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 dmix alloys Spherical alloys !athecut alloys Admixed alloys "ispersalloy #"ensply$ %aliant &h" Spherical alloy %aliant Megalloy
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 Sy(ralloy Lathe cut )ndiloy #shofu$ 3. Advantages and disadvantages of spherical and admixed amalgams. Spherical Admixed

*aster set )ncreased strength due to gCu particles +arlier initial strength Contacts easier to develop ,e-uires less condensation force Disadvantages Slower set .etter adaptation around pins /eeds more condensation force Crown preps at same appointments "ifficult around pins # fter 01 to 23 minutes$ . Advantages and disadvantages of spherical amalgams ,e-uire less mercury than lather-cut, (ecause they have smaller and spherical particles which has smaller surface area and less spaces (etween particles

 +asier to condense into areas of difficult access #around pins$ (ecause they provide less resistance to condensation pressures Hardens rapidly when compared to lathe cut alloys Smoother for carving, (urnishing and polishing Disadvantages!"ifficult to achieve tight proximal contacts (ecause of plashy nature ". Advantages and disadvantages of lathe cut alloys dvantages-+asier to achieve tight proximal contacts, (ecause they resist the forces of condensation well "isadvantages-difficult to condense around pins Harden more slowly-greater chances of marginal fracture during removal of matrix (and /ot as smooth for carving and (urnishing and polishing when compared to lathe-cut #. Advantages and disadvantages of Admixed alloys Have the advantage of spherical alloys (ut not their disadvantages Have the (ody of lathe cut when condensing +asily condensed with good adaptation High Cu admixed alloys are good and they do not corrode #first hour '32 and 42 hours 2'0$

 !ow copper alloys seals the margins fasters than high copper as corrosion products are responsi(le for self sealing $. What are the lining material availa%le under amalgam Calcium hydroxide Type-))) 5)C Type-)% Z6+ &rand names Calcium hydroxide '(C "ycal !ife #7err$

%itra (ond *u8i )) !C *u8i !inning Cement !C #5C$ 9nmodified-Tempac Cavitic #type )%$ &olymer modified-),M

)*+ ,ype (#type )))$ #Type-)))$

.. What are %asic cavity preparation steps/ (nitial '$ 6utline form and initial depth
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4$ &rimary resistance form 0$ &rimary retention form 2$ Convenience form 0inal 3$ ,emoval of any remaining infected dentin or old restorations: ;$ &ulp protection if indicated <$ Secondary resistance and retention forms =$ &rocedure for finishing external walls >$ *inal procedures li?e cleaning, inspecting and sealing (deal Dimensions of amalgam cavity preparations )deal depth ':3 to 4mm 1:4 to 1:3mm into dentin xial depth 1:4 to 1:=mm deep in dentin Clearance 1:3mm gingival from ad8acent tooth )sthmus width @th of the intercuspal distance #' to ':3 faciolingually$ xial dentinal depth around 1:3 to 1:;, ,oot 1:<3mm to 1:=mm Class-% xial depth 1:=mm gingival wall ':43mm occlusal wall and 1:3mm into dentin 1. 0unctions of matrix %ands and 2edges.
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$ 3atrix %ands ,igidity, rigid enough to withstand the forces while condensation: .$ +sta(lishment of proper anatomical contours C$ ,estoration of correct proximal contacts "$ &revent overhang margins +$&rovides good surface finish in proximal areas which is difficult to finish: *$ Wedges Separation of teeth #helps in contact (rea?ing$ 5$ &roper adaptation of matrix H$ &revent overhanging margins )$ &rotect gingival tissues and ru((er dam: 14. ,ypes of matrix %ands Tofflemire which is straight and contrangled Si-iueland which is wide and narrow utomatrix Compound supported copper (and T (and &allodent matrix system 6mni matrix 11. What matrix 2ill u select and 2hat 2ill u chec5/ 6niversal matrix #Tofflemire-straight and contrangled$ Advantages 9sed when three surfaces of posteriors are involved or tooth has (een prepared
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 &osition the (and and retainer are fairly sta(le ,etainer is easily separated from (and &recontoured (ands availa(le re-uire little or no modification after positioning around the tooth .ands are availa(le with varying occlusogingival measurements (vory 7o!1 matrix dvantages d8usta(le metal retainer &rovide the missing wall for the single proximal surface restoration %arying siAe (ands availa(le Automatrix .est indications %ery large class )) preparations especially those replacing one or more cusps Advantages- uto loc? loop can (e positioned either facial or lingual surface with e-ual ease Disadvantage .ands are not precontoured and development of physiological proximal contours is difficult 12. Different %et2een matrix and retainer/ ,2o types With retainer
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Tofflemire )vory no-' Si-iueland &allodent Without retainer utomatrix T-(and #used in children$ Compound supported copper (and Mylar strip

