Class II Restorations Dr Jamal Naim Dean of the faculty of dentistry University of Palestine/Al-Zahra City

Bite Wing X-ray

MO, OD, MOD

Restorative techniques There are several different restorative techniques available to the clinician. We will discuss two options. Amalgam Filling Composite Filling

Gaining Access

Depth

Outline

Proximal Caries

Outline Bur # 330

Caries removal Clean DEJ and remove infected dentine. Size of bur determined by extent of caries

Proximal Box Preparation Preparation of gingival seat, buccal and lingual walls and axial wall of the proximal box

Proximal Box Preparation Adjacent tooth protection with matrix band

Proximal Box Preparation Extent buccal and lingual walls of proximal Box so margins lie into self cleansing areas

Proximal Box Preparation Don’t leave unsupported enamel Gingival seat parallel to occlusal surface

Proximal Box Preparation

Caries removal Line dentin with adequate base material (zinc phosphate cement or GIC)

Matrix Band Apply matrix band Apply wedge from palatal side Burnish contact area

Review cavity The cavity must be checked for the followings before manipulation of amalgam Adequate self-retention. Proper resistance. CSA 90. No caries, debris or moisture. Pulp is protected with cavity varnish, linear or base material depending on the cavity depth. Proper matrix is fitted.

Restoration Transfer amalgam to cavity in increments Start with proximal box

Restoration Condense amalgam thoroughly Use largest possible plugger

Restoration Overfill the cavity Separate amalgam from the matrix with a probe

Restoration Carve with half hollenbach carver Carve from tooth to filing following the margins Don’t over carve

Matrix removal

Matrix removal Remove the wedge Remove band first distal then mesial

The gingival margin is then checked for any over hanged margin of amalgam using sharp probe and also carving of the gingival embrasure if needed.

Finishing Complete carving Burnish all possible areas

Finishing The patient is then instructed not to use this side for the next 24 hours to avoid cracking or fracturing of the restoration. Also the patient should be advised to come after 24 hours for finishing and polishing of amalgam. Why? After 24 hours of carving to avoid disturbing crystallization of amalgam.

Finishing and polishing Aims: 1. Removal of any premature contact, marginal flashes or marginal over hangs. 2. Provide a lustrous homogenous amalgam surface. Advantages: 1. Increases corrosion resistance. 2. Decreases bacterial plaque retention and liability to recurrent caries. 3. Minimizes gingival irritation. 4. Improves strength of amalgam, as it removes the surface irregularities that act as stress concentration areas.

Finishing and polishing Technique: Finishing: Using finishing bur in a direction from the tooth to restoration. Using sandpaper discs for accessible surface.

Finishing and polishing Technique: Polishing: Using pumice with brush or rubber cup. Avoid heat generation, as it will lead to attraction of Hg to the surface resulting in: a) Weakening of the surface. b) Weakening of the bulk due to the formed porosity.

Matrix Bands Matrix: That which contains and gives shape and form to anything. Dental matrix: A piece of metal or non-metal, which gives form and support to the restoration during packing and hardening. Used only with direct restorative materials, which are packed into the cavity in the plastic form.

Matrix Bands

Tofflemire Matrix band

Tofflemire Matrix band

Function of matrix Serves as temporary wall or walls during condensation of plastic materials packed into compound or complex cavities. Gives form and shape to the restoration especially in contact area. Maintains this form of the restoration until it hardens. Prevents gingival marginal overhangs.

Wooden wedges The matrix band should be properly supported with a wedge to provide adaptation of the band on the gingival floor and prevents marginal overhangs.

The cavity should be properly matriced and wedged before manipulation of amalgam.

Management of Matrix band

Management of Matrix band

Management of Matrix band

Management of Matrix band

Management of Matrix band

Management of Matrix band

Matrix band application

Matrix band application

Matrix band application

Matrix band removal

Matrix band removal

Hawe Matrix

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