1. Copyright 2003, Elsevier Science (USA). All rights reserved. Restorative and Esthetic Dentistry Chapter 48 Copyright 2003, Elsevier Science (USA). All rights reserved. No part of this product may be reproduced or transmitted in any form or by any means, electronic or mechanical, including input into or storage in any information system, without permission in writing from the publisher. PowerPoint ® presentation slides may be displayed and may be reproduced in print form for instructional purposes only, provided a proper copyright notice appears on the last page of each print-out. Produced in the United States of America ISBN 0-7216-9770-4

2. Copyright 2003, Elsevier Science (USA). All rights reserved. Introduction Restorative and esthetic dentistry is the treatment of the general dental needs of a patient.

3. Copyright 2003, Elsevier Science (USA). All rights reserved. Restorative Dentistry  Specific conditions that initiate a need for restorative dentistry are: Initial or recurring decay. Replacement of failed restorations. Abrasion or the wearing away of tooth structure. Erosion of tooth structure.  Specific conditions that initiate a need for restorative dentistry are: Initial or recurring decay. Replacement of failed restorations. Abrasion or the wearing away of tooth structure. Erosion of tooth structure.

4. Copyright 2003, Elsevier Science (USA). All rights reserved. Esthetic Dentistry  Specific conditions that initiate a need for esthetic treatment are: Discoloration due to extrinsic or intrinsic staining. Anomalies due to developmental disturbances. Abnormal spacing between teeth. Trauma.  Specific conditions that initiate a need for esthetic treatment are: Discoloration due to extrinsic or intrinsic staining. Anomalies due to developmental disturbances. Abnormal spacing between teeth. Trauma.

5. Copyright 2003, Elsevier Science (USA). All rights reserved. Principles of Cavity Preparation  Initial cavity preparation Develop the outline form and initial depth. Establish primary resistance form. Establish primary retention form. Provide a convenience form.  Initial cavity preparation Develop the outline form and initial depth. Establish primary resistance form. Establish primary retention form. Provide a convenience form.

6. Copyright 2003, Elsevier Science (USA). All rights reserved.  Final cavity preparation Remove any remaining enamel in the preparation, infected dentin, or old restorative material. Apply additional resistance and retention locks, grooves, and coves to provide strength in the maintenance of the restoration. Place dental materials that may include lining agents, bases, and desensitizing or bonding agents for pulpal protection and better retention.  Final cavity preparation Remove any remaining enamel in the preparation, infected dentin, or old restorative material. Apply additional resistance and retention locks, grooves, and coves to provide strength in the maintenance of the restoration. Place dental materials that may include lining agents, bases, and desensitizing or bonding agents for pulpal protection and better retention. Principles of Cavity Preparation  cont’d

7. Copyright 2003, Elsevier Science (USA). All rights reserved. Table 48-1: Terminology in Understanding Cavity Preparation

8. Copyright 2003, Elsevier Science (USA). All rights reserved. Patient Preparation for Restorative Procedures  Inform the patient of the procedure to be performed and what to expect during the treatment.  Position the patient correctly for the dentist and the type of procedure.  Explain each step as the procedure progresses.  Inform the patient of the procedure to be performed and what to expect during the treatment.  Position the patient correctly for the dentist and the type of procedure.  Explain each step as the procedure progresses.

9. Copyright 2003, Elsevier Science (USA). All rights reserved. Responsibilities of the Chairside Assistant  Know the procedure and be able to anticipate the dentist's needs.  Prepare the setup for the procedures.  Provide moisture control and better visualization by means of high ‑ velocity suction and air ‑ water syringe.  Transfer dental instruments and accessories.  Mix and transfer dental materials.  Maintain patient comfort and appropriate exposure control precautions.  Know the procedure and be able to anticipate the dentist's needs.  Prepare the setup for the procedures.  Provide moisture control and better visualization by means of high ‑ velocity suction and air ‑ water syringe.  Transfer dental instruments and accessories.  Mix and transfer dental materials.  Maintain patient comfort and appropriate exposure control precautions.

10. Copyright 2003, Elsevier Science (USA). All rights reserved. Components of a Restorative Procedure  Dentist evaluates the tooth to be restored.  Dentist obtains local anesthesia.  Assistant readies the type of moisture control to be used during the procedure.  Dentist prepares the tooth for the restoration.  Dentist determines the type of dental materials to be used.  Assistant mixes and transfers the dental materials.  Dentist burnishes, carves, or finishes the dental material.  Dentist checks the occlusion of the restoration.  Dentist finishes and polishes the restoration.  Dentist evaluates the tooth to be restored.  Dentist obtains local anesthesia.  Assistant readies the type of moisture control to be used during the procedure.  Dentist prepares the tooth for the restoration.  Dentist determines the type of dental materials to be used.  Assistant mixes and transfers the dental materials.  Dentist burnishes, carves, or finishes the dental material.  Dentist checks the occlusion of the restoration.  Dentist finishes and polishes the restoration.

