Faculty Teaching Guide for Dental Materials

Module - Restorative Materials

 

 

Faculty Teaching Guide for Dental Materials

Module: Restorative Materials
Review of Previous Module
Review topics from the previous module to confirm understanding prior to presenting new material.
Module Overview
Advances in dental materials have been rapid in the area of esthetics, such as the expanded application of composites for posterior restorations, and in the development of fluoride releasing glass ionomer cements and filling materials.  This module discusses a large variety of dental materials that the dental assistant will use every day.  Each material has unique properties in order to perform specific functions. Restorative dentistry, also called operative dentistry, provides direct restoration of tooth structure by reproducing the original shape of the tooth.
 

 

Resources
This module utilizes the following learner resources:
Textbooks: 
Dental Assisting, A Comprehensive Approach, 2nd edition, by Donna J. Phinney and Judy Halstead. Delmar Learning, 2004. ISBN 1-4018-3480-9. 
Materials and Procedures for Today’s Dental Assistant, by Ellen Dietz, Delmar Learning, 2004. ISBN: 1401837336.
Workbook: Workbook to Accompany Dental Assisting, A Comprehensive Approach, 2nd edition, by Donna J. Phinney and Judy Halstead, prepared by Karen L. Waide, Delmar Learning, 2004. ISBN 1-4018-3483-3. 
Instructor’s Manual: Instructor’s Manual to Accompany Delmar’s Dental Assisting, A Comprehensive Approach, 2nd edition, by Donna J. Phinney and Judy Halstead. Delmar Learning, 2004. ISBN 1-4018-3482-5.
Delmar’s Dental Assisting Video Series: Delmar Learning. ISBN 0-7668-1031-3.
Electronic CD-ROM: Delmar’s Dental Assisting Interactive Skills and Procedures CD-ROM, ISBN 1-4018-3485-X.
Faculty CD-ROM: The faculty CD-ROM includes this Faculty Guide and the PowerPoint for Dental Materials.
Additional Resources
Safety Standards and Infection Control for Dental Assistants, by Ellen Dietz. Delmar Learning, 2002. ISBN 0-7668-2659-7.
Electronic Classroom Manager to Accompany Delamr’s Dental Assisting, A Comprehensive Approach, 2nd edition, by Donna J. Phinney and Judy Halstead. Delmar Learning, 2004. ISBN: 1-4018-3484-1.
Section 1: Dental Cements
Section Overview
The mouth is a harsh environment. It is warm and moist, has corrosive conditions, experiences drastic temperature changes, as well as stresses involved during mastication.  The properties of dental materials must be able to withstand these tough conditions and be biocompatible with the body.
Outline of Section 1
Part A: Dental Material Properties
Part B: Dental Cements
Learning Objectives and Competencies
These learning activities directly address the Learning Objectives and Competencies
as stated.
Knowledge:

• Define the Key Terms.

Comprehension

• Explain properties of dental materials.
• List materials used to restore cavity preparations.
• Explain composition, uses, and manipulation of dental cements.

Application:

• Demonstrate manipulation of zinc phosphate, polycarboxylate, glass ionomer, and zinc oxide eugenol  

       cements.

Learning Activities
These learning activities directly address the Learning Objectives and Competencies as stated.

[Insert Homework Assignment icon] Key Term Glossary (Part A, All Objectives)
[Insert In-Class Activity icon] Set Up and Manipulating Calcium Hydroxide(Part A, Objective 3-4)
[Insert In-Class Activity icon] Prepare and Manipulate Resin Cements(Part A, Objective 3-4)
[Insert In-Class Activity icon] Prepare and Utilize Acid Etch Solution (Part A, Objectives 3-4)
[Insert In-Class Activity icon] Manipulate Bonding Materials (Part A, Objectives 3-4)
[Insert Homework Assignment icon] Textbook Assignment (Parts A-B, All Objectives)
[Insert In-Class Activity icon] Manipulate Zinc Phosphate Cement(Part B, Objectives 4-5)
[Insert In-Class Activity icon] Manipulate Zinc Ozide Eugenol Cement (Part B, Objectives 4-5)
[Insert In-Class Activity icon] Manipulate Polycarboxylate Cement(Part B, Objectives 4-5)
Insert In-Class Activity icon] Glass Ionomer Cement(Part B, Objectives 4-5)
[Insert Homework Assignment icon] Posttest (Part B, All Objectives)
Part A: Dental Material Properties
Overview
Dental materials must be compatible with the oral environment. They must be strong enough to withstand the forces of chewing, protect the tooth and oral tissues, not harmful to the body, resemble natural dentition, and be easily formed and placed in the mouth. This part examines the many diverse properties of dental restorative materials. Understanding these properties will enable the dental assistant to provide quality care and maximum patient comfort.
Initial Questions and Activities
1.   Who of you have fillings in your teeth?  Are they silver fillings or tooth colored?

• There will be a variety of responses to this question depending on learners’ previous experience.  Encourage learners to share their experiences with the class.  Discuss with them how they will learn to help the dentist restore tooth structure for their patients, and that some of them may become expanded function dental assistants, placing and finishing these restorations themselves after the dentist prepares the tooth.

