RESTORATIVE 1. Liners indications, types, advantages of GIC liner. How GI bond to tooth structure? Chemical bonding.

GIC in loc s? Liners are thin layer of material used to provide a barrier to protect dentin. Contribute electrical insulation thermal protection and pulpal treatment. Indicated under metallic restorations !not "ell bonded to tooth structure# and under tooth coloured materials if tooth prep is too close to the pulp. Types$ Solution liners !varnishes %&' um# Suspension liners !thic(er %)&%' um# cements liners !thic(est for pulpal medication and thermal protection ).%&* mm#. +ases !cement bases *&% mm# provide thermal protection mechanical support for the restoration. Liners and bases may be combined in a sin,le preparation. -oderate depth$ .OE currently R-/I. 0eepest portion calcium hydro1ide "hen microscopic pulp e1posure to encoura,e dentinal brid,in, !reparative dentine#. .OE and C2 cannot be used to,ether stron, e1othermic reaction. .inc phosphate cement and resin&reinforced .OE cement "ere "idely used before. Then 3olycarbo1ylate cement4 and then li,ht cured resin modified /I or compomers provide chemical adhesion ,ood mechanical stren,th fluoride release "ell&controlled settin, and rapid achievement of stren,th !A0VA5TA/ES# +efore in a deep restoration$ calcium hydro1ide liner then a base for mechanical support and stress distribution then varnish. Currently li,ht&cured calcium hydro1ide and /I material. 6or indirect restoration mechanical undercuts or bondin, of base material to prepared dentin. In a shallo" tooth e1cavation *.'&% mm of remainin, dentin thic(ness not need for pulpal protection. In moderate deep liner of .OE or calcium hydro1ide for amal,am Calcium hydro1ide for composites !eu,enol inhibits polymeri7ation# If pulp e1posure calcium hydro1ide spherical amal,am recommended as it re8uires less condensation pressure. If e1tensive dentin lost cement base over calcium hydro1ide liner. Sealer or bondin, a,ent and then the restoration. A liner should not e1tend closer than * mm to a slot or pin. Summary of pulpal protection procedures !-edicament9liner9sealer# Shallo" e1cavation -oderate 0eep e1cavation !R0T : % mm# e1cavation !R0T !R0T ; ).' mm# ).'&% mm# Amal,am 5o9no9sealer 5o9base9sealer C29base9sealer Composite 5o9no90+S 5o9no90+S C29no90+S /old inlays and 5o9no9cement 5o9base9cement C29base9cement onlays Ceramic 3R 6R3 5o9no90+S CC 5o9no90+S CC C29no90+S CC 3ulpal protection includes pulpal medication dentin sealin, thermal insulation electrical insulation and mechanical protection. Sealer$ /luma or 2urriseal4 +ase$ Vitremer or 0urelon cement4 Cement$ lutin, cement !e.,. R-/IC#. CC$ composite cement !e.,. Rely < lutin, cement#4 C2$

0ycal liner4 0+S$ dentin bondin, system4 6R3$ fiber reinforced prosthesis4 3R$ processed resin4 R0T$ remainin, dentin thic(ness. !. "hat do you use for etching and ma e a drawing of the etched area. Acid etchin, !or conditionin,# dissolves the smear layer !residual or,anic and inor,anic components "henever a tooth is prepared "ith a bur or other instrument# and produces microscopic relief "ith undercuts on the surface to create an opportunity for mechanical bondin,. Acid etchin, transforms the smooth enamel into a very irre,ular surface and increases it surface free ener,y. 3hosphoric acid ,el =)>&?)>. Total etch techni8ue simultaneous application of an acid to enamel and dentin current strate,y. Self etchin, primers$ etchin, and primin, of dentin and enamel not rinsed off. 3orcelain and processed composites veneers are etched "ith *)> hydrofluoric acid for % minutes. Etchin, enamel affects both the prism core and prism periphery. Etchin, dentin affects the intertubular and peritubular dentin enlar,in, the tubular openin,s removin, much of the surface of hydro1yapatite and leavin, an interconnected net"or( of colla,en fibrils. The acid !li8uid or ,el# =%>&=@> phosphoric acid is ,ently applied to the appropriate surface to be bonded (eepin, the e1cess to a ma1imun ).' mm past the anticipated e1tend of the restoration. 6or 6issure sealants etch for =) seconds "ash for =) sec dry for *' sec cure sealant for A) seconds. 6or abrasion lesion cleanse dentine "ith dentine conditioner polyacrylic acid for *' seconds "ash mi1 /IC apply put matri1 leave for ? min apply bond and cure for ?) seconds. #. $ifferences between matrices, advantages, disadvantages? A matri1 is placed "hen a pro1imal surface is to be restored. ObBectives$ provide proper contact provide proper contour confine the restorative material and reduce the amount of e1cess material. 