Principles of Cavity Preparation I

Dr.Ghada Maghaireh BDS, MS, ABOD

Lecture Outline

Objectives of tooth preparation Factors affecting tooth preparation Stages and steps of tooth preparation

Definition of Tooth Preparation

The mechanical alteration of defective, injured, or diseased tooth to best receive a restorative material that will reestablish a healthy state for the tooth, including esthetic corrections where indicated, along with normal form and function.

Objectives of Tooth Preparation

Remove all defects & provide necessary protection to the

pulp.

Extend the restoration as conservatively as possible. Form the tooth preparation so that under masticatory forces the tooth or restoration will not fracture or the restoration will not be displaced. Allow for functional & esthetic placement of restorative material.

Factors Affecting Tooth Preparation

1. Diagnosis:

The reason for placing the restoration in the tooth Periodontal & pulpal status

Esthetic factor
Relationship with other treatment plans The risk potential of the patient for other dental caries

2. Knowledge of Dental Anatomy:

Gross picture of the tooth both internally and externally must be visualized.

The thickness of enamel, dentin and position of the pulp.

Relation to other supporting tissues.

3. Patient Factors:

The patient knowledge & appreciation for good dental health.

Patients economic status. The patient age.

4. Conservation of Tooth Structure:

Preservation of the vitality of the tooth by avoiding the

application of poor or careless operative procedures on the tooth.

Restorations should be made as small as possible. Small tooth preparations result in restorations that has

little effect on both inter-arch & intra-arch relationships

as well as esthetics.

5. Restorative Material Factors:

Amalgam Vs resin composite. The ability to isolate the operating field. The extension of the problem (i.e. caries).

Stages and Steps of Tooth Preparation

Stages & Steps of Tooth Preparation

1. 2. 3. 4.

Initial Stage Outline form & initial depth Primary resistance form Primary retention form Convenience form

Final Stage
5. Removal of any remaining infected dentin 6. Pulp protection if indicated 7. Secondary resistance & retention forms 8. Procedures for finishing external walls 9. Final procedures: cleaning, inspecting & sealing

Initial Tooth Preparation Stage

1. Outline form & initial depth

Placing the preparation margins in the positions they will occupy

in the final preparation.

Preparing an initial depth of 0.2 to 0.8 mm pulpally of the DEJ position.

3 principles:
1. All weakened enamel should be removed. 2. All faults should be included. 3. All margins should be placed in position to afford good finishing of the margins of the restoration.

2. Primary resistance form:

The shape & placement of the preparation walls that best enable both the restoration and the tooth to withstand, without fracture, masticatory forces delivered principally in the long access of the tooth

Principles of resistance form:

1. Box shape with relatively flat floor.

- Masticatory forces are directed along the long access of the tooth

2. Keep the cavity as small as possible.

- Pulpal & axial walls should be maintained just in dentin if at all DEJ possible. - If caries invaded the interjacent dentin, only the carious dentin should be removed.

3. Rounded well-defined internal line angles.

- Well-defined line angles aid in establishing uniform depth and
prevent rotation of the restoration.

4. Cap cusps or include weakened tooth structure within the restoration.

5. Provide enough thickness of restorative material to prevent its fracture.

- The restorative material may fracture if the cavity preparation is too shallow.

6.To bond the material to tooth structure when possible.

Factors Affecting Resistance Form

Remaining tooth structure: Affect need

and type of resistance form.

Type of restorative material: amalgam Vs

composite.

3. Primary Retention Form:

The shape or form of the conventional preparation that resist displacement or removal of the restoration from tipping or lifting forces

Principles: Depends on the

restorative material
Amalgam In most Class I and Class II, walls should converge occlusally. In class II, occlusal dovetail aid in retention. In Class V, walls diverge outward to provide strong enamel margin, retention obtained by grooves in the dentinal walls.

Composite Micromechanical bond by acid etching & bonding

References: The Art & Science of operative Dentistry (chapter # 6)