10/3/17

Fundamentals of Tooth
Preparation
Mohammad Atieh BDS MS
Department of Conservative Dentistry
Jordan University of Science and Technology

§ Tooth preparation :
§ It is the mechanical alteration of a defective, injured, or
diseased tooth to allow placement of restorative material
Definition that re-establishes normal form and function and
esthetics (when indicated)

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§ When there is a disease:

§ Dental caries.
§ Tooth wear : other form of tooth structure loss not related
to oral biofilm but to other factors that mechanically or
chemically abrade tooth structure.

§ Improper function due to:

When § Destruction from dental caries.

§ Defective previous restoration
Restorations § Fractured tooth

are Indicated? § Complete fracture

§ Greenstick fracture
§ Congenital malformation
§ Improper position
§ To facilitates tooth replacement with fixed or
removable partial dentures.

§ Conservatively remove defective tooth structure.

§ Form a tooth preparation that resists fracture/
displacement of the restoration or fracture of the tooth.
Objectives of § Allow for esthetic and functional placement of a
Tooth restorative material.

Preparation

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1. General Factors:
§ Pulpal and periodontal status
§ Occlusal relationship
§ Relationship of the tooth to be resorted to the overall
comprehensive treatment plan of the patient.

Factors 2. Dental Anatomy:

Affecting Tooth
§ Direction of enamel rods
§ Enamel and dentin thicknesses
Preparation § Size and position of the pulp

3. Patient Factors:
§ Caries risk
§ Disease control stage vs definitive stage.
§ Esthetic concerns
§ Economic status
§ Medical condition
Factors
Affecting Tooth 4. Conservation of Tooth Structure

Preparation § Preserves the vitality of the pulp

§ Results in stronger tooth/restoration complex

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5. Restorative Material Factors:

§ Preparation requirements
§ Direct and indirect restorative materials have preparation
requirements for strength and retention.

Factors § Indirect restorations requires draw.

Affecting Tooth § Sensitivity to moisture

Preparation

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§ “Dental caries is a multifactorial, transmissible,

infectious oral disease caused primarily by the
complex interaction of cariogenic oral flora (biofilm)
with fermentable dietary carbohydrates on the tooth
surface over time”

Dental Caries § This leads to localized dissolution and destruction of

the calcified tissues of the teeth.

§ Caries is episodic with alternating phases or

demineralization and remineralization that may occur
simultaneously in the same lesion.

§ Caries can be described according to nature,

Nomenclature location, extent and rate.

of Caries

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§ Primary

§ Secondary
Nature

§ Residual

§ Forward caries

§ Backward caries :
Spread § Caries extends from DEJ into enamel

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§ Pit and fissure caries

Location

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§ Pit and fissure caries

§ Smooth surface caries

Location

§ Root-surface caries

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§ Incipient (Reversible):
§ Enamel appears opaque white when air-dried and
disappear when wet.
§ Caries has not extended to DEJ.
§ Enamel is intact and can be reminerlized:

Extent

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§ Incipient (Reversible):
§ Enamel appears opaque white when air-dried and
disappear when wet.
§ Caries has not extended to DEJ.
§ Enamel is intact and can be reminerlized:
§ A reminerlized lesion

Extent § Opaque white / shiny whtie or brown-black( from extrinsic

coloration)
§ Hard-surfaced
§ Same appearnace wet/dry

§ Cavitated caries ( Irreversible)

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Reminerlized
Incipient

Dr. Mohammad Atieh

Cavitated
(Irreversible)

Dr. Mohammad Atieh

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https://hubpages.com/health/Enamel-Hypoplasia-Causes-Symptoms-and-Treatment

Non-Hereditary Enamel Hypoplasia

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§ Acute (Rampant) Caries

§ Numerous soft, light-colored lesions.
§ Infectious

§ Chronic ( Slow)
§ Enamel is brown to black in color

• Arrested
Rate • Enamel is brown to black in color
• Hard-surfaced
• Arrested dentine is usually wide open, dark and hard.

