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dove-tail isthmus
Reverse S
Evaluation of depth
From Fig. 3 and Fig 4, the height of the occlusal cavity is shown to be approximately 2.0mm, which satisfies the clinical requirement in step 1: occlusal preparation that depth of the occlusal preparation should 1.5 to 2.0mm to ensure adequate retention of amalgam restoration.
Evaluation of depth
Undercuts Fig. 6: Periodontal probe placed on gingival floor of mesial box reveals a depth of 3.0mm Fig. 7: After removal of unsupported enamel, periodontal probe shows the gingival floor is 3.0mm deep Fig. 8: Periodontal probe is place on the floor of the occlusal preparation to show it is 2.0mm deep
Note that in Fig. 7 and Fig. 8, the buccal and lingual walls of the mesial box as well as the walls of the occlusal preparation are slightly undercut, which are there to provide adequate retention factors for the amalgam restoration.
Fig. 9: An universal matrix band tightened around 36 using a matrix retainer, with wooden wedge
Fig. 10: Amalgam is inserted and packed into the prepared cavity
Procedure: A ball burnisher 155 is first used to adapt the restoration with the cavity walls. Then, a Hollenbach carver is used to carve the required cuspal features and grooves.
Procedure: After a wait of 24 hours, the amalgam is polished using a slow speed handpiece with an amalgam polishing kit. Tungsten-carbide burs are first used to reshape the cusps and define the grooves. Then, abrasive burs, from coarse to fine, are used to gradually reduce scratches. Finally, plastic burs are used to achieve the shiny brilliance. Sandpaper strips, coarse to fine, are used to polish the interproximal area.
Reflection:
Major problems in preparation: In order to protect the 35 from damage when creating the mesial box, a Tofflemire universal matrix was placed around it. This caused a visual impairment because the part of the matrix would obscure the mesial marginal ridge from direct view. To go around this, I had to use indirect vision with a mirror, combined with tactile sense of my bur to create the mesial box. This was difficult because water spray would quickly cover the mirror and I had to rely on mainly tactile sense. However, the difficulty reduces with practice as I found more adequate positions for the mirror with less water spray and my tactile sense improved. Adaptation of the matrix band to the tooth was rather difficult because even when tightened fully, the matrix band does not perfectly adapt to the mesial box of the cavity preparation such that all edges of box are touching the matrix band. Manually contouring a curve into the matrix band with a ball burnisher helped slightly, but still did not perfectly adapt the matrix band to the tooth. This resulted in excess amalgam at the interproximal region that had to be gradually removed by abrasive amalgam polishing strips. If grooves have been cut into the amalgam using tungsten-carbide burs, the plastic polishing burs may not be narrow enough to reach the entire depth of the groove, making this area difficult to polish completely. A periodonotal probe was therefore used to access and burnish the grooves.
Reflection:
Other points to note: During the creation of the mesial box in step 3, I switched to using a 256 bur because its larger diameter and longer length provides easier access when deepening the mesial extension to required depth. Using sandpaper abrasive strips to polish the amalgam at the interproximal area can be quite a tedious process, as it requires both manual dexterity and many back-and-forth repetitions of all the strips of different roughness. In fact, 3 different strips were used one was very coarse and is metallic, and is intended for polishing amalgam, while the other two were coarse and fine strips are intended for polishing composite resin. I chose to use the strips for composite resin as well because they are finer than the metallic strip for amalgam, and thus can give me a smoother finish. Conclusion: Overall, my class II preparation went fairly smoothly besides the two difficulties listed above. I believe with more practice, I can develop more speed and accuracy in performing similar cavity restorations in the future.
References
Kidd, E., Smith, B., Watson, T. (2003). Pickards Manual of Operative Dentistry (8th ed.). United States: Oxford University
Press. Summitt, J., Robbins, J., Schwartz, R. (2000). Fundamentals of Operative Dentistry (2nd ed.). Singapore: Quintessence Publishing.