CAVITY PREPARATION IN PRIMARY TEETH Index – 1. Definition and classification of tooth preparation 2. Basic Steps of tooth preparation 3.

Principles of tooth preparation 4. Class 1 cavity preparation 5. Class 2 cavity preparation 6. Class3 cavity preparation 7. Class 4 cavity preparation 8. Class 5 cavity preparation 9. References Definition of cavity preparationTooth preparation is the mechanical alteration of a defective,injured, or diseased tooth to receive a restorative material that re-establishes a healthy state for thee tooth, including esthetic correction where indicated and normal form and function. Black's classification Class I lesion • Lesions that begin in the structural defects of teeth such as pits, fissures and defective grooves. • Locations include  Occlusal surface of molars and premolars  Occlusal two thirds of buccal and lingual surfaces of molars and  Lingual surfaces of anterior tooth Class II lesions They are found on the proximal surfaces of the bicuspids and molars. Class III lesions • Lesions found on the proximal surfaces of anterior teeth that do not involve or necessitate the removal of the incisal angle.

Class IV lesions Lesions found on the proximal surfaces of anterior teeth that involve the incisal angle. Class V lesions

including proximal surface where the marginal ridge is not included in the cavity preparation Sturdevant’s classification Simple cavity A cavity involving only one tooth surface Compound cavity . Finn’s modification Class I Cavities involving the pit and fissures of the molar teeth and the buccal and lingual pits of all teeth. Class II Cavities involving proximal surface of molar teeth with access established from the occlusal surface Class III Cavities involving the proximal surfaces of the anterior teeth which may or may not involve a labial or a lingual extension Class IV A restoration of the proximal surface of an anterior tooth which involve the incisal angle Class V Cavities present on the cervical third of all teeth. Class VI (Simon's modification) Lesions involving cuspal tips and incisal edges of teeth.Lesions that are found at the gingival third of the facial and lingual surfaces of the anterior and posterior teeth.

Resistance form It is the shape given to the cavity to enable the tooth as well as the restoration to withstand the stresses of mastication.Internal outline form . • Butt joint between the tooth and restoration • .5 mm into the dentin.5mm of the tooth structure exists between two carious surfaces. then they should be joined. 0.2 .External outline form Features • • • • • • • • • Extend cavity margins to sound tooth structure Margins should be extended to include all defective enamel Cavity margins should be placed in self-cleansable areas Include all the pits and fissures Extend outline form to provide sufficient access The pulpal floor and axial wall should have an average depth of 0.A cavity involving two surfaces of a tooth Complex cavity A cavity that involves more than two surfaces of a tooth Principles of cavity preparation Outline form The locations that the peripheries of the completed tooth preparation will occupy on tooth surfaces. Margins of the cavity preparation should not be in contact with the opposing tooth.3 mm clearance from the adjacent tooth while preparing the proximal box in class II cavities.0. Features • Flat pulpal and gingival walls • Utilizing box form of cavity preparation • Cavity prepared in such a way that strong cusp and ridge areas remain with adequate dentin support • Rounded internal line angles to avoid stress concentrations. . If less than 0.

The pulpal floor should be 0. • Occlusal dovetail in the case of proximo occlusal cavities where only one proximal surface is involved. Removal of any remaining infected dentin • • small carious lesion.1/5th the intercuspal distance.5mm below the dentino-enamel junction Retention form It is comprised of those factors of cavity design that prevent the restoration from being displaced. accessible embrasures and intact marginal ridges. Features • Modifications of cavosurface margins for ease of placement of restorative material.• • • • • • Removal of unsupported enamel 90 degree cavo-surface angle Adequate bulk of the restorative material Adequate depth and width of the cavity The width of the cavity should not be more than 1/4th . for condensation. or lingual embrasures in a tooth with wide. • Extension of buccal and lingual walls for visibility and access to deeper portions of the cavity. Features • Retention grooves are used in class III and Class V cavities. adaptation and finishing. the infected dentin can be completely removed. • Pins placed into the dentin • Acid etching of the enamel • The proximal box of class II design is divergent gingivally to contribute to the retention form. . • The proximal lesion can be instrumented from the facial. Convenience form It includes shaping the cavity to facilitate access for instrumentation. In large carious lesion if infected dentin still remains inspite of following the above procedures it is removed using a round bur in slow speed handpiece or using spoon excavator • • Finishing the enamel walls • It is the further development of specific cavosurface design and degree of smoothness that will bring about the maximum effectiveness of the restorative material being used.

