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31

Adhesive

-applied to dentin
-light cured
-making a hybrid layer= collagen surrounded by resin

32

4th generation

etch and rinse
3 steps

-etch---rinse enamel and dentin
-primer application
-adhesive application

33

5th generation

etch and rinse
2 steps

-etch-rinse enamel and dentin
-primer & adhesive bodning resin are applied together

34

6th generation

self etch
2 step

-etch & prime-  1 step, no rinsing
-adhesive bonding

 

35

7th generation

self etch
1 step
no rinsing

-etch, prime, & adhesive bonding resin all at once

36

1- etch and rinse

2-self etch

1-removes smear layer
demineralizes superficial dentin
remaining collagen & resin= hybrid layer
---technique sensitive, with large amt of enamel left

2-doesnt remove smear and is incorporated into resin (hybrid)
demin & infiltration of adhesive into superficial dentin
---better results, provide more predictable bonding to dentin 

37

8th generation

-etchant, primer & hydrophobic resin---like 4th gen

-etchant isnt rinsed---like 6th generation 

adv= less sensitivity, dentin is wet w/ etchant that isnt rinsed, after primer cant be dried, can be used w/ all composite materials

disadv= lack of clinical research at this time

38

CDMI uses

-excite f

-5th generation---etch and rinse
----etch & rinse and then solvent (ethanol)

cavity prep= smear layer

39

1-etching enamel

2-etching dentin

1-30-40% phosphoric
demin enamel= irreg inc SA

2-removes smear layer, superficial demin of dentin, opens tubules, collagen layer remains

etchants rinsed w/ H20
dentin needs to stay moist

40

Summary of etching

-etch enamel
-etch dentin
-rinse/leave moist
-primer---adhesive application, air thin, light cure
-after application of primer---adhesive, dentin= shiny hybrid

41

2 factors that control mandibular movement

1-posterior controlling= the condyles
via the sagittal, horizontal, and frontal plane

2-anterior controlling= anterior teeth

42

1- Condylar movement as Vertical Determinants

2-Condylar movement as Horizontal Determinants

1-influence cusp height & fossa depth

2-influence ridge direction & groove position

-define the dimensions the tooth cusps & horizontal paths that the cusps will travel along surfaces to avoid making interfering contacts

43

4 vertical determinants of posterior condylar

1-angle of eminence

2-plane of occlusion

3-curve of spee

4-lateral translation working movement

44

1-angle of eminence

2- 45 degree slope

1-steeper the slope of eminence, the greater the downward movement of the condyles during translation===greater downward movement of mandible

2-45 degree slope for eminence= mandible moving downward at 45 degree rate of inclination
as it goes downward it will then separate the teeth by that same 45 degree


if slope of eminence increases so will separation of teeth
so steeper condylar guidance= taller cusps MAY be and the flatter condylar guidance the shorter cusps MUST be

45

1-the occlusal plane

2-change of angulation of above

1-imaginary line drawn from incisal edges of maxillary anterior teeth along cusp tips of maxillary posterior

2-changes in angulation of plane of occlusion from horizontal plane will effect posterior tooth cusp height

---occlusal plane that parallels the horizontal = tooth separation at same angle as articular eminence
---as plane becomes more parallel to angle of eminence= less tooth separation
---plane becomes more divergent from angle of eminence= greater tooth separation 

so more parallel the occlusal plan to angle= shorter cusps MUST be and divergent the occlusal plane is from angle of eminence, taller cusps MAY be

46

Curve of Spee

1-anteroposterior curve extending from tip of mandibular canine along buccal cusp tips of mandibular posterior teeth
-changes in degree of curvature of curve of spee effects cusp height


-greater curvature of curve of spee (more acute arc of curvature) the shorter custs MUST BE
-less acute (flatter) the curvature of curve of spee, taller cusps MAY be

47

4 horizontal determinants of posterior condylar

1-distance from working side condyle

2-distance from midsagittal plane

3-lateral (working) translational movement

4-intercondylar distance

= movement of opposing cusps in horizontal plane= working & nonworking paths in harmony w/ ridge direction & groove position of tooth

48

1-Mandibular movement guided by condyles---horizontal

2- curvature becomes flatter...

