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Textbook of Operative Dentistry
Nisha Garg, Amit Garg
CHAPTER 1:
Introduction to Operative Dentistry
DEFINITION
HISTORY
INDICATIONS OF OPERATIVE DENTISTRY PROCEDURES
Caries
Noncarious Loss of the Tooth Structure due to Attrition, Abrasion, Abfraction and Erosion
Attrition
Abrasion
Erosion
Malformed, Traumatized, or Fractured Teeth (Fig. 1.6)
Esthetic Improvement (Figs 1.7 and 1.8)
Replacement or Repair of Restoration
PURPOSE OF OPERATIVE DENTISTRY
Diagnosis
Prevention
Interception
Preservation
Restoration
Maintenance
REVIEW QUESTIONS
CHAPTER 2:
Tooth Nomenclature
TYPES OF HUMAN TEETH (FIG. 2.2)
Incisors (Fig. 2.3)
Canines (cuspids)
Premolars (bicuspids) (Fig. 2.4)
Molars (Fig. 2.5)
SETS OF TEETH
TOOTH NOTATION SYSTEMS
Zsigmondy-Palmer System (Fig. 2.7)
Universal (National) System
Permanent Teeth
Modified Version of Universal System Order for the Primary Dentition (Fig. 2.8)
FDI World Dental Federation (Two-digit Notation)
Permanent Teeth (Fig. 2.9)
Deciduous Teeth
Comparison of Tooth Notation Systems
NOMENCLATURE OF TOOTH SURFACES
Buccal Surface
Labial Surface
Facial Surface
Mesial Surface
Distal Surface
Lingual Surface
Occlusal Surface
Incisal Surface
Gingival Surface
Cervical Surface
Anatomic Crown
Clinical Crown
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 (Fig. 2.20)
Acute Dental Caries
Rampant Caries
Chronic Dental Caries
NOMENCLATURE RELATED TO NONCARIOUS DEFECTS OF TEETH
Attrition (Fig. 2.21)
Abrasion
Erosion
Abfraction
Resorption
Localized Nonhereditary Enamel Hypoplasia
Localized Nonhereditary Enamel Hypocalcification
QUESTIONS
CHAPTER 3:
Structure of Teeth
ENAMEL
Composition
Structure
Clinical Significance
Thickness
Color
Strength
Significance
Structure Present in Enamel (Fig. 3.3)
Gnarled Enamel
Bands of Hunter-Schreger
Enamel Tufts
Enamel Lamellae
Significance
Enamel Spindles
Striae of Retzius
Prismless Layer
Dentino-enamel Junction
Occlusal Pits and Fissures
Functions of Enamel
Clinical Significance of Enamel
DENTIN
Composition
Color
Thickness
Hardness
Dentinal Tubules (Table 3.1)
Predentin
Peritubular Dentin (Fig. 3.9)
Intertubular Dentin (Fig. 3.9)
Primary Dentin
Secondary Dentin
Reparative Dentin/Tertiary Dentin
Sclerotic Dentin
Dead Tracts
Clinical Considerations of Dentin
DENTAL PULP
Histology of Dental Pulp
Odontoblastic Layer
Cell Free Zone of Weil
Cell Rich Zone
Structural or Cellular Elements
Odontoblasts
Fibroblasts
Undifferentiated Mesenchymal Cells
Defence Cells (Fig. 3.14)
Extracellular Components
Fibers
Ground Substance
Anatomy of Dental Pulp
Pulp Chamber
Root Canal
Functions of Pulp
Formation of Dentin
Nutrition of Dentin
Innervation of Tooth
Defense of Tooth
Age Changes in Pulp
Morphologic Changes
Physiologic Changes
PERIRADICULAR TISSUE
Cementum
Types
Periodontal Ligament
Periodontal Fibers (Fig. 3.19)
Cells
Nerve Fibers
Blood Vessels
Alveolar Bone
Cells and Intercellular Matrix
QUESTIONS
CHAPTER 4:
Physiology of Tooth Form
FUNCTIONS OF TEETH
Mastication
Speech
Esthetics
Protection of Supporting Tissues
PHYSIOLOGY OF TOOTH FORM
Gingiva
Marginal/Unattached Gingiva
Attached Gingiva
Gingival Sulcus/Crevice
PRESERVATION OF THE PERIODONTIUM
Contour
Height of Epithelial Attachment
Marginal Ridges
Embrasures
Functions of Embrasure
Interproximal Spaces (Fig. 4.17)
Proximal Contact Areas
Trauma From Occlusion (TFO)
Types of Trauma from Occlusion
Clinical Findings
Radiographic Findings of TFO
Management of TFO
OCCLUSION AND OPERATIVE DENTISTRY
Angle's Classification for Interarch Relationship
Class I (Neutrocclusion)
Class II (Distocclusion)
Class III (Mesiocclusion)
Occlusal Schemes
Mutually Protected Occlusion/Anterior Protected Occlusion/Posterior Disclusion
Unilaterally Balanced Occlusion/Group Function Articulation
Bilaterally Balanced Occlusion
Various Mandibular Movements During Function
Interocclusal Records
Freeway Space or Interocclusal Space
Features of an Ideal Occlusion
Factors of Occlusion Affecting Operative Dentistry
Supporting Cusp/Stamp Cusp or Centric Holding Cusp (Fig. 4.37)
Nonsupporting Cusp/Noncentric Cusp/Gliding Cusps (Fig. 4.38)
Alignment of Teeth and Dental Arches
Interarch Tooth Relationships
Curve of Spee (Anteroposterior Curve)
Curve of Wilson
QUESTIONS
CHAPTER 5:
Dental Caries
SITES OF DENTAL CARIES (FIGS 5.1A TO D)
EPIDEMIOLOGY OF DENTAL CARIES
Measuring Caries Activity
Prevalence
Incidence
DENTAL PLAQUE/BIOFILM
Features of Biofilm
Components of Biofilm
Inorganic Components
Organic Components
Development of Biofilm
Pathogenic Properties of Cariogenic Bacteria and Pathogenesis of Dental Caries
Hypothesis Concerning Relation Between Plaque and Caries
THEORIES OF DENTAL CARIES
Acidogenic Theory
Role of Dental Plaque
Role of Carbohydrates
Role of Microorganisms
Role of Acids
Proteolytic Theory
Proteolysis-Chelation Theory
Chelation
“Caries Balance Concept” (Proposed by Featherstone) (Fig. 5.6)
LOCAL FACTORS AFFECTING THE INCIDENCE OF CARIES (FIG. 5.7)
The Host
Environment of the Tooth: Saliva and Diet
Saliva
Diet (Fig. 5.10)
The Bacteria
Time Period
IRRADIATION AND DENTAL CARIES
CLASSIFICATION OF DENTAL CARIES
According to Their Anatomical Site
According to Whether It is a New Lesion or Recurrent Carious Lesion
According to the Activity of Carious Lesion
According to Speed of Caries Progression
Based on Treatment and Restoration Design
Visual Classification (Occlusal Surfaces)
Based on Pathway of Caries Spread (Figs 5.25A and B)
Forward Caries
Backward Caries
