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Restorations in Pediatric
Dentisty
Dr. Sami Malik Abdulhameed
B.D.S.; M.Sc.
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Objectives of the lecture
To review the ideal dental office setup
To review the moisture control and isolation
To review the restorative materials used in pediatric dentistry To review the Matrices & bands
To review different cavity preparation techniques and some
modifications
To review crown restorations for posterior & anterior teeth
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Restorative Goals
Relief pain & Cease
disease process Restore function
Improve esthetics
Preserve space forpermenant dentition
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Copyright 2003, Elsevier Science (USA). All rights reserved.
Moisture ControlIn
Restorative PediatricDentistry
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Copyright 2003, Elsevier Science (USA). All rights reserved.
Objective: Maintain an environment that keepsthe operating field free of excess water, saliva,blood, tooth fragments, and excess dentalmaterials.
Introduction
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Small, strawlike oral evacuator used duringless invasive dental procedures.
Indications for use:
Preventive procedures such as aprophylaxis or fluoride treatments.
Helps control saliva and moistureaccumulation under the dental dam.
For the cementation of crown or bridge.
During an orthodontic bonding procedure.
Saliva Ejector
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Used for most dental procedures, especiallywhen the dental handpiece is in use.
Indications for use
Keep the mouth free of saliva, blood, water,and debris.
Retracts the tongue and cheek away from thefield of operation.
Reduces the bacterial aerosol caused by thehigh-speed handpiece.
HVE
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Oral evacuation tips Operative suction tips
Designed with a straight or slight angle inthe middle.
Beveled working end.
Made of durable plastic or stainless steel.
Surgical suction tips
Much smaller in circumference.
Made of stainless steel.
HVE- contd
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Thumb-to-nose grasp
Pen grasp
Right hand
Grasping the HVE
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Fig. 36-4 Grasping the HVE.
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IDEAL ISOLATION
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Objectives of Ideal Isolation Provide optimum visibility and access to
operative site.
Prevent moisture contamination of teeth. Retract and control soft tissue of tongue, lip,
and mucosa.
Protect patient against aspiration of dental
instruments and materials. Provide patient comfort.
Be easily and rapidly accomplished.
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Copyright 2003, Elsevier Science (USA). All rights reserved.
A triangular absorbent pad placed over theStensen's duct blocks the flow of saliva andprotects the tissues in this area.
Dry-Angles
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Copyright 2003, Elsevier Science (USA). All rights reserved.
A thin stretchable latex material becomes abarrier when appropriately applied to selectteeth.
The Dental Dam
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Rubber Dam Application
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Types of Dental Materials
F release material
( Glass Ionomer)Resin Modified Glass
Ionomer
CompositeAmalgam
Stainless Steel
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Fluoride-Releasing MaterialsGlass Inomer & Resin Modified Glass Inomer
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Glass Inomer Cement loses and gains watereasily:
Early moisture contamination leads to increased
solubility and poor esthetics,(protect for first 7 minutes).
Laterdesiccation causes shrinkage and crazing,
(maybe even months later).
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halo effect around restoration ~ 3 mm.
Level around restoration ~ 10 ppm.
Level in saliva of average patient ~ 0.08 ppm.
Fluorine release from GIC does not lead to
restoration breakdown.
GIC - Fluoride Release
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ADA Classification
Type I: luting agents (Ketac-Cem, Fuji I)
Type II: restorative material
a = tooth-colored (Ketac-Fil, Fuji IX)
b = reinforced (Ketac-Silver, Miracle Mix)
Type III:
fast-set liners and bases (Ketac-Bond)
Classification OF GI
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Strengths:
Ionic exchange leads to adhesion to
tooth structure (chemical bond).
Fluoride release and rechargeable.
GIC Physical Properties
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GICPhysical Properties
Weaknesses
Moisture sensitivity.
Lack of command cure, i.e. doesnt curewith light.
Esthetics.
Not recommended for stress-bearing areas. Difficult handling.
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High caries risk patient
Atrumatic Restorative Treatment (ART)
Pediatric dentistry
Class V lesions
Liners & bases & sandwich technique
Luting agents
Core buildups ??? Maybe if > 2/3 of tooth structure remains
Orthopedics (bone substitute material)
GIC Indications
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Steps of Clinical Use of Glass Inomer
1. Mechanical retention in preparation
advised (no bevels).
