NJXDG Exam Latest Study Guide with Correct Answers 2024, Exams of Nursing

Download NJXDG Exam Latest Study Guide with Correct Answers 2024 and more Exams Nursing in PDF only on Docsity! 1 NJXDG Exam Latest Study Guide with Correct Answers 2024 Applying topical fluoride gel or foam (efda) - ANSWER Selecting the tray 1) Select a disposable tray that is of the appropriate size for the patient's mouth. The tray must be long and sufficiently deep to cover all erupted teeth completely without extending beyond the distal surface of the most posterior tooth. Trays are available in sizes to fit primary, mixed, and adult dentition. If the patient's mouth can accommodate it, you may use a double-arch tray. This saves time by treating both arches at the same time. Remember, trays are discarded after a single use & if you try a tray in the mouth but do not use it that tray must be discarded. Preparing the teeth 2) Check to see whether calculus is present; if it is not, no preparation is required. Fluoride diffuses easily through the acquired pellicle and bacterial plaque. 3) If calculus is present, request that the dentist or dental hygienist remove it. The presence of plaque will not affect the uptake of fluoride. Applying the topical fluoride 4) Seat the patient in an upright position and explain the procedure. Having the pt upright prevents gel from going into the throat. 2 5) Instruct the pt not to swallow the fluoride. 6) Select the appropriate tray, and load it with a minimal amount of fluoride, following guidelines according to the patient's age. 7) Dry the teeth using air from the air water syringe. For fluoride to be maximally effective, the teeth must be dry when the fluoride is applied. 8) Insert the tray, and place cotton rolls between the arches. Ask the patient to bite up and down gently on the cotton rolls, to squeeze the fluoride over all tooth surfaces. 9) promptly place the saliva ejector, and tilt the patient's head forward. 10) Set the timer for the appropriate amount of time in accordance with the manufacturer's instructions. During this time, do not leave the patient unattended. 11) On completion, remove the tray, but do not allow the pt to rinse or swallow. Promptly use the saliva ejector or the high-volume oral evaluator tip to close the lips tightly around the saliva ejector. Removing excess saliva and fluoride solution will make the pt more comfortable and less likely to rinse with water. 12) Instruct and the pt not to rinse, eat, drink, or brush the teeth for at least 30 minutes. These activities could disturb the action of the fluoride. Documentation - date - "applied APF fluoride get. Instructed pt not to eat for 30 min.) 5 space between the gingiva and the tooth. Use both hands to move the floss up and down on one side of the tooth. 6) Repeat these steps on each side of all teeth in both arches; including the posterior surface of the last tooth in each quadrant. 7) As the floss becomes frayed or soiled, move a fresh area into the working position. Documentation - date - "provided flossing demonstration and instruction. Patient practiced technique and did well. - operator Using an instrument intraorally (EFDA) - ANSWER 1) Seat and place the pt in the supine position. 2) Position yourself as the operator. 3) Adjust the dental light to illuminate the oral cavity. 4) Using a pen grasp, pick up the mirror with your nondominant hand and the explorer with your dominant hand. 5) Instruct your pt to open his/her mouth and turn toward or away from you, depending on the location of the mouth. 6) Establish a fulcrum close to the area that you will be exploring with your 6 instrument. 7) Adapt the explorer to the most posterior tooth in the upper right quadrant. A well-adapted instrument prevents damage to the tooth and surrounding tissue. 8) Follow around the tooth with the mirror and the explorer, and examine all surfaces through visualization and touch. Preparing, placing, and removing the dental dam (EFDA) - ANSWER Patient preparation 1) Check the pt's record for contrainidications, and identify the area to be isolated. Inform the pt of the need to place a dental dam, and explain the steps involved. 2) Assist the dentist in the administration of local anesthetic. The dentist will determine which teeth are to be isolated and will note whether any malposed teeth must be accommodated. 3) Apply lubricating ointment to the pt's lip with a cotton roll or cotton-tipped applicator. Pt's comfort is a matter of concern throughout placement and removal of the dental dam. 4) Place yourself in the operator's position, and adjust your pt for easier access. 5) Use the mouth mirror and the explorer to examine the site where the dam is to be placed. It should be free of plaque and debris. If the dam is placed in an area with plaque and debris, the dam could push the plaque and debris into the sulcus and irritate the gingival tissues. If debris and plaque is 7 present, selective coronal polishing is performed on these teeth before dam is applied. 6) Floss all contacts involved in placement of the dental dam. Any tight contacts may tear the dam. Punching the dental dam 7) Use a template or stamp to mark on the dam the teeth to be isolated. 8) Correctly punch the marked dam according to the teeth to be isolated. Be sure to use the correct size of punch hole for the specific tooth. 9) If teeth have tight contacts, lightly lubricate the holes on the tooth surface (undersurface) of the dam. This eases placement of dam. Placing the clamp and the frame 10) Select the correct size of the clamp. 11) Secure the clamp by tying a ligature of dental tape on the bow of the clamp. 12) Place the beaks of the dental dam forceps into the holes of the clamp. Grasp the handles of the dental dam forceps, and squeeze to open the clamp. Turn upward, and allow the locking bar to slide down to keep the forceps open for placement. 13) Retrieve the dental dam forceps. Position the lingual jaws of the clamp first, then the facial jaws. During placement, keep an index finger on the clamp to prevent the clamp from coming off before it has been stabilized on 10 cut from hole to hole, creating one long cut. 31) When all septa are cut, the dam is pulled lingually to free the rubber from the interproximal space. 32) Using the dental dam forceps, position the beaks in the holes of the clamp, and open the clamp by squeezing the handle. Gently slide the clamp from the tooth. 33) Remove both the dam and the frame at the same time. 34) Use a tissue or the dam napkin to wipe moisture from the pt's mouth, lips, and chin. 35) Inspect the dam to ensure that the entire pattern of the torn septa of the dental dam has been removed. 36) If a fragment of the dental dam is missing, use dental floss to check the corresponding interproximal area of the oral cavity. Fragments of the dental dam left under the free gingiva can cause gingival irritation. Assisting in the administration and monitoring of nitrous oxide/oxygen sedation (EFDA) - ANSWER 1) Seat the pt, update the medical history, and take and record vital signs. 2) Review the use of N2O w pt to eliminate his/her fear. 3) Place the pt in a supine position. 4) Select and place a mask of appropriate size of the tubing. 5) Have the pt put on the mask, and adjust the fit. 11 6) Tighten the tubing once it is comfortable for the pt (To eliminate the need for the pt to hold the mask in place and to prevent leakage from around the mask). 7) If the mask pinches or causes discomfort, place a gauze square under the edge. Administration 8) At the dentist's instructions, begin adjusting the flow meter for O2 flow only. The pt is given 100 percent O2 for at least 1 minute (to assist the dentist in determining the pt's tidal volume). 9) At the dentist's direction, adjust N2O flow in increments of 0.5 to 1/L min, and reduce O2 flow by a corresponding amount. Most machines perform this function automatically. 