Sweet
423
The walls of the proximal box were
prepared with just sufficient flare to
establish the margins in immune areas,
but this flare should be kept minimal
always. Decreased flare of the walls
( i ) increases the retention of the prep­
aration, (2) provides a greater bulk of
filling material in the box area and thus
enhances resistance form, and (3) re­
duces concentration of stresses.
Sum m ary
A detailed outline based on instrumen­
tation has been presented for the prep­
aration of a Class I I amalgam cavity
CAVITY PREPARATION IN
DECIDUOUS TEETH
Charles A . Sweet, D.D.S., San Francisco
t is not my intention to minimize the
I contribution of numerous dentists who
have added greatly to our knowledge of
cavity preparation in deciduous teeth,
but rather to explain how this informa­
tion should be applied in order to achieve
a finished restoration that will last until
the tooth is normally exfoliated, with a
minimum of pulpal involvement and
maximum resistance to secondary attack
by caries. The published works of J . C.
Brauer, F. E. Hogeboom, W. C. McBride
and James Nuckolls should be studied,
as much valuable information can be
obtained from them.
Preparation of cavities in deciduous
teeth should be governed by a scientific
knowledge of (1) morphology of decid­
uous teeth, (2) type of filling material to
J.A.D.A., Vol. 38, April 1949 . . .
in deciduous molars. The preparation
derived then was analyzed to determine
whether or not it met mechanical stand­
ards. In certain respects the preparation
failed to conform precisely to mechanical
principles. These variations were de­
scribed and defended. The preparation
discussed in this paper was based on the
mechanical principles which utilize best
the favorable properties of silver amal­
gam. Whenever morphology of the tooth,
comfort of the patient and efficiency of
technic warranted, mechanical principles
were violated slightly to meet the situa­
tion.— 725 North University Avenue.
be used, (3) esthetics and (4) economics.
The measurements of deciduous teeth
shown in Figures 1 through 4 are im­
portant in cavity preparation. They have
been taken from drawings and models by
Nuckolls.1 These data have been con­
firmed by exact measurements of roent­
genograms and ground sections of ex­
tracted teeth. There are occasional slight
variances in individual teeth, not exceed-
Read a t the midwinter m eeting o f the Chicago D ental
Society, February 12, 1948.
Associate professor of operative dentistry (dentistry
for ch ild ren ), College o f rhysicians and Surgeons, A
School o f Dentistry.
Figures 5 and 12 are from Grossman, L . I . (ed itor),
L ip p in cotts H andbook o f D ental P ractice . (Sw eet,
C . A ., “ Pedodontics,” p. 303 .) Philadelphia: J . B .
Lippincott Company, 1948.
1. f
M cBrid e, W . C ., Juvenile Dentistry ed. 4. (Nuck­
olls, Jam es, Morphology of the Deciduous T eeth,*'
p. 309.) Philadelphia: L e a & Febiger, 1945.
424
ing 0.3 mm., which can be disregarded
in designing cavities. In Figure 1, right,
one drawing serves for the lower decidu­
ous central and lateral incisors, as they
are approximately equal in size, with a
variance of only 0.1 mm.
Silver amalgam is an ideal filling ma­
terial for deciduous teeth when cavities
are properly prepared to receive this type
of restoration. It will stand the stress of
mastication and last as long as the de­
ciduous tooth is normally retained. When
properly contoured and highly polished,
restorations of silver amalgam are en­
tirely acceptable esthetically (Fig. 5 ).
Cast restorations are equally successful
in deciduous teeth when cavities are prop­
erly prepared to receive them, but silver
amalgam meets the average person’s
economic situation and reduces the cost
of dental services for the child.
The morphology of deciduous teeth
should determine the size of instruments
to be used and the type of cavity prepara­
tion to be made in order to minimize pul-
pal" involvement and insure a long-lasting
restoration.
To obtain the desired results, careful
positioning of the patient is advisable,
and proper equipment, operative skill
and control of the patient are essential.
Instrumentarium
1. No. 33^2, 35 and 36 inverted cone
burs for the contra angle handpiece.
2. No. 33/2 and 35 inverted cone burs
for the straight handpiece.
3. No. 1, 6, 7 and 8 round burs for the
contra angle handpiece.
4. No. 700, 701 and 702 tapered fis­
sure burs for the contra angle handpiece.
5. Small right and left spoon exca­
vators.
6. Medium right and left spoon exca­
vators.
7. Medium binangle or Wedelstaedt
chisel.
8. Small tapered mounted stone for the
contra angle handpiece.
The Journal of the American Dental Association
9. Mouth mirror, cotton pliers and ex­
plorer.
C lass I Cavities
Type A.— Beginning Cavities. — 1. A No.
33/2 inverted cone bur in the Contra
angle handpiece is used to enter the pit
or fissure, and all faulty or precipitous
grooves are carried out to areas of smooth
enamel.
2. A No. 35 inverted cone bur is used
in the contra angle handpiece to enlarge
the grooves and establish a pulpal wall
conforming to the contour of the occlu­
sal surface.
3. The grooves are widened and the
cavity outline established with a No. 701
tapered fissure bur in the contra angle
handpiece. The lateral walls should not
parallel each other but should parallel
the external surface of the tooth (Fig.
6, le ft).
4. All remaining carious material is
removed with the small spoon excavator.
5. Peripheral smoothness is obtained by
using a tapered mounted stone in the
contra angle handpiece, being careful not
to bevel the cavity outline.
Type B.— Deep Cavities.—1. A No. 35 in­
verted cone bur in the contra angle
handpiece is used to eliminate all faulty
or precipitous grooves.
2. Further enlargement of these
grooves is accomplished with a No. 36
inverted cone bur in the contra angle
handpiece and a pulpal wall is estab­
lished conforming to the contour of the
occlusal surface. The lateral walls should
not parallel each other but should paral­
lel the external surface of the tooth if
possible.
3. The outline form for the carious
area and the rest of the cavity is best
completed with a No. 702 tapered fissure
bur in the contra angle handpiece (Fig.
6, right).
4. All remaining carious material is re­
moved with the medium sized spoon ex-
Sweet J.A.D.A., Vol. 38, A p ril 1949 . . . 425

