INTERNATIONAL ISLAMIC UNIVERSITY MALAYSIA

KULLIYYAH OF DENTISTRY

MANUAL FOR OPERATIVE DENTISTRY

(PHASE 1: YEAR 2)
PART 1

BACHELOR OF DENTAL SCIENCE

PREPARED BY:

Dr. Shawfekar Hj Abdul Hamid

BDS, BEd, MSc, MDSc
KOD
IIUM

LIST OF CONTENTS

1. Fundamentals of cavity preparation. 5

1.1 Introduction. 5

1.2 Objective of cavity preparation. 5

1.3 Definition of cavity preparation. 5

1.4 Principle of cavity preparation and lining. 5

1.4.1 Principle of tooth preparation. 5
1.4.2 Cavity preparation terminology and abbreviation. 6
1.4.3 Preparation of lining. 6

1.5 Cavity classification, location, and description. 7

1.5.1 Cavity classification. 7
1.5.2 Cavity location, and description. 11

1.6 Procedure in cavity preparation. 14

1.6.1 Cavity preparation walls. 14
1.6.2 Cavity preparation floor. 15
1.6.3 Cavity preparation angles 16.
1.6.4 Cavity preparation point angles. 16
2. Moisture control and tooth isolation. 18

2.1 Mouth Rinsing: 18

2.1.1 Performing a mouth rinse. 18

2.2 Oral Evacuation Method: 19

2.2.1 Saliva ejector 19
2.2.2 High-Volume oral Evacuator 20
2.2.3 Positioning the High-Volume Evacuator during a procedure 23

2.3 Isolation techniques: 24

2.3.1 Cotton rolls 24
2.3.2 Cotton rolls placement 25
2.3.3 Related aids 25
2.3.4 Placement and removal of cotton rolls 27

2.4 Rubber dam isolation: 28

2.4.1 Dental dam equipment 29
2.4.2 Preparation of dental dam application 32
2.4.3 Preparation, placement, and removal of dental dam. 34

3. Caries excavation and temporary restoration. 39

3.1 Access cavity and caries excavation. 39

3.1.1 The establishment of outline form. 39
3.1.2 The establishment of resistance form. 40
3.1.3 The establishment of retention form. 41
3.1.4 Convenience form. 41
3.1.5 The treatment of residual caries. 41
3.1.6 Finishing of enamel walls and cavo-surface margins. 42
3.1.7 The toilet of the cavity or cleaning of cavity. 42

3.2 Temporary restoration. 43

3.2.1 Introduction. 43
3.2.2 Note on principles of caries excavation. 43
3.2.3 Temporary restoration with Zinc Oxide and Eugenol. 44
3.2.4 Temporary restoration with GIC (Fuji VII). 46
3.2.5 Temporary restoration with Zinc Phosphate. 47
3.2.6 Temporary restoration with Gutta-Percha. 48

4. Preventive resin restoration. 51

4.1 Fissure sealant. 51

4.2 Pit restoration with composite. 54
4.3 Pit restoration with GIC (Ketac Molar). 56

5. Acid-Etch Techniques and Abrasion Cavity Restoration. 58

5.1 Acid-etch technique. 58

5.2 Abrasion cavity restoration. 59

6. Amalgam restoration. 60

6.1 Amalgam restoration materials. 61

6.2 Class I amalgam restoration 62
6.3 Class II small and medium amalgam restoration. 100
6.4 Class V amalgam restoration. 130

7. Composite restoration. 133

7.1 Composite restoration materials. 136

7.2 Class III composite restoration. 137
7.3 Class IV composite restoration. 154
7.4 Class V composite restoration. 167

1. FUNDAMENTALS OF CAVITY PREPARATION.

1.1 Introduction:

Cavity preparation is the mechanical alternation of defective, injured or

diseased tooth in order to best receive a restorative material that will
reestablish a healthy state for the tooth including esthetic correction when
indicated, along with normal from and function. Teeth needs for restoration are
variety of reasons as follow:
• To restore the integrity of the tooth surface.
• To restore the function of the tooth.
• To restore the appearance of the tooth.
• To remove the diseased tissue from the tooth.

1.2 Objectives of cavity preparation:

The objectives of general cavity preparation are:

• To remove diseased tissue as necessary and at the same time provides the
protection to the pulp.
• To locate the margins of the restoration as conservative as possible.
• To ensure the cavity form, it should be under the force of mastication of
the tooth or the restoration or booth will not fracture and restoration should not
be displaced.
• To allow the restorative material and functional placement.

1.3 Definition of cavity preparation:

Cavity preparation is the mechanical alternation of a tooth to receive a

restorative material, which will return the tooth to proper anatomical form,
function, and esthetics. The procedure of the preparing the tooth is the removal
of the defective or friable tooth structure. Any remaining infected or friable
tooth structure may result of further carious progression, sensitivity or pain or
fracture of the tooth and / restoration.

1.4 Principle of cavity preparation and lining:

1.4.1 Principles of tooth preparation.

Gain access to caries.

Remove all caries.
Cut away all significantly unsupported enamel.
Extended margins so that they are accessible for instrumentation and
cleaning.
Why restore?
To restore function.
To prevent further spread of an active lesion, this is not amenable to
preventive measures.
To prevent pulp vitality.
To restore aesthetics.

1.4.2 Cavity preparation terminology and abbreviation.

Simple cavity: Preparation involving one surface of the tooth.

Compound cavity: Preparation involving two surfaces of the tooth.
Complex cavity: Preparation involving three or more surfaces of the tooth.
For record and communication, the description of a cavity preparation is
abbreviated by using the first latter, capitalized, of each tooth surface
involved. Examples are
(1) An occlusal cavity is an O.
(2) A preparation involving the mesial and occlusal surfaces is a MO.
(3) A preparation involving the distal and occlusal surfaces is a DO.
(4) A preparation involving the mesial, occlusal and distal surfaces is a MOD.
Abbreviations for simple, compound, and complex cavities:
MOD: :Mesio-occlusal-distal
DO: :Disto-occlsal
MO: :Mesio-occlusal
MI: :Mesio-incisal
 DI: :Disto-incisal
LI: :Linguo-incisal
DL: :Disto-lingual
MODBL: :Mesio-occluso-disto-bucco-lingual
I=incisal, M=Mesial, D=Distal, B=Buccal, O=Occlusal

1.4.3 Preparation of Lining.

Although the placement of cavity liners and base is not a step in cavity
preparation, it is a step in adapting the preparation for receiving the final
restorative material. The used of air-water spray coolant in high-speed rotary
instrument also protects the pulp as it dissipates the heat generated during
cavity preparation. The use of lining/liner or base in cavity preparation becomes
essential when the cavities finish deep in the dentine or when the cavities lie
close to the pulp. In a deep or extensive cavity, usually lining material was
placed first. Lining may serve one or more of the following purposes;

• Protective lining/Pulp protection

• Therapeutic lining
• Structural lining

a b

Fig-1.1 (a) and (b) Protective or Therapeutic

lining

Fig-1.2 Structural lining

Protective lining/Pulp protection

To protect dentine and pulp in metallic and in non-metallic
restoration. The lining materials are;
1. Zinc Oxide and Eugenol Cement
2. Fortified Zinc Oxide Cement
3. Calcium Hydroxide Cement
4. Zinc Phosphate Cement

Therapeutic lining
To apply medicament such as chlorobutanol, carbolized resin,
silver nitrate, and etc. The medicament may be applied directly to the dentine and
covered with zinc oxide eugenol. Recommended materials are Fuji lining LC.
Ledermix cement, Dycal (CaOH), Zinc oxide eugenol cement. Can be placed the
thickness 0.5 mm or less.

Structural lining
The structural function of a lining is usually combined with its
protective function. Recommended materials are Zinc oxide eugenol cement, kalzinol
cement, Fiji IX, Fuji II, and Fiji II LC. Can be placed the thickness 2mm or more.

1.5 Cavity classification, location, and description:

1.5.1 Cavity classification.

G.V Black developed five standard cavity classifications and sixth class was added
later.
Class I: :Class I caries are developmental cavities in the pit and fissure
of teeth (following Fig-1.3)
They are located in: :
The occlusal surface of the posterior teeth (premolar and molar)
The buccal or lingual pit of molar
The lingual pit near the cingulum of the maxillary incisors.

Class I cavity:

The Fig-1.3 Shown the class I caries, (A).Occlusal surface of premolar

and molar, (B).Buccal surface of Molar, (C ).Lingual surface of Maxillary
incisors. Restoration with amalgam is recommended and some extents are
counteracted by adhesive materials as composite and glass ionomers cement.

(c)

Fig 1.3 Class I cavity

Class II cavity:

Class II caries are on the proximal (mesial or distal ) surface of the

posterior teeth (premolars and molars)
The following Fig-1.4(1) shown on the proximal surfaces of (A) premolar and
molar, (B) placed prior to an MO or MOD restoration on the surface of premolar and
molar
The bottom part of the following figure is Class III cavity.

Fig-1.4 (1) Class II and (2) Class III caries.

Class III cavity:

Class III caries are on the interproximal surface (mesial or distal) of the
anterior teeth (canines, lateral incisors and central incisors.
The above Figure Fig-1.4(2) shown the class III cavity (M and D on the
interproximal surface of central incisor and lateral incisor Fig-1.4 (2).

Class IV Cavity:

Class IV caries are on the interproximal surface (mesial or distal) of

anterior teeth include the incisal edge.
The Fig-1.5 showing class IV cavity.
 Fig-1.5 Class IV cavity

Class V cavity:

Class V: Caries affecting on the cervical surfaces.

The Fig 1.6 showing the class V cavity.

Fig-1.6A The class V cavity.

Class VI cavity:

Class VI: Cavity affecting by abrasion on facial surface of the teeth.

The Fig-1.6 B shown the class VI cavity.

Fig-1. 6B Class VI cavity.

Root service caries.

As gingival recession
The fig-1.7 shown root service cavity.

Fig-1.7 Root service cavity.

1.5.2 Location and description.

Class I: Decay is diagnosed in the pits and fissures (Fig-1.8) of the occlusal
surfaces of molars and premolars, buccal or lingual pits of molars, and lingual
pits of maxillary incisors. Because most of this type of decay is confined to a
small area, the dentist will choose to restore these surfaces with composite
(tooth-colored) resins.

Fig-1.8 Decay in the pit and fissure of occlucal

surface of molar and premolar.

Class II: Decay is diagnosed in the proximal (mesial or distal) (Fig-1.9) surfaces
of premolars and molars. Because this surface area is harder to detect visually, a
radiograph is used to detect the decay. The design of the restoration will most
commonly include the occlusal surface and may possibly involve more than two
surfaces. The type of dental materials used to restore this classification is
either silver amalgam (chosen for its strength) or newer composite (tooth-colored)
resins designed for posterior teeth (chosen for esthetic appeal). If the tooth has
extensive decay, the dentist may choose to crown the tooth with a gold or
porcelain inlay, only, or crown.
 Fig-1.9 Decay in mesial or distal surface
of premolars and molars.

Class III: Decay is diagnosed in the proximal (mesial or distal) (Fig-1.10)

surfaces of incisors and canines. This decay is similar to that of class II,
except it involves anterior teeth. It is easier for the dentist to access these
surfaces with less tooth structure affected. The type of dental material used to
restore this classification is composite (tooth-colored) resins (for esthetic
appearance).

Fig-1.10 Decay in the proximal (mesial or distal)

surfaces of incisors and canines.

Class IV: Decay is diagnosed in the proximal (mesial or distal) (Fig-1.11)

surfaces of incisors and canines. The difference between class IV and class III
decay is that class IV involves the incisal edge or angle of the tooth. The type
of dental material used to restore this classification is composite (tooth-
colored) resins (for esthetic appearance). If the tooth has extensive decay, the
dentist may choose to crown the tooth with a porcelain crown.

Fig-1.11 Decay in mesial or distal and incisal edge or angle of the

tooth.

Class V: Decay is diagnosed in the gingival third of facial or lingual (Fig-1.12)

surfaces of any tooth. This is also referred to as a smooth surface decay. The
type of dental material used to restore this classification depends on which teeth
are affected. If the decay occurs in posterior teeth, the dentist may choose
silver amalgam; if anterior teeth are involved, composite (tooth-colored) resin
will most likely be used.

Fig-1.12 Decay in the gingival third of facial or lingual surfaces.

Class VI: Decay is diagnosed on the incisal edge of anterior teeth and the cusp
tips of posterior teeth (Fig-1.13). Class VI decay is caused by abrasion (wear)
and defects. The dental material is chosen based on which teeth are involved.

Fig-1.13 Decay on the incisal edge of anterior teeth and

the cusp tips of the posterior teeth.

1.6 Procedures of cavity preparation:

1.6.1 Cavity preparation walls.

Surfaces of the wall were prepared by operator internal boundaries of the cavity.
The surrounding walls of the cavity take the name of the surface of the tooth
towards which they are placed;
• Internal wall: An internal wall is a prepared cavity surface, which does not
extend to external tooth surface.
• Axial wall: An internal wall is parallel with the long axis of the tooth
and adjacent or nearest pulp chamber or pulp canals.
• Pulpal wall: An internal wall is both perpendicular to the long axis of
the tooth and coronal to the pulp.
• External wall: An external wall is a prepared cavity surface, which extends
to the external surface of the tooth.
• Mesial wall: An external wall towards the mesial surface of the cavity.
• Distal wall: An external wall towards the distal surface of the cavity.
• Occlusal wall: An external wall towards the occlusal surface of the cavity.

1.6.2 Cavity preparation floor.

Floors (or seat) – term used which refers to the bottom or wall representing the
deepest penetration in a cavity preparation (Fig-1.14). They are reasonably flat
and perpendicular to the occlusal forces that are directed occluso-gingivally.
Examples are:
• The pulpal wall, which can also be known as pulpal floor.
• The gingival wall, which also known as gingival floor (as in Class II or
Class V).
• Such floors provide a stabilizing seat for the restoration, thus
distributing the stresses evenly in the tooth.

Fig-1.14 Cavity preparation floor.

1.6.3 Cavity preparation angles.

Line angle term given to a line formed by the junction of two walls or a wall and
a floor (Fig-1.15), named by combining the names of the two walls, e.g.
• Mesio-buccal line angle: Disto-buccal line angle, Axio-pulpal line angle.
• Internal line angle: A line angle which apex point, into the tooth
(faciopulpal).
• External angle: A line angle which apex point, away from the tooth (e.g.,
axio-pulpal)

Fig-1.15 Cavity preparation line angle (occlusal view)

1.6.4 Cavity preparation point angles.

Point angle: Term given to a point where the three surfaces or three line angles
(Fig-1.16) are meeting. It was named by combining the names of the three walls,
e.g.
• Mesio-biccal-pulpal point angle, Disto-lingual-pulpal line angle.

Cavosurface angle: Term given to the angle of tooth structure formed by the
junction of a prepared cavity wall and the external surface of the tooth.
• Whilst the principles have been systematically set out in a specific number
of steps and stages. There is a certain degree of overlapping, and principles
affecting stage frequently have a bearing on another. Additionally, some steps may
be overlooked depending upon the clinical situation. Pulp protection is needed in
the case where cavity preparation finishes deep into the dentin or lie close to
the pulp.
• We should aim to provide the best form, which will protect the tooth while
achieving maximum durability of the restoration.

Fig-1.16 Cavity preparation point angle

Fig-1.17 Cavity preparation line angles, point angles and carvo-surface margin
( upper mesial view, lower occlusal view)Caries) must be removed.

2. MOISTURE CONTROL AND ISOLATION

During the dental procedure, one of the most responsibilities is to maintain the
clinical field. The tooth, surrounding tissue, and the oral cavity can be come a
“catch all” for water, saliva, blood and tooth fragments. The type of procedure
you are assisting in and the access to the area will be dictate the type of
isolation method chosen.

2.1 Mouth Rinsing:

The two basic types of rinsing procedures used in dentistry are limited-area
rinsing and complete mouth rinsing.
Limited-area rinsing is performed frequently because the debris can be
accumulated during the preparation o tooth. This must be quickly without delay in
the procedure.
The completed mouth rinse is performed at the completion of dental
procedure.

2.1. 1 Performing a Mouth Rinse

Fig-2.1 Performing a mouth rinse.

Equipment and supplies

1. HVE tip
2. Saliva ejector
3. Air-water syringe

Procedure steps
1. Decide which oral evacuation system would be best for the rinsing procedure.
2. Grasp the air-water syringe in your left hand and the HVE or saliva ejector
in your right hand.

Limited-Mouth Rinse
1. Turn on the suction, and position the tip toward the site for a limited-area
rinse.
2. Spray the combination of air and water onto the site to be rinsed. Purpose:
The combination of the air and water provides more force to clean the area
thoroughly.
3. Suction all fluid and debris from the area, being sure to remove all fluids.
4. Dry the area by pressing the air button only.

Full-Mouth Rinse
1. Have the patient turn toward you. Purpose: Turning the head allows the water
to pool on one side, making it easier for you to suction.
2. Turn on the HVE or saliva ejector, and position it in the vestibule of the
patient’s left side. Note: Position the tip carefully so that it does not come
into contact with soft tissue.
3. With HEV or saliva ejector tip positioned, direct the air-water syringe from
the patient’ maxillary right across to the left side, spraying all surfaces.
4. Continue down to the mandibular arch, following the same sequence from right
to left. Purpose: This pattern of rinsing forces the debris to the posterior
mouth, where the suction tip is positioned for easier removal of fluids and
debris.

2.2 Oral Evacuation Method:

2.2.1 Saliva Ejector

This instrument used to remove small amount of saliva or water from a patient’s
mouth. It is small straw like tube has flexible to conform to many areas in the
mouth (Fig-2.2).

Fig-2.2 Saliva ejector.

2.2.2 High-Volume Oral Evacuation

The high-volume oral evacuator (HVE) is stronger source of moisture control,

commonly used during dental procedure.
Maintain the mouth free from saliva, blood, water, and debris.
Retract the tongue or cheek away from the procedure site.
Reduce the bacterial aerosol caused by the high-speed handpiece.
Oral Evacuation Caution: Improper or careless use of the HVE could cause
soft tissue to be accidentally ‘sucked’ into the tip, and tissue damage could
result. Keeping the tip at an angle to the soft tissue helps prevent this from
happening. If the soft tissue is accidentally ‘sucked’ into the tip, rotate the
angle of the tip to break the suction or quickly turn the vacuum control off to
release the tissue.
HVE Tips: The most commonly used HVE tips are made of a semihard plastic
that is sterilized after a single use. Tips are also available in stainless steel,
which also must be sterilized before reuse (Fig-2.3).

Fig-2.3 HVE tips.

HVE tips are available with either straight or with a slight angle in the
middle. All types have two beveled working ends (beveled meaning slanted.) The
bevel is slanted downward for use in the anterior portion of the mouth. For use in
the posterior portion of the mouth, the bevel is slanted upward.
When placing the HVE tip into the handle of the suction unit, the tip is
pushed into place through a plastic protective barrier, which will cover the HVE
handle. If the incorrect end of the tip has been placed in the suction, do not
turn it around; it is now contaminated and must be replaced with a new tip.
 Holding the Oral Evacuator: The oral evacuator may be held in two ways:
either the thumb-to-nose grasp or pen grasp (Fig-2.4). Either method provides
control of the tip, which is necessary for patient comfort and safety. Many
assistants alternate between positions, depending on the resistance of the tissue
to retract and the area being treated.

