Scanning Electron Microscopy of Cavity Margins Finished

with Chisels or Rotating Instruments at Low Speed

LEIF TRONSTAD and TORGER INGAR LEIDAL
Dental Institute of Experimental Research, University of Oslo, Blindern, Oslo 3, Norwa^

The quality of the margins of the box portions of Class II cavities finished with chisels
or rotating instruments at low speed was
scored according to a cavity margin index
system proposed by the authors. Adequate
results were obtained with the combined use
of abrasive paper disks and gingival margin

trimmers.
The achievement of smooth cavity walls is
an important aspect of cavity preparation.
Regardless of choice of filling material, the
integrity of the restoration may be affected
by irregularities at the cavity margins.',2
A controversy has existed for some 50 years
as to whether cavity margins should be finished with chisels or rotating instruments;3,4
the supporters of the latter method have divergent views with regard to choice of bur as
well as rotating speed.5-8 The main reason
for the conflicting attitudes toward this problem seems to be the lack of adequate methods of investigation. With the introduction
of scanning electron microscopy in clinical
dental research,9-11 this difficulty has been
overcome, and Boyde and coworkers'2-'5
have in several reports demonstrated the
feasibility of this method in the study of
cavity preparation techniques. However, despite their meaningful illustrations, these
studies seem to suffer from some shortcomings. For instance, the Class II cavities studied were not prepared facing an intact surface of a neighboring tooth, and it appears
questionable whether some of the reported
results could have been reproduced under
all clinical conditions. Also, it may appear
that the evaluation of the findings of such
studies would be easier and probably more
reliable if the quality of the margins were

scored according to the criteria of an indei

system.
The purpose of the present report is tc
illustrate, by means of scanning electron mi
croscopy, the quality of cavity margins fin.
ished with traditional techniques under reproducible, simulated clinical conditions and
to evaluate and compare the suitability of
the different techniques, using a cavity margin index (CMI) system proposed by the
authors.

Materials and Methods

Sixty-five premolars extracted from children for orthodontic reasons were used in
the experiments. The teeth had been fixed
in 10% neutral buffered Formalin and stored
in 70% alcohol. They were selected from a
great number of clinically sound teeth after
the relative flawlessness of their surfaces had
been established by stereomicroscopic examination.
The premolars were mounted in plaster
in groups of six to imitate anatomic contacts
(Fig 1). Mesio-occlusal Class II cavities were
prepared in the teeth. To simulate clinical
conditions as far as possible, no cavity was
prepared in the first (mesial) tooth of each
group. Thus, each cavity was prepared facing an intact proximal surface of a neighboring tooth (Fig 1). All the cavities were
prepared by the same operator (T.I.L.) with
a tungsten carbide bura in an air turbine
with water spray. The margins of the boxes
then were finished with various commonly
used instruments and techniques that will be
described in detail.
CHISELS.-An enamel hatchetb was used to
finish the mesiobuccal and mesiolingual margins of nine teeth. The instrument was held
' No. 1557, S. S. White Co., Philadelphia, Pa.

Received for publication July 2, 1973.

Black 53-54, 10-6-12, Ash, London, Eng.

1167
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1168

TRONSTAD AND LEIDAL

j Dent Res

September-October 1974

FIG 1.-Diagram indicating arrangement of teeth mounted in plaster. Mesioocclusal cavities were prepared under simulated clinical conditions, facing an
intact surface of neighboring tooth. Direction of rotation of finishing burs is
indicated by arrows.

in a pen grasp and used with a pushing

technique. The gingival margins of 19 teeth
were finished with a gingival margin trimmere held in a modified palm and thumb
grasp.l1

