Faculty Calibration

1
Faculty Calibration

• Class II Amalgam

Gary Harmatz, DDS
2
We are trying to pursue that elusive entity we
refer to as,

• EXCELLENCE

3
Goals

• Help our students receive the finest pre-clinical
  education as possible
• Ultimately provide our patients with exceptional
  dental care
• To develop a faculty who are experts in the field
  of Restorative Dentistry
• To develop a faculty that enjoy teaching and
  learning.
• To develop a faculty that can work together and
  have a positive impact on their students.

4
Helping our Students Receive the Finest Education

• Understanding concepts, techniques and criteria.
• Calibration
• Development of improved teaching techniques

5
We need to have a high expectation ofour
students and
ourselves
6
We cannot accept mediocrity
7
INSPIRE MOTIVATE FACILITATE INFLUENCE
ENCOURAGE
8
Enthusiasm and Enjoyment
9
Let Me Show You
10

• Calibrate
• Demonstrate
• Visualize

11
WE COACHNOT CHECK
12
COACHING

• PASSION
• PATIENCE
• PERSISTANCE

13
Open to Improvement
14
Communication between Faculty
15
WE CAN MAKE A DIFFERENCE
16
DESIGN SPECIFICATION

• Outline Form
• Internal form
• Retention
• Enamel Wall Finish Debridement
  (Cavofinish)

17
OUTLINE FORM

• Outline circumscribes all caries,
  decalcification, fissured grooves existing
  restorations
• Margins terminate on smooth areas for finishing
• The occlusal width as minimal as possible, yet
  allow for proper amalgam condensation, 1 mm
  optimal (range 1 to 1.5 mm)

18
1 mm
19
Small Amalgam Condenser
1.0mm
20
Large Amalgam Condenser
T
1.5mm
Small End
21
Large Amalgam Condenser
T
1.5mm
Small End
22
OUTLINE FORM

• Proximal extensions, facial, lingual gingival,
  provide uniform access from adjacent tooth for
  finishing
• .5 mm is optimal (range .25 to .75 mm)

23
(No Transcript)
24
(No Transcript)
25
0.5mm
26
(No Transcript)
27
T
28
Correct
Incorrect
Incorrect
29
(No Transcript)
30
(No Transcript)
31
256 Carbide Fissure Bur
32
OUTLINE FORM

• The adjacent teeth have not been abraded or
  altered unless re-contouring is indicated to
  achieve better proximal contours to the
  restoration

33
Damage to Adjacent Tooth
34
Damage to Adjacent Tooth
T
35
INTERNAL

• Pulpal depth is sufficient to allow for an
  adequate bulk of amalgam to resist fracture
• 1.5 mm at the sallowest point
• 2 mm at the occlusal walls
• (range of 1.5 to 2.5 mm)

36
(No Transcript)
37
(No Transcript)
38
1.0mm
39
T
1.0mm
40
lt 1.5mm
41
T
lt 1.5mm
42
INTERNAL

• Axial depth deep enough to allow for proper
  condensation and proper placement of retention
  without weakening the enamel.
• 1 mm and at least 05 mm into dentin
• (range of .75 to 1.5 mm)
• Axial wall tapered toward the center of the
  tooth.

43
(No Transcript)
44
(No Transcript)
45
(No Transcript)
46
INTERNAL

• Axial walls curved to follow the external surface
  of the tooth
• Pulpal axial line angle beveled at 45º
• All caries removed
• Appropriate base or liner placed
• Base or liner is indicated when the pulpal or
  axial depth is greater than .5 mm deeper than
  minimal

47
(No Transcript)
48
(No Transcript)
49
(No Transcript)
50
(No Transcript)
51
RETENTION

• Retentive features that function to resist
  movement of the restoration in any direction.
• Occlusal dovetail
• Proximal retentive grooves
• Proximal retentive features provide for
  sufficient bulk to resist fracture of the
  amalgam. (.4-.5 mm)
• Proper use of pins or slots (As necessary)

52
(No Transcript)
53
(No Transcript)
54
(No Transcript)
55
(No Transcript)
56
Margins and Cavo-Surface

• Enamel walls supported by dentin
• Proximal walls meet surface at right angles for
  proper bulk of amalgam
• Occlusal walls at 90º to line from facial to
  lingual cusp tips or slightly undercut

57
Unsupported Enamel
58
(No Transcript)
59
(No Transcript)
60
ENAMEL WALL FINISHDEBRIDEMENT

• Walls are smooth and free of irregularities
• All debris removed from preparation and
  surrounding structures

61
(No Transcript)
62
UNSUPPORTED ENAMEL
T
63
T
DEBRIS
64
ROUGH CAVOSURFACE
65
(No Transcript)
66
(No Transcript)
67
(No Transcript)
68
Amalgam RestorationCondensation and Carving
69
(No Transcript)
70
(No Transcript)
71
(No Transcript)
72
AMALGAM CONDENSATION CARVING

• Surface
• Marginal Integrity
• Occlusal Anatomy/Function
• Axial Contour/Proximal Contacts

73
SURFACE

• Uniformly smooth
• Free of pits or voids
• Well condensed/Surface hard

74
ROUGH PITTED SURFACE
75
(No Transcript)
76
MARGINAL INTEGRETY

• Not detectable to an explorer
• No excess beyond the margin
• No submarginal area

77

• Submarginal areas on the occlusal surface of
  greater than .2mm require repacking of the
  preparation
• Any submarginal areas in the gingival 1/2 of the
  proximal or at the gingival margin are
  unacceptable and require repacking of the
  preparation.

