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BASIC PRINCIPLES PREPARATION
Needs & Objectives The needs for preparing the tooth structure and the objectives of these preparations should be discussed in details to draw the rules, requirements and criteria of proposed preparations. This should clarify that operative dentistry is not a drill and fill policy. Biology & Mechanics The student should be aware that we are dealing with a respectful living structure that should be biologically considered. Also, we are working in a complex mechanical environment of the oral cavity that should be considered in different restorative treatments of the tooth structure. Variations A complete understanding of the variations of the characters of different preparations and properties of available restorations should be developed.
DR. YASSER ALI AL-MORTADA AL-WASIFI
LECTURER OF OPERATIVE DENTISTRY AIN SHAMS UNIVERSITY
BASIC PRINCIPLES OF TOOTH PREPARATION. AL-WASIFI, Y.A. __________________________________________________________________________________________
This basic knowledge must not be constructed as simply treating a tooth, but rather in context of treating a person. The physiologic and psychologic aspects of the patient must be given proper consideration. In the sense of local treatment, biological and mechanical factors regarding care of the tooth tissues and contiguous oral tissues are paramount.
he displine of operative dentistry harbors the essential knowledge of basic tooth restoration, which is of utmost importance to dental practitioner.
In the past, most restorative treatment was due to caries (decay), and the term “cavity” was used to describe a carious lesion in a tooth that had progressed to the point that part of the tooth structure had been destroyed. Thus, the tooth was cavitated (a breach in the surface integrity of the tooth) and was referred to as a “cavity”. Likewise, when the affected tooth was repaired, the cutting or preparation of the remaining tooth structure to best receive a restorative material was referred to as a “cavity preparation”.
Now, many indications for treatment for teeth are not due to caries and therefore, the preparation of the tooth is no longer referred to as “cavity preparation” but as “tooth preparation”, and the term “cavity” is used only as a historical reference.
Tooth preparation is defined as, any alteration of the defective, injured or diseased tooth in order to best receive a restorative material which will re-establish a healthy state for the tooth including esthetic correction where indicated, along with normal form and function.
a tooth may be restored in a preventive sense.A. For restoration of occlusion. 3. Y. Locate the margins of the restoration as conservatively as possible. Allow for the esthetic and functional placement of the restorative material. esthetic demands of patients is a reason for placing and replacing restorations. 3. To remove all defects and give the necessary protection to the pulp. 6. 4. Another often-occurring need is the replacement or repair of restorations with serious defects. 2. This is performed by following definite steps during cavity preparation to minimize irritation to vital tooth structure. Lastly. 4. PRINCIPLES OF TOOTH PREPARATION There are some general and fundamental principles. 7. Repair a tooth after destruction from carious lesion. Repair of fractured tooth. Form the cavity so that the tooth or the restoration will not fracture under forces of mastication and the restoration will not be displaced. These principles are essentially discussed under biologic and mechanical forms. In general. the objectives of tooth preparation are: 1. These steps are: 3 . Restorations are also required to restore form and function. AL-WASIFI. which must be realized in preparing cavities for the reception of restorative materials. __________________________________________________________________________________________ NEEDS AND OBJECTIVES OF RESTORATIVE INTERVENTION Teeth need restorative intervention for a variety of reasons: 1.BASIC PRINCIPLES OF TOOTH PREPARATION. 5. As previously mentioned. 2. The biological concept aims to preserve the tooth vitality and function and protect the supporting structures.
These steps are: a) Obtaining the outline form. the mechanical concept is performed by following tooth preparation procedure which is divided into several steps. 3. Each should be thoroughly understood and each step should be accomplished as perfectly as possible.V. There are occasions. c) Working in a completely aseptic field. This can be achieved through a correct mechanical cavity design as follows: 1. AL-WASIFI. Y. f) Cleaning and toileting. The cavity should be designed to decrease the magnitude of the destructive stresses acting on the remaining tooth and the restoration. b) Prevention of caries recurrence. e) Finishing of enamel and external cavity walls.BASIC PRINCIPLES OF TOOTH PREPARATION. c) Convenience form. when the sequence is altered. 4 . d) Removal of any remaining infected dentin. The cavity design should decrease the deleterious and damaging effect of tensile stresses created within the tooth as a result of defect. 2. Black. thermal and chemical irritation during cavity preparation. but this is the exception and not the general rule. The mechanical concept is primarily concerned with the preservation of the structural integrity of both the tooth and restoration and retaining the restoration inside its corresponding preparation. b) Performing resistance and retention forms.A. however. As stated earlier by G. Provision of adequate means of retention to prevent displacement of restoration under functional forces. __________________________________________________________________________________________ a) Pulp protection against mechanical.