ROTATING INSTRUMENTS.-The mesiobuccal,

mesiolingual, and gingival margins of ten
teeth were finished with a steel straight crosscut fissure bur no. ld driven by a conventional engine with water spray at approximately 6,000 rpm. The finishing of the margins was carried out with the bur rotating
"out of the cavity"; that is, if the mounted
teeth are considered to represent the lower
right jaw, the mesiolingual margin was finished with the bur rotating in a clockwise
direction, whereas at the mesiobuccal margin, the bur rotated in an anticlockwise direction. Similarly, at the gingival margin the
bur rotated in a clockwise direction at the
lingual aspect, but was run anticlockwise
toward the buccal side of the tooth (Fig 1).
The margins of another ten cavities were
finished with a steel tapered finishing bur
no. 3.e This instrument was used in exactly
the same manner as described for the fissure
bur.
In ten cavities the embrasure margins
were finished with three-quarter-inch abrasive paper disks: the mesiobuccal margins
with garnet, extra fine grit, no. 616f and the
mesiolingual margins with cuttlefish, regular
grit no. 236.f The paper disks rotated in a
clockwise direction without water spray at
6,000 rpm. A new disk was used for each
margin.
c Black 79-80, 15-80-8-12, Ash, London, Eng.

Ash, London, Eng.

Komet, Lemgo, Ger.
S. S. White Co., Philadelphia, Pa.

Finally, the gingival margin of ten specimens was finished with an inverted cone
diamond bur no. DB 202.9 This instrument
has an extra thin and extra long neck and is
especially made for finishing of gingival margins.'7 The diamond was used in a conventional engine with water spray and with the
same speed and direction of rotation as for
the steel burs.
When the finishing procedures were completed, the cavities were subjected to a heavy
water spray for ten seconds followed by a
blast of air for five seconds. The teeth were
removed from the plaster, and selected teeth
were immersed in 5% sodium hypochlorite
solution for 72 hours, after which they were
cleaned in water. All teeth were dehydrated
and air-dried, and the areas of interest were
given an electrically conducting coat of carbon and gold in a vacuum evaporator. The
margins of the box portion of the cavities
were then examined in a scanning electron
microscope usually operated at 25 kv.
EVALUATION OF THE FINDINGS.-The condition of the cavity margins was scored according to a CMI system. This index system was
designed on the basis of a pilot study in
which several finishing procedures were used.
The criteria for the CMI system are as follows:
Score 0 = perfect margin (Fig 2);
Score 1 = acceptable margin. Few, isolated small chips at the enamel
edge (Fig 3);
Score 2 = imperfect margin. Continuous
row of small chips (Fig 4)
and/or some larger chips at
the enamel edge (Fig 5);
g Dentatus, Hagersten, Swed.

hJSM-50A, Jeol, Tokyo, Jap.

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FIG 6.-Part of unacceptable cavity margin, CMI sco-e 3.

7. enamel.edge
Parti-6 Rof unac
e c ity
mrgin,
C I s
iga=ne
:E^<(a_
has r c..cued
(orig
m
tu.rFIG bXi

ltiX.$.

DE;

v:-SB 11

:s~~~~~~~~~~~l b: ':> B;'

