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1
CLASS I CAVITY
PREPARATION
GUIDED BY- DONE BY-
Dr. SANDEEP METGUD Dr. RAMSUNDAR HAZRA
Dr. DEEPALI AGRAWAL (1ST YEAR PG)
DEPARTMENT OF CONSERVATIVE DENTISTRY
AND ENDODONTICS
2
CONTENTS-
 INTRODUCTION
 DEFINITION
 FACTORS TO CONSIDER BEFORE TOOTH PREPARATION
 CLINICAL TECHNIQUE FOR CLASS I AMALGAM
a) CONSERVATIVE CLASS I
b) EXTENSIVE CLASS I
c) OCCLUSOLINGUAL CLASS I
d) OCCLUSOFACIAL CLASS I
 CLASS I COMPOSITE RESTORATION
 TOOTH PREPARATION:AMALGAM V/S COMPOSITE
 REFERENCES 3
INTRODUCTION-
 In the past, most restorative treatment was due to
Caries(decay).
 A breach in the surface integrity was referred to as
Cavity.
 Now many indications for treatment for teeth are
not due to caries, and the preparation of the tooth
no longer referred as Cavity preparation, but as
Tooth preparation.
4
 Tooth preparation is the mechanical alteration of a
defective, injured, or diseased tooth to receive a
restorative material that re-establishes a healthy
state for the tooth, including esthetic corrections
where indicated and normal form and function.
(By Sturdevant)
 Cavity preparation is the mechanical removal of
caries and shaping the remaining tooth tissue in
such a way so that after restoration it can withstand
masticatory forces and will be able to prevent
subsequent caries.
(By Vimal K Sikri)
5
CLASSIFICATIONS OF TOOTH
PREPARATION-
 According to Anatomic areas involved and by
associated type of treatment was presented by
Black.
 Designated as Class I, II, III, IV, V.
 Class VI – additional Classification.
6
7
DEFINITION-
 Class I Restoration-All pit and fissure
restorations are Class I, and they are assigned
to three groups.
 A)Restorations on Occlusal Surface of
Premolars and Molars.
 B)Restorations on Occlusal Two-Thirds of the
Facial and Lingual Surfaces of Molars.
 C)Restorations on lingual Surface of Maxillary
Incisors. 8
9
 Class I could be – a) Simple Occlusal Cavity
b) Compound Occlusal Cavity
-OcclusoBuccal
-Occluso Palatal/Lingual
c) Complex Occlusal Cavity
d) Buccal Pit
e) Anterior Palatal Pit
10
TOOTH PREPARATION WALLS:
f:facial; d:distal; l:lingual; m:mesial; p:pulpal
11
CLASS I LINE ANGLES AND POINT ANGLES
LINE ANGLES- fp:faciopulpal; df:distofacial; dp:distopulpal;
dl:distolingual; lp:linguopulpal; ml:mesiolingual: mp:mesiopulpal;
mf:mesiofacial.
POINT ANGLES- dfp:distofaciopulpal; dlp:distolinguopulpal;
mlp:mesiolinguopulpal; mfp:mesiofaciopulpal.
12
FACTORS TO CONSIDER BEFORE
TOOTH PREPARATION-
 Extent of caries
 Occlusion
 Pulpal Involvement
 Esthetics
 Patient’s Age
 Patient’s Home care
 Gingival Status
 Anesthesia
 Bone support
 Patient’s Desires
 Material Limitations
 Operator Skill
 Enamel rod direction
13
FACTORS TO CONSIDER BEFORE
TOOTH PREPARATION-
 Extent of old restorative material
 Extent of defect
 Pulpal protection
 Contours
 Economics
 Patient’s Risk status
 Bur design
 Radiographic assessment
 Patient cooperation
 Fracture Lines
 Tooth anatomy
 Ability to isolate area
14
CLASS I AMALGAM RESTORATION-
 Amalgam is used for the restoration of many
carious and fractured posterior teeth and in the
replacement of failed restoration.
 If properly placed it provides many years of service.
 Understanding the physical properties of amalgam
and the principles of tooth preparation.
15
TOOTH PREPARATION CLASS I
CONSERVATIVE CLASS I AMALGAM
RESTORATION
 It is recommended to protect the pulp.
 Preserve strength of the tooth.
 To reduce deterioration of the amalgam
restoration.
TOOTH
PREPARATION
INITIAL TOOTH
PREPARATION
FINAL TOOTH
PREPARATION
16
CLINICAL TECHNIQUE OF CLASS I
AMALGAM-
INITIAL CLINICAL PROCEDURES
 Isolation with Rubber dam-when removing deep caries
less than 1mm from the pulp.
