Amalgam restorations are tricky, especially when you know that you will be judged, or ranked for the quality of your work. This becomes relevant when you are appearing for NDEB equivalency exam like NDECC, or for a dental school bench test. From patient's point of view, all they want is a good quality filling that serves them for years to come.
Amalgam has that inherent tendency to crumble. So, if a participant or a dentist is not cautious, restoration would break down, and would require immediate replacement.
Here are the 5 things you can do to prevent damage to the marginal ridge of your amalgam restoration.
Condense Amalgam Well: Using a smaller end condenser, push amalgam well into the proximal box. This will ensure that there are no voids or spaces inside the material dwelling in the proximal boxes. It's easy for amalgam to be compressed or crumble, when the major bulk in the box contains voids or uncondensed amalgam.
2. Overfill The Proximal Box & The Occlusal Part Of The Cavity: An underfilled proximal box leads to marginal deficiencies, which is a critical error. Lack of adequate material in proximal box also leads to burnishing difficulties. In the absence of burnishing, amalgam could not withstand the carving , or any other forces, and may crumble. This is especially important in the proximal box.
3.Burnishing The Amalgam In The Proximal Box: This step will ensure that amalgam present at the cavosurface of the proximal box has enough strength to withstand any pulling forces. Amalgam blends with the cavosurface irregularities when compressed during burnishing, and would sustain any normal carving or manipulative forces without breaking apart.
4. Remove Excess Amalgam In Contact With The Band:
This step will ensure that there is least amount of pull off when the band is removed. Since the amalgam is vulnerable and fragile in the initial stage of condensation, or when band is ready to be removed, this step should not be underestimated. Remove all excess amalgam that encroaches upon the occlusal embrasure, and comes in contact with the tofflemire band.
5. Create Mesial Or Distal Fossa When The Band Is Still In Place: In a rush to see how the contact looks like in your class 2 amalgam restoration, you could end up removing tofflemire band sooner than necessary. Now, when you begin carving, you have to scoop out some material in order to create distal or medial fossa. Instrumentation in this area is a source of lateral forces on the marginal ridge. Marginal ridge, hence, could crumble if not properly supported with a band, or burnished along the cavosurface.
Whether you are a new graduate in dentistry, or you challenging NDECC exam for NDEB Equivalency , or Australian Dental Council Practical Examination to become a licensed dentist in Canada or Australia, these guidelines will ensure that this anatomical feature of your amalgam restoration is sound and safe. This will ensure that it goes through the evaluation phase. INBDE examination does not involves practical assessment.
There are many training courses available to help you prepare for this technical task. If you are seeking online training, there is an online course to help you learn the fundamentals of clinical assessments in dentistry. https://www.itdonline.ca/courses/ndeb-acs-ndecc . This course comes with instructor support, and you can access this course till you pass your exam.