.E

ER
~~~~~~~~~~~~~~

x.

( as

:(

tE ^

:<

z~~~~~~~~~~~~~~~~~~~~~~~~~ce E: b

Se

;b~~~~g~~i X$:;;s~~~~~~~~~~~~g iS:E~~~~~~~~kai'B,

=; i'B,: BiX
jm;}'

>

":E
,#E

te

;:R)E .'E'i~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~i

P'C

S#
iE!

tinuous row

frac-E s | | l | | ::<.+:. .

3. C

X T~
X -t < A V

>>;gi ~iMi-i~ AB nS t
tZ:S~~~~~s:5;:E st i-E f b C (le S- ,(s~~~~~~~~~~~~~~~~~~~~~~iS>!zz>

*-X,9y3\. :E;

t.

::: >6 X yB X i:: .9 i.:SiB'E B1Sz(<o'#ts

&

@W.

.B, Ux

see _~~~~~~~~~.

,^

x, ,-'t

i W; z ;$ ]t; 4 5 i~~~~~~~~~~~s<j:\i':ixt::;"ej"':5#'&S

_~~~~~~.
......

4 ar'R, ~m

cavity
wal (oi mag v150)
sman_rl
Xlchp is see at enme edg (rg ma x10
FI
Pr of imefc cavity magi CMI scor 2 Lag chip (arrws
obere
.isF
at enml ed5g33
e (ori
' ma x 150
of are cip isEsee at ename edg

(oi mag x150)

mag X 150) .~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~........

cavity wall (orig

FIG 5.-Part of

perfect cavity margin, CMI

score ESeamel
2.

(arws)
surace

is oseren at enamel edge (orig mag X150).

FIG 6.-Part of imperfct~al cavity margin, CMI score23 Continuous rowo
.
smalarg chips is seen at enlamel edge (orig mag x15 O)

unacceptable cavity margin, CMI

edge has occurred (orig mag x l 50)

FIG, 7.-Part of
t ure of enamel

score 3.

Continuous frac-

1169

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1170

j Dent Res

TRONSTAD AND LEIDAL

September-October

1974

TABLE 1
QUALITY OF THE EMBRASURE MARGINS OF CLASS II BOXES SCORED ACCORDING
TO THE CAVITY MARGIN INDEX SYSTEM
Score

No. of
3 Impossible

Margins

Enamel hatchet

18

..

...

10

Steel, cross-cut fissure bur

Clockwise rotation
Anticlockwise rotation

10
10

...

1
6

5
3

Steel, plain finishing bur

Clockwise rotation
Anticlockwise rotation

10
10

...

1
7

6
2

Abrasive paper disks

Garnet, extra fine grit
Cuttlefish, normal grit

15
15

13
13

2
2

Score 3 = unacceptable margin. Many

large chips (Fig 6) or a continuous fracture of the enamel
edge (Fig 7).

The scorings were performed at a magnification of approximately 150 times.

Results
EMBRASURE MARGINS.-The condition of
the embrasure margins as scored according
to the criteria of the CMI system is shown
in Table 1.
The enamel hatchet gave only imperfect
(CMI score 2) or unacceptable (CMI score
3) margins. In two instances, a score could
not be assessed with this instrument because
the hatchet had not touched the margin of
the cavity wall (Fig 8).
The quality of the margins finished with
steel burs varied between perfect (CMI score
0) and unacceptable (CMI score 3). However, no appreciable difference was detected
between the effect of the cross-cut fissure bur
and the finishing bur. Both types of bur
gave better margins when run anticlockwise

(backwards) (median CMI score 1) than

when rotated clockwise (median CMI score
2)
Both types of abrasive disks gave consistently good results, and with this finishing
method, 26 of 30 margins were rated as perfect (CMI score 0). At the remaining four
margins, some defects that apparently were
caused by the ultraspeed bur had not been
completely eliminated by the sandpaper
disks. At some of the margins finished with
cuttlefish disks, debris that seemed to originate from the disks was seen adhering to
the cavity wall and the tooth surface (Fig 9).
GINGIVAL MARGINS.-The condition of the
gingival margins as scored according to the
criteria of the CMI system is seen in Table 2.
The gingival margin trimmer gave neatly
finished margins (median CMI score 0) (Fig
10). Only 2 of 19 margins had defects of
such dimensions that a CMI score 2 was warranted. The steel fissure and finishing burs
and the diamond bur all gave imperfect or
unacceptable gingival margins (median CMI
score 3). Regardless of direction of rotation,
these instruments invariably caused a frac.

TABLE 2
QUALITY OF THE GINGIVAL MARGINS OF CLASS II BOXES SCORED ACCORDING
TO THE CAVITY MARGIN INDEX SYSTEM
Score

No. of

Gingival margin trimmer

Steel, cross-cut fissure bur
Steel, plain finishing bur
Diamond bur

Margins

Impossible

19
10
10
10

10
...
...
...

7
...
...
...

2
1
2
1

...
8
7
7

...

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FIG 8.-Pait of embiasuie margin aftet attempt to finish with an enamel hatchet. Instrument
has been in contact swith only limited area (ar rows) of cavity wall (CW) Otherwise, tracks of
ultraspeed bui aie rcognized. ES, enamel surface (orig mag x50).
Ftc 9.-Part of embiasuxe margin finished with a cuttlefish abrasive tlisk, normal grit. l)ebris
originating from (lisk is seeni adhering to cavity wall (CW) and enamel siiiface (ES) (orig mag
x 150).
FIr. 1O.-Part of gingival margin (GM) finished with gingival margin trimmer. Margin is
tatetl as perfect (CMI score 0) ES, enamel surface (otig mag X150)