13. 8o2 do you use matrix/ &osition the (and !esser circumferences of matrix and slot of retainer is toward gingivally .urnishing (urnish pad first on resilient paper (and with egg shaped (urnisher to develop proper proximal contour &lacement (and should (e 'mm (eyond gingival margin +valuate with explorer the gingival margin of cavity for proper extension-(eyond cavity margin +valuate proximal proper level of contact and proximal contour (y placing mirror or (uccal and lingual side with reflected light )t should (e convex with contact and 8unction of occlusal 'B0rd and middle 'B0rd +valuate occlusally the location of contact (uccolingually and re(urnish if re-uired either in
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mouth or remove retainer and do it out side mouth with flat (ac? end of spoon excavator #-((9$ Some times matrix (and has to (e cut in order to avoid in8ury to the gingival attachment 1 . :esistance form; ho2 do u achieve/ *lat pulpal floor Minimal extension of external wall Strong ideal enamel margins Sufficient depth to provide ade-uate thic?ness of amalgam (ul? >1 degrees cavosurface margin 1". 9rimary resistance form; ho2 do you achieve/ *lat pulpal and gingival floor Minimal extension to allow strong cusp and ridge areas #isthmus width$ ,estricting occlusal outline from to area receiving minimal occlusal contact ,ounding sharp internal line angles to decrease stress concentration To provide minimum depth of ':3 to 4mm to provide (ul? of the restoration .ox shape .evel the gingival wall to get full length of enamel rods 1#. 8o2 do you achieve primary retention form/
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 6cclusal convergence of facial and lingual walls "ovetail design 6cclusal convergence of mesiofacial and mesiolingual wall of proximal (ox Secondary retention form can (e achieved (y &roximal loc?s &ins Slots malgam pins Coves 1$. (f recent filling is high 2hat does the patient complain and ho2 do you determine it Sensitivity to cold &ain on (iting Shiny spot if amalgam filling "etermined with articulating paper pical &eriodontitis 1.. What happens if occlusion is high or 2hat are the symptoms of high point/ &ain or sensitivity on (iting &atient feels discomfort *racture of amalgam #if its high point$ &atient may develop &ara functional ha(it &atient may get facial pain
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 "eviation of closure of mandi(le from normal position 11. 8o2 to chec5 if occlusion is high <amalgam filling=. s? the patient to close slightly and chec? visually the occlusal anatomy: Chec? occlusion Chec? visually occlusal anatomy s? the patient to (ite lightly, if amalgam filling there will (e a shiny spot Chec? with articulating paper Chec? with shim stoc? will not come out while pulling during light closure Chec? occlusion centric occlusion, lateral excursion and excursive movements

24. What happens if occlusion is not high %ut there is gross excess of amalgam/ &roximal overcountouring overhang margin &la-ue accumulation *ood lodgment 5ingival trauma ffects the periodontal health inflammation of surrounding soft tissues:

21. 8o2 2ill you remove excess amalgam/ :

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 Cith amalgam carver or (lade on proximal surface Cith proximal finishing stripes 5reen stone with pumice #remem(er there is no need for post (urnishing for high Cu amalgams$: 22. (nstructions to patient after filling 0or amalgam restorations-li-uid food for 4 hours: /o hard food chewing on that side at least for 42 hours Slight sensitivity may (e present )f any discomfort and sensitivity persisting more than two wee?s as? the patient to report to clinic for chec? up s? patient to come for polishing and finishing if indicated

23. (f you restore an amalgam in a %ruxer; 2on>t it 2ear a2ay/ .est material to use is gold To prevent wearing and to ta?e initial loading fast setting spherical amalgam is (etter to use )ncrease retention and resistance forms of the cavity preparation )dentify and remove the high points s? not to (ite or ta?e any thing till the amalgam sets /ight guard and occlusal splints should (e considered
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 Try to find out the etiology and treat the condition 2 .8o2 do u restore amalgam in %ruxer; 2ont it %rea5 a2ay/ High cu spherical amalgam is used as it has early setting strength #4;4 Mpa$ Try to avoid centric holding stop from your cavity preparation 9se of proper cavity design to have good (ul? of amalgam, so it resist the occlusal forces 5ood resistance form should (e o(tained void any high points after restoration 5ive occlusal splint advice patient no to (ite any hard things 2". What is the %est material for %ruxer/ Cast gold restoration is (est for (ruxer Type ) small lesions without stress (earing areas Type-)) inlay or onlay Type ))) crown and (ridge wor? Type )% ,&" frame wor?

2#. Do you %urnish amalgam %efore or after condensation; if so 2hy/

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 9recarve %urnishing )s a form of condensation &roduce denser amalgam at the margins of occlusal preparation restored with conventional amalgam alloys #heavy stro?es mesio-distally$ Marginal adapta(ility and faciolingually with large (urnisher )s a continuous process of condensation .etter marginal adapta(ility "enser amalgam at margin .rings up the excess mercury to margins 9ost carve %urnishing !ight ru((ing action )mprove smoothness and satiny appearance #not shiny$ "enser amalgam #conventional$ )s a via(le su(stitute for conventional polishing High copper no post carve (urnishing #it has no significant effect$

2$. When do you stop %urnishing/ 6n (urnishing you achieve a smooth satiny surface: t this time u stop (urnishing

