Principles of cavity

preparation

.Definitions
These are number of general and
fundamental basics, which must be realized in
preparing cavities for the reception of
restorative materials.

Classification
I- Biological
principles:
Pulp protection.
Prevention of caries
recurrence.
Aseptic procedures.
Protection of
gingival and
periodontal tissues.

II- Mechanical
principles:
Outline form.
Resistance and retention
form.
Convenience form.
Removal of remaining
carious dentin.
Finishing of enamel wall.
Toilet of the cavity.

Biological principles:
Definition
Steps followed during cavity
preparation to minimize irritation
to the vital tooth structures.

Forms of biological
:principles
Pulp protection.
Prevention of caries recurrence.
Aseptic procedures.
Protection of gingival and
periodontal tissues.

Pulp protection.
Against irritation:
Mechanical.
Thermal.
Chemical.

Against mechanical
:irritation
Avoid direct traumatic injury to the pulp.
Avoid unnecessary pressure and wrong
direction of instruments.
Avoid cutting through recessional lines
of the pulp chamber.
Avoid over cutting of dentine and
weakenening of tooth structure.
Avoid sharp line angles with the cavity.

Against thermal
.irritation
Avoid heat generation during
cavity preparation.
Avoid working without coolant.
Avoid long time working.

Against chemical
:irritation
Avoid using chemicals and caustics
for toilet of the cavity.
Avoid using air jet for a long time.

Prevention of caries
recurrence.
Removal of all carious enamel and
dentine.
Proper extension of cavity margins
to self-cleansable area.
Removal of all undermined enamel.
Proper inclination of CSA with the
type of restoration.

Aseptic procedures.
Using a sterile instruments.
Application of rubber dam to keep
the fields clean and dry.

Protection of gingival and

Avoid overhang gingival margins of the
.periodontal
tissues
restoration.
Proper matricing during restoration of
compound cavities.
Proper wedging of the matrix.
Controlled cutting to avoid instrument
slippage and soft tissues injury.
Avoid using irritating chemicals near the
gingival margins of the cavity.

II. Mechanical principles

Definition
Steps followed during cavity
preparation for preservation of the
structural integrity of both the
tooth and restoration by decreasing
the tensile stresses to be within the
physical tolerance of these
structures.

Objectives
1.Provision of adequate retention to the
restoration.
2.Provision of correct resistance against
fracture to both the tooth and
restoration.
3.Conservation of maximum amount of
tooth structure.

Steps of cavity preparation

According to G.V.Black , the mechanical
steps of cavity preparation are:
1.Outline form.
2.Resistance and retention forms.
3.Convenience form.
4.Removal of remaining carious dentin.
5.Finishing of enamel wall.
6.Toilet of the cavity.

N.B.:
If the cavity is too deep and
caries is extensive, step (4) can be
interchanged with step (2) to
determine:
1.The cavity depth.
2.The extent of lesion.

1. Outline form
Definition
The external shape of the
completed cavity boundaries.
The shape of CSA of the prepared
cavity.

Fundamentalsofoutlineform
1. All carious lesion must be included within
the outline.
2. All pits, fissures, grooves and retentive
areas must be included within the outline.
3. The cavity margins should be extended to
sound tooth structure without undermined
enamel and in a self-cleansible area.

4. All carious and undermined enamel must be

included in the prepared cavity.
5. The outline must be in the form of
harmonious sweeping curves, in order to:
a) Prevention of recurrent caries.
b) Avoidance of stress concentration areas.
c) Better esthetics.

6. Cavities approaching each other

must be connected to avoid leaving
a weak ridge between them which
is liable to fracture.
7. Extension for prevention or
cutting for immunity??????????????.

Adverse effects of extension for prevention:

1. Weakening of the sound tooth
structure.
2. Increased irritation to the pulp.
3. Increased liability for gingival and
periodontal problems in compound
cavities.
Increased liability to recurrent caries.

2. Resistance and retention

form
Definition
Resistance form: Form given to the
prepared cavity to prevent fracture of
restoration or / and tooth structure.
Retention form: Form given to the
prepared cavity to prevent displacement
of the restoration

Factors affecting resistance

form
a) Occlusal force:
b) Cavity design:
c) Physical properties of the restorative
material:

a)
Occlusal
force:and affected by:
1.
Magnitude:
Variable
Type of food.
Type of occlusion.
Power
of masticatory muscles.
Age of the
patient.

2.Direction:
3.Character:
Static forces Centric.
Dynamic force Eccentric.
Cyclic force Functional.

We can conclude that cyclic force

with different magnitudes and
directions are present during
mastication producing fatigue of
the restorative material and
enhance its fracture.

b) Cavity design:
1. Walls direction: Should be
either parallel or perpendicular to
the long axis of the tooth to
decrease the analysis of force into
destructive tensile components.

2. Depth and width: That gives

bulk to the restorative material to
withstand the occlusal forces.

It is better to gain bulk through

the depth rather than width as
width increases the subjected area
of restoration to stresses.
Depth x 2 = Strength x 4
Width x 2 = Strength x 2.