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Steps of Clinical Use of Glass Inomer
2. Dentin conditioning (10
% polyacrylic acid for
10-20 seconds).
3. Inject into preparation.
Overfill the preparation.
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Steps of Clinical Use of Glass Inomer
4. Trim excess with finishing bur (wet, with very
light pressure as the cement material cuts
easily!) and polish (if necessary). Be cautious
not to over-reduce, the material is softer than
composite resin.
5. Dry the surface and paint on a thin layer of light-
cured unfilled resin (smoothes the surface and
prevents desiccation but lowers fluoride release.
(optional)
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Glass Ionomers
Advantages
Bond to tooth structure
Physical properties similar
to dentin Moisture tolerant
Release fluoride (5 years)
Fluoride rechargable
Less microleakage
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Glass Ionomers
Disadvantages
Not as strong
Poor wear Increased setting time
Not as esthetic as
composite
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Glass Ionomer Indications
Smooth surface lesions
Small anterior proximal lesions
i.e. areas of low stress
High caries risk patients
Sealants
Base underneath deep carious lesions
Good cement for stainless steel crowns and bracketsand bands
Interim Therapeutic Restorations
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Resin Modified Glass Ionomer
Mixture of glass, an
organic acid, and resin
polymer that harden
when light cured
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Resin Modified Glass Ionomer
Advantages
Increased wear and
fracture toughness
Some fluoride release Comand cure
Increased esthetics
Disadvantages
Not as strong as
composite or amalgam
Less fluoride release thanglass ionomer
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Amalgam
mixture of mercury
(43%-54%) and
powdered alloy
(silver, tin, zinc and
copper)
Once mixed sets
automatically
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Amalgam
Advantages
Quick and easy
manipulation
Less moisture sensitive
Microleakage decreases
with time
Good mechanicalproperties
economical
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Amalgam
Disadvantages
Non bonding
Bulk for strength Proper preparation to
prevent fracture
Wide isthmus
Rounded line angles
Poor esthetics Dental amalgam
controversy
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Composite
Mixture of powdered
glass and plastic resin
Polymerization reaction
initiated by light
Various level of filler
particles can change
esthetics, mechanical
properties, and viscosity
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Composites
Advantages
Micromechanical Bond
Esthetic andpolishable
Conservative
preparation
Preventative Sealants
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Composites
Disadvantages
Moisture sensitive
Technique sensitive Multiple steps
Time consuming
Polymerization
shrinkage leads to
microleakage
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Composite Indications
Small pit and fissure
caries
Class I, II, III, IV andV restorations in
primary and
permanent teeth
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Anterior Strip Crowns
Anterior Restorations
Primary anterior
crown forms
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Stainless Steel
Pre-fabricated
Full coverage
restoration Pre-crimped with 6
sizes
Adapted to tooth
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Stainless Steel
Advantages
Strongest
Preventative
Can be adapted for
space maintainer
Disadvantages
Poor esthetics
Post op discomfort
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Stainless Steel Indications
Pulpotomy
Extensive caries
Fractured teeth Hypoplastic molars
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Stainless Steel Crown Indications
Space Maintainer
Distal Shoe / loop
High caries riskchildren
Patients that require
general anesthetic for
dental treatment
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Stainless Steel Crown
Crown and loop
Placed on tooth that
has extensive decaywith space
maintenance needs
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Anterior Stainless Steel Crowns
Anterior SSC with
windows
Flowable composite Acid etched
Micromechanical and
mechanical retention
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Copyright 2003, Elsevier Science (USA). All rights reserved.
Matrix Systems for
Restorative Dentistry
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Copyright 2003, Elsevier Science (USA). All rights reserved.
Introduction
Amatrix system provides and takes the placeof the proximal tooth surface that was removedto restore the proximal contours and contact totheir normal shape and function.
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Types of Matrices
w Tofflemire
does not fit contour of primary tooth well difficult to fit multiple matrices
W T-band
w Spot welded allows for multiple matrix placement
requires a spot welder chairside
w Automatrix - costly
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Copyright 2003, Elsevier Science (USA). All rights reserved.
