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Filling and Materials

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shahnavaz khijmatgar

on 14 October 2012

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Transcript of Filling and Materials

Filling and Materials To Understand the basic concepts of different fillings and materials. Aim To study different classes of cavities.

To study the different classes of filling materials.

The know the advantages and disadvantages of the filling materials.

To study various instruments to handle the filling materials.

To study different kinds of equipments in dentistry. Objectives The Aims of tooth restoration. INTRODUCTION To restore the tooth to its normal shape.

To restore the function of tooth, for adequate mastication.

To restore the retentive shape of the tooth if it acts as a bridge abutment.

To restore aesthetics.

Alleviate discomfort or pain. Blacks Classification (1891) Classification of cavities Class I.

Class II.

Class III.

Class IV.

Class V. Class I Class II Class III Class IV ClassV Principles of Cavity Preparation No caries or plaque must be left on the cavity walls.

Undermined enamel is removed.

The cavity is made retentive by cutting tiny grooves in the cavity walls.

Burs, chisels and cervical margin trimmers are then used to finish of the cavity. Instruments Excavator

Low speed hand piece.

Enamel chisel.

Cervical margin trimmers. Retension Permanent fillings requires good retension.

There are two types of fillings used for retension (a) Plastic.
(b) Prefabricated. (a) Plastic fillings

They are soft and plastic.

These includes temporary cements, amalgam,glass ionomer cement and composite fillings. (b) Pre-fabricated These are Inlays.

These are made in labs and cemented in place in the practice. Retension of Plastic fillings is Obtained by simply cutting tiny grooves in the cavity walls.

For Mesial and Distal surfaces restorations a dovetail is made. Retension for Inlays Parallel walls of the cavity.
Mesial and distal dislodgement. Cavity Lining A "Lining" is an insulating layer of cement. Functions:
Temperature.
Chemical.
Mechanical.
Biological. Materials:
Zinc oxide eugenol.
Zinc phosphate.
Calcium hydroxide.
Glass ionomer.
Zinc Polycarboxylate. Polishing To trim excess spots or high spots or prominent edges.

Some fillings are polished immediately and some are done in later visits. Moisture Control Protect the patient from fluid inhalation.

Ensure the patient is comfortable during treatment.

Allow the dentist good visibility.

Allow the restorative material correctly, without moisture contamination.

Allow the adhesion of cements and linings to the tooth.

Allow the uncontrolled loss of materials from the cavity during use, such as acid etchant which can burn soft tissues. Suction High Speed.
Low Speed. A dental nurse assists a dentists by holdong a wide-bore aspirator tube to provide high speed suction. Absorbent materials Cotton wool rolls.
Absorbent pads. Blowing of the cavity. Rubber dam Best method of moisture control.

It is a thin sheet of rubber which is placed over a tooth to isolate.

A Rubber dam punch, used for punching a small hole in the rubber sheet.

Rubber dam clamp which is fixed to the tooth.

Rubber dam clamp forceps helps to fix clamps.

Rubber dam frame is used to support the sheet of rubber.