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2.. 8o2 2ill you restore occlusion in amalgam restorationsD Chen occlusal surfaces are involved in the cavity preparation use articulating paper to register preoperatively the centric holding stops and excursive contacts so that these mar?ed areas can (e either excluded from the outline form or properly restored: &roper condensation, precarve (urnishing and carving 6vercarving should (e 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 Chec? occlusion visually and (y articulating paper lways chec? occlusal clearance or interference with articulating paper in centric occlusion, lateral excursion movement and protrusive movements 21. What is the purpose of condensation/ daptation of the amalgam to cavity walls +liminate void spaces that produce denser amalgam "ecrease mercury content in restoration The ideal condensation time #4'B4 to 0'B4 minutes and it may (e high for high copper amalgam$: 34. When is polishing of amalgam is done; and 2hat is the purpose of amalgam polishing/

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malgam polishing is done after 42 hours #as crystalliAation of amalgam is not complete$: *or high cu amalgams no need of finishing-less time for polishing, these are less suscepti(le to tarnish and corrosion 9urpose To complete the carving ,efine anatomy, contour and marginal integrity To get the smooth surface of the restoration for (ecoming self cleansing area To get tarnish resistance always use wet polishing with slow speed hand piece to minimiAe release of mercury vapor and heating of amalgam restoration )f mercury is (rought to surface it will appear cloudy: this will produce corrosion and loss of strength of amalgam and 6verheated amalgam may permanently damage pulp 31. 8o2 2ill u polish amalgam/ What speed you 2ill use to polish the amalgam +xplain retention form in this particular case *inish and polishing is usually done after 42 hours (ecause crystalliAation is not complete: *inishing and polishing achieves tarnish and corrosion free amalgam

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 Chec? the occlusion with articulating paper, if discrepancy is present correct with pointed white fused alumina stone or green car(orandum stone: )f scratches are left with this use of ru((er a(rasive point is indicated to remove these scratches )nitiate polishing procedure (y using a coarse, ru((er a(rasive point at low speed and air-water spray to produce an amalgam surface with a smooth, satiny appearance )f the amalgam surface does not exhi(it this appearance after only few seconds of polishing, and if surface is too rough, resurfacing with a finishing (ur is necessary, followed (y coarse ru((er a(rasive point to develop the satiny appearance: )t is important that ru((er 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 s an alternative to ru((er a(rasive point, final polishing can (e done using a ru((er cup with flour of pumice followed (y a high luster agent, such as precipitated chal? )nterproximal surface may (e smooth enough with matrix (and and should (e finished if accessi(le ,etention form-all steps of cavity preparation should (e followed lso depends on the type of restoration used 32. 8o2 do you do amalgam finishing/
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 Chec? the occlusion with articulating paper and evaluate the margins with explorer )f (oth have (e corrected then use white fused alumina stone or green car(orandum stone StoneEs long axis is held at right angle to margin Then re-evaluate the margin and occlusion 9se large round finishing (ur no 2B; to remove scratches #scratches are formed (y white and greenstone$ 9olishing 9se coarse ru((er a(rasive point )t will give smooth and satin appearance Here if you donEt get the appearance do the finishing and polishing again High polishing 9se medium and fine ru((er a(rasive point lternatively to ru((er a(rasive points use ru((er cup with flour of pumice followed (y precipitated chal?

33. 8o2 do you chec5 contact area after restorationD Ce usually chec? with dental floss #u hear clic? sound with tight contacts and if the dental floss frays #tear$, contacts are not smooth and there may (e overhangs:

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 %isually chec? for all em(rasures #occlusal, gingival, facial, lingual$ Site of contact point posteriors middle 'B0rd and anteriors incisal 'B0rd 8o2 to chec5 proximal over counters ? %isual 6verhangs Tactile sensation with explorers, radiographs, dental floss: 3 . 8o2 does gamma 2 phase interfere 2ith strength of amalgam SnHg phase is gamma 4 phase and is wea?est and least resistant to corrosion and so needs to (e eliminated: )n high Cu alloys tin has greater affinity to Cu and it forms tin-copper phase instead of tin-mercury phase: TinCopper phase is tarnish and corrosion resistance and is stronger than tin-mercury phase:

3" What is ditching. "itching is the deterioration of amalgam tooth interface on the occlusal surfaces as a result of wear, fracture or improper cavity preparation: 3# Which scale is used to measure ditching/
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 %isually +xplorer drooping into opening Shallow ditching less than 1:3mm polishing is enough #no replacement$ More than 1:3mm fissure sealant or composite replacement: 3$. What is amalgam creep/ Creep is time dependant deformation of amalgam under stress: s strength increases - Creep decreases: To minimiAe creep "ecrease mercury alloy ratio )ncrease condensation pressure 3. .Will you add freshly mixed amalgam if it is insufficient!@+S 31. 0inishing amalgam for spherical amalgam immediately ? @+S 4. Where areas contact areas located/ Maxillary and mandi(ular incisors the contact area are located in incisal 'B0rd and more facially Molars they are situated at 8unction (etween incisal 'B0rd and middle 'B0rd or in middle 'B0rd

