: "ro+ides $ost retraction of soft tissues Part B: <iners* 9ases* and Ce$ents *iners -t%e onl use of liner is to effect a "ul"al res"onse to la do0n re"arati+e dentin as used for direct or near "ul"al e,"osure -traditional liner used is CaO' -!lass iono$er liners $a be used in con7unction 05 co$"osite restorations as stress brea4er in class I co$"osites and on root surface of class II co$"osite -s%ould %a+e t%ic4ness of ( $icrons -s%ould differentiate bt0 liners and +arnis%es 1- <iners: sus"ensions of CaO' in 0ater 2D Cal-1 $a contain fluoride -liners are t%ic4er t%an +arnis%es .- Varnis%es: solution liners of resin in li#uid 2Co"alite-+arnis%es s%ouldn:t be used under co$"osites b5c disru"t $ono$er -+arnis%es under a$al!a$ ser+e to reduce microleakage and seals tubules -do not act as t%er$al barriers

#ases -additional bul4 fro$ base affords $ec%anical and t%er$al "rotection 2lo0 t%er$al conducti+it - to "ul" under $etal 2a$al!a$5!old- restorations -ter$ed base 0%en .$$ or t%ic4er 0%ic% f,n to re"lace $issin! dentin structure 1- Glass iono$er: %as been reco$$ended as base to o+erl an CaO' liner -"rotects liner fro$ a$al!a$ condensation or dissolution of liner fro$ etc%ant a""lication for co$"osite -used for "osterior co$"osites* "orcelain5co$"osite inla s or onla s* and a$al!a$ -considered near ideal base b5c ad%eres to toot% structure* sna" set 0%en li!%t-cured* anticario!enic 2fluoride-releasin!-* and can bond to co$"osite .- Qinc "%os"%ate5&inc "ol carbo, late: used under !old restorations -$ust use +arnis% before &inc "%os"%ate a""lication /- Secondar bases: &inc "%os"%ate ce$ent o+er CaO' base o+er "ul" e,"osure 2direct "ul" ca"Thermal $nsulation Capacity of #ase Dependent "n9 1- T%ic4ness of base .- T%er$al conducti+it of base /- Densit of base #ase 0se ,/ -mal%am estorations 1- S%allo0 e,ca+ations: if .3$$ dentin re$ains after "re"* onl sealer needed 2Glu$a Desensiti&er or Co"alite.- Koderatel dee" e,ca+ations: if bt0 )( and .$$ of dentin re$ains* GI base can be "laced to build total t%ic4ness fro$ "ul" to .$$ t%en sealer /- Dee" e,ca+ation: if less t%an A)($$ or s$all "ul" e,"osure encountered* "lace CaO' liner and .$$ GI base t%en sealer #ase 0se ,/ Composite estorations 1- S%allo0 e,ca+ations: if .3$$ dentin re$ains* no +arnis%* liner or base needed 2GI ce$ent $a be "laced.- Koderatel dee" e,ca+ations: if bt0 A)($$-.$$ dentin re$ains* GI base can be "laced to fill /- Dee" e,ca+ations: if MA)($$ or s$all "ul" e,"osure encountered* CaO' "laced* t%en GI base #ase 0se ,/ $ndirect $nlay/"nlay estorations 1- S%allo0 to $oderatel dee" e,ca+ations: if at least A)($$ of dentin re$ains* no liner or base needed .- Dee" e,ca+ations: if less t%an A)($$ or s$all "ul" e,"osure occurs* "lace CaO' onl Cements -s%ould %a+e t%ic4ness of 1(-.( $icrons 1- Glass iono$er: $ost co$$on ce$ent1 used $ostl for final ce$entation of cro0ns5brid!es -fluoride releasin! 2anticario!enic-* $icro$ec%anical and c%e$ical bonds* nonirritatin! -0ater-based -contain fluoroalu$ina-silica !lass "o0der and "ol acr lic acid solution -least solubilit after settin! .- Qinc "ol carbo, late: &inc o,ide "o0der and "ol acr lic acid solution -used for final ce$entation of cro0ns5brid!es -nonirritatin! but not as stron! as ot%er ce$ents -0ater-based -$ost solubilit after settin! -first ce$ent de+elo"ed to c%e$icall bond to toot% structure /- Qinc "%os"%ate: 0ater-based ce$ent for final ce$entation of cast cro0ns5brid!es 2not "o"ular-%i!%l acidic 2"' ;).- and can cause "ul"al da$a!e so need +arnis% underneat% to "rotect "ul" -&inc o,ide "o0der and ort%o"%os"%oric acid li#uid -$ust be $i,ed on cold !lass slab to increase 0or4in! ti$e b retardin! e,ot%er$ic r,n -s%rin4s sli!%tl on settin!

-su"erior stren!t% co$"ared ot%er ce$ents ;- Qinc o,ide eu!enol 2QOE-: oil-based ce$ent 05 sedati+e effect on "ul" -can:t use 05 co$"osite b5c eu!enol in%ibits "ol $eri&ation -also can:t be used in direct "ul" ca"s b5c irritates "ul" when in direct contact -can be used as te$"orar ce$ent 2lo0 stren!t%-&inc o,ide* resin* &inc acetate* accelerator* and eu!enol li#uid -%as "' of around ?* 0%ic% $a4es it one of least irritatin! ce$ents $nterim estorations -ce$ents $i,ed to a t%ic4er consistenc can be used as te$"orar fillin!s -QOE is $ost co$$on 2IRK- and "rotects "ul"* reduces "ul" infla$$)* and $aintains toot% structure -s%ould be $i,ed in under 1 $inute Part @: Pro"erties of Restorati+e Katerials 0ltimate Stren%th -defined as "oint on stress-strain cur+e at 0%ic% fracture occurs -/ +ariables: 1- Co$"ressi+e stren!t%: stress re#uired to fracture a $aterial 0%en forces a""lied o""osite and to0ards eac% ot%er 2"ressin!-ena$elRa$al!a$FdentinRco$"osite .- Tensile stren!t%: forces a""lied o""osite and a0a fro$ eac% ot%er 2"ullin!-dentinFa$al!a$Fco$"ositeFena$el /- S%ear stren!t%: forces a""lied o""osite and to0ard eac% ot%er but at difft) "ositions 2slidin!Dimensional Chan%e -is t%e "ercent of e,"ansion or contraction of a $aterial -0%en t%er$al e,"ansion of toot% does not e#ual t%at of restoration* t%e differin! e,"ansions result in lea4a!e of fluids bt0 t%e t0o -percolation refers to inter$ittent inlet and outlet of fluid lea4a!e and can result in $ar!inal deca -coefficient of t%er$al e,"ansion: $easures "er unit len!t% e,"ansion if a $aterial is %eated b 1 de!ree C -co$"ositeFa$al!a$F!oldRtoot% Thermal Conducti!ity -#uantit of %eat transferred "er second across an area and len!t% 0%en te$") difference is 1 de!ree C5c$ -!oldFa$al!a$Fco$"ositeRtoot% Stress -force "er unit area -stressRforce5area -t%e s$aller t%e area t%e force is a""lied* t%e !reater stress e,"erienced -a s$all area of contact on restoration %as $ore stress t%an broad area of contact Strain -c%an!e in defor$ation "er unit len!t% of $aterial sub7ected to stress -rubber %as !reater defor$ation 2strain- t%an !old Elastic Modulus -$easure of stiffness5ri!idit of $aterial -%i!%er elastic $odulusR$ore ri!id $aterial -elastic li$it: !reatest stress an ob7ect can be sub7ected to in 0%ic% it can return to its ori!inal di$ension once force is re$o+ed -$aterial loaded be ond elastic li$it results in both elastic and plastic deformation -!oldFena$elFa$al!a$Fco$"ositeFdentin

