The instruments and materials needed:
| Exam Kit | Cotton Rolls |
| Operative Kit | Articulating Paper |
Local anesthesia set-up
Rubber dam set-up
Burs: 330 for primary tooth; 34,556 for permanent tooth #4, #6 round burs.
1. With gauze, dry the tissue in the area to be anesthetized and apply topical anesthetic for 60 seconds. NO tell, show, do for local anesthetic injection. Local anesthetic is administered.
2. After the injection, have the patient rinse.
3. Rubber dam is applied. Remember to tie dental floss to the lingual hole of the clamp before seating it. The floss will be attached to the rubber dam frame or napkin chain for clamp retrieval if dislodged.
4. Begin prep by establishing ideal depth about 1/2 mm into dentin for primary teeth; 3/4 mm into dentin for permanent teeth.
5. Complete the ideal outline form: a series of gentle arcs and curves with no acute angles.
6. Excavate remaining carious material using spoon excavators and/or round burs with a slow speed handpiece. Lateral excavation precedes deep excavation.
7. Complete the preparation with rounded internal line angles, a flat pulpal floor, occlusal convergence, cavity walls parallel to respective external surfaces. Rinse and dry tooth.
8. Place Vitrebond (glass ionomer) in areas where the preparation is beyond 3/4mm in dentin. A base may be needed over the Dycal in very deep preparations.
9. Place small increments of amalgam in the preparation and step-condense (overlap) well. Fill to excess covering all margins. (1-2mm excess).
10. Burnish amalgam. Use acorn carver to create the preliminary anatomy.
11. Carve the restoration with a carver. Remove any amalgam beyond cavo-surfaces ("flash") in fissures using an explorer.
12. Remove the rubber dam and check the occlusion with articulating paper. Adjust occlusion.
13. Smooth the finished amalgam with a wet cotton pellet.
14. Remember to give home care instructions to the patient and parent regarding the local anesthesia and restoration.