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Textbook of Operative Dentistry
Nisha Garg, Amit Garg
CHAPTER 1:
Introduction to Operative Dentistry
INTRODUCTION
DEFINITIONS
HISTORY
INDICATIONS
Caries
Noncarious Loss of the Tooth Structure
Attrition
Abrasion
Erosion
Malformed, Traumatized, or Fractured Teeth
Esthetic Improvement
Replacement or Repair of Restoration
Developmental Defects
OBJECTIVES
Diagnosis
Prevention
Interception
Preservation
Restoration
Maintenance
RECENT ADVANCEMENTS
SUMMARY
EXAMINER’S CHOICE QUESTIONS
CHAPTER 2:
Tooth Nomenclature
INTRODUCTION
Dental Anatomy
Rationale of Tooth Anatomy
DENTAL ARCHES AND QUADRANTS
TYPES OF HUMAN TEETH
Incisors
Canines (Cuspids)
Premolars (Bicuspids)
Molars
TYPES OF DENTITION
TOOTH NOTATION SYSTEMS
Zsigmondy-Palmer System/Angular/Grid System
Universal (National) System/ADA System
Modified Version of Universal SystemOrder for Primary Dentition
Federation Dentaire International (FDI) System
Permanent Teeth
Deciduous Teeth
NOMENCLATURE OF TOOTH SURFACES
NOMENCLATURE RELATED TO DENTAL CARIES
Dental Caries
Primary Caries
Secondary (Recurrent) Caries
Residual Caries
Active Carious Lesion
Inactive/Arrested Carious Lesion
Pit and Fissure Caries
Smooth Surface Caries
Root Caries
Acute Dental Caries
Rampant Caries
Chronic Dental Caries
NON CARIOUS DEFECTS OF TEETH
Attrition
Abrasion
Erosion
Abfraction
Resorption
Localized Nonhereditary Enamel Hypoplasia
Localized Nonhereditary Enamel Hypocalcification
SUMMARY
EXAMINER’S CHOICE QUESTIONS
CHAPTER 3:
Structure of Teeth
INTRODUCTION
ENAMEL
Composition
Structure
Significance
Thickness
Color
Strength
Significance
Structures
Gnarled Enamel
Bands of Hunter-Schreger
Enamel Tufts
Enamel Lamellae
Enamel Spindles
Striae of Retzius
Prismless Layer
Dentino-enamel Junction
Occlusal Pits and Fissures
Functions
Clinical Significance
DENTIN
Composition
Color
Thickness
Hardness
Structure
Dentinal Tubules
Predentin
Peritubular Dentin
Intertubular Dentin
Primary Dentin
Secondary Dentin
Reparative Dentin/Tertiary Dentin
Sclerotic Dentin
Dead Tracts
Functions
Clinical Considerations
DENTAL PULP
Histology
Odontoblastic Layer
Cell-free Zone of Weil
Cell-rich Zone
Structural or Cellular Elements
Odontoblasts
Fibroblasts
Undifferentiated Mesenchymal Cells
Defence Cells
Extracellular Components
Fibers
Ground Substance
Anatomy
Pulp Chamber
Root Canal
Functions
Formation of Dentin
Nutrition of Dentin
Innervation of Tooth
Defense of Tooth
Age Changes
Morphologic Changes (Changes in Appearance)
Physiologic Changes (Changes in Function)
PERIRADICULAR TISSUE
Cementum
Types
Periodontal Ligament
Periodontal Fibers
Cells
Nerve Fibers
Blood Vessels
Functions
Alveolar Bone
Cells and Intercellular Matrix
SUMMARY
EXAMINER’S CHOICE QUESTIONS
CHAPTER 4:
Physiology of Tooth Form
INTRODUCTION
FUNCTIONS OF TEETH
Mastication
Speech
Esthetics
Protection of Supporting Tissues
PHYSIOLOGY OF TOOTH FORM
Gingiva
Marginal/Unattached Gingiva
Attached Gingiva
Gingival Sulcus/Crevice
PROTECTIVE FUNCTIONAL FORM OF THE TEETH
Height of Contour
Significance
Height of Epithelial Attachment
Significance
Marginal Ridges
Importance
Clinical Significance
Embrasures
Labial/buccal and Lingual Embrasures
Incisal/occlusal Embrasures
Gingival Embrasure
Functions of Embrasure
Significance
Interproximal Spaces
Proximal Contact Areas
Types of Proximal Contact
TRAUMA FROM OCCLUSION (TFO)
Types of Trauma from Occlusion
Based on Etiology
Based on Chronicity
Clinical Findings
Radiographic Findings
Diagnosis of Premature Contacts
Management
Grooving
Spheroiding
Pointing
OCCLUSION AND OPERATIVE DENTISTRY
Definitions
Occlusion
Static Occlusion
Dynamic Occlusion
Malocclusion
Occlusal Contact
Parafunctional (Nonfunctional) Contacts
Interferences
Hyperfunction
Bruxism
Bruxomania
Clenching
Centric Occlusion
Centric Relation
Maximum Intercuspation
Angle’s Classification for Interarch Relationship
Class I (Neutroclusion)
Class II (Distoclusion)
Class III (Mesioclusion)
Features of an Ideal Occlusion
Factors of Occlusion Affecting Operative Dentistry
Supporting Cusp/Stamp Cusp or Centric Holding Cusp
Characteristic Features of Supporting Cusps
Significance of Supporting Cusps
Nonsupporting Cusp/Noncentric Cusp/Gliding Cusps
Significance Nonsupporting Cusps
Interarch Tooth Relationships
Surface Contact
Cusp and Fossa Apposition (Figs 4.35A and B)
SUMMARY
EXAMINER’S CHOICE QUESTIONS
CHAPTER 5:
Dental Caries
INTRODUCTION
DEFINITIONS
Dental Caries
Cariology
SITES
EPIDEMIOLOGY
Prevalence
Incidence
DENTAL BIOFILM
Features of Biofilm
Protection of Bacteria in Biofilm
Trapping Nutrients in Biofilm
Providing Favorable Conditions for Different Bacterial Species in Biofilm
Exchange of Genetic Material Between Different Species of Bacteria in a Biofilm
Components of Biofilm
Inorganic Components
Organic Components
Development of Biofilm
Formation of Pellicle
Colonization of Bacteria
Maturation of Biofilm
THEORIES
Acidogenic Theory/Chemicoparasitic Theory
Role of Dental Plaque
Role of Carbohydrates
Role of Microorganisms
Role of Acids
Proteolytic Theory
Proteolysis-Chelation Theory
“Caries Balance Concept”(Proposed by Featherstone)
ETIOLOGY
Primary Factors
Modifying Factors
Tooth
Substrate (Environmental Factors)
Saliva
Diet
Bacteria
Time Period
Modifying Factors
Age
Sex
Race
Hereditary
Systemic Health
Occupation
CLASSIFICATION
According to their Anatomical Site
Pit and Fissure Caries
Smooth Surface Caries
Root Caries
According to New Lesion or Recurrent Lesion
Primary Caries
Recurrent Caries
Residual Caries
According to Speed of Caries Progression
Active Carious Lesion
Inactive/Arrested Carious Lesion
Chronic Caries
Rampant Caries
Based on Treatment and Restoration Design
Class I
Class II
Class III
Class IV
Class V
Class VI
Visual Classification (Occlusal Surfaces)
Based on Pathway of Caries Spread
Forward Caries
Backward Caries
Based on Extent of Caries
Incipient Caries
Cavitated Caries
Based on Number of Tooth Surfaces Involved
Simple Caries
Compound Caries
Complex Caries
WHO System of Caries Classification
Graham Mount’s Classification
HISTOPATHOLOGY
Enamel Caries
Smooth Surface Caries
Pit and Fissure Caries
Zones in Enamel Caries
Dentinal Caries
