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SUMMARY OF TERM 2

SUMMARY OF TERM 1

Clinical Skills Tests

#1 26 O Psycho-motor Preparation

At the time I remember just feeling good about the fact that i could drill any kind of something into a plastic tooth. Looking back, I sucked lol.

#2 36 O Composite

It's weird to think we used to just do one tooth for a skills test. And weirder to think it used to be a challenge. It's cool to see how far we've come in just a few months.

#3 35 O Amalgam & 36 O Amalgam

Remembering to have the marginal ridges diverging and the rest converging. I used to have basically zero anatomy in my amalgam fills. I hadn't developed a feel for it and always erred on the side of undercarving. These would have had heavy contacts.

#4 26 OL Amalgam, 26 B Composite & 46 B Amalgam

The OL prep can be challenging because there is an oblique ridge to avoid and a cusp to not blow out. Convenience form must also be considered. There is a lingual step. The 26 B prep is a little triangle on the buccal groove that must be beveled and the 46 B is a smile the must have retention grooves occlusally.

#5 45 D Slot Composite & 46 MO Amalgam

The slot prep does not involve the occlusal surface like an amalgam slot prep would because composite doesn't require mechanical retention. With my periodontal probe, I measure the distance it will take to break contact and then drill that far down. The 46 MO prep must not only break contact gingivally, but buccally and lingually as well.

#6 24 D Slot Composite, 25 DO Amalgam, 25 B Composite & 26 MOD Amalgam

The slot prep is similar to the one above. The 25 DO requires mechanical retention for amalgam and, therefore, involves the occlusal surface. The 25 B composite is an open smile with an occlusal bevel and the 26 MOD prep must break contact buccally and lingually because of the material.

#7 44 DO Amalgam, 45 MOD Amalgam & 46 MO Amalgam

The 44 DO involves the occlusal surface because amalgam requires mechanical retention. The 45 MOD must break contact buccally and lingually, as does the 46 MO. It is important to have the matrix band tight because the proximal aspect of the fill needs to not impinge on the adjacent proximal surface as this would create a concavity in the fill.

#8 22 ML/DL Composite, 23 DL Composite & 24 M Slot Composite

The 22 ML/DL preps might be favorite. I used a modified grip that feels stable and comfortable. The 23 DL is the same as the 22. I usually err on the shallow side for these preps. Clinically, the prep would just reach the extent of the caries. The 24 M slot just have to break contact gingivally. I use the burnisher to get some occlusal anatomy back into the tooth, but leave some material to be taken off so that I can get rid of the air inhibited layer, which is undesirable.

#9 11 MI Composite, 21 MI Composite & 22 ML/DL Composite

The class III preps are the same as above. I used a full width chamfer on the class IV's. I wrap the cure-thru matrix band around the prep and fill it with composite while my fingers contour the lingual and buccal aspects. The gold shanks are good to use, followed by the polishing discs.

#10 12 ML/DL Composite, 15 D Slot Composite & 16 MOB Wrap Amalgam

The class III's are the same as above. The 15 D slot just has to break contact gingivally. The 16 MOB wrap is filled from the occlusal first, then the buccal to make sure that the proximal aspect of the prep is adequately filled. Also, the buccal part of the prep must be deeper than 1 mm for amalgam.

46 MODBL Wax Carving

Once you have sanded down a 46, drilled a few holes in the root (for retention of the wax), placed a matrix band and melted a sufficient amount of wax inside of it, you are ready to start carving. First, using the discoid side of the discoid/cleoid instrument, carve the central groove in line with those of the adjacent teeth. It should be approximately 0.5 mm above where you want it when the tooth is finished. Next, carve the lingual groove and the two buccal grooves using the discoid. Be sure to extend these grooves gingivally as appropriate for the 46. The mesial, distal and marginal fossae are then defined. The cleoid is used next to refine the occlusal anatomy. The metal spatula is then used to shape the lingual and buccal surfaces to the proper dimensions. It is then used to adjust the lingual and buccal cusp heights to match those of the adjacent teeth. The spatula is used parallel to the gingival plane. Shaping the cusp tips can be done with the spatula as well, or other appropriate instrument. Lastly, the secondary grooves are added before the tooth is finished.

