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Class II Cavity

Preparation for
Amalgam

Characteristics of these
:lesions

It is difficult to be detected until it will be


of considerable size.

Bite-wing radiographic film is helpful


for correct diagnosis.

:Class II could be

walls

In few cases, the proximal lesion can be


prepared from the facial or lingual
embrasures (e.g., teeth with wide, accessible
.embrasures and intact marginal ridges)

Compound Class II
For most molars and premolars with
proximal lesions, the occlusal surface or
part of it should be included in the cavity
preparation for access purposes
(Extension for convenience).

I. Outline form

Occlusal outline form:

The occlusal segment follows


the same fundamentals already
given for the Class I amalgam
except that the external outline is
extended proximally toward the
defective proximal surface.

Outline form of proximal box


depend on:
1. Extent of carious lesion proximally.
2. Location and extent of the contact areas.
3. Convexity of the proximal surfaces:
The more convex the proximal surfaces
are, the wider the embrasures and the
smaller the dimension of the contact areas.
Consequently, the less will be the required
extension of the cavity preparation outline.

4. Modifying factors affecting outline form:

1. Masticatory loads:
The greater the masticatory load, the
less should be the extent of the cavity
preparation to reduce the surface area of
the restoration subjected to high loading.
2. Localized cariogenic factors:
Greater activity of cariogenic factors
(tooth position, partial denture
attachment,..) indicates greater extent of
the cavity into self-cleansable areas.

3. esthetics:
Esthetics can modify the outline form in
a class II cavity preparation by minimizing
the facial extent of the cavity, especially in
the mesio-facial margins of premolars and
first molars.
4. Tooth position:
Malalignment and rotation of teeth can
impede or facilitate the access to proximal
lesions and accordingly modify the outline
form.

Include all caries, faults, or existing


restorative material.
Create 90-degree cavosurface margins
(i.e., butt joint margins).
Establish (ideally) not
more than 0.5 mm clearance with the
adjacent proximal surface facially, lingually,
and gingivally.

:External outline
a- Bucco

and linguo-proximal margins


are extended:
to include caries.
to break contact with the adjacent tooth
to provide convenience form and
uniform accessibility along their entire
lengths.

b- Gingival floor is
extended to include caries and break
contact with the adjacent tooth gingivally.
It is a straight line between the gingival
termination of the buccal and lingual
proximal CSM.

:Internal outline
a- Axial Wall should:

be placed into dentin approximately 0.5


mm from DEJ.
follow curvature of DEJ bucco-lingually
follow curvature of DEJ occluso-gingivally
(tapered occlusally).

NOTE: Proximal depth (from the proximal


surface to the axial wall) is greater
occlusally than at the gingival floor area
because enamel is thicker occlusally than
in the gingival region.

b- Proximal Walls Direction


Buccal and lingual walls of proximal box
are parallel to the enamel rods direction
and perpendicular to the tooth surface
because the enamel rod radiates from the
DEJ at right angles to the outer surface of
the tooth.

c- Gingival floor:

Parallels the enamel rod directions; often


cervically inclined.
Mesio-distally and bucco-lingually :
Gingival floor is kept parallel to the
pulpal floor.

3. Isthmus

Is the junction between the


occlusal part of a restoration and the
proximal, facial or lingual parts).

Cavity width at the isthmus


should kept narrow as possible (1/4
intercuspal distance)

A uniform curve done regularly in most


cases where a narrow proximal contact
and wider embrasure exist.
A straight line done in case of open
contact.
A reverse (S) curve done in case of broad
contact and narrow embrasures.
The buccal wall of preparations of lower
molars where contact deviated buccally .
The buccal wall of mesial cavities of first
maxillary premolars and molars for
esthetic reasons.

Have a dentin supported

bucco-proximal wall.

II. Resistance form


As a fact

During centric and excursive


movements of the mandible, both the
restoration and tooth structure are
periodically loaded both separately
and jointly. This causes different
stress patterns.

1. Tensile stresses at the


isthmus portion of the
restoration.
2. Compressive stresses in the
remaining tooth structure,
apical to the restoration.

3. Shear stresses at the


junction of the surrounding
tooth structure and
corresponding floors, with a
tendency toward fracture.
3

Remember that:

Amalgam is least resistance to tensile stress


and most resistant to compressive stress.
Tooth structure is least resistant to shear stress
particularly when interrupted by a cavity
preparation).

So, several factors must be accommodated in the


cavity design to resist occluding cyclic loading
while minimizing tensile loading in the amalgam
and shear loading in the remaining tooth
structure.