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 Chen u go posteriorly contact points goes gingivally So increase occlusal em(rasures 1. 8o2 2ill u come to 5no2 the patient is suffering from 9arafunctional ha%its/ History of early morning facial pain &ain of masticatory muscles &atient spouse complaining of grinding sound at nights +arly morning headaches History of stress or depression History of sensitivity 6cclusal wear facets 5eneraliAed attrition .ro?en restorations 2. &ruxism!2hen u restore tooth in co/ *r relieve it a little %it to prevent fracture /o, you need to restore tooth in C6 and need to give splint otherwise it changes occlusion 3. (ndications; advantages and role of complex restorations in overall treatment plan. Also give long term complications of these restorations $ (ndications ': Chen large amount of tooth structure is missing

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4: Chen increased resistance and retention form are re-uired 0: Chen -uestiona(le &ulpal or &"! prognosis 2: )n case of acute and severe caries 3: *inal definitive restoration ;: *oundations #core$ Advantages ': &rotect pulp from oral cavity #oral fluid, (acteria and thermal stresses$ 4: Maintain occlusion 0: Control caries and pla-ue 2: Cost effective 3: &rovide anatomical contour ;: 7eeps gingival healthier <: Conservation of tooth structure =: Cost effective Disadvantages ': "entinal micro fractures #pin holes, pin placements$ 4: )ncreased micro lea?age #with varnish and not using amalgam (onding$ 0: &ulpal penetrations and perforations 2: Tooth anatomy #difficult to produce contacts, contours and anatomy$ Contraindications 4: +sthetic demands 0: 6cclusal discrepancy

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2: natomic and functional considerations #&ara functional ha(its$ . When and 2hy u decide to reduce cusp Chen the facial extension is 4B0rd from the primary groove toward the cusp tip, reduction of cusp is mandatory Chen extensive caries or previous restoration undermines cusp and (ecome wea?er ,eduction is done to increase resistance form in order to eliminate wea? cusp and to avoid cuspal fracture ". 3easurements of cusp capping. *or amalgam - 4mm functional cusps and ':3mm for nonfunctional cusps: *or porcelain 4mm functional cusps and ':3mm for nonfunctional cusps: *or metal ':3mm functional cusps and 'mm for nonfunctional cusps: Complex Amalgam :estorations *unctional Cusps for !ower Teeth - .uccal cusps *unctional Cusps for 9pper Teeth &alatal cusps

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 Cusp capping for amalgam restorations <page!sturdervant!$$4= *unctional cusps 4mm /on *unctional cusps ':3mm The occlusal contour of the reduced cusp should (e similar to the normal contour of the unreduced cusp ny sharp internal corners of the tooth preparation formed at the 8unction of prepared surfaces should (e rounded to reduce stress concentration in the amalgam and thus improve its resistance to fracture from occlusal forces Chen reducing only one of two facial or lingual cusps, the cusp reductions should (e extended 8ust past the facial or lingual groove, creating a vertical wall against the ad8acent unreduced cusp 2; When do you use pins/ )ndications of pins Cith few or no vertical walls Chen large amount of tooth structure missing Chen u need one more cusp capping Chen u need increased resistance and retention form *inal definitive restoration
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 Core (uild up $. 9ins in Amalgam :estorations and their guidelines in placing/ 'uidelines for placing pins The depth of the pin hole varies from ':0 to 4mm depending on the diameter of pins used: However the general guideline for pinhole depth is 4mm Self threading pins are most retentive pins, (ut the pulpal stress is maximum, when pin is inserted perpendicular to the pulp s the diameter of the pin increases the retention also increases, (ut potential effects on pulp may also increase due to more stresses induced The pin extension into dentin and amalgam greater than 4mm is unnecessary for pin retention and is contraindicated to preserve the strength of the dentin and the amalgam s a rule one pin per missing axial line angle There should (e at least 'mm of sound dentine around the circumference of the pin hole, this elicits minimal pulpal response The pin hole should (e positioned no closer than 1:3 to 'mm to the "+F or no closer than ' to ':3mm to the external surface of the tooth, whichever distance is greater #(efore pin Hole location carefully pro(e gingival crevice to determine if any a(normal contours exist that

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would predispose the tooth to the external perforation s a rule, the pinhole should (e parallel to the ad8acent external surface of the tooth Chenever three or more pinholes are placed, they should (e located at different vertical levels on the tooth if possi(le, this will reduce stresses resulting from pin placement in the same horiAontal plane of the tooth Spacing (etween pins, or the inter pin distance depends on the siAe of the pin used: The minimal pin distance is 0mm for the mani?in #1:2=mm$ and 3mm for the minim #1:;'mm$: Maximum inter pin distance results in lower levels of stress in dentin: Dangerous areas in pin placements *luted and furcal areas should (e avoided: Specifically external perforations may result from pinhole placement over following areas &rominent mesial concavity of the maxillary first premolar t the midlingual and midfacial (ifurcations of mandi(ular first and second molars t the midfacial, midmesial and middistal furcations of the maxillary first molars and second molars &ulpal penetration may result from pin placement at the mesiofacial corner of the

