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This document provides instructions for preparing a Class II MODL amalgam restoration involving reducing the mesiolingual cusp and extending the preparation distally to include a lingual groove box. It describes the outline form, dimensions, and characteristics of preparing proximal boxes and incorporating retentive locks. The summary is as follows:
1) The preparation involves reducing the mesiolingual cusp and extending the outline form distally to cover the cusp and include a lingual groove box.
2) Dimensions for the proximal boxes and lingual groove box are provided, including axial wall depth and cavosurface margins.
3) Retentive locks are to be prepared in the axial line angles
This document provides instructions for preparing a Class II MODL amalgam restoration involving reducing the mesiolingual cusp and extending the preparation distally to include a lingual groove box. It describes the outline form, dimensions, and characteristics of preparing proximal boxes and incorporating retentive locks. The summary is as follows:
1) The preparation involves reducing the mesiolingual cusp and extending the outline form distally to cover the cusp and include a lingual groove box.
2) Dimensions for the proximal boxes and lingual groove box are provided, including axial wall depth and cavosurface margins.
3) Retentive locks are to be prepared in the axial line angles
Copyright:
Attribution Non-Commercial (BY-NC)
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Scarica in formato PDF, TXT o leggi online su Scribd
This document provides instructions for preparing a Class II MODL amalgam restoration involving reducing the mesiolingual cusp and extending the preparation distally to include a lingual groove box. It describes the outline form, dimensions, and characteristics of preparing proximal boxes and incorporating retentive locks. The summary is as follows:
1) The preparation involves reducing the mesiolingual cusp and extending the outline form distally to cover the cusp and include a lingual groove box.
2) Dimensions for the proximal boxes and lingual groove box are provided, including axial wall depth and cavosurface margins.
3) Retentive locks are to be prepared in the axial line angles
Copyright:
Attribution Non-Commercial (BY-NC)
Formati disponibili
Scarica in formato PDF, TXT o leggi online su Scribd
CLASS II Complex AMALGAM PREPARATION: MODL on #19 or #30 Retentive facets: proximal retentive locks, slot/grooves, amalgapins, convergent axial walls Armamentarium Basic: mirror, explorer, perio probe, cotton pliers, periodontal probe Rubber dam kit: frame, dam, clamp, punch, forceps, floss Operative kit: burs - # 330, 245, !, 2, 169/169L, 57/58, 956/957; hand instruments Spoon excavators, Hatchets (10-8-14 Sm.), Chisels, Margin Trimmers (Sm. & Lrg) Matrix kit: toffelmire band holder and band, wedges, crown and collar scissors Amalgam Condensers: carrier, well, pluggers (serrated sm. - 0/1 and med./lrg.- 1/2 or 3/4), Burnishers: ball - #1, ball-football - #26/29, acorn 321/21B, duckhead contouring Carvers: Cleoid-discoid (sm. & med/lrg.), Hollenback 3S/3/IPC, Ward 1/2, 3 Tanner Hand pieces: fast, slow (contra-angle attachments)
Procedure:
1. Check the occlusion: Use articulating ribbon and tap the jaws of the manikin. Remember the location of the marks and use them as an aid in carving the restoration. Get Occlusion Check-Off By Instructor Before Proceeding 2. Reduce the mesiolingual cusp 2.5 3.0 mm. and have it approved by your instructor 3. Outline Form: The outline form should be identical to that of the conventional Class II MOD amalgam preparation with a widening distally to cover the ML cusp to the lingual groove where it extends gingivally to a lingual box preparation.
Classic Cl II MOD amalgam preparation: Isthmus width is 1.5 mm. 2.0 mm depth of pulpal floor and should be parallel to an imaginary line connecting the buccal and lingual cusp tips. 0.5 mm. clearance of gingival cavosurface margin O.2 0.5 mm. clearance of facial and lingual proximal walls Smooth, flat pulpal and gingival floors, perpendicular to plane of occlusion Bevelled axio-pulpal line angle and gingival cavosurface margin planed apically Convergent (occlusally) facial and lingual axial walls 90 0 cavosurface margins of facial and lingual proximal walls Axial wall depth (of both proximal boxes) is a minimum of 1.0 mm and duplicates the convexity of the proximal outer surface of the tooth.
