Indian Dental Academy: will be one of the most relevant and exciting training center with best faculty and flexible training programs for dental professionals who wish to advance in their dental practice,Offers certified courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic Dentistry, Periodontics and General Dentistry.
Indian Dental Academy: will be one of the most relevant and exciting training center with best faculty and flexible training programs for dental professionals who wish to advance in their dental practice,Offers certified courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic Dentistry, Periodontics and General Dentistry.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
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Retention and relapse /certified fixed orthodontic courses by Indian dental a...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
Dental Implants: Your Guide to the Implant Placement ProcessAndrew Martin
This presentation provides a comprehensive overview of the dental implant process, including risks associated with tooth loss, dental implant candidacy, benefits of dental implants, implant placement process and more.
Retention & relapse in orthodonticsChetan Basnet
Retention:
Maintaining newly moved teeth in a position long enough to aid in stabilizing correction.
-Moyer
Relapse:
It has been defined as the loss of any correction achieved by orthodontic treatment.
-Moyer
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
Retention and relapse /certified fixed orthodontic courses by Indian dental a...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
Dental Implants: Your Guide to the Implant Placement ProcessAndrew Martin
This presentation provides a comprehensive overview of the dental implant process, including risks associated with tooth loss, dental implant candidacy, benefits of dental implants, implant placement process and more.
Retention & relapse in orthodonticsChetan Basnet
Retention:
Maintaining newly moved teeth in a position long enough to aid in stabilizing correction.
-Moyer
Relapse:
It has been defined as the loss of any correction achieved by orthodontic treatment.
-Moyer
Intra & extra coronal restoration resistance form /certified fixed orthodont...Indian dental academy
Welcome to Indian Dental Academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy has a unique training program & curriculum that provides students with exceptional clinical skills and enabling them to return to their office with high level confidence and start treating patients
State of the art comprehensive training-Faculty of world wide repute &Very affordable.
silver Amalgam cavity preparation for class 1 /certified fixed orthodontic co...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Lecture 3 Facial cosmetic surgery
Maxillofacial Surgery
Dental Students Fifth Year second semester
Al Azhar University Gaza Palestine
Dr. Lama El Banna
https://twitter.com/lama_k_banna
Lecture 1 Facial cosmetic surgery
Maxillofacial Surgery
Dental Students Fifth Year second semester
Al Azhar University Gaza Palestine
Dr. Lama El Banna
https://twitter.com/lama_k_banna
Facial neuropathology Maxillofacial SurgeryLama K Banna
Lecture 4 facial neuropathology
Maxillofacial Surgery
Dental Students Fifth Year second semester
Al Azhar University Gaza Palestine
Dr. Lama El Banna
https://twitter.com/lama_k_banna
Lecture 2 Facial cosmetic surgery
Maxillofacial Surgery
Dental Students Fifth Year second semester
Al Azhar University Gaza Palestine
Dr. Lama El Banna
https://twitter.com/lama_k_banna
Lecture 12 general considerations in treatment of tmdLama K Banna
Maxillofacial Surgery
Dental Students Fifth Year First semester
Lecture Name 12 general considerations in the treatment of TMJ
Al Azhar University Gaza Palestine
Dr. Lama El Banna
Maxillofacial Surgery
Dental Students Fifth Year First semester
Lecture Name TMJ temporomandibular joint
Lecture 10
Al Azhar University Gaza Palestine
Dr. Lama El Banna
https://twitter.com/lama_k_banna
Lecture 11 temporomandibular joint Part 3Lama K Banna
Maxillofacial Surgery
Dental Students Fifth Year First semester
Lecture Name TMJ temporomandibular joint Part 3
Lecture 11
Al Azhar University Gaza Palestine
Dr. Lama El Banna
Maxillofacial Surgery
Dental Students Fifth Year First semester
Lecture Name TMJ anatomy examination 2
Lecture 9
Al Azhar University Gaza Palestine
Dr. Lama El Banna
Lecture 7 correction of dentofacial deformities Part 2Lama K Banna
Maxillofacial Surgery
Dental Students Fifth Year First semester
Lecture Name Correction of dentofacial deformities Part 2
Lecture 7
Al Azhar University Gaza Palestine
