Operative dentistry

Dr lobna abo elnasr

Complex amalgam ( pin retained) restoration

Complex cavity involve more than 2 sufaces + capping of 1 or 2 casps

Indication:

Controlled restoration in tooth with questionable pulp or periodontal prognosis Contolled restoration in tooth with acute or sever caries Definite final restoration Foundation under fixed restoration Alternative fo fixed crown and bridges due to high cost Interim restoration for teeth requie occlusal adjustment Old age

Resistance form : box like pepaation + removal of undermined enamel

Retention form: depends on remaining tooth structure pins and slot more auxillary retention( locks , coves) What are the goals of contolled restoration Resistance of tooth against fracture Protect pulp from oral fluids Control of caies and plaque Anatomical contour to protect gingival tissue

Contraindication: tooth in esthetic area patient with occlusal problem

Tooth cannt restoed directly due to anatomical or fuctional consideration Advantages: Cheaper than indirect crown Conservation of time one appointment

Dis advantages: dentinal microfracture during pin hole and slot preparation making internal stresses

Microleakage around all types of pins Decrease strength of amalgam ( tensile strength of amalgam , horizontal stresses of pins) Resistance form doesnot protect the tooth from fracture as extracoronal restoration Penetration and perforation into the pulp and external tooth structure especially with pin Difficulty in obtaining proper contour especially with lage cavity NB Vetical: parallel to long axis Horizontal : peripendicular to long axis

Pin etained amalgam estoration:

Definition: any restoration gaining resistance and retention from one or more pins which cannt be gained from slot , locks, undercuts Site: large class 2, class 4 on distal surface of upper canine

Tooth preparation: Initial tooth preparation: Same as for amalgam when fasciolingual extention of occlusal prepaation exceeds 2 thirds or more of distance between fascial and lingual casp

Casp capping: week casp , cavity extend to or more than 2 thirds of distance between casp tip and central groove
Initially by depth orientation groove 2 mm on functional casp and 1.5 mm on non functional casp

Sharp internal corners rounded decease stress concentration,increase resistance form resistance form : with flat pulpal and gingival walls

Retention form: slight convergence of fascial and lingual walls fascial and lingual walls plus fascial and lingual groove Final tooth preparation: Removal of caries , old restoration Calcium hydroxide liner RMGIC liner or base shouldnot extend closer than 1 mm to slot or pin Coves peripenicular to long axis locks parallel to long axis Casp reduction decease height of vertical walls so decrease retention

Pin hole preparation

By using twist drill latch type or depth limiting drill at low speed ( 300-500) RPM first make pilote hole with round bur to localize position of the pin the complete the hole in one or two thrust( movement) Apply intermittent pressure

If u use the depth limiting work until u reach the depth limiting portion then remove the the handpiece rotating to prevent beak For the twist drill its length is 4-5 mm so u make a pin hole of length 2 mm in dentin

Drill cant be used for more than 20 holes otherwise it will be dull dull drill: increase the pressure on handpiece, increase the frictional heat and cracks in dentin
Location of the pin hole: How to determine the location of the pinhole: Knowing the anatomy of tooth and pulp Radiograph Piodontal probe Patient age Pin should be placed in aeas of greatest bulk of amalgam pin hole is placed at cevical third or molars and premolars not closer than 0.5 mm to DEJ not closer than 1.5 mm from external surface

Correct angulation very important to avoid external surface perforation or amalgam penetration

We can put the drill in gingival cevice and adjust flat to tooth surface move on occlusal surface without changing angulation starting drill parrellel to adjacent external surface

For better condesation of amalgam , beter clearence we make a recess by depth 0.5 mm in the vetical wall interior to pin by 245 bur for adquate condensation of amalgam

Ppilote hole is made by ound bur 0.2 mm them complete with the drill to avoid slipping of the drill ( cawling)

For inadquate depth we use depth limiting drill on the surface For retention we can place 2 pins and more but with rules pins r placed at different vertical levels to reduce vertical stresses

Inter pin distance from 3-5 mm

External perforation occurs in : ptominent mesial concavity on upper fist molar midlingual and midfascial of lower first and second molar midfascial , midmesial and middistal of upper first and second molar there are critical location ( dont put pin there) Distal of lower molar Lingual of ypper molars Tiltedt teeth

When there is limited interarch space , care must be taken to avoid external perforation on distal

Rule: one pin for missing axial line angle more pins more retention but pins reduce resistance form so tooth liable more to fracture For occluso gingival reduction by 2 mm no need for pins

Types of pins: self theading , cemented, frictional lock self threading most common now
Types for self threading pins: TMS(threaded mate system) Standard, self shearing,two in one, link plus, link seies Most common standard , link series link plus

Self threading pins: Length of the hole is 2 mm Diameter of pin hole is smaller than diameter of pin So the threads of pin engage in dentin due to dentinal elasticity It is the most retentive one Threads dont engage in dentin through entire width

Disadvantages: vertical and horizontal stresses formed during insertion leading to dentinal crazing great danger on pulp
Advantages: Versatility Wide range of sizes Color coding system Greater retention Gold plated system so leminate the possibility for corrosion

Cemented pins:

Depth of the hole 3- 4mm Pin hole diameter larger than pin diameter Pins used ae stainless steel may be threaded or serrated Frictional lock Diameter of pin hole smaller than pin diameter Pins ae tapped in place retained by resiliency of dentin More retentive than cemented one

Self threaded pin (TMS)

SELF SHEARING
Titanium o stainless steel Color coded plastic sleeves Used in latch type contraangle Once the pin reach the bottom of the hole shearing is off

STANDARD PIN Length of the pin is 7 mm The only pin not applied in the hole by the latch type conta only by hand wrench

Flattened end to be engaged in hand wrench feeling reaching the bottom of hole by tactile sense it can be reversed on quater to one half turn after insertion to full depth to reduce stesses at the apical end of the pin hole

Two in one: 2 pins one shorter than the other long one is 9.5 mm once it each the bottom it shears in half leaving length of the pin extending from dentin with the other half r emaining in hand wrench

Contraangle for link series , link plus hand wrench:

It is moving in clockwise direction and reversed quarter to half turn in anticlock wise direction It is used only for standard

Adjust ment of length of pin:

Length of the pin in amalgam is 2 mm Thickness of amalgam from the end of pin is 2 mm Emoval of excess length of pin by high speed hand piece Duing removal of excess tweezethe pin with TMS bending toolto allow enough thickness of amalgam occlusogingivallyr stabilize the pin , high vaccum suction near it to remove excess Or by bending

Size of the pin color coding systtem, gold larger than silver larger than red larger than pink

Factors affecting selection ofnpin on base of size : Amount of retention desired Amount of dentin available to receive pin For sevely involved posterior tooth use red one to reduce risk of crazing of dentin , pilpal penetration, potentional perforation Silver one used as abackup when pinhole over prepaed for red (wide hole gives silver pin) Pink pin is too small to give retention

Silver pin called minim red pin callen minikin

How many pins to be used depends on:

Amount of dentin available Amount of retention required Amount of lost tooth sttrucure Size of pin ( silver pin is more retentive than red one)