Cavity preparation of parmenent tooth

Department of pediatrics and

preventive Dentistry

Darshan (14)
Chitransh (13)
Steps of tooth preparation

Initial tooth preparation stage

Step 1: Outline form and initial depth

Step 2: Primary resistance form

Step 3: Primary retention form

Step 4: Convenience form

• Final tooth preparation stage

Step 5: Removal of any remaining infected dentin or old restorative material (or both), if indicated

Step 6: Pulp protection, if indicated

Step 7: Secondary resistance and retention forms

Step 8: Procedures for finishing external walls

Step 9: Final procedures-cleaning, inspecting, desensi- tizing

Step 1: Outline form and initial depth

Definition

Establishing the outline form means:

1. Placing the preparation margins in the positions they will occupy in the final
preparation except for finishing enamel walls and margins.

2. Preparing an initial depth of 0.2-0.5mm pul- pally of the DEJ position or 0.8mm pulpally
to normal root-surface position
Principles

The three general principles on which outline form is established

regardless of the type of tooth preparation being prepared are as
follows:

1. All unsupported or weakened (friable) enamel 1. usually

should be removed.

2. All faults should be included.

3. All margins should be placed in a position to allow finishing of

the margins of the restoration
Features:
Generally, the typical features of establishing proper outline form and initial depth are:

1. Preserving cuspal strength

2. Preserving marginal ridge strength 3. Minimizing faciolingual extensions

4. Connecting two close (<0.5mm apart) defects or tooth preparations

5. Restricting the depth of the preparation into dentin

Rules for establishing outline form for pit-and-fissure tooth preparation
1. Extend the preparation margin until sound tooth structure is obtained, and no unsupported or weakened enamel
emains.

2. Avoid terminating the margin on extreme emi- nences, such as cusp heights or ridge crests.

3. If the extension from a primary groove includes one half or more of the cusp incline. Consideration should be
given to capping the cusp. If the extension is two thirds, the cusp capping procedure is most often the proper
procedure (Fig. 9.7) to remove the margin from the area of masticatory stresses

Extend the preparation margin to include all of the fissure that cannot be eliminated by appro- priate enameloplasty
Fig. 9.8).

5. Restrict the pulpal depth of the preparation to a maximum of 0.2mm into dentin. To be as conservative as
possible, the preparation for an occlusal surface pit-and-fissure lesion to be re- stored with amalgam is first
propared to a depth

of 1.5mm
 Enameloplasty:
Definition Enameloplasty is a prophylactic procedure that involves
the removal of a shallow, enamel develop- mental fissure or pit to
create a smooth, saucer shaped surface that is self-cleansing or
easily cleaned
Indications:
1. A fissure may be removed by enameloplasty if one third or less of
the onamel depth is involved, with out preparing or extending the
tooth preparation.
2. The presence of a shallow fissure that approach- es or crosses a
lingual or facial ridge may be re moved by enameloplasty
Step 2: Primary Resistance Form :

Definition:

Primary resistance form may be defined as the shape and placement of the preparation walls that best
en- able the remaining tooth structure and the restoration to withstand, without fracture, masticatory
forces de- livered principally along the long axis of the tooth.

Principles:

1.First principle of horizontal floors

2.Second principle of buccolingual extension
3. Principle of rounded line angles Thied
4.Fourth principle of cusp capping
5.Fifth principle of restorative material thickness
6.Sixth principle of bonding to the tooth
Features:
The design features of tooth preparation that enhance primary resistance form are as follows:

1. Relatively horizontal floors

2. Box-like shape

3. Inclusion of weakened tooth structure 4. Preservation of cusps and marginal ridges

5. Rounded internal line angles

6. Adequate thickness of restorative material

7. Reduction of cusps for capping, when indicated

 Step 3: Primary Retention Form:

Definition :
Primary retention form is the shape or form of the conventional preparation that prevents displacement or
removal of the restoration by tipping or lifting for es for nonbonded restorations.

Principles :
Because retention needs are related to the restorative material used, the principles of primary retention
form vary, depending on the material.

Primary retention form for amalgam restorations:

For amalgam restorations in most class I and all class II conventional preparations, the material is retained in
the tooth by developing external tooth walls that converge occlusally seo Fig. 9.9A).
Primary retention form for composite
restorations :
Composite restorations primarily are retained in the
tooth by a micromechanical bond that develops be
tween the material and the etched and primed tooth
structure. In such restorations, enamel and dentin are
etched by an acid (when using an etch-and-rinse ad-
besive), and dentin is primed with an adhesive before
placement of the composite

Additional retention may be accomplished when the

surface area of the enamel available for bonding is
increased by a beveled or flared (>90 degrees) enamel
marginal configuration.
 Step 4: Convenience Form

Definition :
Convenience form is the shape or form of the preparation that provides for adequate observation, acces-
sibility, and ease of operation in preparing and restor- ing the tooth.
 Final Tooth Preparation Stage

Step 5: Removal of Any Remaining Enamel Pit or Fissure, Infected Dentin, or Old
Restorative Material, if Indicated

Definition:

Removal of any remaining enamel pit or fissure, in fected dentin, or old restorative material is the
elim nation of any infected carious tooth structure faulty restorative material left in the tooth after
initia tooth preparation.
Affected and Infected Dentin :
Infected dentin has bacteria present, and collagen is irreversibly denatured. It is not remineralizable and must be
removed. Affected dentin has no bac teria, and the collagen matrix is intact, is reminer- alizable, and should be
preserved.
To clinically dis- tinguish these two layers, the operator traditionally observes the degree of discoloration (extrinsic
stain- ing) and tests the area for hardness by the feel of an explorer tine or a slowly revolving bur

Removal of infected dentin

1. Large areas of soft caries usually are best re- moved with spoon excavators by flaking up the caries
around the peripheryand peeling it off in layers. The bulk of this ma- terial is removed easily in a few large
pieces.

