Amalgams final preparation 1.

What is the composition of amalgam Silver increases strength and expansion Tin-decreases strength and lengthens the setting time Copper-increases strength, decreases tarnish and corrosion and creep Zinc-prevents oxidation of the other metals in alloy during the manufacturing process Mercury-wets alloy particles and decreases strength in excessive amounts 2. What are different types of amalgam and trade names Classification High copper and low copper Zinc and Zinc free amalgams Admix alloys Spherical alloys Lathecut alloys Admixed alloys Dispersalloy (Densply) Valiant PhD Spherical alloy Valiant Megalloy Sybralloy Lathe cut Indiloy (shofu) 3. Advantages and disadvantages of spherical and admixed amalgams. Spherical Faster set Earlier initial strength Requires less condensation force Better adaptation around pins Crown preps at same appointments (After 30 to 45 minutes) Admixed Increased strength due to Ag-Cu particles Contacts easier to develop Disadvantages Slower set Needs more condensation force Difficult around pins

4. Advantages and disadvantages of spherical amalgams Require less mercury than lather-cut, because they have smaller and spherical particles which has smaller surface area and less spaces between particles

Easier to condense into areas of difficult access (around pins) because they provide less resistance to condensation pressures Hardens rapidly when compared to lathe cut alloys Smoother for carving, burnishing and polishing Disadvantages-Difficult to achieve tight proximal contacts because of plashy nature

5. Advantages and disadvantages of lathe cut alloys Advantages-Easier to achieve tight proximal contacts, because they resist the forces of condensation well Disadvantages-difficult to condense around pins Harden more slowly-greater chances of marginal fracture during removal of matrix band Not as smooth for carving and burnishing and polishing when compared to lathe-cut 6. Advantages and disadvantages of Admixed alloys Have the advantage of spherical alloys but not their disadvantages Have the body of lathe cut when condensing Easily condensed with good adaptation High Cu admixed alloys are good and they do not corrode (first hour 154 and 24 hours 413) Low copper alloys seals the margins fasters than high copper as corrosion products are responsible for self sealing

7. What are the lining material available under amalgam Calcium hydroxide Type-III GIC Type-IV ZOE Brand names Calcium hydroxide GIC Dycal Life (Kerr) Vitra bond Fuji II LC Fuji Linning Cement LC (GC) Unmodified-Tempac (type III) Cavitic (type IV) Polymer modified-IRM (Type-III)

ZOE Type IV

8. What are basic cavity preparation steps? Initial 1) Outline form and initial depth 2) Primary resistance form 3) Primary retention form 4) Convenience form Final - 5) Removal of any remaining infected dentin or old restorations. 6) Pulp protection if indicated 7) Secondary resistance and retention forms 8) Procedure for finishing external walls 9) Final procedures like cleaning, inspecting and sealing Ideal Dimensions of amalgam cavity preparations Ideal depth 1.5 to 2mm 0.2 to 0.5mm into dentin Axial depth 0.2 to 0.8mm deep in dentin Clearance 0.5mm gingival from adjacent tooth Isthmus width th of the intercuspal distance (1 to 1.5 faciolingually) Axial dentinal depth around 0.5 to 0.6, Root 0.75mm to 0.8mm Class-V Axial depth 0.8mm gingival wall 1.25mm occlusal wall and 0.5mm into dentin

9. Functions of matrix bands and wedges. A) Matrix bands Rigidity, rigid enough to withstand the forces while condensation. B) Establishment of proper anatomical contours C) Restoration of correct proximal contacts D) Prevent overhang margins E) Provides good surface finish in proximal areas which is difficult to finish. F) Wedges Separation of teeth (helps in contact breaking) G) Proper adaptation of matrix H) Prevent overhanging margins I) Protect gingival tissues and rubber dam. 10. Types of matrix bands Tofflemire which is straight and contrangled Siqiueland which is wide and narrow Automatrix

Compound supported copper band T band Pallodent matrix system Omni matrix

11. What matrix will u select and what will u check? Universal matrix (Tofflemire-straight and contrangled) Advantages Used when three surfaces of posteriors are involved or tooth has been prepared Position the band and retainer are fairly stable Retainer is easily separated from band Precontoured bands available require little or no modification after positioning around the tooth Bands are available with varying occlusogingival measurements Ivory No-1 matrix Advantages Adjustable metal retainer Provide the missing wall for the single proximal surface restoration Varying size bands available

Automatrix Best indications Very large class II preparations especially those replacing one or more cusps Advantages-Auto lock loop can be positioned either facial or lingual surface with equal ease Disadvantage Bands are not precontoured and development of physiological proximal contours is difficult 12. Different between matrix and retainer? Two types With retainer Tofflemire Ivory no-1 Siqiueland Pallodent Without retainer Automatrix T-band (used in children) Compound supported copper band

