Large Posterior Direct Restorations

You can use either a ___, ___, or ___ to provide the makeshift walls of a large posterior restoration

Tofflemire

separating ring

sectional

The Tofflemire should be placed ...

outside of the arches

U facing gingival

metal portion facing occlusal

What modifications can be made to a Tofflemire band?

wedges can be placed to tighten the band and form better contour

Small opening in accessible areas (buccal and lingual) are accepted because ___ can be removed after curing

overhangs

How can small openings be avoided, though? This is the goal... you don't want open margins

through tightening the band with wedges

burnishing the band against the adjacent tooth

polishing/finishing along the margins

Burnishing the band also gives you improved ___ and ___

contact and contour

(of the restoration with the adjacent tooth)

A gap occurs where the matrix band enters the ___ of the Tofflemire

holder

this is the part with the occlusal metal piece and gingival U

How can you correct this gap?

by adding additional piece of matrix in stead of the gap

When restoring with composite, consider using the ____ technique to keep the Tofflemire band in place

alternate wedge

wedge one side at a time (the side that is currently having composite added to it)

What tooth should be restored first, if there are two adjacent class II restorations on both #18 and #19?

19

the more mesial tooth

After restoring #19, evaluate the distal contour of #19 and ___ before restoring #18

refine/recontour It

___ may have distorted the distal contour of #19

Condensation pressure

If the adjacent tooth, when creating a large posterior restoration, is missing, you can expect ___

morphing

you need to account for/correct this

Generally speaking, you restore the ___ prep first... after prepping the ___ cary beforehand

smaller

larger

(if two caries are adjacent to one another)

When filling in a large posterior restoration, consider using ___ at first so as to avoid any gaps/open margins

flowable

Flowable composite implementation may lead to increased ___ at the margins

overhangs/excess

A wedge should only have the ___ emerge on the other side of the tooth when being placed

tip

If more than the tip emerges from the other side, this means that the wedge is ___

too small

When evaluating a restoration, you need to look at ___

every angle/POV

It is especially important to check the ___ of these class II restorations, where it is easier to notice open margins (as compared to the ___)

proximals

occlusal

You place a Tofflemire matrix band ___ above marginal ridge and ___ below gingival cavosurface margin

1 mm

1 mm

Why do you place it 1 mm above the marginal ridge?

allows for overfilling and carving of MR

Proper placement of wedge closes the ___, thus preventing overhangs near the base of the crown

gingival margin

Formation of overhangs causes ___ and ___

perio defects

decay

After wedging, use an ___ to check for gaps, trapped dam or tissue, and loose friable enamel

explorer

You want to feel a smooth surface from ___ to ___

tooth to restoration

___ help to provide ample separation between two teeth

solid (wooden) wedges

___ is a special wedge technique used to close gingival gaps found on maxillary first premolars

Wedge-wedging

Wedge-wedging involves ___ the two wedges

stacking

one horizontal, one vertical

Why do maxillary first premolars require special wedging to close the gap next to them and the adjacent canine?

mesial root fluting exists

___ is a special wedge technique used for wide proximal boxes (B/L)

Double-wedging

Wedges in the double-wedging configuration are ___, not stacked

side-by-side

___ wedging involves stacking the stacking wedges, but in a different manner than wedge-wedging

Piggy-back

How?

both horizontal, one on top of the other

Piggy-back wedging is used for ___ and ___ gingival embrasures

deep

large

When applying a matrix, the retainer should be placed on the ___ of the teeth

buccal side

As aforementioned, the ___ of the retainer faces gingivally

open (U) end

Facing the U down allows for ___

separate removal of the retainer and band

First, remove the ___, then remove the ___

retainer

band

The large knob should be turned ___ to increase diameter

counterclockwise

Turn the small knob ___ to release the band from the retainer

counterclockwise

Remove the band at a ___ angle into the remaining tooth structure for additional support of the restoration

45 degree

Check margin integrity of the tooth-restoration using an ___

explorer

Using which restorative material does it become extra imperative to do the above explorer-guided step?

composite, since it blends into tooth structure more than amalgam

Margins should be acceptable (smooth and continuous), but they also can be classified as ...

over-contoured

overhanging

under-contoured

open

Avoid over-carving the anatomy, producing __ margins

thin/fragile

Remove excess ___ to avoid bacterial infiltration

flash

You need to have marked contact on both the ___ and ___

occlusal of the tooth

the restoration