Lec8

OPERATIVE DENTISTRY 2 | DOD2 41

Auxiliary Retention Forms for CAR

Ture Dr Kathrene Faye Lampa
First Semester – Midterms
Auxiliary Retention Forms  Cemented pin
 Pins
 Friction-locked pin
 Dentinal Slots
 Self-threading pin
 Amalgapins

 Groove Extensions

(1) Cemented Pin

Tooth Preparation for Pin-Retained
Amalgam Restoration
 A pin-retained amalgam (also referred to as a "pin amalgam") is  Primary source of retention: Cement
defined as any restoration requiring the placement of one or more
 Least retentive
pins in dentin to provide adequate resistance and retention forms.
 Pinhole is bigger than the diameter of the pin
 Pins are used whenever adequate resistance and retention forms are
not able to be established with slots, grooves, or undercuts only.  Embedded 3 mm into dentin
 Amalgam restorations including pins have significantly greater  Cement enters through the rough walls
retention compared with restorations using boxes only or restorations
relying solely on bonding systems.  Used to build foundation after endodontic
treatment

Pins
 More conservative of tooth structure
than other retention forms (2) Friction Locked
 Usually made of metal, stainless steel
 Inserted like a nail hammered into place
 Inserted vertically
 Retained by friction in a small, narrow
 Increases retention form pinhole
 Decreases resistance form of tooth &  Fewer serrations
amalgam
 Embedded 3mm into dentin
 May cause dentinal crazing
 Used in vital teeth with good access and ease
 Formation of small crack on dentin
of tapping the pins
 Increases risk of pulpal & periodontal
perforation
(3) Self Threading
 Frequently used in preparations with little or no vertical walls  Most Frequently used

 Many serrations

 Most retentive - ↑ serrations, ↑ retention

 Inserted like a screw - threaded in place

 Embedded 2mm into dentin, but there

must also be 2mm of the pin jutting out
into the amalgam and another 2mm of
amalgam on top of the pin

 Clearance of at least 4mm from the

area where you will put it

 Used in vital teeth

Pin Type Cemented Friction-locked Self-threading

Types of Pins Size of pinhole .001-.002 in .001 in smaller .0015 in smaller

 larger than pin than pin than pin (1) Pin size

Source of Cementing Resiliency of Resiliency of  Self- threading pins are available in several sizes
retention medium dentin dentin
 Size of pin is determined by:
Depth of pin 3 mm 3 mm 2 mm
insertion in  Amount of dentin available to receive pin
dentin
 Amount of retention needed

*The complete width of the threads of self-threading pins does not engage
dentin

**size of pinhole is very critical to what type of pin to use

Factors affecting Pin Retention in Dentin

 Pin type: Self-threading > friction-locked > cemented
**Four sizes of the Thread Mate System (TMS) pins. A. Regular (0.78 mm), B.
 Surface characteristics(serration): the greater the depth & number of Minim (0.61 mm), C. (Minikin) (0.48), D. Minuta (0.38 mm)
elevations on pin, the better the retention

 Orientation: Retention is increased by putting pins in non-parallel

(2) Number of pins
manner(slightly offset)
 Factors to consider:
 Number of pins: Within limits, increasing # of pins increases retention
 Amount of missing tooth structure
 (1) Amount of missing tooth structure,
(2) Amount of dentin available to receive pins safely,  Amount of available dentin
(3) Amount of retention required,
(4) Pin size  Amount of retention needed

 One pin per missing cusp and placed on the axial line angle  Size of pins

 Diameter of pin: Within limits, increasing diameter of pins increases  General rule: One pin per missing line angle
retention

 Surface of pin: The number and depth of the elevations (serrations or

threads) on the pin influence retention of the pin in the amalgam (3) Pin location is aided by:
restoration.
(a) Knowledge of normal pulp anatomy: The line angles are the four corners

 Max # of pins in a Molar = 4

 Extension Into Dentin and Amalgam:
 Self-threading pin extension into dentin and amalgam should be
approx. 1.5 to 2 mm to preserve the strength of dentin and
amalgam.
 Extension greater than this is unnecessary for pin retention and
is contraindicated.
 You never put a pin in the middle (midbuccal or midlingual)
because you can perforate into the periodontium
 Maxillary molars: never put pins in the cusps or furcations;
palatal root location
 Mandibular molars: don't put pins in the mid-buccal and mid-
lingual

 Maxillary first premolars: never put a pin in the mid- mesial

 Fluting on the rooth surface PM1

(b) Current radiograph of tooth

 Gives indication of pulp chamber position & proximal tooth

surface contour

 They will only tell you how big the pulp is and what to avoid,
not to tell you where not to place the pin
Technical Considerations in Pin Placement
(c) Periodontal probing

 to check if any abnormal contours exist

 Don't break the epithelial attachment

 You want to feel for the contour of the proximal surface

(d) Patient's age

 Harder to work on younger patients because of their bigger **Care must be exercised when preparing pinholes in mesially fitted molars
pulp chambers to prevent external perforation on mesial surface (A) and pulpal penetration
on the distal surface (B).

