DEPARTMENT OF CONSERVATIVE & OPERATIVE DENTISTRY

Presented by:
Anjali Arora
Roll no.06
BDS final year (Batch2005-06)
 SOME IMPORTANT TERMS :
CAVITY: refers to a defect in the tooth enamel or in both
enamel & dentin due to carious process.

Cavity preparation: It is the mechanical alteration of a

defective, injured, or diseased tooth to receive a restorative material
that reestablishes a healthy state for the tooth including esthetic
corrections where indicated along with normal form and function.
 Class I caries Class II caries Class III caries

Classification of cavity

Class IV caries Class V caries Class VI caries

preparation
Internal walls : surface of
prepared cavity that is inside the
tooth & does not extend onto the
external tooth surface. Its 2
types are:
(1) Axial wall – internal wall parallel
to long axis of tooth.
(2) Pulpal wall : internal wall
perpendicular to the long axis of
tooth & is occlusal to dental
pulp.
External wall : prepared surface
that extends to the external tooth
surface. Eg. Facial, mesial,
distal, lingual & gingival walls.
Floor or seat : refers to prepared wall that is
relatively flat & perpendicular to the occlusal forces
which are directed along the long axis of tooth.

Enamel wall : that portion of the prepared external

wall which is composed of enamel.

Dentinal wall : that portion of prepared external wall

which is composed of dentin. This wall usually
incorporates mechanical retentive features.
Angles in cavity preparation

Line angle : junction of two

walls in a cavity preparation
along a definite line.

Point angle : junction of

three walls in a cavity
preparation at a point.

Cavosurface angle : angle of

the tooth structure formed
by the junction of a
prepared wall & the
external tooth surface.
 What determines cavity design ?
The structure & properties of the dental tissues.

The disease process itself.

The properties of restorative material.

Occlusal relationships & esthetic needs of the

patient.

The economic status, age & health of the patient.

Initial cavity preparation stage

STEP 1: Outline form & initial depth.

STEP 2: Primary resistance form.
STEP 3: Primary retention form.
STEP 4: Convenience form.

Final cavity preparation stage

STEP 5: Removing any enamel pit or fissure, infected dentin
or old restorative material.
STEP 6: Pulp protection.
STEP 7: Secondary resistance.
STEP 8: Finishing the external walls & margins
STEP 9: Final procedures – cleaning, inspecting, varnishing &
conditioning
STEP 1: OUTLINE FORM AND INITIAL
DEPTH
DEFINITION:
Establishing the outline form means:

placing the preparation margins

in the position they will occupy in
the final, preparation, except for
finishing the enamel walls and
margins.

 preparing an initial depth of 0.2-

0.5mm pulpally beyond the DEJ.
FACTORS:

Certain factors affect the decision regarding the extent of the

outline form. They are:

1) Extent of the carious lesion, defect or faulty old restoration.

2) Esthetic requirements which may affect the choice of the restorative

material and modify the cavity design.

3) Occlusal relationships which may require alterations in the outline

form.

4) Contour of the adjacent tooth which may dictate certain

modifications to secure proper form and strength.

5) Cavosurface marginal configuration will vary depending on the

restorative material employed.
 FEATURES:
1) Preserve cuspal strength.

2) Preserve marginal ridge strength.

3) Minimize faciolingual extensions.

4) Use enameloplasty wherever possible.

6) Restrict the depth of the preparation into dentin to a
maximum of 0.2-0.5mm.
 STEP 2: PRIMARY RESISTANCE FORM
DEFINITION-
This is that shape and placement of the cavity walls that best enables
both the restoration and the tooth to withstand, without fracture, the
masticatory forces delivered principally along the long axis of the
tooth.
FEATURES-
The following features enhance primary resistance form:

Relatively flat floors.

Box shape.

Including all weakened tooth structure.

Preservations of cusps and marginal ridges.

Rounded internal line angles.

Adequate thickness of the restorative material.

Reduction of cusps for capping when indicated.