Key Concepts	References and Activities	Slides
Introduction to Module		Slides 1-2
Introduction to Section 1		Slide 3
Key Terms	[Insert Home Ass icon] Key Term Glossary	Slide 4
Dental Material Properties	Chapter ___, pgs. ____ (Phinney & Halstead) Chapters ____ (Dietz) [Insert In-Class Activity icon] Set Up and Manipulating Calcium Hydroxide [Insert In-Class Activity icon] Prepare and Manipulate Resin Cements [Insert In-Class Activity icon] Prepare and Utilize Acid Etch Solution [Insert In-Class Activity icon] Manipulate Bonding Materials [Insert Home Ass icon] Textbook Assignment	Slides 5-6

[ ] Group Activities [ ] Homework [ ] Individual Activity [ ] Internet Activity [ ] In-Class Discussion [ ] In-Class Act [ ] Evaluation  
[Insert In-Class Act icon] In-Class Activities

• Set Up and Manipulating Calcium Hydroxide (Part A, Objectives 3-4). Goal: To have learners set up for and manipulate calcium hydroxide. Instructor should ensure enough materials and supplies are available for the activity. Learners should be graded on the procedure steps as outlined on pg. ____, Chapter ____(Phinney & Halstead). Learner workbooks contain check off sheets that can be utilized.
• Prepare and Manipulate Resin Cements (Part A, Objectives 3-4). Goal: To have learners prepare and manipulate resin cements in a two paste, powder/liquid, or syringe system. Learners should be placed into teams for this activity. Learners should be graded on the procedure steps as outlined on pg. ____, Chapter ____(Phinney & Halstead). Learner workbooks contain check off sheets that can be utilized.
• Prepare and Utilize Acid Etch Solution (Part A, Objectives 3-4). Goal: To have learners prepare and utilize acid etch solution. Learners should be graded on the procedure steps as outlined on pg. ____, Chapter ____(Phinney & Halstead). Ensure proper PPE is used by learners. Learner workbooks contain check off sheets that can be utilized.
• Manipulate Bonding Materials (Part A, Objectives 3-4). Goal: To have learners manipulate bonding materials. Instructor ensure enough materials and supplies are available for learners. Learners should be graded on the procedure steps as outlined on pg. ____, Chapter ____(Phinney & Halstead). Learner workbooks contain check off sheets that can be utilized.
• [Insert In-Class Dis Ques icon] In-Class Discussion
• 1.   How should the patient be seated in the dental chair for the procedure if the filling is going to be in a   
•       mandibular tooth?
• The patient should be seated in a supine position with the light directed downward for mandibular illumination.

[Insert Home Ass icon] Homework Assignments
Key Term Glossary. Learners will define key terms listed in the PowerPoint presentation.  They are to enter this glossary on disk, in a dedicated notebook or in a designated part of a notebook. They are expected to augment information from text or lecture with other resources including any available in the school or public libraries or on the Internet and will be graded at the end of the module on completeness and presentation.

• Textbook Assignment. Learners are to read Chapter _____ (Phinney & Halstead).
• Presentation Tools
• Note: If you change Objectives or Assignments, don’t forget to change the slides accordingly.

Slide 1	[Insert DM 2-1] DM – Stands for Dental Materials. The 1st number “2” represents the Module called Restorative Materials. The 2nd number indicates the slide number.	Power Point Presentation for Dental Materials with Labs Module:  Restorative Materials Prior to introducing this module. Ask learners if any questions remain from the previous module. If questions remain review the material as needed. Introduce this module.
Slide 2	[Insert DM 2-2]	Module:  Restorative Materials Introduce the sections and each part.
Slide 3	[Insert DM 2-3]	Section 1:  Dental Cements Discuss each objective in detail. Learners need to know what they will be learning and why. Try to relate it back to their careers as dental assistants.
Slide 4	[Insert DM 2-4]	Key Terms (cont.) Review each key term and discuss. Homework Assignment: Stop here and go over the Key Term Glossary assignment.
Slide 5	[Insert DM 2-5]	Part A: Dental Material Properties Introduce learners to the many properties of dental materials.  Go through each term and explain what it means. Explain how many foods we eat are acidic and that even plaque has some acidic properties. Discuss how adhesion is necessary for dental materials to be able to stay in place on the tooth.  Explain how normal biting forces in the posterior of the mouth are stronger than in the anterior areas. Discuss how metals and alloys for restorations are susceptible to corrosion and tarnish. Point out that aluminum, zinc, and nickel tend to oxidize relatively easily and that the more precious metals silver, platinum, and gold resist oxidation. Explain that tooth structure and restorative materials in the mouth will expand when warmed by hot foods and beverages, but contract when exposed to cold substances, and that such expansions and contractions over time, may result in breaking the marginal seal of a filling. Address how the elastic limit is the maximum stress a material will withstand without permanent deformation, and that certain materials will change shape or flow. Discuss galvanic response resulting from dissimilar metal fillings in opposing or adjacent teeth, how this small electrical current is carried through the saliva to the pulp, and that the patient may call the office to say it is like they are biting on foil. Explain that hardness is the toughness of a material, that microleakage can take place between the tooth and filling material at the margin where they meet, and discuss mechanical verses chemical retention. Make clear that many dental cements are used underneath the stronger filling materials, to form a base in deep cavities, and to insulate the pulp from possible chemical and thermal trauma, because some cements can be dissolved if exposed to oral fluids. Ensure understanding of how materials may conduct temperature, especially metal fillings, and how this causes expansion and contraction, and therefore dimensional change.  Question: Think of the last time you had a hot drink with cold food, or hot food and a cold drink. How did these temperature changes feel on your teeth and restorations? Explain that viscosity is the resistance of a material to flow and that many materials used in dentistry need to be viscous. Explain that the wettability of a material is its property to flow over a surface.
Slide 6	[Insert DM 2-6]	Biting Forces Explain that tensile or tension forces are two sets of forces directed away from each other in a straight line, that compression is two sets of forces directed toward each other, and shear is two sets of forces directed parallel to each other. Point out that force applied to a dental restoration may be a combination of tensile, compressive, and shear. Short Activity: Stop and show Video #4 from Delmar’s Dental Video Series.