Fig-2.4 Method of holding the oral evacuator

tip: Top; thumb-to-nose grasp, and Bottom; pen grasp.

When assisting a right-handed dentist, hold the evacuator in the right hand.
When assisting a left-handed dentist, hold the evacuator in the left hand.
The other hand is then free to use the air-water syringe or transfer
instruments to the dentist as needed.
To be most efficient in HVE placement, you should position the HVE tip in
the mouth first, and then the dentist can position the hand piece and mouth mirror
(Fig-2.5).

Fig-2.5 A The HVE tip is placed on the lingual surface

and slightly distal to the tooth being prepared. On
the
mandibular it is also used to retract the tongue
(Placement of HEV tip on maxillary and mandibular right side).

Fig-2.5 B The HVE tip is placed on the opposite surface of

the
tooth being prepared; for example, if the dentist is working
on
the facial surface, the HVE tip is positioned on the lingual
surface.
(Placement of HEV tip on maxillary and mandibular anterior side).

Fig-2.5 C The HVE tip is placed on the buccal

surface and slightly distal to the tooth

being
prepared, also helping to retract the
cheek.
(Placement of HEV tip on maxillary and mandibular left
side).

2.2.3 Positioning the High-Volume Evacuator During a procedure

Equipment and Supplies

1. Sterile HVE tip
2. Plastic barrier cover for HVE handle and hose
3. Cotton rolls.
 Procedure Steps.
1. Place the HVE tip in the holder by pushing the end of the tip into the
holder through the plastic barrier. Purpose: Leaves the opposite end exposed and
ready for use.
2. If necessary, use the HEV tip or a mouth mirror to gently retract the cheek
or tongue.
3. For a mandibular site, place a cotton roll under suction tip. Purpose:
Provides patient comfort, aid in stabilizing tip placement, and prevent injury to
the tissue.
4. Place the bevel of the HEV tip as close as possible to the tooth being
prepared. Purpose: Suction will draw the water into the tip immediately after it
leave the tooth being prepared.
5. Position the bevel of the HEV tip parallel to the buccal or lingual surface
of the tooth being prepared.
6. Place the upper edge of the HEV tip so that it extends slightly beyond the
occlusal surface. Purpose: Suction will catch the water spray from the hand piece
as it leaves the tooth being prepared.

Fig-2.6 Posterior Placement. Fig-2.7 Anterior

Placement.

2.3 Isolation techniques:

2.3.1 Cotton Rolls

During tooth preparation, water is expressed from the high speed hand piece to
cool the tooth and remove debris. However, when placing a composite or amalgam
restoration or when cementing a cast restoration a clean, dry environment is
necessary.
One method of ensuring dry conditions is the use of cotton rolls. When a
dental dam is not an option, cotton roll isolation is used as an alternative
method to control moisture in the operative area. (Isolation, as used here, means
to keep the area separated and dry.)
Cotton rolls are available in a variety of sizes and are flexible so they can
be bent to fit an available space. Some cotton rolls have a light coating on the
surface to make them slightly stiff. A softer type of cotton roll is not coated,
but is wrapped with a cotton thread.
There are advantages and disadvantages to using cotton rolls:

Advantages
1. Can be placed quickly and securely
2. Are simple to use
3. No additional equipment is needed for placement.

Disadvantages
1. Do not prevent contamination of the area by the patient tongue.
2. Do not prevent debris from dropping into the mouth or throat.
3. If removed, dry cotton rolls may adhere to the oral mucosa, which can injury
the tissue.
4. Must be replaced if they get wet before the procedure is completed.

2.3.2 Cotton Roll Placement

When part of the maxillary arch is isolated, cotton rolls are placed on the cheek
side of the teeth in the mucobuccal fold. This fold holds the cotton rolls
securely in place. (The mucobuccal fold is the area where the masticatory mucosa
covering the alveolar ridge turns upward and becomes the lining mucosa of the
cheek) (Fig-2.8)

A B
Fig-2.8 A and B , Cotton roll placement for the maxillary
arch.

Because of movements of the tongue and the tendency of saliva to pool in the
floor of the mouth, cotton roll isolation is more difficult to achieve in the
mandibular arch. Cotton rolls are placed in both the mucobuccal fold and on the
lingual side of the arch (Fig-2.9).

A B
Fig-2.9 A and B, Cotton roll placement for mandibular arch.

When the anterior portion of the mandible is isolated, cotton rolls and a
saliva ejector can be used. To isolate the posterior portion, two cotton rolls and
a saliva ejector may be used (Fig-2.10).
Depending on the location, cotton rolls are placed and removed with either
cotton pliers or gloved fingers. If the cotton rolls become saturated.

Fig-2.10 cotton roll placement for anterior.

2.3.3 Related Aids

Dry Angle: Some dentist will use a triangle-shaped absorbent pad to

help isolate posterior areas in both the maxillary and mandibular arches. The pad
is placed on the buccal mucosa over Stensen’s duct (Fig-2.11). (This duct from the
parotid gland is located opposite the maxillary second molar.)
These pads block the flow of saliva and protect the tissue in this area. Follow
the manufacturer’s directions for placement and if necessary replace pad if they
become soaked before the procedure is completed. To remove, use water from the
air-water syringe to thoroughly wet the pad before separating it from the tissue.

Fig-2.11 Application of a dry angle.

2.3.4 Placement and removal of Cotton Rolls

Equipment and Supplies

1. Basic setup
2. Cotton rolls
3. Air-water syringe

Maxillary placement
1. Have the patient turn toward you with their chin raised. Purpose: Provide
better visualization and easier placement of cotton roll.
2. Using the cotton pliers, pick up a cotton roll so that it is positioned
evenly with the beaks of the pliers.
3. Transfer the cotton roll to the mouth, and position it securely in the
mucobuccal fold closet to the working field. Note: Once you place the cotton roll
with the pliers, you may want to use your gloved finger or handle end of the
cotton pliers to push the cotton roll further into the mucobuccal fold.
4. This placement can be used for any location on the maxillary arch.

Cotton rolls placement for maxillary.

Mandibular placement
1. Have the patient turn toward you with the chin lowered. Purpose: Provides
better visualization and ease in the placement of the cotton roll.
2. Using the cotton pliers, pick up a cotton roll so that it is positioned even
with the beaks of the pliers.
3. Transfer the cotton roll to the mouth, and position it securely in the
mucobuccal fold closet to the working field.
4. Carry the second cotton roll to the mouth, and position it in the floor of
the mouth between the working field and the tongue. Note: Have the patient lift
the tongue during the placement and then relax to help secure the cotton roll in
position.
5. If you are placing cotton rolls for the mandibular anterior region, bend
the cotton roll before placement for better fit.
6. If using saliva ejector for the procedure, place it after the cotton roll is
in position in the lingual vestibule.

Cotton rolls placement for

mandibular.

Cotton roll removal

1. At the completion of a procedure, remove the cotton roll before the full
mouth rinse. If the cotton roll is dry, moisture it with water from air-water
syringe. Purpose: Dry cotton rolls will adhere to the oral mucosa lining and
tissue may damage when a dry cotton roll is pulled away from the area.
2. Using cotton pliers, retrieve the contaminated cotton roll from the site.
3. If appropriate for the procedure, perform a limited rinse.

2.4 Rubber dam isolation:

The dental dam is a thin latex barrier used to isolate a specific tooth or several
teeth during treatment (Fig-2.12). These teeth are referred to as being isolated.
The dental dam is applied after the local anesthetic has been administrated and
while the dentist is waiting for it take effect.
Before the application of the dental dam, the isolated teeth should be clean and
free of plaque or debris. If not removed, the plaque or debris could be dislodged
and injure the gingival tissue. When indicated, tooth brushing or selective
coronal polishing is performed before dam placement.
Before placing the dental dam, review the patient’s medical history for any
indications of latex sensitivity. If this is a problem, the dentist must be
consulted before the application is continued.

Fig-2.12 Dental dam.

2.4.1 Dental Dam Equipment

The specialized equipment used for rapid and efficient placement of dental dam is
shown in Figure-2.13 and described in table 2.1.

Indications for use of dental dam

a. It serves as an important infection control protective barrier.
b. It safeguards the patient’s mouth against contact with debris, acid-etch
materials and other materials during treatment.
c. It protects the tooth from accidentally inhaling or swallowing debris, such
as small fragments of a tooth or scraps of restorative material.
d. It protects the tooth from the contamination of saliva or debris if pulpal
exposure accidentally occurs.
e. It protects the remainder of oral cavity from exposure to infectious
material when an infected tooth is opened during endodontic treatment.
f. It provides the moisture control that is essential for the placement of
restorative materials.
g. It improves access during treatment by retracting the lips, tongue, and
gingival.
h. It provides better visibility because of the contrast of color of the dam
and the tooth.
i. It increases dental team efficiency, discourages patient conversation, and
may reduce time required for some treatment.

Fig-2.13 Dental dam setup for application.

Table-2.1 Dental dam and equipment.

Type of Equipment
Description of Equipment
Dam Material

Material comes in latex or latex-free material. Size is 6 x 6 0r 5 x 5.

Comes in a wide range of colors. There are three gauges of thickness (thin,
medium, and heavy).
Dental dam frame

It is a “U” shaped frame made of either plastic or metal stretches the

material away from the face and being worked on.
Dental dam napkin

A cotton absorbent sheet placed between the dental dam and patient.
Lubricant A water-soluble material that can be placed on the underside of the dam
around the punched area for easier placement between tight contacts.

Dental dam punch

 A hole punch device used to create the holes in the dam that expose the
teeth to be isolated. The sizes used for specific teeth are:
No.1 Mandibular incisors
No.2 Maxillary incisors
No.3 Premolars and canines
No.4 Molars and bridge abutments
No.5 Anchor tooth with the clamp

Dental dam stamp

Stamp designed in the shape of dental arch that imprints teeth on the dental dam
to be punched.
Dental dam forceps

A forceps that is used in the placement and removal of the dental dam clamp.
Dental dam clamps

A crown-shape piece of metal that anchors the dental dam material on a tooth.
There are many designs of clamps that fit the contour of each tooth in the mouth.
For safety purposes, it is important to always ligate to bow portion of a clamp
with floss before placing in the mouth. This will prevent the clamp from being
accidentally swallowed.

2.4.2 Preparation of the Dental Dam Application

Each application of dam is preplanned to accommodate the dentist’s preferences,
the tooth and teeth involved, and the procedure to be preformed. Several important
factors must be included in planning for holes to be punched in the dental dam.
i. The arch, its shape, and any irregularities, such as missing teeth or a
fixed prosthesis
ii. The number of teeth to be isolated
iii. Identification of the anchor tooth and location of the key punch hole
iv. The size and spacing of the other holes to be punched; (the anchor tooth
holds the dental dam clamp, and the keypunch hole covers the anchor tooth).

Maxillary Arch Applications

In preparation for maxillary application, the dam material is stamped or marked.
This mark automatically designates the margin of dam for these holes. If the
patient has a mustache or very thick upper lip, it is necessary to allow extra
space for the anterior teeth area.
 Mandibular Arch Applications.
In preparation for mandibular application, the dam is stamped or marked. Because
of the small size of the mandibular anterior teeth, the holes are punched closer
together than those for posterior teeth.
Curve of the Arch
It is necessary to make the adjustments to accommodate an extremely narrow or wide
arch. Failure to do this will increase the difficulty when inverting the edges of
the punched holes of the dam. Bunching the stretching on the lingual aspect of the
dental dam occur if the curve of the arch is punched too narrow or too wide. Folds
and stretching of the dam on the facial aspect occur if the arch is punched too
curved or too narrow.

Malaligned Teeth
If a tooth or teeth are misaligned within the dental arch, special consideration
of their position is taken before the dental dam is punched. (Malaligned and
malposed mean that the individual tooth is not in its normal position within the
dental arch.) If a tooth is lingually positioned, the hole punch size remains the
same, but the hole is placed about 1 mm lingually from the normal arch alignment.
If the tooth is facially positioned, the hole punch size remains the same, but the
hole is placed about 1 mm facially from the normal arch alignment.
Teeth to be Isolated
Single-tooth isolation is used commonly for endodontic treatment and for selective
restorative procedures, such as Class V restorations. Some dentists choose to
isolate only the tooth to be treated. Others prefer to have two teeth isolated so
that the second tooth acts as an anchor tooth to hold the clamp. During treatment
in the posterior area, this provides more stability and better visibility. For
multiple-tooth isolation, in which optimum stability is needed, it is desirable to
have the quadrant isolated having this many teeth isolated counteracts the pull on
the dam that is created by the curvature of the teeth in the arch. When anterior
maxillary teeth are to be treated, maximum stability is achieved by isolating the
six anterior teeth (canine to canine).

Key Punch Hole

The anchor tooth holds the dental dam clamp. The key punch hole is punched in the
dental dam to cover the anchor tooth. A larger, number 5-size hole is necessary
for the key punch because it must also accommodate the clamp.

Hole Size and Spacing

The size of each hole selected on the dental dam punch must be appropriate for the
tooth to be isolated. A correctly sized hole allows the dam to slip easily over
the tooth and fit sungly in the cervical area. This is important to prevent
leakage around the dam. In general, the holes are spaced from 3.0 to 3.5 mm
between the edges, not the centers, of the holes. This allows adequate spacing
between the holes to create a septum that slips between the teeth without tearing
or injuring the gingival. The septum is the portion of the dental dam between the
holes of the punched dam. During application, this portion of the dam is passed
between the contacts (Septum is singular, septa is plural).
Ethical Implications
In the application of the dental dam, you may be asked to place this by yourself.
If this is the cave, verify that this is a legal function in your state for dental
assistants and that you have had special training in the application process.

2.4.3 Preparation, Placement, and Removal of Dental Dam.

Equipment and supplies
1. Basic setup
2. Precut 6-by-6-inch dental dam
3. Dental dam stamp and inkpad or template and pen
4. Dental dam punch
5. Dental dam clamp or clamps with ligature attached
6. Dental dam clamp forceps
7. Young frame
8. Dental dam napkin
9. Dental tape or waxed floss
10. Cotton rolls
11. Lubricant for patient’s lips
12. Lubricant for dam
13. Black spoon
14. Crown and bridge scissors

Fig-2.13 The basic setup for dental application.

Patient preparation
1. Check the patient’s record for contraindications and to identify the area to
be isolated. Inform the patient of the need to place a dental dam, and explain the
steps involved.

2. Assist the dentist in the administration of local anesthetic. The operator will
determine which teeth are to be isolated and note whether there are any malposed
teeth to be accommodated.

3. Apply lubricating ointment to the patient’s lip with a cotton roll or cotton
tip applicator.
Note: The patient’s comfort is of concern throughout the placement and removal of
the dental dam.

4. Use the mouth mirror and explorer to examine the site where the dam is to be
placed. It should be free of plaque and debris. Purpose: If the dam is placed in
an area with plaque and debris, the dam could push the plaque and debris into the
sulcus and irritate the gingival tissue. Note: If debris or plaque is present,
selective tooth brushing or coronal polishing is performed on these teeth before
the application of the dental dam.

5.Floss all contacts involved in the placement of the dental dam. Purpose: Any
tight contacts may tear the dam.

Punching the dental dam

1. Use a template or stamp to mark on the dam the teeth to be isolated.

2. Correctly punch the marked dam according to the teeth to be isolated. Be sure
to use the correct size of punch hole for the specific tooth.

3. If the teeth have tight contacts, lightly lubricated the holes on the tooth
surface (under surface) of the dam. Purpose: This eases placement of dental dam
over the contact area of the teeth.

Placing the clamp and frame

1. Select the correct size of clamp.

2. Secure the clamp by tying a ligature of dental tap on the bow of the clamp.

3. Place the beaks of the rubber dam forceps into the hole of the clamp. Grasp the
handles of the rubber dam forceps, and squeeze to open the clamp. Turn upward, and
allow the locking bar to side down to keep the forceps open for placement.

4. Place yourself in the operator’s position, and adjust your patient for easier
access.

5. Retrieve the rubber dam forceps. Positions the lingual jaw of the clamp first,
then the facial jaw during placement, keep an index finger on the clamp to prevent
the clamp from coming off before it has been stabilized on the tooth.

6. Check the clamp for fit.

Fig-2.15 Lingual placement. Fig-2 16 Keep an index

finger on clamp

Fig-2.17 Position the frame over the dam. Fig-2.18 Use the floss and pushing the
dam.

7 Transfer the dental dam to the side; stretch the punched hole for the anchor
tooth over the clamp.
8 Using cotton pliers, retrieve the ligature and pull it through so that it is
exposed and easy to grasp if necessary.
9 Position the frame over the dam and slightly pull the dam, allowing it to
hook onto the projections of the frame. Purpose: Ensures a smooth and stable fit.
10 Fit the last of the dam over the last tooth to be exposed at the opposite
end of the anchor tooth. Purpose: This stabilizes the dam and aids in locating the
remaining punch holes for the teeth to be isolated.
11 Using the index fingers of both hands, stretch the dam on the lingual and
facial surfaces of the teeth so that the dam slides through each contact area.
12 With a piece of dental tape or waxed floss, floss through the contacts,
pushing the dam below the proximal contacts of each tooth to be isolated. Note:
Slide the floss through the contact rather than pulling it back through the
contact. This will keep the dam in place.
13 If the contacts are extremely tight, use floss or a wedge placed into the
interproximal area to separate the teeth slightly.
14 A ligature is placed to stabilize the dam at the opposite end of the anchor
tooth.

4. Inverting the dental dam

1. Invert, or reverse, the dam by gently stretching it near the cervix of the
tooth.
a. Purpose: Inverting the dam creates a seal to prevent the leakage of saliva.
2. Apply air from the air-water syringe to the tooth being inverted to help in
turning the dam material under.
a. Purpose: When the tooth surface is dry, the margin of the stretched dam
usually inverts into the gingival sulcus as the dam is released.
3. A black spoon or burnisher can be used to invert the edges of the dam.
4. When all punched holes are properly inverted, the dental dam application is
complete.
5. If necessary for patient comfort, a saliva ejector may be placed under the
dam. This is positioned on the floor of the patient’s mouth on the side opposite
the area being treated.
6. If the patient is uncomfortable and has trouble breathing only through the
nose, cut a small hole in the palatal area of the dam by pinching a piece of dam
with cotton pliers and cutting a small hole near the palatal area.

Fig-2.19 Inverting the dam.

5. Removing the dental dam

1. If a ligature was used to stabilize the dam, remove it first. If a saliva
ejector was used, remove it.
2. Slide your finger under the dam parallel to the arch and pull outward so
that you are stretching the holes away from the isolated teeth. Working from
posterior to anterior, use the crown and bridge scissors to cut from hole,
creating one long cut.
3. When all septa are cut, the dam is pulled lingually to free the rubber from
the interproximal space.
4. Using the dental dam forceps, position the beaks into the holes of the
clamp, and open the clamp squeezing the handle. Gently slide the clamp from the
tooth.
5. Remove both the dam and the frame at one time.
6. Use a tissue or the napkin to wide the patient’s mouth lips, and chin free
of moisture.
7. Inspect the dam to ensure that the entire pattern of the torn septa of the
dental dam has been removed.
8. If a fragment of the dental is missing, use dental floss to check the
corresponding interproximal area of the oral cavity. Purpose: Fragment of the
dental dam left under the free gingival can cause gingival irritation.

Fig-2.20 Removing the clamp. Fig-2.21 Remove the clamp gently.