BASIC PRINCIPLES OF TOOTH PREPARATION. e) Finishing of enamel and external cavity walls. d) Removal of any remaining infected c) Working in a completely aseptic field. structural integrity of both the tooth and restoration and retaining the restoration inside its corresponding preparation. __________________________________________________________________________________________ Remember that The biological concept aims to The mechanical concept is primarily preserve the tooth vitality and function and concerned with the preservation of the protect the supporting structures. the following precautions should be considered: Avoid direct traumatic injury of the pulp.A. c) Convenience form. the steps biological concept are: followed to perform the mechanical concept a) Pulp protection against mechanical. forms. Black. b) Performing resistance and retention cavity preparation. Avoid sharp line angles within the cavity. Avoid unnecessary pressure and wrong direction of instruments. Avoid over cutting of dentin and weakening of the tooth structure. Avoid cutting across the recessional lines of the pulp chamber.V. I. f) Cleaning and toileting. which act as stress concentration areas. are: thermal and chemical irritation during a) Obtaining the outline form. Y. dentin. BIOLOGICAL CONCEPT OF TOOTH PREPARATION I-A) PULP PROTECTION: 1) Against mechanical irritation: To perform pulp protection against mechanical irritation during cavity preparation. 5 . The steps followed to perform the According to G. AL-WASIFI. b) Prevention of caries recurrence.
BASIC PRINCIPLES OF TOOTH PREPARATION. Removal of all undermined enamel. 6 . which may fragment under force leaving a marginal ditch that leads to food accumulation and recurrent caries. Avoid long time working. Proper inclination of CSA suitable with the type of restoration to provide support to the restoration and enamel at cavity margins that prevents their fragmentation and recurrence of caries. Y. __________________________________________________________________________________________ 2) Against thermal irritation: To perform pulp protection against thermal irritation during cavity preparation. the following precautions should be considered: Removal of all carious enamel and dentin. 3) Against chemical irritation: To perform pulp protection against chemical irritation during cavity preparation. fissures and vulnerable areas to caries Proper extension of cavity margins to self-cleansable areas. Avoid using air jet for long time. Avoid working without coolant.A. AL-WASIFI. The cavity outline should be extended to include all pits. the following precautions should be considered: Avoid heat generation during cavity preparation. the following precautions should be considered: Avoid using of chemicals and caustics for toilet of the cavity. Undermined enamel is that not supported by sound dentin. I-B) PREVENTION OF CARIES RECURRENCE: To decrease the incidence of caries recurrence after cavity preparation.
5. 5-1): 1. grooves and retentive areas must be included within the outline. fissures. 2. Use disposable tools as much as possible. __________________________________________________________________________________________ I-C) WORKING IN A COMPLETELY ASEPTIC FIELD: It is unwise to treat a tooth and infect the patient with a dangerous systemic disease that could be transmitted via the dental office. All the circumference of carious lesion must be included within the outline. the followings should be considered: Use sterile instruments. AL-WASIFI.BASIC PRINCIPLES OF TOOTH PREPARATION. in order to: a) Prevent caries recurrence. MECHANICAL CONCEPT OF TOOTH PREPARATION II-A) OBTAINING THE OUTLINE FORM: Definition: Outline form of prepared cavity is defined as the external shape of the completed cavity boundaries. Y. The outline must be in the form of harmonious sweeping curves. the following cardinal rules should be considered (Fig. Fundamentals of outline form: To obtain ideal outline form. i. This constitutes a horrible issue to most of the dental patients allover the world.e. 4. Application of rubber dam to keep the fields clean and dry. II. and decrease the chance of droplet infection. 7 . All pits.A. All carious and undermined enamel must be included in the prepared cavity. the shape or pattern of CSA of the prepared cavity. To reduce the risk of cross infection. 3. b) Avoid stress concentration areas. Follow the instructions of ADA and WHO to control infection in dental office. The cavity margins should be extended to sound tooth structure without undermined enamel and in a self-cleansable area.