FACTORS-
Certain factors affect the resistance form of the
preparation:

Amount of remaining occlusal contact.

Amount of remaining tooth structure.

Type of restorative material.

Whether or not the restoration can be bonded to the

tooth.
 STEP 3: PRIMARY RETENTION FORM

DEFINITION-
This is that shape or form of the tooth preparation that
resists displacement or removal of the restoration tipping or
lifting forces. Often features that enhance retention form
also enhance resistance form.
PRINCIPLES-
The principles of primary retention form vary according to the
restorative material:

For Amalgam : occlusal dovetail – prevent tipping of restoration &

occlusal convergence of walls.

For Composite : acid etching & bonding ( micromechanical

retention)
- enamel bevel

For cast metal : close parallelism of opposing walls with slight

divergence occlusally

For direct filling gold : elastic compression of dentin during

condensation
 Occlusal dovetail
prevents tipping of the
restoration by occlusal
forces.

Occlusal convergence of the preparation wal

RETENTION FORM
 STEP 4: CONVENIENCE FORM

DEFINITION:

This is that shape or form of the cavity that provides for

• adequate observation
• accessibility
• ease of operation in preparing
• restoring the tooth.

FEATURES:

•Providing adequate width and lateral extensions

•Refining line and point angles
•Providing proximal clearance from the adjacent tooth
•Occlusal divergence for cast gold inlays
 STEP 5: REMOVAL OF ANY REMAINING ENAMEL PIT OR FISSURE,
INFECTED DENTIN OR DEFECTIVE OLD RESTORATIVE MATERIAL left
in the tooth after initial tooth preparation.

PRINCIPLES:
The deeper portions of carious dentin may generally exhibit two
distinct areas:

1.Infected dentin 2.Affected dentin -

 more superficial layer  deeper layer

soft and Leathery in consistency  hard in consistency

 light brown in color.  dark brown in colour.
 high concentration of  It does not contain bacteria and is
bacteria and the collagen is reversibly denatured.
irreversibly denatured.
 This layer must therefore be preserved.
 This layer is not remineralizable
and must therefore be removed.

If infected dentin remains after establishing the pulpal and axial walls
during initial tooth preparation, then it has to be eliminated during the
final tooth preparation stage.
fected dentin can be removed by :-
- spoon excavator
-round steel burs at slow speed
- slow speed round carbide bur with water
coolant.
Ideal method of removing this material would be one in

which minimal pressure is

exerted,
frictional heat is minimized,
 complete control of the
instrument is available.
achieved by-

 use of a round carbide bur, in

-high speed hand piece
-with air coolant
- slow speed

complete control of operator on the instrument

Old restorative material removal is
indicated if :

- it affects esthetics.

- compromise retention of new restoration.

- evidence of secondary caries.

- marginal deterioration of old restoration.

 STEP 6 PULP PROTECTION
This is actually not a step in tooth preparation in the strictest sense it is a step in
adapting the preparation for receiving the final restoration it is considered under
final preparation stage.
Need for pulp protection
Thermal and Mechanical protection

emical protection electrical insulation

Need for pulp protection

Barrier to prevent Pulp medication to allow

microleakage pulp recovery in case of
deep defects
 Pulp Protection
Traditional liners
Liners are volatile or aqueous
suspensions or dispersions of
zinc oxide or calcium hydroxide
that can be applied to a tooth
surface in a relatively thin films'
Liners provide:
 Barrier that protects the dentin
from noxious agents from
either the restorative material or
oral fluids,
 initial electrical insulation,
 some thermal protection.
Bases
Bases are the cements used in
thicker dimensions beneath
permanent restorations
Bases provide :
for mechanical, chemical, and
thermal protection of the pulp.
Examples
 zinc phosphate;
 zinc oxide-eugenol;
calcium hydroxide;
polycarboxylate;,
some type of glass ionomer.
Dycal
The specific pulpal response desired dictates the choice of liner :

 if removal of infected dentin does not extend deeper than 1 to 2 mm from the
initially prepared pulpal or axial wall, usually no liner is indicated.