Early Dentinal Changes
Advanced Dentinal Changes
Zones of Dentinal Caries
DIAGNOSIS
Visual-Tactile Method of Diagnosis
Conventional Methods
Advances in Visual Method
Radiographic Methods
Caries of Different Surfaces of Teeth
Conventional Methods of Radiography
Recent Advances in Radiographic Techniques
Electrical Conductance Measurement
Vanguard Electronic Caries Detector
Lasers
Qualitative Laser Fluorescence
Diagnodent
Optical Coherence Tomography (OCT)
Polarization Sensitive Optical Coherence Tomography (PSOCT)
Dye Enhanced Laser Fluorescence (DELF)
ARRESTED CARIES
Stages of Development of Arrested Caries
First Stage
Second Stage
Third Stage
RECURRENT CARIES (SECONDARY CARIES)
Etiology
Microbiology
Clinical Diagnosis
Difficulties in Diagnosis of SecondaryCaries are due to—
Classification by Espelid and Tveit (1991)
Treatment
ROOT CARIES
Etiology
Intraoral Factors
Extraoral Factors
Features of Root Caries
Diagnosis
Prevention
Treatment
Restorative Materials Used for Treatment of Root Caries
CARIES RISK ASSESSMENT
Caries Activity Tests
Unstimulated Salivary Flow Test
Saliva Viscosity Test
Resting pH of Unstimulated Saliva
Salivary Buffering Capacity Test
S. mutans, Lactobacillus Test
PREVENTION
Methods to Reduce Demineralizing Factors
Dietary Measures
Methods to Improve Oral Hygiene
Chemical Measures
Methods to Increase Protective Factors
Methods to Improve Flow, Quantity and Quality of Saliva
Chemicals Altering the Tooth Surface or Structure
Application of Remineralizing Agents
Pit and Fissure Sealant
CURRENT METHODS OF CARIES PREVENTION
Genetic Modalities in Caries Prevention
Genetically Modified Foods
Genetically Modified Organisms
Caries Vaccine
Rationale of Caries Vaccine
Problems in Development of Caries Vaccine
Three Routes have been Tried to AchieveCaries Immunity in Animal Studies
Appropriate Animal Models for Testing Caries Vaccine
MANAGEMENT
Chemomechanical Caries Removal
Ozone Treatment of Dental Caries
Technique of Using Ozone Therapy
Caries Removal Using Air Abrasion
Lasers
SUMMARY
EXAMINER’S CHOICE QUESTIONS
CHAPTER 6:
Cutting Instruments
INTRODUCTION
Materials Used for ManufacturingCutting Instruments
Carbon Steel
Stainless Steel
Carbide Inserts
Heat Treatment of Materials
Hardening Heat Treatment
Tempering Heat Treatment
CLASSIFICATION
GV Black Classification
Marzouck’s Classification
NOMENCLATURE
Order
Suborder
Class
Subclass
PARTS OF HAND CUTTING INSTRUMENTS
Handle or Shaft
Shank
GV Black’s Classification of Instruments Based on Number of Shank Angles
Blade or Nib
INSTRUMENT FORMULA
Three-Number Formula
Example of Three-Number Formula
Four-Number Formula
Example of Four-Number Formula
DIFFERENT INSTRUMENT DESIGNS
Bevels in Cutting Instruments
Single Bevel Instruments
Bibeveled Instruments
Triple-beveled Instrument
Circumferential Bevel
Direct and Lateral Cutting Instruments
Direct Cutting Instruments
Lateral Cutting Instruments
Instruments ends
EXPLORING INSTRUMENTS
Mouth Mirrors
Types
Uses
Explorer
Parts
Types
Uses
Tweezers
Probes
Uses
Types
HAND CUTTING INSTRUMENTS
Chisels
Straight Chisel
Monoangle Chisel
Binangle Chisel
Triple Angle Chisel
Wedelstaedt Chisel
Hatchet
Gingival Margin Trimmer
Uses
Excavators
Ordinary Hatchet
Hoe Excavators
Angle Former
Spoon Excavator
Knives
Files
Cleiod-Discoid
Offset Hatchet
Triangular Hatchet
RESTORATIVE INSTRUMENTS
Cement Spatulas
Plastic Filling Instrument
Condensers
Amalgam Carriers
Carvers
Burnisher
Uses
Composite Resin Instruments/Teflon-coated Instruments
INSTRUMENT GRASPS
Modified Pen Grasp
Inverted Pen Grasp
Palm and Thumb Grasp
Modified Palm and Thumb Grasp
FINGER RESTS
Intraoral Finger Rests
Conventional
Cross-arch
Opposite Arch
Finger on Finger
Extraoral Finger Rest
Palm Up
Palm Down
METHODS OF USE OF INSTRUMENTS
SHARPENING OF HAND INSTRUMENTS
Goals
Principles
Devices
Mechanical
Mounted Stones
Unmounted/Handhold Stones
Guidelines
Sharpness Test
Scrape Test
Thumbnail Test
ROTARY CUTTING INSTRUMENTS
Types of Rotary Cutting
Handpieces
Types
Dental Burs
Materials Used for Bur
Classifications of Burs
Parts of a Bur
Modifications in Bur Design
Bur Size
Bur Design
Factors Affecting Cutting Efficiency of Bur
RECENT ADVANCES IN ROTARY INSTRUMENTS
Fiberoptic Handpiece
Smart Prep Burs
Availability
Chemical Vapor Deposition Diamond Burs
Fissurotomy Burs
ABRASIVE INSTRUMENTS
Diamond Abrasive Instruments
Classification
Factors Influencing the Abrasive Efficiencyand Effectiveness
Other Abrasive Instruments
Finishing and Polishing Instruments
Finishing Burs
Brushes
Diamond Instruments and Pastes
Paper-carried Abrasives
Rubber-ended Rotary Tools
Cloth
Felt
ULTRASONIC INSTRUMENTS
Hazards and Precautions withUltraspeed Cutting Instruments
Pulpal Damage
Precautions to Avoid Pulpal Trauma
Damage to Soft Tissue
Precautions
Damage to Ear
Inhalation Problems
Eye Injuries
USE OF LASER
Light Absorption and Emission
Tissue Effects of Laser Irradiation
Photochemical Effects
Biostimulation
Photothermal Interaction
Thermal Effects of Laser Irradiation
Photomechanical and Photoelectrical Interaction
Laser Effects on Dental Hard Tissues
Precautions to be Taken While Using Lasers
Personal Protective Equipment
SUMMARY
EXAMINER’S CHOICE QUESTIONS
CHAPTER 7:
Principles of Tooth Preparation
INTRODUCTION
DEFINITION
PURPOSE
OBJECTIVES
TYPES OF RESTORATION
FACTORS AFFECTING RESTORATIONS OF A TOOTH
Tooth Factors
Primary or Permanent
assessment of Occlusal Relationship
Assessment of Pulpal and Periodontal Status
Knowledge of Dental Anatomy
General Patient Factors
Patient’s Exposure to Fluoride
Presence of any Parafunctional Habit
Restoration Related Factors
Type of Restoration
Physical Properties of the Restoration
Whether Moisture Control can be Achieved or not
Technical Expertise
TERMINOLOGY
Simple Tooth Preparation
Compound Tooth Preparation
Complex Tooth Preparation
Walls
Internal Wall
External Wall
Pulpal Wall
Axial Wall
Floor
Cavosurface Angle Margin
Line Angle
Point Angle
NUMBER OF LINE AND POINT ANGLES
Class I Tooth Preparation
Line Angles
Point Angles
Class II Tooth Preparation
Line Angles
Point Angles
Class III Tooth Preparation
Line Angles
Point Angles
Class IV Tooth Preparation
Line Angles
Point Angles
