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Pedia class II

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Pediatric Dentistry I …

Pediatric Dentistry I
Forth Year


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  • 1. 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
  • 2. Modifications  Relatively wider isthmus width one-third the inter cuspal distance  Conservative proximal extensions light, but cannot pass an explorer tip through
  • 3. Modifications No proximal grooves No reverse curves
  • 4. Class II
  • 5. 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
  • 6. Class II Cavity Preparation Mandibular
  • 7. Class II Cavity Preparations No MOD’s on first primary molars !!
  • 8. Class II Cavity Preparations
  • 9. Protect adjacent proximal surface
  • 10. Class II cavity preparation in Primary molars
  • 11. Cross-sectional View of Class II  Gingival floor position  Box is perpendicular to long axis  Rounded angles
  • 12. Correct Incorrect Class II cavity preparation in Primary molars
  • 13. Correct Incorrect Class II cavity preparation in Primary molars
  • 14. Class II cavity preparation in Primary molars Correct Incorrect Incorrect
  • 15. Common Errors - Class II’s
  • 16. 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
  • 17. 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
  • 18. 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
  • 19. 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
  • 20. Adapt Matrix Band to Tooth
  • 21. 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
  • 22. 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
  • 23. Condensation and Carving  “Back to back” condensation of Class II’s  Carving described as “hill and valley”  Polishing procedure
  • 24. 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
  • 25. Finishing of Amalgam Restorations • Reduce tarnish and corrosion • Improve marginal integrity Polishing should be delayed for 24 hours
  • 26. 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.
  • 27. “slot” preparation • Modified class II cavity design for the • placement of RMGIs.
  • 28. 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
  • 29. Lack of buccal clearance / unsupported enamel CLASS II COMPOSITE RESIN RESTORATION
  • 30. Outline form includes all carious defects
  • 31. Bevel gingival margin
  • 32. Gingival bevel
  • 33. Clearance ( convenience form )
  • 34. Clearance ( convenience form ) Clearance Place explorer tip on gingival floor and pull through buccal/lingual space
  • 35. AE – enamel 15 seconds
  • 36. Rinse thoroughly
  • 37. Well wedged Tofflemire band
  • 38. Palodent band - bitine ring
  • 39. Application of bond resin to moist dentin
  • 40. Air thin bond resin
  • 41. Light-cure bond resin 20 seconds
  • 42. Apply thin layer of flowable C.R.
  • 43. Apply thin layer of flowable C.R.Light-cure flowable C.R.for 30 seconds
  • 44. Express a small amount of C.R. before using
  • 45. Place C.R. with a condenser
  • 46. 1st. application of C.R.
  • 47. 1st. application of C.R. Light-cure 1st. layer of C.R. 30 seconds
  • 48. 2nd. application of C.R.
  • 49. Use of contact instrument
  • 50. Light curing 2nd. C.R. application 30 seconds
  • 51. Hole left after removal of contact instrument
  • 52. 3rd. application of C.R.
  • 53. Developing occlusal anatomy before curing
  • 54. 40 second cure of final increment of C.R.
  • 55. Use of round bur to develop anatomy
  • 56. Use an explorer to check for flash/ditching
  • 57. Use of Soflex disk to shape marginal ridge
  • 58. Check occlusion / adjust
  • 59. Finishing diamond Finishing bur White stone Round bur C.R. polishing system
  • 60. C.R. polishing system
  • 61. Acid etching prior to placing surface sealant
  • 62. Application of a surface sealant