Part B: Dental Cements
Overview
A wide assortment of dental cements are used for various applications.  They are dispensed as powder and liquid, two-paste systems, or in a capsule.  Each has unique properties and specific functions.  Dental assistant’s must thoroughly understand how to manipulate cements at chairside as well as the function of each.
Initial Questions and Activities

• 1.   What would happen if a metal filling is placed near the tooth pulp? 
•       The tooth would be very sensitive to temperature.  Metal conducts temperature, so the dentist will line the cavity with a base or cement to insulate the pulp from thermal trauma.
• 2.  Why would it be important for adhesion of crowns and bridges to tooth structure?
•       The prostheses must be cemented on the tooth or teeth and should last a lifetime for the patient.

Key Concepts	References and Activities	Slides
Dental Cements	Chapter ___, pgs. ____ (Phinney & Halstead) Chapter ___ (Dietz) [Insert In-Class Activity icon] Manipulate Zinc Phosphate Cement [Insert In-Class Activity icon] Manipulate Zinc Ozide Eugenol Cement [Insert In-Class Activity icon] Manipulate Polycarboxylate Cement [Insert In-Class Activity icon] Glass Ionomer Cement	Slide 7-14
Assessment Questions	[Insert Homework Ass icon] Textbook Assignment [Insert Homework Ass icon] Posttest	Slide 15

[ ] Group Activities [ ] Homework [ ] Individual Activity [ ] Internet Activity [ ] In-Class Discussion [ ] In-Class Activity [ ] Evaluation  
[Insert In-Class Act icon] In-Class Activities

• Manipulate Zinc Phosphate Cement (Part B, Objectives 4-5). Goal: To have learners Manipulate Zinc Phosphate Cement. Instructor should ensure enough materials are available for learners. Learners should be graded on the procedure steps as outlined on pg. ____, Chapter ____(Phinney & Halstead). Learner workbooks contain check off sheets that can be utilized.
• Manipulate Zinc Ozide Eugenol Cement (Part B, Objectives 4-5). Goal: To have learners Manipulate Zinc Oxide Eugenol Cement. Instructor should ensure enough materials are available for learners. Learners should be graded on the procedure steps as outlined on pg. ____, Chapter ____(Phinney & Halstead). Learner workbooks contain check off sheets that can be utilized.
• Manipulate Polycarboxylate Cement (Part B, Objectives 4-5). Goal: To have learners Manipulate Polycarboxylate Cement. Instructor should ensure enough materials are available for learners. Learners should be graded on the procedure steps as outlined on pg. ____, Chapter ____(Phinney & Halstead). Learner workbooks contain check off sheets that can be utilized.
• Glass Ionomer Cement (Part B, Objectives 4-5). Goal: To have learners Glass Ionomer Cement. Instructor should ensure enough materials are available for learners. Learners should be graded on the procedure steps as outlined on pg. ____, Chapter ____(Phinney & Halstead). Learner workbooks contain check off sheets that can be utilized.

[Insert In-Class Dis Ques icon] In-Class Discussion

• 1.  What types of viscosity did you work with when taking alginate impressions and then pouring them with plaster and stone materials?
•      The alginate material is thick and viscous.  The plaster and stone are less viscous than alginate, so that they can be poured into the patient’s impression, yet much more viscous than the water used when preparing these materials.
• [Insert Home Ass icon] Homework Assignments
• Textbook Assignment. Learners are to read Chapters ____ (Dietz).
• Posttest.  Have learners complete the Skills Mastery Assessment: Posttest in Chapters ____ (Dietz).

Ideas for learners struggling with this material …

• Develop Questions.  Suggest learners develop questions for the exam as if they were the instructor.  Then, answer the questions.  Encourage them to use this as a review tool for exams.  They should assess how close they are to the real questions on each exam.  Soon they will be able to accurately predict the questions.
• Ideas for learners who are ahead and want to learn more …
• Web Research.  Have learners go to the website http://www.dentsply.com and review the product catalogue for new products. Be prepared to discuss their discoveries in class.
• Presentation Tools
• Note: If you change Objectives or Assignments, don’t forget to change the slides accordingly.

