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Dental Law: Abandoment
Withdrawing a patient from treatment without giving reasonable notice or providing a competent replacement.
Dental Law: Administrative Law
Category of law that involves regulations established by government agencies.
Dental Law: Board of Dentistry
State Agency that adopts rules and regulations and implements the specific state’s Dental Practice Act.
Dental Law: Child abuse
Any act that endangers or impairs a child’s physical or emotional health or development.
Dental Law: Civil Law
Category of law that deals with relations of individuals, corporations, or other organizations.
Dental Law: Contract Law
Category of law that involves an agreement for services in exchange for payment (contract).
Dental Law: Criminal Law
Category of law that involves violations against the state or government.
Dental Law: Dental Auxiliary
Dental assistants, dental hygienists, and dental laboratory technicians.
Dental Law: Direct Supervision
Level of supervision in which the dentist is physically present when the dental auxiliary performs delegated functions.
Dental Law: Due care
Just, proper, and sufficient care, or the absence of negligence.
Dental Law: Elder Abuse
Includes physical or sexual abuse, financial exploitation, emotional confinement, passive neglect, or willful deprivation of an elderly person.
Dental Law: Expanded Functions
Specific intraoral functions delegated to an auxiliary that require increased skill and training.
Dental Law: Expressed contract
A contract that is established through verbal or written words.
Dental Law: Felony
A major crime, such as fraud or drug abuse. Conviction can result in imprisonment of 1 year or longer.
Dental Law: General Supervision
Level of supervision in which the dental auxiliary performs delegated functions according to the instructions of the dentist, who is not necessarily physically present.
Dental Law: HIPAA
The Health Insurance Portability and Accountability Act of 1996; specifies federal regulations ensuring privacy regarding a patient’s health-care information.
Dental Law: Implied Consent
Type of consent in which the patient’s action indicators consent for treatment.
Dental Law: Implied Contract
Contract that is established by actions, not words.
Dental Law: Informed Consent
Permission granted by a patient after he or she is informed about the details of a procedure.
Dental Law: Infraction
Minor offence that usually results in only a fine.
Dental Law: Licensure
License to practice in a specific state.
Dental Law: Malpractice
Profession negligence.
Dental Law: Mandated Reporter
Designated professionals who are required by law to report known or suspected child abuse.
Dental Law: Misdemeanor
Offense that may result in imprisonment of 6 months to 1 year.
Dental Law: Patients of record
Individual who has been examined and diagnosed by the dentist and has had treatment planned.
Dental Law: Reciprocity
System that allows individuals in one state to obtain a license in another state without retesting.
Dental Law: Res gestae
Late for “things done.” Statements made by a person present at the time of an alleged negligent act that are admissible as evidence in a court of law.
Dental Law: Res ipsa loquiture
Latin for “the thing speaks for itself.”
Dental Law: Respondeat superior
Latin for “Let the master answer.” Legal doctrine that holds an employer liable for the acts of the employee.
Dental Law: Spousal Abuse
Domestic violence intentionally inflicted by a family member or members.
Dental Law: Standard of Care
Level of knowledge, skill, and care comparable with that of other dentists who are treating similar patients under similar conditions.
Dental Law: State Dental Practice Act
Document of law that specifies legal requirements for practicing dentistry in a particular state.
Dental Law: Statutory Law
Law enacted by legislation through U.S. Congress, state legislature or local legislative bodies.
Dental Law: Tort Law
Involving an act that brings harm to a person or damage to property.
Dental Law: Written Consent
Consent that involves a written explanation of diagnostic findings, prescribed treatment, and reasonable expectations about treatment results.
How many molars are present in the mandibular arch?
6
The permanent mandibular second molar differs from the permanent mandibular first molar by number of?
Cusps
Which is not found on the occlusal surface of a mandibular molar?
Cingulum
A cusp of carabelli is located on a maxillary first molar of the?
Mesiolingual cusp
3 round protuberances
Mamelons
What is found on both posterior and anterior teeth?
Marginal ridges
A ligual pit is most commonly found on what teeth #’s?
7 and 10
What molar is likely to have 3 buccal cusps?
Mandibular first
The label Mesiobucco-occlusal is appropriate for?
Point Angle of a posterior tooth
On a maxillary first premolar what is the groove that sperates the buccal and lingual cusps?
Central groove
The molar with a Y,H, or U pattern
Mandibular second premolar
A facial and lingual triangular ridge join to form?
Transverse ridge
Cusps for a mandibular first molar
mesiolingual, mesiofacial, distolingual, distofacial, distal
Major difference between first and second molars?
1st molars has 5 cusps, 2nd molars have 4 cusps
Which is true of oblique ridges?
Only Maxillary molars have Oblique ridges
Facial surfaces of teeth include what?
Labial and Buccal surfaces
Elevated crests of enamel that form mesial and distal margins of the occlusal surface
Marginal ridges
The bulk of a tooth is made up of
Dentin
Interproximal spaces between teeth
Gingival papillae
Mesial and distal marginal ridges are found on
Both Posterior and Anterior teeth
The distal triangular fossa of the maxillary first molar is separated from the central fossa by the?
Oblique ridge
A pinpoint depression where two or more grooves meet?
Pit
V-shaped spaces between proximal surfaces of two adjoining teeth
Embrasure
A cavity prep the includes the mesial incisal angle of a maxillary central incisor is a?
Class IV
Overbite
Vertical overlap of maxillary incisors
Centric occlusion
Touching together of the upper and lower teeth when jaws are closed
Overjet
Horizontal space between upper and lower incisors
Excursive movements
Movement of jaw from left to right
Protrusive movements
Thrusting lower jaw forward
Crossbite
Mandibular teeth are facial to their maxillary counterparts
Working cusps
Lingual of upper; Buccal of lower
Non-working cusps
Buccal of upper; Lingual of lower
Walls of a molar
pulpal floor,buccal,distal,lingual,mesial
Features of the occlusal surface of a permanent maxillary molar include..
distomarginal ridge, mesiomarginal ridge, oblique ridge, distomarginal ridge, cusp of caribelli
Structure that covers the anatomical crown of a tooth
Enamel
The maxillary first premolar differs from the maxillary second premolar in that the maxillary first premolar has:
2 roots, one buccal and one lingual
The relationship between the working end of the instrument and the tooth surface
Adaptation
Carious lesions are least likely to occur on
Cusp tips
Instruments used to place amalgams/composite resins into preps
Compactors
The radicular pulp continues with the tissues of the periapical area via the
Apical Foramen
The part of the clamp that is expanded to fit over the tooth
Jaw
Strength and wear rates of a composite are critical to consider when selecting a material for placement of what class for stength
class I,II, and III
The most versitile composite
Hybrid
Prior to placement of a class II
Both a wedge and matrix band are needed
Restoring a class II with too large an increment of composite at once can cause post-op sensitivity due to
Undercurring, shrinkage and improper condensing
Everything should be dispensed according to what?
The Manufacturer’s Instructions
Curing lights should be tested weekly to
ensure that the bulb is intense enough to cure through the composite
Total Etch
etching the enamel and all involved dentin of the prep
During composite finishing procedure a green stone is used to
remove areas of excess composite when necessary
Sequence for polishing composite
white stone, brown point, green point, white point, polishing paste
Mechanical retention
between tooth and bonding agent
Chemical retention
between bonding agent and composite
Composites can be
self cured, light cured and dual cured
Post-op sensitivity with posterior restorations can result from
hyper occlusion, over etching and operative trauma
Which area of a class V amalgam is carved free hand
the central portion
During a class II composite procedure the ring of a sectional matrix is placed
after placing the wedge
Which situation would cause a composite restoration to fail?
an internal void, moisture contamination, and improper light curing
When polishing composite its best to go from
Course to Fine
Acid etch technique utilizes
35% phosphoric acid
The most critical difference that distinguishes composite material is
the particle size
Direct supervision is defined as the dentist remaining where while treatment is being preformed
in the facility
EFDAs are not permitted to..
Do anything Final!
Gingival retraction cord soaked in epinephrine can cause
Tachycardia
acetone, alcohol and water
Carrying agents
Bonding is never used as an
lubricant
To prevent post-op sensitivity the EFDA should apply what as the first increment in a class II prep
flowable
The sequence for finishing and polishing a composite
finishing bur, coarse, medium, fine discs, polishing paste
Primer must be dispensed immediately to prevent
evaporation
Coronal polishing
Removing plaque and stains from coronal surfaces of teeth
Polishing does NOT improve the uptake of professionally applied FL2 therefore polishing is _ before FL2 application
NOT NECESSARY
Exogenous stains are caused by environmental sources and are classified in to subdivisions including:
Intrinsic and Extrinsic stains
Which is an example of an endodgenous stain?
an excessive amount of fluoride during development of the tooth
What polishing paste is recommended for use on filled hybrid composite restoration?
Aluminum oxide
An Oral Prophy includes
Removal of calculus and debris
Extrinsic/Exogenous stain
A stain that may be removed from the surface of the teeth(food and drink)
Intrinsic/Endogenous stain
A stain that cannot be removed for the surface of the teeth(smoking,tobacco,dental amalgam)
Which is the most common technique for stain removal?
Rubber cup polishing
What damage can result for using the prophy angle at a high speed?
it can cause frictional heat that can burn the gingiva and damage the tooth
HEIGHT OF CONTOUR on the facial surface of a posterior tooth is
at the Cervical third
Slow flow or movement of amalgam
Creep
Carious lesions located on the proximal surfaces of molars and premolars
class II
Carious lesions located on the proximal surfaces of central and lateral incisors
class III
Cavosurface margins should be check with
an explorer
A wedge is used for what class of amalgam restoration?
class II
Where should you begin restoring a class II prep?
along the gingival floor
walls of a class II cavity prep
mesial, distal, buccal, lingual, axial, gingival
The addition of which metal to the dental alloy will reduce gamma phase?
Copper
When placing a tofflemire retainer you place the wedge from what surface?
the lingual
2 metals in gammaphase
Mercury and Tin
An auto matrix is used for what class restoration?
class II
The walls for a class II prep included the axial wall and the gingival floor which
is adjacent to the gingvial tissues
In a class II amalgam retentive grooves/points can be found in the _ point angles
axiogingivalproximal
The diagonal slot of the tofflemire should be placed toward the what for easy removal?
the gingival
5 metals in amalgam
Silver,Copper, Mercury,Tin and Zinc
The best way to prevent overhang is?
proper band and wedge placement
Marginal ridges should be carved __ higher than the proximal teeth
1mm
Copalite is an example of a what?
A Base
Glass Ionomers can be used as what?
a liner, base and a esthetic restoration
Glass Ionomer releases what?
Fluoride
The closest wall to the pulp on a class V and the wall that runs along the axis of the pulp is called the?
the axial wall
Calcium Hydroxide is no longer recommended as a liner under the entire restorative material because?
it has poor compressive strength
Zinc Oxide Eugenol is indicate for what procedure?
sedative temporary restoration
Walls of a class I
mesial, pulpal. distal, lingual, and facial
Bases and liners are placed on that walls
axial,pulpal walls
The junction of the walls of a cavity prep with the external surface of the tooth is the?
Cavosurface
A cavity prep that included the mesial incisal angle of a maxillary central incisor
class IV
The weakest phase of amalgamation
Gamma Phase
Properly mixed amalgam should
not appear dry or grainy, be slightly dull, and hold together without crumbling
The incisal wall of a class V prep of an incisor is termed the what wall of a class V prep of a molar
the occlusal surface
If a spill of amalgam is undertriturated the result is
hard, crumbly, difficult to condense
Glass Ionomer cement can be used in what procedure
post and core build up
What can be used as a sedative dressing under a restoration
Zinc Oxide Eugenol
The liner of choice to be placed with less than 1mm of tooth structure over the pulp
Calcium Hydroxide
What base requires cavity vanish under it to protect the pulp?
Zinc Phosphate
What material would NOT be the best choice for under a composite restoration?
Zinc Oxide Eugenol
In what direction should the polishing stroke move?
from the gingival third toward the incisal/occlusal surface of the tooth
What % of sodium is in FL2
5%
Systemic FL2
ingested by food, drink and FL2 supplements
Topical FL2
applied directly to the teeth
How much FL2 should be consumed
1 part per million
Anticariogenic means
prevents caries
With FL2 gel and foam you may not eat or drink for how long?
30 minutes
FL2 does what to tooth surfaces?
slows demineralization and enhances remineralization
Class I
occlusals of posterior teeth.
lingual pits of maxillary incisors
Class II
posterior teeth with mesial or distal
Class III
anterior teeth with mesial or distal
Class IV
anterior teeth with an incisal
Class V
gumline
Class VI
always writen out
Furcation
Area between the roots
Fulcrum
Position that provides stability for the operator
Parts of a tofflemire retainer
spindle, vice, guide slot in vice, head w/ outer guideslot, inner nut, outer nut
Spindle
Threaded rod that moves through the entire retainer to secure or loosen the band in the vise
Vice
A Box shapped device that has opening for the spindle to move in and out
Guide Slot in vice
A recepticle for the side and ends of the matrix
Head with Outer Guide Slot
Holds the matrix for 3 seperate positions right, left, or straight
Inner Nut
Controls postion of the vice to open or close the band and increases or decreases the circumfrence of the band loop
Outer Nut
Tightens or looses the spindle against the matrix band in the vice
Parts of an instrument
handle, shank, and working end
Activation
Movement of the instrument
Rubber Dam
eliminates saliva from the field of operation and allows the clinical crown to be exposed while retracting the lips and cheeks
6 advantages of the rubber dam
1.dry, clean, visible field
2.protection of patient and operator
3.economic factors
4.improved properties of dental materials
5.retraction of soft tissues
6.application of medications
Parts of a dental clamp
jaw,forcep holes, points, and the bow
2 types of rubber dam clamps
wingless and wigned
Bases and liners can be used as
sealers,reinforcers,insulators,obtundents, and pulp stimulators
Cavity varnishes can be used as
sealers
Reinforcers
used to protect the pulp form the pressures exerted on it during amalgam placement. a material can be an insulator and a reinforcer and the same time
Insulators
also referred to as bases and are placed to insulate the pulp from thermal irritation
Types of Insulators
ZOE, zinc phosphate cement, and zinc polyacrylic cement
Obtundents
have the ability to soothe the sensitive pulp or reduce the irritability of a pulp
Stimulators
used in deep cavity preps where the remaining layer of dentin over the pulp is very thing in order to stimulate a thickening of the dentin layer
Calcium Hydroxide is a stimulator it may be used as
as an indirect pulp cap over a near exposure and as a direct pulp cap over an area of exposed pulp, used in a very large carious legion
Minimal depth restoration
0.5mm to 1.5mm
Enamel restoration
between 1mm into dentin
Near pulp exposure
less than 0.5mm from the pulp
Mercury to alloy ratio
the greater % or mercury in amalgam the greater the expansion
Trituration time
the longer mixing time, the less expansion
Characteristics of amalgam
1.size and shape of alloy particles
2.ratio to mercury alloy
3.manipulation (trituration and condensation)
Galvanism
when 2 or metals rub to conduct electric current
The EFDA cannot
administer or supervise the use of any kind of anesthesia,N2O, perform endodontic procedures or conduct any type of dental exam. Diagnoses and treatment plans are also prohibited.
How many hours of Continuing Ed do EFDA’s need?
10hrs
When do EFDA’s renew their licenses?
On March 31st, biennually every odd year
Dental Florosis or “Mottled Enamel”
when FL2 consumption exceeds 1ppm(part per milllion)
Enamel Hypoplasia
is developmental and is a mineralization defect
Desicating
over drying
Moral Turpitude
personal misconduct done knowingly contrary to justice, honesty or good morals
Wetting agents/Carrying agents
help carry bonding agent to dental tubules
Tacycardia
rapid heart beat, could be caused by retraction cord soaked in epinephrine
Sealant is a liquid resin monomer (BIS_GMA)
Sealants obliterate grooves, deep pits and fissures on occlusal surfaces
What stone is used for amalgam?
green stone
What stone is used for composites?
white stone
Etch is made of
Phosphoric Acid, 37% is placed on enamel and dentin
Stainless steel finishing strips
will remove flash from gingival and interproximal areas
Guide Channels and the Diagonal Slot of a tofflemire should face
toward the gingiva
Using a tofflemire retainer what is hard to achieve
interproximal contacts
Areas of Continuing Ed that are accepted include:
1.diagnosis and treatment of oral pathosis
2.clinical and technological subjects
3.abuse and neglect
4.emergency procedures excluding CPR
Areas of Continuing Ed that are not accepted
1.billing
2.office management
3.communication skills
4.insurance reimbursment
Contraindications for sealants include:
1.rampant caries
2.interproximal lesions
3.tooth has been in the mouth for several years and has no decay
How many days do EFDA’s have to report name or adress changes to the state board?
10 days
When are EFDA Continuing Ed hours due by?
March 31st biennually
Cingulum
a bulge or prominence of enamel found on the cervical third of the lingual surface of an anterior tooth.
Cusp
a major developmental convexity on or near the occlusal surface of a posterior tooth.
Cusp
Found on the incisal edges of canines,
Cusp
a premolar usually has two of these on the buccal and lingual surfaces.Mandibular second premolar may sometimes have three of these.