 For single Maxillary tooth, caries is not extensive,
moisture control is achieved with cotton rolls and
profound anesthesia.
 Preoperative assessment of occlusal relationship of
involved and adjacent teeth.
17
INITIAL TOOTH PREPARATION
 It is defined as establishing the outline form by
extension of the external walls to sound tooth structure,
while maintaining a specified, limited depth and
providing resistance and retention forms.
 The Outline form for Class I should include only the
faulty, defective occlusal pits and fissures.
 Occasionally the marginal outline for Maxillary
premolars is Butterfly shaped.
18
IDEAL OUTLINE FORM
Ideal outline form incorporates the following resistance form
principles-
 Extending around the cusps to conserve tooth structure and
prevent the internal line angles from approaching the pulp
horns too closely.
 Keeping the facial and lingual margin extensions as minimal
as possible between the central groove and the cusp tips.
 Extending the outline to include fissures, placing the margins
on relatively smooth, sound structure.
 Minimally extending into the marginal ridges without removing
dentinal support.
19
IDEAL OUTLINE FORM
 Eliminating a weak wall of enamel by joining two
outlines that come close together i.e. <0.5mm
apart.
 Extending the outline form to include enamel
undermined by caries.
 Using enameloplasty on the terminal ends of
shallow fissures to conserve tooth structure.
 Establishing an optimal, conservative depth of the
pulpal wall.
20
21
ARMAMENTARIUM
1. BURS-
Nos 245 Bur
Nos 330 Bur
22
2. HAND INSTRUMENTS-
Excavators
Enamel Hatchets
Binangle Chisels
Curved Wedelstaedt Chisels
23
SEQUENCE OF PREPARATION
INITIAL TOOTH PREPARATION
Enter the deepest or most carious pit with a
punch cut using No. 245 carbide bur
As the bur enters the pit, the proper depth of
1.5mm should be established
Depth of external walls is 1.5 to 2mm;
Pulpal depth is 0.1 to 0.2mm into dentin 24
25
SEQUENCE OF PREPARATION
Incline bur distally to establish proper occlusal divergence
to distal wall
For Premolars, distance from the margin of extension to
the proximal surface should not be less than 1.6mm; For
Molars, the minimal distance is 2mm
While maintaining the bur’s orientation and depth, the
preparation is extended distofacially or distolingually 26
27
SEQUENCE OF PREPARATION
Maintain the bur’s orientation and depth and, with
intermittent pressure extend along the central fissure
towards the mesial pit, following DEJ
The pulpal floor should follow the DEJ,Maintain a uniform
flat pulpal floor depth
Ideally, the width of the isthmus should be just wider than
the diameter of the bur;
Minimal Faciolingual width and Minimal Occlusal
convergence are desired
28
SEQUENCE OF PREPARATION
Remainder of any occlusal enamel defects is included, facial
and lingual walls are extended if necessary
Conservative preparation should have an outline form with
gently flowing curves and distinct cavosurface margins
For Initial tooth preparation pulpal floor should remain at the
initilal ideal depth, even if restorative material or caries
remains,Remaining caries is removed in final tooth preparation29
30
PRIMARY RESISTANCE FORM
 Sufficient area of relatively flat pulpal floor in sound
tooth structure.
 Minimal extension of external walls.
 Strong, ideal enamel margins.
 Sufficient Depth(1.5mm)
PRIMARY RETENTION FORM
 Parallelism or slight occlusal convergence of two or
more opposing, external walls.
31
FINAL TOOTH PREPARATION
 Removal of remaining defective enamel and
infected dentin on the pulpal floor.
 Pulp protection, where indicated.
 Procedures for finishing external walls.
 Final procedures of cleaning and inspecting the
prepared tooth.
32
SEQUENCE OF PREPARATION
FINAL TOOTH PREPARATION
Enamel pit and fissure remnants in the pulpal floor should
be removed
If pit and fissure remnants are few and small, they can be
removed with a suitably sized, round carbide bur or spoon
excavators
When removing infected dentin, the excavation should
be stopped when tooth structure feels hard or firm;A
sharp explorer is more reliable than a rotating bur in
judging the adequacy of removal of infected dentin
33
34
 If the tooth preparation is of ideal or shallow
depth, no liner or base is indicated.
 In deeper carious excavations-remaining
dentin thickness is 0.5-1mm-Place a thin
layer(0.5-0.75mm) of a light cured RMGI Base.
 It should be placed only over the deepest
portion of the excavation.
 The entire dentin surface should not be
covered.
