SET 1

Frequent sugar intake prolongs the

1. Instrument Formula ( Black’s demineralization phase, increasing caries
Instrument Formula) risk.

Black’s instrument formula consists of Fluoride and remineralizing agents help

three or four numbers describing hand neutralize acids faster
instruments:
3. Methods of Gingival Retraction
Three-number formula (for instruments
with a straight cutting edge): Gingival retraction techniques are used to
displace gingival tissues and provide
1. Blade width in tenths of a better access during restorative
millimeter. procedures. The methods include:
2. Blade length in millimeters.
3. Blade angle in centigrades 1. Mechanical Retraction:
(°/100).
Retraction cords (plain or
Four-number formula (for instruments with impregnated with hemostatic
an angled cutting edge): agents).
Copper bands or rubber dams.
1. Blade width in tenths of a
millimeter. 2. Chemical Retraction:
2. Cutting edge angle (if not
perpendicular to the blade). Hemostatic agents like aluminum
3. Blade length in millimeters. chloride or ferric sulfate.
4. Blade angle in centigrades. Epinephrine-impregnated cords
(caution in hypertensive patients).
Example: A gingival margin trimmer may
have the formula 10-95-7-14, where 10 = 3. Surgical Retraction:
width, 95 = cutting edge angle, 7 = length,
and 14 = blade angle. Electrosurgery (removes excess
gingival tissue).
2. Stephen’s Curve (pH Drop After Laser retraction (precise and
Sugar Consumption) minimally invasive).

graphical representation of pH changes in 4. Mechanical-Chemical Retraction:

the oral environment following the intake
of fermentable carbohydrates. Retraction pastes (kaolin-based or
aluminum chloride pastes).
●​ Initial pH (~6.8-7.0): Normal resting Choice of method depends on
pH before eating. tissue health, bleeding control, and
procedural needs.
●​ Rapid pH drop (<5.5): Acid
production by bacteria (e.g., 4. Personal Protection Barriers
Streptococcus mutans). (Infection Control in Operative
Dentistry)
●​ Critical pH (5.5): Demineralization
of enamel begins. Personal Protection Barriers (PPBs) in
preventing cross-infection:
Recovery phase: Saliva buffers and
restores pH within 30-60 minutes. 1. Protective Clothing:

Disposable gowns and lab coats.

Clinical Relevance:
 Head caps to prevent hair
contamination. Cuts and removes the matrix band
after restoration placement.
2. Gloves:
Advantages: Better access and
Examination gloves (for routine visibility compared to Tofflemire.
procedures).

Sterile surgical gloves (for invasive 6. Types of Direct Filling Gold (DFG)
procedures). based on its form and handling properties:
Utility gloves (for cleaning and
sterilization). 1. Mat Gold (Foil Gold):

3. Face Protection: Thin gold sheets requiring

condensation.
Masks (N95, surgical masks) for
aerosol protection. 2. Cohesive Gold:
Face shields for high-aerosol
procedures. Sticks to itself upon condensation.

4. Eye Protection: 3. Non-Cohesive Gold:

Safety glasses or goggles to Requires mechanical retention as it

prevent splatter. doesn’t bond intrinsically.

5. Hand Hygiene: 4. Electrolytic Precipitate (Sponge Gold):

Alcohol-based rubs or proper Porous and easier to handle.

handwashing techniques.
5. Powdered Gold:
6. Rubber Dam Isolation:
Fine gold particles used with
Prevents saliva and aerosol binders.
contamination.
DFG is rarely used today due to
5. Parts of AutoMatrix System technique sensitivity.

