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Copyright 2003, Elsevier Science (USA). All rights reserved.
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Introduction
Restorative and esthetic dentistry is the
treatment of the general dental needs of a
patient.

Restorative Dentistry
 Specific conditions that initiate a need for
restorative dentistry are:
• Initial or recurring decay.
• Replacement of failed restorations.
• Abrasion or the wearing away of tooth
structure.
• Erosion of tooth structure.

Esthetic Dentistry
 Specific conditions that initiate a need for
esthetic treatment are:
• Discoloration due to extrinsic or intrinsic
staining.
• Anomalies due to developmental
disturbances.
• Abnormal spacing between teeth.
• Trauma.

Principles of Cavity Preparation
 Initial cavity preparation
• Develop the outline form and initial
depth.
• Establish primary resistance form.
• Establish primary retention form.
• Provide a convenience form.

 Final cavity preparation
• Remove any remaining enamel in the
preparation, infected dentin, or old restorative
material.
• Apply additional resistance and retention
locks, grooves, and coves to provide strength in
the maintenance of the restoration.
• Place dental materials that may include lining
agents, bases, and desensitizing or bonding
agents for pulpal protection and better retention.
Principles of Cavity
Preparation− cont’d

Table 48-1: Terminology in Understanding Cavity
Preparation

Patient Preparation for Restorative
Procedures
 Inform the patient of the procedure to be
performed and what to expect during the
treatment.
 Position the patient correctly for the dentist
and the type of procedure.
 Explain each step as the procedure
progresses.

Responsibilities of the Chairside Assistant
 Know the procedure and be able to anticipate
the dentist's needs.
 Prepare the setup for the procedures.
 Provide moisture control and better
visualization by means of high‑velocity suction
and air‑water syringe.
 Transfer dental instruments and accessories.
 Mix and transfer dental materials.
 Maintain patient comfort and appropriate
exposure control precautions.

Components of a Restorative Procedure
 Dentist evaluates the tooth to be restored.
 Dentist obtains local anesthesia.
 Assistant readies the type of moisture control to be
used during the procedure.
 Dentist prepares the tooth for the restoration.
 Dentist determines the type of dental materials to be
used.
 Assistant mixes and transfers the dental materials.
 Dentist burnishes, carves, or finishes the dental
material.
 Dentist checks the occlusion of the restoration.
 Dentist finishes and polishes the restoration.

Class I Restorations
 A class I lesion affects the pit and fissures of
the teeth.
 Surfaces involved are:
• Occlusal surfaces of premolars and molars.
• Occlusal two thirds of the facial surfaces of
mandibular molars.
• Occlusal third of the lingual surfaces of the
maxillary molars.
• Lingual surfaces of maxillary incisors, most
frequently in the pit near the cingulum.

Fig. 48-5, A-D Class I restoration.

Class II Restorations
 A class II lesion is an extension of the class I
lesion into the proximal surfaces of premolars
and molars.
 Areas for class II decay involve:
• Two-surface restoration of a posterior tooth.
• Three-surface restoration of a posterior
tooth.
• Four- or more surface restoration of a
posterior tooth.

Fig. 48-7, A-C Class II restorations.

Class III and IV Restorations
 A class III lesion affects the interproximal
surface of incisors and canines.
 A class IV lesion involves a larger surface
area, which includes the incisal edge and the
interproximal surface of incisors and canines.

Fig. 48-8 Class III restoration.

Fig. 48-9 Class IV restoration.

Class V Restorations
 A class V restoration is classified as a smooth
surface restoration. These decayed lesions
occur at:
• The gingival third of the facial or lingual
surfaces of any tooth.
• The root of a tooth, near the cementoenamel
junction.

Complex Restorations
 Retentive Pins
• Placed when decay has extended into the
cusp of a tooth and undermined the
enamel and dentin.
• The general understanding when using
retention pins is that one pin is placed for
each missing cusp.

Intermediate Restorations
 Restoration that is placed for a short term.
 Factors for placing an intermediate
restoration is:
• The health of the tooth.
• Waiting to receive a permanent restoration.
• Financial reasons.

Direct Bonded Veneers
 A veneer is a thin layer of tooth‑colored
material applied to the facial surface of a
prepared tooth.
 A veneer is used to improve the appearance of
teeth that are:
• Abraded.
• Eroded.
• Discolored with intrinsic stains.
• Darkened after endodontic treatment.

Tooth Whitening
 Commonly known as vital bleaching, tooth
whitening is a noninvasive method of
lightening dark or discolored teeth.

Indications for Using a Tooth Whitener
 Indications for procedure:
• Extrinsic stains from foods, cigarette
smoking, coffee, or tea.
• Aged teeth.
• Intrinsic stains, such as mild tetracycline
stains and mild fluorosis.

Whitening Products
 Chemical makeup
• Active ingredient
• Either carbamide peroxide or hydrogen
peroxide.
• Gel base
• With one or a mixture of propylene glycol,
glycerin, and water.
• Thickener
• Carbopol.

Tooth-Whitening Procedure
 Material is placed in a thermoplastic custom tray
that the patient wears for a designated period.
• For the 10% to 16% carbamide peroxide gels,
the wear schedule would be for 1 hour, twice
a day for the first week and once a day for the
second week.
• For the 20% to 22% mixture, 1 hour a day for
a 2-week period.
• For the hydrogen peroxide 15 to 30 minutes,
2 or 3 times a day for a 2-week period.

Possible Complications to Tooth Whitening
 Thermal hypersensitivity
• Patient may experience sensitivity to heat and
cold after removal of tray and material. The use
of sensitive-type toothpaste is recommended.
 Tissue irritation
• Gingival tissue exposed to any excess gel may
be caused by improper tray fit, allowing the
material to ooze onto the gingiva. The patient is
recommended to not overfill the tray with
material and to remove any excess after seating
the tray.

Dental Assistant's Role in Tooth-Whitening
Procedure
 Aid in the recording of the medical and dental
history.
 Assist in making the shade selection.
 Take intraoral photographs before and after the
procedure.
 Take and pour up the preliminary impression for the
custom tray.
 Fabricate and trim the tray.
 Provide postoperative instructions on the use of the
material.
 Assist in weekly or biweekly clinical visits.

Patient Instructions for Tooth-
Whitening Procedure
 Brush and floss before tray placement.
 Place gel in tray in an equal limited amount.
 Seat tray.
 Instruct the patient not to have any food or drink
when wearing the tray.
 Instruct the patient to wear the tray for the
recommended time.
 If the patient experiences any problems during
this time, discontinue use and discuss with the
dentist.

Tooth-Whitening Strips
 Thin, flexible strips coated with an adhesive
hydrogen peroxide whitening gel.
 The patient peels off the backing like a Band-
Aid and presses the strip to the facial anterior
teeth, making sure that the upper edge of the
strip is at the gingival margin. The remaining
portion of the strip is folded onto the lingual
surface.

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