Cusp Of Carabelli
Only found on the maxillary first molars
Cusp of Carabelli
only found on tooth #3 and #14
Cusp of Carabelli
The fifth cusp, located on the mesial-lingual surface of many maxillary first molars.
Cusp
Maxillary first and second molars and mandibular second molars usually have four of these
Fossa
irregular depressions or concavities on the surface of anterior and posterior teeth
Central Fossa
the depression or concavity found in the central portion of the occlusal surface of molars
Ridge
The linear elevation on the surface of a tooth.
Marginal Ridge
The rounded boarder of enamel that forms the mesial and distal boundaries of the occlusal surface of molars and premolars
Marginal Ridge
the mesial and distal boundaries of the lingual surfaces of incisors and cuspids.
Triangular Ridge
a ridge on a molar or premolar that descends from the tips of the cusp towards the central part of the occlusal surface.
Transverse Ridge
the ridge formed by two triangular ridges that extend across the surface of posterior teeth.
Oblique Ridge
Ridge crossing the occlusal surface of only maxillary molars in an oblique direction
How many major fossa’s are there
4
lingual Fossa
Central Fossa
Mesial and Distal triangular fossa
Lingual Fossa
depression or concavity found on the lingual surface of mandibular and maxillary incisors located between the mesial and distal marginal ridges
Triangular Fossa
located on the occlusal surface of the molars and premolars distal to the mesial marginal ridge and mesial to the distal marginal ridge
Triangular Fossa
are always bordered by three developmental ridges one of which is the marginal ridge named according by there location
Developmental Grooves
major grooves or lines between the ridges of a tooth named according to there location
Supplemental groove
grooves that are less distinct, shallow linear depression on the surface of teeth and are supplemental to developmental grooves , do not mark he junction on primary parts of a tooth
Spillway
a shallow depression adjacent to a developmental groove located on the occlusal surface of posterior teeth, originating in the mesial and distal triangular fossa,and extending over the mesial and distal marginal ridges towards the buccal and lingual embrasure areas
Spillway
provides an escape for food from the occlusal surface during the mastication process
Pit
a small pin point depression located at the junction of developmental grooves at the termination of those grooves.
Fissure
developmental or supplemental grooves with incomplete closure of enamel an explorer may catch or stick because the incomplete closure of the enamel
Wall
a vertical or horizontal surface within cavity preparation named for the surfaces toward which it faces or for a structure it approximates
Cavosurface
the uncut tooth structure adjacent to the cavity preparation.
Line angle
A line formed along the junction of two walls or of one wall and the cavosurface margin and named according to the walls and services involved
Point angle
A point formed by the junction of three walls within a cavity preparation and named according to the three Walls involved
Retentive features
Retentive features Grooves pits or prepared areas in the Dentin along the line angles or point angles of the preparation to enhance the mechanical retention of the restorative materials and named according to their location
Mamelons
Three bulges on the inside so edge of the newly irrupt it essential incisor which usually disappear from attrition
Cingulum
A convex area on the lingual surface of anterior teeth near the gingiva
Furcation
The dividing point of a multi rooted tooth
Mesial
The surface towards the midline
Distal
The surface away from the midline
Labial
The outside surface which is towards the lips
Lingual
The inside surface which is toward the tongue
Palatal
On the maxillary arch towards the palate
Buccal
The outside surface which is towards the cheek
Occlusal
The chewing surface on posterior teeth
Incisal
The biting or cutting edge on anterior teeth
Facial
The labial and buccal surfaces may also be known as
Apex
At or near the end of the root
Groove
A small linear depression on the surface of a tooth
Lobe
A developmental segment of the tooth
Amalgam
is an alloy powder mix with liquid mercury
Silver
Strength
Tin
Workability
Copper
Corrosion resistance
Zinc
Suppresses oxygen
Zinc
0-2%
Copper
13-27%
Tin
22-30%
Silver
40-70%
Zinc
Prevent oxidation during manufacturing process reduces brittleness
Tin
Aids in combining the mercury with alloy
Copper
Add strength and decreases expansion of amalgam
Silver
Combined easily with mercury
Amalgam scrap
Hazardous waste
Amalgam scrap
Designate a dry air tight and labeled container for unused leftovers of this material to be stored for recycle
Trituration
The process by which mercury and the alloy powder are mixed
Amalgamation
Another name for trituration
Overmixed or over triturated amalgam will look
Soupy
Under mixed or under triturated amalgam will look
Will be Crumbly
Trituration of amalgam
Always read the manufactures instructions to get a perfect mix
Amalgam restoration is placed
In increments
Carvers
Used to gain proper contours
Burnishers
Used to smooth and polish irregularities
Articulating paper
Used to check occlusion
Condensers
Also called pluggers
Condenser
Used to pack amalgam filling material into cavity preparation
Condenser
Hammer like working end is large enough to compress soft amalgam
Carvers
Have sharp cutting edges that are used to shape or form or cut to the anatomy into amalgam restoration’s
Hollenback carver
Design for carving in between interproximal to the services
Discoid-cleoid
Used on occlusal surfaces to carve
Acorn carver
Used to quickly carve basic anatomy on a Occlusal surfaces
Mechanical
Any push or pull motion creates force stress and strain
Force
Creates stress
Stress
Is the reaction within the material
Strain
The actual change in the material
Tensile stress
Pull and stretch
Compressive
Push
Shear
Sliding
Creep
Time-dependent strain or deformation that is produced by stress
Thermal
Changes in temperature
Creep
Black look around amalgam caused by microleakage can cause an amalgam restoration to extend out of the cavity preparation can cause marginal breakdown
Electrical
Currents in the mouth also referred to as galvanic shock
Galvanic shock
Occurs when dissimilar metals in the mouth such as silver amalgam restoration is against gold restorations acted like a battery and apon contact conduct an electrical current resulting in pain this occurs especially when the amalgam is newly placed
Corrosive
The gradual distraction of material usually metal by chemical reaction with its environment
Lathe cut alloy (conventional)
The cutting rate is precisely controlled to maintain the desired average particle size and size distribution.
Spherical alloy particles
They are around and require less mercury then lathe cut alloys because this powders particles have a smaller surface area per volume then do the lathe cut alloy particles
Mercury
It is used in the mixing process to form the amalgam restoration
Mercury
It is a metal in liquid form used to wet dry alloy particles upon condensing this rich layer rises to the surface and is carved off or aspirated from the restoration by the assistant
Mercury
Approximately only 3% is left in the amalgam restoration of this
Mercury ratio to alloy
Higher the percentage of this in the amalgam of the easier to mix and the slower to set yet it weakens the amalgam and makes polishing more difficult
Most mercury to alloy ratios are less than what percentage
54% because minimum mercury produces a stronger alloy
Mercury
Setting time is quicker 2.5 minutes
Corrosion
Slow deterioration by being eaten or worn away
Tarnish
To become do the luster of; discolor
Occlusion
The static relationship between the incising or mastication surfaces of maxillary or mandibular teeth or tooth analogues
ICP
Intercuspal position/ the way the teeth fit together
MIP
Maximum intercuspation/reffered to Centric contact position same as ICP
Define ICP and MIP
The complete intercuspation of the opposing teeth independent of condylar position; A position that is determined by the way the teeth fit together
Centric relation position
A bone to bone relationship repeatable position of the Johansson it is used by restorative dentist to full mouth reconstruction’s and fabrication of dentures
Eccentric contacts
Tooth to tooth contact that occur when the jaw moves out of the centric relation position to the right to the left or forward
Protrusive movement
A straight forward movement of the Jaw
What is the primary function of the posterior teeth
To masticate or crush food before swallowing and to support the occlusion
What is the primary function of the anterior teeth
To incise/cut or tear food and to protect the posterior teeth by preparing them won the John moves into any of the eccentric position
Lateral excursions
Movement of the jaw to the right or left
Temporary restorations
Typically should be out of the occlusion to allow the tooth to become asymptomatic and to make it last longer because it is not strong enough to withstand normal wear for long periods
Teeth that contact prematurely may produce the following problems
-Excessive tooth wear
-Tooth pain or sensitivity
-Fracture of the opposing tooth or restoration
- movement/shifting of a tooth or teeth due to orthodontic pressures of the prematurity
- widening of the periodontal ligament resulting in a loosening of the tooth
-Interferences in the harmonious movement of the TMJ and muscles of mastication
In general it should not or should be the goal of the operator to remove all marks from the new restoration?
Should not
Class 1 occlusion
The normal biting relationship between the maxillary and mandibular teeth also known as neutro-occlusion
Class 2 occlusion
In this abnormal biting relationship the mandible appears to slightly retrude and the maxilla appears protrusive also known as retrognarhiccprofile a overbite or overjet.
Class 3 occlusion
This abnormal relationship the mandibular teeth project further forward then the maxillary teeth also known as a underbite and prognathic profile.
Overjet
The horizontal projection of maxillary teeth beyond the mandibular teeth
Crossbite
When the jaw protrudes sideways a lateral misalignment
Attrition
Due to normal occlusal wear
Abfracation /bruxism
Due to clenching and grinding
Erosion or corrosion
Due to chemical process common and eating disorder as in acid reflex not bacterial activity
Abrasion
Due to overzealous brushing
Facets
Smooth worn areas on the occlusal or incisal surfaces of teeth resulting from Costco function during mastication or parafunction also known as premature contact
Working cusps
The lingual cusp tips of maxillary posterior and buccal cusp tips of mandibular
Non-working cusps
The buccal cusp tips of maxillary posterior and lingual cusp tips of mandibular
Tooth wear
Stress, Friction, and corrosion
Dental dam
Use for isolation; teeth are exposed and isolated through this ;will be placed after anesthesia and only placed by dentist or an EfDA
Plastic dental dam frame
Placed under the dental dam
Stainless steel/metal dental dam
Placed over the dental dam
Lubricants
Maybe needed for the lips of the patient also can be placed on the underside of the damn to help slide over the teeth and the clamp
Dental dam punch
Used to punch holes in the damn
Punch plate
A rotary platform with five or six holes of different sizes cut into the face of the plate
Dental dam for steps
Used to place an remove the dental dam clamp
The punch plate has how many hole sizes
1-5
Parts to a rubber dam clamp
Jaw, forceps holes, points, bow
Jaw of a rubber dam clamp
The part of the clamp that is expanded to fit over a tooth
Forcep holes In a rubber dam clamp
The holes in the jaws where the forceps attaches to the clamp
Points in a rubber dam clamp
The parts of the jaws that contact the tooth when the clamp is properly placed on the tooth
Bow
An arched band of metal joining the two jaws of the clamp together, a piece of waxed dental floss acting as a safety ligature is tied to this
There are two types of clamps for the dental dam
Winged and wingless
Size 5 hole in the dental dam punch is for
For molars
Size 3 hole in the dental dam punch is for
For premolars, canines and maxillary central incisors
Size 2 hole in the dental dam punch is for
For mandibular incisors and maxillary lateral’s
Size 1 hole in the dental dam punch is for
For Lower anterior teeth
Dental dam thickness
Thick, medium, heavy
Dental dams are in what colors
Dark colors
Dental dam sizes
6×6 and 5×5
There are three types of dental dam clamps
Posterior clamps, anterior clamps, pediatric clamps
Bases or liners
Used to protect the pulp or to aid in it’s recovery or both
Sealer
Seals off cavity preparation seals off the microscopic space between the tooth surface and restoration helps to prevent post op sensitivity
Physical pulpal stimuli
Thermal, galvanic and desiccation
Mechanical pulpal stimuli
Vibration from handpiece, occlusal trauma or condensation pressure
Chemical pulpal stimuli
Acidic dental materials
Biologic pupal stimuli
Carries, bacteria from the mouth
Dental liner
Thin layer of material placed in the deepest portion of the cavity preparation closest to the pulp
Calcium hydroxide/Dycal
Most common dental liner used to stimulate repairitive Dentin and does not bond to the tooth
How many types of Dentin is there
Three types of primary, secondary and reparative
Direct pulp capping
The pulp is exposed and may be bleeding
Indirect Pulp capping
Pulp is not directly exposed
Dycal
A liner that is often used as a temporary cement using a base and a catalyst mix together and is only used as a liner Only used on the exposed pulp
Vitre bond
Can be used as a base or aligner double layer is a base And using one layer is a liner mostly use under composite is a glass ionomer Is to be placed on the full floor
IRM
Used for temporary restoration and is a zinc oxide eugenol
Liner
Used at the deepest part
Base
Used above the liner
Varnish
Also a desensitizer, liquid used under amalgam to seal dental tubules and reduce microleakage
Reinforcers
Bases used to protect the pulp from the pressures exerted on it during amalgam placement or condensing can be an insulator and a reinforcer at the same time
Insulators
Also referred to as bases place to insulate the pulp from thermal irritation ex:zinc oxide/ eugenol
Zinc phosphate
Copalite
Used under an amalgam restoration only no mixing is required
Sealers
Desensitizers used to desensitize the tooth by sealing the dential tubules, A universal varnish can be this,And bonding agents can act as one
Coronal polishing
Technique used to remove supragingival plaque and stains from the Coronal surfaces of the teeth
Extrinsic stain
Stain on External surfaces of the teeth and can be removed
Oral prophylaxis
Complete removal of calculus,debris,stain and plaque
Full mouth polish
All surfaces need polishing
Selective polishing
Not every surface needs to be polished polish only the surfaces with stain
Polishing agents ex:prophy paste
Are abrasive and can remove a small amount of the outer enamel layer
Fulcrum
Finger rest using the third ring finger
Polishing steps
Use overlapping strokes, start at the gingival third and work your way up to the occlusal/incisal, this closing agent can be used to identify areas of plaque and to elevate polishing, follow the fluoride treatment if indicated
Endogenous stain
An intrinsic stain acquired during tooth development. Also known as a tetracycline stain.
Intrinsic Stain
When the inner surface of the tooth darkens, gets yellow tint, or stain.
Topical fluoride
Toothpaste, mouth rinses, gels, varnish/painted on the teeth
Systemic fluoride
Foods and beverages, prescribe dietary supplements
Dental fluorosis
Chronic over exposure to fluoride Found in children younger than six years of age with developing teeth
Sealants
Dental resin applied to the pit and Fissure area of the Tooth to prevent tooth decay
Sealants
Pits and Fisher’s filled in areas Of the tooth that are susceptible to carries
Sealants
A barrier that prevents bacteria and carbs from creating acid that cause decay in the inaccessible areas of the teeth
Sealants
If properly applied will remain completely sealed for about 5 to 10 years, may only be done on virgin surfaces
How to place a sealant
Polish, rinse, etch,rinse, apply and then light cure
Etch
Phosphoric acid
In Pennsylvania who can place sealants
A dentist, hygienist or a expanded function dental assistant
Fissurotomy
The conservative clinical procedure to treat non-cavitated pit and Fissure Carries or initial carries
Acid etch enamel surface for
15-60 seconds
Enamel looks __ after etching
Frosty
Proper placement of sealant is what percentage effective
100%
Primary cause of sealant failure is
Moisture control
Can also cause sealant failure
Inadequate etching
Abandonment
Withdrawing a patient from treatment without giving a reasonable notice or providing a competent replacement
Administrative Law
Category of law that involves regulations established by government agencies.
Board of dentistry
State agency that adopts rules and regulations and implements the specific stated dental practice act
Child abuse
Any act That endangers or impairs a child’s physical or emotional health or development
Civil law
Category of law that deals with the relations of individuals corporations or other organizations
Contract law
Category of law that involves an agreement for services in exchange for payment ex: contract
Criminal law
Category of law that involves the violations against the state or government
Dental auxiliary
Dental assistance, dental hygienist, and dental laboratory technicians
Direct supervision
Level of supervision in which the dentist is physically present when the dental auxiliary performs delegated functions
Due care
Just, proper, and sufficient care, or the absence of negligence
Elder abuse
Includes physical or sexual abuse financial exploitation, emotional, confinement, Passive neglect or willful deprivation of an elderly person
Expanded function
Specific intraoral function delegated to an auxiliary that require increased skill in training
Expressed contract
A contract that is established through verbal or written words
Felony
A major crime, such as fraud or drug abuse. Conviction can result in imprisonment of one year or longer
General supervision
Level of supervision in which the dental auxiliary performs delegated functions according to the instructions of the dentist, who is not necessarily physically present
HIPPA
The health insurance portability and accountability act of 1996; specifies federal regulations and sharing privacy regarding a patient healthcare information
Implied consent
Type of consent in which the patient action indicators consent for treatment
Implied contract
Contract that is established by actions, not words
Informed consent
Permission granted by a patient after he or she is informed about the details of a procedure
Infraction
Minor offense that usually results in only a fine
Licensure
License to practice in a specific state
Malpractice
Profession negligence
Mandated reporter
Designated professionals who are required by law to report known or suspected child abuse
Misdemeanor
Offense that may result in imprisonment of six months to a year
Patients of record
Individual who has been examined and diagnosed by the dentist and has had treatment planned
Reciprocity
System that allows individuals in one state to obtain a license in another state without retesting
Res gestae
Late for “things done “. Statements made by a person present at the time of an alleged negligent act that are admissible as evidence in a court of law
Res ipsa loquiture
Latin for “the thing speaks for itself “
Respondeat superior
Latin for “let the master answer”. Legal doctrine that holds an employer liable for the acts of the employee
Spousal abuse
Domestic violence intentionally inflicted by a family member or members
Standard of care
Level of knowledge, skill, and care comparable with that of other dentist who are treating similar patients under similar conditions
State dental practice act
Document of law that specifies legal requirements for practicing dentistry in a particular state
Statutory law
Law enacted by legislation through US Congress state legislature or local legislative bodies
Tort law
Involving an act that brings harm to a person or damage to property
Written consent
Consent that involves a written explanation of diagnostic findings, prescribed treatment, and reasonable expectations about treatment results
Class I restoration
Curious lesion that are located in pits and fissures of the occlusal, facial and lingual surfaces of the posterior teeth and on the lingual surface of the anterior teeth
Class II restoration
Located on the proximal surfaces of premolars and molars
Class III restoration
Carious lesions that are located on the proximal surfaces of central, laterals and canines (anterior teeth) that do not involve the incisal angle
Class IV restoration
Carious lesions located on the proximal surfaces of anterior teeth that involve the insides of angle
Class V restoration
Carious lesions are located on the gingival third of the facial and lingual surfaces of anterior and posterior teeth.
