Restorative Procedures

Copyright 2003, Elsevier Science (USA). All rights reserved.

Restorative and Esthetic Dentistry

Chapter 48

Copyright 2003, Elsevier Science (USA).

All rights reserved. No part of this product may be reproduced or transmitted in any form or by any means, electronic or mechanical, including input into or storage in any information system, without permission in writing from the publisher.

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Produced in the United States of America

ISBN 0-7216-9770-4


Introduction

Restorative and esthetic dentistry is the treatment of the general dental needs of a patient.


Restorative Dentistry

Specific conditions that initiate a need for restorative dentistry are:• Initial or recurring decay. • Replacement of failed restorations. • Abrasion or the wearing away of tooth

structure.• Erosion of tooth structure.


Esthetic Dentistry

Specific conditions that initiate a need for esthetic treatment are:• Discoloration due to extrinsic or intrinsic

staining. • Anomalies due to developmental

disturbances. • Abnormal spacing between teeth. • Trauma.


Principles of Cavity Preparation

Initial cavity preparation• Develop the outline form and initial

depth.• Establish primary resistance form. • Establish primary retention form.• Provide a convenience form.


Final cavity preparation

• Remove any remaining enamel in the preparation, infected dentin, or old restorative material.

• Apply additional resistance and retention locks, grooves, and coves to provide strength in the maintenance of the restoration.

• Place dental materials that may include lining agents, bases, and desensitizing or bonding agents for pulpal protection and better retention.

Principles of Cavity Preparation− cont’d


Table 48-1: Terminology in Understanding Cavity Preparation


Patient Preparation for Restorative Procedures

Inform the patient of the procedure to be performed and what to expect during the treatment.

Position the patient correctly for the dentist and the type of procedure.

Explain each step as the procedure progresses.


Responsibilities of the Chairside Assistant

Know the procedure and be able to anticipate the dentist's needs.

Prepare the setup for the procedures. Provide moisture control and better

visualization by means of high velocity suction ‑and air water syringe.‑

Transfer dental instruments and accessories. Mix and transfer dental materials. Maintain patient comfort and appropriate

exposure control precautions.


Components of a Restorative Procedure Dentist evaluates the tooth to be restored. Dentist obtains local anesthesia. Assistant readies the type of moisture control to be

used during the procedure. Dentist prepares the tooth for the restoration. Dentist determines the type of dental materials to be

used. Assistant mixes and transfers the dental materials. Dentist burnishes, carves, or finishes the dental

material. Dentist checks the occlusion of the restoration. Dentist finishes and polishes the restoration.


Class I Restorations A class I lesion affects the pit and fissures of

the teeth. Surfaces involved are:

• Occlusal surfaces of premolars and molars. • Occlusal two thirds of the facial surfaces of

mandibular molars. • Occlusal third of the lingual surfaces of the

maxillary molars. • Lingual surfaces of maxillary incisors, most

frequently in the pit near the cingulum.


Fig. 48-5, A-D Class I restoration.


Class II Restorations

A class II lesion is an extension of the class I lesion into the proximal surfaces of premolars and molars.

Areas for class II decay involve:• Two-surface restoration of a posterior tooth. • Three-surface restoration of a posterior

tooth. • Four- or more surface restoration of a

posterior tooth.


Fig. 48-7, A-C Class II restorations.


Class III and IV Restorations

A class III lesion affects the interproximal surface of incisors and canines.

A class IV lesion involves a larger surface area, which includes the incisal edge and the interproximal surface of incisors and canines.


Fig. 48-8 Class III restoration.


Fig. 48-9 Class IV restoration.


Class V Restorations A class V restoration is classified as a smooth

surface restoration. These decayed lesions occur at:• The gingival third of the facial or lingual

surfaces of any tooth.• The root of a tooth, near the

cementoenamel junction.


Complex Restorations

Retentive Pins • Placed when decay has extended into the

cusp of a tooth and undermined the enamel and dentin.

• The general understanding when using retention pins is that one pin is placed for each missing cusp.


Intermediate Restorations Restoration that is placed for a short term. Factors for placing an intermediate

restoration is:• The health of the tooth. • Waiting to receive a permanent restoration. • Financial reasons.


Direct Bonded Veneers A veneer is a thin layer of tooth colored ‑

material applied to the facial surface of a prepared tooth.

A veneer is used to improve the appearance of teeth that are:• Abraded.• Eroded.• Discolored with intrinsic stains.• Darkened after endodontic treatment.


Tooth Whitening

Commonly known as vital bleaching, tooth whitening is a noninvasive method of lightening dark or discolored teeth.


Indications for Using a Tooth Whitener

Indications for procedure:• Extrinsic stains from foods, cigarette

smoking, coffee, or tea. • Aged teeth. • Intrinsic stains, such as mild tetracycline

stains and mild fluorosis.


Whitening Products

Chemical makeup• Active ingredient

• Either carbamide peroxide or hydrogen peroxide.

• Gel base • With one or a mixture of propylene glycol,

glycerin, and water. • Thickener

• Carbopol.


Tooth-Whitening Procedure

Material is placed in a thermoplastic custom tray that the patient wears for a designated period.• For the 10% to 16% carbamide peroxide gels,

the wear schedule would be for 1 hour, twice a day for the first week and once a day for the second week.

• For the 20% to 22% mixture, 1 hour a day for a 2-week period.

• For the hydrogen peroxide 15 to 30 minutes, 2 or 3 times a day for a 2-week period.


Possible Complications to Tooth Whitening

Thermal hypersensitivity • Patient may experience sensitivity to heat and

cold after removal of tray and material. The use of sensitive-type toothpaste is recommended.

Tissue irritation• Gingival tissue exposed to any excess gel may

be caused by improper tray fit, allowing the material to ooze onto the gingiva. The patient is recommended to not overfill the tray with material and to remove any excess after seating the tray.


Dental Assistant's Role in Tooth-Whitening Procedure Aid in the recording of the medical and dental

history. Assist in making the shade selection. Take intraoral photographs before and after the

procedure. Take and pour up the preliminary impression for the

custom tray. Fabricate and trim the tray. Provide postoperative instructions on the use of the

material. Assist in weekly or biweekly clinical visits.


Patient Instructions for Tooth-Whitening Procedure

Brush and floss before tray placement. Place gel in tray in an equal limited amount. Seat tray. Instruct the patient not to have any food or

drink when wearing the tray. Instruct the patient to wear the tray for the

recommended time. If the patient experiences any problems during

this time, discontinue use and discuss with the dentist.


Tooth-Whitening Strips

Thin, flexible strips coated with an adhesive hydrogen peroxide whitening gel.

The patient peels off the backing like a Band-Aid and presses the strip to the facial anterior teeth, making sure that the upper edge of the strip is at the gingival margin. The remaining portion of the strip is folded onto the lingual surface.

Restorative Procedures

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