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VARNISH

   Composition

   Manipulation

   Properties

   Uses
Definition:


It is a natural gum like copal resin or synthetic

resin dissolved in organic solvents such as ether,

chloroform or alcohol
Composition:

Copal and nitrated cellulose are typical examples of natural

gum and the solvents used to dissolve these materials can be

ether,   acetone   benzene,   ether   acetate,   ethyl    alcohol,

chloroform,    amylacetate    and     medicaments        such   as

chlorobutanol, thymol and eugenol are also added. Recently

fluoride are included in its composition. Flouride varnishes are

used to prevent/arrest decay on smooth surfaces in young
Manipulation:

On a patient, Cavity varnish is applied with the help of small

cotton pellet with the help of wire or R.C Reamer or a brush

applicator. Thin layers of varnish are applied on the floor,

walls including cavosurface margins. Gentle stream of air

can be used to remove the excess.Apply a second coat and

the bottle should be tightly capped after use to minimize loss

of solvent.
Contraindication:

-     Composite – free monomer layer dissolves the varnish


-     Ca(OH)2/ ZOE beneficial affects are lost


-     Polycarboxylate – interferes with adhesion

-     GIC – blocks fluoride penetration.
Properties:

1. It is not a physical or mechanical insulator, provides
   chemical barrier.

2. Thickness: 2-40µm

3. Always applied in 3 layers to be more effective
Uses:

1. 1.Prevents marginal Leakage / Microleakage

2. Prevents penetration of acids from ZnP cement i.e prevents
   chemical penetration.

3. Prevents penetration of corrosion products from amalgam
   therefore prevents discoloration of tooth.

4. Decreases post operative sensitivity and pain.

5. It may be used as a surface coating over certain restorations
   to protect them from dehydration or from contact with oral
   fluids until they harden.eg.silicate andGI cements
Liners:


  Definition: It is liquid in which CaOH and zinc oxide

  (occasionally)are suspended in a solution of natural

  or synthetic resins.
Composition:

1. Ca(OH) / ZnO – Therapeutic agent

2. Ethyl alcohol – Solvent

3. Ethyl cellulose – Thickening agent

4. Barium sulfate – Radiopacifier

5. Fluorides – Anticariogenic
Manipulation:

Trade names:Dycal and Life


It is available as 2 paste systems both of which contain

Ca(OH) and one consists of accelerator
Equal amounts of material from each tube is collected over a


glass slab or mixing pad with help of PD probe both are


mixed till homogeneous colour is got and with same


instrument it is carried -
- to deepest portion of the cavity and since it is fluid in

consistency it readily flows or gets painted over the cavity


over which the thermal insulating base or temporary


restoration is provided.
Properties:

1. Acts as a thin barrier between the restoration and the

   remaining dentine and protects the pulpal tissue from

   irritation caused by physical,mechanical,biological, or

   chemical agents .

2. Like cavity varnish it neither possesses mechanical

   properties nor provides thermal insulation.
Uses:

1. As pulp capping agent due to its sealing ability.

2. As anticariogenic cement because it stimulates the

   production of secondary or reparative dentin.

3. Prevents post operative sensitivity or pain.

4. It is compatible with all types of restorative materials.
BASES
Bases :
Chemical and Thermal, Mechanical Insulation


Cements:
General applications
Classification
Individual Cements - Composition
                       - Manipulation
                       - Properties
                       - Uses
General Applications:

1. Thermal and chemical insulation

2. Temporary restorations – Zn OE

3. Intermediate restorations – IRM

4. Permanent restorations – GIC

5. Temporary Luting – Type I ZOE

6. Permanent Luting – GIC, ZnP, Zn Poly Carb
7. Cementation of orthodontic appliances

8. As sedative dressing for the pulp of freshly prepared tooth

9. As pulp capping agents

10. Pit and fissure sealants – Composites, GIC

11. Core build-up

12. Root canal sealants Gutta-percha

13. Periodontal dressings
Clinical Considerations:

Clinical Judgements about the need for specific liners and

bases are linked to the amount of remaining dentin thickness

(RDT), considerations of adhesive materials, and the type of

restorative material being used.
In a shallow tooth excavation, which includes 1.5 to 2mm or

more of RDT, there is no need for pulpal protection other than

in terms of chemical protection. For an amalgam restoration,

the preparation is coated with two thin coats of a varnish, or a

dentin bonding system, and then restored.
For a composite restoration, the preparation is treated with a


bonding system (etched, primed, coated bonding agent) and


then restored.
In a moderately deep tooth excavation for amalgam that

includes some extension of the preparation toward the pulp so

that a region includes less – than – ideal dentin protection, it

may be judicious to apply a liner only at that site using ZOE or

calcium hydroxide.
Either one may provide pulpal medication, but the effects


will be different. ZOE cement will release minor quantities of


eugenol to act as an obtundent to the pulp.
How ever, in a composite tooth preparation, eugenol has the


potential to inhibit polymerization of layers of bonding agent


or composite in contact with it.
Therefore calcium hydroxide is normally used, if a liner is


indicated. If the RDT is very small or if pulp exposure is a


potential problem, then calcium hydroxide is used to stimulate


reparative dentin for any restorative material.
Cements Used In operative Dentistry:
Silicate Cement

Zinc Phosphate Cements

Zn Silicophosphate Cements

Zn Polycarboxylate Cements

Zinc Oxide Eugenol Cements

Glass Ionomer Cements

Resin Cements

Calcium hydroxide cements
Zinc Phosphate Cement:

                    Available as Powder and Liquid
Powder.

Zn Oxide – 90%

Mg Oxide – 8-9%

SiO2, Bismuth trioxide, Barium oxide – traces

Liquid.

Phosphoric acid (85%) and water (33+ 5%)
Chemistry of Setting:

When the alkaline powder comes in contact with acidic liquid it

partially dissolves in liquid. It is an exothermic reaction. The set

cement consists of hydrated amorphous network of ZnP that

surrounds partially dissolved ZnO2 particles.
Manipulation:

Properties:

1. Mixing time – 60-90secs

2. Setting time – 5-9mins

3. Compressive strength (24hrs) – 13000psi : 103.5Mpa

4. Tensile strength (24hrs)    – 800psi      5.5Mpa
5.     Film Thickness – 25-40µm

6.     Solubility/Disintegration – 0.2%

7.     Pulp response – Moderate / Severe

8.     pH – 3Mins – 3.5

           24hrs – 6.6

Because of pulp irritation, cannot be used deep carious
lesions.
Uses:

Primary Uses

1. As luting agent for restorations and orthodontic
   appliances.

Secondary Uses:

1. Thermal insulating agent

2. Intermediate restoration
ZINC SILICOPHOSPHATE
It is a combination of silicate and ZnP cement

Properties fall between those of ZnP and silicate.

pH: lower than of ZnP

and has got degree of translucency.

Anticariogenic property because of fluorides.
Zinc Polycarboxylate:

Composition:

Available as powder and liquid

Available as powder to be mixed with plain water

Powder

ZnO

MgO

Traces of other oxides
Liquid:

Polyacrylic acid

Tartaric acid

Maleic acid

Iticonic acid
Properties:
1. Working time : 3-6mins

2. Setting time 5.5mins

3. Mixing time: 30 to 60secs

4. Compressive strength (24hrs): 8000psi

5. Tensile strength: 900psi

6. Film thickness: 21µm

7. Pulp response: mild

   Binds chemically to tooth structure
Uses:

Primary Uses

1. Luting agent for cementation of restorations

2. Thermal insulating base

Secondary uses

   cementation of orthodontic appliances and intermediate
   restorations
Advantages over ZnP

-    Not irritant to pulp due to high mol. size

-    Binds chemically to tooth structure

-    Can be used safely in moderately deep cavities.