10) At 1-minute intervals, the previous step is repeated until the dentist determines that the pt has reached the baseline reading. This slow process minimizes the risk of administering too much N2O. 11) Note the pt's baseline level. 12) Monitor the pt closely throughout the procedure. Oxygenation 13) Toward the end of the procedure, N2O is depleted and 100 percent O2 is administered, as directed by the dentist. Oxygenation of pts for a minimum of 5 minutes helps prevent diffusion hypoxia, which creates a feeling of 12 light-headedness. 14) After oxygenation is complete, remove the mask. Slowly position the pt upright. Bringing the pt upright too quickly may cause postural hypotension. 15) Record the pt's baseline levels of N2O and O2 and response during analgesia. This documentation provides a legal record of care and serves as a reference for future care and administration of N2O/O2 sedation (analgesia). 16) Take and record vital signs. 17) Document the procedure. Applying calcium hydroxide (EFDA) - ANSWER 1) Position yourself as the operator. 2) Using the mirror and the explorer, examine the cavity outline of the preparation, and determine where the material is to be placed. This should be discussed with the dentist. 3) Rinse and dry the preparation, and isolate w cotton rolls or dental dam. 4) Dispense small, equal amounts of the catalyst and base paste onto the paper mixing pad. The area to be covered will be 0.5 to 1 mm, depending on the size of the cavity preparation. 5) Using a circular motion, quickly mix (10-15 seconds) the material over a small area of the paper pad with the spatula . 6) Use gauze to clean the spatula. 7) With the tip of the applicator, pick up a small amount of the material, and apply a thin layer at the deepest area of the preparation. 15 seconds. 7) Incorporate the remaining portion into the mixture. Continue mixing for an additional 20 to 30 seconds. The material should be thick and putty-like. 8) Pick up half the material w your spatula, and roll it into a small ball. Do this with the other portion as well to make the material easier to place into the cavity preparation. 9) Pick up the material by placing the condenser into the material; then carry it to the preparation. 10) Use a light tapping stroke to adapt the material into place. 11) Ensure that the entire pulpal floor is covered with the base. 12) Have the dentist evaluate your skills. 13) Document the procedure. Mixing and placing zinc phosphate as a base (EFDA) - ANSWER 1) Position yourself as the operator. 2) Using the mirror and explorer, examine the cavity outline of the preparation, and determine where the material is to be placed. 3) Rinse and dry the preparation, and isolate with cotton rolls or dental dam. 4) Dispense the powder and the liquid onto the slab. Use the powder-to-liquid ratio recommended to produce a thick, putty-like mix. This requires more powder in proportion to the amount of liquid used. 5) Mixed to the desired consistency. 16 6) Form the completed mix into a small ball. 7) Pick up the material by placing the condenser into the material; then carry it into the preparation. 8) Using a light tapping stroke, adapt the material into place. 9) Ensure that the entire pulpal floor is covered w the base. 10) Have excess powder available for use when the material is condensed into the tooth. This powder will prevent the instrument from sticking to the material. 11) Have the dentist evaluate your skills. 12) Document the procedure. Mixing and placing polycarboxylate cement as a base (EFDA) - ANSWER 1) Position yourself as the operator. 2) Using the mirror and the explorer, examine the cavity outline of the preparation, and determine where the material is to be placed. 3) Rinse and dry the preparation, and isolate w cotton rolls or dental dam. 4) Dispense the powder and liquid onto the pad. When used for a base, the liquid portion is decreased to make a thicker consistency. 5) Incorporate all the powder into the liquid , with the total mixing time not to exceed 45 seconds. 6) Form the completed mix into a small ball. 7) Pick up the material by placing the condenser into the material; then carry 17 it into the preparation. 8) Using a light tapping stroke, adapt the material into place. 9) Ensure that the entire pulpal floor is covered with the base. 10) Clean and disinfect the equipment immediately. This cement must set for approximately 5 minutes before placement of the permanent restoration. 11) Have the dentist evaluate your skills. 12) Document the procedure. Applying an etchant material (EFDA) - ANSWER 1) Position yourself as the operator. 2) Using the mirror and the explorer, examine the cavity outline of the preparation, and determine where the material is to be placed. 3) The prepared tooth must be isolated from contamination. A dental dam or cotton rolls are placed before the etching process begins. Saliva must not contaminate the preparation. 4) The surface of the tooth structure must be clean and free of any debris, plaque, or calculus before etching is begun. Debris on the surface may interfere with the etching procedure. 5) After cleaning, the surface is carefully dried but is not desiccated. Too much drying of the tooth structure will harm the tooth. 6) The etchant is selected. Most manufacturers supply a gel etchant in a syringe that can be applied to enamel or dentin. The gel allows the etchant to be carefully placed only where it is needed. 20 a moist cotton pellet, leaving the tooth moist. You do not want the tooth completely dry. 2) Apply a bond adhesive to enamel and dentin; then dry gently. Avoid excess adhesive on all prepared surfaces. 3) Light-cure each surface for 10 seconds. 4) Apply primer to etched porcelain or roughened metal surfaces. Dry for 5 seconds. 5) Dispense a 1:1 ratio onto a mixing pad; then mix for 10 seconds. Apply a thin layer of cement to the bonding surface of restoration. 6) Once crown is seated, margins may be light cured for 40 seconds or allowed to self cure for 10 minutes from the start of mixing. For porcelain and precured composite crowns, margins must be light-cured for 40 seconds. Mixing zinc oxide-eugenol for temporary cementation - ANSWER 1) Measure the pastes onto the mixing pad at equal lengths, approximately 1/2 inch per unit of restoration. 21 2) Replace the caps immediately. 3) Incorporate the two pastes together. 4) Mix while wiping the material over an area of the mixing pad. 5) The material should be smooth and creamy and prepared within 20-30 seconds. 6) Immediately fill the temporary coverage w the cement. Fill the provisional rather than line it, since the material is weaker than permanent cement. 7) Clean and disinfect the equipment immediately. Mixing zinc-oxide eugenol for permanent cementation - ANSWER 1) Measure the powder and place it onto the mixing pad. Replace the cap on the powder immediately. 2) Dispense the liquid near the powder on the mixing pad. Replace the cap on the liquid container immediately. 22 3) Incorporate the powder into the liquid all at once; spatulate for 30 seconds. 4) Initially, the mix is putty-like, but with additional mixing for 30 seconds, it will become more fluid for loading into a casting. 5) Clean and disinfect the equipment immediately. Mixing polycarboxylate for permanent cementation - ANSWER 1) Gently shake the powder to fluff the ingredients. Measure the powder onto the mixing pad and immediately recap. 2) Dispense liquid then recap. 3) Use flat side of spatula to incorporate all powder quickly into the liquid at one time. The mix must be completed within 30 seconds. 4) A correct mix should be somewhat thick and should have a shiny, glossy surface. If material has lost its glossiness or exhibits a stringy weblike consistency, it has begun setting and should not be used. 5) Clean and disinfect equipment immediately. 