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Biological Principles of Tooth Preparation

Prof. Wedad Etman; MD, PhD Conservative Dentistry; Faculty of Dentistry, Tanta University

Biological Principles of Tooth Preparation


These principals are primarily concerned with the health and integrity of the remaining tooth tissues; I. PROTECTION OF THE PULP II. PREVENTION OF CARIES RECURRENCE III. ASEPTIC PROCEDURES

I. PROTECTION OF THE PULP


The pulp must be protected against all sorts of irritations during cutting. Thus the following should be considered; . Cutting must be parallel to the recessional lines of the pulp. . Unnecessary pressure is unacceptable.

I. PROTECTION OF THE PULP


. Limiting the exposed amount of dentin. . Unnecessary heat generation should be avoided during cutting. . Large round burs should be used at low speed while removing soft dentin from deep cavity floors. . No cavity caustics, chemicals or sterilizers should be used.

II. PREVENTION OF CARIES RECURRENCE


. Removing all carious enamel or dentin. . Extension of the cavity margins to include all areas susceptible to caries as pits and fissures. . Removal of all undermined enamel. . Correct cavo -surface angle according to the physical characteristics of the restoration type must be performed.

III. ASEPTIC PROCEDURES


. Use clean and sterile instruments. . Isolation of the operative field. . Maintenance of clean, dry and sterile hands.

New approach in decision making, cavity design and tooth preparation:

Biological forms of cavity preparation

Biological Forms of Tooth Preparation

A. Diagnostic Factors B. Patient Factors C. Conservative Factors D. Material Factors

A. Diagnostic Factors
. There must be a reason to place a restoration in the tooth: caries, fractured teeth, esthetic needs or for improved form or function. . An assessment of both pulpal and periodontal status will influence the potential treatment. . Assessment of occlusal relationships. . Patients concern for esthetics should be considered.

A. Diagnostic Factors
. The relationship of a specific restorative procedure with another treatment planned for the patient must be considered. . The risk potential of the patient to further dental disease should be assessed. A highrisk patient may require altered treatment planning initially until the risk factors are better controlled.

B. Patient Factors
. The patient's knowledge and appreciation of good dental health. . The patient's economic status. . The patient's age. . Whether or not adequate isolation of the operating site can be obtained. . Caries in this patient, is it reversible (incipient) or irreversible (cavitated); active or not. Caries risk assessment

C. Conservative Factors
. While one of the primary objectives of operative dentistry is to repair the damage from dental caries, the preservation of the vitality and integrity of the tooth is paramount. . The pulp should not be subjected to unnecessary abuse. . The less tooth structure removed the less the potential damage that may occur to the pulp.

C. Conservative Factors
. The smaller the tooth preparation, the easier it is to retain the restorative material in the tooth. . Examples of conservative tooth preparation features:
Minimal extensions of the tooth preparations, especially facio-lingually and pulpally. Supragingival margins and Rounded internal line angles. Only uncoalescent fissures are excised, enameloplasty and fissure sealant instead of extension for prevention.

D. Material Factors
. An amalgam restoration requires specific mechanical tooth preparation for resistance and retention. . An indirect cast metal restoration also requires a specific tooth preparation form that provides:
Draw or draft to provide seating, A beveled cavosurface configuration.

D. Material Factors
. Adhesive composite restorations or GIC do not typically require tooth preparations as precise as those for amalgam and cast metal restorations. . Ceramic inlay restorations do require specific preparation depths and wall designs but do not require complex cavosurface marginal configurations. . Bonded amalgam restoration still requires the same tooth preparation as for non-adhesive amalgam restoration.