Cavity preparation is the mechanical alternation of defective, injured or diseased tooth in order to best receive a restorative material that will reestablish a healthy state for the tooth including esthetic correction when indicated, along with normal form and function. The reason of the need for restoration as follow: To restore the integrity of the tooth surface. To restore the function of the tooth. To restore the appearance of the tooth. To remove the diseased tissue from the tooth.
3
CLASSIFICATION
(G.V. BLACK CLASSIFICATION)
Black suggested that it was necessary to Remove additional tooth structure to gain access and visibility . Remove all trace of demineralized enamel and dentin from the floor, walls and margins of the cavity. Make room for the insertion of the restorative material in sufficient bulk to provide strength. Provide mechanical interlocking retentive designs. Extend the cavity to self-cleansing areas to avoid recurrent caries.
6
CLASS I
The lesions involving the occlusal surfaces of molars and premolars, the occlusal 2/3 of buccal and lingual surfaces of molars, and the palatal pits in anterior teeth. CLASS II
The lesions involving the proximal surfaces of the posterior teeth with access established from the occlusal surface. CLASS III
The lesions involving the proximal surfaces of anterior teeth which may or may not involve a labial or a lingual extension & not involving incisal edge. 7
CLASS IV
The lesions involving all proximal surfaces of anterior teeth which involves the incisal edge.
CLASS V The lesions involving the cervical third of all teeth, including the proximal surface of posterior teeth where the marginal ridge is not included in the cavity preparation.
8
ACCORDING TO SITE INVOLVED Site 1 . Pits, fissures and enamel defects on occlusal surfaces of posterior teeth or other smooth surfaces. Site 2 . Approximal enamel in relation to areas in contact with adjacent teeth. Site 3 . The cervical one third of the crown or, following gingival recession, the exposed root surface.
ACCORDING TO THE SIZE AND EXTENT OF THE LESION AT THE TIME OF IDENTIFICATION Size 0 . The earliest lesion that can be identified as the initial stages of demineralisation. This needs to be recorded but will be treated by eliminating the cause and should therefore not require further treatment, Size 1 . Minimal surface cavitation with involvement of dentine just beyond treatment by remineralisation alone. Some form of restoration is required to restore the smooth surface and prevent further plaque accumulation, Size 2 . Moderate involvement of dentine following cavity preparation. Remaining enamel is sound, well supported by dentine and not likely to fail under normal occlusal load. The remaining tooth is sufficiently strong to support the restoration,
10
Size 3 . The lesion is enlarged beyond moderate. Remaining tooth structure is weakened to the extent that cusps or incisal edges are split, or are likely to fail if left exposed to occlusal load. The cavity needs to be further enlarged so that the restoration can be designed to provide support to the remaining tooth structure, Size 4 . Extensive caries or bulk loss of tooth structure e.g. loss of a complete cusp or incisal edge has already occurred.
11
Obtaining Outline Form Obtaining Primary Resistance Form Obtaining Primary Retention Form Obtaining Convenience Form Removal of Remaining Carious Dentin Obtaining Secondary Resistance & Retention Form Providing Pulp Protection Finishing of Enamel Walls & Margins Performing the Toilet of the Cavity
13
ARMAMENTARIUM
Basic Instruments mouth mirror, explorer, tweezer, etc. Hand Instruments Excavators, enamel hatchet, monoangle or biangle chisels, Gingival Marginal Trimmer. Rotary Instruments Burs No.-carbide burs 55, 56, 57. Ultraspeed and conventional speed contrangle handpiece. Safety glasses.
14
Definition:
These are pit and fissure type cavities that involve the occlusal surfaces of molars and premolars, the occlusal 2/3 of buccal and lingual surfaces of molars, and the palatal pits in anterior teeth.
15
16
remain unnoticed until the lesion becomes of a considerable size. 2. A conical spread in both enamel and dentin, with the bases of cones at the Dentinoenamel Junction. 3. It is rapid burrowing at the dentinoenamel junction. These lesions may involve one or more surfaces and hence a simple or compound cavity should be prepared.
17
Marginal ridge walls should be 1/2 distance from mesial and distal pit to the crest of each marginal ridge and in a direction parallel to these ridges.
20
Pulpal Floor mesio-distally is flat and perpendicular to the long axis of the tooth
23
INTERNAL FORM
Buccal and Lingual Walls are Parallel to each other and to the Long Axis of the Crown (Provides retention)
BUCCO-LINGUAL VIEW
Buccal, Lingual, and Proximal Walls meet Pulpal Floor at sharp angle Buccal and Lingual Walls meet Proximal in smooth, rounded form.
29
30
automatically for effective retention and, therefore, no special retentive features are required.
31
34
Procedure
The outline form is performed by first gaining access through the enamel to the carious dentin floor of the cavity followed by making the necessary cavity extensions.
35
36
The bur is held at a right angle to the involved surface of the tooth and light pressure in an in-and-out direction is exerted. Cutting is continued until the Dentinoenamel Junction is reached.
37
The
bur is rotated, and carefully introduced through the opening just obtained, so that its weak corners do not touch the enamel and get dulled.
38
below the dentinoenamel junction 1/2-1 mm. Gentle pressure is applied in the direction of required extension.
moving in-and-out of the cavity and at right angle to the tooth surface. In this way, the bur will undermine and lift the cut enamel, and at the same time unclog itself.
39
Deepest or most carious pit entered with a punch cut using No. round bur or No.245 inverted cone bur oriented perpendicular to long axis of tooth. Depending on cuspal incline, depth of prepared external walls is 1.5 2 mm and 1.5mm pulpal depth measured at central fissure. Desired pulpal depth 0.1 to 0.2 mm into dentin.
