alex complex amalgam
TRANSCRIPT
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Alex Chen
Complex amalgam preparation & restoration
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Complex Amalgam Preparation critical reuirements
Tooth: 46 MODBCritical
requirements of
this procedure
Rationale of requirements and supporting literature New skills accomplished in this excercise,
problems encountered, and breakthrough
moments
id m! product
meet these
requirements"
Class ##
Amalgam$
Reerse !
1" The reerse ! shape# is nee#e# #$e to the
%i#ening of the preparation of the proximal ox"
The ! shape allo%s the proximal ox to maintain'(o )aos$rfa)e an# opening $))al*ling$al )onta)ts
%hile presering so$n# tooth str$)t$re at the sametime +!)h%art, et al- .((6/"
." 0t sho$l# e note# that the reerse !2 is notal%a3s nee#e# an# sometimes een e)omes a !2
shape #epen#ing on the lo)ation of the )onta)t %iththe a#a)ent tooth"
To a)hiee a reerse !2 +%hen nee#e#/-
0 learne# to )$t the proximal ox part
an# o))l$sal part of the preparationseparatel3 an# finall3 oin them
together" This ens$re a #istin)t !2shape# preparation is forme#"
es
%pen
interproximal
contact
1" Allo%s is$al erifi)ation that all )aos$rfa)e
margins are pla)e# in so$n# tooth str$)t$re+Roertson et al"- .((6/"
." Conenien)e of a))ess for finishing an#
polishing"
" Allo% self7)leansing of the )aos$rfa)e margin
to #e)rease ris8 of pla9$e a))$m$lation an#se)on#ar3 )aries +athi an# Morta,ai- .((4/"
;The a#antage of not rea8ing the )onta)t is the
The proximal )onta)t %as #iffi)$lt to
open as it $s$all3 en# $p too %i#e" M3sol$tion %as opening the )onta)t
slightl3 %ith a fine nee#le nose# $r"
es
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)onseration of tooth str$)t$re an# etter ens$re of
proximal )onta)t" s no$n#ermine# enamel ro#s" Also- it ma8es s$re the
amalgam is of s$ffi)ient $l8 than if the angle istoo a)$te" This #e)reases the )han)e of the enamel
or amalgam fra)t$res +Roerson- .((6/"
This %as fairl3 eas3 to a)hiee 3)he)8ing the preparation from o))l$sal
ie%"
es
*alls con)ergent
occlusall!
O))l$sal )onergen)e resists restoration
#islo#gement o))l$sall3 3 me)hani)al retention+!$mmit et al"- .((6/"
0 ha# no tro$le %ith this re9$irement" es
+ shelf$1" Parallel to
o))l$sal plane
." ?$st into #entin" lat an# e9$al
%i#th thro$gho$t
1" The parallelism of $))al shelf to o))l$sal planegies it the most resistan)e to%ar#s o))l$sal loa#
3 eliminating the ramp effe)t that %o$l# o))$r if
the shelf an# o))l$sal plane are not parallel" Theparallelism also ens$res that the res$lting amalgam
restoration %ill e e9$al in thi)8ness tho$gho$t theo))l$sal plane- %hi)h helps resist fra)t$re"
." The shelf is $st into #entin to ens$re s$ffi)ient$l8 for the amalgam restoration to resist fra)t$re"
" The shelf is flat to ens$re that the res$lting
amalgam restoration %ill e e9$al in thi)8ness#is)$sse# in point 1"
0 learne# to $se the ( $r length as ag$i#e for #epth" Also- 0 smoothen an#
flatten the shelf 3 r$nning a $r a)ross
it at @.( spee#"
es
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Alex Chen
Complex amalgam preparation & restoration
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Pulpal slot$
1" 0n area of
)entral grooe
." At least 1mm in#epth" A))ommo#ates
smallest )on#enser
1" P$lpal slot is pla)e# in the area of )entral grooe
e)a$se that>s %here the p$lp is f$rtherst a%a3
from the o))l$sal plane" m satisfie# %ith the
positioning efore 0 start )$tting #o%n
more aggressiel3"
es
Pin$
1" Parallel to)aos$rfa)e
." ?$st into #entin" Clearan)e of
1" The pin parallels the )aos$rfa)e to preent
perforating the tooth as the tooth tapers to%ar#s)eri)al"