Fig-2.22 Remove the dam and frame at one time

3. CARIES EXCAVATION AND TEMPORARY RESTORATION.

3.1 Access cavity and caries excavation.

3.1.1 The establishment access cavity and outline form.

• In based primarily on the location and extent of the carious lesions, tooth
fracture, or erosion.
• In carious lesion, the rough outline form is established after penetration
into carious dentine and removal of enamel overlying the carious dentine. The
final outline is not established until carious dentine and its overlying enamel
have been removed.
• The initial cutting can be achieved by using either flat fissure tungsten
carbide or a small round diamond bur.
• The above caries should be removed either by using slow speed stainless
steel round bur or spoon excavators (hand instruments).
• Caries at dentinoenamel junction (DEJ) and soft, infected dentine (active
caries) must be removed.
• With the used of plastic (frasaco) teeth in the laboratory, access is gained
by preparing an initial depth of 0.2 to 0.8 mm below the dentinoenamel junction.
• Cavity margins are placed in the positions where they will occupy the final
preparation.

Fig-3.1 Access cavity and outline form.

Fig-3.2 Depth of cavity preparation and pulpal relation.

3.1.2 The establishment of resistance form.

Defined as the design of the internal form of the cavity preparation or walls that
will enable both the restoration and the tooth, to withstand the masticatory
forces without fracture. The fundamental principles involved in obtaining
resistance form are as follow:
• Enamel walls are supported by sound dentine.
• Utilize the proximal box shape with a relatively flat floor.
• Junction of the proximal box walls should be rounded off to avoid sharp line
angle.
• Proximal axial wall is at the right angles to the pulpal and gingival floor.
• Rounded and internal line angle to reduce stress concentration.
• Cavo-surface line angles are kept away from areas of stress such as
inclination and tips of cusps.
• The axiopulpal line angle should be rounded off to allow reasonable
thickness of material in this area.
• Provide enough thickness of restorative material to resist fracture under
load (1.5 mm to 2.0 mm occlusogingivally).
• Restrict the extension of external wall to allow strong cusp and ridge to
remain with dentine support.
• Cusp capping weak cusps in extensive cavity preparations.

3.1.3. The establishment of retention form.

Defined as that shape of the prepared cavity that resists displacement or removal
of the restoration from tipping or lifting forces. Since retention needs are
related to the restorative material used, the principles of retention form varies
depending on the used restorative materials.
• For amalgam restoration , in class I and class II cavity preparations, the
materials is retained in the tooth by developing external cavity wall which
converge occlusally.
• For composite resin restoration, in class III and class IV cavity
preparation, the external walls diverge outwardly to provide strong enamel
margins.
• In some cases, retentive coves, grooves, locks or dovetails are incorporated
to increase the retention of these restorative materials to the tooth structure.
• Composite restorations are retained in the tooth by a physical bond, which
develops between the material and acid-etched tooth structure.
• Glass Ionomer Cement (GIC) restorations are retained in the tooth by
chemical bond which develops between the material and conditioned tooth structure.

3.1.4. Convenience form.

Defined as the shape or form of the cavity which allows adequate observation,
accessibility and ease of operation during preparation and restoration of the
tooth.
• Widening access to permit space for bur and instruments (instruments for
tooth cutting, instruments for carrying restorative materials and instruments for
placing and condensing the restorative materials) upon placement of restorative
material.
• Convenience form which involves the removal of sound, strong tooth structure
should be limited and which is necessary.

3.1.5 The treatment of residual caries.

Removal of remaining carious dentine, applies primarily to the caries in the

deepest part (pulpally) of the preparation. Other caries have been removed when
the outline form was established. It may also include (where applicable), the
elimination of any defective restoration left in the tooth after initial cavity
preparation and to consider as follow:
• Remaining deep caries is carefully removed with a slow speed stainless steel
round bur (if possible, under water spray) or a sharp excavator.
• Pay particular attention to the lateral spread of caries at the DEJ; ensure
to clean DEJ first before attempting deeper caries.

3.1.6 Finishing of enamel walls and cavo-surface margins.

This is ensure the cavo-surface margin are smooth and continuous to

facilitate finishing of restoration margins. The objectives of finishing the cavo-
surface margins and walls are:
• To provide a mechanically strong interface between tooth and restoration.
• To obtain the best possible marginal seal at the tooth / restoration
interface.
• To obtain an optimal angle of the materials at the tooth / restoration
interface.
• To allow for a smooth marginal junction.
• To define where the restorative materials should end.
Should remove any sharp edges or margin, which could be a stress
concentration
area or point and might break or fracture.

Factors to be considered are:

• Enamel walls must follow the direction of the enamel rod.
• For restoration not utilizing bonding (e.g.: using amalgam), any unsupported
weak or fragile enamel must be removed.
• For bonded restorations (e.g. using composite resin, GIC, compomer or resin-
modified GIC), enamel that is not supported by dentin and is not exposed to
significant occlusal loading is frequently allowed to remain in place and is
reinforced by bonding to its internal surface.

3.1.7 The toilet of the cavity or cleaning of cavity.

Final procedures in cavity preparation included as follow:

• Washing all debris from the cavity (tooth chips, saliva, blood etc) using
air-water spray.
• Ensure that the cavity is not wet, lightly dry the cavity using air spray
(be careful not to dessicate exposed dentin).
• Inspect cavity carefully for any traces of remaining debris, caries, fragile
enamel, and deminearlized tooth structure.
•

Advice to the patient: In the clinic, every patient should be

explained about the treatment given and must given an advice post-operatively. For
example is to advise patient not to eat hard food at new amalgam restoration site
due to a risk of break because amalgam is not fully set within 24 hours. Others
include the oral hygiene care.

3.2 Temporary restoration.

3.2.1 Introduction.

Operative dentistry among others involves restoration of carious teeth. In this

module will learn the technique of removing caries while maintaining the health
and integrity of the pulp. The objectives of this simulation study are:
• Detect carious lesions on extracted teeth.
• Use the correct instruments to gain access and remove carious dentine at the
DEJ (periphery of cavity) as well as over the pulp.
• Identify carious dentine, which needs to be removed (infected dentine) and
those, which can be left behind (affected dentine).
• List the temporary restorative materials, which is available in the dental
faculty.
• Correctly mix and apply the temporary restorative material into the cavity.

3.2.2 Note on principles of caries excavation.

• Remove caries at the peripheral first before doing the central part.
Remaining dentine at the periphery of the cavity must be clear of stains and hard
dentine. All decayed, stained and softened dentine must be removed peripherally
for a distance of about 1 to 1.5 mm from the amelo-dentinal junction (ADJ) (Fig-
3.1).
• Removal of central caries – this must be done carefully to avoid exposing
the pulp iatrogenically. Although can leave hard and stained dentine in the
central part of the cavity (overlying the pulp).

F ig-3.1 Caries excavation.

 In any carious cavity, beneath the active caries there is
a layer of possibly stained and definitely decalcified dentine. This is healthy
and should not be removed. If remove all stained dentine, will be remove the
healthy layer above the pulp and will expose the pulp.

3.2.3 Restoration with Zinc Oxide and Eugenol.

Simple zinc oxide and eugenol, mixed to firm putty consistency, or the same cement
containing an accelerator such as zinc acetate, are equally useful in this role.
Zinc oxide and eugenol is frequently said to be obtunded, and the cement mixed
with clove oil even more so. Certainly, it is non-irritant to freshly cut dentine,
but it frequently leaves a cavity highly sensitive except when it has remained for
some months. There are occasions when the deepest layer overlying the pulp can be
left in a position when the remainder is removed. This deep layer may then be
used as a lining or sublining to the permanent restoration.

There are 2 exercises should be complete;

ESERCISES

TASK
TEETH

Exercise 1
Caries excavation and temporary restoration using Zinc Oxide Eugenol ( Kalzinol).

Natural teeth / Frasaco teeth: 1 molar (upper or lower), carious and cavitated
notbinvoling the proximal surfaces.

Exercise 2
Caries excavation and temporary restoration using Rein Modified Glass Ionomer
cement (Fuji VII)

Natural teeth / frasoco teeth: 1 molar (upper or lower), carious and cavitated not
involving the proximal surfaces.

The equipment and materials needed are as listed below:

No.
Stage
Equipment / Material

1
Access

TC High speed bur 010 / 012

2
Caries free

Slow speed round bur (size 014 -023)

3
Lining

Calcium hydroxide (Dycal) .

Glass Ionomer Cement (Vitrebond)

4
Temporary Restoration (Cement)

Zinc Oxide Eugenol (Kalzinol)

Glass Ionomer Cement (Fuji VII)

5
Cement mixing
Glass slab
Spatula

6
Placement of restorative material

Plastic Instrument

7
Others
Gauze

• Gain access the cavity by removing some overlying unsupported enamel with
high-speed bur.
• Remove all the caries along the DEJ using a large slow speed round bur.
• Remove soft and leathery carious dentine from the pulpal floor using a spoon
excavator.
• Restore the cavity using Zinc Oxide Eugenol (Kalzinol).
• Ensure that the restoration is homogenous with the tooth.

Fig-3.2 Access cavity with Fig-3.3

Remove the caries
High speed bur.
Low speed round bur.
 Fig-3.4 Placement of temporary restorative material
into the class II prepared molar.

3.2.4 Restoration with GIC (Fuji VII).

• Gain access, remove all caries from DEJ and soft and leathery dentine from
the pulpal floor, after that wash and dry.
• Apply dentine conditioner for 15 seconds, wash and dry.
• Mix Fuji for 10 seconds.
• Apply fuji into the cavity and shape the restoration.
• Light cure the restoration for 15 seconds
• Check the restoration; ensure that it conforms to the anatomy.

Fig-3.5 Apply conditioner. Fig-3.6 Fuji VII

capsule.

Fig-3.7 Fuji capsule mixer. Fig-3.8 Placed the Fuji into

the cavity

Fig-3.9 Shape the restoration.

3.2.5 Restoration with Zinc Phosphate Cement.

Zinc phosphate cement may also be used as a temporary filling. Small wisps
of cotton wool lightly impregnated with clove oil or eugenol may be placed over
the pulp and into the deeper undercuts to reduce the possibility of irritation.
This cement may be used as a thick creamy mix or as a thick mix of putty
consistency. If a thick creamy mix is used, a blunt-ended probe is the most
suitable instrument for teasing the cement, a small portion at a time, into the
appropriate part of the cavity. With cement of putty consistency, a discrete
portion of cement is carried to position on a small round-ended plastic instrument
is suitable. When in position, the cement should be tamped firmly against the
cavity surface and conformed to the correct shape with plastic instruments
moistened with alcohol.

Fig-3.10 Mixing zinc phosphate cement with stainless

Steel spatula on thick glass slab.

3.2.6 Restoration with Gutta-percha.

Temporary gutta-percha can be used for short periods in simple cavities

affecting one surface, or in compound cavities well enclosed and not exposed to
excessive bite. It is unreliable as a cavity seal, but if the surface of the mass
is made tacky by immersion in chloroform before insertion, it is probable that
closer adaptation to cavity walls can be achieved. This particular is easy to
remove but often leaves the dentine of the cavity hypersensitive, to reduce it by
applying carbolated resin to the cavity before insertion of gutta-percha. Although
the wide range of usefulness temporary cement material is zinc oxide and eugenol.

3.3 Mounting the teeth.

Some of the exercises that will involve using natural teeth which mounted on
plaster blocks. In this exercise, how to mount the teeth in the blue Perspex tray.
First mix the plaster with water thickly and pour into the Perspex tray, then the
tooth mounted onto the plaster in the middle of tray. Please note this mounted
teeth can use for the exercise (1) caries excavation and temporary restoration and
(2) class V restoration.
Mount the teeth list below. They are listed according to the order of
exercise in this simulation clinic. If you do not have all the teeth now, you may
mount them in stages, i.e. mount the teeth that you will be using first. You must
mount at least six teeth for each exercise; the teeth which going to use, should
be mounted in the middle.

3.3.1. The teeth need for mounting.

NO. TEETH CRITERIA EXERCISE

1 2 Molars
(upper/lower) Large occlusal caries, preferably not involving the proximal
surfaces.

Caries excavation and temporary restoration.

Mount on plaster block for table to exercise.

2 2 Canines or premolars
(upper/lower) Sound or with abrasion cavity on the baccal surface.

Class V restoration.

Mount on plaster block for table to exercise.

Ensure that at least 5 mm of root surface is exposed.

3 2 Incisors
(upper/lower) Small or medium size caries on the proximal surface.

Class III restoration

COMPETENCY TEST

Must be an upper incisor tooth

4 1 Incisors
(upper/lower) Sound or with proximal caries involving an incisal angle/edge.

Class IV restoration.

5 1 molar
(upper/lower) Sound or stained fissure.

Fissure sealant.
6 1 molar
(upper/lower) Caries localized in a pit, other fissures sound.

Preventive Resin Restoration.

7 2 premolar and/or molar
(upper/lower) Small caries on proximal surface (< 1/3 width of tooth).

Class II composite resin restoration.

______________

COMPETENCY TEST
8 1 molar
(upper/lower) Caries (medium/large) on occlusal surface.

Class 1 amalgam restoration.

9 1 premolar or molar
(upper/lower) Medium or large caries on the proximal surface (> 1/3 width of
the tooth).

Large Class II amalgam restoration.

10 1 molar
(upper/lower) Large caries involving 1 or more cups.

Pinned and bonded amalgam.

 4. PREVENTIVE RESIN RESTORATION.

4.1 Fissure sealant

Sealant restoration was born, for the use of pit and fissure sealants. Dental
sealant is highly effective in preventive dental caries in the pit and fissure
areas of the teeth. 100% caries protection by properly placed and retained the
dental sealants on the tooth surface. The technique restore the carious area and
seals the rest of the fissures. The restoration is indicated where a cavity is
present (either a microcavity in the enamel or in a cavity with dentine at its
base). The lesion will usually be visible on a bite viewing radiograph as an area
of radiolucency in the dentine. Fissure sealant is also can be placed on molar
during development, to prevent decay.

Fig-4.1 Placed Fissure Sealant

Application for dental sealants.

The technique for applying fissure sealant on a molar tooth, which should not have
carious. The equipments and materials are as Fig-4.1.

Fig-4.2 Materials and equipments for dental sealants.

Applying fissure sealant on a molar tooth:

• Apply rubber dam.
• Clean the tooth using prophylaxis paste and brush, wash and dry.
• Acid etch for 15 seconds, wash and dry.
• Placed fissure sealant-just enough to flow within fissures and grooves.
• Light cure for 10 seconds.
• Check occlusion.

Fig-4.3 Place the etching on cleaned molar tooth.

Fig-4.4 Light curing for 10 sec.

 Fig-4.5 Checking Occlusion

Fig-4.6 Completed of fissure sealant on permanent molar.

4.2 .1 Pit restorations with Composite resin.

Cavity preparation:

o Isolated with rubber dam.

o A small round bur is used to remove caries and access cavity.
o If the cavity much larger, place the lining and then place etching.
o GIC place as second liner.
o The cavity is filled with an increment of posterior composite and light
cure.
o Place final increment of composite and light cure.
o Completed restoration.

Fig-4.7A Composite Resin materials set.

Fig-4.8 Occlusal cavity in molar. Fig-4.9 Access Cavity.

Fig-4.10 Lining is placed. Fig-4.11 GIC

is placed.
 Fig-4.12 Placed Composite and Light-cure Fig-4.13 Place final
composite.

Fig-4.14 Completed restoration. Fig-4.15

After 5 years.

Fig-4.16 After 9 years Fig-4.17

After 14 years.

4.2.2 Pit restoration GIC Light-Cure.

Glass ionomer cement (Fig-4.17) is one of the newer cement systems. The GIC
(ketac molar) is type one system of GIC light-cure, which also can be used for pit
and fissure sealant (Fig-4.18 to Fig-4.23).

Fig-4.17A Various brand name of GIC.

Fig-4.19 B Ketac Molar GIC material including liquid,

powder and conditioner.

Fig-4.18 Remove the caries and rinse. Fig-4.19 Apply the

conditioner.

Fig-4.20 Dry the cavity. Fig-4.21

Mixing the GIC

Fig-4.22 Place the GIC Fig-4.23 Complete restoration.

 5. ACID-ETCH TECHNIQUE AND ABRATION CAVITY RESTORATION.

5.1 Acid-etch technique.

Equipment and supplies: Basic setup, cotton rolls /dental dam for isolation,
applicator (cotton pellets for liquid etching and syringe tip for gel), etching
material, high-velocity evacuator, air-water syringe and timer(Fig-5.1).

Procedure:

4. The prepared tooth must be isolated with rubber dam or cotton rolls
5. The surface of the tooth must clean and free from any debris, plaque or
calculus.
6. After clean, dry surface carefully.
7. The etching material is place only where it is needed (Fig-5.2).
8. The tooth structure is etched from 15 to 30 seconds.
9. After etching, the surface is thoroughly rinsed and dried for 15 to 30
seconds.
10. An etched surface has a frosty-white appearance.

Fig-5.1 Basic set for etching technique.

Fig-5. 2 Place the Etching gel on the molar tooth.

5.2 Abrasion cavity restoration.

Defects occurring at the cervical areas of the teeth may be due to the effects of
caries, abrasion from toothbrush and tooth paste, erosion and a fraction. In this
exercise, will simulate an abrasion cavity on a natural tooth and restore it using
GIC. Restoration of abrasion cavity with Fuji II :
• Prepare a cervical abrasion cavity on the buccal surface a canine or
premolar tooth (using pear bur). This step will only be done if using a sound
natural tooth.
• Choose a suitable cervical matrix, bend it to shape.
• Pumice the tooth surface, wash and dry.
• Apply conditioner for 15 seconds, wash and dry.
• Place the GIC (Fuji II) material into the cavity, cover with the cervical
matrix, remove any excess material and wait until the material is set.
• Remove the matrix.
• Apply the bonding agent on the restoration and light cure.
• Final restoration, polishing (only if necessary) should be done 24 hours
after placement.

Fig-5.3 Abrasion cavity 3mm height and width. Fig-5.4 Band with matrix.
 Fig-5.5 Pumice the tooth surface. Fig-5.6 Applying the
conditioner.

Fig-5.7 Place the Fuji II. Fig-5.8

Remove the matrix.

Fig-5.9 Place the bonding and light cure. Fig-5.10 Complete

restoration.

6. AMALGAM RESTORATION.

6.1 Amalgam Restoration Materials.

After the cavity has been prepared and the liners and base has been placed, the
tooth is ready to be restored. One of the most common restorative materials is
dental amalgam., which has been used for many years, dental amalgam is an
effective, long lasting, and comparatively inexpensive restorative materials.
Amalgam is a combination of an alloy with mercury. An alloy is a combination of
two or more metals.

Fig-6.1 Mercury Spill Kit. Fig-6.2 Example of

Amalgam Capsules

Fig-6.3 Kerr amalgamators. Fig-6.4 Placing capsule in the

amalgamator.

Fig-6.5 Activating the amalgam timer. Fig-6.6 Loading an

amalgam carrier.

Fig-6.7 Placing amalgam scrapes Fig-6.8 Amalgam bonding

materials.
in a sealed container.

Fig-6.9 Matrix Band. Fig-6.10 A (U/right, L/ left), B

(U/left, L/right).
6.2 Class I amalgam restoration

6.2.1 Armamentarium.

6.2.1.A Tray setup.

• Mouth mirror
• Explorer
• Tweezers
• Periodontal probe
• Hatchet
• Gingival marginal trimmer.

