How to pass the CDCA ADEX Exam Part 5 Restorative and Perio
TLDRThe video script provides a detailed guide on dental restoration techniques using a typodont, emphasizing the importance of creating tight contacts during the procedure. It suggests pre-wedging to create space for a matrix or rubber dam and offers tips for dealing with tight contacts, such as using a micro brush or fingernail for separation. The script also covers the use of various dental instruments like enamel hatchets and diamonds for precise work, and the importance of checking for caries and maintaining closed interproximal contacts. Additionally, it discusses the use of metal matrices for burnishing against adjacent teeth and the application of finishing and polishing techniques. The guide highlights the need for careful packing of composite to avoid open margins and the use of lubricants to prevent composite lifting. It concludes with advice on checking occlusion and the importance of thorough caries examination, ensuring a successful dental restoration.
Takeaways
- 🦷 **Pre-wedging**: Use a micro brush or fingernail to create space for tight contacts before placing the matrix or rubber dam.
- 🔍 **Visibility of DEJ**: If the dentin enamel junction (DEJ) is hard to see, wetting and drying it can make it more visible, which is crucial for proper margin placement.
- 📏 **Measurements for Margins**: For central incisors, aim for 1.5mm from the DEJ, and for laterals, 1.25mm from the cuspidal surface margin.
- 🚫 **Closed Contacts**: Aim for closed contacts in your preparation to ensure a tight seal that won't let light pass through, which is a common check during evaluations.
- 🛠️ **Instrument Care**: Be cautious with enamel hatchets on brittle teeth to prevent fractures; use diamonds for better control and less noise.
- 📐 **Box Preparation**: Use specific diamond burrs for creating boxes, ensuring a 1mm isthmus width to accommodate microbrushes for bonding.
- 🛡️ **Protecting Adjacent Teeth**: Utilize interdental guards and wedges to prevent damage to adjacent teeth during the preparation process.
- 🔩 **Matrix and Wedge Use**: For anterior teeth, apply clamps from premolar to premolar for extra space and ease of operation.
- 🧹 **Finishing Touches**: Use large round carbide burrs for trimming and polishing systems like Jiffy for a smooth and shiny finish.
- 🔍 **Finding Caries**: Use explorers to locate soft areas indicative of caries, ensuring to probe every surface thoroughly.
- ⚖️ **Occlusal Check**: After the composite is placed, check occlusion to ensure there's light to no contact on the composite to prevent damage.
Q & A
What is the main issue when working with a typodon and how can it be resolved?
-The main issue is that the contacts in a typodon are very tight, making it difficult to work with. This can be resolved by pre-wedging, which creates a little bit of space to facilitate the placement of matrices or rubber dams.
What tool can be used to pre-wedge and why is it effective?
-A micro brush can be used for pre-wedging because it allows for quick insertion and removal, effectively creating space where needed.
If a micro brush is not available, what alternative method can be used to create space under the rubber dam?
-If a micro brush is not available, a thick fingernail can be used to create a separation between the teeth, helping the rubber dam to pop down.
What is the purpose of using a plastic instrument for wedging, and what is the caution associated with it?
-A plastic instrument can be used to create separation between the teeth, but it's not recommended because it can bend and may not maintain the required separation. It should be used carefully to avoid damaging the gingiva or causing an open contact.
How does one ensure a closed contact when working on the anterior portion of a typodon?
-To ensure a closed contact, one should use measurements such as 1.5mm from the DEJ (dental enamel junction) for central incisors and 1.25mm from the capital surface margin for laterals. The DEJ can be made more visible by wetting and then drying the area slightly.
What is the benefit of keeping the contact closed during the preparation of a typodon?
-Keeping the contact closed ensures that there is no light passing through when the typodon is held up to the light by examiners, which is a test for open contacts. A closed contact is visibly required and helps avoid failures in the examination.
What are some tips for making the boxes of a preparation nice and square?
-Using enamel hatchets with light pressure and slowly shaving down the tooth can help create a nice and square box. It's also recommended to watch educational videos for prep design, such as those by Stevenson Dental Solutions, for further guidance.
Why is it important to have a wide enough isthmus width during the preparation?
-A wide enough isthmus width is important because if it's too small, it becomes difficult to get a microbrush in for bonding. This ensures that there are no voids on the bottom and that everything can be packed in properly.
What are some methods to protect adjacent teeth during the preparation process?
-Inter guards, fender wedges, and wedge guards can be used to protect adjacent teeth. These are placed between the teeth to prevent accidental damage while creating the box.
How can one find cavities during the preparation of a typodon?
-One can find cavities by preparing one tooth at a time, looking for the 'stick' with an explorer, listening for a scritchy sound, and feeling for soft areas. If the explorer picks at a soft area, white material may flick off, indicating a cavity that needs to be removed.
What is the recommended way to ensure a closed interproximal contact when using a matrix?
-Using metal matrices is recommended because they can be burnished against the adjacent tooth, ensuring a closed contact. Additionally, using a large enough wedge can create more separation, helping to achieve a closed contact.