Posterior Matrix System
Universal retainerAlso referred to as the Tofflemire retainer.
This device holds the matrix band inposition. The retainer is positioned most
commonly from the buccal surface of thetooth being restored.
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Components of a Universal Retainer
Posterior Matrix System
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Posterior Matrix System-contd
Matrix bands Matrix bands are made of flexible stainless
steel and are available in premolar, molar,and universal sizes and thicknesses.
The largercircumference of the band isthe occlusal edgeand is always placedtoward the occlusal surface.
The smallercircumference of the band is
the gingival edgeand it is always placedtoward the gingiva.
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Fig. 49-2 Types of matrix bands.
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Automatrix System The automatrix system is an alternative to a universal
retainer. There is no retainer used to hold the band in place.
Bands are already formed into a circle and areavailable in assorted sizes in both metal and plastic.
Each band has a coil like autolock loop. A tightening wrench is inserted into the coil and
turned clockwise to tighten the band.
When finished, the tightening wrench is inserted into
the coil and turned counterclockwise to loosen theband.
Removing pliers are used to cut the band.
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Fig. 49-9 Automatrix system.(Courtesy of Dentsply Caulk.)
Copyright 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
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Matrix Systems for Primary
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Matrix Systems for Primary
Teeth The T-band is a T-shaped copper band.
When formed, the top portion of the T allowsthe straight portion to adjust and fit thecircumference of the primary molar.
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Copper T-band used for primary molars.
Copyright 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Additional Matrix Systems for
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Aspot-welded band is a form-fitted bandplaced around a prepared tooth, thenremoved and placed in a smaller form of awelder that fuses the metal together to make
a custom band.
Additional Matrix Systems forPrimary Teeth
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Spot Welded Matrix
w Cut matrix and spot weld
ends
3/16 wide and thin (..002)
matrix
w Form a loop
w Hold ends in spot welderw Weld at low setting
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Copyright 2003, Elsevier Science (USA). All rights reserved.
Fig. 49-8 Spot-welded band.
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Matrices for Composite Restorations
A plastic matrix, also referred to as acelluloid matrix or mylar strip, is used forclass III and IV restorations in which theproximal wall of an anterior tooth is missing.
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Copyright 2003, Elsevier Science (USA). All rights reserved.
A clear matrix system.(Courtesy of Premier Dental Products.)
Copyright 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Th U f Cl M t i
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The Use of a Clear Matrix
The matrix is placed interproximally beforethe etching and priming of a tooth. Thisprotects adjacent teeth from these materials.
After placement of composite material, a
matrix is pulled tightly around the tooth tohelp reconstruct its natural contour.
The clear plastic matrix allows the curing light
to penetrate the material and complete thecuring process.
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Sectional Matrices
A thin polished palodent-type band and atension ring produce a tight anatomic contactfor composite resin materials for class IIrestorations.
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Fig. 49-10 Sectional matrices.
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Sectional matrices.(Courtesy of Garrison Dental Solutions.)
W d
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Wedges
Awedge is either triangular or round andmade of wood or plastic.
The wedge is inserted into the lingualembrasure to position the matrix band firmly
against the gingival margin of thepreparation.
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Fig. 49-6 A wedge correctly positioned.
Restorati e Dentistr for Children
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Restorative Dentistry for Children
BY DR SAMI MALIK ABDULHAMEED.