." The pin is $st into #entin to #e)rease the ris8 of
0 #i# not hae prolem %ith pla)ing the
pin"
*A
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Complex amalgam preparation & restoration
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smallest )on#enser perforation an# stress pla)e# on the tooth that ma3
)a$se mi)rofra)t$re of #entin or gross fra)t$re of
the )ro%n" +B$rgess et al"- 1''/
" The a))ommo#ation of the smallest )on#enser isfor proper )on#ensation of amalgam #$ring
restoration"
Retention
groo)es$1" a))ommo#ates
smallest )on#enser
1" The a))ommo#ation of the smallest )on#enser is
for proper )on#ensation of amalgam #$ringrestoration"
The retention grooes are fairl3 eas3 to
pla)e" 0 $se the ( $r to ens$re the%all )onergen)e is maintaine#"
*A
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Complex amalgam preparation & restoration
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Complex Amalgam Preparation pictures
Complex Amalgam Preparation
!iscussion
0n a)hieing this rea87thro$ghs- ho% %ill this help 3o$ in #efining 3o$rself as a #entist
The iggest prolem 0 ha# %ith the )omplex amalgam preparation is the proximal tro$gh retentie feat$re"Preparing this feat$re is har# for me e)a$se 0 )annot is$ali,e the area as 0 )$t as m3 ision +oth #ire)t an#in#ire)t/ is lo)8e# 3 m3 han#pie)e" This )a$se# me to hae less )ontrol oer m3 preparation an# m3 tro$ghs
%o$l# t$rn o$t either too #eep or too %i#e" 0 trie# to sole the prolem 3 tr3ing to fin# the optimal pla)ement of
m3 mirror an# the mani8in hea# position to is$ali,e the area 0>m )$tting- $t ha# no s$))ess" Eent$all3- 0 learne#to #epen# on m3 ta)tile sense to estimate the #epth of m3 $r an# )$t slo%l3" 0 %o$l# also )he)8 m3 #epth
fre9$entl3 %ith in#ire)t ision $ntil the re9$ire# #epth an# %i#th is met" This rea87thro$gh ta$ght me that
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aaa
%pen
interproximal
contact
Re)erse '( to ca)osurface +uccal shelf$
1" Parallel too))l$sal plane
." ?$st into #entin" lat an# e9$al
%i#th thro$gho$t
Proximal trough:
1" B$tts $p againstaxial %all
." At least 1mm in#epth
" ("5mm into #entin
*alls con)ergent
occlusall!
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Complex amalgam preparation & restoration
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sometimes a %e )annot al%a3s see %here %e are %or8ing an# some g$essing %or8 is inole#" 0n these )ases-patien)e is extremel3 important" For8ing slo%ing an# )he)8ing o$r o%n %or8 )onstantl3 is the %a3 to pro#$)e the
optimal res$lt"
0 also felt that the )omplex amalgam preparation reall3 re9$ires $s to reall3 hae a #eep $n#erstan#ing of the
tooth str$)t$re an# retention me)hani)s" Compare# to the other )lasses of preparations %e learne# efore %here the
shape an# feat$res of the preparations are 9$ite similar in the same )lass of lesions- there are great ariailit3 in the#esign of the preparation in )omplex amalgam preparation as %e hae man3 #ifferent feat$re options %e )an
)hoose from" The operators nee# to hae a firm $n#erstan#ing of the anatom3 of the tooth an# the retention
me)hanism to alan)e the remoal of so$n# tooth str$)t$re that %ea8ens the tooth an# the retention nee#e# for therestoration" This is an ex)ellent example of ho% #entists nee# to )onstantl3 appl3 their 8no%le#ge an# $stif3 their
%or8 instea# of follo%ing a fixe# re)ipe"
Complex Amalgam "estoration critical reuirements
Tooth: 46 MODBCritical
requirements
of thisprocedure
Purpose of critical requirements and supporting literature New skills accomplished in this excercise,
problems encountered, and breakthrough
moments
id m! product
meet these
requirements"
Close
Contact
-. Pre)ent food impaction.