AutoMatrix is a retainerless matrix system 7. Bevels in Cast Restorations

for class II restorations. It consists of:
Bevels improve the marginal fit and
1. Matrix Band: adaptation of cast restorations. According
to Sturdevant, types include:
Preformed stainless steel band
that adapts to the tooth. 1. Full Bevel (Heavy Bevel):

2. AutoLock Loop: ~45° bevel for gold inlays and

onlays.
Built-in locking mechanism for
securing the band. 2. Chamfer Bevel:

3. Tightening Device (AutoMatrix Wrench): Rounded margin for metal-ceramic

and gold crowns.
Used to tighten the band securely.
3. Knife-Edge Bevel:
4. Band Remover (Snipper):
 Thin margin for metal crowns in
gingival areas. Hydrogen peroxide diffuses into enamel
and dentin.
4. Shoulder Bevel:
2. Oxidation:
Modified shoulder finish for
metal-ceramic crowns. Free radicals (OH⁻, O₂⁻) break down
pigmented molecules.
5. Gingival Bevel:
3. Color Change:
Applied to proximal cavity margins
for better adaptation Large stain molecules become smaller,
8. Hybrid Layer (Resin-Dentin Interface less pigmented, increasing light reflection.
in Adhesive Dentistry)
Types of Bleaching:
The Hybrid Layer, as described in
Sturdevant, is the resin-infiltrated zone Vital bleaching (extrinsic and intrinsic
between dentin and adhesive resin. stains).

Formed by: Non-vital bleaching (for root canal-treated

teeth).
1. Etching (Demineralization):
Exposes collagen fibrils. Side Effects:

2. Primer Application: Maintains Tooth sensitivity (managed with

collagen structure. fluoride).

3. Resin Infiltration: Polymerizes Gingival irritation (prevented with

within collagen network. proper isolation).

Functions: 10. Principles of Minimal Intervention

Dentistry (MID)
Provides micromechanical
retention. Minimal Intervention Dentistry (MID)
approach focuses on preserving maximum
Reduces microleakage and tooth structure while effectively managing
secondary caries. caries. The key principles include:

Challenges: 1. Early Diagnosis & Risk Assessment

MMP activity degrades collagen. Use advanced diagnostic tools

(radiographs, caries detection
Water sorption weakens bond over dyes, laser fluorescence).
time. Identify high-risk patients (diet, oral
hygiene, saliva quality).
MMP inhibitors (e.g.,
chlorhexidine) help preserve the 2. Remineralization of Non-Cavitated
hybrid layer. Lesions

9. Mechanism of Bleaching Use fluoride, calcium-phosphate

remineralizers (CPP-ACP), and
Sturdevant explains bleaching as a sealants to reverse early caries.
chemical oxidation process involving: Modify diet to reduce acidic and
sugary foods.
1. Penetration:
3. Conservative Cavity Design
●​ Use pre-capsulated amalgam
Follow "extension for prevention" is instead of bulk mercury to
outdated; instead, use selective minimize spills.
caries removal. ●​ Avoid direct contact with mercury
Preserve affected (remineralizable) and always use gloves and masks.
dentin rather than removing all ●​ Proper ventilation in operatory
demineralized tissue. rooms to reduce vapor
accumulation.
4. Adhesive & Biomimetic Restorations ●​ High-volume suction during
amalgam removal to minimize
Use composites, glass ionomer aerosol exposure.
cements (GIC), and bioactive ●​ Use rubber dams to prevent
materials to support natural tooth mercury ingestion.
structure.
Avoid traditional amalgam unless Storage & Disposal
necessary.
5. Preservation of Pulp Vitality Store scrap amalgam in sealed, airtight
containers with water or a fixer solution.
Indirect and direct pulp capping
using MTA (Mineral Trioxide Dispose of amalgam waste through
Aggregate) or calcium hydroxide. authorized hazardous waste services.
Perform partial caries removal in
deep lesions rather than complete Avoid discarding amalgam in drains or
excavation. regular trash.

