General Dentistry

Chapter 48

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 Chapter 48

Lesson 48.1

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 Learning Objectives
 Define, spell, and pronounce the Key Terms.
 Describe the process and principles of cavity
preparation.
 Discuss the differences between assisting
with an amalgam and with a composite
restoration.

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 Introduction

Restorative and aesthetic dentistry is

focused on the general dental
needs of the patient.

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 Restorative Dentistry
 Specific conditions that initiate a need for
restorative dental treatment are:
 Initial or recurring decay.
 Replacement of failed restorations.
 Abrasion or the wearing away of tooth structure.
 Erosion of tooth structure.

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 Esthetic Dentistry
 Specific conditions requiring aesthetic dental
treatment:
 Discoloration due to extrinsic or intrinsic staining
 Anomalies due to developmental disturbances
 Abnormal spacing between teeth
 Trauma

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Terminology in Cavity Preparation

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 Initial Cavity Preparation
 Outline form
 Design and initial depth of sound tooth structure
 Resistance form
 Shape and placement of cavity walls
 Retention form
 To resist displacement or removal
 Convenience form
 Provides accessibility in preparing and restoring
the tooth

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 Final Cavity Preparation
 Removal of decayed dentin or old restorative
material
 Insertion of resistance and retention with
the use of hand cutting instruments
and burs.
 Placement of protective materials (liners,
bases, desensitizing, or bonding)

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 Patient Preparation for
Restorative Procedures
 Inform the patient what to expect throughout
the procedure.
 Position the patient correctly for the dentist
and the type of procedure.
 Explain each step to the patient as the
procedure progresses.

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 Responsibilities of the Chairside
Assistant
 Prepare the setup for the procedures.
 Know and anticipate the dentist’s needs.
 Provide moisture control.
 Transfer dental instruments and accessories.
 Mix and transfer dental materials.
 Maintain patient comfort.

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 Steps in the Restorative Procedure
 The dentist evaluates the tooth to be restored.
 The dentist administers local anesthesia.
 The assistant readies the chosen means of moisture control.
 The dentist prepares the tooth.
 The dentist determines the type of dental materials.
 The assistant mixes and transfers the
dental materials.
 The dentist burnishes, carves, or finishes the dental material.
 The dentist checks the occlusion of
the restoration.
 The dentist finishes and polishes the restoration.

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 Class I Restorations
 These restorations are used in class I lesions,
affecting the pits and fissures of the teeth.
 The following surfaces are involved:
 Occlusal pits and fissures of
premolars and molars
 Buccal pits and fissures of
mandibular molars
 Lingual pits and fissures of the maxillary molars
 Lingual pits of maxillary incisors, most frequently in
the pit near
the cingulum

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 Fig. 48-5 Class I restorations.

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 Class II Restorations
 A class II lesion is the extension of a class I
lesion into the proximal surfaces of premolars
and molars.
 The following surfaces are involved:
 Two-surface restoration of posterior teeth
 Three-surface restoration of posterior teeth
 Four-surface (or more) restoration of posterior
teeth

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 Fig. 48-7 Class II restorations.
(From Baum L, et al: Textbook of operative dentistry , ed 3, Philadelphia, 1995, Saunders.)

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 Class III and IV Restorations
 Class III lesion
 Affects the interproximal surface of incisors and
canines
 Class IV lesion
 Involves a larger surface area, including the incisal
edges and interproximal surface of incisors and
canines

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Fig. 48-9 Class III composite restoration.

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Fig. 48-10 Class IV composite restoration.

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 Class V Restorations
 Class V restoration
 Classified as a smooth-surface restoration.
 Decayed lesions occur at:
 Gingival third of the facial or lingual surfaces of
any tooth
 Root of a tooth, near the cementoenamel junction

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Fig. 48-13 A, Class V conventional tooth preparation. B,
Schematic representation illustrating tooth preparation.
(From Roberson T, et al: Textbook of operative dentistry , ed 4, Philadelphia, 2006, Elsevier.)

