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Concepts of Cavity Prep PDF
Concepts of Cavity Prep PDF
CONCEPTS IN CAVITY
PREPARATION
CONTENTS
Introduction
G.V. Blacks classification
Shortcomings of blacks classification
Rationale for introduction of new concept
Modification in cavity design
New methods for caries removal
Conclusion
The modern concept for restorative dentistry is based on
conservation and has concentrated on the importance of
preservation of the sound tooth structure by taking the measures
to preserve the integrity of teeth from being affected or by
undergoing treatment protocols which involve the minimum
intervention just necessary to restore the tooth as an active
member in the masticatory apparatus and to ensure its future
performance.
G. V. BLACK’S
CLASSIFICATION
Black suggested that it was necessary to
A further problem was that it was a classification of cavity designs for amalgam a
this was the principal restorative material available. The result was that, regardless
of the size of the lesion, a specific cavity design was required to deal with it.
Caries was rampant and the role of bacterial flora and the significance of fluoride
were not understood.
There were limitations in the available instruments for cavity preparation as well as
the selection of restorative materials.
WHY IS A CHANGE
NECESSARY
Rationale for introduction of new concept
The understanding of the ion migration that occurs, both out of and
back into tooth structure, as a result of the caries process. It is now
recognised that this is reversible, so the early lesion can be healed and
recognition of the initiation of the disease process is imperative
Gingival seat were taken below the Gingival seat is always kept supra-
gingival
sub-gingival level
Reverse curve was not emphasized Reverse curve is usually given
While cavity preparation
points to remember…..
1. Always follow the philosophy of minimally invasive dentistry.
2. Perform the least amount of dentistry needed in any situation.
3. NEVER ever remove more tooth structure than is absolutely required to
restore teeth to their normal condition.
4. Always use dental materials that conserve maximal tooth structure over
time.
5. Use only the strongest and longest lasting materials to reduce the need
for future repair and replacement.
6. Use dental procedures that minimize the number of necessary
appointments.
7. Select dental laboratories that use minimal invasive materials for the
restoration of teeth
8. Use only restorative materials that do not wear opposing teeth more
than enamel.
Minimally Invasive cavity
preparation procedures
Fissurotomy
Tunnel preparation
Mini-box or slot type preparation
Fissurotomy
The fissurotomy bur is a new approach to ultra conservative dental treatment
tapered bur
Acid etchant
Flowable composite
Various Fissurotomy burs
Conventional bur versus fissurotomy bur
Steps
Pit & fissure areas are probed
Fissures are explored for decay with the bur
Fissurotomy
The tapered shape of the bur allows the cutting tip to encounter
few dentinal tubules
The bur also has been designed to minimize heat build up and
vibration
Esthetic
Disadvantages
Principle
If proximal lesion is close to marginal ridge, entry is made
through the outer slope of the marginal ridge; contacts are
not disturbed as far as possible
Mini Box or Slot type
Technique
A slot type ppn with an occlusal access involves the carious lesion & extending
it gingivally, facially & lingually
Preparation
Slow speed hand piece with small diameter round bur used to obtain access
Finally the cavity is Acid etched, bonded, & filled with composite resin or GIC
Mini box v/s G V blacks method
RESTORATIVE MATERIALS
FOR MINIMAL
INTERVENTION
Adhesion in Restorative
Other materials:-
Resin-mod GIC
Properties:-
Materials
Advantages:-
Limits the removal of sound tooth structure
Limits the cutting of open dentinal tubules
Limits pulpal irritation & pain
Carisolv Gel
Carisolv s a chemomechanical method for caries
removal.
It is a mixture of amino acids and 05% sodium
bicarbonate
The resultant high-pH chloramines reacts with
denatured collagen in carious dentin
Softened dentin is removed with special hand
instruments
Caridex v/s Carisolv
Chemo-mechanical
method of Caries
stable 1 hr 20min
Steps
Chemo-mechanical
Caries is removed
Dried surface of dentin “frosted & irregular
appearance”
Also, a more recent study has used the enzyme pronase, a non-specific
proteolytic enzyme originating from Streptomyces griseus, to help
remove carious dentine.