Class V Tooth Preparation
Line Angles
Point Angles
GUIDELINES
CLASSIFICATION
STEPS
INITIAL STAGE
Outline Form and Initial Depth
Definition
Factors Affecting the Outline and Initial Depth form of Tooth Preparation
Principles
Features for Establishing A Proper Outline form are:
Outline form for Pit and Fissure Lesions
Outline form for Smooth Surface Lesions—Outline form of Proximal Caries (Class II, III and IV lesions)
Rules for Making Outline form for Proximal Preparation
Rules for Class V Cavities
Enameloplasty
Primary Resistance Form
Factors Affecting Resistance Form
Features of Resistance Form
Primary Retention Form
Retention form for Different Restorations
Convenience Form
Features of Convenience Form
FINAL STAGES
Removal of Any Remaining Enamel Pit or Fissure, Infected Dentin and/or Old Restorative Material, if Indicated
Pulp Protection
Secondary Resistance and Retention Forms
Mechanical Features
Treatment of the Preparation Walls
Procedures for Finishing the External Walls of the Tooth Preparation
Finishing of the Preparation Walls Results in
Final Procedures: Cleaning, Inspecting and Sealing
SUMMARY
EXAMINER’S CHOICE QUESTIONS
CHAPTER 8:
Patient Evaluation, Diagnosis and Treatment Planning
INTRODUCTION
PATIENT EVALUATION
Case History
Chief Complaint
History of Present Illness
Dental History
Medical History
Allergies or Medication
Communicable Diseases
Systemic Diseases
Physiological Changes Associated with Aging
Social Status of the Patient
EXAMINATION AND DIAGNOSIS
Clinical Examination
Inspection
Palpation
Percussion
Auscultation
Exploration
Periodontal Evaluation
Evaluation of Carious Lesions
Evaluation of Existing Restorations
Radiograph
Indications
Study Casts
Laboratory Investigations
Occlusion Examination
Pulp Vitality Tests
Thermal Test
Electric Pulp Testing
Procedure
Test Cavity
Anesthesia Testing
Bite Test
Recent Advances in Pulp Vitality Testing
Laser Doppler Flowmetry (LDF)
Pulp Oximetry
Dual Wavelength Spectrophotometry
Measurement of Surface Temperature of Tooth
Transillumination with Fiberoptic Light
TREATMENT PLANNING
TREATMENT RECORD
SUMMARY
EXAMINER’S CHOICE QUESTIONS
CHAPTER 9:
Patient and Operator Position
INTRODUCTION
DENTAL CHAIR AND PATIENT POSITIONS
Common Positions for Dental Procedures
Upright Position
Almost Supine
Reclined at 45 Degree
OPERATING POSITION
Right Front Position (7 o’clock)
Right Position (9 o’clock)
Right Rear Position (11 o’clock)
Direct Rear Position (12 o’clock)
CONSIDERATIONS FOR DENTISTS WHILE DOING cases
Operating Stool
SITTING ARRANGEMENT OF OPERATOR AND ASSISTANT
Zones of Working Area
Instrument Exchange Zone
Static Zone
Instrument Exchange
Magnification
SUMMARY
EXAMINER’S CHOICE QUESTIONS
CHAPTER 10:
Isolation of the Operating Field
INTRODUCTION
COMPONENTS OF ORAL ENVIRONMENT
Saliva
Moving Organs
Lips and Cheek
Gingival Tissue
Buccal and Lingual Vestibules
Floor of Mouth
Adjacent Teeth and Restoration
Respiratory Moisture
EQUIPMENT NEEDED FOR ISOLATION
METHODS OF MOISTURE CONTROL
DIRECT METHODS
Rubber Dam
Indications
Contraindications
Rubber Dam Equipment
Rubber Dam Accessories
Rubber Dam Sheet
Rubber Dam Clamps/Retainer
Rubber Dam Forceps
Rubber Dam Frame
Rubber Dam Punch
Rubber Dam Template
Petroleum Jelly
Dental Floss
Wedjets
Rubber Dam Napkin
Recent Modifications in the Designs of Rubber Dam
Placement of Rubber Dam
Methods of Rubber Dam Placement
Management of Difficult Cases
Removal of Rubber Dam
Absorbents (Cotton Roll and Cellulose Wafers)
Low-Volume Evacuator
Precautions to be Taken While Using Saliva Ejector
High-Volume Evacuator
Air-Water Syringe
Throat Shield
Cheek Retractors
Mouth Prop
PHARMACOLOGICAL MEANS
Advantage
Disadvantages
Methods Used for Gingival Tissue Management
Physicomechanical Means
Methods for Physicomechanical Means
Chemical Means
Chemicomechanical Methods
Different Chemicals used are:
Rotary Curettage (Gingettage)
Electrosurgical Methods
Principles
Actions by Electrosurgery
Rules for Electrosurgery
For Cutting Type of Action
For Coagulation Type of Action
Surgical Methods
SUMMARY
EXAMINER’S CHOICE QUESTIONS
CHAPTER 11:
Infection Control
INTRODUCTION
RATIONALE
CROSS-INFECTION
Different Routes of Spread of Infection
Patient to Dental Health Care Worker
Dental Health Care Worker to the Patient
Patient to Patient
Dental Office to the Community
Community to the Patient
GENERAL PRECAUTIONS
Personal Protection Equipment
Barrier Technique
Hand Hygiene
Types of Hand Scrubs
Indications for Hand Hygiene
Handwash Technique (Figs 11.5A to F)
Spaulding’s Classification of Instruments
INSTRUMENT PROCESSING PROCEDURES
Presoaking (Holding)
Procedure
Cleaning
Methods used for Cleaning
Control of Corrosion by Lubrication
Packaging
STERILIZATION OF INSTRUMENTS
Methods of Sterilization
Autoclave/Moist Heat Sterilization
Dry Heat Sterilization/Hot Air Oven
Chemical Vapor Sterilization/Chemiclave
Ethylene Oxide Sterilization (ETOX)
Irradiation
Boiling Water
Oil
Glass-bead Sterilizer
CAUSES OF STERILIZATION FAILURE
Improper Cleaning
Improper Timings
Improper Placement
Malfunctioning of Sterilization Equipment
MANAGEMENT OF DENTAL EQUIPMENT
Handpieces
Dental Unit Water Systems (DUWSs)
NEEDLE STICK INJURY
Measures to Prevent Needle Stick Injuries
Management
DISINFECTION
Methods
Disinfection by Cleaning
Disinfection by Heat
Disinfection by Low Temperature Steam
Disinfection by Chemical Agents
Levels of Disinfectant
Alcohols–Low-level Disinfectant
Phenolic Compounds—Intermediate-level, Broad Spectrum Disinfectant
Aldehyde Compounds—High-level Disinfectant
Antiseptics
Alcohols
Aqueous Quarternary Ammonium Compounds
Iodophor Compounds
Chloride Compounds
Diguanides
INFECTION CONTROL CHECKLIST
Infection Control During the Pretreatment Period
Chairside Infection Control
Infection Control during the Post-treatment Period
SUMMARY
EXAMINER’S CHOICE QUESTIONS
CHAPTER 12:
Pain Management in Operative Dentistry
INTRODUCTION
PHARMACOSEDATION
IATROSEDATION
PAIN CONTROL
Opioid Drugs
Non-opioid Drugs
Local Anesthesia
Definition
Classification of Local Anesthetic Agents
Following Factors should be kept in Mind Prior to Administration of Local Anesthesia
Precautions to be taken beforeAdministration of Local Anesthesia