and high vacuum evacuation equipment. cotton rolls. Class II cavities • • • • Due to the presence of broad contact gingival floor of the proximal box should be wide so as to place the margins in self cleansing areas The box should converge occlusally with the buccal and lingual wall paralleling the external tooth surface.5 mm into dentin The pulpal floor should be flat. tunneled or grooved for sufficient bulk of the restoration. Conditioning of the cavity may be done in certain cases like bonding systems for amalgam and composite restorations Modifications of Cavity Preparation in Primary Teeth Few factors have to be taken into consideration while restoring the primary teeth. The proximal walls should not be flared as it would lead to unsupported enamel. The axiopulpal line angle must be rounded. .Cleansing of the cavity • • The operating field should be kept clean and adequately isolated by the use of rubberdam. Any remaining caries lesion should be removed using round burs. These include: • The smaller tooth dimension of the deciduous dentition • The thin enamel covering the teeth • Broad contact areas • Proximity of the pulp chamber to outer tooth surface • Narrow occlusal table Class I cavities • • • • Due to the narrow occlusal table present the isthmus should not be more than 1/3rd the intercuspal distance The depth should not be more than 0.

• Blend the outline to form smooth-flowing arcs and curves. The proximal box should allow the passage of an explorer tip between its margins and adjacent tooth in all three directions. is not as shiny as enamel. • Establish a sharp cavosurface angle in the lateral walls with the No. and reduce marginal failure. • Go from distal to mesial surface. Dentin is much softer to the touch. buccally. 330 bur. • Maintain a width approximately one third the width of the occlusal table. Round line angles are easier areas to condense amalgam into. gingivally and lingually. . Retention pits can be placed at the axiobucco gingival and axio linguo gingival point angles. and usually is yellow. • Round line angles with the No. The walls are parallel or slightly undercut to the external surfaces of the tooth. This convergence aids in retention of the restorative material. A dovetail may be placed in the middle 1/3 of the lingual surface of the tooth.5 mm from the bur tip to the shank. at the cervical area of the tooth. All internal line angles should be rounded. • Slightly round the pulpal floor. It is approximately 1. This blending establishes the walls of the cavity preparation • Contour the outline parallel to the mesial and distal marginal ridges. Internal outline form • Penetrate 0. • Maintain a bulk of tooth structure on the marginal ridges. • The No. The sharp cavosurface angle is an asset to improve carving and polishing.50 to 1. 330 bur shank is a good depth marker. an overlay of the distobuccal cusp is prepared Since the enamel rods. Gingival cavity wall is inclined occlusally to parallel the enamel rod direction.0 mm into the dentin.• • • • Retention can be improved by a 'U' shaped retention groove along the amelodentinal junction of the proximal box When the cavity margins exceeded that of an ideal preparation particularly in the case of a mandibular first primary molar. 169L bur. Class I cavity preparation External outline form • Start preparation by penetrating the occlusal surface with the No. Class III cavity • • • • When the contact is open. 330 bur. the outline is triangular with base towards the gingival aspect of the cavity. Include all deep and defective grooves in the preparation. • The walls are wider at the pulpal floorthan at the occlusal opening. are oriented occlusally the gingival seat should not be beveled. and they reduce internal stress on the amalgam restoration.