2elps protect adBacent tooth from bein, dama,ed !placed on the adBacent tooth for this reason#.2elpful ensurin, mar,inal adaptation and stren,th of the restoration. 6or a matri1 to be effective it should be$ easy to apply and remove e1tend beyond the ,in,ival mar,in e1tend above the mar,inal rid,e hei,ht and resist deformation durin, material insertion. Cniversal !tofflemire# compound&supported precontoured automatri1 system and S8ueland. Cniversal !tofflemire# ideally indicated "hen = surfaces of a posterior tooth have been prepared. Can be placed on the facial or lin,ual aspect. -atri1 bands of various occluso&,in,ival "idths are available. Still does not meet the ideal retainer and band. The conventional flat tofflemire band must be shaped !burnished# to achieve proper contour and contact. The uncontoured bands are available in % thic(nesses. 3recontoured bands are simpler to use less chair time little adBustment after positionin,. Tofflemire retainer helps to hold the cotton roll in place for moisture control. 3re "ed,in, "ill compensate for the thic(ness of the band ensurin, proper contact. Compound supportin, cooper band matri1$ rarely used more ri,id provides better contact and contour virtually trouble free durin, proper removal and re8uires very little pro1imal carvin, after the matri1 removal only one thic(ness.

3recontoured matri1 strips$ ready for application to the tooth suitable for mandibular premolars and distal of upper canines4 "ith the bitine rin,. Automatri1$ ? types of bands use for e1tensive class II especially "hen replacin, cusps. The auto&loc( loop can be positioned either on the facial or lin,ual surface the bands are not precontoured. Convenience improved visibility because of absence of a retainer. Clear polyester matrices are other type come precontoured to use "ith the tofflemire are thic(er not recommender for lar,e posterior composites restoration cannot be contoured donDt provide resistance to condensation. %. Crac tooth syndrome, symptoms, diagnosis, treatment 0ia,nosed by history usin, fracfinder !force is directed to one cusp# pain upon pressure release pain to cold and hot foods probin, "ith an e1plorer sin,s and symptoms stainin, and transillumination. Consist of an incomplete fracture of a posterior tooth "ith vital pulp4 the fracture involves enamel and dentin. Symptoms include pain on che"in, referred pain and sensitivity to thermal chan,es. The most common symptom is sharp pain that occurs upon release of che"in, pressure. -ost crac(s run mesiodistally. -ost common are molars of older patients teeth "ith class I restorations or that are unrestored but have an opposin, plun,er cusp occludin, centrically a,ainst a mar,inal rid,e. -andibular molars ma1illary molars and ma1illary premolars. The ideal treatment consists of applyin, a stainless steal band to the tooth "ith cessation of symptoms confirmin, the dia,nosis revie" after %&? "ee(s follo"ed by a full covera,e restoration. Cr,ent care is reduction of its occlusal contacts remove any placed restoration and dress "ith sedative dressin,. 0efinitive treatment is full occlusal covera,e to preserve pulpal vitality. If sensitivity to temperature chan,es has not ceased endodontic therapy has to be considered. The pro,nosis for a vertical root fracture e1tendin, apically from the alveolar crest is poor and tooth e1traction is indicated. &. 'easons cusp brea s in ()$ amalgams. Insufficient resistance form "hen preparin, the tooth cavity. Ehen the facial or lin,ual e1tension e1ceeds %9= the distance from a primary ,roove to the cusp tip reduction of the cusp for amal,am is re8uired to provide ade8uate resistance form. Inade8uate tooth preparation insufficient bul( of amal,am *. $ifference between pin and slot? "hen do you use slots and when pins? 3ins in dentine to provide ade8uate resistance and retention form. Slot is a retention ,roove in dentin "hose len,th is in a hori7ontal plane. -ay be used in conBunction "ith pin retention or as an alternative to it. 3ins are used "henever ade8uate resistance and retention forms cannot be establish "ith slots loc(s or undercuts only. In canines lin,ual dovetail is an alternative to pin retention. They both has advanta,es and disadvanta,es slot remove more teeth structure "hile pins have the ris( of perforation pulp chamber periodontal li,ament and must have enou,h space for the use of pins. 3in retention is used more fre8uently in preparations "ith fe" or not vertical "alls. Slots are indicated in short clinical cro"ns and in cusps that have been reduced to %&= mm for amal,am.

