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Operative Dentistry
2Naghman Zuberi
Definition of Operative Dentistry Operative dentistry is
the ART and SCIENCE of the
diagnosis, treatment, prognosis of defects of teeth which do not require full coverage restorations for correction.
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Indication of Operative Dentistry Caries; Malformed, discolored,
or fractured teeth; Restoration replacement.
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Program of Operative Treatment Patient assessment Examination and diagnosis Treatment planning Pain control: local anesthetic Isolation of the operating field
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Cavity preparation Matrix application Preparation of materials Insertion and carving of materials Finishing and Polishing
Program of Operative Treatment
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Cavity Preparation
The mechanical alteration of a defective, injured, or diseased tooth in order to best receive a restorative material which will re-establish a healthy state for the tooth including esthetic corrections where indicated, along with normal form and function.
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Cavity Structure
walls angles cavity
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Classification of cavity
Class I Class II Class III Class IV Class V Class VI
—G.V.Black in 1908
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Cavity
Simple cavity: only one tooth surface is involved.
Compound cavity: two surfaces are involved.
Complex cavity: three or more surfaces are involved.
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Let us Classify The Cavities
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Class 1
Class 2
Class 1
Class 2
Class 3
Class 4
Class 5
Class 6
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Stages and Steps in Cavity Preparation
Initial cavity preparation stage
Final cavity preparation stage
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Initial cavity preparation stage
Step 1 Outline form and initial depth
Step 2 Primary resistance form
Step 3 Primary retention form
Step 4 Convenience form
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Final cavity preparation stage
Step 5 Removal of any remaining infected
dentin if indicated
Step 6 Pulp protection
Step 7 Secondary resistance & retention form
Step 8 Procedure for finishing external walls
Step 9 Final procedures
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Initial cavity preparation stage
Step 1 Outline form and initial depth
Step 2 Primary resistance form
Step 3 Primary retention form
Step 4 Convenience form
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Outline Form and Initial Depth Ⅰ
Definition: placing the cavity margins in the positions they will occupy in the final preparation;
preparing an initial depth of 0.2~0.8 mm pulpally of the dentinoenamel junction position or normal root surface position.
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Maxillary Class Ⅰ outline form
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Mandibular Class Ⅰ outline form
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Maxillary Class Ⅱ outline form
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Mandibular Class Ⅱ outline form
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Common Error
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Outline Form and Initial Depth Ⅱ
Principles: without any exception all friable and/or weakened enamel should be removed
all faults should be included
all margins should be placed in a position to afford good finishing of
the margins of the restoration.
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Outline Form and Initial Depth Ⅲ
Features: preserving cuspal strength
preserving marginal ridge strength
minimizing facio-lingual extension
using enameloplasty
connecting two close faults or cavities
restricting the depth of the preparation into dentin.
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Initial cavity preparation stage
Step 1 Outline form and initial depth
Step 2 Primary resistance form
Step 3 Primary retention form
Step 4 Convenience form
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Primary Resistance Form Ⅰ
Definition: The shape and placement of the cavity
walls that best enable both the restoration and the tooth to withstand, without fracture, masticatory forces delivered principally in the long axis of the the tooth.
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Primary Resistance Form Ⅱ
Principles: To utilize the box shape with a relatively flat floor to resist occlusal loading by virtue of being at right angles to mastication force;
To restrict the extension of the external walls (keep as small as possible) to allow strong cusp and ridge areas to remain with sufficient dentin support;
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Primary Resistance Form Ⅲ
Principles:To have a slight rounding of internal line angles to reduce stress concentration in tooth structure;
To provide enough thickness of restorative material to prevent its fracture under load.
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Primary Resistance Form Ⅳ
Feature: Box shape
Relatively flat floors
Inclusion of weakened tooth structure
Preservation of cusps and marginal ridges
Rounded internal line angles
Adequate thickness of restorative materials
Reduction of cusps for capping if indicated
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Initial cavity preparation stage
Step 1 Outline form and initial depth
Step 2 Primary resistance form
Step 3 Primary retention form
Step 4 Convenience form
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Primary Retention Form Ⅰ
Definition: The shape or form of the prepared
cavity that resists displacement or removal of the restoration from tipping or lifting forces.
In many respects retention and resistance form are accomplished in the same cutting procedure.
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Primary Retention Form Ⅱ
Principles: depending on the materials Amalgam restoration:
developing external cavity walls that converge occlusally and dovetail design
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The devotail design provide retention form to the occlusal portion of the cavity.
The occlusal convergence of the walls offers retention in the proximal portion of the cavity against displacement occlusally.
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Primary Retention Form Ⅲ
Principles: depending on the materialsComposite restoration:
a mechanical bond between the material
and conditioned, prepared tooth structure.
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Initial cavity preparation stage
Step 1 Outline form and initial depth
Step 2 Primary resistance form
Step 3 Primary retention form
Step 4 Convenience form
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Convenience Form Ⅰ
Conception: The shape or form of the cavity that
provides for adequate observation, accessibility, and ease of operation in preparing and restoring the cavity.
