wk 2- class V restorations/subging CORD isolation

abrasion cause

mechanical wear- like toothbrush habit

abrasion affect

teeth in groups- often unilateral

abrasion tx

comosite- hybrid or flowable

abfraction cause

stress corrosion- occlusion related

abfraction affects

single tooth- often upper premolars first

abfraction tx

composite- hybrid or flowable, light cured GIC

erosion cause

chemical erosion- gastric causes

erosion affects

teeth in groups- lingual on upper and buccal on lowers

erosion tx

composite- hybrid or flowable

what is the basic erosive wear examination

• the mouth is divided into 6 distinct areas for evaluation, using the criteria for sextant scores from 0 to 3 and the surfaces w the highest score is recorded for each sextant

• the scores are summed to obtain a cumulative score that is the basis for determining interventions

management challenges for erosive tooth wear

• early dx of erosive lesion

• initiation of preventative strategies and behavioral changes

• early intervention w minimally-invasive restorative procedures

early dx of erosive tooth wear should include

• charting of erosive lesions

• sensitive teeth

• staining

• making note of areas of exposed dentin

preventative habits that reduce the risk fo erosive tooth wear

• staying hydrated

• rinsing w water before brushing

• brushing w fluoride toothpaste

• not brushing for at least 1-2 hours after an acid challenge

erosive tooth wear score 0

no erosive tooth wear

erosive tooth wear score 1

initial loss of surface texture

erosive tooth wear score 2 (dentin)

distinct defect; hard tissue loss involving <50% of the surface area (only molar)

erosive tooth wear score 3 (dentin)

hard tissue loss involving >/= 50% of the surface area

if the cumulative score for erosive tooth wear is 0-2 (not rlly any ETW), what are the general guidelines for management

• routine maintenance for observation

• repeat at 3-yr intervals

if the cumulative score for erosive tooth wear is 3-8 (low), what are the general guidelines for management

• oral hygiene, dietary assessment

• routine maintenance and observation

• repeat at 2-yr intervals

if the cumulative score for erosive tooth wear is 9-13 (medium), what are the general guidelines for management

• oral hygiene, dietary assessment

• routine maintenance

• fluoride measures

• avoid restorations requiring tissue removal

• repeat at 6-12 month intervals

if the cumulative score for erosive tooth wear is >/= 14 (high), what are the general guidelines for management

• oral hygiene, dietary assessment

• routine maintenance

• fluoride measures

• repeat at 6-12 month intervals

• consider restoration

when thinking of the scema of pathodynamic mechanism of tooth surface lesion, what are the 3 factors

• stress- abfraction

• friction- wear

• biocorrosioin- chemical, biochemical, electrochemical degradation

what are the 7 situation when you would restore non-carious cervical lesions (NCCLs)

• active, cavitated carious lesions associated w the lesion- CRA must be conducted (carious or complex cervical lesion)

• cervical margins are subgingival precluding plaque control inc caries- biocorrosion and periodontal disease risk

• extensive tooth structure loss, which compromises the integrity of the tooth

• defect is in close proximity to the pulp, or the pulp has been exposed

• persistent dentinal hypersensitivity, in which noninvasive therapeutic options have failed

• prosthetic abutment

• esthetic demand- by pt request

funx of B4 clamp

aids in isolation by retracting tissue without harming surrounding gingival tissue

which clamos are used to provide access if rubber dam is used

• #212

• #B4

besides clamps, what is another way you can get isolation

retraction cords

response from astringents

contraction-retraction of the tissues

response to hemostatic agents

constrict blood flow through coagulation

common compounds of astringents/hemostatic agents

• ferric sulfate 15-20%: viscostat

• aluminum potassium sulfate

• aluminum sulfate

• aluminum chloride 20-25%

• racemic epinephrine 4-8%

when to place cord

before preparation or before restorative material placement

steps of cord placement

1. eval the health of gingiva and the depth of the sulcus to select the proper cord- single or double

2. soak the cord in astringent/hemostat, avoid axcess solution

3. loop cord around tooth, depending ont he preparation area; adjust length to cover mesial and distal

4. repeat process for a second cord if needed

5. when time to remove- wet cord w water so it won’t grab and tear the tissues when removed and create more bleeding

6. after removal, you have about 30 sec until gingiva goes back, use this time to further subgingival finish if needed

where is the cord actually packed

in the sulcus, ~1-3 mm; so don’t be aggressive

4th gen adhesive

three-step bonding- total etch and rinse (go-to)

1. PA etch, rinse

2. primer, dry

3. bond

5th gen adhesive

2-step total etch and rinse (stay away??)

1. PA etch, rinse/dry

2. primer + bond, dry

6th gen adhesive

2-step self-etch (go-to??)

1. self etch + primer, dry

2. bond

types of adhesive monomers

• 10-MDP

• GPDM

7th gen universal all-in-one

one step self etch→ universal

1. self etch + primer (then dry) + bond

when you want to protect adjacent teeth from etching, what can you use

teflon tape (but don’t like at school)

why use teflon tape to protect adjacent teeth from etching

• thin, non-sticky and chemically inert

• smooth surface and very low friction w surface

• resistant to water and etchant

• soft, easy to manipulate and shape on/between surfaces

• cheap and safe