CLASS II. FIRST PART nPreclinical dentistry II. 1. lroubal@med.muni.cz 1 Class II. Defects affecting one or both proximal surfaces of posterior teeth. Location: premolar Interdental space nProximal space is caries danger area (below the contact point). n nInterdental space is infilled with interdental palilla, that moves apically during the time and the space is open. n nDental caries begins below the contact point. lroubal@med.muni.cz 3 Class II. 4 I:\Lékárníci\Šmardová.JPG Origin: Proximal surface below the contact point Propagation of dental caries from the occlusal surface lroubal@med.muni.cz 5 Symptoms ØNo symptoms ØIncreased sensitivity (cold, sweet) ØRetention of food ØDefect (carious lesion is open – the enamel is broken) ØBite sensitivity (when carious lesion is open) lroubal@med.muni.cz 6 Diagnosis ØVisual changes of tooth structure (chalk white colour). n ØTransillumination (white light, or Diagno Cam). n ØRadiography Ø n n lroubal@med.muni.cz 7 vychozistav klinekseparace n lroubal@med.muni.cz 8 I:\obrazové a případové případové studie\pripad 02\DSC_0355.JPG lroubal@med.muni.cz 9 n IMG_0393 kreplovahorni1 Bite wing bw1.jpg lroubal@med.muni.cz 10 The sensor is placed in a special holder Central beam goes perpendiculary to the sensor as well as the long axis of the tooth And parallel with interdental septa lroubal@med.muni.cz 11 bitewing1 bitewing2 D1 –radiolucency till ½ of enamel D2 – radiolucency till the border of enamel and dentin D3 – radiolucency that reached the outer half of the dentine D4 - radiolucency reaching the inner half of dentine uhlík2.JPG DIAGNOCam DIAGNOcam_mit_Halter.jpg lroubal@med.muni.cz 15 vychozistav zacatekpreparacekavity Filling materials nAmalgam n nComposite materials n nGlass ionomer cements lroubal@med.muni.cz 16 Choice of the material depends on nSize of carious lesion n nLevel of oral hygiene n nOcclusal loading n nCooperation of the patient and other factors n n n lroubal@med.muni.cz 17 lroubal@med.muni.cz 18 Preparation - amalgam ØConventional preparation acc. to the Black´s rules Ø ØSlot preparation n ØLarge preparation – cusp(s) involved Ø lroubal@med.muni.cz 19 Preparation - adhesive materials (composites, glass ionomers) Ø Conventional preparation for composites Ø ØAdhesive slot Ø ØTunnel preparation 20 kavity2 Occlusal cavity Proximal cavity - box Conventional preparation amalgam lroubal@med.muni.cz 21 kavity2 Pulpal walls Axial wall Gingival wall Isthmus [USEMAP] lroubal@med.muni.cz 22 mo mod MO, OD: one proximal surface affected – mesio occlusal distoocclusal MOD: mesiodistoocclusal [USEMAP] lroubal@med.muni.cz 23 Access to the cavity nFrom the occlusal surface n nThrough the undermined enamel n nSeparation using wooden wedges is useful n [USEMAP] lroubal@med.muni.cz 24 vychozistav Pre op preparačni nastroje [USEMAP] lroubal@med.muni.cz 25 zacatekpreparacekavity preparačni nastroje Access to the cavity [USEMAP] lroubal@med.muni.cz 26 vylomeni kavitankavitasklinkem Breaking the thin enamel layer out of the cavity Wooden wedge [USEMAP] lroubal@med.muni.cz 27 n DSC_0349 DSC_0361 Ø Remove of the gingiva that grows into the cavity [USEMAP] lroubal@med.muni.cz 28 Cavosurface margin and extention for prevention nProximal box: nVestibullary and orally – axial walls (the border between the oral/vestibular and proximal surface. nBelow the free gingiva (0,5 mm) nOcclusal nClass I. [USEMAP] lroubal@med.muni.cz 29 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. [USEMAP] lroubal@med.muni.cz 30 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 [USEMAP] lroubal@med.muni.cz 31 Retention ØOcclusal cavity