     No need to use cavity varnish.
ZINC OXIDE
EUGENOL
Type I :     Temporary luting or cementation

Type II:     Permanent cementation ex: kalzinol

Type III:    Intermediate restoration, thermal insulating
             base, temporary restoration.

Type IV:     Cavity liners or subbase

Examples:

Type III: IRM

Type IV: Dycal and life
Basic Composition:

As Powder and Liquid

Powder:

ZnO- Main ingredient – 70%

White rosin – reduces brittleness of cement

Zinc acetate – improves strength

Zinc stearate – acts as plasticizer
Liquid:

Eugenol : 85%

                 Sedative effect to pulp

Olive Oil: 15%
Modifications in basic composition

Type II –    Ethoxy benzoic acid/Resins are added increases
                   the strength of the cement

Type III-    Resin reinforced, partially polymerized surface
             treated with propionic acid

-            Increases strength and abrasive resistance

Type IV –    2 paste system. Active ingredient in both pastes
             is Ca OH.
Examples: Type      I: Tempbond / Neogenol / Freegenol
                    II: Kalzinol
                    III: IRM
                    IV: Dycal


Chemistry of Setting:
ZnO + H2O        Zn (OH)2
                 Zn hydroxide
Zn (OH)2 +2HE       ZnE2 + 2H2O
Base      Acid      Zn – eugenolate salt
MANIPULATION
Mixed on glass slab or mixing pad. Powder is dispensed and

liquid is collected just prior to the mixing. Bulk of the powder

is incorporated into the mixture and spatulated with a stainless

steel spatula till it becomes paste on creamy in consistency.

Powder or cotton fibers can be added which will improve the

retention of the cement in the cavity.
Properties:


Setting time : 4-10mins


Compressive strength (after 24hrs): 4000psi


Film thickness: 25um


Solution and disintegration: 0.04% by wt


Pulp response mild
Uses:

Primary Application

1. Temporary restoration

2. Intermediate

3. Temporary luting

4. Permanent

5. Thermal insulating base

6. Pulp capping agent
Secondary application

•   As root canal sealants and in RC restorations

•   Periodontal dressings
CALCIUM HYDROXIDE CEMENT
Available as powder or 2 paste cements

       It is available as dry powder or two paste system.

Mixed either with distilled water or saline to form a paste as

it can also be suspended in chloroform and conveyed to the

required area with the help of a syringe
When available as 2 paste cements.

One paste

   – monomer of methyl cellulose as initiator and CaOH

Other paste:

   Calcium hydroxide and catalyst, when they are brought in
   contact methyl cellulose undergoes polymerization and
   porous matrix is formed

   pH:11
Mechanism of action:

Uses:

1. Cavity liner

2. Pulp capping agents
GLASS    IONOMER
CEMENT
   Invention,
   Composition,
   Classification,
   Setting Reaction,
   Properties,
   Variations in basic composition,
   Indications,
   Contraindications,
   Manipulation and clinical procedures for placement.
Invented in 1969 but first reported by Wilson & Kent


1971. It was invented in a creative response to inadequate


materials particularly from deficiencies of silicates.
1. It adheres to tooth structure


2. Translucent


3. Releases fluorides


4.Has also all favorable properties


5. Biocompatible and Bioactive
COMPOSITION
POWDER

Consists of calcium aluminosilicate glass containing fluoride.

SiO2         -       30%

Al2O3        -       19.9%

Al F3            -    2.6%

CaF2             -   34.5%

NaF              -    2.6%

AlPO4            -    10%

Radioopacifiers like Strontium, Barium and Lanthanum
Fluoride is one of the main components.

 It lowers fusion temperature,

 Improves strength provides translucency and therapeutic


  value

 and improves working characteristics of the cement
Powder particles are obtained by heating all these particles


between 11000 C - 16000 C
LIQUID

Polyacrylic acid which is a polyacrylite which is a polymer

of carbonic acid.

Some amount of maleic acid and itaconic acid is added.

Sometimes poly acrylic acid is blended dry with the powder

so that it is mixed with either water or tartaric acid.
CLASSIFICATION BASED ON USE
Type I: As luting agent

Type II: As restorative agent

Type III: Liners and bases and pit and fissure sealants

Type II: Conventional

         Reinforced – Metal modified Glass Ionomers
CHEMISTRY OF SETTING
When the powder comes in contact with the liquid to form a


paste, surface of powder particles are attacked by liquid. Ca,



Al, Na, F ions are released into the aqueous medium.
Calcium polysalts form 1st eventually followed by a Al poly

salts which form cross linking's. They undergo hydration to

form gel matrix and there are untreated powder particles

surrounded by silica gel. Set cement consists of agglomeration

of powder particles surrounded by silica gel in an amorphous

matrix of hydrated Ca and Al polysalts.
PROPERTIES
1. Translucency – mainly due to fluoride


2. Adhesion


3. Biocompatibility
1. Glass Ionomer cement is an esthetic filling material. Its

   translucency arises because of powder particles which is

   a clear glass. But it takes 24hrs to achieve, mature and

   develop full translucency. Only after this period one can

   appreciate the colour match with the adjacent      tooth

   structure.

   Color of GIC remains unaffected by oral fluids unlike

composite resins which tends to discolor.
2.      It enables the conservative approach for the

restoration because providing mechanical undercuts to retain

the material is not necessary. This is of   particular importance

while restoring cervical abrasions and erosions and there will

be a tight marginal seal.    Hence less percolation of bacteria

around cavity        margins and walls
Type of Adhesion


Chemical bond and can be improved using conditioners


like polyacrylic acid and citric acid.
BIOCOMPATIBILITY
GIC are therapeutic materials. Their adhesion to the tooth

structure ensures a marginal seal thus eliminating secondary

caries by sustained release of fluorides. These materials are not

only biocompatible and bioactive because they promote bone

growth can be used as bone cements after endodontic surgery.
The adverse effects on vital tissues are minimal. Hence a
protective barrier is rarely required

4. Setting time 4-5mins

5. Compressive strength (24hrs): 20000 psi

6. Tensile strength: 400 psi

7. Hardness: 60KHN

8. Solubility and disintegration 0.4% by wt

9. Pulp response – Mild

10. Anticariogenic activity.
Variation in Composition:


1. Miracle Mix


2. Cermet ionomer
GIC are weak in tensile strength. so incorporation of


metal alloy particles into the powder can reinforce the


cement one such product commercially available is         miracle


mix.
Here alloy powder particles and glass ionomer powder
particles are mixed by dentist or   assistant before mixing
with liquid.

 There is improvement in strength.

 It does not take up a good surface finish and

   cannot be burnished.

 Abrasive resistance is less than conventional GIC.
Hence in an attempt to improve these properties cermet

ionomer cements were introduced, in this cement metal

alloy particles like Ag and Au are sintered to the powder

particles which have to be mixed with polyacrylic acid to get

a smooth paste.
These get a good surface finish and can be burnished and

have good abrasive resistance.


But cannot be compared with composites and amalgam.
INDICATIONS:

1.Can be used as a luting agent

2. Can be used for restorations

Restoration of cervical abrasions and erosions without
cavity preparation.

Restoration of class III carious lesions

Restoration of class V carious lesions
3. Pit and fissure sealants

4. Thermal insulating base

5. As cavity liner wherein cariostatic action is required

6. Core building material

7. Tunnel preparation

8. Sandwich technique
CONTRAINDICATIONS
It is a brittle material with low tensile strength and
esthetically not as good as composites therefore cannot be
used in following situations.