Matrix
Most common, A thin stainless steel band that is contoured to approximate the shape of the missing axIal tooth structure.
The two most common bands are
Universal band and extension band
Universal band
Used for class II preparations in which the proximal portion is prepared to a minimal depth and width
Extension band
Is wider and is used when the occlusogingival dimensions of the preparations exceed the width of the universal band
In addition to stainless steel bands
Copper tubes brass tea bands and pre-con toward stainless steel matrices
Tofflemire retainer
Used to hold the matrix band.
Matrix retainer are also known as
Tofflemire retainer
Spindle
Threaded rod containing a pointed tip. It can move through the entire length of the retainer to secure loose in the band in the vice.
Vice
A box shaped device at the lower end of the retainer that has an opening for the threaded spindle to move in and out.
Head with outer guide slot
The end of the retainer with three slots holds the matrix band for three separate positions (right, left, and forward)
Guide slot in the vice
Functions as a receptacle for the side and ends of the matrix
Inner adjusting knob or nut
Controls the position of the vice to open or close the band and increases or decreases the circumference of the band loop
Outer locking knob or nut
Tightens or loosens the spindle against the matrix band in the vice
Matrix placement for upper left teeth
Retainer head up, Guide slot openings facing you, and band loop on left side of the retainer head
Matrix placement for the upper right teeth
The retainer head up, Guide slot opening facing you, and band loop on the right side of the retainer head
Matrix placement for the lower left teeth
Retainer head down, guide slot opening spacing you and the band loop on the left side of the retainer head
Matrix placement for the lower right teeth
Retainer head down, guide slot opening facing you, and band loop on the right side of the retainer head
Improper placement of the matrix band can result in
Food impaction in open Contacts, open contacts, displacement of the matrix band during condensing, and overhangs
If an overhang is not corrected it can cause
Irritation to the gingival tissues and possible loss of underlying bone
The Matrix band must extend approximately how many millimeters below the gingival margin of the preparation?
1 mm
The Matrix band must extend and no farther than _____mm above the occlusal surface of the tooth?
1.5-2mm
Wedges serve two functions when inserted against the Matrix band?
to minimize overhang and to separate the teeth to ensure proper contact
what materials are wedges made out of?
wood, plastic, or metal
what are three shapes wedges come in?
straight, contoured, and non-contoured
which embrasure is larger and more ideal when placing a wedge?
lingual embrasure
what is the most common type of wedge
triangular or round wooden wedge
what instrument do you use to place a wedge
cotton pliers
on the toffelmier retainer the diagonal slot surface is always position towards the _?
gingiva
the toffelmier retainer is positioned from the _ surface of the tooth?
buccal
where does the handle of the toffelmier retainer extend out of from the oral cavity
the corner of the lips
a clear plastic matrix retainer would be used for what classes of fillings?
class 3 or class 4
when would you place the clear band when placing a restoration
before etching or bonding to protect the adjacent teeth
sectional Matrix
a thin polished Polident-type material band and tension ring produce tight anomic contact for composite resin materials in class 2 restoration
two Matrix Systems designed for primary teeth
the T band and the spot-welded band
Esthetic restorative material is used to:
-replace removed tooth structure due to trauma or decay
-hides discoloration, mottling, and reshaping of the teeth
-restore form and function
-matches color and translucency
Commonly used material for CL III, IV, and V.
composite
Before composite there were 3 types of materials that used to be used for esthetic restorative materials.
-porcelain
-silicate cement
-unfilled acrylic resins
Pros of composite restorations.
elimates undercuts, saves tooth structure, and reduced gaps.
porcelain
First tooth colored Dental material , molded within a cavity prep, baked in the oven, cemented in prep, and expensive.
silica cement
used 1870s to 1970s, relatively aesthetic, powder liquid combination
silica cement advantages
powder releases fluoride
silica cement disadvantages
liquid releases phosphoric acid which is bad for the pulp, opaque in color, rough, low compressive force, and soluble which means it will wash out of prep overtime
unfilled acrylic resins
a form of organic plastic, similar to denture resin, powder to liquid to mix
Pros to unfilled acrylic resin
easy to place and smooth, aesthetic, resist fracture
cons to unfilled acrylic resin
has poor thermal expansion allowing the filling to expand and contract which produces sensitivity
what year was composite developed
1960
what is what is the composition of composite
glycidylmethacrylate+bisphenol A=bis-gma
three materials found in organic filler throughout the resin Matrix
quartz or silica, lithium aluminum silicate, barium glasses
what is the importance of inorganic fillers in composite
reduces thermal expansion
bis – GMA is
the composition of composite
advantages to using composite
- resist solubility, dehydration, disintegration, and abrasion
- better compressive strength for chewing and hardness
- resist thermal expansion, lower expansion/contraction, reduction in percolation/marginal
- excellent marginal adoption with etching Bond
- improved marginal seal between composite and enamel
- better color stability
- has both mechanical and chemical retention
4 types of composite
conventional composite, micro filled resin, hybrid composite resin, micro hybrid composite
conventional composite
- known as macro filled
- 75 to 80% inorganic fillers
- particle size is large
- rough in texture
- more susceptible to discoloration from extrinsic stains
- fillers make it easier to distinguish carries under a filling on a radiograph
- not used for anterior fillings
75 to 80% inorganic filler
conventional Composites or macro field resins
micro filled resin
- 35 to 50% inorganic filler
- polishable
- designed to improve the rough surface characteristics of conventional Composites resembles the tooth enamel
- very small particles of colloidal silica result in very polishable surface
- susceptible to wear, increases water absorption
- good for anteriors
35 to 50% inorganic filler
micro filled resin
hybrid composite resin
- 70 to 80% in organic material
- submicron particles mixed with larger particles
- develop to combined good physical properties of conventional Composites with smooth surface micro hybrids
- best of old and new can be used everywhere
70 to 80% in organic material
hybrid composite resin
micro hybrid composite
-mix of particle size and most popular
- combines the properties of micro filled with hybrids to create a polishable strong system
- Esthetics is superb
- very broad range of Shades and opaqueness so that the tooth shade can be duplicated
flowable composite
-lower viscosity
-typically used in the first increments of a composite to fill the purple floor
- for tiny Preps
2 types of cavity Preps
conventional or modified
conventional Preps
-crafts using only carbide Burrs and handheld instruments
- acid etching improves the marginal seal and reduces the marginal discoloration with resin material
modified prep
- do not normally extend into the
- Diamond burs can be used to put in a bevel on the enamel
- allows for more end on attaching of the enamel rods
Define depth of cure
the thickness of composite that is cured by a light source
Function of Anterior Teeth.
Tear/Incise Food
Function of Posterior Teeth.
Grind Food
Portion of the tooth that extends from the Incisal or occlusal surface to the CEJ..
Anatomical Crown.
Also referred to as the cervical line ..
Appears as a slight constriction that encircles the tooth…
CEJ ( Cementoenmael Junction)
The Visible Portion of the Anatomical Crown.
Clinical crown
Area Where the Root Divides.
Furcation.
The actual division into 2 OR more roots..
Furrow
Same Arch Touches Or Meets…
Contact Area.
Contact Area
Two Purposes..
1) Food Trap (Prevent)
2) Stabilize Dental Arches.
What can eliminate a contact area?
Tooth Movement.
Loss of Teeth.
Poorly contoured Restorations.
Good Contact
Stabilizes the teeth to prevent drifting or tipping and protect soft tissues.
No Contact
Food Impaction resulting in tissue damage and Plaque Build Up.
Continuous with the inter-proximal space between the teeth..
Embrasures.
Covers the anatomical Crown of the Tooth and Varies in Thickness in Different Area’s of the tooth…
Enamel.
Enamel is thicker at ..
The Incisal and Occulusal Surface.
Hardest tissue in the body and is very brittle…
Enamel.
What color is enamel?
Yellowish white to grayish white, but also depends on the underlying dentin.
Enamel is composed of rods (prisms) that are formed as cells called..
Ameloblasts.
The bulk of the tooth is made up of ..
Dentin.
2nd hardest material in the body…
Dentin.
The hard connective tissue lying just inside the enamel and cementum..
Dentin.
Normally yellowish white and darker than enamel and slowly darkens with age..
Dentin.
Dentin is distinguished by enamel by..
Dentin = Dull flat appearance.
Enamel= translucent and shiny.
With Explorer (when scratched)
Dentin =
Enamel=
Dentin = Dull Sound.
Enamel= High Pitch.
Formed by cells called odontoblasts and develops with the pulp from dental papilla of the tooth bud…
Dentin.
3 Major Types of Dentin…
1)Primary.
2) Secondary.
3) Reparative.
Produced before the tooth erupts and shortly after eruption…
Primary Dentin.
A continuation of primary dentin that forms at a slower rate as the tooth ages and throughout the life of a tooth..
Secondary Dentin.
_ OR tertiary dentin forms rapidly when tooth has received an excessive stimulus from caries, cavity preparation , OR other trama…
Reparative.
A Defense reaction to an area of injury..
Reparative Dentin.
Ridge of enamel on the base or margin of a tooth..
Cingulum.
The hard dental tissue covering the anatomical roots of teeth..
Cementum.
Cementum is fromed by cells called..
Cementoblasts
Cementum appears..
Light yellow, slightly lighter than dentin.
Cementum is visible on teeth where..
The gingiva had receded or has been removed.
Dentin has..
- High Fluoride content of all materialized tissue.
- Does NOT have it’s own blood supply.
-Rely’s on the periodontium ligament for nutrition.
Two Types of Cementum..
!) Acellular
2) Cellular
Extends from the cementoenamel junction toward the root apex covering a large portion of the tooth..
Acellular Cementum.
Cannot Replace itself if it is diseased or has been removed mechanically…
Acellular Cementum.
On the apex of the root is made of cells that are actively producing new layers of cementum throughout the life of the tooth..
Cellular Cementum.
Provides the developmental protective, and sensory mechanism or the tooth and the nutrients and metabolic processes necessary to sustain it’s life..
The Pulp.
The Pulp is in a _ __ with one or more root canals.
Pulp Chamber.
The pulp is divided into…
1) The coronal Pulp located in the pulp chamber in the crown portion of the tooth. Including ; Pulp Horns.
2) Radicular Pulp ( The pulp in the canals of the roots.)
The Pulp serves 4 Functions..
1) Formative or Developmental.
2)Nutritive.
3)Sensory.
4) Defensive or Protective.
Where the nerves, arterioles, and venues (components of arteries and veins) enter and leave the pulp..
Apical Forman.
The pulp may be harmed by..
1) Sterilizing, Cleaning, Drying , and desensitizing agents.
2) Temperature.
3) Air.
4) Pressure.
5) Some cavity Liners.
6) Some temporary or permanent restorative materials.
A major developmental convexity on or near the occlusal surface of a posterior tooth..
Cusp
A cusp is also found on the Insical edges of…
Canies.
Premolar’a usually have _ Cusps called: _, and __.
2 Cusps
Buccal and Lingual Cusps.
A mandibular 2nd premolar sometimes has 3 cusps…
1 buccal and 2 lingual.
Maxi alley 1st and 2nd molars
Mandibular 2nd molars have 4 cusps;
1) Mesiobuccal
2) Distobuccal
3) Mesiolingual
4) Distolingual
Upper First Molars may also have a 5th cusp on the _.
Lingual surface of the mesiolingual cusp.
Called the cusp of Carabelli..
Any Linear elevation on the surface of the tooth… Narrow Developmental elevation…
Ridge
Ridge are identified as…
Medial, distal, lingual, and Buccal.
The Edge of all Incisal teeth..
An incisal ridge.
The Rounded border of enamel that forms the medial and distal boundaries …
Marginal Rdige.
Anterior Marginal ridges =
Mesial and Distal.
Ridge or an elevation that defends from the cusp and widens as it run down to the middle area of the occlusal surfaces…
Triangular Ridge.
Union of two triangular ridges..
Transverse Ridge.
The transverse ridge os located on the..
Mesial Portion of the mandibular 1st molar or distal.
Elevated area of enamel that extends obliquely across the occlusal of the tooth..
Oblique Ridge.
Oblique Ridge is only on..
The occlusal surface of maxillary molars.
Oblique ridge is formed by two triangular ridges extending from..
The Disto- buccal to the mesiolingual-lingual cusp.
There is only __ oblique ridge on each maxillary molars.
1
Maxillary Molars are the only teeth with an ….
Oblique Ridge.
Irregular Depressions or con cavities on the surface of anterior and posterior teeth …
Fossae
The depression or concavity found on the lingual surface of mandibular and maxillary incisors located between the mesial and distal marginal ridges..
Lingual fossa
Depression of concavity found in the central portion of the occlusal surface of molars..
Dental Fossa
Located on the occlusal surface of the distal to the marginal ridge and mesial to the distal marginal ridge..
Triangular Fossa.
Groove that extends in a mesial- distal direction across the occlusal surface and divides the buccal portion of the crown from the lingual portion…
Central Developmental Groove.
Groove that separated the buccal cusp molars..
Buccal Developmental Groove
Groove that separates the lingual cusps of molars.
Lingual developmental groove.
shallow, linear depression ( Grooves that are less distinct)
Supplemental Grooves.
A shallow depression adjacent to a developmental groove…
Also provides and escape for food from the occlusal surface during the mastication process..
Spillway
Small pin point depressions located at the junction of the developmental grooves or at the termination of those grooves..
Pits
Developmental or supplemental grooves with incomplete closers of enamel…
Fissures
Major Grooves or lines between ridges or the tooth..
Developmental grooves
Are used to cut and tear food..
Cuspids= canines
Longest tooth in the mouth..
Maxillary cuspid.
Used to grasp, tear and pulverize food..
Bicuspids = premolars
The premolars generally have cusps that are not as sharp as _ premolars…
2nd, 1st
the maxillary premolars usually have two roots and the maxillary _ premolar usually have 1 root.
1st, 2nd
The _ mandibular premolar is smaller than the _ mandibular premolar..
Both single rooted.
1st , 2nd
The Most Stable Tooth int he dental arch due to it’s root length and buccal and lingual thickness….
The maxillary cuspid.
on _ premolars the lingual is slightly smaller than the buccal cusps…
Mandibular
Normally Mulitirooted teeth used for grinding solid foods…
Molars
Maxillary Molars have a crown that is shoerter than the _ molar.
2nd , 1st
Maxillary secondary have _ cusps and _ roots.
4 cusps and 3 roots.
_ molars are the largest and strongest teeth in the mandibular arch…
Mandibular.
Mandibular 1at molar has __ cusps.
5 cusps
Mesio-buccal
Disto-buccal
Distal
Disto-lingual
Mesiolingual
Mandibular 1st molar = _ roots.
Two Roots
Mandibular 2nd molars have _ cusps and roots.
4 cusps and two roots
-Mesiolingual
Mesiobuccal
Distolingual
Distobuccal
4 cusps ;
Mesio- lingual
Distolingual
Mesiobuccal
Distobuccal and sometime a 5th cusp on the mesio lingual….
Maxillary 2nd Molars.
3 roots ; Mesiobuccal, Distobuccal and lingual…
Mandibular molars
Classes of cavity preparations include …
-wall
-cavosurface
-point angle
-retentive features.
A vertical or horizontal surface within the cavity preparation names for the surface which is faces or for structure it approximates is…
Wall
The uncut tooth structure adjacent to the cavit preparation…
Cavosurface.
A line formed along the junction of two walls or of one wall and the cavosurface Marvin and named according to the walls and surfaces involved…
Line angle
A point formed by the junction of 3 walls within the cavity preparation according to the 3 walls involved …
Point angle
Grooves, pits, or prepared areas in the dentin along the line angles or point angles of the preparation to enhance the mechanical retention of the restorative materials and named according to thier location….
Retentive features.
The _ consisted of the oral hard and soft tissues that support the teeth…
Periodontium
The periodontium is divided into …
1) Gingival unit; attached or free gingiva and the alveolar mucosa.
2) The attachment apparatus consisting of the cementum periodontal ligaments, and alveolar process.