Slide 7	[Insert DM 2-7]	Part B:  Dental Cements Review Part A. Review the homework and answer questions as needed. Introduce Part B. Explain that a wide variety of dental cements are used in dentistry.  Address the purposes for each type of cement.
Slide 8	[Insert DM 2-8]	Material Preparing for Restoration Explain the purpose of a cavity liner. Discuss how some liners, such as calcium hydroxide, provide therapeutic benefits to the tooth. Point out that fluoride compounds have been added to certain cavity liners in an attempt to reduce the possibility of secondary caries around permanent restorations or to reduce sensitivity. Discuss low strength verses high strength bases.  Explain that low strength bases are also referred to as liners, intermediary bases, or pulp-capping agents. Address how varnishes aid in the reduction of post-operative sensitivity when applied to dentinal surfaces under newly placed fillings. Explain that cements can be used to hold materials to tooth structure, or used as a high strength base underneath restorations. Discuss how bonding agents work together with acid etched enamel to create a combination of mechanical and chemical bonding of dental restorative materials to tooth enamel and dentin, and that there are a wide variety of bonding material systems available.
Slide 9	[Insert DM 2-9]	Calcium Hydroxide Inform learners that calcium hydroxide is used for lining deep cavities or for direct pulp capping. Explain how it provides some thermal insulation and stimulates production of secondary dentin between the pulp and the filling material. Point out that sometimes a high strength base will be placed over the calcium hydroxide material. Ensure learners understand that they only need to mix a small amount of equal portions of calcium hydroxide.
Slide 10	[Insert DM 2-10]	Copalite Varnish Discuss how cavity varnishes are used to seal the dentinal tubules that have been cut during the cavity preparation.  Ensure learners understand that varnishes are not used under resin or composite materials as they affect the setting of the filling material.
Slide 11	[Insert DM 2-11]	Luting Cements Remind learners that luting means to bond or cement materials together and that in dentistry we have permanent, temporary, and intermediate cements. Review each of the cements listed on the slide and inform learners that they will have the opportunity to work with each material every day in their dental office depending on the preferences of the dentist.
Slide 12	[Insert DM 2-12]	Zinc Phosphate Cement Discuss how a proper amount of powder should be incorporated into the liquid slowly, and mixed on a cool glass slab to slow the setting time.  Explain how the chemical setting results in an exothermic reaction, giving off of heat, which must be dissipated or the cement will become thick and set too fast. Tell learners that is why a cool glass slab must be used and the cement spread over the entire surface, in a figure eight motion as it is mixed. Ensure learners understand that the lid for the liquid must be replaced immediately after dispensing because when exposed to humidity, it will absorb water, and when exposed to dry air, tends to result in a loss of water, causing a changing its chemistry.
Slide 13	[Insert DM 2-13]	Glass Ionomer Cements Explain that glass ionomers come in many different dispensing methods, where the powder is a fluoroaluminumsilicate glass. Point out that glass ionomer cements bond chemically to enamel and dentin during the setting process, and that they have become popular due to their ability to release fluoride into the tooth structure. Ensure learners understand these materials are very sensitive to moisture, so the tooth must be completely dry.
Slide 14	[Insert DM 2-14]	Polycarboxylate Cement Explain that the liquid of the polycarboxylate cement liquid is extremely viscous, so it is often dispensed with a syringe.  Point out that the dispensing of the liquid should be done immediately before mixing, to prevent evaporation of water, and that the mixed cement should be used only as long as it still appears glossy on the surface.  Explain that once the surface appears dull, the cement develops stringiness and is too thick to use.  Ensure learners understand that the cement spatula must be cleaned immediately after use with alcohol, or it will be extremely difficult to remove after it is completely set.
Slide 15	[Insert IDA 2-15]	Assessment Questions Short Activity: Stop here and have learners answer the questions on the slide. Review material as needed to enhance understanding. In-Class Activity: Stop here for the in-class activities. Homework Assignment: Stop here to assign and discuss the homework.

Section 2: Amalgam Restorations
Section Overview
The goal of restorative dentistry is to re-establish a tooth to its full function in the mouth, in an esthetically pleasing manner, with as little loss of healthy tooth structure as possible.  There are many choices of restorative materials available.  This section discusses the material that has been used in dentistry the longest.
Outline of Section 2
Part A: Cavity Preparations
Part B: Amalgam Restorative Material
Learning Objectives and Competencies
These learning activities directly address the Learning Objectives and Competencies as stated.
Knowledge
6.   Define the Key Terms.
Comprehension
7.   List the components of amalgam alloy.

• Identify cavity preparation terminology.

Application
9.  Demonstrate manipulation of calcium hydroxide and cavity varnish.
10. Demonstrate the steps of an amalgam restorative procedure.
Learning Activities
These learning activities directly address the Learning Objectives and Competencies as stated.
[Insert Homework Assignment icon] Key Term Glossary (Part A, Objectives 7-9)
[Insert In-Class Activity icon] Manipulating Calcium Hydroxide (Part A, Objective 9)
[Insert In-Class Activity icon] Using Cavity Varnish(Part A, Objective 9)
[Insert In-Class Activity icon] Using Amalgamator (Part B, Objective 10)
[Insert In-Class Activity icon] Assisting an Amalgam Procedure (Part B, Objective 10)

 

Part A: Cavity Preparations
Overview
The shapes of all cavity preparations are designed for maximum retention of the restorative material within the tooth, so that the filling is able to receive compressive forces and to minimize tension or shear of the restorative material. Understanding this will help the dental assistant realize why the dentist prepares the cavity in a specific form.
Initial Question and Activities

• 1.  Why would it be important to seal the dentinal tubules?
•       The dentinal tubules lead to the tooth pulp, and after being cut by the dentist, will be uncomfortable for the patient if not sealed. 
•  
•  