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Cavity Preparation
Dr. Sami malik abdulhameed
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Objectives
wTo be able to identify and
distinguish morphologicdifferences between primary and
permanent teeth. To apply the
knowledge of morphology inclinical procedures for pediatric
patients
M h l i l C id i i hM h l i l C id i i hM h l i l C id i i h
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Morphological Considerations in the
Primary Dentition
w The crowns of primary
teeth
are shorter have a narrower occlusal
table
have a more pronounced
cervical constriction
have thinner enamel and
dentin layers
Morphological Considerations in the
Primary Dentition
w The crowns of primary
teeth
are shorter have a narrower occlusal
table
have a more pronounced
cervical constriction
have thinner enamel and
dentin layers
Morphological Considerations in the
Primary Dentition
w The crowns of primary
teeth
are shorter have a narrower occlusal
table
have a more pronounced
cervical constriction
have thinner enamel and
dentin layers
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Morphological Considerations in the
Primary Dentitionw The crowns of primary teeth
have enamel rods that run in a slightly occlusal
direction from the DEJ have broad flat contact areas between primary
molars
have nearly the same mineral content as
permanent teeth
have a lighter, more homogeneous color
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Contact Area
Point contact
Broad, flat contact
Morphological Considerations in the
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Morphological Considerations in the
Primary Dentition
w The pulps of primary teeth are larger than that of the permanent tooth in
relation to crown size
are closer to the outer surface of the tooth the mesial pulp horn is pronounced occlusally
more closely follow the surface of the crown
usually have a pulp horn under each cusp
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Comparison of Pulps
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Influences of Primary Tooth Morphology
w Tooth Preparations
Need to take into account tooth
size, pulp size and enamel anddentin thickness
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Instrumentation
w Utilize a # 245 bur
w Tip -
measure width andlength of cutting shank
w High speed
w Minimal use of hand
instruments
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Cl A l
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Class I Amalgam Preps
w Pulpal Floor Depth -
.5 - 1 mm into dentin primary molars - 1.25 to 1.50mm
w Intercuspal width - 1/3rd
w Rounded internal line anglesw B-L walls slightly undercut
w M-D walls flare at marginal ridges
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Mandibular Molars Outline Form
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Maxillary Molars Outline Form
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Internal Form of a Class I Prep
w 1) depth .5 - 1mm
into dentin
w2) angle of floor andwalls is rounded
w 3) slightly rounded
pulpal floor
Avoids pulp
w 4) sharp cavo-
surface angle
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General Considerations
w Adhere to GV Blacks principles with
respect to outline, resistance, retention andconvenience form and finishing of enamel
walls.
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Class II Cavity Prep - Mandibular
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Class II Cavity Preps - Maxillary
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Class II Amalgam Preps
w Accomplish occlusal outline form
w Extend proximal box into self cleaning area
leave 90 degree cavosurface margins isthmus width 1/3
w Proximal box in an occlusal gingival
direction is parallel to the long axis of thetooth
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Class II, continued
w B-L walls of box should converge
occlusally
w Gingival floor should be beneath thecontact, at, or just beneath the gingival
tissue
w Axial wall should follow the contour of thetooth
1 mm in width
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Cross-sectional View of Class II
w 1a) gingival floor
position 1b) box is
perpendicular to long
axis
w 1c) rounded angles
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Common Errors -Class IIs
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Modifications
w Concave pulpal floor
and gingival seatw Rounded internal line
angles
both decrease stress in
the restorationView from distal surface
of primary 1st molar
B L
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Modifications
w Relatively wider
isthmus width
one-third the
intercuspal distance
w Conservative proximal
extensions
you can see light, butcannot pass an explorer
tip through
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Class 2 slot preparation
Class V Restorations
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Copyright 2003, Elsevier Science (USA). All rights reserved.
Class V Restorations
Aclass Vrestoration is classified as a smoothsurface restoration. These decayed lesionsoccur at:
The gingival third of the facial or lingual
surfaces of any tooth. The root of a tooth, near the
cementoenamel junction.
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Condensation and Carving
w Back to back condensation of Class IIs
w Carving described as hill and valley
w Polishing procedure is same as taught for
permanent teeth
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Condensation and Carving
w Back to back condensation of Class IIs
w Carving described as hill and valley
w Polishing procedure is same as taught for
permanent teeth
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Polishing!
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Failures of Amalgam Restorations
w Fracture of the isthmus of a Class II
due to insufficient bulk of amalgam
w Marginal failure in proximal box area due to excessive flare of the cavosurface
margin
w Recurrent caries failure to extend preparation adequately
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Class III Cavity - Cuspids
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Dovetail is placed on lingual of maxillary cuspids and
the facial of mandibular cuspids.
Proximal box is placed perpendicuar to a line tangent to
the surface on which the dovetail is placed.
