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Pediatric Dentistry I

Pediatric Dentistry I
Forth Year

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    Pedia class II Pedia class II Presentation Transcript

    • Modifications  Concave pulpal floor and gingival seat  Rounded internal line angles both decrease stress in the restoration View from distal surface of primary 1st molar B L
    • Modifications  Relatively wider isthmus width one-third the inter cuspal distance  Conservative proximal extensions light, but cannot pass an explorer tip through
    • Modifications No proximal grooves No reverse curves
    • Class II
    • Class II cavity preparation in Primary molars • Complete class 1 using #330 bur • Extend occlusal outline to marginal ridge • Switch to #245 Bur - 3 mm length • Sweep bur buccolingually in a pendulum motion and in a gingival direction. • Break contacts and check with explorer • Axial wall should follow external contour • Width of isthmus 1/3 of occlusal table • Proximal box widest at gingival margin • Rounded axiopulpal line angle • No bevel at the gingival margins
    • Class II Cavity Preparation Mandibular
    • Class II Cavity Preparations No MOD’s on first primary molars !!
    • Class II Cavity Preparations
    • Protect adjacent proximal surface
    • Class II cavity preparation in Primary molars
    • Cross-sectional View of Class II  Gingival floor position  Box is perpendicular to long axis  Rounded angles
    • Correct Incorrect Class II cavity preparation in Primary molars
    • Correct Incorrect Class II cavity preparation in Primary molars
    • Class II cavity preparation in Primary molars Correct Incorrect Incorrect
    • Common Errors - Class II’s
    • Failures of Amalgam Restorations Fracture of the isthmus of a Class II due to insufficient bulk of amalgam Marginal failure in proximal box area due to excessive flare of the cavo-surface margin Recurrent caries failure to extend preparation adequately
    • w T-band w Tofflemire • does not fit contour of primary tooth well • difficult to fit multiple matrices w Spot welded • allows for multiple matrix placement • requires a spot welder chair side w Auto-matrix • costly Types of Matrices
    • Spot Welded Matrix  Cut matrix and spot weld ends 3/16 “ wide and thin (..002”) matrix  Form a loop  Hold ends in spot welder  Weld at low setting
    • Adapting Matrix Band Place band over tooth with welded on buccal Seat band extends 0.5-1 mm gingival to the cavo-surface margin Band extend occlusally .5-1mm beyond the marginal ridge Stabilize band with finger
    • Adapt Matrix Band to Tooth
    • Matrix Grasp welded ends with flat-nose, serrated pliers (#110) at center of buccal surface of tooth tightly Spot weld band at crease and trim ends Return to tooth and wedge properly Remove matrix by inserting flat blade instrument between tooth and matrix at crease
    • Cavity Bases and Liners – Purpose of base prior to condensation is to prevent thermal insulation for the pulp. – Use of calcium hydroxide influences formation of secondary dentin. • Initiates local inflammatory response at site of contact between pulp and calcium hydroxide
    • Condensation and Carving  “Back to back” condensation of Class II’s  Carving described as “hill and valley”  Polishing procedure
    • Condensing & Carving of Amalgam • Using an amalgam carrier, add increments & condense using positive finger rest. • Overfill prep, begin to carve and burnish the occlusal portion with a lateral condenser • After initial set, create the marginal ridge using an explorer • Carve restoration & remove excess from margins using a cleoid-discoid or hollenback carver • Carefully remove band and burnish restoration using a ball burnisher. • Apply moist cotton pellet or pumice paste for final smoothening • Remove rubber dam and check occlusion
    • Finishing of Amalgam Restorations • Reduce tarnish and corrosion • Improve marginal integrity Polishing should be delayed for 24 hours
    • Interproximal Box • Buccal and lingual walls should go straight out into the interproximal box in Class II cavity preparations • Buccal & lingual walls convergent towards occlusal • Gingival floor just past contact or height of contour, flat & well defined • Axial wall convex to follow the surface anatomy • Axial depth should be 1 mm • Buccal and lingual cusps adjacent to box should have plenty of sound tooth structure left ie. They shouldn't be too thin.
    • “slot” preparation • Modified class II cavity design for the • placement of RMGIs.
    • CLASS II PREPARATION COMPARISON • AMALGAM - 0.5 mm into dentin - no cavo-surface bevel - 0.5 mm prox.clearance - isthmus 1.0+ - no gingival bevel - occlusal dovetail • COMPOSITE - 0.5 mm into dentin - cavo-surface bevel - 0.5 mm prox. clearance - isthmus 1.0+ - gingival bevel - no dovetail needed
    • Lack of buccal clearance / unsupported enamel CLASS II COMPOSITE RESIN RESTORATION
    • Outline form includes all carious defects
    • Bevel gingival margin
    • Gingival bevel
    • Clearance ( convenience form )
    • Clearance ( convenience form ) Clearance Place explorer tip on gingival floor and pull through buccal/lingual space
    • AE – enamel 15 seconds
    • Rinse thoroughly
    • Well wedged Tofflemire band
    • Palodent band - bitine ring
    • Application of bond resin to moist dentin
    • Air thin bond resin
    • Light-cure bond resin 20 seconds
    • Apply thin layer of flowable C.R.
    • Apply thin layer of flowable C.R.Light-cure flowable C.R.for 30 seconds
    • Express a small amount of C.R. before using
    • Place C.R. with a condenser
    • 1st. application of C.R.
    • 1st. application of C.R. Light-cure 1st. layer of C.R. 30 seconds
    • 2nd. application of C.R.
    • Use of contact instrument
    • Light curing 2nd. C.R. application 30 seconds
    • Hole left after removal of contact instrument
    • 3rd. application of C.R.
    • Developing occlusal anatomy before curing
    • 40 second cure of final increment of C.R.
    • Use of round bur to develop anatomy
    • Use an explorer to check for flash/ditching
    • Use of Soflex disk to shape marginal ridge
    • Check occlusion / adjust
    • Finishing diamond Finishing bur White stone Round bur C.R. polishing system
    • C.R. polishing system
    • Acid etching prior to placing surface sealant
    • Application of a surface sealant