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maxillary first molar and the mandi(ular first molar Chen possi(le the location of pin holes on the distal surface of the mandi(ular molars and lingual surface of maxillary molars should (e avoided, (ecause o(taining the proper direction for preparing a pinhole in these locations is difficult (ecause of the a(rupt flaring of the roots 8ust apical to the cementoenamel 8unction: )f the pinhole is to (e placed parallel to the external surface of the tooth crown, penetration into the pulp is li?ely 9reparation of 9in 8ole /o 'B2th (ur is first used to prepare a pilot hole #dimple$ approximately one half the diameter of the (ur at desired pin location: This will prevent the crawling of pin drill "etermine angulation for twist drill: &lace drill in gingival crevice and position it flat against tooth /ow move it occlusally into position without changing angulation o(tained ,epeat the procedure and get correct angulation /ow prepare pinhole in one or two thrusts until depth-limiting portion of drill is reached Cith drill tip in its proper position and with the hand piece rotating at very low speed #011 to 311 rpm$, apply pressure to the drill, and prepare the pinhole

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 The drill tip should never stop rotating from insertion to removal from the pinhole to prevent the drill from (rea?ing while in the pinhole 9lacement of pins ll pin designs can (e inserted with an appropriate hand wrench conventional latch-type contra-angled hand piece also can (e used to insert any of the pins except the standard design #recommended for lin? plus and lin? series$ Cith 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 standard design pin is placed in the appropriate wrench and slowly threaded cloc?wise into the pinhole until a definite resistance is felt when the pin reaches the (ottom of the hole: The pin should then (e rotated one--uarter to one-half turn countercloc?wise to reduce the dentinal stress created (y the end of the pin pressing the dentin )f ru((er dam is not used, a gauAe throat shield must (e place in order to prevent accidental swallowing 6nce the pins are placed, evaluate their length: ny length of pin greater than 4mm should (e removed

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 To remove the excess length of pin, use a sharp 'B2th or G or ';>! (ur at high speed and oriented perpendicular to the pin: )f oriented in different direction, it may result in rotating the pin in cloc?wise: lso during removing pin, the pin may (e sta(iliAed with a small hemostat or cotton pliers /ow chec? for tightness of pin and now determine whether pins have to (e (end, so that they will (e within the contour of final restoration and to provide ade-uate (ul? of amalgam (etween the pin and the external surface of the final restoration &ins are not to (e (ent t ma?e them parallel or to increase their retentiveness However, occasionally pins are (end to condense amalgam occlusogingivally Chen pins re-uire (ending, a TMS (ending tool is used: The (ending tool should (e placed on the pin where the pin is to (e (ent, and with firm controlled pressure, the (ending tool should (e rotated until the desired amount of (end is achieved hand instrument such as condenser or spoon excavator should not (e used, as they cause dentinal craAing or fracture of dentin: also the operator have less control with a hand instrument Disadvantages or Complications 2ith 9ins "entinal micro fractures
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 "entinal craAing Microlea?age Strength of amalgam or composite could (e reduced &erforation of pulp &erforation into periodontal ligament and furcation areas *racture of pins .ro?en drills !oose pins and pinholes too large Tooth anatomy complicating the pin placement .. Can u %end pins in attempt to provide more retention/ &ins can not (e (end to increase retention or to ma?e them parallel &ins are (end to position them within the contour of restoration To provide ade-uate (ul? of amalgam To allow condensation of amalgam occlusogingivally &in (ends with TMS (ending tool, not with another instrument 1. 8o2 do you prepare pin holes/ fter ascertaining position of pinhole from external tooth surface ma?e starting pin hole with
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'B2th round (ur approximately one half the diameter of the (ur &urpose accurate placement of the twist drill and preventing the slipping of the drill when we are placing hole &revent crawling once it (egun to rotate "rill the pinholes with same siAe Twist drill in ultra slow hand piece #011 to 311 rpm$ using only one or 4thrusts other wise it (ecomes wider hole /ever use dull drill #change drill after 41 uses$

"4. With 2hat materials the pins are made of/ TMS pins are usually made up of titanium or stainless steel plated with gold "1. What are the different designs availa%le/ Standard, Two-in-one, Self shearing and !in? plus and !in? series The lin? series and lin? plus are recommended The Minuta, Min?in, and minim pins are availa(le in lin? series "2. What are the different siAes of pins availa%le and 2hat is commonly used and 2hy/