Based on Number of Tooth Surfaces Involved
Classification According to the Severity
WHO System of Caries Classification
Radiographic Caries Classification (See Figs. 5.53A to E)
Graham Mount's Classification
HISTOPATHOLOGY OF DENTAL CARIES
Enamel Caries (Fig. 5.33)
Smooth Surface Caries (Figs 5.34A to D)
Pit and Fissure Caries (Figs 5.36A to D)
Zones in Enamel Caries
Dentinal Caries
Early Dentinal Changes (Fig. 5.38)
Advanced Dentinal Changes
Zones of Dentinal Caries (Fig. 5.39)
DIAGNOSIS OF DENTAL CARIES
Visual-Tactile Method of Diagnosis
Conventional Methods
Disadvantages
Visual examination
Advances in Visual Method
Illumination
Radiographic Method of Diagnosis
Caries of Different Surfaces of Teeth
Types of Radiographic Method Used
Conventional Methods of Radiography
Intraoral Periapical Radiography
Bitewing Radiographs (Fig.5.51)
Occlusal and Panoramic Radiographs (Fig. 5.52)
Xeroradiography
Classification of Caries as seen on Radiograph (Figs 5.53A to E)
Recent Advances in Radiographic Techniques
Digital Radiography
Computerized Image Analysis
Substraction Radiography
Magnetic Resonance Microimaging (MRMI)
Electrical Resistance Measurement
Vanguard Electronic Caries Detector
Lasers
Argon Laser
Diode Laser
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 of Recurrent Caries
Treatment of Secondary Caries
ROOT CARIES (Fig. 5.63)
Etiology of the Root Caries
Diagnosis
Prevention
Treatment of Root Caries
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 (Fig. 5.64)
Salivary Buffering Capacity Test
S Mutans, Lactobacillus Test
PREVENTION OF DENTAL CARIES
Methods to Reduce Demineralizing Factors
Dietary Measures
Methods to Improve Oral Hygiene (Fig. 5.66)
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
Appropriate Animal Models for Testing Caries Vaccine
MANAGEMENT OF DENTAL CARIES
Chemochemical Caries Removal
Mechanism of Action of Chemochemical Caries Removal Method
Ozone Treatment of Dental Caries
Technique of Using Ozone Therapy
Caries Removal Using Air Abrasion
Lasers
QUESTIONS
CHAPTER 6:
Cutting Instruments
INTRODUCTION
Metals Used for Manufacturing Cutting Instruments
The Carbon Steel
Stainless Steel
Heat Treatment of Materials
CLASSIFICATION OF HAND CUTTING INSTRUMENTS
Classification Given by GV Black
Classification Given by Marzouck
PARTS OF HAND CUTTING INSTRUMENTS
Handle or Shaft
Shank
Blade or Nib
Instrument Formula
DIFFERENT INSTRUMENT DESIGNS
Bevels in Cutting Instruments
Single Bevel Instruments
Bibeveled Instrument (Fig. 6.10B)
Triple-beveled Instrument
Circumferential Bevel
Direct and Lateral Cutting Instruments
Single and Double Ended Instruments
EXPLORING INSTRUMENTS
Mouth Mirrors
Types of Mirror Faces (Fig. 6.12)
Uses of Mouth Mirror
Explorer
Parts
Types of Explorer (Figs 6.16A to C)
Tweezers
Probes
Types
HAND CUTTING INSTRUMENTS
Chisels
Straight Chisel
Angled Chisel
Hatchet
Gingival Margin Trimmer
EXCAVATORS
Ordinary Hatchet
Hoes
Angle Former (Figs 6.29A and B)
Spoon Excavator
Knives
Files
Cleiod-discoid
RESTORATION INSTRUMENTS
Cement Spatulas
Plastic Filling Instrument
Condensers
Amalgam Carriers
Carvers (Fig. 6.40)
Burnisher (Fig. 6.43)
Composite Resin Instruments
INSTRUMENT GRASPS
Modified Pen Grasp (Fig. 6.46)
Inverted Pen Grasp
Palm and Thumb Grasp (Fig. 6.50)
Modified Palm and Thumb Grasp (Figs 6.51A and B)
FINGER RESTS
SHARPENING OF HAND INSTRUMENTS
Principles of Sharpening
Devices Used for Sharpening
Mechanical
Mounted Stones
Unmounted/Handhold Stones
Guidelines for Sharpening Operative Instruments
ROTARY CUTTING INSTRUMENTS
Types of Rotary Cutting
Handpieces
Classification of Handpiece
Types of Handpiece
Dental Burs
Materials Used for Bur (Fig. 6.62)
Classifications of Burs
Part of a Bur (Fig. 6.63)
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 (Fig. 6.79)
Classification
Factors Influencing the Abrasive Efficiency and Effectiveness
Other Abrasive Instruments
Finishing and Polishing Instruments (Fig. 6.83)
Finishing Burs
Brushes
Diamond Instruments and Pastes
Paper-carried Abrasives
Rubber Ended Rotary Tools
Cloth
Felt
ULTRASONIC INSTRUMENTS
HAZARDS AND PRECAUTIONS WITH ULTRASPEED 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
QUESTIONS
CHAPTER 7:
Principles of Tooth Preparation
INTRODUCTION
PURPOSE OF TOOTH PREPARATION
Replacing Restorations
Treatment of Malformed, Fractured and Traumatized Teeth (Fig.7.3)
Esthetic Improvement (Fig. 7.4)
Restoration of Tooth Material Loss (Fig. 7.5)
TYPES OF RESTORATION (FIGS 7.6A AND B)
TERMINOLOGY OF TOOTH PREPARATION
Tooth Preparation
Simple, Compound and Complex Tooth Preparation
Simple Tooth Preparation
Compound Tooth Preparation
Complex Tooth Preparation
Tooth Preparation Walls
Internal Wall
External Wall
Pulpal Wall
Axial Wall
Floor
Cavosurface Angle Margin/Tooth Preparation Margin
Line Angle
Point Angle
NUMBER OF LINE ANGLES AND POINT ANGLES IN DIFFERENT TOOTH PREPARATION DESIGNS
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
TOOTH PREPARATION
Classification of Tooth Preparations
STEPS IN TOOTH PREPARATION
Initial Tooth Preparation
Outline Form and Initial Depth
Enameloplasty
Primary Resistance Form
Primary Retention Form
Convenience Form
Final Stages of Tooth Preparation
Removal of Any Remaining Enamel Pit or Fissure, Infected Dentin and/or Old Restorative Material, if Indicated
Pulp Protection
Secondary Resistance and Retention Forms
Procedures for Finishing the External Walls of the Tooth Preparation
Final Procedures: Cleaning, Inspecting and Sealing