25 area for evaluation of the procedure. Taking a mandibular preliminary impression (EFDA) - ANSWER Preparation 1) Gather all necessary supplies. 2) Seat and prepare the pt. 3) Explain the procedure to the pt. 4) Select and prepare the mandibular impression tray. 5) Take two measures of room temperature water with two scoops of alginate. Mix the material. Loading the mandibular impression tray 6) Gather half the alginate in the bowl onto the spatula, then wipe alginate into one side of the tray from the lingual side. Quickly press the material down to the base of the tray. This removes any air bubbles trapped in the tray. 7) Gather the remaining half of the alginate in the bowl onto the spatula; then load the other side of the tray in the same way. 8) Smooth the surface of the alginate by wiping a moistened finger along the surface. Seating the mandibular impression tray 26 9) Place additional material over the occlusal surfaces of the mandibular teeth. This places extra material in the fissures and interproximal surfaces to create less discrepancy in the anatomy of the impression. 10) Retract the patient's cheek with your index finger. 11) Turn the tray slightly sideways when placing into the mouth. 12) Center the tray over the teeth. 13) Press down the posterior border of the tray first to form a seal. 14) Push down the anterior portion of the tray and ask the pt to lift the tongue to the roof of the mouth and then relax it. This allows the alginate to form an impression of the lingual aspect of the alveolar process. 15) Instruct the pt to breathe normally while the tray is in place. 16) Observe the alginate around the tray to determine when the material has set. When set, the material should not register a dent when pressed with a finger. Removing the mandibular impression 17) First, place your fingers on the top of the impression tray. This protects the maxillary teeth from damage during removal of the mandibular tray. 18) Gently break the seal between the impression and the peripheral tissues by moving the inside of the pt's cheeks or lips with your finger. 19) Grasping the handle of the tray with your thumb and index finger, use a firm lifting motion to break the seal. 27 20) Snap up the tray and impression from the dentition. 21) Have the pt rinse w water to remove any excess alginate material. 22) Evaluate the impression for accuracy. 23) Rinse, disinfect, wrap in a slightly moistened towel, and place the impression in the appropriate precaution bag. Taking a maxillary preliminary impression (EFDA) - ANSWER Preparation 1) Gather all necessary supplies. 2) Seat and prepare the pt. 3) Explain the procedure to the pt. 4) Select and prepare the mandibular impression tray. 5) Take two measures of room temperature water with two scoops of alginate. Mix the material. Loading the maxillary impression tray 6) Load the maxillary tray in one large increment, using a wiping motion to fill the tray from the posterior end. This helps prevent the formation of air bubbles in the material. 7) Place the bulk of the material toward the anterior palatal area of the tray. This prevents the alginate from flowing beyond the tray and into the throat during tray placement. 30 place, the pt may close the teeth together instead of biting directly into the wax, resulting in an inaccurate bite registration. 3) Place the wax over the biting surfaces of the teeth and check the length. If the wax extends so far beyond the last tooth that the pt is uncomfortable, remove the wax from the pt's mouth. Use the laboratory knife to shorten the length of wax. 4) Use a heat source to soften the wax. 5) Place the softened wax against the biting surfaces of the teeth. 6) Instruct the pt to bite gently and naturally into the wax. 7) Allow the wax to cool. The wax will cool quickly and may be removed from the mouth in 1-2 minutes. 8) Remove the wax bite registration carefully to avoid distortion. 9) Write the pt's name on a piece of paper and keep it with the wax bite registration. 10) Store the wax bite registration w the impressions or casts until it is needed during trimming of the casts. Taking a face-bow registration (EFDA) - ANSWER 1) Attach the vertical indicator rod to the analyzer bow. 2) Attach a disposable index tray or a bite-fork to the analyzer bow. 3) Prepare the bite-fork w a disposable index tray or with compound bite tabs. If using compound bite tabs, they will need to be softened in warm water before placement. 31 4) When positioning the bite-fork in the mouth, make sure the pt bites slowly. 5) Align the vertical indicator rod with the pt's facial midline. This registers the dental midline of the teeth to the frontal plane. 6) While making sure the pt maintains the incisal contact w the bite-fork, position the analyzer bow until the lateral wings are level. It is best to complete this while standing directly in front of the pt. 7) Remove tray or bite-fork from the bow; this becomes the permanent bite-fork registration record that will be used by the dentist or dental laboratory technician in mounting the study cast. 8) Document the procedure. Placing and carving an intermediate restoration - ANSWER 1) Clean, dry, and isolate the site w cotton rolls or a dental dam. 2) Examine the tooth and preparation, making sure to keep a mental note of the outline of the preparation. When you begin carving, you need to know how far to carve back to the tooth structure. 3) If the preparation includes a proximal wall, you will need to place the appropriate matrix and wedge for the preparation. 4) Mix the IRM to the appropriate consistency. 5) Using your plastic instrument (FP-1), take increments of the material to the preparation. If an interproximal box is present, begin filling this area first. This area is more difficult to see, and material must be packed against the 32 tooth for proper contour. 6) After each increment, condense the material while first using the small end of the condenser. 7) Continue filling the preparation until it becomes overfilled. You want enough material to be able to carve back to the tooth structure. Carving stage 8) If a matrix system was used, use an explorer to run around the matrix band to remove any excess material from the marginal ridge and the proximal box. Remove the matrix at this time, leaving the wedge in place. 9) Remove any excess material from the occlusal surface, using the discoid/cleoid carver, to keep the interproximal space open for easier carving. 10) Complete the final carving of the occlusal surface w the discoid/cleoid carver, making sure to carve back to the normal anatomy of the tooth. Look at the same tooth on the opposite side of the arch for anatomic landmarks. 11) If an interproximal surface was involved, use the Hollenback carver to remove any excess material from the interproximal area, making sure not to create an overhang or indentation in the material. 12) Once all carving has been completed, remove the wedge. 13) To check the occlusion, instruct the pt to bite down gently on articulating paper. 14) After the final carving, take a wet cotton pellet and wipe over the 35 14) Discard the matrix band into the sharps container. 15) Using #110 pliers, grasp the base of the wedge to remove it from the lingual embrasure. The wedge remains in place to help prevent fracture of the restoration when the matrix band is removed. 16) The restoration is now ready for the final carving steps. Placing a plastic matrix for a class III or class IV restoration (EFDA) - ANSWER 1) Examine the contour of the tooth and preparation site, paying special attention to the outline of the preparation. 2) Contour the matrix strip. 