Recent Advances in Local Anesthesia
WAND System of Local Anesthesia
Comfort Control Syringe (CCS)
Transcutaneous Electrical Nerve Stimulation (TENS)
Electronic Dental Anesthesia (EDA)
Needle-less Syringes
SUMMARY
EXAMINER’S CHOICE QUESTIONS
CHAPTER 13:
Matricing and Tooth Separation
INTRODUCTION
MATRICING
Parts of Matrix
Retainer
Band
Functions
Ideal Requisites
CLASSIFICATION
According to Method of Retention
According to its Preparation
According to Transparency
According to the Type of Band Material
According to the Tooth Preparation forWhich they are Used
Ivory Matrix Holder (Retainer) No. 1
Indication
Ivory Matrix Band Retainer No. 8
Indications
Tofflemire Universal Matrix Band Retainer (designed by Dr BF Tofflemire)
Indications
Types of Tofflemire Matrix
Parts of Tofflemire Retainer
Placement of Tofflemire Retainer and Band
Procedure for Removal of Tofflemire Retainer and Band
Modification in Tofflemire Retainer
Steele’s Siqveland Self-adjusting Matrix Holder for Tapering Teeth
Indication
Anatomical Matrix Band/Custom-made MatrixCompound Supported Matrix
Indications
Materials Used
Procedure for Placement of Anatomical Matrix Band
Removal
Retainerless Automatrix System
Components
Indications
Steps of Placement
Steps of Removal
T-shaped Matrix Band
Indication
S-shaped Matrix Band
Indications
Full Circle or Ring Bands
Indications
Plastic Matrix Strips
Types
Technique for Placement
Indications
Precontoured Sectional Matrix and Contact Rings
Steps of Application and Removal
Indication
Aluminum or Copper Collars
Indication
Transparent Crown Forms Matrices
Indications
Anatomic Custom-made Matrix
Indication
TOOTH SEPARATION
Reason for Tooth Separation
METHODS OF TOOTH SEPARATION
Slow or Delayed Separation
Indication
Seperating Rubber Ring/Band
Rubber Dam Sheet
Ligature Wire/Copper Wire
Gutta-percha Stick
Oversized Temporary Crowns
Fixed Orthodontic Appliances
Rapid or Immediate Tooth Separation
Principles used in Rapid Separator
SUMMARY
EXAMINER’S CHOICE QUESTIONS
CHAPTER 14:
Pulp Protection
INTRODUCTION
PULPAL IRRITANTS
EFFECT OF DENTAL CARIES ON PULP
EFFECT OF TOOTH PREPARATION ON PULP
Pressure
Heat Production
Vibrations
Remaining Dentin Thickness
Speed of Rotation
Nature of Cutting Instrument
EFFECT OF CHEMICAL IRRITANTS ON PULP
Factors Influencing the Effect of Restorative Materials on Pulp
PULP PROTECTION PROCEDURES
Pulp Protection in Shallow and Moderate Carious Lesions
Pulp Protection in Deep Carious Lesions
Indirect Pulp Capping
Direct Pulp Capping
MATERIALS USED FOR PULP PROTECTION
Classification of Pulp Protective Agents
Varnish
Resin Bonding Agents
Liners
Materials used as Liners
Bases
Classification
Materials Used as Bases
DEFENSE MECHANISM OF PULP
Tubular Sclerosis
Smear Layer
Reparative Dentin Formation
Healthy Reparative Reaction
Unhealthy Reparative Reaction
Destructive Reaction
Prevention of pulpal damage due to operative procedure
SUMMARY
EXAMINER’S CHOICE QUESTIONS
CHAPTER 15:
Interim Restoration
INTRODUCTION
OBJECTIVES
REQUIREMENTS
PURPOSE
MATERIALS
For Intracoronal Preparation
Gutta-percha Stick
Dental Cements
For Extracoronal Preparations
Crown Forms
CONCLUSION
SUMMARY
EXAMINER’S CHOICE QUESTIONS
CHAPTER 16:
Bonding Agents and Techniques
INTRODUCTION
EVOLUTION OF ADHESIVE DENTISTRY
INDICATIONS FOR USE OF ADHESIVES
HISTORY
DEFINITIONS
Adhesion or Bonding
Adherend
Adhesive/Adherent
MECHANISM OF ADHESION
micromechanical
Adsorption
Diffusion
Combination
Factors Affecting Adhesion
Wetting
Contact Angle
Surface Energy
Surface Contamination
Water
ENAMEL BONDING
Abbreviations Commonly Used for Resin Chemicals
Conditioning
Etching
Steps for Enamel Bonding
Mechanism of Etching
Effects of Etching
Factors Affecting Effects of Etching on Enamel
Summary of Acid Etching and Enamel Bonding
DENTIN BONDING
Problems Encountered during Dentin Bonding
Moist vs Dry Dentin
If the Dentin Surface is Made Too Dry
If the Dentin Surface is Too Wet
DENTIN BONDING AGENTS
Mechanism of Bonding
Ideal Requirement of Dentin Bonding Agent
Classification of Modern Adhesives
Based on Generations
Based on Smear Layer Treatment
Based on Number of Steps
EVOLUTION OF DENTIN BONDING AGENTS
First Generation Dentin Bonding Systems
Second Generation Dentin Bonding Systems
Third Generation Dentin Bonding Systems
Fourth Generation Dentin Bonding Agents
Mechanism of Bonding
Components of Fourth Generation Adhesives
Fifth Generation Dentin Bonding Agents
Sixth Generation Dentin Bonding Agents
Types of Sixth Generation Bonding Agents
Mechanism of Bonding
Seventh Generation Dentin Bonding Agents
Nanofilled Bonding Agents
Three-step Etch and Rinse Adhesives
Two-step Etch and Rinse (one-bottle) Adhesives
Self-etch Adhesives
HYBRIDIZATION
Hybridization (Given by Nakabayachi in 1982)
Zones of the Hybrid Layer
SMEAR LAYER
Definition
Formation
Structure
Depth
Depth of Smear Layer Depends on the Following Factors
Components of the Smear Layer
Role of the Smear Layer
CLASSIFICATION OF MODERN ADHESIVES
Smear Layer Modifying Agents
Smear Layer Removing Dentin Adhesives
Smear Layer Dissolving Adhesives
GLASS IONOMER BASED ADHESIVE SYSTEM
Steps
FAILURE OF DENTIN BONDING
Reasons for Failure of Dentin Bonding
Critical Steps for Success of Dentin Bonding
SUMMARY
EXAMINER’S CHOICE QUESTIONS
CHAPTER 17:
Composite Restorations
INTRODUCTION
DEFINITION
HISTORY
COMPOSITION
Organic Matrix
Fillers
Coupling Agents
Initiator Agents
Inhibitors
Coloring Agents
Ultraviolet Absorbers
CLASSIFICATION
TYPES
Macrofilled Composite Resin/Conventional/Traditional
Small Particle Composite Resins
Microfilled Composites Resins
Hybrid Composite Resins
RECENT ADVANCES
Flowable Composite Resin
Indications
Contraindications
Condensable (Packable) Composites
Indications
Giomers
Chemistry
Indications
Compomers (Polyacid ModifiedComposite Resins)
History
Composition of Compomers
Setting Reaction
Properties
Clinical Usage
Organically Modified Ceramic (ORMOCER)
Composition
Properties
Indications
Antibacterial Composites/Ion-releasing Composites
Chlorhexidine
Methacryloyloxydecyl Pyridinium Bromide (MDPB)
Silver
Smart Composite
Expanding Matrix Resins for Composites
PROPERTIES OF COMPOSITE
Coefficient of Thermal Expansion
Water Absorption
