Instruments needed:
| Exam Kit | Cotton rolls |
| Operative Kit | Articulating paper |
| T-band matrix | Amalgam |
| Vitrebond | Wedges |
Burs: Primary teeth: #330, #245
Permanent teeth: 34, 556, 700
Round burs (both #4, #6)
Local Anesthetic set-up
Rubber dam set-up
1. Describe the planned procedure to the patient. (For example: "we are going to clean your sick tooth and fix it with a silver filling".)
2. With gauze, dry the tissue in the area to be anesthetized and apply topical anesthetic for 60 seconds (minimum). Local anesthesia is administered.
3. After the injection, rinse.
4. Rubber dam is placed (floss is tied to the lingual aspect of the clamp).
5. Begin the preparation by establishing ideal depth.
6. Complete the appropriate occlusal outline form. (For a primary tooth, this is accomplished by using a 330 bur). The outline must be a series of gentle arcs and curves and without acute angles. The isthmus width is between 1/3 and ½ the labio-lingual intercuspal width of the tooth.
7. Begin the proximal preparation by extending the occlusal outline form to the marginal ridge. The proximal box is extended buccally and lingually only enough to allow an explorer to pass between the teeth. The proximal box is extended gingivally until an explorer can pass between the teeth along the entire gingival margin and extended axially ½ mm into dentin for primary teeth (3/4 mm into dentin for permanent teeth). The axial wall parallels the proximal contour. The proximal box converges occlusally.
8. The internal line angles should be rounded in order to 1) avoid the relatively large pulp horns and to 2) reduce internal stress in line angles. The pulpal and gingival floors are flat. All unsupported enamel rods on the gingival margin and proximal walls are removed. Due to the occlusal direction of primary enamel rods, no gingival flare is created. The preparation walls are occlusally convergent and are parallel to the respective external surface. The "apparent undermining" of the occlusal surface compensates for enamel rod direction in primary molars.
9. After the "ideal" preparation is completed, any remaining caries is removed using spoon excavators and/or round burs in the low-speed hand piece.
10. Vitrebond (glass ionomer) is placed in any areas where the excavation has extended beyond ideal depth. A T-Band and wedge are placed.
11. Beginning in the proximal box, amalgam is placed and condensed in small
"step" or overlapped increments. The preparation is overfilled by
1-2mm.
12. The amalgam surface is burnished using the acorn or ball burnisher. Initial occlusal anatomy is created with the acorn carver-burnisher. Use the explorer to eliminate any "flash" or excess amalgam beyond cavo-surfaces in fissures.
15. An occlusal embrasure is created by running an explorer along the inside of the matrix band against the external aspects of the marginal ridge. The occlusal surface is carved with the carver. Marginal ridge height, a critical failure point should be at the same height as the adjacent tooth.
16. The T-Band is opened and the matrix band is removed obliquely and laterally. The proximal and gingival margins are checked with an explorer. If adjustments are necessary, they are accomplished with a Hollenback or Gollobin carver.
17. The rubber dam is removed. The occlusion is *checked with articulating paper and the amalgam is adjusted if necessary. The amalgam is smoothed using a wet cotton pellet.
18. Home care instructions regarding local anesthetic effects are given to the patient and the parent; patient should refrain from eating for 30 minutes.
*Instruct the patient to "Gently close until the teeth barely touch." Repeat the instructions until appropriate registration is obtained.