AIR ABRASION/KINETIC TOOTH PREPARATION
Technique
Uses of Air Abrasion Technology
QUESTIONS
CHAPTER 8:
Patient Evaluation, Diagnosis and Treatment Planning
INTRODUCTION
PATIENT EVALUATION
Case History
Chief Complaint
History of Present Illness
Past 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
Study Casts (Fig. 8.26)
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
QUESTIONS
CHAPTER 9:
Patient and Operator Position
INTRODUCTION
CHAIR AND PATIENT POSITIONS
Upright Position (Fig. 9.3)
Almost Supine (Fig. 9.4)
Reclined 45 Degree (Fig. 9.5)
OPERATING POSITION
Right Front Position (7 o'clock) (Fig. 9.7)
Right Position (9 o'clock) (Fig. 9.8)
Right Rear Position (11 o'clock) (Fig. 9.9)
Direct Rear Position (12 o'clock) (Fig. 9.10)
CONSIDERATIONS FOR DENTISTS WHILE DOING PATIENT
Operating Stool
SITTING ARRANGEMENT OF OPERATOR AND ASSISTANT (FIG. 9.12)
Zones of Working Area
Instrument Exchange Zone
Instrument Exchange
Magnification
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
Advantages of Moisture Control
Patient Related Factors
Operator Related Factors
EQUIPMENT NEEDED FOR ISOLATION OF OPERATING FIELD
Isolation with Rubber Dam
Rubber Dam Sheet (Fig. 10.3)
Rubber Dam Clamps
Rubber Dam Forceps (Fig. 10.7)
Rubber Dam Frame (Figs 10.8 and 10.9)
Rubber Dam Punch (Fig. 10.10)
Rubber Dam Template (Fig. 10.11)
Rubber Dam Accessories
Rubber Dam Napkin (Fig. 10.15)
Recent Modifications in the Designs of Rubber Dam
Insti-Dam
Handi Dam
Dry Dam
Placement of Rubber Dam
Methods of Rubber Dam Placement
Management of Difficult Cases
Malpositioned Teeth
Extensive Loss of Coronal Tissue
Crowns with Poor Retentive Shapes
Teeth with Porcelain Crowns
Leakage
Removal of Rubber Dam
Absorbents (Cotton Roll and Cellulose Wafers) (Figs 10.19 to 10.22)
Low Volume Evacuator
Precautions to be Taken While Using Saliva Ejector
High Volume Evacuator
Air-Water Syringe
Throat Shield
Cheek Retractors
Mouth Prop
PHARMACOLOGICAL METHODS
METHODS USED FOR GINGIVAL TISSUE MANAGEMENT
Physicomechanical Means
Methods for Physicomechanical Means
Placement and Removal of Retraction Cord (Figs 10.30A to E)
Chemical Means (Fig. 10.33)
Chemicomechanical Methods
Vasoconstrictors
Astringents (Biologic Fluid Coagulants)
Tissue Coagulants
Rotary Curettage (Gingettage) (Fig. 10.34)
Electrosurgical Methods (Fig. 10.35)
Four Types of Actions are done in this (Figs 10.36 and 10.37)
Rules for Electrosurgery
Surgical Methods
QUESTIONS
CHAPTER 11:
Infection Control
RATIONALE FOR INFECTION CONTROL
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
OBJECTIVE OF INFECTION CONTROL
UNIVERSAL PRECAUTIONS
Personal Protection Equipment
Barrier Technique
Hand Hygiene
Indications for Hand Hygiene
Handwash Technique (Figs 11.5A to F)
CLASSIFICATION OF INSTRUMENTS
INSTRUMENT PROCESSING PROCEDURES
Irradiation
Ionizing Radiation
Nonionizing Radiation
Boiling Water
Oil
Glass Bead Sterilizer (Fig. 11.10)
MANAGEMENT OF DENTAL EQUIPMENT
Handpieces
Dental Unit Water Systems (DUWSs)
NEEDLE STICK INJURY
Measures to Prevent Needle Stick Injuries
DISINFECTION
Methods of Disinfection
Disinfection by Cleaning
Disinfection by Heat
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 (Fig. 11.15)
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 Posttreatment Period
QUESTIONS
CHAPTER 12:
Pain Control
INTRODUCTION
METHODS OF PAIN CONTROL IN DENTAL CLINIC
ANXIETY CONTROL
Iatrosedation
Pharmacosedation
Benzodiazepines
LOCAL ANESTHESIA (Fig. 12.1)
Definition
Classification of Local Anesthetic Agents
Classification Based on Chemical Structure
Classification Based on Duration of Action
Techniques of Local Anesthesia
Supraperiosteal/Local Infiltration Technique
Regional Nerve Block
Advantages of Local Anesthesia
Recent Advances in Local Anesthesia
Wand System of Local Anesthesia (Fig. 12.4)
Comfort Control Syringe
Transcutaneous Electrical Nerve Stimulation (TENS)
Electronic Dental Anesthesia
Needle-less Syringes
USE OF HIGH SPEED ROTARY INSTRUMENTS WITH SHARP BURS AND COOLANTS
ANALGESIA
Opioid Drugs
Nonopioid Drugs
Selective COX-2 Inhibitors
HYPNOSIS
QUESTIONS
CHAPTER 13:
Matricing and Tooth Separation
INTRODUCTION
MATRICING
Parts of Matrix
Retainer
Band
Requirements of a Matrix Band
Classification of Matrices
Depending upon Their Method of Retention
Depending upon Its Preparation
On the Basis of Transparency
Depending upon the Tooth Preparation for Which They are Used
Ivory Matrix Holder (Retainer) No. 1 (Figs 13.5 and 13.6)
Ivory Matrix Band Retainer No. 8 (Figs 13.8 and 13.9)
Tofflemire Universal Matrix Band Retainer (Fig 13.10)
Types of Tofflemire Matrix
Parts of Tofflemire Retainer (Fig. 13.12)
Knurled nuts
Types of bands
Procedure for removal
Removal of retainer
Removal of band
Steele's Siqveland Self-adjusting Matrix Holder for Tapering Teeth (Fig. 13.20)
Anatomical Matrix Band/ Compound Supported Matrix
Materials Used
Procedure
Removal
Retainerless Automatrix System
T-Shaped Matrix Band
S-Shaped Matrix Band
Full Circle or Ring Bands
Plastic Matrix Strips
Precontoured Matrix/Palodent Bitine System
Steps of Application and Removal
Aluminum or Copper Collars
Transparent Crown Forms Matrices
Anatomic Custom Made Matrix
TOOTH SEPARATION
Reason for Tooth Separation
Methods of Tooth Separation
Slow or Delayed Separation
Rapid or Immediate Tooth Separation
Types of Plastic Wedge
Modified Wedging Techniques
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
PULP PROTECTION PROCEDURES
Pulp Protection in Shallow and Moderate Carious Lesions
