Presented By: Rahul Mishra, Junior Resident-I, UP Dental College & Research Centre, Lucknow.

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DEFINITION OF CAVITY PREPARATION
Cavity preparation is the mechanical alternation of a tooth to receive a restorative material, which will return the tooth to proper anatomical form, function, and esthetics. The procedure of the preparing the tooth is the removal of the defective or friable tooth structure. Any remaining infected or friable tooth structure may result of further carious progression, sensitivity or pain or fracture of the tooth and / restoration.
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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.
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it should not be under the force of mastication of the tooth. • To ensure the cavity form. • To locate the margins of the restoration as conservative as possible. 4 . • To allow the functional placement of the restorative material.OBJECTIVES OF CAVITY PREPARATION • To remove diseased tissue as necessary and at the same time provides the protection to the pulp.

•Extended margins so that they are accessible for instrumentation and Cleaning.PRINCIPLES OF CAVITY PREPARATION •Gain access to caries. •Cut away all significantly unsupported enamel. •Removal of all carious lesions. 5 .

walls and margins of the cavity. 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. •Make room for the insertion of the restorative material in sufficient bulk to provide strength. •Extend the cavity to self-cleansing areas to avoid recurrent caries.CLASSIFICATION (G. 6 .V. •Provide mechanical interlocking retentive designs.

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 . the occlusal 2/3 of buccal and lingual surfaces of molars.CLASS I The lesions involving the occlusal surfaces of molars and premolars. CLASS II The lesions involving the proximal surfaces of the posterior teeth with access established from the occlusal surface. and the palatal pits in anterior teeth.

including the proximal surface of posterior teeth where the marginal ridge is not included in the cavity preparation. CLASS V The lesions involving the cervical third of all teeth.CLASS IV The lesions involving all proximal surfaces of anterior teeth which involves the incisal edge. 8 .

Approximal enamel in relation to areas in contact with adjacent teeth. fissures and enamel defects on occlusal surfaces of posterior teeth or other smooth surfaces. the exposed root surface. Site 2 . following gingival recession. 9 .ACCORDING TO SITE INVOLVED Site 1 . Site 3 . The cervical one third of the crown or. Pits.

The earliest lesion that can be identified as the initial stages of demineralisation. well supported by dentine and not likely to fail under normal occlusal load. Moderate involvement of dentine following cavity preparation. Remaining enamel is sound. The remaining tooth is sufficiently strong to support the restoration. This needs to be recorded but will be treated by eliminating the cause and should therefore not require further treatment. Size 1 . Size 2 . 10 .ACCORDING TO THE SIZE AND EXTENT OF THE LESION AT THE TIME OF IDENTIFICATION Size 0 . Some form of restoration is required to restore the smooth surface and prevent further plaque accumulation. Minimal surface cavitation with involvement of dentine just beyond treatment by remineralisation alone.

11 .Size 3 . Extensive caries or bulk loss of tooth structure e. The cavity needs to be further enlarged so that the restoration can be designed to provide support to the remaining tooth structure.g. The lesion is enlarged beyond moderate. or are likely to fail if left exposed to occlusal load. Size 4 . loss of a complete cusp or incisal edge has already occurred. Remaining tooth structure is weakened to the extent that cusps or incisal edges are split.

• Each diseased tooth has an individual cavity form determined by caries involvement. morphology of tooth and its location in oral cavity – leading to new conservative cavity designs. 12 .DESIGN AND PREPARATION OF CAVITIES • The design and preparation of cavities are based on Black’s principles that have been determined and reapplied with importance directed towards protection of tooth in preparation rather than only on the material.

STEPS IN THE CAVITY PREPARATION (Given by G V Black) 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 .

• Hand Instruments – Excavators. explorer. Gingival Marginal Trimmer. 57. 56. monoangle or biangle chisels. enamel hatchet.-carbide burs 55. • Rotary Instruments – •Burs No. tweezer. 14 . etc. • Safety glasses. • Ultraspeed and conventional speed contrangle handpiece.ARMAMENTARIUM • Basic Instruments – mouth mirror.

15 . the occlusal 2/3 of buccal and lingual surfaces of molars.Definition: These are pit and fissure type cavities that involve the occlusal surfaces of molars and premolars. and the palatal pits in anterior teeth.

These areas are retentive for food and thus invite caries. These are self-cleansable areas. 16 . they may get involved by caries due to their inherent defective structure. However.

These lesions may involve one or more surfaces and hence a simple or compound cavity should be prepared. It is rapid burrowing at the dentinoenamel junction. A small surface opening which may remain unnoticed until the lesion becomes of a considerable size. 3.These lesions are clinically characterized by: 1. with the bases of cones at the Dentinoenamel Junction. 2. A conical spread in both enamel and dentin. 17 .

and angular grooves between the cusps and with a minimum width. fissures. 18 .Simple occlusal cavities Designing the Outline Form The outline form of a routine class I cavity should describe a symmetrical design running in sweeping curves along all pits.