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 0our siAes of pins are availa%le 2ith corresponding color!coded drill ,3S ? 0or severely involved posterior teeth Mini?in pins 1:2=mm Minim pins 1:;'mm Minuta pins 1:1'3 inch Mini?in pins are generally used (ecause of less dentinal craAing and less perforations ,egular pins has highest dentinal craAing and perforations "3. What are different types of pins/ Cemented pins *riction-loc? pins Self-threaded pins #more retentive than all$ some of the Self-threaded pins are Thread mate system ColteneBChaledent Mahwah, /ew8ersy " . What should %e 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 horiAontal forces: Slots should (e convergent occlusally 1:3mm occlusally 1:;mm gingivally and 1:;mm deep
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 4-2mm length, minimum greater than 'mm Should (e away ':3mm away from external tooth surface Slot very close to pulp can cause pulpal inflammation Slot 9reparations Slot is a retention groove in dentin whose length is in a horiAontal plane: Slot retention may (e used in con8unction 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 horiAontal force as do longer slots The slot is placed in the gingival floor 1:3mm to 'mm axial of the "+F: The slot is 'mm or more depending on the distance (etween the vertical walls Slots are placed with 00G inverted cone (ur #or @th inverted cone (ur: The width of the slot at apex is around 1:3mm and at (ase is 1:;mm and the depth is around 1:;mm: The length of the slot can vary from ' to 4mm depending on the retention needed n alternative techni-ue is to prepare the slot initially with a no ';>! (ur, then ensure convergence (y refining it with a /o 00'B4 (ur

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 &in retention is used more fre-uently in preparations with few or no vertical walls: Slots are particularly indicated in short clinical crowns and in cusps that have (een reduced 4 to 0mm for amalgam Compared to pin placement slot re-uire more tooth structure removal (ut are less li?ely to create micro fractures and perforations with pin placements ,emem(er that the slot depth can (e of 1:3mm to 'mm in depth: The length can (e also 4mm to 2mm depending on the distance (etween the remaining vertical walls "". 9roximal loc5s; coves and amalgapins and 2hat are the uses/ *unctionH Counter the proximal displacement of restoration "epth -1:3mm in dentin !ength-if greater than 4mm vertical wall, it will terminate at axiolinguopulpal point angle "iminish depth occlusally-if less than 4mm axial wall, then proximal loc?s are extended occlusally to disappear midway (etween "+F and enamel margin &repared with 00'B4 or 'B2th round (ur or ';>! (ur 9roximal Loc5s <page!$4"=

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 &roximal retention loc?s are place in axiofacial and axiolingual line angles #(elieved to strengthen the isthmus of class )) restoration and are (elieved these loc?s are significantly (etter than axiogingival grooves in increasing the restorationEs fracture strength To prepare a retention loc?, /o ';>! (ur is used with air coolant and reduced speed to improve tactile feel and control: The retention loc? is always placed 1:4mm inside the "+F regardless the depth of the axial wall, which maintains the enamel support Some operators prefer @th (ur to cut the proximal loc?s: The rotating (ur is carried into the axiolinguogingival or axiofaciogingival point angle and then moved parallel to "+F to the depth of the diameter of the (ur: )t is then drawn occlusally along the axiolingual or axiofacial line angle, allowing the loc? to (ecome shallower and to terminate at the axiolinguopulpal or axiofaciopulpal point angle #or more occlusally if the line angles are less than 4mm in length$ Coves in amalgam restorations Coves are prepared in a horiAontal plane and loc?s are prepared in vertical plane .oth of them are prepared (efore placement of pinholes and inserting pins Amalgapins
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re circular cham(ers cut vertically into dentin to provide resistance and retention from for the restoration, these features are called amalgam inserts Studies (y Seng #depth ':2mm in diameter and depth$ and Shavell #depth of 0mm with no ''3; (ur$ have shown that the resistance to displacement provided (y amalgapins is similar to that provided (y pins )t has (een demonstrated that depth of ':3 to 4:1mm is ade-uate for amalgapins and that an amalgapin with a diameter of 1:= to 'mm is sufficient (urs used are no 00m or no 3; or no ''3< or no ''3; (y shavel$ "#. What are the causes of cuspal fracture/ )nade-uate cavity preparation )mproper restoration Heavily restored tooth &arafunctional ha(its .ruxism Malocclusion

"$. 8o2 do you diagnose incomplete cusp fracture/ +xclude other causes of pulpal and periodontal pain
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 &ain on (iting and while releasing Tooth slooth or orange wood stic? or cotton roll or ru((er dis? "uplicate the patient pain Transillumination "yes-stain tooth Magnifying loops )ndirect aid-ortho (and, and sealant is place if patient pains stops, diagnosis could (e made in restored tooth some times cusp may fly off while removing ".. Signs and Symptoms of C,S Symptoms +xperience cold sensitivity Sharp pain of short duration while chewing Signs Cold sensitivity on pulp test .iting test will (e positive Signs of &arafunctional ha(its 6cclusal wear facets +vidence of malocclusion Heavily filled tooth or large restorations