Factors Affecting Water Absorption of Composites
Wear Resistance
Wear in Composites
Factors Affecting Degradation/Wear of Composites
Surface Texture
Radiopacity
Modulus of Elasticity
Solubility
Creep
Polymerization Shrinkage
Polymerization Shrinkage can Result in—
Polymerization Shrinkage can be Reduced by
Configuration or C-factor
Esthetics of Composites
Microleakage and Nanoleakage
Microleakage
Nanoleakage
Biocompatibility
Working and Setting Times
Light Cure Composites
Mixing for Self-cure Composites
DEGREE OF CONVERSION
Factors Affecting Degree of Conversion
Curing Time
Shade of Composite
Distance and Angle between Light Source and Resin
Temperature
Resin Thickness
Intensity of Curing Light
Type of Filler
INDICATIONS
Class I and Class II Tooth Preparations
Class III, IV and V Preparations
Class VI Preparations
Esthetic Improvement Procedures: For Example:
Erosion or Abrasion Defects
Hypoplastic or Other Defects
Core Build
Luting Cement
Miscellaneous
CONTRAINDICATIONS
Difficult Moisture Control
Heavy Occlusal Stresses
Class V Lesions
lack of Technical Skill
Caries on Canine
High Caries Susceptibility and Poor Oral Hygiene
Subgingival or Root Caries
CLINICAL techniques for composite placement
Local Anesthesia
Oral Prophylaxis
Composite Selection
Shade Selection
Guidelines for Initial Shade Selection
Isolation
Tooth Preparation
Designs of Tooth Preparation for Composites
Bonding
Composite Placement
Instruments Used for Composite Insertion
Incremental Layering Technique (Fig. 17.37)
Horizontal Technique (Fig. 17.38)
U-shaped Layering Technique (Fig. 17.39)
Vertical Layering Technique (Fig. 17.40)
Oblique Technique (Fig. 17.41)
Three-site Technique (Fig. 17.42)
Successive Cusp Build-up Technique
Bulk Technique
Polymerization of Composite Resins
Self-curing Composite Resin
Light-activated Composite Resins
Curing Lamps
Tungsten-quartz Halogen Curing Unit
Plasma Arc Curing (PAC) Unit
Light Emitting Diode Unit
Argon Laser Curing Unit
Final Contouring, Finishing and Polishing of Composite Restorations
FAILURES
Marginal Defects in Composite Restorations
INDIRECT RESTORATIONS
Classification of Indirect Composite Restorations
Classification Based on Method of Fabrication
Classification Based on Method of Curing
Classification Based on Evolution
Fiber Reinforced Composite
Indication for Use of Fiber Reinforced Composites
Contraindications for Use of Fiber Reinforced Composities
Ceromers (Ceramic Optimized Polymer)
Composition
Indications
RESIN CEMENTS
Uses
Types of Resin Cements
Available in the form of:
Composition
Powder
Liquid
Polymerization can be Achieved by any Means
Techniques for Using Resin Cements
SUMMARY
EXAMINER’S CHOICE QUESTIONS
CHAPTER 18:
Tooth Preparation for Composite Restorations
INTRODUCTION
Prerequisites for Tooth Preparation
CLASS III TOOTH PREPARATION
Conventional Class III Tooth Preparation
Indication
Steps
Beveled Conventional Class III Tooth Preparation
Indications
Steps
Modified (Conservative) Class III Tooth Preparation
Indication
Steps
CLASS IV TOOTH PREPARATION
Conventional Tooth Preparation
Features of Conventional Class Iv Preparation for Composites
Beveled Tooth Preparation
Modified (Conservative) Tooth Preparation
CLASS V TOOTH PREPARATION
Conventional Tooth Preparation
Indication
Steps of Tooth Preparation
Beveled Conventional Tooth Preparation
Indications
Modified (Conservative) Tooth Preparation
Indications
TOOTH PREPARATION FOR POSTERIOR COMPOSITE RESTORATION
Indications
Contraindications
CLASS I TOOTH PREPARATION
Conventional Design
Modified Design
Steps
Beveling of the Enamel Margin Results in–
CLASS II TOOTH PREPARATION
Advantages
Contraindications
Steps
Modification
Features of Class Ii Composite Tooth Preparation
RESTORATIVE TECHNIQUE FOR COMPOSITES
Matrix Application
Pulp Protection
Etching of the Tooth Preparation
Application of Adhesive System
Composite Placement
Placing Self-cured Composite
Placing Light-cured Composites
Final Contouring, Finishing and Polishing
Checking the Occlusion
Glazing/Rebonding
Purpose of Glazing/Rebonding
Steps
REPAIR OF COMPOSITE RESTORATIONS
INDIRECT COMPOSITE INLAYS AND ONLAYS
Indications
Contraindications
Tooth Preparation for Composite Inlays and Onlays
Outline Form
Laboratory Technique of CompositeInlays and Onlays
SUMMARY
EXAMINER’S CHOICE QUESTIONS
CHAPTER 19:
Esthetic Dentistry
INTRODUCTION
ELEMENTS OF DENTAL ESTHETICS
Size, Shape and Width of Teeth
Size of Tooth
Shape of Teeth
Width of Teeth
Symmetry and Proportionality of Teeth
Symmetry
Proportion
Tooth Alignment
Axial Inclination of the Tooth
Contacts and Embrasure Form
Gingival Esthetics—Shape and Contour
Facial Proportions
Color and Translucency
Color
Translucency
General Considerations
ESTHETICS AND OPERATIVE DENTISTRY
Ameloplasty/Enameloplasty
Bleaching
Restorations with Composite Resins
Technique of Using Composite Resins
Orthodontic Treatment
Veneers
Indications
Types of Veneers
Direct Veneer Technique
Indirect Veneer Technique
Repair of Veneers
Full Coverage Crowns
Crown
CONCLUSION
SUMMARY
EXAMINER’S CHOICE QUESTIONS
CHAPTER 20:
Dental Amalgam
INTRODUCTION
HISTORICAL DEVELOPMENTS
DEFINITIONS
Alloy
Amalgam
Dental Amalgam
Dental Amalgam Alloys
CLASSIFICATION
COMPOSITION
Effects of Constituent Metals onProperties of Amalgam
TYPES
Generations of Dental Amalgam
PROPORTIONING
SETTING REACTION
For Lathe-cut Low Copper Alloys
For Admixed High Copper Alloys
For Unicompositional Silver Alloy
Structure of Set Amalgam
PHYSICAL PROPERTIES
Dimensional Change
Factors Affecting Dimensional Changes of Amalgam
Mercuroscopic Expansion
Causes
Consequences of Mercuroscopic Expansion
Strength
Plastic Deformation (Creep)
Factors Affecting Creep
Corrosion
Biocompatibility
Thermal Conductivity
Coefficient of Thermal Expansion
Microleakage
INDICATIONS
Class I Preparation
Class II Preparations
Class V Preparations in which
Class VI Preparations
Class III Preparations
Post-endodontic Restoration
In Teeth with Questionable Prognosis
Tooth Having Fractured Cusp
CONTRAINDICATIONS
Esthetics
Small to Moderate Class I and Class II Preparations
Grossly Decayed Teeth
RECENT ADVANCES
Mercury-free Direct Filling Alloy
Low Mercury Alloy
Bonded Amalgam System