Cl II MODL amalgam preparation with ML Cusp Coverage and Lingual Groove Box: Amalgapin will be utilized instead of slot at ML cusp Three box preparations: two proximal (M & D) boxes and a lingual groove box (Cl I) preparation extending gingivally. Axial wall depth (of both proximal boxes) is a minimum of 1.0 mm and duplicates the convexity of the proximal outer surface of the tooth; and the on the lingual a minimum of 1.0 mm. apical to the level of the ML cusp reduction roxlmal reLenLlve locks ln axlo-faclal and axlo-llngual llne angles of proxlmal boxes Bevelled axio-pulpal line angles and gingival cavosurface margins planed apically in all three boxes Convergent (occlusally) facial and lingual axial walls 90 0 cavosurface marglns of faclal and llngual walls of proxlmal boxes as well as M and u walls of llngual groove box SloL !"#$%#&'( '(*+,#- ./ 0$.+ Llngual Croove reparaLlon/8ox roxlmal 8eLenLlve Locks roxlmal 8eLenLlve Locks 8everse Curves 90 0
Cavosurface Margln lsLhmus x (Lo 1/3) ulsLance 8eLween Cusps 2
4. Proximal box preparation: Prepare the buccal portion of the mesial/distal dovetail as you normally would, using care not to extend the dovetail buccally farther than the contact area. Prepare the lingual of the prep by extending it from the isthmus slightly lingual to the mesial/distal pit. Using the #169 bur, connect the two sides of the preparation, while moving the bur mesially/distally and gradually thinning the marginal ridge, leaving only a thin shell of material between the bur and the adjacent tooth. Using a slight pendulum motion, move the bur from side to side, gradually deepening the prep to approximately 3.5 mm. With the small hatchet, break away the final pieces of material protecting the adjacent tooth. With the #169 bur expand the box to the proper dimensions (the small hatchet and gingival margin trimmer can aid you in this task). Do not try to remove too large a piece of tooth structure with the hand instruments or use a dull instrument for this task. This will cause the manikin tooth to chip and ruin your preparation. The axial wall height of the box should be 1.0 mm measured from the pulpal floor, with a convexity reflecting that of the unprepared proximal wall. Use care not to break any of the proximal contacts (buccal, lingual, gingival) by more than 0.5 mm (this can be measured by passing the first 1.0 mm of the #23 explorer through the contact, if any more of the explorer passes through, the contact is too wide).
Smooth all walls of the preparation with the appropriate burs and hand instruments. The walls of both proximal boxes and lingual box should have smooth cavosurface margins. Use the gingival margin trimmer to bevel all three axio-pulpal line angles and plane gingival cavosurface margins
0.5 mm. clearance of gingival cavosurface margin O.2 0.5 mm. clearance of facial and lingual proximal walls
The buccal and lingual walls should converge slightly (3 0 )
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5. Retentive facets: Primary retention form is provided by the occlusal convergence of facial and lingual walls and by the dovetail design of the occlusal step, if present. Proximal retention locks may also increase the fracture resistance of the amalgam restoration. The use of retention locks in proximal boxes is controversial. However, the use of retention locks is recommended in tooth preparation with extensive proximal boxes. Retentive locks, slots, grooves, amalgapins, pins, etc. provide secondary retention form. Ideally secondary retention form for the occlusal and proximal portions of the preparation should be independent of each other. The occlusal convergence of the facial and lingual walls and the dovetail design (if needed) provide sufficient retention form to the occlusal portion of the tooth preparation. The occlusal convergence of the mesiofacial and mesiolingual walls offers retention 8evelled axlo-pulpal llne angle and planed glnglval cavosurface angle 8everse curve evldenL ln faclal proxlmal wall, conservlng sound LooLh sLrucLure and aLLalnlng 90 0 cavosurface angle Llngual Croove 8ox reparaLlon CuLllne lorm Slmllar ouLllne form wlLh llngual box 4
in the proximal portion of the preparation against displacement occlusally. To enhance retention form of the proximal portion, proximal locks may be indicated to counter proximal displacement. Many operators use proximal locks routinely to ensure that each portion of the tooth preparation is independently retentive. However, evidence suggests that retentive locks may not be needed in conservative, narrow proximal boxes.