Proportionate *imit -stress at 0%ic% $aterial no lon!er f,ns as elastic 2!reatest stress t%at can be "roduced before "er$t) defor$ation e,ists-!reatest stress "roduced suc% t%at stress is directl "ro"ortional to strain - ield stren!t%: arbitrar stress "oint i$$ediatel %i!%er t%an "ro"ortionate li$it and defines "oint at 0%ic% "er$t) defor$ation be!ins -!oldFena$elFa$al!a$Fco$"ositeFdentin -brittleness is $easure of $aterial:s li4eliness to fracture at its "ro"ortional li$it -brittle $aterial %as %i!% co$"ressi+e stren!t% and lo0 tensile stren!t% Coefficient of Thermal E+pansion -$easure of tendenc of $aterial to c%an!e s%a"e 0%en sub7ected to te$") c%an!e -"ossible brea4 in $ar!inal seal of restoration beco$es i$$inent 0%en t%ere is $ar4ed difference in CTE bt0 toot% and restoration -one of conse#uences of t%er$al e,"ansion and contraction is percolation 0%ic% is c clic in!ress5e!ress of fluids at restoration $ar!ins -"ossibilit of recurrent deca increases 05 increased "ercolation -ran4s of CTE: toot%M!oldMa$al!a$Mco$"ositeMunfilled resins 3al!anic Shoc( -brief* but electrical sensation one can recei+e 0%en t0o dissi$ilar $etals co$e into contact in $out% -e,) a$al!a$ and !old on o""osite arc%es touc% 0%en 0et 05 sali+a -usuall occurs i$$ediatel after insertion of ne0 restoration and !enerall it !raduall subsides and disa""ears in a fe0 da s Ductility and Mallea.ility 1- Ductilit : abilit of $etal to easil be 0or4ed into desired s%a"es -decreases 05 increase in te$" .- Kalleabilit : $etal bein! able to be %a$$ered into t%in s%eet 05o ru"ture -increases 05 increase in te$") -!old is $ost ductile and $alleable $etal* and sil+er is second esilience -ener! a $aterial can absorb before onset of an "lastic defor$ation Part 1A: A$al!a$ Restorations Composition of -mal%am 1- Sil+er 2A!- 2$ost-increases e,"ansion and stren!t%* decreases 0or4in! ti$e and cree" .- Tin 2Sn- 2$ost-decreases e,"ansion and stren!t%* increases 0or4in! ti$e and cree" -0or4s o""osite of sil+er /- Co""er 2Cu- 2s$all-increases e,"ansion and stren!t%* decreases 0or4in! ti$e and cree" -also decreases corrosion -decreases 0ea4 . "%ase ;- Qinc 2Qn- 2s$all-increases e,"ansion dra$aticall 0%en e,"osed to sali+a -a$al!a$ conta$inated 05 $oisture durin! condensation reacts 05 Qn to for$ '. !as* leadin! to increased e,"ansion* decreased stren!t%* "ost-o" "ain* and increased corrosion -pre!ents o+idation b actin! as a sca+en!er (- Kercur 2'!- 2s$all-increases e,"ansion* 0or4in! ti$e* and cree"1 decreases stren!t% -increased $ercur content allo0s for se+ere $ar!inal brea4do0n

-$ercur content s%ould be less t%an ((S -reacts to "roduce difft) a$al!a$ "%ases 2initiates r,n 05 allo -a$t of $ercur re$ainin! in set a$al!a$ related to %o0 $uc% of $ercur -ric% $atri, left in a$al!a$ after condensation -4e is to $ini$i&e a$t of $atri, for$in! durin! r,n -b condensin! a$al!a$* $ercur -ric% $atri, 0ill co$e to surface and be re$o+ed 0%en car+in! -$ercur +a"or $ost li4el occurs durin! condensation* so %i!%-s"eed suction s%ould be used Types of -mal%am 1- <o0 co""er: inferior "ro"erties1 >S or less co""er1 s"%erical "articles .- 'i!% co""er: %i!% co""er allo s %a+e 1A-/AS Cu b 0ei!%t a- S"%erical: %as !reater lea4a!e and "osto" sensiti+it 2less $ercur -s"%erical a$al!a$s %i!% in co""er %a+e best tensile and co$"ressi+e stren!t% b- <at%e-cut: irre!ular 2%i!%er $ercur c- Ad$i,ed: co$bo of s"%erical and lat%e-cut 2easier to car+e but need $ore condensation force-co""er adds stren!t% b eli$inatin! . "%ase -s$aller "article si&e results in increased co$"ressi+e stren!t% and decreased settin! e,"ansion Properties of -mal%am -linear coefficient of t%er$al e,"ansion 2<CTE- is !reater t%an toot% structure -co$"ressi+e stren!t% of %i!% co""er a$al!a$ is si$ilar to toot% structure -a$al!a$ %as 1A, $ore co$"ressi+e stren!t% t%an tensile stren!t% -0ea4 condensation results in +oids* causin! 0ea4er a$al!a$ -a$al!a$ is brittle and %a+e lo0 ed!e stren!t% -creep is t%e !radual di$ensional c%an!e resultin! fro$ constant stress -%i!% co""er a$al!a$s %a+e no clinicall rele+ant cree" or flo0 b5c . "%ase eli$inated -o+er5undertrituratin! increase cree" -increasin! condensation "ressure decreases cree" -a$al!a$ is a %i!% t%er$al conductor and "oor t%er$al insulator -a$al!a$ s%ould not contract or e,"and after settin! -tarnis%in! and corrosion result fro$ c%e$ical r,ns bt0 a$al!a$ and oral en+iron$ent a- tarnis%: results in discoloration at a$al!a$ surface -discoloration $ost li4el a sulfide b- corrosion: results in destruction of restoration as it occurs dee"er in bod of a$al!a$ -s$oot%er* "olis%ed a$al!a$s %a+e decreased corrosion and tarnis% -$ar!inal lea4a!e decreases 05 ti$e due to increased corrosion b "roducts 2tin sulfide-discolored* corroded su"erficial la er on a$al!a$ surface is t%e sulfide Delayed E+pansion of -mal%am -due to: 1- Insufficient trituration and condensation .- Conta$ination b $oisture durin! condensation 2"rinci"le cause of failures-$oisture conta$ination !reatl reduces co$"ressi+e stren!t% Trituration -"rocess of $i,in! t%e allo 05 $ercur in a$al!a$ator 2coats alloy particles ,/ mercurya- Dndertriturated: dull *cru$bl * decreased stren!t%* increased cree" b- O+ertriturated: 0et* runn * +er decreased stren!t%* increased cree"* increased corrosion -o+ertriturated better t%an undertriturated c- Pro"erl triturated: s%in * s$oot%* %o$o!enous -A! and Sn react to for$ sil+er allo * 0%ic% reacts 05 '! to for$ dental a$al!a$ -lon!er trituration ti$e decreases settin! e,"ansion

