Class II Amalgam

Cavity Preparation

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 Agenda
Class II Amalgam Cavity
Basic Concepts
Principleof cavity Preparation
Armamentarium
Criteria for Evaluation Time-efficient
Steps
Tips & Tricks
Reasons for failure

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 Cavity Classification
CLASS I CAVITY
1) Pits & fissures
2) Occlusal surface of premolars & molars
3) Occlusal 2/3 rd of buccal & lingual surface
4) Lingual surface of maxillary incisors

CLASS II CAVITY
Restoration on Proximal surface of posterior teeth

CLASS III CAVITY

Restoration on the proximal surface of the anterior teeth that do not involve incisal edge

CLASS IV CAVITY
Restoration on the proximal surface of anterior teeth that do involve the incisal edge

CLASS V CAVITY
Restoration on the gingival third of the facial/lingual surfaces of all teeth

CLASS VI CAVITY: Simon

Restoration on the incisal edge of anterior teeth and occlusal cusp height of posterior teeth
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 Basic Nomenclature

CLASS II CAVITY - DEFINITION:

A CAVITY THAT IS PRESENT ON THE PROXIMAL

SURFACES OF PREMOLARS AND MOLARS (G V
BLACK)

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 Metabolism
Certain bacteria in the mouth (Streptococcus
mutans) metabolize carbohydrates (leftover
from food debris) to form acids.
Attack the surfaces of the teeth and slowly
cause demineralization through the loss of
calcium and phosphorous
Lesions develop on any tooth surface and start
at the outer surface of enamel, slowly
progressing towards dentin.
A cavity is fully-formed once the lesion
passes through the dentin-enamel junction into
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the dentin.
 Indications
Moderate to large cavities
Non-aesthetic areas
Saliva loaded areas
Zones of heavy occlusal loads
Restorations extending to root surfaces

ContraIndications
Anteriors
Small to moderate carious lesions
Galvanism
07 Low pain threshold: Post-operative sensitivity
 Why proximal box- Class II
To include all caries, faults, or existing restoration
Create a 90-degree cavosurface margin
Establish ideally not more than 0.5mm clearance with adjacent facial, lingual, and gingival
wall ⅔ of dentin (0.5-0.6mm) & ⅓ of enamel (0.2-0.3mm)

PROXIMALLY THE FACIAL AND LINGUAL WALLS ARE POSITIONED IN A SELF-

CLEANSING AREA WITH CLEARANCE OF 0.2-0.3MM FROM ADJACENT TOOTH:
CONVENIENCE FORM.

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 Components of Proximal Box

Gingival seat

Axial wall

Facial and lingual wall Isthmus

Exit Angles

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 Gingival Seat
Should be placed 1-2mm below contact
(i.e., supragingival)
Subgingival in young patients and patients
with high caries index
Shape: Flat and perpendicular to the long
axis of the tooth
Width: In premolars - 0.6 to 0.8mm and
molars - 0.8 to 1mm
When placing a gingival margin in
cementum, the round toothpick/triangular
wedge is placed in gingival embrasure to
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protect the underlying gingiva
 Axial wall
Placement in dentin
Should be parallel to the long axis of the tooth
For convenience form
Providing additional bulk of amalgam
Retentive grooves can be easily placed in dentin.
Shape: Follow the contour of the tooth (convex) or straight for increased resistance and
retention
The length of the axial wall from the pulpal floor is 0.4-0.6mm
Width is not uniform triangular shape apex towards occlusal and base towards the
gingival seat

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 Isthmus
The junction between the
occlusal portion and proximal
facial and lingual part of the
preparation
The width should be ¼ of the
inter- cuspal distance

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 Ideally, the proximal flare should
be perpendicular to the external
tooth surface.