Design features for protection of


the mechanical integrity of the
restoration and remaining tooth
.structure
1. Isthmus
In the isthmus potentially deleterious
tensile stresses occur under any type of
loading with the fulcrum of bending
occurs at the axio-pulpal line angles.

To solve this problem:


Increase the bulk of amalgam near the
marginal ridge, while bringing the axiopulpal
line angle away from stress concentration
area and closer to the surface by:
1. Slanting the axial wall toward the pulpal floor
creating an obtuse axio-pulpal line angle
increasing the amalgam bulk and reduce
tensile stresses.

2. Roundation of axio-pulpal line angle to avoid


stress concentration at the isthmus and
increase the amalgam bulk at the fulcrum.

3. Avoid increasing the cavity width at the


isthmus portion to decrease the surface area
receiving deleterious occluding stresses.

4. Pulpal and gingival floors should be

perfectly flat to resist forces at the correct


angulation.
5. Every part of the preparation (occlusal,
facial, lingual or proximal) should be self
retentive:
If every part of the restoration is locked
in the tooth structure independently from
other parts, there will be minimal stresses
at the junction of one part to another, i.e.,
the isthmus.

Additional features in the


;6.restoration
Avoid placing or leaving any surface

discontinuities , such as carved deep


developmental grooves, scratches, at
these critical areas in the restoration to avoid
stresses accentuation leading to fatigue
failure.
7. Finally, by checking the occlusion to
eliminate prematurities in the restoration,
immediate overloading and failure can be
avoided.

2. Margins:
Remember that:
Amalgam has good compressive
strength when it has sufficient bulk (1.5
mm minimum), any frail, feather-edged
margins of amalgam occurred if the
cavosurface angles of preparation are
beveled, will fracture easily under
occluding forces.

To avoid amalgam fracture:

Create Butt joint amalgam-tooth


structure at the margins.
Leave No frail enamel at the
cavosurface margins.
Remove flashes of amalgam on tooth
surface adjacent to amalgam
margins.

A, Failure caused by weak enamel margin.


B, Failure caused by weak-amalgam margin.
C, Proper direction to proximal walls results in full-length
enamel rods and 90-degree amalgam at the margins.
Note,
retention locks have been cut 0.2 mm inside DEJ, and their
direction of depth is parallel to DEJ.

III. Retention form


Displacing forces:

Proximal (lateral) displacement


To prevent such displacement, selfretaining facial and lingual grooves proximally
are necessary, in addition to occlusal
dovetail.
Occlusal displacement
By inverted truncated cone shaping
of key parts of the preparation.

Every

part of the cavity preparation


should be self retaining, independent
in its retention from the rest of the
cavity to minimize shear
concentration areas at the junction of
different parts of the restoration, with
less failure to be expected as a result.

Convenience form
The occlusal involvement is, in itself, a
convenience form.
Freeing of contacts.
Accentuation of cavity walls and
margins.
Selection of suitable sized instruments.

:Operative procedure

After finishing of occlusal part and


before extending into the involved
proximal marginal ridge visualize the
final location of the facial and lingual
walls of the proximal box relative to the
contact area.

While maintaining the established pulpal


depth and with the bur parallel to the long
axis of the tooth crown, extend the
preparation mesially (or distally), stopping
approximately 0.8 mm (the diameter of the
end of the bur) short of cutting through the
marginal ridge into the contact area.

The occlusal step in this region is made


slightly wider faciolingually than in the
Class I preparation because additional
width is necessary for the proximal box.

Proximal Box

The initial procedure in preparing the


outline form of the proximal box is the
isolation of the proximal enamel by the
proximal ditch cut which prevents the
bur from marring the proximal surface of
the adjacent tooth.
With the same orientation of the bur,
position it over the DEJ in the pulpal floor
next to the remaining proximal marginal
ridge.

Allow the end of the bur to cut a ditch


gingivally along the exposed DEJ, two thirds
at the expense of dentin and one third at the
expense of enamel.
The 0.8-mm diameter bur end will cut
approximately 0.5 to 0.6 mm into dentin and
0.2 to 0.3 mm into enamel.

Proximal ditch cut results in


axial wall that follows outside To further isolate and weaken proximal
enamel, bur is moved toward and
contour of proximal surface
perpendicular to proximal surface (parallel
to direction of enamel rods).
Side of bur may emerge slightly through
proximal surface at level of gingival floor
(arrow).

A. Using spoon
excavator to fracture
out weakened
proximal enamel.

B. Proximal view with


proximal enamel
removed.

C. Removing the
remaining undermined
proximal enamel with
enamel hatchet on
facial proximal wall,
lingual proximal wall,
and gingival wall.

