Cavity Preparation for Class III and

Class V Amalgam Restorations

1
2 Contents
 Introduction

 Class III Cavity Preparation

1. Indications
2. Contraindications
3. Cavity Preparation
4. Restorative Technique

Sturdevant's Art and Science of Operative Dentistry 5th Edition

3 Contents
 Class V Cavity Preparation
1. Indications
2. Contraindications
3. Cavity Preparation
4. Restorative Technique

 Conclusion

 References

Sturdevant's Art and Science of Operative Dentistry 5th Edition

4 Introduction
 Class III restorations are indicated for defects located on the
proximal surface of anterior teeth that do not affect the
incisal edge

 Class V restorations are indicated to restore defects on the

facial or lingual cervical one third of the tooth

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Cavity Preparation for Class III

Amalgam Restorations
6 Indications
 Generally reserved for the Distal Surface of Canines if:
i. The preparation is extensive with only minimal facial
involvement
ii. The gingival margin involves cementum
iii. Moisture control is difficult

 Amalgam may be used for any Class III restoration that

does not involve facial surface or undermine incisal corner

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7 Contraindications
 Class III Amalgam restorations are usually contraindicated
in aesthetically important areas

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8 Advantages
 Class III Amalgam restorations are stronger than the Class
III Direct Composite restorations

 Easier to place

 Easy to finish and polish without damage to the adjacent

surfaces

 Less expensive

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9 Disadvantages
 Metallic and unaesthetic

 Require 90-degree cavosurface margins, specific and

uniform axial depths – results in less conservation of tooth
structure

 Mercury contamination

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10 Line Angle and Point Angles

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Burs Used Dimensions

No. ¼ Round Bur 0.5 mm Diameter

No. ½ Round Bur 0.7 mm Diameter

No. 1 Round Bur 0.8 mm Diameter

No. 2 Round Bur 1.0 mm Diameter

245 Bur 1 mm Diameter 3mm Length

33 ½ Bur Max 1.75 mm Min 0.6 mm

Length 2.33 mm

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12 Class III Cavity Preparation
 INITIAL TOOTH PREPARATION:
 No. 2 round bur – entry cut
 No. ½ or No. 1 bur – tooth/carious lesion is small

Entry for Class III tooth preparation on maxillary canine.

A, Bur position is perpendicular to enamel surface at point of entry.
B, Initial penetration through enamel is directed toward cavitated, carious lesion.
C, Initial entry should isolate proximal enamel, while preserving as much of the marginal ridge as
possible. D, Initial cutting reveals DEJ (arrow)

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 Initial Axial depth 0.5 to

0.6 mm inside DEJ

 0.75 to 0.8 mm Axial

Depth when the gingival
margin in cementum

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 Small Lesion – facial margin is extended 0.2 to 0.3 mm into the

facial embrasure – curved outline from incisal to gingival margin
 Lingual outline – blends with incisal and gingival margins in a
smooth curve – preparation with little or no lingual wall
 Cavosurface angle 90 degrees at all margins – lingual margin
obtuse

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 Lingual wall meets axial wall at an

obtuse angle or may be continuous
with the axial wall

 Axial wall should be uniformly deep

into dentin and follow the
faciolingual contour of the external
tooth surface

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Conserve tooth structure at distoincisal corner to reduce
the potential for subsequent fracture

Distofacial (A) and incisal (B) views of canine to show curved proximal
outline necessary to preserve distoincisal corner of tooth.
Incisal margin of this preparation example is located slightly incisally of proximal
contact (but whenever possible, the margin may be in the contact area).

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 No. ½ is used to accentuate the axial line angles

 This facilitates subsequent placement of retention grooves and
leaves the internal line angles slightly rounded

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 FINAL TOOTH PREPARATION:

 Remaining infected carious dentin on the axial wall is
removed using No. 2 or No. 4 (at low speed) round or spoon
excavaters

 Secondary retention form provided by;

1. Gingival Retention Groove
2. Incisal Cove
3. Lingual Dovetail

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1. Gingival Retention Groove

Preparing gingival retention form.

A, Position of No. ¼ bur in axiofaciogingival point angle.
B, Advancing bur lingually to prepare groove along axiogingival line
angle.
C, Completed gingival retention groove

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2. Incisal Cove

Preparing incisal retention cove.

A, Position of No. ¼ bur in axioincisal point angle
B, Completed incisal cove.

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 3. Lingual Dovetail
21
 Used in large preparations – especially preparations with
excessive incisal extension

 Should be conservative – not extending beyond

mesiodistal midpoint of the lingual surface

 Axial depth – 1mm – axial wall parallel to the lingual

surface of the tooth

 May or may not be in dentin

 No. 245 bur is used

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A, Bur position at correct depth and angulation to begin cutting.

B, Initial cut in beginning dovetail.
C, Bur moved to most mesial extent of dovetail.
D, If possible, cutting should not extend beyond midlingual position.

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E, Bur cutting gingival extension of dovetail.

