CHAPTER 4 OPERATIVE DENTISTRY

INTRODUCTION

Operative dentistry is the area of dental practice concerned with the prevention and treatment of defects in tooth enamel and dentin. Since many patients need treatment that is provided in operative dentistry, this is where most of the dental assistants are assigned. Operative dentistry includes the treatment and restoration of carious teeth with metallic and nonmetallic dental materials. These materials are usually amalgam, composite resins, and glass ionomer restorations.

PURPOSE

Operative dentistry provides treatment to restore a patient's dental condition to a healthy, functional, and esthetically (pleasing to the eye) acceptable level. Operative dentistry primarily is responsible for the restoration of decayed or fractured teeth. This chapter provides information and procedures that you may be required to perform in operative dentistry.

AREAS OF OPERATIVE DENTISTRY

You must be aware that each operative procedure may not be performed in the same manner. Basic procedures are usually performed during each operative appointment. Some of these procedures are also used in other dental specialties. The areas discussed in this chanter are as follows:

Identification of operative instruments

Miscellaneous instruments, materials, and equipment

Four-handed dentistry

Basic dental procedures

Operative procedures

Supply procedures

IDENTIFICATION OF OPERATIVE INSTRUMENTS

Because of the many hard to reach areas in the human mouth and various functions required, operative instruments come in a wide variety of sizes and shapes. To be an effective dental assistant, you must be able to understand why, where, and when the dentist will use them. We will discuss hand cutting instruments, amalgam instruments that consist of condensers, carvers and burnishers, and composite (resin) instruments.

HAND CUTTING INSTRUMENTS

Many dental procedures require the use of hand instruments with sharp cutting edges. This cutting instrument group used in operative dentistry includes excavators, chisels, hatchets, hoes, and gingival margin trimmers. They are used in the cavity preparation of both amalgam and composite (resin) restorations.

Spoon Excavators The spoon excavator is a double-ended instrument with a spoon, claw, or disk-shaped blade. Spoon excavators are used primarily to remove debris from tooth cavities. Their tips and sides are designed for cutting action. The most common sizes are the small and the large (fig. 4-1) spoon extractors.

Chisels Dental chisels are commonly referred to as miniature chisels. Chisels are used to cleave (split) tooth enamel, to smooth cavity walls, and to sharpen cavity preparations. The two most common types used in operative dentistry are the Wedelstaedt and biangle chisels (fig. 4-2). The Wedelstaedts have slightly curved shanks and are used primarily on anterior teeth. The biangle chisels have two distinct angles - one at the shank, and one at the working end. This design allows access to tooth structures that would not be possible with straight chisels.

Hatchets A dental hatchet (fig. 4-3) resembles a camper's hatchet, except much smaller. Like dental chisels, some have single cutting ends, and others have cutting edges on both ends of the handle. Hatchet blades are set