Fig. I. — L e ft : U p p er d ecidu ou s incisors. R ig h t: L ow er decidu ou s incisors

MCOT1IR1 tnnviKCTUH nanam am mm tm oim nmw non tuffH

occiim
{¡ami

nmnsjrt -.'/-'i
FMH.HBIH OBBS^ECTKW FH&UMLCROaSDCTlPK
« 5 0 f f t * . TO UNBUrL liW it j

Fig. s . — L e ft : U pper a n d low er decidu ou s cuspids. R ig h t: U pper first decidu ou s m olar

N
UCKat-J;

KCtUW
L
its aib'n. rfinam fta
OOUfiflL

rwom
ir!wr'i W7.armi
BBTa-ftClflTOtlHSmtfij rtso-frra. hi uwufitM ttm m inw nM jentl
ntSOffltlff TQPb!0-L»apLi|^

Fig- 3■— L e ft : L o w er first decidu ou s m olar. R ig h t: U p p er secon d decidu ou s m olar

426 The Journal of the American Dental Association

cu t from sound tooth structure toward

axujfi' fta m m tia a B i r o t nanm; should cut no deeper than ju s t b eneath
ww mm.
m m m i to neot«haIS |
Fig. 4 .— L o w er secon d decidu ou s m olar
cavator or a No. 6 to No. 8 round bur,
even though the pulp m ay be exposed.
5. Peripheral smoothness is obtained depth of the cu ttin g blades of th e N o. 36
by using a tapered m ounted stone in the
con tra angle hand piece, being careful
not to bevel the cavity outline.
Class II Cavities
Occlusal Step.— 1. An opening is m ade in
sound tooth structure in one of the pits
w ith a No. 1 round bur or No. 33/2 in ­
verted cone bur in th e con tra angle h and ­
piece, to a depth slightly b eneath the
dentino-enam el ju nction .
2. A straight cu t is m ade fro m this pit blades and one-h alf their depth. T h is step
into the proxim al carious area w ith a No.
35 inverted cone bur. I t is less painfu l to
caries (F ig . 7, le ft).
3. W ith a No. 36 inverted cone bur
in the contra angle hand piece, th e o cclu ­
sal step is fully prepared. T h e op erator
the dentino-enam el ju n ctio n , so th a t th e
finished preparation of the occlusal step
will follow the inclined planes of the
original occlusal surface. In this way, the
horns of the pulp under the cusps will
not be endangered (F ig . 7, r ig h t).
I t must be emphasized th a t the o cclu ­
sal step should a tta in the m axim um
w idth possible where it jo in s the proxim al
portion o f the cavity preparation.
4. T h is occlusal step is un dercu t to the
inverted cone bur, or 0.5 m m .
5. T h e b u ccal and lingual walls o f the
occlusal step should n ot parallel each
other but should parallel the bu ccal and
lingual extern al surfaces.
6. I f ad ditional bulk of filling m aterial
is deem ed necessary, a deeper cu t is m ade
in the cen tral portion of the step w ith a
No. 35 inverted cone b u r in deciduous
first m olars or a No. 3 6 inverted cone bur
in deciduous second m olars. T h is cut
should be th e exact width o f th e cu tting
w ithin the occlusal step will n ot endanger
the pulp o f the tooth (F ig . 8, le ft ).