11. Copyright 2003, Elsevier Science (USA). All rights reserved. Class I Restorations  A class I lesion affects the pit and fissures of the teeth.  Surfaces involved are: Occlusal surfaces of premolars and molars. Occlusal two thirds of the facial surfaces of mandibular molars. Occlusal third of the lingual surfaces of the maxillary molars. Lingual surfaces of maxillary incisors, most frequently in the pit near the cingulum.  A class I lesion affects the pit and fissures of the teeth.  Surfaces involved are: Occlusal surfaces of premolars and molars. Occlusal two thirds of the facial surfaces of mandibular molars. Occlusal third of the lingual surfaces of the maxillary molars. Lingual surfaces of maxillary incisors, most frequently in the pit near the cingulum.

12. Copyright 2003, Elsevier Science (USA). All rights reserved. Fig. 48-5, A-D Class I restoration.

13. Copyright 2003, Elsevier Science (USA). All rights reserved. Class II Restorations  A class II lesion is an extension of the class I lesion into the proximal surfaces of premolars and molars.  Areas for class II decay involve: Two-surface restoration of a posterior tooth. Three-surface restoration of a posterior tooth. Four- or more surface restoration of a posterior tooth.  A class II lesion is an extension of the class I lesion into the proximal surfaces of premolars and molars.  Areas for class II decay involve: Two-surface restoration of a posterior tooth. Three-surface restoration of a posterior tooth. Four- or more surface restoration of a posterior tooth.

14. Copyright 2003, Elsevier Science (USA). All rights reserved. Fig. 48-7, A-C Class II restorations.

15. Copyright 2003, Elsevier Science (USA). All rights reserved. Class III and IV Restorations  A class III lesion affects the interproximal surface of incisors and canines.  A class IV lesion involves a larger surface area, which includes the incisal edge and the interproximal surface of incisors and canines.  A class III lesion affects the interproximal surface of incisors and canines.  A class IV lesion involves a larger surface area, which includes the incisal edge and the interproximal surface of incisors and canines.

16. Copyright 2003, Elsevier Science (USA). All rights reserved. Fig. 48-8 Class III restoration.

17. Copyright 2003, Elsevier Science (USA). All rights reserved. Fig. 48-9 Class IV restoration.

18. Copyright 2003, Elsevier Science (USA). All rights reserved. Class V Restorations  A class V restoration is classified as a smooth surface restoration. These decayed lesions occur at: The gingival third of the facial or lingual surfaces of any tooth. The root of a tooth, near the cementoenamel junction.  A class V restoration is classified as a smooth surface restoration. These decayed lesions occur at: The gingival third of the facial or lingual surfaces of any tooth. The root of a tooth, near the cementoenamel junction.

19. Copyright 2003, Elsevier Science (USA). All rights reserved. Complex Restorations  Retentive Pins Placed when decay has extended into the cusp of a tooth and undermined the enamel and dentin. The general understanding when using retention pins is that one pin is placed for each missing cusp.  Retentive Pins Placed when decay has extended into the cusp of a tooth and undermined the enamel and dentin. The general understanding when using retention pins is that one pin is placed for each missing cusp.

20. Copyright 2003, Elsevier Science (USA). All rights reserved. Intermediate Restorations  Restoration that is placed for a short term.  Factors for placing an intermediate restoration is: The health of the tooth. Waiting to receive a permanent restoration. Financial reasons.  Restoration that is placed for a short term.  Factors for placing an intermediate restoration is: The health of the tooth. Waiting to receive a permanent restoration. Financial reasons.

21. Copyright 2003, Elsevier Science (USA). All rights reserved. Direct Bonded Veneers  A veneer is a thin layer of tooth ‑ colored material applied to the facial surface of a prepared tooth.  A veneer is used to improve the appearance of teeth that are: Abraded. Eroded. Discolored with intrinsic stains. Darkened after endodontic treatment.  A veneer is a thin layer of tooth ‑ colored material applied to the facial surface of a prepared tooth.  A veneer is used to improve the appearance of teeth that are: Abraded. Eroded. Discolored with intrinsic stains. Darkened after endodontic treatment.

22. Copyright 2003, Elsevier Science (USA). All rights reserved. Tooth Whitening  Commonly known as vital bleaching, tooth whitening is a noninvasive method of lightening dark or discolored teeth.