6.2.1. B Cavity preparation

• Contra-angle slow speed hand piece.
• Burs- stainless steel (SS), tungsten carbide (TC), diamond burs.

6.2.1.C Condensation and curving

• Amalgam carrier
• Amalgam condenser
• Carver
• Ball burnisher

6.2.1.D Finishing and polishing

• Multifluted SS finishing burs- variety of shapes
• Finishing stones- variety of shapes
• Bristle brush
• Rubber cup
• Cotton roll
• Dappen dishes
• Flour of pumice
• Whiting

6.2.2 Class I cavity

The occlusal carious lesion begin in the area of pit and fissure where
bacterial plaque is free to attack the inaccessible and poorly fused enamel
ridges. Access to the lesion can be initially opening into the dentine through the
most affected portion of the tooth. Cavity preparation is extended to all
defective pit and fissures and into those areas that seems subject to future
breakdown.

6.2,2.1 Outline form

• Caries should be eliminated and rough outline of the cavity prepared.
• Margins should be placed on sound tooth structure.
• Conserve ridges involved in occlusal contacts whenever possible.
• Include all defective pit and fissures.
6.2.2.2 Resistance form
• Create flat pulpal floor (perpendicular to the long axis of the tooth).
• Prepare wall that create 90 degree cavo-surface margins of enamel
• Prepare wall that create 90-degree cavo-surface margins of amalgam.
• Round all internal line angles.
• Preserve adequate bulk of the mesial and distal marginal ridges.
• Provide sufficient depth of pulpal floor occlusogingivally (1.5-2.0 mm) to
resist fracture.
6.2,2.3 Retention form
• Should create walls that are parallel to each other or converge occlusally.

6.2.2.4 Convenience form

• The cavity should be of sufficient width to include the defect but otherwise
as narrow as the available smallest plugger to allow sufficient condensation of
amalgam.

6.2.2.5 Removal of remaining carious dentine

• Removal of remaining carious dentine applies primarily to the caries in the
deepest part (pulpally) of the preparation.
• It may also include (where applicable), the elimination of any defective
restoration left in the tooth after initial cavity preparation.
• For exercise on frasaco teeth, this step is obviously unnecessary and cavity
preparation depth is confined to 1.5 – 2.0 mm.

6.2.2.6 Finishing of enamel walls.

• Remove all unsupported enamel rods. Unnecessary step in frasaco teeth except
to remove any unsupported plastic at cavo-surface margin.
• Smooth the cavosurface margins so that amalgam can be adequately carved and
finished.

6.2.2.7 Features of the prepared cavities.

• The outline for the cavity wall is placed halfway from the center of the
defective pit, fissures and grooves (Fig-6.11).
• A bucco-lingual width of 1.5 mm through the central groove and 1 mm in other
extensions should place the wall in sound enamel and dentine (Fig-6.11).
• The pulpal depth is measured 1.5 mm from the central fissure, desirably
about 0.2 mm into dentine (Fig-6.12).

A B C

Fig-6.11 A Initial caries, B Instrumentation , C Final

outline.

Fig-6.11D Cavity outlines Fig-6. 12

Cavity measurements.

• The pulpal floor is flat and parallel to the occlusal plane of the tooth.
• The depth of the prepared external walls is 1.5-2mm, depending on the cuspal
inclines.
• The prepared external walls (mesial, distal, lingual and buccal) are
parallel to each other and perpendicular to the pulpal floor (Fig-6.13A). However,
in some cases, the walls are prepared with a slight occlusal divergent (Fig-
6.13B).

Fig-6.13A External walls. Fig-6.13 B

Occlusal walls.
• In the case where extension of the preparation ( to include fissure or
caries ), becomes closer into the mesial and / or diatal marginal ridges, the
preparation require slight tilting of the bur distally ( not more than 10
degrees ). This creates a slight occlusal divergent to prevent undermining the
dentine support of the marginal ridge.
• This principle is applicable when there is a limited distance between the
proximal surface extensions to the marginal ridges. For premolar teeth, the
distance should not be less than 1.6mm (figure-6.14). for molars, the minimal
distance is 2 mm. direction of mesial and distal walls is influenced by remaining
thickness of marginal ridges as measured from mesial or distal ridge. Mesial and
distal wall should converge occlusally when distance from a to b is greater than
1.6 mm (left). If the distance is 1.6 mm or less, the walls must diverge
occlusally to conserve ridge supporting dentine (right).

Fig-6.14 The direction of mesial and distal walls

thickness.

• The cavity should be of sufficient width to include the defect but as narrow
as possible, realizing that it must be wide enough to permit instrumentation such
as insertion and condensing of amalgam.
• Occlusal outline covers all the primary grooves and is located in the middle
1/3 of the occlusal surface (Fig-6.15).

Fig-6.15 Primary grooves

outline.

• The mesial and distal margins should be parallel with the corresponding
marginal ridges (Fig-6.16).

Fig-6.16 Mesial and distal margins parallel to marginal and

oblique ridge.

6.2.3 Preparation cavity class I.

• Pencil was used to defective grooves on the occlusal surface of the tooth.
(Fig-6.17, Fig-6.18).
• Place a jet 330 tungsten carbide bur, flat fissure diamond or a small round
bur (size 1 or 2) in the hand piece ( jet 330 bur; present in both high and slow
speed, SS round bur; in slow speed, fissure diamond; present both in high and slow
speed).

A B C
Fig-6.17 A Pencil defective groove, B TC Jet 330, C Example of TC burs (Jet
330,245)

Fig-6.18 Pencil the defective

groove.

• Position the bur in the central fossa at right angle / perpendicular to the
occlusal surface (Fig-6.19, Fig-6.20).
• Enter the central pit with the bur and cut to just below the dentinoenamel
junction approximately 1.5 mm (fig-6.21).

Fig-6.19 Bur position Fig-6.20 Perpendicular to

Fig-6.21 Cut below
occlusal
serface. dentinoenamel junction.

• Apply light intermittent pressure to avoid burning the tooth.

• Remove the debris from the operating area with a gentle stream of air.
• Move the bur along the fissures and grooves to obliterate the penciled
defects maintaining the depth specified (2 mm) and keeping the bur perpendicular
to the occlusal surface.
• Maintain uniform depth of the pulpal floor.
• Remove the enamel just short of the desired outline form.
• Using bur in slow-speed hand piece, smooth the pulpal floor as well as
preparing the facial and lingual walls to achieve parallelism (Fig-6.22).
• All preparation walls must be parallel or 90 degree to the pulpal floor
(Fig-6.23), except in the case where there is a limited distance between the
proximal surfaces extensions to the marginal ridges as previously explained in
6.2.2.7.
• Eliminate any sharp corners of the cavosurface outline (Fig-6.24) with the
bur and remove any debris.

Fig-6.22 Achieve cavity wall. Fig-23 Pulpal floor. Fig-6.26

Eliminate corner

6.2.4 Placement of lining or base.

• The use of lining / liner or base in cavity preparation becomes essential

when the cavities finish deep in the dentine or when the cavities lie close to the
pulp. Otherwise, placement of the lining or bases may be indicating as follow
(Fig-6.25,26 and 27).

Fig-6.25 Lining. Fig-6.26 Varnish Fig-6.27 Liner and Base.

6.2.5 Restoration of cavity.

6.2.5.A Trituration

• The process includes the combining or mixing of liquid mercury with dry
amalgam ally power. This process is carried out using amalgamators or amalgam
triturators. The objectives are;
1. To coat each particle of alloy with mercury.
2. To begin the reaction that will produce a solid mass.
• The required amount of amalgam is triturated with a 1:1 ratio of alloy and
mercury in an amalgamator.
• For trituration time, please follow the manufacturer’s instruction.
• After the triturating is completed, empty the contents of the capsule onto
the glass dish and begin the condensation immediately.
• Nowadays, use of encapsulated amalgam alloy ready for trituration is
recommended ( a weight, standardized amount of amalgam power and mercury sealed in
a capsule).
• The encapsulated products provide more consistent mixes of amalgam and are
safer for use in the dental office.

6.2.5.B Condensation

• Condensation is the processes of compressing and directing the dental

amalgam into the tooth preparation with amalgam condensing instruments (condensers
or pluggers) until the preparation is completely filled and then, overfilled with
a dense of amalgam.
• Proper condensation of amalgam promote;
1. Better adaptation of the amalgam to the walls of the preparation.
2. Elimination of voids due to compaction of the materials.
3. Reduction in the amount of residual mercury in the restoration.
4. Greater restoration strength.

• Voids and increased residual mercury have been associated with weakened
amalgam product thus reduce the strength of the restorations.
• Adequate condensation techniques requires a significant amount of force to
be applied to the condenser;
1. The force should be about 2-5 kg when using admixture amalgam.
2. For special amalgam, the force is considerably less, because heavy forces
tend to push the spherical particles to the side and “punch through” the amalgam
mass.
3. The size of the condenser end determines the amount of force to be exerted
to the amalgam mass: the larger the end, the less force per unit area is applied.
4. Therefore, larger condenser must exert more force on the condenser to
deliver adequate condensation pressure.
5. Amalgam should be condensed both vertically and horizontally or laterally
(towards the walls of the preparation) (Fig-6.28).

Fig-6.28 Lateral and occlusogingival force to

Properly condense amalgam.

• When amalgam is condensed, mercury is brought to the surface creating a

mercury-rich amalgam on the surface.
• To reduce the amount of mercury left in the restoration (residual mercury),
the preparation is overfilled, and the mercury excess is carved off.
• The lower the residual mercury left in the restoration, the higher its
strength.
Condensation procedure.

• This condensation procedure must be completed within three to four minutes

from the start of trituration.
• If the amalgam is not used within this time, the remaining mix should be
discarded and a new mix prepared.
• Fill the smallest end of the amalgam carrier with the triturated amalgam.
• Holding the carrier like a pen, pick up the amalgam by pushing the carrier
into it (Fig-6.29).
• Inject one-half of the amalgam in the carrier into the prepared cavity (Fig-
6.30).
• Use the smaller end of the no.1 small round condenser to pack the amalgam
into the cavity (Fig-6.31).
• Start condensation in the central pit area, directing the condenser at right
angle to the pulpal floor while exerting firm force on the amalgam to pack it onto
the floor and into the line angle.
• In condensing amalgam, always be sure to use a condenser that fit the cavity
and to exert firm pressure on the amalgam. The condenser must be able to reach the
pulpal floor in all parts of the cavity (Fig-6.31 to Fig-6.33).

Fig-6.29 Picking up the amalgam. Fig-6.30 Inject amalgam.

Fig-6.31 Condensing Fig-6.32 Incorrect condenser. Fig-6.33 Correct condenser

• Firm condensation pressure is necessary in order to;

1. Remove excess mercury from the mix,

2. Push the alloy particles together to mark a dense filling.
3. Adapt the amalgam to all part of the cavity.
4. Remove voids in the amalgam.

• Remove the mercury-rich surface from the amalgam with the condenser.
• Continue adding and condensing small increment of amalgam until the cavity
preparation is filled and all portions of the amalgam are thoroughly condensed.
• Add additional amalgam and use the larger end of the round condenser to
overfill the cavity.
• Condensed the excess amalgam beyond the margins and the final contour. In
this case, the surface of residual mercury will be carved away (Fig-6.34).

Fig-6.34 Condensing excess.

6.2.5.C Burnishing.

• After it is condensed with amalgam condenser, amalgam should be further

condensed with a large burnisher, such as an ovoid (football) burnisher. This
called “precarving burnishing”.
• This should take place immediately after completion of condensation.
• Apart from aiding condensation, burnishing is the first step in shaping the
occlusal surface of the restoration.
 Procedure of burnishing.

1. Using the ball furnisher with firm hand pressure, burnish the amalgam from
the central sulcus to the margins.
2. This burnishing will draw the excess mercury into the over packed amalgam,
which will be removed during carving procedure ( Fig-6.35 and Fig-6.36).
3. After carving is completed, the margins may be burnished again with light
hand pressure to remove any roughness or flash remaining, thus ensuring a better
marginal integrity (Fig-6.37).

Fig-6.35 Burnishing. Fig-6.36 Remove excess Fig-6.37 Remove

roughness.
Mercury.

6.2.5.D Carving

• Should begin immediately after condensation and precaving burnishing.

• May be carved with any bladed dental instrument that has sharp edge. Most
commonly used instruments are cleoid-discoid carver, Hollenbach or H carver (some
may find spoon excavator useful for amalgam carving).
• Most amalgam carving is perfomed using pulling strokes. Pushing strokes can
be advantageous in developing occlusal anatomy (grooves).
• Small class I and class II should be carved with enamel surface as a guide.
• The carver should rest on the enamel adjacent to the preparation and be
pulled in a direction parallel to the margins of the preparation.
• When a stroke perpendicular to the margin of preparation is needed, carver
should be pulled from enamel to amalgam.

Procedure Amalgam carving

1. Remove the bulk of the over packed mercury rich amalgam with the large
carver (Fig-6.38).
2. Carve from distal to mesial, resting a portion of the blade on the adjacent
tooth structure (Fig-6.39) to lessen the chances of removing too much amalgam
( Fig-6.40).
3. Remove the excess amalgam shaving from the occlusal surface with a genetic
stream of air.
4. Develop the occlusal anatomy of the restoration with a carver. Carve along
the margins, resting the side of blade on the inclines of the cusps (Fig-6.41).
5. Keep the point of the carver centered between the margins of the restoration
and use short, light strokes to carve the amalgam.
6. This will reestablish the desired contours and grooves and will avoid thin
and weak margins (Fig-6.42)
7. Examine the carving with a carver and remove any thin layer or flash of
amalgam that extends out over the enamel surface.
8. The amalgam must be carved back to the cavity margins to prevent subsequent
fracture at the margins.
9. Lightly wipe the occlusal surface with a cotton roll to remove any particles
of amalgam.

Fig-6.38 Remove excess Fig-6.39 Carving guide Fig-6.40 Carving

 Fig-6.41 Develop occlusal anatomy Fig-6.42 Carver
centered

6.2.5.E Checking occlusion

• Occlusion is checked when the carving appear to be correct.

• This is accomplished with an articulating paper that marks the contact when
the maxillary and mandibular teeth are brought together.
• A piece of articulating paper is placed over the restoration and the patient
is instructed to close his / her mouth very lightly to check if the occlusion is
correct.
• Remember to advise the patient not to bite too hard because of the danger of
fracturing the restoration, which is weak at this stage.
• Amalgam that has not been carved adequately will have “high spot” present on
its surface, which should then be removed by additional carving.
• It is important to check the occlusion before the amalgam becomes hard as
the adjustment of occlusion with hand instrument becomes difficult once the
amalgam has set.
• The process of light closure with articulating paper is repeated, and
additional carving is accomplished until the teeth can be closed to pre-
restoration occlusion.

6.2.5.F Finishing and polishing

Finishing of an amalgam restoration includes evaluating the restoration

for problems and correcting those, to ensure margins are even and contours and
occlusion are correct as well as smoothing the restoration.

Polishing is defined as smoothing the surface to a point of high

gloss or luster. Allow at least 24 hours for the amalgam process to be completed
before polishing the restoration.
• Begin any necessary finishing procedure by marking the occlusion with
articulating paper and evaluate the margin with an explorer.
• If the occlusion in to be improved, white or green stone can be used to
correct the discrepancy.
• The area may be further smooth using light pressure with a suitably shaped
finishing bur (Fig-6.47). The bur should be held perpendicular to the margin to
guide the bur and prevent UN necessary amalgam removal (Fig-6.43).
• Then, margin is re-checked with the explorer (Fig-6.44).

Fig-6.43 Eliminate discrepancies. Fig-6.44 Check with

explorer.

• If the grooves or fossa is not adequately defined, a small round bur may be
used to define the grooves.
• Polishing procedure is initiated by using a course, rubber abrasives point
at low speed and air-water spray to produce a smooth, satiny appearance of an
amalgam surface. It is crucial to use rubber point at slow speed as the points
disintegrate and can elevate the restoration / tooth temperature if used in high
speed.
• If amalgam surface does not exhibit smooth, satiny appearance after
polishing, the surface is probably still rough. Then, resurfacing with a finishing
bur should be repeated.
• When the surface of the amalgam is moderately polished with no scratches
present, a high polish can be imparted to the restoration with a series of medium-
and fine grit abrasive points.
• As an alternative to rubber abrasive point, final polishing can be
accomplished using a brush with flour of pumice and finally, with the rubber cup.

Fig-6.45 Brush Polish. Fig-6.46

Final Polish.

Fig-6.47A Multifluted finishing burs (Stainless

steel).
Use for smoothing the surface and enhancing the anatomy
and marginal Adaptation of amalgam/restorative materials.

Fig-6.47 B Outline form of various class I

preparation.

6.2.6 Practical cavity class I.

1. 36 Buccal pit, 36 Occlusal ( Entire fissure involved)

2. 25 Occlusal (Central fissure only)
3. 17 Occlusal (Oblique ridge preserved)
PRACTICAL SESSION

1. INSTRUCTION: Buccal pit amalgam on 36

Date:…………………….

ACTIVITY
LECTURER’S NAME AND SIGNATURE

COMMENTS

Cavity Preparation
-outline form
-resistance form
-retention form
-convenience form
-finish of enamel walls
-cavity toilet

Base / lining
-understand the indication
-materials used
-sufficient thickness
-uniform layer
-confine to area that is necessasary

Filling and Carving

-underfill / overfill
-overhanging or deficient margin
-maintain anatomy
-maintain contact point
(if applicable)

Polishing
-smooth and shiny
-fissures maintain
-marginal ridges maintain

PRACTICAL SESSION

2. INSTRUCTION: Class I amalgam on 36 (include all fissure)

Date:…………………….
 ACTIVITY
LECTURER’S NAME AND SIGNATURE

COMMENTS

Cavity Preparation
-outline form
-resistance form
-retention form
-convenience form
-finish of enamel walls
-cavity toilet

Base / lining
-understand the indication
-materials used
-sufficient thickness
-uniform layer
-confine to area that is necessasary

Filling and Carving

-underfill / overfill
-overhanging or deficient margin
-maintain anatomy
-maintain contact point
(if applicable)

Polishing
-smooth and shiny
-fissures maintain
-marginal ridges preserved

PRACTICAL SESSION

3. INSTRUCTION: Class I amalgam on 25 (central fissure only)

Date:…………………….

ACTIVITY
LECTURER’S NAME AND SIGNATURE

COMMENTS

Cavity Preparation
-outline form
-resistance form
-retention form
-convenience form
-finish of enamel walls
-cavity toilet

Base / lining
-understand the indication
-materials used
-sufficient thickness
-uniform layer
-confine to area that is necessasary

Filling and Carving

-underfill / overfill
-overhanging or deficient margin
-maintain anatomy
-maintain contact point
(if applicable)

Polishing
-smooth and shiny
-fissures maintain
-marginal ridges preserved

PRACTICAL SESSION

4. INSTRUCTION: Class I amalgam on 17 (marginal ridge preserved)

Date:…………………….

ACTIVITY
LECTURER’S NAME AND SIGNATURE

COMMENTS

Cavity Preparation
-outline form
-resistance form
-retention form
-convenience form
-finish of enamel walls
-cavity toilet

Base / lining
-understand the indication
-materials used
-sufficient thickness
-uniform layer
-confine to area that is necessasary
Filling and Carving
-underfill / overfill
-overhanging or deficient margin
-maintain anatomy
-maintain contact point
(if applicable)

Polishing
-smooth and shiny
-fissures maintain
-marginal ridges preserved

PRACTICAL SESSION

5. INSTRUCTION : Buccal pit amalgam on 26

Date:…………………….

