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Amalgam Polishing and Pulp Vitality Testing

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Suzanne Garrison

on 9 June 2014

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Transcript of Amalgam Polishing and Pulp Vitality Testing

Amalgam Polishing
Dental Practice Benefits
Until polished, amalgam restorations aren't considered complete.
A properly contoured, polished restoration will contribute to the longevity of the restoration and the health of the surrounding periodontium.
Amalgam Polishing
Things to Remember
Amalgam polishing requires a slightly abrasive paste (such as pumice or tin oxide)
Thermal heat from polishing can cause damage to the pulp, while also bringing the mercury to the top of the amalgam, giving a "cloudy" appearance.
While polishing, direct compressed air onto the amalgam
Prevention of Recurrent Decay
Rough/unsmooth margins after placement of amalgam restorations cause a risk in plaque and debris build up.
Polishing- smooths and creates a lustrous finish of those surfaces allowing plaque and debris reduction and making the restoration easier to clean.
Prevention of amalgam deterioration
Tendency to tarnish and corrode
Tarnish- discoloration on the surface of the amalgam. Faster onset with unpolished amalgams. Non-damaging.
Corrosion- destructive attack on surface that causes pitting and breakdown of margins of restorations.
Mainteanance of periodontal Health
Maintain a healthy environment
Ensure patients ability to cleanse the areas.
Most critical areas that affect patients OH and periodontium are: F, L, & proximal surfaces.
Embrasures & contact areas are of importance because this is where food and debris get trapped.
Restorations that are improperly placed in the contours can cause periodontal breakdown to occur.
Recontouring the improperly placed restoration allow for better polishing procedures
Prevention of occlusal problems
A restoration that is left in premature occlusion can cause:
Pain & sensitivity, Esp. in mastication
Severe cases: restoration or opposing tooth may fracture
Therefore, performing polishing procedures lead to increase in the lifetime of the restoration.

Amalgam Polishing and Pulp Vitality Testing
By: Nikki Braswell and Suzanne Garrison

Amalgam Polishing
Purposes of polishing
Prevention of recurrent decay
Reduces plaque, preventing the amalgam from tarnishing
Reduces likelihood of amalgam corrosion
Prevention of Amalgam deterioration
Marginal breakdown: leads to recurrent caries or fractures of the restorations.
Smooth polished surfaces are less likely to build up acids, plaque and debris, which is less likely to tarnish.
Finishing Amalgam Restorations
removing marginal irregularities
defining anatomical contours
smoothing the surface roughness of the restoration.
Polishable Amalgams
No fractures in restorations
Proximal contact is present
Anatomy and occlusion can be maintained or improved.
All margins can be controlled to be flush with the surface margin of the cavity preparation.
What is pulp vitality testing?
Nerve tester conducts stimuli to sensory nerve receptors
Pulp vitality depends on blood supply
The stimuli may cause the patient to feel pain
Pulp Vitality Testing
Pulp Vitality Testing
Control Teeth
Choose a healthy tooth of the same type (ex.-molar, premolar,etc.)
Choose tooth in opposite quadrant
Types of Patient Pain
No pain indiciates a dead pulp
Pain that lingers
Pain that immediately subsides
Pulp Vitality Testing
Types of Pulp Tests
Percussion and Palpation Test
Thermal Sensitivity Test
Mobility Test
Selective Anesthesia Test
Transillumination Test
Depth of Decay Test
Electric Pulp Testing
Pulp Vitality Testing
Percussion Test
Tap the incisal/occlusal surface with the opposite end of a mirror handle
Palpation Test
Apply firm pressure, with a gloved finger, to the mucosa directly above the root apex
Contraindications for polishing restorations
with gross overhangs that need replacement
in teeth to be extracted or crowned
with recurrent decay that need to be replaced

Precautions when AM polishing
Maintain functional anatomy by using polishing instruments in the prescribed manner.
Do not weaken the restoration by improper contouring.
Prevent damage to the patient’s soft tissues.
Protect the patient from polishing debris.