Tooth is surrounded by a cuff of tissue that is not attached to the tooth called…
Free Gingiva.
The space between the tooth and their free gingiva..
Gingival Sulus
The portion of the free gingiva located in the interproximal areas…
Interdental papilla
Tissues extending from the level of the depth of the gingival sulcus to the mucogingival junction….
Attached Gingiva
A thin soft tissue that is loosely attached to the underlying bone…
Alveolar Muscosa
Is delineated from the attached gingiva by the mucogingival junction and continues apically …
Alveolar mucosa
The process of the maxilla or mandible known as..
Alveolar process
Underlying the soft tissue is the Osseous tissue is …
Alveolar Bone.
Tooth is attached to the alveolar bone by bundles of tissue fibers arranged in groups called the …
Periodontal Ligament.
Class 1
Pits and fissures of posterior teeth
Class 2
interproximal cavities on posterior teeth
Class 3
Interproximal of anterior teeth
Class 4
interproximal and incisal edge of anterior teeth
Class 5
Gingival 3rd of the tooth.
Advantages for good isolation;
1) Better visibility to the area being restored.
2) Clean and Dry cavity walls.
3) Development of full properties in the materials being used, which may be inhibited by moisture.
4) Easier access to cavity walls in the placement of liners, base, and restorative materials.
Cotton Rolls
-Oldest method
-recommended for short procedures.
Placed in the vestibules or the floor of the mouth adjacent to the operating sites.
Advantages of cotton roll isolation method..
The cheek and tongue are slightly retracted gibing better visibility.
Disadvantage of Cotten rolls..
- constant changing of cotton rolls due to saturation
-risk of contamination and moisture are increased. - limited retraction
- No protection against the patient aspirating foreign materials or chemicals.
Eliminates saliva from the field of controlling the soft tissues, increases access to the operating site by controlling lips, cheek, and tongue , and protects the patient against aspiration and foreign materials…
Dental Dam
6 advantages of using a rubber dam…
1) Dry, Clean, and Visible field of operation.
2) Protection of the patient and operator.
3) Decreased operating time.
4) Improved properties of dental materials.
5)Retraction of soft tissues.
6)Application of medicaments.
Disadvantages of using the dental dam..
- Physical conditions ( asthma , latex allergy, hermetic lesions.)
- Claustrophobic.
-Past bad experiences.
-Conditions in the oral cavity (partially erupted teeth .
How many teeth should be exposed with the use of the dental dam?
General guideline is to isolate at least 1 distal and two teeth mesial to the tooth being restored.
A rough proximal area can ..
Tear the dental dam and should be eliminated prior to tooth being restored.
Correct punching of the rubber damn take note;
Size, shape and alignment of the teeth.
Clamps vary in..
Size, shapes and styles.
Clamps can be ..
Wing or wing-less
Always attach dental floss to _ before use..
Clamp
The part of the clamp that is expanded to fit over a tooth..
Jaw
The holes in the jaws where the forceps attached to the clamp..
Forceps holes.
An arch band metal joining the two jaws a of the clamp together. A piece of waxed dental floss, acting as a safety ligature, is ties to bow of the forceps of the forceps holes.
Bow
The bow of the clamp should be positioned ..
Distal and occlusal to the clamped tooth.
The clamp is positioned ..
Over the tooth.
The clamp should contact the tooth in …
At least 4 areas or paints. )two on each Jaw.)
What size rubber dam..?
6×6 dark colored medium or heavy material is recommended.
Size 5 punch
Molars
Size 3 punch..
Premolars, canies and maxillary central incisors.
Size 2 punch
Mandibular incisors and maxillary laterals.
U shape frame faces…
Downward
Stretching dam too tightly will cause
The dam to pull off and expose teeth.
What do you use to stabilized the dental damn?
A piece of floss by gating the tooth farthest from the clamped tooth.
The first step in removing a dental dam?
Free the interdental dam with scissors.
Used only when access to caries lesion is affected by the gingiva or rubber dam..
Gingiva retractor
Gingival retractor has..
2 bows ,2 jaws, and four notches instead of holes for the clamp forceps.
The retractor has a …
Specific lingual and facial side.
The facial slow extends more..
Apically than the lingual slope.
3-6 mm
Gingival retractor.
0.5-1mm
Gingival – position of the facial jaw.
Class 6
Insical edge or cusp tip only
best for of isolation
Rubber dam
Stabilizes and secures the dental damn materials in place.
Dental Dam Clamp.
The tooth the clamp is placed on. The anchor tooth is one or two teeth distal of the tooth being restored..
Anchor tooth
Used for class 5 restoration on anterior.
Cervical clamps
Is tied to the bow of a clamp making it easy to retrie e if the clamp slips off the anchor tooth. It is used for a ligature or safety line..
Dental Floss.
Assists in inverting. Or tucking, the dental dam material around the teeth to prevent moisture leakage. It can also be used to ease the dental damn material through tight contacts.
Dental Floss
Small amount of _ is placed on the back side of the rubber dam. Helps slip the dental dam over the teeth..
Lubricant
Used to protect the pulp or to aid in its recovery, or both..
Bases and liners
Causes of irritated or damaged tooth..
1) caries
2) Traumatic Occlusion.
3) Effect of cutting nuts.
4) Desiccation
5) Condensation Pressure.
6) Chemical irritant ion from restorative materials.
7)Temperature changes
8) Dimensional Changes.
9) Lack of Marginal Seal.
Bases and liners may be used as..
-Sealers
-Reinforcers;
-Insulators
-obtundents
-pulp stimulators
Sealers funtion
To seal off the cavity preparation, used in very thin layers
Seals aka
Liners
Cavity varnishes are
Sealers
Seals dentin tubules that are exposed during amalgam cavity prep.
Cavity Varnish
Varnishes are placed only under …
Amalgam restorations.
Varnishes cannot be placed under composites due to
The reaction it will have to soften the resin material.
Materials that have Lowe solubility and are able to seal the cavity surface below an amalgam restoration..
Resin Cements
Resin cements are used as
Liners in preparations and are more common than varnishes.
Resin cements cannot be used for
Direct pulp capping as it can cause irritation.
Fluoride in water
1 part per 1 million
Cavity varnish is applied with a
Micro Brush
Bases used to protect the pulp from pressures exerted on it during amalgam placement ( condensing .) this material can be used as an insulator and a rein forced at the same time…
Reinforcers
Functions of reinforcers..
to protect the pulp from the pressures exerted on the tooth during the amalgam condensing.
Reinforcers are placed
In a
Thick layer between the restorative material and the dentin.
Reinforcer can be placed thinly as a
Liner
Insulators are ..
Reinforcers but stimulators ( calcium hydroxide ) do not have the strength to be reinforcers there foot they are liners.
Insulators are also referred to as
Bases
Insulators are placed in
Thick layers and are placed to insulate pulp from thermal irritation.
Zinc oxide – Eugenia is used as an
Insulating base and reinforcer.
Zinc oxide -Eugenol
Oil of cloves; has soothing effect on painful irritated pulp.
Zinc oxide eugenol cam be used ..
Under amalgam or as a temp restoration.
eugenol interferes with the
Setting reaction of infilled and filled composites resin materials.
Zinc phosphate cement is used as..
An insulator and reinforcer
Main ingredient in zinc phosphate cement..
Phosphoric acid
Phosphoric acid is..
Chemically irritation to the pulp.
Zinc phosphate =
Heat releasing ( exothermic)
Can be used for esthetic purposes along with pulp protection.
Zinc phosphate cement
Thick layer is placed..
Zinc phosphate
Zinc poly acrylic cements are also called..
Carboxylate and polycarboxylate
Zinc poly acrylic cements are used as
Insulators and reinforcers.
Zinc Polyacrylic Cement is weaker that
Zinc Phosphate cement but, is less irritating to the pulp.
disadvantage of zinc poly acrylic cement =
Poor handling characteristics.
Have the ability to soothe the sensitive pulp or reduce the irritability of the pulp..
Obtundents
Obtundents will decrease the
Reaction and reduce the pain.
Oil of cloves serves as an
Obtundents, found in zinc eugenol cements.
Dentin is the
Natural protector and insulator foot the pulp.
Used to deep cavity preparation where remaining layer of dentin over the pulp is very thin in order to stimulate a thickening of the dentin layer…
Stimulators.
Miley irritating to the pulp that has a beneficial effect..
Pulp Stimulators
Stimulators help with
Chemical and thermal protection.
The material used as a pulp stimulator ..
Calcium Hydroxide
Two paste system = Base and catalyst =
Calcium hydroxide
Calcium hydroxide material is
Radiopaque , visible on x-rays
Can be used as a indirect pulp cap
Calcium hydroxide
The depth of cavity preparation may be broken down into 4 categories;
1)minimal depth into enamel or 1mm into dentin.
2) Moderate depth between 1mm into dentin but greater that 0.5 mm from pulp
3) near pulp exposure (less than 0.5 mm from the pulp)
4)pulp album exposure
Minimal depth restoration extends about
0.5mm-1.5 mm into the dentin.
Thickness of calcium hydroxide should be ..
0.5 mm
Calcium hydroxide should never be close than
1.0 mm to the cavosurface margin.
Steps
1) calcium hydroxide
2) Zinc oxide eugenol cement
3) Varnish
Steps
1) calcium hydroxide
2) varnish
3) zinc phosphate or glass ionomer
Pulp all exposures can occur
Mechanically or throughly the caries process.
Not recommended under composite restoration materials..
Copal varnish and zinc oxide- eugenol
Designed top provide some thermal protection ..
Glass Ionomer
Can be acid etched at the same time to achieve retention around the untied prep.
Glass ionomer
Can be used as an estheic restoration ..
Glass ionomer
Bonds well to a tooth structure and releases fluoride to resist recurrent decay..
Glass ionomer
Bonds directly top enamel , dentin, cementum , and stainless steal.
Glass Ionomer
Acid base reaction =
glass ionomer
Advantages of glass ionomer.
- Easily dispensed.
- Material bond ability
-Fluoride releasing
Can be used as a base or liner
glass ionomer
Sensitive to moisture contact and will cause failure to the material
Glass ionomer
Glass ionomer me can be placed under
Composite resins
Etch time
15 seconds
Preparation is to be restored with a material that is contaminated within the cusp tips
Intracoronal
Preparation involves the removal of cusp tips or extends over the cusp tipis on the facial or lingual, the restoration needs an ..
Extracoronal temporary one that surrounds tooth structure.
ZOE cements should not be used as a base beneath composite restorations because:
ZOE cements are most likely
Used intracoronal temporary cements.
Gutta percha has been used
As a temporary restoration.
Needs to be heated for placement and may cause pulp damage
Gutta percha
Poor marginal seal and difficult to place and contour
Gutta percha
Zinc phosphate =
Heat releasing
Dominates the field of esthetic restorations
Composites
Used for class 4 restorations due to strength. They do not polish to the same high finish as the microfilm and hybrids.
Macrofill composites
Used for class 3 and 5 restorations. They are esthetic restoration and polish well leaving a high-luster finish.
Microfill composite
A combinations of both macrofill and microfill. They are used both in anterior and posterior areas of the mouth..
Hybrid composites
East to place , reach small pieces ,and esthetic. Disadvantages are they are not strong and cannot fill large preps.
Flowable composites
An abnormal horizontal distance between the labial surface of the mandibular anterior teeth and the labial surface of the maxillary anterior teeth is?
Overjet
The maxillary teeth vertically over the incisal one – third of the mandibular anterior teeth.
Over bite
Child abuse must be reported in
48 hours
As an efda how many days do you have to report address or name change ?
10 days
3 pout of 10 credits must be on containing education on
Coronal polishing
CE credits that are not excepted are;
Billing, office management,practice building , insurance reimbursement , and communication skills.
CE credits that are excepted
Clinical and technological subjects ,emergent procedures other than CPR certification , diagnosis and treatment of oral pathology , infection control, abuse and neglect, medical and scientific subjects, laws and regulations pertaining to dentists ,dental hygienist and Efdas.
Efdas bust work under
Direct supervision of the dentist
Dentist needs to be in office for efda to practice
Direct supervision
What can EFDAS do in PA
-rubber dams
-place amalgam / composite
-matrix band/ wedges
-apply bases and liners
-place sealants
-coronal polish
-take impressions
-perform fluoride treatment
Only tofflemire or auto matrix band can be used
Amalgam
Mylar strip, sectional matrix, tofflemire or auto matrix bands can be used..
Composite
Holds the band and securely in place and also prevents excess filling material from escaping between the tooth and the matrix band (over hang)
Wedge
Forms the missing surface or wall and reestablishes the normal contour of the prepared tooth while being filled with restorative material
Matrix band
When restoring posterior teeth, the marks left by the articulating paper should appear
As dots
Which type of matrix is commonly used for amalgam restorations?
Tofflemire matrix
When placing liners in the cavity preparation it is best to use a small
Ball ended instrument
The metal alloy used in amalgam is primary composed of
Siiver
When performing composite restoration the composite is often places into layers to
Reduce the effect or polymerization shrinkage
Which type of adhesive would typically be used to temporily cement crowns and bridges?
Zinc oxide eugenol
Amalgam made from a combination of metals is referred to as an
Alloy
Metals commonly found in amalgam is;
Sliver, tin copper and zinc
The mixing process is called
Trifurcation
Leads to a increase in flow and corrosion and decrease strength .
Gamma 2 phase
Amalgam break down also called
Creep
The slow change in dimensions of the amalgam prolonged exposure to stress.
Creep
The major cause of gross fracture of amalgam restorations found in the
Design of the cavity prep.
Characteristics of amalgam
Strength and setting time determined by ;
1) the size and shape of the alloy particles
2) ratio of mercury to alloy
3) manipulation ( such as mixing time (trituration) and condensation
Acorde =
Condense
Particulars are rounded
Spherical alloy
Controlled to maintain desired average particle size and size distribution
Lathe cute
The greater the percentage of mercury in the final amalgam, the greater the expansion of the material and the lower the strength of the final amalgam
Mercury – alloy ratio
The longer the mixing time, the less expansion or the greater contraction
Trituration time
Increasing pressure during placement decreases the expansion
Condensation
Moisture greatly increases the amount of expansion in the alloy sand is even more pronounced in zinc containing alloys.
Contamination
Produces drier mix, and lacks cohesiveness to mass when it is placed, reduces amalgam strength..
Under trituration
Results pin porosity or voids thats decreases strength . Results in excess mercury that. Weakens the amalgam restoration and leaves it more susceptible to corrosion and tarnish ..
Inadequate consecration force
Occurs when dissimilar metals in the mouth, such as silver amalgam restoration against gold restoration, act like a battery and upon contact, conduct an electric current resulting in pain.
Galvanism
Occurs when amalgam is newly placed
Galvanism
Creep
Marginal break down
Mercury by itself is
Toxic
Mercury is packaged in two different ways ;
1) dispenser that accepts a vial of pellets of alloy and container of mercury .
2) capsules with pre measured amounts
The larger embrasures are
Lingual embrasures
Lateral
Side to side
Protrusion
In and out
Centric occlusion
Normal bite
The static relationships between incising or masticating surfaces of maxillary or mandibular teeth..
Dental occlusion
Independent tooth contact
Centric relation
Heavy or peen=mature contacts are identified as articulating paper marks that appear
Denser or as a halo with the center clean.
On posterior teeth marks should appear as
Dots
Anterior marks
Incisal eg=dues or cingulum areas
Maxillary =
Mandibular =
B
L
Loss of tooth structure results from 3 basic physio – chemical mechanisms
1) stress
2) Friction ( attrition or abrasion)
3) Corrosion ( Erosin)
Erosion
Chemical process
Amalgam condensers
-Small; 0.5 – 1mm diameter nibs
- Large; 1.5- 2.0 mm nibs
Proper condensing of amalgam will..
- Promote adaptation of the amalgam to the walls and the margins of the concavity preparation.
- compact the amalgam to eliminate voids
- reduce the amount of Rudy all mercury when mercury rich amalgam is used.
- Increase the strength of the amalgam restoration.
To remove the excess amalgam beyond the margins and contour the restoration so it resembles its original contour..
Carving
Carving removes..
The mercy -rich layer because the higher the amount of mercury the weaker the amalgam..
An area where the amalgam is below the margin of the prep..
Submarginal area
If the submarginal is greater than 1.2 mm amalgam needs to
Be removed and replaced.
Under contoured amalgam
Remove and replace
Over contoured amalgam
Can be adjusted with finishing and polishing techniques at a later date.
Amalgam has a
Dull luster
Amalgam does not extend over the
Cavosurface
Used for carving class 1 restorations
Cleoid-discoid carver
With amalgam placing the matrix and wedge ..
Place matric through the contact area so it extends 2mm – 3mm facially and 0.5m to 1mm apically to the gingival margin.
concave
Inward
Convex
Outward
Finishing and polishing amalgam should not be done until it has reached it’s final set at ..
24-48 hours after it was placed.
Premature amalgam polishing will weaken restoration.
Weaken
Amalgam discoloration =
Tarnish
Occurs on a surface and subsurface of the restoration that results from chemical or electro chemical reaction with in the oral enviroment
Corrosion
Corrosion can cause
Determination of the amalgam material
Are used for bulk reduction
Stones
Made up of steel instead of carbide steel like those used for prep
Amalgam finishing burs
Used for contouring and finishing amalgam restorations..
