class i & ii comp-2008
TRANSCRIPT
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G.V. Black Classification
Classes of Cavitated LesionsClass I - pits and fissures
Class II - proximal surfaces of posterior
teeth
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Restorative Materials
Amalgam
Composite
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Lesion-Specific Restoration
vs
Material Specific Restoration
Material-Specific E.g. The use of
amalgam to restoreClass I and II caries
lesion
Cavity form is basedon the physical
properties and the
technique used for
placing the material
Lesion-Specific E.g. The use of
composite resin torestore Class I and II
caries lesion
Cavity form is basedon the location and
size of the lesion
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Advantages (vs amalgam)
Conservation of tooth structure - overall astronger restored tooth
More esthetic
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Lesion-Specific Restoration
Cavity PreparationPRINCIPLE
The outline form/extension of thepreparation should bedictated by the size andthe location of the lesion.
Cavosurface margin andall internal surfaces aresmooth
RATIONALE
Conservation of toothstructure
Viscous compositematerial will not adaptwell into rough orirregular surface
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Lesion-Specific Restoration
Cavity PreparationPRINCIPLE
All aspects of thepreparation should beaccessible to the curinglight
The preparation shouldbe free of foreign debris
RATIONALE
Direct light contact isrequired for
polymerization of the
resin
Allow for optimalbonding
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Pits and Fissures Caries (Class I)
Cavity Preparation
Locate lesions (diagnosisof lesions)
Use of an appropriatebur (about the size of the
lesion) to gain access to
the lesion through the
groove/pit
Remove lesion and looseenamel
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Diagnosis of Pits and Fissures
Lesions Radiographs - limited
usefulness except for
deep lesions Explorer - limited
usefulness (wedgingeffect)
Visual - primarydiagnostic tool
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Diagnosis of Pits and Fissures
Lesions Use an explorer to removeplaque and food debrisfrom the fissure orifice Under good lighting,isolation (dry) andmagnification; visuallyinspect for any damage tothe enamel Look for any subtle colorchanges around the pits andfissures
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Diagnosis of Pits and Fissures
Lesions
Enamel is low in opacity, thus anychanges in color (e.g. caries dentin)
in the underlying dentin will showthrough the enamel
Look for a gray shadow or opaquearea around the pits and fissures - a
halo Ignore the color change within thepits and fissures
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Accessing the lesion through
the groove/pit245 fissure bur
Enamel
DEJ
Dentin
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Direct visual access to the
lesion
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Caries removal using a round
bur on a slow speed handpiece
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Unable to remove all the lesion
due to limited access
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Increase access - remove
remaining lesionEnlarge the access
area until you are
able to visually
inspect the DEJ;
Because caries start
spreading laterally atthe DEJ, any
discoloration at DEJ is
an indication of the
presence of caries
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Class I Cavity Preparation
Pre-Op
Preparation
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Preventive Resin Restoration (PRR)
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Diagnosis of Proximal CariesPrimary diagnostic tool
- bitewing radiographs
Secondary diagnostic tool- visual (looking for
changes in the opticalproperities of the marginal
ridge under bright light)
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Proximal Caries (Class II)
Cavity Preparation
Proximal carieslesion is usually
located lingual and
gingival to the
proximal contact
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Class II Composite Restoration
Cavity PreparationPenetrate through the
marginal ridge until you
reach the lesion, then extend
buccally, gingivally andlingually (as needed) to
remove the lesion
Initially leave a thin layer of
enamel at the proximal areato prevent accidental
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Class II Composite Restoration
Cavity Preparation
Due to the shape of
the bur, there will
be loose enamel
at the margin
(buccal and lingual
proximal)
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Matrix
Toffelmire matrix system Dr. Hildebrandts manual pp. 3.C.24 - 3.C.26 .0015 or .001 (ho-band) Good wedging is vital to getting good proximal
contact (if lesion dictate the complete removal of theproximal contact area)
Well burnished Other matrix systems
Palodent System - Bitine ring
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Tofflemire Matrix System
Instruction - Dr.Hildebrandts manual
pp. 3.C.24
Burnish the band usingan egg burnisher on a2x2 gauze (at least 3layers)
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Plugger - for placing posteriorcomposite
SuperPlugger
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Using an explorer, remove excess from the embrasure area before
curing. Avoid direct operatory light.
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Build to slightly overcontour
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After curing of the final increment, ready to
remove the tofflemire band
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Finishing/PolishingTechniques
Finishing burs Needle shape finishing bur (7902) for bulk removal of
excess composite at the embrasures (buccal, lingual
and occlusal) Egg shape finishing bur (7404) for creating occlusal
anatomy and adjusting occlusal contact
#12 Bard-Parker blade for removing gingival overhangand excesses at the buccal and lingual embrasures
Soflex disks for final finishing and polishing at theembrasures (buccal, occlusal, lingual)
Enhance/PoGo composite finishing system (occlusalsurface)
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Soflex Disks
For finishing and polishing Course, medium, fine and
superfine
Course and medium -finishing
Fine - finishing/polishing Superfine - polishing Extra-thin series -
excellent for finishing/polishig embrasures area
Plastic backed; extra
thin series
Paper backed; thicker series
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After removal of matrix band
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#7902 finishing bur for gross removal of excesses on bu, li and occl
embrasures
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#12 Bard-Parker blade for removing gingival overhang
and excesses on buccal/lingual embrasure area
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Alternative instruments to #12 Bard-Parker
2-3 KnifeContour 1-2
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Solflex disks to finish the embrasures/margin area; in
a SLOW/continuously moving motion
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Lesion becoming accessible/visible
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Removal of lesion
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Finished Preparation
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Toffelmire Matrix
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Total Etching
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Remove excess adhesive/composite
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Occlusal adjustment using #7404 finishing bur
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Using the solfex disk for final finishing and polishing
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Final Restoration
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Laboratory exercise
Distal composite on tooth #20 Box form Buccal extension
Buccal wall still in contact Gingival extension
1/2 mm clearance fromadjacent tooth
Buccal-lingual dimension
3 mm
Lingual wall clear contact Mesial-distal dimension
1 to 11/4 mm axial depth