Copyright © 2005 by Elsevier Inc. All rights reserved. General Dentistry Chapter 48.

Copyright © 2005 by Elsevier Inc. All rights reserved.

General Dentistry

Chapter 48


Introduction

Restorative and esthetic dentistry

focuses on the general dental

needs of the patient.


Restorative Dentistry

• Specific conditions that initiate a need for restorative dental treatment are:

– Initial or recurring decay

– Replacement of failed restorations

– Abrasion or the wearing away of tooth structure

– Erosion of tooth structure


Esthetic Dentistry

• Specific conditions that initiate a need for esthetic dental treatment are:

– Discoloration due to extrinsic or intrinsic staining

– Anomalies due to developmental disturbances

– Abnormal spacing between teeth

– Trauma


Terminology in Cavity Preparation


Initial Cavity Preparation

• Outline Form

– Design and initial depth of sound tooth structure

• Resistance Form

– Shape and placement of cavity walls

• Retention Form

– To resist displacement or removal

• Convenience Form

– Provides accessibility in preparing restoring tooth


Final Cavity Preparation

• Removal of decayed dentin, or old restorative material

• Insert resistance and retention with the use of hand cutting instruments and burs

• Placement of protective materials (liners, bases, desensitizing or bonding)


Patient Preparation for Restorative Procedures

• Inform the patient what to expect throughout the procedure.

• Position the patient correctly for the dentist and the type of procedure.

• Explain each step to the patient as the procedure progresses.


Responsibilities of the Chairside Assistant

• Prepare the setup for the procedures.

• Know and anticipate the dentist's needs.

• Provide moisture control.

• Transfer dental instruments and accessories.

• Mix and transfer dental materials.

• Maintain patient comfort.


Steps in the Restorative Procedure • Dentist evaluates the tooth to be restored.

• Dentist obtains local anesthesia.

• Assistant readies the type of moisture control.

• Dentist prepares the tooth.

• Dentist determines the type of dental materials.

• Assistant mixes and transfers the dental materials.

• Dentist burnishes, carves, or finishes the dental material.

• Dentist checks the occlusion of the restoration.

• Dentist finishes and polishes the restoration.


Class I Restorations

• Class I lesion affecting the pit and fissures of the teeth

• Surfaces involved are:

– Occlusal pits and fissures of premolars and molars

– Buccal pits and fissures of mandibular molars

– Lingual pits and fissures of the maxillary molars

– Lingual pits of maxillary incisors, most frequently in the pit near the cingulum


Fig. 48-5 Class I restoration


Class II Restorations

• Class II lesion is the extension of the Class I lesion into the proximal surfaces of premolars and molars.

• Surfaces involved:

– Two-surface restoration of posterior teeth

– Three-surface restoration of posterior teeth

– Four- or more surface restoration of posterior teeth


Fig. 48-6 Class II restorations (From Baum L et al: Textbook of operative dentistry, ed 3, Philadelphia, 1995, Saunders.)


Class III and IV Restorations

• Class III Lesion

– Affects the interproximal surface of incisors and canines

• Class IV Lesion

– Involves a larger surface area, which includes the incisal edge and interproximal surface of incisors and canines


Fig. 48-7 Class III restoration (From Baum L et al: Textbook of operative dentistry, ed 3, Philadelphia, 1995, Saunders.)


Fig. 48-8 Class IV restoration (From Baum L et al: Textbook of operative dentistry, ed 3, Philadelphia, 1995, Saunders.)


Class V Restorations

• Class V Restoration

– Classified as a smooth surface restoration

• These decayed lesions occur at:

– Gingival third of the facial or lingual surfaces of any tooth

– Root of a tooth, near the cementoenamel junction


Fig. 48-9 Class V restoration (From Baum L et al: Textbook of operative dentistry, ed 3, Philadelphia, 1995, Saunders.)