Restoration of Proximal-Incisal
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Caries in Primary Anterior Teeth
u Esthetic Resin Restoration
u Stainless Steel Crownu Open-Face Steel Crowns
u Direct Resin Crowns
C i (S i ) C
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Composite (Strip) Crowns
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Preventive
restorationresin
PREVENTIVE RESIN
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PREVENTIVE RESIN
RESTORATION (PRR)
OBJECTIVES:
1. List the indications and contra-indicationsfor PRR for primary and permanent teeth.
2. Describe the PRR materials.
3. Describe the clinical procedures for PRR.4. Identify the advantages of using PRR and
their cost effectiveness.
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The patient presented with infiltration
of the fissures an eroded amalgam
The decayed fissures were opened usingspecial burs, allowing the retention of
healthy tissue to be maximised. The
amalgam restoration was removed.The
dentine was properly cleaned of carioustissue.
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ATRAUMATIC RESTORATIVE
TREATMENT
A.R.T
INTRODUCTION
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INTRODUCTION
Atraumatic restorative treatment (ART) is aprocedure that involves removal of carioussubstance from the tooth using hand instrumentsand restoring with adhesive restorative material.
This is being developed for less industrialized
communities in special groups such as refugeesand people living in financially deprivedcommunities who are unable to obtain a restorativedental care.
ART has broken many barriers and allowed deliveryof dental restorative treatments possible despiteunavailability of electricity or communities that cannot afford dental treatment.
CONTINUED
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CONTINUED
Glass Ionomer is the material of choice for ART thatcan be applied to early stages of caries
development that would halt or slows the caries
progression due to the slow release of fluoride.
It is important to understand that ART is only abranch of oral health care that need to start with
health promotion messages, healthy diet and good
oral hygiene.
With ART one attempts to conserve as much tooth
structure as possible to prevent further decay to
achieve the goal ofTeeth forLife.
CONTINUED
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CONTINUED
Instrument needed for ART is very convenient to carryaround by bus or bicycle in a bag.
In addition delivering this treatment oral care workers
travel to rural communities for oral health education.
ART is a very friendly procedure to patients that could beutilized to be effectively used on children and fearful
adults.
For this reason, ART is widely used even in industrialized
countries because it supports minimal intervention andminimal invasion of the patient.
Interim Therapeutic Restorations
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Interim Therapeutic Restorations
Removing carious tissuesusing hand instrumentsonly
Less traumatic No need for electricity
Conservation of toothstructure
Low cost
Glass Ionomer
Bonds to tooth
Releases fluoride
ART Applications
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Great technique for root cariesGood alternative in field conditions
Excellent for fearful children
Good alternative in medicallycompromised patients
Good alternative in mentally
compromised
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PRINCIPLES OF ART
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PRINCIPLES OFART
2 main principles of ART are:
1. Removing carious tooth tissues using handinstruments only
2.
Restoring the cavity with a restorative material thatsticks to the tooth.
Why GIC?
It bonds chemically to both enamel and dentine, it isfluoride releasing and it does not inflame gingiva orpulp.
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INDICATION AND CONTRAINDICATIONS
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Indications:
There is a cavity involving dentine
Able to access the cavity with hand instruments.
Contraindications:
Presence of infection (abscess or fistula)
Pulp is exposed Chronic inflammation of pulp
Cavity is inaccessible with hand instruments.
PREPARING THE CAVITY
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Place a cotton roll and dry the working tooth. Use the dental hatchet to gain access and
excavators to remove soft caries and unsupported
enamel.
It is very important that:
1. All soft caries is removed at enamel-dentine
junction.
2. To avoid exposure of pulp in deep cavities, leave a
small portion of affected dentine near pulp region.
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CONTINUED
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After 1-2 minutes check the occlusion.
If the ART restoration too high, remove the stained
portion of restoration with a carver blade.
Ask the patient not to eat for an hour.
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PROCEDURE FOR RESTORING
MULTIPLE SURFACE CAVITIES
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MULTIPLE SURFACE CAVITIES
Prepare the cavity in a dry environment usingcotton rolls.
Place a matrix strip between teeth with a wedgefor support under the contact point and gummargin.
Condition the cavity and fill it with GICcompletely.
Use the finger press techniqueRemove excess and wait for 1-2 minuets.