Fig. 5 .— A m algam restorations in decidu ou s m olars, properly contoured an d highly p olished

Sweet J.A.D.A., Vol. 38, April 1949 . . . 427

Fig. 6.— L e ft : Class I cavity with latera l walls parallelin g th e extern al su rface o f th e tooth.
R ig h t: C o m p leted outlin e form o f Class I cavity

Fig. 7 .— L e ft : In itial cut in Class I I cavity prep aration . R ig h t: O cclusal step p rep aration
follow in g th e in clin ed plan es o f the cusps

Fig. 8.— L e ft : A step w ithin th e occlu sal step fo r a d d ition al bu lk o f filling m aterial.
R ig h t: C orrect d ep th o f gingival wall
428 The Journal of the Am erican Dental Association

Fig. 9.— L e ft : R eten tion pit in bu ccogin gival angle. R ig h t: A x iopu lpal line angle rou n d ed
fo r a d d ition al bulk o f am algam

Proximal Preparation. — 1. O verhanging n ot attem p t to b ring the buccogingival

enam el on the b u ccal and lingual aspects
is chipped o ff w ith the binangle or
W edelstaed t chisel.
2. W ith a No. 36 inverted cone bur in cen ter portion o f th e proxim al surface,
the co n tra angle hand piece, the gingival
w all is p rep ared ; the b u r is moved buc- gival w all should b e no deeper axially
colingually u n til sound tooth structure
has been reached. T h e op erator should
Fig. 1 0 .— R eten tion pits at bu ccogin gival an d
linguogingival angles
and linguogingival angles to th e level o f
the cen ter o f th e gingival m argin, fo r
caries always penetrates deepest in the
unless the cavity is very shallow. T h e gin­
th an the w idth o f the cu ttin g blades of
th e N o. 35 inverted cone b u r in deciduous
first m olars or th e N o. 36 inverted cone
bur i'n deciduous second m olars (F ig . 8,
rig h t).
3. All carious dentin is rem oved, even
though th e pulp may be exposed, w ith the
m edium sized right and left spoon e x ca ­
vators or No. 6 to No. 8 round bur.
4. W ith the No. 702 tapered fissure bur
in th e co n tra angle hand piece, th e buccal
and lingual em brasures are opened up.
T h e b u cca l and lingual walls o f the
proxim al portion of the cavity should not
p arallel each other b u t should parallel
the b u cca l and lingual external surfaces.
5. Added retention is obtained by cu t­
ting a small pit a t the buccogingival and
linguogingival angles, using about 1 mm .
of the tip of a No. 700 tapered fissure bur
(F ig . 9 , le ft).
6. A dditional bulk o f filling m aterial
fo r strength is obtained by rounding the
step a t the axiopulpal line angle w ith a
No. 702 tapered fissure bur (F ig . 9,
r ig h t).
7. Peripheral smoothness is obtained by
Sweet J.A.D.A., Vol. 38, A p ril 1949 . . . 429

Fig. n . — A : R eten tion p it at incisal angle. B : B u ccal d ov etail utilized on low er cuspid.
C : L in g u al d o v etail p osition ed gingivally with p ro p er d ep th . D : Class V cavity in decidu ou s
cen tral incisor

