cavity preparation and fillings

Operative Dentistry

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Definition of Operative Dentistry Operative dentistry is

the ART and SCIENCE of the

diagnosis, treatment, prognosis of defects of teeth which do not require full coverage restorations for correction.

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Indication of Operative Dentistry Caries; Malformed, discolored,

or fractured teeth; Restoration replacement.

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Program of Operative Treatment Patient assessment Examination and diagnosis Treatment planning Pain control: local anesthetic Isolation of the operating field

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Cavity preparation Matrix application Preparation of materials Insertion and carving of materials Finishing and Polishing

Program of Operative Treatment

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Cavity Preparation

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

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Cavity Structure

walls angles cavity

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Classification of cavity

Class I Class II Class III Class IV Class V Class VI

—G.V.Black in 1908

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Cavity

Simple cavity: only one tooth surface is involved.

Compound cavity: two surfaces are involved.

Complex cavity: three or more surfaces are involved.

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Let us Classify The Cavities

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Class 1

Class 2

Class 1

Class 2

Class 3

Class 4

Class 5

Class 6

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Stages and Steps in Cavity Preparation

Initial cavity preparation stage

Final cavity preparation stage

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Initial cavity preparation stage

Step 1 Outline form and initial depth

Step 2 Primary resistance form

Step 3 Primary retention form

Step 4 Convenience form

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Final cavity preparation stage

Step 5 Removal of any remaining infected

dentin if indicated

Step 6 Pulp protection

Step 7 Secondary resistance & retention form

Step 8 Procedure for finishing external walls

Step 9 Final procedures

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Initial cavity preparation stage

Step 1 Outline form and initial depth

Step 2 Primary resistance form

Step 3 Primary retention form

Step 4 Convenience form

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Outline Form and Initial Depth Ⅰ

Definition: placing the cavity margins in the positions they will occupy in the final preparation;

preparing an initial depth of 0.2~0.8 mm pulpally of the dentinoenamel junction position or normal root surface position.

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Maxillary Class Ⅰ outline form

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Mandibular Class Ⅰ outline form

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Maxillary Class Ⅱ outline form

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Mandibular Class Ⅱ outline form

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Common Error

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Outline Form and Initial Depth Ⅱ

Principles: without any exception all friable and/or weakened enamel should be removed

all faults should be included

all margins should be placed in a position to afford good finishing of

the margins of the restoration.

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Outline Form and Initial Depth Ⅲ

Features: preserving cuspal strength

preserving marginal ridge strength

minimizing facio-lingual extension

using enameloplasty

connecting two close faults or cavities

restricting the depth of the preparation into dentin.

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Initial cavity preparation stage

Step 1 Outline form and initial depth

Step 2 Primary resistance form

Step 3 Primary retention form

Step 4 Convenience form

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Primary Resistance Form Ⅰ

Definition: The shape and placement of the cavity

walls that best enable both the restoration and the tooth to withstand, without fracture, masticatory forces delivered principally in the long axis of the the tooth.

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Primary Resistance Form Ⅱ

Principles: To utilize the box shape with a relatively flat floor to resist occlusal loading by virtue of being at right angles to mastication force;

To restrict the extension of the external walls (keep as small as possible) to allow strong cusp and ridge areas to remain with sufficient dentin support;

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Primary Resistance Form Ⅲ

Principles:To have a slight rounding of internal line angles to reduce stress concentration in tooth structure;

To provide enough thickness of restorative material to prevent its fracture under load.

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Primary Resistance Form Ⅳ

Feature: Box shape

Relatively flat floors

Inclusion of weakened tooth structure

Preservation of cusps and marginal ridges

Rounded internal line angles

Adequate thickness of restorative materials

Reduction of cusps for capping if indicated

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Initial cavity preparation stage

Step 1 Outline form and initial depth

Step 2 Primary resistance form

Step 3 Primary retention form

Step 4 Convenience form

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Primary Retention Form Ⅰ

Definition: The shape or form of the prepared

cavity that resists displacement or removal of the restoration from tipping or lifting forces.

In many respects retention and resistance form are accomplished in the same cutting procedure.

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Primary Retention Form Ⅱ

Principles: depending on the materials Amalgam restoration:

developing external cavity walls that converge occlusally and dovetail design

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The devotail design provide retention form to the occlusal portion of the cavity.

The occlusal convergence of the walls offers retention in the proximal portion of the cavity against displacement occlusally.

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Primary Retention Form Ⅲ

Principles: depending on the materialsComposite restoration:

a mechanical bond between the material

and conditioned, prepared tooth structure.

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Initial cavity preparation stage

Step 1 Outline form and initial depth

Step 2 Primary resistance form

Step 3 Primary retention form

Step 4 Convenience form

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Convenience Form Ⅰ

Conception: The shape or form of the cavity that

provides for adequate observation, accessibility, and ease of operation in preparing and restoring the cavity.