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Convenience Form Ⅱ
Principles:
Allow access for caries removal Allow access for restoration placement Allow access to margins for finishing,
evaluation and cleaning
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Convenience Form
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Final cavity preparation stage
Step 5 Removal of any remaining infected
dentin if indicated
Step 6 Pulp protection
Step 7 Secondary resistance & retention form
Step 8 Procedure for finishing external walls
Step 9 Final procedures
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Removal of any remaining infected dentin if indicated
Definition: The elimination of any infected
carious tooth structure or faulty restorative material left in the tooth after initial cavity preparation.
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Removal of dentinal caries using round burs and spoon excavators
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Final cavity preparation stage
Step 5 Removal of any remaining infected
dentin if indicated
Step 6 Pulp protection
Step 7 Secondary resistance & retention form
Step 8 Procedure for finishing external walls
Step 9 Final procedures
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Pulp protection
Using liners or bases
to protect the pulp or
to aid pulpal recovery or both.
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Final cavity preparation stage
Step 5 Removal of any remaining infected
dentin if indicated
Step 6 Pulp protection
Step 7 Secondary resistance & retention form
Step 8 Procedure for finishing external walls
Step 9 Final procedures
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Secondary resistance and retention forms Ⅰ
Most compound and complex cavity preparations require additional resistance and retention form.
The exception being those preparations that are very conservative.
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Secondary resistance and retention forms Ⅱ
Mechanical forms
Cavity wall conditioning form
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Mechnical form:
Proximal locks Proximal slots
58Naghman ZuberiProximal locks
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Slot on gingival wall
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Final cavity preparation stage
Step 5 Removal of any remaining infected
dentin if indicated
Step 6 Pulp protection
Step 7 Secondary resistance & retention form
Step 8 Finishing external walls
Step 9 Final procedures
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Finishing the external walls Ⅰ
Definition: is the further development of a
specific cavosurface design and degree of smoothness that produces the maximum effectiveness of the restorative material being used.
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Finishing the external walls Ⅱ
Objectives: To create the best marginal seal possible
between the restorative material and tooth structure;
To afford a smooth marginal junction; To provide maximum strength of both the
tooth and the restorative material at and near the margin.
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The strongest enamel margin is that marginwhich is composed of full-length enamel rodsthat are supported on the cavity side by shorterenamel rods, all of which extend to sound dentin.
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Finishing the external walls Ⅲ
The design of the cavosurface angle
The degree of smoothness of the wall
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The design of the cavosurface angle: depending on the material
amalgam: 90°
composite: beveling 30°~ 40°
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Final cavity preparation stage
Step 5 Removal of any remaining infected
dentin if indicated
Step 6 Pulp protection
Step 7 Secondary resistance & retention form
Step 8 Procedure for finishing external walls
Step 9 Final procedures
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Final procedures
cleaning inspecting varnishing conditioning
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Cavity preparation Matrix application Preparation of materials Insertion and carving of materials Finishing and Polishing
Program of Operative Treatment
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Matrix Application
Tofflemire Matrix System
Ivory Matrix System
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Matrix retainer, Band & Wedge
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Matrix in Retainer
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Contour Matrix
Rounded instrumentsuch as a spoon excavator
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Matrix on Tooth
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Occlusal View
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Wedge place
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Contour Band
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Ready for restoration
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Cavity preparation Matrix application Preparation of materials Insertion and carving of materials Finishing and Polishing
Program of Operative Treatment
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Armamentarium
Amalgam Capsule Amalgamator Squeeze Cloth Amalgam carrier
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Activate Mercury
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Cavity preparation Matrix application Preparation of materials Insertion and carving of materials Finishing and Polishing
Program of Operative Treatment
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Insertion and carving
Class Ⅰ
Class Ⅱ
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Armamentarium
Amalgam Condensers Anatomic Burnishers Carves— Cleoid or Discoid
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Check condenser fit
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First increment
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Start with the smallest condenser
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Step condenser over mass
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Continue adding increment
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Condense toward walls
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Use alternative instruments
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Overpacked
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Create initial grooves
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Create initial grooves
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Carve to margin
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Enhance grooves
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Remove flash
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Final shape and burnishing
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Completed restoration
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Initial Increment
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Initial Condensation
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Lateral Condensation
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Overpacking
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Marginal Ridge Condensation
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Condense to Margins
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Create Occlusal Embrasure
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Occlusal Embrasure
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Occlusal Embrasure
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Occlusal Embrasure
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Removing Ridge
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Removing Band
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Flash & Excess
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Moving Excess
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Check with interproximal carve
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Instrument on Tooth Structure
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Completed Restoration
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Rubber dam removal
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Cavity preparation Matrix application Preparation of materials Insertion and carving of materials Finishing and Polishing
Program of Operative Treatment
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Polishing
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Evaluate the restoration Class I
Verify that cavosurface margin can be seen— Flash— Underfilled— Voids
Check the overall shape of the anatomy
— Look for bulky ridges that might be high in occlusion
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Evaluate the restoration Class II
Check proximal contact
Check flash and overhangs proximally
Check underfill proximally
Check outline form
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Check Occlusion
Evaluate carefully with marking paper or ribbon in Miller forceps
Check gently in centric occlusion
Check all excursive movement
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