+. "hat should be the dimensions of retentive slots prepared in an e,tensive amalgam cavity? Slots$ ).A mm deep ).' mm "idth * mm or more in len,th and ).' to * mm inside dentino&enamel Bunction. 3repared alon, the ,in,ival floor a1ial to the 0EF. Slots are placed on the facial lin,ual mesial and distal aspects of the preparation. -ay be continuous or se,mented. -. .dditional retention comple, amalgam Insufficient remainin, tooth structure&pin slots undercuts amal,am bondin, techni8ues to enhance retention and resistance form. Coves may be used to provide additional retention form in a preparation that utili7es pins or slots. 3ro1imal loc(s also are placed in the pro1imal bo1 and in other locations "here sufficient vertical tooth preparation re8uires. These loc(s and coves should be prepared before preparin, pinholes and insertin, pins. Types of pins Self threadin, pins !most fre8uently used most retentive# friction&loc(ed !intermediate# and cemented !less retentive#. 3inhole depth % mm. 3lacin, pins in a non parallelin, manner increases their retention. Stren,th of amal,am restoration decreases. 6our si7es of pin available. Selection dependin, on the amount of missin, tooth structure amount of dentin available the amount of retention desired and the si7e of the pins. Ehen only %&= mm of the hei,ht of the cusp is missin, no pin is re8uired. < ray useful for placement. Occlusal clearance should be sufficient to provide % mm of amal,am over the pin. Should be positioned not closer than ).'& * mm to the 0EF or should be positioned no closer than * &*.' mm to the e1ternal surface of the tooth "hichever distance is ,reater. Should be parallel to the adBacent e1ternal surface of the tooth. Should be placed on a flat surface perpendicular to the direction of the pinhole. 6luted and furcal areas should be avoided !- of *rst premolar midL and mid6 of mandibular molar midL mid6 and mid- and mid0 furcations of the ma1illary molars#. Avoid on 0 of mandibular molars and L of ma1illary molars. 3repare pinhole "ith drill tip in proper position and "ith handpiece rotatin, at lo" speed apply pressure to the drill prepare pinhole in * or % movements and remove the drill. All of the pin desi,ns can be inserted "ith an appropriate hand "rench or a contran,le hand piece. % mm len,th is optimal. 3in holes for cemented pins are =&? mm depth cemented "ith any lutin, a,ent. 6or foundations pinholes must be located farther from the e1ternal surface of the tooth. 0entin bondin, systems are recommended for e1tensive preparations "ith deep e1cavations capped cusps and in "ea( teeth. /. "hy would you place slots and grooves for retention instead of pins in an e,tensive cavity for amalgams? Slots and loc(s and deepened pro1imal bo1 are enou,h for retention4 plus dentin bondin, systems.

10. 1atient has gingival recession in %s what is the cause? Abrasion or9 and Abfraction. Abrasion is the physical "ear of a tooth caused by an e1ternal a,ent !toothbrush#. 5on&carious defect in tooth structure usually located at or near the cemento& enamel Bunction and ,enerally on the buccal surface of teeth. Csually caused by abrasion due to e1cessive or incorrect toothbrush use. Abfraction lesions due to fle1ure of teeth under e1cessive occlusal loadin,. Teeth are not ri,id structures. Teeth bend either laterally or a1ially durin, occlusal loadin,. This fle1ure produces the ma1imal strain in the cervical re,ion producin, micro fractures in the thinnest re,ion of enamel in the CEF. Such fractures predispose enamel to loss "hen e1posed to toothbrush abrasion and9or chemical erosion. Sometimes causes the loss of bonded class V restorations in preparation "ith no retention ,rooves. Attrition is physical "ear caused by movement of one tooth a,ainst another. It affects interpro1imal and occlusal surfaces. Increase "ith more abrasive diets and in bru1ism. Erosion is loss of tooth substance from non&bacterial chemical attac(. 11. "hat material would you use to restore a minimal cavity? Sealer and amal,am +ondin, and composite. 