Conservative Dentistry 1- Dent 335 (Operative Dentistry) Manual First Semester 2013-2014

Dr.Ghada Maghaireh, Course Coordinator

Jordan University of Science and Technology Faculty of Dentistry Department of Conservative Dentistry

Jordan University of Science and Technology Faculty of Dentistry Department of Conservative Dentistry First Semester 2013-2014 DENT 335. CONSERVATIVE DENTISTRY 1 (4 credit hours: 1 theory, 3 practical) Jordan University of Science and Technology Faculty of Dentistry Department of Conservative Dentistry First Semester Course Syllabus Course Information Course Title Course Code Prerequisites Course Website Instructor Office Location Office Phone Office Hours E-mail Teaching Assistant(s) Course Description This preclinical course includes a theoretical and practical component. The theoretical component is designed to give the third year students basic cognitive knowledge of the principals, terminology, instruments, materials and techniques utilized in the practice of Operative Dentistry. The practical component provides the student with the initial experience in the application of restorative procedures for managing the carious process on phantom heads. The student should perform a series of clinical exercises utilizing current instrumentation, materials, and techniques. Conservative Dentistry 1(Operative Dentistry) Dent 335 None N-A Dr.Ghada Maghaireh N-A N-A gmaghair@just.edu.jo

Text Book Title Author(s) Publisher Year Edition Book Website References

Fundamentals of Operative Dentistry James B.Summitt, J.William Robbins, Richard S.Schwartz Third Edition The Art & Science of Operative Dentistry, Theodore 2

M.Roberson, Harald O.Heymann, Edward J.Swift JR., Sixth Edition. * Other assigned reading materials Assessment Policy Assessment Type Midterm Theoretical Exam Midterm Practical Exam Lab work during semester N-A 10% 20% will be distributed as follow: Cavity preparation =15 Amalgam placement =5 10% the average of assignments given during semester, evaluation is going to be made in each lab session 60% will be distributed as follow: Theory: 15 % Practical: 45 % will be distributed as follow: Cavity preparation = 25 Tofflemire application = 5 Amalgam placement = 15 N-A N-A Weights 30%

Final Exam

Attendance Participation

Course Objectives 1. To understand the principals, terminology, instruments, materials and techniques used in the practice of Operative Dentistry 2. To understand the use of amalgam, resin composite and glass inomer materials in the scope of operative Dentistry. 3. To understand the basic principles of cavity design for amalgam and resin composite restorations and glass ionomer. 4. To practice caries removal and pulp protection prior to restorative procedures on extracted natural teeth. 5. To understand and practice operator positions for

20%

30% 10%

10%

operative procedures. Teaching & Learning Methods Classroom lectures Tests and exams Review of exams Textbook reading assignments Lab demonstrations and videos The Operative Dentistry manual Learning Outcomes: Upon successful completion of this course, students will be able to Related Objective( Reference s) Chapter # 6 Fundamentals List and differentiate 1 between different methods of cavities classifications. Chapter # 6 Fundamentals Identify the 1 component parts of a prepared cavity. Chapter# 5 Art & science List and describe the basic steps in 1 cavity preparation, in order or sequence. Identify instruments Chapter # 6 Fundamentals 1 by name and use. Chapter# 5 Art & science Describe and give reasons for the differences 2 between the cavity preparation for amalgam and resin composite. Chapter #5 6 Art & science List the basic physical properties of and describe 3 differences between amalgam and resin composite 1&2 Chapter 11 Fundamentals List the steps in placement and

2&3

describe the differences in theses steps for amalgam and resin composite. List and describe differences between finishing and polishing techniques for amalgam and resin composite. List the basic physical properties of glass inomer, differentiate between different types of glass inomer materials and their uses. Describe the materials and techniques used in caries removal and pulp protection, including burs, spoon excavators, cavity liners, and temporary restorative materials. Identify the basic positions for the operator while performing operative dentistry procedures.