-      Class II cavity

-      Class IV cavity

-      Fractured incisal edge

-      Lost cusps

-      Restorations where esthetic is a prime consideration
MANIPULATION AND CLINICAL PROCEDURE:


1. Select the shade


2. Prepare the cavity required


   If remaining dentine is less than 0.5mm provide

   Ca hydroxide lining.
3.    Isolate the tooth from saliva

4.    Apply surface conditioner which will improve
adhesion

5.    Wash and gently dry the cavity without dehydrating
            dentine

6.    Reisolate and dry gently

7.    Dispense cement on a glass slab or a mixing pad and
mix thoroughly for 30 sec with agate spatula using   folding
method.

8.    Convey the material to the cavity
9.     Place matrix if required matrix can be cellophane or
       mylar strip. Allow cement to set

10.     Remove the matrix and remove the excess by using
       sharp surgical blade or knife and before it comes in
       contact with moisture a protective barrier is applied
       either with cavity varnish, petroleum jelly

Final polishing is postponed for 24hours but however modern
GIC’s can be finished and polished immediately after their
restorations.
Matrices in operative Dentistry
• Definition

• Objective

• ideal requirements

• classification

• Indications of matrices
Definition:


“A   properly shaped piece of metal or non metal that

supports and gives form to the restoration during its

insertion and hardening”
Objectives:

1. To provide temporary wall of resistance during insertion
   and hardening of the material.

2. To displace or retract gingiva and rubber dam

3. To achieve dryness and non-contamination of operating
   field.

4. To maintain shape of the restoration till it sets

5. To resist and compensate for dimensional changes that
   can occur during setting.
6. To maintain natural contact and contours


7. To promote health of inter dental gingiva by preventing


             overhanging restorations.
Ideal Requirements:

1. Should replace the missing wall temporarily

2. Should be rigid, flexible

3. Should have good stability

4. Should be easily applied and removed

5. Should be less cumbersome

6. Should be more comfortable for the patient

7. Should be reusable, sterilisable
8. Inexpensive

9. Should not react or adhere to the restoration material

10. Should be small and handy so that access and visibility

   is not affected.

11. Matrix band should extend about 1mm over marginal

      ridge.
CLASSIFICATION:


I Based on area of restoration


a) Anterior – Cl III, Cl IV


b) Posterior – extended Cl I and Cl II
II Based on material used.

•   Metallic – ex: stainless steel, copper and brass

•   Non metallic ex: Celluloid and polyester


    available as strips, open faced crowns (semicircular shape),

    crown forms (surrounds full tooth)
III Based on method of retention

a) Without mechanical retainers

b) With mechanical retainers

Ex:

A] Black’s matrix and copper band supported by impression

   compounds

B] Toffelmire, Ivory no. 1,8, Sequiland
IV Gilmore’s classification:

a) Custom made

   Prepared by dentist or assistant suitable size matrix is cut
   and impression compound placed in the place of wedge.

b) Mechanical

   Toffelmire, sequiland, ivory no. 1 and 8

c) Miscellaneous

   T-Band, soldered band, copper band, orthodontic band,
   seamless band, blacks matrix.
V Patented (Branded) and Non patented
INDIVIDUAL MATRICES
Ivory No. 1

The band encircles one of posterior proximal surfaces therefore
indicated in unilateral Class II cavities.

Band is attached to the retainer through wedge shaped
projections which engage the tooth thru the embrasures of
unprepared surface.
Ivory No. 8:

Band encircles entire crown therefore indicated for bilateral

class II cavities,

Extended Class I and also for unilateral

Class II in which adjacent tooth is missing.
Tofflemire:

Also called as universal matrix

designed by B.R.Toffelmire.

Best used when 3 surfaces of

posterior teeth have been prepared.
Advantages:

-        Convenience

-        Placement on tooth buccal and lingual surface but
         however lingual approach requires contra angle
design

-        Retainer can be easily separated from band without
         disturbing restoration.
Available in smaller sizes also so that it can be


comfortably used in deciduous dentition.


Bands available in 2 thickness 0.05 and 0.038mm
Blacks Matrix:

A metallic band is cut so that it will extend only slightly over

buccal and lingual surfaces of the tooth beyond buccal and

lingual extremities of cavity preparation.

This band is tied to the tooth with either a floss or wire at the

corners of gingival ends of band.
Auto matrix:

Retainers not used, designed for any tooth in the arch

regardless of its dimension. Best used in large class II

cavity.

 Those replacing one or more cusps and

 In pin amalgam restorations.
Advantages:
-    Convenience
-    Improved visibility due to absence of retainer
-    Facial and lingual placement
-    Reduced time for application
-    Number of teeth can be restored in one visit
Disadvantages:
Expensive
WEDGES

Definition


Classification


Uses
Definition:


Material made up of either wood or synthetic material that is

used along with matrices during insertion and hardening of

plastic restoration material.
 It is pointed,

 Triangular in cross section

 Base of cone is towards interdental papilla.
Classification:

I Based on material used:

-      Wooden

-      Plastic

II Based on availability

-      Preformed

-      Custom made – prepared by dentist / assistant
III Based on surface treatment:

-     Medicated – coated with astringents

-     Non – medicated


IV Based on material used

-     Natural

-     Synthetic
USES:

-       Used along with matrix during insertion and

hardening of restoration material.

-       It helps in close adaptability of matrix band to the

        tooth thereby preventing restorative material getting

        accumulated over the inter dental papilla which is

        called overhang of restoration thereby preserving

        health of periodontium.
-   To immobilize matrix band

-   To cause separation

-   To retract gingiva and rubber dam

-   To arrest bleeding temporarily
SEPERATORS:

-   Tooth movement

-   Objectives of separation

-   Principles of separation

-   Methods of separation
TOOTH MOVEMENT:


  Act of separating / involved teeth from each other or


  bringing them closer to each other or changing their


  positions in one or more directions.
OBJECTIVES:

1. To move drifted, tilted and rotated teeth to their

   physiologically indicated position to maintain natural

   contacts and contours.

2. To close the space between the teeth which is not closed by

   restorative methods.
3. To move the teeth in order to improve the health of
     periodontium.
4. To move the teeth apically (intrusion) and to move the teeth
     incisally (occlusally) called extrusion to make them
     restorable.

5. In order to expose the proximal surface to polish proximal
     restorations.

6.    To change the position of teeth from non-functional
     position to a functional position.
7. To detect proximal caries which is not detected by

   conventional methods.


8. For easy placement of matrix band


9. To remove foreign bodies collected between teeth which

   is not removed by floss, brush or explorer.
Principles:


1. Wedge principle


2. Traction principle
1. Wedge principle:

      Separation is achieved by placing pointed wedge shaped
      device between the teeth and slowly inducing pressure.

      Ex: Elliot’s separator, Wedges.
2. Traction principle:

It is achieved by a mechanical device which engages
proximal surface of teeth to be separated by holding arms
and then separation is achieved.

Ex: Non interfering true separator, Ferrior double bow
separator.
Methods of separation:



Rapid / Immediate Separation



Slow / Delayed Separation
Advantages of Rapid Separation:

Procedures is quick and stable

Disadvantages:

Chance of rupturing Periodontal Ligament fibers and it
will cause pain or soreness.

Examples:

Wedge, Ivory Separator, Elliot’s separator, Non interfering
true separator, Ferrior double bow separator.
Delayed Separation:

Advantages:

1. Less chances of tearing Periodontal ligament fibers

   and doesn't cause much pain.