The final shape of the outline form for Class I carious lesion. The extent of surface involvement in enamel. Extension for prevention or cutting for immunity.A. 6. Y. Cavities approaching each other must be connected to avoid leaving a weak ridge between them which is liable to fracture. i. 7. 8 . B. AL-WASIFI. The lateral spread of caries at DEJ. E. The carious lesion should be included. A. D. Factors affecting extension for prevention: 1. 3.BASIC PRINCIPLES OF TOOTH PREPARATION.e. The outline of the cavity should be extended to area self-cleansable. Esthetic demands necessitate the use of special outline with minimal extension. Fig. C. The outline form includes all defective pits. Extension for prevention (Cutting for immunity): Definition: Extension of cavity margins to a self-cleansable area to decrease the possibility of caries recurrence. __________________________________________________________________________________________ c) Obtain better esthetics. degree of undermining. fissures and grooves. 5-1: Designing the outline form for pits and fissures lesion. Also the weakened unsupported enamel is included. 2.
3. AL-WASIFI. Extending the proximal outline up to the axial line angles of the tooth in direction bucco-lingual. Oral hygiene. Contact area in proximal cavities: Location.e. Restorative material as different extensions is used with different restorative materials. Extending the occlusal outline up to 2/3 of the cusp inclined plane. the lesser will be the extension due to tooth attrition. 2. 4. 5. __________________________________________________________________________________________ 4. 3. Increased irritation to the pulp. 2. the lesser will be the extension. Increased liability to recurrent caries. the more to be ideal. Weakening of the sound tooth structure. dimensions and tightness of contact area determine the isthmus outline of compound class II cavities to ensure the cavity outline is located in area self-cleansable. the older the patient. Patient age. 9 . the embrasures. Extending the outline of cervical buccal and lingual cavities (Class V) up to above the maximum height of contour and below the healthy gingival margin. Technique: 1. The isthmus outline will follow one of the Ingerham′s lines according to the width of the contact area. the better the oral hygiene. Increased liability for gingival and periodontal problems in compound cavities. the lesser will be the extension.A. Factors modifying the outline form: 1. Adverse effects of extension for prevention: 1. Force of mastication.BASIC PRINCIPLES OF TOOTH PREPARATION. i. Y. 7. Extending the gingival floor below the health gingival margins. 6. 4.
The reverse curve outline provides the adjusted required CSA at 90º and also conserves much more tooth structure. AL-WASIFI. Reverse curve in case of wide contact area. C. Reverse curve. the outline form will follow one of the Ingrham’s lines. __________________________________________________________________________________________ These lines may be (Fig. Straight line of small contact area. Y. Uniform curve in case of moderately sized contact area.BASIC PRINCIPLES OF TOOTH PREPARATION. • • 10 . 5-2: To ensure proper freeing of the contact area and placing the cavity walls in the embrasures. A. Remember that • The reverse curve outline is always required in the buccal wall rather than the lingual as the contact area is always shifted toward the buccal rather than lingual. B. The reverse curve outline could only be performed in the lingual wall when the caries extension is far lingual at the isthmus portion. Fig. for cases with open or too small contact between teeth Uniform or universal.A. for cases with tight and broad contact between teeth. for cases with moderate touch or plus contact between teeth. 5-2): Straight.