Chapter 11 Fundamentals

Chapter 13 Fundamentals

Handout

Handout

Useful Resources The Art & Science of Operative Dentistry, Theodore M.Roberson, Harald O.Heymann, Edward J.Swift JR., Fourth Edition. * Other assigned reading materials Course Content Week Topics Chapter in text

1 ( Sep.22) 2 ( Sep. 29) 3 ( Oct. 6) 4 (Oct.13) 5 ( Oct.20) 6 ( Oct.27) 7 (Nov.3) 8 (Nov.10) 9 ( Nov.17) 10 (Nov.24) 11 (Dec.1) 12 (Dec.8) 13 (Dec.15) 14 (Dec.22) 15(Dec.29)

Introduction Caries classification + cavity classification Instrumentation Happy Eid Principles of Cavity Preparation I Principles of Cavity Preparation II Amalgam Restorations I Amalgam Restorations II Glass Inomer Restorations Midterm Exam (The first 6 lectures) Liners and bases Principles of Adhesion I Principles of Adhesion II Resin Composite Restorations I Resin Composite Restorations II

Chapter # 6 Fundamentals Chapter # 6 Fundamentals Chapter# 5 Art & Science Chapter# 5 Art & Science Chapter # 6 Fundamentals Chapter # 11 Fundamentals Handout + Chapter # 13 Fundamentals Handout + Chapter # 5 Fundamentals Chapter # 8 Fundamentals Chapter # 8 Fundamentals Chapter # 9 & #10 Fundamentals Chapter # 9 & #10 Fundamentals

Additional Notes Attendance: Students must attend 100% of all scheduled classes and labs. Class participation is required. Should an absence be necessary, student should contact the course instructor immediately. Work missed can ONLY make up with an excused absence. No make-up exams or quizzes will be given for unexcused absences. Late arrivals to class are unexcused absences. All course make-ups, test, and so forth, must be completed within 14 days from the date of the excused absence. Laboratory: Required Teeth: Lower 6 (10 teeth), Upper 6 (4 teeth), Upper 4(4 teeth), Lower 4 or 5 (4 teeth), Upper central incisor (4 teeth), Upper canine (4 teeth).Natural molar tooth (2 teeth) High speed burs: Straight fissure bur (medium, # 56) 4 burs, round bur (small, #1/2) 2 burs, diamond finishing burs. Low speed burs: Straight fissure bur (medium, # 56) 2 burs, round bur (small, # 2 and large size # 6) 2 burs. Lab Schedule Week 1 (22-26/9) Lab Procedure 1 +2 Introduction to ODS Lab Tooth number 6

2(29/9-3/10) 1 2(29/9-3/10) 2 3(6/101 10/10) 3(6/1010/10 4(13-17/10) 4(13-17/10) 5(20-24/10) 5(20-24/10) 6(27-31/10) 6(27-31/10) 7(3-7/11) 7(3-7/11) 8(10-14/11) 8(10-14/11) 9(17-21/11) 9(17-21/11) 10(2428/11) 10(2428/11) 11(1-5/12) 11(1-5/12) 12(8-12/12) 12(8-12/12) 13(1519/12) 13(1519/12) 14(222

Exercise for operator positions+ Instruments + Class I amalgam preparation (DEMO) Class I amalgam preparation Class I amalgam preparation + buccal pit Class I amalgam preparation Happy Eid Happy Eid Amalgam restoration of the teeth (DEMO) Amalgam restoration of the teeth Class I amalgam preparation with lingual extension +with buccal extension (DEMO) Amalgam restoration Class II amalgam preparation MO (DEMO) Class II amalgam preparation DO Amalgam restoration for Class II teeth (DEMO) Finish amalgam preparation Midterm Practical Exam (Class I cavity preparation + restoration) (1 hour) Midterm Practical Exam (Class I cavity preparation + restoration) (1 hour) Class II MOD amalgam preparation + amalgam restoration Finish amalgam restoration Class III cavity preparation + composite restoration (DEMO) Class III cavity preparation + composite restoration Class IV cavity preparation + composite restoration (DEMO) Class IV cavity preparation + composite restoration Class II cavity preparation MO for composite restoration Class II composite restoration Class V cavity preparation+ Glass inomer

Lower 6 Lower 6 Lower 6 Upper 6

1 2 1 2 1 2 1 2 1 2 1 2 1 2 1 2 1 2 1

Lower 6 3 TEETH Upper & Lower 6 Upper and Lower 6 Lower 6 Upper 6 Lower 6 Lower 6 Lower 6 Lower 4 2 TEETH Upper 1 Upper 1 Upper 1 Upper 1 Upper 4 Upper 4 Upper 3