 Every completed tooth preparation should be
inspected and cleaned before restoration.
 Tooth preparation should be free of debris after
rinsing tooth with air-water syringe. 35
36
 An occlusal cavosurface bevel is contraindicated
in an amalgam cavity preparation.
 Provide an approximate 90-100 degree
cavosurface angle which should result in 80-90
degree amalgam at the margins.
 Amalgam is a brittle material with low edge strength
and tends to chip under occlusal stress.
37
TYPICAL CLASS I TOOTH PREPARATION ON
MAXILLARY PREMOLAR
38
OTHER CONSERVATIVE CLASS I
AMALGAM PREPARATIONS
 Facial pit of Mandibular molar
 Lingual pit of Maxillary lateral incisor
 Occlusal pits of Mandibular 1st Premolar
 Occlusal pits and fissures of Maxillary 1st Molar
 Occlusal pits and fissures of Mandar 2nd Premolar
39
VARIATIONS IN DESIGN FOR CLASS I
MAXILLARY 1ST MOLAR
40
VARIATIONS IN DESIGN FOR CLASS I
LOWER 1ST MOLAR
41
EXTENSIVE CLASS I AMALGAM
RESTORATIONS
 Caries is considered extensive if the distance
between infected dentin and the pulp is judged to
be less than 1mm or when the facilolingual extent
of the defect is up the cuspal inclines.
 Extensive caries requires a more extensive
restoration.
42
INITIAL CLINICAL PROCEDURES
Isolation of the operating site.
If caries excavation exposes the pulp,
pulp caping may be more often
successful if the site is isolated with a
properly applied rubber dam.
Preoperative occlusal assessment and
anesthetic administration-factors.
43
TOOTH PREPARATION-
INITIAL
Using a No. 245 bur at high speed and oriented with its
long axis parallel to the long axis of the tooth
crown,prepare the outline, primary resistance, and
primary retention form
An initial depth of 1.5-2mm should be maintained
The preparation is extended laterally to
remove all enamel undermined by caries by
alternatively cutting and examining the
lateral extension of the caries
44
TOOTH PREPARATION-
FINAL
Removal of remaining infected dentin
If pulp exposure occurs the operator must decide whether
to apply a direct pulp cap of calcium hydroxide or to treat
endodontically
For pulpal protection, a thin layer (0.5-0.75mm) of Calcium
hydroxide liner may be placed. 45
TOOTH PREPARATION-
FINAL
A thin base of RMGI should be used over Calcium hydroxide
Usually no Secondary resistance or retention features are
necessary
Primary resistance form-Extend the outline of the tooth
preparation to include only undermined and defective structure
Primary Retention-Occlusal convergence of enamel walls
46
CLASS I OCCLUSOLINGUAL AMALGAM
RESTORATIONS
 Occlusolingual amalgam restorations may be used
on maxillary molars when a lingual fissure connects
with the distal oblique fissure and distal pit on the
occlusal surface.
 Tooth preparation includes the following-
1) Tooth preparation should be no wider than
necessary.
2) Ideally mesiodistal width of the lingual extension
should not exceed 1mm except for extended caries
or undermined enamel.
3) When indicated, the tooth preparation should
be cut more at the expense of the oblique ridge
rather than centering over the fissure. 47
4) Especially on smaller teeth, the occlusal portion may have a
slight distal tilt to conserve the dentin support of the distal
marginal ridge.
5) The margins should extend as little as possible onto the
oblique ridge, distolingual cusp, and distal marginal ridge.
48
49
CLASS I OCCLUSOFACIAL AMALGAM
RESTORATIONS-
 Occasionally, mandibular molars
exhibit fisssures that extend from the
occlusal surface through the facial
cusp ridge and onto the facial surface.
50
51
CLASS I COMPOSITE RESTORATIONS
 In 1959, Skinner wrote, ‘The esthetic quality of a
restoration may be as important to the mental
health of the patient as the biological and technical
qualities of the restoration are to his physical or
dental health.’
 Composites are presently the most popular tooth-
colored materials, having completely replaced
silicate cement and acrylic resin.
 The ADA indicated the appropriateness of
composites for use as pit and fissure sealants,
preventive resin restorations, and Class I and II
restorations for initial and moderately sized lesions.
52
 ADA further stated, ‘ When used correctly in the
primary and permanent dentition, the expected lifetime
of resin-based composites can be comparable to that
of amalgam in Class I, Class II, and Class V
restorations’.
 Composite is a material that has sufficient strength for
Class I and II restorations.
 Because Composite is bonded to enamel and dentin,
tooth preparations for composite can be very
conservative.
