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CLASS II AMALGAM

Design Principles

CLASS II

Class II cavitated caries lesions

Class II cavitated caries lesions

opaque white haloes identify areas of enamel undermining and decalcication from within

radiographic appearance of the Class II caries lesion

E1 lesion conned to outer half of enamel

E2 lesion reaches into inner half of enamel

cavitated lesion spreading radiolucency at DEJ

Primary Caries

E2

D1

Primary Caries D2 D1

D3

Accepted Terminology extending into proximal extending gingivally preparing a proximal box

Jargon dropping a box deepening cervically

The Class II cavity prepared to receive amalgam has two parts

the occlusal portion

design principles are the same as for the Class I cavity

the proximal portion or proximal box

design principles will be presented now

names of walls for the the occlusal portion of the Class II cavity are similar to the Class I

Class II

Class I

BUCCAL WALL

Class II
DISTAL WALL BUCCAL WALL

MESIAL WALL LINGUAL WALL

Class I

DISTAL WALL

LINGUAL WALL

PULPAL FLOOR

Class II

Class I

PULPAL FLOOR

names of walls for proximal portion of Class II cavity

DISTAL WALL

BUCCAL WALL

LINGUAL WALL

GINGIVAL SEAT

BUCCAL WALL

LINGUAL WALL

BUCCAL OCCLUSAL WALL

LINGUAL OCCLUSAL WALL

BUCCAL PROXIMAL WALL

LINGUAL PROXIMAL WALL

AXIAL WALL

names of line angles for proximal portion of Class II cavity

AXIO-PULPAL LINE ANGLE AXIO-BUCCAL LINE ANGLE AXIO-LINGUAL LINE ANGLE

BUCCO-GINGIVAL LINE ANGLE AXIO-GINGIVAL LINE ANGLE

LINGUO-GINGIVAL LINE ANGLE

names of cavosurface margins for proximal portion of Class II cavity

BUCCAL PROXIMAL CAVOSURFACE MARGIN

LINGUAL PROXIMAL CAVOSURFACE MARGIN

GINGIVAL CAVOSURFACE MARGIN

names of point angles for proximal portion of Class II cavity

AXIOBUCCOGINGIVAL POINT ANGLE BUCCOGINGIVOCAVOSURFACE POINT ANGLE

AXIOLINGUOGINGIVAL POINT ANGLE LINGUOGINGIVOCAVOSURFACE POINT ANGLE

PROXIMAL OUTLINE FORM


PRINCIPLE RATIONALE

straight B & L outlines near parallel to long axis of tooth gingival outline perpendicular to long axis of tooth

conservative of tooth structure resists forces of occlusion

EXTENSION
a balance between conservation of tooth structure and the need for access and to remove defective tooth structure

PROXIMAL EXTENSION
PRINCIPLE RATIONALE

encompasses carious tissue eliminates unsupported enamel encompasses contiguous ssures encompasses contiguous restorations

eliminates infected tissue eliminates weakened tooth structure reduces risk of secondary caries maximizes restoration lifespan

PROXIMAL EXTENSION
PRINCIPLE RATIONALE

clears adjacent tooth by 0.5mm (0.3 - 0.65mm)

access for matrix band allows inspection of restoration margin access for nishing

PROXIMAL DEPTH
proximal depth is M-D dimension of proximal box

PROXIMAL DEPTH
proximal depth is M-D dimension of proximal box

Syn: axial depth NOT pulpal depth

PROXIMAL DEPTH
PRINCIPLE RATIONALE

0.5mm into dentin 1.25 - 1.5 mm measured at level of gingival seat

sufcient bulk of amalgam to prevent fracture maximum thickness of dentin protecting pulp

AXIAL WALL
PRINCIPLE RATIONALE

smooth straight O-G, parallel to long axis of tooth parallels curvature of tooth surface B-L

optimize adapatation of amalgam to wall uniform bulk of amalgam to prevent fracture maximum pulpal protection

AXIO-PULPAL LINE ANGEL


PRINCIPLE RATIONALE

rounded or beveled

reduces risk of amalgam fracture

GINGIVAL SEAT
PRINCIPLE RATIONALE

smooth, at, straight perpendicular to long axis of tooth M-D & B-L enamel planed at margin

optimize adaptation of amalgam to walls resists forces of occlusion elimination of friable enamel
plane margin enamel

A-A

BUCCAL & LINGUAL WALLS


PRINCIPLE
RATIONALE

smooth, straight G-O wall nearest functional cusp convergent 6 G-O wall nearest nonfunctional cusp parallels long axis of tooth

optimize adaptation of amalgam to walls


helps lock restoration in tooth (retention) preserves strength of cusps (resistance form)
FC NFC

tangent

BUCCAL & LINGUAL WALLS


PRINCIPLE
RATIONALE

angle with proximal cavosurface 90-110 (measured to tangent)


nt e g n ta

optimizes strength of both amalgam and enamel at margin


110

90

tang ent

the cavosurface angle is dened as the angle in metal at the margin of a restoration

90 70

BUCCAL & LINGUAL WALLS


PRINCIPLE
RATIONALE

proximal cavosurface angle is 70-90 (measured to tangent)


90 70

optimizes strength of both amalgam and enamel at margin

90

110

PROXIMAL RETENTION GROOVES


PRINCIPLE RATIONALE

placed in B&L proximal walls 0.5mm deep to DEJ directed laterally, not pulpally extending from G seat to A-P line angle 0.5mm deep gingivally, fading away occlusally rounded cross-section

provides mechanical lock against displacement proximally prevents encroachment on pulp prevents undermining enamel maximizes retention while minimizing weakening of tooth

CAVITY REFINEMENT
PRINCIPLE RATIONALE

internal line angles welldened but not sharp

maximizes amalgam resistance to dislodgement reduces stress concentration & risk of subsequent tooth fracture

cusp fracture

CAVITY REFINEMENT
PRINCIPLE RATIONALE

B-G and L-G line angles have slight radius

reduces stress concentration & risk of subsequent tooth fracture difcult to condense thick amalgam into sharp point angles

CAVITY REFINEMENT
PRINCIPLE
RATIONALE

cavosurface margins well-dened & wellsupported

easier to visualize & carve following condensation optimize adaptation of amalgam to margins eliminates weak tooth structure maximizes marginal integrity

CAVOSURFACE MARGINS

cavosurface margin unsupported, rough


tooth surface

poorly dened

enamel

CAVOSURFACE MARGINS

cavosurface margin unsupported, rough amalgam


tooth surface

poorly dened

enamel

ditching

CLEANLINESS
PRINCIPLE RATIONALE

cavity is free of debris & moisture

facilitates adaptation of amalgam to the cavity improves physical properties of the restoration by elimination of voids & foreign material

TISSUE PRESERVATION
PRINCIPLE RATIONALE

rubber dam intact adjacent tooth undamaged gingival soft tissues not unduly traumatized

isolation important to quality of result prevention of postoperative sensitivity, inammation, & nidus for further caries attack