EXERCISE NO.

10: TUNNEL PREPARATION AND RESTORATION WITH DIRECT

COMPOSITE RESIN AND GLASS IONOMER CEMENT

Procedure

Tooth Preparation and Restoration Procedures:

1. Dry tooth to be prepared. Mark with the articulating paper the centric occlusal relationship.

2. Place a wooden wedge below the proximal surface.

3. Cut the through the occlusal enamel 2 mm inside the marginal ridge with a No. 2 round

diamond. Make sure that the marks made by the articulating paper in centric holding contacts are

not removed. Continue penetrating through the enamel with a slow-speed round bur or a spoon

excavator with reference to the depth measuredon the

radiograph. The perioprobe is used to measure the depth. Transilluminate to help visualize the

lesion.

4. Determine the extent of decay with the use of a caries indicator and an explorer. Remove the

stained caries completely cutting into the proximal wedge.

5. Remove the wedge and check the extent of the preparation. If the gingival completely fills the

proximal space, small preparations may not be visible.

6. Repeat staining with the caries indicator to ensure caries removal.

7. Another bite-wing radiograph may be taken to ensure if the preparation includes all the carious

lesion.

8. Apply a thin layer of calcium hydroxide if the preparation is near the pulp.

9. Position a small piece of metal matrix at the proximal to cover the preparation opening. Insert

and adapt the wedge.

10. Clean the preparation with polyacrylic acid, then wash and dry. A 20% stannous fluoride

solution may be used to wash the dentin instead of the poly acrylic acid

11. With a syringe, inject the autocured (radiopaque and has better physical properties than other

GI) glass ionomer up to the dentinoenamel junction. Obliterate completely the proximal access

and cover all dentin walls.

12. After it has set, etch both enamel and the glass ionomer for 30 seconds or as per instruction

of the manufacturer. Prime and bond. Insert and adapt the composite on the enamel walls and

cure.

13. Remove the wedge, matrix, and any proximal glass-ionomer flash/excess with a Bard Parker

blade. Floss.

14. Finish the occlusal with a fine-grit diamond and finish and polish.

Review Questions

1. Draw a tunnel preparation using the mesiodistal longitudinal view of your specimen tooth.

Indicate and label the restorative materials recommended for

2. Give the indication and limitation for a tunnel restoration.

3. Why is composite resin the choice of material within the enamel wall of the tunnel

preparation?

4. How much sound tooth structure should be considered before opting for a tunnel restoration?

Show the measurement in your drawing with respect to your reference points.