2. No mechanical device required.

3. Separators can be left in place for weeks together.
Disadvantages:

Procedure is time consuming and is not stable.

Examples:

         Brass wire/ligature wire, heavy rubber dam material,

rubber     elastics,   oversized   temporaries.   Orthodontic

appliances.
MANAGEMENT OF
DEEP CARIOUS
LESIONS
Zones of dentinal caries


Effects of caries on pulp dentin organ


Diagnosis of deep carious lesions


Prognosis based on pulp exposure

Treatment.
Zones of Dentinal Caries:
1. Decayed zone
2. Septic zone
3. Dimineralized zone
4. Transparent zone – zone of dentinal sclerosis
5. Opaque zone




                   Zones of decay in     Zones of decay in
                   acute decay.          chronic decay.
Decayed zone:
Characterized by –
     Complete absence of mineral structure
     Organic matrix is completely decomposed
     Collagen fibres are lost and if they are present they
      have lost their cross striations and internal links
      Significantly invaded by microorganisms and
plaque deposits.
Septic zone

-     Called so because here you find highest population
      of microorganisms, even though dentine is
demineralized its      frame work structure can be
appreciated.

-      Collagen fibers may have normal cross links but
      internal links are lost.
-       Dentinal tubules are widened and cavitated.

-        Remaining mineral structure are deformed and

scattered irregularly.

-       Color may range from light yellow to dark reddish

brown
Dimineralized Zone:

-    Important diagnostically and therapeutically

-    Dentinal matrix intact

-    Collagen fibers normal

-    Dentinal tubules normal dimensions

-    Repair is taking place in the form of re-mineralization
Transparent Zone:
-     Also called zone of dentinal sclerosis.
-     Looks transparent in ground section but radio opaque
      in radiographs.
-     Here undisturbed repair mechanism is taking place.
-     We can find few microorganisms.
-     Slightly discoloured and very hard when compared to
normal dentine.
Opaque Zone:

It is characterized by intratubular fatty degeneration with

lipid deposits being precipitated from fatty degeneration of

the peripheral odontoblastic processes.
The maximum resistance to pulpal penetration occurs with

the arrival of the transparent and demineralized zone.

However, if the septic zone penetrates the pulp chamber, the

P-D organ will be unable to offer any resistance, and will

suffer complete collapse.
Caries can produce 3 types of irritation to underlying

pulp.


Biological – from microorganisms and their metabolites


Chemical – Acids released


Physico– Mechanical – due to reduced effective depth of pulp

dentine organ.
Severity of these irritation depends on

-     Type of Decay

-     Duration of Decay

-     Depth of Involvement

-     Number and pathogenecity of microorganisms

-     Tooth resistance – depends on thickness of remaining
      dentine, permeability and Ca++, F+ content.
Diagnosis and Prognosis of Deep Caries Lesions

1. Pain

2. Radiographs

      Indicate

      a.     The proximity of carious lesions to pulp
            chamber and root canal system

      b.     Any pulpal changes in the form of intra
            pulpal and peripulpal calcification

      c.     The thickening of periodontal ligament with an
                   intact lamina dura etc.
3. Pulp testing

       a. Thermal

       b. Electric pulp testing

4. Direct pulp exposure

5. Percussion

6. Type of dentine
Treatment:

               Direct

Pulp capping

               Indirect
Indirect pulp capping


Clinical Procedure


Decayed and infected zones and the external part of decalcified

zone are excavated using a spoon excavator.
All surrounding walls should be cleared of soft tooth

structure and debris to improve the stability of temporary

restoration.

       Suitable capping material either calcium hydroxide or

ZnO liner is placed over the remaining dentine at the deepest

portion.
Then the cavity is sealed with either modified ZnOE Type III

or polycarboxylate cement or sometimes amalgam can be

used.
A radiograph is taken

Patient is recalled after 4-6wks if it is Calcium hydroxide and

6-8 wks if it is ZnO.

When the patient comes back a fresh radiograph is taken and

diagnostic information regarding pain is collected and

compared with pre treatment records.
If signs and symptoms and radiograph findings indicates no

degeneration in the pulp the pulp capping procedure is

considered as a clinical success and we can plan for

permanent restoration.


If repair has not taken place it is better to go in for RCT.
Direct pulp Capping

The tooth can be considered a candidate for DPC

a. There are no signs and symptoms of degeneration in PD
   organ.

b. The exposure has small diameter relative to the pulp size

c. There is no hemorrhage from the exposure site, if there is
   then blood should immediately coagulate in the form of
   small button.

d. Dentine at periphery should be sound.
TREATMENT


All the procedures are same except few things.


1. The tooth to be operated should be isolated from saliva

   application of rubber dam is mandatory.
2. Cavity floor and exposed site should be gently washed and

   irrigated with sterile water or saline solution.


3. Drying should be done with cotton pellet but never with

   air from 3 way syringe patient is called after 6-8wks if it is

   Ca OH and 8-9wks if it is ZnO.
Composite Resins:

Definition

Composition

Classification

Polymerization mechanisms

Advantages and Disadvantages

Indications and Contraindications

Clinical procedures for Placement
Definition:

It is a compound with two or more distinctly different materials

the props of which are either superior or intermediate to those of

individual constituents.

Examples:

Natural: Tooth, Enamel and Dentine
Composition:

Organic matrix              Major constituents

Inorganic fillers

Coupling agent

Activator or initiator

Inhibritor – Hydroquinone

Colour pigments

Radiopaque fillers – Barium, Strontium, Zirconium
Commonly used matrix:
Are monomers that are aromatic diacrylics examples:
BISGMA – Biphenol Glycidyl dimethacrylate
UEDMA – Urethene Dimethacrylate
TEGDMA – Tri ethylene Glycol Dimethacrylate
Inorganic Fillers are manufactured by grinding glass or quartz to
produce particles ranging from 0.1-100um. Silica particles small
as 0.04um called as micro fillers can also be produced by option
process incorporation of filler particles into the resin matrix will
significantly improve physical and therm expansion water
sorption polym. Shrinkage ___ reduced whereas compressive,
tensile it and modulus of elasticity are increased.
Coupling agents help in binding filler particle to the resin
matrix. This not only improves mechanical properties but also
provides hydrolytic elasticity i.e it presents water penetrating at
matrix filler interface.
Commonly used: Organosilanes
Class
I Based on filler particle size
Conventional – 8-12um
Small particle - 1-5um
Micro filled – 0.04-0.4um
Hybrid          - 1um
II Based on polymerization mechanical
Chemically (or self activated)
Light activated
III Based on area of restorations
Anterior
Posterior
Polymerization mechanisms
Chemically
Available as 2 paste systems one or contains benz perox initiator
and the other contains tent amine activator.
When thus 2 or brought in contact free radicals are released and
polymerization begins.
Light:
Available as single paste system loaded in a syringe. Has a photo
   initiator mol and amine activator. When it is exposed to the
   light of correct wavelength photo initiator gets excited reacts
   with activator, free radicals are released and polymerization
   starts                      has also range between 400-500nm.
   Visible light of the spectrum is used to cure the composites. It
   is produced by a            hallogen bulbwhich is delivered to
   the required area by a fibre optic disadvatgaes of using U.V
   light.
1. Limited depth of curing
2. Polymerization shrinkage
3. Occlar hazards
Indications and Contraindications:

1. From Class I to Class IV cavities except high stress bearing
   areas like extensive Class II and extended Class I’s

2. Class V cavities in which control of saliva can be achieved.

3. In restoration of developmental defects like enamel
   hypoplasia, densein dente microdontia, malpositioned teeth

4. Non carious lesions like cervical abrasions erosions.

5. Treatment of fracture incisal edge

6. Splinting of luxated teeth.
7. Closing diastema (less than 1mm)

8. Veneering of discoloured teeth.

9. Veneering of metallic restorations

10. Core buildings

11. Composite Inlays

12. Repair of old composite restorations
Contraindications:

1. High stress bearing areas like ext class I class V cusp
   heights and redges

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96812770 cavity-liners-and-bases

  • 1.
  • 2. VARNISH  Composition  Manipulation  Properties  Uses
  • 3. Definition: It is a natural gum like copal resin or synthetic resin dissolved in organic solvents such as ether, chloroform or alcohol
  • 4. Composition: Copal and nitrated cellulose are typical examples of natural gum and the solvents used to dissolve these materials can be ether, acetone benzene, ether acetate, ethyl alcohol, chloroform, amylacetate and medicaments such as chlorobutanol, thymol and eugenol are also added. Recently fluoride are included in its composition. Flouride varnishes are used to prevent/arrest decay on smooth surfaces in young
  • 5. Manipulation: On a patient, Cavity varnish is applied with the help of small cotton pellet with the help of wire or R.C Reamer or a brush applicator. Thin layers of varnish are applied on the floor, walls including cavosurface margins. Gentle stream of air can be used to remove the excess.Apply a second coat and the bottle should be tightly capped after use to minimize loss of solvent.
  • 6. Contraindication: - Composite – free monomer layer dissolves the varnish - Ca(OH)2/ ZOE beneficial affects are lost - Polycarboxylate – interferes with adhesion - GIC – blocks fluoride penetration.
  • 7. Properties: 1. It is not a physical or mechanical insulator, provides chemical barrier. 2. Thickness: 2-40µm 3. Always applied in 3 layers to be more effective
  • 8. Uses: 1. 1.Prevents marginal Leakage / Microleakage 2. Prevents penetration of acids from ZnP cement i.e prevents chemical penetration. 3. Prevents penetration of corrosion products from amalgam therefore prevents discoloration of tooth. 4. Decreases post operative sensitivity and pain. 5. It may be used as a surface coating over certain restorations to protect them from dehydration or from contact with oral fluids until they harden.eg.silicate andGI cements
  • 9. Liners: Definition: It is liquid in which CaOH and zinc oxide (occasionally)are suspended in a solution of natural or synthetic resins.
  • 10. Composition: 1. Ca(OH) / ZnO – Therapeutic agent 2. Ethyl alcohol – Solvent 3. Ethyl cellulose – Thickening agent 4. Barium sulfate – Radiopacifier 5. Fluorides – Anticariogenic
  • 11. Manipulation: Trade names:Dycal and Life It is available as 2 paste systems both of which contain Ca(OH) and one consists of accelerator
  • 12. Equal amounts of material from each tube is collected over a glass slab or mixing pad with help of PD probe both are mixed till homogeneous colour is got and with same instrument it is carried -
  • 13. - to deepest portion of the cavity and since it is fluid in consistency it readily flows or gets painted over the cavity over which the thermal insulating base or temporary restoration is provided.
  • 14. Properties: 1. Acts as a thin barrier between the restoration and the remaining dentine and protects the pulpal tissue from irritation caused by physical,mechanical,biological, or chemical agents . 2. Like cavity varnish it neither possesses mechanical properties nor provides thermal insulation.
  • 15. Uses: 1. As pulp capping agent due to its sealing ability. 2. As anticariogenic cement because it stimulates the production of secondary or reparative dentin. 3. Prevents post operative sensitivity or pain. 4. It is compatible with all types of restorative materials.
  • 16.
  • 17. BASES
  • 18. Bases : Chemical and Thermal, Mechanical Insulation Cements: General applications Classification Individual Cements - Composition - Manipulation - Properties - Uses
  • 19. General Applications: 1. Thermal and chemical insulation 2. Temporary restorations – Zn OE 3. Intermediate restorations – IRM 4. Permanent restorations – GIC 5. Temporary Luting – Type I ZOE 6. Permanent Luting – GIC, ZnP, Zn Poly Carb
  • 20. 7. Cementation of orthodontic appliances 8. As sedative dressing for the pulp of freshly prepared tooth 9. As pulp capping agents 10. Pit and fissure sealants – Composites, GIC 11. Core build-up 12. Root canal sealants Gutta-percha 13. Periodontal dressings
  • 21. Clinical Considerations: Clinical Judgements about the need for specific liners and bases are linked to the amount of remaining dentin thickness (RDT), considerations of adhesive materials, and the type of restorative material being used.
  • 22. In a shallow tooth excavation, which includes 1.5 to 2mm or more of RDT, there is no need for pulpal protection other than in terms of chemical protection. For an amalgam restoration, the preparation is coated with two thin coats of a varnish, or a dentin bonding system, and then restored.
  • 23. For a composite restoration, the preparation is treated with a bonding system (etched, primed, coated bonding agent) and then restored.
  • 24. In a moderately deep tooth excavation for amalgam that includes some extension of the preparation toward the pulp so that a region includes less – than – ideal dentin protection, it may be judicious to apply a liner only at that site using ZOE or calcium hydroxide.
  • 25. Either one may provide pulpal medication, but the effects will be different. ZOE cement will release minor quantities of eugenol to act as an obtundent to the pulp.
  • 26. How ever, in a composite tooth preparation, eugenol has the potential to inhibit polymerization of layers of bonding agent or composite in contact with it.
  • 27. Therefore calcium hydroxide is normally used, if a liner is indicated. If the RDT is very small or if pulp exposure is a potential problem, then calcium hydroxide is used to stimulate reparative dentin for any restorative material.
  • 28. Cements Used In operative Dentistry: Silicate Cement Zinc Phosphate Cements Zn Silicophosphate Cements Zn Polycarboxylate Cements Zinc Oxide Eugenol Cements Glass Ionomer Cements Resin Cements Calcium hydroxide cements
  • 29. Zinc Phosphate Cement: Available as Powder and Liquid Powder. Zn Oxide – 90% Mg Oxide – 8-9% SiO2, Bismuth trioxide, Barium oxide – traces Liquid. Phosphoric acid (85%) and water (33+ 5%)
  • 30. Chemistry of Setting: When the alkaline powder comes in contact with acidic liquid it partially dissolves in liquid. It is an exothermic reaction. The set cement consists of hydrated amorphous network of ZnP that surrounds partially dissolved ZnO2 particles.
  • 31. Manipulation: Properties: 1. Mixing time – 60-90secs 2. Setting time – 5-9mins 3. Compressive strength (24hrs) – 13000psi : 103.5Mpa 4. Tensile strength (24hrs) – 800psi 5.5Mpa
  • 32. 5. Film Thickness – 25-40µm 6. Solubility/Disintegration – 0.2% 7. Pulp response – Moderate / Severe 8. pH – 3Mins – 3.5 24hrs – 6.6 Because of pulp irritation, cannot be used deep carious lesions.
  • 33. Uses: Primary Uses 1. As luting agent for restorations and orthodontic appliances. Secondary Uses: 1. Thermal insulating agent 2. Intermediate restoration
  • 35. It is a combination of silicate and ZnP cement Properties fall between those of ZnP and silicate. pH: lower than of ZnP and has got degree of translucency. Anticariogenic property because of fluorides.
  • 36. Zinc Polycarboxylate: Composition: Available as powder and liquid Available as powder to be mixed with plain water Powder ZnO MgO Traces of other oxides
  • 38. Properties: 1. Working time : 3-6mins 2. Setting time 5.5mins 3. Mixing time: 30 to 60secs 4. Compressive strength (24hrs): 8000psi 5. Tensile strength: 900psi 6. Film thickness: 21µm 7. Pulp response: mild Binds chemically to tooth structure
