complex restoration combined

resistance or retention
direct and indirect anchorage

he restoration of SEVERELY DAMAGED BUT VITAL TEETH with amalgam would require some procedures that will improve the [?] form which may be accomplished through [?]

replace
fractured
caries
a very large restoration

amalgam restoration of complex preparation is used to [?] tooth structure that have [?] or are severely involved with [?] or have [?]

bonding
alternative retentive technique

amalgam resoration of complex preparation may involve the REPLACEMENT OF ONE OR MORE CUSPS by utilizing a [?] or an [?].

slots, grooves, pins

examples of direct anchorage

pin retained crown

example of indirect anchorage

ROBBINS & SUMMIT (1988) AND SMALES (1991):

gave the name for this type of restoration as complex amalgam restoration

one or more
auxiliary retention

complex amalgam restoration is An amalgam restoration in which [?] CUSPS ARE RECONSTRUCTED, in combination with any form of [?]

cavity preparation designed to provide ADEQUATE RETENTIVE AND RESISTANCE FORM.

key to success of complex amalgam restoration

1. Presence of a VERTICAL WALL

2. Placement of GROOVES, SLOTS OR PINS

SINCE THE WALLS AND PORTIONS ARE LOST, IT IS NECESSARY FOR THE PREPARATION TO HAVE THE FOLLOWING CHARACTERISTICS:

1. Patient has SIGNIFICANT OCCLUSAL PROBLEMS

2. Tooth cannot be properly restored with a direct restoration because of ANATOMIC OR FUNCTIONAL CONSIDERATIONS

3. Esthetics

contraindications of amalgam retsoration for complex preparation

1. Conserves tooth structures

2. Appointment time

3. Resistance and retention form

4. Economics

advantages of amalgam restoration for complex preparation

1. Dentin Microfractures

2. Microleakage

3. Decreased strength of amalgam

4. Resistance form

5. Penetration and perforation

6. Tooth anatomy

disadvantages of amalgam restoration for complex preparation

indirect casted restoration

A weakened tooth is best restored with a properly designed [?]

1. pins

2. slot

3. grooves

WHEN CONVENTIONAL RETENTION ARE NOT ADEQUATE BECAUSE OF REMAINING TOOTH STRUCTURE THE FOLLOWING MAY BE USED:

1. Cuspal coverage

2. Pin-Retained Amalgam Restoration

3. Amalgapins

4. Slot-Retained Amalgam Restorations form

5. Amalgam Foundations

6. Bonded Amalgam Restorations

type of complex amalgam restorations

dentin
horizontal plane

slot retained amalgam restoration is a retention groove in [?] whose length is in a [?]

vertical walls
retention locks
oppose one another

slot retained amalgam restoration is more frequently used in preparations with [?] that allow [?] to [?]

short clinical crowns
reduced 2 - 3 mm

Slots are particularly indicated in [?] and in cusps that have been [?] for amalgam

¼ round bur

use of coves are placed with?

additional retention form
pins
slots

coves are placed to provide [?] in a preparation that utilizes [?]/ it may also be used for preparations utilizing [?]

proximal box
sufficient vertical tooth preparations permits

proximla locks are placed in the [?] and in locations where [?]

inverted cone bur

slots are prepared usually with what bur?

0,5 mm

0.8mm

width of slots

• in occlusal portion: [?]

• in cervical portion: [?]

0.6 mm

how deep should slots be

2mm

depth of coves

tapered fissure

bur used for proximal locks?

full crown
endodontically treated teeth

Amalgam foundations are placed in preparations for a [?], especially in [?]

composite and reinforced glass ionomer.

RESTORATIVE MATERIAL USED FOR FOUNDATIONS OTHER THAN AMALGAM:

easy to use
stronger than composite and glass ionomers

Amalgam is preferred as a foundation material because it is [?] and [?]

remaining coronal tooth structure
secondary preparation retention features

amalgam foundation may not depend primarily on [?] for support. Instead, on [?]

pins, slots, coves, proximal retention lock and bonding

secondary preparation retention features

chamfer

amalgam foundations mainly rely on [?] retention

adequate retention can be gained by filling from the orifices

extension into the canal space of 2-4 mm is recommended

chamfer retention:

• if the height of the available chamber is 4-6 mm": [?]