Pulp Protection in Deep Carious Lesions
In Moderately Deep Carious Lesions
Indirect Pulp Capping
Direct Pulp Capping
Clinical Procedure
MATERIALS USED FOR PULP PROTECTION (Fig. 14.12)
Varnish
Adhesive Sealer
Liners (Fig. 14.16)
Bases (Fig. 14.22)
Zinc Oxide Eugenol
Zinc Phosphate Cement
Polycarboxylate Cement (Fig. 14.23)
Glass Ionomer Cement
METHODS OF PULP PROTECTION UNDER DIFFERENT RESTORATIONS
Amalgam
Effects of Amalgam on Pulp
Precautions to be Taken While Using Amalgam as a Restorative Material
PULP PROTECTION IN ACCORDANCE WITH DEPTH OF TOOTH PREPARATION
Restorative Resins
Precautions to be Taken While Using Composite Resin as a Restorative Material
Glass Ionomer Cements
Cast Gold Restorations
DEFENSE MECHANISM OF PULP
Tubular Sclerosis
Smear Layer
Reparative Dentin Formation
QUESTIONS
CHAPTER 15:
Interim Restorations
INTERIM RESTORATION
Purpose of Interim Restoration
MATERIALS USED FOR INTERIM RESTORATIONS
Gutta-percha Stick
Chemical Structure
Manipulation
ZINC OXIDE EUGENOL CEMENT (FIG. 15.1)
Setting Reaction of Zinc Oxide Eugenol Cement
Manipulation of Zinc Oxide Eugenol (ZOE) Cement
Manipulation of Powder and Liquid System
Paste-paste System
Working Time and Setting Time
Biocompatibility of Zinc Oxide Eugenol Cement
ZINC PHOSPHATE CEMENT (FIG. 15.6)
Composition
Setting Reaction
Manipulation of Cement
Manipulation of Zinc Phosphate Cement
Mechanical Properties
Biocompatibility
Clinical Uses
Zinc Silicophosphate Cements
Composition
ZINC POLYCARBOXYLATE CEMENT (FIG. 15.12)
Composition
Manipulation of Zinc Polycarboxylate Cement
Setting Reaction
Working Time and Setting Time
Bonding of Polyacrylate Cement to Tooth Structure
Mechanical Properties
Solubility
Biological Considerations
Calcium Hydroxide
Mixing Calcium Hydroxide Cement Armamentarium
FOR EXTRACORONAL PREPARATIONS
Crown Forms
Criteria of Using Crowns
Materials
Acrylic Restorations (Figs 15.15 and 15.16)
CONCLUSION
QUESTIONS
CHAPTER 16:
Bonding to Enamel and Dentin
INTRODUCTION
ADHESIVE DENTISTRY
Indications for Use of Adhesives
Mechanism of Adhesion (Figs 16.2A to C)
Factors Affecting Adhesion
Wetting
Contact Angle (Fig. 16.5)
Surface Energy
Surface Contamination
Water
ENAMEL BONDING
Steps for Enamel Bonding
Mechanism of Etching
DENTIN BONDING
Conditioning of Dentin
Priming of Dentin
Moist vs Dry Dentin
Wet Bonding
Dry Bonding
DENTIN BONDING AGENT
Mechanism of Bonding
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
Fifth Generation Dentin Bonding Agents
Sixth Generation Dentin Bonding Agents
Advantages of Self Etching Primers
Disadvantages of Self Etching Primers
Seventh Generation Bonding Agents (Fig.16.28)
Nanofilled Bonding Agents
Advantages of Using Small Fillers
Three-step Etch and Rinse Adhesives
Two-step Etch and Rinse (one-bottle) Adhesives
Self-etch Adhesives
HYBRID LAYER AND HYBRIDIZATION
Hybridization (Given by Nakabayachi in 1982)
Zones of the Hybrid Layer (Fig. 16.31)
SMEAR LAYER
Structure
Depth
Formation of the Smear Layer
Components of the Smear Layer
Role of the Smear Layer
Disadvantages of the Smear Layer
Removal of the Smear Layer and its Antimicrobial Implications
Role of the Smear Layer in Dentin Bonding
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 (FIG. 16.35)
QUESTIONS
CHAPTER 17:
Composite Restorations
INTRODUCTION
COMPOSITION OF COMPOSITES
Organic Matrix
Fillers
Coupling Agents
Coloring Agents
Ultraviolet Absorbers
Initiator Agents
Inhibitors
CLASSIFICATION OF COMPOSITES
TYPES OF COMPOSITE RESINS
Macrofilled Composite Resins
Microfilled Composites Resins (Fig.17.3)
Hybrid Composite Resins
RECENT ADVANCES IN COMPOSITES
Flowable Composite Resin (Fig. 17.6)
Indications
Condensable (Packable) Composites (Fig.17.7)
Indications
Giomers
Chemistry
Indications
Compomers (Polyacid Modified Composite Resins) (Fig.17.8)
History
Composition
Setting Reaction
Properties
Clinical Usage
Organically Modified Ceramic (ORMOCER)
Composition (Fig.17.9)
Indications
Antibacterial Composites/Ion Releasing Composites
Chlorhexidine
Methacryloxydecyl Pyridinium Bromide (MDPB)
Silver
Smart Composite
Expanding Matrix Resins for Composites
PROPERTIES OF COMPOSITE RESTORATIVE MATERIALS
Coefficient of Thermal Expansion
Water Absorption
Factors Affecting Water Absorption of Composites
Wear Resistance (Fig. 17.11)
Wear in Composites
Surface Texture
Radiopacity
Modulus of Elasticity
Solubility
Creep
Polymerization Shrinkage
Configuration or C-factor
Esthetics of Composites
Biocompatibility
Working and Setting Times
Light Cure Composites
Mixing for Self-cure Composites
POLYMERIZATION OF COMPOSITES/DEGREE OF CONVERSION
Curing Time
Shade of Composite
Distance and Angle between Light Source and Resin
Temperature
Resin Thickness
Inhibition of Air
Intensity of Curing Light
Type of Filler
INDICATIONS OF COMPOSITE RESTORATIONS
CONTRAINDICATIONS OF COMPOSITES
CLINICAL PROCEDURES
Local Anesthesia
Preparation of the Operating Site
Composite Selection
Shade Selection
Initial Shade Selection
Isolation
Tooth Preparation
Designs of Tooth Preparation for Composites
Bonding
Composite Placement
Instruments Used for Composite Insertion
Incremental Layering Technique (Fig. 17.35)
Horizontal Technique (Fig. 17.36)
U-shaped Layering Technique (Fig. 17.37)
Vertical Layering Technique (Fig. 17.38)
Oblique Technique (Fig. 17.39)
Three-site Technique (Fig. 17.40)
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 (Figs 17.41 and 17.42)
Plasma Arc Curing (PAC) Unit
Light Emitting Diode Unit (Figs 17.43 and 17.44)
Argon Laser Curing Unit
