Class II. Defects affecting one or both proximal surfaces of posterior teeth. Location: Interdental space  Interdental space is caries danger area (below the contact point).  Interdental space is infilled with interdental palilla, that moves apically during the time and the space is open.  Dental caries begins below the contact point. lroubal@med.muni.cz 2 Class II. 3 Origin: Proximal surface below the contact point Propagation of dental caries from the occlusal surface lroubal@med.muni.cz 4 Symptoms  No symptoms  Increased sensitivity (cold, sweet)  Retention of food  Defect (carious lesion is open – the enamel is broken)  Bite sensitivity (when carious lesion is open) lroubal@med.muni.cz 5 Diagnosis  Visual changes of tooth structure (chalk white colour).  Transillumination (white light, or Diagno Cam).  Radiography lroubal@med.muni.cz 6 lroubal@med.muni.cz 7 lroubal@med.muni.cz 8 Bite wing lroubal@med.muni.cz 9 lroubal@med.muni.cz 10 D1 – projasnění do ½ tlouš´tky skloviny D2 – projasnění na hranici skloviny a dentinu D3 – projasnění do dentinu D4 - projasnění sahající do dřeňové dutiny DIAGNOCam lroubal@med.muni.cz 14 lroubal@med.muni.cz 15 lroubal@med.muni.cz 16 lroubal@med.muni.cz 17 lroubal@med.muni.cz 18 Sedelmayer RTG vyšetření – Bite Wing 4 stupňový grading Filling materials  Amalgam  Composite materials  Glass ionomer cements lroubal@med.muni.cz 19 Choice of the material depends on  Size of carious lesion  Level of oral hygiene  Occlusal loading  Cooperation of the patient and other factors lroubal@med.muni.cz 20 lroubal@med.muni.cz 21 Preparation - amalgam  Conventional preparation acc. to the Black´s rules  Slot preparation  Large preparation – cusp(s) involved lroubal@med.muni.cz 22 Preparation - adhesive materials (composites, glass ionomers)  Conventional preparation for composites  Adhesive slot  Tunnel preparation 23 Occlusal cavity Proximal cavity - box Conventional preparation amalgam lroubal@med.muni.cz 24 Pulpal wallsAxial wall Gingival wall Isthmus lroubal@med.muni.cz 25 MO, OD: one proximal surface affected – mesio occlusal distoocclusal MOD: mesiodistoocclusal lroubal@med.muni.cz 26 Access to the cavity From the occlusal surface Through the undermined enamel Separation using wooden wedges is useful lroubal@med.muni.cz 27 Pre op lroubal@med.muni.cz 28 Access to the cavity lroubal@med.muni.cz 29 Breaking the thin enamel layer out of the cavity Wooden wedge lroubal@med.muni.cz 30  Remove of the gingiva that grows into the cavity lroubal@med.muni.cz 31 Cavosurface margin and extention for prevention Proximal box: Vestibullary and orally – axial walls (the border between the oral/vestibular and proximal surface. Below the free gingiva (0,5 mm) Occlusal Class I. lroubal@med.muni.cz 32 v American rule Tangents from the middle of treated tooth to the next tooth – where these cross the treated Tooth there are borders of the preparation lroubal@med.muni.cz 33 Retention  Occlusal cavity  Undercuts  Grooves 34 Axiální stěny divergují gingiválně Rýhy a zářezy Autoretention Grooves Proximal cavity – box Slight divergency of axial walls Gingival wall follows the cementoenamel junction Gingival wall is below free gingiva lroubal@med.muni.cz 35 Resistance  No undermined enamel  No sharp edges  Isthmus is 1/3 – 1/4 intercuspidal distance  Angle between axial and gingival wall: 90°, or 85°  Width of gingival wall is 1 mm at least  Thickness of the filling 2 – 4 mm (4mm if cusp replacing) lroubal@med.muni.cz 36 Cavosurface angle Gingival wall Isthmus 37 Excavation of carious dentin Rounded bur (Caries Detector, Kuraray, Japonsko; Caries Marker, VOCO,Německo) lroubal@med.muni.cz 38 Finishing of the walls of the cavity  Red coded diamond bur  Chisel on the gingival wall (if in enamel) 39 40 lroubal@med.muni.cz 41 lroubal@med.muni.cz 42 Final check  Goog light, miror lroubal@med.muni.cz 43 Pulpal wall Axial wall Gingival wall Isthmus lroubal@med.muni.cz 44 Matrix placement  Matrix primarily is used when a proximal surface is to be restored The objectives: - Provide proper contact - Provide proper contour - Confine the restorative material - Reduce the amount of excess material lroubal@med.muni.cz 45 Matrices  Ivory I retainer Ivory 1  Hawe Neos retainer Ivory 8  Tofelmire matrix and retainer lroubal@med.muni.cz 46 lroubal@med.muni.cz 47 lroubal@med.muni.cz 48 Wedges  Wooden wedges - tighten the matrix band - compress the gingiva - separate the teeth lroubal@med.muni.cz 49 Wedging  Slip the matrix band over the tooth )apical to the gingiva margin – 0,5, - 1 mm)  Tighten the matrix, check it with probe  Place a wedge  Turn the retainer ¼ counterclockwise  Contour the band 50 Amalgamators lroubal@med.muni.cz 51 Condensation of amalgam  Condensor – with the straight front  Power driven condensation How big should the front be? lroubal@med.muni.cz 52 lroubal@med.muni.cz 53 lroubal@med.muni.cz 54 lroubal@med.muni.cz 55 lroubal@med.muni.cz 56 lroubal@med.muni.cz 57 lroubal@med.muni.cz 58 lroubal@med.muni.cz 59 lroubal@med.muni.cz 60 Base  Zinkoxidphosphate cement  Zinkoxidkarboxylate cement  Glass ionomer cement  Zinkoxideugenol On pulpal walls only! lroubal@med.muni.cz 61 The base must be hardened lroubal@med.muni.cz 62 Instruments  Preparation  Filling  Finishing and polishing lroubal@med.muni.cz 63 Cpátko tyčinkové lroubal@med.muni.cz 64 Ořezávač -Frahm lroubal@med.muni.cz 65 lroubal@med.muni.cz 66 Sapin lroubal@med.muni.cz 67 Discoid-cleoid lroubal@med.muni.cz 68 Amalgam carrier lroubal@med.muni.cz 69