3. Conservation: Maximum conservation

of remaining sound tooth structure to avoid
their weakening and fracture.

4. Pulpal floor: Should be flat and

smooth to avoid stress concentration and to
provide equal distribution of occlusal
stresses.

5. Line angles: Should be rounded

without sharpness to avoid stress
concentration.

6. Amount of retention: Adequate

amount of retention for each part of the cavity
increases the stability of the restoration under
stresses.

7. CSA: Should be given the correct

inclination according to:
1. Type of restoration.
2. Direction of enamel rods.
For amalgam and composite CSA 90 .
For gold inlay CSA 135 , to protect
enamel rods.

8. Weak cusps: Which have their

bases smaller than their heights.
Such a cusp should be reduced to
decrease the height in relation to its
base.

 This is called cusp tipping in case of

using amalgam to cover this cusp and
should be for at least of 2 mm to
provide strength to the amalgam.
This is called cusp coverage by
performing counter bevel in case of
using cast gold restoration to protect
such a cusp i.e. In-onlay.

Typesofretentivefeatures:
a) By utilizing dentin:
b) By modifying the cavity outline:
c) By modifying cavity design:
d) Special retentive features:

a) By utilizing dentin:
1.Mechanicalundercuts:
2.Frictionalwallretention:
3.Grippingactionofdentin:
Thiswilloccuronlywithgoldwithgoldfoilrestoration.

4.Pinretention.

b) By modifying the cavity outline:

1.Dovetaillock:Incompoundproximalcavities.
2.Occlusallock:Incompoundproximalcavities.
3.Buccalandlingualextensions:Toprevent
proximaldisplacement.
4.Extensionforretention:Performedbyextension
totheothersideofthecavity.

c) By modifying cavity design:

1. Proximal axial grooves: In amalgam
cavity, it extends from gingivo-axial line
angle up to the axio-pulpal line angle,
along the axio-buccal and axio-lingual
line angle with undercut.
In gold cavity, it extends up to CSA
without undercut.
2.Grooves in dentin line angles.

d) Special retentive features:

1.Acid etching for composite

restoration.
2 Dowel pin retention i.e. Post
inside the root canal.

Factors affecting selection of retentive form

1.Type of restorative material.
2.Available amount of remaining
tooth structure.
3.Esthetic demands.
4.Amount of retention needed.
5.Pulp vitality.
6.Type of occlusion.

N.B.
Stability: Prevention of restoration
displacement towards the center.
Gained by: 1. Definite cavity walls.
2. Flat pulpal floor.
3. Definite and slightly
rounded line
angles.

Retention: Prevention of restoration

displacement towards the periphery.
It is either:
Axial against vertical
displacement.
Lateral against lateral
displacement.

3. Convenience form
Definition:

Shape given to the cavity to

make it easily seen, reached and
restored.

Conveniencefeatures
1.

Accentuation of point and line angles.

2. Slight extension of cavity outline to

facilitate insertion and condensation of the
restorative material.
3. Roundation of axial line angles.

4. Beveling of enamel wall with:

a. Gold to protect marginal enamel.
b. Composite increase surface area for
acid

etching.

5. Selection of smaller specially designed

instruments enable the operator to prepare
surfaces, which are difficult to reach.

6. Mechanical methods:
Application of tooth separators.
Application of gingival retracting cords.
Rubber dam.

4. Removal of remaining carious

dentin
Definition
It is the process of removing decay
and decalcified enamel and dentin.

Cariespattern

In enamel Follows the direction

of enamel rods.

At DEJ Lateral spread in all

directions.

In dentin Follows the direction

of dentinal tubules.

Theroutinecavitydepth
1. Pulpal depth: 0.5 - 1 mm beyond the
DEJ.
It may be up to 1.5 mm
beyond the DEJ in case of amalgam to
increase the bulk of material.
2. Axial depth: 0.5 - 1 mm beyond DEJ
in premolars.
1 - 1.5 mm beyond DEJ
in
molars.

The cavity must extend deeper to

DEJ
in order to:

1. Avoid cutting at this sensitive area

i.e. DEJ.
2. To get sure that there is no undermined
enamel resulted from the lateral spread of
caries at DEJ.
3. To detect lateral spread of caries at DEJ.
4. To provide sufficient bulk of the
restoration.
5. To add retentive features.

Conditions
at routine
Three conditions
may becavity
found depth
at the
routine cavity depth.

a) Hard sound viable dentin:

The best condition.
Finish enamel walls and apply either
varnish in case of amalgam or calcium
hydroxide liner in case of composite.

b) Hard discolored dentin:

In posterior teeth could be left as it
is considered as sound dentin, but it is
only discolored due to chromogenic
bacterial products.
In anterior teeth must be removed
as it appears from enamel affecting
esthetic.

C ) Soft dentin:

Which is painful, denoting presence

of viable protoplasmic processes, and

which may be discolored (chronic caries)
or not (acute caries).

This layer constitutes the floor of

deep and moderately deep cavities.