Final Contouring, Finishing and Polishing of Composite Restorations
FAILURES IN COMPOSITE RESTORATIONS
Marginal Defects in Composite Restorations (Fig. 17.50)
INDIRECT COMPOSITE 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 (FIGS 17.52A AND B)
Uses
Types of Resin Cements
Composition
Powder
Liquid
Technique for Using Resin Cements
QUESTIONS
CHAPTER 18:
Tooth Preparation for Composite Restorations
CLASS III TOOTH PREPARATION
Conventional Class III Tooth Preparation (Figs 18.1A and B)
Beveled Conventional Class III Tooth Preparation
Steps
Modified (Conservative) Class III Tooth Preparation
Steps
CLASS IV TOOTH PREPARATION
Tooth Preparation for Conventional Class IV Preparation (Fig. 18.10)
Beveled Conventional Class IV Preparation
Modified (Conservative) Class IV Preparation
CLASS V TOOTH PREPARATION
Conventional Class V Preparation
Beveled Conventional Class V Tooth Preparation
Modified (Conservative) Class V Tooth Preparation
TOOTH PREPARATION FOR POSTERIOR COMPOSITE RESTORATION
Advantages of Posterior Composite Restoration
Disadvantages
CLASS I TOOTH PREPARATION
Conventional Design for Class I Tooth Preparation
Modified Design for Class I Tooth Preparation (Fig. 18.21)
CLASS II TOOTH PREPARATION
Modification for Class II Composite Restoration
RESTORATIVE TECHNIQUE FOR COMPOSITES (FIGS 18.31A TO R)
Matrix Application
Etching of the Tooth Preparation
Application of Adhesive System
Pulp Protection
Composite Placement
Placing Self-Cured Composite
Placing Light-Cured Composites
Final Contouring, Finishing and Polishing of Composite Restoration
Checking the Occlusion
Glazing
REPAIR OF COMPOSITE RESTORATIONS
INDIRECT COMPOSITE INLAYS AND ONLAYS
Tooth Preparation for Composite Inlays and Onlays (Figs 18.45A and B)
Outline Form
Laboratory Technique of Composite Inlays and Onlays
QUESTIONS
CHAPTER 19:
Esthetics and Operative Dentistry
INTRODUCTION
Tooth Proportionality (Height and Width)
Contacts, Connectors and Embrasures
Gingival Esthetics—Gingival Shape and Gingival Contour
Facial Proportions
PRINCIPLES OF ORGANIZATION
Visual Forming (Ordering)
Harmony and Variety
Balance (Fig. 19.17)
Dominance
ESTHETICS AND OPERATIVE DENTISTRY
Ameloplasty/Enameloplasty
Bleaching
Restorations with Composite Resins
Technique of Using Composite Resins
Orthodontic Treatment
Veneers
Indications
Types of Veneers
Types of Full Veneers
Direct Veneer Technique
Indications
Procedure
Direct Full Veneers
Window Preparation (Fig. 19.28)
Incisal Lapping Preparation (Fig. 19.29)
Indirect Veneer Technique
Processed Composite Veneers
Etched Porcelain Veneers
Castable Ceramic Veneers
Veneer for Metal Restoration
Repair of Veneers
Full Coverage Crowns
Crown
CONCLUSION
QUESTIONS
CHAPTER 20:
Amalgam Restorations
INTRODUCTION
HISTORICAL DEVELOPMENT OF AMALGAM
COMPOSITION OF AMALGAM POWDER
COMPOSITION OF AMALGAM ALLOYS (TABLE 20.1)
Effects of Constituent Metals on the Properties of Amalgam
Proportioning
Classification of Amalgam
Setting Reaction of Amalgam
For Lathe-cut Low Copper Alloys
For Admixed High Copper Alloys
For Unicompositional Silver Alloy
Structure of Set Amalgam
INDICATIONS OF AMALGAM RESTORATION
CONTRAINDICATIONS OF AMALGAM RESTORATION
TYPES OF AMALGAM POWDER
PHYSICAL PROPERTIES OF AMALGAM
Dimensional Change
Factors Affecting Dimensional Changes of Amalgam
MERCUROSCOPIC EXPANSION
Phenomenon
Consequences of Mercuroscopic Expansion
Strength
Plastic Deformation (Creep) (Fig. 20.6)
Corrosion
Biocompatibility
Thermal Conductivity
Coefficient of Thermal Expansion
Microleakage in Amalgam
RECENT ADVANCES IN AMALGAM
Mercury Free Direct Filling Alloy
Low Mercury Alloy
Bonded Amalgam System
Indications of Bonding
Technique of Bonded Amalgam
Future of Bonded Amalgam Restoration
Gallium in Place of Mercury in Amalgam
Properties of Gallium Amalgam Restorations
Conclusion
Consolidated Silver Alloy
PRINCIPLES OF TOOTH PREPARATION FOR AMALGAM RESTORATIONS
Amalgam Restoration for 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 of Different Teeth (Figs 20.23 to 20.25)
Tooth Preparation on Occlusal Surface with Buccal or Lingual Extension (Fig. 20.26)
Class II Tooth Preparation for Amalgam Restoration
Reverse Curve
Primary Resistance Form
Primary Retention Form
Final Tooth Preparation
Modifications in Class II Preparation 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
Amalgam Restoration for Class III Tooth Preparation
Initial Tooth Preparation
Final Tooth Preparation
Class V Tooth Preparation for Amalgam Restoration
Initial Tooth Preparation
Final Tooth Preparation
Class VI Tooth Preparation for Amalgam Restoration
Steps of Tooth Preparation (Fig. 20.62)
STEPS OF AMALGAM RESTORATION
Selection of Amalgam Alloy
Mercury Alloy Ratio (Fig. 20.63)
Trituration
Mulling
Application of Matrix Band
Insertion of Amalgam (Figs 20.70A and B)
Condensation (Fig. 20.71)
Condensation Depends upon Following Factors
Burnishing
Carving
Checking the Contact Points
Checking the Occlusion
Finishing and Polishing
To Minimize Heat Production
Steps for Finishing and Polishing of Amalgam
FAILURES OF AMALGAM RESTORATIONS
Reasons for Failure of Amalgam Restorations
Poor Case Selection
Defective Tooth Preparation
Defective Amalgam Manipulation
Defective Matrix Adaptation
Postrestorative Failures
MERCURY HYGIENE
Mercury Exposure in Dental Office
Steps to Reduce Mercury Exposure in the Dental Clinic
Dental Mercury Hygiene Recommendations in Dental Office
Mercury Toxicity (Fig. 20.87)
Acute Mercury Poisoning
IS DENTAL AMALGAM SAFE?