26/12) 14(2226/12) 15(29/122/1) 15(29/122/1) 16(5/1-9/1)

2 1 2

16(5/1-9/1)

+composite restoration (DEMO) Caries detection and excavation on natural tooth exercise Caries detection and excavation on natural tooth exercise Cavity liner placement + Placement of IRM temporary restoration Handout of all teeth & Assessment sheet Final practical Exam (Class II amalgam preparation + restoration) Handout of all teeth & Assessment sheet Final practical Exam (Class II amalgam preparation + restoration)

Molar with occlusal caries Molar with occlusal caries Molar with occlusal caries Lower 6

Lower 6

Conservative Dentistry 1- Dent 335 (Operative Dentistry) Evaluation Sheet STUDENT NAME: Procedure Class I amalgam preparation Class I amalgam preparation + buccal pit Class I amalgam preparation Class I amalgam preparation with buccal extension Amalgam restoration of Class I Amalgam restoration of Class I + Buccal pit Amalgam for Class I preparation with buccal extension Class I amalgam preparation with lingual extension Amalgam restoration for Class I with lingual extension Class II MO amalgam preparation Class II DO amalgam preparation Amalgam restoration for Class II MO Amalgam restoration for Class II DO Class II MOD amalgam preparation Class II MOD amalgam restoration Class III cavity preparation Class III composite restoration Class IV cavity preparation Class IV composite restoration Class V cavity preparation Class V composite restoration Class II MO cavity preparation Class II MO composite restoration Class V cavity preparation Class V Glass inomer restoration Caries detection and excavation on natural tooth exercise Caries detection and excavation on natural tooth exercise Cavity liner placement Placement of IRM temporary restoration STUDENT NUMBER: Tooth number Mark Lower 6 Lower 6 Upper 6 Lower 6 Lower 6 Lower 6 Lower 6 Upper 6 Upper 6 Lower 6 Upper 6 Lower 6 Upper 6 Lower 4 Lower 4 Upper 1 Upper 1 Upper 1 Upper 1 Upper 3 Upper 3 Upper 4 Upper 4 Upper 3 Upper 3 Natural tooth Natural tooth Natural tooth Natural tooth Signature

Evaluation Criteria 9: Excellent 8: Good 6-7: Satisfactory 5 and under: failure Grade 5 and under is unacceptable and will not be considered in the continuous assessment, the student should repeat the work until he/she get a satisfactory mark. All work should be finished and marked in the assigned date, any work that is completed after the assigned date will be graded as pass only (6).

Class I Amalgam Preparation P External Outline Form Convergence of B & L Walls Pulpal Depth Pulpal Floor (Horizontal) Margins Line Angles Correct Convergent 1.5-2 mm Correct Smooth Defined P Slight Error Slight divergent Slightly shallow/ Slightly deep Slight error Rough Lack Definition F Unacceptable Gross Divergance > 3 mm deep Unacceptable Grossly Rough Poorly Defined

Class I Amalgam Restoration P Margins Smooth & Regular No Damage No pits or voids Smooth Correct P Excess or Deficiency Damage Pits or voids Rough Slight Error F Gross Excess

Tooth Structure Condensation Surface Finish Anatomy

Gross Damage Gross Voids Grossly Rough Unacceptable

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Class II Amalgam Preparation P External Outline Form (O) External Outline Form (P) Correct Correct P Slight Error Slight Error Slight divergent Slight divergent Slightly shallow/ Slightly deep Slight error Angled Rough Slight Error F Unacceptable Unacceptable Gross Gross > 3 mm deep Unacceptable Unacceptable Grossly Rough Unacceptable

Convergence of B & L Walls (O) Convergent Convergence of B & L Walls (O) Convergent Pulpal Depth Pulpal Floor (Horizontal) Gingival Floor Margins Retention Grooves 1.5-2 mm Correct Horizontal Smooth Correct

Class II Amalgam Restoration P Margins Smooth & Regular No Damage No pits or voids Smooth Correct Proper Height, Width & Contour P Excess or Deficiency Damage Pits or voids Rough Slight Error High, Low Wide or Narrow F Gross Excess

