Fundamentals of

tooth preparation
Dr. Ethar Osman Mukhtar
Introduction:
In the past, most restorative treatment was
for caries and the cutting or preparation of
the remaining tooth structure to receive a
restorative material was referred to as cavity
preparation.
Currently, many indications for treatment are
not related to caries, and the preparation of
the tooth is termed tooth preparation.
Definition of tooth preparation:

Tooth preparation is the mechanical

alteration of a defective, injured , or
diseased tooth to best receive a
restorative material that will re-establish
normal form and function of the tooth,
including esthetic corrections where
indicated.
 Need for restorations:
1. Dental caries lesion.
2. Replacement or repair of restoration.
3. Fractured teeth.
4. Congenital malformation.
5. Esthetic consideration.
6. As part of fulfilling other restorative needs.
 Objectives of tooth preparation:
1- Remove all defects and provide necessary protection
to the pulp.

2- Extend the restoration as conservatively as possible.

3- Form the tooth preparation so that under masticatory

force, the tooth or the restoration or both will not
fracture, and the restoration will not be displaced.

4- Allow for the esthetic and functional placement of a

restorative material.
 Factor affecting tooth
preparation:

2- 3-
1-General Conservation Restorative
factors of tooth material
structure factors
c.Patient
a.Diagnosis b.Knowledge
factors
of dental
anatomy
Factors affecting tooth preparation:
1- General factors:
a. Diagnosis:
 Beforeany restorative procedure, a complete and
thorough examination must be made.
 There must be a reason to place a restoration in the
tooth. The reasons may include caries, fractured
teeth, esthetic needs, or needs for improved form or
function.
Factors affecting tooth preparation:
1- General factors:
a. Diagnosis:
 An assessment of both pulpal and periodontal status.
 Assessment of occlusion.
 Esthetic consideration.
 Relationship with other ttt plan i.e tooth being an
abutment in a fixed or removable partial denture.
 Assess the patient caries risk.
Factors affecting tooth preparation:
1- General factors:
b. Knowledge of dental anatomy:
Knowledge of the anatomy of each tooth and it’s related
parts is a prerequisite for understanding of tooth
preparation.
 The thickness of the enamel and dentin.
 The size and position of the pulp.
 The relationship of the tooth to supporting tissues.
Factors affecting tooth preparation:
1- General factors:
c. Patient factors:
Play an important role in determining the appropriate
restorative treatment.
 Patient knowledge and appreciation of good dental
health.
 Economic status.
 Age.
Factors affecting tooth preparation:
2- Conservation of tooth structure:
Every effort should be made to make restorations as small as
possible.
 The less tooth structure removed, the less potential
damage that may occur to the pulp.
 The smaller the tooth preparation, the easier it is to retain
the restorative material in the tooth.
 The smaller the tooth preparation, the stronger will be the
remaining tooth structure.
 Small tooth preparations result in restorations that have
less effect on both intra-arch and inter-arc relationships
(occlusion).
Factors affecting tooth preparation:
3- Restorative material factors:
Type of restorative material used affects the tooth
preparation.
Selection of restorative material depends upon:
 Economic and esthetic consideration of the patient.
 Ability to isolate the operating area.
 Extend of the lesion/defect.
Terminology of tooth preparation:
 Simple tooth prep. (involves 1 surface).
 Compound tooth prep. ( involves 2 surfaces).
 Complex tooth prep.( involves 3 or more surfaces).
Tooth preparation in surface is abbreviated by using
the first letter of the surface involved.
 For example:
 Preparation involves the occlusal surface is an O.
 Preparation involving the mesial and occlusal
surfaces is an MO.
 Preparation involving the mesial, occlusal, and
distal surfaces is an MOD.
 Tooth preparation walls:
• There are internal walls and external walls.
External wall:
 Isthe prepared surface that extends to
the external tooth surface.
 The external wall take the name of the
tooth surface that the wall is adjacent
to.
 For example: buccal, lingual, mesial,
distal.
 Tooth preparation walls:
• There are internal walls and external walls
Internal wall:
 Isthe prepared surface that doesn’t
extend to the external tooth surface.
Axial wall:
 Isthe internal wall parallel to the long
axis of the tooth.
Pulpal wall:
 Isthe internal wall that is perpendicular
to the long axis of the tooth and occlusal
to the pulp.
Tooth preparation walls:
Enamel wall:
 Isthe portion of a prepared external wall
consisting of enamel.
Dentinal wall:
 Isthe portion of a prepared external wall
consisting of dentine.
Tooth preparation walls:

Floor/ Seat:
 Isthe prepared wall that is horizontal
and perpendicular to the occlusal force.
 Examples: pulpal floor, gingival floor.
Tooth preparation angles:
Line angle:
 The junction of two surfaces.
Internal line angle:
 The line angle whose apex points into
the tooth.
External line angle:
 Theline angle whose apex points
away from the tooth.
Point angle:
 The junction of three surfaces.
Tooth preparation angles:
Cavosurface angle:
 The junction of a prepared wall and
external surface of the tooth.
 The cavosurface angle varies
according to:
i. Location on the tooth.
ii. Direction of the enamel rods in the
prepared wall.
iii. Type of the restorative material to be
used.
Classification of tooth preparation:
 As presented by G.V.Black, based on the diseased
anatomic area involved and the associated type of
treatment.
 This was divided into 5 classes, a 6th class was added later
on.
Class I preparations:
 All pit-and-fissure preparations are Class I,
and they are assigned to three groups, as
follows;
1. Preparations on Occlusal Surface of
Premolars and Molars.
2. Preparations on Occlusal Two Thirds of
the Facial and Lingual Surfaces of Molars.
3. Preparations on Lingual Surface of
Maxillary Incisors.
Class II preparations:

 Preparations on the proximal surfaces of

posterior teeth.
Class III preparations:

 Preparations on the proximal surfaces of

anterior teeth that do not involve the
incisal angle.
Class IV preparations:

 Preparations on the proximal surfaces of

anterior teeth that involve the incisal
edge.
Class V preparations:

 Preparations on the gingival third of the

facial or lingual surfaces of all teeth
Class VI preparations:

 Preparations on the incisal edge of anterior

teeth or the occlusal cusp tips of posterior
teeth.
 Steps of tooth preparation:
Initial tooth Final tooth
preparation stage preparation stage

Step 1: outline form and Step 5: removal of any remaining

initial depth. infected dentin or old restoration.
Step 2: primary resistance Step 6: pulp protection.
form. Step 7: secondary resistance and
Step 3: primary retention retention form.
form. Step 8: finishing external walls.
Step 4: convenience form. Step 9: cleaning, inspecting,
desensitization.
Step 1 : outline form and initial depth

Definition:
 Placing the preparation margins in the positions they
will occupy in the final preparation and preparing an
initial depth of 0.2-0.5 mm pulpally to the DEJ.
Principles:
i. All weakened or unsupported enamel should be
removed.
ii. All faults should be included.
iii. All margins should be placed in positions that allow
finishing.
Step 1 : outline form and initial depth

Factors affecting the outline form:

i. The extent of the carious lesion, defect, or
faulty old restoration.
ii. Esthetic considerations.
iii. Occlusal relationship.
iv. Adjacent tooth contour.
v. The desired cavosurface angle.
Step 1 : outline form and initial depth

Features:
To establish a proper outline form and initial depth:
i. Preserve cusp strength (minimize faciolingual
extension).
ii. Preserve marginal ridge strength (mesiodistal
extension).
iii. Connect too close defects or preparations (< 0.5
mm apart).
iv. Restrict the depth of preparation into dentin.
v. Use of enameloplasty.
 Enameloplasty:reshaping of the fissures to make
them non-retentive and less prone to caries.
Step 2: primary resistance form