__________________________________________________________________________________________ 2. 6. 5. undermined labial enamel wall of Class III cavities could be left to preserve the natural tooth appearance. So. In case of ductile materials.A. no bulk depth or width specifications are needed. Physical properties of the restorative material: Brittle materials are in need for depth bulk with minimal width to decrease the surface of restoration exposed to occlusal force and to increase their strength. 3. Age of the patient: Young aged patient shows increased liability for caries recurrence. 11 . Technique of construction of restoration: Indirectly constructed restorations. So.BASIC PRINCIPLES OF TOOTH PREPARATION. 4. While in cases with bad oral hygiene. Esthetic needs: The outline extension may be affected by the location of the cavity. the outline should be well extended to insure all carious lesion and retentive area. AL-WASIFI. At the same time conservative due to increased liability to remake the cavity as a result of caries recurrence. Oral hygiene of the patient: Patients with good oral hygiene. all caries susceptible areas must be included in the cavity outline and the cavity should be extended to area selfcleansable. wax pattern and casting of the metal. Y. the outline width should be minimal as much as possible. In anterior teeth ultra conservative outline form should be performed in order to preserve the natural esthetic appearance of the tooth structure as much as possible. ultra conservative outline form could be performed. such as cast gold restoration or esthetic inlays. require further widening of the outline to allow easy and accurate manipulation of the impression. So.
the gingival margin of Class V cavity preparation should be hidden subgingivally and the incisal wall is just limited to the defect in case of tooth colored restorations in the anterior region and the incisal wall is given the shape of a graceful curve for maximum esthetics. AL-WASIFI. The stress response of the remaining tooth structure and the restoration is affected by 3 major factors. Factors affecting stress response of tooth structure and restoration: For proper designing of the resistance features of the prepared cavity. Y. slight extension of the cavity outline is indicated. a detailed understanding of the stress response of both the remaining tooth structure and the restoration should be obtained. Graceful curve is performed by cutting the incisal wall parallel to the curvature of the labial height of contours. II-B) PERFORMING RESISTANCE & RETENTION FORMS: Definitions: Resistance form is defined as that form given to prepared cavity to prevent fracture of remaining tooth structure or/and the restoration. inseparable and interrelated steps.A. So. __________________________________________________________________________________________ For esthetic demands. which are: 12 . Remember that • Resistance and retention forms are two distinct but yet.BASIC PRINCIPLES OF TOOTH PREPARATION. Retention form is defined as that form given to prepared cavity to prevent displacement or dislodgement of the restoration out of the prepared cavity. Convenience: Areas of inaccessibility do hinder proper instrumentation and restoration. 7.
tensile or shear and this depends on the form and shape of the loaded surface as well as the inclination of the cavity walls at which the stresses transmitted will be analyzed 3. Walls and floors: Should be either parallel or perpendicular to the long axis of the tooth to decrease the analysis of force into destructive tensile components (Fig. it varies from location to another in the same patient and also from time to another. direction and character. type of occlusion and inter-cuspation. c) The physical properties of the restorative material. b) The cavity design: 1. type of food.A. 13 . AL-WASIFI. 2. Also. 53). Direction: It may be directed as compressive. b) The cavity design. We can conclude that cyclic force with different magnitudes and directions are present during mastication producing fatigue of the restorative material and enhance its fracture. dynamic in eccentric lateral movement and cyclic and repetitive during masticatory function. Magnitude: That differs from patient to another according to the action of the mastication muscles. Y. age and sex. __________________________________________________________________________________________ a) The occlusal loading force. they should be flat and smooth to avoid stress concentration and to provide equal distribution of occlusal stresses. 1. Also. a) The occlusal loading force: Occlusal loading force affects the stress response of tooth and restoration through its magnitude. Character: It may be a static force in centric occlusion.BASIC PRINCIPLES OF TOOTH PREPARATION.