What are some finishing and polishing techniques recommended for the final stages of preparation?
-Using a large round carbide at high speed to trim off excess, followed by the Jiffy polishing system, can effectively remove flash and make the surface shiny. If there is a lot of flash, a proximal strip or a 12 blade can be used for trimming, and a scaler can be used to remove excess composite.
Outlines
😀 Tight Contact Management in Restorative Dentistry
This paragraph discusses techniques for managing tight contacts when working with a typodont. The speaker suggests using pre-wedging with a micro brush to create space for the matrix or rubber dam. They also mention using a fingernail or plastic instrument for creating separation if a micro brush is not available. The importance of closed contacts is emphasized, and the use of a mirror to check for light leakage is recommended. The paragraph also covers the placement of clamps and the measurement considerations for anterior teeth.
🛠️ Techniques for Creating Square Boxes and Protecting Adjacent Teeth
The second paragraph focuses on creating square boxes in dental preparation and protecting adjacent teeth. It advises using enamel hatchets with light pressure to prevent tooth fracture. The speaker recommends diamond burrs for better results and watching educational videos for guidance. The importance of a wide isthmus for accessing the bottom of the preparation is highlighted. Various tools such as inter guards and fender wedges are discussed for protecting adjacent teeth, and the use of an air-driven handpiece for trimming enamel overhangs is mentioned for safety.
🔍 Finding Caries and Ensuring Closed Interproximal Contacts
This paragraph details the process of finding caries in a tooth and ensuring closed interproximal contacts. The speaker recommends using different explorers to check every surface thoroughly and to feel for soft areas that may indicate caries. The use of metal matrices for maintaining closed contacts is discussed, along with the advantages of metal over plastic matrices. Tips for using a ring to create separation and checking the ring's condition before use are provided. The paragraph concludes with advice on finishing and polishing, including the use of carbide burrs and polishing systems.
📏 Checking Occlusion and Avoiding Open Margins
The fourth paragraph emphasizes the importance of checking occlusion and avoiding open margins. It suggests using a probe for accurate measurements and ensuring that there is no more than light contact on the composite. The speaker also provides advice on dealing with flash and excess composite, recommending the use of specific instruments like a 12 blade or a scaler. The paragraph concludes with a reminder to check for caries multiple times to avoid missing any during the procedure.
🧤 Tips for Packing Composite and Avoiding Common Pitfalls
The final paragraph offers tips for packing composite into the dental preparation. It addresses the issue of the flowable base lifting off and suggests using a bond on the glove or instrument to prevent this. The speaker also advises wedging from the lingual side when working on anterior teeth to reduce flash. The paragraph concludes with an offer of help for any difficulties that may arise during the procedure.
Mindmap
Keywords
💡Typodont
💡Pre-wedging
💡Matrix
💡Rubber dam
💡DEJ (Dentinoenamel junction)
💡Closed contact
💡Enamel hatchet
💡Microbrush
💡Burnishing
💡Composite
Highlights
Pre-wedging is a recommended technique to create space when working with tight contacts in dental procedures.
Using a micro brush for wedging allows for quick insertion and removal, creating space for the matrix or rubber dam.
If a micro brush is not available, a thick fingernail can be used to create separation between teeth for rubber dam placement.
For anterior teeth, clamps can be placed from premolar to premolar for extra working space without the need to push a mirror against everything.
Measuring the central incisors should be 1.5mm from the DEJ, and laterals 1.25mm as of 2022 standards.
Moistening and then drying the DEJ can make it easier to visualize, which is crucial for accurate inner proximal contact measurements.
Closed contacts are preferable as they guarantee a solid contact when examined by the CDCA examiners.
Using a mirror to shine light through the contact can help identify any open contacts that need correction.
Stevenson Dental Solution videos are recommended for learning about dental prep design and using diamond burrs effectively.
Ensuring a wide enough isthmus width is important for allowing the microbrush to reach all areas for proper bonding.
Protecting adjacent teeth during the procedure can be achieved using inter guards, fender wedges, and wedge guards.
An air-driven handpiece is safer for trimming off enamel overhangs as it has less torque and is less likely to drive through metal.
Finding cavities involves using all senses except smell, with a focus on the texture and sound when probing the tooth surface.
Using three different explorers increases the chance of finding cavities due to variations in sharpness and probing ability.
Metal matrices are preferred for ensuring closed interproximal contacts and can be burnished against the adjacent tooth.
Checking the integrity of rings used in dental procedures is important to prevent open contacts and maintain separation force.
Finishing and polishing can be done using a large round carbide followed by the Jiffy polishing system for a shiny and clean result.
To avoid composite lifting during packing, using a lubricant on tools can prevent the composite from sticking and being pulled up.
When packing composite, it's important to ensure no open margins and to check occlusion for light to no contact on the composite.
Using a 0.7mm pencil or a condenser from the kit can help measure and ensure the width between contacts is within acceptable limits.
Transcripts
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