Terminology of Tooth
preparations

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§ First letter for tooth surface Capitalized

§ Examples:
§ Mesial (M) – Distal (D)

Abbreviated § Occlusal (O) – Incisal(I)

§ Facial / Buccal ( F/B)
Descriptions § Lingual(L)

Preparation
Walls

Vertical Vs Horizontal

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Preparation Angles

§ Line angle
§ The junction between to planar surfaces of different
orientations.

Preparation Angles

§ Point angle
§ The junction between three planar surfaces of
different orientation

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Cavosurface
Angle and
Margin

§ Substitue –al with o :

Combination of § MO prep – Mesio-occlusal prep

Terms § MOD prep –Mesio-occlusal-dital prep

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Strong Enamel!

Unsupported
Enamel

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§ Intracoronal (Box-like)

§ Extracoronal

Intracoronal
VS
Extracoronal
§ Both intracoroanl
and Extracoroal
prepation

Anatomic
VS
Clinical Crown

Dr. Mohammad Atieh

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Classification of Tooth
Preparations

§ Class I – V, Class VI was added later.

§ Was used originally based on the observed frequency
Black’s original of carious lesions on certain aspects of the tooth.

classification § The same classification is used to describe the location

carious lesions and restorations too.

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§ Pit and fissure preparations:

Class I § Occlusal surfaces of molars and premolars

Preparations
§ Occlusal two-thirds of the F and L surfaces of Molars
§ The lingual surfaces of maxillary incisors

Class II § Involving the proximal

surfaces of posterior teeth.
Preparations

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§ Involving the proximal

surfaces of anterior teeth
Class III not including the incisal

Preparations edge.

§ Involving the proximal

Class IV surfaces of posterior teeth
including the incisal edge.
Preparations

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§ Preparations on the gingival

Class V third of the facial and lingual

Preparations surfaces of all teeth.

§ Involving the incisal

edges of anterior teeth
Class VI or the occlusal cups Dr. Mohammad Atieh

Preparations tips of posterior teeth.

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Steps of Conventional
Tooth Preparation for
Direct Restorations

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Initial Preparation Stage

§ Step 1: Outline Form and Initial depth:

§ Establishing outline:
§ Placing the preparation margins into their final planned
positions :
§ In tooth structure, or
§ In good old restorative material.

Initial Tooth § Should be visualized before touching the tooth.

§ All unsupported and fragile enamel should be removed (

Preparation some may be left in areas of esthetic concerns like anterior

teeth )

Stage

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§ Step 1: Outline Form and Initial depth:

§ Establishing outline:
§ Placing the preparation margins into their final planned
positions :
§ In tooth structure, or
§ In good old restorative material.

Initial Tooth § Should be visualized before touching the tooth.

§ All unsupported and fragile enamel should be removed (

Preparation some may be left in areas of esthetic concerns like anterior

teeth )

Stage § Final finishing of enamel walls and margins will be done in

the final preparation stage.
§ Preparing the Initial depth
§ 0.2-0.5 mm inside the DEJ .
§ On the root. The initial depth will be 0.8 mm pulp ally.

Extension for
Prevention

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Include Faulty
Area

§ Step 1: Outline Form and Initial depth:

§ Requirements:
§ Preserving cuspal strength
§ Limiting FL extensions

Initial Tooth
Preparation
Stage

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§ Step 1: Outline Form and Initial depth:

§ Requirements:
§ Preserving cuspal strength
§ Limiting FL extensions
§ Preserving ridges
§ Connecting two close (<0.5 mm apart) defects or tooth

Initial Tooth preparations

§ Restricting the depth
Preparation
Stage

§ Step 2: Primary Resistance From:.

§ It is the shape and placement of preparation in a way to
enable tooth/restoration complex to resist fracture under
masticatory loads:
§ Box-shaped preparation
§ Relatively horizontal pulpal and gingival floorsà to direct

Initial Tooth occlusal forces perpendicular to the long axis of the tooth

Preparation
Stage

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§ Step 2: Primary Resistance From:.

§ It is the shape and placement of preparation in a way to
enable tooth/restoration complex to resist fracture under
masticatory loads:
§ Box-shaped preparation .
§ Relatively horizontal pulpal and gingival floorsà to direct

Initial Tooth occlusal forces perpendicular to the long axis of the tooth.
§ Protecting cusps and ridges by limiting extension and

Preparation maintaining enough dentinal support .