4. Flat pulpal floor but with incorrect angulation. increase the strength of the material and its resistance to fracture. it was proofed that it is better to provide bulk to the restoration through depth (within limits to avoid pulpal irritation) rather than width. But. AL-WASIFI. A. Fig. __________________________________________________________________________________________ Fig. 5-4). Y. 2.1/3 the intercuspal distance (Fig. Increasing the width will weaken the remaining tooth structure and the restoration as it leads to increased surface area of the restoration exposed to occlusal force.BASIC PRINCIPLES OF TOOTH PREPARATION. 3.5 – 1mm beyond the DEJ and a cavity width of 1/4 . B.A. Conservation: Maximum conservation of remaining sound tooth structure as much as possible is recommended to avoid their fracture.1/3 the intercuspal distance will decrease the exposed area of restoration to occlusal loading force. Line angles: All axial line angles of the prepared cavity should be rounded in the form of sweeping curves to avoid stress concentration. 5-3: Flat pulpal floor. Correct angulation of pulpal floor parallel to the occlusal plane and at right angle to the occluding force. Increasing the bulk of the restoration especially brittle ones. 14 . For compound cavities. It is recommended to get a cavity depth of 0. Cavity width and depth: Both of them are responsible to provide bulk to the restoration. 5-4: Minimal cavity width 1/4 .
4-6).A. For ductile materials such as gold. AL-WASIFI. 5. 4-5: Rounding the axio-pulpal line angle to reduce stress concentration on the restorative used. Cavo-surface angle: It should have a correct angulation suitable with the physical properties of the restorative material and the direction of enamel rods. Fig. it should be 135º to allow burnishing of the gold over the enamel margin that provides protection. C) The best compromise is obtained with a 90° CSA. B) An obtuse CSA protects the outer ends of enamel rods and strengthens the enamel margins but grossly weakens the margins of brittle restoratives. A) An acute CSA strengthens the margins of brittle restoratives but undermines the inner ends of enamel rods and grossly weakens the enamel margin and therefore is absolutely contraindicated. Y. Any deviation from correct angulation may lead to fracture or tooth structure or restoration at margin (Fig. which results in a sound enamel margin with no undermined rods and a strong restoration margins. 5-5).BASIC PRINCIPLES OF TOOTH PREPARATION. Fig. For brittle materials such as amalgam CSA should have 90 º angles to get the strongest enamel wall and provides strength to amalgam at margins. 15 . 5-6: The cavo-surface angle with brittle restoratives should be adjusted to the best compromise between the tooth and restoration. __________________________________________________________________________________________ rounding of the axio-pulpal line angle is recommended as it leads to decreased stress concentration and adds bulk to the restoration (Fig.
On the contrary to the strong and ductile gold this is utilized for protection of the weakened tooth structure. Relatively flat floors. These substances are especially sensitive to tensile stresses. Weak cusp: Weak cusp is that which have its base smaller than its heights that may lead to cusp splitting under loading force.BASIC PRINCIPLES OF TOOTH PREPARATION.A. cements and porcelain because they have high compressive but very low tensile and shear strength values. i. This is called cusp tipping in case of using amalgam to cover this cusp and should be for at least of 2 mm to provide strength to the amalgam. 2. Such a cusp should be reduced to decrease the height in relation to its base. In compound prepared cavities. 16 . AL-WASIFI.e. which provides the following advantages: The seat of the restoration (pulpal and gingival wall) is placed at a distinct right angle to the direct of functional stresses. Forms of resistance: The design features of cavity preparation that enhance primary resistance form are: 1. In-onlay. i. Y. c) The physical properties of restorative material: The tensile type stresses are the significant stresses for the brittle substances as amalgam.e. Amount of retention: Adequate amount of retention for each part of the cavity increases the stability of the restoration under stresses. 7. It is also called cusp coverage by performing counter bevel in case of using cast gold restoration to protect such a cusp. Box shape. __________________________________________________________________________________________ 6. each part should have its own ample independent retention to avoid fatigue and fracture of the restoration at the isthmus area. they cannot withstand high tensile stresses without fracture and cannot be finished to thin margins otherwise ditching will occur.