/. 0aintaining health of interproximal soft tissue
1Roberson et al., /''23.
# had a lot of trouble with this
requirement. 4he most important
step in ensuring a closed contact #
find is to laterall! condense the
amalgam )er! well towards the
5es
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Complex amalgam preparation & restoration
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6. Pre)ent tooth migration 10amoun and Ahmed,
/''23.
ad7acent tooth in the contact area to
close the contact.
+ height ofcontour
-3 #n proper
alignment
/3 #n proper
arch contour
+ cups
-3 #n proper
alignment
Central
groo)e
-3 #n proper
arch
alignment
1" proper alignment an# )onto$r of )$sps proi#eoptim$m integrit3 of the )$sps"
." Properl3 repro#$)e# )entral grooe gies i#eal
o))l$sion %hen arti)$late# %ith the opposing )$sps aso))l$sal relationship is repro#$)e# +Taernier an#
Colon- 1'G'/"
"
0 al%a3s follo% a s3stemi) se9$en)e%hen )aring the in#ii#$al feat$res"
M3 pro)ess is #es)rie# in the follo%ing#is)$ssions se)tion"
Another prolem 0 str$ggle# %ith is the
ten#en)3 to oer)are the )$spal ri#ges"
0 fin# that %hen 0 )are the ling$al)$spal ri#ge- the tip of m3
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Complex amalgam preparation & restoration
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position
Properl!
shaped
marginalridge
-3 Not o)erl!
bulk!
/3 4rue
position le)el
with ad7acent
ridges
An ex)essiel3 high restoration %o$l# ta8e other teeth
o$t of o))l$sion" A))or#ing to !$mmitt et al" +.((6/-
)onta)ts #$ring o))l$sion sho$l# neer o))$r onrestoration alone" 0f this happens- the restoration sho$l#
e ta8en o$t of o))l$sion an# ens$re )onta)t is onrestoration as %ell as tooth str$)t$re sim$ltaneo$sl3
+!$mmitt et al"- .((6/"
0 ma8e s$re the marginal ri#ges are leel
%ith a#a)ent ri#ges 3 leeling it %ith
the flat en# of the ea)h )arer"
N%
#n occlusion
-3 proper
cusp9fossaerelationship
An ex)essiel3 high restoration %o$l# ta8e other teetho$t of o))l$sion" A))or#ing to !$mmitt et al" +.((6/-
)onta)ts #$ring o))l$sion sho$l# neer o))$r onrestoration alone" 0f this happens- the restoration sho$l#e ta8en o$t of o))l$sion an# ens$re )onta)t is on
restoration as %ell as tooth str$)t$re sim$ltaneo$sl3"
0 %o$l# al%a3s )he)8 the o))l$sion %ithan arti)$lating paper to ens$re none or
onl3 minimal )onta)t on m3 restoration"
5es
Proper cusp
height$
0+ cusp
higher than
+ cusp,
higher than cusp
The )$sps nee# to e in proper positions to otain
)orre)t o))l$sion" 0f )$sps are too high- hea3 o))l$sal
for)es )an lea# to fra)t$re of the restoration +!$mmitt etal"- .((6/"
0 fin# it helps a lot to loo8 at a irgin 46
as a example %hile )aring to get a
is$al i#ea of the height relationships ofthe )$sps"
5es
No marginal
)oids
0arginal )oids or o)erhangs accumulates food
debris and plaque. 4his ma! lead to recurrent caries.
epending on location, marginal )oid could also
make the restoration susceptible to fracture 10ahler
and 0arant:, -;'3.