Mylar strip

13. How do you use matrix? Position the band Lesser circumferences of matrix and slot of retainer is toward gingivally Burnishing burnish pad first on resilient paper band with egg shaped burnisher to develop proper proximal contour Placement band should be 1mm beyond gingival margin Evaluate with explorer the gingival margin of cavity for proper extensionbeyond cavity margin Evaluate proximal proper level of contact and proximal contour by placing mirror or buccal and lingual side with reflected light It should be convex with contact and junction of occlusal 1/3rd and middle 1/3rd Evaluate occlusally the location of contact buccolingually and reburnish if required either in mouth or remove retainer and do it out side mouth with flat back end of spoon excavator (VIIP) Some times matrix band has to be cut in order to avoid injury to the gingival attachment 14. Resistance form, how do u achieve? Flat pulpal floor Minimal extension of external wall Strong ideal enamel margins Sufficient depth to provide adequate thickness of amalgam bulk 90 degrees cavosurface margin

15. Primary resistance form, how do you achieve? Flat pulpal and gingival floor Minimal extension to allow strong cusp and ridge areas (isthmus width) Restricting occlusal outline from to area receiving minimal occlusal contact Rounding sharp internal line angles to decrease stress concentration To provide minimum depth of 1.5 to 2mm to provide bulk of the restoration Box shape Bevel the gingival wall to get full length of enamel rods 16. How do you achieve primary retention form? Occlusal convergence of facial and lingual walls Dovetail design Occlusal convergence of mesiofacial and mesiolingual wall of proximal box Secondary retention form can be achieved by Proximal locks

Pins Slots Amalgam pins Coves

17. If recent filling is high what does the patient complain and how do you determine it Sensitivity to cold Pain on biting Shiny spot if amalgam filling Determined with articulating paper Apical Periodontitis

18. What happens if occlusion is high or what are the symptoms of high point? Pain or sensitivity on biting Patient feels discomfort Fracture of amalgam (if its high point) Patient may develop Para functional habit Patient may get facial pain Deviation of closure of mandible from normal position

19. How to check if occlusion is high (amalgam filling). Ask the patient to close slightly and check visually the occlusal anatomy. Check occlusion Check visually occlusal anatomy Ask the patient to bite lightly, if amalgam filling there will be a shiny spot Check with articulating paper Check with shim stock will not come out while pulling during light closure Check occlusion centric occlusion, lateral excursion and excursive movements

20. What happens if occlusion is not high but there is gross excess of amalgam? Proximal overcountouring overhang margin Plaque accumulation Food lodgment Gingival trauma Affects the periodontal health inflammation of surrounding soft tissues.

21. How will you remove excess amalgam? . With amalgam carver or blade on proximal surface With proximal finishing stripes Green stone with pumice (remember there is no need for post burnishing for high Cu amalgams).

22. Instructions to patient after filling For amalgam restorations-liquid food for 2 hours. No hard food chewing on that side at least for 24 hours Slight sensitivity may be present If any discomfort and sensitivity persisting more than two weeks ask the patient to report to clinic for check up Ask patient to come for polishing and finishing if indicated

23. If you restore an amalgam in a bruxer, wont it wear away? Best material to use is gold To prevent wearing and to take initial loading fast setting spherical amalgam is better to use Increase retention and resistance forms of the cavity preparation Identify and remove the high points Ask not to bite or take any thing till the amalgam sets Night guard and occlusal splints should be considered Try to find out the etiology and treat the condition 24 .How do u restore amalgam in bruxer, wont it break away? High cu spherical amalgam is used as it has early setting strength (262 Mpa) Try to avoid centric holding stop from your cavity preparation Use of proper cavity design to have good bulk of amalgam, so it resist the occlusal forces Good resistance form should be obtained Avoid any high points after restoration Give occlusal splint advice patient no to bite any hard things

25. What is the best material for bruxer? Cast gold restoration is best for bruxer Type I small lesions without stress bearing areas

Type-II inlay or onlay Type III crown and bridge work Type IV RPD frame work

26. Do you burnish amalgam before or after condensation, if so why? Precarve burnishing Is a form of condensation Produce denser amalgam at the margins of occlusal preparation restored with conventional amalgam alloys (heavy strokes mesio-distally) Marginal adaptability and faciolingually with large burnisher Is a continuous process of condensation Better marginal adaptability Denser amalgam at margin Brings up the excess mercury to margins Post carve burnishing Light rubbing action Improve smoothness and satiny appearance (not shiny) Denser amalgam (conventional) Is a viable substitute for conventional polishing High copper no post carve burnishing (it has no significant effect)

