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Essentials of Dental Assisting
This practical guide offers everything a dental assistant needs to know and
more. With full color photographs and detailed step-by-step instructions,
this essential reference focuses on the core clinical skills and the knowledge
a practicing dental assistant needs. Also delves into the “behind-the-
scenes” skills of dental assisting, such as legal issues, infection control,
common medical emergencies, patient pain and anxiety control, radiography
and more. This guide is ideal for staff training and provides experienced
staff with a comprehensive reference to patient care.
• Easy-to-follow organization offers 28 easy-to-read chapters that cover
profession basics and sciences, infection control, chairside treatment
foundations, patient care and clinical procedures
• Step-by-step procedures for skills that dental assistants must master,
featuring a consistent format that includes a goal, equipment needed,
chronological steps, and rationales
• Specific chapters on specialized dentistry such as periodontics,
endodontics and pediatric dentistry
• Full-color artwork – hundreds of photos, illustrations and charts make it
easy to see exactly how to accomplish tasks
Book, 505 pages
Book ISBN# 978-1-941807-34-7
“A lot of dentists are training
their assistants nowadays …
The guide is clear, clean, concise
and easy to understand.”
– Doni L. Bird, CDA, co-author
Misch’s Avoiding Complications
in Oral Implantology
See how to effectively manage ALL dental implant complications
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Book, 891 pages
Book ISBN# 978-0-323-37580-1
Fluoridation Facts is the ADA’s premier resource on fluoridation,
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338 PARTEight ✴ Restorative Dentistry
FIGURE 21-7 Placement of a retention pin for added internal strength.
• The dentist will evaluate the tooth to be restored.
• The dentist will administer local anesthesia (see Chapter 14).
• The assistant will prepare and assist in the type of moisture
control (cotton roll, dry angles, dental dam) to be used for
the procedure (see Chapter 10).
• The dentist will prepare the tooth, including using dental
hand instruments and dental handpieces with rotary instru-
ments (see Chapter 19).
• The dentist will specify which dental materials are to be used
(see Chapter 20).
• The assistant will prepare and assist in the placement of the
• The assistant will prepare and assist in checking the
• The dentist will finish and polish the restoration.
See Procedure 21-4: Assisting in a Class II Amalgam Restora-
tion, and Procedure 21-5: Assisting in a Class III or IV Com-
If the loss of tooth structure is greater than the remaining
natural tooth, then the dentist must decide whether to (1) move
ahead and restore the tooth with an amalgam or a composite
material, or (2) change the treatment plan and replace the tooth
structure with a cast restoration. Bonding techniques and reten-
tion pins are best suited for use in teeth that require very large
restorations with little tooth structure remaining to provide
strength and retention for the amalgam.
Retention pins provide internal strength to the placed mate-
rial (Figure 21-7). These pins are available in a variety of diam-
eters (widths) and styles to fit all sizes of teeth. Because all
retention pins are very small (approximately one half the size
of a bur) and are easily dropped, the dental dam should be
indicated for this procedure.
A veneer is a thin layer of tooth-colored material that can be
directly bonded onto the tooth or fabricated in the laboratory
using a porcelain material and then cemented to the tooth
surface (Figure 21-8).
Veneers are used to improve the appearance of teeth that
are slightly abraded, eroded, or discolored from stains or from
endodontic treatment. Veneers can also be used to improve the
alignment of teeth or to close a diastema.
Vital bleaching, also referred to as tooth whitening, is a tech-
nique that involves the whitening of the external surfaces of the
teeth. This desired whitening is completed for esthetic purposes,
not for restorative purposes (Figure 21-9).
FIGURE 21-8 Veneers placed on teeth #8 and #9 to reduce
discoloration and to cover stain. A, Before placement. B, After
placement. (From Heymann HO, Swift EJ, Ritter AV: Sturdevant’s
art and science of operative dentistry, ed 6, St. Louis, 2013,
CHAPTER 21 ✴ Restorative Procedures 335
bonding material may be required before the amalgam or com-band
posite is placed.
A tooth that is to receive a Class II, III, or IV restoration will
have a minimum of one interproximal wall or surface of the
tooth removed during the cavity preparation stage. By including
the use of a matrix system, a temporary wall is created, against
which the restorative material is placed until the
The universal retainer and matrix band is the system most
commonly used when placing posterior restorations (Figure
21-1). The retainer firmly holds the matrix in place. A matrix
is a metal or clear plastic band used to replace the missing
proximal wall of a tooth during placement of the restorative
material. (Matrix is singular. The plural form is matrices.) Clear
plastic matrices are used for anterior composite restorations.a
A wedge is triangular or round and is supplied in wood or
plastic (Figure 21-2). The wedge is available in different sizes,
depending on the location and space between the teeth. By
Regardless of the type of dental material selected, understand-
ing the steps of a restorative procedure is important. The steps
include removal of the decay by the dentist, preparation of the
tooth cavity, placement of dental materials, and finishing the
The most detailed part in restoring a tooth is the cavity
preparation. The purpose of cavity preparation is to remove the
decay along with a small amount of healthy tooth structure,
which, when completed, provides a solid foundation for the
restorative dental material to be placed as a final restoration. To
understand the different types of tooth preparations, you can
review the types of cavity classifications in Chapter 12.