ACTIVITY
LECTURER’S NAME AND SIGNATURE

COMMENTS

Cavity Preparation
-outline form
-resistance form
-retention form
-convenience form
-finish of enamel walls
-cavity toilet

Base / lining
-understand the indication
-materials used
-sufficient thickness
-uniform layer
-confine to area that is necessasary

Filling and Carving

-underfill / overfill
-overhanging or deficient margin
-maintain anatomy
-maintain contact point
(if applicable)

Polishing
-smooth and shiny
-fissures maintain
-marginal ridges maintain
6.2.7 Class I cavity with lingual/palatal extension.

6.2.7A. Armamentarium

• Tray setup:
1. Mouth mirror
2. Exploer
3. Tweezers
4. Periodontal probe
5. hatchet
6. Gingival Marginal Trimmer

• Cavity preparation:

1. contra-angle slow speed hand piece

2. burs; stainless steel(SS), Tungsten carbide (TC), and diamond burs
• Matricing:
1. Tofflemire matrix retainer
2. universal matrix band
3. wooden wedges scissors
4. plastic instrument

• Condensation and carving:

1. amalgam carrier
2. amalgam condenser / plugger
3. amalgam carver
4. burnisher

• Finishing:
1. multiflute SS finishing burs; variety of shapes
2. finishing stones- variety of shapes
3. bristle brush
4. rubber cup
5. cotton roll
6. dappen dish
7. flour of pumice

6.2.7B Preparation of class I with palatal extension

• The occlusal preparation follows the principles for a class I cavity

preparation.
• The margins are halfway from the center of the defective grooves (Fig-6.48).
• The occlusal portion of the occluso-lingual preparation has minial width to
preserve adjacent tooth structure.
• However, when the disto-lingual cusp is small, the occlusal portion of the
occluso-lingual preparation is cut more at the expense of the oblique ridge. This
will avoid weakening the disco-lingual cusp (Fig-6.49).
• The lingual portion of the occluso-lingual preparation is a box, which has a
flat gingival floor / set, with the mesial and distal wall parallel with one
another (Fig-50).

Fig-6.48 Cavity margins fig-

6.49 Cavity Shape.

(A) (B)
Fig-6.50 (A) Box shape lingual , (B) Flat seat and
parallel wall.

• The extremities of the occlusal grooves and the portion of the wall adjacent
to the marginal ridges are prepared at 95 degree to the pulpal floor. This result
in a slight flare in this area (Fig-51) or the axial wall diverges occlusally.
• This principle is indicated only when the distance between the mesial and /
or distal axial walls of the preparation to the marginal ridge or to the buccal
and /or lingual tooth surface is 1.6 mm or less for premolar and 2.00 mm for molar
teeth.
• If the distance are more than 1.6 mm for premolar and more than 2.00 mm for
molar teeth (to the marginal ridge or to the buccal and / or lingual tooth surface
and no extension is necessary to include a pit or fissure caries), the mesial and
/ or distal axial walls are prepared to converge occlusally. This principle has
been previously described for better understanding.
• The pulpal floor of both preparations is flat in dentin.
• The axial wall of the occluso-lingual preparation is flat, in dentin, and at
a slight obtuse angle to the pulpal floor (Fig-6.52).

Fig-6.51 Occlusal view

Fig-6.52 Axial wall view

6.2.7C Measurement of prepared cavity

Fig-6.53 Occlusal view Fig-6.54 Cavity depth Fig-6.55

Measurements

6.2.7 D Procedure of cavity preparation

• Pencil the defective grooves on the occlusal and lingual surface of the
tooth as illustrated (Fig-6.56).
• Enter the penciled occlusal lesion with the bur in the high or slow-speed
hand piece.
• Position the bur perpendicular to the occlusal surface and with light and
intermittent pressure; penetrate to depth of approximately 1.5 mm. this will
establish the level of the pulpal floor (Fig-6.57).
• Remove the debris from the operating area to increase visibility.
Maintaining the depth specified and holding the bur perpendicular to the pulpal
floor, move the bur along the grooves to obliterate the penciled defects.
• Create and maintain a flat pulpal floor (Fig-6.58).

Fig-6.56 Pencil the groove. Fig-6.57

Cavity depth.

Fig-6.58 Flat pulpal floor. Fig-6.59

Direction of cut

• Enter the occlusal portion of the penciled occlusal-lingual lesion with the
bur to establish the depth of the pulpal floor (again 1.5 mm). then move the bur
facially to prepare the distal pit area of the preparation.
• This cut should be slightly more at the expense of the oblique ridge to
avoid weakening the small disto-lingual cusp.
• Move the bur lingually at the proper depth along the occlusal groove until
the bur has cut through the lingual surface (Fig-6.59).
• Position the bur parallel to the lingual surface at the lingual groove and
begin preparing the lingual step with the side of the bur (Fig-6.60).
• This will produce a cut that is deeper toward the occlusal (2.0 mm) than at
the gingival (1.5 mm), resulting in an axial wall entirely based in dentin.
• Extend the lingual box gingival to the termination of the lingual groove.
• Do not make the cavity wider than the width of the bur or extend the pulpal
floor deeper than previously indicated.
• Finish the occlusal portion of the occluso-lingual preparation with the bur,
flaring only the distal extremity of the groove and the portion of the wall
adjacent to the marginal ridge if the distance is 1.6 mm or less (Fig-6.61,62).
Otherwise, the axial walls are prepared at least parallel to the pulpal floor or
slightly converge occlusally.

Fig-6.60 Bur position Fig-6.61 Occlusal view. Fig-6.62 Occlusal

portion finished

• Position the bur perpendicular to the lingual surface and with the end of
the bur flatten the axial wall, while using the side of the bur to prepare
parallel mesial and distal wall (fig-6.63).
• Use the end of the bur to flatten and finish the gingival wall.
• The gingival wall must meet the tooth surface at a 90-degree angle.
• A flat gingival seat at the lingual extension is desirable for resistance
form.
• The retention form of the lingual extension is accomplished by cutting
retention grooves or locks with the side of the bur.
• Grooves are placed in dentin in both mesio-axial and disto-axial line
angles.
• Grooves are placed in dentin in both mesio-axial and disto-axial line
angles.
• Grooves taper occlusally and terminate at the level of the pulpal floor
(Fig-6.63).
• Finish the mesial and distal wall of the lingual step with the enamel
hatchet, using a planning-scarping action (Fig-6.64)
Fig-6.62 Flatten axial wall Fig-6.63 Retention grooves.

Fig-6.64 Finish with enamel hatchet.

6.2.7 E Matricing

Preparations with missing wall such as in the case of occluso-palatal/lingual and

Class II require the use of a matrix to confine the restorative material during
placement. The purpose of the matrix is to:
• Substitute for missing walls so that adequate condensation forces can be
applied
• Allow re-establishment of contact with the adjacent tooth
• Restrict extrusion of the amalgam and formation of an overhang at the
interproximal margin
• Provide adequate physiologic contour for the proximal surface of the
restoration
• Impart an acceptable surface texture to the proximal surface, particularly
the contact area that cannot be carved and burnished.

The most commonly used matrix in the United States is Tofflemire

system. Others Type of matrix systems available are Squiveland, Auto-matrix and
Palodent Matrix (held in place by Bitine ring).

A. Tofflemire matrix

• Two type : straight and contrangle ( Fig-6.65)

Fig-6.65 Shows the two types of Tofflemire

matrix.

• Consist of 6 main components: (Fig-6.66, 67, 68, 69).

1. Locking nut
2. Adjusting nut
3. Retaining screw
4. Vise
5. Head
6. Matrix band (which goes into the vise and head).

Fig-6.66 Parts of a retainer.

Fig-6.67 Parts of the Toffiemire retainer.

Fig-6.68 Occlusal and gingival edge of the band. Fig-6.69 Vise slot of matrix
holder
B. Matrix band placement

• Turn the locking nut on the matrix retainer counterclockwise to free the
retaining screw from the slot on the vise (Fig-6.66)
• Position the Tofflemire retainer with the head up and the slot in the vise
and the head facing you (Fig-6.67).
• Form a loop with the matrix band and line up the end of the band. The edge
of the band, which is toward the gingival, forms a smaller circumference than the
occlusal side (Fig-6.68)
• With the occlusal edge of the band facing the slot, insert the band into the
vise so that the band ends are adjust visible at the end of the vise slot (Fig-
6.69).
• The loop of the band may extend from the head of Tofflemire retainer in one
of three directions (1) straight, (2) left, (3) right (Fig-6.70).

Fig-6.70 The loop of the band extension.

• With the retainer head up and the slot facing you, thread the band into the
head and out through the right slot for application on a maxillary right tooth and
mandibular left.
• For application on a maxillary left tooth and mandibular right, thread the
band through the left slot.
• Turn the locking nut clockwise to secure the band in the retainer (Fig-
6.71A, B).
• Place the band on the tooth, with the retainer on the facial side (Fig-
6.72).

(A) (B)
Fig-6.71 (A) Mandibular left, (B) Maxillary right.

Fig-6.72 Placement of bend on the tooth

Fig-6.73 The slot in the head of matrix directed to

gingival

Fig-6.74 The slot in the head of matrix directed to occlusal.

• The band must be assembled with the slot in the head directed gingivally,
not occlusally (Fig-73).
• Make sure that the band covers the gingival margin of the cavity
preparation.
• Turn the adjusting nut on the retainer clockwise until the band fit snugly.
• To avoid injury to the gingival and the periodontal fibers do not overseat
the band.
6.2.8 F Restoration of palatal extended class I cavity.
A. TRIRURATION

• Prepare as describe in previous section 5.2.5 A in class I amalgam

restoration.

B. CONDENSATION

• Follow procedure described in previous section 5.2.5 B for condensation on

the occlusal surface.
• Inject a small increment of amalgam into the lingual step portion of the
occluso-lingual cavity and use the small end of the condenser to pack the amalgam
into the lingual step.
• Direct the condenser gingivally and laterally while exerting firm force on
the amalgam to thoroughly condense it along the mesial, distal, and gingival
margins.
• Continue to add and condense small increments of amalgam until the amalgam
is condensed along the entire length of the mesial and distal margins of the
lingual step.
• Add and condense small increments of amalgam to fill the occlusal portion of
the cavity.
• Use the small end of the round condenser to pack the amalgam into this area
(Fig-6.74).
• Use the larger end of the condenser to over pack the cavity with additional
amalgam.
• Lateral condensation of amalgam toward all walls will improve adaptation
(left) and overfill should be condensed with a large condenser (right) (Fig-6.75).

Fig-74 Use small condenser. Fig-6.75 Use large

condenser.

C. BURNISHING

• Follow the same procedures as described in the previous section 5.2.5 C.

D. CARVING

• Remove the excess amalgam inside the matrix strip with an explorer. This
will lessen the chances if fracturing the amalgam when the strip is removed (Fig-
6.76).

Fig-6.76 Remove excess amalgam.

• Turn the locking nut the matrix retainer counterclockwise to release the
matrix band from the retainer. Remove the retainer in an occlusal direction (Fig-
6.77).
• Remove the matrix band from the tooth (Fig-6.78).
• Remove the bulk of the over packed and burnished mercury- rich amalgam from
both restoration with the caver.
• Carve along the margins, resting a portion of the blade on the adjacent
tooth structure (Fig-6.79).

Fig-6.77 removal of retainer.

Fig-6.78 Remove matrix band. Fig-6.79 Carve

along margins.

• Remove the amalgam shaving from the tooth with a gentle stream of air.
• Develop the anatomy of the occluso-lingual restoration with a carver.
• Keep the point the carver more toward the distal to reestablish the desired
groove (Fig-6.78, 79).
• Develop the anatomy of the occlusal restoration with a carver.
• Carve along the margins, resting the side of the blade on the inclines of
the cusps.
• Maintain the point of the carver centered between the margins th reestablish
the desired contours and grooves. Remove any thin layer of amalgam that extends
out over the enamel surface.
• Lightly wipe the occlusal and lingual surface with a cotton roll to remove
any particles of amalgam.

Fig-6.80 Position carver. Fig-

6.81 Develop anatomy.

E. CHECKING THE OCCLUSION

• Follow the same procedures as described in previous section 5.2.5 E.

• Examine the restoration for high spots. Reduce any high spot with additional
carving.

F. FINISHING AND POLISHING

• Follow the same procedures as described in previous section 5.2.5 F.

6.2.9 Practical class I cavity with lingual/palatal extension.

6.2.9A Class I with palatal extension on 17

PRACTICAL SESSION

1. INSTRUCTION: Class I amalgam with palatal extension on 17

Date:…………………….

ACTIVITY
LECTURER’S NAME AND SIGNATURE
 COMMENTS

Cavity Preparation
-outline form
-resistance form
-retention form
-convenience form
-finish of enamel walls
-cavity toilet

Base / lining
-understand the indication
-materials used
-sufficient thickness
-uniform layer
-confine to area that is necessasary

Filling and Carving

-underfill / overfill
-overhanging or deficient margin
-maintain anatomy
-maintain contact point
(if applicable)

Polishing
-smooth and shiny
-fissures preserved
-marginal ridges preserved

6.3 Class II small and medium amalgam restoration.

6.3.1 Armamentarium

Basic tray setup

1. Mouth mirror
2. Explorer
3. Tweezers
4. Periodontal probe

Cavity preparation

1. Contra-angle slow speed hand piece

2. Burs
3. Enamel hatchet
4. Gingival marginal trimmers

Matricing

1. Tofflemire matrix retainer

2. Universal matrix band
3. Wedge and wood
Condensation and carving

1. Amalgam carrier
2. Condenser
3. Carvers

Finishing and polishing

1. Finishing burs
2. Green and white stone
3. Fine and extra-fine cuttlefish disks
4. Rubber point
5. Rubber cup
6. Bristle brush
7. Dappen dishes
8. Flour of pumice
9. Proximal strip

6.3.2 Preparstion of class II cavity on lower molar (MO).

• This preparation combines the features of an occlusal cavity and the

proximal box.

• The occlusal margins of the preparation starts from the center of the
defective grooves, fissures and pits.
• The walls are parallel to one another and are perpendicular to the pulpal
floor as noted in (Fig-6.82 ).
• However, in some cases, the walls are prepared with a slightocclusal
divergent or flare (Fig-6.83).
• In some cases where extension of the preparation (to include fissure or
caries), becomes closer into the mesial and/or distal marginal ridges, the
preparation require slight tilting of the bur distally (not more than 10
degrees).This creates a slight occlusal divergent to prevent undermining the
dentin support of the marginal ridge.
• This principle is applicable when there is limited distance between the
proximal surfaces extensions to the marginal ridge as previously described in
“features of the prepared cavities”.
• The occlusal view shows that the facial and lingual walls of the proximal
box are extended into their respective embrasures only enough to be free of
contact with the adjacent tooth. These walls diverge slightly to meet the tangent
to the mesial surface at a 90 degrees angle (Fig-6.84).
• The mesial view shows that the lingual wall of the proximal box is parallel
or to the long axis of the tooth.
• The facial walls approximately parallel or to the facial surface (Fig-6.85).
• The gingival wall is flat and perpendicular to the long axis of the tooth.
• The pupal floor is flat in dentin, and parallel to the occlusal plane of the
tooth (Fig-6.86).
• The axial wall is parallel to the long axis and curves slightly to follow
the facio-lingual curvature tooth. This wall is in dentine (Fig-6.87).
• The axio-pulpal line angle is beveled. Any unsupported enamel is removed
from the gingivo-cavosurface (Fig-6.87, 88).
• There are retentive grooves in the lingo-axial and facio-axial line angles.
These grooves in the dentine only and follow the facio-lingual curvature of the
axial wall (Fig-6.89).
 Fig-6.82 Outline form Fig-6.83 Occlusal
view

Fig-6.84 Ficial and lingual wall Fig-6.85 Mesial

view.

Fig-6.86 Gingival and pulpal floor Fig-6.87 Axial wall

position.
position.

Fig-6.88 Beveled angle. Fig-6.89 Linguo-axial & fasio-axial

retentive grooves.

Measurements of Class II cavity (in mm)

Fig-6.90 Occlusal view Fig-6.91 Mesial view

Fig-6.92 Cross-sectional view

6.3.3 Some examples of common class II cavity features in maxillary premolars

and molars.

Fig-6.93 Slot on M & D Fig-6.94 MO & DO Fig-

6.95 MOD

Fig-6.96 DO preparation Fig-6.97 MO distal pit Fig-6.98 MO with

disto-
with distal pit with marginal ridge.
-palatal extension.

Fig-6.99 DO with mesiocclusal fissure. Fig-6.100 MOD preparation.

6.3.4Procedure of cavity preparation

• Pencil the defective grooves on the occlusal surface of the tooth (Fig-6 101
).
• With articulating paper, record the occlusal contact of the opposing tooth.
• Modify the outline form so that the margins of the preparation do not lie on
a contact area.
• Enter the pit nearest the involved proximal surface with a no.245 bur tilted
as illustrated.
• Proximal, the long axis of the bur and the long axis of the tooth crown
should remain parallel during the cutting procedures.
• Ass the bur approaches the distal pit, the proper depth (one-half to two-
thirds the length of the cutting portion of the bur),which just exposes the
dentin, should be established (approximately 1.5 mm) (Fig-6.102 ).

Fig-6-101 Pencil defective grooves Fig-102 Burs

position.

• Remove the debris from the operating area with a gentle stream of air.
• Move the no.245 bur distally along the depth specified and keeping the bur
perpendicular to the occlusal surface.

• Extend the cut toward the mesial to obliterate the penciled defects.
As you approach the marginal ridge, direct the cut toward the center of the
contact area. Do not break through the mesial marginal ridge at this time (Fig-
6.103 ).
• Use the bur in a hand piece as a guide for determining the occlusogingival
depth of the preparation.
• With the bur stationary, hold it vertically next to the mesio-facial surface
of the tooth so that the tip of the bur is 0.5 mm below the contact area.
• This is where the gingival wall will be. Note how much of the bur must
penetrate the tooth to reach the desired level of the gingival wall (Fig-6.104
).

Fig-6.103 Marginal ridge Fig-6.104 Occlusogingival depth.

• With the no.245 bur, start the end of the bur cutting along the exposed
proximal dentinoenamel junction, two third at the expense of the dentin and one-
third at the expense of the enamel.
• Need to ensure that the bur’s long axis is approximately parallel to the
long axis of the tooth crown, but tilted slightly to the distal.
• With the pressure directed gingivally and slightly towards the mesial to
keep the against the proximal enamel, pendulate the bur facially and lingually
along the dentinoenamel junction.
• Because the dentin is softer and cuts easier than the enamel, the bur should
be held against the harder enamel to guide and create an axial wall that follows
the outside contour of the proximal surface.
• The mesio-distal width of the completed proximal ditch cut should be one-
third in enamel and two-thirds in dentine.
• When the proximal ditch cut is all in dentine, the axial wall often is too
deep. Because the proximal enamel becomes less thick from occlusal to the
gingival, the end of the bur will come closer to the external tooth surface as the
cutting moves gingivally.
• The proximal ditch cutting is diverged gingivally so that the facio-lingual
dimension at the gingival will be greater that at the occlusal (Fig-6.105, 106,
107).
• Do not remove all of the proximal enamel but leave a thin shell of enamel in
this area to protect the adjacent tooth from contact with the bur.
• Break out the thin remaining proximal enamel with the enamel hatchet, using
it as lever to fracture the enamel.
• Finish the facial, lingual, and gingival wall of the proximal box with the
enamel hatchet using a planning-scraping action (Fig-6.108, 109 ).
 Fig-6.105 Proximal depth. Fig-6.106 Gingival
seat position.