27. When do you stop burnishing? On burnishing you achieve a smooth satiny surface. At this time u stop burnishing

28. How will you restore occlusion in amalgam restorations? When occlusal surfaces are involved in the cavity preparation use articulating paper to register preoperatively the centric holding stops and excursive contacts so that these marked areas can be either excluded from the outline form or properly restored. Proper condensation, precarve burnishing and carving Overcarving should be avoided put the carver on unprepared tooth surface parallel to margin to preserve continuity of surface contour across the margins and helps to prevent over carving Check occlusion visually and by articulating paper Always check occlusal clearance or interference with articulating paper in centric occlusion, lateral excursion movement and protrusive movements

29. What is the purpose of condensation? Adaptation of the amalgam to cavity walls Eliminate void spaces that produce denser amalgam Decrease mercury content in restoration The ideal condensation time (21/2 to 31/2 minutes and it may be high for high copper amalgam).

30. When is polishing of amalgam is done, and what is the purpose of amalgam polishing? Amalgam polishing is done after 24 hours (as crystallization of amalgam is not complete). For high cu amalgams no need of finishing-less time for polishing, these are less susceptible to tarnish and corrosion

Purpose To complete the carving Refine anatomy, contour and marginal integrity To get the smooth surface of the restoration for becoming self cleansing area To get tarnish resistance always use wet polishing with slow speed hand piece to minimize release of mercury vapor and heating of amalgam restoration If mercury is brought to surface it will appear cloudy. this will produce corrosion and loss of strength of amalgam and Overheated amalgam may permanently damage pulp 31. How will u polish amalgam? What speed you will use to polish the amalgam Explain retention form in this particular case Finish and polishing is usually done after 24 hours because crystallization is not complete. Finishing and polishing achieves tarnish and corrosion free amalgam Check the occlusion with articulating paper, if discrepancy is present correct with pointed white fused alumina stone or green carborandum stone. If scratches are left with this use of rubber abrasive point is indicated to remove these scratches Initiate polishing procedure by using a coarse, rubber abrasive point at low speed and air-water spray to produce an amalgam surface with a smooth, satiny appearance If the amalgam surface does not exhibit this appearance after only few seconds of polishing, and if surface is too rough, resurfacing with a finishing bur is necessary, followed by coarse rubber abrasive point to develop the satiny appearance.

It is important that rubber points used at low speed to prevent danger of point disintegrating at high speeds and the danger of elevated temperature of the restoration and the tooth which may cause damage to the pulp As an alternative to rubber abrasive point, final polishing can be done using a rubber cup with flour of pumice followed by a high luster agent, such as precipitated chalk Interproximal surface may be smooth enough with matrix band and should be finished if accessible Retention form-all steps of cavity preparation should be followed Also depends on the type of restoration used

32. How do you do amalgam finishing? Check the occlusion with articulating paper and evaluate the margins with explorer If both have be corrected then use white fused alumina stone or green carborandum stone Stones long axis is held at right angle to margin Then re-evaluate the margin and occlusion Use large round finishing bur no 4/6 to remove scratches (scratches are formed by white and greenstone) Polishing Use coarse rubber abrasive point It will give smooth and satin appearance Here if you dont get the appearance do the finishing and polishing again High polishing Use medium and fine rubber abrasive point Alternatively to rubber abrasive points use rubber cup with flour of pumice followed by precipitated chalk 33. How do you check contact area after restoration? We usually check with dental floss (u hear click sound with tight contacts and if the dental floss frays (tear), contacts are not smooth and there may be overhangs. Visually check for all embrasures (occlusal, gingival, facial, lingual) Site of contact point posteriors middle 1/3rd and anteriors incisal 1/3rd How to check proximal over counters Visual Overhangs Tactile sensation with explorers, radiographs, dental floss.

34. How does gamma 2 phase interfere with strength of amalgam SnHg phase is gamma 2 phase and is weakest and least resistant to corrosion and so needs to be eliminated. In high Cu alloys tin has

greater affinity to Cu and it forms tin-copper phase instead of tinmercury phase. Tin-Copper phase is tarnish and corrosion resistance and is stronger than tin-mercury phase.

35 What is ditching. Ditching is the deterioration of amalgam tooth interface on the occlusal surfaces as a result of wear, fracture or improper cavity preparation.

36 Which scale is used to measure ditching? Visually Explorer drooping into opening Shallow ditching less than 0.5mm polishing is enough (no replacement) More than 0.5mm fissure sealant or composite replacement.