The dentist will use a high-speed handpiece with a variety
of burs and hand instruments to accomplish this preparation
step. Once the decay is removed, the dentist will use the high-
speed handpiece with a different-shape bur to place retentive
grooves in the preparation. These small grooves in the tooth
allow the material to flow into the groove area, harden, and
create the retentive result.
In the next step, the dentist determines the type of restorative
material that will be used. This decision is based on the size,
shape, and location of the preparation. With small preparations,
an amalgam or composite material can be directly placed over
sound dentin. With deeper preparations, a cavity liner, base, and
FIGURE 21-1 Matrix and wedge correctly positioned.
FIGURE 21-2 Assortment of wedges. (Courtesy Premier Dental
Products Company, Plymouth Meeting, Pennsylvania.)
Dental Conditions Requiring Esthetic Dental
• Discoloration attributable to extrinsic or intrinsic
• Anomalies caused by developmental disturbances
• Abnormal spacing between teeth
Dental Conditions Requiring Restorative Dental
• Management and treatment of carious lesions by
restoring them with a permanent restoration
• Restoration of defects in tooth structure
• Replacement of failed restorations
• Abrasion or wearing away of tooth structure
• Erosion of tooth structure
Restorative dentistry is indicated when teeth are to be
restored to their original structure with the use of direct and
indirect restorative dental materials. The common types of pro-
cedures include amalgam restorations, composite resin restora-
tions, and complex restorations.
Esthetic dentistry is directed on improving the appearance
of teeth by restoring imperfections with direct and indirect
restorative materials or with the use of whitening techniques.
The common types of procedures are composite resin restora-
tions, resin veneer restorations, and tooth whitening.
336 PARTEight ✴ Restorative Dentistry
FIGURE 21-3 Assorted matrix bands.
FIGURE 21-4 Burnishing the matrix band will provide a better
contour. (From Heymann HO, Swift EJ, Ritter AV: Sturdevant’s
art and science of operative dentistry, ed 6, St. Louis, 2013,
make proper contact with the adjacent tooth (Figure 21-4).
To contour the band, place the band on a paper pad, using a
burnisher or handle end of cotton pliers. Rub the inner surface
of the band until the ends begin to curl. This thins the band
and provides a normal curvature of the band to fit around the
The universal retainer, also referred to as Tofflemire retainer, is
a device that holds the matrix band in position. The compo-
nents of the universal retainer are described in the box titled
“Components of a Universal Retainer.”
See Procedure 21-1: Assembling a Matrix Band and Univer-
1. Spindle: This internal screwlike pin fits into the diagonal
slot to hold the ends of the matrix band. When the retainer
is assembled, the spindle point must be clear of the slot
while the band is slid into the slot and then tightened.
2. Outer guide slots: Also known as guide channels,
these slots are located at the end of the retainer and
serve as channels to guide the loop of the matrix band.
The channel selected is determined according to the
quadrant that is being treated.
3. Outer knob: The outer knob is used to tighten or loosen
the spindle within the diagonal slot and to hold the
matrix band securely in the retainer. To tighten the
Components of a Universal Retainer
(stabilizes band in holder)
2 Outer slot to hold
position of band
Diagonal slot to receive ends
placing a wedge, the proper anatomic contour of restoration
Posterior Matrix System
The matrix band and universal retainer should be assembled
before the procedure to save time during the procedure.
Matrix bands selected for Class II posterior restorations are
made of a flexible stainless steel and are available in universal
and extension sizes. The band wraps around the tooth, creating
a temporary wall (Figure 21-3).
Before the band and the retainer are assembled, the band
should be contoured in the proximal area so the tooth can
The Handbook of Clinical Techniques in Pediatric Dentistry
This handy reference equips clinicians with added expertise and skills to identify issues of the
developing dentition. The handbook clearly describes treatment procedures for the primary and
young permanent dentitions, including pulp therapy for primary and young permanent molars,
extractions, space maintenance, and more. The most common treatment needs are discussed with
the goal of increasing clinician and staff confidence while decreasing chair time and stress.
Book, 188 pages
Book ISBN# 978-1-118-79269-8
Fluoridation Facts assists policy makers
and the public in making informed decisions
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