Pin Location
 Pinhole must be positioned at least 1 mm from the DEJ or 1.5 mm
from external tooth surface.

 The pinhole should be

parallel to the adjacent
external surface of the
tooth.

 Never directly on the DEJ

 Never put pins too close

to the vertical walls

 Don't put a pin too close to axial wall **When placing pinholes in molars and interarch space is limited, care must
be exercised to prevent external perforation on distal surface.
 This will make amalgam condensation difficult

 Provide 0.5 mm clearance around pin by preparing a "cove"

 When using 3 or more pins, locate them at different levels, if possible.

 Stresses will not be placed in same transverse plane

 Pulpal stress is maximal when the self-threading pin is inserted

perpendicular to the pulp.

A, Pin placed too close to the vertical wall such that adequate condensation
of amalgam is jeopardized, B and C, Recessed area prepared in the vertical
wall of the mandibula molar with a No. 245 bur to provide adequate space
for amalgam condensation around the pin.  Interpin distance (spacing between pins): must be considered for
those with more than one prepared pinhole.

 The optimal interpin distance depends on the size of pin to be

 Pin holes should be located on a flat surface perpendicular to used.
direction of the pinhole.
 Minimal interpin distance

 3mm for the Minikin (0.019 inch [0.48 mm])

 5mm for the Minim (0.024 inch [0.61 mm])

 The diameter of the prepared pinhole is 0.0015 to 0.004 inch smaller

than the diameter of the pin for self-threading types

 The depth of the pinhole varies from 1.3 to 2 mm, depending on the
diameter of the pin used but a general guideline for pinhole depth is
2mm
 Pin Placement
 Prepare a pilot hole using a 1/4 bur

 Angulate twist drill so it is parallel to tooth's external surface

 Prepare pinhole using twist drill in 1-2 thrusts up to 2 mm.

 Thread pin to bottom of pinhole

 Evaluate length of pin extending from dentin

 Using a sharp 1/4 bur held perpendicular to pin, cut pin to length

 Evaluate need for bending pins

**Five (5) possible locations of failure of pin-retained restorations:

(a) fracture of restorative material
(b) sepration of pin from restorative material
(c) fracture of pin
(d) separation of pin from dentin
(e) fracture of dentin

 If needed, use bending tool to bend pin properly

 Pins are bent to provide adequate bulk of amalgam around pin

Tooth Preparation for Slot-Retained
Amalgam Restoration
 When loss of vertical coronal height is approximately 2 to 4 mm, then
use of slots, in horizontal areas where no vertical walls remain, may be
indicated to gain secondary retention form for the complex amalgam
restoration.

Dentinal Slots
 Are retention grooves whose length is in a transverse plane (horizontal  In addition to any slot placement, retention grooves and coves may be
retention groove in dentin). utilized in association with remaining vertical walls

 Prepared in dentin with a 33 ½(inverted cone) or 330(pear) bur 1.0
mm from the DEJ.
 May be prepared continuously from one axial wall to another or
several short ones may be made.
 Coves are prepared in a horizontal plane
 Grooves are prepared in a vertical plane.
 Coves also may be used in preparations using slots.

RULES  Proximal retention grooves, as described for wide Class II

preparations, also are placed in the proximal box and in other
 One slot per missing axial line angle. locations where sufficient vertical tooth preparation permits.

 Increasing the width and depth of the slot does not increase the Coves
retentive strength of the amalgam restoration.

 The walls of the slot should work together with other vertical walls to
create an overall convergence of the preparation so as to enhance
retention of the restoration.

**Coves prepared in dentin with No. X bur. where appropriate.

Vertical Grooves

**Slots. A and B. With a No. 330 bur. dentinal slots are prepared
approximately 1 mm deep and 0.5 to 1 mm inside the DEJ.
*coves shallow version of dentinal slot

**Vertical grooves prepared in dentin with a No. X round

or No. 169L bur. where appropriate.

*continuous or not continuous

 Not as conservative of tooth structure

 There must be sufficient dentin on which to prepare the slots

 Because they are 0.5 mm deep pulpally, there is less risk of pulp or
periodontal perforation.

** Groove (A), Slot (B), and coves (C).

Dentinal Slots vs Pins

Coves and Grooves  There is no statistically significant difference in
retention between pins and slots
 To decide which , it depends on the amount of
tooth structure left

AMALGAPINS
 Children of pins and dentinal slots ("hybrid")

 Pins made of amalgam (combination of pins and amalgam)

 Prepare 2.0 mm deep pinholes, bevel lips of hole and plug amalgam

GROOVE EXTENSIONS
 Adequate retention usually can be achieved by the placement of a
horizontal groove in the gingival and occlusal aspect of the
preparation.

 Marginal ridge extensions

 Prevents rotational forces

 Extension on buccal against lingual displacement (and vice versa)