Tooth Structure Condensation Surface Finish Anatomy (O & B) Marginal Ridge

Gross Damage Gross Voids Grossly Rough Unacceptable Gross

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Class V Amalgam Preparation P External Outline Form Convergence of O & G Walls Pulpal Depth Axial Wall Margins Line Angles Correct Convergent 1.25-1.5 mm Convex Smooth Defined P Slight Error Slight divergent Slightly shallow/ Slightly deep Slight error Rough Lack Definition F Unacceptable Gross Divergance > 3 mm deep Unacceptable Grossly Rough Poorly Defined

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Class V Preparation for Glass Inomer P External Outline Form Convergence of O & G Walls Pulpal Depth Axial Wall Margins Line Angles Correct Convergent 1.25-1.5 mm Convex Smooth Defined P Slight Error Slight divergent Slightly shallow/ Slightly deep Slight error Rough Lack Definition F Unacceptable Gross Divergance > 3 mm deep Unacceptable Grossly Rough Poorly Defined

Class V Glass Inomer Restoration P Margins Smooth & Regular No Damage No pits or voids Smooth Correct P Excess or Deficiency Damage Pits or voids Rough Slight Error F Gross Excess

Tooth Structure Placment Surface Finish Anatomy

Gross Damage Gross Voids Grossly Rough Unacceptable

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Class III Composite Preparation P External Outline Form Axial Extension Margins Line Angles Internal Walls Correct 1.0-1.25 mm Smooth Defined Smooth P Slight Error Slightly shallow/ Slightly deep Rough Lack Definition Rough F Unacceptable > 2.5 mm deep Grossly Rough Poorly Defined Grossly Rough

Class III Composite Restoration P Margins Surface Finish Tooth Structure No Excess or Deficiency Smooth Polished No Damage P Excess or Deficiency Rough, Dull Damage F Gross Excess Gross Rough Gross Damage

Facial & Proximal Contour Lingual Contour

Correct Correct

Not Correct Not Correct

Unacceptable Unacceptable

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Class IV Composite Preparation P External Outline Form Axial Extension Margins Line Angles Internal Walls Correct 1.0-1.25 mm Smooth Defined Smooth P Slight Error Slightly shallow/ Slightly deep Rough Lack Definition Rough F Unacceptable > 2.5 mm deep Grossly Rough Poorly Defined Grossly Rough

Class IV Composite Restoration P Margins Surface Finish Tooth Structure No Excess or Deficiency Smooth Polished No Damage P Excess or Deficiency Rough, Dull Damage F Gross Excess Gross Rough Gross Damage

Facial & Proximal Contour Lingual Contour

Correct Correct

Not Correct Not Correct

Unacceptable Unacceptable

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Class II Composite Preparation P External Outline Form (O) External Outline Form (P) B & L Walls (O) B & L Walls (O) Pulpal Depth Pulpal Floor (Horizontal) Gingival Floor Margins Correct Correct Parallel Parallel 1.5-2 mm Correct Horizontal Smooth P Slight Error Slight Error Slight divergent Slight divergent Slightly deep Slight error Angled Rough F Unacceptable Unacceptable Gross Gross > 3 mm deep Unacceptable Unacceptable Grossly Rough

Class II Composite Restoration P Margins Smooth & Regular No Damage P Excess or Deficiency Damage F Gross Excess

Tooth Structure

Gross Damage

Surface Finish Anatomy (O & P) Marginal Ridge

Smooth Polish Correct Smooth, Regular No Excess or open Margin

Rough Slight Error Rough, Excess Open Margin

Grossly Rough Unacceptable Unacceptable

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NATURAL TOOTH EXCERSISE Caries Removal/Liner 1. Select an extracted molar with caries An extracted molar with occlusal caries will be used for this exercise. Check the pits and grooves with an explorer. Choose a molar with a definite explorer catch in a pit or a fissure that indicates caries. Do not use a molar with gross caries that extends to the pulp. Discuss caries location and the proposed outline of the preparation with the instructor before proceeding. 2. Mount the tooth 3. Cut an initial Class I prep Cut an initial (ideal) Class I cavity preparation and then get instructors approval. 4. Excavate Caries Caries remaining in the pulpal floor after the initial prep is cut should be removed with a round bur and the slow speed handpiece. Choose the size of the round bur that is about the size of the area of the carious dentin. Check remaining dentin with explorer. If sticky or leathery dentin remains, remove it with the low speed handpiece. Do not be too aggressive when probing pulpally or when using the handpiece in the area over the pulp to avoid pulp exposure. If soft, carious dentin extends all the way to the pulp, then a pulp exposure cannot be avoided since all of the caries must be removed. 5. Check for undermined enamel If caries has extended laterally under cusps, then switch to the high speed handpiece and widen the enamel portion of the prep to remove the undermined (no dentin support) enamel. Next, check the lateral walls for carious dentin that may have been exposed by widening the cavity. Switch back to the slow speed handpiece to remove any remaining caries. 6. When caries removal is complete, get the preparation checked by the instructor. 7. Place a liner. The next step is to apply the liner to the area of dentin that is deeper than the ideal because of caries removal. 8. Place IRM temporary filling.