How to Polish?
Start all rotary instruments just prior to touching the restoration.
Keep instruments moving over the surface.
Use short overlapping strokes
Use each polishing instrument on the surface it was designed for.
Make sure to not destroy functional anatomy by flattening cusps or marginal ridges, by removing the contact, or by ditching or grooving the restoration.

Prevent Soft Tissue Damage
To avoid slipping off the tooth:
Retract the tongue, cheek, and lips during the procedure.
Position instruments so they will not abrade or lacerate gingival tissues while polishing.
Use a secure grasp and stable fulcrum with all instruments.
Rinse all abrasive agents out of sulcus area and mouth after polishing.
Review procedure with Patient
Educate your patients about the value of the polishing procedure.
Explain to your patients why you are doing this; what it will do for them; how you are going to do it; and when you are finished, show them the polished restoration.

Pulp Vitality Testing
Thermal Sensitivity Tests
Heat Test- a tiny piece of gutta-percha is heated in a flame, then it's applied to the buccal/facial surface of the tooth (not very useful)
Cold Test- ethyl chloride, dry ice, or ice is applied to the tooth surface to determine the response of the tooth
Pulp Vitality Testing
Mobility Test
Dental mobility scale is measured 0-3
Mobility is testing using a meta instrument and one finger
Pulp Vitality Testing
Selective Anesthesia Test
Not used on mandible since the mandibular nerve block anesthetizes whole quadrant
Only used when the patient can't tell which tooth is causing pain
Local anesthetic is administered from posterior to anterior
Pulp Vitality Testing
Transillumination Test
Identifies vertical fractures in crowns
A shadow is produced at the sight of the fracture when a light source (usually fiber optic) is directed through the tooth from the lingual side
Pulp Vitality Testing
Depth of Decay Test
Definitive test where decay is removed to determine if there's irreversible or reversible pulpitis
If decay has penetrated the pulp, it's irreversible pulpitis
It decay hasn't penetrated the pulp yet, it's usually reversible pulpitis
Pulp Vitality Testing
Electric Pulp Test
Device that delivers a current of high frequency electrical stimulus to the pulp
Needs to be supported by other diagnostic findings because it can give false-negative and false-positive results, just like other tests
Pulp Vitality Testing
Types of Electric Pulp Testers
Plug in
-Advantages-more dependable
-Disadvantages- needs electrical outlet
- new models have a grounding connection for the patient to hold
Battery Operated
-Advantages- portable and hand-held
-Disadvantages- batteries run down
Pulp Vitality Testing
Electric Pulp Testing Precautions
For patients with a pacemaker or life-support device, a review of their medical history and medical consult with their cardiologist is necessary. The pulp tester may cause a malfunction of the pacemaker or life-support device.
Pulp Vitality Testing
Factors that may influence reliability of an electric pulp tester
control teeth may not respond appropriately
pulps that are dying produce varying responses to stimuli
moisture on the tooth
tester touches the gingiva
weakened batteries
sensitive restorations on teeth
for molars, some root canals may be vital, while others are dying
Pulp Vitality Testing
Procedure for using an electric pulp tester:
1) assemble equipment
2) explain procedure to the patient
3) Isolation and drying of teeth to be tested
4) Test control tooth first
5) Set the current level at 0
6) Place a small amount of toothpaste on the tip of the pulp tester electrode
7) Tell patient to raise hand when sensation is felt
8) Place tip of electrode on the buccal/facial surface of the tooth around the cervical 3rd to middle 3rd (don't use pressure)
9) Increase the current level gradually, until the patient feels a sensation, and record the response in the patient's record
10) Repeat same steps on the tooth to be diagnosed
Pulp Vitality Testing

New Pulp Testing Devices
Pulse Oximetry- records blood oxygen saturation levels during intravenous anesthesia procedures in medical practices.
Laser Doppler Flowmetry- measures the blood flow in extremely small blood vessels
Dual Wavelength Spectrophotometry- measures oxygen changes in capillary beds, instead of the supply vessels.
Essentials of Dental Hygiene: Clinical Skills;
Cooper, Weichmann, Chapter 10
Wilkins pages 267-270
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