1-greater distance between working condyle and given tooth = greater angle between eccentric

2- as object moves further form center of rotation

so further tooth is away from working condyle= greater angle between working/nonworking

49

Overjet (anterior controlling)

2-overbite (anterior controlling)

1-horizontal relationship between anterior teeth

-anterior-posterior distance between incisal edges of maxillary + mandibular anterior teeth

2- vertical relationship between anterior teeth

-amount that the anterior teeth of 1 arch vertically overlaps teeth of opposing arch

50

Anterior Guidance

-overjet & overbite = disclusion (separation) of posterior teeth during eccentric mandibular movement

-protrusive, right working, and right nonworking

-vertical determinant

-impacts only cusp height & fossa depth 

-steeper anterior guidance angle= greater downward movement of mandible= greater separation of posterior teeth
-shallower angle of guidance= less downward movement of mandible= less posterior tooth cusp separation

51

-summary of anterior guidance 

-so steeper anterior guidance, the taller the cusps MAY BE
-shallower anterior guidance, the shorter the cusps MUST BE 

-factor of proximity influences posterior tooth anatomy

-is dominant factor both in occlusal anatomy & mandibular movement bc of proximity to posterior teeth

52

1-infection control 

2-standard precautions that are preventive

3-infections may be encountered in oral health

4-how are infections transmitted

1- various policies and procedures (Standard Precautions) to prevent the spread of infectious diseases in the health care setting.

2-against exposure too blood, body fluids, non intact skin, mucous membranes, any other tissues

3-HIV, CMV, tuberculosis, Hep B, C, D, Hepes, Staph, Strep

4-open wounds, puncturing of skin, ingesion, inhalation, & mucosal transmission

53

1-bloodborne

2-Hep B

3- Hep C

4-HIV

5-PPE

1-risk of transmission after percutaneous exposure 

2-22-31%risk clinical  37-62% HBV serologic

3-1.8%

4-0.3%

5-gowns, masks, eye protection, gloves

54

1-gowns

2-masks

3-eyewear

4-gloves

1-covers arms to wrist & closed at neck...
resistant to liquids
-disposed if soiled and over work clothes

2-over mouth and nose to prevent breathing of infectious---reduces risk of transmission
change between patients

3-prevent injury from airborne or splattering
needs side shields

4-touching patient/materials that come in contact w/ infectious
touch patient, sterilized instruments
once on dont touch anything that cant be disinfected
must remove after 
wash hands 15 s, put on, and then wash after

55

Surface Disinfection

-w/in 3 ft radius of patients = contaminated w/ barrier

-disinfect counter tops, hoses, simulator head/torso

-with isopropanol & diisobutyl phenoxyethyl ammonium chloride

-wear clean gloves and wife clean the surface---use second wipe to keep surface wet  and then discard and wash hands

56

1-Prevention of early childhood tooth decay
2-disease mangement in kids
3-access to dental care service in kids
4-systems of integration/coordination in kids

1-fluoride, reduction of bacteria that causes tooth decay, guidance for parents

2-risk assessment for tooth decay, spectrum of dental treatment

3-age 1 dental visit, dental home, dental workforce + professional development

4-partnership w/ health & childcare providers, state & local dental public health programs, policiy development

57

1-leading causes of death in the US

2-underlying causes 

3- why are dentists involved

4- faces 2 kinds of malnutrition

1-heart disease, cancer, & stroke

2-tobacco, lifestyle, diet

3-bc we see patients on regular basis, spend more time with them, can show them direct effect, treat women, and can be as effective as physicians

4-hunger & dietary excess----obesity, diabetes, CVD, dental caries 

58

Vitamins for good health

-Fe- cells w/ O2 through HgB---red tongue
-Zn- immune, wound healing, & sexual maturation---poor wound healing
-Ca- nerve, muscle activity, mineralization, membrane transport---osteoporosis
-Vitamin D- inc Ca absorption, reduces hypertension---rickets
-Vitamin B12- synthesis of RBCs and myelin---anemia

59

1-Diet counseling

2- "diet" products

3-saliva

1-asses dietary habits, bod weight, identify changes needed, identify barriers to change, setting goals, finding support, & maintaining changes

2- diet suppresents= acidic
diets detoxify are acidic
diet soda pop is acidic 
milk= 6, coffee= 5, tomato juice= 4, redbull= 3.3, poweade= 2.8, lemon= 2


3-buffer---saliva pH is 6-7.5, bicarbonate ion
inc metabolic rate---> inc flow rate--> bicarb conc inc--> raises pH

60

1-sugars

2-development of caries

3-sucrose

1-dietary cause of caries
intake of extrinsic sugars greater than 4x's a day= inc caries 
shouldnt excees 60 g/day

2-cariogenic food--> dental biofilm--> acid formation-->demineralization-->dental caries

3-sucrose is a dimer of glucose & fructose
s. mutans break is down to individual sugars & metabolize fructose intracellularly for energy as part of glycolysis= release lactic acid