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Cavity Preparations and Restorations

Class I amalgam preparation: Outline: Include mesial & distal pit. Central, buccal & lingual grooves. Isthmus width: 1-1.25 mm. Pulpal depth: 1.5-2.0 mm. B, L walls: Parallel or slightly convergent occlusally. M, D walls: Diverge occlusally. Retention: no grooves or points. Margins: No bevel.

Class I amalgam Restoration: Grooves: Central & triangular grooves. Fossae: Mesial & distal pits. Cusp planes: B & L slopes reproduce triangular ridges. Margins: smooth and regular. No excess amalgam over margins (flash). No deficiencies or open margins. Condensation: No pits or voids. Surface finish: uniformly smooth and free of scratches and irregularities. Burnished.

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Buccal pit preparation: Outline: Located at gingival end of buccal groove. Diameter: 1mm. Axial depth: Axial wall is 1.5 mm deep. Wall angulation: Walls are 90 to cavosurface and parallel. Retention: no grooves or points are necessary. In larger preps, retention may be placed in mesial, distal and gingival walls. Margins: No bevels.

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Class I with buccal extension amalgam preparation: Outline: Include M, C, D pits. L groove. Extend B groove to include B pit on buccal surface. Isthmus width: 1-1.25 mm. Pulpal depth: 1.5-2.0 mm. B, L walls: Parallel or slightly convergent occlusally. M, D walls: Those on occlusal diverge occlusally. Those on facial extension are parallel. Axial wall: Parallel B surface. 1.25 mm deep. Retention: Grooves in M, D walls of buccal extension to pulpal floor. Margins: No bevel.

Class I with buccal extension amalgam restoration: Grooves: Central, buccal and lingual grooves. None on facial surface. Central groove is not straight. Fossae: Mesial & distal pits. 2 central pits. Cusp planes: B & L slopes reproduce triangular ridges. Inclines are not concave. Margins: smooth and regular. No excess amalgam over margins (flash).No deficiencies or open margins. Condensation: No pits or voids. Surface finish: uniformly smooth and free of scratches and irregularities. Burnished.

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Class I with lingual extension amalgam preparation: Outline: Central pit, mesial pit, of buccal groove. L shaped preparation. Include distal pit and lingual groove. Isthmus width: 1-1.25 mm. Pulpal depth: 1.5-2.0 mm. Pulpal floor slopes occlusally toward lingual to maintain constant depth. B, L walls: Parallel or slightly convergent. M, D walls: Mesial diverges. Distal wall is vertical. M, D walls of the extension: Parallel. Axial wall: Parallel to lingual surface. Depth 1.25 mm. Retention: Grooves in the lingual box. In M, D walls, from gingival to pulpoaxiall line angle. Margins: No bevels.

Class I with lingual extension amalgam restoration: Grooves: O: Central and buccal grooves. Extension: Groove on occlusal but not lingual. Fossae: Central, mesial & distal pits. Cusp planes: B & L slopes reproduce triangular ridges. Inclines are not concave. Margins: smooth and regular. No excess amalgam over margins (flash). No deficiencies or open margins. Condensation: No pits or voids. Surface finish: uniformly smooth and free of scratches and irregularities. Burnished

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Class II amalgam preparation: Outline: Include mesial or distal pit. Isthmus width: 1-1.25 mm. Pulpal depth: 1.5-2.0 mm. Proximal clearance: Visually free of contact, 0.25-0.5 mm. B, L walls: Parallel or slightly convergent occlusally. B & L walls of box form 90 angle with proximal surface. Axial wall: Convex, vertical, 1-1.25 mm deep measured mesiodistally at the gingival floor. Retention: Grooves in B- & L- axial line angles from gingival to pulpal. Depth head of bur (0.25 mm). Pulpoaxial line angle: Rounded or beveled. Margins: No bevels.

