Principles of Cavity Preparation

Last lecture we stopped at burs , now we will continue : Burs are composed of three parts : 1) shank : which is fixed on the hand piece. 2) Neck : that connects the head to the shank and transmit the force to the head. 3) Head : the working part of the bur. When we put the bur in the hand piece the force come from the hand piece to the shank then from the shank to the head by the neck.

Burs can be classified according to two things : 1) Head of bur : As we call them in the lab , we have fissure bur, round bur, pear shaped. 2) Number : unfortunately we dont use the number. The number of Pear . shaped bur is 330 We have a lot of burs but at this picture we just have the basic burs that we use in the clinic and its important to know them, and to know that most of them are made from Tungsten carbide.

We have : Round : we have high-speed and slow-speed ( its head is round ) 2) Inverted cone : also we have high-speed and slow-speed. (the tip is larger than the base so we call it inverted ) 3) Pear shaped : because it looks like the pear. 4) Straight fissure : because its straight from both sides. 5) Tapered fissure : the base is broad and the apex is tapered.
1)

Recommended burs

From left to the right : first four are round but they are differ from each other by the size of the head ( , , 2 , 4 , 6, 8 ) . Number 5 is inverted, number 6 is tapered, number 7 is straight , number 8 is tapered, the last is straight. *** Dont care about the number we just need the shape. Finishing burs : They are tungsten carbide also , but we call them finishing burs , we use them to finish restoration ( composite , amalgam) , they come in several size and shaped , we have : 1) 2) 3) Round Torpedo Tapered

They come in mini/small size and have more blades than normal so cutting efficiency is more and we use them in finishing and polishing. Instrument grasps -Its very important because you will take the grasp like a habit so you must learn the correct grasp . -The more efficient grasp is the pen grasp ( we use it as the pen and we use the rest of our fingers to rest so we will have more support and we can control the hand pieces better and we will not harm the patients oral cavity) . -We have the palm and thumb grasp but its less supportive. So please any instrument in the lab use the pen grasp.

Now we are going to start the new lecture . Principles of cavity preparation 12-

Objective of tooth preparation Factors affecting your tooth preparation

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Stages and steps of tooth preparation

Stages and steps of tooth preparation The doctor now doesnt follow them because she has the experience but for us we have to follow them to learn. For example in the lab we drill all fissures in tooth preparation but in the clinic we just include the fissures that contain the caries only so we will be more conservative, but here we learn the ideal cavity preparation. Definition of tooth preparation : The mechanical alteration of defective, injured, or diseased tooth to best receive a restorative material that will reestablish a healthy state for the tooth, including esthetic corrections where indicated, along with normal form and function. Why we do the cavity preparation ?? To remove the defect from the tooth whether this defect is caries, trauma, or congenital defect of the tooth , so we want to remove this defect, and put it in a form or a shape that will receive the restorative materials ( like what we do in amalgam, we prepare the tooth with depth = 1.5mm if the depth is less the amalgam will fracture) so we are prepare a certain shape to receive the restorative material to return the tooth to its normal shape and function ( like making fissures, grooves, slope of the cusps, line of cusps.. ) and esthetic ( when we use composite its not just for function but also for esthetic)

The objective :
1Remove all defects & provide necessary protection to the pulp. 2Extend the restoration as conservatively as possible ( because once you remove the tooth structure you remove it from the residual of the tooth and you will in more danger when you are close to the pulp). 3Form the tooth preparation so that under masticatory forces the tooth or restoration will not fracture or the restoration will not

be displaced.( when we form tooth preparation we have two forms: resistance form and retention form ) ***Resistance form : to resist fracture of bone, tooth and restoration. ***Retention form : to avoid removal of the restoration from the tooth. 4Allow for functional & esthetic placement of restorative material. Factors affecting tooth preparation : Diagnosis : I will not hold the burs and start drilling the tooth without knowing the cause of the problem or knowing the proper diagnosis of the tooth in the patients mouth in the patient so we are treating the patient. The reason for placing the restoration in the tooth : why we will do this cavity ? I want just to return the function ? or I care about the esthetic only ? to protect the pulp ?? you need to know the answers for these questions before doing the cavity! Periodontal & pulpal status : its very important ( for example if the tooth has a class 1 caries and needs cavity preparation and restoration but at the same time this tooth is hopeless for example it is moving because there is a periodontal disease and its suppose that it will not last more than 2 months in the patients mouth, so we need to make RCT after the restoration , we will drill the restoration again then make RCT. so we need to know the status of the tooth before doing the cavity. Esthetic factor: it depends on the patient. Relationship with other treatment plans. The risk potential of the patient for other dental caries : some patients we considered them as high risk of caries so we place any restoration that could release fluoride like modified glass ionomer cement.
1) 2)

Knowledge of Dental Anatomy:

When you prepare the cavity we need to know the dental anatomy ( enamel , dentin , pulp) , we need to know that the thickness of enamel in the occlusal part is thicker than in the cervical part, so when we are drilling 1.5mm in the occlusal surface maybe we are not in the dentin but in the

cervical part we are sure that we are in the dentin and close to the pulp. Also when we prepare a tooth we will consider a young patient differs from an old patient why?? Because with age we will have Recession for the pulp ( decreasing in the size of the pulp) because we are having secondary dentin, tertiary dentine so you are having more tooth structure to work with in old patient because of the thickness of dentin and the height of the pulp will be changed.