Ø Ø Undercuts Ø ØGrooves [USEMAP] 32 II Axiální stěny divergují gingiválně slotbazant Rýhy a zářezy slotak Autoretention Grooves Proximal cavity – box Slight divergency of axial walls Gingival wall follows the cementoenamel junction Gingival wall is below free gingiva [USEMAP] lroubal@med.muni.cz 33 Resistance ØNo undermined enamel ØNo sharp edges ØIsthmus is 1/3 – 1/4 intercuspidal distance Ø Angle between axial and gingival wall: 90°, or 85° ØWidth of gingival wall is 1 mm at least Ø Thickness of the filling 2 – 4 mm (4mm if cusp replacing) [USEMAP] lroubal@med.muni.cz 34 cavosurface sadrova2 Cavosurface angle Gingival wall Isthmus [USEMAP] 35 Excavation of carious dentin n Rounded bur preparačni nastroje kardetektor (Caries Detector, Kuraray, Japonsko; Caries Marker, VOCO,Německo) rosenbohrer carisolv4 [USEMAP] lroubal@med.muni.cz 36 Finishing of the walls of the cavity Ø Ø Red coded diamond bur Ø ØChisel on the gingival wall (if in enamel) Ø n [USEMAP] 37 orezani okraju sikmitka dlatka [USEMAP] 38 orezani okraju sikmitka dlatkovakci [USEMAP] lroubal@med.muni.cz 39 frezy preparačni nastroje [USEMAP] lroubal@med.muni.cz 40 Final check n Ø Ø ØGoog light, miror n n [USEMAP] lroubal@med.muni.cz 41 kavity2 Pulpal wall Axial wall Gingival wall Isthmus [USEMAP] lroubal@med.muni.cz 42 Matrix placement ØMatrix primarily is used when a proximal surface is to be restored nThe objectives: -Provide proper contact -Provide proper contour -Confine the restorative material -Reduce the amount of excess material [USEMAP] lroubal@med.muni.cz 43 Matrices ØIvory I retainer Ivory 1 Ø Ø Hawe Neos retainer Ivory 8 Ø ØTofelmire matrix and retainer [USEMAP] lroubal@med.muni.cz 44 konturace matrice konturacematrice1 klinky matrice napinace [USEMAP] lroubal@med.muni.cz 45 n tofelmire TOFELMIRE2 TOFELMIRE3 [USEMAP] lroubal@med.muni.cz 46 Wedges Ø Wooden wedges Ø n - tighten the matrix band n - compress the gingiva n - separate the teeth klinky [USEMAP] lroubal@med.muni.cz 47 Wedging ØSlip the matrix band over the tooth )apical to the gingiva margin – 0,5, - 1 mm) ØTighten the matrix, check it with probe ØPlace a wedge ØTurn the retainer ¼ counterclockwise Ø Contour the band Ø [USEMAP] 48 amalgADM duomat lariovibro Amalgamators [USEMAP] lroubal@med.muni.cz 49 Condensation of amalgam n Condensor – with the straight front n nPower driven condensation n nHow big should the front be? [USEMAP] lroubal@med.muni.cz 50 podavani cpani amalgam v prebytku [USEMAP] lroubal@med.muni.cz 51 cpanistroj1 cpanistroj2 [USEMAP] lroubal@med.muni.cz 52 n klinekseparace [USEMAP] lroubal@med.muni.cz 53 n vylomeni [USEMAP] lroubal@med.muni.cz 54 n podlozzka [USEMAP] lroubal@med.muni.cz 55 n zrcadůleni [USEMAP] lroubal@med.muni.cz 56 n orez [USEMAP] lroubal@med.muni.cz 57 n hotovaagvypln [USEMAP] lroubal@med.muni.cz 58 Base ØZinkoxidphosphate cement ØZinkoxidkarboxylate cement ØGlass ionomer cement ØZinkoxideugenol n nOn pulpal walls only! [USEMAP] lroubal@med.muni.cz 59 preparaceag9 preparaceag11 The base must be hardened [USEMAP] lroubal@med.muni.cz 60 Instruments nPreparation (see previous pictures) n n nFilling n n nFinishing and polishing [USEMAP] lroubal@med.muni.cz 61 cpáátkko tyčinkov Condensor with the straight front [USEMAP] lroubal@med.muni.cz 62 frahm Carver - Frahm [USEMAP] lroubal@med.muni.cz 63 agfrh agdiscoui wiland discoid [USEMAP] lroubal@med.muni.cz 64 sapin Sapin [USEMAP] lroubal@med.muni.cz 65 disccoidcl Discoid-cleoid [USEMAP] lroubal@med.muni.cz 66 nosičamalgáámu Amalgam carrier [USEMAP] lroubal@med.muni.cz 67 orrzavani1 orezdisc orizfrahmem hlazeni Carving Burnishing [USEMAP]