1. The Restorative Process M.D.A. Ch. 48; Ch. 28
General Dentistry
The Restorative Process
M.D.A. Ch. 48;
Ch. 28

2. Restorative Dentistry
Specific conditions that initiate a need for restorative dental treatment are:
Initial or recurring decay
Replacement of failed restorations
Abrasion or the wearing away of tooth structure
Erosion of tooth structure

3. Esthetic Dentistry
Specific conditions that initiate a need for esthetic dental treatment are:
Discoloration due to extrinsic or intrinsic staining
Anomalies due to developmental disturbances
Abnormal spacing between teeth
Trauma

4. Terminology in Cavity Preparation

5. Initial Cavity Preparation
Outline Form
Design and initial depth of sound tooth structure
Resistance Form
Shape and placement of cavity walls
Retention Form
To resist displacement or removal
Convenience Form
Provides accessibility in preparing restoring tooth

6. Final Cavity Preparation
Removal of decayed dentin, or old restorative material
Insert resistance and retention with the use of hand cutting instruments and burs
Placement of protective materials (liners, bases, desensitizing or bonding)

7. Patient Preparation for Restorative Procedures
Inform the patient what to expect throughout the procedure.
Position the patient correctly for the dentist and the type of procedure.
Explain each step to the patient as the procedure progresses.

8. Responsibilities of the Chairside Assistant
Prepare the setup for the procedures.
Know and anticipate the dentist's needs.
Provide moisture control.
Transfer dental instruments and accessories.
Mix and transfer dental materials.
Maintain patient comfort.

9. Steps in the Restorative Procedure
Dentist evaluates the tooth to be restored.
Dentist obtains local anesthesia.
Assistant readies the type of moisture control.
Dentist prepares the tooth.
Dentist determines the type of dental materials.
Assistant mixes and transfers the dental materials.
Dentist burnishes, carves, or finishes the dental material.
Dentist checks the occlusion of the restoration.
Dentist finishes and polishes the restoration.

10. Class I Restorations
Class I lesion affecting the pit and fissures of the teeth
Surfaces involved are:
Occlusal pits and fissures of premolars and molars
Buccal pits and fissures of mandibular molars
Lingual pits and fissures of the maxillary molars
Lingual pits of maxillary incisors, most frequently in the pit near the cingulum

11. Fig. 48-5 Class I restoration

12. Class II Restorations
Class II lesion is the extension of the Class I lesion into the proximal surfaces of premolars and molars.
Surfaces involved:
Two-surface restoration of posterior teeth
Three-surface restoration of posterior teeth
Four- or more surface restoration of posterior teeth

13. Fig Class II restorations (From Baum L et al: Textbook of operative dentistry, ed 3, Philadelphia, 1995, Saunders.)

14. Class III and IV Restorations
Class III Lesion
Affects the interproximal surface of incisors and canines
Class IV Lesion
Involves a larger surface area, which includes the incisal edge and interproximal surface of incisors and canines

15. Fig Class III restoration (From Baum L et al: Textbook of operative dentistry, ed 3, Philadelphia, 1995, Saunders.)

16. Fig Class IV restoration (From Baum L et al: Textbook of operative dentistry, ed 3, Philadelphia, 1995, Saunders.)

17. Class V Restorations Class V Restoration
Classified as a smooth surface restoration
These decayed lesions occur at:
Gingival third of the facial or lingual surfaces of any tooth
Root of a tooth, near the cementoenamel junction

18. Fig Class V restoration (From Baum L et al: Textbook of operative dentistry, ed 3, Philadelphia, 1995, Saunders.)

19. Recording the Dental Examination
Specific criteria required to know prior to charting:
Black’s classification of cavities
Tooth diagrams
Tooth numbering systems
Color coding
Charting

20. Fig. 28-7 Black’s classification of cavities

21. Fig. 28-8 Anatomic diagram for charting

22. Fig. 28-9 Geometric diagram for charting

23. Fig. 28-10 A, Universal numbering system

24. Fig. 28-10 B, ISO/FDI numbering system

25. Fig. 28-9 C, Palmer Notation System

26. Fig. 28-11 Color coding in charting (Courtesy of Eaglesoft)

27. Soft Tissue Examination
Extraoral Features
Face, neck, tissue changes, skin abrasions, lips
Cervical lymph nodes
Temporomandibular joint
Oral habits
Intraoral Features
Interior of the lips
Oral mucosa
Tongue
Floor of the mouth

28. Examination and Charting of the Periodontium
Specific periodontal findings to be recorded:
Overall health condition of gingiva
Signs and location of inflammation
Location and amount of plaque and calculus
Areas of unattached gingiva
Areas of periodontal pockets measuring greater than 3 mm
Presence of furcation involvement
Dental mobility scale

29. Dental Mobility Scale

30. Furcation Involvement
Furcation-the anatomical region of multirooted teeth where the roots separate.
Class I= ^ Early involvement: <1mm
Class II= ∆ Moderate involvement: (1)between 1mm & 3mm; (2) >3mm
Class III= ▲Severe involvement: Through and through, covered by soft tissue
Class IV=▲+ Severe involvement: through and through, complete visualization

31. 3 Main types of bridges:
Traditional bridges involve creating a crown for the tooth or implant on either side of the missing tooth, with a pontic in between. Traditional bridges are the most common type of bridge and are made of either porcelain fused to metal or ceramics.
Cantilever bridges are used when there are adjacent teeth on only one side of the missing tooth or teeth.
Maryland bonded bridges (also called a resin-bonded bridge or a Maryland bridge) are made of plastic teeth and gums supported by a metal framework. Metal wings on each side of the bridge are bonded to your existing teeth.

32. Maryland Bridge

33. Cantilever Bridge
A cantilever bridge is a fixed bridge that attaches to adjacent teeth on one end only.
In areas of your mouth that are under less stress, such as your front teeth, a cantilever bridge may be used. Cantilever bridges are used when there are teeth on only one side of the open space.