AFAMS Master Lesson Plan (MLP)
Dental Therapist Program EO 009.01 Place an Amalgam Restoration
Instructor
Serial/Semester
Location
Start/Finish Time
LESSON OBJECTIVE
Performance: Place an Amalgam Restoration (Class 1,2 and 5)
Conditions:
Given: supervision.
Denied:
nil.
Environment: classroom / clinic.
.
Standard:
The Dental Therapist Trainee will place the amalgam restoration by:
1.
Preparing for amalgam restoration
2.
Placing the matrix and wedge
3.
Placing any pre-restorative treatments as required to include
4.
Triturating the Amalgam
5.
Placing the amalgam within the appropriate timeframe
6.
Picking up the amalgam with an appropriate instrument
7.
Condensing the amalgam within the preparation
8.
Repeating picking up, placing and condensing as required
9.
Completing initial carving of the amalgam restoration
10.
Removing the wedge as required
11.
Removing matrix band as required
12.
Removing the rubber dam
13.
Completing final carving
14.
Verifying occlusion as required
15.
Adjusting the occlusion as required
16.
Verifying contacts and marginal integrity by flossing between contacts as required
17.
Burnishing the Amalgam restoration
Date
AFAMS Master Lesson Plan (MLP)
Dental Therapist Program EO 009.01 Place an Amalgam Restoration
TEACHING POINTS
1.
Preparing for amalgam restoration
2.
a) Knowing safe handling of amalgam
during procedures
a) Techniques
b) Posterior matrix system
b) Knowing the supplies and instruments
required for amalgam restoration to
include:
i)
Placing the matrix and wedge
c) Type of matrix
Plugger
ii) Carver
iii) Burnisher
iv) Tofflemire matrix
v) Articulating forceps
vi) Articulating paper
vii) Dappen dish
viii) Amalgam capsule/ contents
ix) Amalgam carrier
i)
3.
Knowing the amalgamator mixer
setting in accordance with the
manufacturer’s recommendations for
the specific product.
Placing any pre-restorative treatments as
required to include
a) Liner
d) Base
4.
Triturating the Amalgam
a) Grabbing a capsule
b) Activating the capsule as required
c) Placing the capsule in the amalgamator
d) Verifying amalgamator settings in
accordance of manufacturer instructions
e) Pushing the start button
f) Removing the capsule upon cycle
completion
g) Understanding how to manipulate the
working time:
i)
How to increase working time
i)
How to decrease working time
AFAMS Master Lesson Plan (MLP)
Dental Therapist Program EO 009.01 Place an Amalgam Restoration
5.
Placing the amalgam within the appropriate
timeframe
6.
Picking up the amalgam with an appropriate
instrument
a) dispensing the amalgam into a dappen
dish
b) Picking up amalgam with an amalgam
carrier in the dappen dish
b) recognizing normal or under mixed
consistency of triturated amalgam:
c) Placing the amalgam in the preparation
I.
Normal mix consistency:
Amalgam carrier technique to place amalgam in the
restoration preparation
(1) Smooth
(2) Shiny
(3) Homogenous
(4) Optimal handling.
II.
Under mixed consistency:
(1) Grainy
(2) Dry
(3) Crumbles easily
i)
7.
Difficult to manipulate
Condensing the amalgam within the
preparation
a) Using an amalgam plugger with adequate
force to achieve:
i)
Complete adaptation to retentive
areas, walls and cavosurface margins
of the restoration preparation
ii) Complete removal of air voids
b) Know the consequences of incorrect
condensing of the amalgam in the
preparation
8.
Repeat picking up, placing and condensing as
required
AFAMS Master Lesson Plan (MLP)
Dental Therapist Program EO 009.01 Place an Amalgam Restoration
9.