Check the occlusion and it is important to havenon occluding contacts with the opposing tooth.
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PRESS-FINGER TECHNIQUE
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PRESS-FINGER TECHNIQUE
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AFTER PRESSING
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AFTER APPLYING WATERPROOFING
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SURVIVAL OF GIC SEALANTS3 year old glass-ionomer sealant
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y g
SURVIVAL OF GIC SEALANTS2 year old glass-ionomer sealant
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MONITORING
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It is important to collect any information if any painis being experienced and if ART restoration was
accepted.
Assess if the patient is satisfactory with the
restoration within first 4 weeks. The clinical evaluation is planned annually or
biannually depending on the risk statues and oral
hygiene.
FAILED OR DEFECTIVE RESTORATION
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A restoration is no longer satisfactory when :1. It is completely missing
2. Fractured restoration
3. Much of the restorative material is worn away.
4. Caries have developed at the restoration marginor else where on the tooth surface.
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Use of Stainless Steel Crowns
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u Introduced to pediatric dentistry by Dr. William
Humphrey in 1950
prior to that orthodontic bands filled with
amalgam were a last resort necessity is the mother of invention
u Considered superior to large multisurface
amalgam restorations and have a longer clinical
lifespan than two or three surface amalgams
(Dawson et al., 1981)
Objectives
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j
u The student should be able to:
Describe the indications for stainless steel
crowns.
Understand the principles of preparation,
adaptation, and cementation of a successful
stainless steel crown.
To properly prep a dentoform tooth for a SSC
and properly adapt a crown to fit it.
Crowns vs. Class II Amalgams
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g
Crowns 90% successful from date
of placement, regardless
of age
Majority of failures are
related to pulp failure, not
restoration failure (false
failure)
Not as esthetic however
More expensive
Class II Amalgams Success rate is highest
when life expectancy of
the tooth is less than 3
years
Better looking than
crowns
Cheaper than crowns
Approximately 50%
failure rate when placed
in children
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Rampant Caries Caries involving three or more surfaces
Recurrent caries
Following pulp therapy
Developmental defects
Fractured teeth
Severe bruxism
Orthodontic appliance fabrication
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Indications
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Rampant caries
Three surface radiographic decay
.:Indications
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Indications
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Non-ideal two surface, or 3 surface decay
:Indications
Recurrent caries
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.:Indications
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Indications Developmental Defects
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.:Indications Fractured amalgams
.:IndicationsSevere Bruxism
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Severe Bruxism
.:IndicationsOrthodontic Appliance Fabrication
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Crown / loop
Distal Shoe
Contraindications
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u Esthetics
u Teeth that are nearing exfoliation
u Mechanical problems space loss
caries beneath the level of the bone
u Permanent restoration in the permanentdentition
Types of Crowns
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Rocky MountainUnitek
Ion
Types of Crowns
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Rocky Mountain
First crown developed,originally by an orthodontist
Must be trimmed Must be contoured
Not crimped
Rarely used today due to
significant time to fabricate at
chairside
Types of Crowns
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Unitek
Second crown developed
Pre-trimmed
Must be contoured Must be crimped
Primarily composed of
chromium and steel, this is
strongest of the three crowns
Types of Crowns
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Ion
Latest evolution
Pre-trimmed
Pre-contoured
Pre-crimped
Softer metal, but designedto snap over prep without
any alterations
What you will need
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u Burs and stones
#169
heatless stoneu Pliers and instruments
contouring plier
crimping plier
u Polishing
Clinical Procedures
Pre-treatment evaluation
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Pre treatment evaluation
Prior to placing rubber dam, check occlusion
Vertical space loss? Horizontal space loss?
Soft tissue change? Mobility?
Rubber dam is mandatory!!! Crowns are
very slippery when wet with saliva
Must have adequate anesthesia, particularly
on the palate.
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Horizontal space loss: #E has shifted mesially into #D
Vertical Space loss: U #E has palatal cusp erupted into L #E
caries
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Squares vs. rectangles (maxillary molars vs. mandibular molars) -
Hint!!! - distal caries on a mandibular primary first molar
will alter its shape to look more like a square! When this
happens, choose a maxillary primary first molar crown from the
opposite arch (I.e. - space loss on lower left primary first molar.
