Class IL acc. to Black Defects affecting one or both proximal surfaces of posteri Ml Morphology of proximal space Dental plaque Contact point - area ^^^^^^^^ The space below (filled of interdental papilla, the level of the papilla is decreasing during the time) The space above (habitually clean place) lroubal@med.muni.cz 2 Symptoms > No symptoms > Increased sensitivity (cold, sweet) > Retention of food > Defect (carious lesion is open — the enamel is broken) > Bite sensitivity (when carious lesion is open) lroubal@med.muni.cz 3 Diagnosis - Visual changes of tooth structure Inspection, good illumination, magnification - Imaging methods X ray - radiography Transillumination (DIFOTI) lroubal@med.muni.cz 4 Radiography Bite wing DIFOTI (Digital Fibre Optic Trans-Illumination) Digitální forma FOTI — zdroj bílého světla — kamera s CCD senzorem — počítač — zobrazení jako obrázek DIAGNOCam 4 — caries in dentin next to enamel 5 - large caries in dentin DIAGNOCam Preparation - amalgam > Conventional preparation acc. to the Black's rules > Slot preparation > Large preparation — cusp(s) involved lroubal@med.muni.cz 14 Preparation - adhesive materials > Conventional preparation for composites > Adhesive slot > Tunnel preparation lroubal@med.muni.cz Conventional preparation Occlusal cavity Proximal cavity - box lroubal@med.muni.cz 16 Access to the cavity From the occlusal surface Through the undermined enamel Separation using wooden wedges is useful lroubal@med.muni.cz Access to the cavity lroubal@med.muni.cz 20 lroubal@med.muni.cz 21 Cavosurface margin and extention for prevention Proximal box: Axial walls Gingival wall Occlusallv Class I. lroubal@med.muni.cz 23 Steny v aproximalnf kavite jsou : axial, gingival walls Divergent Gingival wall 1. Is 1 - 1,5mm wide 2. The angle between pulpal wall and gingival wall is 90° 3. It goes parallel to cementoenamel junction 26 Cavosurface margin - axial walls American rule obsolete lroubal@med.muni.cz 27 Cavosurface margin - axial walls Check the contact area — the filling must reconstruct the contact area —and be appr. 0,5 mm over lroubal@med.muni.cz Retention > Occlusal cavity with undercuts > Divergency of axial walls > Grooves lroubal@med.muni.cz lroubal@mea.muni.cz 30 Resistancy > No undermined enamel > No sharp edges > Isthmus is 1/3 — 1/ 4 intercuspidal distance > Angle between axial and gingival wall: 90°, or 85° > Width of gingival wall is 1 mm at least > Thickness of the filling 2 — 4 mm (4mm cusp replacing) lroubal@med.muni.cz lroubal@med.muni.cz 34 Excavation of carious dentin Rounded bur * I ľ! (Caries Detector, Kuraray, Japonsko; Caries Marker, VOCO,Nemecho) lroubal@med.muni.cz 35 Finishing of cavity walls > Red coded diamond bur > Chisel on the giongival wall (if in enamel) lroubal@med.muni.cz lroubal@med.muni.cz 38 Final check > Goog light, miror lroubal@med.muni.cz 40 Matrix placement > Matrix primarily is used when a proximal surface is to be restored The objectives: - Provide proper contact - Provide proper contour - Confine the restorative material Reduce the amount of excess materia lroubal@med.muni.cz Matrices > Ivory I retainer Ivory 1 > Hawe Neos retainer Ivory 8 > Tofelmire matix and retainer lroubal@med.muni.cz Wedges > Wooden wedges - tighten the matrix band - compress the gingiva - separate the teeth lroubal@med.muni.cz 44 Wedging > Slip the matrix band over the tooth)apical to the gingiva margin — 0,5, - 1 mm) > Tighten the matrix, check it with probe > Place a wedge > Turn the retainer % counterclockwise > Contour the band lroubal@med.muni.cz 46 lroubal@med.muni.cz 48 Condensation of amalgam ■ Condensor — stamen is the best one ■ Power driven condensation How big the stamen should be?? lroubal@med.muni.cz 49 Base > Zinkoxidphosphate cement On pulpal walls only! lroubal@med.muni.cz 57 Instruments Preparation :par Filling Finishing and polishing lroubal@med.muni.cz lroubal@med.muni.cz 61