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Da130 restorative materials

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Da130 restorative materials

  1. 1. RESTORATIVE MATERIALS DA 130 Dental Materials and Anatomy and Physiology
  2. 2. HISTORY OF DENTAL AMALGAM  Has been in use for over 150 years in dentistry  “Amalgam” actually means a mixture of metals  Consists of Mercury: Alloy  Alloy made up of varying percentages of silver, tin, copper and zinc  Percentages of alloy and mercury were once mixed by the hand of the dental assistant  Research soon discovered that mercury was a hazardous material, so standards of handling were developed
  3. 3. WHEN DO WE USE DENTAL AMALGAM?  Dental amalgam is still considered a safe and effective means to restore a tooth  Amalgam is often used for:  Primary and permanent teeth  For stress bearing areas of the mouth (usually posterior)  For areas where moisture contamination is not a concern  For cost purposes  When aesthetics is not a concern
  4. 4. MERCURY HAZARDS?  Although dental amalgam contains mercury, when it is mixed with the alloy, the chemical composition changes, and it becomes harmless  Mercury on it’s own is liquid metal, and considered hazardous  Premeasured capsules prevent dental personnel from handling mercury in it’s liquid state
  5. 5. HOW TO HANDLE DENTAL AMALGAM  There is still a risk to healthcare workers regarding dental amalgam; therefore:  We use PPE when handling  We use premeasured capsules  We make sure we close the door of the triturator when mixing amalgam  Always use the suction during application to prevent patient aspiration, which could lead to potential toxicity  Have a mercury spill kit handy if a spill should occur, do not vacuum up!  Have an amalgam scraps container to place excess amalgam, do not throw in garbage!
  6. 6. TRITURATOR AKA AN AMALGAMATOR
  7. 7. WHEN TO USE CAUTION WITH DENTAL AMALGAM:  When mixing the dental amalgam  Mercury vapors will be released  Keep door to triturator closed during mixing  When handling amalgam  Use a no-touch technique (even with gloves on)  Use instruments to pass material, never touch with bare hands!  When restoring a tooth with an existing amalgam restoration  Be sure to use your PPE, vapors are given off when handpiece is in use  When cleaning amalgam after completion of procedure  Place in a amalgam scraps container  A container with a tight lid and keep either dry or with a small amount of radiographic fixer
  8. 8. ADDITIONAL PRECAUTIONS:  Do not sterilize extracted teeth with amalgam restorations  Waste haulers will remove for a fee  Replace amalgam traps at regular intervals  Use a mercury spill kit if you have scraps or loose mercury
  9. 9. AMALGAM ARMAMENTARIUM  Basic set-up (mirror, explorer and college pliers)  Spoon excavator  Tofflemire and wedges (if needed)  Amalgam carrier  Amalgam well  Condenser or plugger  Carvers  Hollenback  Cleoid/Discoid  Burnishers  Acorn / Ball  Articulating paper forceps  Triturator
  10. 10. PROCEDURE STEPS:  Patient is given local anesthesia  Tooth is prepared – with a high speed and low speed handpiece  Tofflemire is placed – if there is interproximal involvement)  Medicaments placed (if necessary) – bases or liners  Amalgam is mixed – with triturator  Amalgam is packed – into a carrier
  11. 11. PROCEDURE STEPS:  Amalgam is transferred – into the tooth  Amalgam is condensed – using condenser  Anatomy is carved – into amalgam with hollenback and cleoid/discoid  Tofflemire is removed  Restoration is smoothed – using burnishers  Tooth height is checked – using articulating paper  Adjustments may be necessary – return back to carvers and burnishers  Give patient post-operative instructions
  12. 12. COMPOSITE RESTORATIVE PROCEDURE:  Composite has been the restorative material of choice for some time now  The growing concern of the public in regards to the safety of dental amalgam created the demand for high strength, aesthetically pleasing composite resin
  13. 13. COMPOSITION OF COMPOSITE RESINS:  Resin matrix:  Dimethacrylate aka BIS-GMA: a fluid monomer (liquid)  Fillers: quartz and silica (minerals and crystal compounds)  Macrofilled: larger particles found in resin, known for high strength  Microfilled: smaller particles in resin, known for aesthetic qualities and ability to polish  Hybrid: most commonly used today, provide high strength and aesthetically pleasing results  Flowable: used in a syringe, this variation of composite is used for it’s flowable consistency  Dentist’s will often use this to place on floor of preparation  Sealant composites: similar to flowable, but consistency is even thinner to allow flow into pits and fissures of occlusal surfaces
  14. 14. THE RIGHT SHADE:  Critical to creating a cosmetic final result  Use a universal shade guide  Unless a lab provides the office with a separate one  Take shade in natural light  Turn dental light off  Use a hand mirror, and have patient approve shade prior to use  Documentation of approval and selected shade is also necessary
  15. 15. TECHNIQUE SENSITIVE:  Composite is affected by a number of factors, many of which the dental assistant can control:  Moisture contamination  Saliva  Light sensitive  Composite will begin to set if exposed to any light  Considerations for use with other materials  Certain dental materials cannot be used with composite:  Eugenol based medicaments  Fluoride treatments  Dental sealers (varnish)
  16. 16. MEANS OF ISOLATION:
  17. 17. ETCH AND BONDING AGENTS  Composite fillings are not created with mechanical retention, chemical retention is necessary  Acid etch – phosphoric acid  Used to open enamel rods and dentin tubules  Similar to sandpaper on wood  Tooth should appear chalky white when properly done.  Primer is used to condition tooth and aids in bonding  Bonding agent unifies the tooth and material
  18. 18. MICROSCOPIC IMAGES OF ENAMEL RODS  Before etching  After etching
  19. 19. MICROSCOPIC IMAGES OF DENTIN TUBULES  Dentin and nerve tissue  Enamel and dentinal tissue
  20. 20. ARMAMENTARIUM:  Basic set-up  Spoon excavator  Plastics instrument  Condenser  Burnisher  Articulating paper forceps  Matrix strips  Composite/dispensing unit  Acid etch  Prime and Bond system  Curing light
  21. 21. PROCEDURE STEPS:  Dentist administer local anesthesia to the patient  Shade is taken  Always prior to preparation  Tooth is prepared – with dental handpieces  Tooth is isolated – meaning, protecting the tooth from moisture and contaminants  Cotton rolls, dri-angles and rubber dam are indicated  Acid-etch is placed – creates porosities on the tooth surface  Usually for 20-40 seconds  Thoroughly rinse for 20 seconds  Replace wet cotton rolls
  22. 22. ETCH FIRST, THEN APPLY BONDING AGENTS
  23. 23. PROCEDURE STEPS  Dry tooth  Place primer – conditions tooth to receive bond  Dry tooth  Place bonding agent – allows for unification of tooth and composite material  Cure  With light for 20 seconds  Place composite material  Flowable first on floor of prep  Hybrid placed in layers and cured in increments  Final details are created  Final cure – 40-60 seconds
  24. 24. FINAL STEPS  After completion of the procedure, the dentist will check the occlusion (how the patient bites)  Once optimal occlusion is achieved, the dentist will polish the restoration

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