Dr. Lama El Banna
Lecture 8 management of patients with orofacial cleftsLama K Banna
Maxillofacial Surgery
Dental Students Fifth Year First semester
Lecture Name management of patients with orofacial clefts
Lecture 8
Al Azhar University Gaza Palestine
Dr. Lama El Banna
Lecture 5 Diagnosis and management of salivary gland disorders Part 2Lama K Banna
Maxillofacial Surgery
Dental Students Fifth Year First semester
Lecture Name Salivary gland 2
Diagnosis and management of salivary gland disorders Part 2
Al Azhar University Gaza Palestine
Dr. Lama El Banna
Lecture 6 correction of dentofacial deformitiesLama K Banna
Maxillofacial Surgery
Dental Students Fifth Year First semester
Lecture Name Correction of dentofacial deformities
Lecture 6
Al Azhar University Gaza Palestine
Dr. Lama El Banna
lecture 4 Diagnosis and management of salivary gland disordersLama K Banna
Maxillofacial Surgery
Dental Students Fifth Year First semester
Lecture Name Salivary gland
Diagnosis and management of salivary gland disorders
Al Azhar University Gaza Palestine
Dr. Lama El Banna
Maxillofacial Surgery 1
Dental Students Fifth Year First semester
Lecture Name maxillofacial trauma Part 3
Al Azhar University Gaza Palestine
Dr. Lama El Banna
Maxillofacial Surgery
Dental Students Fifth Year First semester
Lecture Name maxillofacial trauma part 2
Al Azhar University Gaza Palestine
Dr. Lama El Banna
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Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
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New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...
Operative dentistry fifth year
1. Operative Assignment 2
Prepared by:
Lama El Banna
Marof Hamouda
Haneen Al Galiz
Dalia Al Siksik
Ayah Tbasi
Safaa Abu Maqaseb
Bushrah Al Shaaer
Alaa Haboush
Supervisor:
2. Dr. Inas AlAlem
Clinical Technique for Class I Amalgam Restoration
Class I restorations restore defects on the occlusal surfaces of posterior teeth, the occlusal
thirds of the facial and lingual surfaces of molars, and the lingual surfaces of maxillary anterior
teeth.
Initial Clinical Procedures A preoperative assessment of the occlusal relationship of the involved
and adjacent teeth is necessary. After administration of local anesthetic, isolation of the
operating field with the rubber dam is recommended .
Rubber dam isolation is especially indicated when removing deep caries (judged to be <1 mm
from the pulp), during amalgam condensation, and for mercury hygiene. In addition, the dam
prevents moisture contamination of the amalgam mix during insertion.
Tooth Preparation for Class I Amalgam Restoration
Initial Tooth Preparation: is defined as establishing the outline form by extension of the
external walls to sound tooth structure while maintaining a specified, limited depth (usually just
inside the DEJ) and providing resistance and retention forms.
The ideal outline form for an amalgam restoration incorporates the following resistance
form principles that are basic to all amalgam tooth preparations of occlusal surfaces.
1- Extending around the cusps to conserve tooth structure and prevent the internal line angles
from approaching the pulp horns.
2- Extending the outline to include fissures, placing the margins on relatively smooth, sound
tooth structure.
3- Extending the outline form to include enamel undermined by the caries lesion.
4- Using enameloplasty on the terminal ends of shallow fissures to conserve tooth structure.
5- Establishing an optimal, conservative depth of the pulpal wall.
Class I occlusal tooth preparation is begun by entering the deepest or most carious pit with a
No.245 carbide bur at high speed with air-water spray. A punch cut is performed by orienting
the bur such that its long axis parallels the long axis of the tooth crown.
When the pits are equally defective, the distal pit should be entered as illustrated. Entering the
distal pit first provides increased visibility for the mesial extension. the bur should be positioned
such that its distal aspect is directly over the distal pit, minimizing extension into the marginal
ridge (see Fig. 10.28C). he bur should be rotating when it is applied to the tooth and should not
stop rotating until it is removed from the tooth .
3. On posterior teeth, the approximate depth of the DEJ is located at 1.5 to 2 mm from the occlusal
surface. As the bur enters the pit, an initial target depth of 1.5 mm should be established. his is
one half the length of the cutting portion of the No. 245 bur. he 1.5-mm pulpal depth is
measured at the central fissure.
The pulpal wall is established 0.1 to 0.2 mm into dentin.