Key Concepts	References and Activities	Slides
Introduction to Section 2		Slide 13
Key Terms	[Insert Home Ass icon] Key Term Glossary	Slide 14
Cavity Preparations	Chapter ____, pgs. ____ (Phinney & Halstead) [Insert Group Activity icon] Manipulating Calcium Hydroxide [Insert Group Activity icon] Using Cavity Varnish [Insert Group Activity icon] Using Amalgamator [Insert Home Ass icon] Textbook Assignment [Insert Home Ass icon] Posttest	Slides 15-21

[ ] Group Activities [ ] Homework [ ] Individual Activity [ ] Internet Activity [ ] In-Class Discussion [ ] In-Class Activity [ ] Evaluation  

 

 

[Insert In-Class Act icon] In-Class Activities

• Manipulating Calcium Hydroxide (Part A, Objective 9). Goal: For learners to again practice manipulating calcium hydroxide. Instructor should ensure there are enough materials and supplies for the class and separate learners into teams. Learners should be graded on the procedure steps as outlined on pg. ____, Chapter ____(Phinney & Halstead). Learner workbooks contain check off sheets that can be utilized.
• Using Cavity Varnish (Part A, Objective 9). Goal: For learners to gain experience using cavity varnish. Instructor should ensure there are enough materials and supplies for the class and separate learners into teams. Learners should be graded on the procedure steps as outlined on pg. ____, Chapter ____(Phinney & Halstead). Learner workbooks contain check off sheets that can be utilized.
• Using Amalgamator (Part A, Objective 10). Goal: For learners to gain experience using an amalgamator. Instructor should ensure there are enough materials and supplies for the class and separate learners into teams. Learners should be graded on the procedure steps as outlined on pg. ____, Chapter ____(Phinney & Halstead). Learner workbooks contain check off sheets that can be utilized.

[Insert In-Class Dis Ques icon] In-Class Discussion
1.   What were some of the problems found with manipulating calcium hydroxide, the resin cement, the etchant,  
and the bonding materials?
Discuss proper techniques for using these materials.  Explain clearly to
learners how to perform each step again now that they have experience
manipulating these materials.
2.   What does calcium hydroxide do for the tooth?
Calcium hydroxide is used for lining deep cavities or for direct pulp
capping.  It provides some thermal insulation and stimulates production
of secondary dentin between the pulp and the filling material.
[Insert Home Ass icon] Homework Assignments
Key Term Glossary. Learners will define key terms listed in the PowerPoint presentation.  They are to enter this glossary on disk, in a dedicated notebook or in a designated part of a notebook. They are expected to augment information from text or lecture with other resources including any available in the school or public libraries or on the Internet and will be graded at the end of the module on completeness and presentation.

• Textbook Assignment. Learners are to read Chapter ___ (Dietz).
• Posttest.  Have learners complete the Skills Mastery Assessment: Posttest in Chapter ___ (Dietz).

Ideas for learners struggling with this material …

• Take Time To Read. Encourage learners to read the textbook more than once or twice.  Inform them that the first reading is a preview.  The second time it will be effective learning.  The third will be an important review.
• Ideas for learners who are ahead and want to learn more …
• Web Research. Suggest that these learners find web sites that are useful in learning the topic.  This will help them keep up with the latest news. Encourage them to consider finding at least two websites that can help them keep current and review them each week.  This is a good habit to take to the workplace.
• Presentation Tools

Note: If you change Objectives or Assignments, don’t forget to change the slides accordingly.

Slide 16	[Insert DM 1-16]	Section 2: Amalgam Restorations Discuss each objective in detail. Learners need to know what they will be learning and why. Relate it back to their careers as dental assistants.
Slide 17	[Insert DM -17]	Key Terms Review each key term and discuss the importance of knowing the definition of each. Homework Assignment: Stop here to discuss the Key Term Glossary assignment.
Slide 18	[Insert DM 1-18]	Part A: Cavity Preparations Inform learners that tooth structure will need to be restored to its natural function due to the decay process, fracture, abrasion, undesirable esthetics, or attrition.
Slide 19	[Insert DM 2-19]	Cavity Preparations (cont.) Discuss the elements involved in cavity preparation. Explain that the cavity preparation design helps keep the restoration in place as well as to aid in resistance to occlusal forces.
Slide 20	[Insert DM 2-20]	Cavity Preparations (cont.) Address how each part of the prep relates to the name of the surface of the tooth.  Note to Instructor: During this discussion refer learners to the Cavity Preparation Identification section on pg. ____ in Chapter ____ (Phinney & Halstead). Remind learners that a line angle is where two surfaces meet and a point angle refers to where three surfaces meet.
Slide 21	[Insert DM 2-21]	Steps of Cavity Preparation Ensure learners understand the basic steps of a cavity preparation.  Point out that the enamel is cut with a high speed bur, which prepares the shape of the cavity, then the low speed is used to remove any decay that is present, and hand instruments are used to refine the outline of the prep. Explain that the area must be free of moisture before the base or liner is placed in the tooth. In-Class Activity: Stop here for the in-class activities. Homework Assignment: Stop here and review the Key Terms Glossary homework assignment.

Part B: Amalgam Restorative Material
Overview

• A freshly mixed mass of silver alloy and mercury has a plasticity that permits it to be packed or condensed into a prepared tooth cavity and shaped to re-establish its form and function.  The toxicity of mercury has forced dental material manufacturers to create better quality restorative materials, although amalgam is still an excellent replacement for tooth structure and is still the most popular filling material. Understanding how to manipulate dental materials is the role of dental assisting. Depending on state regulations, expanded function dental assistants may be asked to place and shape restorations in patient’s mouths independently, but under supervision of the dentist.