  • 39. Uses: Primary Uses 1. Luting agent for cementation of restorations 2. Thermal insulating base Secondary uses cementation of orthodontic appliances and intermediate restorations
  • 40. Advantages over ZnP - Not irritant to pulp due to high mol. size - Binds chemically to tooth structure - Can be used safely in moderately deep cavities. No need to use cavity varnish.
  • 42. Type I : Temporary luting or cementation Type II: Permanent cementation ex: kalzinol Type III: Intermediate restoration, thermal insulating base, temporary restoration. Type IV: Cavity liners or subbase Examples: Type III: IRM Type IV: Dycal and life
  • 43. Basic Composition: As Powder and Liquid Powder: ZnO- Main ingredient – 70% White rosin – reduces brittleness of cement Zinc acetate – improves strength Zinc stearate – acts as plasticizer
  • 44. Liquid: Eugenol : 85% Sedative effect to pulp Olive Oil: 15%
  • 45. Modifications in basic composition Type II – Ethoxy benzoic acid/Resins are added increases the strength of the cement Type III- Resin reinforced, partially polymerized surface treated with propionic acid - Increases strength and abrasive resistance Type IV – 2 paste system. Active ingredient in both pastes is Ca OH.
  • 46. Examples: Type I: Tempbond / Neogenol / Freegenol II: Kalzinol III: IRM IV: Dycal Chemistry of Setting: ZnO + H2O Zn (OH)2 Zn hydroxide Zn (OH)2 +2HE ZnE2 + 2H2O Base Acid Zn – eugenolate salt
  • 48. Mixed on glass slab or mixing pad. Powder is dispensed and liquid is collected just prior to the mixing. Bulk of the powder is incorporated into the mixture and spatulated with a stainless steel spatula till it becomes paste on creamy in consistency. Powder or cotton fibers can be added which will improve the retention of the cement in the cavity.
  • 49. Properties: Setting time : 4-10mins Compressive strength (after 24hrs): 4000psi Film thickness: 25um Solution and disintegration: 0.04% by wt Pulp response mild
  • 50. Uses: Primary Application 1. Temporary restoration 2. Intermediate 3. Temporary luting 4. Permanent 5. Thermal insulating base 6. Pulp capping agent
  • 51. Secondary application • As root canal sealants and in RC restorations • Periodontal dressings
  • 53. Available as powder or 2 paste cements It is available as dry powder or two paste system. Mixed either with distilled water or saline to form a paste as it can also be suspended in chloroform and conveyed to the required area with the help of a syringe
  • 54. When available as 2 paste cements. One paste – monomer of methyl cellulose as initiator and CaOH Other paste: Calcium hydroxide and catalyst, when they are brought in contact methyl cellulose undergoes polymerization and porous matrix is formed pH:11
  • 55. Mechanism of action: Uses: 1. Cavity liner 2. Pulp capping agents
  • 56. GLASS IONOMER CEMENT
  • 57. Invention,  Composition,  Classification,  Setting Reaction,  Properties,  Variations in basic composition,  Indications,  Contraindications,  Manipulation and clinical procedures for placement.
  • 58. Invented in 1969 but first reported by Wilson & Kent 1971. It was invented in a creative response to inadequate materials particularly from deficiencies of silicates.
  • 59. 1. It adheres to tooth structure 2. Translucent 3. Releases fluorides 4.Has also all favorable properties 5. Biocompatible and Bioactive
  • 61. POWDER Consists of calcium aluminosilicate glass containing fluoride. SiO2 - 30% Al2O3 - 19.9% Al F3 - 2.6% CaF2 - 34.5% NaF - 2.6% AlPO4 - 10% Radioopacifiers like Strontium, Barium and Lanthanum
  • 62. Fluoride is one of the main components.  It lowers fusion temperature,  Improves strength provides translucency and therapeutic value  and improves working characteristics of the cement
  • 63. Powder particles are obtained by heating all these particles between 11000 C - 16000 C
  • 64. LIQUID Polyacrylic acid which is a polyacrylite which is a polymer of carbonic acid. Some amount of maleic acid and itaconic acid is added. Sometimes poly acrylic acid is blended dry with the powder so that it is mixed with either water or tartaric acid.
  • 66. Type I: As luting agent Type II: As restorative agent Type III: Liners and bases and pit and fissure sealants Type II: Conventional Reinforced – Metal modified Glass Ionomers
  • 68. When the powder comes in contact with the liquid to form a paste, surface of powder particles are attacked by liquid. Ca, Al, Na, F ions are released into the aqueous medium.
  • 69. Calcium polysalts form 1st eventually followed by a Al poly salts which form cross linking's. They undergo hydration to form gel matrix and there are untreated powder particles surrounded by silica gel. Set cement consists of agglomeration of powder particles surrounded by silica gel in an amorphous matrix of hydrated Ca and Al polysalts.
  • 71. 1. Translucency – mainly due to fluoride 2. Adhesion 3. Biocompatibility
  • 72. 1. Glass Ionomer cement is an esthetic filling material. Its translucency arises because of powder particles which is a clear glass. But it takes 24hrs to achieve, mature and develop full translucency. Only after this period one can appreciate the colour match with the adjacent tooth structure. Color of GIC remains unaffected by oral fluids unlike composite resins which tends to discolor.
  • 73. 2. It enables the conservative approach for the restoration because providing mechanical undercuts to retain the material is not necessary. This is of particular importance while restoring cervical abrasions and erosions and there will be a tight marginal seal. Hence less percolation of bacteria around cavity margins and walls
  • 74. Type of Adhesion Chemical bond and can be improved using conditioners like polyacrylic acid and citric acid.
  • 76. GIC are therapeutic materials. Their adhesion to the tooth structure ensures a marginal seal thus eliminating secondary caries by sustained release of fluorides. These materials are not only biocompatible and bioactive because they promote bone growth can be used as bone cements after endodontic surgery.
  • 77. The adverse effects on vital tissues are minimal. Hence a protective barrier is rarely required 4. Setting time 4-5mins 5. Compressive strength (24hrs): 20000 psi 6. Tensile strength: 400 psi 7. Hardness: 60KHN 8. Solubility and disintegration 0.4% by wt 9. Pulp response – Mild 10. Anticariogenic activity.
  • 78. Variation in Composition: 1. Miracle Mix 2. Cermet ionomer
  • 79. GIC are weak in tensile strength. so incorporation of metal alloy particles into the powder can reinforce the cement one such product commercially available is miracle mix.
  • 80. Here alloy powder particles and glass ionomer powder particles are mixed by dentist or assistant before mixing with liquid.  There is improvement in strength.  It does not take up a good surface finish and cannot be burnished.  Abrasive resistance is less than conventional GIC.
  • 81. Hence in an attempt to improve these properties cermet ionomer cements were introduced, in this cement metal alloy particles like Ag and Au are sintered to the powder particles which have to be mixed with polyacrylic acid to get a smooth paste.
  • 82. These get a good surface finish and can be burnished and have good abrasive resistance. But cannot be compared with composites and amalgam.
  • 83. INDICATIONS: 1.Can be used as a luting agent 2. Can be used for restorations Restoration of cervical abrasions and erosions without cavity preparation. Restoration of class III carious lesions Restoration of class V carious lesions
  • 84. 3. Pit and fissure sealants 4. Thermal insulating base 5. As cavity liner wherein cariostatic action is required 6. Core building material 7. Tunnel preparation 8. Sandwich technique
  • 86. It is a brittle material with low tensile strength and esthetically not as good as composites therefore cannot be used in following situations. - Class II cavity - Class IV cavity - Fractured incisal edge - Lost cusps - Restorations where esthetic is a prime consideration
  • 87. MANIPULATION AND CLINICAL PROCEDURE: 1. Select the shade 2. Prepare the cavity required If remaining dentine is less than 0.5mm provide Ca hydroxide lining.