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 Walls, Line angles and Point Angles

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 Principles of cavity preparation

Outline form and Initial depth:

Establishing the outline form means

placing preparation margins in
positions they will occupy in the final
preparation.
Initial depth of 0.2 to 0.8mm pulpal to
DEJ or normal root surface position

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 General principles to follow in outline form:
Extend preparation to sound tooth structure
Avoid terminating or margins on cuspal heights/ridge crests
Extend margins to allow sufficient access for proper manipulative procedures
Restrict the axial wall pulpal depth of proximal preparation to a maximum of 0.2-
0.8mm into the dentin
Gingival margins in the proximal contact area should extend apically to a minimum
clearance of 0.5mm between gingival margins of the adjacent tooth
The facial and lingual margin in the proximal area is usually extended into their
respective embrasures

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 Primary resistance form

Shape and placement of

preparation walls that best enable
tooth structure and restoration to
withstand without fracture
masticatory forces delivered
principally in the long axis of the
tooth

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 Primary Retention and Convenience form

Primary retention: That shape or

form of the conventional preparation
that resists the displacement or
removal of the restoration from
tipping/lifting forces

Convenience form: That shape or

form of the preparation that provides
for adequate observation,
accessibility, and ease of operation
in preparing and restoring the tooth
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 Secondary Resistance and Retention

Retention locks:
These are vertically oriented at maxillofacial and axio-lingual line angles
Should be placed 0.2mm inside the DEJ
Indicated in extensive proximal preparation; preparation with short walls

Four characteristics of retention locks:

Position: Axiofacial and axio-lingual line angle
Depth: 0.5mm at the level of the gingival floor
Translation: No. 167L bur positioned parallel to DEJ so that it should bisect
the axiofacial and axio-lingual line angles
Occluso-gingival direction

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 Slots:

Horizontally placed retentive grooves in dentin primarily on gingival floors

Indicated in crowns with short length and preparations with short walls

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 Pins:
Small threaded structure placed in pinholes
Placed in gingival seat/ axial angles
The depth of pinholes is 2mm in dentin and 0.2mm in restoration
Used when locks cannot achieve adequate retention form undercuts only
Occlusal offsets and cleats:
Horizontal grooves placed in a buccolingual direction prevents lingual displacement of
restoration
Occlusal cleats are placed in bulbous part of crown provide good anchorage

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 Other features of cavity design
which helps to maintain the integrity
of the restoration:

Rounding of Axio-pulpal line angle

Increasing depth of cavity near isthmus area
Pulpal and gingival floor near isthmus should be perfectly
flat By slanting the axial wall
Every part of cavity preparation should be self retentive
Remove all discontinuity in the preparation, i.e.,
scratches, grooves
By eliminating the occlusal prematurities in the
24 restoration
 Reverse S Curve
Develops while making mesio-facial enamel
wall perpendicular to enamel rods
Lingually reverse curve is very slight often
unnecessary because of the large
embrasure form.

Created to provide:
Butt joint in the preparation margin
To relieve the contact
To place the proximal margins in a self-
cleansing area

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 Armamentarium
Typodont
Instrument cassette- Mouth Mirror, 23/1
Probe, Hemostat, Tweezer/cotton
forceps,
Class II: Hatchet, GMT
Wooden wedges, matrix, metal bands
(ultrathin, thin)
Cotton rolls
Burs
Electric Handpiece
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 Class II Amalgam Preparation - Criteria

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 Class II Amalgam Preparation - Criteria

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 Class II Amalgam Preparation - Criteria

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STEPS IN AMALGAM PREPARATION
First 10 minutes:

Maintain Ergonomics- Thighs parallel to the floor, 11- 12

o'clock position, check the chair height, be comfortable
with your surroundings.
Try out your handpiece, check your burs, segregate the
instruments you will be using, take note of the tooth you
will be working on
Check the tooth's stability of interest and check adjacent
teeth for any damage.
Spend 5 minutes imagining your markings and exit angles
Take a pencil and mark the buccolingual extent of the
proximal box

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STEPS IN AMALGAM PREPARATION
OCCLUSAL CLASS I OUTLINE: 10min

Initial punch cut of 1 mm in depth at the central pit with 330

Extend B-L and M-D along with the natural anatomy/ grooves
of the tooth
B-L extension should be minimal - 0.5 mm into the grooves

Use a 330 bur to increase the width of the cavity and have
a uniform depth of 1.5 mm.
Adjacent tooth protection using the band technique or
insert a wedge
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STEPS IN AMALGAM PREPARATION
PROXIMAL BOX: 15 min
Use 245 burs to make a ditch cut on the proximal side
B-L motion and go deep
Leave thin ledge of enamel, break off with a hatchet
Check the gingival clearance - a probe should be able to
pass through - beyond the contact area
Check the B-L extension of the box.
Check if the buccal and lingual walls are exiting at 90
degrees.
Incorporate reverse curve in maxillary premolars and
molars, and other teeth.
Tip 169 burs by 5 degrees to give slight occlusal
convergence

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STEPS IN AMALGAM PREPARATION
SMOOTHENING THE PREPARATION: 5 min

Use the 556 burs slow speed in the occlusal cavity to

define the line and point angles.