-mal%amation -reaction of sil+er allo 05 $ercur : -A!/Sn 2 - 3 '! A!/Sn 2 - 3 A!/'!; 2 1- 3 Sn/'! 2 .- is stron!est "%ase* 1 is second stron!est* and . is 0ea4est5$ost corrosi+e "%ase -stron!est "%ase %as no $ercur b5c $ercur decreases stren!t% -addin! Cu eli$inates 0ea4 . "%ase -!ood condensation and car+in! can $ini$i&e a$ount of $ercur -ric% a$al!a$ -d!anta%es and Disad!anta%es of -mal%am 1- Ad+anta!es a- stren!t% e- "ro+en %istor of use b- 0ear resistance f- lo0er fees c- eas to use !- lon! ter$ clinical lon!e+it d- less tec%ni#ue sensiti+e .- Disad+anta!es a- not est%etic b- conducti+it c- toot% "re" $ore de$andin! and less conser+ati+e Concerns for -mal%am 1- Kercur content and dis"osal .- Re$o+al of toot% structure /- Est%etics ;- Dnless bonded* no bondin! benefits (- Recurrent caries >- Kar!inal lea4a!e until corrosion occurs 2se+eral $ont%s-

Mercury Contro!ersy -lac4 of scientific e+idence t%at a$al!a$ "oses %ealt% ris4s to %u$ans e,ce"t for rare aller!ic r,ns -efforts under0a to reduce en+iron$ental $ercur to 0%ic% ""l are e,"osed to lessen e,"osure -t%ere is no e+idence ensurin! t%at alternati+e $aterials "ose lesser %a&ard -true aller!ies to a$al!a$ rarel %a+e been re"orted 21 in 1AA $illion ""l-mal%am 0ses 1- Nonest%etic cer+ical lesions .- <ar!e class I and II restorations 0%ere %ea+ occlusion 0ill be on t%e $aterial /- Class I and II restorations 0%ere isolation "roble$s e,ist ;- Te$"orar 5caries control restorations (- 6oundations >- Patient sensiti+it to ot%er $aterials ?- Cost is factor B- Inabilit to do a !ood co$"osite equirements for Successful -mal%am estorations 1- 'i!% co""er $aterial .- @A de!ree ca+osurface $ar!ins /- Ade#uate t%ic4ness of a$al!a$ 21-.$$;- Kec%anical retention for$ (- Sealin! of tubules >- Good condensation 2includin! laterall -

Principles of Tooth Preparation 1- Initial sta!e a- "lace toot% "re" e,tension into sound toot% structure at $ar!inal areas 2not "ul"all or a,iall b- e,tend de"t% "ul"all and a,iall to unifor$ di$ension c- "ro+ide an initial for$ t%at retains a$al!a$ d- establis% toot% "re" $ar!ins in for$ t%at results in @A de!ree a$al!a$ $ar!in once a$al!a$ is inserted .- 6inal sta!e -re$o+es an re$ainin! defect 2caries5old restoration- and incor"orates an additional "re" features 2slots* "ins* etc)- to ac%ie+e retention and resistance for$ $nitial Tooth Prep Depth -all initial de"t%s of toot% "re" for a$al!a$ relate to DE8* e,ce"t in t0o instances: a- H%en occlusal ena$el %as been si!nificantl 0orn t%inner b- H%en "re" e,tends onto root surface 1- Initial de"t% "ul"all 0ill be A).$$ inside DE8 or 1)($$ as $easured fro$ de"t% of central !roo+e* 0%ic%e+er results in !reatest t%ic4ness of a$al!a$ .- Initial de"t% of a,ial 0all 0ill be A).$$ inside DE8 0%ere retention loc4s are used -dee"er e,tension allo0s "lace$ent of retention loc4s 0it%out under$inin! $ar!inal ena$el -a,ial de"t%s on root surface s%ould be A)?(-1$$ dee" to "ro+ide roo$ for retenti+e !roo+es and bul4 of a$al!a$ "utline )orm for -mal%am -all 0alls $eet surface of toot% at @A de!ree an!le -0%en $a4in! "re" e,tensions* e+er effort s%ould be $ade to "reser+e stren!t% of cus"s and $ar!inal rid!es -0%en "ossible* outline for$ s%ould be e,tended around cus"s and a+oid under$inin! dentin su""ort of $ar!inal rid!e ena$el -0%en +ie0ed fro$ occlusal* t%e facial and lin!ual "ro,i$al bo, ca+osurface $ar!ins of class II "re" s%ould be @A de!rees -facial and lin!ual "ro,i$al bo, 0alls s%ould e,tend 7ust into facial and lin!ual e$brasures -"ro+ides ade#uate access for "erfor$in! "re"aration* easier "lace$ent of $atri,* and easier condensation and car+in! of a$al!a$ Ca!osurface Mar%in for -mal%am -if eit%er ena$el or a$al!a$ %as $ar!inal an!les less t%an @A de!rees* t%e are sub7ect to fracture Primary etention )orm -retention for$ "re"arations loc45retain restorati+e $aterial in t%e toot% -for co$"osites* $icro$ec%anical bondin! "ro+ides $ost of retention -for bot% bonded and nonbonded a$al!a$s* t%e a$al!a$ $ust be $ec%anicall loc4ed inside toot% -a$al!a$ retention "ro+ided b : 1- Kec%anical loc4in! of a$al!a$ into surface irre!ularities of "re""ed toot% .- Pre"aration of +ertical facial and lin!ual 0alls t%at con+er!e occlusall -in+erted cone bur 2.;(- "ro+ides correct 0all s%a"e for retention /- <oc4s* !roo+es* co+es* slots* "ins* ste"s* a$al!a$"ins 2all of t%ese t "e are actuall secondar retention for$-retenti+e !roo+es can be "laced in a,iobuccal and a,iolin!ual line an!les in "ro,) bo,es

