Approximal lesions in anterior teeth

• What are approximal caries?

  caries in the region of the contact point
• What is imbrication?

  Anterior teeth in the same arch which overlap each other.
• What to do if there is doubt of dentine involvement?

  Radiograph the tooth
• Why is detecting approximal caries important?

  • prevent early lesion progression
  • prevent new lesion formation
• How to prevent/manage approximal caries?

  • OHI (interproximal cleaning) • Diet Analysis & Advice • Fluoride Toothpastes/supplements • Topical Fluoride, Professionally applied (e.g. Duraphat
• How to operate on approximal caries?

  1) Take shade before applying dam 2) Approach from palatal side if possible 3) Use round burs (541 too large) 4) Preserve the incisal edge 5) cut enough for visual access 6) Bevel enamel margins (if composite)
• Why is bevelling composite margins important?

  - To expose more prisms for bonding - To reduce the visibility of the join between composite and tooth - Maximum composite bevel: 1mm
• What dental material do you not bevel for?

  GIC - its too weak in thin sections (Also do not bevel where it will have occlusal contact)
• What are the steps for restoration?

  1) Prep - rubber dam 2) (Lining?) Then Etch 3) Bond 4) Wedge & Matrix 5) Restore
• When is a lining used?

  If you estimate cavity floor is within 1mm of the pulp and there may still be caries
• What can be used as a lining?

  • Use Calcium Hydroxide (e.g. Dycal, Life) • Tiny spot at deepest part of cavity • You can protect the CaOH2 layer (from etch and spray) with light-cured RMGI (e.g. Vitrebond)

  
• What is the function of the wedge?

  - Holds the matrix in place - Keeps the dam out of the way- slightly separates the teeth- prevents gingival excess filling material
• What is the function of the matrix?

  Ensures material sets under pressure (minimising contraction effects) • Gives good contour • Gives good surface finish • Protects neighbour from etch, bond, etc

  
• How do you choose the right restorative material?

  • Adhesive materials 1st choice – more conservative (not amalgam) • Composites preferred to GIs for aesthetics & wear resistance • Glass Ionomers for root caries/high risk patients (but not when occluded on, or unstable acid erosion. Limited to Class V) • RMGI preferred to compomer if high caries risk
• What other factors are needed to be considered when choosing the right restorative material?

  Location: Anterior/Posterior Supra or sub-gingival Crown, Root, or both Extent: Width / Depth Caries risk: (low, medium, high) Visibility, and Patient Expectations
• What are the results of trauma?

  • Coronal Fracture - Enamel / Dentine /Pulp • Cracks in Crowns • Root Fracture • Luxation (Dislodged) • Avulsion (knocked out!) • Sometimes leading to Pulp Death (Necrosis) • Class IV
• How do you test for pulp death?

  Vitality test
• What is a coform matrix?

  • Used for one incisal corner • Choose mesial or distal

  
• What is a Odus Pella Crown form?

  • Used for one whole incisal edge • Choose Right or Left

  
• What is an acetate matrix strip?

  Strip used for freehand work

  
• What types of finishing burs are used?

  super fine diamond