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Preparation for
Amalgam
Characteristics of these
:lesions
:Class II could be
walls
Compound Class II
For most molars and premolars with
proximal lesions, the occlusal surface or
part of it should be included in the cavity
preparation for access purposes
(Extension for convenience).
I. Outline form
1. Masticatory loads:
The greater the masticatory load, the
less should be the extent of the cavity
preparation to reduce the surface area of
the restoration subjected to high loading.
2. Localized cariogenic factors:
Greater activity of cariogenic factors
(tooth position, partial denture
attachment,..) indicates greater extent of
the cavity into self-cleansable areas.
3. esthetics:
Esthetics can modify the outline form in
a class II cavity preparation by minimizing
the facial extent of the cavity, especially in
the mesio-facial margins of premolars and
first molars.
4. Tooth position:
Malalignment and rotation of teeth can
impede or facilitate the access to proximal
lesions and accordingly modify the outline
form.
:External outline
a- Bucco
b- Gingival floor is
extended to include caries and break
contact with the adjacent tooth gingivally.
It is a straight line between the gingival
termination of the buccal and lingual
proximal CSM.
:Internal outline
a- Axial Wall should:
c- Gingival floor:
3. Isthmus
bucco-proximal wall.
Remember that:
2. Margins:
Remember that:
Amalgam has good compressive
strength when it has sufficient bulk (1.5
mm minimum), any frail, feather-edged
margins of amalgam occurred if the
cavosurface angles of preparation are
beveled, will fracture easily under
occluding forces.
Every
Convenience form
The occlusal involvement is, in itself, a
convenience form.
Freeing of contacts.
Accentuation of cavity walls and
margins.
Selection of suitable sized instruments.
:Operative procedure
Proximal Box
A. Using spoon
excavator to fracture
out weakened
proximal enamel.
C. Removing the
remaining undermined
proximal enamel with
enamel hatchet on
facial proximal wall,
lingual proximal wall,
and gingival wall.
Wedging:
A, Round toothpick wedge placed in gingival embrasure protects
gingiva and rubber dam during preparation of proximal box.
B, Triangular wedge is indicated when deep gingival extension of
proximal box is anticipated, because wedge's greatest crosssectional dimension is at its base. Consequently, it will more readily
engage the remaining clinical tooth surface
N.B. If additional use of the bur is indicated, a matrix band may be
used around the adjacent tooth to prevent marring its proximal surface
Proximal retention
To enhance retention form of the proximal
portion, proximal locks may be indicated to
counter proximal displacement.
N.B: Retentive locks may not be needed in
conservative, narrow proximal boxes.
Retentive locks prepared using the No. 1/4
bur or No. 169 bur.
Preparation of retention locks using a No. 169 bur with air coolant
(to improve vision) and reduced speed (to improve tactile "feel" and
control).
The bur is placed in the properly positioned axiolingual (axiobuccal)
line angle and directed to bisect the angle approximately parallel to
the DEJ.
The bur is tilted to allow cutting to the depth of the diameter of the
end of the bur at the point angle and permit the lock to diminish in
depth occlusally, terminating at the axiolinguo-pulpal (axiobuccopulpal) point angle.
Cusp capping
Indication:
When the occlusal outline form
extends from a primary groove to
within two thirds of the distance to a
cusp tip, that cusp is usually
weakened and should be capped.
:Procedure
Cusp capping