F, Incisal and gingival extensions of dovetail.
G, Completing isthmus. Proximal and lingual portions are connected by incisal and gingival walls in smooth curves.
H, Completed lingual dovetail

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 Retention coves – incisal corner and

gingival corner of the dovetail –
enhances retention

 Coves are prepared with No. 33 ½

bur in dentin that does not
immediately support lingual enamel

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25 Restorative Technique

1. Matrix Placement:

 Wedged, compound supported matrix – used for Class III

Amalgam Restorations

 5/16 inch (8mm) wide, 0.002 inch (0.05mm) thick, stainless

steel strip matrix material

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 Strip matrix – covers 1/3 of the facial surface – extends

through proximal to lingual surface

 Lingual portion is trimmed by cutting the strip at an angle –

corresponds to the slope of the lingual surface

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 The strip is contoured to approximate the circumferential

contour of the tooth

 Strip – burnished using an egg-shaped burnisher – impart

desired contact and contour form

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 Strip positioned, wedge placed, facial portion
of the strip is stabilized with low fusing
compound

 Small amount of compound may be used

lingually to position and stabilize matrix
against linguogingival corner

 Precontoured metallic matrices may also be

used

 Small preparation – matrix is sufficiently rigid –

compound may not be used
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2. Condensation and Carving:
 Condensation and Carving of Amalgam – similar to the
techniques of the posterior teeth

 Condensers – chosen that are best suited in each part of

the tooth without binding

 Condensation is carried in 1mm increments

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 Carving – remove excess amalgam – the matrix retainer

and band and wedges are removed

 The proximal surface should require minimal carving and

establish proper contact with the adjacent tooth

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Cavity Preparation for Class V

Amalgam Restorations
 32 Indications

 Nonaesthetic areas
 Areas where moisture control is difficult
 Areas that are significantly deep gingivally
 Carious lesion extending gingivally – requiring soft tissue
flap reflection

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Summitt’s Fundamentals of Operative Dentistry A Contemporary Approach, Fourth Edition Pg 793 and
33 Contraindications
 Aesthetically important areas

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34 Advantages
 Class V Amalgam restorations are stronger than the Class V
Direct Composite restorations

 Easier to place

 Easy to finish and polish without damage to the adjacent

surfaces

 Less expensive

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35 Disadvantages
 Metallic and unaesthetic

 Require 90-degree cavosurface margins, specific and

uniform axial depths – results in less conservation of tooth
structure

 Mercury contamination

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36 Line Angles and Point Angles

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37 Class V Cavity Preparation
 Initial Preparation:
 Entry into the carious lesion – Tapered Fissure bur –
limited initial axial depth of 0.5 mm into the DEJ

 Total axial depth is 1 to 1.25 mm

 Preparation in the root surface – axial depth 0.75 mm

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Dentistry 5th Edition Pg No. 797-798
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When extending incisally (A), gingivally (B), mesially (C), and

distally (D), position the bur to prepare these walls perpendicular to external tooth surface

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 Axial wall – convex mesiodistally and incisogingivally

(occlusogigivally) as it follows the contours of the facial
surface of the tooth

 Axial wall deeper at the incisal wall – (1-1.25mm) – more

enamel

 Axial wall depth at the gingival wall – (0.75-1mm) – less

enamel

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40  Final Preparation:
 Any remaining infected axial wall dentin – removed – No.
2/ No. 4 round bur

 No inherent retention – as the cavity walls diverge facially

 No. ¼ bur used to prepare two retention grooves

a] at incisoaxial line angle
b) at gingivoaxial line angle

 Grooves are placed 0.2 mm inside DEJ and 0.25 mm deep

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 Alternatively, 4 retention
coves may be prepared, 1
each at 4 axial point angles

 Conserves dentin near the

pulp

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 Large Preparations that include line angles:

 Maxillary 2nd molars most commonly affected

Tooth preparation on maxillary molar.

A, Caries extending around distofacial corner of tooth.
B and C, Distal extension is accomplished with round bur

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D-F, Gingival margin trimmer may be useful in completing distal half of

preparation when handpiece access is limited

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G, Gingival margin trimmer may be used to provide retention grooves.

H, Angle-former chisel may be used to prepare retention grooves in distal portion
of preparation.
I, Completed tooth preparation.

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 Class V outline approaches existing proximal

restoration – extend slightly into the bulk of
the proximal restoration

 Class II and Class V restorations on the same

tooth – Class II is completed before initiating
Class V

 Done to avoid damage to the Class V

restoration by matrix band and wedge
needed for Class II restoration

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47 Restorative Technique
1. Matrix Placement:
 Most Class V Restorations are placed without the use of
matrix band
 When axial wall is convex mesiodistally, condensation
is difficult
 Preferred method of application of matrix that confines
amalgam in mesial and distal portions of the
preparation

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5th Edition Pg No. 802
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 Conventional Tofflemire band and retainer may be used with a

window cut into the band allowing access to the preparation for
condensation

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2. Condensation and Carving:

Inserting amalgam. A, Place amalgam into preparation in small increments.

B, Condense first into retention grooves with small condenser.
C, Condense against mesial and distal walls.
D, Overfill and provide sufficient bulk to allow for carving

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 Carving may begin immediately after insertion of amalgam

 Carving is done with Hollenback carver held parallel to the
margins
 Side of the carver should always rest on unprepared tooth surface
adjacent to prepared cavosurface margin – prevents overcarving

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Carving and contouring restoration

A, Begin carving procedure by removing excess and locating incisal margin. B and C, Explorer
may be used to remove excess and locate mesial and distal margins.
D, Remove excess and locate gingival margin

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3. Finishing and Polishing:

 Slightly moistened cotton pellet may be used to smooth
the carved restoration further

 Polishing restorations of high copper amalgam is

unnecessary as it is less prone to corrosion and marginal
deterioration

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53 Conclusion
 Class III and Class V Amalgam Restorations are stronger
than direct restorations

 They can be placed in areas where moisture control is

difficult

 However, Class III and Class V Amalgam Restorations are

not popular as adhesive restorations as they offer a more
aesthetically acceptable choice for patients

Sturdevant's Art and Science of Operative Dentistry 5th Edition

54 References
 Sturdevant's Art and Science of Operative Dentistry 5th Edition

 Summitt’s Fundamentals of Operative Dentistry A Contemporary

Approach, Fourth Edition

 M.A. Marzouk Operative Dentistry Modern Theory and Practice

 Vimal Sikri Pre-Clinical Conservative Dentistry Second Edition

55

Thank You