Wedging:
A, Round toothpick wedge placed in gingival embrasure protects
gingiva and rubber dam during preparation of proximal box.
B, Triangular wedge is indicated when deep gingival extension of
proximal box is anticipated, because wedge's greatest crosssectional dimension is at its base. Consequently, it will more readily
engage the remaining clinical tooth surface
N.B. If additional use of the bur is indicated, a matrix band may be
used around the adjacent tooth to prevent marring its proximal surface

Primary resistance form


1.The pulpal and gingival walls being relatively
flat and perpendicular to forces directed with
the long axis of the tooth.
2. Restricting extension of the walls to allow
strong cusps and ridge areas to remain with
sufficient dentin support.
3. Restricting the occlusal outline form (where
possible) to areas receiving minimal occlusal
contact.

4.The reverse curve optimizing the strength


of both the amalgam and tooth structure at
the junction of the occlusal step and
proximal box.
5. slightly rounding the internal line angles to
reduce stress concentration in tooth
structure (automatically created by bur
design).
6. providing enough thickness of restorative
material to prevent its fracture under
mastication.

Primary retention form is provided by the


occlusal convergence of facial and lingual
walls and by the dovetail design of the
occlusal step.

Removal of remaining caries

The presence of infected carious dentin


on a portion of either the pulpal floor or
axial wall does not indicate deepening the
entire wall. Infected carious dentin is
removed with a slowly revolving round bur
of appropriate size or a spoon excavator
or both.

Infected carious dentin in the axial wall is


removed with suitably sized round burs or
spoon excavators or both.

The pulpal depth of the axiofacial,


axiolingual, and axiogingival line angles
should never be altered because of the
presence of caries in the axial wall central of
these line angles.

Secondary resistance &


retention
forms
using the gingival
margin trimmer to bevel or
round the axiopulpal line angle, thereby
increasing the bulk of and decreasing the
stress concentration within the restorative
material.

Proximal retention
To enhance retention form of the proximal
portion, proximal locks may be indicated to
counter proximal displacement.
N.B: Retentive locks may not be needed in
conservative, narrow proximal boxes.
Retentive locks prepared using the No. 1/4
bur or No. 169 bur.

Preparation of retention locks using a No. 169 bur with air coolant
(to improve vision) and reduced speed (to improve tactile "feel" and
control).
The bur is placed in the properly positioned axiolingual (axiobuccal)
line angle and directed to bisect the angle approximately parallel to
the DEJ.
The bur is tilted to allow cutting to the depth of the diameter of the
end of the bur at the point angle and permit the lock to diminish in
depth occlusally, terminating at the axiolinguo-pulpal (axiobuccopulpal) point angle.

Proximal axial grooves


(locks)
Prepared at the axio-buccal and axio-lingual line
angles in extensive cavity preparations

Cutting of proximal retention grooves at the


.expense of buccal and lingual walls not axial

Planning of Enamel Walls

The preparation walls and margins should not


have unsupported enamel and marginal
irregularities.
Ideally there should be a 90-degree
cavosurface angle (maximum of 100 degrees)
at the proximal margin. This angle aids in
obtaining a marginal amalgam angle of 90
degrees (no less than 80 degrees).
Butt joint relationship of enamel and amalgam
creates the strongest margin.

Bevel of enamel portion of gingival


wall is established with gingival
margin trimmer to ensure full-length
enamel rods forming gingival
margin.

Sharp angles at linguo-gingival


and facio-gingival corners are
rounded by rotational sweep with
gingival margin trimmer.

Final procedures: Cavity


toilet

A sharp explorer is then used to check


the details of the prepared cavity and to
loosen the tooth debris which are then
blasted out with air.

Cusp capping
Indication:
When the occlusal outline form
extends from a primary groove to
within two thirds of the distance to a
cusp tip, that cusp is usually
weakened and should be capped.

:Procedure

Cusp reduction for an amalgam restoration


should result in a uniform amalgam thickness
over the reduced cusp of 1.5 to 2 mm. The
thicker amount is necessary for functional
cusps. These dimensions provide adequate
strength for the amalgam.
The cusp reduction should occur as early in
the preparation as can be determined to
provide better access and vision for
completing the preparation.

To reduce the cusp, orient the No. 245 bur


parallel to the cuspal incline and make
several depth cuts in the cusp (to a depth of
1.5 or 2 mm). The depth cuts will provide
guides for the correct amount of cusp
reduction.

Without depth cuts, after the beginning


reduction of the cusp the operator may no
longer know how much more reduction is
necessary.

Use the bur to reduce the cusp,


following the mesiodistal inclines of
the cusp. This results in a uniform
reduction.

Cusp capping