if very deep excavations , pulpal exposures. Calcium Hydroxide Stimulate

reparative dentin

Liners and bases in exposure areas should be applied

 without pressure.
approx 1-mm thickness (Calcium Hydroxide )
 overlaid with a base for amalgam or cast metal restorations.

for composite restorative materials, a liner of calcium hydroxide is indicated only

when pulpal exposure or the excavation is judged to be within 0.5 mm of the pulp

If deep excavations ,no pulpal exposures zinc oxide eugenol liner
(except for composite restorations)
 Retention groove

Slot

Step- 7 SECONDARY
RESISTANCE AND
RETENTION FORM.
amalgapins.

Beveled enamel margins ETCHING AND SEALING

SECONDARY RESISTANCE AND RETENTION
FORM.
Featured as two forms :

Mechanical feature include:

- retention grooves & coves

- groove extensions

- skirts

- beveled enamel margins

- pins, slots, steps & amalgampins

Conditioning procedures :

- etching & bonding ( for GIC)

Step 8 :Finishing the external walls of the
preparation:
Objectives :
- provides smooth marginal junction b/w the restoration
& tooth
- provide close adaptation b/w the restoration & tooth
- provide maximum strength

Factors :
- direction of enamel rods
- support of enamel rods both at DEJ & at
preparation side
- choice of restorative material
- location of margin
- degree of smoothness desired
Features :

- Design of the cavosurface angle

For amalgam – 90 degree cavosurface angle to
compensate for the low edge strength of
material
Degree of smoothness or roughness of the wall
STEP 9: FINAL PROCEDURES: CLEANING, INSPECTING, AND SEALING

Final procedures in tooth preparation include

 cleaning of the preparation
 inspecting the preparation
 applying a sealer when indicated.

cleaning of the preparation

-removing all chips and loose debris accumulated,

-drying the preparation
if debris clings to the walls -loosen this material with an explorer or small cotton pellet.
It is important not to dehydrate the tooth by overuse of air or by the application of alcohol

 final complete inspection of the preparation done for :

-any remaining infected dentin,

-unsound enamel margins,
-Or any condition that renders the preparation unacceptable to receive the
restorative material.

visual inspection is done to confirm its appropriateness.

 applying a sealer when indicated.

Composite restorations, require some treatment which includes

-etching enamel and dentin and placing a dentin bonding agent

creates a strong mechanical bond between the composite and the dentin.
INDICATION FOR AMALGAM RESTORATION

Moderate to large Class I and Class 11 restorations

amalgam
foundations placed

Class V restorations
Foundations (including for
badly broken-down teeth
Basic bur head shapes.
 Bur no.245 is used

 Pear shaped

 Head length-3mm

 Diameter-0.8mm
PROCEDURE FOR MAKING CAVITY PREPRATION FOR AMALGAM RESORATION
Class 1 cavity preparation design for
other teeth
Step in placing a class 1amalgam
restoration
Step in placing a
class 1amalgam
restoration
Step in placing a
class 1amalgam
restoration
 Classification of Restorative Materials

Restorative Materials can be

classified
Lasting Qualities according to :
Working Properties Mode of Use
Temporary Plastic restorative material Directly used restorative materials
Zinc Oxide- eugenol Amalgam Amalgam
Zinc phosphate cement Cements Cements, Bases
Silicate cement Resins Bonding agents
Self-curing acrylic resin Pure Gold Pit and fissure sealants
Gutta-percha Ceramics Composites
Glass ionomer cements
Permanent Non-Plastic restorative material Direct filling gold
Pure Gold Cast Gold Alloys Direct filling ceramics
Cast Metal Alloy Castable dental ceramics
Amalgam Autocopy milling ceramics- Indirectly used using restorative materials
Ceramics Cast metal restorative materials
Indirect dental ceramic materials
Metal ceramic material
PREVENTION IS ALWAYS BETTER THEN CURE