-mal%ampins -retention on "in increases as dia$eter of "in increases -lar!est "in t%at can be safel "laced s%ould be selected -one "in "er $issin! a,ial line an!le s%ould be used -o"ti$al "lace$ent is at line an!les5corners of toot% 0%ere root $ass is !reatest and ris4 of "erforation is lo0est -"ins s%ould not be bent* but if necessar use a bendin! tool 2not %and instru$ent-"laced to increase retention of lar!e restorations* but 0ea4en restoration o+erall -"laced at least A)($$ inside DE8 and 1)($$ fro$ ca+osurface $ar!in -s%ould e,tend .$$ into dentin and restorati+e $aterial -coatin! "ins 05 ad%esion "ro$oters i$"ro+es fracture resistance of core $aterials -t "es of "ins: 1- Ce$ented -serrated "ins t%at are ce$ented into "in%oles lar!er t%an dia$eter of "in .- 6riction-loc4 -ta""ed into "in%oles s$aller t%an dia$eter of "in -not to be used in RCT teet% /- Self-t%readin! 2$ost retenti+e-co$es in self-li$itin! drill of o"ti$al .$$ de"t% and self-s%earin! "ins -$ost co$$on t "e used -disad+anta!es: create stresses t%at cra&e toot% structure* increase $icrolea4a!e* can cause "ul"al "roble$s Primary esistance )orm -%el"s restoration and toot% resist fracture fro$ occlusal forces a- resistance for$ features t%at "re+ent toot% fro$ fracturin! include: 1- Kaintainin! as $uc% un"re""ed toot% structure as "ossible 2cus"s and $ar!inal rid!es.- Pul"al and !in!i+al 0alls5floors "re"ared "er"endicular to occlusal forces /- Rounded internal "re" an!les ;- Re$o+in! unsu""orted50ea4ened toot% structure (- Placin! "ins into toot% 2secondar resistance for$>- 9e+elin! !in!i+al floor to "re+ent fracture of unsu""orted ena$el in t%is area -onl done if in ena$el* not if !in!i+al floor in ce$entu$ -not re#uired in "ri$ar teet% b5c ena$el rods e,tend occlusall in !in!i+a t%ird b- resistance for$ features t%at "re+ent a$al!a$ fro$ fracturin! include: 1- Ade#uate t%ic4ness of a$al!a$ 21)(-.$$ in occlusal contact areas1 A)?($$ in a,ial areas.- Kar!inal a$al!a$ an!le of @A de!rees of $ore /- 9o,-li4e "re" for$ to "ro+ide unifor$ a$al!a$ t%ic4ness ;- Rounded a,io"ul"al line an!les in class II "re"s Con!enience )orm -features t%at $a4e "rocedure easier or area $ore accessible -includes e,tension of outline for$ so $ar!inal for$ can be establis%ed* caries better accessed* $atri, band "lace$ent* or a$al!a$ to be inserted* car+ed* and finis%ed Secondary esistance and etention )orm -if it is deter$ined t%at insufficient resistance5retention for$ e,ists* additional "rocedures can be "laced -$an features t%at en%ance retention for$ also en%ance resistance for$ -includes !roo+es* slots* loc4s* co+es* "ins* a$al!a$"ins -usuall * t%e lar!er t%e toot% "re"* t%e $ore need for secondar resistance5retention for$

Matri+ #and 1- Ob7ecti+es a- "ro+ide "ro"er contact b- "ro+ide "ro"er contour c- confine restorati+e $aterial d- reduce a$ount of e,cess $aterial .- Place$ent "rinci"les a- $ust be eas to "lace and re$o+e b- $ust e,tend belo0 !in!i+al $ar!in and abo+e $ar!inal rid!e %ei!%t b at least 1$$ c- $ust resist defor$ation durin! a$al!a$ condensation -$ost difficult toot% to ada"t $atri, band to is $esial surface of $a,) 1st PK due to de+elo"$ental de"ression -dia!onal slot on Toffle$ire al0a s "laced to0ard !in!i+a to facilitate eas se"aration of Toffle$ire fro$ $atri, band in occlusal direction 8ed%es 1- De"ress !in!i+a a"icall .- Cause $ini$al se"aration /- Kini$i&e oo&in! of fluids t%rou!% rubber da$ -inserted t%rou!% facial or lin!ual e$brasure* 0%ic%e+er is lar!er -0ed!in! action $ust "ro+ide enou!% se"aration to co$"ensate for t%ic4ness of $atri, band Condensin% the -mal%am -lateral condensation +er i$"ortant in "ro,i$al bo, to ensure confluence of a$al!a$ 0it% $ar!ins -s"%erical a$al!a$ is $ore easil condensed t%at ad$i,ed 2lat%e-cut- a$al!a$ -s$aller a$al!a$ condenser are to be used first to allo0 a$al!a$ to be "ro"erl condensed into internal line an!les and secondar retention features -s$aller t%e condenser "oint* t%e !reater "ressure e,erted on a$al!a$ -once a$al!a$ is "laced to sli!%t e,cess 05 condensers* a "re-car+e burnis% s%ould be done 05 acorn5e!!s%a"ed burnis%er to finali&e condensation and re$o+e e,cess a$al!a$ Car!in% the -mal%am -nonbonded a$al!a$s are easier to car+e t%an bonded a$al!a$s due to e,cess ad%esi+e resin 0%ic% accu$ulates at $ar!ins -care $ust be ta4en to "re+ent brea4in! out %u!e c%un4s of a$al!a$ 0%en car+in! bonded a$al!a$ 1- Occlusal areas: discoid-cleoid used to car+e occlusal areas a- Rounded discoid "art used first on un"re"ared ena$el surface and "ulled "arallel to $ar!in to re$o+e e,cess a$al!a$ fro$ $ar!in b- Cleoid "art used ne,t to car+e in !roo+e and "it anato$ c- Discoid "ortion used a!ain to s$oot% out anato$ic for$ d- for lar!e class II a$al!a$s* initial car+in! of $ar!inal rid!es and occlusal e$brasure areas can be done 05 e,"lorer ti" "ulled alon! inside of $atri, band e- e$brasure and $ar!inal rid!e for$ s%ould be as identical as "ossible to ad7acent toot% f- %a+in! definite and rounded occlusal anato$ %el"s "ro+ide s"ill0a s for esca"e of food fro$ occlusal table .- 6acial5lin!ual areas: 'ollenbec4 car+er useful in t%ese areas* or base of a$al!a$ 4nife 2/;5/( scaler-contour of cer+ical areas of facial5lin!ual s%ould be con+e, and follo0 toot% structure /- Pro,i$al e$brasure areas: a$al!a$ 4nife5scaler useful for contourin! "ro,i$al e$brasures -"ro,i$al contact can be c%ec4ed 05 floss 2carefull - or reflectin! li!%t t%rou!% contact )inishin% the -mal%am -occlusal contacts s%ould be c%ec4ed 05 articulatin! "a"er and ad7usted as needed -li!%tl $oistened cotton "ellet can be used to s$oot% and "olis% a$al!a$

