RESTO 1 LEC (Sept 8, 2011) PULP PROTECTION: Liners and Bases

FACTORS TO CONSIDER WHEN CHOOSING LINERS AND BASES 1. Thickness of remaining dentin (or depth of the cavity) 2. Type of restorative material to be used 3. Consideration for the use of adhesive or bonding agent Shallow Tooth Preparation Amalgam 1. Depth: 0.5mm from DEJ Thickness of RDT 1.5-2mm (depth: shallow tooth preparation) 2. Type of restorative material. Posterior tooth esthetic is not to be considered. You choose amalgam tooth prep. You can also consider using composite. 3. No adhesive/bonding to be done *Pulp protection (amalgam; shallow): cavity filler which is placed on the preparation/prepared walls. Do not use cavity varnish in your practice. Ideally, you use cavity filler. *Adhesive material/bonding agent: make sure that the bonding agent you will be using for amalgam is for amalgam and not for composite. There is a different procedure. You do not cure this bonding agent for amalgam. Composite E.g. Class III preparation: 1. Depth: Shallow tooth prep. 2. Type of Restorative material: composite (anterior tooth) *Pulp protection: place a bonding agent. Before placing the bonding agent, you have to etch, bond and then you do the placement of adhesive. Follow the manufacturers instruction. Bonding agents are also classified as 1st 8th generation. There are no more 1, 2 and 3rd generation in the market. You still have the 4th generation (3-step total etch technique) Total Etch: Three Step (TE3) separate etchant, separate primer, .. 1. Etchant 2. Primer 3. Bonding agent Apply the acid and then wash. After etching, you have to wash as well Total Etch: Two Step (TE2) more convenient 1. Etchant 2. Primer and Bonding agent in one bottle After etching, you also have to wash. Follow the manufacturers direction (how many minutes you need to etch, prime and bond) Self-Etch: Two Step (SE2) 1. Etchant and Primer together 2. Bonding agent Difference from the Total Etch (2-step) a. Do not wash b. Bond. Place the adhesive Self-Etch: One Step (SE1) Etchant, primer and adhesive are together. Place the bonding agent for shallow cavity prep Moderately Deep Tooth Preparation Amalgam Pulp protection: RMGI (resin modified glass ionomer) You still have a substantial thickness of remaining dentin After placing a GI cement, place your sealer. Flat and smooth pulpal floor Composite Pulp protection: bonding agent Another option: you may do sandwich technique (put GI in dentin and then composite on the bevel of enamel wall) Typically, you do only bonding and place your composite as your restorative material. Very Deep Tooth Preparation <5mm of dentin remaining but dentin is still intact. Amalgam Pulp protection: place CaOH (not more than 0.5mm on the deepest portion of the cavity prep). Remove CaOH on the cavosurface margins and the walls because it will cause [ditching] and you might develop secondary dental Put it only in the deepest portion. The purpose of CaOH is to promote reparative dentin formation. Place a base. Amalgam is a thermal conductor. Thus, you need to place RMGI cement. Place your sealer Pulp  CaOH  GI  Sealer Another school of thought: In a very deep tooth preparation, they do not recommend placement of CaOH. GI and sealer only. Composite Class III: Very Deep Tooth Prep Place CaOH not greater than 0.5mm You dont need to place a liner (GI) You can immediately place composite resin because it is a good thermal insulator. CaOH  Bonding agent  Composite Resin Another school of thought: you also palce RMGI (sandwich technique), then place the bonding agent, and composite resin. Both: (Some school of thought) consider not placing CaOH on a very deep tooth prep. Therefore, if you have an actual pulp exposure (mechanical), definitely, place your CaOH. MTA (mineral trioxide aggregate) is another material use instead of CaOH.

PROCEDURES FOR AMALGAM TOOTH PREPARATION

(read it in the manual!!! because she is the author!! =P)

1.

Choice of the Alloy and Hg Alloy Copper (Cu) Content a. High Cu Alloy
Fast Set Regular Set if you are not skilled in manipulation of amalgam Pre-weighed (in capsule) no need to use squeeze cloth; placed in an amalgam well (ideally); acceptable if placed on a dappen dish

b.

Low Cu Alloy

Lathe Cut Alloy Spherical Alloy Admixed Alloy >>Check the differences of these 3 alloy particles!! (in sturdevants!!)

Mercury (Hg)
How do you know if Hg is not contaminated? (Check this!!)

2.

Proportioning [and Trituration] Increasing Dryness Technique

8 : 5 - Hg-Alloy Ratio Squeeze using a cotton plier to prevent contamination and then condense. Do condensation by increments (part by part) When you condense, the tendency of the Hg is to come up to the surface. Add another one, the one on top will get the Hg on the surface of the previous one. Overfill (or overpacking) as you reach the surface. The excess Hg tends to come up to the surface. The purpose of this is to remove further excess Hg on the surface of the overpacked amalgam. Another reason is for carving.

Hemes Technique
1:1 ratio (when you use the pre-weighed and the amalgamator)

3.

Mulling
(manual) The purpose of mulling is to further have a homogenous mix of alamgam. When you use the IDT (after squeezing), you place on a piece of rubber dam and mull with your thumb and index finger (2-5 sec). In a squeeze cloth, place it in your palm and mull with your thumb Amalgamator after the required time for trituration in the amalgamator, remove pestle and place it back on the amalgamator (2-3 seconds)

4.

Matricing
Simple Class I and II you dont necessarily need a Matrix Assembly - Matrix Band - Matrix Holder/Retainer - Wedge Band

If you have a Compound, Complex Class II and Compound, Complex Class I, you need your matrix assembly. **Check the purpose of matrix band and purpose of wedge. If you have, bring matrix band, holder and wedge next meeting (weh? Haha) Different types of matrix band: (manual) Automatrix does not use matrix band holder; more expensive compared to Tofflemire matrix band. More examples in the manual. MOD cavity. One has an extensive gingival preparation. Convolution of the matrix band is placed on the gingiva of deeper preparation.. unless, if both are deep, do not cut the other one. Blablabla Manual manual manual!!!! =)) Read about the placement of matrix band on the matrix holder. Matrix band: Smaller diameter gingival edge Bigger diameter occlusal edge 3 slots 2 side slots and 1 end slot. Side slot the arm of the holder should be parallel to the buccal surface of the tooth. Insert the band on the side slot. Use this so that the holder is parallel to the buccal surface of the tooth End slot if you use this, the holder will be perpendicular to the buccal surface. If you are doing on the molars, you might the angle of the mouth. This is the wrong placement. Sliding car on one side, there is a slot (called slot of the sliding car); on the other side, there is no slot. When you will be inserting the matrix band, insert first the bigger diameter (occlusal edge of the band) on the slot of the sliding car. The one with a larger diameter is parallel with the side with no slot. The one with smaller diameter is in line with the slot of the sliding car. Why isnt the gingival edge inserted first in the matrix holder? This is for easy removal of the matrix band from the holder. Use the smaller knob to lock the matrix band. Turn clockwise Bigger knob when you want to widen the loop (turn counterclockwise) Insert first the occlusal edge (slot of sliding car) and also to the side slot (guided slot) then you lock. The slot of the slotted guide should be towards the gum tissue (gingivally) so when you remove, the order is: Remove the wedge Remove the holder: release counterclockwise (smaller knob) to unlock. just pull this occlusally Last is the matrix band Finish reading Check the drawing Setting of amalgam How to carve Pointers to consider when carving amalgam Pointers to consider during condensation of amalgam

READ!! Sturdevants Manual Liners and Bases Amalgam ZnO For recitation (?) not sure!!