23. Copyright 2003, Elsevier Science (USA). All rights reserved. Indications for Using a Tooth Whitener  Indications for procedure: Extrinsic stains from foods, cigarette smoking, coffee, or tea. Aged teeth. Intrinsic stains, such as mild tetracycline stains and mild fluorosis.  Indications for procedure: Extrinsic stains from foods, cigarette smoking, coffee, or tea. Aged teeth. Intrinsic stains, such as mild tetracycline stains and mild fluorosis.

24. Copyright 2003, Elsevier Science (USA). All rights reserved. Whitening Products  Chemical makeup Active ingredient Either carbamide peroxide or hydrogen peroxide. Gel base With one or a mixture of propylene glycol, glycerin, and water. Thickener Carbopol.  Chemical makeup Active ingredient Either carbamide peroxide or hydrogen peroxide. Gel base With one or a mixture of propylene glycol, glycerin, and water. Thickener Carbopol.

25. Copyright 2003, Elsevier Science (USA). All rights reserved. Tooth-Whitening Procedure  Material is placed in a thermoplastic custom tray that the patient wears for a designated period. For the 10% to 16% carbamide peroxide gels, the wear schedule would be for 1 hour, twice a day for the first week and once a day for the second week. For the 20% to 22% mixture, 1 hour a day for a 2-week period. For the hydrogen peroxide 15 to 30 minutes, 2 or 3 times a day for a 2-week period.  Material is placed in a thermoplastic custom tray that the patient wears for a designated period. For the 10% to 16% carbamide peroxide gels, the wear schedule would be for 1 hour, twice a day for the first week and once a day for the second week. For the 20% to 22% mixture, 1 hour a day for a 2-week period. For the hydrogen peroxide 15 to 30 minutes, 2 or 3 times a day for a 2-week period.

26. Copyright 2003, Elsevier Science (USA). All rights reserved. Possible Complications to Tooth Whitening  Thermal hypersensitivity Patient may experience sensitivity to heat and cold after removal of tray and material. The use of sensitive-type toothpaste is recommended.  Tissue irritation Gingival tissue exposed to any excess gel may be caused by improper tray fit, allowing the material to ooze onto the gingiva. The patient is recommended to not overfill the tray with material and to remove any excess after seating the tray.  Thermal hypersensitivity Patient may experience sensitivity to heat and cold after removal of tray and material. The use of sensitive-type toothpaste is recommended.  Tissue irritation Gingival tissue exposed to any excess gel may be caused by improper tray fit, allowing the material to ooze onto the gingiva. The patient is recommended to not overfill the tray with material and to remove any excess after seating the tray.

27. Copyright 2003, Elsevier Science (USA). All rights reserved. Dental Assistant's Role in Tooth-Whitening Procedure  Aid in the recording of the medical and dental history.  Assist in making the shade selection.  Take intraoral photographs before and after the procedure.  Take and pour up the preliminary impression for the custom tray.  Fabricate and trim the tray.  Provide postoperative instructions on the use of the material.  Assist in weekly or biweekly clinical visits.  Aid in the recording of the medical and dental history.  Assist in making the shade selection.  Take intraoral photographs before and after the procedure.  Take and pour up the preliminary impression for the custom tray.  Fabricate and trim the tray.  Provide postoperative instructions on the use of the material.  Assist in weekly or biweekly clinical visits.

28. Copyright 2003, Elsevier Science (USA). All rights reserved. Patient Instructions for Tooth- Whitening Procedure  Brush and floss before tray placement.  Place gel in tray in an equal limited amount.  Seat tray.  Instruct the patient not to have any food or drink when wearing the tray.  Instruct the patient to wear the tray for the recommended time.  If the patient experiences any problems during this time, discontinue use and discuss with the dentist.  Brush and floss before tray placement.  Place gel in tray in an equal limited amount.  Seat tray.  Instruct the patient not to have any food or drink when wearing the tray.  Instruct the patient to wear the tray for the recommended time.  If the patient experiences any problems during this time, discontinue use and discuss with the dentist.

29. Copyright 2003, Elsevier Science (USA). All rights reserved. Tooth-Whitening Strips  Thin, flexible strips coated with an adhesive hydrogen peroxide whitening gel.  The patient peels off the backing like a Band- Aid and presses the strip to the facial anterior teeth, making sure that the upper edge of the strip is at the gingival margin. The remaining portion of the strip is folded onto the lingual surface.  Thin, flexible strips coated with an adhesive hydrogen peroxide whitening gel.  The patient peels off the backing like a Band- Aid and presses the strip to the facial anterior teeth, making sure that the upper edge of the strip is at the gingival margin. The remaining portion of the strip is folded onto the lingual surface.