53
CLINICAL INDICATIONS-
 Small and moderate restorations
 When esthetics is considered
 Restorations that does not provide all of the
occlusal contacts
 Restorations that does not have heavy
occlusal contacts
 Restorations that can be appropriately
isolated
 As foundations for crown
 For economic/interim use reasons
54
CONTRAINDICATIONS-
When the operating site cannot be
isolated
Heavy occlusal stresses are
present
All the occlusal contacts are on
composite only
Restorations that extend onto the
root surface 55
ADVANTAGES-
Esthetics
Conservative tooth structure
removal
Easier, less complex tooth
structure
Economics
Insulation
Bonding benefits
56
DISADVANTAGES-
1. Material related
2. Require more time to place
3. More technique sensitive
4. More expensive than amalgam
restorations
57
CLINICAL TECHNIQUE FOR DIRECT
CLASS I COMPOSITE RESTORATION
INITIAL CLINICAL PROCEDURES-
Anesthesia and shade selection
Assessment of the preoperative
relationship of the tooth to be
restored
Isolation of the operating area 58
TOOTH PREPARATION
 The three typical composite preparations-
Conventional, Beveled conventional and
Modified
 Beveled Conventional design rarely would
be used except for groove extensions.
 Conventional-When increased resistance
form is needed; for large preparations
 Modified- Typically uses more flared
cavosurface forms without uniform or flat
pulpal or axial walls. 59
ARMAMENTARIUM
Operator prefer Diamond
instrument.
Flat tipped bur or diamond
Inverted cone cutting instruments
with rounded corners
60
CONVENTIONAL CLASS I TOOTH
PREPRATION
 For large Class I, one enters the tooth in the distal
pit area of the faulty occlusal surface with inverted
cone diamond, positioned parallel to the long axis
of the crown.
 Pulpal floor-1.5mm initial depth
 Facial and Lingual measurement-1.75mm depth
 Initial depth- Approx. 0.2mm inside DEJ
 Facial and lingual extension and width are dictated
by caries, old restorative material, or fault
 Extensions into Marginal ridges should result in
approx. 1.6mm of thickness remaining tooth
structure for premolars and 2mm for molars 61
 The occlusal margin does not have a beveled or
flared form, it is left as prepared
 The inverted cone instrument results in occlusal
walls that converge oclusally, enhancing retention
form.
 The marginal form of a groove extension on the
faical or lingual surface may be beveled with a
diamond, resulting in a 0.25-0.5mm width bevel at a
45 degree angle to the prepared wall.
 A large Class I composite tooth preparation-
Conventional design.
 If facial or lingual groove included- Combination of
Conventional and beveled conventional.
62
MODFIED CLASS I TOOTH PREPARATION-
 Minimally involved Class I lesions or faults may be
restored with composite using modified tooth
preparations.
 Less specific in form, having a scooped out
appearance.
 Prepared with a small round or inverted cone
diamond or bur.
 Initial pulp depth is still 1.5mm or approx 0.2mm
inside DEJ, but may not be uniform.
 Entire bevel or flare becomes part of the final tooth
preparation.
63
CONCLUSION-
TOOTH PREPARATION: AMALGAM VS COMPOSITE
FEATURES AMALGAM COMPOSITE
OUTLINE FORM Include fault
May extend to break
proximal contact
Include adjacent
suspicious area
Same
Same
No
PULPAL DEPTH Uniform 1.5mm Remove fault; not
usually uniform
AXIAL DEPTH Uniform 0.2-0.5mm
inside DEJ
Remove fault; not
usually uniform
CAVOSURFACE MARGIN Create 90-degree
amalgam margin
> Equal to 90
degrees
64
FEATURES AMALGAM COMPOSITE
BEVELS None(Except Gingival) Large
preparation,
esthetics, and
seal
TEXTURE OF PREPARED
WALLS
Smoother Rough
CUTTING INSTRUMENT Burs Burs or
Diamonds
PRIMARY RETENTION
FORM
Convergence
Occlusally
None
SECONDARY RETENTION
FORM
Grooves, slots, locks,
pins
Bonding; grooves
for very large or
root surface
preparation
RESISTANCE FORM Flat floors, rounded
angles, box-shaped
Same for large
preparations
65
FEATURES AMALGAM COMPOSITE
BASE INDICATIONS Provide 2mm
between pulp and
amalgam
Not needed
LINER INDICATIONS Ca(OH)2 over direct
or indirect pulp caps
Same
SEALER GLUMA desensitizer
when not bonding
Sealed by bonding
system used
66
REFERENCES-
Sturdevant's Art and Science of
Operative Dentistry, 5th edition
2006.