Class II amalgam restoration: Grooves: Central & triangular grooves. Fossae: mesial & distal pits. Cusp planes: B & L slopes match those of tooth. Inclines are not concave. Contacts: Visual contact with adjacent tooth. Definite but not excessive resistance to floss. Embrasures: Occlusal, gingival, facial and lingual embrasures are reproduced. Marginal ridge: Same height as that on adjacent tooth. Margins: smooth and regular. No excess amalgam over margins (flash). No deficiencies or open margins. Condensation: No pits or voids. Surface finish: uniformly smooth and free of scratches and irregularities. Burnished

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Class III cavity preparation: Outline: Lingual approach, just gingival to contact area. Incisal margin is in middle of contact area and doses not break contact. Rectangular with no sharp angles. Incisogingival width: 1.75-2 mm without bevel. Mesiodistal width (axial depth): 1.25 mm without bevel. Facial wall: Parallel to lingual surface. 90 to proximal. 1.5 mm deep measured at axial wall. I, G walls: Parallel or slightly divergent. 90 to surface. No undercuts. Axial wall: Parallel to proximal surface. 90 to lingual. Margins: Place round bur, 45 bevels on accessible margins. Use flame finishing bur on low speed handpiece.

Class III composite restoration: Contour: Contours follow that of tooth. Proximal is convex, lingual is concave occlusogingivally. Contact: Incisal potion contacts adjacent tooth. Embrasure: 4 embrasures are present. Note that occlusal embrasure is tooth. Margins: smooth and regular. No excess or deficiencies detectable visually or with explorer. Composite does not extend beyond cavosurface margin. Surface finish: uniformly smooth and free of pits. Polished to shine. No dirt or discoloration.

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Class IV cavity preparation (Simulated fracture): Outline: Remove both facial and lingual walls to simulate fracture. Incisogingival width: 5 mm or sufficient to break contact6 mm with gingival bevel included. Keep margin above the gingiva when beveling. Mesiodistal width: 2 mm at contact, 1.5 mm at gingival floor before beveling. Facial wall: Parallel to lingual surface. 90 to proximal. 1.5 mm deep measured at axial wall. Preparation bevels: 1.5-2 mm width bevel on facial. 1 mm width on gingival & lingual.

Class IV composite restoration: Contour: Facial, lingual & proximal contours and line angles reproduce tooth and match the adjacent tooth. Incisal edge/point angle: Incisal edge is horizontal and matches the adjacent. Point angle is same shape as the adjacent. Contact: Incisally located at height of contour of adjacent tooth. Visually present contact. Contact area is convex. Embrasure: Incisal and gingival embrasures are symmetrical with the adjacent. Margins: smooth and regular. No excess or deficiencies detectable visually or with explorer. Composite does not extend beyond cavosurface margin. Surface finish: uniformly smooth and free of pits. Polished to shine. No dirt or discoloration.

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Class II composite preparation: Outline: Include mesial or distal pits. Isthmus width: 1-1.25 mm. Pulpal depth: 1.5-2.0 mm. Proximal clearance: Visually free of contact, 0.25-0.5 mm. B, L walls: Parallel or slightly convergent occlusally. B & L walls of box form 90 angle with proximal Surface. Axial wall: Convex, vertical, 1-1.25 mm deep measured mesiodistally at the gingival floor. Pulpoaxial line angle: Rounded or beveled. Margins: No bevels.

Class II composite restoration: Grooves: Central & triangular grooves. Fossae: mesial or distal pit. Cusp planes: B & L slopes match those of tooth. Inclines are not concave. Contacts: Visual contact with adjacent tooth. Definite but not excessive resistance to floss. Embrasures: Occlusal, gingival, facial and lingual embrasures are reproduced. Marginal ridge: Same height as that on adjacent tooth. Margins: smooth and regular. No excess amalgam over margins (flash). No deficiencies or open margins. Surface finish: uniformly smooth and free of scratches and irregularities. Polished.

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