"1. Which tooth is more commonly effected in C,S and 2hy

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 !ower mandi(ular molar is most commonly affected (ecause there is some em(ryonic pro(lem during development #This may (e due to developmental wea?ness of the tooth:#incomplete fusion of areas of calcification$ )n specific mandi(ular second molars are affected (ecause this tooth is in the area of masticator muscle attachments, so ta?es the greater forces of mastication Mandi(ular second molars, followed (y mandi(ular first molars and maxillary premolars, are the most commonly affected teeth More prone to development of caries Sharp lingual cusp Heavily restored teeth #4. Does the crac5 in crac5 tooth syndrome visi%le/ Crac?s rarely show up on radiographs Mesial-distal crac?s can never (e seen .uccal-lingual crac?s will only appear if there is actual separation of the segments or the crac? happens to (e at exactly the same angle as the x-ray (eam Ta?ing periapicals from more than one angle and ta?ing (ite wings may increase the chance of catching a crac?-induced defect early in its development #1. 8o2 often do you see a fractured cusp in a practice ? once in a 2ee5

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#2. *%liBue ridge considerations &reservation 6f 6(li-ue ,idge Consider lways Try To &reserve 6(li-ue ,idge .e, )t &rovides Cross Splinting Support To The Tooth (nvolve o%liBue ridge Chen less than 1:3mm sound tooth structure (etween two cavities )f deep fissures and )f undermined #3. What is the %est material to restore %uccal cusp of 9remolar. $ )ndirect ceramic onlay .$ &*M onlay C$ &*M Crown or all ceramic crown "$ malgam with pin # . What is the thic5ness of the %ase ? 4.$"!2mm 3*D restoration distal cusp reduction 2ith pin retained amalgam. What 5ind of amalgam you are using 8igh Cu Admix alloy!Dispersalloy or -allian 9hD #". 3arginal :idge preservation. &remolars its ':;mm minimum Molars its 4mm minimum

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 8o2 2ould u achieve this ? divergence of wall distally or mesially rather than converging to prevent undermining of marginal ridge #';>! .9,$ ##. What is the function of dovetail/ )t gives increased retention )t prevents the mesiodistal displacement of restoration #$. What is the ideal 2idth of the proximal %ox/ 1:4 to 1:0 mm clearance from the ad8acent tooth 1:3mm clearance with gingival margin #.: 6pper premolar; only %uccal and lingual 2alls remaining 2hat material 2ill u use and 2hat treatment options you have/ malgam (uild up with pin or without pins Composite with pin or without pins 5old inlay or ceramic onlay &*M crown ll ceramic crown #1. What 2ould happen if there is no adeBuate thic5ness of amalgam covering the cusp/ Chances of fracture of restoration Chance of fracture of tooth
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 9 canEt get enough resistance malgam has low tensile strength, low edge strength, so enough (ul? of material is needed to withstand occlusal forces $4. Why 2ould u place slots 2ith grooves for retention instead of pins in an extensive cavity for amalgam/ dvantage of slot-slots can use with short clinical crowns )ncreased retention and resistance form (y (ul? of amalgam !ess chances of micro fracture !ess chances of microlea?age !ess chance of pulpal perforations )f placed within in 1:3mm of pulp wont produce pulpal inflammation !ess chances of creating internal stress on dentin

$1. What are the forces acting on the restoration/ 6cclusal forces - perpendicular to those forces of mastication that are directed in the long axis of the tooth 3asticatory forces !ong axis of tooth 6(li-uely directed forces !aterally directed forces

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 What are the forces affecting on the restoration <urvi= %ertical or o(li-ue forces 6cclusal forces Masticatory force in o(li-ue or vertical direction !ifting forces $2. Why have u done your minimal cavity preparation li5e this; ho2 did u 5no2 ho2 %ig to cut it/ Minimal extension of facial and lingual walls to conserve dentin supporting the cusps as well as facial and lingual ridges there(y maintaining as much strength of remaining tooth structure as possi(le so remaining tooth structure has resistance to fracture This resistance is against o(li-uely delivered forces, as well as those on toothEs 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 $3. Why 2hen 2e restore tooth; 2e have to follo2 contour of tooth and 2hat happens 2ith overcountour or undercountour/ )mproper em(rasure form-food will not deflect itself leading to food lodgment and periodontal pro(lems "ifficulty in using dental floss )mpinges on soft tissues )rritation to tongue
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 &la-ue and food lodgment due to improper deflective action $ . Why do you not prepare the cavity for erosion cavities/ 8o2 do you get retention form for restoration/ +rosion is a non-carious lesion /o caries excavation needed /ot a stress (earing area "epends on choice of restorative material *or example 5)C #chemical (onding$, composites#micromechanical (onding$ they do not need or re-uire extensive cavity preparation nd at this areas these materials do not need excessive thic?ness to withstand occlusal forces These material rely on adhesive systems for retention $". (f the patient comes complaining of sensitivity after amalgam placement 2hat 2ill %e the cause and ho2 to overcome it/ Two reasons for sensitivity after amalgam placement Sometimes due to high points Sometimes due to open dentinal tu(ules after cutting dentin 8ydrodynamic theory ? changes in the direct of fluid are perceived as pain (y mechno-receptor near the pulp Tactile, thermal or osmotic stimuli can induce changes in fluid flow and elicit pain receptor
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 ,reatment Correct the etiology ,emove the high points with large round diamond finishing (ur and then polish with ru((er cup with pumice .loc? dentinal tu(ules (efore restoration with dentin (onding agent "o not cut dentine overAealously in dry field Some times it could (e normal discomfort which could (e relieved in few days $#. What are the causes of dentinal hypersensitivity; and ho2 do u treat it/ +xposed dentinal tu(ules +rosion ttrition 5ingival recession Caries lesions The degree of sensitivity is influenced (y the num(er and siAe of the open tu(ules Treating the etiology is prime important *luorides &eriodontal treatment of gingival recession Sensitivity tooth pastes "entine (onding agents 9se of liner are (ases when even indicated
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 Correction of &arafunctional ha(its if present $$. What are the characteristics of inlays/ 6cclusal depth-':=mm &roximal (ox follows curvature of original tooth surface *ollow outline precise path of withdrawal xiogingival groove- 1:4mm deep 5ingival, proximal (evels 23 degrees, 1:=mm width Cidth of (ox 8ust pass contact area xial depth 'mm .uccal and lingual walls for retention &roximal clearance at gingival level from ad8acent tooth 1:;mm ,ound all sharp angles 5ood conservation of (uccal and lingual cusps $.. What is smear layer and 2hy it should %e removed/ )f the tooth structure is cut or polished during dental treatments, the tu(ules orifices (ecome occluded with de(ris called smear layer Smear layer consists of primarily of tooth de(ris (ut also contains pla-ue, pellicle and salines and possi(le (lood and saliva Smear layer occludes the dentinal tu(ules and forms a smear plugs Smear layer decreases the dentinal permea(ility (y =;I
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 "ecreased diffusion of (onding resin Smear layer loosely adherent to the (onding system $1. 8o2 2ould you follo2 up the case/ ,ecall visits Chec?ing for signs and symptoms clinically %itality tests ,adiographs Study models