Textbook Of Operative Dentistry,
By Vimal K Sikri
67
68

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Class i cavity preparation

  • 1. 1
  • 2. CLASS I CAVITY PREPARATION GUIDED BY- DONE BY- Dr. SANDEEP METGUD Dr. RAMSUNDAR HAZRA Dr. DEEPALI AGRAWAL (1ST YEAR PG) DEPARTMENT OF CONSERVATIVE DENTISTRY AND ENDODONTICS 2
  • 3. CONTENTS-  INTRODUCTION  DEFINITION  FACTORS TO CONSIDER BEFORE TOOTH PREPARATION  CLINICAL TECHNIQUE FOR CLASS I AMALGAM a) CONSERVATIVE CLASS I b) EXTENSIVE CLASS I c) OCCLUSOLINGUAL CLASS I d) OCCLUSOFACIAL CLASS I  CLASS I COMPOSITE RESTORATION  TOOTH PREPARATION:AMALGAM V/S COMPOSITE  REFERENCES 3
  • 4. INTRODUCTION-  In the past, most restorative treatment was due to Caries(decay).  A breach in the surface integrity was referred to as Cavity.  Now many indications for treatment for teeth are not due to caries, and the preparation of the tooth no longer referred as Cavity preparation, but as Tooth preparation. 4
  • 5.  Tooth preparation is the mechanical alteration of a defective, injured, or diseased tooth to receive a restorative material that re-establishes a healthy state for the tooth, including esthetic corrections where indicated and normal form and function. (By Sturdevant)  Cavity preparation is the mechanical removal of caries and shaping the remaining tooth tissue in such a way so that after restoration it can withstand masticatory forces and will be able to prevent subsequent caries. (By Vimal K Sikri) 5
  • 6. CLASSIFICATIONS OF TOOTH PREPARATION-  According to Anatomic areas involved and by associated type of treatment was presented by Black.  Designated as Class I, II, III, IV, V.  Class VI – additional Classification. 6
  • 7. 7
  • 8. DEFINITION-  Class I Restoration-All pit and fissure restorations are Class I, and they are assigned to three groups.  A)Restorations on Occlusal Surface of Premolars and Molars.  B)Restorations on Occlusal Two-Thirds of the Facial and Lingual Surfaces of Molars.  C)Restorations on lingual Surface of Maxillary Incisors. 8
  • 9. 9
  • 10.  Class I could be – a) Simple Occlusal Cavity b) Compound Occlusal Cavity -OcclusoBuccal -Occluso Palatal/Lingual c) Complex Occlusal Cavity d) Buccal Pit e) Anterior Palatal Pit 10
  • 11. TOOTH PREPARATION WALLS: f:facial; d:distal; l:lingual; m:mesial; p:pulpal 11
  • 12. CLASS I LINE ANGLES AND POINT ANGLES LINE ANGLES- fp:faciopulpal; df:distofacial; dp:distopulpal; dl:distolingual; lp:linguopulpal; ml:mesiolingual: mp:mesiopulpal; mf:mesiofacial. POINT ANGLES- dfp:distofaciopulpal; dlp:distolinguopulpal; mlp:mesiolinguopulpal; mfp:mesiofaciopulpal. 12
  • 13. FACTORS TO CONSIDER BEFORE TOOTH PREPARATION-  Extent of caries  Occlusion  Pulpal Involvement  Esthetics  Patient’s Age  Patient’s Home care  Gingival Status  Anesthesia  Bone support  Patient’s Desires  Material Limitations  Operator Skill  Enamel rod direction 13
  • 14. FACTORS TO CONSIDER BEFORE TOOTH PREPARATION-  Extent of old restorative material  Extent of defect  Pulpal protection  Contours  Economics  Patient’s Risk status  Bur design  Radiographic assessment  Patient cooperation  Fracture Lines  Tooth anatomy  Ability to isolate area 14
  • 15. CLASS I AMALGAM RESTORATION-  Amalgam is used for the restoration of many carious and fractured posterior teeth and in the replacement of failed restoration.  If properly placed it provides many years of service.  Understanding the physical properties of amalgam and the principles of tooth preparation. 15
  • 16. TOOTH PREPARATION CLASS I CONSERVATIVE CLASS I AMALGAM RESTORATION  It is recommended to protect the pulp.  Preserve strength of the tooth.  To reduce deterioration of the amalgam restoration. TOOTH PREPARATION INITIAL TOOTH PREPARATION FINAL TOOTH PREPARATION 16
  • 17. CLINICAL TECHNIQUE OF CLASS I AMALGAM- INITIAL CLINICAL PROCEDURES  Isolation with Rubber dam-when removing deep caries less than 1mm from the pulp.  For single Maxillary tooth, caries is not extensive, moisture control is achieved with cotton rolls and profound anesthesia.  Preoperative assessment of occlusal relationship of involved and adjacent teeth. 17
  • 18. INITIAL TOOTH PREPARATION  It is defined as establishing the outline form by extension of the external walls to sound tooth structure, while maintaining a specified, limited depth and providing resistance and retention forms.  The Outline form for Class I should include only the faulty, defective occlusal pits and fissures.  Occasionally the marginal outline for Maxillary premolars is Butterfly shaped. 18