Distal extension into the distal marginal ridge to include a fissure or caries occasionally requires
a slight tilting of the bur distally (≤10 degrees). his creates a slight occlusal divergence to the
distal wall to prevent undermining the marginal ridge of its dentin support.
For premolars, the distance from the margin of such an extension to the proximal surface
usually should not be less than ~1.6 mm . For molars, this minimal distance is ~2 mm.
Minimal distal (or mesial) extension often does not require changing the orientation of the bur’s
axis from being parallel to the long axis of the tooth crown.
While maintaining the burs orientation and depth, the preparation is extended distofacially or
distolingually to include any fissures that radiate from the pit consideration should be given to
changing to a bur of smaller diameter or to using enameloplasty. Both of these approaches
conserve the tooth structure and therefore minimize weakening of the tooth.
When the central fissure has minimal caries, one pass through the fissure at the prescribed
depth provides the desired minimal width to the isthmus. Ideally the width of the isthmus should
be just wider than the diameter of the bur. It is well established that a tooth preparation with a
narrow occlusal isthmus is less prone to fracture .
If the fissure extends onto the marginal ridge, which results in less than 1.6mm marginal ridge
after preparation, the long axis of the bur should be changed to establish a slight occlusal
divergence to the mesial/distal wall to avoid undermining the enamel in the marginal area.
The strongest and ideal enamel margin should be
composed of full-length enamel rods attached to sound
dentin, supported on the preparation side by shorter
rods that are also attached to sound dentin.
The pulpal floor is almost always in dentin, depending
on the enamel thickness.
The adequate form of amalgam cavity preparation
requires that the extent of the preparation be adjusted
to provide adequate access, visibility and complete
removal of caries.
The initial preparation should ensure that all the
caries lesion is removed from the DEJ. At this stage, the pulpal wall should remain at the initial
ideal depth, even if any restorative material or soft caries lesion remains in the pulpal wall.
Remaining caries and, (if present, old restorative material) is removed during the final tooth
preparation.
Enameloplasty is not indicated in areas of contact, in these cases when enameloplasty is
contraindicated and deep fissure is found 3 are available:
1. Make no further change in the outline form (strongly considered except
in patients at high risk for caries).
2. Extend through the marginal ridge when margins would be lingual to the contact.
3. Include the fissure in a conservative Class II tooth Preparation.
4. In extensive caries depth, RDB less than 1mm, put liner on the pulpal floor before continuing
the preparation, this helps in reducing more stresses on the pulp during cavity preparation.
In extensive caries width, caries involving cuspal inclines,
orientation of the bur is important to make occlusal conversion with
Cavosurface angle of 90-100 degrees, this gives a space for
supported amalgam restoration.
For amalgam, cavity preparation should extend to the DEJ, even
in smaller caries, and extend laterally to remove all enamel
undermined by the caries lesion and examining the lateral
extension of the lesion.
Primary resistance form is obtained by extending outline of
the preparation to include only undermined and defective tooth structure Retention form
1. Primary retention form,, occlusal convergence of the enamel wall
2. Secondary retention,, undercuts area left in Dentin
When extending the outline form, Enameloplasty should be used in any indicated case Capping
the cusp is indicated when the defect extends to more than one half the distance between the
primary groove and cusp tip, When the distance is two third, cusp reduction and coverage to
prevent fracture during function.
Final tooth preparation include,,
1 removal of remaining defective enamel and soft Dentin
2 pulp protection
3 finishing the external wall
4 debridement (cleaning) and inspecting the preparation Maximum preparation depth =2 mm
If the remnants are few and small, they may be removed with an appropriate carbide bur
Removal of remaining lesion is best achieved by using a discoid type spoon excavator or slowly
revolving round carbide bur without affecting resistance form Usually no secondary resistance
or retention form features are necessary class 1 amalgam restoration An occlusal cavosurface
bevel is contraindicated in tooth preparation for amalgam restoration It is important to provide an
approximate 90_100 degree cavosurface angle, Which result in 80_90 degree amalgam at the
margins, this feature provide strength for restoration and tooth and prevent the chipping of
amalgam (brittle material) under occlusal load
Types of preparation may be restored by amalgam
1 faucial pit of mandibular molar
2 lingual pit of the maxillary lateral incisors
3 occlusal pit of the mandibular first premolar
4 occlusal pit and fissure of maxillary first molar
5 occlusal pit and fissure of the mandibular second premolar
Restorative Technique for Class I Amalgam Preparation
Desensitizer Placement:
A dentin desensitizer is placed in the preparation according to manufacturer recommendations
before amalgam condensation.