Complex Restorations

• Decay has extended beyond normal size or shape

• Retention Pins

– Decay has extended into the cusp of a tooth and undermined the enamel and dentin

– General understanding when using retention pins

• One pin is placed for each missing cusp


Fig. 48-10 Retention pins placed for added retention


Intermediate Restorations

• Restoration placed for a short term

• Primary Factors for Placement

– The health of the tooth

– Waiting to receive a permanent restoration

– Financial reasons


Procedure Fig. 48-5-3 Placement of IRM


Direct Bonded Veneers

• Veneer

– Thin layer of tooth-colored material applied to the facial surface of a prepared tooth

• Used to improve the appearance of teeth that are:

– Abraded

– Eroded

– Discolored with intrinsic stains

– Darkened after endodontic treatment


Fig. 48-11 Veneers placed to reduce brightness and cover stain (From Roberson T et al: Sturdevant’s art and science of operative dentistry,

ed 4, St. Louis, 2002, Mosby.)


Fig. 48-12 Veneers placed to close a diastema (From Roberson T et al: Sturdevant’s art and science of operative dentistry,

ed 4, St. Louis, 2002, Mosby.)


Tooth Whitening

Known as vital bleaching, tooth

whitening is a noninvasive method of

lightening dark or discolored teeth.


Indications for Using a Tooth Whitener

• Indications for Procedure

– Extrinsic stains from foods, cigarette smoking, coffee, or tea

– Aged discolored teeth

– Intrinsic stains, such as mild tetracycline stains and mild fluorosis


Fig. 48-13 Before and after picture of tooth whitening used for extrinsic stains


Fig. 48-14 Before and after picture of tooth whitening used for intrinsic stains

(From Roberson T et al: Sturdevant’s art and science of operative dentistry, ed 4, St. Louis, 2002, Mosby.)


Whitening Products

• Chemical Makeup

– Active ingredient

• Either carbamide peroxide or hydrogen peroxide

– Gel base

• With one or a mixture of propylene glycol, glycerin, and water

– Thickener

• Carbopol


At-Home Tooth-Whitening Procedure

• Material placed in a thermoplastic custom tray that the patient wears for a designated period.

– For the 10% to 16% carbamide peroxide gels, the wear schedule would be 1 hour, twice a day for the first week and once a day for the second week

– For the 20% to 22% mixture, 1 hour a day for a 2-week period

– For the hydrogen peroxide 15 to 30 minutes, 2 or 3 times a day for a 2-week period


Tooth-Whitening Strips

• Thin, flexible strips coated with an adhesive hydrogen peroxide whitening gel.

• Application

– Patient peels off the backing like a Band-Aid and presses the strip to the facial anterior teeth.

– The remaining portion of the strip is folded onto the lingual surface.


Possible Complications to Tooth Whitening

• Thermal Hypersensitivity

– Patient may experience sensitivity to heat and cold after removal of tray and material. The use of sensitive-type toothpaste is recommended

• Tissue Irritation

– Gingival tissue exposed to excess gel caused by improper tray fit. Recommend to patient not to overfill tray with material and remove any excess after seating the tray


Dental Assistant's Role in Tooth-Whitening Procedure

• Aid in recording the medical and dental history

• Assist in making shade selection

• Take intraoral photographs before and after

• Take and pour up preliminary impressions for tray

• Fabricate and trim tray

• Provide postoperative instructions

• Assist in weekly or biweekly clinical visits


Patient Instructions for Tooth-Whitening Procedure

• Brush and floss before tray placement.

• Place equal amounts of gel in tray.

• Seat tray.

• Do not eat or drink when wearing the tray.

• Wear tray for the recommended time.

• If the patient experiences any problems, discontinue use and discuss with the dentist.

Copyright © 2005 by Elsevier Inc. All rights reserved. General Dentistry Chapter 48.

Documents

restoration slide

cavity preparation slide

bonding slide

cingulum slide

restoring tooth slide

restorative procedure

teeth trauma slide

restorative dental treatment