1!. "hat should be the amount of reduction for a functional and non functional cusp for amalgam onlay? Ehen the 6acio&lin,ual e1tension of the occlusal preparation e1ceeds %9= the distance bet"een the facial and lin,ual cusp tip reduction of the cusp!s# for amal,am is re8uired for the development of ade8uate resistance form. The reduction should be % mm for functional cusps and *.' mm for non&functional cusp. Ehen reducin, only one or t"o facial or lin,ual cusps the cusp reduction should be e1tended Bust past the facial or lin,ual ,roove creatin, a vertical "all a,ainst the adBacent unreduced cusp. 1#. If the lesion has close pro,imity to the pulp, what would be the materials you would use to restore the cavity? 1ulp protection, base, restorative material? Calcium 2ydro1ide as pulp protector /IC as base Composite amal,am indirect restoration as restorative material. 1%. 2ypes of amalgam? Amal,am alloy is silver&tin alloy varyin, amounts of cooper and small amounts of 7inc. Lo"&cooper amal,am %&'> or conventional amal,ams$ corrosion because formation of tin&mercury phase !,ammas t"o#. 2i,h cooper amal,am*%&=)>$ the increased cooper content prohibits the formation of the corrosive phase !,amma t"o# "ithin the amal,am mass. Can be either spherical or admi1ed in composition. Spherical amal,am$ contains small round alloy particles that are mi1ed "ith mercury to form the mass. +ecause the shape of the particles the material is condensed into the tooth preparation "ith little condensation pressure. 2i,h early stren,th suited for very lar,e amal,am restorations !comple1 amal,am#.

Admi1ed amal,am$ contains irre,ular shaped and si7ed particles sometimes combined "ith spherical shapes. Re8uires more condensation pressure assistin, in displacin, matri1 bands to more easily ,enerate pro1imal contacts. 5e" amal,ams alloys$ lo" mercury or mercury free replaced "ith ,allium or indium. A hi,h cooper amal,am alloy is recommended for comple1 amal,am restoration because of e1cellent clinical performance and hi,h early compressive stren,ths. Spherical alloys have a hi,her early stren,th and can be condensed 8uic(er "ith less pressure to ensure ,ood adaptation around the pins. 3ro1imal contacts are easier to achieve "ith admi1ed alloys e1tended "or(in, time for condensation removal of matri1 and final carvin,. Condensate until overfilled. Remove e1cess on the occlusal surface develop anatomy mar,inal rid,es and define occlusal embrasures "ith an e1plorer. +e careful "hen removin, matri1. Remove retainer first if tofflemire loosen automatri1 and remove matri1 "ith laterally oriented short ran,e movements. Complete carvin,. 0evelop facial and lin,ual contours "ith hollenbac( carver or an e1plorer. Evaluate mar,ins and occlusal contacts pass thin un"a1ed dental floss. 1&. "hat ind of amalgam do you prefer? 2i,her cooper spherical or admi1 1*. "hat is the admi, type? It is a hi,h cooper amal,am. It combined the conventional and spherical type. 1+. "hy use high cooper? Eliminate the "ea(est ,amma % phase less corrosion *G. "hich is the better material to restore deep cavitiesH ,lass ionomer ! base# silver amal,am !fillin,# *I. How do you chec if the contact is clinically acceptable after restoration? 0ental floss for pro1imal contact articulatin, paper for occlusal contact. !0. "hat is the action of calcium hydro,ide when it is placed close to the pulp? Stimulates reparative dentin formation. Antibacterial properties induce minerali7ation of adBacent pulp. !1. "hat happen if there is not ade3uate thic ness of amalgam covering the cusp? 5ot ade8uate resistance form. Tend to failure. Inade8uate thic(ness of amal,am "hich "ill cause fracture under load. !!. 4evel in composites? Csed to increase both the surface area of etchable enamel and to ma1imi7e the effectiveness of the bond by etchin, more enamel rods. Retention and mar,inal seal are improved by bevellin, some enamel mar,ins. +evelin, increases favourable end&on etchin, of enamel prisms and increases the surface area for bondin,. Incorporation of a cavosurface bevel enables the