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Convenience Form Ⅱ

Principles:

Allow access for caries removal Allow access for restoration placement Allow access to margins for finishing,

evaluation and cleaning

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Convenience Form

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Final cavity preparation stage

Step 5 Removal of any remaining infected

dentin if indicated

Step 6 Pulp protection

Step 7 Secondary resistance & retention form

Step 8 Procedure for finishing external walls

Step 9 Final procedures

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Removal of any remaining infected dentin if indicated

Definition: The elimination of any infected

carious tooth structure or faulty restorative material left in the tooth after initial cavity preparation.

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Removal of dentinal caries using round burs and spoon excavators

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Final cavity preparation stage

Step 5 Removal of any remaining infected

dentin if indicated

Step 6 Pulp protection

Step 7 Secondary resistance & retention form

Step 8 Procedure for finishing external walls

Step 9 Final procedures

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Pulp protection

Using liners or bases

to protect the pulp or

to aid pulpal recovery or both.

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Final cavity preparation stage

Step 5 Removal of any remaining infected

dentin if indicated

Step 6 Pulp protection

Step 7 Secondary resistance & retention form

Step 8 Procedure for finishing external walls

Step 9 Final procedures

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Secondary resistance and retention forms Ⅰ

Most compound and complex cavity preparations require additional resistance and retention form.

The exception being those preparations that are very conservative.

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Secondary resistance and retention forms Ⅱ

Mechanical forms

Cavity wall conditioning form

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Mechnical form:

Proximal locks Proximal slots

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Slot on gingival wall

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Final cavity preparation stage

Step 5 Removal of any remaining infected

dentin if indicated

Step 6 Pulp protection

Step 7 Secondary resistance & retention form

Step 8 Finishing external walls

Step 9 Final procedures

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Finishing the external walls Ⅰ

Definition: is the further development of a

specific cavosurface design and degree of smoothness that produces the maximum effectiveness of the restorative material being used.

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Finishing the external walls Ⅱ

Objectives: To create the best marginal seal possible

between the restorative material and tooth structure;

To afford a smooth marginal junction; To provide maximum strength of both the

tooth and the restorative material at and near the margin.

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The strongest enamel margin is that marginwhich is composed of full-length enamel rodsthat are supported on the cavity side by shorterenamel rods, all of which extend to sound dentin.

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Finishing the external walls Ⅲ

The design of the cavosurface angle

The degree of smoothness of the wall

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The design of the cavosurface angle: depending on the material

amalgam: 90°

composite: beveling 30°~ 40°

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Final cavity preparation stage

Step 5 Removal of any remaining infected

dentin if indicated

Step 6 Pulp protection

Step 7 Secondary resistance & retention form

Step 8 Procedure for finishing external walls

Step 9 Final procedures

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Final procedures

cleaning inspecting varnishing conditioning

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Cavity preparation Matrix application Preparation of materials Insertion and carving of materials Finishing and Polishing

Program of Operative Treatment

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Matrix Application

Tofflemire Matrix System

Ivory Matrix System

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Matrix retainer, Band & Wedge

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Matrix in Retainer

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Contour Matrix

Rounded instrumentsuch as a spoon excavator

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Matrix on Tooth

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Occlusal View

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Wedge place

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Contour Band

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Ready for restoration

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Cavity preparation Matrix application Preparation of materials Insertion and carving of materials Finishing and Polishing

Program of Operative Treatment

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Armamentarium

Amalgam Capsule Amalgamator Squeeze Cloth Amalgam carrier

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Activate Mercury

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Cavity preparation Matrix application Preparation of materials Insertion and carving of materials Finishing and Polishing

Program of Operative Treatment

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Insertion and carving

Class Ⅰ

Class Ⅱ

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Armamentarium

Amalgam Condensers Anatomic Burnishers Carves— Cleoid or Discoid

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Check condenser fit

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First increment

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Start with the smallest condenser

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Step condenser over mass

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Continue adding increment

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Condense toward walls

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Use alternative instruments

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Overpacked

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Create initial grooves

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Create initial grooves

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Carve to margin

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Enhance grooves

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Remove flash

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Final shape and burnishing

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Completed restoration

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Initial Increment

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Initial Condensation

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Lateral Condensation

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Overpacking

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Marginal Ridge Condensation

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Condense to Margins

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Create Occlusal Embrasure

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Occlusal Embrasure

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Occlusal Embrasure

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Occlusal Embrasure

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Removing Ridge

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Removing Band

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Flash & Excess

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Moving Excess

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Check with interproximal carve

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Instrument on Tooth Structure

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Completed Restoration

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Rubber dam removal

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Cavity preparation Matrix application Preparation of materials Insertion and carving of materials Finishing and Polishing

Program of Operative Treatment

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Polishing

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Evaluate the restoration Class I

Verify that cavosurface margin can be seen— Flash— Underfilled— Voids

Check the overall shape of the anatomy

— Look for bulky ridges that might be high in occlusion

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Evaluate the restoration Class II

Check proximal contact

Check flash and overhangs proximally

Check underfill proximally

Check outline form

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Check Occlusion

Evaluate carefully with marking paper or ribbon in Miller forceps

Check gently in centric occlusion

Check all excursive movement

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