QUESTIONS
CHAPTER 21:
Pin Retained Restorations
INTRODUCTION
Definition (Fig. 21.1)
INDICATIONS FOR PIN AMALGAM RESTORATIONS
CONTRAINDICATIONS OF PIN AMALGAM RESTORATIONS
RETENTIVE PINS
Direct Pins
Cemented Pins (Fig. 21.2)
Friction Locked Pins (Fig. 21.3)
Self-threading Pin (Fig. 21.4)
Pin Design
Standard Pin (Fig. 21.6)
Self-shearing Pin (Fig. 21.7)
Two-in-one Design (Fig. 21.8)
Link Series (Fig. 21.9)
Link Plus Series (Figs 21.10 and 21.11)
Pin Insertion
PRINCIPLES AND TECHNIQUES OF PIN PLACEMENT
Pin Size
Number of Pins
Interpin Distance (Fig. 21.14)
Length of Pin into Dentin and Amalgam (Fig. 21.15)
Location of Pin Placement (Figs 21.16 and 21.17)
Preparation of Pinhole
Pin Bending and Trimming
Placement of Pin Amalgam Restorations
Matrix Placement
Placement of Alloy
Carving of Amalgam
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 OF PIN RETAINED RESTORATIONS
Within the Restoration (Fig. 21.25)
Within Pin
At Pin Restoration Interface
At Pin Tooth Interface
Within Tooth
Broken Drills (Fig. 21.30)
Loose Pins
Pulpal Penetration and Periodontal Perforation
Heat Generation
Microleakage
PIN AMALGAM FOUNDATION
ALTERNATIVES TO PINS FOR ADDITIONAL RETENTION IN AMALGAM RESTORATION
QUESTIONS
CHAPTER 22:
Direct Filling Gold
INTRODUCTION
PROPERTIES OF DIRECT FILLING GOLD
INDICATIONS FOR THE USE OF DIRECT FILLING GOLD
For Restoration of Tooth Preparations
Erosion
To Repair Margins
For Hypoplastic Defect
CONTRAINDICATIONS FOR THE USE OF DIRECT FILLING GOLD
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
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 or Annealing
PRINCIPLES OF TOOTH PREPARATIONS FOR DIRECT FILLING GOLD RESTORATIONS
Class I Tooth Preparation
Class II Tooth Preparation
Advantages of this Preparation
Class III Tooth Preparation
Class IV Tooth Preparation
Class V Tooth Preparation
Variations in Class V Preparation (Figs 22.17A to D)
STEPS OF DIRECT FILLING GOLD RESTORATION
Building of Restoration
Paving of Restoration
Compaction of Direct Filling Gold
Compaction of Gold Depends upon Following Factors
Finishing of Restoration
Burnishing (Fig. 22.28)
Contouring
Polishing
Final Burnishing
FUTURE OF GOLD IN DENTISTRY
QUESTIONS
CHAPTER 23:
Cast Metal Restorations
INTRODUCTION
Alloys Used for Dental Use
Desirable Properties of Dental Casting Alloys
Classification and Composition of Dental Casting Alloys (Tables 23.1 and 23.2)
INDICATIONS OF METAL INLAY AND ONLAY
CONTRAINDICATIONS OF METAL INLAY AND ONLAY
PRINCIPLES OF TOOTH PREPARATION FOR CAST METAL INLAY
Path of Draw
Inlay Taper
Circumferential Tie
Bevels
Flares
Primary flare
STEPS OF TOOTH PREPARATION FOR INLAY
Initial Tooth Preparation
Occlusal Outline Form
Proximal Box Preparation
Resistance and Retention Form
Final Tooth Preparation
Placement of Grooves, Bevels and Flares
Gingival Bevel
Occlusal Bevels
MODIFICATIONS IN CLASS II TOOTH PREPARATION FOR INLAY
In Mandibular First Premolar
Esthetic Reasons
In Maxillary Molars with Unaffected and Strong Oblique Ridge
Class II Preparation with Gingival Extensions to Include the Root Surface Lesion
Capping of Cusp
Steps
TOOTH PREPARATION FOR CAST METAL ONLAY (FIGS 23.45A TO C)
Steps of Tooth Preparation for Onlay
Occlusal Outline Form
Proximal Box Preparation
Cusp Reduction (Fig. 23.47)
Retention and Resistance Form
Final Preparation
ADDITIONAL RETENTION AND RESISTANCE FORM FEATURES FOR CAST RESTORATION
TECHNIQUE FOR 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
Dental Stones
Electroformed Dies
Indications
Wax Pattern Fabrication
Direct Wax Pattern Method
Indirect Wax Pattern Method
Steps for Fabricating
Spruing (Fig. 23.60)
Principles of Optimal Sprue Design
Washing of Wax Pattern
Investing (Fig. 23.61)
Casting Procedure
Burnout of Wax Pattern/Wax Elimination and Heating
Cleaning of Casting
Advantages of Quenching
Trying in the Casting
Cementation of the Casting (Figs 23.64 to 23.66)
CASTING DEFECTS
Surface Roughness and Irregularities
Causes
Prevention
Distortion
Causes
Prevention
Incomplete Casting and Rounded Margins (Fig. 23.67)
Causes
Prevention
Discoloration
Causes
Prevention
Porosity
Solidification Shrinkage Defects
Causes
Prevention
Microporosity
Causes
Prevention
Gaseous Defects
Causes
Prevention
Backpressure Porosity
Causes
Prevention
Subsurface Porosity
PIN RETAINED CAST RESTORATIONS (FIGS 23.69A TO G)
Indications for Pin Retained Cast Restorations
QUESTIONS
CHAPTER 24:
Glass Ionomer Cement
INTRODUCTION
History of Glass ionomer cements
CLASSIFICATION OF GLASS IONOMER CEMENTS
GENERATION OF GLASS IONOMERS (FIG. 24.2)
First Generation of Glass Ionomer Cement
ASPA I
ASPA II
ASPA III
ASPA IV
Second Generation of Glass Ionomer Cement
Water Mixed GICs/Water Hardening Glass Ionomer Cements