Finishing discs
May be used to finish amalgam restorations are
Amalgam knife and file
Many be used as polishing agents
Pumice and tin oxide
May be used on the interproximal areas
Sand paper strips with fine grit.
Glass ionomer
Bonds to enamel with no etchant
retrusive movement
Back
Protrusive movement
Forward
lateral movement
side to side
etch
37 to 50 percent phosphoric acid
If saliva contamination occurs reetch for
10 sec
Rinse etch for
45-60 seconds
Y shaped occlusal
Mandibular premolars
rubber dam
Invert with blunt instrument, anchor 1 tooth distal and seat lingual first
Reinforcers
Prevent amalgam from being pushed into pulp, protects from pressure of amalgam condensing
Fluorosis
Mottled enamel from excessive fluoride
No fluoride for
Children under 6
Fluoride reduces caries
40-50 percent
Margination
a procedure for removal of excessive restorative material from margins of restorations
Child Abuse Reporting
Call CPSL immediately and make an oral report. 48 hours for written report online. If not reported it is a misdemeanor usually punished by fine
NONWORKING CUSPS
mandibular lingual and max buccal
supporting cusps
Mandibular buccal and max palatial
Ideal depth of prep
1.5 mm
Oblique ridge
Ridges only on occlusal of max molars
Axial wall
parallel to the long axis of the tooth, adjacent to pulp
Teeth with 2 buccal grooves
Mans first molars
Insulators
Insulate pulp from thermal irritation: ZOE ZIMC PHOSPHATE
zinc phosphate
Insulator and reinforcer. Main ingredient to phosphoric acid. Chemically irritation to pulp
Zinc Polyacrylic Cement
Kind to pulp
OBTUNDENTS
Soothe sensitive pulp, ZOE IRM
STIMULATORS
Mildly irritating to pulp form reparative dentin, calcium hydroxide
Minimal depth restoration
0.5mm to 1.5mm
not used under composites
Cavity varnish and zoe
Increases strength of amalgam
Copper
Makes best temps
Self cure composite
Cavity varnish is a
Sealer
Shallow liner depression
Groove
Marks left on articulating papers should appear as
Dots
First step in removing a rubber dam
Free interdental dam with scissors
Type of matrix most commonly used for amalgam restorations
Tofflemire
When placing liners on cavity prep use a small
Ball ended instrument
Metal alloy in amalgam is primarily composed of
Silver
The composite is placed in layers to
Reduce polymerization shrinkage
Teeth need sealants that
Have deep fissures
Adhesive to temp cement crown and bridges
ZOE
Bond between enamel and bonding agent is
Mechanical
Cure as much as at a time
4mm
Smoothing and polishing amalgam
What agent is used in topical anesthetic?
Benzocaine
How long should topical anesthetic be placed for more profound soft tissue analgesia?
60 to 90 seconds
Dry angles are an effective way to control saliva secretions from
stensen’s duct
what type of ZOE lacks strength and long-term durability?
type I (temporary cement)
This type of cement is a hybrid of silicate and polycarboxilate cement
glass ionomer
what material is supplied as a paste/paste system and also in cartridges?
polyether
What does the term elastomeric mean?
having elastic or rubber-like qualities
an alginate absorbing excess water is termed what?
imbibition
what is a final impression used for?
an accurate reproduction of teeth and surrounding tissue
what is the negative reproduction of dental arches and surrounding tissues?
impression
at what point in a procedure is a mylar matrix placed?
before etching
the retainer (toffelmire) is positioned from what surface?
buccal
Where is the wedge inserted to position the matrix band firmly against the gingival margin?
lingual embrasure
what instruments are used to contour a matrix band?
burnisher or mirror handle
a matrix band is made of what?
thin flexible steel
what stabilizes the tofflemire matrix band?
wooden wedge
what type of stain can chlorhexidine cause?
extrinsic
most common type of temporary coverage for crown and bridge?
custom provisional
why only intermittent pressure of a tooth when polishing?
heat dissipates between strokes
Course, extra course, medium, fine and extrafine are different _ of polishing paste?
grit
removal of calculus, debris, stain, and plaque from teeth
oral prophylaxis
where on the tooth do you begin to use prophy cup?
gingival third
what is the different between catalyst and a base?
Base- basic ingredient of material
catalyst- increases the rate of chemical reaction (makes it set)
Would you use a polymer crown on an anterior tooth? why?
yes, because its tooth colored
What is a class I cavity
decay in pits and fissures of occlusal surface
What is a class II cavity
decay on proximal (mesial or distal) surfaces of premolars and molars
What is a class III cavity?
decay in proximal surfaces (Mesial or distal) of incisors and canines
What is a class IV cavity?
decay in proximal surfaces (mesial or distal) of incisors and canines and involves the incisal edge or angle of tooth
What is a class V cavity?
decay on the gingival third of facial or lingual surface of any tooth
what is a class VI cavity?
decay on incisal edges of anterior teeth and the cusp tips of posterior teeth caused by abrasion, wear, or defects
Stensen’s duct
back cheek by first molar
pterygomandibular raphe
Fold of tissue that extends from the junction of the hard and soft palates down to the mandible
gingival embrasure
triangular space of gums between the teeth
incisal embrasure
triangular space between incisal edge of teeth
furcation
The space between two roots where they meet the crown
Frenum
Band of tissue that passes from the facial oral mucosa at the midline of the arch to the midline of the inner surface of the lip
oropharynx
central portion of the pharynx between the roof of the mouth and the upper edge of the epiglottis
uvula
soft tissue hanging from the middle of the soft palate
dorsal
top of tongue
ventral
underside of tongue
Buccal vestibule
Area between the cheeks and the teeth or alveolar ridge
labial vestibule
between the incisors and the lips
buccal mucosa
Mucous membrane lining the cheek.
attatched gingiva
middle section of gums
alveolar mucosa
Oral mucosa immediately apical to mucogingival junction
mucogingival junction (MGJ)
Distinct line of color change in the tissue where the alveolar membrane meets with attached gingivae
keratinized gingiva
From gingival margin to mucogingival line / junction
Includes free and attached gingiva
Floor of mouth
located inferior to the ventral surface of the tongue
Commissures
corners of the lips
mylohyoid ridge
bony ridge on the lingual surface of the mandible
mental foramen of mandible
one of two holes located on the anterior surface of the mandible. It permits passage of the mental nerve and vessels.
hamular notch
The palpable notch formed by the junction of the maxillary tuberosity and the pterygoid hamulus of the sphenoid bone. Also called the pterygomaxillary notch.
linea alba
white line on the cheek
True or false: a dental lathe is used to adjust restorations in the mouth?
false
a film of sulfides on an amalgam restoration is
tarnish
a tooth that exhibits pain and sensitivity during mastication is a symptom of what
premature occlusion
after placing an amalgam, the surface is somewhat rough. what can this result in?
plaque being caught in restoration potentially causing decay
alginate impressions must be poured within __ so that distortion does not occur
1 hour
besides hardness, size and shape of abrasive agents, what other factors must be considered when polishing amalgams?
concentration of abrasive agent
true or false: centric relation is a measure measurement of where the teeth are positioned when the joints are aligned correctly and in contact?
false
finishing a restoration involves contouring, removal of marginal discrepancies, _ the anatomy and _ the amalgam surface
defining, smoothing
having a poor contact which increases the potential of food impaction is a _ proximal area
under contoured
heat during polishing of an amalgam restoration cause two things. Pupal damage and what?
Bringing mercury from restoration to the surface, causing tarnish
How can the length or depth of the alginate impression tray borders be extended?
utility wax
If a restoration does not produce the original contours of the tooth, the restoration may need what?
more recontouring or be replaced
True or False: Rubber dam is the only way to isolate a tooth that needs to be polished?
false
The time from induction of an anesthetic to its complete reversal is its…
duration
there are two commonly used polishing agents used when polishing amalgams. one is pumice, the other is _
tin oxide
to avoid injury, the rubber polishing cup is directed _ from the gingival third and pressed _ against the tooth surface
away, lightly
True or False: topical anesthetic has a higher potential for overdose reaction due to being prepared in a higher concentration
true
What does the term synersis mean as it relates to alginate impressions?
the evaporation of water from alginate
What is not an instrument used for finishing and polishing amalgam restorations: brownie points, green stone, carver, prophy cup
carver
When would a light gauge, vacuum-formed resin material be used?
bleach tray or provisional coverage
what type of stain, found on some children’s teeth, can be caused by poor hygiene and the fungi are retained in bacterial plaque?
green stain
what is the Theory of Selective polishing?
only polish the teeth that have staining or need it, not all of the teeth
what is not something you evaluate before polishing an amalgam? Fractures, overhangs, restoration age, decay
restoration age
what the solution for topical anesthetic is compared to that of a local anesthetic, the concentration in a topical solution is
greater than local
Which type of impression material should be used to acquire an impression with low tear resistance and high dimensional stability on tooth #18? hydrocolloid, polyether, polysiloxane, polysulfide
polysiloxane
topical anesthetic comes in which forms?
liquid, gel, spray, and patch
a cingulum pit cavity preparation on tooth #10 is considered which classification?
class I
the permanent tooth that has an H-shaped groove pattern on its occlusal surface is the
mandibular second molar
why is a sedative base placed in a tooth prior to placing a restoration
soothes an irritated or damages pulp
when the pulp is stimulated by vibrations from a handpiece, this is referred to as what type of stimulus?
mechanical
which of the following is a source of gingival and periodontal infections? oral mucosa, tooth decay, calculus, planktonics
calculus
decay that is found on proximal surfaces of anterior teeth is classified in black’s classification as
class III
what is another name for polysulfide material?
rubber base
in order to minimize the loss of water evaporation when mixing a cement, it is recommended to
dispense the powder first
What are two parts of a model?
anatomic and art
what is one reason a provisional restoration is applied?
prevent the prepared tooth from drifting
what making a bleach tray with a vacuum former, how far should the material sag before it is lowered down over the model?
1/2 inch
the tip of the explorer is used at the gingival edge of a restoration with over-lapping strokes to do what?
remove excess cement
what is the mixing motion for Zinc phosphate cement
broad figure eight movements on a cool, dry glass slab (mixing time 1-2 minutes)
when selecting pastes for the coronal polishing procedures, what is most important to consider?
grit
what ingredient is released from glass ionomer to inhibit recurrent decay?
flouride
topical ointments are more effective when
the site is dried with gauze prior to application
What is the basic set up for cement removal?
mirror, explorer, spoon excavator, dental floss and 2×2 gauze
what cement is the most versatile and can be used as a base?
Zinc-oxide eugenol cement (ZOE)
name three cementing errors
improper mixing technique humidity, incorrect temperature
what is the best temperature for the water mixing alginate?
room temperature -70 degrees
who takes the final impression?
dentist
the flat side of the wedge is placed next to what?
cervical margin
dry-angle isolation is recommended for what area of the mouth?
mandibular posterior buccal quadrant
what type of isolation technique provides a decreased amount of contaminated aerosol exposure to the operator?
saliva ejector or HVE
what is the outer knob used for
used to tighten or loosen the spindle within the diagonal slot. hold matrix band securely in the retainer
the function of the wedge in a matrix system is
separate the teeth and prevent overhangs
the smaller circumference of a tofflemire matrix band is placed
toward the gingiva
when should impression for a provisional be taken?
before the dentists prepares the tooth
what is used to remove excess polishing agent interproximally?
dental floss
what is used to control the speed of the handpiece?
rheostat
what is used to remove stain from deep pits and fissures
bristle brush
coronal polishing is limited to what portion of the tooth?
clinical crown
what is the clinical crown?
the portion of the tooth visible in the mouth
what in ZOE is soothing to a tooth
eugenol
cavity liner is used to
protect the pulp
Angle Class I
nutroocclusion
Angle Class II Division I
overjet with anterior teeth protruded
Angle class II division 2
is associated with lingually displaced maxillary teeth and excessive labial inclination of the maxillary central incisors
angles class III
mesioocclusion or underbite
when taking alginate impressions, if you want to reduce the amount of bubbles, what can you do?
mix thoroughly against the rubber bowl
what property does copper give in an amalgam filling?
corrosion ability
Difference between ditching and flashing?
ditching- deficient amalgam
flashing- excess amalgam
methylmethacylate materials have high during __
shrinkage, polymerization
what direction do you move your instrument to remove excess cement?
horizonal
what is the device used to test curing lights output?
radiometer
how is polycarboxylate powder mixed into liquid?
all at the same time and mixed completely
what is the mixing time for polycarboxylate
30 seconds
zinc phosphate type I
permanent cement, fine grain
zinc phosphate type II
medium grain
- recommended for an insulating base for a deep cavity prep
- mix on a cool glass slab because of the exothermic reaction
what dental dam clamp is used for a class V anterior restoration?
double-bowed cervical clamp
what ingredient in ZOE makes it necessary to mix on an oil resistant paper pad?
eugenol
cementation of ceramic or resin inlays, veneers, orthodontic bands, direct bonding or orthodontic brackets and all metal castings can be done with what cement?
composite resin cement
Type I cements are classified as what type of cement?
luting agent and are used for long term cementation of cast restorations
what are different techniques for mixing elastomeric materials?
paste system, automix, mixing unit, putty system
what alters setting time of alginate impression material
water temperature
to achieve maximum strength of an impression, you should do what?
leave it in the mouth for the full length of time recommended by manufacturer
what are preliminary impressions used for?
diagnostic models, custom trays, provisional coverage orthodontic appliances, pre and post treatment records
what is used with a palodent matrix?
tension ring
clear plastic retainers for placing composite resin are called what?
celluloid or Mylar strips
what matrix system design minimizes extrusion of composite material at the gingival, mesial and distal margins of a preparation?
sectional
Inner Knob on a tofflemire?
used to increase or decrease the size of a matrix band loop
a tofflemire matrix band should extend beyond the cavity preparation and near the gingiva by how far
1-1.5mm
what type of calculus is located apical to the margin of the gingiva, extending along the tooth surface?
subgingival
who can perform an oral prophylaxix?
dentist or hygienist
the pressure used on rubber cup when polishing causes what to happen?
edges of polishing cups to flare
how do you hold a handpiece with a prophy angle?
pen grasp
these are soft and webbed, and used to polish and smooth surfaces of teeth
polishing cup
the technique to remove plaque and stain only from the coronal surfaces of theeth
coronal polishing
composite resins that are light-cured and polished to a high gloss are
microfilled
what is the difference between coronal polishing and scaling?
coronal removes stains and scaling removes calculus under tissue
what is a wear facet?
a wear mark on the tooth
what does the operator use to pack the first of amalgam?
small end of the condenser
what hand piece is used to make an adjustment to a temp crown?
slow speed
criteria of selection of restorations to be polished
no fractures to restoration, proximal contact precent in class II restoration, anatomy can be maintained or improved, margins can be contoured to be flush, occlusal can be maintained or improved
what type of base is placed in a cavity preparation to protect from thermal shock?
insulating
how close to the gingival margin is the material trimmed to avoid irritation?
0.5 mm
what can be caused if the margin of material is overextended?
gingival recession or irritation
During coronal polishing, what is the mirror used for?
indirect vision, wiping motion, lip, tongue and cheek retraction
what provisional material generates heat during polymerization and may traumatize the pulp or soft tissues?
chemical-cured acrylic
to dissipate the heat from zinc phosphate while mixing, what should you do?
spatulate over a wide area on a cool glass slab
how does a rubber dam aid in infection control and isolation
by providing a physical barrier and reducing salivary contamination
what type of ZOE has reinforcing agents that have been added for strength
type II
Glass ionomer type I
cementation of metal restoration
glass ionomer type II
designed for restoring areas of erosion in Class V.
glass ionomer class III
liner and dentin bonding
what type of impression material is best because of its dimensional stability?
polysiloxane
what are the two components of an elastomeric impression material?
base and catalyst
water evaporating from materials is called what?
synersis
what is the most common irreversible hydrocolloid?
alginate
three classifications of impressions taken during dental procedures
preliminary, final and bite registration
what is a polodent type matrix band?
small, oval shaped stainless steel matrix
what is the purpose of a dental dam?
to provide moisture control for the placement of restorative materials
what is the internal screw-like pin that fits into the diagonal slot to hold the end of a matrix band called?
spindle
another name for a tofflemire?
universal retainer
what is the correct order to place items for a class II restoration
dental dam, matrix band, wedge
what type of provisional is sued when appearance is important
preformed polycarbonate crown
another term for finger rest
fulcrum
what position should the patient’s chin be in during coronal polishing to provide access to the maxillary arch?
up
which endogenous stain cannot be removed by coronal polishing
dental fluorosis
what type of mixing pad would you use on ZOE?
waxed paper pad
what is the purpose of using an amalgamator for dental amalgam?
triturate the material
what does inverting the dam mean?
placing rubber dam around the cervical margin of tooth
what is one advantage of using a bis-acrylic composite material for a provisional restoration?
good tissue biocompatibility
what are the four components of a composite resin?
organic resin matrix, inorganic fillers, coupling agent, pigments
what technique is recommended for removing temporary cement from interproximal areas?
tie a knot in the middle of the floss
what is used to maintain function to the area of the mouth that has had a preparation for a crown or bridge before final restoration is placed?
provisional (temp crown or bridge)
the powder of glass ionomer should be divided into __
halves, first half mixed into liquid and completely incorporated before mixing in the second half
what is the appearance of zinc phosphate cement after mixing?
creamy and stringy
what is the advantage of using ZOE as a temporary luting cement?
its ability to soothe a sensitive tooth
what should ZOE temporary cement look like after mixing? what is the mixing time?
smooth and creamy with a mixing time of 20-30 seconds
What is hystersis?
change in temperature that causes the reversible hydrocolloid material to transform from one physical state to another
which impression technique requires that the patient practice normally opening and closing the mouth prior to the impression?
bite registration
which level of environmental protection agency registered surface disinfectant is generally suitable for disinfection of impression materials?
intermediate level
what is the best way to position the maxillary impression tray for a patient that has a gagging tendency?
seat maxillary tray from posterior to anterior
which impression material has a high dimensional stability and low tear resistance
polysiloxane
what are the advantages of a digital impression?
no need to pour up the impression
which chemical is used in gingival retraction techniques as a vasoconstrictor
epinephrine
a prefabricated crown should exhibit what specific characteristics
fit snugly, esthetically acceptable, contours are similar to natural teeth, adequate interproximal contacts and aligned within arch, no more than 0.5 mm of space between margin and crown
what is the proper procedure for handling a final impression after removal from the patient’s mouth?
rinse, dry disinfect
what metal is used for cast type restoration?
