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Preparo e restauração classes II e V em amálgama

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Preparo e restauração classes II e V em amálgama

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Preparo e restauração classes II e V em amálgama

  1. 1. Prof. Ms. Guilherme TerraDisciplina de Dentística Operatória AplicadaPREPAROS E RESTAURAÇÕES EMAMÁLGAMA
  2. 2. CLASSIFICAÇÃO DAS CAVIDADES Classificação de Black.  Classe I;  Classe II;  Classe III;  Classe IV;  Classe V.
  3. 3. CLASSIFICAÇÃO DE BLACK Classe II.  Cavidades que envolvam as faces proximais dos pré-molares e molares.
  4. 4. CLASSE II
  5. 5. CLASSE II Segue os mesmos parâmetros já estabelecidos para as cavidades classe I. Realiza-se um desgaste complementar envolvendo parte das cristas marginais, porém sem rompê-las. Proteger o dente vizinho com uma matriz de aço. A caixa proximal só deve ser iniciada após a complementação do preparo oclusal.
  6. 6. CLASSE II Com fresa cilíndrica, realizar a caixa proximal.
  7. 7. CURVA REVERSA DE HOLLEMBACK
  8. 8. CURVA REVERSA DE HOLLEMBACK
  9. 9. INCLINAÇÃO DA PAREDE AXIAL Ângulo áxio-pulpar arredondado
  10. 10. ACABAMENTO DO PREPARO Realizado com broca cilíndrica laminada em baixa rotação. Acabamento das paredes de esmalte com os cortantes de Black.  Machado  Enxada
  11. 11. CLASSE II Características finais do preparo
  12. 12. SISTEMAS DE MATRIZES Dispositivos que substituem paredes ausentes, possibilitando um correto contorno de uma restauração. Mondelli, 1990 reproduzir o contorno do dente proporcionar área de contato confinar o material no interior da cavidade não atingir o dente vizinho durante o preparo cavitário
  13. 13. CUNHAS E MATRIZES Conferem à cavidade o contorno correto da porção proximal da restauração;Utilizada para não deixar excessos interproximais. Diversos tipos no mercado:  Matrizes tipo Boomerang – conjunto com porta matriz  Matrizes individuais pré-contornadas  Pallodent – Dentsply  Unimatrix – TDV  Composi Tigth – GDS Garrison
  14. 14. CONJUNTO MATRIZ BOOMERANG - PORTAMATRIZ
  15. 15. CONJUNTO MATRIZ BOOMERANG - PORTAMATRIZ
  16. 16. POSICIONAMENTO DO CONJUNTO MATRIZBOOMERANG - PORTA MATRIZ
  17. 17. MATRIZES PRÉ-CONTORNADAS
  18. 18. MATRIZES PRÉ-CONTORNADAS
  19. 19. CUNHAS INTER-PROXIMAIS
  20. 20. CUNHAS INTER-PROXIMAIS
  21. 21. PREPARO CAVITÁRIO “SNAKE EYES” Devido à presença da ponte de esmalte na face oclusal do primeiro pré-molar inferior, este preparo consta de duas pequenas cavidades. Realiza-se a abertura com fresa diamantada esférica. Segue o preparo com fresa diamantada cilíndrica.
  22. 22. PREPARO CAVITÁRIO “SNAKE EYES” O preparo deverá restringir-se às fossas mesial e distal. Conservar a ponte de esmalte. A abertura deve permir a penetração do instrumento condensador.
  23. 23. PREPARO CAVITÁRIO “SNAKE EYES”
  24. 24. PREPARO CAVITÁRIO “SNAKE EYES” A parede pulpar deve acompanhar a inclinação da câmara pulpar e da face oclusal.
  25. 25. PREPARO CAVITÁRIO CLASSE II DE ALMQVIST“SLOT VERTICAL” Indicado em lesões cariosas estritamente proximais. O acesso para esse preparo é feito pela superfície oclusal. Mínimo de desgaste de tecido sadio.
  26. 26. “SLOT VERTICAL” Envolve apenas a crista marginal da face oclusal. Distância intercuspídea de ¼. As paredes vestibular e lingual devem convergir para oclusal.
  27. 27. “SLOT VERTICAL” A parede cervical terá a extensão necessária para a remoção do tecido cariado. Ângulo áxio-gengival avivado.
  28. 28. “SLOT VERTICAL” Retenções adicionais (canaletas) nos ângulos áxio- vestibular e áxio-lingual.
  29. 29. “SLOT VERTICAL” As paredes presentes são axial, gengival, vestibular e lingual. Proteger o dente vizinho com uma matriz de aço. Também utiliza-se conjunto matriz-porta matriz.
  30. 30. “SLOT VERTICAL”
  31. 31. “SLOT VERTICAL” Convergência das paredes V e L
  32. 32. “SLOT VERTICAL” Características finais do preparo