17 .A. __________________________________________________________________________________________ The tendency to split the buccal and lingual cusps of bicuspids and molars by forces transmitted through the restoration is greatly diminished since the inverted truncated cone shape prevents the wedging action of the restoration inside the tooth (Fig. 5-7). It provides retention by friction due to relative parallelism of the axial walls It allows access to and easy visualization of the interior of the cavity. Preservation of cusps and marginal ridges 5. A) that will prevent restoration movement. whereas rounded pulpal floor. resulting in splitting of tooth structure. 5-7: Box form cavity will provide flat pulpal floor. Reduction of cusps for capping when indicated.BASIC PRINCIPLES OF TOOTH PREPARATION. Fig. Seats on sound dentin peripheral to excavations of infected dentin (creation of dentin ledges). 8. which allows for an easier and better instrumentation and filling. Restorative materials tend to adapt better against its plane surfaces. Y. B) is conductive to restoration rocking action producing a wedging force. It allows the employment of retention features in dentin 3. Inclusion of weakened tooth structure 4. AL-WASIFI. Rounded internal line angles 6. Adequate thickness of restorative material 7.
Gripping action of dentin. 4-8b). 5-8: A) Basic primary retention form in Class II cavity preparation for amalgam with longitudinal external walls of proximal and occlusal portions converging occlusally and B) for cast inlay with similar walls slightly diverging occlusally. to prevent proximal displacement. Extension for retention. due to its visco-elasticity. stress relaxation of dentin will grip the restoration.A. Dove tail lock. 4. 3. Pin retention. 2. through converging the cavity walls occlusally (Fig. 18 . Y. Occlusal lock. Fig. performed by extension to the other side of the cavity. 4-8a).BASIC PRINCIPLES OF TOOTH PREPARATION. Mechanical undercuts. 5-9: Occlusal dove tail that adds retention and prevent tipping of the cast restoration. between parallel opposing cavity walls (Fig. This will occur only with gold foil restoration. Frictional wall retention. 3. Fig. in compound proximal cavities (Fig. 4. 5-9). Buccal and lingual extensions. AL-WASIFI. __________________________________________________________________________________________ Types of retentive features: a) By utilizing dentin: 1. b) By modifying the cavity outline: 1. in compound proximal cavities. 2.
A. Reverse gingival bevel at the gingival floor with gold inlay. 5-10: Cutting proximal axial grooves to provide lateral retention should be in expense of buccal and lingual walls rather than axial wall to provide lateral retention and avoid pulp exposure. in amalgam cavity. Y. 2. It prevents proximal displacement and rotation around axio-pulpal line angles (Fig. Fig. 5-11: Reverse gingival bevel cut with GMT of tapered fissure. It could not be used with amalgam cavities as it will lead to stress concentration and mercury accumulation at axio-gingival line angle resulting in excessive weakening of amalgam. AL-WASIFI. 5-11). it extends up to CSA without undercut (Fig.BASIC PRINCIPLES OF TOOTH PREPARATION. In gold cavity. along the axio-buccal and axio-lingual line angle with undercut. Proximal axial grooves. Fig. 19 . 5-10). 3. __________________________________________________________________________________________ c) By modifying cavity design: 1. Grooves in dentin line angles. it extends from gingivo-axial line angle up to the axio-pulpal line angle.
Esthetic demands. 5. i.e. Lateral. • • 20 . 4. Type of occlusion. __________________________________________________________________________________________ d) Special retentive features: 1. against lateral displacement. Flat pulpal floor. Dowel pin retention. Pulp vitality. Axial. 3. Type of restorative material. 6. It is gained by: 1. post inside the root canal. Retention means prevention of restoration displacement towards the periphery. against vertical displacement. Available amount of remaining tooth structure. Definite cavity walls. 2. Remember that • • Stability is mean prevention of restoration displacement towards the center. 2. It is either: 1.BASIC PRINCIPLES OF TOOTH PREPARATION. Amount of retention needed. Definite and slightly rounded line angles. Y. AL-WASIFI. for non vital pulp will not provide gripping action of dentin due to excessive dehydration.A. 2. abnormal occlusion increases the magnitude of stresses. Factors affecting selection of retentive form: 1. Adhesive systems for composite restoration. 2. 3.