Polishin% -mal%am estorations -s%ould 0ait at least .; %rs to "olis% a$al!a$ to $a4e sure it is co$"letel set -s%ould use 0et abrasi+e "o0der in "aste for$ to "re+ent o+er%eatin! "ast >A C51;A 6 2dan!er "oint-/ reasons to "olis% a$al!a$s: 1- reduce $ar!inal discre"ancies and $a4e $ore % !ienic .- reduce $ar!inal brea4do0n /- "re+ent tarnis%in! and i$"ro+e a""earance epairin% an -mal%am estoration -if "art of a$al!a$ fractures durin! insertion* t%e defecti+e "ortion can be re"re""ed as a s$all restoration 05 a ne0 $i, of a$al!a$ condensed directl into defect and 0ill ad%ere to a$al!a$ alread "resent Class 5 -mal%am )orm -outline for$ s%ould be defor$ed tra"e&oid 24idne -bean- and is deter$ined b location and si&e of caries -retention for$ "ro+ided b retenti+e !roo+es "laced at !in!i+oa,ial and incisoa,ial line an!les -$esial and distal 0alls s%ould ne+er e,tend "ast transitional line an!les -occlusal and !in!i+al 0alls s%ould be !entl cur+ed arcs as deter$ined b contour of free !in!i+al $ar!in -t0o arcs s%ould be as "arallel to eac% ot%er as "ossible -occlusal arc is usuall lon!er of t0o -$esial* distal* !in!i+al* and incisal 0alls s%ould all di+er!e out0ard Common Pro.lems of -mal%am estorations 1- Posto" sensiti+it : caused b lac4 of ade#uate condensation or "ro"er dentinal sealin! .- Kar!inal +oids: caused b inade#uate condensation or $aterial "ullin! a0a fro$ toot% durin! car+in! /- Kar!inal rid!e fracture: caused b not roundin! a,io"ul"al line an!le* lea+in! rid!e too %i!%* incorrect e$brasure for$* i$"ro"er $atri, re$o+al* and o+er&ealous car+in! ;- A$al!a$ scra" and $ercur collection dis"osal Contro!ersial Topics in -mal%am 1- A$al!a$ safet : a$al!a$ is a safe $aterial and DS Public 'ealt% Ser+ice %as re"orted its safet -"ro"er %andlin! of a$al!a$ and its dis"osal are i$"ortant .- S"%erical +s ad$i,ed a$al!a$: s"%erical a$al!a$ %as ad+anta!es in "ro+idin! %i!%er earlier stren!t% and "er$ittin! use of less "ressure -ad$i,ed a$al!a$ "er$its easier "ro,i$al contact de+elo"$ent b5c of %i!%er condensation forces /- 9onded a$al!a$ restorations: bonded a$al!a$s are no lon!er reco$$ended* but if used* s%ould be li$ited to lar!er restorations and still %a+e secondar retenti+e features ;- Pro,i$al retention loc4s: s%ould onl be used for lar!er a$al!a$ restorations b5c correct "lace$ent if difficult Part 11: Dental 9ondin! -d!anta%es of #ondin% to Tooth Structure 1- <ess $icrolea4a!e >- Kore conser+ati+e toot% "re"s .- <ess $ar!inal stainin! ?- I$"ro+ed retention /- <ess recurrent deca B- Reinforce$ent of re$ainin! toot% structure ;- <ess "ul" sensiti+it @- Kore conser+ati+e t,t of root surface lesions (- Reduced sensiti+it in cer+ical erosion5abrasion 0ses of -dhesi!e Techniques 1- C%an!e s%a"e and color of anterior teet% .- Restore class I-VI lesions /- I$"ro+e retention for $etal or P6K cro0ns ;- 9ondin! cera$ic restorations (- 9ondin! indirect co$"osites >- Sealin! "its and fissures @- 9ond conser+ati+e toot%-re"lace$ent restorations 1A- Re"air e,istin! restorations 11- Pro+ide foundation for cro0ns5onla s 1.- Desensiti&e e,"osed root surfaces 1/- I$"re!nate dentin to decrease ris4 of caries 1;- 9ond fra!$ents of anterior teet%

?- 9ondin! ort%o brac4ets 1(- 9ond "refabricated and cast "osts B- 9ondin! "erio s"lints 1>- Reinforce re$ainin! ena$el5dentin after "re"s Enamel !s Dentin #ondin% 1- Ena$el bondin!: /A-;AS "%os"%oric acid a- 1( second etc% is sufficient b- fast* reliable* "redictable* and stron! c- $icrolea4a!e +irtuall none,istent d- resists "ol $eri&ation s%rin4a!e forces of co$"osite .- Dentin bondin!: "enetration of ad%esi+e $ono$ers into colla!en fibers left b acid etc%in! a- slo0er* less reliable* and less "redictable b- $a %a+e $icrolea4a!e c- si$ilar or %i!%er bond stren!t%s t%an ena$el d- $a not resist "ol $eri&ation s%rin4a!e forces of co$"osite )actors -ffectin% -.ility to #ond to Dentin 1- Kicrostructural features of dentin a- Dentin co$"osition: $uc% less $ineral* $ore or!anic 2t "e I colla!en-* and $ore 0ater t%an ena$el 2ena$el is @AS $ineral % dro, a"atiteb- Dentin tubules: "eritubular* intratubular* and intertubular c%annels -tubules run fro$ "ul" to DE8 and contain odontoblastic e,tensions and fluid -tubules are $uc% lar!er and nu$erous near "ul" t%an DE8 -fluid $o+e$ent inside tubules is dictated b "ul"al "ressure c- Dentin sclerosis: a!in! dentin* dentin belo0 caries* or dentin e,"osed to oral fluids %a+e increased $ineral content and is $ore resistant to acid-etc%in! and t%erefore "enetration of dentin ad%esi+e is li$ited d- S$ear la er: debris left of surface after cuttin! -consists of % dro, a"atite and altered* denatured colla!es -fills orifices of dentin tubules* decreasin! dentin "er$eabilit -etc%in! re$o+es s$ear la er* resultin! in !reater fluid flo0 onto dentin surface 0%ic% can interfere 05 ad%esion e- <inear coefficient of t%er$al e,"ansion: dentin %as <CTE ;, less t%an co$"osite $aterial .- Toot% factors a- Attrition: nor$al toot% 0ear b- Abrasion: $ec%anical 0ear due to abnor$al forces 2toot%brus%in!c- Erosion: 0ear due to c%e$ical "resence d- Abfraction: bio$ec%anical loadin! causes loss of toot% structure in cer+ical re!ion -occlusal forces cause toot% to bend* $a4in! $icrofractures in t%in cer+ical ena$el /- Katerial factors: co$"osites s%rin4 as t%e "ol $eri&e* creatin! %i!% stresses ;- Pre"aration factors: "re"s 05 $ulti"le 0alls %a+e li$ited stress relief o""ortunit for co$"osite* so t%e %i!% C-factor 2confi!uration factor- $a result in internal bond disru"tion and $ar!inal !a"s -C-factor deter$ined b ratio of bonded:unbonded surfaces 0it%in a toot% "re" -%i!% C-factor $a indicate increased ris4 for "osto" sensiti+it Dentin #ondin% Systems 1- Total etc% 2ena$el and dentin etc%ed.- Self-etc%in! "ri$er s ste$s 2SEP-

