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OPERATIVE DENTISTRY
DEFINITION, SCOPE, AND OBJECTIVES

OPERATIVE DENTISTRY
The branch of Oral Health Services dealing with: 1. Prevention. 2. Restoration.

Of the Defects of Natural Teeth

DEFINITION :

Operative dentistry is the science and art dealing with the prevention and restorations of any Defect that occurs in the hard tooth structures.

THE PRACTICE OF OPERATIVE DENTISTRY

It occupies about 70% of the dentist time and necessitates the formation of Cavities of specific design and form to receive the restorative material of choice to restore the tooth.

1. Carious Lesions 2. Non-Carious Lesions


a. Attrition c. Erosion e. Hypo-calcification g. Trauma b. Abrasion d. Hypo-plasia f. Discoloration

3. Replacement Needs e.g. Dissimilar metals fillings, fractured filling, recurrent caries etc.

ATTRITION

ABRASSION

EROSION

DISCOLOR TOOTH

Developmental structural defects Enamel Hypoplasia: Acquired condition

Amelogenesis imperfecta: Hereditary abnormality

Insufficient amount of enamel, soft enamel, friable and easy lost

Dentinogenesis imperfecta: hereditary condition Teeth appear yellow-brown to gray Enamel is fractured easily due to poor support provided by the abnormal dentin

Hereditary * Peg-shaped lateral incisor * Hutchinsons incisor * Mulbery molars


Seen with congenital syphilis

Enamel hypocalcification: (hypomineralized)

Accidental traumatic fracture of teeth.

Ditched Amalgam Restoration

RESTORATION:
Is an artificial substitute which replace the missing portion of the hard tooth tissues. Restorations must not only retain the tooth to its normal form, function, strength, and esthetic, but they must also provide for the health of the supporting tissues. Faulty restorations are a common etiological factor of periodontal disease. An unfavorable response of the periodontium will result in occlusal disharmonies. If not corrected, thus causing traumatic occlusion.

AIMS & OBJECTIVEs:


RESTORATION OF THE DEFECTS OF TOOTH/TEETH:

Results:
1. 2. 3. 4. 5. 6. Proper Tooth Form and shape Proper Functioning of the tooth Improving the strength of the tooth Improving the Esthetic Proper relationship with adjacent teeth and gingiva , improving the integrity of the tooth supporting tissues Improving the integrity of stomatognathic system

All of Above enhance the general health and welfare of the patient.

COMBINATION
SCIENCE
1. Basics of Medicine. 2. Basics of Engineering & Physics.

ART
1. Manual Skill. 2. Artistic approach.

To practice Operative Dentistry, a Dentist should have following four abilities:


1. To be a good doctorknowing the Basic Medicine / Applied Biology. 2. Can use the basic principles of Engineering and Physics. 3. Highly developed Technical / Manual skill. 4. Can demonstrate Artistic Abilities.

Two Main Braches:


1. Preventive dentistry

1. Primary Prevention 2. Secondary Prevention 3. Tertiary Prevention

A. Diagnosis

2.

Restorative dentistry

B. Interception C. Prevention D. Preservation E. Restoration

Primary Prevention
To prevent the occurrence of carries,need:
a. Multiple fluoride therapy b. Good Oral Hygiene practice c. Pits and fissures Sealants d. Diet Counseling e. etc.

Secondary Prevention
To arrest the carries at its initial stage ,need the measures :
a. To arrest the carries b. For re-mineralization of incipient carries c. Like minor remedies e.g. small pit fillings. d. etc.

Tertiary Prevention
To treat the established form of carries and prevent its spread and recurrence:
. Direct and indirect filling of the cavities of the teeth

DIAGNOSIS

Proper diagnosis of defect include:


* history taking * clinical examination * special investigations/tests to find out the :

* location of defect * extension of defect


* correct treatment planning it include: * the design of tooth preparation * the selection of restorative materials * the selection of restorative procedure

INTERCEPTION
To prevent further loss of tooth structure by Halting active disease. It includes : in Patients home care habit. Removal of the Lesion. Altering Tooth form. Recontouring of tooth Correct Occlusion etc.
Change

PREVENTION Prevention of recurrence of caries It is possible when the principle of extension for prevention during cavity preparation is applied. For example : Bringing the margins of the final prepared to the self-cleansable areas of the tooth by including the non self-cleansable areas in the cavity of the tooth

PRESERVATION During the tooth preparation for restoration , it is essential to preserve the: Important anatomy of tooth.