Platinum, gold, palladium
to take an accurate impression of the subgingival margin of the tooth preparation the width of the gingival sulcus created by gingival retraction should me _ mm.
0.3-0.4
is polishing necessary before the application of fluoride?
no
what are extrinsic stains?
stains that appear on the exterior of the tooth and can be removed;
what are endogenous stains?
originate from within the tooth through developmental and systemic disturbances (fluorosis or tetracycline);
what are intrinsic stains?
originate outside the tooth from environmental agents and cannot be removed.
what are exogenous stains?
originate outside the tooth from environmental agents (extrinsic or intrinsic);
reasons for polishing amalgams?
Prevent recurrent decay, deterioration of amalgam surface, and maintain periodontal health.
what is direct supervision
dentist is physically present when the DA performs the function
what is indirect supervision
the dentist must be in the dental office but not necessarily present in the same treatment room as the assistant.
what is general supervision?
the dentist must be in the dental office but not necessarily present in the same treatment room as the assistant. dentist not physically present
A matrix must be used to create a temporary wall for which of the following classifications of tooth restoration?
II, III and IV
know why a wedge is used and where they are placed?
Inserted into the lingual embrasure to hold the matrix band firmly against the gingival margin of the preparation.
what is the exact spot where adjacent teeth actually touch each other?
contact point
Which permanent molar is usually the first tooth to erupt and is known as the keystone of the dental arch?
maxillary first molar
what makes patient education most effective?
when it is reinforced and repeated
what is an alloy?
a mixture of two metals
something with a high viscosity flows
not easily
what is polymerization?
the process by which the resin material is changed from a pliable state into a hardened restoration.
what is galvanic reaction?
an electrical current that takes place when two different or dissimilar metals come together
What is the bow on a dental dam clamp
rounded portion of the clamp that extends through the dam
what is the wing part on a clamp?
designed on clamps with extra extension to help retain the dam
what is the prong on the clamp?
four points on the clamp that must be seated firmly on tooth to stabilize clamp
what is the hole in the dental dam clamp?
used to place dental dam forceps into in order to stretch the clamp over the tooth and remove clamp when finished
what is the jaw on the dental dam clamp?
encircle the tooth and are shaped into four prongs
what sizes are dental dams?
5×5 and 6×6
what is a thin dental dam used for?
endodontic procedures
what a a medium thickness dental dam used for
operative procedures
what is a heavy thickness dam used for?
when tissue retraction and extra resistance to tearing is needed
how far apart are the holes in the dental dam punched from one another
3.0 to 3.5 mm
what is an EFDA
Expanded Functions Dental Auxiliary
When did it start in OHIO
1976
How do you become an EFDA
- complete an accredited program
- pass the Ohio board exam for EFDA
- register with the state dental board
Cannot practice EFDA until registered
how many hours do you need
100 hours of pre-clinical
80 hours of clinic
Who is eligible
- unlicensed dentists
- dental students
- graduates of foreign dental colleges
- CDA: certified dental assis.
- RDH: licensed or not
What tasks can EFDA do
- CAN DO –> REMEDIABLE TASKS: dont cause irreparable change in the oral cavity
e.g. sealants, amalgam, non-metallic
What is beyond an EFDA
“NON-DELEGABLE taks”
- CANNOT DO –> IRREMEDIABLE TASKS:
- diagnosing
- tx planning
- final placement or adjustment of fixed or removable appliance
- therapeutic intraoral adjustment of any fixed or removable appliance
- cutting procedures utilized for preparation of a tooth or involving the periodontium
- placement of final root canal
- final impression for prosthetic restoration
- occlusal registration for prosthetic restorations
- final placement of restorations or crowns
-retraction of gingival sulcus prior to impressions
-procedures using light amplification (LASER)
limitations to EFDA
- have to work under direct supervision ==> dentist has to be in the office
- some things can be done under general supervision (e.g. sealants, fluoride)
per dentist @ ONE time there can be:
- 3 EFDAs
- 4 RDH
Commission on Dental Testing (CODT)
- offers TWO exams/year
- test bank of 14 teeth
- 3 teeth in 2 hours
- 75 question written exam same day after clinical
Commission on Dental Competency Assessments (CDCA)
- New to EFDA in 2015
- offers 2 public exams @ case western
-offers closed exams at schools - 100 questions written exam different day
What is the slow speed hand piece used for?
- finishing and polishing composite restorations
- coronal polishing
part to the slow speed
- swivel adaptor
- motor to angle adaptor (attaches to latch head and friction grip head)
- friction grip head
- latch head
- motor
What is the high speed hand piece used for?
- tooth preparation: cutting of enamel and dentin
- finishing and polishing composite restorations
class I preparation walls
- buccal wall
- lingual wall
- pulpal wall
- mesial wall
- distal wall
no occlusal wall
retention feature: Narrowing toward occlusal from buccal to lingual
class II preparation walls
Walls
- buccal wall
- lingual wall
- pulpal wall
Box
- axial wall*
- gingival wall*
with buccal and lingual from occlusal
*= new surface
No occlusal wall
if it is only open on the distal it could have a mesial wall OR vice versa OR not have it
retention grooves
- axiobuccal
-axiolingual
class III preparation walls
- facial wall*
- gingival wall
- axial wall
- incisal wall*
no lingual wall
preping a class III
prep tooth from the lingual for esthetic reasons
class V
- occlusal wall/incisal*
- gingival wall
- axial wall
- mesial wall
- distal wall*
class V retention grooves
- gingivoaxial
- occlusoaxial
Walls of Class I with buccal extension
- buccal wall (on the occlusal portion)
- mesial wall (in extension)
- distal wall (in extension)
- axial wall
- gingival wall
Class I with buccal extension
- has a buccal groove in the middle of the extension
retention grooves: mesioaxial & distoaxial line angles
First: condense occlusal and pulpal floor
Second: condense extension
positioning of operator
R handed operatior: 9-12 o’clock
(assistant 2-4 o’clock)
L handed operatior: 12-3 o’clock
(assistant 8-10 o’clock)
positioning of patient and/or typodont
Mandibular= tilted up
Maxillary= supine
basic instrument set up
- Mirror
- Explorer #2 (pig-tail)
- sickle explorer
- cotton pliers
applicator instruments
- dycal
- spatula
- 8-A
- amalgam carrier
condensers
- 3 different sizes
- to pack amalgam
(smallest= most force)
(largest = over fill) - composite
burnishers
anatomical
- carves anatomy for amalgam
ball burnisher
- carves anatomy for composite
carvers for amalgam ONLY
cleoid-discoid
- cleoid: shape cusps
- discoid: pits and fossa
hollenback
- carve cusps, grooves, pits
minnesota
- good for removing overhang
- used interproximally
Composite instument
CVIPC
- longer and sharper than 8A
excavators
spoons
evaluation
- Mirror
- Explorer #2 (pig-tail)
- sickle explorer
- miller forceps (holds occlusion paper)
specific instruments for amalgam
- cleoid/discoid
- hollenback
- minnesota carver
- dappen dish
specific instruments for composites
-smooth condenser
- CVIPC
- 8A
- composite contact former (the one with a double sided point )
- composite gun
finishing burs
round= occlusal anatomy
flame= interprox
ET= for composite
problems with margins
from filling to tooth = submarginal (> .2mm is unacceptable)
from tooth to filling = flash/overhang
catches both ways = open margin
types of occlusion: maximum intercuspal position
AKA: centric
teeth touch uniformly (tap, tap)
types of occlusion:* lateral excursive
slide of jaw left to right
types of occlusion:* protrusive movement
jutting jaw forward
what is functional occlusion
occluding during normal function
what is parafunctional occlusion
occluding while bruxing
pre-molar anatomy
- mesial and distal pit
- central groove
- triangular ridge
- transverse ridge
for 2nd mandibular pre-molars with 3 cusps–>
“y shape”
mandibular 1st molars
- 5 functional cusps
- MOST susceptible to decay
- 3 pits (mesial, distal, central)
- grooves: 2 bucal & central & lingual
- central groove zig-zags
- NOT SYMMETRICAL
mandibular 2nd molars
- 4 cusps
- SYMMETRICAL
- “+” shape groove
- 3 pits
Amalgam
- Mecanical retension
steps for restoring class I amalgam
Initial: Add copal and blow air
- condense to OVERFILL
(B and then L)
2.Discoid to clean up margins
(from tooth to filling)
- anatomical burnisher
(form pits and grooves) - ceoid or hollen back to define cusps
(the point goes in the groove) - check occlusion
grading for class I amalgam
occlusion: no high marks
proximal: NO
anatomy: proper pits and grooves
margins: check margins
smoothness:smooth look, NOT SHINY
mercury hygiene
- use in well ventilated areas
- use pre-capsulated
-no carpet or absorbant coverings - use water and HVE
- do not vacuum
- store old amalgam in air-tight sealed containers
advantages of amalgam
- moldable and then hardens
- abrasion resistant
- high strength
disadvantage of amalgam
- dimensional change
**thermal expansion
**percolation (shrinks when exposed to cold temps in the mouth) - corrosion (can also be a benefit)
- thermal conductivity (protect the pulp)
- creep (grows)
- galvanization
- esthetics
force with small nib condenser
less force needed
what does burnishing do
improves surface properties by reducing voids
how does moisture effect amalgam
it makes it WEAKER
Over triturated amalgam
dry and crumbly, quick setting
Under triturated amalgam
wet and mushy = loss in strength, corrosion
Too much mercury = ??
low strength (WEAKER)
remove plash or setting will be slow
What is plash
shiny mercury layer at the top
Too little mercury = ??
faster set
Class II amalgam restoration instruments
- toffelmire retainer
- matrix band
- wedges
types of wedges
Colorful wedges anatomical wedges
(used on posterior)
pink: x-large
purple: large
yellow: medium
white: small
Wood wizard wedges
wide base= equilateral (on posterior)
large = tiki (on anterior)
small (on anterior)
placement of wedge
- gingival to the gingival margin
why use a wedge
- hold band against tooth
- separate teeth slightly
- prevent overhang
- want it to fit snug
2 types of toffelmire retainers
- contra-angle
- universal
3 types of matrix
- #1 universal or straight
- 1 regular
- 1.5 thick
- #2 extended
- has 2 bumps
- for deeper preps
- dead soft
- used with composite
- extend to occlusal and gingival margin .5mm-1mm*
parts of toffelmire
Short knob (outer) = tightens
Large Knob (Inner) = diameter
placing toffelmire and matrix band
- band extends 0.5-1 mm gingival and occlusal
- matrix band narrows towards gingiva
- slots of toffelmire towards gingiva
when to use a wedge
- ALWAYS when there is an adjacent tooth
- help establish proximal contact and proximal contour
- hold band against tooth
- prevent overhang
- use cotton pliers to apply
Class V restorations
NEXT FEW SLIDES
anatomy of class V
convex:
- Mesial to distal
- Occlusal to gingival
restoring a class V with amalgam
- use two increments
- condense in retention grooves and inaccessible areas 1st
- OVERFILL with largest condenser
carving a class V amalgam
- trace with discoid
- hollenback (with tip towards embrasure)
evaluation of a class V
occlusion: NO
proximal: NO
anatomy: slightly bulging convexity
margins: flush
smoothness:look for scratches
Isolation techniques
next set of slides
cellulose wafer (dri-angles)
used for maxillary
*stenson’s duct
Advantages of isolation
- soft tissue protection
- moisture control
- gives us visibility
- protection from aspiration of material
- patient comfort
- ease of placement
- reduced aerosols
- improved product placement
- avoid contamination (especially composite)
cotton rolls
used for mandibular
*wharton’s duct
Benefits of cellulose wafer (dri-angles) and cotton rolls
- fast application
- easily saturated
- minimal tissue retraction
- cellulose wafer can be reflective
other things used for isolation
-svedopter
-rubber dam
svedopter
- for the mandibular
- attaches to saliva ejector
- metal plate for tongue retraction
- good option w/ cotton rolls if dam is not possible
What is the gold standard
a Rubber Dam
Rubber dam
- it is non-latex
advantages of rubber dam
- protects patients tissues
-isolates tooth - dry field
- protects patient from swallowing materials
disadvantages of rubber dam
patient with respiratory issues and high anxiety
rubber dam armamentarium
- rubber dam punch
- young’s frame
- clamp forceps
- 8-A
- scissors
- clamp
- floss
- rubber dam material
- template and pen
- lubricants for dam and patient
- saliva ejector
- 2×2
Wing vs. wingless clamps
clamp sizes
2 = premolars
3 = small molars
7,8,14 = molars
212 for class V
rubber dam clamp sizes
- Premolar
- Molar (bigger)
active vs. inactive
Active= curves
rubber dam clamp Parts
- jaws
- points (4)
- forcep holes
- points
- bow, bridge
- wings
preparing your rubber dam
punch rubber dam holes
Guidelines:
- place clamp 1 tooth distal to the tooth you are working on
- holes 2 teeth mesial
total holes: 4
placing the clamp
- bow towards the distal
- place on the lingual and then the buccal
- you want the 4 points on the cervical portion of tooth
placing the rubber dam
- place the rubber dam in the mouth with the clamp OR over a pre-placed clamp
- Snip a corner of the rubber dam & place as a wedge on the mesial of the most mesial tooth
- Stretch to fit over each tooth, floss in between
- invert around each tooth with 8-A and air
Removing the rubber dam
- clear debris
- stretch the dam
- snip each interseptal piece with scissors
- remove wedge, clamp and dam
- evaluate dam for missing pieces
What is a sealant made out of
Bis-GMA: bisphenol A-glycidyl methacrylate (MATRIX)
it also has fillers
filled sealants
- have glass or silica particles
- more resistant to wear
- must adjust occlusion
unfilled sealants
- flowable
- readily wears away
- don’t have to adjust occlusion
when and where to place a sealant
When
- there are prominent grooves/pits
- staining but NO breakdown
- after full eruption
Where
- occlusal, lingual of maxillary, buccal on mandibular
technique for placing sealants
- isolate tooth
- remove debris
- re-isolate if necessary
- etch with 37% phosphoric acid
- rinse and dry
- apply sealant into grooves – forms resin tags
- polymerization with VLC composites
- remove air inhibited layer (bitter & wet)
- check margins and proximal, adjust occlusion
COMPOSITE FLASH CARDS
mechanical retention
locked into grooves like a puzzle piece
chemical retention
chemical interaction between 2 substances “bonding” them together
What is a modified composite prep
beveling
Steps for placing composite
- set up armamentarium
- choose shade
(in natural light, before rubber dam, moist tooth) - place rubber dam
- prep occurs
- memorize prep
- place mylar strip [for class 3]
- etch (10-15 sec)
- rinse and dry
- switch mylar strip, if necessary
- place wedge
- prime and bond CHEMICAL RETENTION to composite
- scrub for 15-20 sec
- air thin and cure prime and bond
- place composite (condense, shape, remove flash)
- wrap mylar and CURE [for class 3]
- remove mylar strip [for class 3]
- evaluate margins & contact
- finish
- remove rubber dam
- check occlusion
- polish
- have dentist do the final check
curing depth of composite
2mm
What is a conventional prep
normal, not beveled
What is beveling and benefits
- exposes more enamel rods for BETTER RETENTION
- more surface area for etching
- improves esthetics- better blending of composite and enamel
- strengthening remaining tooth structure
- 0.5 mm deep
- 45 angle to enamel
- not used on posterior occlusal surfaces
(can be used on buccal of a posterior restor.)
contraindications for placing posterior composites
- cavosurface margin on cementum
- poor accessibility
- occlusal wear
- poor oral hygiene
- poor isolation
-crowding
what is used to cut a prep
Carbid burs NOT diamonds
overfill layer with composite?