3) Slide the matrix interproximally, ensuring that the gingival edge of the matrix extends beyond the preparation. If the matrix does not completely cover the preparation, the cavity preparation could be filled incorrectly. If a matrix is placed during the etching process, make sure a new matrix is used for placement of the composite resin material. 4) Using your thumb and forefinger, pull the band over the prepared tooth on the facial and lingual surfaces. 5) Using pliers, position the wedge within the gingival embrasure. The wedge can be positioned from the facial or the lingual side for anterior restorations. 6) After the preparation has been filled and light-cured, the matrix is removed. Placing and removing gingival retraction cord (EFDA) - ANSWER Preparation 36 1) Rinse and gently dry the prepared tooth; isolate the quadrant w cotton rolls. Dry tissue makes it easier to see the details of the gingival tissue and place the retraction cord. 2) Cut a piece of retraction cord 1 to 1.5 inches in length, depending on the size and type of tooth under preparation. The length is determined by the circumference of the prepared tooth and the placement technique to be used. 3) Use cotton pliers to form a loose loop of the cord. This makes the cord easy to slip over the tooth, but the loop is not tied or knotted. Placement 4) Make a loop in the retraction cord, slip it over the tooth, and position the loop in the sulcus around the prepared tooth. 5) Using the cord-packing instrument and working in a clockwise direction, pack the cord gently into the sulcus surrounding the prepared tooth, so that the ends are on the facial aspect. The ends in this position are easier to reach for removal of the cord. 6) Pack the cord into the sulcus by gently rocking the instrument slightly backward as the instrument is moved forward to the next loose section of retraction cord. Repeat this action until the length of cord is packed in place. 7) Overlap the cord where it meets the first end of the cord. The ends may be tucked into the sulcus on the facial aspect. An alternative is to leave a short length of cord sticking out of the sulcus. This makes it easier to grasp and quickly remove the cord. When a wider and deeper sulcus is required, two 37 retraction cords may be placed with one on top of the other. Before the impression material is taken, remove the top cord. After the impression is completed, remove the second retraction cord. 8) The cord should be left in place for a maximum of 5-7 minutes. Instruct the pt to remain still to keep the area dry. This time allows the cord to push tissue away from the tooth and stay in this position. The exact time depends on the type of chemical retraction used. Removal 9) Grasp the end of the retraction cord w cotton pliers, and remove it in a counterclockwise direction (the reverse of the method used in packing). 10) Remove the retraction cord just before the impression material is placed. Usually the operator removes the cord while the assistant prepares the syringe-type impression material. 11) Gently dry the area and apply fresh cotton rolls. The impression is taken immediately. 12) Document the procedure. Fabricating and cementing a custom acrylic provisional crown (EFDA) - ANSWER 1) Obtain an alginate impression of the arch before the teeth are prepared. You want the provisional coverage to be a replica of the tooth before the dentist prepares it. 2) Check the impression to be sure it is free of debris and tears in the area 40 20) Document the procedure. Fabricating and cementing a custom acrylic provisional bridge (EFDA) - ANSWER 1) The thermoplastic tray is prepared before the scheduled appointment and before the teeth are prepared. The provisional coverage should be a replica of the teeth before the dentist prepares them. 2) Isolate the prepared teeth to maintain moisture control. 3) Lightly apply petroleum jelly or a liquid medium to the prepared teeth to facilitate separation of the acrylic dough from the preparations. 4) Prepare the provisional material cartridge for application. 5) Express the acrylic resin from a cartridge directly into the tray. 6) Place the acrylic-loaded tray back into the prepared teeth. 7) Allow the material to reach an initial set, which takes approximately 3 minutes, and remove the tray from the pt's mouth. 8) Carefully remove the provisional coverage from the tray, and replace it onto the pt's teeth. This avoids excess shrinkage during the final curing stage. 9) After final set, remove the provisional coverage and mark the marginal border and contact points of the provisional coverage w a pencil to provide better visualization of the markings. 10) Trim the acrylic resin to within 1 mm of the gingival shoulder of the prepared tooth w an acrylic bur or stone. Any trimming completed by the EFDA must be completed outside the mouth with use of the lowspeed 41 handpiece and acrylic burs. 11) Check the occlusion, accuracy, and completeness of the provisional coverage, and adjust as necessary. Remove the provisional coverage from the prepared teeth, and complete the trimming w an acrylic bur. 12) Remove the provisional coverage and take it to the laboratory where it is polished w a sterile white rag wheel and pumice on the laboratory lathe. Safety eyewear must be worn throughout the trimming and polishing procedure. In addition, be aware that the rag wheel could remove a large bulk of acrylic or could overheat and cause distortion of the provisional coverage. 13) Temporarily cement the provisional coverage w provisional cement, such as zinc oxide-eugenol (Tempbond) or intermediate restorative material. 14) Check the occlusion w articulating paper. If any reduction is required, the dentist will use an acrylic-trimming bur. 15) Document the procedure. Fabricating and cementing a preformed provisional crown (EFDA) - ANSWER 1) With the dentist, examine the prepared tooth for size and shape. 2) Select the preformed crown unit that best suits the area of the mouth. 3) Try on the crown for size and shape, and make any needed adjustments w a slow-speed handpiece outside of the mouth. 4) Mix the resin as directed and fill the shell, making sure not to trap any air bubbles in the material. 42 5) Seat the shell over the tooth or teeth, and ask the pt to bite down. You will notice excess resin flowing from the shell into the margins and contacts. 6) Use your fingers to apply pressure to the buccal and lingual areas of the crown. 7) Remove excess resin from the margins after 20 to 30 seconds. 8) Lift the crown on and off the tooth until the resin has hardened. The time required for setting of this material is approximately 90 seconds. This prevents the crown from locking onto the tooth. 9) Mark the patient's occlusion with articulating paper and with a pencil around the margins and contact points, and then adjust using acrylic burs, discs, and rubber wheels. 10) Finish the crown or bridge. 11) Cement with temporary cement. 12) Document the procedure. Repairing a fractured denture (EFDA) - ANSWER 1) Disinfect the denture. 2) Align the fractured denture parts and apply sticky wax. 3) Examine the denture and block out all the undercuts on the internal surface that will be exposed to the plaster with a slurry mix or blockout wax. Blocking out the undercuts enables you to remove the plaster cast after it sets. Do not block out undercuts along the fractured line. 4) Prepare a plaster mix. 45 15) Document the procedure. Removing a periodontal dressing (EFDA) - ANSWER 1) Gently insert the spoon excavator under the margin. 2) Use lateral pressure to pry the dressing gently away from the tissue. The area may still be sensitive, and the newly healed tissue is delicate and easily injured. 3) If sutures are embedded in the dressing material, cut the suture material free. Remove the sutures gently from the tissue. Accidentally pulling the sutures could be painful for the pt and might open the wound. 