Complete initial carving of the amalgam
restoration
10.
a) Pull large end of wedge with forceps or
pliers
a) Identify carving instruments and when to
use them to include:
i)
Removing the wedge as required
b) Verify the integrity of the wedge
Discoid cleoid
c) Keep the wedge for additional
restorations on the same patient or
dispose
ii) Hollendback
iii) Amalgam knife
b) Carving exposed amalgam restoration
surfaces, not covered by the matrix band,
based on tooth morphology and estimated
occlusion
c) Carving amalgam to achieve:
i)
Restored form and function
ii) Smooth surface
iii) Anatomically correct appearance
iv) Continuous surface contour from
amalgam to tooth structure
d) Remove amalgam waste by rinsing and
suction
11.
Removing matrix band as required
a) Technique to remove the matrix band to
include:
i)
Loosen tightening screw
ii) Hold matrix in place with finger or
appropriate instrument
iii) Remove the Universal retainer,
leaving the matrix band in place
iv) Remove the matrix band carefully by
sliding motion so as to avoid
fracturing the restoration
12.
Removing the rubber dam
a) Remove the retainer with the retainer
forceps
b) Carefully stretch the rubber dam towards
cheek and cut the interproximal rubber
dam with scissors
c) Pull interproximal rubber dam toward the
tongue
d) Lift the rubber dam off the teeth
e) Verify the integrity of the rubber dam by
laying flat on table top
b) Keeping the matrix band for additional
restoration on the same patient or dispose
f) Find remaining pieces of rubber dam and
remove with appropriate instrument
c) Verify there is no fracture of the
restoration and that the interproximal
contact appears adequate.
g) Clean and rinse mouth for patient
comfort and visibility
h) Advise the patient not to close their
mouth as final carving is not complete
and the restoration may fracture from
tooth contacts
AFAMS Master Lesson Plan (MLP)
Dental Therapist Program EO 009.01 Place an Amalgam Restoration
13.
Complete final carving
14.
a) Finalizing the carving with consideration
for tooth morphology and patient
occlusion
i)
Define maximum intercuspation
ii) Marking occlusal contacts with
articulating paper
b) Using the carving:
i)
Verifying occlusion as required
a) Verify for maximum intercuspation:
Discoid cleoid
b) Verify for excursive interferences:
i) Define excursive interferences
ii) Marking excursive contacts during
excursions
c) Using proper supplies and instruments
required
i) Articulating forceps
ii) Articulating paper
ii) Hollendback
iii) Amalgam knife
c) Verify criteria:
i) Surface quality:
(1) Smoothness
ii) Margin integrity:
d) Comparing indication marks on opposite
and neighboring teeth and restoration:
(1) Adaptation to walls and
cavosurface margin
i)
(2) No flash, ditching or overhang
No mark means too light contact
ii) Heavy mark means too strong contact
iii) Contour and function:
iii) Equal imprint means right adjustment
of occlusal contacts
(1) Morphological contours restored
(2) Proximal contact restored
e) Knowing the consequence of restoration
fracture at this step:
(3) Occlusal contacts correspond
with the opposing dentition
i)
(4) Defined anatomy
Redo the restoration (this could be at
any step from 13-17)
(5) No fractured portion of the
restoration
iv) Damage to other structures:
15.
(1) Minimal or no damage to soft
tissue or adjacent teeth
Adjusting the occlusion as required
a) Selective additional carving of marked
areas on newly placed restoration to
remove interferences
b) Repeat the verification and adjustments
in maximum intercuspidation and
excursive occlusion until complete:
i)
When occlusion marking appears
evenly distributed along arch and are
in appropriate locations based on
morphology
c) Know consequences of a high contact:
i)
Fracture of restoration or opposing
tooth
16.
Verifying contacts and marginal integrity by
flossing between contacts as required:
a) Ensuring an adequate resistance to floss
is present
b) Ensuring no interproximal overhang by
smooth passing of floss with no tearing,
shredding or catching
c) Remove overhang as needed with the
same instruments and techniques
d) Understand the consequences of an
inadequate restored interproximal contact
AFAMS Master Lesson Plan (MLP)
Dental Therapist Program EO 009.01 Place an Amalgam Restoration
ii) Irritation of periodontal tissues
iii) Causing temporomandibular joint
problem or muscular discomfort
related to grinding
iv) Sensitivity and pain for the patient
18.