  • 88. 3. Isolate the tooth from saliva 4. Apply surface conditioner which will improve adhesion 5. Wash and gently dry the cavity without dehydrating dentine 6. Reisolate and dry gently 7. Dispense cement on a glass slab or a mixing pad and mix thoroughly for 30 sec with agate spatula using folding method. 8. Convey the material to the cavity
  • 89. 9. Place matrix if required matrix can be cellophane or mylar strip. Allow cement to set 10. Remove the matrix and remove the excess by using sharp surgical blade or knife and before it comes in contact with moisture a protective barrier is applied either with cavity varnish, petroleum jelly Final polishing is postponed for 24hours but however modern GIC’s can be finished and polished immediately after their restorations.
  • 90.
  • 92. • Definition • Objective • ideal requirements • classification • Indications of matrices
  • 93. Definition: “A properly shaped piece of metal or non metal that supports and gives form to the restoration during its insertion and hardening”
  • 94. Objectives: 1. To provide temporary wall of resistance during insertion and hardening of the material. 2. To displace or retract gingiva and rubber dam 3. To achieve dryness and non-contamination of operating field. 4. To maintain shape of the restoration till it sets 5. To resist and compensate for dimensional changes that can occur during setting.
  • 95. 6. To maintain natural contact and contours 7. To promote health of inter dental gingiva by preventing overhanging restorations.
  • 96. Ideal Requirements: 1. Should replace the missing wall temporarily 2. Should be rigid, flexible 3. Should have good stability 4. Should be easily applied and removed 5. Should be less cumbersome 6. Should be more comfortable for the patient 7. Should be reusable, sterilisable
  • 97. 8. Inexpensive 9. Should not react or adhere to the restoration material 10. Should be small and handy so that access and visibility is not affected. 11. Matrix band should extend about 1mm over marginal ridge.
  • 98. CLASSIFICATION: I Based on area of restoration a) Anterior – Cl III, Cl IV b) Posterior – extended Cl I and Cl II
  • 99. II Based on material used. • Metallic – ex: stainless steel, copper and brass • Non metallic ex: Celluloid and polyester available as strips, open faced crowns (semicircular shape), crown forms (surrounds full tooth)
  • 100. III Based on method of retention a) Without mechanical retainers b) With mechanical retainers Ex: A] Black’s matrix and copper band supported by impression compounds B] Toffelmire, Ivory no. 1,8, Sequiland
  • 101. IV Gilmore’s classification: a) Custom made Prepared by dentist or assistant suitable size matrix is cut and impression compound placed in the place of wedge. b) Mechanical Toffelmire, sequiland, ivory no. 1 and 8 c) Miscellaneous T-Band, soldered band, copper band, orthodontic band, seamless band, blacks matrix.
  • 102. V Patented (Branded) and Non patented
  • 104. Ivory No. 1 The band encircles one of posterior proximal surfaces therefore indicated in unilateral Class II cavities. Band is attached to the retainer through wedge shaped projections which engage the tooth thru the embrasures of unprepared surface.
  • 105. Ivory No. 8: Band encircles entire crown therefore indicated for bilateral class II cavities, Extended Class I and also for unilateral Class II in which adjacent tooth is missing.
  • 106. Tofflemire: Also called as universal matrix designed by B.R.Toffelmire. Best used when 3 surfaces of posterior teeth have been prepared.
  • 107. Advantages: - Convenience - Placement on tooth buccal and lingual surface but however lingual approach requires contra angle design - Retainer can be easily separated from band without disturbing restoration.
  • 108. Available in smaller sizes also so that it can be comfortably used in deciduous dentition. Bands available in 2 thickness 0.05 and 0.038mm
  • 109. Blacks Matrix: A metallic band is cut so that it will extend only slightly over buccal and lingual surfaces of the tooth beyond buccal and lingual extremities of cavity preparation. This band is tied to the tooth with either a floss or wire at the corners of gingival ends of band.
  • 110. Auto matrix: Retainers not used, designed for any tooth in the arch regardless of its dimension. Best used in large class II cavity.  Those replacing one or more cusps and  In pin amalgam restorations.
  • 111. Advantages: - Convenience - Improved visibility due to absence of retainer - Facial and lingual placement - Reduced time for application - Number of teeth can be restored in one visit Disadvantages: Expensive
  • 113. Definition: Material made up of either wood or synthetic material that is used along with matrices during insertion and hardening of plastic restoration material.
  • 114.  It is pointed,  Triangular in cross section  Base of cone is towards interdental papilla.
  • 115. Classification: I Based on material used: - Wooden - Plastic II Based on availability - Preformed - Custom made – prepared by dentist / assistant
  • 116. III Based on surface treatment: - Medicated – coated with astringents - Non – medicated IV Based on material used - Natural - Synthetic
  • 117. USES: - Used along with matrix during insertion and hardening of restoration material. - It helps in close adaptability of matrix band to the tooth thereby preventing restorative material getting accumulated over the inter dental papilla which is called overhang of restoration thereby preserving health of periodontium.
  • 118. - To immobilize matrix band - To cause separation - To retract gingiva and rubber dam - To arrest bleeding temporarily
  • 119. SEPERATORS: - Tooth movement - Objectives of separation - Principles of separation - Methods of separation
  • 120. TOOTH MOVEMENT: Act of separating / involved teeth from each other or bringing them closer to each other or changing their positions in one or more directions.
  • 121. OBJECTIVES: 1. To move drifted, tilted and rotated teeth to their physiologically indicated position to maintain natural contacts and contours. 2. To close the space between the teeth which is not closed by restorative methods.
  • 122. 3. To move the teeth in order to improve the health of periodontium. 4. To move the teeth apically (intrusion) and to move the teeth incisally (occlusally) called extrusion to make them restorable. 5. In order to expose the proximal surface to polish proximal restorations. 6. To change the position of teeth from non-functional position to a functional position.
  • 123. 7. To detect proximal caries which is not detected by conventional methods. 8. For easy placement of matrix band 9. To remove foreign bodies collected between teeth which is not removed by floss, brush or explorer.
  • 124. Principles: 1. Wedge principle 2. Traction principle
  • 125. 1. Wedge principle: Separation is achieved by placing pointed wedge shaped device between the teeth and slowly inducing pressure. Ex: Elliot’s separator, Wedges.
  • 126. 2. Traction principle: It is achieved by a mechanical device which engages proximal surface of teeth to be separated by holding arms and then separation is achieved. Ex: Non interfering true separator, Ferrior double bow separator.
  • 127. Methods of separation: Rapid / Immediate Separation Slow / Delayed Separation
  • 128. Advantages of Rapid Separation: Procedures is quick and stable Disadvantages: Chance of rupturing Periodontal Ligament fibers and it will cause pain or soreness. Examples: Wedge, Ivory Separator, Elliot’s separator, Non interfering true separator, Ferrior double bow separator.
  • 129. Delayed Separation: Advantages: 1. Less chances of tearing Periodontal ligament fibers and doesn't cause much pain. 2. No mechanical device required. 3. Separators can be left in place for weeks together.
  • 130. Disadvantages: Procedure is time consuming and is not stable. Examples: Brass wire/ligature wire, heavy rubber dam material, rubber elastics, oversized temporaries. Orthodontic appliances.
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  • 139. Zones of dentinal caries Effects of caries on pulp dentin organ Diagnosis of deep carious lesions Prognosis based on pulp exposure Treatment.