  33. 33. PREPARO CAVITÁRIO CLASSE II DEROGGENKAMP COM ACESSO VESTIBULAR“SLOT HORIZONTAL” Indicado em casos selecionados. A lesão cariosa deve encontrar-se em estágio inicial. Deve encontrar-se com acesso favorável por vestibular ou lingual. Semelhante a um preparo classe V na face proximal.
  34. 34. “SLOT HORIZONTAL” Retenções adicionais (canaletas) nos ângulos em toda a extensão da parede axial.
  35. 35. “SLOT HORIZONTAL” Realizado abaixo do ponto de contato, próximo a junção amelo-cementária.
  36. 36. CLASSIFICAÇÃO DE BLACK Classe V.  Cavidades preparadas no terço gengival, nas faces vestibular e lingual / palatina de todos os dentes.
  37. 37. CLASSE V Indicado quando houver cárie nas faces livres do dente, no terço cervical vestibular ou lingual. Em geral, esse tipo de cavidade já se encontra aberta. Quando não se encontra aberta, realizar a abertura com fresa esférica. Preparo realizado com fresa cilíndrica (1090, 1091 ou 1092).
  38. 38. CLASSE V A parede axial deverá acompanhar o contorno da face vestibular. As paredes oclusal e gengival devem ser perpendiculares à parede axial.
  39. 39. CLASSE V As paredes mesial e distal devem ser ligeiramente divergentes.  Acompanhar a inclinação dos prismas e formar um ângulo reto com a superfície externa do dente.
  40. 40. CLASSE V Esse tipo de cavidade é mais larga do que profunda. Necessidade de retenções adicionais. Fresa tronco cônica invertida.
  41. 41. CLASSE V Características finais do preparo
  42. 42. Restaurações emamálgama de prata
  43. 43. INSERÇÃO Deve ser inserido em pequenas porções com o auxílio do porta amálgama.
  44. 44. CONDENSAÇÃO Visa o preenchimento da cavidade e a perfeita adaptação do amálgama com as paredes e ângulos. Visa também a compactação da massa. Realizada por um condensador de amálgama.
  45. 45. BRUNIDURA PRÉ-ESCULTURA Realizada com um brunidor ovóide ou esférico, com pressão firme sobre o amálgama. O intuito é remover o excesso de mercúrio.
  46. 46. ESCULTURA  Realizada logo após a brunidura pré-escultura com o instrumento de Hollemback .  O tempo de trabalho para a escultura pode variar de 3 a 15 minutos dependendo da liga.  Amálgama de cristalização rápida  3 a 6 minutos  Amálgama de cristalização regular  6 a 10 minutos  Amálgama de cristalização lenta  10 a 15 minutos
  47. 47. BRUNIDURA PÓS-ESCULTURA Realizada com leve pressão em movimentos circulares. Dar maior brilho e lisura superficial.
  48. 48. ACABAMENTO E POLIMENTO  Reduz o depósito de placa e prolonga a vida da restauração.  Corrigi discrepâncias marginais e melhora o contorno.  Deve ser feito, no mínimo após 48 horas.
  49. 49. ACABAMENTO E POLIMENTO  O acabamento é realizado com fresas multilaminada s de 12 ou 30 lâminas, em baixa rotação.
  50. 50. ACABAMENTO E POLIMENTO  Nas proximais usa-se tiras de lixa.  O polimento deve ser feito com movimentos intermitentes e sob refrigeração, para evitar o afloramento de mercúrio.
  51. 51. ACABAMENTO E POLIMENTO O polimento dever ser iniciado com as pontas de borracha mais abrasiva para as menos abrasivas, em baixa rotação. Estas borrachas abrasivas são encontrados nas cores marron (mais abrasiva), verde e azul;
  52. 52. SEQUÊNCIA CLÍNICA Isolamento do campo operatório; Adaptação do porta matriz (Classe II); Adaptação da cunha interproximal;
  53. 53. SEQUÊNCIA CLÍNICA Trituração do amálgama; O amálgama deve ser colocado num pote Dapen de vidro; Acomodar o material e condensar primeiro nas proximais (Classe II);
  54. 54. SEQUÊNCIA CLÍNICA Condensar contra as paredes e ângulos;
  55. 55. DELIMITAÇÃO DA CRISTA MARGINAL Remoção dos excessos grosseiros
  56. 56. SEQUÊNCIA CLÍNICA Brunir com movimentos circulares e rápidos;  Brunimento pré- escultura; Delimitar a crista marginal com explorador (Classe II);
  57. 57. SEQUÊNCIA CLÍNICA Esculpir com o Hollemback apoiando a ponta ativa do instrumento em dente, seguindo a inclinação das vertentes; Aguardar a cristalização inicial;
  58. 58. SEQUÊNCIA CLÍNICA Brunimento pós-escultura.

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