Initial Questions and Activities
1. What are some of reasons a tooth may need to be restored?

•     A tooth may need a restoration due to caries, a fracture, abrasion, attrition, or for esthetics.

Key Concepts	References and Activities	Slides
Amalgam Restorative Materials	Chapter ___, pgs. ___ (Phinney & Halstead) Chapter ____ (Dietz)	Slides 22-23
Assessment Questions	[Insert Group Activity icon] Assisting an Amalgam Procedure	Slide 24

[ ] Group Activities [ ] Homework [ ] Individual Activity [ ] Internet Activity [ ] In-Class Discussion [ ] In-Class Activity [ ] Evaluation  
[Insert In-Class Act icon] In-Class Activities

• Assisting an Amalgam Procedure (Part B, Objective 10). Goal: For learners to gain experience assisting during an amalgam procedure. Instructor should ensure there are enough materials and supplies for the class and separate learners into teams. Instructor should be the operator for this procedure. Learners should be graded on the procedure steps as outlined on pg. ____, Chapter ____(Phinney & Halstead). Learner workbooks contain check off sheets that can be utilized.
• [Insert In-Class Dis Ques icon] In-Class Discussion

1.  What is the pulpal wall?
The pulpal wall is the floor of the preparation over the pulp chamber.

• 2. What is a point angle?

A point angle is where three tooth surfaces meet.
Ideas for learners struggling with this material …

• Improve Concentration. Suggest learners improve their concentration by, working in a quiet environment, eliminating external distractions, avoid internal distractions, take breaks when needed, get sufficient rest, lower stress levels, and exercise.
• Ideas for learners who are ahead and want to learn more
• Web Research: Have learners research on the web for more information on cements, restorative materials, bases, and liners. Learners should be prepared to discuss their findings with the class.

Presentation Tools
Note: If you change Objectives or Assignments, don’t forget to change the slides accordingly.

Slide 22	[Insert DM 2-22]	Part B:  Amalgam Restorative Material Review Part A. Make sure that any remaining questions are answered. Discuss the complete homework and review any areas that need more clarification. Introduce Part B. Discuss how amalgam restorations are easy to insert, maintain anatomical form well, maintain adequate resistance to fracture, prevent marginal leakage, and provide a long service for the patient. Explain that the drawbacks of dental amalgam are that their color does not match tooth structure, is more brittle than desirable, subject to corrosion and galvanic action, and eventually show marginal breakdown. Ensure learners understand that amalgam alloy should not be contaminated with moisture during its condensation or expansion of the material will occur after placement.
Slide 23	[Insert DM 1-23]	Amalgam Restoration Set-up Address the importance of the proper set up for an amalgam restoration. Explain to learners that they will have the opportunity to practice setting up and going through the steps of an amalgam restoration. Point out that the alloy powder and the mercury are mixed, or triturated, inside a capsule with an amalgamator, and that the material can be over-mixed or under-mixed, so it is important to read the manufacture’s directions for how long to mix when using any dental material.
Slide 24	[Insert DM 1-24]	Assessment Questions Short Activity: Ask the group to answer these questions to assess their comprehension of the material recently presented. Review any material that does not seem clear. In-Class Activity: Stop here to complete the in-class activities. Homework Assignment: Stop here to assign and discuss the homework.

Section 3: Composite Restorations
Section Overview
Composite restorations are often called tooth colored fillings.  They are dependent on etching and bonding techniques and are usually distributed as composite restorative systems. This section discusses bonding methods and materials used for ideal tooth replacement.
Outline of Section 3
Part A: Bonding Agents
Part B: Composite Restorative Materials
Learning Objectives and Competencies

These learning activities directly address the Learning Objectives and Competencies

as stated.

Knowledge

11. Define Key Terms.

Comprehension

• Explain the use of glass ionomer, resin reinforced glass ionomer, and compomer restorative materials.

 

• Explain the composition of composite resins.

Application

• Demonstrate manipulation of etchant material and bonding agents.

 

15.  Demonstrate the steps of a composite restorative procedure.
Learning Activities
These learning activities directly address the Learning Objectives and Competencies as stated.

[Insert Homework Ass icon] Key Term Glossary(Part A, Objective 11)
[Insert In-Class Activity icon] Using Acid Etch(Part A, Objective 14)
[Insert In-Class Activity icon] Using Bonding Material(Part A, Objective 14)
[Insert In-Class Activity icon] Manipulate Resin Cement (Part A, Objectives 13 and 15)
[Insert In-Class Activity icon] Assisting During a Light-Cured Composite(Part B, Objectives 13 and 15)
[Insert In-Class Activity icon] Assisting During a Self-Cure Composite(Part B, Objectives 13 and 15)
[Insert In-Class Activity icon] Glass Ionomer Restoration(Part B, Objectives 12 and 15)
[Insert Homework Activity icon] Instrument Set Up Review(Part B, All Objectives)
[Insert Homework Ass icon] Workbook Assignment(Part B, All Objectives)
[Insert Homework Ass icon] End of Chapter Activities(Part B, All Objectives)
Part A: Bonding Agents
Overview
Bonding agents are vital to the success of resin and composite restorations. When adequate bonding is achieved, more conservative cavity preparations can be used, and the original strength of the clinical crown approximated, due to less tooth structure being removed. Dental assistants must understand various bonding systems in order to be able to perform the tasks required of them.
Initial Questions and Activities
1. How would a filling stick to tooth structure?
    The shape of the cavity preparation is mechanical retention, but a combination of mechanical and chemical retention is accomplished through etching the tooth surface and bonding materials together.