8eLenLlve Locks aL axlo-faclal and axlo-llngual llne angles of proxlmal boxes Preparation of a retention lock: use a No. 169L bur with air coolant (to improve vision) and reduced speed (to improve tactile "feel" and control). The bur is placed in the properly positioned axiolingual line angle and directed (i.e., translated) to bisect the angle approximately parallel to the DEJ. This positions the retention lock 0.2 mm inside the DEJ, thus maintaining the enamel support. The bur is tilted to allow cutting to the depth of the diameter of the end of the bur at the point angle and permit the lock to diminish in depth occlusally, terminating at the axiolinguopulpal point angle. In a similar manner prepare the facial lock in the axiofacial line angle. When the axiofacial and axiolingual line angles are less than 2 mm in length, reduce the tilt the bur slightly so that the proximal locks are extended occlusally to disappear midway between the DEJ and the enamel margin. There are four characteristics or determinants of proximal locks: (1) position, (2) translation, (3) depth, and (4) occlusogingival orientation. Position refers to the axiofacial and axiolingual line angles of initial tooth preparation (0.2 mm axial to DEJ). It is important to note that the retention locks should be placed 0.2 mm inside the DEJ, regardless of the depth of the axial walls and axial line angles. Translation refers to the direction of movement of the axis of the bur. Depth refers to the extent of translation (i.e., 0.5 mm at gingival floor level). Occlusogingival orientation refers to the tilt of the No. 169L bur, which dictates the occlusal height of the lock, given a constant depth. Some operators prefer using the No. 1/4 bur to cut the proximal locks. The rotating bur is carried into the axiolinguogingival (or axiofaciogingival) point angle, and then moved parallel to the DEJ to the depth of the diameter of the bur. It is then drawn occlusally along the axiolingual (or axiofacial) line angle, allowing the lock to become shallower and to terminate at the axiolinguopulpal (or axiofaciopulpal) point angle (or more occlusally if the line angles are less than 2 mm in length). Regardless of the method used in placing the locks, extreme care is necessary to prevent the removal of dentin that immediately supports the proximal enamel. In addition, it is essential not to prepare the locks entirely in the axial wall (i.e., incorrect translation [moving the bur only in a pulpal direction]), because no effective retention is obtained and there is a risk of pulpal involvement. An improperly positioned axiofacial or axiolingual line angle must not be used as a positional guide for the proximal lock. If the axial line angle is too shallow, the lock may undermine the enamel of dentinal support. If the line angle is too deep, preparation of the lock may result in exposure of the pulp. Retention locks should always be placed in the facial and lingual proximal walls (0.2 mm inside the DEJ), regardless of the depth of the axial wall. 3
Boxes and Walls Proximal Retention Lock Vertical Plane (169L or ! round) Convergent Walls Boxes W A L L W A L L B O X B O X Missing Cusp? Groove or Cove Horizontal Plane
Amalgapins Shavell, H. J Ca Dent Assoc 1980; 8: 48-55 Amalgapin Advantages Quick Standard armamentarium Stress-free Minimal weakening of tooth Additional occlusal reduction unnecessary Disadvantages Vulnerable to early fracture Tensile strength poor initially Need abundant dentin (but so do pins) Proper condensation essential Indications: Loss of coronal tooth structure Minimal occlusal-gingival height short clinical crowns, minimal room for pins
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Amalgapin Technique Prepare hole-SLOW SPEED choice of burs 330 = .8 mm, 1157 = 1 mm located in dentin 1 mm diameter 1.5 - 2 mm deep bevel at cavosurface margin #2 round bur follow tooth anatomy not LA
6. Matrix Placement: Adaptation Problems
Purpose Band confines amalgam/composite Supports amalgam during condensation Restores anatomical contour Restores contact area(s)
Adaptation Extends 1 mm below gingival margin Doesnt impinge on gingiva Doesnt entrap gingiva or rubber dam Extends > 1 mm occlusal to marginal ridge Extends < 2 mm occlusal to marginal ridge
Lower wedge Llp Lrlmmed Lo ellmlnaLe lnLerference wlLh Loffelmlre holder off-seL Lo lmprove conLour AdapLaLlon problems when proxlmal box ls exLenslve and exLend onLo faclal and llngual surfaces CounLerslnk occlusal porLlon of channel wlLh #2 bur > 1 mm lnLo denLln > 0.3 mm lnLo denLln Ideal Properties Rigid: Confine - - prevent gingival excess Supports amalgam during condensation Restore anatomical contour - - where contour of band is a match Flexible: Establish contour - - proximal contact Convenient application / removal Restores anatomical contour
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Adaptation Problems