37. What is amalgam creep? Creep is time dependant deformation of amalgam under stress. As strength increases - Creep decreases. To minimize creep Decrease mercury alloy ratio Increase condensation pressure

38 .Will you add freshly mixed amalgam if it is insufficient-YES 39. Finishing amalgam for spherical amalgam immediately YES 40. Where areas contact areas located? Maxillary and mandibular incisors the contact area are located in incisal 1/3rd and more facially Molars they are situated at junction between incisal 1/3rd and middle rd 1/3 or in middle 1/3rd When u go posteriorly contact points goes gingivally So increase occlusal embrasures 41. How will u come to know the patient is suffering from Parafunctional habits? History of early morning facial pain Pain of masticatory muscles

Patient spouse complaining of grinding sound at nights Early morning headaches History of stress or depression History of sensitivity Occlusal wear facets Generalized attrition Broken restorations

42. Bruxism-when u restore tooth in co? Or relieve it a little bit to prevent fracture No, you need to restore tooth in CO and need to give splint otherwise it changes occlusion 43. Indications, advantages and role of complex restorations in overall treatment plan. Also give long term complications of these restorations A) Indications 1. When large amount of tooth structure is missing 2. When increased resistance and retention form are required 3. When questionable Pulpal or PDL prognosis 4. In case of acute and severe caries 5. Final definitive restoration 6. Foundations (core) Advantages 1. Protect pulp from oral cavity (oral fluid, bacteria and thermal stresses) 2. Maintain occlusion 3. Control caries and plaque 4. Cost effective 5. Provide anatomical contour 6. Keeps gingival healthier 7. Conservation of tooth structure 8. Cost effective Disadvantages 1. Dentinal micro fractures (pin holes, pin placements) 2. Increased micro leakage (with varnish and not using amalgam bonding) 3. Pulpal penetrations and perforations 4. Tooth anatomy (difficult to produce contacts, contours and anatomy) Contraindications 2. Esthetic demands 3. Occlusal discrepancy 4. Anatomic and functional considerations (Para functional habits)

44. When and why u decide to reduce cusp When the facial extension is 2/3rd from the primary groove toward the cusp tip, reduction of cusp is mandatory When extensive caries or previous restoration undermines cusp and become weaker Reduction is done to increase resistance form in order to eliminate weak cusp and to avoid cuspal fracture 45. Measurements of cusp capping. For amalgam - 2mm functional cusps and 1.5mm for nonfunctional cusps. For porcelain 2mm functional cusps and 1.5mm for nonfunctional cusps. For metal 1.5mm functional cusps and 1mm for nonfunctional cusps. Complex Amalgam Restorations Functional Cusps for Lower Teeth - Buccal cusps Functional Cusps for Lower Teeth Palatal cusps Cusp capping for amalgam restorations (page-sturdervant-770) Functional cusps 2mm Non Functional cusps 1.5mm The occlusal contour of the reduced cusp should be similar to the normal contour of the unreduced cusp Any sharp internal corners of the tooth preparation formed at the junction of prepared surfaces should be rounded to reduce stress concentration in the amalgam and thus improve its resistance to fracture from occlusal forces When reducing only one of two facial or lingual cusps, the cusp reductions should be extended just past the facial or lingual groove, creating a vertical wall against the adjacent unreduced cusp

46 When do you use pins? Indications of pins With few or no vertical walls When large amount of tooth structure missing When u need one more cusp capping When u need increased resistance and retention form Final definitive restoration Core build up

47. Pins in Amalgam Restorations and their guidelines in placing? Guidelines for placing pins The depth of the pin hole varies from 1.3 to 2mm depending on the diameter of pins used. However the general guideline for pinhole depth is 2mm Self threading pins are most retentive pins, but the pulpal stress is maximum, when pin is inserted perpendicular to the pulp As the diameter of the pin increases the retention also increases, but potential effects on pulp may also increase due to more stresses induced The pin extension into dentin and amalgam greater than 2mm is unnecessary for pin retention and is contraindicated to preserve the strength of the dentin and the amalgam As a rule one pin per missing axial line angle There should be at least 1mm of sound dentine around the circumference of the pin hole, this elicits minimal pulpal response The pin hole should be positioned no closer than 0.5 to 1mm to the DEJ or no closer than 1 to 1.5mm to the external surface of the tooth, whichever distance is greater (before pin Hole location carefully probe gingival crevice to determine if any abnormal contours exist that would predispose the tooth to the external perforation As a rule, the pinhole should be parallel to the adjacent external surface of the tooth Whenever three or more pinholes are placed, they should be located at different vertical levels on the tooth if possible, this will reduce stresses resulting from pin placement in the same horizontal plane of the tooth Spacing between pins, or the inter pin distance depends on the size of the pin used. The minimal pin distance is 3mm for the manikin (0.48mm) and 5mm for the minim (0.61mm). Maximum inter pin distance results in lower levels of stress in dentin. Dangerous areas in pin placements Fluted and furcal areas should be avoided. Specifically external perforations may result from pinhole placement over following areas Prominent mesial concavity of the maxillary first premolar At the midlingual and midfacial bifurcations of mandibular first and second molars At the midfacial, midmesial and middistal furcations of the maxillary first molars and second molars Pulpal penetration may result from pin placement at the mesiofacial corner of the maxillary first molar and the mandibular first molar When possible the location of pin holes on the distal surface of the mandibular molars and lingual surface of maxillary molars should be avoided, because obtaining the proper direction for preparing a pinhole in these locations is difficult because of the abrupt flaring of the roots