Definition:
 Resistanceform is the shape of the preparation
that enable the remaining tooth structure and
the restoration to withstand masticatory forces
( directed with the long axis of the tooth)
without fracture.
 Step 2: primary resistance form
Principles:
 Use box shape with a relatively horizontal floor.
 Restrict the extension of the external walls to maintain
sufficient dentin support to cusps and ridge areas.
 Rounding of line angles to reduce stress concentration.
 Capping or covering weak cusps.
 Provide enough thickness of the restorative material to
prevent it’s fracture.
 Bond the material to tooth structure when possible
 Minimum thickness of different
restorative materials to resist fracture

Composite Ceramic Cast metal amalgam Type of

restoration

Non specific mm 2 1-2mm 1.5mm Minimum

thickness
Step 2: primary resistance form

Factors affecting resistance:

i- The occlusal contact:
 On both the restoration and the remaining tooth
structure.
 The greater the contact the greater will be the
risk of fracture.
ii- The amount of the remaining tooth structure.
iii- The type of the restorative material.
iv- Bonding of the restoration to the tooth.
Step 3: primary retention form

Definition:
 Primary retention form is the form of the
preparation that prevent displacement or removal
of the restoration by tipping or lifting forces.
Step 3: primary retention form
Principles of retention:
Retention depends on the type of the restorative
material.
 For conventional amalgam:
 Mechanical retention obtained through:
i. Convergence of buccal and lingual walls in
class I and II.
ii. Occlusal dovetail in class II.
 For composite restorations:
 Micromechanical retention.
Step 4: convenience form

Definition:
 Itis the form of the preparation that provides
observation, accessibility and ease of operation.
 Itmay necessitate extension of facial, mesial, lingual
or distal walls.
 Extension of facial margins of anterior teeth is
contraindicated
 Steps of tooth preparation:
Initial tooth Final tooth
preparation stage preparation stage

Step 1: outline form and Step 5: removal of any remaining

initial depth. infected dentin or old restoration.
Step 2: primary resistance Step 6: pulp protection.
form. Step 7: secondary resistance and
Step 3: primary retention retention form.
form. Step 8: finishing external walls.
Step 4: convenience form. Step 9: cleaning, inspecting,
desensitization.
Step 5: removal of any infected dentine
or old restoration
 Removal of infected dentin while retain the
affected dentin.
 Using spoon excavator or round carbide bur in
slow speed hand piece.
Step 5: removal of any infected dentine
or old restoration
 Removal of old restorative material is indicated
only when:
i. The old material may negatively affect esthetic.
ii. The old material may decrease the retention.
iii. Radiographic evidence indicate caries beneath the
restoration.
iv. The periphery of the restoration are not intact.
v. The tooth was symptomatic preoperatively.
Step 6: pulp protection if indicated

 Reasonfor using liners or bases is to either

protect the pulp or to aid pulpal recovery or both.
Step 7: Secondary resistance and
retention forms
 These could be considered together, they are
divided into 2 types:
i. Mechanical preparation features.
ii. Treatment of cavity walls by etching, priming, &
adhesive material.
Step 7: Secondary resistance and
retention forms
Mechanical features:
 Retention locks, grooves & coves for amalgam.
 Skirts, in gold restoration.
 Beveled enamel margin: used in composite + cast
metal.
 Pins, slots , steps and amalgam pins.
Step 8: Finishing the external walls of
the tooth preparation
Definition:
 Isthe further development(when indicated) of a
specific cavosurface design and degree of
smoothness or roughness that produce the maximum
effectiveness of the restorative material being used.
Step 9: Final procedure: cleaning,
inspecting, and desensitizing
 Washing the cavity and drying .
 Visualize any debris or defect.
 Use of desensitizers( for non bonded restorations) or
dentin bonding agents (for bonded restorations) to
limit post operative sensitivity.
Thanks