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1

Goals of Isolation of the Operating Field

-moisture control
-retraction
-harm prevention

2

Moisture Control

-saliva, blood, crevicular fluid, humidity

-necessary for proper restorative material applic

-bonding procedures need moissture controls for optimum results

3

Retraction

-access and visibility

-lips, cheek, tongue, gingival tissue

4

harm prevention

-prevents aspiration/swallowing of objects

-protexts tissues from instruments

-protects patients from irriating materials/ bad taste

-protexts operator from saliva + aerosol (infection control)

5

1-rubber

2-hole punch

1-1864, dr. sanford barnum

2-1882- SS White

6

Rubber Damn isolation

-protect patient
-patient comfort
-better visualization
-improve qualit of care
-inc. productivity
-improve retention of bonded restorations
-infection control
-for licensing exam

 

7

disadv of rubber damn

-may not be places where there is insuffiecient eruption of teeth so no clamp stability

-time consuming

-patient objection

8

Materials used for Rubber Dam

-non latex
-medium
-darker colors are preferable 

9

1-young frame
2-plastic frame
3-clamp forceps

1-metal---U shaped w/ open end towards nose

2-endodontics, doesnt interfere w/ radiographs

3-placement/removal of clamb from abutment of tooth----open jaws of the clamp and carries clamp to tooth

10

1-wingless retainer
2-winged retainer
3-Retainers

1-positioned on tooth w/o rubber dam, damn goes over retainer...easier to see placement of retainer

2-damn is placed on wings of retainer and both applied at once
-one step application
-wings give additional retraction from rubber damn

3- 4 pts of retainers contact tooth at line angles
engage tooth cervical to height of contour
not extend past mesial & distal angles of tooth bc it would inferfere w/ matrix/wedge placement
may get gingival trauma

11

1- retainers with points directed gingivally

2-N27
3-13A
4-12A
5-14A

6- anterior retainer

1-placement on partially erupted teeth

2-small molars

3-lower left & upper right molars

4-lower right & upper left molars

5-partially erupted molars

6-retainer is placed after rubber damn, gives retraction of gingival tissue & protects gingival tissue

12

other methods to retain rubber damn

-wedgets
-rubber damn material
-ligation w/o floss

-usually w/ anterior of mouth

13

1-size 1
2-size 2
3-size 3
4-size 4
5-size 5

1-mand incisors
2-max incisors
3-canines & bicuspids
4-molars
5-molars

14

1-extension for the posterior teeth

2-extension for the incisors

3-extension for canine

4- minimum extension for restorative procedures 

1- 1-2 teeth posterior to the treatment tooth to the contralateral canine 

2-from 1st premolar to 1st premolar...may/may not need clamps

3-1st molar to contralateral canine

4-3 teeth: treatment tooth, 1 tooth anterior, 1 tooth posterior

15

Problems w/ holes

1-holes punched too close together
stretches the dam too much
causes gaps

2-holes punched too far apart
too much dam material between teeth 
causes bunching

---double punch hole w/ the retainer 

16

Placement of Retainer

-forceps open jaw of retainer and carry retainer to tooth

-bow is towards distal

-seal retainer from lingual then over buccal contour
 

17

Isolation of Teeth

-pull dam over bow
-after posterior tooth isolate, isolate anterior 
-secure anterior w/ wedget or clamp or floss
-leave teeth in betwene until frame is in place
-isolate the rest of the teeth

18

Winged Clamp Technique

-dam is on retainer
-dam & retainer go at the same time
-winged retainer & damn are placed on posterior abutment at same time

19

Rubber dam removal

-remove debris
-cut septa
-remove wedgets
-remove clamps/ dam at same time

20

Other methods of Isolation

-cotton rolls
-dry angles
-super clamp---retracts & protects tongue and lip
-optra damn---3D, frame dam all in one
-optragate---retraction of lips and cheeks, doesnt isolate each tooth
-isoprep retractor---bleaching
-isolite system---retracts tissue, suction, & light

21

Enamel

-inorganic
-prisms are made of hydroxyapatite crystals
---parallel to one another
---from DEJ to outer surface in radial pattern
-in key hole like pattern

22

Etchants

-phosphoric acid
-gel so it stays in place
-removed via rinsing

23

Etching Enamel

-30-40% phosphoric
-15-30 s of demin of surface 
-inc surface area for bonding
-inc surface roughness
-dec surface tensions

---frosty white appearance

-addition of bodnign resin makes resin tags in etched enamel= micromechanical retention

24

problems w/ etching

-over etching
-etching= decalcification to a big depth---no etch pattern

-dec ability to form resin tags
-lower bond strength
-clinically overetched enamel cant be distinguished
-outer 5 um of enamel= amorphous, if unprepared = more etching time
-if has fluorosis needs more etching time

-bond strength to enamel is reduced when etched enamel= contaminated (blood, saliva, oil) and then etch surface again for 10 s

25

1- enamel

2-dentin

1-more minerals than water, very little organic

2-50% minerals, and then 25% 25% for organic & water

26

Smear Layer

-cavity prep = smear layer

-debris from grinding & organic matter
-smear layer differs depending on instruments
-makes smear plugs in tubules
-loosely adheres to dentin

27

1-dentin

2-bonding to dentin

1-dentin is always wet
smear layer is present
when smear is removed, fluid seeps out of tubules
communicates w/ pulp

2-30-40% phosphoric, 15 s, removes smear, demineralizes surface dentin

28

1-bonding to enamel

2-enamel/dentin bonding systems

1-bonding system
-etchant (30-40% phos)
-adhesive----hydrophobic resin, works bc very little H20

2-etchant (37% phos)
-primer---hydrophillic in solvent (acetone, ethanol, H20)
-adhesive---hydrophobic resin

29

1-enamel bonding
2-dentin bonding
3- what happens when dentin is etched

1-inorganic
can be dried
hydrophobic resin can be applied to dried enamel and cured

2-organic
dentin is wet and stays wet
hydrophyllic primer is needed


3-smear layer is removed
dentin is demineralized 
collagen layer remains

30

Dentin cant be dried...

-must be moist to prevent collapse of remaining collagen

-if dried, bond strength to dentin decreases

-if dried then must be rewet to rehydrate

-must be primed, priming removes residual H20 to allow for infiltration of hydrophobic adhesive resin