Use a No. Extend the proximal box gingivally beneath the contact area to the interproximal area. Class II cavity preparation • • Complete a Class I cavity outline as described. keep in mind that (a) it is even with or slightly below the gingiva. Class III cavity preparation for primary incisors . 330 bur to extend the occlusal outline through the marginal ridge. sharp cavosurface margins. This area is determined by the clearance of an explorer tip. as determined by carious lesion depth. should follow the contour of the tooth.4 or 6 round bur in a slow-speed handpiece. If two primary molars are being done together back to back. extend the proximal box into self-cleaning areas. Use the enamel hatchet to remove any overhanging enamel in the proximal box • • • • • Occlusal view • • Form the isthmus so that it is one half the width of the occlusal table and connects the proximal with the occlusal dovetail. Cross-section proximal box area • • In establishing the gingival floor. • Extends so an explorer tip can pass through the embrasure. as do all line angles. Occlusal and internal views The proximal box area: • Gently curves buccolingually to follow the contour of the proximal surface. and retention. as determined by the carious lesions. Keep the proximal box in an occlusogingival direction roughly parallel to the long axis of the tooth. • Has no bevel at the gingival margin. A large spoon excavator works as well. Rinse the preparation with water. The axial wall. and (c) it has rounded line angles. Inspect for caries removal. (b) it is perpendicular to the long axis of the tooth. Use a NO. Curve the proximal wall gently. do so now. Keep the bur parallel to the long axis of the tooth. Attempt to leave 90° cavosurface margins.• If the active caries has not been removed during cavity preparation. The isthmus) is approximately one half to one third the width of the occlusal surface. if possible. Move the bur in a pendulating motion from lingual to buccal. • Has gently rounded axiopulpal line angles. Extend the No. 330 bur into the proximal surfaces. creating an angle 90° to the axial surface of the tooth.

Leave adequate tooth structure incisal to the dovetail. and 1 to 2 mm above the dentinoenamel junction • • • • . 330 bur to place the mesial wall along a line ofthe tooth parallel to its long axis. Contour the pulpal wall so that it corresponds to the external lingual surface of the tooth.Class III cavity preparation for primary canines Maxillary primary canines: Lingual outline form Use a No. Maintain the gingival wall parallel to.

Penetrate about 0. 330 bur to form a triangular preparation with gently rounded curves. Extend the preparation incisally to remove the contact point. make sharp cavosurface angles and smooth them with a No. . with adequate clearance for carving with an explorer. being careful to leave adequate tooth structure. Place the gingival wall below the gingival crest. following the contour of the dentinoenamel junction. Slightly round all internal line angles. governing the extension by the adjacent tooth.5 to 1.0 mm beyond the dentinoenamel junction. Retention is optional with the half-round bur at pulpal and incisal line angles. 169L Modified Class III cavity preparation • • • • • The modified Class III preparation is indicated in the presence of an incipient lesion with no proximal contact and excel lent access: Use a No. Restore with a composite restorative material.Proximal outline form • • • • Maintain the labial wall parallel to the external labial surface.

use a tapered diamond bur to obtain a bevel on the entire incisal & gingival cavosurface margin. The bevel extending about 2mm or at least 1mm beyond the fractured margin & tapered. 5th edition 2. Dentinal undercuts for mechanical retention will be placed if the pear shaped bur is used. The no. Cavity may be kidney shaped.Class IV cavity preparation • • • For class IV fractured incisal edges.330 bur can be used to cut the cavity. References – 1. if needed. may be obtained by the use of the lingual dovetail. Class V cavity preparation • • • • The outline form should be limited to the carious lesion & any adjacent decalcified areas. Clinical pedodontics-Finn – 4th edition 3. Sturdevant . Pediatric operative dentistry – kennedy – 4th edition . Manual of pedodontics – Andlaw – 3rd edition 4. The art and science of operative dentistry. Additional retention.

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