Stage

§ Step 2: Primary Resistance From:.

§ It is the shape and placement of preparation in a way to
enable tooth/restoration complex to resist fracture under
masticatory loads:
§ Box-shaped preparation .
§ Relatively horizontal pulpal and gingival floorsà to direct

Initial Tooth occlusal forces perpendicular to the long axis of the tooth.
§ Protecting cusps and ridges by limiting extension and

Preparation maintaining enough dentinal support .

§ Rounding external line angles à reduces stress
Stage concentration in tooth structure.
§ Rounding external line angles à reduces stress
concentration in restorative materials (especially non-
bonded ones)

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§ Step 2: Primary Resistance From:.

§ It is the shape and placement of preparation in a way to
enable tooth/restoration complex to resist fracture under
masticatory loads:
§ Box-shaped preparation .
§ Relatively horizontal pulpal and gingival floorsà to direct

Initial Tooth occlusal forces perpendicular to the long axis of the tooth.
§ Protecting cusps and ridges by limiting extension and

Preparation maintaining enough dentinal support .

§ Rounding external line angles à reduces stress
Stage concentration in tooth structure.
§ Rounding external line angles à reduces stress
concentration in restorative materials (especially non-
bonded ones)
§ Covering weak cusps.

§ Step 2: Primary Resistance From:.

§ It is the shape and placement of preparation in a way to
enable tooth/restoration complex to resist fracture under
masticatory loads:
§ Box-shaped preparation .
§ Relatively horizontal pulpal and gingival floorsà to direct

Initial Tooth occlusal forces perpendicular to the long axis of the tooth.
§ Protecting cusps and ridges by limiting extension and

Preparation maintaining enough dentinal support .

§ Rounding external line angles à reduces stress
Stage concentration in tooth structure.
§ Rounding external line angles à reduces stress
concentration in restorative materials (especially non-
bonded ones)
§ Covering weak cusps.
§ Provide enough thickness of restorative material

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§ Step 2: Primary Resistance From:.

§ It is the shape and placement of preparation in a way to
enable tooth/restoration complex to resist fracture under
masticatory loads:
§ Box-shaped preparation .
§ Relatively horizontal pulpal and gingival floorsà to direct
occlusal forces perpendicular to the long axis of the tooth.

Initial Tooth § Protecting cusps and ridges by limiting extension and

maintaining enough dentinal support .
Preparation § Rounding external line angles à reduces stress
concentration in tooth structure.
Stage § Rounding external line angles à reduces stress
concentration in restorative materials (especially non-
bonded ones)
§ Covering weak cusps.
§ Provide enough thickness of restorative material
§ Bonding material to tooth structure when appropriate

§ Step 3: Primary Retention From:.

§ It is the shape or form of the preparation that prevents
displacement or removal of the restoration by tipping or
lifting forces for non-bonded restorations:
§ By providing occlusal convergence

Initial Tooth
Preparation
Stage

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§ Step 4: Convenience From:.

§ It is the shape or form of the preparation that provides
adequate observation, accessibility, and ease of
operation in preparing and restoring the tooth.
§ May require extending external walls to again adequate
access to deeper area of the preparation.

Initial Tooth
Preparation
Stage

Final Preparation Stage

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§ Step 5: Removal of any remaining infected dentine

or old restorative material if indicated

Final
Preparation
Stage

§ Step 6: Pulp protection if indicated

Final
Preparation
Stage

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§ Step 7: Secondary retention and resistance form

Final
Preparation
Stage

§ Step 8: Final finishing of the external walls

§ To create optimal junction between the tooth and
restorative material.
§ Provide maximal strength of the tooth and the restorative
material at and near the margin.

Final § Factors to consider:

Preparation § The direction of enamel rods.

§ The support of enamel rods.

Stage § The type of restorative material ( provide beveled margin

or not)
§ The location of the margin.
§ The degree of smoothness or roughness desired.

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§ Step 9: Final cleaning, inspection and disinfection

Final
Preparation
Stage

§ Art and Science of Operative Dentistry, 6th

Reference Edition.(Chapter 5)

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Weekend Quiz § Chapter 2 and covered material of today’s lecture.

Thanks!

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