just apical to the cementoenamel junction. If the pinhole is to be placed parallel to the external surface of the tooth crown, penetration into the pulp is likely Preparation of Pin Hole No 1/4th bur is first used to prepare a pilot hole (dimple) approximately one half the diameter of the bur at desired pin location. This will prevent the crawling of pin drill Determine angulation for twist drill. Place drill in gingival crevice and position it flat against tooth Now move it occlusally into position without changing angulation obtained Repeat the procedure and get correct angulation Now prepare pinhole in one or two thrusts until depth-limiting portion of drill is reached With drill tip in its proper position and with the hand piece rotating at very low speed (300 to 500 rpm), apply pressure to the drill, and prepare the pinhole The drill tip should never stop rotating from insertion to removal from the pinhole to prevent the drill from breaking while in the pinhole Placement of pins All pin designs can be inserted with an appropriate hand wrench A conventional latch-type contra-angled hand piece also can be used to insert any of the pins except the standard design (recommended for link plus and link series) With hand piece, place the pin in it and place the pin in the pin hole and now activate hand piece at low speed until the plastic sleeve shears from the pin A standard design pin is placed in the appropriate wrench and slowly threaded clockwise into the pinhole until a definite resistance is felt when the pin reaches the bottom of the hole. The pin should then be rotated one-quarter to one-half turn counterclockwise to reduce the dentinal stress created by the end of the pin pressing the dentin If rubber dam is not used, a gauze throat shield must be place in order to prevent accidental swallowing Once the pins are placed, evaluate their length. Any length of pin greater than 2mm should be removed To remove the excess length of pin, use a sharp 1/4th or or 169L bur at high speed and oriented perpendicular to the pin. If oriented in different direction, it may result in rotating the pin in clockwise. Also during removing pin, the pin may be stabilized with a small hemostat or cotton pliers Now check for tightness of pin and now determine whether pins have to be bend, so that they will be within the contour of final restoration

and to provide adequate bulk of amalgam between the pin and the external surface of the final restoration Pins are not to be bent t make them parallel or to increase their retentiveness However, occasionally pins are bend to condense amalgam occlusogingivally When pins require bending, a TMS bending tool is used. The bending tool should be placed on the pin where the pin is to be bent, and with firm controlled pressure, the bending tool should be rotated until the desired amount of bend is achieved A hand instrument such as condenser or spoon excavator should not be used, as they cause dentinal crazing or fracture of dentin. also the operator have less control with a hand instrument Disadvantages or Complications with Pins Dentinal micro fractures Dentinal crazing Microleakage Strength of amalgam or composite could be reduced Perforation of pulp Perforation into periodontal ligament and furcation areas Fracture of pins Broken drills Loose pins and pinholes too large Tooth anatomy complicating the pin placement 48. Can u bend pins in attempt to provide more retention? Pins can not be bend to increase retention or to make them parallel Pins are bend to position them within the contour of restoration To provide adequate bulk of amalgam To allow condensation of amalgam occlusogingivally Pin bends with TMS bending tool, not with another instrument

49. How do you prepare pin holes? After ascertaining position of pinhole from external tooth surface make starting pin hole with 1/4th round bur approximately one half the diameter of the bur Purpose accurate placement of the twist drill and preventing the slipping of the drill when we are placing hole Prevent crawling once it begun to rotate Drill the pinholes with same size

 Twist drill in ultra slow hand piece (300 to 500 rpm) using only one or 2thrusts other wise it becomes wider hole Never use dull drill (change drill after 20 uses) 50. With what materials the pins are made of? TMS pins are usually made up of titanium or stainless steel plated with gold 51. What are the different designs available? Standard, Two-in-one, Self shearing and Link plus and Link series The link series and link plus are recommended The Minuta, Minkin, and minim pins are available in link series 52. What are the different sizes of pins available and what is commonly used and why? Four sizes of pins are available with corresponding color-coded drill TMS For severely involved posterior teeth Minikin pins 0.48mm Minim pins 0.61mm Minuta pins 0.015 inch Minikin pins are generally used because of less dentinal crazing and less perforations Regular pins has highest dentinal crazing and perforations