Reinforced Glass Ionomer Cements
Resin-modified Glass Ionomer Cement (Fig. 24.3)
Highly Viscous Conventional Glass Ionomer Cement/High Viscosity Autocure Glass Ionomers
Advantages of Highly Viscous Glass Ionomers
Easily Mixable Glass Ionomer Cements
Glass Ionomer Stabilization and Protection Material
GC Fuji VIII (Fig. 24.8)
COMPOSITION OF GLASS IONOMER CEMENT
GIC Powder
GIC Liquid
Water Settable Glass Ionomer
Metal Reinforced Glass Ionomer Cement
Miracle Mix (Silver Alloy Admix Glass Ionomer Cement) (Fig. 24.11)
Cermet Cement
Resin-modified Glass Ionomer
Advantages of Resin-modified Glass Ionomer Cements (Fig. 24.13)
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 OF GLASS IONOMER CEMENT
CONTRAINDICATIONS OF GLASS IONOMER CEMENTS
PROPERTIES OF GLASS IONOMER CEMENT
Physical Properties
Biocompatibility
Water Sensitivity
Adhesion
Fluoride Release
Esthetics
Margin Adaptation and Leakage
Radiopacity
USES OF GLASS IONOMER CEMENTS
As Pit and Fissure Sealants
As Liners and Bases (Figs 24.21 and 24.22)
As Luting Agents (Fig. 24.23)
Manipulation
As Orthodontic Brackets Adhesives (Figs 24.25 and 24.26)
For Restorations of Class III and Class V Lesions (Fig. 24.27)
Fissure Sealing
Restoration of Root Caries
High Caries Risk Patients
Emergency Temporary Restorations
For Intermediate Restorations
For Core Build Up (Fig. 24.28)
Atraumatic Restorative Treatment (ART)
Steps for ART Technique (Figs 24.29A to D)
Sandwich Technique
Steps of Sandwich Technique
CLINICAL STEPS FOR PLACEMENT OF GLASS IONOMER CEMENT
Isolation
Instrumentation
Tooth Preparation
Mechanical Preparation
Class III Tooth Preparation
Class V Tooth Preparation
Class I Tooth Preparation
Class II Tooth Preparation
Internal Preparation on Occlusal Fossa
Tunnel Restoration
Technique
Chemical Preparation for GIC (Fig. 24.45)
Mixing of Cement
Restoration
Finishing and Polishing
Surface Protection
QUESTIONS
CHAPTER 25:
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
COMPOSITION
High Fusing Porcelains
Feldspar
Kaolin
Quartz
Medium and Low Fusing Ceramics
Glass Modifiers
Intermediate Oxides
Boric Oxide (B2O3)
Opacifying Agents
Coloring Agents
Stains or Color Modifiers
METHODS OF STRENGTHENING PORCELAIN
Chemical Strengthening (Fig. 25.2)
Dispersion Strengthening
Thermal Tempering
Reduce the Number of Firing Cycles
Creating Residual Compressive Stresses
Transformation Toughening
METAL CERAMIC RESTORATIONS (FIG. 25.3)
Porcelain-metal Bond (see Fig. 25.3)
Micromechanical Bonding
Chemical Bonding
Composition of Metal Ceramic Alloys and Ceramics
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 (Fig. 25.6)
In Ceram
In Ceram Spinel
Castable Ceramic (Fig. 25.7)
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 (Fig. 25.8)
Outline Form
PORCELAIN LAMINATE VENEERS
Indications
Contraindications
Tooth Preparation
FULL CERAMIC CROWNS
Indications
Contraindications
Tooth Preparation
Occlusal Reduction (Fig. 25.12)
Facial Reduction
Lingual Reduction (Fig. 25.13)
Chamfer Preparation (Fig. 25.14)
Finishing
FABRICATION OF CERAMIC RESTORATIONS
Firing on Platinum Foil
Fabrication Using Refractory Die
Steps
Lost Wax Technique
Machined Restorations Using CAD-CAM
Cementation
QUESTIONS
CHAPTER 26:
Tooth Hypersensitivity
INTRODUCTION
DEFINITION
NEUROPHYSIOLOGY OF TEETH
MECHANISM OF DENTIN SENSITIVITY
Theories of Dentin Sensitivity
Neural Theory
Odontoblastic Transduction Theory
Hydrodynamic Theory
INCIDENCE AND DISTRIBUTION OF DENTIN HYPERSENSITIVITY
Intraoral Distribution
ETIOLOGY AND PREDISPOSING FACTORS (FIG. 26.7)
DIFFERENTIAL DIAGNOSIS (FIG. 26.12)
DIAGNOSIS
TREATMENT STRATEGIES
Management of Tooth Hypersensitivity
Home Care with Dentifrices (Fig. 26.14)
Strontium Chloride Dentifrices
Potassium Nitrate Dentifrices
Fluoride Dentifrices
In-office Treatment Procedure
Rationale of Therapy
Treatment Options to Reduce the Diameter of Dentinal Tubules can be
Varnishes
Corticosteroids
Partial Obliteration of Dentinal Tubules
Dental Resins and Adhesives
Lasers
Patient Education
Dietary Counseling
Toothbrushing Technique
Plaque Control
QUESTIONS
CHAPTER 27:
Management of Discolored Teeth
INTRODUCTION
CLASSIFICATION OF DISCOLORATION
ETIOLOGY OF TOOTH DISCOLORATION
Intrinsic Stains
Pre-eruptive Causes
Hematological Disorders
Disease of Enamel and Dentin
Defects in Dentin Formation
Posteruptive Causes
Extrinsic Stains
Daily Acquired Stains
Chemicals
BLEACHING
HISTORY OF TOOTH BLEACHING
CONTRAINDICATIONS FOR BLEACHING
Poor Case Selection
Dentin Hypersensitivity
Extensively Restored Teeth
Teeth with Hypoplastic Marks and Cracks
Defective and Leaky Restoration
MEDICAMENTS USED AS BLEACHING AGENTS (FIGS 27.12A AND B)
Constituents of Bleaching Material
CONSTITUENTS OF BLEACHING GELS
