Alex Complex Amalgam

8/10/2019 Alex Complex Amalgam

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Alex Chen

Complex amalgam preparation & restoration

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Complex Amalgam Preparation critical reuirements

Tooth: 46 MODBCritical

requirements of

this procedure

Rationale of requirements and supporting literature New skills accomplished in this excercise,

problems encountered, and breakthrough

moments

id m! product

meet these

requirements"

Class ##

Amalgam$

Reerse !

1" The reerse ! shape# is nee#e# #$e to the

%i#ening of the preparation of the proximal ox"

The ! shape allo%s the proximal ox to maintain'(o )aos$rfa)e an# opening $))al*ling$al )onta)ts

%hile presering so$n# tooth str$)t$re at the sametime +!)h%art, et al- .((6/"

." 0t sho$l# e note# that the reerse !2 is notal%a3s nee#e# an# sometimes een e)omes a !2

shape #epen#ing on the lo)ation of the )onta)t %iththe a#a)ent tooth"

To a)hiee a reerse !2 +%hen nee#e#/-

0 learne# to )$t the proximal ox part

an# o))l$sal part of the preparationseparatel3 an# finall3 oin them

together" This ens$re a #istin)t !2shape# preparation is forme#"

es

%pen

interproximal

contact

1" Allo%s is$al erifi)ation that all )aos$rfa)e

margins are pla)e# in so$n# tooth str$)t$re+Roertson et al"- .((6/"

." Conenien)e of a))ess for finishing an#

polishing"

" Allo% self7)leansing of the )aos$rfa)e margin

to #e)rease ris8 of pla9$e a))$m$lation an#se)on#ar3 )aries +athi an# Morta,ai- .((4/"

;The a#antage of not rea8ing the )onta)t is the

The proximal )onta)t %as #iffi)$lt to

open as it $s$all3 en# $p too %i#e" M3sol$tion %as opening the )onta)t

slightl3 %ith a fine nee#le nose# $r"

es

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)onseration of tooth str$)t$re an# etter ens$re of

proximal )onta)t" s no$n#ermine# enamel ro#s" Also- it ma8es s$re the

amalgam is of s$ffi)ient $l8 than if the angle istoo a)$te" This #e)reases the )han)e of the enamel

or amalgam fra)t$res +Roerson- .((6/"

This %as fairl3 eas3 to a)hiee 3)he)8ing the preparation from o))l$sal

ie%"

es

*alls con)ergent

occlusall!

O))l$sal )onergen)e resists restoration

#islo#gement o))l$sall3 3 me)hani)al retention+!$mmit et al"- .((6/"

0 ha# no tro$le %ith this re9$irement" es

+ shelf$1" Parallel to

o))l$sal plane

." ?$st into #entin" lat an# e9$al

%i#th thro$gho$t

1" The parallelism of $))al shelf to o))l$sal planegies it the most resistan)e to%ar#s o))l$sal loa#

3 eliminating the ramp effe)t that %o$l# o))$r if

the shelf an# o))l$sal plane are not parallel" Theparallelism also ens$res that the res$lting amalgam

restoration %ill e e9$al in thi)8ness tho$gho$t theo))l$sal plane- %hi)h helps resist fra)t$re"

." The shelf is $st into #entin to ens$re s$ffi)ient$l8 for the amalgam restoration to resist fra)t$re"

" The shelf is flat to ens$re that the res$lting

amalgam restoration %ill e e9$al in thi)8ness#is)$sse# in point 1"

0 learne# to $se the ( $r length as ag$i#e for #epth" Also- 0 smoothen an#

flatten the shelf 3 r$nning a $r a)ross

it at @.( spee#"

es

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Alex Chen


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Pulpal slot$

1" 0n area of

)entral grooe

." At least 1mm in#epth" A))ommo#ates

smallest )on#enser

1" P$lpal slot is pla)e# in the area of )entral grooe

e)a$se that>s %here the p$lp is f$rtherst a%a3

from the o))l$sal plane" m satisfie# %ith the

positioning efore 0 start )$tting #o%n

more aggressiel3"

es

Pin$

1" Parallel to)aos$rfa)e

." ?$st into #entin" Clearan)e of

1" The pin parallels the )aos$rfa)e to preent

perforating the tooth as the tooth tapers to%ar#s)eri)al"

." The pin is $st into #entin to #e)rease the ris8 of

0 #i# not hae prolem %ith pla)ing the

pin"

*A

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Alex Chen


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smallest )on#enser perforation an# stress pla)e# on the tooth that ma3

)a$se mi)rofra)t$re of #entin or gross fra)t$re of

the )ro%n" +B$rgess et al"- 1''/

" The a))ommo#ation of the smallest )on#enser isfor proper )on#ensation of amalgam #$ring

restoration"

Retention

groo)es$1" a))ommo#ates

smallest )on#enser

1" The a))ommo#ation of the smallest )on#enser is

for proper )on#ensation of amalgam #$ringrestoration"

The retention grooes are fairl3 eas3 to

pla)e" 0 $se the ( $r to ens$re the%all )onergen)e is maintaine#"

