CONSERVATIVE DENTISTRY

BLACK’S CLASSIFICATION OF CAVITIES

CLASS I: The lesions involving the occlusal surfaces of molars and premolars , the occlusal 2/3 of buccal and
lingual surfaces of molars, and the palatal pits in anterior teeth.

CLASS II: The lesions involving the proximal surfaces of the posterior teeth with access established from the
occlusal surface.

CLASS III: The lesions involving the proximal surfaces of anterior teeth which may or may not involve a labial
or a lingual extension & not involving incisal edge

CLASS IV: The lesions involving all proximal surfaces of anterior teeth which involves the incisal edge.

CLASS V: The lesions involving the cervical third of all teeth, including the proximal surface of posterior
teeth where the marginal ridge is not included in the cavity preparation.

Class VI: Preparations on incisal edges of anterior and cusp tips of posterior teeth without involving any
other surfacecome under class VI.

STEPS IN THE CAVITY PREPARATION (GIVEN BY G V BLACK)

A) Stage I Initial Tooth Preparation Steps:

 Obtaining Outline Form: Placing the preparation margins to the place they will occupy in the final
tooth preparation except for finishing enamel walls and margins, Maintaining the initial depth of
0.2 to 0.8 mm into the dentin, Outline form defines the external boundaries of the preparations.
 Obtaining Primary Resistance Form: Primary resistance form is that shape and placement of
preparation walls to best enables both the tooth and restoration to withstand, without fracture the
stresses of masticatory forces delivered principally along long axis of the tooth. Factors affecting
resistance form: Amount of occlusal stresses, Type of restoration used, Amount of remaining tooth
structure.
 Obtaining Primary Retention Form: Primary retention form is that form, shape and configuration of
the tooth preparation that resists the displacement or removal of restoration from the preparation
under lifting and tipping masticatory forces.
 Obtaining Convenience Form: The convenience form is that form which facilitates and provides
adequate visibility, accessibility and ease of operation during preparation and restoration of the
tooth.

B) Stage II Final Tooth Preparation Steps:

 Removal of Remaining Carious Dentin: After the establishment of external and internal outline form
, if any of the remaining carious tooth structure or defective restorative material is left in tooth, it is
to be removed in this stage. Infected dentin must be removed even, if it leads to exposure of pulp
which is treated accordingly.
 Providing Pulp Protection, If Indicated: Pulp protection is achieved using liners, varnishes and bases
depending upon: The amount of remaining dentin thickness, Type of the restorative material used.
 Obtaining Secondary Resistance & Retention Form: This step is needed in complex and compound
tooth preparations where added preparation features are used to improve the resistance and
retention form of the prepared tooth.
  Finishing of Enamel Walls & Margins: Finishing of the enamel margins should be done irrespective
of restorative material used.
 Final Procedures; Cleaning, Inspecting and Sealing: The final step in tooth preparation is cleansing
of the preparation. This includes the removal of debris, drying of the preparation, and final
inspection before placing restorative materials.

DENTAL AMALGAM

DEFINITION “Amalgam is a special type of alloy in which mercury is one of the component”

ADVANTAGES:

 Ease of use
 High compressive strength
 Excellent wear resistance
 Favorable long-term clinical results
 Economic
 Can be bonded to tooth structure
 Self-sealing ability

DISADVANTAGES:

 Lack of esthetics
 Less conservative
 Non-insulating
 Corrosion and galvanism
 Lack of reinforcement of weakened tooth structure
 Difficulty in restoring proper tooth anatomy

ADHESION SYSTEM 4, 5, 6, 7 G
Adhesion (or bonding) is defined in dentistry as the forces or energies between atoms or molecules at
an interface that hold two surfaces together.

 Fourth Generation (Total etch technique) Acid etching of dentin. Separate primer. Increased bond
strength. Fourth generation (total etch technique; etch &rinse tech; three step technique) Concept
complete removal of the smear layer Etching of both enamel &dentin Primer Bonding agent (three
step) Technique sensitive. These system incorporated monomers with high diffusivity and
compatibility to wet dentin.
 Fifth Generation (two steps) Etch and rinse (total etch) (etch separately and then primer &bonding
in one bottle) Combined primer and adhesive in one bottle. Maintained high bond strengths .
 Sixth Generation (self etch approach) “Self-etching” primers. Reduced incidience of post-treatment
sensitivity. Bond strengths lower than fourth- and fifth generations. More simple Post operative
hypersensitivity.
 Seventh Generation “All-in-One”. Combines etching, priming and bonding. Single solution. Good
bond strength and margin sealing. They achieve the same objective as the 6th generation except
that they simplified the multiple sixth generation materials into a single component, single bottle
system, thus avoiding any mistake in mixing. Seventh generation bonding agents also have
disinfecting and desensitizing properties.
ETCHING SYSTEM (WHAT, WHEN)
Etching It is the process of increasing the surface reactivity by demineralizing the superficial calcium layer
and thus creating the enamel tags, Pattern of etching:

 Type I etching pattern: preferential removal of enamel prism core

 Type II etching pattern: preferential removal of prism peripheries
 Type III etching pattern: not related to prism morphology

ETCHING ENAMEL: affects both prism core and prism periphery. transforms smooth enamel into very
irregular surface.

ETCHING DENTIN: Affects intertubular and peritubular dentin. Removes the smear layer and exposes
collagen network to achieve optimal adhesion to the dentinal surface.

SMEAR LAYER (SUBSTANCES)

Smear unit (smear layer): when tooth surface is altered using hand or rotary instruments, cutting debris are
smeared on enamel and dentin surface.

Components of Smear Layer Smear layer consists of both organic and inorganic Components.

 The inorganic material in the smear layer is made up of tooth structure and some nonspecific
inorganic contaminants.
 The organic components may consist of heated coagulated proteins.

GLASS IONOMER
Glass ionomers are water-based, self-adhesive restorative materials in which the filler is a reactive glass
called fluoroaluminosilicate glass and the matrix is polymer or copolymer of carboxylic acids.

The setting reaction of these materials involves an acidbase reaction. There are two main types of glass
ionomers:

• Conventional glass ionomer

• Resin-modified glass ionomer