6. Long-Term Monitoring & Patient Health Risks of Mercury Exposure

Education
Emphasize oral hygiene, fluoride Acute exposure: Headaches, dizziness,
use, and recall visits. nausea.
Use preventive treatments like
sealants in high-risk patients. Chronic exposure: Kidney damage,
tremors, cognitive issues.
7. Minimally Invasive Treatment Options
Modern alternatives like composites and
Atraumatic Restorative Treatment glass ionomer cements (GIC) reduce
(ART): Hand instruments + GIC for reliance on amalgam.
caries removal.
Microabrasion & Laser Treatment: 2. Advances in Rotary Instruments in
Non-invasive enamel preservation. Operative Dentistry

Advancements in rotary instruments to

improve efficiency, precision, and patient
comfort.
SET 2
1. High-Speed Handpieces (Air-Turbine &
Electric Handpieces)
1. Mercury Hygiene
Operate at 200,000–500,000 rpm
Mercury hygiene is essential in preventing for rapid cutting.
mercury exposure during the handling of
dental amalgam. Sturdevant outlines the Electric handpieces provide better
following guidelines: torque control and precision.

Precautions During Amalgam Use

 Use of fiber-optic lighting and Odontoblasts are connected to
water spray for better visibility and nerves via synapses, transmitting
cooling. pain signals.

2. Slow-Speed Handpieces
4. Golden Proportion
Operate at less than 40,000 rpm,
used for caries removal, polishing, Sturdevant describes the Golden
and finishing. Proportion (1.618:1) as a mathematical
ratio used in esthetic dentistry to create
3. Lasers (Er:YAG, CO₂, Nd:YAG) harmonious smile designs.

Minimally invasive with reduced Ideal Proportion in Anterior Teeth:

heat generation and microcracks.
Lateral incisor width = 62% of central
Used for caries removal, cavity incisor width.
preparation, and soft tissue
procedures. Canine width = 62% of lateral incisor
width.
4. Air Abrasion & Ultrasonics

Air abrasion: Uses aluminum oxide Clinical Application:

particles to remove caries without
a drill. Used in veneers, crowns, and smile
makeovers for natural esthetics.
Ultrasonic instruments: Used for
conservative tooth preparation and Assists in designing tooth shapes, sizes,
scaling. and symmetry.

3. Theories of Dentin Hypersensitivity 5. Types of Veneers

Sturdevant describes dentin Veneers are thin shells bonded to anterior

hypersensitivity as a sharp pain caused by teeth for esthetic enhancement.
exposed dentinal tubules. Theories
include: 1. Direct Composite Veneers

1. Hydrodynamic Theory (Most Accepted) Chairside application, minimally

invasive.
Fluid movement within dentinal Cost-effective, but prone to
tubules stimulates nerve endings, staining.
causing pain.
2. Indirect Composite Veneers
Stimuli: Cold, air, sweets, tactile
pressure. Fabricated in dental labs, more
durable than direct veneers.
2. Neural Theory
3. Porcelain (Ceramic) Veneers
Odontoblasts act as pain
receptors, directly transmitting Highly esthetic, stain-resistant, and
signals to nerves. durable.
Require minimal enamel reduction
3. Odontoblastic Transduction Theory (0.3–0.7 mm).

4. Lumineers (No-Prep Veneers)

 Zinc Oxide Eugenol (ZOE) –
Ultra-thin porcelain veneers, Temporary restorations and
requiring no or minimal tooth sedative fillings.
preparation.
Intermediate Restorative Material
5. Zirconia Veneers (IRM) – Reinforced ZOE for
extended use.
Used for high-strength, esthetic
cases in bruxism patients. Cavit (Self-Sealing Material) –
Porcelain veneers provide the best Used in endodontics.
long-term esthetic results.

Interim restorations maintain tooth

6. Rapid Methods of Tooth Separation structure and function until definitive
treatment.
According to Sturdevant, rapid tooth
separation aids in matrix placement and 8. Types of Pins in Complex Amalgam
crown preparations. Restoration

Methods: Pins provide mechanical retention in large

amalgam restorations.
1. Wedge Placement:
Wooden or plastic wedges push teeth Types:
apart.
1. Cemented Pins:
2. Orthodontic Separators:
Elastic bands or springs create space Retained using dental cement, less
within days. retention than threaded pins.