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 . The mesial and distal wall should have a slant or slight divergence from the pulpal floor outward to avoid undermining the marginal ridges.

PERPENDICULAR IN MESIALDISTAL DIRECTION .

•Pulpal Floor mesio-distally is flat and perpendicular to the long axis of the tooth .

The lingual and the buccal wall should be parallel to the respective tooth surface. the cavity is extended just sufficient to eliminate the defective and susceptible tissues. 23 .In a bucco-lingual direction.

•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. .

LONG AXIS OF THE TOOTH .

LONG AXIS OF THE CROWN .

It is governed only by the extent of caries in both enamel and dentin and the amount of extension or need to eliminate pits and fissures to secure smooth margins. It must be reemphasized that the outline form for class 1 cavities should be very conservative since they involve cleansable areas. 27 .

Isthmus just wide enough to accept instrumentation 1/4th intercuspal distance .

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CORRECT OUTLINE FORM 30 .

 The form of this cavity provides automatically for effective retention and. i. therefore. no special retentive features are required.. Boxing the preparation. 31 .e.Obtaining the Resistance and Retention Forms  The resistance form here consists chiefly of a pulpal wall parallel to the occlusal plane with dentin walls at right angles to it.

and then scooped out in few and large pieces.  In moderately deep and deep cavities. 32 .Removal of remaining Carious Dentin  In small size cavities. the carious dentin is peeled off carefully at the sides using large spoon excavators. This is continued until a sound dentin floor is reached. the carious dentin should have been removed during making the cavity extensions.  Only light pressure in a direction parallel to that of the pulp is utilized.

This may be done by sharp and regular edged chisels and hatchets. stones. or undermined enamel. plane fissure burs. All sharp corners in enamel must be rounded. as they may contain short enamel rods.Planning of Enamel Walls The enamel walls of the cavity should be finished free from any loose. or sand-paper discs. short. and trimmed to meet the tooth surface at a right cavo-surface angle. 33 .

Performing of the toilet of the cavity 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 warm air. 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 .

. a carious pit or fissure. access is obtained by employing a small round bur #330.• In case of initial carious lesions. • In big carious lesions. i. access is started at the most defective area of enamel. access is obtained easily by breaking down the undermined enamel overlying the carious dentin.e. • In either case. 36 . using a suitable size chisel.

 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. 37 . Cutting is continued until the Dentinoenamel Junction is reached.

The bur is rotated. and carefully introduced through the opening just obtained. fissures. and deep developmental grooves are made using a #330 round bur held at Right Angle To The Surface Of The Crown. 38 . The necessary cavity extensions through pits. so that its weak corners do not touch the enamel and get dulled.

In this way. 39 . Gentle pressure is applied in the direction of required extension. and at the same time unclog itself. the bur should be kept moving in-and-out of the cavity and at right angle to the tooth surface.With the bur seated in the cavity just below the dentinoenamel junction 1/2-1 mm. the bur will undermine and lift the cut enamel. During cutting.

This is obtained by using a #56 fissure bur held perpendicular to the surface of the tooth.Provision of ample resistance and adequate retention through boxing of the preparation could be obtained. 40 . All the line angle in dentin must be squared up by help of the HOE Excavators.

•Deepest or most carious pit entered with a punch cut using No. ½ 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.
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•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.
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•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.
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46 . •The gingival wall is placed at or slightly occlusal to the height of contour of the tooth.Buccal Pit Cavities •The outline of these cavities usually describes a triangle with its base facing the gingival wall and its sides forming the mesial and distal walls.

OUTLINE FORM FOR PIT RESTORATIONS 47 .

and 48 . The enamel walls are planed in the direction of enamel rods perpendicular to the axial wall.All walls are extended just enough to eliminate defective enamel and dentin.

It should be re-emphasize that the shape of the cavity will be governed by the extension of caries.Hoe excavators are used to smooth the axial wall and make it parallel with the external surface of the tooth. accordingly the outline of these cavities may be a rounded or oval in shape. 49 .

The cutting is done in dentin at the dentinoenamel junction using a #56 bur until the occlusal ridge is undermined and removed. 50 .Buccal and Lingual Extensions In case of occluso-buccal and occlusolingual cavities extensions are made through the fissures and towards the respective surfaces.

a step is indicated: a #330 or 56 bur is used to cut the dentin at the dentinoenamel junction. applying pressure in a gingival direction and at the same time moving the bur mesio-distally. 51 .If the caries is still gingival to the level of the pulpal seat.

The enamel thus undermined. Retentive grooves are then made in dentin along the axio-mesial and axiodistal line angles. 52 . is broken down with chisels. The cavity walls and margins are finished as previously described.

53 . flattening of which to obtain the required resistance form. where removal of the carious dentin will leave a round cavity floor.In case of deeply-seated caries. will expose the pulp.

The following technique is used: a) The cavity floor is covered with a sub base followed by a base or base alone which fills it to the routine cavity depth. 54 .