  • 140. Zones of Dentinal Caries: 1. Decayed zone 2. Septic zone 3. Dimineralized zone 4. Transparent zone – zone of dentinal sclerosis 5. Opaque zone Zones of decay in Zones of decay in acute decay. chronic decay.
  • 141. Decayed zone: Characterized by –  Complete absence of mineral structure  Organic matrix is completely decomposed  Collagen fibres are lost and if they are present they have lost their cross striations and internal links  Significantly invaded by microorganisms and plaque deposits.
  • 142. Septic zone - Called so because here you find highest population of microorganisms, even though dentine is demineralized its frame work structure can be appreciated. - Collagen fibers may have normal cross links but internal links are lost.
  • 143. - Dentinal tubules are widened and cavitated. - Remaining mineral structure are deformed and scattered irregularly. - Color may range from light yellow to dark reddish brown
  • 144. Dimineralized Zone: - Important diagnostically and therapeutically - Dentinal matrix intact - Collagen fibers normal - Dentinal tubules normal dimensions - Repair is taking place in the form of re-mineralization
  • 145. Transparent Zone: - Also called zone of dentinal sclerosis. - Looks transparent in ground section but radio opaque in radiographs. - Here undisturbed repair mechanism is taking place. - We can find few microorganisms. - Slightly discoloured and very hard when compared to normal dentine.
  • 146. Opaque Zone: It is characterized by intratubular fatty degeneration with lipid deposits being precipitated from fatty degeneration of the peripheral odontoblastic processes.
  • 147. The maximum resistance to pulpal penetration occurs with the arrival of the transparent and demineralized zone. However, if the septic zone penetrates the pulp chamber, the P-D organ will be unable to offer any resistance, and will suffer complete collapse.
  • 148. Caries can produce 3 types of irritation to underlying pulp. Biological – from microorganisms and their metabolites Chemical – Acids released Physico– Mechanical – due to reduced effective depth of pulp dentine organ.
  • 149. Severity of these irritation depends on - Type of Decay - Duration of Decay - Depth of Involvement - Number and pathogenecity of microorganisms - Tooth resistance – depends on thickness of remaining dentine, permeability and Ca++, F+ content.
  • 150. Diagnosis and Prognosis of Deep Caries Lesions 1. Pain 2. Radiographs Indicate a. The proximity of carious lesions to pulp chamber and root canal system b. Any pulpal changes in the form of intra pulpal and peripulpal calcification c. The thickening of periodontal ligament with an intact lamina dura etc.
  • 151. 3. Pulp testing a. Thermal b. Electric pulp testing 4. Direct pulp exposure 5. Percussion 6. Type of dentine
  • 152. Treatment: Direct Pulp capping Indirect
  • 153. Indirect pulp capping Clinical Procedure Decayed and infected zones and the external part of decalcified zone are excavated using a spoon excavator.
  • 154. All surrounding walls should be cleared of soft tooth structure and debris to improve the stability of temporary restoration. Suitable capping material either calcium hydroxide or ZnO liner is placed over the remaining dentine at the deepest portion.
  • 155. Then the cavity is sealed with either modified ZnOE Type III or polycarboxylate cement or sometimes amalgam can be used.
  • 156. A radiograph is taken Patient is recalled after 4-6wks if it is Calcium hydroxide and 6-8 wks if it is ZnO. When the patient comes back a fresh radiograph is taken and diagnostic information regarding pain is collected and compared with pre treatment records.
  • 157. If signs and symptoms and radiograph findings indicates no degeneration in the pulp the pulp capping procedure is considered as a clinical success and we can plan for permanent restoration. If repair has not taken place it is better to go in for RCT.
  • 158. Direct pulp Capping The tooth can be considered a candidate for DPC a. There are no signs and symptoms of degeneration in PD organ. b. The exposure has small diameter relative to the pulp size c. There is no hemorrhage from the exposure site, if there is then blood should immediately coagulate in the form of small button. d. Dentine at periphery should be sound.
  • 159. TREATMENT All the procedures are same except few things. 1. The tooth to be operated should be isolated from saliva application of rubber dam is mandatory.
  • 160. 2. Cavity floor and exposed site should be gently washed and irrigated with sterile water or saline solution. 3. Drying should be done with cotton pellet but never with air from 3 way syringe patient is called after 6-8wks if it is Ca OH and 8-9wks if it is ZnO.
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  • 164. Composite Resins: Definition Composition Classification Polymerization mechanisms Advantages and Disadvantages Indications and Contraindications Clinical procedures for Placement
  • 165. Definition: It is a compound with two or more distinctly different materials the props of which are either superior or intermediate to those of individual constituents. Examples: Natural: Tooth, Enamel and Dentine
  • 166. Composition: Organic matrix Major constituents Inorganic fillers Coupling agent Activator or initiator Inhibritor – Hydroquinone Colour pigments Radiopaque fillers – Barium, Strontium, Zirconium
  • 167. Commonly used matrix: Are monomers that are aromatic diacrylics examples: BISGMA – Biphenol Glycidyl dimethacrylate UEDMA – Urethene Dimethacrylate TEGDMA – Tri ethylene Glycol Dimethacrylate Inorganic Fillers are manufactured by grinding glass or quartz to produce particles ranging from 0.1-100um. Silica particles small as 0.04um called as micro fillers can also be produced by option process incorporation of filler particles into the resin matrix will significantly improve physical and therm expansion water sorption polym. Shrinkage ___ reduced whereas compressive, tensile it and modulus of elasticity are increased.
  • 168. Coupling agents help in binding filler particle to the resin matrix. This not only improves mechanical properties but also provides hydrolytic elasticity i.e it presents water penetrating at matrix filler interface. Commonly used: Organosilanes Class I Based on filler particle size Conventional – 8-12um Small particle - 1-5um Micro filled – 0.04-0.4um Hybrid - 1um
  • 169. II Based on polymerization mechanical Chemically (or self activated) Light activated III Based on area of restorations Anterior Posterior Polymerization mechanisms Chemically Available as 2 paste systems one or contains benz perox initiator and the other contains tent amine activator. When thus 2 or brought in contact free radicals are released and polymerization begins.
  • 170. Light: Available as single paste system loaded in a syringe. Has a photo initiator mol and amine activator. When it is exposed to the light of correct wavelength photo initiator gets excited reacts with activator, free radicals are released and polymerization starts has also range between 400-500nm. Visible light of the spectrum is used to cure the composites. It is produced by a hallogen bulbwhich is delivered to the required area by a fibre optic disadvatgaes of using U.V light. 1. Limited depth of curing 2. Polymerization shrinkage 3. Occlar hazards
  • 171. Indications and Contraindications: 1. From Class I to Class IV cavities except high stress bearing areas like extensive Class II and extended Class I’s 2. Class V cavities in which control of saliva can be achieved. 3. In restoration of developmental defects like enamel hypoplasia, densein dente microdontia, malpositioned teeth 4. Non carious lesions like cervical abrasions erosions. 5. Treatment of fracture incisal edge 6. Splinting of luxated teeth.
  • 172. 7. Closing diastema (less than 1mm) 8. Veneering of discoloured teeth. 9. Veneering of metallic restorations 10. Core buildings 11. Composite Inlays 12. Repair of old composite restorations
  • 173. Contraindications: 1. High stress bearing areas like ext class I class V cusp heights and redges