• if the height of available chamber is 2mm or less: [?]

1. use of desensitizer or bonding system

2. matrix placement

3. inserting the amalgam

4. contouring and finishing the amalgam

steps of proper restorative technique

1. clean the preparation

2. inspect for detection and removal of any debris

3. apply varnish or desensitizer

procedures to do after the preparation is completed

air and water spray
visible moisture
desiccate

you should clean the preparation with [?] and remove [?] but do not [?] the tooth

detection
removal of any debris

you should inspect the preparation for [?] and [?]

dentin permeability and sensitivity

application of varnish or dentin desensitizer reduces [?]

shavell in 1980

introduced this technique for complex amalgam restorations

less than
threaded pins

the shear strength of amalgapin in significantly [?] amalgam with [?]

#245 or tapered bur

bur to use for preparation of dentin chamfer for amalgapin

parallel
external

for amalgapin, the bur is used [?] to the [?] surface of the tooth

2-3 mm

depth of amalgapin

RETENTION, RESISTANCE AND THE MARGINAL SEAL

The use of adhesive resin helps in IMPROVING THE [?] of the amalgam restoration

dual characteristics
optimal wetting

The amalgam bonding system require [?] to achieve [?]

because amalgam is STRONGLY HYDROPHOBIC and tooth structures are HYDROPHILIC

The amalgam bonding system require DUAL CHARACTERISTICS to achieve OPTIMAL WETTING —— WHY?

4-methacryloxyl ethyl trimellitate anhydride (4-META)

wetting agent of bonding system

self curing
dual curing

Adhesive used for amalgam must be [?] OR [?]

tooth, intervening resin, and amalgam

tooth restoration interface is composed of?

tag
micromechanical locking
10-Methacryloxy decyl dihydrogen phosphate (10-MDP)

tooth resin bond includes [?] formation ([?]) in addition to the use of [?]

phosphate monomer
tin and copper
q chemical adhesion

in the bonding interface, the [?] interacts with the [?] in amalgam to provide [?]

1. AUXILIARY retention

2. REINFORCEMENT of remaining tooth structures

3. CONSERVATIVE preparations

4. Improvement of MARGINAL SEAL

5. Economics

6. Time factor

7. LOW GINGIVA-OCCLUSAL HEIGHT of the teeth

indications for bonding interface

1. EXTENSIVELY CARIOUS teeth where ECONOMICS plays a part

2. Use of amalgam in LOW GINGIVA-OCCLUSAL HEIGHT

3. CONSERVATIVE tooth preparation

4. Reduces marginal leakage

5. REINFORCES TOOTH STRUCTURE weakened by caries and tooth preparation 6 Reduces POSTOPERATIVE SENSITIVITY after an amalgam restoration

advantages of bonding interface

1. Time consuming

2. Technique sensitive

3. Multi-stepped procedure

4. During condensation, RESIN MAY BE DISPLACED towards the adjacent tooth surfaces and produces radiological artifacts at the gingival floor of the proximal box - which can be erroneously interpreted as RECURRENT CARIES.

5. LIMITED PERIOD OF USE to allow proper evaluation of clinical performance

limitations and disadvantages of bonding interface

displaced
adjacent tooth surfaces
radiological artifacts
gingival floor
recurrent caries

1. During condensation, RESIN MAY BE [?] towards the [?] and produces [?] at the [?] of the proximal box - which can be erroneously interpreted as [?]

1. Apply matrix assembly

2. Etchant is applied for 15-20 SECONDS to ENAMEL AND DENTIN SIMULTANEOUSLY.

3. Rinse etchant from the preparation

4. Dry preparation

5. Apply PRIMER to dentin and enamel surfaces.

6. TRITURATE amalgam, ready to be inserted in the preparation

7. Apply adhesive on the tooth surfaces

8. IMMEDIATELY CONDENSE amalgam into the preparation

9. Proceed with the CARVING, THEN FINISHING AND POLISHING

procedure of bonding interface

facilitates the intermingling of the unset amalgam and resin before its setting.

importance of immediately condensing the amalgam

satisfactory matrix

One of the most DIFFICULT STEP in restoring a severely involved posterior tooth is the development of a [?]

shape of the msising cusps

Matrix for complex amalgam should provide the [?] that will be formed by the amalgam.

height
additional matrix material
inside

additional cusp height

Tofflemire retainers use matrix bands, which are NOT SUFFICIENT TO PROVIDE THE [?] NEEDED, so an [?] is added to the [?] of the matrix to provide ADDITIONAL [?]

spot welded

For PROPER POSITIONING of the cut pieces of matrix band they can be [?]

modelling compound

Spot welded matrix band are STABILIZED using ?