41
Maintaining depth, cavity extended to include all defective supplemental and developmental grooves (No.57 plain St. fissures carbide bur). Isthmus width of 1/4th intercuspal distance so that it does not reduces the strength of tooth (Diameter of bur should be considered). If fissure extends farther into marginal ridge, slight occlusal divergence is given, to prevent undermining of marginal ridge & to provide dentinal support.
42
Pulpal floor remains at initial ideal depth, relatively flat, in dentin and provides a strong stable seat for restoration.
Enameloplasty done on terminal ends of shallow fissures to conserve tooth structure. Final tooth preparation includes removal of remaining defective enamel / infected dentin, pulp protection and finishing of external walls accomplished with hand instruments.
43
44
45
47
48
shape of the cavity will be governed by the extension of caries, accordingly the outline of these cavities may be a rounded or oval in shape.
49
In case of occluso-buccal and occlusolingual cavities extensions are made through the fissures and towards the respective surfaces. The cutting is done in dentin at the dentinoenamel junction using a #56 bur until the occlusal ridge is undermined and removed.
50
53
54
55
56
Principles
I. OUTLINE FORM Smooth flowing, regular curves.
Rationale
Angular irregularities in the outline are susceptible to fracture during condensation a smooth flowing outline is easier to visualize and carve following condensation.
57
II. EXTENSIONS (Extension for Prevention) Conservation of tooth structure is the basis for all cavity preparations in order to preserve the strength of the tooth. However, sufficient extension of cavity preparations is necessary to ensure access (convenience form) for instrumentation, removal of defective tooth structure, insertion and finish of the restorative material, and maintenance of the restoration (prevention).
58
Principles
A. Extensions consist of: a. Caries and decalcifications
Rationale
eliminates defective tooth structure and eliminates areas (pits, fissures, etc.) which are susceptible to recurrent caries and facilities oral hygiene procedures (extension for prevention).
b. Enamel unsupported by sound dentin c. Pits and fossae d. Major fissures and grooves e. Existing restorations
59
Principles
B. Bucco lingual extension
1. Extend fully in areas of buccal and lingual grooves to terminate on smooth surfaces.
Rationale
to allow a smooth tooth-restoration margin to be created (easier to finish and keep clean).
60
Principles
2. Extend minimally in areas of triangular ridges (optimal isthmus width is intercuspal distance or less) terminating on smooth surfaces.
Rationale
to preserve the strength and function of the cusps while eliminating susceptible grooves or defective tooth structure (must be wide enough to allow condensation).
61
Principles
C. Mesio-distal extension 1. Stop short of the marginal ridge crest
Marginal ridge walls should be 1/2 distance from mesial and distal pit to the crest of each marginal.
Rationale
Principles
3. Groove extensions are kept narrow (mesiodistally) where possible terminating on smooth tooth structure.
Rationale
to preserve strength of cusps while eliminating susceptible grooves and/or defective tooth structure (must be at least as wide as the narrowest condenser).
63
Principles
Rationale
4. If marginal ridge is unsupported or very thin it should be included, resulting in a Class II preparation.
If not included the marginal ridge may fracture. (amalgam will be stronger than the unsupported enamel)
64
Principles
Rationale
III. RESISTANCE/ RETENTION FORM A. Depth = 0.1-0.2mm into dentin (approx. 2 mm measured at triangular ridges). Minimum depth is required to provide sufficient bulk to prevent fracture and retain the amalgam.
65
Principles
B. Pulpal floor
1. Smooth and flat 2. Parallel to the occlusal plane
Rationale
Uniform thickness of restorative material. resists occlusal stress (resistance form) and forces of condensation.
66
Principles
C. Buccal and lingual walls 1. Smooth and curved mesio-distally. 2. Smooth and straight pulpo-occlusally.
Rationale
67
Principles
Rationale
To provide mechanical lock or retention to the occlusal portion and create bulk at the margins.
68
Principles
Rationale
protects buccal and lingual surfaces from being undermined (RESISTANCE FORM).
69
Principles
D. Mesial and distal wall 1. Smooth and straight
Rationale
70
Principles
Rationale
protects marginal ridge from being undermined or weakened (enamel must be supported by dentin)
71
72
Principles
IV. CAVITY FINISH A. Pulpo-occlusal line angle is well defined (no point angles are present) and follows general configuration of cavosurface outline.
Rationale
increases retention of the amalgam restoration and preparation is more easily visualized.
73
Principles
B. Cavosurface margins
Rationale
74
Principles
C. Cleanliness cavity is free of debris and moisture.
Rationale
facilitates adaptation of amalgam to the cavity and improves the physical properties of the restoration by elimination of void or foreign material.
75
Principles
V. TISSUE RESERVATION A. Rubber dam is intact
Rationale
preserves isolation, eliminates moisture.
conservation of tooth structure. prevention of postoperative pain and inflammation.
76
REFERENCES
1. 2. 3. 4. 5. 6. ART & SCIENCE OF OPERATIVE DENTISTRY- STURDEVANT. OPERATIVE DENTISTRY- WEINE OPERATIVE DENTISTRY- MARZOUK DENTISTRY FOR THE CHILD AND ADOLESCENT- MCDONALD. ESTHETICS IN DENTISTRY- GOLDSTEIN. CLASSIFICATION & CAVITY PREPARATION FOR CARIOUS LESION- G J MOUNT & W R HUME. 7. MINIMALLY INVASIVE DENTISTRY- JADA, Vol. 134, January 2003 8. CARIES PREVENTION CURRENT STRATEGIESNEW DIRECTIONS- JADA, Vol. 127, October 1996
77