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 Study the contact area (contact point): The axial walls (cavosurface margins) are approx. o 0,5 mm vestibulary and orally Over this area. The contact of the treated tooth is made of the restorative materials. Axial walls Gingival wall is parallel with the cementoenamel junction and it is situated appr. 0,5 mm below free gingiva. lroubal@med.muni.cz 33 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 34 Retention ➢ Occlusal cavity ➢ Undercuts ➢ Grooves 35 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 36 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 37 Cavosurface angle Gingival wall Isthmus 38 Excavation of carious dentin Rounded bur (Caries Detector, Kuraray, Japonsko; Caries Marker, VOCO,Německo) lroubal@med.muni.cz 39 Finishing of the walls of the cavity ➢ Red coded diamond bur ➢ Chisel on the gingival wall (if in enamel) 40 41 lroubal@med.muni.cz 42 lroubal@med.muni.cz 43 Final check ➢ Goog light, miror lroubal@med.muni.cz 44 Pulpal wall Axial wall Gingival wall Isthmus lroubal@med.muni.cz 45 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 46 Matrices ➢ Ivory I retainer Ivory 1 ➢ Hawe Neos retainer Ivory 8 ➢ Tofelmire matrix and retainer lroubal@med.muni.cz 47 lroubal@med.muni.cz 48 lroubal@med.muni.cz 49 Wedges ➢ Wooden wedges - tighten the matrix band - compress the gingiva - separate the teeth lroubal@med.muni.cz 50 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 51 Amalgamators lroubal@med.muni.cz 52 Condensation of amalgam ◼ Condensor – with the straight front ◼ Power driven condensation How big should the front be? 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 lroubal@med.muni.cz 61 Base ➢ Zinkoxidphosphate cement ➢ Zinkoxidkarboxylate cement ➢ Glass ionomer cement ➢ Zinkoxideugenol On pulpal walls only! lroubal@med.muni.cz 62 The base must be hardened lroubal@med.muni.cz 63 Instruments ◼ Preparation ◼ Filling ◼ Finishing and polishing lroubal@med.muni.cz 64 Cpátko tyčinkové lroubal@med.muni.cz 65 Ořezávač -Frahm lroubal@med.muni.cz 66 lroubal@med.muni.cz 67 Sapin lroubal@med.muni.cz 68 Discoid-cleoid lroubal@med.muni.cz 69 Amalgam carrier lroubal@med.muni.cz 70 Carving Burnishing