.4. Causes of pain in cusp fracture is due to the flexion of cusp during function leads to pain .1. Would you ta5e radiograph %efore; during and after treatments/ ctually it depends on the treatment procedures ) do, for endodontics and any other surgical procedures and periodontics we may need to ta?e J-rays during and after treatments:

.2. What 2ould happen to tooth after trauma/ May (e asymptomatic for few days &ulpal necrosis, an?ylosis, resorption, impacted, May (e extruded, intruded or avulsion, !uxation or su(luxation Concussion
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.3. What 2ill u do to provide fixation; flexi%le and rigid splints; 2hy and for ho2 long/ *lexi(le splint-/iti ortho wire 1'2 gauge for avulsion and intrusion for one wee? Semi rigid /iti 1'; or 1'= gauge for root fracture, alveolar fracture and severe !uxation for 0-2wee?s *or sta(iliAation of tooth, decrease discomfort of patient and avoid occlusal interference .". What is the action of Ca<*8=2 2hen used as a pulp capping agent $ "irect pulp capping agent )t may stimulate the pulp to form secondary odonto(lasts, which in turn produce a dentin (ridge across the exposure site: .$ )ndirect &ulp capping agent )f the pulp is healthy, secondary odonto(lasts will differentiate and form a reparative dentin to further protect #thermal, chemical, mechanical protection$ C$ nti(acterial property - High &h of ''-'4 (actericidal: "$ Hard setting calcium hydroxide is "KC ! +$ Ca #6H$4 in methylcellulose (ase slow setting &ulpdent: .#. What is the difference %et2een setting and non setting calcium hydroxide and uses of each/

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 Hard setting is used in direct pulp capping procedure #dycal$ /on-setting #pulpdent$ is used as endodontic intracanal medicament ,oot fracture &erforation pexification .$. What is the action of calcium hydroxide 2hen it is placed close to the pulp ? direct pulp capping Direct 9ulp Capping calcium hydroxide dressing may stimulate the pulp to form secondary 6dono(lasts which can produce a layer of reparative dentin called dentin (ridge to seal the pulp form further insult and it also have (actericidal effects (ndications for direct pulp capping The exposure is small which is less than 1:3mm in diameter The tooth has (een asymptomatic showing no signs of &ulpitis The hemorrhage from the exposure site is easily controlled The exposure occurred in a clean, uncontaminated field #such as that provided (y a ru((er dam The invasion of pulp was relatively atraumatic with minimal physical irritation to the pulp tissue ... (ndirect pulp capping indications and procedure/
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 9sually all soft infected dentin must (e removed However if pulpal exposure is anticipated (y the complete excavation of all -uestiona(le dentin, indirect pulp capping indicated Thin layer of remaining carious dentin #affected dentin #hard$ is not excavated (ut is left intact )t is then covered with calcium hydroxide (ase and the excavated area is restored with temporary material &roximity of calcium hydroxide material to the pulpal tissue promotes reparative dentin formation Thus the -uestiona(le remaining dentinal area may remineraliAe and form a dentine (ridge in this area This re-hardening of -uestiona(le dentine area usually occurs in ;-=wee?s This procedure prevents fran? pulpal exposure and prevents potential adverse pulpal response to such as exposure

9ro%lems 2ith polycar%oxylate cement What instruction 2ould you give the patient sensitivity for one month <if not :C,=

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