3. Brass Wire Separation: 2. Friction-Locked Pins:

A brass wire is twisted between teeth to
widen the contact area. Tightly wedged into drilled holes.

4.Sof-LexStrips (Interproximal Reduction):

Abrades enamel to gain minor space.
3. Self-Threading Pins (Most Common)
5. Mechanical Separators:
Mallets and spreaders used in Screwed into dentin, providing the
prosthodontics. strongest retention.

Wedge placement is the most common Self-threading pins are the most
method used in operative dentistry. commonly used due to superior
retention.
7. Interim Restoration
9. Chemico-Mechanical Removal of
An interim restoration is a temporary filling Dental Caries
used to protect the tooth until the final
restoration is placed. Atraumatic caries removal using chemical
agents instead of drilling.
Common Materials:
Common Agents:
Glass Ionomer Cement (GIC) –
Fluoride-releasing, used in deep Carisolv (Sodium Hypochlorite & Amino
cavities. Acids): Softens carious dentin.
Papacarie (Papain-Based Enzyme):
Biocompatible and minimally invasive.
Used in pediatric and geriatric patients for
painless caries removal.

10. Indirect Pulp Capping

Sturdevant describes indirect pulp capping

as a method to preserve vital pulp in deep
carious lesions.

Procedure:

1. Remove infected dentin but preserve

affected dentin.

2. Apply a protective liner:

Calcium hydroxide (Dycal) → Induces

tertiary dentin.
Mineral Trioxide Aggregate (MTA) →
Better pulp healing.
GIC or ZOE as base.

3. Seal with a temporary or final

restoration.

Prevents pulp exposure and allows

healing without root canal treatment.
 SET 3
Removes adsorbed gases, moisture, and
contaminants.
1. Indications for Inlay Cavity
Improves cohesion between gold layers
Dental inlays are indirect restorations that during condensation.
fit within the cavity preparation without
covering cusps. Degassing ensures a pure gold surface,
enhancing the strength of the restoration.
Indications:

1. Moderate to Large Carious Lesions 3. Bleaching Techniques in Vital Tooth

Ideal for Class I and Class II Vital tooth bleaching is done externally
cavities with minimal occlusal using oxidizing agents.
stress.
Techniques:
2. Teeth with Intact Cusps
1. In-Office Bleaching
If cusps are weak, an onlay is
preferred instead of an inlay. Hydrogen peroxide (30–35%)
activated by heat, light, or lasers.
3. Teeth Requiring Better Contour &
Contact Quick results in 1–2 visits.

Inlays restore proximal contacts 2.At-Home Bleaching (Dentist-Supervised)

better than direct fillings.
Carbamide peroxide (10–22%) in
4. Aesthetic Needs custom trays.

Ceramic or composite inlays are Takes 2–4 weeks for noticeable

used in posterior teeth for better effects.
esthetics than amalgam.
3. Over-the-Counter Bleaching
5. High Occlusal Load Areas
Low-concentration hydrogen
Gold inlays are used for their peroxide strips, gels, or toothpaste.
strength and longevity in
high-stress areas. Least effective and slowest.

Inlays offer precise contouring and 4. Laser-Assisted Bleaching

longevity but require extensive
tooth preparation. Uses diode or argon lasers to
enhance peroxide action.
2. Degassing in DFG (Direct-Filled
Gold) Fastest but expensive.

Degassing is a process in Direct-Filled 4. Flares in Cast Restoration

Gold (DFG) restorations to remove
contaminants and improve adhesion. Flares are beveled extensions in cavity
preparations for cast restorations (inlays,
Steps: onlays, crowns)

Gold foil is heated in a furnace at Functions:

370–427°C (700–800°F).
 ●​ Provides smooth transition Prevents overhanging margins.
between restoration and tooth Maintains proper adaptation of the
surface. restoration.
●​ Enhances marginal fit and
prevents overhanging margins. Types of Matrix Systems:
●​ Prevents weak enamel from
chipping at the margin. 1.​ Tofflemire (Universal) Matrix –
Used for Class II amalgam
Types: restorations.

