CLASS I CAVITY PREPARATION
Dr. / Reham M. Attia
Class I: Pit and fissure cavity occur
in :
the occlusal surfaces of premolars
and molars
the occlusal two-third of buccal
lingual, paltal surface of molars
lingual surface of incisors
It may be :
Simple
Compound
Complex
How the choice of restorative
materials affects a cavity
preparation?
General principles of
cavity preparation
I- Biological
II- Mechanical
The basic principles of tooth
preparation are as follows:
1. Initial tooth preparation:
• Outline form
• Primary resistance form
• Primary retention form
• Convenience form
2. Final tooth preparation:
• Management of remaining caries
• Secondary resistance and retention form
• Pulp protection, if required
• Finishing of enamel margins
• Final inspection of the preparation
Outline Form
The outline form means extending the preparation
margins to the place they will occupy in the final
preparation.
Following facts, must be kept in mind while making
outline form:
• Removal of all carious and defective pits and fissures .
• The out line form should be include all its pits and
fissures to avoid the caries recurrence ( extension for
prevention)
• Removal of all unsupported enamel rods
• To avoid ending preparation margins in high stress
areas like cusp tip and crest of the ridges.
• Placing margins on sound tooth structure.
Simple class I have the following walls
and floor
Outline form for class I
The outline form varies from one tooth to
another .
• Premolars:
• Upper premolars have “ Dumb- bell “
shape or butterfly shape .
In lower first premolar if the cavity confined to
pit only – snack eyes
,but if they involve entire occlusal surface
,then they resemble like upper premolar.
In tricuspid lower second premolar it will
assume Y-shape
Molars :
•Preparation in lower first molars
have an elongated shape mesio-distally
with three lateral extensions ( two
buccal and one lingual ).
•Lower second molar an elongated shape
mesio-distally with two lateral extensions
opposing to each other .
In upper molars if cavity involves all the
occlusal surfaces ,the preparation elongated
mesio-distally with two lateral extension not
opposing to each other .
If the oblique ridge is not involved the mesial
preparation will assume kidney shape & distal
will appear as heart shape .
Steps:
• Gain access with round bur .
• With the help of no. 245 bur, establish the
external outline form to extend all margins
into sound tooth tissue.
• Bur should be kept parallel to long axis of
the tooth to make a ditch in the carious
portion of the tooth and it should be rotating
when applied to the tooth and should not stop
rotating until removed.
Maintain the initial depth of 1.5 mm, this is
approxi-mately one-half the length of the cutting
bur.
This should be, at least 0.5 mm in dentin to
provide adequate strength to resist fracture due
to occlusal forces While maintaining the
same depth and bur orientation, move the bur
to extend the outline to include the central
fissure. The margins of preparation not only
extend into sound tooth tissue but also involve
adjacent deep pits and fissures in the
preparation.
Extend the margin mesially and distally
but do not involve marginal ridges.
These walls should have dovetail shape
to provide retention to the restoration.
While working towards mesial and
distal surface, orient the bur towards
respective marginal ridge. This will
result in slight divergence of mesial
and distal walls which helps to provide
dentinal support for marginal ridges
If less than 1.5mm
An isthmus is a land bridge, a narrow strip of land that stretches
across a body of water to connect two larger land masses. The Greek
isthmos means "neck," so you can see how isthmus came to mean the
connecting strip between land masses
The isthmus width should be as narrow as
possible, it should not be wider than1\3 – 1\4
th the intercuspal distance.
The deep pit and fissure defects less than 0.5
mm apart should be included within the outline
form.
The external outline form should have smooth
curves, straight lines and rounded angles.
All unsupported and demineralized enamel
should be removed.
Primary Resistance Form
Resistance form is that shape given to a
preparation planned to afford such a seat for
the restoration so as to best enable it to
withstand the occlusal stresses.
Primary resistance form should
have following features:
Shape of the preparation should be like a box
with flat floor .This helps the tooth to
resist occlusal masticatory forces without
any displacement.
Though puplal floor should be flat, at the
same time it should follow the contour of
occlusal surface .
in lower 1st premolar ,where the lingual cusp
is very small & buccal cusp is pronounced
with very large pulp horn. So in this case we
have to make flat pulpal floor which is
parallel to imaginary line joining the tips of
the buccal and lingual cusp.
Flat pulpal floor prevents rocking of
the restoration which produce
wedging forces
• Provide adequate thickness of amalgam keep the
minimum occlusal depth of 1.5 mm. To provide
enough thickness of restorative material to prevent
its fracture under load.
• Provide the cavosurface angle of 90° (amalgam
restoration ) .
Restrict the extension of
external walls
so as to have strong marginal ridge areas
with sufficient dentin support.