  • 19. IDEAL OUTLINE FORM Ideal outline form incorporates the following resistance form principles-  Extending around the cusps to conserve tooth structure and prevent the internal line angles from approaching the pulp horns too closely.  Keeping the facial and lingual margin extensions as minimal as possible between the central groove and the cusp tips.  Extending the outline to include fissures, placing the margins on relatively smooth, sound structure.  Minimally extending into the marginal ridges without removing dentinal support. 19
  • 20. IDEAL OUTLINE FORM  Eliminating a weak wall of enamel by joining two outlines that come close together i.e. <0.5mm apart.  Extending the outline form to include enamel undermined by caries.  Using enameloplasty on the terminal ends of shallow fissures to conserve tooth structure.  Establishing an optimal, conservative depth of the pulpal wall. 20
  • 21. 21
  • 22. ARMAMENTARIUM 1. BURS- Nos 245 Bur Nos 330 Bur 22
  • 23. 2. HAND INSTRUMENTS- Excavators Enamel Hatchets Binangle Chisels Curved Wedelstaedt Chisels 23
  • 24. SEQUENCE OF PREPARATION INITIAL TOOTH PREPARATION Enter the deepest or most carious pit with a punch cut using No. 245 carbide bur As the bur enters the pit, the proper depth of 1.5mm should be established Depth of external walls is 1.5 to 2mm; Pulpal depth is 0.1 to 0.2mm into dentin 24
  • 25. 25
  • 26. SEQUENCE OF PREPARATION Incline bur distally to establish proper occlusal divergence to distal wall For Premolars, distance from the margin of extension to the proximal surface should not be less than 1.6mm; For Molars, the minimal distance is 2mm While maintaining the bur’s orientation and depth, the preparation is extended distofacially or distolingually 26
  • 27. 27
  • 28. SEQUENCE OF PREPARATION Maintain the bur’s orientation and depth and, with intermittent pressure extend along the central fissure towards the mesial pit, following DEJ The pulpal floor should follow the DEJ,Maintain a uniform flat pulpal floor depth Ideally, the width of the isthmus should be just wider than the diameter of the bur; Minimal Faciolingual width and Minimal Occlusal convergence are desired 28
  • 29. SEQUENCE OF PREPARATION Remainder of any occlusal enamel defects is included, facial and lingual walls are extended if necessary Conservative preparation should have an outline form with gently flowing curves and distinct cavosurface margins For Initial tooth preparation pulpal floor should remain at the initilal ideal depth, even if restorative material or caries remains,Remaining caries is removed in final tooth preparation29
  • 30. 30
  • 31. PRIMARY RESISTANCE FORM  Sufficient area of relatively flat pulpal floor in sound tooth structure.  Minimal extension of external walls.  Strong, ideal enamel margins.  Sufficient Depth(1.5mm) PRIMARY RETENTION FORM  Parallelism or slight occlusal convergence of two or more opposing, external walls. 31
  • 32. FINAL TOOTH PREPARATION  Removal of remaining defective enamel and infected dentin on the pulpal floor.  Pulp protection, where indicated.  Procedures for finishing external walls.  Final procedures of cleaning and inspecting the prepared tooth. 32
  • 33. SEQUENCE OF PREPARATION FINAL TOOTH PREPARATION Enamel pit and fissure remnants in the pulpal floor should be removed If pit and fissure remnants are few and small, they can be removed with a suitably sized, round carbide bur or spoon excavators When removing infected dentin, the excavation should be stopped when tooth structure feels hard or firm;A sharp explorer is more reliable than a rotating bur in judging the adequacy of removal of infected dentin 33
  • 34. 34
  • 35.  If the tooth preparation is of ideal or shallow depth, no liner or base is indicated.  In deeper carious excavations-remaining dentin thickness is 0.5-1mm-Place a thin layer(0.5-0.75mm) of a light cured RMGI Base.  It should be placed only over the deepest portion of the excavation.  The entire dentin surface should not be covered.  Every completed tooth preparation should be inspected and cleaned before restoration.  Tooth preparation should be free of debris after rinsing tooth with air-water syringe. 35
  • 36. 36