Light flare (20–30° bevel) → Used 2.​ Mylar Strip – Used for anterior
in gold restorations. composite restorations.

Heavy flare (45° bevel) → Used 3.​ Automatrix & Sectional Matrix –
when greater strength is needed. Used for composite restorations
with better contact adaptation.
Flares improve the longevity and marginal
integrity of cast restorations. Matrix systems ensure proper restoration
contour and minimize post-operative
5. Self-Threaded Pins adjustments.

Self-threaded pins are used to increase

retention in complex amalgam 7. Rake Angle in Cutting Instruments
restorations.
The rake angle refers to the angle of the
Functions: cutting edge relative to the surface being
cut in burs and hand instruments.
Mechanically locks restoration into dentin.
Types:
Improves resistance to dislodgment in
large restorations. 1. Positive Rake Angle

Used when cusps are missing or The cutting edge is inclined

fractured. forward.
More aggressive cutting but less
durable.
Self-threaded pins provide the best
retention but may cause microfractures in
dentin. 2. Negative Rake Angle

The cutting edge is angled

6. Function of Matrix backward.
Provides stronger, longer-lasting
A matrix system is used in direct cutting (used in carbide burs).
restorations to recreate proper tooth
contour and contact points. 3. Neutral Rake Angle
Cutting edge is perpendicular to
Functions: the surface.

Forms the missing wall of a cavity to

contain the restorative material. 8. Erosion

Helps in shaping proximal contours and Erosion is the progressive loss of tooth
restoring contact areas. structure due to non-bacterial acids.
Causes:
Examples:
Dietary acids: Citrus fruits, carbonated
drinks. Calcium hydroxide (Dycal) →
Stimulates tertiary dentin
Gastroesophageal reflux disease (GERD): formation.
Stomach acid erosion.
Resin-modified glass ionomer
Bulimia & Acidic Medications: Frequent (RMGI) → Provides fluoride
vomiting leads to enamel loss. release.

2. Cavity Bases (Thicker Layer, >0.5 mm)

Clinical Features:
Used when bulk buildup is needed to
Smooth, shiny surfaces without protect deep cavities.
bacterial plaque.
Examples:
Cupping of occlusal surfaces in
posterior teeth. Glass ionomer cement (GIC) →
Fluoride-releasing, bonds to
Loss of surface anatomy in anterior dentin.
teeth.
Zinc phosphate cement → Strong
mechanical support.
Management:
Zinc oxide eugenol (ZOE) →
●​ Dietary modification: Reduce acidic Soothing effect but weak strength.
foods.
●​ Fluoride application: Strengthens 3. Varnishes & Adhesive Sealers
enamel.
●​ Restorations: Composite or GIC in Fluoride varnishes protect against
severe cases. post-op sensitivity.

Bonding agents (DBA) seal

Erosion is irreversible but can be dentinal tubules, preventing
prevented by lifestyle changes and microleakage.
fluoride treatments.
4. Pulp Capping

SET 4 Indirect pulp capping: Calcium

hydroxide or MTA applied over thin
remaining dentin.
1. Methods of Pulp Protection
Direct pulp capping: Used when
Pulp protection is essential to prevent pulp is minimally exposed.
thermal, chemical, mechanical, and
bacterial damage during restorative Pulp protection is crucial to
procedures. maintain tooth vitality and prevent
post-op sensitivity.
Methods:

1. Cavity Liners (Thin Layer, <0.5 mm) 2. Types of Wedges

Used for mild protection against

chemical and thermal irritants.
Wedges are used in matrix systems to ●​ Used cyanoacrylate and
achieve proper contact and prevent phosphate esters.
overhangs in restorations. ●​ Still had poor dentin penetration
and low bond strength (5-10 MPa).
Types:
3rd Generation (1980s)
1. Wooden Wedges
●​ Acid-etching introduced for dentin.
Made of softwood (maple, birch). ●​ HEMA-based primers improved
bonding.
Slightly compressible, adapts well ●​ Bond strength: 10-15 MPa.
to gingival embrasure.
Can absorb moisture and expand, 4th Generation (1990s) – Gold Standard
improving contact.
2. Plastic (Resin) Wedges Total-etch technique (etch + prime + bond
separately).
More rigid and durable.
Radiolucent, making them less ●​ Formation of hybrid layer for
visible on X-rays. stronger bonding.
Do not expand like wooden ●​ Bond strength: 15-25 MPa.
wedges.