using a m ounted stone in the co n tra angle in the con tra angle hand piece, beginning
hand piece, being carefu l n o t to bevel the in the proxim al cavity halfw ay betw een
cavity outline. th e gingival and incisal aspects and ex­
tending fro m th e proxim al cavity to th e
Class III Cavities m edian line. I t should b e only as deep as
the cu ttin g blades o f th e bur.
Class I I I cavities are m ade accessible
2. T h is original cu t is extended entirely
by using the N o. 33^2 and N o. 35 in ­
gingivally w ith a No. 35 inverted cone
verted cone burs in th e straight hand ­
b u r in th e co n tra angle handpiece. In
piece. T h e op erator m ust take advantage
order to ob tain sufficient w idth o f the
o f all slight undercuts bu t should n ot en ­
labial or lingual dovetail, the preparation
cro ach axially deeper th an the w idth o f
must always be carried to or b eneath the
the cu ttin g blades o f th e bur.
m argin of the gingiva. T h e dovetail
1. W ith th e N o. 33/2 inverted cone
should be as wide as possible a t its ju n c ­
bur, a sm all p it 0.5 m m . deep is placed
tion w ith th e proxim al cavity. I t should
at the linguogingival and buccogingival
be n o deeper than the cu ttin g blades of
angles p arallel to the axial w all (F ig .
a No. 35 inverted cone b u r (F ig . 11, C ) .
1 0 ).
2. A sm all p it 0 .5 m m . deep is placed
a t th e incisal angle also (F ig . 11, A ) .
3. A ll rem aining carious m aterial is
rem oved w ith the sm all righ t and left
spoon excavators, even though th e pulp
m ay be exposed. T h e enam el is smoothed
by use o f the m edium binangle or W edel-
staedt chisel.

Modified Class III and Class IV Cavities

T o produce a satisfactory cavity p rep­

aration in m odified Class I I I and Class
I V cavities, ad vantage m ust be taken of
the lingual dovetail fo r the upper teeth
or th e labial dovetail fo r th e lower teeth
(F ig . 11, B and C ) .
1. T h e labial or lingual dovetail cu t is
Fig. i a . — U pper cen tral incisors restored with
m ade w ith a No. 33/2 inverted cone bur am algam
 430
3. The proximal portion of the cavity
is now prepared the same way as in the
Class I I I cavity, with the No. 33/2 and
No. 35 inverted cone burs in the contra
angle handpiece, except that the incisal
pit or hole is omitted because it would
perhaps dangerously undermine the in­
cisal edge.
4. All remaining carious material is
removed with the small or medium right
and left spoon excavators, even though
the pulp may be exposed. The enamel is
smoothed by use of a medium binangle
or Wedelstaedt chisel and the tapered
mounted stone.
C lass V C avities
Class V cavities are entered with an
inverted cone bur and are generally en­
larged to a reasonable size with the larger
inverted cone and fissure burs. The op­
TOPICAL FLUORIDE SOLUTIONS FOR CONTROL
OF DENTAL CARIES: CONSIDERATIONS
PERTINENT TO THEIR CLINICAL APPLICATION
H . Berton M cC a uley, D.D.S., Bethesda, M d .
d e q u a teconfirmation of the effective­
A ness of topically applied fluoride solu­
tions in limiting dental caries in chil­
dren renders available to the profession
a useful means for controlling at least
partially this hitherto practically uncon­
trolled disease. Properly and intelligently
utilized, fluorine constitutes an important
and greatly needed instrument of preven­
tion. Such utilization requires that the
dentist familiarize himself with fluoride
solutions, their application to the teeth
and their therapeutic limitations. Maxi­
The Journal of the American Dental Association
erator should take advantage of the slight
undercuts caused by the cutting blades of
the inverted cone burs in order to secure
sufficient retention. All remaining carious
material is removed with the small or
medium right and left spoon excavators
(Fig. 11, D ). Smoothness of the periph­
eral enamel is obtained by using the me­
dium binangle or Wedelstaedt chisel and
the mounted stone.
Com m ent
These cavity preparations have been
engineered to give adequate retention
and to allow sufficient bulk of silver
amalgam to withstand the stress of mas­
tication. The preparations are designed
to avoid endangering the pulp, and they
are extended far enough to protect the
teeth from further attacks by caries
(Fig. 12).
mum results can be expected only
through the practice of a well defined
technic of administration and course of
treatment that are adequately supported
by clinical evidence.
Evidence for the efficacy of topically
' T his article wag prepared a t the request of the Coun­
cil on D ental Therapeutics and is officially authorized
for publication in t h e j o u r n a l o f j h e a m e r i c a n d e n ­
t a l a s s o c i a t i o n by the director o f the National Insti­
tutes o f H ealth. T h e opinions expressed are those of
the author and do not necessarily reflect the opinions
of the Council on D ental Therapeutics.
Senior assistant dental surgeon (R K U . S . Public
H ealth Service, N ational Institu te o f D ental Research,
National Institutes o f H ealth, Bethesda, M d.