53. What are different types of pins? Cemented pins Friction-lock pins Self-threaded pins (more retentive than all) some of the Self-threaded pins are Thread mate system Coltene/Whaledent Mahwah, Newjersy 54. What should be the dimensional retentive slots prepared in an extensive amalgam restoration. Slot is a secondary retention feature and is place in transverse direction in dentin to resist horizontal forces. Slots should be convergent occlusally 0.5mm occlusally 0.6mm gingivally and 0.6mm deep 2-4mm length, minimum greater than 1mm

Should be away 1.5mm away from external tooth surface Slot very close to pulp can cause pulpal inflammation

Slot Preparations Slot is a retention groove in dentin whose length is in a horizontal plane. Slot retention may be used in conjunction with pin retention or as an alternative to it Slots are usually placed on the facial, lingual, mesial, and distal aspects of the tooth preparation McMaster has shown that shorter slots provide as much resistance to horizontal force as do longer slots The slot is placed in the gingival floor 0.5mm to 1mm axial of the DEJ. The slot is 1mm or more depending on the distance between the vertical walls Slots are placed with 33 inverted cone bur (or th inverted cone bur. The width of the slot at apex is around 0.5mm and at base is 0.6mm and the depth is around 0.6mm. The length of the slot can vary from 1 to 2mm depending on the retention needed An alternative technique is to prepare the slot initially with a no 169L bur, then ensure convergence by refining it with a No 331/2 bur Pin retention is used more frequently in preparations with few or no vertical walls. Slots are particularly indicated in short clinical crowns and in cusps that have been reduced 2 to 3mm for amalgam Compared to pin placement slot require more tooth structure removal but are less likely to create micro fractures and perforations with pin placements Remember that the slot depth can be of 0.5mm to 1mm in depth. The length can be also 2mm to 4mm depending on the distance between the remaining vertical walls 55. Proximal locks, coves and amalgapins and what are the uses? Function: Counter the proximal displacement of restoration Depth -0.5mm in dentin Length-if greater than 2mm vertical wall, it will terminate at axiolinguopulpal point angle Diminish depth occlusally-if less than 2mm axial wall, then proximal locks are extended occlusally to disappear midway between DEJ and enamel margin Prepared with 331/2 or 1/4th round bur or 169L bur Proximal Locks (page-705) Proximal retention locks are place in axiofacial and axiolingual line angles (believed to strengthen the isthmus of class II restoration and are

believed these locks are significantly better than axiogingival grooves in increasing the restorations fracture strength To prepare a retention lock, No 169L bur is used with air coolant and reduced speed to improve tactile feel and control. The retention lock is always placed 0.2mm inside the DEJ regardless the depth of the axial wall, which maintains the enamel support Some operators prefer th bur to cut the proximal locks. The rotating bur is carried into the axiolinguogingival or axiofaciogingival point angle and then moved parallel to DEJ to the depth of the diameter of the bur. It is then drawn occlusally along the axiolingual or axiofacial line angle, allowing the lock to become shallower and to terminate at the axiolinguopulpal or axiofaciopulpal point angle (or more occlusally if the line angles are less than 2mm in length) Coves in amalgam restorations Coves are prepared in a horizontal plane and locks are prepared in vertical plane Both of them are prepared before placement of pinholes and inserting pins Amalgapins Are circular chambers cut vertically into dentin to provide resistance and retention from for the restoration, these features are called amalgam inserts Studies by Seng (depth 1.4mm in diameter and depth) and Shavell (depth of 3mm with no 1156 bur) have shown that the resistance to displacement provided by amalgapins is similar to that provided by pins It has been demonstrated that depth of 1.5 to 2.0mm is adequate for amalgapins and that an amalgapin with a diameter of 0.8 to 1mm is sufficient burs used are no 33m or no 56 or no 1157 or no 1156 by shavel) 56. What are the causes of cuspal fracture? Inadequate cavity preparation Improper restoration Heavily restored tooth Parafunctional habits Bruxism Malocclusion

57. How do you diagnose incomplete cusp fracture? Exclude other causes of pulpal and periodontal pain Pain on biting and while releasing

 Tooth slooth or orange wood stick or cotton roll or rubber disk Duplicate the patient pain Transillumination Dyes-stain tooth Magnifying loops Indirect aid-ortho band, and sealant is place if patient pains stops, diagnosis could be made in restored tooth some times cusp may fly off while removing 58. Signs and Symptoms of CTS Symptoms Experience cold sensitivity Sharp pain of short duration while chewing Signs Cold sensitivity on pulp test Biting test will be positive Signs of Parafunctional habits Occlusal wear facets Evidence of malocclusion Heavily filled tooth or large restorations