Indications of Bonding
Bonding Interface
Technique of Placing Bonded Amalgam
Gallium Amalgam
Composition
Setting Reaction
Properties of Gallium Amalgam Restorations
Consolidated Silver Alloy
PRINCIPLES OF TOOTH PREPARATION
Class I Tooth Preparations
Outline Form
Steps
Primary Resistance Form
Primary Retention Form
Convenience Form
Final Tooth Preparation
Removal of Remaining Carious Dentin
Protection of Pulp if Needed
Finishing of the Enamel Walls and Margins
Final Cleaning and Inspection of the Preparation
Tooth Preparation on Occlusal Surface with Buccal or Lingual Extension
Tooth Preparations on Occlusal Surfaces of Different Teeth
Class II Tooth Preparation for Amalgam Restoration
Outline of Proximal Preparations is Controlled by the Following Factors
Outline Form
Primary Resistance Form
Primary Retention Form
Final Tooth Preparation
Factors Affecting Class II Preparation Design
Extent of Caries
Esthetic Requirement
Relationship with Adjacent Tooth
Requirements for Abutment Teeth for Partial Dentures
Rotated Teeth
Modifications in Class II Design
Slot Preparation
Simple Box Preparation
Esthetic Considerations
For Rotated Teeth
Unusual Outline Form
Conservative Preparation for Mandibular First Premolar and Maxillary Molar
Adjoining Restoration
Modification for Abutment Teeth
Class III Tooth Preparation for Amalgam Restoration
Initial Tooth Preparation
Final Tooth Preparation
Class V Tooth Preparation
Initial Tooth Preparation
Final Tooth Preparation
Class VI Tooth Preparation forAmalgam Restoration
Steps of Tooth Preparation
STEPS FOR AMALGAM RESTORATION
Selection of Amalgam Alloy
Mercury Alloy Ratio
Trituration
Objectives
Tests
Mulling
Application of Matrix Band
Insertion of Amalgam
Condensation
Rules
Objectives
Factors Affecting Condensation
Burnishing
Objectives of Precarve Burnishing
Carving
Objectives of Carving are to Achieve Restoration with
Checking the Contact Points
Checking the Occlusion
Postcarve Burnishing
Objectives
Finishing and Polishing
Steps for Finishing and Polishing of Amalgam
A Polished Amalgam Restoration should have the Following Features
FAILURES
Signs of Failures
Marginal Ditching
Proximal Overhangs
Improper Marginal Ridges
Poor Anatomic Contours
Voids
Fracture of Restoration or Tooth
Poor Occlusal Contacts
Improper Proximal Contacts
Secondary or Recurrent Caries
Amalgam Blues
REASONS FOR FAILURE
Improper Case Selection
Defective Tooth Preparation
Inadequate Occlusal Extension
Under Extension of the Proximal Box
Overextended Tooth Preparation
Depth of Preparation
Curved Pulpal Floor
Lack of Butt Joint at Cavosurface Angle
Unsupported Enamel Rods
Improper Proximal Preparation
Sharp Line Angles
Improper Secondary Retention
Incomplete Removal of the Defective Enamel
Defective Amalgam Manipulation
Inappropriate Condensation
Incorrect Mercury Alloy Ratio
Contamination during Manipulation
Faulty Finishing and Polishing
Overcarving
Defective Matrix Adaptation
Post-restorative Failures
Post-restorative Pain
Premature Fracture of Restoration
MERCURY HYGIENE
History of Conflicts Regarding Amalgam Use
Forms of Mercury
Mercury Exposure in Dental Office
Steps to Reduce Mercury Exposure in the Dental Clinic
Storage of Mercury
Trituration of Amalgam
Designing of Office
Insertion and Condensation of Amalgam
Polishing of Amalgam
Disposal of Scrap Amalgam
Disposal of Mercury Contaminated Waste
Removal of Old Amalgam Restorations
Cleaning of Mercury Contaminated Instruments
Monitoring of Mercury Vapors
Dental Mercury Hygiene Recommendations in Dental Office
Mercury Toxicity
Factors Affecting Toxic Effects of Mercury
Acute Mercury Poisoning
Levels of Hg Toxicity
IS DENTAL AMALGAM SAFE?
SUMMARY
EXAMINER’S CHOICE QUESTIONS
CHAPTER 21:
Pin-retained Restorations
INTRODUCTION
DEFINITION
INDICATIONS
CONTRAINDICATIONS
RETENTIVE PINS
Indirect Pins/Parallel Pins
Direct Pins/Non-parallel Pins
Types
Cemented Pins
Friction Locked Pins
Self-threading Pin
Pin Design
Pin Insertion
Principles and Techniques of Pin Placement
Cavity Preparation for Pin Amalgam Restorations
Pulp Protection
Preparation of Pin Hole
Factors Affecting Pin Hole Preparation
Pin Size
Number of Pins
Interpin Distance
Length of Pin into Dentin and Amalgam
Location of Pin Placement
Technique of Preparation of Pinhole
Pin Bending and Trimming
Matrix Placement
Placement of Amalgam
Carving of Amalgam
Removal of the Matrix
Finishing and Polishing Procedure
FACTORS AFFECTING RETENTION OF PINS IN TOOTH STRUCTURE
Pin Diameter
Pin Number
Pin Type
Pin Depth in Dentin
Cementing Agents
Association Between Pin Channel and Pin Circumference
Type of Dentin
FACTORS AFFECTING RETENTION OF PINS IN RESTORATIVE MATERIAL
Pin Length
Pin Number
Pin Diameter
Pin Orientation
Pin Shape
Interpin Distance
Pin Restoration Interphases
Surface Characteristics
Bulk of Material Surrounding the Pin
PINS AND STRESSES
Pins, Stresses and Tooth
Pins, Stresses and Restorative Material
FAILURE
Within the Restoration
Within Pin
At Pin Restoration Interface
At Pin Tooth Interface
Within Tooth
Broken Drills
Loose Pins
Pulpal Penetration and Periodontal Perforation
Heat Generation
Microleakage
PIN AMALGAM FOUNDATION
Alternatives to pins for additional retention in Amalgam restoration
Amalgapin
Horizontal pin
Slot
Circumferential Slot
Lock
SUMMARY
EXAMINER’S CHOICE QUESTIONS
CHAPTER 22:
Direct Filling Gold
INTRODUCTION
PROPERTIES
INDICATIONS
For class I, II, III, V and VI Cavities
Erosion
To Repair Margins
For Hypoplastic Defect
CONTRAINDICATIONS
Young Patients
Limited Accessibility
Size of the Lesion
Poor Periodontal Condition
Temperament of Patient
Handicapped Patient
Esthetics
Heavy Occlusal Stresses
Prognosis of the Tooth
TYPES OF GOLD
Gold Foil/fibrous Gold
Preparation of Different Forms of Gold Foil
Crystalline Gold or Electrolytic Precipitate
Types of Crystalline Gold
Powdered Gold or Gold-dent or Granular Gold
FORMS OF GOLD
Cohesive Form
Noncohesive Form
STORAGE OF GOLD
Degassing/Annealing
Heating on Alcohol Flame
Electric Annealer
Hazards during Degassing
PRINCIPLES OF TOOTH PREPARATIONS
Class I Tooth Preparation
Class II Tooth Preparation
Class III Tooth Preparation
Class IV Tooth Preparation
Class V Tooth Preparation