Insertion and Carving of the Amalgam
5. The triturated amalgam is placed into an amalgam well. The outline of the tooth preparation
should be reviewed before inserting amalgam to establish a mental image that will later aid in
carving amalgam to the cavosurface margin.
Amalgam should be carefully condensed into the pulpal line angles .The preparation should be
overpacked 1 mm or more using heavy pressure.
This ensures that the cavosurface margins are completely covered with well-condensed
amalgam. Final condensation over cavosurface margins should be done perpendicular to the
external enamel surface adjacent to the margins. The overpacked amalgam should then be
precarve
Finishing and Polishing of the Amalgam
carving may begin immediately after, the Hollenback carver may be used, with care not to
overcarving the groove or fossa areas. All carving should be done with the edge of the blade
perpendicular to the margins as the instrument is moved parallel
to the margins. Part of the edge of the carving blade should rest on the unprepared tooth
surface adjacent to the preparation margin.
Using this surface as a guide helps prevent overcarving amalgam at the margins and produces
a continuity of surface contour across the preparation margins. During carving, thin amalgam
should be removed from areas of enameloplasty. Thin amalgam left in these areas may fracture
because of its low edge strength. Deep occlusal anatomy should not be carved into the
restoration because these may thin the amalgam at the margins and weaken the restoration.
Under Carving leaves thin portions of amalgam (subject to fracture) on the unprepared tooth
surface. he thin portion of amalgam extending beyond the margin is referred to as lash. he
mesial and distal fossae should be carved slightly deeper than the proximal marginal ridges
After carving is completed, the outline of the amalgam margin should reflect the contour and
location of the prepared cavosurface
margin, An amalgam restoration that is more than minimally overcarved (i.e., a sub- marginal
defect >0.2 mm) should be replaced.f the total carving time is short enough, the smoothness of
the carved surface may be improved by wiping with a small, damp ball of cotton held with the
cotton pliers. Alternatively, postcarve burnishing may beissure and distal pit on the occlusal
surface.
Tooth preparation of class l occlusal lingual and occlusofacial amalgam restoration :
1.tooth preparation should be no wider than necessary, mesiodistal width of the lingual
extension should not exceed 1mm.
2.tooth preparation should be more at the expense of the oblique ridge , rather than
cantering over the fissure.
3.Especially on smaller teeth , the occlusal portion may have a slight distal tilt to conserve
the dentin support of the distal ridge.
4.Margins should extend as little as possible onto the oblique ridge , distolingual cusp ,
and marginal ridge
5.To conserve distal marginal ridge , bur should cut mesial to the pit rather than distal5. To
conserve distal marginal ridge , bur should cut mesial to the pit rather than distal
Insertion and light curing of the composite.
The technique for insertion of class 2 posterior composite is best to restore the proximal box
portion of the preparation first .
●It is important to place and light cure the composite incrementally to maximize the curing
potential and to reduce the negative effects of polymerization shrinkage.
●The number of increments will depend on the size of the proximal box.
●The first increments should be placed along the gingival floor and should extend slightly
up the facial wall.
●The increment should be no more than 2 mm thick.
●A second increment is then placed against the lingual wall to restore about two thirds of
the box.
●The final increment is then placed to complete the proximal box and develop the
marginal ridge.
6. ●Increments should be light cured for as long as needed , depending on the shade and
opacity of the composite used and the power of the light curing unit.
●Composite resin placement may be made more difficult by the stiffness and stickiness of
some composite.
●Heating the composite prior to insertion may help overcome these problems.
●The increased temperature lowers the viscosity of the composite resin.
Finishing and polishing of the composite:
●The occlusal surface is shaped with round or oval, 12 bladed carbide finishing bur or
finishing diamond.
●Excess composite is removed at the proximal margins and embrasure with a flame
shaped , 12 bladed carbide finishing bur or finishing diamond and abrasive discs.
●Narrow finishing strip may be used to smooth the gingival proximal surface.
Done
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