  • 37.  An occlusal cavosurface bevel is contraindicated in an amalgam cavity preparation.  Provide an approximate 90-100 degree cavosurface angle which should result in 80-90 degree amalgam at the margins.  Amalgam is a brittle material with low edge strength and tends to chip under occlusal stress. 37
  • 38. TYPICAL CLASS I TOOTH PREPARATION ON MAXILLARY PREMOLAR 38
  • 39. OTHER CONSERVATIVE CLASS I AMALGAM PREPARATIONS  Facial pit of Mandibular molar  Lingual pit of Maxillary lateral incisor  Occlusal pits of Mandibular 1st Premolar  Occlusal pits and fissures of Maxillary 1st Molar  Occlusal pits and fissures of Mandar 2nd Premolar 39
  • 40. VARIATIONS IN DESIGN FOR CLASS I MAXILLARY 1ST MOLAR 40
  • 41. VARIATIONS IN DESIGN FOR CLASS I LOWER 1ST MOLAR 41
  • 42. EXTENSIVE CLASS I AMALGAM RESTORATIONS  Caries is considered extensive if the distance between infected dentin and the pulp is judged to be less than 1mm or when the facilolingual extent of the defect is up the cuspal inclines.  Extensive caries requires a more extensive restoration. 42
  • 43. INITIAL CLINICAL PROCEDURES Isolation of the operating site. If caries excavation exposes the pulp, pulp caping may be more often successful if the site is isolated with a properly applied rubber dam. Preoperative occlusal assessment and anesthetic administration-factors. 43
  • 44. TOOTH PREPARATION- INITIAL Using a No. 245 bur at high speed and oriented with its long axis parallel to the long axis of the tooth crown,prepare the outline, primary resistance, and primary retention form An initial depth of 1.5-2mm should be maintained The preparation is extended laterally to remove all enamel undermined by caries by alternatively cutting and examining the lateral extension of the caries 44
  • 45. TOOTH PREPARATION- FINAL Removal of remaining infected dentin If pulp exposure occurs the operator must decide whether to apply a direct pulp cap of calcium hydroxide or to treat endodontically For pulpal protection, a thin layer (0.5-0.75mm) of Calcium hydroxide liner may be placed. 45
  • 46. TOOTH PREPARATION- FINAL A thin base of RMGI should be used over Calcium hydroxide Usually no Secondary resistance or retention features are necessary Primary resistance form-Extend the outline of the tooth preparation to include only undermined and defective structure Primary Retention-Occlusal convergence of enamel walls 46
  • 47. CLASS I OCCLUSOLINGUAL AMALGAM RESTORATIONS  Occlusolingual amalgam restorations may be used on maxillary molars when a lingual fissure connects with the distal oblique fissure and distal pit on the occlusal surface.  Tooth preparation includes the following- 1) Tooth preparation should be no wider than necessary. 2) Ideally mesiodistal width of the lingual extension should not exceed 1mm except for extended caries or undermined enamel. 3) When indicated, the tooth preparation should be cut more at the expense of the oblique ridge rather than centering over the fissure. 47
  • 48. 4) Especially on smaller teeth, the occlusal portion may have a slight distal tilt to conserve the dentin support of the distal marginal ridge. 5) The margins should extend as little as possible onto the oblique ridge, distolingual cusp, and distal marginal ridge. 48
  • 49. 49
  • 50. CLASS I OCCLUSOFACIAL AMALGAM RESTORATIONS-  Occasionally, mandibular molars exhibit fisssures that extend from the occlusal surface through the facial cusp ridge and onto the facial surface. 50
  • 51. 51
  • 52. CLASS I COMPOSITE RESTORATIONS  In 1959, Skinner wrote, ‘The esthetic quality of a restoration may be as important to the mental health of the patient as the biological and technical qualities of the restoration are to his physical or dental health.’  Composites are presently the most popular tooth- colored materials, having completely replaced silicate cement and acrylic resin.  The ADA indicated the appropriateness of composites for use as pit and fissure sealants, preventive resin restorations, and Class I and II restorations for initial and moderately sized lesions. 52
  • 53.  ADA further stated, ‘ When used correctly in the primary and permanent dentition, the expected lifetime of resin-based composites can be comparable to that of amalgam in Class I, Class II, and Class V restorations’.  Composite is a material that has sufficient strength for Class I and II restorations.  Because Composite is bonded to enamel and dentin, tooth preparations for composite can be very conservative. 53