Dental floss id used to work the rubber between the teeth. Instruments 1- Mouth Mirror.
2- Right-angle probe.
3- College tweezers.
4- Excavators.
5- Amagam plugger.
6- Burnisher.
7- Plastic Instruments. Mouth mirror Instruments For vission, to reflect light onto the tooth, to protect and retract the soft tissues. Right Angle Probe to feel cavity margins, to detect softened dentine, to detect overhanging restorations. College tweezers Instruments To hold and carry various items. Excavators Small and large, to spoon out softened dentine. Amalgam pluggers Instruments To press the plastic materials into the cavity.
To ensure no air spaces remain under the material.
To remove excess mercury from the amalgam mix. Burnishers Ball and pear shaped.
To ensure the material margins are fully adapted to the cavity walls, to prevent leakage under the restorations. Plastic Instruments Instruments To adapt the plastic filling material to the cavity walls.
To remove excess filling material before setting occurs.
To ensure a smooth marginal contact from the restoration to the tooth. Cavities arecut with hand pieces.
Speed depends on the type of hand piece used.
The hand piece have built in water spray to reduce heat generated.
Airturbine hand pieces have very high speeds.
Airturbine uses friction grip diamond or tungsten carbide burs to cut easily.
The advantage of airturbine is ease of cutting.
The disadvange is lack of tactile sensation. Hand Pieces These hand pieces run at around 40,000 revolution per minute.
These are used for root canal treatment.
Removal of carious dentine.
They are more friendly user.
They have good tactile sensation provided is much better.
Some are contrangle hand piece.
Straight hand piece. Slow hand pieces Bur are low speed are made of stainless steel.
Diamond. ( High Speed)
Tungsten carbide. (High speed)
Contrangle hand piece are short and have a notch fits by latch grip.
short burs in air turbine hand pieces gives a friction grip.
Miniature hand pieces and burs for children. BURS Round - Used for gaining acces to the cavities and at low speed for removing caries.
Pear - used for shaping and smoothing cavities.
Fissure - used for shaping and outlining the cavity. Shapes of the Burs Zinc Oxide Eugenol Cement.
Zinc Phophate Cement.
Zinc Polycaboxylate cement. Temporary Filling Materials As an emergency measure to seal a cavity and prevent carious ingress.
During endodontic treatment, repeated excess is required.
During inlay construction to seal the preparation while the permanent inlay is constructed.
To allow symptomatic tooth to settle and become symptom free, before being permanently sealed. Purpose of Temporary Filling Quick mixing and placement.
Cheap compared with permanent restorative materials.
easily removed from the cavity when required.
Not strong enough to be chewed on routinely.
Have varying degrees of adhesiveness to the tooth.
Some contain sedative ingredients to help settle inflamed pulps. The key features of TF Preparation as zinc oxide powder and eugenol liquid.
Mixed by spatulation on a glass slab with a metal spatula.
Used as a temporary filling, as a lining in deep cavities, during root filling and as a sedative dressing. Zinc-oxide and Eugenol Preparation as zinc oxide powder and phosphoric acid liquid.
Mixed by spatulation on a cool glass slab with a metal spatula.
Used as a temporary filling, as a lining, as a luting cement and for endodontics. Zinc Phosphate Preparation as zinc oxide and polyacrylic acid as powder, and sterile water as liquid.
Mixed by spatualtion on a glass slab with a metal spatula.
used as a temporary ,a s a luting cement, as a lining and for endodontics. Zinc polycarboxylate Preparation as a preformed cones or sticks of rubber.
Only requires heat to become plastic.
used as a temporary filling with zinc oxide and in endodontics and vitality testing. Gutta Percha Materials Advantages and Disadvantages Advantages Disadvantages Zinc Oxide Eugenol Cheap; sedative to inflamed
pulp. Reacts with composites;
Eugenol can burn to the soft tissues Zinc phosphate Sets quickly; sets hard;
Adhesive to dentine Irritant to pulp in deep cavity;
Moisture sensitive Zinc Polycarboxylate Most adhesive cement Sticks easily to instruments so difficult to place. Gutta Percha None over other cements listed Messy to use; poor margin adaptation
in cavity Preparation as a calcium hydroxide and resin in solvent.
Usually supplied in ready-mixed paste form.
Used as a lining under other materials, in pulp capping procedures and in endodontics.
Advantages - Alkaline, so it counteracts acidic zinc phophate, and kills bacteria causing caries.
Disadvantages - It is soluble in water, and not strong enough to use alone.
Modern calcium hydroxide cements are availaible as light cured liners. Calcium Hydroxide Set hard enough to chew on without fracture.
Easy to use and place, using the usual conservation intruments.
Have a reasonable working lifespan.
Be safe in the oral cavity.
Do not deteriorate in saliva. Permanent Restorations General properties The three commonly used materials are; Permanent Restoration Amalgam.
Composite.
Glass ionomer. This is the commonest permanent restorative material.
It is supplied as a powdered alloy AMALGAM Silver - 70%
Tin
Copper
inc Mercury Modern amalgams are provided in sealed containing the alloy powder and liquid mercury.