Fig-6.107 Occlusal convergence. Fig-6.108 Finishing

the wall.

Fig-6.109 Finishing with planning-scraping

action.

• With the gingival margin trimmer, from a slight bevel at the axio-pulpal
line angle (Fig- 6.110).
• With the same instrument, sweep across the gingivo-cavosurface to remove
unsupported enamel rods and cause a slight rounding of the facio-gingival and
linguo-gingival line angle (Fig-6.111, 112).

Fig-6.110 Bevel axio-pulpal line angle Fig-6.111 Bevel gingivo-

carvosurface

margin.

• With the no.169L (TC) or tapered diamond bur in the slow-speed hand piece,
cut a retentive groove in the linguo axial line angle (Fig-6.113 ).
• Begin at the lingo gingivo axial point angle and used only the tip of the
bur drawing it occlusally (in the dentin only).
• The groove should be about 0.5 mm deep at gingival and gradually fade
towards the occlusal (Fig-6.114 ).

• Avoid placing the groove entirely at
the axial dentinal wall. Remember that the
curvature” of the axial wall. In addition,
beyond the height of the pulpal floor”.
• Use the same method described in the
in the fascio-axial line angel.
the expense of either the lingual or
groove must “follow the facio-lingual
the groove “must not extend occlusally
previous step to cut a retentive groove

Fig-6.112 Line angle rounded. Fig-6.113 Groove placement.

Fig-6.114 After groove placement.

 6.3.5A Figures of class II on second premolar (MO)

Fig-6.115 Visualization of proximal preparation. Fig-6.116

Proximal box.

Fig-6.117 Mesial wall fractured off using hand instrument.

Fig-6.118 Undermined proximal enamel removed using hatchet.

Fig-6.119 Beveling axiopulpal line angle.

Fig-6.120 A.Bevel enamel portion of gingival wall using gingival marginal

trimmer, B&C. Round off linguogingival and buccogingival corners by rotational
sweep with gingival marginal trimmer.

6.3.5B Figures of class II on first premolar (MO)

Fig-6.121 A. Two surface preparation, B.Occlusal view, C. Proximal view.

Fig-6.212 Compare the difference between 34&34 in size of pulp chambers, lingual
cusps direction of pulpal walls.

6.3.5C Figures of class II on second premolar (MOD).

Fig-6.213 MOD preparation of second premolar.

Fig-6.124 MOD cavity of first premolar.

6.3.5D Figures of class II cavity preparation on

maxillary first molars.

Fig-6.125A. MOD Caries of first molar. Fig-6.125B M&D restoration on

molar.
 Fig-6.126 A.Conventional MO preparation, B. MO preparation
extended to distal pit, C. MOL preparation distal pit and oblique ridge, D. MO
with buccal fissure extension.

6.3.5E Figure of class II cavity on mandibular fist molar.

Fig-6.127A. MOD preparation on Fig-6.127B.

MOD amalgam
mandibular first molar.
restoration on mandibular molar.

Fig-127C. MOD cavity with lining. Fig-127D. MOD restoration on

molar

replaced one lingual cusp.

6.3.6 Matricing

• Thread the band into the retainer head. Then turn the locking nut clockwise
to secure the band in the retainer.
• Position the retainer head is facing you. Form a loop with matrix band and
line up the end of the band. Rest the band on a paper pad and with a ball
burnisher contours the proximal area of the band about 1 mm from the edges.
• Place the band on the tooth; make sure that the band covers the gingival
margin of the cavity preparation.
• The band must be wide enough gingivo-occlusally to provide a wall along the
entire length of the proximal box. Ideally it should extend about I mm above the
adjacent marginal ridge, but not higher. If necessary, trim the band with a
scissors to obtain correct dimensions. Turn the adjusting nut on the retainer
clockwise until the band fits snugly (Fig-6.128).

Fig-6.128 A Placed the Fig-6.128B Placed the strip,

matrix band. band and wedge.

Fig-6.128C Band placement.

• To avoid injury to the gingival and the periodontal fibers, take care not to
force the matrix band too for gingivally.
• Shape the wedge with carver to fit it to the mesial gingival embrasure form.
Insert the wedge from the lingual into the mesial embrasure as far as it will go
with a tweezer.
• Recontour the band with the ball burnisher to establish close contact
between the band and the adjacent tooth. A cavity base is placed as stated in
class I if indicated.

Fig-6.129 Shown the correct placement of matrix band.

6.3.7 Restoration on class II cavity.

6.3.7A Trituration.

Prepare a previously described for class I.

6.3.7B Condensation.

• Fill the carrier with the triturated amalgam. Inject one half of the amalgam
in the proximal box.
• Use a small end of the founded diamond shaped condenser to pack the amalgam
into the proximal box.
• Direct the condenser gingivally and laterally while exerting firm pressure
on the amalgam to thoroughly condense it along the facial, lingual and gingival
margins and into the retentive grooves.
• Remove the mercury rich amalgam with the large end of the condenser.
Continue to add and condense increments of amalgam until the amalgam is condensed
along the entire length of the facial and lingual margins of the proximal box.
• Add and condense small increments of amalgam to fill the occlusal portion of
the cavity. Use the small end of round condenser to pack the amalgam into the
area. (Fig-6.130).
• Add additional amalgam and use the large end of round condenser to over pack
the cavity, condensing the excess amalgam well beyond the margins and final
desired contour.

Fig-6.130 Amalgam condensation.

6.3.7C Burnishing.

• Burnish all accessible occlusal margins.

6.3.7D Carving.

• With an explorer, remove the excess amalgam inside the occlusal opening of
the matrix band. Roughly carved the restorations which will lessen the chances of
fracturing the amalgam when the strip is removed and to reduce the level of the
marginal ridge area to that of the adjacent tooth (Fig-6.131).
• Remove the wedge with a tweezers.
• Then turn the locking nut on the matrix retainer counterclockwise to release
the band.
• Remove the retainer from the band in an occlusal direction.
• Carefully withdraw the matrix band first from the opposite proximal surface.
• Do not lift the band directly toward the occlusal because this will tend to
fracture or dislodge the unset amalgam.
• Remove the excess amalgam at the gingival margin and shape the gingival
embrasure with the interproximal carver, using the remaining tooth structure as a
guide. Insert the carver first from the facial and then from the lingual and curve
along the entire length of the gingival margin, take care not to flatten this
area.
• Use a carver to remove the excess amalgam from the facial and lingual
proximal margins and to contour the facial, lingual, and occlusal embrasures.
• Carve along the margins in an occlusal direction resting the blade on the
adjacent tooth structure (Fig-6.132).
• Remove the excess amalgam from the occlusal surface with the discoid-cleoid
carver. Carve along the margins from distal to mesial.
• Begin developing the occlusal anatomy with the carver, guiding the tip of
the carver to establish the occlusal contours and grooves over the marginal ridge
(Fig-6.133).
• Examine the restoration to make sure that no amalgam extends over the tooth
surface beyond the cavity margins (Fig-6.134).
• Lightly wipe the occlusal surface with cotton to remove any particles of
amalgam.

Fig-6.131 Remove excess amalgam.

Fig-6.132 Contour facial, lingual and occlusal embrasures.

Fig-6.133 Develop occlusal anatomy.

Fig-6.134 Examine restoration.

6.3.7E Checking Occlusion.

• Examine the restoration for any high contact or high spot using articulating
paper by closing the upper and lower jaw lightly on each other.
• Reduce any high spots with additional carving with amalgam carver.
• The process of light closure with articulating paper is repeated, and
additional carving is accomplished until the teeth can be closed to pre-
restoration occlusion.

6.3.7F Finishing and Polishing

• Allow at least 24 hour for the amalgam to harden thoroughly before polishing
the restoration.
• Smooth the facial and lingual margins and round the marginal ridge with the
fine and extra-disks .If the margins were carved smoothly, the fine disk need not
be used.
• Using a slow speed and light, intermittent pressure move the disk gingivo-
occlusally along the margins and up onto the occlusal surface. A few revolutions
with the disk should make the margins smooth (Fig-6.135).
• Proximal strips can also be used to contour the proximal surface of the
restoration.
• “Avoid damaging the proximal contact” of the proximal contact of the
restoration and “injuring the proximal gingival”.
• Check the proximal margins with the explorer. There should be no catch of
the explorer tin when passed in either direction across the margins.
 Fig-6.135 A Finishing with fine disc.

Fig-6.135B Abrasive-coated discs Fig-6.135 C Mandrel (snap-on or

(Polishing discs). screw-on).

Fig-6.135D Finishing instruments.

PRACTICAL CLASS

Cavity Class II with Amalgam Restoration.

6.3.3 B DO on 46
6.3.3 C MOD on 35
6.3.3 D MO on 16 (preserve distal pit)
6.3.3 E DO on 26 (preserve mesial pit)
PRACTICAL SESSION

1. INSTRUCTION: Class II amalgam on 37 (MO)

Date:…………………….

ACTIVITY
LECTURER’S NAME AND SIGNATURE

COMMENTS

Cavity Preparation
-outline form
-resistance form
-retention form
-convenience form
-finish of enamel walls
-cavity toilet

Base / lining
-understand the indication
-materials used
-sufficient thickness
-uniform layer
-confine to area that is necessasary

Filling and Carving

-underfill / overfill
-overhanging or deficient margin
-maintain anatomy
-maintain contact point
(if applicable)

Polishing
-smooth and shiny
-fissures preserved
-marginal ridges preserved

PRACTICAL SESSION

2. INSTRUCTION: Class II amalgam on 46 (DO)

Date:…………………….

ACTIVITY
LECTURER’S NAME AND SIGNATURE

COMMENTS
Cavity Preparation
-outline form
-resistance form
-retention form
-convenience form
-finish of enamel walls
-cavity toilet

Base / lining
-understand the indication
-materials used
-sufficient thickness
-uniform layer
-confine to area that is necessasary

Filling and Carving

-underfill / overfill
-overhanging or deficient margin
-maintain anatomy
-maintain contact point
(if applicable)

Polishing
-smooth and shiny
-fissures preserved
-marginal ridges preserved

PRACTICAL SESSION

3. INSTRUCTION: Class II amalgam on 35 (MOD)

Date:…………………….

ACTIVITY
LECTURER’S NAME AND SIGNATURE

COMMENTS

Cavity Preparation
-outline form
-resistance form
-retention form
-convenience form
-finish of enamel walls
-cavity toilet

Base / lining
-understand the indication
-materials used
-sufficient thickness
-uniform layer
-confine to area that is necessasary

Filling and Carving

-underfill / overfill
-overhanging or deficient margin
-maintain anatomy
-maintain contact point
(if applicable)

Polishing
-smooth and shiny
-fissures preserved
-marginal ridges preserved

PRACTICAL SESSION

4. INSTRUCTION: Class II amalgam on 16 (preserve distal pit)

Date:…………………….

ACTIVITY
LECTURER’S NAME AND SIGNATURE

COMMENTS

Cavity Preparation
-outline form
-resistance form
-retention form
-convenience form
-finish of enamel walls
-cavity toilet

Base / lining
-understand the indication
-materials used
-sufficient thickness
-uniform layer
-confine to area that is necessasary

Filling and Carving

-underfill / overfill
-overhanging or deficient margin
-maintain anatomy
-maintain contact point
(if applicable)
Polishing
-smooth and shiny
-fissures preserved
-marginal ridges preserved

PRACTICAL SESSION

5. INSTRUCTION: Class II amalgam on 26 (preserve mesial pit)

Date:…………………….

ACTIVITY
LECTURER’S NAME AND SIGNATURE

COMMENTS

Cavity Preparation
-outline form
-resistance form
-retention form
-convenience form
-finish of enamel walls
-cavity toilet

Base / lining
-understand the indication
-materials used
-sufficient thickness
-uniform layer
-confine to area that is necessasary

Filling and Carving

-underfill / overfill
-overhanging or deficient margin
-maintain anatomy
-maintain contact point
(if applicable)

Polishing
-smooth and shiny
-fissures preserved
-marginal ridges preserved

6.3.2. Class II amalgam in clinical procedure.

The tooth is prepared with dental handpieces and assorted burs. Once
the tooth is prepared, it is restored with dental amalgam.
Equipment and supplies (Fig-6.136 to Fig-6.138).
• Basic setup: mouth mirror, explorer, cotton pliers.
• Air-water syringe tip, HVE tip, and saliva ejector.
• Cotton rolls, gauze sponges, pellets, cotton tip applicators, and floss.
• Topical and local anesthetic setup.
• Rubber dam setup.
• High- and low-hanpieces.
• Assortment of dental burs
• Spoon excavator
• Hand cutting instruments (hatches, chisels, hoes, and gingival margin
trimmers).
• Paper pad, cement spatula, and placement instrument.
• Matrix retainer, matrix bands, and wedges.
• Locking pliers or hemostat.
• Amalgam capsules.
• Amalgam well.
• Amalgam carrier and condensers.
• Amalgamator.
• Carving instruments.
• Articulating paper and forceps.

Fig-6.136 Amalgam procedure tray Fig-6.137 (A) Matrix band and wedge
placed
Setup armamentarium. ( B ) Matrix band
retainer.

Fig-6.138 Lining material.

Procedure Steps.
• Greet and prepare the patient for the procedure. Review the medical history.
• Prepare for the administration of the topical and local anesthetic.
• Placed the rubber dam (Fig-6.139 to Fig-6.141).
• Prepared the cavity.
• Placed the lining.
• Placed the matrix band with retainer.
• Prepared the amalgam capsules then placed the amalgam into the cavity and
condensed the amalgam.
• Carving and burnishing the amalgam.
• After finishing the curving of the anatomy in the restoration, removed the
matrix carefully.
• Remove the rubber dam carefully.
• Used the articulating paper and the check occlusion.
• The restoration is wiped off with a wet cotton roll and to remove any blue
mark left by articulating paper. Rinse the patient’s mouth thoroughly to clean any
debris from the mouth.
• The patient is cautioned not to chew on restoration for a few hours and
dismissed.

Fig-6.139 Cavity being prepared by dentist. Fig-6.140 Loaded carrier, ready for
use.

Fig-6.141 placing the articulating paper.

6.3 Class II complex amalgam restoration.

Fig-6.142 Complex (large) Cavity Fig-6.143 MO Complex.

Fig-6.144 Complex MO Fig-6.145 Complex MOD.

Fig-6.126 The complex cavity restored with amalgam

restoration which protects the entire occlusal surface.

Fig-6.147 The complex (large) cavity, length 5.5 mm, deep 2.5 mm

Note: The cavity preparation, restoration of class II compound/complex large

cavities should be follows as described as in preparation of class II amalgam
restoration.

6.4 Class V amalgam restoration.

Class V carious cavities occur as a result of stagnation on the surface close to

the gingival margin, more commonly on the buccal than on the lingual aspect. The
cavity may frequently extend below the free gingival margin and if recession has
occurred the carious area which may extend into the cementum and dentine if the
root. The restoration of the class V cavities resembles in many ways that of class
I, however some significant interesting differences. it is worthy of note that
cavities in premolar and molar teeth, the use of reversed mirror head is a
considerable help. This simple variation of the normal mouth mirror often gives
better retraction of the cheek, reflection of light on the cavity, and a reflected
view of the working field, with considerably greater case of manipulation.

Fig-6.148 Eighteen years old amalgam restoration on anterior mandibular

teeth.

Fig-6.149 Numerous stained class V caries lesions.

Fig- 6. 150 A moderately deep, V-shaped cervical notch in a maxillary

canine.

6.4.1 Cavity preparation

The outline form of this type of cavity usual conforms to the general shape
shown in Fig-6.
The cavity preparation may be started in either one of two ways. Removal of
carious tissue may be performed with an excavator or with a round bur No.4 or 5,
in a straight handpiece in preference to a contra-angle, where access permits. The
bur should be used with light, circular, stroking movement.
The completed cavity should be of uniform depth between 1.5 and 2 mm.
The principles applying to the lining of this cavity are in all respects the
same as in the case of the class I cavity. The contour of the floor is established
in the same way.
Enamel margins should be surveyed and smoothed with the enamel finishing
bur, whilst at the same time establishing the 90-degree cavo-surface angle.
The use of high-speed instruments in this type preparation is little
difference in general technique. A fissure bur may be used from the outset through
to the completion of preparation and the effective water spray provides a clear
field. Lightness of touch and ease of control assist in avoidance of the gum
margin.

Fig-6.151 Outline form of Fig-6.152 A hand instrument

may be used
class V cavity on premolar as a matrix for class V
amalgam restoration.

Fig-6.153 Class V restoration on Fig-6.154 Place the rubber

dam to
canine and premolar need to re restore. control the bleeding and
moister

Fig-6.155 Cavity preparation Fig-6.156 A

custom matrix,

stabilized with wedges to

support amalgam placement.

6.4.2 Insertion of amalgam

The cavity toilet completed and dry field obtained, the insertion of amalgam
follows the same pattern as that described for class I cavities.
Amalgam insertion starts in the normal manner when the cavity is two-thirds
filled the matrix band is placed and condensation proceeds through the aperture
previously made ,packing toward the cavity margin.
A smooth, highly polished filling is perhaps of greater importance in the
class V restoration.
Care in curving to eliminate irregularities after condensation.
Polishing proceeds as previously described and a rubber cup is used in place
of the cup-shape brush and then completed final restoration.

Fig-6.157 Complete Amalgam Fig-6. 158 Final Restoration

Insertion with
amalgam.

7. COMPOSITE RESTORATION.
Composite restoration known as tooth colored restoration. There is nothing more
gratifying than the sight of an intact young anterior dentition in an adolescent
or preadolescent patient, particularly the healthy, natural gingival-enamel
relationship that is characteristically observed in young dentitions.
Tooth-colored restorative materials have increasingly been used to replace
missing tooth structure and modify tooth color and contour, thus enhancing facial
esthetics. The search for an ideal esthetic material for conservative restoration
has resulted in improvements in materials and techniques, particularly in recent
years. Synthetic resins and the acid etch technique represent major advances.
Adhesive materials that have strong bond to enamel and dentin further simplify
restorative techniques.
Cavity preparation technique for class III, class IV, class V, which is to be
restored with direct tooth colored restorative materials, is covered this chapter.

CLASS III CAVITY:

• The cavity is a box formed by the incisal, facial, gingival, and axial walls
(Fig-7.1).
• Every attempt is made to maintain contact with the adjacent tooth with
natural tooth structure (Fig-7.2).
• Extension of the outline form is minimal.
• Retentive grooves in the incisal and gingival dentinal walls are optional
(Fig-7.5).
• Positioning matrix band for class III cavity (Fig-7.6).
• Various size and form of class III cavities (Fig-7.3, 7.4 and 7.7 to 7.10).

Fig-7.1 Cavity shape. Fig-7.2

Maintain contact.

Fig-7.3 (A) Point of entry to class III Fig-7.4 Larger

preparation with
Cavity in mandibylar canine , (B) Small lingual lock
retention.
Preparation with cervical and mesial retention.

Fig-7.5 Cavity outline. Fig-7.6

Matrix band in position

for class III.