Variations in Class V Preparation
STEPS OF DIRECT FILLING GOLD RESTORATION
Building of Restoration
Tie Formation
Wall Banking
Formation of Shoulder
Paving of Restoration
Compaction of Direct Filling Gold
Objectives of Compaction
Compacting Instrument
Direction
Amount of Force
Pattern of using Force
Finishing of Restoration
Burnishing
Contouring
Polishing
Final Burnishing
FUTURE OF GOLD IN DENTISTRY
SUMMARY
EXAMINER’S CHOICE QUESTIONS
CHAPTER 23:
Cast Metal Restorations
INTRODUCTION
DEFINITIONS
Inlay
Onlay
Class II Inlay
Class II Onlay
Partial Crown
Crown
PROPERTIES OF DENTAL CASTING ALLOYS
CLASSIFICATION AND COMPOSITION
Alloys Used for Cast Restorations
INDICATIONS
CONTRAINDICATIONS
BASIC DESIGN OF CAST METAL INLAY
Path of Draw
Inlay Taper
Circumferential Tie
Bevels
Flares
STEPS OF TOOTH PREPARATION
Initial Tooth Preparation
Occlusal Outline Form
Proximal Box Preparation
Resistance and Retention Form
Final Tooth Preparation
Placement of Grooves
Gingival Bevels
Final Cleaning, Drying and Inspection of the Cavity
MODIFICATIONS IN CLASS II
In Mandibular First Premolar
Esthetic Reasons
In Maxillary Molars with Unaffected andStrong Oblique Ridge
Class II Preparation with Gingival Extensions to Include the Root Surface Lesion
Capping of Cusp
Steps
TOOTH PREPARATION FOR CAST METAL ONLAY
Steps of Tooth Preparation for Onlay
Occlusal Outline Form
Proximal Box Preparation
Cusp Reduction
Retention and Resistance Form
Final Preparation
ADDITIONAL RETENTION AND RESISTANCE
TECHNIQUE of MAKING CAST METAL RESTORATION
Impression Taking for Cast Metal Restoration
Record of Interocclusal Relationship
Temporary (Interim) Restoration
Direct Technique
Indirect Technique
Working Cast
Working Die
Die Materials
Commonly used Materials for Making Die are
Wax Pattern Fabrication
Direct Wax Pattern Method
Indirect Wax Pattern Method
Spruing
Principles of Optimal Sprue Design
Washing of Wax Pattern
Investing
Principles of Investing
Casting Procedure
Burnout of Wax Pattern/Wax Elimination and Heating
Temperature Requirements for Various Investments
Methods of Alloy Melting
Casting Machines
Cleaning of Casting
Quenching
Pickling
Trying in the Casting
Cementation of the Casting
To Prevent Post-cementation Pain
CASTING DEFECTS
Surface Roughness and Irregularities
Causes
Prevention
Distortion
Causes
Prevention
Incomplete Casting and Rounded Margins
Causes
Prevention
Discoloration
Causes
Prevention
Porosity
Solidification Shrinkage Defects
Gaseous Defects
Backpressure Porosity
Subsurface Porosity
PIN-RETAINED CAST RESTORATIONS
Indications for Pin-retained Cast Restorations
SUMMARY
EXAMINER’S CHOICE QUESTIONS
CHAPTER 24:
Glass Ionomer Cements
INTRODUCTION
CLASSIFICATION
HISTORY
COMPOSITION
Conventional
GIC Powder
Reinforced Glass Ionomer Cements
Resin-modified Glass Ionomer Cement
Highly Viscous Conventional Glass Ionomer Cement/High Viscosity Autocure Glass Ionomers
Water Mixed GICs/Water HardeningGlass Ionomer Cements
SETTING REACTION
Setting Reaction of Autocure Glass Ionomer Cement
Ion-leaching Phase
Hydrogel Phase
Polysalt Gel Phase
Setting Reaction of Resin-modified Glass Ionomers
Setting Time
Film Thickness
INDICATIONS
CONTRAINDICATIONS
PROPERTIES
Physical
Biocompatibility
Water Sensitivity
Adhesion
Fluoride Release
Esthetics
Margin Adaptation and Leakage
Radiopacity
USES
As Pit and Fissure Sealants
As Liners and Bases
As Luting Agents
As Orthodontic Bracket Adhesives
For Restorations of Class III and Class V Lesions
Fissure Sealing
Restoration of Root Caries
High Caries Risk Patients
Emergency Temporary Restorations
For Intermediate Restorations
For Core Build Up
Atraumatic Restorative Treatment (ART)
Indications of ART Technique
Steps for ART Technique
Sandwich Technique
Synonyms of Sandwich Technique
Indications of Sandwich Technique
Steps of Sandwich Technique
CLINICAL STEPS FOR PLACEMENT
Steps for Placement of GIC
Isolation
Tooth Preparation
Mechanical Preparation
Class III Tooth Preparation
Indications
Class V Tooth Preparation
Indications
Class I Tooth Preparation
Indications
Steps
Class II Tooth Preparation
Internal Preparation on Occlusal Fossa
Tunnel Preparation
Indications
Contraindications
Chemical Preparation for GIC
Mixing of Cement
Restoration
Finishing and Polishing
Surface Protection
Commercial Brands of Glass Ionomer Cement
SUMMARY
EXAMINER’S CHOICE QUESTIONS
CHAPTER 25:
Tooth Hypersensitivity
INTRODUCTION
DEFINITION
MECHANISM OF DENTIN SENSITIVITY
Theories of Dentin Sensitivity
Neural Theory
Odontoblastic Transduction Theory
Hydrodynamic Theory
INCIDENCE AND DISTRIBUTION
Intraoral Distribution
ETIOLOGY AND PREDISPOSING FACTORS
DIFFERENTIAL DIAGNOSIS
DIAGNOSIS
TREATMENT
Management of Tooth Hypersensitivity
Natural Process Contributing to Desensitization
Home-Care with Dentifrices
Strontium Chloride Dentifrices
Potassium Nitrate Dentifrices
Fluoride Dentifrices
In-office Treatment Procedure
Rationale of Therapy
Criteria for Selecting Desensitizing Agent
Treatment Options to Reduce the Diameter of Dentinal Tubules
Patient Education
Dietary Counseling
Toothbrushing Technique
Plaque Control
SUMMARY
EXAMINER’S CHOICE QUESTIONS
CHAPTER 26:
Management of Discolored Teeth
INTRODUCTION
CLASSIFICATION
Classification of Extrinsic Stains (Nathoo in 1997)
ETIOLOGY
Intrinsic Stains
Pre-eruptive Causes
Posteruptive Causes
Extrinsic Stains
Daily Acquired Stains
Chemicals
Intrinsic Stains
Pre-eruptive Causes
Posteruptive Causes
Extrinsic Stains
Daily Acquired Stains
Chemicals
BLEACHING
Mechanism
Contraindications
Poor Case Selection
Dentin Hypersensitivity
Extensively Restored Teeth
Teeth with Hypoplastic Marks and Cracks
Defective and Leaky Restoration
BLEACHING AGENTS
Hydrogen Peroxide
Sodium Perborate
Carbamide Peroxide
HOME BLEACHING TECHNIQUE
Indications
Contraindications
Commonly used Solution for Night Guard Bleaching
Factors Affecting Prognosis
Steps of Tray Fabrication
Thickness of Tray
Treatment Regimen
Maintenance
Side Effects
IN-OFFICE BLEACHING
Thermocatalytic Vital Tooth Bleaching
Indications
Contraindications
Equipment Needed
Light Sources
Procedure
Nonthermocatalytic Bleaching
Steps
Microabrasion
Indications
Contraindications
Protocol
BLEACHING OF NONVITAL TEETH