4) Gently use dental floss to remove all fragments of dressing material from the interproximal surfaces. Remaining fragments could cause discomfort for the pt and result in tissue irritation. 5) Irrigate the entire area gently w warm saline solution to remove the superficial debris. 6) Use the HVE tip or saliva ejector to remove the fluid from the pt's mouth. 7) Document the procedure. Performing suture removal (EFDA) - ANSWER 1) The surgeon will examine the surgical site to evaluate healing. If healing is satisfactory, the sutures may be removed. 2) Swab the site w an antiseptic agent to remove any debris. 3) Use cotton pliers to hold the suture gently away from the tissue to expose 46 the attachment of the knot. 4) Slip one blade of the suture scissors gently under the suture. Cut near the tissue. 5) Use cotton pliers to grasp the knot, and gently tug it so the suture slides through the tissue. Never pull the knot through the tissue. 6) If bleeding occurs, irrigate the surgical site with an antiseptic solution or warm saline solution. Apply a compress briefly to the surgical site to promote clotting. 7) Count the sutures that have been removed, and compare this number w the number documented in the pt's record. 8) Document procedure. Rubber cup polishing (EFDA) - ANSWER 1) Check the pt's medical history for any contraindications to the coronal polishing procedure. 2) Seat and drape the pt w a waterproof napkin. Ask the pt to remove any dental prosthetic appliance that he or she may be wearing. Provide the pt w protective eyewear. 3) Explain the procedure to the pt and answer any questions. 4) Inspect the oral cavity for lesions, missing teeth, tori, and so forth. 5) Apply a disclosing agent to identify areas of plaque. Maxillary right posterior quadrant, buccal aspect (11 o clock or 12 o clock 47 position may be used) 6) Sit in the 8 o clock to 9 o clock position. 7) Ask the pt to tilt the head up and turn slightly away from you. 8) Hold the dental mirror in your left hand. Use it to retract the cheek or for indirect vision of the more posterior teeth. 9) Establish a fulcrum on the maxillary right incisors. Maxillary right posterior quadrant, lingual aspect (11 o clock or 12 o clock position may be used) 10) Remain seated in the 8 o clock to 9 o clock position. 11) Ask the pt to turn the head up and toward you. 12) Hold the dental mirror in your left hand. Direct vision in this position w use of the mirror provides a clear view of the distal surfaces. 13) Establish a fulcrum on the lower incisors, and reach up to polish the lingual surfaces. Maxillary anterior teeth, facial aspect 14) Remain in the 8-9 o clock position. 15) Position the pt's head tipped up slightly and facing straight ahead. Make necessary adjustments by turning the pt's head slightly toward or away from you. 50 37) Establish a fulcrum on the mandibular anterior teeth, and reach back to the posterior teeth. Mandibular anterior teeth, facial aspect 38) Sit in the 8-9 o clock position, or in the 11-12 o clock position. 39) As necessary, instruct the pt to make adjustments to head position by turning toward or away from you or by tilting the head up or down. 40) Use your left index finger to retract the lower lip. Direct and indirect vision can be used in this area. 41) Establish a fulcrum on the incisal edges of the teeth adjacent to the ones being polished. Mandibular anterior teeth, lingual aspect 42) Sit in the 8-9 o clock position, or in the 11-12 o clock position. 43) As necessary, instruct the pt to make adjustments to the head position by turning toward or away from you or by tilting the head up or down. 44) Use the mirror for indirect vision, to retract the tongue, and to reflect light onto the teeth. Direct vision often is used in this area when the operator is seated in the 12 o clock position, but indirect vision also can be helpful. 45) Establish a fulcrum on the mandibular cuspid incisal area. Mandibular right quadrant, buccal aspect 51 46) Sit in the 8 o clock position. 47) Ask the pt to turn the head slightly away from you. 48) Use the mirror to retract tissue and reflect light. The mirror also may be used to view the distal surfaces in this area. 49) Establish a fulcrum on the lower incisors. Mandibular right quadrant, lingual aspect 50) Remain in the 8 o clock position. 51) Ask the pt to turn the head slightly toward you. 52) Retract the tongue w the mirror. 53) Establish a fulcrum on the lower incisors. Mandibular right quadrant, lingual aspect (11 or 12 o clock position may be used) 54) Sit in the 8-9 o clock position. 55) Ask the pt to turn the head slightly toward you. 56) retract the tongue with the mirror. 57) Establish a fulcrum on the lower incisors. Documentation 52 58) document the procedure. Application of dental sealants (EFDA) - ANSWER 1) Place the dental dam or cotton rolls and saliva ejector to isolate teeth to be sealed. Moisture contamination w saliva or water can cause a lost or leaking sealant. 2) Clean the surfaces of the teeth to be sealed with pumice or oil-fluoride free paste. 3) Use a three-way syringe and HVE to rinse and dry thoroughly. Remove any retained polishing paste. Some dentists prefer to clean out the fissures w a small round or needle shaped bur or diamond rotary instrument. This allows them to inspect the fissures for the presence of caries. 4) Place etchant on enamel to be sealed for 20-30 seconds. Some teeth need longer etching times, such as primary teeth and teeth with fluorosis. 5) Rinse with warm water for 10-15 seconds. 6) If using cotton rolls, carefully replace them or dry them out w the HVE. Be certain that saliva does not contaminate the freshly etched surfaces of the enamel will need to be re-etched for 15 seconds. 7) Dry the teeth thoroughly. Properly etched enamel should appear frosty. If not adequately etched, re-etch for an additional 30 seconds. 8) Apply sealant according to manufacturer's instructions. Sealant should be gently worked into the pits and fissures to displace trapped air. It should cover the entire fissure but should not overfill the groove pattern because that will probably interfere w the occlusion. 55 Suture techniques - ANSWER The type of extraction performed will determine the suture technique used. 1) Interrupted and horizontal mattress sutures - most commonly placed sutures for single tooth socket 2) Mattress suture and figure 8 suture - used for suturing two or more papillae together. Limited-area rinsing - ANSWER Performed frequently throughout a procedure- accomplished quickly and efficiently, causing no delay in procedure. Frequently accomplished when dentist exits the mouth and pauses for inspection. Full-mouth rinsing - ANSWER Used when pt's entire mouth needs freshening. May be completed after a long restorative procedure, after dental prophylaxis, or before pt dismissal following any dental procedure. 56 Saliva ejector can be used instead of HVE when assistant performs alone. Air-water syringe guidelines - ANSWER - direct syringe tip toward the tooth that is being treated - keep a close distance between the operative site and the syringe tip, to prevent splatter - use the air on the mouth mirror continuously when indirect vision is involved - when you hear the handpiece stop, rinse and dry the site - when completing a limited-area or full-mouth rinse, move the tip while spraying the area Cotton roll isolation - ANSWER Positioned close to the salivary gland ducts to absorb the flow of saliva, and close to the working field to absorb excess water. Most common form of isolation for short procedures, such as exams, application of sealants, cementation of castings, and simple restorations. Dry angle isolation - ANSWER Triangular cotton pad placed over Stensen's duct to absorb saliva to isolate areas in the maxillary and mandibular arches. 