*A

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Complex Amalgam Preparation pictures

Complex Amalgam Preparation

!iscussion

0n a)hieing this rea87thro$ghs- ho% %ill this help 3o$ in #efining 3o$rself as a #entist

The iggest prolem 0 ha# %ith the )omplex amalgam preparation is the proximal tro$gh retentie feat$re"Preparing this feat$re is har# for me e)a$se 0 )annot is$ali,e the area as 0 )$t as m3 ision +oth #ire)t an#in#ire)t/ is lo)8e# 3 m3 han#pie)e" This )a$se# me to hae less )ontrol oer m3 preparation an# m3 tro$ghs

%o$l# t$rn o$t either too #eep or too %i#e" 0 trie# to sole the prolem 3 tr3ing to fin# the optimal pla)ement of

m3 mirror an# the mani8in hea# position to is$ali,e the area 0>m )$tting- $t ha# no s$))ess" Eent$all3- 0 learne#to #epen# on m3 ta)tile sense to estimate the #epth of m3 $r an# )$t slo%l3" 0 %o$l# also )he)8 m3 #epth

fre9$entl3 %ith in#ire)t ision $ntil the re9$ire# #epth an# %i#th is met" This rea87thro$gh ta$ght me that

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aaa

%pen

interproximal

contact

Re)erse '( to ca)osurface +uccal shelf$

1" Parallel too))l$sal plane

." ?$st into #entin" lat an# e9$al

%i#th thro$gho$t

Proximal trough:

1" B$tts $p againstaxial %all

." At least 1mm in#epth

" ("5mm into #entin

*alls con)ergent

occlusall!


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Alex Chen


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sometimes a %e )annot al%a3s see %here %e are %or8ing an# some g$essing %or8 is inole#" 0n these )ases-patien)e is extremel3 important" For8ing slo%ing an# )he)8ing o$r o%n %or8 )onstantl3 is the %a3 to pro#$)e the

optimal res$lt"

0 also felt that the )omplex amalgam preparation reall3 re9$ires $s to reall3 hae a #eep $n#erstan#ing of the

tooth str$)t$re an# retention me)hani)s" Compare# to the other )lasses of preparations %e learne# efore %here the

shape an# feat$res of the preparations are 9$ite similar in the same )lass of lesions- there are great ariailit3 in the#esign of the preparation in )omplex amalgam preparation as %e hae man3 #ifferent feat$re options %e )an

)hoose from" The operators nee# to hae a firm $n#erstan#ing of the anatom3 of the tooth an# the retention

me)hanism to alan)e the remoal of so$n# tooth str$)t$re that %ea8ens the tooth an# the retention nee#e# for therestoration" This is an ex)ellent example of ho% #entists nee# to )onstantl3 appl3 their 8no%le#ge an# $stif3 their

%or8 instea# of follo%ing a fixe# re)ipe"

Complex Amalgam "estoration critical reuirements

Tooth: 46 MODBCritical

requirements

of thisprocedure

Purpose of critical requirements and supporting literature New skills accomplished in this excercise,

problems encountered, and breakthrough

moments

id m! product

meet these

requirements"

Close

Contact

-. Pre)ent food impaction.

/. 0aintaining health of interproximal soft tissue

1Roberson et al., /''23.

# had a lot of trouble with this

requirement. 4he most important

step in ensuring a closed contact #

find is to laterall! condense the

amalgam )er! well towards the

5es

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6. Pre)ent tooth migration 10amoun and Ahmed,

/''23.

ad7acent tooth in the contact area to

close the contact.

+ height ofcontour

-3 #n proper

alignment

/3 #n proper

arch contour

+ cups

-3 #n proper

alignment

Central

groo)e

-3 #n proper

arch

alignment

1" proper alignment an# )onto$r of )$sps proi#eoptim$m integrit3 of the )$sps"

." Properl3 repro#$)e# )entral grooe gies i#eal

o))l$sion %hen arti)$late# %ith the opposing )$sps aso))l$sal relationship is repro#$)e# +Taernier an#

Colon- 1'G'/"

"

0 al%a3s follo% a s3stemi) se9$en)e%hen )aring the in#ii#$al feat$res"

M3 pro)ess is #es)rie# in the follo%ing#is)$ssions se)tion"

Another prolem 0 str$ggle# %ith is the

ten#en)3 to oer)are the )$spal ri#ges"

0 fin# that %hen 0 )are the ling$al)$spal ri#ge- the tip of m3


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Alex Chen


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position

Properl!

shaped

marginalridge

-3 Not o)erl!

bulk!