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 Chapter 48

Lesson 48.2

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 Learning Objectives
 Discuss why retention pins would be selected
for a complex restorative procedure.
 Describe the need for placement of an
intermediate restoration.
 Describe the procedure of composite
veneers.
 Describe tooth-whitening procedures and the
role of the dental assistant.

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 Complex Restorations
 Such restorations are required when decay
has extended beyond the normal size or
shape.
 Retention pins
 Decay has extended into the cusp of a tooth and
undermined the enamel and dentin.
 General understanding when using retention pins:
One pin is placed for each missing cusp.

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Fig. 48-14 Retention (retentive) pins placed in tooth structure
to help retain and support a restoration.

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 Intermediate Restorations
 Restoration placed for a short term.
 Primary factors for placement
 Health of the tooth
 A wait to receive a permanent restoration
 Financial reasons

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Procedure 48-5 Placement of intermediate restorative material.

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 Direct Bonded Veneers
 Veneer
 Thin layer of tooth-colored material, applied to the
facial surface of a prepared tooth
 Used to improve the appearance of teeth that
are:
 Abraded
 Eroded
 Discolored with intrinsic stains
 Darkened after endodontic treatment

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Fig. 48-15 Veneers placed to reduce discoloration and cover stain.
(From Roberson T, et al: Sturdevant’s art and science of operative dentistry , ed 4, St Louis, 2002, Mosby.)

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 Fig. 48-16 Veneers placed to close diastema.
(From Roberson T, et al: Sturdevant’s art and science of operative dentistry , ed 4, St Louis, 2002, Mosby.)

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 Tooth Whitening

Known as vital bleaching, tooth whitening

is a noninvasive method of lightening
dark or discolored teeth.

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 Indications for Using a Tooth
Whitener
 Indications for Procedure
 Extrinsic stains from foods, cigarette smoking,
coffee, or tea
 Aged, discolored teeth
 Intrinsic stains, such as mild tetracycline stains
and mild fluorosis

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 Fig. 48-17 Before-and-after photos of
tooth whitening used for extrinsic stains.

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 Fig. 48-18 Before-and-after photos
of tooth whitening used for intrinsic stains.
(From Roberson T, et al: Sturdevant’s art and science of operative dentistry , ed 4, St Louis, 2002, Mosby.)

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 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

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At-Home Tooth-Whitening Procedure
 Material is placed in a thermoplastic custom
tray that the patient wears
for a designated period.
 With the 10% to 16% carbamide peroxide gels, the
wear schedule is 1 hour twice a day for the first
week and once a day for the second week.
 The 20% to 22% mixture is used for 1 hour a day
for 2 weeks.
 Hydrogen peroxide is used for 15 to 30 minutes,
two or three times a day, for 2 weeks.

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 Tooth-Whitening Strips
 Thin, flexible strips are coated with
an adhesive hydrogen peroxide whitening gel.
 Application
 The patient peels off the backing like a Band-Aid
and presses the strip to the facial anterior teeth.
 The remaining portion of the strip is folded onto
the lingual surface.

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 Possible Complications to Tooth
Whitening
 Thermal hypersensitivity
 Patient may experience sensitivity to heat and cold
after removal of the tray and material. The use of
toothpaste for sensitive teeth is recommended.
 Tissue irritation
 Gingival tissue exposed to excess gel as a result
of improper tray fit may become irritated. Tell the
patient not to overfill the tray with material and to
remove any excess after seating the tray.

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 Dental Assistant’s Role in
Tooth-Whitening Procedure
 Aid in recording the medical and dental history.
 Assist in making shade selection.
 Take intraoral photographs before and after
whitening.
 Take and pour up preliminary impressions for
the tray.
 Fabricate and trim the tray.
 Provide postoperative instructions.
 Assist in weekly or biweekly clinical visits.

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 Patient Instructions for
Tooth-Whitening Procedure
 Brush and floss before tray placement.
 Place equal amounts of gel in tray.
 Seat tray.
 Do not eat or drink when wearing the tray.
 Wear tray for the recommended time.
 If the patient experiences any problems,
discontinue use and discuss with the dentist.

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