1. Stabilize matrix

2. Maintain the shape of the matrix

MODELING COMPOUND SUPPORTED MATRICES WILL:

contour and shape

height

copper band matrices can be used for providing [?] for achieving the additional [?]

thinned
sandpaper disk

Copper bands are THICK, so it has to be [?[] using [?]

high copper alloy
excellent clinical performance and high early compressive strength.

A [?] is strongly recommended for the complex amalgam restoration because it has [?]

spherical alloys
good adaptation

pins

[?] can be condensed QUICKLY with LESS PRESSURE to ensure [?] around the [?]

admixed alloys
condesability

Proximal contacts may be easier to achieve with [?] due to its [?].

1. TRITURATE a mix of amalgam and with the amalgam carrier, TRANSFER some of the amalgam to the GINGIVAL PORTION of the preparation.

2. USING APPROPRIATELY SIZED CONDENSERS: condense each increment of amalgam. - condense the amalgam thoroughly IN AND AROUND THE RETENTIVE FEATURES of the preparation

3. IF AMALGAM BECOMES DRY OR CRUMBLY: immediately triturate a new mix

4. Continue condensation until the preparation is OVERFILLED

5. Do not spend TOO MUCH TIME on occlusal carving - without allowing ADEQUATE TIME for carving the more INACCESSIBLE gingival margins, proximal and axial contours.

6. First, REMOVE THE BULK of excess amalgam on the occlusal surface and GROSSLY DEVELOP the anatomy.

7. ACCURATELY DEVELOPED MARGINAL RIDGE HEIGHTS AND EMBRASURES: reduce the potential of fracturing the marginal ridge(s) when the matrix is removed

8. EVALUATE the margins with an EXPLORER and CORRECT ANY DISCREPANCY.

9. Evaluate the ADEQUACY of each proximal contact by using MIRROR OCCLUSALLY AND LINGUALLY to ensure that no light can be REFLECTED between the RESTORATION AND THE ADJACENT TOOTH at the level of the PROXIMAL CONTACT.

10. The amalgam forming the walls of this “ideal" preparation must have SUFFICIENT BULK to PREVENT FUTURE FRACTURE.

11. Remove the rubber dam and EVALUATE THE OCCLUSAL CONTACTS

12. THIN, UNWAXED DENTAL FLOSS may be passed through the proximal contacts one time to help SMOOTH THE AMALGAM PROXIMAL SURFACE. Passing the floss through a contact more than once may WEAKEN a contact

procedure of inserting the amalgam

in

around

retentive features

condense the amalgam thoroughly [?] AND [?] THE [?] of the preparation

gingival portion

TRITURATE a mix of amalgam and with the amalgam carrier, TRANSFER some of the amalgam to the [?] of the preparation.

occlusal
INACCESSIBLE gingival margins, proximal and axial contours.

Do not spend TOO MUCH TIME on [?] - without allowing ADEQUATE TIME for carving the more [?]

fracturing the marginal ridge(s) when the matrix is removed

ACCURATELY DEVELOPED MARGINAL RIDGE HEIGHTS AND EMBRASURES: reduce the potential of [?]

explorer
discrepancy

EVALUATE the margins with an [?] and CORRECT ANY [?].

mirror
occlusally and lingually
no light can be reflected

Evaluate the ADEQUACY of each proximal contact by using [?]: - [?] Y to ensure that no [?] between the RESTORATION AND THE ADJACENT TOOTH at the level of the PROXIMAL CONTACT.

sufficient
future fracture

The amalgam forming the walls of this “ideal" preparation must have [?] to PREVENT [?].

thin, unwaxed dental floss
smooth the amalgam proximal surface
weaken the contact

[?] may be passed through the proximal contacts one time to help [?]- Passing the floss through a contact more than once may [?]