Fig-7.7 Larger class III cavity. Fig-7.8 Outline form of class III
cavity, a. from
lin
gual, b. from mesial aspects.

Fig-7.9 Use of modified lingual lock as retention in large class III

cavity.

Fig-7.10 a, The persistence of stain at the amelo-dentinal junction. B, The

 appearance of stain at labio-cervical margin, deep to enamel.

Composite Restoration Materials

Fig-7.11 Composite materials. Fig-7.12

Shade guide.

Fig-7.11 A Composites, Bonding, Etching,

Articulating
paper, and Dappen dishes.

Fig-7.11B Some brand of composite

materials.

Fig-7.11 E The instruments, materials, and equipment

for composite restoration.

Class III composite restoration.

7.2.1. Tooth preparation for class III cavity.

7.2.1.1ARMAMENTTARIUM
BASIC TRAY SETUP
1. Mouth mirror
2. Explorer
3. Tweezers
4. Periodontal probe

CAVITY PREPARATION
1. Contra-angle slow-speed hand piece
2. Burs
3. Enamel hatchet

MATRICING
1. Mylar strip
2. Transparent wedges

MIXING AND PLACEMENT

1. Mixing pad
2. Acid etch
3. Unfilled resin /Bonding
4. Composite resin
5. Disposable mixing spatula
6. Plastic instrument

FINISHING
1. Two sided finishing strips
2. Twelve fluted carbide bur

7.2.1.2Cavity preparation

• Pencil the lingual outline form on the tooth (Fig-7.13).

• The contact area is not to be included in the final outline of the
preparation.
• Enter the lingual portion of the tooth near the center of the penciled area
with the round bur in high-speed hand piece (Fig-7.14).
• Hold the bur perpendicular to the lingual surface and move the hand piece
gingivally and incisally to cut a trough.
• Do not remove all of the proximal enamel but leave a thin shell of enamel in
this area.

Fig-7.13 pencil the outline Fig-7.14

Entry point

• With the bur in the slow-speed hand piece, smooth the axial wall and further
develop the box form (Fig-7.15).
• Avoid overextending the preparation facially and incisally.
• It is better to leave an enamel contact with the adjacent tooth when
possible.
• Break out the remaining proximal enamel with the enamel hatchet, using it as
a lever to fracture the thin enamel (Fig-7.16).
• Use the enamel hatchet to smooth the incisal and gingival wall.
• Plane the wall by carefully thrusting the instrument facially.
• Maintain firm control of the instrument to avoid fracturing of the facial
wall.

Fig-7.15 Develop box form Fig-

7.16Break proximal enamel

• Smooth the facial and axial wall with the hatchet.

• Rest the side of the blade against the axial wall and, with the end of the
cutting edge, scrape the facial wall first incisally and then gingivally (Fig-7.17
).
• Clinically, when acids etch technique is being used; a 45-degree bevel along
the cavosurface margin of the enamel is created. This bevel:
1. Increase the tooth surface area for acid etching.
2. Provides an area for unfilled resin tag penetration.
• Clinical results of this additional step are:
1. Increased retention of the restoration.
2. Minimized abrupt visual change from the restorative material to the
remaining enamel surface.
3. Decreased marginal leakage.
• With the round bur in the conventional speed hand piece, cut a retentive
groove at the expense of the dentine in the incisal dentinal wall (Fig-7.18).
• The incisal groove should finish in the dentine only. Avoid undermining the
enamel at the incisal corner.
• Using the method described previously, create a retentive groove in the
gingivo-axial line angle (Fig-7.19).
• The gingival groove may be slightly larger than the incisal due to the
greater bulk of the dentin in this area.

Fig-7.17 Smoothen wall

Fig-7.18 Retentive groove placement. Fig-

7.19 After placement

7.2.1.3 Features of class III cavity involving labial and palatal surface.

Fig-7.20 Class III caries on lateral incisor of mesial aspect

Fig-7.21 Class III caries on central incisor of mesial aspect.

7.2.1.4 Cleaning the tooth

• Using a rubber cup I slow-speed hand piece, clean the enamel surface with
slurry of flour of pumice and water mixed in a dappen dish. Clinically, this has
the effect of removing bacterial plaque and salivary contaminants, and cutting
debris and stain from the prepared cavosurface bevel and adjacent enamel. This
procedure provides a clean surface that is more receptive to acid etching .Do not
use paste-containing fluoride, as this will diminish the effect of acid etching.
• Do not use paste-containing fluoride, as this will diminish the effect of
acid etching.
• Rinse the tooth with a water spray to remove the pumice.
• Carefully dry the tooth with a gentle steam of air (do not over dry/
desiccate the dentin).

7.2.1 5 Lining / base application

• Prior to acid etching, moderate and deeply exposed dentin must be covered
to protect the pulp tissue from:

1. The etching solution

2. The chemical irritation of the composite resin.

• When a great amount of tooth structure has been lost due to caries or
fracture, a base should be used underneath the restoration, Otherwise,
lining the exposed dentin should be sufficient in protecting the pulp.
• Materials for use as lining or base for tooth colored restoration
has been described in “pulp protection”.
• If the cavity is very deep and very close to the pulp ( that requires
indirect pulp capping) or small, pin-point pulp exposure occur while doing cavity
preparation ( that requires treatment with direct pulp capping), then, calcium
hydroxide lining (e.g.; dycal ) need to applied on the tooth surface overlying the
pulp.
• Dispense a drop each of the catalyst and base pastes of the calcium
hydroxide material on a paper-mixing pad (Fig-7.22).
• Using the mixing instrument provide with the material, mix the catalyst and
base together.
• Touch the tip of the mixing instrument to the paste and carry a small amount
to the dentine to be covered.
• Touching the instrument to the dentine will transfer the calcium hydroxide
to it.
• Apply to form a thin, uniform layer and allow the material to set.
• Always remember that calcium hydroxide lining is placed overlying the pulp /
close to the pulp, placement of a base above the calcium hydroxide layer is needed
(using either conventional GIC such as Fuji IX or RM-GIC such as Fuji II LC )
before restoring the cavity with composite resin. This is to protect the calcium
hydroxide layer from fracture as they become rigid after set.
• Inspect the preparation to ensure dentine overlying the pulp has been
covered with the calcium hydroxide. If not, repeat the previous mixing steps.
• Lining / base should not extend beyond the DEJ onto enamel, as it will
inhibit acid etching and subsequent bonding.
• Excess lining / base is removed with an explorer or spoon excavator.

Fig-7.22 A Dycal, Mixing pad, gauge, dycal applicator.

Fig-7.22B Mixing dycal. Fig-7.22C Mixed dycal with

dycal applicator

7.2.1 6 Acid-etch technique

• Dispense two to three drops of phosphoric acid solution (35 % to 37 %

depending on manufacturer’s formulation Fig-7.23) into a plastic well or dappen
dish.
• Use a small brush or applicator, paint the enamel with the acid gently for
20 to 30 seconds (follow the manufacturer’s instruction).
• Then, return the brush to the dispensed acid, and paint the enamel again
with fresh etchant.
• Be certain to coat the prepared enamel bevel as well as 4 to 5 mm of intact
adjacent surface enamel.
• Following the acid application, rinse the tooth thoroughly from all aspects
with a water spray for 30 seconds.
• With the air spray, dry the tooth carefully from all aspects to remove all
moisture. The presence of any moisture on the enamel will interfere with the
successful bonding of the resin. The etched enamel surface should exhibit a chalky
white appearance (can be refer previously described etching technique).

Fig-7.23 Etching materials

7.2.1.7 Placement of unfilled resin / bonding

• Apply one drop of the unfilled resin into a plastic well (is also known to
as intermediary resin, bonding agent and enamel bond).
• Mix the two drops together with a fresh applicator brush, and paint the
unfilled resin over the etched enamel and protected dentine.
• Be sure to paint the unfilled resin beyond the fracture line over the etched
enamel surface (Fig-7.24).
• The resin ensures wetting of and penetration into the etched enamel surface.
This enhances retention and sealing of the composite resin.
• The unfilled resin is then light cured for 10 seconds (Fig-7.25).
.

Fig-7.24 Applying the bonding. Fig-7-25 light

curing.

7.2.1.8 Matricing

• Place a 1 ½-inch Mylar strip interproximally and secure it against the

gingivo-cavosurface with an appropriate wedge (Fig-7.26).
• If necessary, contour the matrix with a warmed large, round burnisher or
contouring plier.
• Test the final position of the strip by practicing your direction of pull,
which will be used in the following procedure ( Fig-7.27 and 7.28).
• The surface quality left by the mylar strip matrix cannot be surpassed by
any finishing or polishing procedure.

Fig-7.26 Strip placement. Fig-7.27

Check fit.

Fig-7.28 The final position.

Fig-7.8 A Mesial cavity filled with composite, the

matrix
strip held in position during setting.

7.2.1.9 Composite resin placement

• Using a plastic instrument, insert the composite resin into the preparation
taking care to avoid creating pockets of air or voids in the restoration.
• The resin should be introduced into the cavity incrementally, with each
layer less than 2 mm in thickness. This is to ensure good depth of curve and to
reduce the polymerization shrinkage of the composite resin.
• Avoid incorporating air voids into the matrix or preparation by slowly
folding small amounts of the material into the most remote parts of the
preparation (Fig-7.29).
• Pack the composite resin using plastic instruments. It is desirable to use
Teflon plastic instrument as compared to metallic plastic instrument because
Teflon cause less scratching to the composite resin surface during packing or
insertion.
• Slightly overfill the preparation (Fig-7.30).
• Pull the mylar strip to create a contour to the restoration that will
require the least amount of finishing and polishing while ensuring good adaptation
of the material to the cavity preparation (Fig-7.31).
• Remember that any further contouring or finishing will only decrease the
surface quality.

Fig-7.29 Material insertion. Fig-7.31

Slightly overfills.

Fig-7.31 Pull the strip to create contour.

7.2.1.10 Finishing and polishing

• With the fine carbide or tapered diamond bur in the high-speed hand piece,
remove any gross marginal excess of material that resists flicking off with the
explorer (Fig-7.32, 33).
• Some of the burs that can be used are diamond bur L10 for contouring the
labial surface and pear shape or F40 bur contouring the palatal surface and
cingulum area.
• White stone (tapered and round shape) can also be used to further contour
the labial and palatal surface of the restorations.
• The proximal surface can be contoured using an inter proximal finishing
strip that has two abrasive surfaces (fig-7.34).

Fig-7.32 lingual view Fig-7.33

Remove marginal excess.

Fig-7.34 finishing with strip.

• Pass the strip through the contact from the incisal aspect.
• With a labio-lingual motion, contour the proximal aspect of the restoration
in order to minimize flash and create a physiologic gingival embrasure.
• Dry the restoration with a gentle stream of air.
• Carefully check for defects such as voids, marginal defects, and excess
material.
• Clinically, additional composite can be added to the restoration, as needed
providing the rubber dam has maintained moisture control.
• The final polish of the restoration is accomplished using snap-on-polishing
discs (Ex, Soflex) in a slow speed hand piece. Starting with the medium, and
progressing to the fine and extra-fine grit, gently polishes all aspects of the
composite restoration.
• Figure 7.35 shows some of the instruments for composite resin polishing.

a b
Fig-7.35 A (a) Polishing strips, (b) finishing diamond burs.

Fig-7.25 B Finishing diamond burs for composites

 (for remove composite excess.

Fig-7.35 C Polishing strips and polishing discs for

composites.

Fig-7.35 D Sof-Lex dicks and the snap-on mandrel and Moore-Flex

Dicks.

Fig-7.35 E Brasseler polishing cup and points and Min-identoflex polishing

cup and point with snap-on mandrel .

7.3 PRACTICAL CLASS FOR CLASS III COMPOSITE RESTORATION.

1. Class III restoration on tooth 12 (mesial).

2. Class III restoration on tooth 33 (distal).
PRACTICAL SESSION

1. INSTRUCTION : Class III composite resin on 12 (Mesial)

Date:…………………….

ACTIVITY
LECTURER’S NAME AND SIGNATURE

COMMENTS

Cavity Preparation
-conservation of tooth structure
-outline form
-resistance form
-retention form
-convenience form
-cavity toilet

Base / lining
-understand the indication
-materials used
-sufficient thickness
-uniform layer
-confine to area that is necessasary

Filling
-underfilled / overfilled
-overhanging or deficient margin
-preserve anatomy
-maintain contact point

Polishing
-smooth and shiny
PRACTICAL SESSION

1. INSTRUCTION: Class III composite on 33 (Distal)

Date:…………………….

ACTIVITY
LECTURER’S NAME AND SIGNATURE

COMMENTS

Cavity Preparation
-conservation of tooth structure
-outline form
-resistance form
-retention form
-convenience form
-cavity toilet

Base / lining
-understand the indication
-materials used
-sufficient thickness
-uniform layer
-confine to area that is necessasary

Filling
-underfilled / overfilled
-overhanging or deficient margin
-preserve anatomy
-maintain contact point

Polishing
-smooth and shiny

7.4Tooth preparation for class III in clinical procedure.

The tooth is prepared with dental handpieces and assorted burs. Once the tooth is
prepared, it is restored with composite.
Equipment and supplies (Fig-7.36 to Fig-7.37).
Basic setup:
• Mouth mirror, explorer, cotton pliers.
• Air-water syringe tip, HVE tip, and saliva ejector.
• Cotton rolls, gauze sponges, cotton pellets, cotton tip applicators, and
dental floss.
• Topical and local anesthetic setup.
• Rubber dam setup.
• High- and low-handpieces.
• Assortment dental burs (including diamond and cutting burs).
• Spoon excavators.
• Hand cutting instruments (biangle chisel and wedelstaedt chisel).
• Base and liner with maxing materials and placement instruments.
• Etching and applicator, if necessary (usually come with composite system).
• Primer ((usually come with composite system).
• Composite materials including a shade guide.
• Composite placement instrument (plastic instrument).
• Curing light with protective shield.
• Celluloide matrix strip and wedges.
• Locking pliers or hemostat.
• Finishing burs or diamonds
• #12 scalpels.
• Abrasive strips.
• Polishing discs.
• Lubricant
• Articulating paper and forceps.

Procedure Steps.
• The patient is seated and prepared for the procedure. Confirm the procedure
and review the medical history.
• Rinse the patient mouth and apply the topical anesthetic and give LA.
• The shade is determined for the composite materials.
• Place the rubber dam.
• Prepare the cavity.
• Placed the base or liner.
• Place the acid-etch for 15 second according to manufacture direction.
• Place the matrix strip and plastic wedge.
• Place the bonding material and light cure (10 sec) according to manufacturer
direction.
• Place the composite into the cavity and light cure (20-30 sec) according to
manufacturer direction, if the material is self-cure mixed and place the cavity
wait for a few minutes to set.
• Remove the matrix strip and wedge.
• Use the low-speed handpiece with finishing burs, diamond, and abrasive discs
to finish the restoration.
• Removed the rubber dam carefully.
• Check the occlusion with the articulating paper, if any high mark removes
it.
• The patient mouth is rinsed and the patient is given postoperative
instructions.

Fig-7.36 Composite tray setup. Fig-7.37 Celluloid matrix strip with

metal clip.

7.5 Class IV composite restoration.

7.5.1 ARMAMENTARIUM
7.5.2 CLASS IV CAVITY

The cavity is represented by an axial wall that is the line of fracture

(Fig-7.38).
For this procedure, contact with the adjacent tooth is broken.
Clinically, however, contact with the adjacent tooth may be maintained in
order to conserve tooth structure. Extension of the outline form beyond the
fracture site is minimized unless weakened or unsupported tooth structure
is present.
The fracture involves a triangular- shaped area of dentin surrounded
by enamel that is beveled at a 45 degree angle, about 1 mm wide.
No undercut or pin is necessary for mechanical retention as the
composite restoration is retained by acid etching the enamel.

Fig-7.38 Class IV line of

fracture.

7.5.2.1 FEATURES OF THE RESTORATION

The restoration restores all missing tooth structure including the

incisal edge, interproximal contact, and contours (Fig-7 .39 ).
It extends 1 to 2 mm beyond the cavosurface bevel.
The restoration terminates on an area of enamel that has been
previously etched and painted with unfilled resin/bonding.

Fig-7.39 Extent of restoration.

(A= extent of prepared cavity, B= extent of composite resin, C=
extent of
unfilled resin, D= extent of etched
enamel)

7.5.2.2 MESIO-INCISAL EDGE

FRACTURE STIMULATION

1. In order to stimulate a defect requiring a class IV composite resin

restoration, a mesio-incisal fracture is created on maxillary central incisor.
2. The simulated fracture should involve a triangular-shaped area of enamel
that is just into dentine.
3. The size of simulated fracture, depending upon the tooth selected, may
increase in order to allow exposure of dentine on the fractures surface for
purpose of this procedure. Clinically, however the preparation of dentine should
be minimized.
4. Pencil the fracture line on the labial and lingual surface on the tooth
selected.
5. The area of tooth structure to be removed and should extend approximately 3
mm gingivally and 3 mm distally from the original mesio-incisal corner.
6. The fracture line should extend gingivally to contact area, so that the
restoration restores the contact as well as the missing mesio-incisal corner.
7. Using a tapered diamond bur in the high-speed hand piece, remove the mesio-
incisal corner of the tooth as described above.
8. a class IV composite resin restoration is retained mainly via acid etched
enamel.
9. Therefore, establishment of retention with mechanical undercuts and threaded
pins is not necessary in a small and moderate-size cavity.
10. With a diamond bur or carbide-finishing bur, create 45-degree bevel 1 mm
wide along the entire cavosurface margin (Fig-7.40).
11. The bevel is located entirely in enamel and should not extend into dentine.
Its purpose is to;
a. Increase the tooth structure area for acid etching.
b. Provide a suitable area for unfilled resin tag penetration.
c. Remove unsupported enamel.

12. Clinically, the bevel has the effect of;

a. Increasing the retention of the restoration.
b. Decreasing the marginal leakage.
c. Minimizing an abrupt visual change from the restorative material to the
remaining enamel surface.

Fig-7.40 Bevel cavosurface margin.

r
7.5.2.3 CLEANING THE TOOTH
1. Using a rubber cup in slow-speed hand piece, clean the enamel surface with
slurry of flour of pumice and water mixed in a dappen dish. Clinically, this has
the effect of removing bacterial plaque and salivary contaminants, and cutting
debris and stain from the prepared cavosurface bevel and adjacent enamel.
2. This procedure provides a clean surface that is more receptive to acid
etching ( Fig-7.41).
3. Do not use paste-containing fluoride, as this will diminish the effect of
acid etching.
4. Rinse the tooth with a water spray to remove the pumice.
5. Carefully dry the tooth with a gentle steam of air (do not over dry /
desiccate the dentin).

Fig-7.41 Clean the enamel.