Carbamide Peroxide (CH6N2O3)
Hydrogen Peroxide (H2O2)
Sodium Perborate
Thickening Agents
Urea
Surfactants
Preservatives
Vehicle
Flavors
Fluoride and 3 percent Potassium Nitrate
FACTORS AFFECTING BLEACHING
MECHANISM OF BLEACHING (Fig. 27.13)
Home Bleaching Technique/Night Guard Bleaching
Indications for Use
Contraindications
Advantages of Home Bleaching Technique
Disadvantages of Home Bleaching Technique
Factors that Guard the Prognosis for Home Bleaching
Commonly used Solution for Night Guard Bleaching
Steps of Tray Fabrication
Thickness of Tray (Fig. 27.14)
Treatment Regimen
Maintenance After Tooth Bleaching
Side Effects of Home Bleaching
In-office Bleaching
Thermocatalytic Vital Tooth Bleaching
Light Sources Used for In-office Bleach
Indications of In-office Bleaching (Figs 27.15A to D)
Contraindications of In-office Bleaching
Advantages of In-office Bleaching
Disadvantages of In-office Bleaching
Procedure
Non-thermocatalytic Bleaching
Steps
Microabrasion
Indications
Contraindications
Advantages
Disadvantages
Protocol (Figs 27.17A and B)
Bleaching of Nonvital Teeth
Thermocatalytic Technique of Bleaching for Nonvital Teeth
Intracoronal Bleaching/Walking Bleach of Nonvital Teeth
Inside/Outside Bleaching Technique
Closed Chamber Bleaching/Extracoronal Bleaching
Laser Assisted Bleaching Technique
Argon Laser
CO2 Laser
GaAlAs Diode Laser (Gallium Aluminum–Arsenic)
Tetracyclin Discoloration
Classification (Lordon and Boskman)
Management of Tetracycline Discoloration
EFFECTS OF BLEACHING AGENTS ON TOOTH AND ITS SUPPORTING STRUCTURES
Tooth Hypersensitivity
Effects on Enamel
Effects on Dentin
Effects on Pulp
Effects on Cementum
Effects on Restorative Materials
Application of Bleaching on Composites has Shown Following Changes
Effect of Bleaching Agents on Other Materials
Mucosal Irritation
Genotoxicity and Carcinogenicity
Toxicity
QUESTIONS
CHAPTER 28:
Minimally Intervention Dentistry
INTRODUCTION
EARLY DIAGNOSIS
NEW CARIES CLASSIFICATION BASED ON SITE AND SIZE OF LESION
ASSESSMENT OF INDIVIDUAL CARIES RISK (HIGH, MODERATE, LOW)
DECREASING THE RISK OF FURTHER DEMINERALIZATION AND ARRESTING ACTIVE LESION
REMINERALIZATION OF INITIAL LESIONS AND REDUCTION IN CARIOGENIC BACTERIA (FIGS 28.4 AND 28.5)
Bioactive Glasses—NovaMin (Fig. 28.6)
Recaldent (CPP-ACP)
MINIMAL INTERVENTION OF CAVITATED LESIONS
Dental Materials Used for Minimally Invasive Treatment
Glass Ionomer Cement (Fig. 28.10)
Composites Resins (Fig. 28.12)
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 (Fig. 28.18)
REPAIR INSTEAD OF REPLACEMENT OF THE RESTORATION
DISEASE CONTROL
Vital Pulp Therapy
CONCLUSION
QUESTIONS
CHAPTER 29:
Cervical Lesions
INTRODUCTION
CLASSIFICATION OF CERVICAL LESIONS
CARIOUS CERVICAL LESIONS
Clinical Features (Fig. 29.2)
Diagnosis
NONCARIOUS CERVICAL LESION
Classification
Erosion
Abrasion (Fig. 29.5)
Abfraction Lesion
Etiology (Fig. 29.9)
Clinical Features of Noncarious Cervical Lesions
Erosion (Fig. 29.10)
Abrasion (Figs 29.11 and 29.12)
Abfraction
Diagnosis of Noncarious Cervical Lesions
History of the Patient
Examination
Radiographs
MANAGEMENT OF CERVICAL LESIONS
Preventive Management
Restorative Management
Restoration of Cervical Lesions Using Composite Resins
Restoration of Cervical Lesion Using Glass Ionomer Cement (Figs 29.16A to D)
Restoration of Cervical Lesion Using Silver Amalgam (Fig. 29.17)
Endodontic Treatment
Periodontal Treatment
QUESTIONS
CHAPTER 30:
Selection of Restorative Materials
INTRODUCTION
FACTORS REGULATING THE SELECTION OF RESTORATIVE MATERIALS
Material Related Factors
Direct Filling Gold
Indications for the Use of Direct Filling Gold
Contraindications for the Use of Direct Filling Gold
Dental Amalgam
Indications of Amalgam Restoration
Contraindications of Amalgam Restoration
Glass Ionomer Cements
Indications of Glass Ionomer Cement
Contraindications of Glass Ionomer Cements
Composites
Indications of Composite Restorations
Contraindications of 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
Factors Effecting Success of Restoration (Fig. 30.4)
QUESTIONS
CHAPTER 31:
Evidence-based Dentistry
INTRODUCTION
DEFINITION
STEPS INVOLVED IN PRACTICING EVIDENCE-BASED DENTISTRY (FLOW CHART 31.1)
Framing Clinical Questions
Purpose of using PICO in Framing Questions
Search and Evaluate the Evidence (Fig. 31.2)
CLINICAL APPLICATION OF EVIDENCE-BASED APPROACH
CONCLUSION
QUESTION
CHAPTER 32:
Nanodentistry and Its Applications
INTRODUCTION
DEFINITION
ADVANTAGES OF NANOTECHNOLOGY
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
SAFETY FACTOR OF NANOROBOTS
CHALLENGES FACED BY NANODENTISTRY
CHALLENGES FACED FOR RESEARCH IN NANOTECHNOLOGY
QUESTIONS
INDEX
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