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In this session, I practice doing fissure sealant for partially erupted 46. I did not do well for 46, so I had another try on 48.
For 46. I dispense the material directly on all pits and fissures, however, it turned out that the material was not evenly spread throughout the fissures, and there were some material on the cusps of the tooth.
Therefore, it is better to dispense the material in the central pit (not too much) and then use small end instrumen (dycal) to spread to the fissures or using thumb to lightly spread to all fissures.

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first rubber dam on a real person (01/02)

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first rubber dam on a real person (01/02)

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This is the first rubber dam I placed on my classmate.
I tried put on the dam first and then the clamp, however, in real person's mouth, because there is lot of saliva, this method does not work as well as in model teeth
Therefore, I place dam and clamp together.
Also, in real person's mouth, to prevent the dam from influencing breathing, I need to hold the dam once I place the clamp on.

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these are the materials needed for impression (alginate, spatula, bowl, measuring cup, tray adhesive, maxillary tray-the right one, and mandibular tray-the left one, bite reg material, cold water for mixing alginate, and hot water for bite reg)
there are some tips for doing impression:
use a small amount of adhesive before loading alginate onto the tray
mixing time should under 60 seconds otherwise the material will harden
stand behind the pt when doing upper arch
stand at the side of pt when doing lower arch
should first align the tray with molars to ensure all the teeth are included
when remove the tray, place finger around the 1st molar region

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the steps of doing a bite registration after taking impression 

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fold the wax into an appropriate size and shape
soften the wax in hot water
place on pt occlusion surface and ask them to bite down

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This is the impression I made for upper arch. The 8s were not fully included

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This is the impression I made for lower arch
Overall it is okay. However, there was some excess material  around the anterior teeth

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These are the retractors that might needed when taking clinical photographs. The choice of the retractor depends on which surface we are going to focus on. Also, we need to adjust the setting so that the photograph appears clear. In clinic, we need to turn on flush (setting TTL/TTLBL). Do not use auto otherwise posterior teeth will be blurry. Set to aperture (mode A). When f stop increases, the depth of field will increase. Use f10-f16 for full face, and f22-f36 for intra oral image. ISO is the brightness of the image, when we increase iso, the brightness increase. ISO 100 for intra oral and ISO 400-800 for full face. White balance usually set as auto.

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For 46 restoration, I recreated the cusps but the distal buccal cusp is flatter than it should be. Therefore, I need to familiarize with the cusp size of 46, and remember the major features. Usually, there are five cusps--three buccal and two lingual. The mesiobuccal cusp is the largest, then mesiolingual, distolingual, distobuccal, and the distal cusp.

I can use ball burnisher to condense the material into the floor of the cavity. Also, I can use the carving tool to recreate the pit and fissure.

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For 16 occlusal, I left some caries on the floor of the cavity. I learn that  if the cavity is greater than 3.5/ 4 mm, we need to leave soft dentine and put gic base to arrest the caries and also to replace the bulk of dentine.

If it is a small/ moderate cavity, we leave firm dentine and then restore.
Also, after removing the caries, there might be some staining on the floor of the cavity, we do not need to remove that as long as it feels hard.

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rubber dam and retraction cord (size 00) are placed for cervical restoration, the retraction cord invert the rubber dam into the gingiva and this gives me a better view to work

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this is another tooth after cavity preparation (selective caries removal). however, the cavity outline should follow the location of caries, I need to remember this to prevent over-preparation

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this is the final restoration, the surface is a little bit rough. there are two ways to prevent this: I can use a longer stroke when adapting resin composite. 2. polish after restoration using high speed football bur (apply light pressure to polish).
Since the restoration is close to the gingival margin, after restoration, I will also need to assess the restoration around gingiva margin using probe.

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this is pulponomy done with tooth 55. this tooth has a MO caries lesion
since maxillary second molar has three roots, three orifices need to be exposed (the red dots)

I learned that I need to de-roof the roof chamber first to create an outline, and then using spoon excavator to amputate the pulp. this can prevent over-preparation.

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this is the second step---applying MTA onto the pulp, to repair the root and seal the root

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this is the third step --applying gic
for the mesial part of the tooth, I did not recreate an appropriate contact point. I could correct by adapting matrix band better to the tooth

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this is after doing occlusal and proximal wall reduction. for proximal wall, I did not make it straight enough, I should angle the bur parallel to the long axis of the tooth and making long stroke otherwise it will be rough

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this is the final stainless steel crown, the height is good but for the mesial aspect, there is lack of contact area, I need to be mindful that not to over prepare the proximal wall

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this is another tooth (75)
before deroof the pulp chamber (red colour)

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after deroof the pulp chamber and amputate the root,  wet cotton palette (damp in saline) is used to arrest bleeding

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after done occlusal (1-1.5mm) and proximal wall reduction

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looking at both lingual and buccal aspect to check the occlusal reduction by comparing to the height of the neighbouring tooth

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this is a tooth (26) with post eruptive breakdown (two dots in the picture), there is no caries
therefore, we need to remove the breakdown and then place restorative material

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this is after the restoration placed
when doing preparation for restoration, need to make sure that there is enough depth for the material (around 2mm)

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this is when fissure sealant is applied onto the tooth occlusal surface

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64 DO, 65 MO caries removal: selective caries removal is applied
need to make sure that the DEJ is clear and not to extend too much occlusally, move vertically to find the caries first and then extend occlusally as needed.

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shade matching-before placing rubber dam, under natural light

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this is a fractured tooth (21), before bevelling
bevelling need to be done next to remove the sharp edge of enamel, and make the restoration look more natural

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palatal wall has be done by using clear strip, now mesial wall is built by using vertical matrix

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this is after recreating the proximal wall. the height of the wall is as same as the neighbouring tooth,
the contact area is a bit tight, therefore, disc can be used to polish the interproximall area

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This is after selective caries removal of MOD caries, DEJ was cleared and some firm dentinal caries left on the floor of the cavity

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since the mesial and distal wall are thin (less than 2mm), I removed the wall and opened the contact area

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After removal of walls, I created depth cut using high speed bur, and then join them together. For this case, the indication for cuspal coverage is that the caries is extending to the cusp and we want to support the cusp and the restoration by doing cuspal coverage.

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this is when restoration was done and before polishing.
I built on distal and mesial wall first and then did the occlusal part. The areas that need improvement are: adapting matrix band better to avoid any excess. Also, need to recreate the cusp better, the cusps need to be more pointy, can comparing this with the neighbouring tooth.