Use the 169L slow speed for the cavity walls to smoothen it.

Use the hatchet to remove any spurs of enamel or

irregularities.

Make sure that the hatchet is sharp (a blunt hatchet may

fracture the tooth)

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STEPS IN AMALGAM PREPARATION
FINISHING: 5 MIN

Round of the axio-pulpal line angle/ Bevel

- Use hatchet/ GMT

Remove undermined edges from the

gingival cavosurface - Use hatchet/ GMT
[Bevelling of the gingival cavosurface is
not required)

Check if there are any irregularities on the

adjacent tooth surface - use a polishing
strip if correctable.

Retention grooves - Bucco-axio and

Linguo- axio line angle
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Clean the operating field
 Important Tips

Give yourself at least three weeks of practice with specific typodont teeth.
Indirect vision: Practice to keep air-rotor head and working field in the same line
of axis
The best Ergonomic position for mandibular posteriors is a 7'0 clock (Curve of
Wilson)
With all the markings, mark the axial wall too
Create punch in the narrowest and straightest area of the central groove
Keep #245 perpendicular or slightly tapered while placing the gingival seat
Go very slow while making a proximal box; spend a minimum of 30 minutes
Chip the proximal wall before the gingival seat placement for better visibility

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 Break the contact area proximally before creating a
Reverse S curve
Use #245 at an angle for occlusal convergence in an
occlusal segment
Use an off-angle chisel to create Exit angles (No enamel
spurs). Practice all the movements with a chisel and
GMT Arrange dental tray in order: PPEs, cotton pellets,
PMT's, Chisel, GMT's Ask for new burs from the proctor,
if required Use ADEX criteria for self-evaluation
Take only an experts' criticism
Practice with the parameters once the school calls,
especially if it's dry cutting. Use light and small strokes
Mandibular first premolars: 30 degrees inclined pulpal
floor Columbia typodont: fishtail
Distal wall divergence
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 Mnemonic for your Amalgam Cavity

F - Flow (Outline)
O - Occlusal Depth
FOCI (5C) IF A McD Finish
C - Circumvention
C - Centralisation
C - Curve (S)
C - Cavosurface Angle at Proximal Boxes
C - Clearance (Proximal, Gingival)
I - Isthmus (Width of the occlusal cavity)

I - Internal Line Angles (Axio-pulpal, gingival)

F - Floor (Pulp and Gingival)

A - Axial Wall (Depth, Convexity, Divergence)

M - Marginal Ridge
C - Convergence (Occlusal and Proximal)
D - Dovetail (Form, Divergence)
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Finish - Damage, Burn Mark, Roughness, Debris
Modifications in class II cavity preparation

SLOT PREPARATION:

Older patients with gingival recession assume that

contact does not need restoration.
Initial depth: 0.75-0.8mm at gingival aspect if the
enamel is present.
Infected caries were not removed at this stage, only at
the end with a round bur.
Prepare retention grooves with ¼ bur in occlusoaxial
and gingivo axial line angles (0.2mm inside DEJ)

The external wall should have a 90-degree cavosurface

angle
MODs

Indicated in the case where both

proximal surfaces involved

Both proximal surfaces share one

pulpal floor

Cavo-surface margin design should

have a 90-degree configuration

Secondary retention features should be

included in the cavity preparation

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 Reasons for failure
Due to faulty case selection
Faulty cavity preparation
Poor matrix adaptation
Due to faulty amalgam
manipulation
Failure of Isthmus leads to insufficient bulk of amalgam
The excessive flare of cavosurface margin leads to Marginal
failure in the proximal box area
Failure to extend preparation adequately leads to
recurrent caries

At the microstructure level:

Corrosion and Tarnish
Stresses associated with masticatory forces
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 Tip:

Victory is always possible for the person

who refuses to stop fighting!!
Napolean Hill
 References

Conservative preparation designs for Class II amalgam restorations J R Sturdevant, DF

Taylor, R H Leonard, WF Straka, T M Roberson, A D Wilder
Sturdevant’s Art and Science of Operative Dentistry - 6th Edition
Modified cavity preparation for class II amalgam restorations - Joseph Rubenstein

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Thank You