55 .b) A ledge is cut on the expense of the buccal and lingual side walls of the cavity for obtaining the required resistance in sound dentin.

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Rationale Angular irregularities in the outline are susceptible to fracture during condensation – a smooth flowing outline is easier to visualize and carve following condensation. regular curves. 57 .Principles I. OUTLINE FORM – Smooth flowing.

sufficient extension of cavity preparations is necessary to ensure access (convenience form) for instrumentation. 58 . insertion and finish of the restorative material. and maintenance of the restoration (prevention). removal of defective tooth structure. However. EXTENSIONS (Extension for Prevention) Conservation of tooth structure is the basis for all cavity preparations in order to preserve the strength of the tooth.II.

fissures. Major fissures and grooves e. Extensions consist of: a. Caries and decalcifications Rationale eliminates defective tooth structure and eliminates areas (pits. Pits and fossae d. etc. b. Existing restorations 59 .) which are susceptible to recurrent caries and facilities oral hygiene procedures (extension for prevention).Principles A. Enamel unsupported by sound dentin c.

Rationale to allow a smooth tooth-restoration margin to be created (easier to finish and keep clean). Bucco – lingual extension 1. 60 .Principles B. Extend fully in areas of buccal and lingual grooves to terminate on smooth surfaces.

Extend minimally in areas of triangular ridges (optimal isthmus width is ¼ intercuspal distance or less) terminating on smooth surfaces.Principles 2. 61 . 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).

to preserve a uniform bulk (strength) to the mariginal ridges. 62 .Principles C. Mesio-distal extension 1. 2. Rationale to preserve strength of marginal ridges. Parallel to the contour of the marginal ridge. 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.

Groove extensions are kept narrow (mesiodistally) where possible terminating on smooth tooth structure. 63 . 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).Principles 3.

resulting in a Class II preparation.Principles Rationale 4. (amalgam will be stronger than the unsupported enamel) 64 . If marginal ridge is unsupported or very thin it should be included. If not included the marginal ridge may fracture.

2mm into dentin (approx. 2 mm measured at triangular ridges). 65 .Principles Rationale III. Minimum depth is required to provide sufficient bulk to prevent fracture and retain the amalgam. Depth = 0.1-0. RESISTANCE/ RETENTION FORM A.

Principles B. 66 . Parallel to the occlusal plane Rationale Uniform thickness of restorative material. Pulpal floor 1. Smooth and flat 2. resists occlusal stress (resistance form) and forces of condensation.

2. Smooth and straight pulpo-occlusally. 67 . Smooth and curved mesio-distally. Buccal and lingual walls 1. Rationale Facilitates adaptation of amalgam and elimination of weak tooth structure.Principles C.

68 . To provide mechanical lock or retention to the occlusal portion and create bulk at the margins.Principles Rationale 3. Converge slightly pulpo-occlusally in areas of triangular ridges (60).

protects buccal and lingual surfaces from being undermined (RESISTANCE FORM). 69 .Principles Rationale 4.Diverge slightly pulpo-occlusally in buccal and lingual groove extensions (60).

Principles D. 70 . Mesial and distal wall 1. Smooth and straight Rationale facilitates adaptation of amalgam and elimination of weak tooth structure.

protects marginal ridge from being undermined or weakened (enamel must be supported by dentin) 71 .Principles Rationale 2. Diverges slightly pulpo-occlusally (forms an obtuse angle with pulpal floor).

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Pulpo-occlusal line angle is well defined (no point angles are present) and follows general configuration of cavosurface outline. CAVITY FINISH A.Principles IV. 73 . Rationale increases retention of the amalgam restoration and preparation is more easily visualized.

74 . Sound (well supported) easier to visualize and carve. Cavosurface margins Rationale 1.Principles B. provides marginal integrity. Sharp (well defined) 2.

75 . Rationale facilitates adaptation of amalgam to the cavity and improves the physical properties of the restoration by elimination of void or foreign material.Principles C. Cleanliness – cavity is free of debris and moisture.

76 B. Rubber dam is intact Rationale preserves isolation. eliminates moisture. conservation of tooth structure. Adjacent soft tissue (periodontium) is intact . prevention of postoperative pain and inflammation. Adjacent tooth structure and restorations are intact C. TISSUE RESERVATION A.Principles V.

ESTHETICS IN DENTISTRY. 134.MCDONALD. 6.G J MOUNT & W R HUME. 7. 3. CLASSIFICATION & CAVITY PREPARATION FOR CARIOUS LESION. OPERATIVE DENTISTRY. Vol. 127. MINIMALLY INVASIVE DENTISTRY. October 1996 77 . CARIES PREVENTION CURRENT STRATEGIESNEW DIRECTIONS. January 2003 8.WEINE OPERATIVE DENTISTRY. 4.REFERENCES 1. ART & SCIENCE OF OPERATIVE DENTISTRY.JADA.JADA.STURDEVANT. Vol.MARZOUK DENTISTRY FOR THE CHILD AND ADOLESCENT. 5.GOLDSTEIN. 2.

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