7. Amalgam Filling Steps:
Mixing Insertion Condensation: Compaction for dense restoration (reduce voids in restoration); overstep condenser nib; Adaptation of increments toward line and point angles o bisecting line angles o trisecting point angles Reduce residual Hg o compaction of amalgam ensures excess mercury moves to next increment o allows for final amalgam structure to be composed of reinforcing residual alloy with a minimum of reaction product matrix Precarve burnishing Carving: Define anatomy Remove excess amalgam Return restoration to occlusal function Perfect physiologic form and function Choose shape and size for area being carved o cleoid-discoid for occlusal o Hollenback carver for occlusal, facial, lingual and interproximal o Interproximal carver for interproximal (can be used for facial and lingual) Loss of convexity and proper embrasure form 8and shorL of deep" glnglval margln Cap when proxlmal box ls exLenslve 8
Whenever possible use cavosurface margin to guide carving instrument to avoid submarginal areas. Steps in carving: 1) Pre-op evaluation 2) Contour overfill during condensation 3) 3) Burnish - - Form basic occlusal anatomy 4) Establish marginal ridge height 5) Establish occlusal embrasure 6) Remove matrix & wedge 7) Finalize gingival margin 8) Finalize proximal contours 9) Finalize facial/lingual embrasures 10) Finalize occlusal anatomy Postcarve burnishing; After carving is complete, use the burnisher to lightly rub on the surface of the restoration. o Makes the surface smoother o Adapts amalgam to cavosurface margins o Do not use to hard a force that will make grooves in the restoration o Stop at point amalgam becomes shiny Checking occlusion Finishing and polishing Adaptation to cavity walls
Lven marglnal rldges and proper llngual helghL of conLour" 1'('*2,- #(- 3.$'*2,- - 24 48 hrs posL-placemenL Coarse flnlshlng- choose shape of roLary lnsLrumenL Lo flL Lhe surface of Lhe resLoraLlon- Lo shape, marglnaLe resLoraLlon (dlscs, cups, and polnLs) ! flnlshlng sLones ! flnlshlng burs llne flnlshlng- smooLh and pollsh Lo lusLer ! 8ubber abraslves from coarse Lo smooLh pollshers, e.g. Shofu - 8rownle, Creenle, & Super Creenle ! ZnC (slurry) ! umlce and Clycerol (aL placemenL??)
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Grading Criteria The outline form should conform to that described above. The occlusal depth should be 2.0 mm (measured at the mesial/distal pit area). The isthmus width must be 1.5 mm. Slightly convergent (3 0 ) axial walls (facial and lingual) The axial wall height should be a minimum of 1.0 mm. All proximal contacts should be open: gingival - a minimum of 0.5 mm; facial & lingual 0.2 to 0.3 mm. The pulpal floor should be smooth and parallel to an imaginary line connecting the buccal and lingual cusp tips. The gingival floor should be smooth and perpendicular to the occlusal plane of the tooth; all walls should be smooth Proximal and lingual boxes: axiopulpal line angle is bevelled; gingival cavosurface planed apically; 90 0 cavosurface margins Retentive locks and amalgapin placement Amalgam filling: contour, marginal adaptation, surface finish
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EVALUATION FORM INSTRUCTIONS: CLASS II MODL MOLAR PREPARATION
Evaluator: _____________________________ Date:__________________ ID Number: ____________________________ Tooth No.: ______________ Circle One: Faculty Student Prep: __________________ Class II Amalgam Preparation (MODL) Grade Sheet (#19 or #30) Points Awarded 3+ 2+ 1+ 0
Smooth, Perpendicul ar Slight Deviati on Modera te Deviati on Unaccepta ble
6. Outline Form (Other Consideration Proper Form Slight Deviati on Modera te Deviati Unaccepta ble 11
s)
on 7. Secondary Retention: proximal locks and amalgapins
Total: ________ A score 0 on items 1, 2 or 4 is an automatic failure. A= 16-18 points B= 12-15 points C= 09-11 points F= <09 points
Class II Amalgam Restoration (MOD) Grade Sheet (#28/#21 or #19/#30) Points 3+ 2+ 1+ 0 1. Margin Integrit y No marginal excess or deficiency detectable (visually or with tine of explorer) at the cavosurface Detectabl e marginal excess or deficienc y <0.2 Marginal excess or deficiency >0.2-0.5 which can include pits and voids at the cavosurface margins Marginal excess or deficienc y >0.5 mm which include pits and voids and have open margins 2. Surface Finish Uniformly smooth and free of pits and voids Slightly grainy rough but free of pits and voids Rough, exhibits significant irregularities , pits and voids Grossly rough and uneven and/or fractured 3. Contou r Reproduces the normal physiologica l contour of the tooth Slight variation in the normal contour, not expected to adversely affect tissue health Does not reproduce the normal contour and expected to severely affect the tissue health Grossly over- contoured or under- contoured and severely affect the tissue surface