59. Which tooth is more commonly effected in CTS and why Lower mandibular molar is most commonly affected because there is some embryonic problem during development (This may be due to developmental weakness of the tooth.(incomplete fusion of areas of calcification) In specific mandibular second molars are affected because this tooth is in the area of masticator muscle attachments, so takes the greater forces of mastication Mandibular second molars, followed by mandibular first molars and maxillary premolars, are the most commonly affected teeth More prone to development of caries Sharp lingual cusp Heavily restored teeth 60. Does the crack in crack tooth syndrome visible? Cracks rarely show up on radiographs Mesial-distal cracks can never be seen Buccal-lingual cracks will only appear if there is actual separation of the segments or the crack happens to be at exactly the same angle as the x-ray beam Taking periapicals from more than one angle and taking bite wings may increase the chance of catching a crack-induced defect early in its development

61. How often do you see a fractured cusp in a practice once in a week 62. Oblique ridge considerations Preservation Of Oblique Ridge Consider Always Try To Preserve Oblique Ridge Be, It Provides Cross Splinting Support To The Tooth Involve oblique ridge When less than 0.5mm sound tooth structure between two cavities If deep fissures and If undermined 63. What is the best material to restore buccal cusp of Premolar. A) B) C) D) Indirect ceramic onlay PFM onlay PFM Crown or all ceramic crown Amalgam with pin

64. What is the thickness of the base 0.75-2mm MOD restoration distal cusp reduction with pin retained amalgam. What kind of amalgam you are using High Cu Admix alloy-Dispersalloy or Vallian PhD 65. Marginal Ridge preservation. Premolars its 1.6mm minimum Molars its 2mm minimum How would u achieve this divergence of wall distally or mesially rather than converging to prevent undermining of marginal ridge (169L BUR)

66. What is the function of dovetail? It gives increased retention It prevents the mesiodistal displacement of restoration

67. What is the ideal width of the proximal box? 0.2 to 0.3 mm clearance from the adjacent tooth 0.5mm clearance with gingival margin

68. Upper premolar, only buccal and lingual walls remaining what material will u use and what treatment options you have? Amalgam build up with pin or without pins Composite with pin or without pins Gold inlay or ceramic onlay

PFM crown All ceramic crown

69. What would happen if there is no adequate thickness of amalgam covering the cusp? Chances of fracture of restoration Chance of fracture of tooth U cant get enough resistance Amalgam has low tensile strength, low edge strength, so enough bulk of material is needed to withstand occlusal forces

70. Why would u place slots with grooves for retention instead of pins in an extensive cavity for amalgam? Advantage of slot-slots can use with short clinical crowns Increased retention and resistance form by bulk of amalgam Less chances of micro fracture Less chances of microleakage Less chance of pulpal perforations If placed within in 0.5mm of pulp wont produce pulpal inflammation Less chances of creating internal stress on dentin

71. What are the forces acting on the restoration? Occlusal forces - perpendicular to those forces of mastication that are directed in the long axis of the tooth Masticatory forces Long axis of tooth Obliquely directed forces Laterally directed forces What are the forces affecting on the restoration (urvi) Vertical or oblique forces Occlusal forces Masticatory force in oblique or vertical direction Lifting forces

72. Why have u done your minimal cavity preparation like this, how did u know how big to cut it? Minimal extension of facial and lingual walls to conserve dentin supporting the cusps as well as facial and lingual ridges thereby maintaining as much strength of

remaining tooth structure as possible so remaining tooth structure has resistance to fracture This resistance is against obliquely delivered forces, as well as those on tooths long axis direction extension also depends on the extension of caries and depends on amount of retention and resistance needed and the type of restorative material used

73. Why when we restore tooth, we have to follow contour of tooth and what happens with overcountour or undercountour? Improper embrasure form-food will not deflect itself leading to food lodgment and periodontal problems Difficulty in using dental floss Impinges on soft tissues Irritation to tongue Plaque and food lodgment due to improper deflective action

74. Why do you not prepare the cavity for erosion cavities? How do you get retention form for restoration? Erosion is a non-carious lesion No caries excavation needed Not a stress bearing area Depends on choice of restorative material For example GIC (chemical bonding), composites(micromechanical bonding) they do not need or require extensive cavity preparation And at this areas these materials do not need excessive thickness to withstand occlusal forces These material rely on adhesive systems for retention 75. If the patient comes complaining of sensitivity after amalgam placement what will be the cause and how to overcome it? Two reasons for sensitivity after amalgam placement Sometimes due to high points Sometimes due to open dentinal tubules after cutting dentin Hydrodynamic theory changes in the direct of fluid are perceived as pain by mechno-receptor near the pulp Tactile, thermal or osmotic stimuli can induce changes in fluid flow and elicit pain receptor Treatment Correct the etiology Remove the high points with large round diamond finishing bur and then polish with rubber cup with pumice