Total Etch #ondin% System -etc%es ena$el and dentin 05 acid si$ultaneousl -t0o t "es: $ulti-bottle s ste$s and one-bottle s ste$s 1- Kulti-bottle s ste$s: etc%ant* "ri$er* and ad%esi+e se"arate 2!old standard-toot% structure is etc%ed 05 acid to o"en $icros"aces in ena$el5dentin 0%ic% cleans debris fro$ surface and increases surface area for bondin! 2etc%ed ena$el is c%al4 * dentin is nor$al-etc%ed dentin e,"oses a la er of colla!en* and "ri$er raises t%e colla!en so ad%esi+e can flo0 bt0 colla!en and interloc4s 05 it to for$ % brid la er -$ost bond stren!t% is fro$ for$ation of % brid la er 2$i, of dentin and resin-t%is seals dentin to decrease "ost-o" sensiti+it -dentin %as !ood bond stren!t% 2as !ood as or better t%an ena$el bondin!.- One-bottle s ste$s: "ri$er and ad%esi+e are co$bined* but etc%ant is se"arate -$ost re#uire 0et bondin! -bondin! $ec%anis$ is also t%rou!% % brid la er -bond stren!t%s not as %i!% as $ulti-bottle s ste$s but +er close -is +er tec%ni#ue sensiti+e and usuall not "erfor$ed an faster t%an $ulti-bottle s ste$s Steps in Multi'#ottle System 1- Etc% dentin and ena$el 05 /;S "%os"%oric acid -etc%es ena$el* re$o+es s$ear la er* o"ens dentin tubules* de$inerali&es dentin* and etc%es out $ineral 2% dro, a"atite- but lea+es colla!en fibrils .- Rinse etc%ant 2$ust lea+e 0et or re0et 05 A#uaPre" or G<DKA Desensiti&er/- Add "ri$er 2'EKA59PDK-'EKA: % dro, et% l $et%acr late1 9PDK: bi"%en l di$et%acr late -"ri$er is resin $ono$er 0ettin! a!ent 0%ic% is bifunctional a- 0ets dentin 2increases surface tensionb- bonds to o+erl in! resin -"ri$er also acts as a sol+ent to "enetrate t%rou!% re$nant s$ear la er into intertubular dentin to fill in s"aces left b dissol+ed % dro, a"atite cr stals ;- Add ad%esi+e5bondin! a!ent 29is-GKA-9is-GKA: bis"%enol A !l cid l $et%acr late -"enetrates "ri$ed intertubular dentin and dentin tubules to "ro+ide "ol $eri&ed surface la er t%an bonds "ri$er and co$"osite Steps in "ne'#ottle System 1- Etc% for 1A seconds .- Rinse 0ell and lea+e $oist /- A""l .-/ la ers of "ri$er5ad%esi+e co$bo* t%in 05 air s"ra * t%en li!%t cure ;- Place co$"osite Self'Etchin% Primer (SEP) #ondin% Systems -etc%ant and "ri$er co$bined or etc%ant* "ri$er* ad%esi+e all co$bined -ob7ecti+e is to re$o+e o"erator +ariables 2rinsin! and dr in!-do not co$"letel re$o+e s$ear la er 20% t%e %a+e less "ost-o" sensiti+it -need to be refri!erated 2%a+e reacti+e co$"onents-$ust use carbide burs for "re"s* not dia$onds b5c dia$onds lea+e $uc% t%ic4er s$ear la er -don:t etc% ena$el as 0ell as "%os"%oric acid -t0o t "es: 1- One-ste" 2all-in-one-: ris4 to use -doesn:t re$o+e s$ear la er -not as !ood bond to dentin .- T0o-ste" 2self-etc% "ri$er* t%en use bondin! ad%esi+e-re#uires $ulti"le coats 2T(-doesn:t re$o+e s$ear la er -no rinsin! needed

-doesn:t bond 0ell to uncut ena$el* so $ust rou!%en ena$el surface -lo0 "ost-o" sensiti+it -d!anta%es/Disad!anta%es of Self'Etchin% Systems 1- Ad+anta!es a- Eas to use b- Eli$inates +ariables 05 0et bondin! c- De"t% of etc% is self-li$itin! d- Sensiti+it is reduced .- Disad+anta!es a- 9ond stren!t%s to ena$el and dentin lo0er b- So$e don:t ade#uatel etc% uncut ena$el c- 9ond stren!t%s to autocurin! co$"osites are "oor d- Clinical "erfor$ance not "ro+en e- 9ond durabilit #uestionable Technique Su%%estions for #ondin% -%ents 1- Dse $icrobrus%es to a""l "ri$er5ad%esi+e .- Place bondin! a!ent in s$all 0ell to $ini$i&e e+a"oration* and re"lace ca" #uic4l /- 'a+e !ood isolation ;- Rou!%en sclerotic dentin to increase surface area and re$o+e so$e of t%e sclerotic dentin (- 9e+el or rou!%en to etc% ena$el >- Kust %a+e dentin $oist 2or re0et- for total-etc% s ste$s ?- A""l and dr "ri$er ade#uatel or $a %a+e !ross lea4a!e and "ost-o" sensiti+it 2dr 05 air s rin!e-too $uc% "ri$er is better t%an too little *on%e!ity of esin to Dentin #onds -t%ere is a loss of bond stren!t% o+er ti$e -"ossibl due to % drol sis of eit%er ad%esi+e resin or colla!en fibers -all-in-one 2one-ste"- t "es s%o0 t%e 0orst results -bond durabilit is $uc% !reater 0%en "eri"%eral $ar!in is all in ena$el Part 1.: Co$"osite Restorations Composition of Composites -t%ree "%ases: 1- Resin $atri,: bis-GKA or DEDKA 2so$eti$es TEGDKA is used.- 6iller "articles a- fine 2A)(-/ u$-: cr stalline silica* lit%iu$ alu$inu$ silicate* !lass b- $icrofine 2A)A; u$-: colloidal silica c- $icro% brid: bot% fine and $icrofine "articles -as filler "article content increases* "% sical* c%e$ical* and $ec%anical "ro"erties i$"ro+e /- Cou"lin! a!ent: silane -added $aterials: 1- Initiators: ben&o l "ero,ide* di4etone* ca$"%oro#uinone .- Accelerators: or!anic a$ines /- Pi!$ents: inor!anic "i!$ents "ro+ide +arious co$"osite s%ades