57 They also protect the tissue in the area. Indications for dental dam - ANSWER - serves as an important infection control barrier in the preparation of teeth - safeguards the pt's mouth against contact w debris, dental materials, or other liquids during treatment - protects the pt from accidentally aspirating or swallowing debris, such as small fragments of a tooth or scraps of restorative material - protects the tooth from contamination by saliva or debris if pulpal exposure accidentally occurs - protects the oral cavity from exposure when an infected tooth is opened during endodontic treatment - provides the moisture control that is essential for the placement of restorative materials - improves access by retracting the lips, tongue, and gingiva from the field of operation - provides better visibility because of the contrasting colors of the dam and the tooth - increases dental team efficiency by discouraging pt conversation and reducing the time required for treatment Dental dam material - ANSWER thin sheet of latex rubber; varies in size, thickness, color 60 The "Otsby Frame" is a round plastic frame w sharp projections on its outer margin. It also is placed outside the dam, and the dam is stretched over the projections of the frame. A newer version is the preframed dam which includes the dam and frame as one piece and is disposed of after its use. Dental dam napkin - ANSWER Disposable dental dam napkin can be used and placed between pt's face and the dam. Primary purpose is to increase pt comfort by absorbing moisture. Napkin also protects pt's face from direct contact w the dam, reducing the risk that the pt may develop a latex allergy. Dental dam lubricants - ANSWER When dam is placed there are 2 types of lubricants that may be selected. One lubricant is placed on the pt's lips to ensure pt comfort. Some operators use zinc oxide ointment and others use petroleum jelly. The second lubricant is water soluble and is placed on the underside of the 61 dam to help dam material slide over the teeth and through the interproximal spaces. Petroleum jelly should not be used for this purpose because it interferes w the setting of certain dental materials and breaks down latex. Dental dam punch - ANSWER Used to create holes in the dental dam needed to expose the teeth to be isolated. The working end of the punch has an adjustable stylus (cutting tip) that makes the hole as it strikes an opening in the punch plate. The punch plate is a rotary platform w five or six holes of different sizes cut into the face of the plate. These holes are approximately 1 mm deep and have sharp edges to accommodate the stylus. The position of the punch plate is rotated to produce holes of different sizes. When the plate is turned, a slight click may be heard as the plate falls into position. This click indicates the stylus is positioned directly over the hole in the punch plate. The correct position of the stylus is checked by slowly lowering the stylus point over the hole in the punch plate. If the stylus is not placed properly it may be dulled or broken. If the holes have ragged edges, they may tear easily as the dam is placed over the crown of the tooth. The holes may also irritate the gingiva and may 62 allow leakage of moisture around the tooth. Size of holes on the punch plate - ANSWER The holes on the punch plate are graduated in size and are numbered from 1 to 5, with 1 being the smallest size. Each size has specific recommended uses. Dental dam stamp and template - ANSWER Used to mark the dental dam with predetermined markings for average adult and pediatric arches. The use of a dental dam template, which has holes where the teeth should be marked, provides greater flexibility when one or more teeth in the arch are out of alignment. The template is placed on the dam and a pen is used to mark through the template to indicate the location of punch holes. Dental dam forceps - ANSWER For the placement and removal of the dental dam clamp. The beaks of the forcep fit into holes on the jaws of the clamp. The handles of the forceps work w a spring action. The beaks of the forceps are turned toward the arch that is being treated. A sliding bar keeps the handles of the forceps in a fixed position while the clamp is being held and positioned on the tooth. 65 same type of tooth in the opposite quadrant. Clamps 7 and W7 are universal mandibular molar clamps, and clamps 8 and W8 are universal maxillary molar clamps. Anterior dental dam clamps - ANSWER Such as clamps 9 and W9, are designed, to retract the gingiva on the facial surface, improve visibility for the restoration of cervical class V cavities and permit isolation of an anterior tooth during endodontic treatment. Pediatric dental dam clamps - ANSWER Clamps for primary teeth are designed to accommodate the smaller sizes and shape of the primary teeth or partially erupted permanent teeth. Clamps for primary teeth are available in sizes 00, W00, and 2. Ligatures on clamps - ANSWER Dental floss or dental tape should always be attached to the bow of the dental dam clamp as a ligature before the clamp is placed in the pt's mouth. The ends should always be kept out of the pt's mouth on the outside of the dam and within easy reach. Dental dam stabilizing cord - ANSWER A disposable latex cord that is an alternative to the conventional clamp method of securing the dental dam in which during insertion, the cord is stretched so that it becomes narrow and 66 then placed interproximally to secure the dental dam material Factors included in dental dam preparation - ANSWER - maxillary or mandibular arch - shape of the arch - any irregularities, such as missing teeth, a fixed prosthesis, or malpositioned teeth - teeth to be isolated - identification of the anchor tooth and location of the keypunch hole - size and spacing of the other holes to be punched Anchor tooth for dental dams - ANSWER Holds the dental dam clamp, and the keypunch hole covers the anchor tooth. Maxillary arch dental dam application - ANSWER Stamp or mark dental dam material and punch holes. Because the holes for maxillary anterior teeth are punch 1 inch down from the upper edge of the dam, it is helpful to stamp or make the extension in the back of the punch plate of the dam punch to indicate 1 inch. This mark designates the margin of the dam for these holes. 67 Mandibular arch dental dam application - ANSWER Dam is stamped or marked and holes are punched, leaving a 2 inch margin from the edge. Because of the smaller size of mandibular teeth, the holes are punched closer together than for posterior teeth. Use a water soluble Subaru ant if crowding or tight contacts are noted. Curve of the arch effect in dental dam - ANSWER It may be necessary to make adjustments to punching the dam to accommodate an extremely narrow or wide arch. If not, there will be difficulty with isolation, causing inversion of the edges of the holes of the dam. Bunching or stretching lingually can occur if the curve of the arch is punched too flat or too wide. Folding and stretching of the dam on the facial aspect occurs if the arch is punched too curved or too narrow. Misaligned teeth effect in dental dam - ANSWER If the tooth is lingually malposed, the hole-punch size remains the same, but the hole is placed about 1 mm lingually from the normal arch alignment. If the tooth is facially malposed, the hole punch size remains the same, but 70 If the holes are too close, the dam may tear or stretch. The stretched holes may leave the gingiva exposed and may cause leakage. If the holes are too far apart, excess material is present between the teeth. This may block the dentist's vision or catch the instrumentation. Dental dam placement methods - ANSWER Two methods are used for dental dam placement. The main difference is the sequencing in placement of the clamp and the dam. The remaining steps are the same. In the one