0arginal )oids are a)oided b!
condensing the amalgam with a lot of
force.
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Complex amalgam preparation & restoration
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mooth no
scratches
1" !)rat)hes on restoration ma3 feel $npleasant to the
patient"
." !)rat)hes also proi#es a pla)e for a)teriaa))$m$lation an# gro%th +Paarmann an# Be)8man-.((5/"
" !)rat)hes ma3 a)t as )enters for )orrosion"+A8eroom et al"- .((6/
0 smoothen m3 restoration %ith a )otton
roll at the en#"
es
Complex Amalgam "estoration pictures
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Complex amalgam preparation & restoration
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Complex Amalgam "estoration !iscussion
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Close Contact Properl! shaped
marginal ridge
1/ ot oerl3 $l83./ Tr$e position
leel %ith a#a)entri#ges Reerse !
;Distal ri#ge is too$l83
Proper cusp height
MB )$sp higher than
B )$sp- higher thanD )$sp Reerse !
Central groo)e
0n proper ar)h
alignment
+uccal height of
contour
1/ 0n properalignment
./ 0n proper ar)h)onto$r
+uccal cups
0n proper alignment
No marginal )oids
mooth no
scratches
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Alex Chen
Complex amalgam preparation & restoration
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0n a)hieing this rea87thro$gh- ho% %ill this help 3o$ in #efining 3o$rself as a #entist
0 ha# a har# time )aring the anatom3 of the molar at first" Fith pra)ti)e- 0 got a lot faster an# m3 restoratione)ame more anatomi)all3 )orre)t" Fhat 0 fo$n# helpe# is haing a s3stemati) approa)h %hile )aring the tooth
feat$res" 0 learne# to %or8 in a fixe# or#er an# al%a3s $se the same instr$ment for a parti)$lar feat$re" or
example- 0 %o$l# al%a3s start 3 #efining the o))l$sal tale %ith an explorer" Then 0 %o$l# )are a ro$gh o$tlineof the )$sps an# grooes %ith the same explorer" 0 %o$l# then moe on to #efine the )$sps %ith a hollena)8 an#
ea)h )arer" This is follo%e# 3 #efining the pits an# marginal grooes %ith a #is)oi#7)leoi#" Hastl3- 0 %o$l#
finish off %ith shaping the $))al or ling$al )onto$r %ith a hollena)8" 0 fo$n# this s3stemi) approa)h ma#e s$reall the feat$res of the restoration is present an# nothing is misse#" Also- repeate# pra)ti)e %ith the same instr$ment
on the same anatomi)al feat$re greatl3 improes m3 spee# an# 9$alit3 of %or8 then if 0 )are# the str$)t$re %ith#ifferent instr$ment ea)h time" This experien)e )learl3 signifie# the importan)e of a#opting a s3stemi) approa)h ino$r #ail3 pro)e#$res" rom a ro$tine patient exam to )ompli)ate# #ental pro)e#$res- haing a s3stemi) approa)h
%ill greatl3 improe the effi)ien)3 an# ma8e s$re eer3thing is )oere#"
Referen)es:
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Complex amalgam preparation & restoration
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A8eroom-
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Rosenstiel- "- A3a#- "- Maghrai- A" +.((5/" Assessment of Conergen)e angles of tooth preparations) &ournal of Dentistry-+G/: 67G"
!)h%art,- R"- !$mmitt- ?"- Roins- F" +.((6/"Fun!amentals of operative !entistry - a contemporary approach +r# e#"/ Chi)ago:
K$intessen)e P$"
Taernier- B"- Colon- P" +1'G'/" $n)tional #ental anatom3 an# amalgam- "ev #!ontostomatol .Paris/)1G+1/: .17.'
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