  • 54. CLINICAL INDICATIONS-  Small and moderate restorations  When esthetics is considered  Restorations that does not provide all of the occlusal contacts  Restorations that does not have heavy occlusal contacts  Restorations that can be appropriately isolated  As foundations for crown  For economic/interim use reasons 54
  • 55. CONTRAINDICATIONS- When the operating site cannot be isolated Heavy occlusal stresses are present All the occlusal contacts are on composite only Restorations that extend onto the root surface 55
  • 56. ADVANTAGES- Esthetics Conservative tooth structure removal Easier, less complex tooth structure Economics Insulation Bonding benefits 56
  • 57. DISADVANTAGES- 1. Material related 2. Require more time to place 3. More technique sensitive 4. More expensive than amalgam restorations 57
  • 58. CLINICAL TECHNIQUE FOR DIRECT CLASS I COMPOSITE RESTORATION INITIAL CLINICAL PROCEDURES- Anesthesia and shade selection Assessment of the preoperative relationship of the tooth to be restored Isolation of the operating area 58
  • 59. TOOTH PREPARATION  The three typical composite preparations- Conventional, Beveled conventional and Modified  Beveled Conventional design rarely would be used except for groove extensions.  Conventional-When increased resistance form is needed; for large preparations  Modified- Typically uses more flared cavosurface forms without uniform or flat pulpal or axial walls. 59
  • 60. ARMAMENTARIUM Operator prefer Diamond instrument. Flat tipped bur or diamond Inverted cone cutting instruments with rounded corners 60
  • 61. CONVENTIONAL CLASS I TOOTH PREPRATION  For large Class I, one enters the tooth in the distal pit area of the faulty occlusal surface with inverted cone diamond, positioned parallel to the long axis of the crown.  Pulpal floor-1.5mm initial depth  Facial and Lingual measurement-1.75mm depth  Initial depth- Approx. 0.2mm inside DEJ  Facial and lingual extension and width are dictated by caries, old restorative material, or fault  Extensions into Marginal ridges should result in approx. 1.6mm of thickness remaining tooth structure for premolars and 2mm for molars 61
  • 62.  The occlusal margin does not have a beveled or flared form, it is left as prepared  The inverted cone instrument results in occlusal walls that converge oclusally, enhancing retention form.  The marginal form of a groove extension on the faical or lingual surface may be beveled with a diamond, resulting in a 0.25-0.5mm width bevel at a 45 degree angle to the prepared wall.  A large Class I composite tooth preparation- Conventional design.  If facial or lingual groove included- Combination of Conventional and beveled conventional. 62
  • 63. MODFIED CLASS I TOOTH PREPARATION-  Minimally involved Class I lesions or faults may be restored with composite using modified tooth preparations.  Less specific in form, having a scooped out appearance.  Prepared with a small round or inverted cone diamond or bur.  Initial pulp depth is still 1.5mm or approx 0.2mm inside DEJ, but may not be uniform.  Entire bevel or flare becomes part of the final tooth preparation. 63
  • 64. CONCLUSION- TOOTH PREPARATION: AMALGAM VS COMPOSITE FEATURES AMALGAM COMPOSITE OUTLINE FORM Include fault May extend to break proximal contact Include adjacent suspicious area Same Same No PULPAL DEPTH Uniform 1.5mm Remove fault; not usually uniform AXIAL DEPTH Uniform 0.2-0.5mm inside DEJ Remove fault; not usually uniform CAVOSURFACE MARGIN Create 90-degree amalgam margin > Equal to 90 degrees 64
  • 65. FEATURES AMALGAM COMPOSITE BEVELS None(Except Gingival) Large preparation, esthetics, and seal TEXTURE OF PREPARED WALLS Smoother Rough CUTTING INSTRUMENT Burs Burs or Diamonds PRIMARY RETENTION FORM Convergence Occlusally None SECONDARY RETENTION FORM Grooves, slots, locks, pins Bonding; grooves for very large or root surface preparation RESISTANCE FORM Flat floors, rounded angles, box-shaped Same for large preparations 65
  • 66. FEATURES AMALGAM COMPOSITE BASE INDICATIONS Provide 2mm between pulp and amalgam Not needed LINER INDICATIONS Ca(OH)2 over direct or indirect pulp caps Same SEALER GLUMA desensitizer when not bonding Sealed by bonding system used 66
  • 67. REFERENCES- Sturdevant's Art and Science of Operative Dentistry, 5th edition 2006. Textbook Of Operative Dentistry, By Vimal K Sikri 67
  • 68. 68