Thermocatalytic Technique ofBleaching for Nonvital Teeth
Intracoronal Bleaching/Walking Bleach of Nonvital Teeth
Indications
Contraindications
Steps
Complications of Intracoronal Bleaching
Precautions to be Taken for Safer Nonvital Bleaching
Inside/Outside Bleaching Technique
Synonyms
Procedure
Closed Chamber Bleaching/Extracoronal Bleaching
Indications of Closed Chamber Technique
Laser-assisted Bleaching Technique
Argon Laser
CO2 Laser
GaAlAs Diode Laser (Gallium-Aluminum-Arsenic)
Effects of Bleaching Agents on Tooth and its supporting structures
Tooth Hypersensitivity
Effects on Enamel
Effects on Dentin
Effects on Pulp
Effects on Cementum
Cervical Resorption
Mucosal Irritation
Genotoxicity and Carcinogenicity
Toxicity
EFFECTS ON RESTORATIVE MATERIALS
Effect of Bleaching Agents on Other Materials
EXAMINER’S CHOICE QUESTIONS
CHAPTER 27:
Minimally Intervention Dentistry
INTRODUCTION
DEFINITION
CONCEPTS (GIVEN BY TYAS ET AL)
EARLY DIAGNOSIS
Caries Classification Based on Site and Size of Lesion
ASSESSMENT OF CARIES RISK
Decreasing the Risk of Further Demineralization and ArrestingActive Lesion
Remineralization of Initial Lesions and Reduction in Cariogenic Bacteria
Indications
Requirements of an IdealRemineralization Material
Different Remineralizing Agents
Fluoride
Bioactive Glasses—NovaMin
Recaldent (CPP-ACP)
Tri-Calcium Phosphate (TCP) (Clinpro Tooth Crème)
ACP Technology {Enamelon, Enamel Care}
Sugar Substitutes-Xylitol
Grape Seed Extract
Calcium Carbonate Carrier – SensiStat
Ozone
Minimal intervention of cavitated lesions
Dental Materials Used for Minimally Invasive Treatment
Glass Ionomer Cement
Composites Resins
Minimally Invasive Treatment Options for Cavitated Lesions
Atraumatic Restorative Technique
Sandwich Technique
Chemomechanical Caries Removal
Pit and Fissure Sealants and Preventive Resin Restorations
Tunnel, Box and Slot Preparation
Tooth Preparations Using Air Abrasion
Tooth Preparation Using Lasers
Repair Instead of Replacement of the Restoration
Factors to be Considered whileTreating an old Restoration
Indications
DISEASE CONTROL
Vital Pulp Therapy
CONCLUSION
SUMMARY
EXAMINER’S CHOICE QUESTIONS
CHAPTER 28:
Cervical Lesions
INTRODUCTION
CLASSIFICATION
CARIOUS CERVICAL LESIONS
Etiology of Cervical Caries
Clinical Features
Diagnosis
NONCARIOUS CERVICAL LESIONS
Classification
Erosion
Abrasion
Abfraction Lesion
Etiology
Clinical Features of Noncarious Cervical Lesions
Erosion
Abrasion
Abfraction
Diagnosis of Noncarious Cervical Lesions
history of the Patient
Examination
Radiographs
MANAGEMENT
Preventive Management
Restorative Management
Restoration of Cervical Lesions UsingComposite Resins
Restoration of Cervical Lesion using Glass Ionomer Cement
Restoration of Cervical Lesion using Silver Amalgam
Endodontic Treatment
Periodontal Treatment
SUMMARY
EXAMINER’S CHOICE QUESTIONS
CHAPTER 29:
Dental Ceramics
INTRODUCTION
DEFINITIONS
Ceramic
Dental Ceramic
Feldspathic Porcelain
Glass Ceramic
Glaze Ceramic
Metal Ceramic Restoration
Aluminous Porcelain
Body Porcelain
Castable Ceramic
CAD-CAM Ceramic
HISTORY
CLASSIFICATION
According to use
According to Fusion Temperature
According to Composition
According to Processing Method
COMPOSITION
High Fusing Porcelains
Feldspar
Kaolin
Quartz
Medium and Low Fusing Ceramics
Glass Modifiers
Intermediate Oxides
Boric Oxide (B2O3)
Opacifying Agents
Coloring Agents
METHODS OF STRENGTHENING PORCELAIN
Chemical Strengthening/Ion Exchange
Dispersion Strengthening
Thermal Tempering
Reduce the Number of Firing Cycles
Creating Residual Compressive Stresses
Transformation Toughening
Proper Glazing of Porcelain
Adhesive Bonding of Ceramic Restorations
METAL CERAMIC RESTORATIONS
Composition of Metal Ceramic Alloys and Ceramics
Porcelain-metal Bond
Micromechanical Bonding
Chemical Bonding
Failures of Metal Ceramic Restorations
CONDENSATION OF PORCELAIN
FIRING OF PORCELAIN
Stages of Firing
Low Bisque Stage
Medium Bisque Stage
High Bisque Stage
COOLING
GRINDING FOR FINAL ADJUSTMENTS
GLAZING
Types of Glazing
ALL CERAMIC SYSTEM
Traditional Powder Slurry Ceramic
Alumina Reinforced Ceramic
Leucite Reinforced Ceramic
Infiltrated Ceramic
In Ceram
In Ceram Spinel
Castable Ceramic
Composition
Pressable Ceramic
Two Types of Pressable Ceramics are Available
Machinable Ceramic
Computer Generated Ceramic Restorations
Examples
CERAMIC INLAYS AND ONLAYS
Indications
Contraindications
Tooth Preparation
Outline Form
PORCELAIN LAMINATE VENEERS
Indications
Contraindications
Tooth Preparation
FULL CERAMIC CROWNS
Indications
Contraindications
Tooth Preparation
Occlusal Reduction
Facial Reduction
Lingual Reduction
Chamfer Preparation
Finishing
FABRICATION OF CERAMIC RESTORATIONS
Firing on Platinum Foil
Fabrication Using Refractory Die
Steps
Lost Wax Technique
Machined Restorations Using CAD-CAM
Cementation
SUMMARY
EXAMINER’S CHOICE QUESTIONS
CHAPTER 30:
Selection of Restorative Materials
INTRODUCTION
FACTORS REGULATING SELECTION
Material-related Factors
Direct Filling Gold
Dental Amalgam
Glass Ionomer Cements
Composites
Cast Gold Inlays
Ceramics Inlays
Tooth-related Factors
Characteristics of the Carious Lesion
Status of the Pulp
Status of the Periodontium
Size, Form and Structure of Teeth
Patient-related Factors
SITE SPECIFIC SELECTION
For Anterior Teeth
For Posterior Teeth
For Class V Cavities
SUCCESS AND FAILURE OF A RESTORATION
SUMMARY
EXAMINER’S CHOICE QUESTIONS
CHAPTER 31:
Evidence-based Dentistry
INTRODUCTION
DEFINITION
STEPS
Framing Clinical Questions
Purpose of using PICO in Framing Questions
Search and Evaluate the Evidence
CLINICAL APPLICATION
CONCLUSION
SUMMARY
EXAMINER’S CHOICE QUESTION
CHAPTER 32:
Nanodentistry and Its Applications
INTRODUCTION
DEFINITION
How are the Nanoproducts Made?
MECHANISM OF ACTION
Dentifrobots
Dentin Hypersensitivity
Nanoanesthesia
Photosensitizers and Carriers
Major Tooth Repair
Orthodontic Nanorobots
Tooth Durability and Esthetics
Nanoimpression
Nanosolution
Nanoencapsulation
Bone Replacement Materials
Nanoneedles
LIMITATIONS
CHALLENGES FACED BY NANODENTISTRY
RESEARCH CHALLENGES IN NANOTECHNOLOGY
SUMMARY
EXAMINER’S CHOICE QUESTION
INDEX
TOC
Index
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