Facio-lingual width should be not more
than 1/3 to 1/4th the intercuspal distance .
As minimum tooth structure is removed, it
increases the resistance of tooth.
• Include all the weakened tooth structure.
• Round off all the internal line and point
angles
Consider capping of cusp for preserving
cuspal strength.
Cusp capping increase the
resistance form of the tooth
Primary Retention Form
Primary retention form prevents the
restoration from being displaced.
Retention can be increased by the following:
• Occlusal convergence (about 2 to 5%) of buccal
and lingual walls.
• Giving slight undercut in dentin near the
pulpal wall
• Occlusal dovetail
Secondary means of
retention and
resistance
Convenience Form
.
The convenience form of the preparation
facilitates and provides sufficient visibility,
accessibility and ease of operation in
preparation and restoration of the tooth.
For amalgam restoration, it is the form or
shape that also permits access of condensing
and carving instruments.
2. Final Tooth Preparation
Removal of Remaining Carious
Dentin
In this, remaining caries, old restorative
material and adjacent deep pits and fissures
are also removed and involved in the
preparation.
In the large preparations with soft caries, the
removal of carious dentin is done with spoon
excavator or slow speed round bur
In this, two-step pulpal floor is made,
i.e. only portion of tooth which is
affected by caries is removed, leaving
the remaining, floor untouched
Infected dentin is soft due to the lack of
mineral content or collagen network. Its
consistency can be likened to cottage cheese
Affected dentin is firmer than infected dentin
due to the presence of the collagen network
and some mineral content.
Healthy dentin is often described as hard
dentin or sound dentin.
The decision of how much infected dentin to
remove is a balance between removing enough
carious dentin to obtain a favorable bond and
effective seal for the restoration, while
maintaining sufficient dentin over the pulp to
ensure pulpal health.
The long-taught dogma of complete caries
removal until hard dentin is achieved — even
at the expense of pulpal exposure — is being
challenged with more conservative, selective
caries-removal protocols.
Protection of Pulp if Needed
Use of pulp protective materials
depends upon following factors:
•A base is not needed in shallow preparations,
as it compromises thickness and thus
compressive strength of amalgam.
• In a deep preparation, a base is placed in
the thickness of 0.5 to 0.75 mm, so as to
protect pulp .
• sure that no trace of the base material
remains on enamel walls of preparation ,as
this would eventually dissolve in the oral
fluids leaving a gap between the restoration
and the tooth resulting in microleakage and
recurrent caries.
How the type of restorative
material used affect
selection of base and liner ?
Finishing of the Enamel
Walls and Margins
Finishing of walls and margins is guided by
the knowledge of dental histology.
At this stage all unsupported enamel is
removed. Cavosurface angle, should be made
90° butt joint type for amalgam restoration.
This provides bulk to restoration, which in
turn provides maximum strength.
What is the difference
between Cavo surface
margin of cavity prepartion
for Amalgam and
Composite restoration
Cast metal
Final Cleaning and
Inspection of the
Preparation
The final stage of tooth preparation is to
clean the preparation thoroughly with water
and air spray. Then dry it with moist air and
inspect it for final appearance .
Avoid over dryness
Simple buccal or palatal
pit
Tooth Preparation on Occlusal Surface
with Buccal or Lingual Extension
• For removal of caries from buccal or lingual pits
and fissures, slight modification in preparation is
needed.
• In this, extend the pulpal floor in the same plane
to include the caries.
• Make a box type preparation with mesial and
distal walls parallel.
• Place retention grooves in the mesial and distal
walls.
• Remove all the unsupported enamel by using
slow speed bur.
The out line of the compound
cavity is formed of two parts:
1- Occlusal cavity
2- Buccal or lingual or palatal extension
box
The extension box have mesial and distal
walls parallel to long axis of the tooth.
The extension prepared at the level of pulpal
floor of the occlusal cavity and formed of
enamel , EDJ and dentine in continuous the
dentine of pulpal floor.
Its level is located at or just above
maximmum height of contour.
If by inspection , there is still extension of caries
cervically , so it is recommended to do buccal or
palatal extension box with step
The box consist of mesial, distal, gingival and
axial
proximal walls
Parallel to long axis of the tooth with slightly
convergence occlussaly.
Gingival wall
Width of the wall about 1.5 – 2 mm
Axial wall
Parallel to long axis of the tooth at right angle
to the gingival wall
Convex ?
Meet the pulpal floor at axio-pulpal line angle
Axio- pulpal line angle should be round
Keep in mined that each part of
the compound class I cavity must
have its own retention and
resistance form - each part have
a separate means of resistance
and retention.
Finally inspect the preparation to evaluate the
need of additional cleaning and additional
finishing.
Thank you