NOO!
placing a posterior class II composite
Matrix bands (BURNISH for good contact)
- dead soft
- plastic band
- use bases/liners as needed
- flowable composite can be place in box
==> 1-2mm then cure
Filling box
- wedge ONE box at a time
- fill ONE box and cure
- wedge and then fill an cure the 2nd box
reasons and solution for post-op sensitivity
- marginal leakage: incomplete polymeriza.
- use bases/ liners and cure in increments
- Occlusal trauma
- ALWAYS check and adjust occlusion
- Acid etch contamination
- rinse thoroughly
- Inadequate bonding: due to contamination
- proper isolation
- Marginal Porosities
- seal margins with unfilled resin
what is the air inhibited layer of composite
- layer of composite exposed to air
- clinically visible
- removed with finishing
posterior composite
- if decay is subgingival it isn’t ideal
– use open sandwich technique
place glass ionomer and then composite =====> this improves bonding since dentin is harder to bond to
=====> GI is also more compatible with moisture than composite
what are bases used for
- protection from bacteria
- protection from over drying
- thermal insulation
- protect pulp from bitting/ condensing forces
characteristics for bases
- should be non irritating
- strong
- prevent leakage
(2) bases
- ZInc phosphate cement
- ZInc oxide and eugenol
(2) liners
- Calcium hydroxide
- Glass Ionomer
characteristics of liners
- thin
- poor strength
- poor thermal protection
- can soothe tooth (obtundent)
tooth anatomy for maxillary
- rhombus in shape
- has oblique ridge ==> found on 1st and 2nd molars ==> goes from ML to DB
- cusp of caribelli on mesiolingual cusp
- mesiolingual is largest cusp
- only has 4 functional cusps–> cusp of caribelli is non-functional
A preventative treatment
Dental sealants are considered
Mechanical
Retention of sealants is a type of __ bonding, in which enamel tags connect with the sealant material
Glass ionomer restorative materials
What material is an ideal choice for class V restorations because they bond directly to enamel, dentin, and cementum
Contamination between etching and priming
What is a common cause of post op sensitivity in a posterior composite restoration?
applying etchant material
When preparing teeth for pit and fissure sealants, which step follows rinsing and drying the polished teeth?
Ergonomics
The science that’s studies the relationship of people to their working environment in order to promote efficiency and reduce stress and strain
Forearms are parallel, feet are flat on the floor
What is the correct sitting position for an EFDA?
Dentinal Primers
Wetting agents that are compatible with moist dentin and bonding agents are known as
-impregnated polishing cup
-super-fine sand paper discs
-polishing pastes
What are the instruments of choice for final polishing of a composite restoration to attain a high luster
leakage at the cervical margin
Incomplete polymerization of composite material may result in
Silver, Tin, Copper, Zinc
What is the composition of alloy powder
Glass ionomers
What is an acceptable material used for dentin protection under composite resin
Both statements are false
Which of the following statements are true? Polishing an amalgam restoration involves removing marginal irregularities and perfecting the amalgam. Finishing is done to obtain a smooth, shiny luster on the surface of the restoration
Apply etchant on the enamel for 15 secs, then move the etchant onto the dentin for another 15 secs for a total of 30 secs
What is the recommended procedure for placing etchant on a cavity preparation?
Add additional composite, it will bond to uncontaminated composite
You have just placed an MOD posterior composite on tooth #3. There is a void and correction is needed. The restoration has not been contaminated what should you do?
Packable/ condensable composite
The composite material that provides handling characteristics most like amalgam is
Toward the light source
What best describes the direction composite resin will shrink when polymerized with a light source
A loss of one or more cusps
What best defines a complex amalgam preparation
Retentive features
Where should you condense the first increment of amalgam in a class V restoration?
Cleaning and drying the prep with a gentle puff of air
You are about to begin restoration of a class V, minimal depth, amalgam cavity prep. You observe the preparation and find it properly designed for maximum retention. Your next step is:
Slightly overfill the restoration
When condensing an amalgam restoration, it is the goal of the EFDA to
Pulpoaxial
When condensing a class II cavity prep, condense amalgam to the level of the _ line angle before condensing to the plural floor
An open contact
Which of the following conditions necessitates replacing an amalgam restoration rather then simply polishing?
Finishing
The process of producing the final shape and contour of the restoration
A smooth, shiny finish
In the finishing and polishing of amalgam restorations, what is the result of using abrasive agents in order of decreasing coarseness, finishing with the least abrasive material
finishing discs
What is the instrument of choice for recontouring and finishing a class V amalgam restoration?
Damaging the contact area
What must you avoid when finishing proximal areas of amalgam restoration
Not the preferred method of preparation for esthetic restorations
Conventional type cavity preparations (cavity designs) for resin placement:
Provides more surface area for acid etch and bonding
Beveling cavosurface margins prior to resin placement
BIS-GMA
What is the matrix of composite resin made out of?
Hydrophilic
Dentin is
BIS-GMA
The plastic like material that surrounds the ceramic material in composite resin consists of
Nanofill
What are the latest categories of composite resins tased on particle size?
Polymerization
The process through which composite resin hardens is known as
Dentin
What dental tissue is comprised of tubules that contain protoplasmic extensions of the cells that line the pulp chamber?
Maxillary central incisor
Which incisor has the most acute (sharp) mesioincisal angle
Mandibular central , maxillary central
The _ incisor is about half the width of the __ incisor
Transverse ridge
A union of two triangular ridges produces a single ridge which is called:
Cavosurface margin
The junctions of the walls of a cavity preparation with he external surface of the tooth
90 Degree Angle
Enamel rods are generally parallel to each other and at a __ degree angle to the enamel surface and the DEJ
Submarginal area
The area where the amalgam is below the cavosurface margin of the preparation?
Least accessible area
Where would the EFDA place the first layer of amalgam in an MO restoration on tooth #18
A catch as the explorer moves from the tooth to the amalgam
An overextension (flash) of restorative material at the cavosurface margin is indicated by
Inability to maintain a dry field during placement
Ms. Jones wants to know what causes sealant failure. What is the most appropriate response to that
Saliva contamination
What is the major source of sealant failure?
Non-delegatable tasks
Under Ohio law, retraction of the gingival sulcus prior to the direct or indirect impression technique is
Clinical and anatomical crowns
On a tooth with extensive gingival recession below the cement-enamel junction, what would be visible?
Axial floor
The floor (wall) of a class V facial cavity prep that runs vertically along the long axis of the tooth is known as
Marginal Ridge
The rounded border of enamel which forms the medial and distal margins of anterior and posterior teeth
DB and ML cusps
Where is the oblique ridge located on maxillary molars
Sterilizing, cleaning, drying and desensitizing agents
Pulp can be harmed by the caries process or by
False
Dental pulp increases in size with age
A combination of dentin and polymer that occurs during dentin conditioning
What is the hybrid layer
What is the term used to describe bonding systems that include a separate phosphoric acid gel from the primer and bonding agent?
Total- etch technique
Improves micro mechanical retention by eliminating or modifying the smear layer
What does dentin conditioning do?
Silane coupling agent
What is the material the combines the matrix with the filler particles in composite resins
The hybrid layer
The thin layer of dentin that is combined with polymer (prime and bond) is
Collodial silica
The filler particles in microfilmed resins is
A small, round finishing bur
What is the instrument of choice for defining grooves on the occlusal surface of an amalgam restoration
Compactors/condensors/packers
What instruments are used to place amalgams, composites, and temp fillings into cavity preps?
Slightly out of occlusion
The occlusion of a properly placed temporary sedative restoration should be
Erosion
Tooth wear on the cervical third of a tooth due to chemical processes
In a fully upright position
What position should the EFDA place the patient for final evaluation of occlusion?
Facial, facially
In a normal centric occlusion, the _ surfaces of the maxillary teeth are positioned _ to the facial surfaces of the mandibular teeth
Biennial
EFDA registration in OH is:
non-delegatable task (DDS performs only)
An irremediable task is defined as
approved and accredited educational program in an institution of higher learning
In ohio, the EFDA auxiliary may receive their training by
Two
A dentist may supervise no more than _ EFDAS at any given time
non-delegatable task
Under OH law, the final placement of any fixed or removable appliance is
EFDA
Who can perform advanced remedial tasks in OH?
CPR by American Red Cross or AHA ONLY
When applying for EFDA certification in OH, the EFDA applicant must show proof of current
Dec. 31st of the year in which registration occurs
Registration as an expanded function dental auxiliary expires on
Pre-wedging
The placement of a wedge before prepping to open the contact to compensate for the thickness of the bond
Clear mylar matrices
The matrix material that facilitates the curing of composite material but can be difficult to adapt to adjacent tooth contour are
Flowable
What restorative material is currently recommended under packable composite for the initial layer?
Clinical crown
When looking into the oral cavity one will most likely see the
gingival embrasure
The embrasure located below the contact area is known as the
Pulp
What tooth tissue provides the developmental, sensory, and nutritive functions of the tooth
Clinical crown
What is the term used to describe the visible part of the tooth in the mouth
Has mamelons
When incisors first erupt, the incisal ridge
Line angle
The junction of two walls in a cavity prep or two surfaces that meet is
Light shaving strokes with part of the instrument on the external enamel surface
Procedures for finishing proximal and embrasure areas of a class III composite restoration, using a gold kno=ife, #12 sure blade, or any hand instrument would involve
When using discs for finishing a composite restoration
Rinse the residue from each disc before proceeding with finer discs
Jaw of a rubber dam clamp
Part of the clamp which are expanded to fit over the tooth
Parallel with the occlusal plane
Jaws of a gingival retractor should be
Cementum
When using a gingival retractor it is important that the _ is not damaged or scratched
dental sealer
Seal off openings of the cut dental tubules to prevent sensitivity
Percolation
The movement of fluid that occurs in the microscopic openings between tooth and restorative materials during thermal dimensional change
Ether, acetone, or chloroform
Cavity varnishes are composed of natural or synthetic resins that are dissolved in solvents such as
Amalgam knife, amalgam file
What hand instruments may an EFDA use to finish amalgam restorations with a small overhang at the gingival cavosurface margin
Tapered green stone
Instrument of choice for removal of gross flash on the occlusal inclined planes of an amalgam restoration
Fossae
Broad irregular depressions or concavities on the occlusal and lingual surfaces of the anterior and posterior teeth
Class III
What caries classification is distolingual restoration of tooth #9
Pulpal floor
The floor (wall) of a class I occlusal prep is known as the
Both the statement and the reason are true
As an EFDA, care must be around the tissues when placing a matrix band, wedging, placement of a rubber dam clamp, use of rotaries, or sub gingival carving. These can all be injurious to the supporting periodontal structures of the teeth.
12-14 inches
Ideally, the distance from operator face to the patient face should be
Parallel to the floor
When restoring a mandibular tooth, best visual access can be obtained with the pt reclined with eh back of the chair angled slightly up (30-40 degrees) and the plane of the mandibular arch is
Carvers
What instruments are used to remove excess amalgam, composite, and temp fillings after the material has been placed in the cavity prep
Burnishers
What instruments are used to rub and smooth amalgam after it has been placed into the cavity prep
Modified pen grasp
Instrument grasp that offers the greatest control during performance of restorative procedures in the oral cavities
Move the hand, wrist and forearm as one unit securing the fulcrum
How does the EFDA accomplish activation of an instrument in order to avoid muscle cramping and fatigue
Creep
The slow movement of an amalgam restoration under compression forces over a period of time
The sandwich technique
The use of glass ionomer under composite resin is
etch for 10 secs, then wash and dry again before placing sealant
After conditioning, rinsing, and drying the tooth, the patient accidentally closes and contaminates the etched surface with saliva. You must:
1 : 1
The catalyst to base ration for a chemically cured sealant material is a _ ratio
First statement is true ; second statement is false.
After sealant placement, the EFDA should check the integrity of sealant with an explorer. If there is presence of a small void int he sealant it is okay to dismiss the pt.
Maintain favorable occlusal relationship and do nothing to alter it
What is the primary goal of the EFDA in restoring occlusion
Centric occlusion
Tooth to tooth contact that occurs when the jaws are closed together with the teeth biting in their interdigitated position
Lateral/ Eccentric movements
Right and left movement of the mandible
Protrusive movement
Movement of the mandible forward
Retentive features
Grooves in prepared areas of dentin along the line/ point angles of the prep that enhance mechanical retention
Caries classification system
Dr. Black is credited with developing
Ridge
Any linear elevation of the surface of the tooth
Cusp tip
A basic difference between canines and incisors is the _ that is unique to canines
The first statement is true ; the second statement is false
Both maxillary and mandibular canines are more rounded on the distal surface. Their distal contact area is in the incisor third.
Lingual Fossa(e)
The concavity that is located on the lingual surface incisor to the cingulum on anterior teeth is known as
Cementum
Tooth tissue that resembles bone
Dentin
Hard connective tissue that lies just inside enamel and cementum
-70% inorganic material
-20% organic material
-10% water
The composition of dentin is approximately
-95.5% inorganic material
-0.5% organic material
-4% water
The composition of enamel is approximately
Smear layer
Cavity preparations with rotary instruments generate cutting debris, some of which is compacted unavoidably into a later on the cut dentinal surface, The layer of material is known as:
Cavity varnish
Eugenol containing cements and __ interfere with the polymerization of composite resin and therefore should not be used with them.
Composite resin
Which of the following esthetic restorative materials is composed of inorganic filler with a matrix of BiphenolA- Glycidyl Methacrylate
Tapered white stone
What instrument would you use to remove an enamel submarginal area that is 0.2 mm or less
Copper
Increased amounts of _ in amalgam can reduce problems with creep and the gamma 2 phase
The DDS is physically present at all times, all acts are in his order, control, and responsibility. He checks pt before the leave.
Direct supervision of a dental auxiliary in OH revised code is defined as:
Working cusp
Cusp tips that occlude into the concavity or embrasure of opposing teeth
Frosty
Properly etched tooth enamel when rinsed and dried should appear
8-12 o’ clock zone
Operating zone for the right handed operator relative to patients face
Perpendicular to the floor
When restoring a maxillary tooth, best visual access can be obtained with the patient reclined in a supine (chair horizontal) position. The plane of the maxillary arch is:
90 degree angle
A carver should be adapted at a _ to the surface being carved
Isolation
For best results of most operative procedures, it is important for the EFDA to maintain complete
Cotton roll
What method of isolation is recommended for short periods of time and is the oldest method used for moisture control
Rubber Dam
What form of isolation is considered ideal in operative procedures
Cleoid- discoid carver
What is the instrument of choice for remove of any excess in a class I amalgam restoration on #29 during the occlusion check
Open margin
A space between restoration and tooth
Tip
When carving a class V amalgam restoration, with a hollenback carver, the gingival margin is carved with the _ of the carver on the tooth surface
At the incisal and occlusal areas
Where is enamel the thickest
Equal amounts of base and catalyst
Self cured composite resins are typically mixed
Tin Oxide
What is the final abrasive used when finishing and polishing amalgams
16
In the federation pentair international system for numbering, a permanent maxillary right first molar is:
Darker shades
Additional curing time may be necessary for _ when placing comp resin
More center in a buccal to lingual direction
When anterior teeth are viewed from the incisor the contact area is located
More buccal in a buccal to lingual direction
When posterior teeth are viewed from the occlusal the proximal contacts are usually located
Gamma 2
The consequence of the mercury mixing with tin in an amalgam that results in excessive corrosion is known as
Mercury, silver, tin, copper, zinc
What is the composition of amalgam
There is reduced access to the gingival margin
What makes carving a class V amalgam restoration challenging?
Holds the instrument handle opposite the thumb
What is the function of the index finger in the modified pen grasp
Tie ligature to the clamp
Before trying a clamp on a tooth, it is important
Periodontum
Collectively, the gingiva, alveolar process, periodontal ligaments, and cementum are known as
1) tip
2) side
3) heel
The working end of a carver (discoid/ cleoid) has a cutting edge divided into three general areas. They are:
Rotary
What instruments are designed to finish and polish amalgam and composite instruments
zinc oxide eugenol
What dental material is considered to have sedative qualities?
Glass ionomer cement
Which of the following materials contains fluoride, which is released over time?
Two coats
What is the recommended number of coats of varnish in a minimal depth restoration that has sufficient dentin to provide thermal insulation?
Exothermic
The setting reaction of zinc phosphate cement that produces heat is referred to as
The use of a cool, glass slab
Control of the exothermic reaction when mixing zinc phosphate material will be assisted by
Amalgam
Armamentarium for the placement of sealers, bases, liners, and dental cement may include all of the following EXCEPT:
Make the loop smaller
When using a tofflemeier retainer, the inner nut is turned clockwise to
Largest embrasure (typically lingual)
A wooden wedge should be placed from the
Class III prep
The cavity classification whose prep is typically triangular in shape having an axial floor and 3 walls best describes the
Heating amalgam for quick removal
The following precautions are recommended by the ADA for mercury hygiene, except
Fluoride
What anti carcinogenic agents is present in glass ionomer cements
First statement is true ; second statement is false
When mixing glass ionomer cement, the working time after mixing is about two mins. @ room temp. The glass ionomer should not be placed int he tooth until it has lost its gloss and shine.