Such soft dentin must be removed

since it is carious and if left will
extend to involve the pulp.
If still soft, caries should be
removed selectively forming dentin
ledge sub-base and base
restoration.

If there is still soft caries it must be

evaluated, either acute or chronic caries.
a) Acute caries Could be left.
Only apply calcium
hydroxide as indirect pulp capping, as the
last layer is sterile.
b) Chronic caries Should be removed
even pulp exposure occurs, as the last
later is infected.

Acute caries

Chronic
caries

Histology

Acid penetration occurs

before bacterial invasion,
so the last layer is sterile,
it is just decalcified i.e.
Affected and not infected.

Acid penetration coincides

with bacterial invasion, so
the last layer is both
infected and affected.

Last layer

Could be left, only apply

calcium hydroxide to
neutralize acidity indirect
pulp capping.

Could not be left and

must be removed even if
leads to pulp exposure.

Patient age

Young less than 20 years.

Old more than 40

years.

Site

First molar teeth and lower

anterior teeth.

Anywhere.

Duration

Short months.

Long years.

Color

Yellow.

Dark brown.

Consistenc

Soft and removed in flacks.

Harder and removed in

debris.

Instruments used to remove caries

1. Hand instruments: Excavators.
Direction parallel to
the pulp horns from the cavity periphery to
the center with scooping motion.
No heat generation.
2.Rotary instruments: Large round bur
with low speed and without pressure.

N.B.
Dentin ledge: Three-dimensional form
in a level pulpal to the cavity.
It impairs the
resistance form, so it should be lined with
sub-base and base to the proper level of
the pulpal floor.
Dentin bridge: Thickness of dentin
protecting the pulp.

5. Finishing of enamel wall

Objectives
1. To give the CSA its correct inclination.
2. To remove any undermined enamel.
3. To produce smooth enamel walls that
increases adaptation of the restoration.
4. To keep the rounded and convenient
outline with proper cusp contours.

6. Toilet of the cavity

Definition

The process of removing all

debris from the prepared cavity

e.g. cut chips, blood, saliva and
bacteria.

Objectives
1. Increasing adaptation of the
restoration to cavity walls.
2. Prevents contamination of the
restorative material.
3. Enables the operator to examine
properly all steps.
4. The cavity should be clean and dry
before insertion of the filling material.

Materials:
1. Phenol leads to pulp necrosis.
2. Silver nitrate Leads to:
Discoloration of tooth structure.
Irritation to the pulp.
Tarnish of amalgam.
3. Alcohol Leads to: Dehydration of
dentin.
Pulp irritation.

Materials:
4. Hot air blast Leads to dehydration
of dentin.
5. Hydrogen peroxide 3%: Highly
effective through its effervescent action.
6. Water spray: The best as it is not a
medicament.
Cotton pellet to dry the
cavity to reduce the use of air stream.
Removal of remaining
water by air for short time.

Adaptation
Definition: The maximum degree of
proximity between the restoration and
the tooth structure.
For proper adaptation: The tooth
surface should be:Smooth.
Dry.
Clean.
The restoration should be properly
constructed.

Thank You

UltraconservativeTreatments
1- Enameloplasy.
2- Pit and Fissure sealant.
3- Spot Preparations.
4- Proximal Slots.
5- Tunnel Preparation.

1- Enameloplasty.
Definition:
Reshaping pits and fissures by rounding
or saucering with a round bur or a diamond
point to render them non retentive for
bacterial plaque.

Indication:
It is indicated when this anatomic
defects are not carious or if carious doesnt
penetrate deeper than the outer 2/3
thickness of enamel.
NB:
Saucering must not be aggressive and CSA
must not exceed than 110.

2- Pit and Fissure sealant.

Adhesive resin systems are used to seal
pit and fissures following acid
demineralization of bordering enamel.

Advantages:
1- Prevent Plaque retention.
2- Cross-tie and reinforce the tooth.
3- Sealing of these anatomic defects prevent the
cariogenic mutans streptococci from the most
favorable shelter.
4- Reduce the number of cariogenic bacteria in the
mouth.
5- Prevent spread and recurrence of infection.

3- Spot Preparations
These are preparations in the same
surface for pit and fissures. This aims to
preserve the structural continuity of the
tooth and prevention of stress concentration
that result from uniting them into
continuous preparation.

However, the intervening tooth

substance should not be less than 0.5mm
thick, weak, or contain undermined enamel
that is liable to fracture.

4- Proximal Slots.
Simple Proximal Cavity.
Initial proximal and root caries provided that
the area is accessible as a result of
a- missing adjacent teeth.
b- excessive gum recession.

5- Tunnel Preparation.
This involves access to and removal of initial
lesion through a tunnel at the respective internal
fossa, without removal of the corresponding
marginal ridge.
A matrix is then fitted, and the cavity is filled with
glass-ionomer cement utilizing the injection
technique.

Disadvantages:
1- It leaves the involved marginal ridge undermined.
2- It creates a structural discontinuity that induces
stress concentration.
3- There is a possibility for incomplete caries
removal.
4- It leaves cement overhang.
5- Deficient condensation with poor proximal
sealing, contact.