Principles of cavity

preparation
Dr. Adel Aladimi
New technique for bleaching
Definition of tooth preparation

 the mechanical alteration of a defective ,

injured ,or diseased tooth to best receive a
restorative material that reestablish a
healthy state for the tooth, including
esthetic corrections where indicated ,along
with normal form and function.
Need of Restoration
 Caries

 Malformed, discolored or fractured teeth

 Restoration replacement
 Objectives of tooth preparation
 Remove all defects and provide necessary
protection to the pulp
 Extend the restoration as conservatively as possible
 Form the tooth preparation so that under the
force of mastication the tooth or restoration or
both will not fracture and the restoration will not
be displaced
 Allow for the esthetic and functional placement
of a restorative material
 Principles of cavity preparation
Aim restore the teeth after removal of
caries with preserving sound tooth
structure .
Factors affecting tooth preparation

1. General Factors
 Pulpal & periodontal status
 Occlusal relationship

2.Dental anatomy
 Direction of enamel rods
 Thichness of enamel /dentin
 Size and positionof pulp
 Relationship of tooth to its supporting tissues
3.Patient factors
 Age
 Esthetic consideration
 Economic status
 Patients with high risk caries

4.Affected & infected Dentine

5. Restorative material factors

 Class 1

Class 6
Class 1 Class 4

Class 2 Class 3

Class 2 Class 5
 Principles of cavity preparation

 establishing outline form

 obtaining retention – form
 obtaining resistance – form
 obtaining convenience -form
 removing of remaining carious lesions
 finishing enamel walls & toilet of cavity
 Outline form

 is defined as the location that the

peripheries of the completed tooth
preparation will occupy on tooth surfaces
“done other words , it is the perimeter of
tooth preparation in width ,length& depth
dimensions.
Maxillary Class Ⅰ outline form
Maxillary Class Ⅱ outline form
Mandibular Class Ⅱ outline form
Common Error
 Outline Form and Initial Depth
Features:
preserving cuspal strength
preserving marginal ridge strength
minimizing facio-lingual extension
using enameloplasty
connecting two close faults or cavities
restricting the depth of the preparation
into dentin.
Outline Form and Initial Depth for pit and
fissure cavities
Controlled by three factors
1- Extension to which enamel has been involved by
caries.

2- Extension to achieve sound and smooth margins.

3- Limited bur depth while extending the

preparaton
 Outline form
 is placing the cavity margins in the
position they will occupy in the final
preparation
 All margins placed on sound tooth structure
 All continuous , non coalesced pits& fissures
should be eliminated
 Margins placed in areas of lessened caries
susceptibility
Rules
 Capping of cusp should be done when cavity
extension is two-third from central fissure to cuspal
eminence.

 Include all fissures that cannot be eliminated by

enameloplasty.

 Restrict the depth.

 Join two lesions if they are less than 0.5 mm apart.

Outline form
 Extension for prevention
 states that the cavity must include also non
carious surfaces of fissures & pits adjacent to the
carious . This is to ensure that the caries will not
return causing break down of the restoration
 conservation of tooth structure
 this rule is changed into extension for self
cleansing thirds means that we restore the
tooth with teeth brushing
Outline form
 For most intercoronal preparation
 penetrate to an average depth of 0.5 mm into
the dentin for three reasons to do
 to avoid seating the restoration on the very
sensitive DEJ where maximum
interconnection of the dentinal tubules exist,
 to give bulk for the restorative material
 to allow the restoration to take advantage of
the dentin elasticity during insertion and
function.
Outline form
 For usual dimension extra co
 Notes
 The cavity margins must include full extend
of caries or enamel decalcification if not lead
to marginal break down
 In development of enamel countries ,
enameloplasty is carried out instead of
involvement of these pits & fissures in our
cavity preparation , also fissures sealant may
be used for prevention of recurrent caries
after restoration .
Outline form
 In proximal surface of the posterior teeth
: occlusal surface must be included
because it becomes continuous in the
proximal preparation
 Margins of restoration are placed into self-
cleansing area
 gingival cavosurface margins are placed
0.5 mm apical to the contact area .Size of
contact area : the contact area must be
eliminated cavity according to the site of
caries at contact is ¼ of the intercuspal
distance .
Outline form
 In gingival direction ,locate the gingival
margin ( finishing line ) on the proximal
tooth surface 0.5-1mm apical to the crest
of the healthy free gingival within the
gingival crevice
 Outline form
 The apical extent of the restoration should not
exceed the bottom of the crevice, because
 the alkalinity of the crevice fluid can neutralize
 The knife-edge relationship of the healthy free
gingival to the adjacent tooth surface will
discourage food accumulation on adjacent
restored surfaces occlusal to the sulcus for
considerable periods during and after food
ingestion.
 Outline form
 because the tooth surface forming one of the
perimeters of the gingival crevice and sometimes the
area parallel with the crest of the free gingival is
considered a relatively immune area to decay
recurrence (if the gingival is healthy).
 If the gingival is diseased, the dentist should estimate
the future location of the crest of the free gingival
after healing occurs, and he should place the gingival
margin of the preparation 0.5-1 mm apical to this
estimated position. There are numerous
modifications to these basic rules which will be
described in single tooth restorations and the
periodontium.
Obtaining retention form
 That shape of the cavity that permits
the restoration to resist displacement
through tipping or lifting forces
 Relationship of the walls
 Occlusal outline area
 Dovetail on the occlusal surface
 Pulpal floor of the cavity
The devotail design provide retention form
to the occlusal portion of the cavity.

