November 2, 2006
DENT 430
Module overview
This is the module overview for 2006.
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August 24, 2006
Announcements
Hi everyone,
Make sure you read Chapter 6 before Monday's class. We'll be talking about fluorosis, so you might want to view some of the photos in the photostream that is under the Sources section.
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February 28, 2006
Matrix Adaptation
1. The T-Band should extend approximately l.0 mm above the marginal ridge and just below the gingival floor. First fold the short tabs at 90° (A), then fold into a ring (B). Place matrix on tooth and pull as tight as you can (C). Then remove matrix from the tooth and pull an additional 0.5 mm tighter. Fold the excess back and flatten with Howe pliers to prevent the band from getting loose. Place the matrix on the tooth without cutting the excess band material. Shortening the matrix can lead to weakness of the folded area.
2.Check that the T-Band fits tightly, is below the gingival seat and is stable
3. The wedge fits tightly into the interproximal embrasure ensuring some separation of the teeth. It is important to wedge the side that needs the most support i.e. you can wedge from either the buccal or lingual. The tip of the explorer should not pass between the tooth and the T-Band at the gingival floor of the proximal box.
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Peptalk # 1
1) If your contact point is open between the teeth before you begin your preps then make a note of the position and related measurements on your evaluation sheet and have it initialled by your instructor. This will be taken into consideration when evaluating the completed restorative work.
2) Always apply RD. Isolate a quadrant with individual holes for each tooth. Attempt to place ligature ties on the teeth that are being worked on, other than the clamped tooth. Pre-wedge for interproximal and SSC preparations. Use a Howe plier to place wedges.
3) Review your handbook and the referenced texts to familiarize yourself with the proper outline form in cavity preparation of primary posterior teeth. Review outline form, depth, and flared boxes!
4) 84 DO prep – Remember not to cross the triangular ridge on the this tooth. When you are preparing the interproximal box, be very careful, as you can easily remove too much tooth structure or iatrogenically damage the adjacent the mesial surface of 85. Air on the conservative side!
5) 54/55 Preps - Don't cross the transverse ridge on 55. On 54, keep your occlusal prep conservative, unless deep and stained grooving exists, in which case you should extend across the entire occlusal surface to include all grooves. For the preclinical session you do need to extend along the whole occlusal surface. Don't undermine the mesial marginal ridge on 54 or the transverse ridge on 55. Remember that on 55 the MO and OL preparations are separate. Draw outline form with a pencil if you want to check it first with your instructor. Fill 54 and 55 simultaneously with stepwise increments. Otherwise one amalgam will bulge out into the empty prep on the adjacent tooth.
6) Review notes about how to apply T-band, or sectional T-bands, and how to remove them safely.
7) SSC -The burs to use are 169L or a diamond (tapered, or cone) for interproximal and something bigger for the occlusal reduction i.e. diamond (barrel, etc.). Reduce the tooth in the following order:
Occlusal reduction. Remove caries and provide pulpal treatment when indicated. Very slight reduction of buccal bulge, and the lingual surface is necessary. Interproximal reduction. Be most careful not to touch the adjacent tooth. NO LEGDES, Don't cut from above. Cur from the side and remember not to exert continuous pressure when cutting with diamond burs, as they heat up rather quickly. Bevel, round corners, and then try on the crown Crimping can be done with 139 pliers, bird beak. Not necessary to make depth grooves as in permanent teeth, just a slight central depression. Remove SSC with a sturdy instrument, such as spoon excavator or the discoid carver. Cement by mixing up Poly F or glass ionomer cement. Fill up 2/3 to the entire crown so that cement will fill the gap. Wipe off excess with wet gauze or paper towel. Wait for it to get doughy and then pull a piece of floss through with a knot.
8) 74DO/75SSC: Please have both preps signed off before placing the restorations. We want you to get experience cutting and restoring two teeth simultaneously. In the primary dentition we often prep a whole quadrant at once. For this procedure, however, your choice of restorative technique may dictate your approach at preparing the teeth. The restorations can be done either of 2 ways:
a. This approach works best when #75 is clamped. Prep 74 DO, and fill the amalgam using tight T band, carve the interproximal to the ideal contour. Then re-wedge and start preparing your 75 for SSC, fit and cement. Advantage: allows time for amalgam to set and allows for nice carving of the gingival margin, Disadvantage: may risk cutting, or fracturing amalgam when seating the SSC.
b. The other approach works best when #36 may be clamped. Prepare both 74 and 75, fit and seat the crown, place your T band and fill the amalgam. After a few minutes, when you are done with the carving, the amalgam should be set. At this time you could remove the crown from #75, readjust if necessary and cement it. Advantage: Won't break amalgam, will get a good contact and contour. Disadvantage, harder to carve the interproximal if the crown rocks when the fit is not ideal.
9) Always remember that in preparing primary teeth, the more time spent at preparing the tooth, the more tooth is destroyed at an alarming rate! Be conservative!
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Hints for Evaluating Cavity Preparation in Primary Posterior Teeth
Remember steps in cavity preparation
- Establishing outline form: proper shape and dimension, centered, smooth flow
- Obtaining resistance form: well defined line angles, and smooth floors, rounded pulpal-axial line angle for the box, appropriate pulpal and axial depths
- Obtaining retention form: convergent walls, n.b. mesial and distal walls should flare slightly, lingual and buccal walls of the box should converge occlusally
- Obtaining convenience form: proper flow but avoid reverse S in the box, proper buccal and lingual extensions in the box to cover the interproximal contact area
- Removing caries
- Finishing walls and margins: no unsupported enamel, smooth walls and floors
- Performing the toilet of the cavity : placing appropriate liners/bases to protect the pulp, smooth pulpal and gingival floors
Occlusal Slot
• Outline form should have a smooth flow along the cavosurface margin, and include all susceptible fissures and preserve cuspal tissue.
• Centered buccal-lingually, buccal-lingual width should be one-third to one-half of the intercuspal distance
• Pulpal floor well defined ie. Should be an even depth of 1.5 mm with respect to cavosurface margins ,and have well defined line angles where it meets buccal and lingual walls
• Buccal and lingual walls slightly convergent
• Distal or mesial wall should flare slightly so as not to undercut the marginal ridge, ie. Be slightly divergent in relation to the central axis of the tooth
Interproximal Box
• Buccal and lingual walls should go straight out into the interproximal box in Class II cavity preparations (ie no reverse S , unless indicated due to a very tight and wide contact)
• Buccal and lingual walls convergent towards occlusal
• Proper buccal and lingual extensions at the gingival floor to include the contact area
• Gingival floor just past contact or height of contour, flat, not slanted, and well defined
• Axial wall convex to follow the surface anatomy
• Axial depth should be 1 mm
• Buccal and lingual cusps adjacent to box should have plenty of sound tooth structure left ie. They shouldn't be too thin.
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January 26, 2006
Welcome to the course
This is the weblog that will be used as a class support. You should bookmark this page or subscribe to it using the RSS, since it will be updated regularly. We will be posting resources, post lecture commentaries, and any other relevant information for this course.
Each posting has a comment box that you can use as a dialogue space with your instructors and fellow students.
The menu bar at the top will give you essentially information such as readings and assignments.
Let's begin!
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