Types of Composites 1- Dnfilled resins -est%etic and s$oot% -discolor o+er ti$e -lo0 0ear resistance* lo0 co$"ressi+e and tensile stren!t% 2softest of all restorati+e $aterials-"ercolated 2e,"and and contract fro$ te$") c%an!e-s%o0 !reatest e,tent of $ar!inal lea4a!e fro$ te$") c%an!e -unfilled resins %a+e lo0est t%er$al conducti+it and diffusi+it .- Silicate ce$ents -fluoride releasin! -biode!raded o+er ti$e /- Con+entional co$"osites -%a+e !lass filler -i$"ro+ed "% sical "ro"erties -%a+e so$e rou!%ness ;- Kicrofill co$"osites -%a+e +er s$all !lass filler 2A)A;u$-reduced "% sical "ro"erties co$"ared to con+entional co$"osites -<CTE* 0ater absor"tion* surface te,ture* elastic $odulus* solubilit * stren!t% -+er s$oot% and e,cellent 0ear resistance -de+elo"s smoothest finish (- ' brid co$"osites 2co$"osite resin5resin-based co$"osite-co$bined s$all and +er s$all !lass filler -!ood "% sical "ro"erties* s$oot%* and !ood 0ear resistance 2o"ti$u$ $ec%anical "ro"erties>- 6lo0able co$"osites -lo0er filler content -%i!%er "ol $eri&ation s%rin4a!e -used for cer+ical lesions* s$all restorations* "edo lesions* and sealants ?- Pac4able co$"osites -increased +iscosit and %i!% filler +olu$e -no docu$ented benefits -used in class I and II restorations B- Nanofill co$"osites -e,tre$el s$all filler "articles 2can incor"orate %i!%er filler content-+er !ood future "otential @- Core buildu" co$"osites -can be self-cure or dual cure $mportant Properties of Composites 1- Coefficient of t%er$al e,"ansion -%i!% CTE causes "ercolation* recurrent caries* and stain -increased resin $atri, leads to increased t%er$al e,"ansion -co$"osites %a+e %i!%er t%er$al e,"ansion t%an a$al!a$ and toot% structure .- Hater absor"tion -%i!% 0ater absor"tion causes deterioration of $aterial /- Pol $eri&ation s%rin4a!e -all co$"osites s%rin4 05 "ol $eri&ation -less resin $atri, causes less s%rin4a!e 2$icro% bid less s%rin4a!e t%an $icrofills-curin! co$"osite in t%in la ers leads to less s%rin4a!e ;- Hear resistance (- Surface te,ture -s$aller filler si&e leads to s$oot%er surface >- Stren!t% -$icro% brids %a+e increased co$"ressi+e stren!t% and fle,ural stren!t% co$"ared to $icrofills

-increased fillers causes increased %ardness and 0ear -bond bt0 co$"osite and etc%ed toot% is "ri$aril $ec%anical Methods of Polymeri1ation/-cti!ation 1- Autocured5C%e$ical cured: $ust $i, to!et%er* 0%ic% can cause disturbance of "ol $eri&ation -uses or!anic "ero,ide initiator 2ben&o l "ero,ide- and tertiar a$ine acti+ator -%a+e less control of insertion ti$e -$a %a+e increased "orosit and discoloration due to c%e$ical $a4eu" of $aterials .- <i!%t-cured: re#uires li!%t source 2e,"ensi+e-1 $ost co$$on -co$"osite "ol $eri&ed b blue li!%t 2;?A n$-a di4etone absorbs li!%t and a$ine acti+ator initiates "ol $eri&ation b su""l in! free radicals -%a+e indefinite insertion ti$e* less "orosit * and less finis%in! re#uired -t "es of curin! li!%ts: tun!sten5%alo!en and <ED 2li!%t e$ittin! diode-$ore "ro$isin! -+isible li!%t curin! s ste$s no0 used 2DV-li!%t curin! s ste$s no lon!er used$mportant Points in *i%ht Curin% Composites 1- 'old li!%t as close to resin as "ossible 20it%in .$$.- Cure co$"osite in 1)(-.$$ incre$ents /- Hit% dar4er resin s%ades* cure lon!er 0ses of Composites 1- Class I-V restorations .- Sealants /- ' "ocalcified areas ;- Partial and full +eneers (- Anato$ic additions >- Resin-bonded brid!es ?- <utin! a!ent5ce$ent B- Diaste$a closure @- 6oundation5core 1A- Te$"orar $aterial 11- 9onded a$al!a$s

-d!anta%es and Disad!anta%es of Composite 1- Ad+anta!es a- Est%etic e- <ess $ec%anical retention for$ needed b- Insulation f- Stren!t%enin! of re$ainin! toot% structure c- 9onds to toot% structure !- Kini$al to no $icrolea4a!e resultin! in decreased stainin!* d- Conser+es toot% structure recurrent deca * or "ost-o" sensiti+it .- Disad+anta!es a- Hear b- Tec%ni#ue sensiti+e c- Pol $eri&ation s%rin4a!e d- C-factor $a cause sensiti+it estorati!e Technique for Composite 1- Re$o+e faults5deca .- Re$o+e areas of $ost 0ea4ened toot% structure -no need for $ec%anical retention unless t%ere is no ena$el 2root surface- or +er lar!e restoration /- Protect "ul" if necessar ;- Pre"are ena$el 2be+el-A)($$ 0ide at ;( de!ree an!le 05 coarse dia$ond 2increases surface area for increased retention(- Etc%* "ri$e* and bond >- Insert and cure co$"osite ?- Contour and "olis% co$"osite Preliminary Considerations 1- Ka4e sure t%ere isn:t %ea+ occlusion on area bein! restored 05 co$"osite .- Clean toot% 05 "u$ice if no "re" is bein! done /- Select s%ade 9E6ORE teet% are dried ;- Ka4e sure ou ac%ie+e !ood isolation