The occlusal convergence of the walls offers

retention in the proximal portion of the cavity
against displacement occlusally.
 Obtaining retention form :
 The walls of cavity must be fabricated either their walls
parallel or converged O. (B&L)
 if know that the enamel prisms or rod are laying in a
perpendicular manner to the surface of the tooth following
the anatomy
 If converge the proximal walls , creates unsupported
enamel while the enamel rods follow the inclination of the
cusps towards the central groove.
 (O) This convergence is done under the cusps by an
inclination of about 5 degrees
 Obtaining retention form :
 the cavity floor should be flat & smooth if not F.
displace leading to leakage of saliva & hence
secondary caries appear
 the small outline form is the less displacement forces
acted upon it . the width of the cavity should be
compared to ICD , the optimum width is ¼ ICD .
 Extra retention can be gained by means of grooves
in cl II , pins
 Note
 Each part of the cavity or a cavity itself
should have its own means of retention e.g.
the proximal box is a separate cavity in the cl
II cavity
 Resistance form
 It is that shape of the cavity walls that
enables both the restoration & the tooth
structure to withstand forces without
fractures
Primary Resistance Form
Principles:
To utilize the box shape with a relatively flat
floor to resist occlusal loading by virtue of being
at right angles to mastication force.
To restrict the extension of the external walls
(keep as small as possible) to allow strong cusp
and ridge areas to remain with sufficient dentin
support.
 Primary Resistance Form
To have a slight rounding of internal line
angles to reduce stress concentration in tooth
structure;
The presence of sharp internal line angles in
GOLD FOIL resist the movement of the
restoration
Sharp internal line and point angles in dentin
serve as convenient “starting” points for
compacting of direct gold.
To provide enough thickness of restorative
material to prevent its fracture under load.
 Primary Resistance Form
Feature:
Box shape
Relatively flat floors
Inclusion of weakened tooth structure
Preservation of cusps and marginal ridges
Rounded internal line angles
Adequate thickness of restorative materials
Reduction of cusps for capping if indicated
 fractures of tooth structure this can be
prevented by
 Cavity width Should not exceed ¼ intercuspal
distance
 Removal of the unsupported enamel ( spread
of caries in the DEJ)
 Flat pulpal floor
 Rounded internal lines angles
 Mesial & distal walls of the cavity parallel or
diverge occlusally
 In cl II cavity gingival seat lines angles
beveled
fractures of the restorative material prevented by

 Cavity width should not exceed ¼ ICD

 Flat pulpal floor
 In clII axiopulpal lines angle is beveled
 Isthmus area is ¼ ICD as distance
 Depth of A. ( brittle ) needs bulk (more than1mm)
 Cavosurface line angle should be as near as
possible to the right angle (90-110)
 >90degrees----- decrease thickness --- fractures
 <90degrees----- unsupported enamel ….. fracture
 Over carving and decrease thickness of the
amalgam lead to broken the restoration
 Under carving ---- high spot, stress cone point.
may lead to T.M.J problems
Convenience form
 It is that shape of the cavity that allows
adequate observation , access ability
&case of operation in preparing
&restoring the Cavity .
 in anterior teeth , labial extension in
contraindicated .
Convenience Form
Convenience form
 using 1/6 ICD in the outline form of the
cavity is more conservative for sound
tooth structure ; but large head of the
amalgam plugger ( condenser) therefore
poor amalgam condensation may result
in the failure of the restoration ,
otherwise we must fabricate smaller size
hand instruments to be more
conservative.
Convenience form
 unsupported enamel on the labial surface of
the anterior teeth is not removed ; since it is
required for esthetic, also it withstand less
forces of mastication.
 Management of remaining caries
 if only one or two sports of caries are present on the
pulpal floor , the level of the floor is not altered , we
remove these spots with the aid of spoon excavator
or with large round bur , although they leave
depressed areas but these are very small in compare
to the entire surface area.
 this will not create stress concentration areas ,
but we must regard the pulp during this
operative procedure avoiding pulp exposure
Removal of dentinal caries using round burs and spoon
excavators
Management of remaining caries
 if numerous , deep carious spots on the
pulpal floor or even the axial wall in cl II , the
entire level of the wall must be altered
(deepened) the optimum depth is (1.5-2mm) in
enamel & the prepared extension into
dentine is about (0.1-0.2mm ).
 Finishing & Toilet
 Purpose :
 best marginal seal between teeth & restoration.
 smooth marginal seal
 Provides max. strength for both enamel& restoration
 achieve the purposes
 Direction of enamel rods
 Support of enamel
 Type of restoration
 Location of margins
 Degree of smoothness
 Note:
 in most cases ,the cavosurface line angles should
be 90degrees. Whereas internal line angles should
be rounded or beveled . however the marginal
strength of the restorative material for a particular
cavity is a factor in determining the best
cavosurface angle and the amount of unsupported
enamel to be removed
 Toilet of the cavity
 Remove all chips &loose debris
 Seek for any caries & unsupported enamel
 Use warm water spray , oil free , water free air
spray
 Sometimes use cotton pellets.