17.
Burnishing the Amalgam restoration
a) Using a burnisher
b) Finalizing a smooth restoration surface
by applying a firm pressure on all
accessible surfaces to create a smooth,
shiny surface
INSTRUCTIONAL STRATEGY
Method:
Practical/demonstration Method
Media:
Skills lab/polyclinic
Environment: Instructional Environment.
OTHER LESSON SPECIFICATIONS
Type of Lesson:
Practical
Resources dentaform (dental model), operative setup (to include amalgam, triturator), scrap amalgam
container
End of Lesson Test:
Instructional Time: 20 hours
Reference(s):
The Fundamentals of Operative Dentistry by
Summit, et al. ISBN 0-86715-452-7
LESSON PLAN APPROVAL
__________________________________________________________
Signature of AHPI Director
_______________________
Date
AFAMS Master Lesson Plan (MLP)
Dental Therapist Program EO 009.01 Place an Amalgam Restoration
INTRODUCTION
Allocated Time:
30 Minutes
Review:
The placement of Amalgam will follow PO 008 (Prepare a Tooth for
Restoration). The act will be continous from cavity preparation to restoration
on a patient, as it is in the patient’s best interest to have the complete
restorative phase completed at once
Objective:
The student should be able to restore Class 1, 2 and 5 amalgam preparations..
Importance:
Restoring the cavity preparation is the last stage of of the restorative cycle. If
the restorative phase is completed improperly, there are many consequences –
including decreased restoration performance (longevity), poor interproximal
contacts, poor occlusal contact development, overhang development, and
pulpal death.
Fit:
This lesson concludes PO 008 and PO 009.
Approach:
The instructor will review the checklist (see below) for each procedure. Then
use training aids to demonstrate the technique and the students will practice on
the dentaform (typodont).
Control Statement:
If you have any questions during the lesson please feel free to ask.
AFAMS Master Lesson Plan (MLP)
Dental Therapist Program EO 009.01 Place an Amalgam Restoration
BODY
1. Teaching Point: Place a Class 1, 2, and 5 Amalgam Restoration
Allocated Time:
20 Hours
PERFORMANCE STEPS:
1.
The Instructor will have a Dental Model (dentoform) and demonstrate to the students how to
restore a premolar or molar Class I, II and V Amalgams using the steps below.
2.
Each student will take their Dental Model (dentaform) restore their Class 1 ,2, and 5 prepared
teeth from EO 008.02.
3.
Review the Standards Para of this document for the details.
Practical: Sequence of Events:
Phase
Amalgam
Restoration
Stage
Class I amalgam
Demtonstration
Class I
Phase 1
Student Practice
Practical Informal
Evaluation
Class 5 amalgam
Demonstration
Phase 2
Class 5
Student Practice
Practical Informal
Evaluation
Class 2 amalgam
Demonstration
Phase 3
Class 2
Student Practice
Practical Informal
Evaluation
Remarks
The instructor will demonstrate the
restoration of a Class I Amalgam using a
previously prepared Class I cavity.
The students will then practice restoring
their previously prepared dentaform teeth –
Class I Amalgams
The instructor will evaluate the student’s
restorations and critique the quality of the
occlusion, margins, and anatomy.
The instructor will demonstrate the
restoration of a Class 5 Amalgam using a
previously prepared Class 5 cavity.
The students will then practice restoring
their previously prepared dentaform teeth –
Class 5 Amalgams
The instructor will evaluate the student’s
restorations and critique the quality of the
occlusion, margins, and anatomy.
The instructor will demonstrate the
restoration of a Class 2 Amalgam using a
previously prepared Class 2 cavity.
The students will then practice restoring
their previously prepared dentaform teeth –
Class 2 Amalgams
The instructor will evaluate the student’s
restorations and critique the quality of the
occlusion, margins, and anatomy.