Basic set-up, amalgam condendors, hollenback carvers
Armamentarium for placing, condensing, and carving a class V amalgam restoration includes:
Cut
In removing the dental dam, the septum is:
19-#22
Tooth #20, is to be restored. Name the teeth to be isolated with a rubber dam.
Rubber dam clamp
What is the key to stabilizing a rubber dam
Over the chin
Where should the closed part of the young frame be positioned ?
examine the rubber dam material for missing pieces
When removing the rubber dam, the last step is to:
Gingival retractor
The clamp of choice for a class V preparation is
Gingival retractor
What clamp will best retract the gingival tissue when restoring a class V restoration?
By eliminating voids and reducing excess mercury
How will adequate condensation pressure strengthen the final amalgam restoration?
Adaption of the matrix band to the tooth to prevent overhangs
What is ONE function of a properly positioned wedge
To compensate to extra space between the tooth and primary matrix
Why would an operator choose to use a secondary matrix strip
obtunding qualities
use of ZnPO4 as a base material does not have
minimal depth restoration
A _ has sufficient bulk of dentin remaining to provide thermal protection f the pulp
Weakened retention oof the restoration
What can happen i one failed to condense amalgam into the mechanical retentive features of a restoration?
Avoid desiccation of of the dentin
To prevent sensitivity in a newly restored tooth, an EFDA should
Zinc oxide and eugenol
What dental material exhibits good obtundant qualities?
Galvanism
What happens when dissimilar metals in the mouth act like a battery upon contact resulting in a discomfort for the pt
Calcium hydroxide
What material is an example of a pulp simulator?
According to manufacturers instructions
How long is a curing light applied to each tooth during the curing of sealants?
Glass ionomer
What dental cement is most compatible with all restorative materials
Because it is irritating to the pulp
Why is zinc phosphate contraindicated for direct placement over the plural area of a tooth with a near exposure
Trituration
mechanical mixing of alloy and mercury
Chemical
The retention between bonding agent and composite resin is
2-3 mm from composite
Where should the operator place the curing light when curing composite?
Composite resin
Which esthetic restorative materials is composed of inorganic filler with a matrix of biphenyl A-glycidyl methacrylate
Periodontum
Collectively, the gingiva, alveolar process, periodontal ligaments, and cementum are known as
Embrasure
A space continuous with an inter proximal space produced by curvatures of teeth in contact in the same arch, that provides a channel or passage through which food escapes from the occlusion of the teeth during mastication
Cleoid-discoid
What is the instrument of choice for recreating fosse in amalgam restorations
below (gingival) to the contact area
Proximal caries usually occur on the smooth surface area
Out of occlusion
When restoring excursive contacts, the marks left by articulating paper on the restoration should be
A shiny facet at the point of premature contact
A patient returns for polishing of a recently placed amalgam restoration. The pt states the filling felt high for a few hours but now is fine. Exam of the new filling will find:
Depends on the size of the preparation
The number of increments required for a class V amalgam restoration is (are)
Will increase plaque accumulation and recurrent decay
An under contoured class V restoration
It is threaded or screwed into the dentin
How is a threaded retention pin used in a complex amalgam restoration
Slightly higher occlusal than the neighboring cusp of the adjacent tooth
Tooth #19-modb complex restoration is to be restored with amalgam. The overfill on the DB cusp should be
Who have high caries risk and teeth with anatomically susceptible tooth surface
Sealants are indicated for patients
24-48 hours post-op
Ideally, amalgam restorations should be finished and polished
Equal density on tooth and restoration
When restoring centric occlusion, the marks left by articulating paper on the restoration should be
Basic remedial task
According to OH law, shade selection for fabrication of appliances or restoration is a
Protection from aspiration
what is NOT a disadvantage of using cotton roll isolation?
Time consuming
What is a disadvantage of rubber dam isolation?
Invert
When applying the dental dam for complete isolation of teeth, the EFDA will need to _ the dam
An explorer
What instrument is used to create the occlusal embrasure and shape the marginal ridge in a class II amalgam restoration
1) Handle
2) Shank
3) Working end
The three basic parts of an instrument are
Glass ionomer
What liner bonds directly to dentin, releases fluoride and is compatible under composite?
Heavy eccentric occlusion
Donut shaped marks on the occlusal surface of a restoration indicate
FDI Numbering System
What tooth numbering system does not use letters when describing primary dentition?
Interproximal papilla
What is the name of the tissue that fills the inter proximal spaces between adjacent teeth
application of pit and fissure sealants
Advanced remedial procedures example
Point angle
The junction of three walls in a cavity prep or three surfaces that meet is known as
A sedative agent
What is the most effective use for zinc oxide eugenol cement
Putty- Like
ZOE should be mixed to a _ consistency when used as an intermediate restoration
To protect the pulp from the pressures exerted on it during condensing
What is the purpose of cement used as a reinforcer in restorative dentistry
Desiccation
The causes of pulpits are many such as through caries. The EFDA must also be careful when performing restorative procedures to avoid irritating the pulp. This includes proper condensing pressure, care against chemical irritating and avoiding _ of the dentin
Finished restoration
Upon removal of the gingiva retractor, the EFDA must avoid touching the tooth and the _ with the jaws of the retractor
At the CEJ
Where are the points of the jaw positioned on a properly placed rubber dam clamp
Polycarboxylate cements and glass ionomer cements
Which of the following cements has polychloric acid in water as it’s liquid
Bases
LWhat material is thick and can be used as thermal insulators under restorative materials
A mixture of different particle types
Which of the following best describes dispersion (admixed) type alloys
Conventional or lathe- cut
Amalgam particles that are irregular in shape require more mercury and greater condensing force best describe
Weakens the restoration
How will a higher percentage of mercury in the amalgam affect it’s properties
Excessive delayed expansion
What undesirable property is caused by bubbles of hydrogen from water due to moisture contamination
Ability to recontour overcharged restorations
All of the following are advantages of a polished amalgam over an unpolished amalgam except
Gingiva
When placing the matrix band, the small diameter of the loop is directed towards the
What could result if the EFDA placed a matrix band too snugly around a tooth w/ a class II prep for an amalgam restoration
The uncut tooth structure adjacent to the cavity prep is the
Cavosurface margin
The cavity preparation located on an anterior tooth at the GINGIVAL third of the tooth is classified as
Class 5/ class V
After a matrix band is removed from a class II amalgam restoration, which area should be carved first, using an explorer or Hollenback?
Gingival cavosurface margin
Which one of the following bases is able to bond to enamel and dentin?
Glass ionomer cement
Placing the dental dam into the sulcus to prevent further leakage is also known as
Inversion
During a class 2 amalgam procedure, the rubber dam is removed when?
Before checking the patients occlusion
Removal of the rubber dam is accomplished by:
Cutting the septal dam before removal
You have just etched a tooth but before you are able to continue with the primer/ bonding agent, the patient closes and swallows, you should:
Dry the tooth, re-etch, rinse and dry and then proceed
When restoring a posterior occlusal composite, the material of choice would be:
Hybrid
When carving amalgam always carve from:
Tooth to amalgam/ along the cavosurface margin/ with the instrument in contact with enamel.
The purpose of inverting the dam is to
Prevent saliva leakage
The distal triangular fossa of the maxillary first molar is separate from the central fossa by what structure
Oblique ridge
Composite resins can be :
Self cured/ light cured/ dual cured
Postoperative sensitivity with posterior composite restorations can result from:
operative trauma/ phosphoric acid overetching of dentin/ hyper occlusion
Which area of a class V amalgam is carved “freehand”
Central portion
EFDAs in PA may perform:
Coronal polishing/ finishing and polishing of composite restorations
During class II composite procedure, the ring of the sectional matrix is placed:
After the band and wedge
Preventive resin restorations are performed when:
The clinician suspects the deep fissures may decay
If a straight- bladed carver is adapted to both of the occlusal and gingival margins of a class V amalgam at the same time, what will result?
“Flattened” central point
Which metal in the dental alloy gives amalgam its strength?
Silver
Of the following instruments, which one WOULD NOT be useful in correcting an overhang of amalgam class II restoration?
Discoid/ Cleoid
Why should you NOT attempt to cure a layer of composite resin that is thicker than 2 mm
The light may not penetrate the resin fully creating a shell effect- the outer layer is polymerized and the inner layer is not
In placing a class II composite, it is often difficult to obtain:
Proximal contacts on posterior teeth
The mandibular buffalo and the maxillary lingual cusps are known as:
Supporting/ working cusps
A wedge not used for a
Class V
Bases and liners can be used for
Any class
Before cementing a temp crown, it is important to check the :
occlusion, contacts and margins
In a class Ii amalgam, you begin to round the marginal ridge and form the occlusal embrasure with an explorer held at about 30° with the tip held against the:
Matrix band
Composite resin should be cured and hardened both
Internally and externally
When placing a Fermin temporary for an onlay prep, retention is assured by
Interlocking the material to the adjacent teeth
A micro-fil is desirable for its polishability in:
Non-stressed, nonstructural areas
The best way to avoid under contoured class V amalgam restoration is to carve the incisal and gingival margins :
Separately
Total etch is:
When the enamel, dentin, and cementum is etched.
The mercury rich layer is removed when:
Burnishing and removing top layer of overfilled amalgam
The sequence of finishing and polishing a composite restoration is:
Finishing but, coarse, medium, fine, polishing paste
A shallow linear depression in a tooth is called a
Groove
When restoring posterior teeth, the marks left by articulating paper should appear:
As dots
On which type of teeth would the placement of sealants be most beneficial?
Teeth with deep fissures
The metal alloy used in amalgam is primarily composed of:
Silver
When placing liners in the cavity prep it is best to use small:
Ball- ended instrument
What is the first step of removing a dental dam?
Free the interseptal dam with scissors
Which cavity classification includes caries on the interproximal surface if anterior teeth?
Class III
When performing a composite restoration, the composite is often placed in layers to:
Reduce the effect of polymerization shrinkage
Which type of matrix is most commonly used for amalgam restorations?
Tofflemire matrix
Which dental function are EFDAs prohibited from performing?
Removing supragingival tartar
When applying a fluoride varnish, do not:
Thoroughly dry the teeth
The primary source of topical fluoride is:
Fluoridated toothpaste
A condition that results from chronic overexposure to fluoride is known as:
Fluorosis
Coronal polishing is a technique:
Used to remove plaque and stains from the coronal surfaces of the teeth
Exogenous stained are caused by environmental sources and are classified into subdivisions including which of the following?
Extrinsic stains and intrinsic stains
Bristle brushes are used to remove stains from:
deep pits and fissures on the enamel surfaces.
The rubber cup should be held
Flat against the tooth and at a 45° angle against the tooth
zinc oxide eugenol
This material is obundent
Glass ionomer
Releases fluoride,can be used as a liner, base, cement and final restoration. Chemically bonds directly to enamel, Dentin, cementum, and stainless steel
What is the correct placement of material for restoring a deep amalgam restoration?
Calcium hydroxide, copal varnish, zinc phosphate and amalgam
To prevent sensitivity
Avoid desiccation of the dentin
What part of the matrix retainer is a box shaped devise at the lower end of the retainer that has an opening for the threaded spindle to move in and out?
Nut
The purpose of a wedge is?
To adapt the band to the cervical region of the tooth and endure teeth don’t bond together
What could result if a matrix band is placed to snug around a tooth with a class to preparation?
Voids in the proximal box
What is attrition?
The gradual loss of tooth structure along the biting surface due to a Occlusal wear
The purpose of acid etching enamel before placing a sealant resin is to
Create micropores into which the sealant will flow to form a mechanical Bond
Which material can be used as a temporary filling material
ZOE
What is a point angle
A point formed by the junction of three walls within a cavity preparation
Which of the following best describes a class 11 restoration
proximal surface of posterior teeth
What structure is part of the attachment apparatus?
Cementum
Application of a base
The material is a putty like consistency. The entire pulpal floor is covered with a base to thickness of 1 to 2 mm. Make sure base is not placed on any margins cavity walls undercuts or retentive groves.
zinc oxide eugenol
Soothe pain for or irritated Pulp obtundent, Insulator and reinforcer, cannot be used with composite resin’s because it interferes with setting reaction, not as strong as other bases
Zinc phosphate cement
It is strong when used as a liner under amalgam can prevent tooth from looking gray, insulator and reinforcer. Cannot be directly against the pulp without a varnish or liner because it is chemically irritating to the pulp due to acid it produces heat, mix on a glass slab
Zinc poly acrylic cement
Less irritating to the pulp than zinc phosphate. Insulator and reinforcer. Not as strong as zinc phosphate, poor handling characteristics
incisor
Used for cutting
canine
Used to cut and tear, Protects the jaw joint during side job movement longest tooth, most stable tooth
Pre-molars
For maxillary, for mandibular I just have two cusps some have three used to grasp tear pulverize food
Molars
Four or five costs, vary in size shape and number of routes based on location in the mouth function chew or grind food
enamel properties
Enamel Has no nerve supply non-vital and therefore not a renewable tissue, hardest mineral tissue in the body and very brittle, produced by enamel blasts, The chemical composition is 95% in organic and 5% organic matter and water, dance memorization gives enamel the ability to resist the where the crown of the tooth is subject to
Ameloblasts
Rods that are formed from cells
Dentin
70% in organic 20% organic and 10% water, formed from cells called ODONTOBLASTS, made up of Dentinal tubules
Odontoblasts
Live in the pulp chamber and extend through the Dentin tubules
Cementum
Hard tissue that covers the an anatomical route, Attached of the tooth to the alveolar bone through the periodontal ligament’s
Periodontium
Consists of two parts: attached apparatus ( what holds the tooth in socket) and the gingival unit
Gingival unit
Interdental papilla, attached gingiva, alveolar mucosa
Cusp of Carabelli
Only on the maxillary first molar m
Cavosurface
Uncut tooth structure adjacent of the cavity preparation
Line angel
Junction of two walls
Varnish (Copalite) liner
Seals Dental tubulars,
Reduces micro leakage around a restoration, acts as a barrier to protect the tooth from highly acid cement such as zinc phosphate, cannot be used with composite
Application of varnish
Apply with a small disposable applicator within the entire preparation ideally two coats, it is important to note that varnish will be placed after the liner or base is applied except with zinc phosphate as a base then varnish is placed before the base
Calcium hydroxide Dycal
Repaired have or secondary Denton, reduces sensitivity, compatible with all types of restorative material, not strong don’t apply to thick
What is composite resin
Organic ( carbon containing) Matrix of resin containing in organic filler particles. Also known as filled a composite resin or dental composite
Resin matrix plus inorganic fillers =
Composite resin
BIS-GMA plus silica etc =
Composite resin
resin matrix
Soft stuff holds everything together
Inorganic fillers
Quartz or silica, lithium aluminum silica barilium glass. If nanofil then Zirconium and zeolite
Glass ionomer Fuji
Contains fluoride reduces Decay, Less irritating to the pulp and has stronger bond, Obtundant, insulator and reinforcer, Compatible with all restorative material
creep
Slow change in dimension of amalgam due to prolonged exposure to stress, repeated chewing forces cause creep breakdown of marginal integrity, high copper amalgams
corrosion
Chemical reaction between the amalgam and the oral cavity that penetrates into the body of the amalgam
Tarnish
Chemical reaction between the amalgam and the oral cavity is restricted to the amalgam surface
Galvanism
Dissimilar metals in the mouth conduct an electric current resulting in pain like a battery
amalgam
A mixture of metal alloy with mercury,The alloy is a fine powder composed mostly of silver tin and copper
The powder
Has round particles (SPHERRICAL cut) Requires less mercury. Irregular particles (LATHE cut ) Condense better requires more mercury.
Dental amalgam metal alloy plus mercury
Silver 41 to 71%, tin 15 to 30%, copper no copper less than 9% hi copper 12 to 38%, zinc 071% mercury mercury rich more than 54% most is less than 54%
Trituration
Mixing process of the metal alloy with the mercury
amalgamation
Reaction of metal alloy with mercury sets and becomes hard
Gamma 2 phase y2
The chemical reaction produced by the combination of tin and mercury, Increases in flow and corrosion and decreases strength which can cause fracturing
Y2
Hi copper amalgams have eliminated the y2 Product increasing resistance to corrosion creep in marginal breakdown
rubber damn
Is placed on the tooth distal to the one you are working on unless you are working on the most distal tooth also wanted to teeth mesial to the one being restored or exposed through the damn
Polished Amalgam
Ability to re-contour over carved restoration
Plastic like material that surrounds the ceramic material in a composite
BIS GMA
Rotary instruments generate cutting debris some of which is unavoidably compacted into a layer on the cut Denton surface known as smear layer
Smear layer
Retention between bonding agent and tooth structure is
Mechanical
Using a Mylar strip will prohibit
Air inhibited layer
In what order should the dental materials be placed when restoring an amalgam restoration
Calcium hydroxide, zinc oxide Eugenol, varnish, Amalgam
What material is irritating to the pulp
Zinc phoshate
What material would be then best base under a composite resin?
Glass ionomer
What part of a rubber dam clamp is described as an arched band of metal joining the two jars of the clamped together
Bow
What dental materials exhibit good obtundant qualities?
Zinc oxide Eugenol
Which of the following teeth contain a oblique ridge
Maxillary first molar