Different Types of Composite Preparations 1- Con+entional "re" a- Re$o+e deca b- 9e+el ena$el c- In non-ena$el areas* use @A de!ree $ar!ins and $ec%anical retention .- 9e+eled con+entional "re" 2re"lace$ent "re"arationsa- Kaintain "re"aration for$ of restoration b- 9e+el ena$el 2$a need to "lace retention on root15; round bur used to $a4e co+e/- Kodified "re"aration a- 6ault5caries dictates outline for$ 2onl re$o+e cariesb- 9e+el ena$el 2e,/Contro!ersial -pproaches 1- 9o, onl "re"s for class II .- Tunnel "re" 2not reco$$ended-$a4e tunnel fro$ occlusal surface do0n and e,tends o+er to "ro,i$al lesion in class II /- Sand0ic% tec%ni#ue Class 5 Composite Prep -rese$bles class V a$al!a$ "re" e,ce"t internal line an!les are $uc% $ore rounded -also %as ca+osurface be+el of A).-A)($$ 0ide to "re+ent $icrolea4a!e 3lass $onomers -fluoro-alu$inosilicate !lass "o0der and li#uid solution of "ol $ers of acr lic acid -%i!% fluoride releasin! -used in class V restorations and lo0 stress-bearin! areas in %i!% ris4 "ts due to lo0 stren!t% and lo0 0ear resistance -lo0 solubilit and %i!% o"acit -co$e in bot% li!%t-cured and self-cured for$s -li!%t-cured "referred b5c of e,tended 0or4in! ti$e and i$"ro+ed "% sical "ro"erties -do not "olis% as 0ell as co$"osites Compomers -co$"osites $odified 05 "ol acid !rou"s -used in lo0 stress areas 2class V- b5c less 0ear resistant t%an nor$al co$"osite -release fluoride Sealants -need micro-mechanical retention* so surface s%ould be cleaned 05 "u$ice and 0ater* isolated* acid-etc%ed and t%en sealant "laced -sealants are 0ea4er t%an co$"osites -stren!t% sacrificed to $a4e it flo0 into "its5fissures -sealants best retained on $a,) and $and) PK* but $a,) and $and 1st $olars benefit $ost fro$ sealants -lo0-+iscosit sealants 0et acid-etc%ed toot% surface best -caries "rotection is 1AAS in "its and fissures t%at re$ain co$"letel sealed -$ost co$$on reason for failure is sali+ar conta$ination -sealants s%ould be "laced ri!%t after toot% full eru"ts Components of Sealants 1- Kono$er: 9is-GKA -$a be diluted 0it% TEGDKA to reduce +iscosit .- Initiator: ben&o l "ero,ide 2self-cure- or di4etone 2li!%t-cure/- Accelerator: a$ine ;- O"a#ue filler: titaniu$ o,ide

"ther Composite Stuff -li!%t 0ill onl cure .-/$$ de"t% incre$ents of co$"osite -cure eac% incre$ent for ;A seconds fro$ eac% an!le Part 1/: Gold Inla 5Onla Restorations -d!anta%es 1- Good trac4 record .- Good fit /- E,cellent $et%od to restore occlusal relations%i" ;- Structurall sound $aterial 2!old 0ill not corrodeDisad!anta%es 1- Not est%etic .- Co$"licated toot% "re"s /- Co$"licated $ar!inal finis%in! ;- Need ade#uate lab su""ort (- 'i!% cost $ndications 1- <ar!e occlusal surface needs .- Toot% contour needs /- 6ractures ;- S"lintin! (- 9racin! for endo treated teet% >- 9rid!e retainers ?- Partial retainers Concepts of Tooth Preparations 1- Kust %a+e dra0 05 di+er!ence to e,ternal surface of .-( de!rees -t%e lon!er t%e 0all* t%e !reater a$t of dra0 needed -increased dra0 causes decreased retention -increased 0all %ei!%t !i+es $ore retention -$ore "arallelR$ore retention .- 9e+eled finis% lines -!i+es !ood $ar!inal fit5ada"tation of !old to toot% t%at can be burnis%ed -can bend a /A-(A de!ree !old $ar!in -M/A de!rees $a be too t%in and brea4 -F(A de!rees $a be too t%ic4 and not bend /- Pul" "rotection often needed -if use liners or bases* $ust be ca"tured in i$"ression ;- Kust %a+e !ood i$"ression to fabricate restoration -spects of 3old $nlay/"nlay Tooth Preparation 1- Occlusal be+el: A)($$ 0idt% at ;A de!ree !old $ar!in .- Groo+e e,tension be+el: also A)($$ 0ide 05 ;A de!ree !old $ar!in /- Cus" counterbe+el: A)(-1$$ 0ide 05 /A de!ree !old $ar!in 2for nonest%etic ca""ed cus"s;- Stubbed $ar!in: A).(-A)($$ 0ide and "er"endicular to lon! a,is of cro0n 2for est%etic ca""ed cus"s(- Secondar flare: e,tends facial and lin!ual "ro,i$al $ar!in into facial5lin!ual e$brasure 2;A de!ree $ar!in>- Collar: be+eled s%oulder desi!n around a ca""ed cus" -"ro+ides bracin! ?- S4irt: e,tends castin! around line an!le to increase retention and resistance for$ -$ar!in is A)($$ c%a$fer B- Gin!i+al be+el: A)(-1$$ 0ide

-$ust blend all be+els into eac% ot%er Part 1;: 6luoride )luoride and Sealants -if to"ical fluoride and sealants bot% to be used* sealant s%ould be "laced before fluoride a""lication Determinin% M% of )luoride -sodiu$ fluoride or sodiu$ $onofluoro"%os"%ate contains about 1$! 6- "er !ra$ toot%"aste -so in B). o& tube* $ust con+ert o& to !ra$s -1 o&R.B)/( ! -B). , .B)/(R./. !ra$s -./. !ra$s toot%"asteR./.$! 6)luoride To+icity -a+era!e adult let%al dose is;-( !ra$s -deat% li4el in c%ild 0%o in!ests $ore t%an 1($! 6-54! 0ei!%t -$ini$u$ let%al dose 2Pro.a.le To+ic Dose- is ( $!6-54! -$ost fluoride absorbed in s$all intestine and e,creted t%rou!% 4idne s pH of )luorides Toothpastes 1- 1)./S Acidulated "%os"%ate fluoride: /-/)( 2acidic-$ost co$$on in-office fluoride t,t -contraindicated in "orcelain* co$"osites* and i$"lants .- .S Sodiu$ fluoride: @). 2basic-$ost co$$on OTC fluoride 2A)A(S Na6/- BS Stannous fluoride: .)1-.)/ 2acidic-bitter $etallic taste* can burn $ucosa* and can stain teet% Part 1(: Kiscellaneous Zones in )our'Handed Dentistry -in relation to "t:s %ead bein! at 1. o:cloc4 "osition 1- O"erator &one: fro$ B-11 o:cloc4 .- Assistant &one: fro$ .-( o:cloc4 /- Transfer &one: fro$ (-B o:cloc4 ;- Static &one: fro$ 11-. o:cloc4 Em.rasure Spaces 1- 9uccal5facial .- <in!ual -lar!er t%an facial /- Occlusal5incisal ;- Cer+ical5!in!i+al )unctions of Em.rasures 1- Ka4e s"ill0a for food .- Ka4e teet% self-cleansin! /- Protect !in!i+al tissue fro$ trau$a )unctions of Pro+imal Contact -rea 1- Su""ort nei!%borin! teet% 2stabili&es dental arc%.- Pre+ent food "articles fro$ enterin! inter"ro,i$al area /- Protect "eriodontiu$ ;- 6or$ e$brasures

Parts of )lame 1- Ki,in! &one: cool and colorless &one -air and !as are $i,ed .- Co$bustion &one: !reenis%-blue &one 0%ere "artial co$bustion occurs /- Reducin! &one: di$ blue ti" -is hottest area in flame and onl "art t%at s%ould be used to %eat allo s ;- O,idi&in! &one: 0%ere final co$bustion bt0 !as and air ta4es "lace