Operative Dentistry FAQs

Fillings: what happens, step-by-step

1. Initial anesthesia with anesthetic agent (e.g., lidocaine 2% with epinephrine 1:100,000) for palatal/buccal injections as needed.
2. Tooth isolation using a rubber dam if the tooth is posterior and moisture control is essential.
3. Removal of decayed tissue with a high-speed handpiece and carbide burs; caries detection using a dye or explorer.
4. Placement of a temporary matrix and wedge to restore contact points; choose composite or amalgam based on location and esthetics.
5. Etching (37% phosphoric acid) for 15–20 seconds, rinse, then apply bonding agent; composite incrementally placed and cured (LED light, 20–40 seconds per increment).
6. Finish and polish to reduce plaque retention; verify bite with articulating paper and adjust as needed.

Worked example: a Class II posterior composite on teeth 2B and 2M typically requires a 60–90 minute appointment with a 24-hour sensitivity window for some patients.

Crowns: prep to provisional

1. Assess tooth structure and plan margins with a rubber dam isolation; decide on material (ceramic, metal-ceramic, or all-ceramic).
2. Gingival retraction and tooth reduction: typically 0.5–1 mm occlusal reduction and 1–1.5 mm facial reduction, with feather-edged margins.
3. Take precise impressions or use digital scanning; fabricate a temporary crown to protect occlusion for 2–3 weeks.
4. At final visit, remove provisional, try-in the final crown, verify fit with the bite, and cement with resin-modified glass ionomer or bonded resin cement depending on material.

Clinical note: Crown prep involves controlled removal to preserve tooth structure while enabling a durable, esthetically compatible final restoration.

Root Canal Basics

Indicated for pulpal necrosis or irreversible pulpitis with radiographic or thermal symptoms. Typical steps include access cavity preparation, canal negotiation, biomechanical preparation with nickel-titanium files (often up to size 30–40), irrigation with sodium hypochlorite, and obturation with gutta-percha.

Timing: a single-visit or multi-visit course depending on infection control, anatomy, and patient symptoms. Recurrence risk minimized with proper sealing and restoration.

Sealants

Indication for children or adults with deep grooves. Procedure involves cleaning, etching, application of bonding agent if needed, and placement of resin-based sealant that bonds to enamel to prevent decay in pits and fissures.

Notes: materials options include light-cured BPA-containing resins; check for resin wear, check occlusion after curing.