FLI 11.-Peifect cornet between embrasure margin (EM) finished with garnet abrasive disk,
extra fine grit (CMI score 0), and gingival margin (GM) finished with gingival margin trimmed
(CMI score 0). ES, enamel surface (orig mag X50).

1171
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1172

TRONSTAD AND LEIDAL

j Dent Res September-October 1974

turing of the surface enamel of the gingival

wall (Fig 7).
CORNERS BE ITWEEN 'THE EMBRASURE

WVALLS

Perfect

or ac-

AND THE GINGIVAL 'MARGIN.

ceptable finish of the corners was achieved

by means of the combined Use of abrasive
paper disks and a gingival margin trimmer
(Fig I 1) . With any other instrument, or
coml)ination of instruments tested, the (jlality of the mar gins in these areas was imperfect o0 unacceptable.
OCHER ()BSFR\VAIONS. In many teeth, the
superficial layer of the cavity walls appeared
to hIe only loosely attached to the underlying
enamel. This phenomenon was most clearly
olbserxved in margins finished with chisels oi
abrasive disks, and it was especially evident
in specimens treated with sodium hypochlorite (Fig 12).

Discussion
TIhe CINII system proposed by the authors

poved

to

be

valuable aid in determining

the effect of a finishing method as well as in

comparing the influence of different technilues. The graduation of the margins in
four levels of perfection was found to be

FIG 12.-Part of embrasure margin finished

with enamel hatchet. Cavity wall (CW) seems
to have surface layer that is only loosely attached to underlying enamel. Specimen has
been treated with 5% sodium hypochlorite for
72 hours. ES, enamel surface (orig mag x150).

suitable, and allowed a sufficient, but still

surveyable, differentiation of the findings.
It should be kept in mind, however, that the
CMI system scores of 0 to 3 are values on
an ordinal scale and therefore not suited for
parametric statistical treatment.1819
As mentioned in the introduction, the
question discussed in the literature has been
whether to use chisels or rotating instruments to obtain the best finish of cavity
margins. However, the findings of the present study suggest that this is not the way to
group the suitable and unsuitable instrLuments. There are a large variety of chisels,
ilut according to their manner of operation
they may be divided into two main groups:
(1) instruments used with a pushing or shaving technique with the edge nearly parallel
with the margin (for example, enamel
hatchet); and (2) instruments used with a
scraping techniqLe with the edge approximately perpendicular to the margin (for
example, gingixal margin trimmer). From
the findings of the present study, it appears
that the enltmel hatchet is not a suitable in
striument for finishing put poses. About 20
years ago, Street5 reached the same conclusion. Tzhe gingival margin trimmer, however, consistently gives neatly finished gingival margins, and it is the only of the instruments tested that is suitable for the final
preparation of this part of the cavity. Surprisingly, the difference in quality of margins finished with hatchets and margin trimmers has not been described previously. In
retrospect, it seems logical that there would
be a difference, and it is conceivable that
the observed effect of these instruments is
valid for other hand instruments used according to the pushing or scraping techniques.
The quality of the margins finished with
steel burs was inconsistent and generally too
poor for the method to be recommended. It
was rather unexpected to find that a conventional cross-cut fissure bur gave equally
good results as a bur especially made for finishing purposes. Also, it was interesting to
observe that the steel burs gave considerably
better embrasure margins when run anticlockwise, that is, backwards, than when rotated clockwise which is what the burs are
designed for. This observation might indicate that a redesign of finishing burs should

le considered.

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Vol1 53 No. 5

Boyde and co-workers'3,14 have claimed

that the quality of cavity margins finished
with burs is consistently better when the bur
rotates in toward the tooth surface and into
the cavity ("entry" side) than when the bur
rotates out of the cavity towards the tooth
surface ("exit" side). Thus, it might be argued that in the present study the burs were
used incorrectly since all margins intentionally were finished as exit margins. However,
an accepted and probably valid principle in
cavity preparation is that a bur, when used
at low speed in a conventional engine with
high torque, should always be rotated out of
the cavity to avoid damaging the cavosurface
angle by "crawling" of the bur.17,2021 Evidently, a bur's tendency to "crawl" may be