step method, the dam and the clamp are placed at the same time. In the two step method, first the clamp is placed and then the dental dam material is stretched over it. Anterior teeth dental dam application - ANSWER The isolation of anterior teeth occurs typically from canine to canine. When the isolation is complete, a dental dam clamp is not required. The dental dam will remain secure with placement of dental tape or with stretching of a small corner of the dental dam interproximal lay between the canine and the first premolar on each side. A cervical or anterior clamp may be required if the gingival third of a tooth is 71 to be restored and if the gingival tissue must be retracted for better exposure. The jaws of this clamp are positioned lightly on the cementum of the root, just below the carious lesion. Occasionally, additional stabilization of the cervical clamp is necessary. Softened stick compound may be used for this purpose. A heat source such as a butane torch or a Bunsen burner is needed. Stabilizing the cervical clamp for the dental dam - ANSWER - soften the red or green stick compound by holding it over a flame until the tip bends, then place the tip in hot water for 5 seconds - twist off approximately 1 inch of the tip, and shape it into a cone - very carefully reheat the cone of the compound in the flame, then place the softened compound under the bow of the clamp (occlusal surface), away from the area to be treated - repeat this procedure for the second bow on the opposite side of the clamp - on completion of treatment, remove the compound before you remove the dam and the clamp Dental dam application for fixed bridhes - ANSWER It is not possible to place the dental dam septum between each tooth when there is a fixed bridge, therefore a specialized technique is required. 72 When you are punching the dental dam, punch a hole for each fully crowned tooth, but do not punch holes for the teeth that are replacing missing teeth. A clamp is placed on the distal aspect of the bridge, and in some situations, a second clamp is placed on the mesial portion. The remainder of the application and the removal are performed as usual. Matrix system characteristics - ANSWER - acts as a temporary wall for amalgam, composite resin, or intermediate restorative material - stabilizes and holds material during the placement and curing stage of the dental material - restores interproximal anatomic contours - restores correct interproximal contact w the adjacent tooth - creates a smooth external surface for the restorative material to be packed against - plural is matrices Posterior matrix systems - ANSWER Universal retainer and matrix band are the most commonly used matrix system used today for class II restorations. 75 - the wedge presses the band against the tooth and causes a slight separation of the teeth - the wedge is slightly wider than the distance between the cervical portions of the adjacent teeth Placing a wedge - ANSWER The instrument used for inserting the wedge is the #110 Howe pliers. The design of the pliers allows the operator to have proper grasp and pressure to position the wedge firmly into the embrasure. For posterior restorations, the wedge is most commonly positioned from the lingual side. Overhang and cupping due to improper wedge and matrix band placement - ANSWER The key criterion when placing a wedge is to create a seamless transition where the tooth and the restoration meet. Improper wedge and band placement can result in overhang or cupping of the final material. If restoration is not contoured properly it can result in overhang; if restoration is indented because of improper contouring, it can result in cupping. Overhang and cupping can cause food to get trapped leading to decay and also make it difficult to floss. It can also contribute to inflamed gingival tissue and periodontal disease and can cause long term bone loss. 76 Criteria for placing the posterior matrix retainer and band - ANSWER - Prepare the matrix band and retainer before the procedure. - Determine the number and type of wedges. - The diagonal slotted surface of the retainer is positioned toward the gingiva. - The retainer is positioned from the buccal surface of the tooth. - The handle of the retainer extends out from the oral cavity at the corner of the lips. - The seated band extends approximately 1 mm below the gingival margin of the preparation. - The seated band extends no farther than 2 mm above the occlusal surface of the tooth. Anterior matrix systems - ANSWER A clear plastic matrix is a type of matrix system used with anterior composite resin or glass ionomer materials. The clear plastic, aka the celluloid strip or mylar strip, is used for a class III or IV restoration when the proximal wall of an anterior tooth is missing. Purposes of the plastic matrix and wedge - ANSWER - The matrix is placed between the teeth before etching and priming of the tooth to protect adjacent teeth from these materials. - After placement of the composite material, the matrix is pulled tightly 77 around the tooth to help in reconstructing its natural contour. - The clear plastic allows the curing light to penetrate the material. How to contour a plastic matrix - ANSWER Pull the matrix lengthwise over the rounded end of the cotton pliers or mirror handle. Lingual surfaces hold the matrix in place while the material is adapted to the preparation. Matrix systems for primary teeth - ANSWER The T band and the spot-welded band T-band - ANSWER A copper based band in the shape of a T. When formed, the top portion of the T allows the straight portion to adjust and fit the circumference of the primary molar. Preparing the T band matrix involves the following steps: 1) Bend the wings of the T band to form a U shaped trough. 2) Slip the free end of the band loosely through the U formations. 3) Close the wings, and pull the free end to make a small loop of the band. 4) Holding the free end toward the facial surface, place the band loop on the tooth to be prepared. 80 preparation - n/a Moderately deep restoration - base Deep restoration - liner - base Ceramic restoration materials in order of use - ANSWER Shallow preparation - bonding system Moderately deep restoration - bonding Deep restoration - liner - bonding 81 Cavity liners - ANSWER A thin layer of flowable material placed in the most excavated area of the dentin layer for a therapeutic effect. This layer protects the pulpal tissue from irritation caused by physical, mechanical, chemical, and biologic elements. Examples are calcium hydroxide and glass ionomer. Calcium hydroxide - ANSWER One of the most frequently selected cavity liners. Examples include Dycal, VLC Dycal, and Life. - It protects the pulp from chemical irritation through its sealing abilities - It stimulates the production of reparative and secondary dentin - It is used for pulp capping of pulpal exposures and near exposure. - It is compatible w all types of restorative materials. Glass ionomer - ANSWER Resin-modified glass ionomer liners are indicated to form a strong bond to dentin, sealing the restoration to reduce microleakage and helping to reduce post op sensitivity. Examples include Vitrebond, Ketac bond, and Fuji lining. Liners are supplied either as a two-paste system (base and catalyst) or as a light-cured material. The material is prepared and placed w the use of a Dycal 82 applicator. The liner is placed in the deepest dentin surface of the preparation. This material is not to be placed on enamel or in retentive grooves of the prep. Cavity sealers - ANSWER Applied in a thin film that provides a protective layer within the prepared cavity. Examples are varnishes and desensitizer. Varnish - ANSWER A type of sealer that consists of one or more natural resins dissolved in an organic solvent. Varnish is placed within the entire