AFAMS Master Lesson Plan (MLP)
Dental Therapist Program EO 009.01 Place an Amalgam Restoration
Restoration Quality Control Checklist applicable to all amalgam restorations.
RESTORATION QUALITY CHECKLIST
Criteria/Quality
Description
Excellent
Satisfactory
Poor, unsatisfactory
Short Margins
Restoration Margin
relative to tooth
structure
None
Minor
Major
A little (for finishing)
A lot
Major
Flashing,
Overhangs
Restoration
Anatomy
Contact Points
Excess Restoration
beyond tooth structure
Surface contour
Natural
Functional
Poor
Surface
Smooth
Semi-smooth
Rough
Voids
None
Very few
Many
Check with
floss/visualization
Definite &
in correct location
Definite but in wrong
location
none
Lingual embrasure
anatomy
Natural
Functional
None
Height relative to next
tooth
Equal
Functional
Not even close
Natural
Functional
Too High
Too Low
Marginal Ridges
Occlusion
Check MI and
excursive patterns
AFAMS Master Lesson Plan (MLP)
Dental Therapist Program EO 009.01 Place an Amalgam Restoration
AFAMS Master Lesson Plan (MLP)
Dental Therapist Program EO 009.01 Place an Amalgam Restoration
Sequential condensation of amalgam
within a cavity. Thorough condensation
brings mercury toward the surface.
When the cavity has been overfilled the
excess mercury-rich amalgam is scraped
away and discarded.
Proper adaptation of the amalgam to the cavity walls to ensure no voids
AFAMS Master Lesson Plan (MLP)
Dental Therapist Program EO 009.01 Place an Amalgam Restoration
Final condensation over cavosurface margins should be done perpendicular to
the external enamel surface directly over and adjacent to the margins of the
cavity preparation.
The ball burnisher is used to rub or burnish the amalgam up against the cavo
surface margin. It will also remove some of the excess amalgam at the same
time and is the first step in shaping the occlusal surface.
Carving the Amalgam
It is important to expose the margins of the cavity preparation in an easily accessible
part of the mass, then follow the gentle curves of the external outline of the
preparation.
AFAMS Master Lesson Plan (MLP)
Dental Therapist Program EO 009.01 Place an Amalgam Restoration
Because of its granular nature, carving may be directed from the
enamel toward the amalgam or parallel with the margin, but
never from the amalgam toward the enamel.This diagram
shows a cleoid-discoid carver directed inwards (from enamel to
amalgam).
Carving without an enamel guide frequently leads to a scooped-out occlusal
surface. Usually you will end up overcarving if you do not use tooth
structure as a guide.
Reproduce tooth anatomy lost to decay and the cavity preparation.
Overcarving and deep occlusal grooves weaken the restoration and
invite chipping of the thinned-out amalgam at the occlusal margins.
AFAMS Master Lesson Plan (MLP)
Dental Therapist Program EO 009.01 Place an Amalgam Restoration
CLASS I AMALGAM RESTORATION
CHECK LIST
a. Assemble armamentarium
(Plugger,Carver,Burnisher,Tofflemire
matrix,Articulating forceps,Articulating paper,Dappen
dish,Amalgam capsule/ contents, Amalgam carrier)
YES
NO
COMMENTS
In a patient, a verification of
exising occlusion would occur
before local anesthetias
b. Place any pre-restorative treatments as required.
c. Triturating the Amalgam
Ensure Proper Mix of
Amalgam – Calibrate
amalgamator is required.
d. Dispensing the amalgam within the appropriate
timeframe into a dappen dish and recogznizing
a good mix.
e. Pickup/Carry the amalgam from the dappen
dish to the operating field.
f. Fill the cavity preparation- proper condesnation
forces and overfilling of the preparation
g. Complete Precarve burnishing and initial
carving of the resotration
h. Remove Rubber Dam
i. Check Occlusion
j. Complete final carving of the restoration
k. Verification of occlusion (MI) and remove
excursive interferences.
