SEMINAR TOPIC “ Class – II cavity preparation for restoration [amalgam and metal inlay] ” cast

Dept.Conservative dentistry & Endodontics

5/5/12

What is TOOTH PREPARATION?????????

Tooth preparation is defined as the mechanical alteration of a defective, injured, or diseased tooth to best receive a restorative material that will reestablish a healthy state for the tooth, including esthetic corrections where indicated, along with normal form and function.
Dept.Conservative dentistry & Endodontics 5/5/12

What are the OBJECTIVES ?????????
is to------(1) remove all defects and provide necessary protection to the pulp, (2) extend the restoration as conservatively as possible, (3) form the tooth preparation so that under the force of mastication the tooth or the 5/5/12 restorationDept.Conservative dentistry
& Endodontics

Greene Vardiman Black,
M.D., D.D.S., LL.D., Sc.D. (1836-1915)

Dept.Conservative dentistry & Endodontics

5/5/12

.........Conservative dentistry & Endodontics 5/5/12 ........... Dept.....CLASS II AMALGAM RESTORATIONS……....

Conservative dentistry & Endodontics 5/5/12 .Amalgam restorations that restore one or both of the proximal surfaces of the tooth may provide years of service to the patient Dept.

.Conservative dentistry & Endodontics 5/5/12 .I NITIAL CLINICAL PROCEDURES…………………………. Dept.

Occlusal contacts should be marked with articulating paper before tooth preparation. The operator should make a mental image of these contacts to serve as guide in tooth preparation and restoration.

Dept.Conservative dentistry & Endodontics

5/5/12

Any opposing "plunging cusp" or other pointed cusp may need to be recontoured to reduce the risk of fracture of the new restoration or the cusp from occlusal forces.

Dept.Conservative dentistry & Endodontics

5/5/12

Initial Tooth Preparation………………………………

Dept.Conservative dentistry & Endodontics

5/5/12

Occlusal outline form (occlusal step).

The occlusal outline form of a Class II tooth preparation for amalgam is similar to that for the Class I tooth preparation.

Using high speed with air-water spray, enter the pit nearest the involved proximal surface with a Dept.Conservative dentistry 5/5/12 & Endodontics punch cut using a No. 245 bur.

The long axis of the bur and the long axis of the crown should remain parallel during cutting procedures.e. 245 bur).. Proper depth of cut is the initial entry 1.Conservative dentistry 5/5/12 & Endodontics . Dept.5 to 2 mm (i. one half to two thirds the length of the cutting portion of a No.

Generally the amount of remaining tooth structure is more important to restoration longevity than the restorative material used. 245 bur. The pulpal floor should be prepared to a uniform depth and is usually flat. Dept.Conservative dentistry & Endodontics 5/5/12 . Narrow restorations provide a greater length of clinical service.Ideally width of isthmus should be the width of the No.

Dept. often unnecessary. parallel to enamel rod direction .Conservative dentistry & Endodontics 5/5/12 .Reverse curve is usually created in mesio-facial aspect . Lingually. reverse curve is very slight.

.....Conservative dentistry & Endodontics 5/5/12 .. Dept.Proximal outline form (proximal box)....

or existing restorative material. faults.e..Conservative dentistry 5/5/12 butt joint & Endodontics .The objectives for extension of proximal margins are to: Include all caries. Create 90-degree cavosurface margins (i. Dept.

Bur position to begin proximal ditch cut..Isolation of proximal enamel. floor). at extension in cementum. Proximal ditch is extended gingivally to desired level of gingival wall (i. A. at moderate extension. c. Variance in pulpal depth of axiogingival line angle as extension of gingival wall varies: a.e.Conservative dentistry & Endodontics 5/5/12 .. Dept. C. at minimal gingival extension. B. b.

When small lesion is prepared.Proximal ditch cut results in axial wall that follows outside contour of proximal surface. gingival margin should clear adjacent tooth by only 0. Dept.Conservative dentistry & Endodontics 5/5/12 .5 mm.

Conservative dentistry & Endodontics 5/5/12 . Dept.Faciolingual dimension of proximal ditch is greater at gingival than at occlusal level. To further isolate and weaken proximal enamel. bur is moved toward and perpendicular to proximal surface .

Conservative dentistry & Endodontics 5/5/12 . there is a danger of the instrument either the adjacent proximal surface ……………… marring Dept.When a rotary instrument is used in a proximal box after the proximal enamel is removed.

Conservative dentistry & Endodontics 5/5/12 .Removing isolated enamel……………………… Dept.

Dept.. Proximal view with proximal enamel removed.Using spoon excavator to fracture out weakened proximal enamel……… Occlusal view with proximal enamel removed……….Conservative dentistry & Endodontics 5/5/12 .

Removing remaining undermined proximal enamel with enamel hatchet………………… Dept.Conservative dentistry & Endodontics 5/5/12 .

On facial proximal wall On lingual proximal wall On gingival wall Dept.Conservative dentistry & Endodontics 5/5/12 .

Conservative dentistry 5/5/12 & Endodontics . Restricting the occlusal outline form (where Dept.Primary resistance form is provided by: The pulpal and gingival walls being relatively flat and perpendicular to forces directed with the long axis of the tooth.

The reverse curve optimizing the strength of both the amalgam and tooth structure at the junction of the occlusal step and proximal box.Conservative dentistry & Endodontics 5/5/12 . Slightly rounding the internal line angles to reduce stress concentration in tooth structure (automatically created by bur design. and Providing enough thickness of restorative material to prevent its fracture under mastication Dept. except for the axiopulpal line angle).

Dept.Retention form  Dovetail design. Occlusal convergence.Conservative dentistry & Endodontics 5/5/12 .

 groove.Conservative dentistry & Endodontics 5/5/12 . rounden axiopulppal angles.Secondary retention and resistance form Retention locks. Dept.

Adjoining restoration-joining MO with existing DO Modifications for abutment teeth for removal Dept.modifications Simple box preparation-only proximal box Slot preparation-similar to cl V but done at proximal side oblique ridge Conservative design-preserves tranverse or Modification to preserve esthetics-45 d rotation of the box.Conservative dentistry partial dentures & Endodontics 5/5/12 .

Final cavity preparation Removal of remaining defective enamel and infected carious dentin Pulp protection Secondary retention and resistance forms Finishing the external walls Cleaning the cavity preparation. Dept.Conservative dentistry & Endodontics 5/5/12 .

2 mm inside D and their direction of depth is parallel to DEJ. & Endodontics C. Failure caused by weak-amalgam Dept. 5/5/12 . Note also th retention locks have been cut 0. Failure caused by weak enamel margin.Conservative dentistry margin. B. Proper direction to proximal walls results in full-length enamel rods and 90-degree amalgam at preparation margin.A.

Conservative dentistry & Endodontics 5/5/12 .TOOTH PREPARATION FOR CAST METAL INLAY Click to edit Master subtitle style Dept.

Sturdevant) Dept.Sturdevant.DEFINITION OF INLAY  Inlay is defined as a fixed intracoronal restoration.Conservative dentistry & Endodontics 5/5/12 . which is then luted into the tooth (Rosensteil)  Class II inlay involves occlusal surfaces and proximal surfaces of a posterior tooth and may cap one or more but not all of the cusps (John R. Clifford M. a dental restoration made outside of a tooth to correspond to the form of prepared cavity.

Indications  It is an alternative to amalgam and composite when higher strength and superior control of contours & contacts is desired.Conservative dentistry & Endodontics 5/5/12 . Used instead of amalgam in patients with low caries rate who require class II with ample supporting dentin Dept.

Conservative dentistry & Endodontics 5/5/12 .Contraindications High caries rate Young patients Esthetic concerns Small restorations Unless sufficient bulk of tooth is there to provide retention and resistance. it is contraindicated Dept.

Advantages Strength Biocompatibility Low wear Control of contours & contacts Dept.Conservative dentistry & Endodontics 5/5/12 .

Disadvantages Higher chair side time & increased appointments Temporary required between preparation & delivery appointments Cost factor Technique sensitive Dept.Conservative dentistry & Endodontics 5/5/12 .

Conservative dentistry & Endodontics 5/5/12 .Basic concepts of cavity design for cast restoration Preparation path Inlay taper Preparation features of circumferential tie  Occlusal & gingival Bevels  Types Functions  Facial & lingual Flares Primary Secondary Dept.

Preparation path Single insertion path All reductions oriented towards one path – path of removal & re-insertion should be perpendicular to plane across cusp tips or parallel to The “line of draw” .

Inlay taper Apico-occlusal taper Cavity walls must diverge from floor outwards To permit unobstructed removal & placement of wax pattern & casting .

 According to Sturdevant :  2 ° – 5 ° from line of draw  Short vertical walls : 2 °  Long vertical walls : > 2 °  According to Charbeneau :  10 ° – 16 ° of convergent angle  5 ° – 8 ° on each wall .

 Taper may be increased or decreased according to following factors : Wall length 10°) Taper required (< Surface involvement in preparation required (< 10°) Need for retention Taper Dept.Conservative dentistry & Endodontics 5/5/12 Taper .

PREPARATION FEATURES OF CIRCUMFERENTIAL TIE  Circumferential tie – peripheral marginal anatomy  Features :  Margins terminating on enamel should fulfill requirements advocated by Noy  In an intracoronal cavity. the circumferential tie is in the form of a bevel. which is a plane of a cavity wall or floor directed away from cavity preparation  Types  Functions  Occlusal & gingival Bevels  Facial & lingual Flares  Primary  Secondary Dept.Conservative dentistry & Endodontics 5/5/12 .

BEVELS  “Flexible extentions” of a cavity preparation.  To provide “lap joint” . or other areas on tooth surface. allowing the inclusion of surface defects. supplementary grooves.

Types & design features of occlusal & gingival bevels  According to their shapes & types of tissue involvement there are 6 types of bevels :  Partial bevel  Short bevel  Long bevel  Full bevel  Counter bevel  Hollow ground (concave) bevel Dept.Conservative dentistry & Endodontics 5/5/12 .

not exceeding 2/3 of its dimension Use : to trim weak enamel rods from margin peripheries .Partial bevel  Involves : part of enamel wall .

but not dentin Class I alloys specially type 1 & 2 Use : mostly with .Short bevel Involves : entire enamel wall .

Long bevel Involves : all enamel wall & up to ½ of dentinal wall frequently used for Class I.II & III alloys preserves internal “boxed-up” resistance & Use : most Advantage : .

Full bevel Involves : all the dentinal & enamel walls of cavity wall or floor impossible to use other bevels deprives the preparation of its internal resistance & retention features Use : only if Disadvantage : .

Counter bevel Use : when capping cusps . to protect & support them an axial cavity wall on facial or lingual surface of tooth gingival inclination facially Used opposite to It will have .

Hollow ground (concave) bevel Any bevel prepared in concave form Allows space for cast material bulk . improves retention & resistance & V cast materials Ideal for Class IV .

Function of Bevels  Satisfies Noy’s requirements  Creates obtuse angled marginal tooth structure strongest configuration of marginal anatomy  Creates acute angled marginal cast alloy most amenable to .

Function of Bevels Reduces error factors (space between cast & tooth substance) Bevel – major retention form . here direct retentive frictional component exists between casting & tooth .

Types & design features of facial & lingual flares Flares – flat or concave peripheral portions of facial & lingual walls 2 types :  Primary flare  Secondary flare .

Primary flare  Conventional & basic part of circumferential tie facially & lingually  Similar to long bevel  Always have specific angulation : 45° to the inner dentinal wall proper  Functions :  (Same as bevels) + they bring proximal margins to cleansable .finishable areas  Indication :  Facial & lingual proximal wall  Note : 5/5/12  If theyDept.Conservative dentistry do not fulfill the objectives of preparation & Endodontics .

SECONDARY FLARE • Flat plane superimposed peripherally to a primary flare • Solely in enamel . sometimes may contain dentin • May have different angulations. involvement & extent Functions : In very widely extended lesions buccolingually In very broad or malposed contact areas In ovoid teeth with undercuts at facial & lingual peripheries .

Conservative dentistry & Endodontics 5/5/12 .Tooth preparation for class II cast metal inlays Dept.

Tooth preparation for class II cast metal inlays  Class II inlay involves occlusal surfaces and proximaal surfaces of a posterior tooth and may cap one or more but not all of the cusps  Steps :  Initial preparation  Occlusal step  Proximal box  Final preparation  Removal of infected carious dentin & pulp .

the cutting instrument used are oriented to a single “draw” path Gingival to occlusal divergence of walls : 2 ° – 5 ° from line of draw Dept.Initial preparation Plane cut tapered fissure carbide burs are used to prepare vertical internal walls of the preparation Throughout the preparation.Conservative dentistry & Endodontics 5/5/12 .

5mm General rule : long axis of bur parallel to long axis of tooth crown 5/5/12 In mandibular molar & premolar -5 ° to 10 ° lingually tilted Dept. 271 bur enter the fossa / pit to an initial depth of 1.Occlusal step With No.Conservative dentistry & Endodontics .

Conservative dentistry & Endodontics 5/5/12 .Extend to uninvolved fossa/pit keeping faciolingual width minimum & marginal ridge strong Dept.

If a fissure extends on the mesial marginal ridge. it is treated by : Enameloplast y Bevel .

Conservative dentistry This provides the desired “Dovetail retention form” which resists distal displacement of 5/5/12 inlay . 169L bur is used so that tooth structure can be conserved Dept.Extension to include faulty facial & lingual fissures radiating from mesial pit & Endodontics Slender No.

Conservative dentistry & Endodontics As the preparation is extended distally. the faciolingual width is progressively widened – till 5/5/12 proximal .The occlusal step is extended distally into distal marginal ridge sufficiently to expose junction of proximal enamel & dentin Dept.

5mm .8mm 2/3 at expense of dentin & 1/3 at expense While penetratin g gingivally.Proximal box Continuing with 271 bur the distal enamel is isolated by cutting a proximal ditch Mesiodistal width of ditch : 0. the proximal ditch is extended Facio & linguoaxial line angles should clear adjacent tooth by 0.2-0.

Make 2 cuts at facial & lingual limit of proximal ditch Until the bur is nearly through the marginal ridge enamel Dept. it is broken away using a spoon excavator 5/5/12 .Conservative dentistry & Endodontics If the wall of enamel is still present.

15 Straight chisel / Binangle chisel/ Enamel hatchet Dept. Axial wall may be planed with 5/5/12 secondary edge .Proximal & gingival walls are planed using hand instruments to remove all remaining enamel Modified palm & thumb grasp used in chisel like motion in occluso – gingival direction No.Conservative dentistry may be & Endodontics Gingival wall is planed using a hoe in lingual to facial scraping direction .

169L bur Endodontics & 5/5/12 .3mm) retention grooves may be cut on the facioaxial & linguoaxial line angles with Dept.Conservative dentistry No.Shallow (0.

Final preparation Removal of infected carious dentin & pulp protection Preparation of bevels & flares Dept.Conservative dentistry & Endodontics 5/5/12 .

Dept.Conservative dentistry 271 bur & Endodontics - 5/5/12 . 2 or 4) / spoon excavator used Light cure GIC placed as base & excess trimmed with No.Removal of infected carious dentin & pulp protection If infected shallow / moderate carious dentin (>= 1mm RDT) - Satisfactory isolation Small round bur(No.

Conservative dentistry & Endodontics 5/5/12 .Preparation of Bevels & Flares Dept.

Preparation of Bevels Slender flame shaped fine grit diamond is used to bevel Gingival retraction cord – widens sulcus to 0.5mm – results in open sulcus – improves visibility & prevents injury to gingival .

undercut will Dept.The instrument is held parallel to gingival third of proximal surface of adjacent tooth If the bur is tilted lingually / buccally.Conservative dentistry of5/5/12 be created at corners the & Endodontics box (commonly seen fault) The bevel should result in 30° – 40°marginal metal on inlay .The cavosurface design helps seal & protect margins & results in strong enamel margin with an angle on 140° 150° To place gingival bevel .

Preparation of Flares Dept.Conservative dentistry & Endodontics 5/5/12 .

Distolingual wall extends into lingual embrasure in 2 planes : 1st termed – lingual primary flare No. 169L or paper disc Slender flame shaped fine grit diamond 2nd termed – can be used to prepare lingual Dept.Conservative dentistry 5/5/12 secondary flare secondary flareEndodontics & Secondary flare are directed to result in 40° marginal metal & 140° marginal enamel .

Conservative dentistry & Endodontics 5/5/12 .The lingual secondary flare is prepared approaching from lingual embrasure moving the instrument mesiofacially Dept.

Conservative dentistry 40° marginal metal should result Completed 5/5/12 facial .Preparation of facial secondary flare Long axis of instrument is along the line of draw with only small tilting mesially & facially & Endodontics To prevent abrasion to adjacent tooth the instrument may be raised occlusally Dept.

Conservative dentistry & Endodontics 5/5/12 .5-1mm wide Should blend with lingual secondary flare Dept.Gingival bevel Should result in 30° marginal metal Instrument is tilted slightly mesially 0.

Difference between preparation for amalgam and inlay Dept.Conservative dentistry & Endodontics 5/5/12 .

50. home [access for finishing.Conservative 5/5/12 Proximal outline diverges occlusally dentistry Converges & Endodontics .INLAY PREPARATION May Support tooth AMALGAM PREPARATION Preparation supported by tooth Retention achieved by nearly parallel From parallel walls & undercuts opposing walls . home care ] care ] Rounded Gingival cavosurface point anglesDefinite angle [for ease of [for ease of finishing gold] condensing amalgam] Dept.5mm clearance 1mm) [access for disking. close adaptation of casting . finishing. cementing medium Good Resistance to occlusal forces Narrower Isthmus width All Margins beveled No Reverse Curve Requires right angle margins Present Poor resistance to occlusal forces More extensive Proximal outline (0.

retentive undercuts placed Flat gingival wall Axiopulpal line angle is Axiopulpal line angle is rounded to prevent voids in the rounded to prevent stress on working die amalgam All margins are beveled No cavosurface bevels Dept.Conservative dentistry & Endodontics 5/5/12 . no undercuts Gingival wall in 2 planes Preparation must not draw .INLAY PREPARATION AMALGAM PREPARATION Preparation must draw .

Thank you Dept.Conservative dentistry & Endodontics 5/5/12 .

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