far less, or even evaded, when using ultraspeed instruments with low torque.
The abrasive paper disks tested gave
neatly finished margins. This is in agreement with previous reports.5"15 Apparently,
it may be inferred from the observations
that the disks should not be too fine, but
really have the ability to remove substance,
and thereby simultaneously, possible defects
at the margins caused by the bur. A too
coarse disk may cause unnecessary deep
scratches in the enamel walls. In some instances, abrasive particles from the disks adhered to the cavity margins to such a degree
that they had not been removed by the cavity toilet procedures. Since the paper disks
that were tested had to be run without water cooling, the temperature at the diskenamel interface rose considerably. Thus, it
is conceivable that glue at the disks may melt
and, with some of the abrasive, be transferred to the enamel wall. Abrasive disks
should, therefore, probably be used only
lightly and intermittently, and they should
be frequently changed.
Of the methods tested, only the combined
use of abrasive paper disks and gingival margin trimmers gave consistently adequate results. However, there is one serious limitation to this method. Sandpaper disks may
be used only if access permits; the embrasure margins of a conservatively cut box cannot be finished with such instruments. Also,
the lack of access may often exclude the use
of other rotating instruments. Thus, there
seems to be an obvious need for a hand instrument in the finishing procedures of the
embrasure margins of Class II boxes. This

FINISHING OF CAVITY MARGINS

1173

instrument, which might be termed an "embrasure margin trimmer," should not work
with a pushing or shaving technique like a
hatchet, but with a scraping technique like
a gingival margin trimmer. Such an instrument has been designed, and prototypes are
currently being tested.
The existence of a surface layer at the
cavity walls which appears not to be firmly
bound to the bulk of the enamel has previously been reported by Boyde and co-workers.13-13 The surface layer has been viewed
as a smeared layer, formed of tissue removed
by the instruments, distorted under pressure,
and welded onto the underlying surface
again.13,14 In a later study, however, Boyde15
alleged that the surface layer consists of
melted enamel. In the present study this
phenomenon was as readily observed in cavities finished with chisels as in those finished
with abrasive disks. The melting temperature of hydroxyapatite is about 1,800 C, and
it is inconceivable that an enamel hatchet
may cause such a rise in temperature on the
enamel surface of a wet cavity. The concept
of a smeared layer is somewhat easier to perceive. It is questionable whether the smeared
layer has any clinical significance at all. But
if truly adhesive filling materials should become available, an additional conditioning
of the cavity walls might be necessary.

Conclusions
The quality of the margins of the box portion of Class II cavities finished with chisels
or rotating instruments at low speed, was assessed by means of scanning electron microscopy. The observable qualitative trait was
assigned a score from 0 to 3 according to the
CMI system proposed by the authors: score
0 = perfect margin, 1 = acceptable margin,
2 = imperfect margin, and 3 = unacceptable margin. The instruments tested yielded
the following median CMI scores for embrasure margins: enamel hatchet, 2; steel
burs, clockwise rotation, 2; steel burs, anticlockwise rotation, 1; abrasive paper disks, 0.
The median CMI scores for gingival margins were: gingival margin trimmer, 0; steel
burs, 3; and diamond bur, 3. Thus, of the
instruments tested adequate results were
obtained only with the combined use of
abrasive paper disks and gingival margin
trimmers.

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1174

TRONSTAD AND LEIDAL

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2. BARTON, R.E.: Fundamentals in Cavity
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8. CANTWELL, K.R.; ALPIN, A.W.; and MAHLER,
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Zahnaerztl Z 23: 717-728, 1968.
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Crystallographic Investigations of Teeth Exposed to Laser Rays, Caries Res 2: 10-18,
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Scanning Electron Microscopy in Clinical
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Class II Cavities, Br Dent J 134: 319-328,
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16. BARTON, R.E.; SOCKWELL, C.L.; and TIAYLOR.
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VANT, C.M.; BARTON, R.E.; BRAUER, J.C.; and

HARRISON, M.L. (eds): The Sat and Science

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