Slight extension of cavity outline to facilitate insertion and condensation of the restorative material.A. 5. instrumented and restored. DEJ. It is also performed with composite resin cavity preparation to increase surface area for acid etching. 3. Beveling of enamel wall with gold restoration to provide room for burnishing the gold to protect marginal enamel. reached. The caries then shows a lateral spread at DEJ then follows the direction of dentinal tubules of dentin. Caries pattern: Caries in enamel follows the direction of enamel rods in a triangular pattern with its base toward the DEJ. 4. Avoid cutting at this sensitive area. Convenience features: 1. 2.5 – 1mm beyond DEJ in order to: 1.e.BASIC PRINCIPLES OF TOOTH PREPARATION. AL-WASIFI. __________________________________________________________________________________________ II-C) CONVENIENCE FORM: Definition: Convenience form is defined as that shape given to the cavity to make it easily seen. i. and determining the prepared cavity depth. Y. II-D) REMOVAL OF REMAINING CARIOUS DENTIN: Definition It is the process of removing decay and decalcified enamel and dentin. The routine cavity depth: The routine cavity depth should be extended 0. Selection of smaller specially designed instruments that enable the operator to prepare surfaces which are difficult to reach. Accentuation of point and line angles. Roundation of axial line angles. 21 .
If there is still soft caries.BASIC PRINCIPLES OF TOOTH PREPARATION. 3. 5. Finish enamel walls and apply either varnish in case of amalgam or calcium hydroxide liner in case of composite. Y. __________________________________________________________________________________________ 2. denoting presence of viable protoplasmic processes. Such soft dentin must be removed since it is carious and if left will extend to involve the pulp. 4. This layer constitutes the floor of deep and moderately deep cavities. Conditions at routine cavity depth: Three conditions may be found at the routine cavity depth. To get sure that there is no undermined enamel resulted from the lateral spread of caries at DEJ. If still soft. To detect lateral spread of caries at DEJ. it must be removed as it appears from enamel affecting esthetic. In anterior teeth. it must be evaluated. a) Hard sound viable dentin: It is considered as the best condition.A. and which may be discolored (chronic caries) or not (acute caries). either acute or chronic caries. If it is an acute caries. b) Hard discolored dentin: It is considered as sound dentin but the discoloration is due to the chromogenicity of microorganisms. c) Soft dentin: Which is painful. To provide sufficient bulk of the restoration. it could be left and sub-base and base are placed before placing the 22 . To add retentive features. it could be left and the final restoration could be placed. caries should be removed selectively forming dentin ledge and the cavity will be deep that needs sub-base and base before placing the final restoration. AL-WASIFI. In posterior teeth.
i. Short by months. Affected and not infected. Degeneration and necrosis.A. Only apply calcium hydroxide as indirect pulp capping. calcium hydroxide to neutralize acidity. Old. It provides no heat generation.e. as the last layer is sterile. Anywhere. AL-WASIFI. Soft and removed in flacks. more than 40 years. Yellow. Hyperemia. indirect pulp Could not be left and must be removed even if leads to pulp exposure.BASIC PRINCIPLES OF TOOTH PREPARATION. only apply affected. 23 .e. Hand instruments: Excavators with different shapes and sizes could be used in a direction parallel to the pulp horns from the cavity periphery to the center with scooping motion. so the last Histology layer is sterile. Long by years. Harder and removed in debris. Instruments used to remove caries: 1. __________________________________________________________________________________________ final restoration. it should be removed even pulp exposure occurs. Dark brown. i. less than 20 years. Y. capping. as the last later is infected. so the last layer is both infected and decalcified. First molar teeth and lower anterior teeth. it is just Chronic caries Acid penetration coincides with bacterial invasion. Could Last layer be left. If it is a chronic caries. Acute caries Acid penetration occurs before bacterial invasion. Patient age Site Duration Color Consistency Pulp reaction Young.