l. Final burnishing of the restoration
Ensure sufficient overfill to
facilitate carving
AFAMS Master Lesson Plan (MLP)
Dental Therapist Program EO 009.01 Place an Amalgam Restoration
CLASS 5 AMALGAM RESTORATION
CHECK LIST
a. Assemble armamentarium
(Plugger,Carver,Burnisher,Tofflemire
matrix,Articulating forceps,Articulating paper,Dappen
dish,Amalgam capsule/ contents, Amalgam carrier)
YES
NO
COMMENTS
In
a
patient,
a
verification of exising
occlusion would occur
before local anesthetias
b. Place any pre-restorative treatments as required.
c. Triturating the Amalgam
Ensure Proper Mix of
Amalgam – Calibrate
amalgamator is required.
d. Dispensing the amalgam within the appropriate
timeframe into a dappen dish and recogznizing
a good mix.
e. Pickup/Carry the amalgam from the dappen
dish to the operating field.
f. Fill the cavity preparation- proper condesnation
forces and overfilling of the preparation
Ensure sufficient overfill
to facilitate carving
g. Complete Precarve burnishing and initial
carving of the resotration
h. Remove Matrix band/Wedge
i. Use explorer to check interproximal to remove
excess flash
j. Remove Rubber Dam
k. Check Occlusion
l. Complete final carving of the restoration
m. Verification of occlusion (MI) and remove
excursive interferences.
n. Final burnishing of the restoration
Use of explorer to check
interproximally to
remove any excess flash
AFAMS Master Lesson Plan (MLP)
Dental Therapist Program EO 009.01 Place an Amalgam Restoration
CLASS 2 AMALGAM RESTORATION
CHECK LIST
a. Assemble armamentarium
(Plugger,Carver,Burnisher,Tofflemire matrix,Articulating
forceps,Articulating paper,Dappen dish,Amalgam capsule/
contents, Amalgam carrier)
YES
NO
COMMENTS
In a patient, a verification
of exising occlusion would
occur before local
anesthetias
a. Place any pre-restorative treatments as required.
b. Place a matrix and wedge
i. Burnish matrix against the adjacent tooth
Ensure matrix is sufficiently occlusal to aid in
overfilling the preparation
c. Triturating the Amalgam
Ensure Proper Mix of
Amalgam – Calibrate
amalgamator if required.
d. Dispensing the amalgam within the appropriate
timeframe into a dappen dish and recogznizing a
good mix.
Mix should be shiny and
not crumble
e. Pickup/Carry the amalgam from the dappen dish to
the operating field.
f. Fill the cavity preparation- proper condensation
forces and overfilling of the preparation
Ensure sufficient overfill to
facilitate carving
g. Complete Precarve burnishing and initial carving of
the resotration
h. Remove Rubber Dam
i. Remove Matrix and Wedge
j. Check Occlusion
k. Complete final carving of the restoration
Pull diagonally to prevent
fracture of the marginal
ridge
AFAMS Master Lesson Plan (MLP)
Dental Therapist Program EO 009.01 Place an Amalgam Restoration
CHECK LIST
YES
NO
COMMENTS
l. Verification of occlusion (MI) and remove excursive
interferences.
m. Final burnishing of the restoration
END OF LESSON TEST
Allocated Time:
Instructions:
Test Questions or
Performance
Expected:3/4
5 Minutes
The Instructor will simply as the group a following questions
1. Does a post carve burnish help to seal the restoration?
2. Do you need a wedge in a class 2 amalgam? Why?
3. True or false – A matrix band is required for a class 2 amalgam?
4. The occlusion must be checked after final carving of the
restoration?
Test Key:
1 – Yes
2 – Yes – to facilitate interproximal contact formation and prevent excess
proximal amalgam flash. It can also secure the matrix band
3 – True
4- Yes
CONCLUSION
This is a the final part of the restorative procedure but an important part. Take the time to understand the
concepts.