1. General Dentistry Chapter 48 1
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2. Chapter 48 Lesson 48.1
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3. Learning Objectives Define, spell, and pronounce the Key Terms.
Describe the process and principles of cavity preparation.
Discuss the differences between assisting with an amalgam and with a composite restoration.
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4. Introduction
Restorative and aesthetic dentistry is focused on the general dental needs of the patient.
Restorative dentistry is also called operative dentistry.
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5. 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.
What type of materials would be used for restorative dentistry?
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6. Esthetic Dentistry
Specific conditions requiring aesthetic dental treatment:
Discoloration due to extrinsic or intrinsic staining
Anomalies due to developmental disturbances
Abnormal spacing between teeth
Trauma
What type of materials are used for aesthetic dentistry?
Why are aesthetics important?
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7. Terminology in Cavity Preparation
Understanding the terminology will help dental assistants prepare the correct instruments for a procedure.
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8. 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 and restoring the tooth
Initial cavity preparation is the first of two stages of cavity preparation and has a set number of steps that the dentist follows in an exact order.
This process is performed to gain access to the decay or defect.
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9. Final Cavity Preparation
Removal of decayed dentin or old restorative material
Insertion of resistance and retention with the use of hand cutting instruments and burs.
Placement of protective materials (liners, bases, desensitizing, or bonding)
Final cavity preparation is the second stage of cavity preparation.
This procedure is followed after the steps in the initial cavity preparation have been completed.
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10. 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.
What is the correct position of a patient during the procedure?
How would the dental assistant explain the procedure to the patient?
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11. 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.
What are the appropriate setup items needed for an amalgam restoration?
What are the appropriate setup items needed for a composite restoration?
How can the dental assistant provide moisture control?
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12. Steps in the Restorative Procedure
The dentist evaluates the tooth to be restored.
The dentist administers local anesthesia.
The assistant readies the chosen means of moisture control.
The dentist prepares the tooth.
The dentist determines the type of dental materials.
The assistant mixes and transfers the dental materials.
The dentist burnishes, carves, or finishes the dental material.
The dentist checks the occlusion of the restoration.
The dentist finishes and polishes the restoration.
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13. Class I Restorations
These restorations are used in class I lesions, affecting the pits and fissures of the teeth.
The following surfaces are involved:
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
Why are class I restorations so common?
What are pits and fissures?
Where are they located?
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14. Fig. 48-5 Class I restorations.
Which anterior teeth would have class I restorations?
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15. Class II Restorations
A class II lesion is the extension of a class I lesion into the proximal surfaces of premolars and molars.
The following surfaces are involved:
Two-surface restoration of posterior teeth
Three-surface restoration of posterior teeth
Four-surface (or more) restoration of posterior teeth
What accessory items would be needed for a class II restoration? (Matrix system.)
Why would this be needed?
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16. Fig. 48-7 Class II restorations
Fig Class II restorations. (From Baum L, et al: Textbook of operative dentistry, ed 3, Philadelphia, 1995, Saunders.)
Which teeth are involved in this example?
Which surfaces are involved in this example?
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17. Class III and IV Restorations
Class III lesion
Affects the interproximal surface of incisors and canines
Class IV lesion
Involves a larger surface area, including the incisal edges and interproximal surface of incisors and canines
What accessory items would be needed for class III and class IV restorations? (Mylar-strip matrix system.)
Why is this needed?
Can a metal matrix system be used?
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18. Fig. 48-9 Class III composite restoration.
Which teeth are involved in this example?
What surfaces are involved in this example?
Why would a dental dam be needed in this procedure?
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19. Fig. 48-10 Class IV composite restoration.
How does a Class IV restoration differ from a Class III restoration?
Why would a dental dam be used?
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20. Class V Restorations Class V restoration Decayed lesions occur at:
Classified as a smooth-surface restoration.
Decayed lesions occur at:
Gingival third of the facial or lingual surfaces of any tooth
Root of a tooth, near the cementoenamel junction
Class V lesions tend to occur in older patients.
Why are older people more susceptible to this type of decay?
What material is generally used for this type of restoration?
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21. Fig. 48-13 A, Class V conventional tooth preparation
Fig A, Class V conventional tooth preparation. B, Schematic representation illustrating tooth preparation. (From Roberson T, et al: Textbook of operative dentistry, ed 4, Philadelphia, 2006, Elsevier.)
What could be used to help reflect the tissue away from the preparation?
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22. Chapter 48 Lesson 48.2
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23. Learning Objectives
Discuss why retention pins would be selected for a complex restorative procedure.
Describe the need for placement of an intermediate restoration.
Describe the procedure of composite veneers.
Describe tooth-whitening procedures and the role of the dental assistant.
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24. Complex Restorations
Such restorations are required when decay has extended beyond the normal size or shape.
Retention pins
Decay has extended into the cusp of a tooth and undermined the enamel and dentin.
General understanding when using retention pins: One pin is placed for each missing cusp.
Retention pins are commonly used in a tooth for retaining and supporting a restoration.
Multiple pins may be placed in one tooth.
Pins are available in different widths and are supplied in a kit.
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25. Fig Retention (retentive) pins placed in tooth structure to help retain and support a restoration.