The mercury is seperated from alloy powder by a rubber diaphragm.

These capsules are kept in amalgamators. Amalgam Capsules Metallic Matrix Band.
Retainer.
Wooden wedges CLASS II CAVITIES The materials required; Easy to use.

Relatively Cheap.

Good Strength.

Able to withstand normal occlusal forces.

Lasts for many years. Advantages Disadvantages Mercury is Toxic.

Not retentive to tooth, so cavities have to be undercut


Can transmit thermal shocks, so liners and bases are required in deeper cavities.

Has to be mixed very accurately to be dimentionally stable.

Asthetics are poor. Inhaled

Absorbed

Ingested Safe Handling and Usage of Amalgam Mercury is a toxic liquid metal that can enter the body
in the following ways; as a vapour though the skin. Thank you Headache

Fatigue

Irritability

Nausea

Diarrhoea Symptoms of Mercury Poisoning Hand Tremors.

Visual defects. Late Symptoms FINAL STAGE KIDNEY FAILURE Wear disposable gloves.

Do not wear open-toed shoes.

Do not wear jewellery Prevention from absorption of mercury through skin Containers of the mercury must be sealed tightly.
Avoid spillage.
Use precapsulatd capsules.
Use high speed hand pieces and carbide burs for removal of hand pieces.
All traces of amalgam should be removed before sterlising.
Keep surgery well ventilated.
Keep ready Mercury spillage kit. To avoid pollution of the air by mercury vapour Smoking, eating, drinking and application of cosmetics should be avoided.
The handling and storage should be at one place.
All handling of mercury and preparation of amalgam must be done over a drip tray.
Splillage should be reported to dentist.
Special kits are availaible for spillage mercury.
Floor covering should not have cracks or gaps.
Modern aspirators must be fitted with an amalgam trap.
waste amalgam must be saved in sealed tubs containing a mercury absorption.
Avoid high surgey temperatures. Surgery Hygiene Special waste contractors Disposal of waste amalgam Mercury Container Mercury Spillage Mercury drawn Lead foils for globules Large Spillage Explain.............. Mercury Blood Test.

Urine Mercury Test Tests for detecting mercury Vapours COMPOSITE FILLING MATERIALS These are tooth coloured materials.

Most commonly used for anterior teeth.

Has wear wear resistance. COMPOSITES Inorganic filler consists of ;

Powdered glass.

Quartz.

Silica.

Other ceramic materials. Composition Inorganic Filler in a resin binder. Microfine Composites.

Hybrid Composites.

Universal Composites. Modified form of the composites Chemical Cure.

Light Cure. Types Supplied in 2 forms of paste.

Resin binder +Inorganic filler.

Another paste consists of catalyst. Chemical Cure System Advantages Disadvantages Superior Asthetics.
Adhesive to enamel using acid etch and primers.
Minimal marginal leakage.
Cavities can be lined with Calcium hydroxide alone.
Strength is suffiecient to be used in smaller posterior restorations.
Can be used for inlays.
Light cured products are used immediately. Technique Sensitive.
Time consuming.
Expensive.
Not enough hardness.
React with all temporary filling materials.
Etchants are strongly acidic.
Curings lamps can cuase damage. ACID ETCHING RESTORATION OF FRACTURED INCISORS RETENSION Restorative Materials A sound understanding of the procedure to be carried out.

The awareness of role in the dental during the procedure.

Records, charts, radiographs, consent forms completed and availaible for the appointment.

Communication

Monitoring

Assistance during the administration of LA.

Provide careful but efficient moisture control and soft tissue retraction

Role of Dental Nurses Be aware of the required lining, base and restorative material to be used for the procedure.

Skillful in passing the instrument to the dentist required.

Follow infection control policy after every use.

Health and safety policy.

Records are kept safe for future reference.



Role of Dental Nurses
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