Choose a crown from the upper right box!!!)
Managing Space Loss
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Another technique for managing space loss
Using the Howe plier, grasp the Unitek crown
on the marginal ridges and gently squeeze
This causes the rectangular crown to become
square. Doing this reduces the mesio-distal
width of the crown, but inceases the bucco-
lingual widthRecontour and recrimp the crown.
Overview
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u Occlusal reduction
u Proximal reduction
u Buccal and lingualreduction
u Beveling
u Round all sharp lineangles and corners
Crown preparation
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Key points to rememberThis is not a cast restoration. The crown does
not rely on a precision fit. Retention relies on
the natural undercuts, the adequacy of thecrimp, and the luting material.
This prep is completely different from that of a
full gold crown prep
Excessive buccal/linqual reduction may result
in a non-retentive crown and an unplanned
extraction!
Crown Preparation
Armamentaria
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Armamentaria
Burs ---
No. 169L FG
Tapered Diamond FG
No. 6 or 8 RA
No. 330 FG
Heatless Stone
Accessories---
Wire wheel
No. 114 contour pliers
No. 800-417 crimping
pliers
Howe pliers
Crown Preparation
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Occlusal reduction
Occlusal beveling
Interproximal reduction
Line angle refinement
Crown Preparation
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Occlusal Reduction - prior to preparation
Crown Preparation
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Occlusal Reduction - using a 330FG or a round wheeldiamond, remove approximately 1-1.5mm.
Crown Preparation Occlusal bevel - use 330FG or tapered diamond
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Occlusal bevel use 330FG or tapered diamond
Occlusal Reduction - 1.0-1.5mm
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Occlusal Reduction - 1.0-1.5mm
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Completed Occlusal Reduction
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u Check reduction with
opposing arch
Crown Preparation Occlusal reduction completed - do not over-reduce the
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p
mesiobuccal aspect (high pulp horn)!!!
Proximal Reduction
Contact with adjacent teeth must be broken
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u Contact with adjacent teeth must be broken
gingivally and buccolingually
u proximal slices converge slightly toward the
occlusal and lingual
DO NOT OVER TAPER
u The gingival margins should have a feather-
edge finish lineu Adjacent tooth structure must not be damaged
Proximal Slices
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Crown Preparation Interproximal reduction - tapered diamond used to avoid
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interproximal ledges which can prevent seating!!!
Crown Preparation
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Completed preparation - should be approximately
1 - 1.5 mm below the plane of occlusion as judged
by comparing adjacent marginal ridge height.
Should be no sharp angles to prevent crown fromseating
Must not be ledged interproximally
Margin should be approximately 1 mm below themarginal gingiva
Crown Preparation
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Crowns for Guiding Teeth
Ectopic Eruption
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Ectopic Eruption
Crown is indicated on a second molar AND the
permanent first molar is hold-type ectopic
Crowns for Guiding Teeth
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Techniques
Pulp treatment is
completed in the usual
manner
Estimate amount of
distal reduction
required
Carefully reduce so
that first molar is not
damaged
Estimated reduction
Crowns for Guiding Teeth
Technique (cont)
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Technique (con t)
Using perio probe,
sound the mesial of
the permanent molar
Unitek crown is
trimmed so that thedistal margin
extends below the
mesial marginal
ridge of the firstmolar. Solder???
Crowns as Space Maintainers
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The primary advantage ofusing a crown instead of a
band is the increased
stability.
May be a one or two step
procedure (usually two)
Angulation of Slices
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Proper slice Improper slice
Ledging
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u Proximal slice must
be extended below
tissue to to avoid
leaving a ledge
Preserving the Outline
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u Remember: crown preparation if a significant part
of the crowns retentive potential
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Round Sharp Line Angles
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u The buccal and lingual proximal line angles
are rounded by holding the bur parallel to
the tooths long axis and blending the
surfaces togetherThe finished contour
should conform to the internal contour of
the stainless steel crown
Crown Adaptation
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u Mark gingival line with a
scaler & trim 1mm beneath
the mark using C&B
scissorsMargins should betrimmed to lie parallel with
the contour of the gingival
tissue and consist of a
series of curves withoutsharp angles
Guidelines
u Resistance in seating without tissue blanching.