A “drill” is used to place the pin in a prepared tooth.
No cementation of the pin is required.
The extended portion of the retention pin is open to adhere to the restorative material that is to be placed.
Why is it important to use a dental dam when preparing and placing pins? (Because the pins are so small, they are easily dropped or misplaced.)
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26. Intermediate Restorations
Restoration placed for a short term.
Primary factors for placement
Health of the tooth
A wait to receive a permanent restoration
Financial reasons
Intermediate restorations are not meant to be permanent.
An intermediate restoration is a preliminary step before a final restoration is placed.
Why has this procedure been approved as an expanded function of the dental assistant?
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27. Procedure 48-5 Placement of intermediate restorative material.
What is the appropriate consistency of the intermediate restorative material?
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28. Direct Bonded Veneers Veneer
Thin layer of tooth-colored material, applied to the facial surface of a prepared tooth
Used to improve the appearance of teeth that are:
Abraded
Eroded
Discolored with intrinsic stains
Darkened after endodontic treatment
Direct veneers are not fabricated by the dental laboratory technician.
Direct veneers are made of a resin composite material.
What are some examples of intrinsic stains?
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29. Fig. 48-15 Veneers placed to reduce discoloration and cover stain
Fig Veneers placed to reduce discoloration and cover stain. (From Roberson T, et al: Sturdevant’s art and science of operative dentistry, ed 4, St Louis, 2002, Mosby.)
Which teeth may have been involved in this procedure?
Are posterior teeth fitted with veneers? Why or why not?
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30. Fig. 48-16 Veneers placed to close diastema
Fig Veneers placed to close diastema. (From Roberson T, et al: Sturdevant’s art and science of operative dentistry, ed 4, St Louis, 2002, Mosby.)
What is a diastema?
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31. Tooth Whitening
Known as vital bleaching, tooth whitening is a noninvasive method of lightening dark or discolored teeth.
How many students know of someone who is currently using a bleaching system?
What does the term “vital” mean?
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32. Indications for Using a Tooth Whitener
Indications for Procedure
Extrinsic stains from foods, cigarette smoking, coffee, or tea
Aged, discolored teeth
Intrinsic stains, such as mild tetracycline stains and mild fluorosis
Patients should be advised that bleaching is neither guaranteed nor permanent.
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33. Fig. 48-17 Before-and-after photos of tooth whitening used for extrinsic stains.
How long do the effects of most whitening systems last? (Between 3 and 5 years.)
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34. Fig Before-and-after photos of tooth whitening used for intrinsic stains. (From Roberson T, et al: Sturdevant’s art and science of operative dentistry, ed 4, St Louis, 2002, Mosby.)
What causes intrinsic stains?
Intrinsic stains are harder to bleach.
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35. Whitening Products Chemical makeup Active ingredient Gel base
Either carbamide peroxide or hydrogen peroxide
Gel base
With one or a mixture of propylene glycol, glycerin, and water
Thickener
Carbopol
Whitening product is only applied to the facial surface of the tooth.
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36. At-Home Tooth-Whitening Procedure
Material is placed in a thermoplastic custom tray that the patient wears for a designated period.
With the 10% to 16% carbamide peroxide gels, the wear schedule is 1 hour twice a day for the first week and once a day for the second week.
The 20% to 22% mixture is used for 1 hour a day for 2 weeks.
Hydrogen peroxide is used for 15 to 30 minutes, two or three times a day, for 2 weeks.
What type of impression is taken?
What symptoms would a patient who wore the bleach tray longer than recommended experience?
Many patients do not see the effects of bleaching if they do the maxillary and mandibular arches at the same time.
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37. Tooth-Whitening Strips
Thin, flexible strips are coated with an adhesive hydrogen peroxide whitening gel.
Application
The patient peels off the backing like a Band-Aid and presses the strip to the facial anterior teeth.
The remaining portion of the strip is folded onto the lingual surface.
Extra-strength whitening strips are dispensed by dental offices only.
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38. Possible Complications to Tooth Whitening
Thermal hypersensitivity
Patient may experience sensitivity to heat and cold after removal of the tray and material. The use of toothpaste for sensitive teeth is recommended.
Tissue irritation
Gingival tissue exposed to excess gel as a result of improper tray fit may become irritated. Tell the patient not to overfill the tray with material and to remove any excess after seating the tray.
Why do patients undergoing tooth whitening need to schedule follow-up dental appointments?
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39. Dental Assistant’s Role in Tooth-Whitening Procedure
Aid in recording the medical and dental history.
Assist in making shade selection.
Take intraoral photographs before and after whitening.
Take and pour up preliminary impressions for the tray.
Fabricate and trim the tray.
Provide postoperative instructions.
Assist in weekly or biweekly clinical visits.
What is the purpose of taking a preshade?
Why are photographs taken before and after the tooth-whitening process?
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40. Patient Instructions for Tooth-Whitening Procedure
Brush and floss before tray placement.
Place equal amounts of gel in tray.
Seat tray.
Do not eat or drink when wearing the tray.
Wear tray for the recommended time.
If the patient experiences any problems, discontinue use and discuss with the dentist.
Why shouldn’t patients eat or drink while wearing the bleaching trays?
What sort of problems may a patient experience during tooth whitening?
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