78
(No Transcript)
79
Occlusal Excess
80
Margin Sub
81
(No Transcript)
82
OCCLUSAL ANATOMY

• Cusp planes, grooves, and marginal ridges
  continuous with existing tooth form
• Functional contacts and anatomy restored

The occlusal morphology should not create a
weakening of the amalgam
83
Deep Occlusal Anatomy
84
Marginal Ridge
85
(No Transcript)
86
Occlusal Anatomy
87
Lacks Anatomy More Ideal
88
The occlusal morphology of the restoration should
duplicate the occlusal morphology of the
unaltered tooth, however the depth of the grooves
should not be as accentuated as the natural tooth
form.
89
(No Transcript)
90
AXIAL CONTOUR - PROXIMAL CONTACTS

• Axial contours continuous with existing tooth
  form
• Proximal embrasures and proximal contacts restored

Proximal contacts should not be open
91
(No Transcript)
92
Proximal Embrasures
93
(No Transcript)
94
(No Transcript)
95
(No Transcript)
96
CLINICAL EXAMINATIONS

• Class II AMALGAM RESTORATIONS

97
AMALGAM RESTORATIONS

• Any tooth requiring a Class II amalgam
  restoration
• One of the proximal surfaces to be treated is in
  contact with the adjacent tooth
• Greater than minimal caries or requiring
  replacement of a defective restoration

98
ORGANIZATION

• Well organized and efficient
• Cassette for the procedure has all of the burs,
  diamonds and instruments required for the
  procedure and that they are in good condition and
  sharp
• Evaluate organization, efficiency and not
  violating the chain of cleanliness
• All required paper work (computer card,
  examination evaluation sheets, daily work sheet),
  patient chart, current radiographs, study casts
  (mounted as required), and diagnostic wax up
  (when indicated) available prior to and during
  the exam

99
ASSISTANCE

• Assistant is not permitted to do any of the
  procedures
• Assistants are also not allowed to provide any
  consultation during the exam.
• Inappropriate help by the assistant is unethical
  behavior
• Should this be observed the exam shall be
  terminated with a 0 grade and the case turned
  over to the ethics
• committee

100
EVALUATION

• Student shall be familiar with their
  patient's medical conditions and medications and
  be prepared to discuss these with you

101
AMALGAM RESTORATIONS

• 3 Hours Time Limit

102
Steps to be Evaluated

• Start
• Rubber dam
• Preparation
• Completed preparation with proper pulpal
  protection
• Finished carving with rubber dam in place
• Completed restoration after rubber dam removal
  and occlusal adjustment within the time limit

103
Start - prior to administration of anesthetic

• Describe the existing conditions and the proposed
  outline on the evaluation form and be prepared to
  discuss
• Any situations that will require extensions
  beyond the minimal that are observable in the
  mouth or on the patients casts should be
  described in detail before beginning the
  procedure
• The proposed outline must be carefully drawn with
  a pencil on an accurate stone cast (not the
  original diagnostic cast)
• All materials, supplies and instruments must be
  available prior to the examination

104
Rubber Dam

• For all procedures the rubber dam must be
  acceptable when the faculty is asked to evaluate
  and it must remain functional during the
  procedure.
• One to five points may be deducted from the final
  exam score if the rubber dam is unacceptable at
  any point in the procedure.
• The rubber dam may be changed any time during the
  procedure if it should become unacceptable.

105
Preparation

• Preparation with Minimal Depth
• Preparation Beyond Minimal Extensions
• Preparation With Greater Than Minimal Depth

106
Preparation with Minimal Depth

• Preparation having caries and/or existing
  restorative material that does not extend deeper
  pulpally and/or axially than a minimal
  preparation should be completed prior to the
  preparation evaluation.

107
Preparations Beyond Minimal Extensions

• If the preparation requires extension of the
  outline beyond the minimal, the extension should
  be agreed to by the examiner either before the
  preparation is started or during the preparation
  of the tooth. Then proceed to final preparation.

108
Preparation With Greater Than Minimal Depth

• Prior To Caries Removal Evaluation
• Preparations having caries and/or existing
  restorative material that extends deeper pulpally
  and/or axially than a minimal preparation must be
  seen prior to removing the caries or restorative
  material.

109
After caries removal

• All caries and/or restorative material must be
  removed and observed prior to basing or placing
  the restoration.

110
Thank You

• Dr. Boris Keselbrener
• Dr. Rick Kahn
• Dr. Rex Inghram
• Dr. Carl Rieder
• Dr. Nate Friedman
• Dr. Alex Koper

111
(No Transcript)