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Check for high spots on occlusal surface
ledges
u Resistance in seating with tissue blanching.Check for
crown too wide (preliminary contouring)
crown too longtissue caught in margin
Contour the Crown
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u Use contouring pliers,
bend the gingival third
of the crowns marginsinward to restore
anatomic margins and to
reduce the marginal
circumference ensuring a
good fit
Crimp the crown
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u With the crown-
crimping plier (#118)
crimp the margin
Replace crown ontooth and check
margins with an
explorer
Finishing and Polishing
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u Use heatless stone to
smooth jagged
edgesThen use a
rubber wheel toremove small
scratches and
smoothPolish surface
of crown to a highshine with tripoli and
rouge
Cementation
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u Clean crown and toothu Fill crown with zinc
phosphate cementSeat
crown, expressing
cement form allmargins and press into
occlusionRemove
excess cement when
partially set
Cross-sectional View
Post-op instructions ?
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u Although a well-adapted and
cemented crown
should not come offunder these
circumstances,
patients and parents
should be warned
of the possibility
Managing Clinical Variations
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u Space Loss
Managing Space Loss
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u May need to increasethe buccal and
lingual
reductionsMay needto compress crown
form on mesial and
distal with Howepliers
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Composite Crowns
BY DR. SAMI MALIK ABDULHAMEED
Objectives
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u To describe the indications for a composite
crown on a primary incisor.To properly
prepare a dentoform tooth for a composite
crown.To properly adapt a crown form andto restore a dentoform tooth.
Restoration of Class IV Caries in
Primary Anterior Teeth
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u Esthetic ResinRestoration
u Stainless Steel Crown
u Open-Face SteelCrowns
u Composite Crowns
Anterior Stainless Steel Crowns
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u Esthetics - poor
u Durability - very good
u Time for placement - fastest
u Selection criteria - severely decayed,
esthetics of minimal importance, gingivalhemorrhage not controlled, inadequate
patient cooperation
Open Faced Stainless Steel Crown
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u Esthetics - okay
u Durability - good, although facing may bedislodgedTime for placement - takes longest
to place due to two-step procedureSelection
criteria - severely decayed teeth, durabiltyneeded, esthetics are a concern
Crown Form Selection
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u Select the appropriate crown form size
from the mesio-distal measurement (mm)
of the tooths incisal edge, or by direct
comparison
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Utilize a fine diamond or a 699
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Tooth Preparation
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u Buccal reduction - to allow the placement of
the restoration within the normal buccal
lingual width of the tooth restored
.5-1 mm
u Lingual reduction - to allow for the
necessary bulk for the strength of the crown
and to prevent for any occlusal interferences
Buccal Reduction
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Lingual Reduction
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Circumfrential Undercut Shoulder
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u Terminates at the crest of the gingiva
u Shoulder depth should be .75-1 mm
u Use inverted cone
Variation
Cervical undercut on facial only
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Removal of caries may also provide undercuts
Crown Adaptation
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u Carefully trim off the
cervical collar with
curved festooning
scissorsTrim crownform so that when
seated, it covers the
shoulder but extends
no more than 1 mmpast tge shoulder
Trial Fitting of Crown Form
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u Try on trimmed crown
form Incisal edges
should line up Place
hole in incisal edge ofcrown with an
explorer to allow vent
for composite to flow
through during crownplacement
Crown Placement
u Etch tooth with phosphoric acid for 30
d
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seconds
u Thoroughly wash and dry etched surface
u Apply bonding agent according to
specifications
Crown Placement
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u Carefully pack the
crown form resin to
avoid entrapment of
air bubbles
i i h fill d
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u Position the filled
crown form over the
prepared tooth so it
extends 1mm over thegingival
marginRemove excess
resin from margins
with an explorerbefore polymerizing
u Slice crown form
Minimal Finishing and Polishing
P l i f
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u Peel it away from
composite crown
u Finish margins
u Adjust occlusionu DO NOT FINISH the
labial surface
polymerization of the
resin against the plastic
provides the smoothest
and most stain resistant
surface
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