/3 4rue

position le)el

with ad7acent

ridges

An ex)essiel3 high restoration %o$l# ta8e other teeth

o$t of o))l$sion" A))or#ing to !$mmitt et al" +.((6/-

)onta)ts #$ring o))l$sion sho$l# neer o))$r onrestoration alone" 0f this happens- the restoration sho$l#

e ta8en o$t of o))l$sion an# ens$re )onta)t is onrestoration as %ell as tooth str$)t$re sim$ltaneo$sl3

+!$mmitt et al"- .((6/"

0 ma8e s$re the marginal ri#ges are leel

%ith a#a)ent ri#ges 3 leeling it %ith

the flat en# of the ea)h )arer"

N%

#n occlusion

-3 proper

cusp9fossaerelationship

An ex)essiel3 high restoration %o$l# ta8e other teetho$t of o))l$sion" A))or#ing to !$mmitt et al" +.((6/-

)onta)ts #$ring o))l$sion sho$l# neer o))$r onrestoration alone" 0f this happens- the restoration sho$l#e ta8en o$t of o))l$sion an# ens$re )onta)t is on

restoration as %ell as tooth str$)t$re sim$ltaneo$sl3"

0 %o$l# al%a3s )he)8 the o))l$sion %ithan arti)$lating paper to ens$re none or

onl3 minimal )onta)t on m3 restoration"

5es

Proper cusp

height$

0+ cusp

higher than

+ cusp,

higher than cusp

The )$sps nee# to e in proper positions to otain

)orre)t o))l$sion" 0f )$sps are too high- hea3 o))l$sal

for)es )an lea# to fra)t$re of the restoration +!$mmitt etal"- .((6/"

0 fin# it helps a lot to loo8 at a irgin 46

as a example %hile )aring to get a

is$al i#ea of the height relationships ofthe )$sps"

5es

No marginal

)oids

0arginal )oids or o)erhangs accumulates food

debris and plaque. 4his ma! lead to recurrent caries.

epending on location, marginal )oid could also

make the restoration susceptible to fracture 10ahler

and 0arant:, -;'3.

0arginal )oids are a)oided b!

condensing the amalgam with a lot of

force.


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Alex Chen


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mooth no

scratches

1" !)rat)hes on restoration ma3 feel $npleasant to the

patient"

." !)rat)hes also proi#es a pla)e for a)teriaa))$m$lation an# gro%th +Paarmann an# Be)8man-.((5/"

" !)rat)hes ma3 a)t as )enters for )orrosion"+A8eroom et al"- .((6/

0 smoothen m3 restoration %ith a )otton

roll at the en#"

es

Complex Amalgam "estoration pictures

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Complex Amalgam "estoration !iscussion

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Close Contact Properl! shaped

marginal ridge

1/ ot oerl3 $l83./ Tr$e position

leel %ith a#a)entri#ges Reerse !

;Distal ri#ge is too$l83

Proper cusp height

MB )$sp higher than

B )$sp- higher thanD )$sp Reerse !

Central groo)e

0n proper ar)h

alignment

+uccal height of

contour

1/ 0n properalignment

./ 0n proper ar)h)onto$r

+uccal cups

0n proper alignment

No marginal )oids

mooth no

scratches


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Alex Chen


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0n a)hieing this rea87thro$gh- ho% %ill this help 3o$ in #efining 3o$rself as a #entist

0 ha# a har# time )aring the anatom3 of the molar at first" Fith pra)ti)e- 0 got a lot faster an# m3 restoratione)ame more anatomi)all3 )orre)t" Fhat 0 fo$n# helpe# is haing a s3stemati) approa)h %hile )aring the tooth

feat$res" 0 learne# to %or8 in a fixe# or#er an# al%a3s $se the same instr$ment for a parti)$lar feat$re" or

example- 0 %o$l# al%a3s start 3 #efining the o))l$sal tale %ith an explorer" Then 0 %o$l# )are a ro$gh o$tlineof the )$sps an# grooes %ith the same explorer" 0 %o$l# then moe on to #efine the )$sps %ith a hollena)8 an#

ea)h )arer" This is follo%e# 3 #efining the pits an# marginal grooes %ith a #is)oi#7)leoi#" Hastl3- 0 %o$l#

finish off %ith shaping the $))al or ling$al )onto$r %ith a hollena)8" 0 fo$n# this s3stemi) approa)h ma#e s$reall the feat$res of the restoration is present an# nothing is misse#" Also- repeate# pra)ti)e %ith the same instr$ment

on the same anatomi)al feat$re greatl3 improes m3 spee# an# 9$alit3 of %or8 then if 0 )are# the str$)t$re %ith#ifferent instr$ment ea)h time" This experien)e )learl3 signifie# the importan)e of a#opting a s3stemi) approa)h ino$r #ail3 pro)e#$res" rom a ro$tine patient exam to )ompli)ate# #ental pro)e#$res- haing a s3stemi) approa)h

%ill greatl3 improe the effi)ien)3 an# ma8e s$re eer3thing is )oere#"

Referen)es:

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A8eroom-


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Rosenstiel- "- A3a#- "- Maghrai- A" +.((5/" Assessment of Conergen)e angles of tooth preparations) &ournal of Dentistry-+G/: 67G"

!)h%art,- R"- !$mmitt- ?"- Roins- F" +.((6/"Fun!amentals of operative !entistry - a contemporary approach +r# e#"/ Chi)ago:

K$intessen)e P$"

Taernier- B"- Colon- P" +1'G'/" $n)tional #ental anatom3 an# amalgam- "ev #!ontostomatol .Paris/)1G+1/: .17.'

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Alex Complex Amalgam