Development:-
1940 - Robert Black
1950 - Tim Rainey, Father of concept of air abrasive micro
dentistry.
1951- S.S White technology introduced AIR- DENT,
1990’s- New technology
Air abrasion
Handpiece
E = ½ m V2
Kinetic energy can be increased by increasing the velocity or
increasing the mass
Note:-
Rotary instrumentation – Mechanical Energy
Air Abrasion – Kinetic Energy
Tools
Abrasive particle – Al2O3
Air - Abrasion
Check occlusion
Advantages
No shattering of enamel or micro fracture as with bur
Air - Abrasion
The fact that the abrasive is water soluble means it does not escape
too far from the operating field. The bombardment of the hard tooth
surfaces by these particles results in a continuous mechanical abrasive
action which removes surface deposits.
this technique is to remove surface enamel stains, plaque and calculus
well away from the gingival margins of healthy teeth.
This, used in conjunction with a thick aluminium oxide and water slurry, created the cutting
action, the mechanism of which was the kinetic energy of water molecules being transferred
to the tooth surface via the abrasive through the high speed oscillations of the cutting tip
It was found that the harder the tissue, the easier it was to cut. Soft, carious dentine
apparently could not be removed, but the harder, leathery, deeper layer was more susceptible.
‘Sono-abrasion’
Sono-abrasion
ultrasonics mentioned above is the use of
Hard tissue Laser – cuts enamel, dentin, decay & soft tissue
Commonly used LASERS
Er:YAG (erbium: yttrium-aluminiumgarnet) and Nd:YAG (neodymium:
YAG) —mid-IR to IR emission
Carbon dioxide lasers (CO2) — IR emission
Excimer lasers (ArF (argon:freon) and XeCl (xenon:chlorine) — UV
Lasers
emission
Holmium lasers
Dye-enhanced laser ablation –— exogenous dye, indocyanine green in
conjunction with a diode laser
Wavelengths:-
Er:YAG – 2940nm
Er, Cr:YSGG – 2780nm
Principle
Deflected
When light encounters matter
Absorbed
Energy not destroyed; used to increase the energy level of the absorbing
Lasers
atom or molecule
Since anesthetic is not used most of the time, there are no numb lips or
tongue, which is often disliked by the patients.
Lasers
The intermittent, light contact mode is short and effortless; the dentist
can see what he or she is doing, and the preparation is clean.
This was possible even when the bacteria were embedded in a collagen
matrix and when the light passed through a zone of demineralised dentine .
Lasers can also be used to cut and seal dentinal tubules, reducing the
possibility of postoperative sensitivity. Further, the patient acceptance of
the muted (popping) sound of lasers is likely to be much better than the
infamous sound of the dental drill dreaded by most patients.
Limitations
The foremost drawback is the cost effectiveness, the
treatment being expensive.
Lasers cannot produce the uneven edges carved
intentionally with a drill, so that dental amalgam or
Lasers
Thermomechanical Ablation
High absorption coefficient in water and high affinity for
hydroxyapatite.
Structure:-
Its made up of 3 atoms of oxygen with a cyclic structure & is very reactive
towards biomolecules
O2 O3
Recall – 3months
Advantages
Kills > 99% micro organisms
Oxidizes caries, speeds up remineralisaion
Remove organic debris, volatile sulphur compounds
Ozone
Adverse Effects
‘Respiratory Distress’
Caries detecting dyes stains demineralised matrix of carious
dentin that should not be removed
Conclusion
In general, the development of caries removal techniques in
restorative dentistry is progressing towards a more biological and
conservative direction. This has been made possible with better
understanding of the aetiology, development and prevention of dental
caries, the emergence of new caries removal techniques and
advances in dental restorative materials. In particular, the
development of reliable adhesive technology in the oral cavity, which
led the way to a minimal cavity preparation concept, has given a great
impetus to the current thinking in this area. The coming decades will
continue to see shifts in the approach to caries removal techniques,
cavity preparation and restoration techniques based on rational
clinical and scientific principles.
“the loss of even a part of human tooth tissue should be considered a
serious injury and dentistry’s goal should be to preserve healthy,
natural tooth structure.”