2. The ideal method of removing harder, heav- ily discolored dentin material would be one in which
minimal pressure is exerted, frictional heat is minimized, and complete control of the instrument is
maintained, Consideration of these factors usually favors the use of a round carbide bur, in a slow- or
high-speed
Removal of old restorative material:
After initial tooth preparation, the initial depths may result in old restorative material remaining on the
pulpal or axial walls. Any remaining old restorative material should be removed if any of the following
conditions are present:

1. The old material may affect negatively the es thetic result of the new restoration (i.e. old amalgam
material left under a new composite restoration).

2. The old material may compromise the amount of needed retention (i.e. old glass ionomer mate- rial
having a weaker bond to the tooth than the new composite restoration using enamel and, dentin
bonding).

3. Radiographic evidence indicates caries is under the old material.

4. The tooth pulp was symptomatic preoperatively

Technique:
This is also accomplished with the use of a round carbide bur, at slow speed (just above stall-out) with
air or air-water coolant. The water spray (along with high-volume evacuation) is used when removing old
amalgam material to reduce the amount of mercury vapor.
 Step 6: Pulp Protection, if Indicated

Causes of pulpal irritation:

The reason for using liners or bases is to protect the pulp or to aid pulpal recovery or both
Use of liners

Definition

A liner is used to medicate the pulp when suspected pulpal inflammation has occurred. The desired
pul- pal effects include sedation and stimulation, the lat- ter resulting in reparative dentin formation.

Liners may also provide:

1. A barrier that protects the dentin from noxious agents from either the restorative material or oral
fluids

2. Initial electrical insulation

3. Some thermal protection.”

Liners may include suspensions or dispersions of calcium hydroxide, zinc oxide, or resin-modified
glass
Use of bases:

Definition:

Bases are materials, most commonly cements, that are used in thicker dimensions beneath
permanent restorations to provide for mechanical, chemical, and thermal protection of the pulp.

Examples of bases include zinc phosphate, zinc polycarboxylate, and the most common, resin
modi- fied glass ionomer (RMGI).
 Step 7: Secondary Resistance and Retention Forms

The secondary retention and resistance forms are of two types:

1. Mechanical preparation features

2. Treatments of the preparation walls with etch.

I. Mechanical features

1. Retention grooves

Vertically oriented retention grooves are used to pro- vide additional retention for
the proximal portions of some conventional tooth preparations.
2. Preparation extensions

Additional retention of the restorative material may be obtained by arbitrarily extending the
preparation for molars onto the facial or lingual surface to include a facial or lingual groove.

3.Beveled enamel margins :

Enamel margins of some composite restorations may have a beveled or flared configuration to
increase the surface area of etchable enamel and to maximize the effectiveness of the bond by
etching more enamel rod ends.

4.Pins and slots:

When the need for increased retention form is unu- sually great, especially for amalgam restorations, several other
features may be incorporated into the preparation.

Pins and slots increase retention and resistance forms.

II.Placement of etchant, primer, or adhesive on prepared walls

1. Enamel wall etching

Enamel walls are etched for bonded restorations that use ceramic, composite, and amalgam
materials. This procedure consists of etching the enamel with an ap- propriate acid, resulting in a
microscopically rough- ened surface to which the bonding material is me- chanically bound.

2. Dentin treatment:

Dentinal surfaces may require etching and priming when using bonded ceramic, composite, or
amalgam restorations. The actual treatment varies with the re- storative material used, but for most
composite resto- rations, a dentin bonding agent is recommended
 Step 8: Procedures for Finishing the External Walls of the Tooth
Preparation

Definition:

Finishing the preparation walls is the further devel- opment, when indicated, of a specific
cavosurface design and degree of smoothness or roughness that produces the maximum
effectiveness of the restora- tive material being used.

Objectives

The objectives of finishing the prepared walls are to:

i. Create an optimal marginal junction between the restorative material and the tooth structure.

Ii. Afford a smooth marginal junction. An acute, abrupt change in an enamel wall outline form re- sults
in fracture potential, even though the enamel may have dentin support
Factors:

The following factors must be considered in the fin- ishing of enamel walls and margins:

1. Direction of the enamel rods

ii. Support of the enamel rods at the DEJ and later- ally (preparation side)

iii. Type of restorative material to be placed in the preparation

iv. Location of the margin

v. Degree of smoothness or roughness desired

 Step 9: Final Procedures – Cleaning, Inspecting and
Desensitizing

Cleaning and inspecting :

The usual procedure in cleaning is to free the prepa- ration of visible debris with water from the syringe
and then to remove the visible moisture with a few light bursts of air from the air syringe.

After all of the visible debris has been removed, the excess moisture is removed. It is important not to
dehydrate the tooth by overuse of air as this may damage the odontoblasts associated with the desic-
cated tubules (Fig.
Desensitizing:

1. The use of desensitizers (for non-bonded resto- rations) and dentin bonding agents (for bonded
restorations) to limit postoperative sensitivity has been recognized.

2. Occlusion of the dentinal tubules limits the po- tential for tubular fluid movement and resultant
sensitivity.

3. Desensitizers are effective disinfectants, pro- vide crosslinking of any exposed dentin matrix and
occlude (‘plug’) the dentinal tubules by crosslinking tubular proteins.