3. Transparent (Clear) Wedges 5th Generation (Late 1990s-2000s)

Used in composite restorations for ●​ One-bottle systems (Etch + Prime

better light curing penetration. + Bond combined).
●​ Simplified application but some
4. Hollow Wedges reduction in bond strength.

Designed for interproximal

adaptation while allowing matrix 6th Generation (Self-Etch Primers, 2000s)
band flexibility.
●​ No separate etching step; self-etch
Proper wedge selection ensures primers used.
tight proximal contacts and ●​ Reduced post-op sensitivity.
prevents gingival overhangs.

7th Generation (All-in-One Adhesives,

3. Generations of Dentin Bonding 2010s)
Agents (DBA)
●​ Etch, prime, bond in a single step.
Dentin bonding agents have evolved to ●​ Easy to use but slightly lower bond
improve bond strength, simplicity, and strength than 4th generation.
durability.

1st Generation (1950s-1960s) Modern trends focus on Universal

Adhesives (8th Gen) that bond to any
●​ Weak chemical bonding to dentin substrate.
(2-3 MPa).
●​ Used Glycophosphoric acid esters.
●​ High microleakage, poor durability. 4. Decontamination Cycle

2nd Generation (1970s) The decontamination cycle in dentistry

refers to steps used to sterilize
instruments and prevent 2. Brass Wire Separation
cross-contamination.
A thin brass wire is twisted
Steps: between teeth for gradual space
creation.
1. Pre-Cleaning (Debris Removal)
3. Wooden Wedges
Ultrasonic cleaning or manual
scrubbing with enzymatic Can be placed for progressive
solutions. separation in minor cases.

2. Disinfection (Intermediate Step) 4. Interproximal Enamel Reduction (IPR)

Surface disinfection using Enamel is selectively removed with

alcohol-based or chlorine-based abrasive strips to create space.
disinfectants.
Slow separation techniques help in
3. Sterilization creating space for restorations,
orthodontic movement, or crown
Autoclave (Steam Sterilization at placement.
121-134°C, 15-30 min).
6. Abfraction
Dry heat sterilization (160-180°C
for 1-2 hours). Abfraction is the loss of tooth structure at
the cervical margin due to biomechanical
Chemical sterilization forces (not decay).
(Glutaraldehyde, Hydrogen
Peroxide Plasma). Causes:

●​ Occlusal stress from bruxism or

4. Storage & Handling malocclusion.
●​ Tooth flexure at the cervical area
Sterile pouches or cassettes causes enamel fractures.
prevent contamination.
Clinical Features:
Proper decontamination ensures
infection control and patient safety. ●​ Wedge-shaped cervical lesions
near the gumline.
5. Slow Tooth Separation ●​ No decay or bacterial involvement.
●​ More common in premolars and
Slow tooth separation is used in canines.
orthodontics or restorative procedures to
gradually create space between teeth. Management:

Methods: 1.​ Occlusal adjustments to reduce

stress.
1. Orthodontic Separators 2.​ Night guards to prevent excessive
occlusal forces.
Elastic separators: Placed between
teeth for several days before Restorative treatment:
banding.
1.​ GIC or composite restorations to
Metal spring separators: Provide restore lost structure.
controlled expansion. 2.​ Avoid over-preparing the lesion, as
it may not progress quickly.
3.​ Abfraction is a non-carious lesion
caused by occlusal forces,
requiring proper diagnosis and
management.