Key Concepts	References and Activities	Slides
Introduction to Section		Slide 25
Key Terms	[Insert Homeword Ass icon] Key Term Glossary	Slide 26
Composite Restorations	Chapter ___, pgs. ___ (Phinney & Halstead) Chapter ___ (Dietz) [Insert In-Class Activity icon] Using Acid Etch [Insert In-Class Activity icon] Using Bonding Material [Insert In-Class Activity icon] Manipulate Resin Cement	Slides 27-31

[ ] Group Activities [ ] Homework [ ] Individual Activity [ ] Internet Activity [ ] In-Class Discussion [ ] In-Class Activity [ ] Evaluation  

[Insert In-Class Act icon] In-Class Activities

• Using Acid Etch (Part A, Objective 14). Goal: For learners to again practice using acid etch. Instructor should ensure there are enough materials and supplies. Separate learners into teams. Learners should be graded on the procedure steps as outlined on pg. ____, Chapter ____(Phinney & Halstead). Learner workbooks contain check off sheets that can be utilized.
• Using Bonding Material (Part A, Objective 14). Goal: For learners again practice using bonding material. Instructor should ensure there are enough materials and supplies. Separate learners into teams. Learners should be graded on the procedure steps as outlined on pg. ____, Chapter ____(Phinney & Halstead). Learner workbooks contain check off sheets that can be utilized.
• Manipulate Resin Cement (Part A, Objective 15). Goal: For learners manipulate resin cement. Instructor should ensure there are enough materials and supplies. Separate learners into teams. Learners should be graded on the procedure steps as outlined on pg. ____, Chapter ____(Phinney & Halstead). Learner workbooks contain check off sheets that can be utilized.

[Insert In-Class Dis Ques icon] In-Class Discussion

• 1.   What were some of the problems you encountered during the amalgam procedure?

Discuss any problems learners had with the amalgam procedure.  Explain techniques to help them and tell learners that they will improve with more experience.
2.  What will happen if the tooth gets wet with water or saliva during the condensing of an amalgam filling?
The amalgam restoration will fail due to the moisture causing the material to expand.
[Insert Home Ass icon] Homework Assignments
Key Term Glossary. Learners will define key terms listed in the PowerPoint presentation.  They are to enter this glossary on disk, in a dedicated notebook or in a designated part of a notebook. They are expected to augment information from text or lecture with other resources including any available in the school or public libraries or on the Internet and will be graded at the end of the module on completeness and presentation.
Ideas for learners struggling with this material …

• Verbalize Thoughts. Encourage learners to try thinking about the concepts out loud.  Tell them to verbalize their thoughts as though teaching the information to others.  Tell them the act of verbalizing uses a different part of the brain and if able to explain something will really think about it and therefore understand it better.

Ideas for learners who are ahead and want to learn more…

• Research Dental Amalgam Filings. Have learners find out the latest information about dental amalgam fillings at http://www.ada.org. and prepare a short report to present to the class.

Presentation Tools
Note: If you change Objectives or Assignments, don’t forget to change the slides accordingly.

Slide 25	[Insert DM 2-25]	Section 3:  Composite Restorations Discuss each objective for this section in detail. Learners need to know what they will be learning and why. Try to relate it back to their careers as dental assistants.
Slide 26	[Insert DM 2-26]	Key Terms Review each key term and discuss the importance of knowing the definition of each. Homework Assignment: Stop here to discuss the Key Term Glossary assignment.
Slide 27	[Insert DM 2-27]	Part A: Bonding Agents Discuss enamel bonding. Point out that bonding to enamel is primarily mechanical and dependent on penetration of the resin into the irregularities on the enamel surface. Explain that to obtain optimum bond strength, the surface must be conditioned with a phosphoric etching solution, which increases surface area for bonding, and demineralized porous enamel rod ends into which the resin can penetrate. Point out that treatment of dentin is designed to remove the smear layer produced by the cavity preparation, but to leave the dentinal tubules plugged, therefore minimizing any pulpal sensitivity. Explain that most bonding agents are light cured and aid in the adhesion of the filling material to the tooth. Explain that they decrease microleakage, but the tooth still needs retention preps to help hold the material in place. Refer learners to the figure in Chapter ____ (Phinney & Halstead) of a microscopic view of etched enamal. In-Class Activity: Stop here for the in-class activities. Homework Assignment: Stop here to assign and discuss the homework.

Part B: Composite Restorations
Overview

• The shape of the cavity preparation, proper procedures when placing materials, matching the tooth shade, and proper composite restoration finishing procedures are all vital to a successful composite filling.  Development of optimum restoration contour and surface texture will minimize accumulation of plaque and decrease stain retention. Dental assistants must thoroughly understand each step in order to help the dentist ensure quality patient restorations.

Initial Questions and Activities

• 1. Why would patients want tooth colored fillings rather than amalgam?
• Tooth colored restorations are always preferred in the anterior areas of the mouth, but with improvements in composite materials, posterior fillings are preferred in order to get away from the use of mercury and to be more esthetically pleasing.