restoration to blend more aesthetically "ith the coloration of the surroundin, tooth structure. +evels are not place on the occlusal surface of posterior teeth or other areas of potential heavy contact. Also not placed on pro1imal mar,ins if results in e1cessive e1tension of the cavosurface mar,ins. Rarely used for posteriors. !#. "hat is the best material to restore the buccal cusp of an upper premolar which has sheared off? Indirect restorations of ceramic or composite restoration !doesnDt last as lon,#. /old =9?cro"n !H Aesthetics#. !%. How can you improve the contact point when you are doing a class ! composite in a posterior tooth? "hy good contact between teeth is difficult in composites? 3re"ed,in, properly contour the matri1 band have matri1 band in contact "ith tooth use a matri1 system that places matri1 only around the pro1imal surface to be restored use specially desi,ned trian,ular li,ht&curin, tips to help hold the matri1 a,ainst the adBacent tooth "hile curin,. Cse a hand instrument to hold the matri1 a,ainst the adBacent tooth "hile curin, the incremental placement of composite. !&. Is it better to put a thin layer of vitrebond on the pulpal and a,ial walls or a thic layer of fu5i I6 on the same walls before placing the composite? "hy? Ehen placin, composite there is not need to place a base. Vitrebond on the pulpal "all to protect the pulp. !*. "hat are the things you have to consider when preparing the tooth for composites? 2ooth preparation for composite? Should be as conservative as possible the e1tend determined by the si7e shape and location of the defect and "hatever e1tensions to provide access for vision and instrumentation. 5ot secondary retention form needed. 5ot need of e1tension into all pits and fissures on the occlusal surface. +evel !J. %%#. Avoid internal sharp an,les. ).' mm bevel placed on the ,in,ival mar,ins "hen enamel is available. Removin, the fault defect old material or friable tooth structure. Creatin, prepared enamel mar,ins more flatted !obtuse# than I) de,rees. Creatin, I) de,rees cavosurface mar,ins on root surface. Rou,henin, the prepared tooth structure "ith a diamond stone. +asic principles of tooth preparation must be follo"ed$ removin, all of the caries fault defect old restorative material in the most conservative "ay !outline form#. The composite material must be retained "ithin the tooth from micromechanical bondin, of the composite to the rou,hened etched and primed enamel and dentin. Sometimes retention ,roove or enamel bevel. !retention form#. Keepin, the tooth stron, and protected from fracture by micromechanical bond flat floors bo1li(e forms floors perpendicular to occlusal forces !resistance form#.Caries removal and Calcium hydro1ide liner "hen pulpal e1posure !pulp protection#. There is no need for any bases under composites restorations because the composite is bonded to the prepared tooth and is insulative.

%@. 2ypes of compositeH Conventional !macrofills# -icrofills 2ybrid 6lo"able pac(able. Conventional !macrofills#$ /ood filler content !@'>&G)> inor,anic filler by "ei,ht#. 3article si7e G um rou,h surface te1ture !2ard to polish# susceptible to discoloration hi,her initial "ear !uneven# poor colour matchin,. -icrofills$ filler content ='>&A)> !inferior mechanical characteristics# colloidal silica particles ).)*&).)? um smooth polished surface less receptive to pla8ue or e1trinsic stainin,. Lo" modulus of elasticity !bend durin, tooth fle1ure& Class V#. 2ybrid composites$ inor,anic filler content of @'>&G'> by "ei,ht. 3article si7e ).?& * um. 3hysical and mechanical properties hi,her than conventional composites. Smooth finish. 3redominant direct aesthetic restorative material. These contain varyin, proportions of microfiller particles and ,round ,lass 8uart7 or ceramic. 6lo"able$ lo"er filler content inferior physical properties lo"er "ear resistance and stren,th. Small class * pit and fissure sealants mar,inal repairs as liner under hybrid. 3ac(able$ increased viscosity and resistance to pac(in,. 5otes$ A1ial depth$ ).@' mm on root. Class I *.' mm occlusal. E1tension into mar,inal rid,es should result in appro1imately *.A mm thic(ness of remainin, tooth structure for premolars and % mm for molars. +evel$ ).' mm "idth at ?' de,ree an,le. Amal,ams$ Class II no retention loc(s needed a1ial depth ).% mm inside 0EF. Retention loc(s needed ).' mm inside 0EF. 0irection of mesial and distal "alls is influenced by remainin, thic(ness of mar,inal rid,e. Should conver,e occlusally "hen thic(ness is ,reater than *.A mm. If less than *.A mm mesial and distal "alls should diver,e occlusally. Loc(s ).% mm from 0EF. 3in$ % mm deep % mm len,th % mm to occlusal ).'&* mm to 0EF *&*.' mm to enamel surface. Slots$ ).A mm deep ).' mm "idth * mm or more lon,.