Pulp vitality. Health of Supporting Tissue. Health of Oral Tissues. Health of Entire Masticatory System.

RESTORATION OF THE DEFECTS OF TOOTH/TEETH The following aims are expected from the restoration :
1. 2. 3. 4. 5. 6. Proper Tooth Form and shape Proper Functioning Improving the Esthetic Proper relationship with adjacent teeth and gingiva Integrity of the tooth supporting tissues Integrity of stomatognathic system

All of Above enhance the general health and welfare of the patient.

PROGNOSIS
The prognosis of the restoration depends on the: a. Status of the pulp. b. Status of the periodontium. c. The extent of lost structure of the tooth. The pulp and periodontium should be Vital and healthy after the restoration of the tooth.

DENTAL CARIES DEFINITION It is a disease of the calcified tissues of the teeth, characterized by a demineralization of the inorganic portion and destruction of the organic substance of the tooth

CAVITY The term cavity refers to a defect in enamel, or in enamel and dentin, usually resulting from the pathologic process of dental caries.

Prepared cavities The performance of those


dental surgical procedures required to expose the carious lesion, permit removal of affected tissues, and so shape the remaining dentin and enamel as to contribute to biologically and mechanically sound restoration.

RESTORATIVE MATERIALS The replacement of lost hard tooth structure cannot be achieved without using the proper restorative dental materials. This include: a. Temporary restorative materials b. Permanent restorative materials

PERMANENT RESTORATIVE MATERIALS INCLUDE

Metal
Amalgam Gold Noble metal Cobalt-chromiumalloys Nickel-chromiumalloya

Polymers
Composite resin Glass-ionomercements Acrylic

Ceramics
porcelain

PERMANENT RESTORATIVE MATERIALS Direct restorative materials * Esthetic restorative materials (composite resin, Glass- ionomer cements and compomer) * Metalic restoration (amalgam, gold foil)

Indirect restorative materials * Cast gold restoration * Porcelain * Castable ceramic restoration

Multiple Procedures to Conserve the Tooth:


Cavity preparation.
1. 2. 3. 4.

.1

Filling with plastic materials (e.g. Amalgam, Composite etc. Filling with Casts (e.g. Inlay, Onlay) Fillings using pins & posts. Filling with Gold.

Amalgam filled teeth

Gold filled teeth

Pins retained restorations

Multiple Procedures to Conserve the Tooth:


2. Conservative esthetic procedures e.g. filling of the cavities in the teeth tooth coloured materials. Additional Conservative Esthetic Procedures (Cosmetic Dentistry). 3. TO IMPROVE: a. Shape and Form of teeth.
Cosmetic Contouring (masculine smile feminine smile) Laminate veneers. .ii Diastima Closure. .iii Alteration of Embrassures. .iv etc. .v .i

with

b. Symmetry and proportionality of teeth Composite build up. c. Position and alignment Composite build up / veneers. d. Surface Texture.
To reproduce pit & fissures, prominences, facets etc. (to proper reflection of light).

e. Colour To match the discoloured teeth with adjacent teeth: i.Accurate shade selection of the restorative material ii.Bleaching treatment f. Translucency. (Degree of translucency is related how deeply light penetrate into tooth or restoration
before it is reflected outward).

Different procedures to restore the translucency of the teeth:e.g. a color modifier is applied under direct composite veneer on a discolored tooth,color modifiers are incorporated in the restoration to match the lines or spotes (e.g. white patches) of the adjacent teeth.

COSMETIC RECONTOURING

DIASTIMA CLOSURE

Alteration of Embrasure

NEED BLEACHING OR VENEERING

Multiple Procedures to Conserve the Tooth:


4.

Conservative alterations of tooth contours and contacts:

a.alterations of shape of natural teeth. b.alteration of Embrasures. c.correction of Diastemas. 5. Microabrasion and Macroabrasion: Microabrasion: To remove intrinsic stains-------which extend 0.2 to 0.3 mm down deep in enamel surface--------by appling a paste containing an acid and abrasive particles-------using special rubber cup with fluted edges in slow motor handpiece. Macroabrasion: To remove the intrinsic stains or defects-------using 12-fluted composite finishing bur or a fine grit finishing diamond stone in a high speed handpiece------no use 30fluted composite finishing bur-----final polishing with an abrasive rubber point

6.

veneer:

A veneer is a layer of tooth-colored material that is a plied on the surface of the tooth to restore localized or generalized defects,intrinsic discoloration and male formed tooth. I. Partial veneer ii.Full veneer 7.

Acid-Etched,Resin-Bonded Splints: