DEFINITION

Smooth surface lesions located on the gingival third of labial, buccal and more rarely the lingual surfaces of all teeth.

Limitations:
Always simple lesions as it involves one surface of a tooth.

These lesions have the following clinical characteristics:

1. Caries is not only the reason of cavitation,
abrasion and erosion may also responsible for their causation.

2. The carious lesion usually starts as a

white or chalky line or area near the center of the gingival 1/3 of the labial or buccal surfaces of teeth. If it occurs on the lingual surface, it is usually associated with denture clasps.

3. Marked sensitivity. 4. Tendency to spread mesially and distally near the axial angles of teeth, it may pass the axial angle of the tooth and unite with a Class II, III or IV cavity.

5. Bell-crowned teeth, and teeth with markedly convex surfaces, are more susceptible to this type of caries.

6. It occurs less frequently than the other types of caries.

7. It is usually affects multiple teeth. This

indicates that the patient has a high caries susceptibility and requires careful extensions of cavity outline.

8-It is more frequent among old-aged patients and is called senile caries, yet it is not uncommon in childhood and adolescence and is often associated with improper oral hygiene and presence of bacterial plaque. In case of old aged individuals, caries may be found to extend gingivally and affect the cementum of the root. Sensitivity will increase and the caries may tend to recur around the margins in cementum.

Application of Principles: The Outline Form:

A. General shape:
Ferrier design, conventional or typical
This is the most recent and accepted now. Generally the classical Class V cavity usually describe a trapezoidal outline with straight margins and round corners, with the short arm being the gingival.

Principles
I. OUTLINE FORM -

Rationale
Conforms to the tooth shape, typical caries location, and site of plaque accumulation.

rounded trapezoid in gingival 1/3.

B. Location of margins
Occlusally: It has to be at, but not including the height or just past the height of contour of the tooth or just include the defective area of the tooth.

Principles
A. Occlusal /incisal outline is straight and parallel to the occlusal plane.

Rationale
More esthetic and harmonious.

Proximally: Far enough mesially and distally to include only the defective and/or the decalcified tooth tissues, yet not encroaching on the axial angles of the tooth, and placed just opposite the axial angles of the tooth.

Gingivally: At or ideally in the occlusal portion of the gingival sulcus space. In cases of gingival recession, the gingival margin should be located supragingivally.

Resistance and Retention Forms:

a. Resistance Form:
No resistance form necessary for these preparation because they are not subjected to a direct functional loading. A minimum dept of 0.5 mm in dentin is required for a uniform bulk of amalgam for strength of the material.

b. Retention Form
For retention, however, as the mandible moves in lateral excursion, the lingual slopes of the buccal and lingual cusps of maxillary teeth load the buccal slopes of the buccal and lingual cusps of mandibular teeth.

Assume that we have a facial Class V restoration in the lower molar tooth, as illustrated in the diagram, and so the tooth is firmly seated in bone, the tooth structure of the crown can move from position (1) to position (2), making a v-shape opening at the margin (usually the occlusal one), together with a facial component of force driving the restoration facially. So, retention will be placed in the occlusal (or incisal) and gingival walls in the form of grooves or retentive holes.

If the occlusal margins approximate the facial or lingual cusps or marginal ridges, it is advisable to make the occlusal walls devoid of any occlusal grooves as this may: i. undermine the structure of these cusps or marginal ridges. ii. display the restorative through the enamel and, therefore, causes objectionable esthetics.

Although these locations are not

mandatory in premolars and in prominent, easily cleansable molar tooth surfaces, locating the margins apical to the height of contour should be decided upon only after carefully considering the cleansing ability and plaque control technique of the patient as well as the natural pattern of cleansing these teeth.

Internal anatomy:
1. In a mesio - distal cross section:

i. The axial wall will be smooth and slightly curved mesiodistally, following the curvature of the facial or lingual surface. This is to provide resistance to the forces of condensation and to provide a maximal pulp protection.

ii. Mesial and distal walls, will appear divergent or flare mesially and distally respectively, going with the direction of enamel rods to form 90 cavo-surface angle. This is to provide strength for the tooth and the amalgam margins and to prevent undermined the enamel walls.

2. In an occluso - gingival longitudinal section:

i. The axial wall:
Will be seen as flat to slightly convex occluso-gingivally depending on the extent of the preparation occluso-gingivally. This will provide maximal pulp protection, while maintaining a uniform minimum dept of 0.5m in dentine.

ii. Occlusal or incisal wall:

It can appear in one of two ways: a. Smooth and straight forming a 90 cavosurface angle following the direction of enamel rods. This is to facilitates condensation and the adaptation of the amalgam restoration and at the same time it prevents undermining of enamel rods.

b. If the occlusal margins is located at,the middle third of the facial or lingual surfaces, it will be formed of two planes; a grooved internal plane, and is made of dentin, and an outer amelo-dentinal plane going with the direction of enamel rods. This will provide a mechanical retention lock in occlusal wall without undermining the enamel rods.

iii. Gingival wall:

Also it can vary in appearance, depending on its location, if it is located on enamel, it requires a small cavo-surface bevel. This will protect the very short gingival enamel rods from fracture during condensation and, at the same time, it terminates the gingival wall with its enamel wall going with the direction of the enamel rods, thus, eliminates the unsupported rods.

In such a manner it appears with two planes; an internal grooved plane made of dentinand an outer flat plane made of enamel.

If the gingival wall is located on cementum of the root, it also appears with two planes, an internal grooved plane made of dentin and an outer flat plane made of dentin and cementum.

All internal line angles in dentine must be squared up except those on the corners, they must be rounded. Also, all point angles must be rounded. This is to facilitate condensation of amalgam.

Convenience form:
The trapesiodal shape with rounded corners and the isolation of the field of operation using the rubber dam will provide a better conveniency for cavity preparation and restoration.

Removal of carious dentine:

As described before.

Finishing of enamel walls and margins:

Enamel margins should be smoothened and should be provided with 90 cavo-surface angle . The gingival bevel is to be placed on the gingival walls that are terminated by enamel and not where the preparation terminates in cementum.

Cavity Debridement
As described before.

This Form of the Cavity :

1. Meets the general principles of cavity preparation. 2. Exhibits a pleasant appearance, and 3. Is easier to restore.

Armamentarium
1. Rubber dam , punch , clamp forceps and clamp no. 212. 2. Burs nos. 330 , 256 , 1/2, 1 , 35 . 3. Hand instruments : curved chisel, mon angle hoe , hand excavator.

Instrumentation Resume for the Class V Preparation

1. No. 256 or 335 bur for penetration and extension of the outline . 2. Axial wall located with the same burs. 3. If required , caries is removed with a slow - speed round bur , as dictated by convenience . 4. Hand excavator may be advised. 5. Gingival and incisal retention placed with no. or bur. 6. Enamel is finished and beveled with a no. 15 Wedelstaedt chisel and 7901 or 242 bur.

Principles
B. Gingival outline is straight and parallel to the occlusal outline.

Rationale
Will allow maximum retention to be placed in cavity walls if occlusal and gingival outlines are parallel.

Principles
C. Mesial and distal outline is straight and parallel to the mesial and distal tooth outline in the gingival 1/3.

Rationale
Conforms to the shape of the tooth.

II. Extensions
Conservation of tooth structure is the basis for all cavity preparation; therefore, extend only far enough to remove defective tooth structure and create sufficient access (convenience form) for instrumentation and insertion of restorative material. In addition, access for finishing and maintenance of the restoration must be provided.

Principles
A.

Rationale
Eliminates weak or defective tooth structure so that margins of the restoration will terminate on sound tooth structure (extension for prevention).

1. Decay, decalcification, and defects. 2. Enamel unsupported by dentin. 3. Eroded, abraded areas. 4. Existing restorations

Circumscribe

Principles
B. Occluso-gingival extensions

Rationale
Provides sufficient access for instrumentation and condensation and for prevention.

1. Occlusally to the height of contour (or to the occlusal extent of the lesion) 2. Gingivally to the gingival extent of the lesion (frequently subgingivally near the C.E.J.)

Principles
C. Mesio-distal

Rationale
Extention for prevention, more esthetic and harmonious.

extention is to the line angles of the tooth (or to the extent of the lesion mesially and distally).

III. RESISTANCE/RETENTION FORM Principles Rationale

A. Depth
1. 0.5 mm in dentin 2. 1-1.25 mm (may vary slightly depending on size of tooth, thickness of enamel and extensions); occlusally 1.5 1.75 mm depth may be required to achieve 0.5 mm in dentin.
A minimum depth is required to provide retention and uniform bulk of amalgam for strength of material further tooth reduction is unnecessary and may result in pulpal encroachment or sensitivity.

Principles
B. Axial Wall
1. Smooth 2. Slightly curved mesiodistally. 3. Straight or slightly curved occlusogingivally depending on the extent of the preparation occlusogingivally.

Rationale
Easier to adapt amalgam to smooth walls provides resistance to forces of condensation and provides maximumal pulpal protection while maintaining uniform minimum depth (0.5 mm in dentin).

Principles

Rationale

C. Mesial and distal walls

1. Smooth and straight occlusogingivally.
Facilitates condensation, adaption.

Principles
2. Flare mesially and

Rationale
provides strength for the tooth and amalgam margins (prevents undermined enamel and provides a 700 - 900 amalgam margin) Resistance form.

distally respectively to form 900 metal margins).

Principles
D. Occlusal or incisal wall 1. Smoothly and straight
mesiodistally.

Rationale
Facilitates condensation, adaption.

Principles
2. Forms a 900
cavosurface angle (occlusal wall is parallel to the enamel rods 900 to a tangent to the external surface).

Rationale
Prevents undermining of enamel rods, assists in providing retention by opposing the gingival wall which forms an acute gingivocavosurface angle.

Principles
3. Occlusal retention
two undercuts .5 mm deep in the dentin of the occlusal wall at the occluso-axial line angle (one mesially and one distally)

Rationale
Provides retention a mechanical lock in occlusal wall without undermining enamel rods.

Principles
E. Gingival wall 1. Smooth and

Rationale
Facilitates condensation, adaption.

straight mesiodistally.

Principles
2. Gingival retention

Rationale
Provides mechanical lock to retain the amalgam (primary retention).

an acute axio-gingival angle (700).

Principles
3. If terminated on enamel
requires a small cavosurface bevel.

Rationale
A small enamel bevel protects the very short gingival enamel rods from fracture during condensation, and eliminates unsupported rods.

Principles
IV. CAVITY FINISH
A. Line Angles
1. Axial line angles are well defined and conform to the configuration of the cavosurface outline form (internal outline).

Rationale

Increase retention

Principles
2. Mesio occlusal,

Rationale
Facilitates condensation.

mesio-gingival, distoocclusal, and distogingival walls form rounded line angles.

Principles
B. Point angles are rounded

Rationale
Facilitates condensation

Principles
C. Cavosurface margins
1. Well defined 2. Strong (sound)

Rationale
Well defined, sound cavosurfaces are required to resist condensation forces and produce a well adapted, durable tooth restoration margin which will resist plaqueaccumulation and prevent recurrent caries.

Principles
D. Cleanliness the cavity must be free of moisture and debris.

Rationale
a clean, dry cavity preparation will allow more intimate adaptation of amalgam to the cavity walls. An amalgam which is placed in a dry environment will have superior physical properties to one placed in a moist environment.

Principles

Rationale

V. TISSUE/DAM PRESERVATION
A. The rubber dam is intact. damage of the dam will cause leakage and loss of isolation (moisture contamination).

Principles
B. Surrounding enamel, dentin, and cementum are preserved undamaged.

Rationale
conserves natural tooth structure eliminates postoperative pain inflammation.

Principles

Rationale

C. Soft tissue undamaged.