Block dentinal tubules before restoration with dentin bonding agent Do not cut dentine overzealously in dry field Some times it could be normal discomfort which could be relieved in few days

76. What are the causes of dentinal hypersensitivity, and how do u treat it? Exposed dentinal tubules Erosion Attrition Gingival recession Caries lesions The degree of sensitivity is influenced by the number and size of the open tubules

Treating the etiology is prime important Fluorides Periodontal treatment of gingival recession Sensitivity tooth pastes Dentine bonding agents Use of liner are bases when even indicated Correction of Parafunctional habits if present 77. What are the characteristics of inlays? Occlusal depth-1.8mm Proximal box follows curvature of original tooth surface Follow outline precise path of withdrawal Axiogingival groove- 0.2mm deep Gingival, proximal bevels 45 degrees, 0.8mm width Width of box just pass contact area Axial depth 1mm Buccal and lingual walls for retention Proximal clearance at gingival level from adjacent tooth 0.6mm Round all sharp angles Good conservation of buccal and lingual cusps

78. What is smear layer and why it should be removed? If the tooth structure is cut or polished during dental treatments, the tubules orifices become occluded with debris called smear layer Smear layer consists of primarily of tooth debris but also contains plaque, pellicle and salines and possible blood and saliva Smear layer occludes the dentinal tubules and forms a smear plugs Smear layer decreases the dentinal permeability by 86% Decreased diffusion of bonding resin Smear layer loosely adherent to the bonding system

79. How would you follow up the case? Recall visits Checking for signs and symptoms clinically Vitality tests Radiographs Study models

80. Causes of pain in cusp fracture is due to the flexion of cusp during function leads to pain 81. Would you take radiograph before, during and after treatments? Actually it depends on the treatment procedures I do, for endodontics and any other surgical procedures and periodontics we may need to take X-rays during and after treatments.

82. What would happen to tooth after trauma? May be asymptomatic for few days Pulpal necrosis, ankylosis, resorption, impacted, May be extruded, intruded or avulsion, Luxation or subluxation Concussion

83. What will u do to provide fixation, flexible and rigid splints, why and for how long? Flexible splint-Niti ortho wire 014 gauge for avulsion and intrusion for one week Semi rigid Niti 016 or 018 gauge for root fracture, alveolar fracture and severe Luxation for 3-4weeks For stabilization of tooth, decrease discomfort of patient and avoid occlusal interference

85. What is the action of Ca(OH)2 when used as a pulp capping agent A) Direct pulp capping agent It may stimulate the pulp to form secondary odontoblasts, which in turn produce a dentin bridge across the exposure site. B) Indirect Pulp capping agent If the pulp is healthy, secondary odontoblasts will differentiate and form a reparative dentin to further protect (thermal, chemical, mechanical protection) C) Antibacterial property - High Ph of 11-12 bactericidal. D) Hard setting calcium hydroxide is DYCAL E) Ca (OH)2 in methylcellulose base slow setting Pulpdent.

86. What is the difference between setting and non setting calcium hydroxide and uses of each? Hard setting is used in direct pulp capping procedure (dycal) Non-setting (pulpdent) is used as endodontic intracanal medicament Root fracture Perforation Apexification

87. What is the action of calcium hydroxide when it is placed close to the pulp direct pulp capping Direct Pulp Capping calcium hydroxide dressing may stimulate the pulp to form secondary Odonoblasts which can produce a layer of reparative dentin called dentin bridge to seal the pulp form further insult and it also have bactericidal effects Indications for direct pulp capping The exposure is small which is less than 0.5mm in diameter The tooth has been asymptomatic showing no signs of Pulpitis The hemorrhage from the exposure site is easily controlled The exposure occurred in a clean, uncontaminated field (such as that provided by a rubber dam The invasion of pulp was relatively atraumatic with minimal physical irritation to the pulp tissue

88. Indirect pulp capping indications and procedure? Usually all soft infected dentin must be removed However if pulpal exposure is anticipated by the complete excavation of all questionable dentin, indirect pulp capping indicated Thin layer of remaining carious dentin (affected dentin (hard) is not excavated but is left intact It is then covered with calcium hydroxide base and the excavated area is restored with temporary material Proximity of calcium hydroxide material to the pulpal tissue promotes reparative dentin formation Thus the questionable remaining dentinal area may re-mineralize and form a dentine bridge in this area This re-hardening of questionable dentine area usually occurs in 6-8weeks This procedure prevents frank pulpal exposure and prevents potential adverse pulpal response to such as exposure

Problems with polycarboxylate cement What instruction would you give the patient sensitivity for one month (if not RCT)