Y. __________________________________________________________________________________________ 2. The outer ends of enamel rods must be covered by the restorative material and inner ends rest on sound dentin. 24 . Gold inlays. Enamel wall must rest on sound dentin. To keep the rounded and convenient outline with proper cusp contours. Rotary instruments: Large round bur with low speed and without pressure.BASIC PRINCIPLES OF TOOTH PREPARATION. Requirements of enamel wall: According to NOY’S rules for keeping strong enamel wall at margins: 1. e. To give the CSA its correct inclination. The enamel wall must take the same inclination of enamel rods. Dentin bridge is the thickness of dentin protecting the pulp. The enamel walls and margins should be finished smooth. 4. To produce smooth enamel walls that increases adaptation of the restoration. 6. 2. • II-E) FINISHING OF ENAMEL WALL: Objectives: 1. 2. so it should be lined with sub-base and base to the proper level of the pulpal floor. To remove any undermined enamel. AL-WASIFI. free from short. The enamel wall must have an inclination suitable with the physical properties of the restorative material. 3. This had done by beveling the enamel rods and using a strong ductile restorative material. Remember that • Dentin ledge is a three-dimensional form in a level pulpal to the cavity. 3. friable or undermined enamel rods. It impairs the resistance form.g. This establishes the strongest required enamel wall. Enamel rods which form the CSA must have their inner ends resting on sound dentin. 4. 5.A. loose.
Beveling of enamel wall: Definition: Beveling means increasing CSA inclination more than 90°. 3. which is the reverse gingival bevel for retention of Class II gold inlay. Location of the cavity wall.e. i.A. 2. Y. in-onlay. Degree of marginal strength of the restorative material. The destructive force is away from it as it is in a palato-labial direction. 25 . 3. There is only one bevel made in dentin. Friability of enamel. CSA 90° for brittle material as amalgam and CSA 135° for ductile material as gold. Long bevel involving the full enamel thickness up to DEJ.BASIC PRINCIPLES OF TOOTH PREPARATION. Counter bevel made against enamel rods of the cusp to make inlay with cusp coverage. Remember that • Undermined enamel is only left in the labial surface of class III because of: Esthetic needs. Direction of enamel rods. 2. Types: 1. Short bevel involving part of enamel thickness. Full bevel including enamel and dentin up to the pulpal floor. AL-WASIFI. 4. The enamel wall must be beveled in case of using high strength restorative material. __________________________________________________________________________________________ 7. 4. It is subjected to minimal force produced from lip musculature. Factors affecting inclination of CSA 1.
Hand instruments. The cavity should be clean and dry before insertion of the filling material. AL-WASIFI. Instruments used for finishing of enamel wall: 1. Prevents contamination of the restorative material. Protection of weak cusps → counter bevel. Making the enamel wall parallel to the direction of enamel rods. 4. 7.g. 5. Enables the operator to examine properly all steps. Cutting fissure bur. Facilitate burnishing of ductile materials. Protection of cement line from solubility. II-E) TOILET OF THE CAVITY: Definition: The process of removing all debris from the prepared cavity. blood. 8. 4. 2. Chisel and hatchets are the instruments of choice with no heat generation. Rotary instruments. Increasing adaptation of the restoration to cavity walls. cut chips. Add retention → reverse gingival bevel. __________________________________________________________________________________________ Functions of bevel: 1. Protection of weak enamel rods.A. Increasing surface area for acid etching needed for retention of composite restoration. 2.BASIC PRINCIPLES OF TOOTH PREPARATION. e. 2. 26 . Y. 6. 3. Objectives: 1. 3. saliva and bacteria. Better esthetic and decreased demarcation of composite restoration.
dry and clean.BASIC PRINCIPLES OF TOOTH PREPARATION. Water spray: The best as it is not a medicament. Y. 3. leads to: Dehydration of dentin. Pulp irritation. Silver nitrate. Cotton pellet to dry the cavity to reduce the use of air stream. but it leads to pulp necrosis. Irritation to the pulp. Tarnish of amalgam. • 27 . The restoration should be properly constructed. 4. Should be washed immediately with warm water to avoid thermal pulp shock. but it leads to: Discoloration of tooth structure. Hot air blast. AL-WASIFI. Removal of remaining water by air for short time. __________________________________________________________________________________________ Technique: 1. 6.A. leads to dehydration of dentin. 5. For proper adaptation: The tooth surface should be smooth. Remember that • Adaptation is the maximum degree of proximity between the restoration and the tooth structure. Alcohol. Phenol. Hydrogen peroxide 3%: Highly effective through its effervescent action. 2.
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