Gross picture of the tooth both internally and externally must be visualized. The thickness of enamel, dentin and position of the pulp. Relation to other supporting tissues ( when we prepare tooth near the supporting tissue like deep class 2 or deep class 5 ) .

3)

Patient Factors: The patient knowledge & appreciation for good dental health. ( if the patient has more knowledge about oral hygiene so we will think about using a good restorative material which could be expensive, but if the patient doesnt brush his teeth or doesnt know about the oral hygiene we will use a less expensive material) . Patients economic status : you shouldnt make any treatment or restoration before asking the patient and telling him how much it will cost.

The patient age: related to the anatomy and to the life expectancy, for example if the patient is very old and has a lot of health disease so we put a good restoration but not very expensive and could be for a short time ( for example if I have a patient (70 years old) and has many medical problems and needs MOD restoration so Ill not make a crown for him or use amalgam, I just use GIC because its less expensive and can be useful for him and will not take a long time to use it ). 4) Conservation of Tooth Structure: We want to make the cavity in a form that is proper for the material but we should be conservative.

Preservation of the vitality of the tooth by avoiding the application of poor or careless operative procedures on the tooth . Restorations should be made as small as possible : ( should be convenient and restorative ; I mean as small as possible and in the form of retention and restoration) Small tooth preparations result in restorations that has little effect on both inter-arch & intra-arch relationships as well as esthetics. : when we make a restoration as small as possible it affects the adjacent teeth(adjacent teeth :intra-arch relationship ), the opposing teeth(apposing teeth : inter-arch relationship) and on the esthetic. when we drill the occlusal surface we remove the fissures and grooves, so it has a little effect than if we replace a cusp; because as much as we do we will not return it to the normal shape of the tooth . we try to do that but we cant do it 100% . In intra-arch when we do class 2 cavity then it will affect the adjacent tooth , if it is small the effect will be less but if its big the interference will be large. So when you make a restoration make it small as possible as you can to make the interference less .

5) Restorative Material Factors: Mainly we are talking about direct restorative materials. Amalgam Vs resin composite. To some extend glass ionomer cement. ( demands for cavity preparation for amalgam will differ from the composite because the amalgam has a mechanical retention but the composite has a micromechanical

retention ( can adhere to the tooth) so the criteria for preparing the cavity will differ) The ability to isolate the operating field. The extension of the problem (i.e. caries).

Stages and Steps of Tooth Preparation

Stages and steps of tooth preparation

Initial Stage Outline form & initial depth. Primary resistance form. Primary retention form. Convenience form.

final Stage
5. Removal of any remaining infected dentin. 6. Pulp protection if indicated 7. Secondary resistance & retention forms. 8. Procedures for finishing external walls . 9. Final procedures: cleaning, inspecting & sealing.

You have to follow these stages because you are still a student so when you are doing the cavity you need to visualize these steps.

a)Initial Tooth Preparation Stage:

1. Outline form & initial depth: Each cavity has its own out line form Placing the preparation margins in the positions they will occupy in the final preparation : Im drawing the outline and he borders ( where Im going to stop) Preparing an initial depth of 0.2 to 0.8 mm pulpally of the DEJ position : I dont go to the full depth at the beginning, I should go to the initial depth and this initial depth is different when Im doing class 1 or class 5 because the thickness of enamel is different, so in class 1 most of my cavity preparation will be in the enamel but in class 5 it will be in dentin.

Why 0.2 to 0.8 ??

0.2mm inside DEJ when Im going to make class1 occlusaly, 0.8mm in class 5, thats mean Ill be in dentin in class 5 for 0.8mm but in class1 Ill be slightly in the dentine just for 0.2mm. ( look at the picture below)

3 principles to put the initial depth and the outline : 1. All weakened enamel should be removed.( because this enamel maybe break in the future ) 2. All faults should be included.( all grooves and fissure ) 3. All margins should be placed in position to afford good finishing of the margins of the restoration ( Ill not leave the border of my cavity at a fissure but at smooth surface so the finishing will be easier)

The end
Done by : Haneen Zuhdi Al-kwamleh Thx a lot Walaa Khdour for the help

Walaa and Eman : Best friends are like diamonds, precious and rare.