12 MILF Composite

This prep is identical to the one on the 22, but on the mesial side.

22 DILF Composite

This prep is also identical to the previous class IV's, but the anatomy and morphology of the lateral is different than the central.

11 MILF Composite

This prep is identical to the one of the 21. I like using the football bur on the lingual and the gold shank on the buccal. The cure-thru matrix establishes a smooth proximal cavosurface margin, but flash can also be eliminated with sanding strips.

11 DL Composite

This prep can be shaped like a half circle or a half square. I prefer the half circle shape because it is conservative and nice to fill. I use a modified grip for this prep because the regular one feels uncomfortable and unstable. I usually err on the side of preps that are too shallow. I sometimes get to a point where I feel like if I go any further it'll be too deep. This is something I need to work on I guess.

44 DO Composite Sandwich

This prep is just a slot that extends subgingivally. Again, a glass ionomer cement is used below the CEJ and composite above.

45 MOD Composite Sandwich

The composite sandwich technique is used to subgingival caries. A glass ionomer cement is used below the CEJ and composite above. The glass ionomer cement is suitable for subgingival caries, because it transiently releases fluoride and is less conducive to recurrent caries. A bur such as the 169 is good for the proximal slot. The incremental technique for composite is important here.

14 DO Composite

Because the material is composite, the prep does not need to extend occlusally for retention. It is simply a slot and must only break contact gingivally. Always important to push the composite into the gingivally corners of the box to avoid voids. The contact is a little further buccally than usual but the prep is still centered around the central groove.

15 MOD Amalgam

This is similar to the 35 MOD prep in terms of retention and shape. The anatomy and morphology are different but similar enough that the same principles can be applied.

16 MOB Wrap Amalgam

This is a relatively difficult prep, but taking it one class it a time makes it manageable. As with all class II's, I like to measure the distance it will take to break contact with the perio probe. After I finish the occlusal part of the prep, I extend the proximal to that measured depth. I then make the class V aspect and extend it to connect to the mesial slot. I go from 330 to 169 to 330 to 169 going from occlusal to proximal to buccal to connecting the class V to the class II. On the fill, once the matrix band is in place, it's good to condense the amalgam occlusally and proximally as far as possible. Then I remove the matrix band and fill the the prep buccally. This is the best way to avoid proximal voids where recurrent caries can occur.

34 DO Amalgam

This does not include the mesial proximal surface but does extend occlusally for retention. The pulpal surface is slightly angled and as a result, so is the preparation.

35 MOD Amalgam

This difference in this prep from the 36 is due to the difference in the anatomy and morphology of the tooth. It extends across the occlusal surface and breaks contact buccally and lingually in the proximal slots.

36 MOD Amalgam

This preparation is nearly identical to the 16 MOD amalgam, other than the absence of an oblique ridge. The occlusal prep can extend from mesial to distal proximal surface without obstruction. This makes it relatively simple. to get some anatomy into the fill.

15 DO, 16 MOD & 17 O Amalgam

Since the prep on the 15 is for amalgam, it must extend occlusally as amalgam requires macro-mechanical retention. Retention grooves in the slot are also necessary. It is a good idea to do either the 15 before the 16, or vice versa, so as to avoid extending one the proximal aspects of the restoration into the adjacent preparation, which would result in a concave fill. I have already talked about the 16 MOD amalgam previously so I don't feel the need to do that again. The 17 is relatively simple. The oblique ridge and marginal ridge are considerations for the distal portion. Trying to remain conservative while retaining sound tooth structure with a divergent prep is the name of the game.

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