class two amalgam restoration in posterior teeth.pptx

Class two amalgam restoration in posterior teeth

1. Class II amalgam restoration

2. Cavity preparation

3. Instruments

4. Obtain proper isolation of the tooth

5. Place a wedge in between adjacent teeth to separate the contact areas

6. Orient the bur over the mesial pit, perpendicular to the occlusal surface  ​   Bur options: pear shaped carbide bur (330)

7. Penetrate the mesial pit to a depth of 1-1.5mm for the initial punch-cut Optional:  The length of the bur may be used to approximate preparation depth  Clinical note:  The final preparation depth is determined by the extent of the carious lesion or existing, faulty restoration

8. Maintaining the 1-1.5mm bur depth, extend the occlusal outline proximally  Always keep the bur perpendicular to the long axis of the tooth Follow the anatomical grooves of the tooth​ ​Leave a small "enamel shell" interproximally to protect the adjacent tooth from iatrogenic damage

9. Use the probe to ensure appropriate dimensions of occlusal extension and evenness of the pulpal floor:  BL width of occlusal outline: at least 1mm  BL width of isthmus: 1-1.5mm   ​BL dimension must accommodate the smallest condenser

10. Extend the occlusal outline buccally on mesial pit to create the proximal dovetail Follow the anatomy of the grooves ​ Bur options: pear shaped carbide burs (330, 245

11. Place the bur in the most mesial portion of the preparation outline, orient the bur 5º mesially, and brush upward to create occlusal divergence at the proximal wall of the dovetail

12. Place the bur within occlusal preparation outline, adjacent to enamel shell and parallel to long axis of tooth   Bur options: pear shaped carbide burs (330, 245)

13. To create the proximal box, extend the preparation gingivally until the gingival contact breaks  The gingival contact is broken <0.5mm When the gingival contact is broken, the tip of the explorer will pass through the broken contact    Drop the box = creating the proximal box!

14. Widen the proximal box to the full length of the contact area by moving bur in the buccal-lingual direction, maintaining the bur depth at the level of the broken gingival contact

15. Break the enamel shell using a hand instrument  Position the flat side of the instrument against the enamel shell and push the instrument outward toward the adjacent tooth   Hand instrument option: enamel hatchet

16. Break the enamel shell using a hand instrument  Position the flat side of the instrument against the enamel shell and push the instrument outward toward the adjacent tooth   Hand instrument option: enamel hatchet

17. Shape proximal box using rotary instruments (high speed with water) The exit angles are 90º degrees to the tooth surface, following the direction of the enamel rods The buccal and lingual walls are occlusally convergent  The axial wall is occlusally divergent 

18. Create the reverse S curve by connecting and smoothing the transition between cavosurface outline and proximal box using rotary instruments (high speed with water) ​ Bur options: pear shaped carbide burs (330, 245)

19. Clinical note:   Extend the ideal preparation to remove remaining caries Check for caries using the explorer or spoon excavator Remove remaining caries using the largest round bur that fits into the preparation with rotary instruments (slow speed) or the spoon excavator   Bur options: round carbide burs (4, 6)​ ​

20. Smooth the preparation with rotary instruments (high speed with water or slow speed) or hand instruments  Remove unsupported enamel Remove steps/ledges  ​ Bevel the axiopulpal line angle   Bur options:  straight fissure or pear shaped ca rbide burs (556, 330) 

21. Common mistake

22. Amalgam restoration

23. Place the Tofflemire matrix band around the toothEnsure the matrix band rises 1mm over the marginal ridge

24. Secure the matrix band by placing a wedge in the buccal and lingual embrasuresInsert the wedge from the lingual using the forceps

25. Use the smallest condenser to vertically and laterally compress amalgam into thepreparation Begin condensing in the proximal boxApply sufficient force when condensing amalgam

26. Slightly overfill preparation with amalgam Use the larger amalgam condenser when the amalgam fill reaches the occlusal surface

27. Firmly burnish the amalgam with the round end of the burnisher

28. Use the explorer tip at a 45 degree angle to the matrix band to remove excess amalgam from the marginal ridge

29. Carefully remove the matrix band Loosen the short swivel to release the matrix band from the matrix band holder 2. Remove the interproximal wedge with forceps 3. Remove the matrix band from the side opposite of the proximal box 4. Lightly hold down the amalgam with and instrument and carefully remove the remaining portion of the matrix band in the bucco- occlusal or linguo-occlusal direction о Removing the matrix band in the occlusal direction may dislodge the restoration

30. Carve anatomy into the restoration • Remove excess amalgam from the proximal aspect and overhang at the gingival margin Instrument options: explorer, proximal carver Develop occlusal anatomy by guiding the instruments along the remaining tooth structure to create grooves and correct cuspal inclinesI nstrument options: acorn burnisher, cleoid-discoid, Hollenback carve Ensure that the marginal ridge is rounded and the height is consistent with that of the adjacent toothInstrument options: explorer, Hollenback

31. Burnish the marginscircumferentially Instrument options: small ball burnisher Clean and smooth the restoration surface with a wet cotton pellet

32. Use floss to check the proximal contact Floss in the gingival direction and pull laterally through embrasure to avoid dislodging the restoration Proper contact should give light resistance and create slight "snap" sound

33. Using articulating paper, check the occlusion of the restoration • Areas of hyperocclusion will mark heavily with the articulating paper •Adjust areas where the restoration is "high"

34. Optional: Polish the restoration • Polishing is performed after amalgam has set, according to the manufacturer's instructions • Smooth the surface using rotary instruments (slow speed)

35. Refrences Hilton, T. J., Ferracane, J. L., &amp; Broome, J. C. (2013). Summitt's fundamentals of operative dentistry a contemporary approach. Quintessence Publishing Co. Inc. Ritter, A. V., Boushell, L. W., Walter, R., &amp; Sturdevant, C. M. (2019). Sturdevant's art and Science of Operative Dentistry. Elsevier.

36. Thank you