7.5.2.4 LINING / BASE APPLICATION

1. Prior to acid etching, moderate and deeply exposed dentine must be covered
to protect the pulp tissue from;
a. The etching solution
b. The chemical irritation of the composite resin.
2. When a great amount of tooth structure has been lost due to caries or
fracture, a base should be used underneath the restoration. Otherwise, lining the
exposed dentine should be sufficient in protecting the pulp.
3. Materials for use as lining or base for tooth colored restoration has been
described in “Pulp Protection”.
4. if the cavity is very deep and very close to the pulp (that requires
indirect pulp capping) or small, pin-point pulp exposure occur while doing cavity
preparation (that requires treatment with direct pulp capping), then ,calcium
hydroxide lining (e.g. Dycal) need to applied on the tooth surface overlying the
pulp.
5. dispense a drop each of the catalyst and base pastes of the calcium
hydroxide material onto a paper-mixing pad (Fig-7.42)

Fig-7.42 Mixing calcium hydroxide

6. Using the mixing instrument provided with the material, mix the catalyst and
base together.
7. Touch the tip of the mixing instrument to the paste and carry a small amount
to the dentine to be covered.
8. Touching the instrument to the dentine will transfer the calcium hydroxide
to it.
9. Apply to form a thin, uniform layer and allow the material to set.
10. Always remember that when calcium hydroxide lining is placed overlying the
pulp / close to the pulp, placement of a base above the calcium hydroxide layer is
needed (using either conventional GIC such as Fuji IX or RM-GIC such as Fuji II
LC) before restoring the cavity with composite resin. This is to protect the
calcium hydroxide layer from fracture as they become rigid after set.
11. Inspect the preparation to ensure dentine overlying the pulp has been
covered with the calcium hydroxide. If not, repeat the previous mixing steps.
12. Lining / base should not extend beyond the DEJ onto enamel, as it will
inhibit acid etching and subsequent bonding.
13. Excess lining / base is removed with an explorer or spoon excavator.

7.5.2.5 ACID-ETCH TECHNIQUE

1. Dispense two to three drops of phosphoric acid solution (35% to 37%

depending on manufacturer’s formulation) into a plastic well or dappen dish.
2. Using a small brush or applicator, paint the enamel with the acid gently for
20-30 seconds (follow the manufacturer’s instruction).
3. Then, return the brush to the dispensed acid, in order to wet the enamel
with fresh etchant (Fig-7.43).
4. Be certain to coat the prepared enamel bevel as well as 4 to 5 mm of intact
adjacent surface enamel.
5. Following the acid application, rinse the tooth thoroughly from all aspects
with a water spray for 30 seconds (Fig-7.44).
6. With the air spray, dry the tooth carefully from all aspects to remove all
moisture. The presence of any moisture on the enamel will interfere with the
successful bonding of the resin. The etched enamel surface should exhibit a chalky
white appearance.

Fig-7.43 Etching Fig-7.44 Rinse

with water.

7.5.2.6 MATRICING

1. Place a 1 – ½ inch length of mylar matrix strip interproximally between the

prepared tooth and the adjacent tooth. The matrix strip should extend gingival to
the cavosurface bevel interproximally.
2. Place a transparent wedge from the labial to secure the gingival portion of
the matrix strip against to tooth being restored (Fig-7.45).
3. Evaluate the position of the matrix strip and its ability to:
Minimize the gingival extent of the composite.
Simulate the contour of the ultimate restoration.
Extend beyond the incisal edge in order to encompass the mesio-incisal
edge being restored.

4. Clinically, a celluloid crown from is often used as an alternate from of

matricing.
5. The crown from must be contoured to the approximate shape of the final
restoration. It serves to delineate both the interproximal, palatal, and labial
contours.
6. Test the final position of the Mylar matrix by practicing young direction of
pull, which will be used in the following procedure.

Fig-7.45 Matrix strip placement.

7.5.2.7 PLACEMENT OF UNFILLED RESIN / BONDING

Applying one drop of the unfilled resin into a plastic well (is also known
to as intermediary resin, bonding agent and enamel bond).
Mix the two drops together with a fresh applicator brush (fig-7.46) and
paint the unfilled resin over the etched enamel and protected dentine.
Be sure to paint the unfilled resin beyond the fracture line over the etched
enamel surface (Fig-7.47).
The resin ensures wetting of and penetration into the etched enamel surface.
This enhances retention and sealing of the composite resin.
The unfilled resin is then light cured for 10 seconds.

Fig-7.46 Mix bonding agent. Fig-7.47 Paint

on etched surface.

7.5.2.8 COMPOSITE MATERIALS

Composite resin restorations can be done with micro filled, marco filled, or
hybrid materials. The micro filled materials should be used to restore incisal
fractures only when the maxillomandibular relationship is normal and when the
remaining natural teeth can serve as the primary support for centric, protrusive,
and protrusive lateral functions.
When the occlusion is heavy and the incisal composite restoration is
expected to bear most of the occlusal load, macrofilled or hybrid type of
composite material are specifically indicated because of their greater fracture
resistance in stress-bearing situations
The best materials for restoration of incisal fracture are as follows:
1. Highly polishable hybrids: Prisma APH; Herculite XRV; Z-100.
2. Heavy filled micro filled composite materials: Heliomolar, Helio Progress.
3. Semipolishable hybrids: Silux plus, durafil VS.
4. Some brand of composite materials set (Fig-7.48).

( A) ( B)
Fig-7.48 Composite resin materials set.

7.5.2.9 COMPOSITE RESIN PLACEMENT

Using a plastic instrument, insert the composite resin into the preparation
taking care to avoid creating pockets of air or voids in the restoration.
The resin should be introduced into the cavity incrementally, with each
layer less than 2 mm in thickness. This is to ensure good depth of cure and to
reduce the polymerization shrinkage of the composite resin.
Remember to stabilize the matrix strip across the palatal aspect of the
cavity preparation with finger pressure during insertion of material.
Once the cavity has been filled, the matrix must be drawn across the
preparation in order to simulate the ultimate contours of the restoration.
Light cure the composite on the labial and lingual surface for 40 seconds
each.
Held the matrix firmly onto the tooth surface for a few minutes while the
composite is being cured or polymerized.
Proper positioning of the strip will minimize the amount of finishing while
ensuring good adaptation of the material to the cavity preparation.
Repeat the previous steps until the cavity is slightly overfilled with the
composite resin.
When using a chemical cure composite resin, place an equal proportion of
base and catalyst pastes of the composite resin on the paper pad. Mix the paste
thoroughly for 30 seconds with a plastic mixing spatula. Condense the freshly
mixed composite resin into the disposable tip of a composite injection syringe.
Seal the tip with a plug provided and place the tip into the syringe. Complete the
loading of the syringe quickly so as not to encroach on the working time of
composite resin. The mix can then be injected into the preparation (Fig-7.49,
7.50).

Fig-7.49 Material placement. Fig-7.50

Positioning the strip.

7.5.2.10CONTOURING, FINISHING, AND POLISHING

Remove the transparent wedge and the Mylar strip.

If gross marginal excess of material present, begin shaping the contours of
the ultimate restoration using a diamond bur in the high-speed hand piece (Fig-
7.51).
Some of the burs that can be used are diamond bur L10 for contouring the
labial surface and pear shape or F40 bur for contouring the palatal surface and
cingulum area.
The composite resin should extend beyond the limits of the cavosurface bevel
for purposes of esthetics, sealing and retention.
Sand paper disks in a slow-speed hand piece may be used on the labial and
incisal aspects to further contour the restoration (Fig-7.52).
White stone (tapered and round shape) can also be used to further contour
the labial and palatal surface of the restorations.
The proximal surface can be contoured using an interproximal finishing strip
that has two abrasive surfaces (Fig-7.53).
Pass the strip through the contact from the incisal aspect.
With a labio-lingual motion, contour the mesial aspect of the restoration in
order to minimize flash and create a physiologic gingival embrasure (Fig-7.54).
Dry the restoration with a gentle stream of air.
Carefully check for defects such as voids, marginal defects, and excess
material. Clinically, additional composite can be added to the restoration, as
needed providing the rubber dam has maintained moisture control.
The final polish of the restoration is accomplished using snap-on-polishing
discs (Ex. Soflex) in a slow speed hand piece. Starting with the medium, and
progressing to the fine and extra-fine grit, gently polishes all aspects of the
composite restoration.
Clinically, the rubber dam may be removed at the completion of finishing so
that the restoration first can be checked in centric occlusion and protrusive
guidance and then polished additionally.

Fig-7.51 Remove excess Fig-7.52 Contour

labial.
 Fig-7.53 Contour lingual. Fig-7.54 Contour
proximal surface.

7.6 Practical Class

Class IV Composite resin on 11 (MI)
Class IV Composite resin on 12 (DI)

PRACTICAL SESSION

1. INSTRUCTION: Class IV composite resin on 11(MI)

Date:…………………….

ACTIVITY
LECTURER’S NAME AND SIGNATURE

COMMENTS

Cavity Preparation
-conservation of tooth structure
-outline form
-resistance form
-retention form
-convenience form
-cavity toilet
Base / lining
-understand the indication
-materials used
-sufficient thickness
-uniform layer
-confine to area that is necessasary

Filling
-underfilled / overfilled
-overhanging or deficient margin
-preserve anatomy
-maintain contact point

Polishing
-smooth and shiny

PRACTICAL SESSION

1. INSTRUCTION: Class IV composite resin on 12 (DI)

Date:…………………….

ACTIVITY
LECTURER’S NAME AND SIGNATURE

COMMENTS

Cavity Preparation
-conservation of tooth structure
-outline form
-resistance form
-retention form
-convenience form
-cavity toilet

Base / lining
-understand the indication
-materials used
-sufficient thickness
-uniform layer
-confine to area that is necessasary

Filling
-underfilled / overfilled
-overhanging or deficient margin
-preserve anatomy
-maintain contact point

Polishing
-smooth and shiny

7.7 Class V composite restoration.

7.7.1 ARMAMENTARIUM

Basic tray setup:

1. Mouth mirror
2. Explorer
3. Tweezers.
4. Periodontal probe.

Cavity preparation:

1. Contra angle slow speed hand piece

2. Burs.

Mixing and placement:

1. Mixing pad.
2. Mixing spatula.
3. Glass ionomer.
4. Cavity conditioner.
5. Plastic instrument (Teflon- type) instrument.

Finishing:

1. Diamond finishing bur

2. White stone points
3. Snap on soflex discs points.

7.7.2 CLASS V CAVITY

Class V cavity preparation, by definition, are located in the gingival one

third of the facial and lingual tooth surfaces. Because of the esthetic
consideration, composite resin or GIC (Fig-7.55A) used for the restoration of
class V lesions. In certain circumstances, GIC and composite (Fig-7.55B) resin
restoration are used together in the same cavity (using different layers of
material), to obtain good adhesive of GIC to dentine and achieve greater aesthetic
and strength of composite resin. This type of technique and restoration is known
as “sandwich technique” and “sandwich restoration”.

(A) (B)
Fig-7.55 (A) GIC Light cure, (B) Composite self sure.
7.7.2.1 OUTLINE FORM
The outline form of the cavity stops at the extent of the defect or caries,
and removal of tooth structure can be kept to a minimum.
However, unsupported enamel should not be left in area subject to high load.
For the restoration of the cervical abrasion lesions, for which glass
ionomer cement is often used, the outline from of the defect is used as cavity
outline from but sometime the coronal (enamel) margin is altered (Fig-7.56 to
7.59).
The cavity margin should ideally be placed above the gingival margin to gain
better moisture control.

Fig-7.56 Class V cavity. Fig-7.57 Large class V cavity

with two pin holes

Fig-7.58 Class V cavity in premolar.

Fig-7.59 Cavity
outline.

7.7.2.2 RETENTION FORM

A particular retention from does not need to be consciously provided, in

fact, if one is too much of a box form, air bubbles will be trapped in the
corners.
In order to increase adhesiveness with the cement, a fresh dentine surface
is exposed as much as possible and any carious dentine is removed.

7.7.2.3 PREPARATION FOR CONVENTIONAL CLASS V CAVITY

The conventional class V for composite is indicated for portion of a carious

lesion entirely or partially on the buccal / labial or lingual root surface of the
tooth.
The preparation will be limited only to removal of any defects and
conserving as much tooth as possible.
The features of the preparation include a 90-degree cavosurface angle,
uniform depth of the axial line angle and sometimes, the retentive groove.
Enter the tooth using a tapered TC or similar shaped diamond bur at a 45-
degree angle to the tooth surface by tilting the hand piece distally.
As the cutting progress distally, maintain the bur’s long axis perpendicular
to the external tooth surface during preparation of the outline form. This should
result in 90-degree cavosurface margins.
The depth of the cavity (axial wall depth) is about 0.75 mm. this depth will
provide adequate external wall width for:
Strength of preparation wall
 Strength of composite
Placement of retentive groove, if necessary.

The axial wall should follow the original contour of the root surface i.e.
convex outward mesiodistally and sometimes occlusogingivally.
Final tooth preparation consists of the following steps:
1. Removing remaining infected dentine on the axial wall or old restoration (if
applicable).
2. 2.Lining, if necessary
3. Sometimes, may need to prepare retentive groove. However, retention groove
is considered unnecessary when axial depth into dentine is only 0.2 mm and the
periphery of tooth of the tooth preparation is still in enamel.

No .1/4 round bur is used to prepare the groove, along the full length of
gingivoaxial and incisoaxial (occlusoaxial) line angles.
These grooves are about 0.25 mm in depth into the external walls.
Beveling of the enamel margin is sometimes done and is indicated in the case
of :
1. The replacement of an existing, defective class V restoration, which not
previously beveled.
2. For a large, new caries lesion.

The advantages of the beveled preparation are:

1. Increase retention due to the greater surface area of etched enamel.
2. Decrease micro leakage due to the enhanced bond between the composite and
the tooth.
3. Decrease the need for groove retention (therefore, less removal of tooth
structure).

A.CLEANING AND CAVITY CONDITIONER

The cavity preparation is rinsed with water and lightly air-dried.

Condition the cavity to cleanse the preparation, which removes the smear
layer and makes the adhesion of the cement to the dentine surface more reliable.

B.PLACEMENT RESTORATION.

It is necessary to remove excessive moisture from tooth structure.

Mixed glass ionomer cement as soon as possible in order to obtain the best
bond.
The restorative glass ionomer cement is placed in the cavity using a syringe
or a special instrument for pacing and contouring GIC.
A cervical matrix can also be used to contour the restoration along the
margins while the restoration is setting.
The basic anatomy is finished while the cement is in the fluid state.

C.CONTOURING.

If fluidity disappears while the anatomy is being carved, do not try to

create any more anatomy, keep your hands off.
Attempts to change the contour after fluidity disappears causes stippling or
bumps on the surface.
If there is a lack of material, another mix is made quickly and an
additional layer added.
 D. FINISHING.

The finishing should be done at least one day after the placement of the
restoration to allow surface hardness to occur.
One technique is to contour the basic anatomy using a diamond point for
finishing, and then to finish the surface with snap on discs or something similar.
Abrasive strip is used to contour the proximal surfaces.
Because the GIC is now stable in water, white stone points and silicone
points can be used with adequate irrigation to contour the restoration.
Finishing with polishing pastes, brushes, and rubber cups should be avoided
because the heat produced may cause craze lines.

7.7.2.4. FEATURES OF CAVITY CLASS V ON CANINE TOOTH.

(A) (B)
Fig-7.60 (A) Class V preparation with composite, (B) Step by step preparation.

Fig-7.61Class V caries and outline form. Fig-7.62 Bur held at

45-degree.

Fig-7.63 Completed large, beveled conventional class V

preparation.

7.7 Practical class.

Class V GIC on 25 (B)
Class V Composite on 11 (B)
Class V GIC on 33 (B)
PRACTICAL SESSION

1. INSTRUCTION: Class V GIC on 25 (B)

Date:…………………….

ACTIVITY
LECTURER’S NAME AND SIGNATURE

COMMENTS

Cavity Preparation
-conservation of tooth structure
-outline form
-resistance form
-retention form
-convenience form
-cavity toilet

Base / lining
-understand the indication
-materials used
-sufficient thickness
-uniform layer
-confine to area that is necessasary

Filling
-underfilled / overfilled
-surface smoothness
-overhanging or deficient margin
-preserve anatomy

Polishing
-smooth and shiny
PRACTICAL SESSION

1. INSTRUCTION: Class V Composite on 11 (B)

Date:…………………….

ACTIVITY
LECTURER’S NAME AND SIGNATURE

COMMENTS

Cavity Preparation
-conservation of tooth structure
-outline form
-resistance form
-retention form
-convenience form
-cavity toilet

Base / lining
-understand the indication
-materials used
-sufficient thickness
-uniform layer
-confine to area that is necessasary

Filling
-under filled / overfilled
-surface smoothness
-overhanging or deficient margin
-preserve anatomy

Polishing
-smooth and shiny

PRACTICAL SESSION

1. INSTRUCTION: Class V GIC on 33 (B)

Date:…………………….
 ACTIVITY
LECTURER’S NAME AND SIGNATURE

COMMENTS

Cavity Preparation
-conservation of tooth structure
-outline form
-resistance form
-retention form
-convenience form
-cavity toilet

Base / lining
-understand the indication
-materials used
-sufficient thickness
-uniform layer
-confine to area that is necessasary

Filling
-under filled / overfilled
-surface smoothness
-overhanging or deficient margin
-preserve anatomy

Polishing
-smooth and shiny

EVALUATION CRITERIA

EVALUATION CRITERIA GRADE

Excellent A student is able to complete the task without any assistance and
direct guidance from the supervisors and has excellent knowledge about the
procedures.
4
Good A student need a minimal amount of help to complete the task and is able to
show evidence of understanding of the concept / procedure.
3
Satisfactory A student need to be repetitively guided to complete the task and
need further explanation about the given concept / procedure.
2
Poor There has been irretrievable damage to the tooth structure and the student
lacks the knowledge of the given concept / procedure. The supervisor has to
complete the stage of treatment for the student.
1
Assessment sheet for hands skill exercises

(1) EXTERNAL OUTLINE FORM(inc bevel) REPEAT

Exercise Marks Signature Marks Signature
Exercise1
Shape 1
Exercise 2
Shape 2
Exercise 3
Shape 3
Exercise 4
Shape 4

(2) INTERNAL FORM (Parallel walls / undercut, internal line angle) REPEAT

Exercise Marks Signature Marks Signature

Exercise1
Shape 1
Exercise 2
Shape 2
Exercise 3
Shape 3
Exercise 4
Shape 4

(3) FINISH ( SMOOTHNESS) REPEAT

Exercise Marks Signature Marks Signature
Exercise1
Shape 1
Exercise 2
Shape 2
Exercise 3
Shape 3
Exercise 4
Shape 4

Reference:
• Pickard HM, 1970 A Manual of Operative Dentistry, 3rd. ed, Oxford University
Press.
• Robinson DS, Bird DL, 2007 Essentials of Dental Assisting, 4th. ed,
Saunders.
• Pickard HM, Kidd EAM, Smith BGN, and Watson TF, 2006 Pickard”s Manual of
Operative Dentistry,8th. ed , Oxford University Press.
• Gopinath VK, Sam’an MI, Noorliza L, Rashid I, and Zaripah B, 2007 Manual
for Opreative Dentistry :P2Y2, USM.
• Phinney DJ, and Halstead JH, 2000 Delmar’s Dental Assisting. A comprehensive
Approach, Delmar Thomson Learning.
• Sikri VK, 2006 Text book of Operative Dentistry, CBS.
• Roberson TM, Heymann HO, and Swift EJ, 2006 Sturdevant’s Art and Science of
Operative Dentistry, 5th.ed, Mosby.
• Summit JB, Robbins JW, Hilton TJ, and Schwartz RS, 2006 Fundamentals of
Operative Dentistry; A contemporary Approach, 3rd.ed, Quintessence.
• Kantorowiczs GF, 1979 Inlays, Crowns and Bridges. A clinical Hand
Book,3rd.ed,Wright.