Key Concepts	References and Activities	Slides
Composite Restorations	Chapter ___, pgs. ___ (Phinney & Halstead) Chapter ___ (Dietz)	Slides 28-31
Assessment Questions	[Insert In-Class Activity icon] Assisting During a Light Cured [Insert In-Class Activity icon] Assisting During a Self-Cure Composite [Insert In-Class Activity icon] Glass Ionomer Restoration [Insert Home Ass icon] Instrument Set Up Review [Insert Home Ass icon] Workbook Assignment [Insert Home Ass icon] End of Chapter Activities	Slide 32
Summary of Module		Slide 33

[ ] Group Activities [ ] Homework [ ] Individual Activity [ ] Internet Activity [ ] In-Class Discussion [ ] In-Class Activity [ ] Evaluation  
[Insert In-Class Act icon] In-Class Activities

• Assisting During a Light-Cured (Part B, Objective 15). Goal: For learners to practice assisting during a light-cured Composite procedure. Instructor should ensure there are enough materials and supplies. Separate learners into teams. Learners should be graded on the procedure steps as outlined on pg. ____, Chapter ____(Phinney & Halstead). Learner workbooks contain check off sheets that can be utilized.
• Assisting During a Self-Cure Composite (Part B, Objective 15). Goal: For learners to practice assisting during a self-cure Composite procedure. Instructor should ensure there are enough materials and supplies. Separate learners into teams. Learners should be graded on the procedure steps as outlined on pg. ____, Chapter ____(Phinney & Halstead). Learner workbooks contain check off sheets that can be utilized.
• Glass Ionomer Restoration (Part B, Objective 15). Goal: For learners to practice during a glass ionomer restoration procedure. Instructor should ensure there are enough materials and supplies. Separate learners into teams. Learners should be graded on the procedure steps as outlined on pg. ____, Chapter ____(Phinney & Halstead). Learner workbooks contain check off sheets that can be utilized.
• [Insert In-Class Dis Ques icon] In-Class Discussion

1.   What must the tooth be conditioned with in order for bonding materials to work?
The tooth must be conditioned with phosphoric acid etch in order to create enamel rod tissue tags for the resin material to penetrate into.
[Insert Home Ass icon] Homework Assignments
Instrument Set-Up Review. Learners will need a computer with a CD-ROM drive to practice to complete this homework. Using the Interactive Skills and Procedures CD-ROM, have learners complete the Specialty Set Up activities. This activity should be a review for learners in preparation of the final exam of the course. Learners should repeat any area that is not clear.
Workbook Assignment. Have learners complete the workbook assignments for Chapter ____ (Phinney & Halstead).
End of Chapter Activities. Have learners complete the Review Questions and Critical Thinking questions at the end of Chapter ____ (Phinney & Halstead).
Ideas for learners struggling with this material …

• Focus on Objectives. Encourage learners to focus on the objectives that they must accomplish by the end of the module.  Tell them to take an assessment of where they stand.  They should ask themselves if they are achieving the objectives or are missing the point?
• Ideas for learners who are ahead and want to learn more…
• Tutor Others. Encourage learners to spend time in the dental lab helping other learners who are struggling with the procedures. Building on their skills while helping others will make a difference in their skill proficiency.

Presentation Tools
Note: If you change Objectives or Assignments, don’t forget to change the slides accordingly.

Slide 28	[Insert DM 2-28]	Part B:  Composite Restorations Review Part A. Make sure that any remaining questions are answered. Introduce Part B. Discuss with learners how varied composite restorative materials are and that they are often called resins or porcelain fillings.  Address the fact that dental manufacturing companies are developing new composite materials often in order to improve these materials and ensure their compatibility with oral tissues as well as the longevity of the restorations.
Slide 29	[Insert DM 2-29]	Composite Compules and Syringe Explain that composite filling materials come in a wide variety of delivery systems.
Slide 30	[Insert DM 2-30]	Composite Restoration Set-up Describe how adequate bonding to enamel is dependent on a dry etched surface that must be kept isolated from moisture. Explain how they must avoid exposure of all light-cured material to light. Also explain that proper finishing procedures establish a smooth surface texture that will reflect light in a similar manner to adjacent tooth enamel, restore proper tooth contour, can minimize occlusal stresses, and have proper adaptation of the resin at the cavosurface margin. Explain that light cured materials undergo some shrinkage as part of the polymerization setting process.
Slide 31	[Insert DM 2-31]	Glass Ionomers and Compomers Address that glass ionomer filling materials can be used in areas where they are not required to undergo occlusal forces and that compomers are the most recent development in dental materials.  Explain that the property of glass ionomer materials to release fluoride has made these more valuable to dentistry.
Slide 32	[Insert DM 2-32]	Assessment Questions Short Activity: Ask the group to answer these questions to assess their comprehension of the material recently presented. Review any material that does not seem clear. Short Activity: Stop and discuss the Case Study at the end of Chapter ____ (Phinney & Halstead). In-Class Activity: Stop here to complete the in-class activities. Homework Assignment: Stop to assign and discuss the homework.
Slide 33	[Insert DM 2-33]	Summary of Module Review with learners the volume of skills they learned during this module and remind them that the more they practice the more proficient and valuable a dental assistant they will become.