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Faculty Calibration

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Title: 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)

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1 mm
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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)

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0.5mm
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T
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Correct
Incorrect
Incorrect
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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)

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1.0mm
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T
1.0mm
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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.

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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

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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)

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

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UNSUPPORTED ENAMEL
T
63
T
DEBRIS
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ROUGH CAVOSURFACE
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Amalgam RestorationCondensation and Carving
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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
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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.

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Occlusal Excess
80
Margin Sub
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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
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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.
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AXIAL CONTOUR - PROXIMAL CONTACTS
  • Axial contours continuous with existing tooth
    form
  • Proximal embrasures and proximal contacts restored

Proximal contacts should not be open
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Proximal Embrasures
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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

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