preparation. Examples include Copalite, Plastodent, and Barrier. Application of a varnish accomplishes the following: - seals dentinal tubules - reduces microleakage around a restoration - acts as a barrier to protect the tooth from highly acidic base or cements such as zinc phosphate. Fluoride varnish - ANSWER Approved in the US in the early 90's. Fluoride varnish has a higher fluoride concentration than any other fluoride marketed, being 5% or 22,600 ppm fluoride. The main advantage is its versatility in use. This gel-like substance is designed to release fluoride on enamel, root structure, and dentin structure. It is applied with a small disposable applicator and placed after liner is applied. The use of varnish interferes with 85 similar to that of dentin. The disadvantage to this material is the phosphoric acid liquid component, which can be irritating to the pulp. Because of this, it is necessary to place a cavity liner before the zinc phosphate insulating base. Polycarboxylate cements are selected as a base for their protective and insulating qualities. It is nonirritating to the pulp and can be placed under all types of direct and indirect restorations. Glass ionomer cement can also be utilized as a base due to it's excellent adhesion to enamel and dentin. Combines light cure convenience w true glass ionomer fluoride release and bond strength. Examples of commercial based cements - ANSWER Zinc-oxide eugenol - IRM - ZOE - ZOE 2200 Zinc phosphate - Dropsin - Fleck's extraordinary - Hybond SP 86 - Modern Tenacin - Zinc cement improved Polycarboxylate - Carboxylon - Chemit - Durelon - Durelon fast set - Hybond - PC cement - Polybond - Poly-F Plus - Tylok Glass ionomer - ASPA - Chembond - Dentin Cement LC - Fuji lining LC - Ketac-bond 87 - Vitrebond - Zionomer Resin-modified glass ionomer - Fuji duet - Vitremer Cement Base application - ANSWER The material is mixed like a putty and condensed into the cavity preparation to provide a buffer or layer between the pulp and the restoration. The entire pulpal floor is covered w a base to a thickness of 1-2 mm. Dental etchant - ANSWER AKA tooth conditioner used prior to bonding and has a frosty appearance. Supplied as a liquid or a gel. 15-20 seconds is the most common recommended time from the manufacturers of etchants. Dental bonding - ANSWER AKA dental adhesion, is the process of attaining a solid and/or liquid contact of one material with another at a single margin. 90 - The dentist knows where to place retention in the prep to help in securing the restoration in place. Convenience form - The dentist has accessibility in preparing and restoring the tooth. Tooth preparation walls terminology - ANSWER Cavity wall - internal surface of the tooth prepared for the restoration Internal wall - cavity wall/surface that does not extend to the external tooth surface External wall - surface of the tooth prep that extends to the external tooth surface; named according to the tooth surface involved: mesial, facial, lingual, or gingival Axial wall - internal wall/surface of the prepared tooth that runs parallel to the long axis of the tooth Pulpal wall 91 - internal wall/surface of a prepared tooth that is perpendicular to the long axis of the tooth; aka the pulpal floor Enamel wall - portion of a prepared external wall that consists of enamel Dentinal wall - portion of a prepared external wall that consists of dentin Tooth preparation angles terminology - ANSWER Line angle - Angle formed by the junction of two walls/surfaces in a cavity preparation (similar to angle formed when two walls of a room meet to form a corner). To identify a line angle, the names of the 2 involves walls/surfaces are combined. For example, the angle formed by the mesial and lingual walls is called the mesiolingual line angle. It is important not to confuse the names of these angles with the names used to describe the surfaces involved in the restoration itself. Point angle - Junction of three walls/surfaces that are coming from a different orientation. 92 Final cavity preparation - ANSWER - Removing any remaining enamel within the prep, diseased dentin, or old restorative material (or a combination). - Inserting additional resistance and retention notches, grooves, and coves to provide strength in maintenance of the restoration. - Placing dental materials, which can include lining agents, bases, and desensitizing for protective purpose, or bonding agents, for pulpal protection and better retention. Class I restorations - ANSWER One surface lesion that involves the pits and fissures of a tooth. Articulating paper must be used to check bite. The Dentist will use a bur to open enamel, taking care not to create any sharp angles or corners within prep. Prep should be smooth throughout internal structure. - occlusal pits and fissures of premolars and molars - buccal pits and fissures of mandibular molars - lingual pits and fissures of maxillary molars - lingual pits of maxillary incisors Class II restorations - ANSWER Extension of class I into the proximal surfaces of the premolars and molars. 95 2) while waiting to receive a permanent restoration or 3) for financial reasons. Uses for dental cements - ANSWER - routinely used as a permanent adhesive material when working w indirect restorations - used as a base for protection of the pulp - as a temporary cement - to retain restorations or appliances in a fixed position within the mouth Classifications of dental cements - ANSWER Classified by the American dental association (ADA) and the International Standards Organization (ISO) according to their properties and intended use: Type I cements - classified as a luting agent - designed to act as an adhesive to hold an indirect restoration to the tooth structure, or to adhere brackets to the tooth surface during ortho treatment. - includes permanent and temporary cements Type II cements - involve materials that can be used as a restorative material, such as 96 Intermediate restorative material and dental sealants Type III cements - include liners and bases that are placed within the cavity preparation Cementing errors - ANSWER - the result if improper mixing technique - time - humidity - incorrect temperature of glass slab Guidelines for mixing dental cements - ANSWER • Before mixing, read and carefully follow the manufacturer's directions for the type of cement being mixed. • Determine the use of the cement (restorative, liner, base, cement); then measure out the powder and liquid according to the manufacturer's instructions. • Place the powder toward one end of the glass slab or paper pad and the liquid toward the opposite end (the space between allows room for mixing). • Divide the powder into increments. Each manufacturer uses a slightly different system for sectioning the powder. Some manufacturers divide the powder into equal parts, whereas others divide the powder into progressively smaller increments. When increment sizes vary, use the smaller increments 97 first. • Incorporate each powder increment into the liquid; then mix thoroughly. The mixing time per increment will vary according to the type of material and its use. Humidity and dental cements - ANSWER If the clinical area is warm or if it is a humid day, permanent exposure of the cement to these environmental conditions can create loss of water from the liquid or addition of moisture to the powder. Always dispense powder first, then the liquid, to minimize the loss of water from evaporation. Wait until it is time to mix the material before placing it on the pad. Do not set out at beginning of procedure. Glass ionomer cement - ANSWER One of the most versatile types of cement used in dentistry. It is a hybrid of silicate and polycarboxylate cements. This cement adheres to enamel, dentin; and metallic materials. Supplied in special formulations according to use: