132
Operative Dentistry

Cavity Preparation and Fillings

Embed Size (px)

DESCRIPTION

m,bnbn

Citation preview

Page 1: Cavity Preparation and Fillings

Operative Dentistry

Page 2: Cavity Preparation and Fillings

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.

Page 3: Cavity Preparation and Fillings

3Naghman Zuberi

Indication of Operative Dentistry Caries; Malformed, discolored,

or fractured teeth; Restoration replacement.

Page 4: Cavity Preparation and Fillings

4Naghman Zuberi

Program of Operative Treatment Patient assessment Examination and diagnosis Treatment planning Pain control: local anesthetic Isolation of the operating field

Page 5: Cavity Preparation and Fillings

5Naghman Zuberi

Cavity preparation Matrix application Preparation of materials Insertion and carving of materials Finishing and Polishing

Program of Operative Treatment

Page 6: Cavity Preparation and Fillings

6Naghman Zuberi

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.

Page 7: Cavity Preparation and Fillings

7Naghman Zuberi

Cavity Structure

walls angles cavity

Page 8: Cavity Preparation and Fillings

8Naghman Zuberi

Classification of cavity

Class I Class II Class III Class IV Class V Class VI

—G.V.Black in 1908

Page 9: Cavity Preparation and Fillings

9Naghman Zuberi

Cavity

Simple cavity: only one tooth surface is involved.

Compound cavity: two surfaces are involved.

Complex cavity: three or more surfaces are involved.

Page 10: Cavity Preparation and Fillings

10Naghman Zuberi

Let us Classify The Cavities

Page 11: Cavity Preparation and Fillings

11Naghman Zuberi

Class 1

Class 2

Class 1

Class 2

Class 3

Class 4

Class 5

Class 6

Page 12: Cavity Preparation and Fillings

12Naghman Zuberi

Stages and Steps in Cavity Preparation

Initial cavity preparation stage

Final cavity preparation stage

Page 13: Cavity Preparation and Fillings

13Naghman Zuberi

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

Page 14: Cavity Preparation and Fillings

14Naghman Zuberi

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

Page 15: Cavity Preparation and Fillings

15Naghman Zuberi

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

Page 16: Cavity Preparation and Fillings

16Naghman Zuberi

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.

Page 17: Cavity Preparation and Fillings

17Naghman Zuberi

Maxillary Class Ⅰ outline form

Page 18: Cavity Preparation and Fillings

18Naghman Zuberi

Mandibular Class Ⅰ outline form

Page 19: Cavity Preparation and Fillings

19Naghman Zuberi

Maxillary Class Ⅱ outline form

Page 20: Cavity Preparation and Fillings

20Naghman Zuberi

Mandibular Class Ⅱ outline form

Page 21: Cavity Preparation and Fillings

21Naghman Zuberi

Common Error

Page 22: Cavity Preparation and Fillings

22Naghman Zuberi

Page 23: Cavity Preparation and Fillings

23Naghman Zuberi

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.

Page 24: Cavity Preparation and Fillings

24Naghman Zuberi

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.

Page 25: Cavity Preparation and Fillings

25Naghman Zuberi

Page 26: Cavity Preparation and Fillings

26Naghman Zuberi

Page 27: Cavity Preparation and Fillings

27Naghman Zuberi

Page 28: Cavity Preparation and Fillings

28Naghman Zuberi

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

Page 29: Cavity Preparation and Fillings

29Naghman Zuberi

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.

Page 30: Cavity Preparation and Fillings

30Naghman Zuberi

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;

Page 31: Cavity Preparation and Fillings

31Naghman Zuberi

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.

Page 32: Cavity Preparation and Fillings

32Naghman Zuberi

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

Page 33: Cavity Preparation and Fillings

33Naghman Zuberi

Page 34: Cavity Preparation and Fillings

34Naghman Zuberi

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

Page 35: Cavity Preparation and Fillings

35Naghman Zuberi

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.

Page 36: Cavity Preparation and Fillings

36Naghman Zuberi

Primary Retention Form Ⅱ

Principles: depending on the materials Amalgam restoration:

developing external cavity walls that converge occlusally and dovetail design

Page 37: Cavity Preparation and Fillings

37Naghman Zuberi

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.

Page 38: Cavity Preparation and Fillings

38Naghman Zuberi

Page 39: Cavity Preparation and Fillings

39Naghman Zuberi

Primary Retention Form Ⅲ

Principles: depending on the materialsComposite restoration:

a mechanical bond between the material

and conditioned, prepared tooth structure.

Page 40: Cavity Preparation and Fillings

40Naghman Zuberi

Page 41: Cavity Preparation and Fillings

41Naghman Zuberi

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

Page 42: Cavity Preparation and Fillings

42Naghman Zuberi

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.

Page 43: Cavity Preparation and Fillings

43Naghman Zuberi

Convenience Form Ⅱ

Principles:

Allow access for caries removal Allow access for restoration placement Allow access to margins for finishing,

evaluation and cleaning

Page 44: Cavity Preparation and Fillings

44Naghman Zuberi

Convenience Form

Page 45: Cavity Preparation and Fillings

45Naghman Zuberi

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

Page 46: Cavity Preparation and Fillings

46Naghman Zuberi

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.

Page 47: Cavity Preparation and Fillings

47Naghman Zuberi

Removal of dentinal caries using round burs and spoon excavators

Page 48: Cavity Preparation and Fillings

48Naghman Zuberi

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

Page 49: Cavity Preparation and Fillings

49Naghman Zuberi

Pulp protection

Using liners or bases

to protect the pulp or

to aid pulpal recovery or both.

Page 50: Cavity Preparation and Fillings

50Naghman Zuberi

Page 51: Cavity Preparation and Fillings

51Naghman Zuberi

Page 52: Cavity Preparation and Fillings

52Naghman Zuberi

Page 53: Cavity Preparation and Fillings

53Naghman Zuberi

Page 54: Cavity Preparation and Fillings

54Naghman Zuberi

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

Page 55: Cavity Preparation and Fillings

55Naghman Zuberi

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.

Page 56: Cavity Preparation and Fillings

56Naghman Zuberi

Secondary resistance and retention forms Ⅱ

Mechanical forms

Cavity wall conditioning form

Page 57: Cavity Preparation and Fillings

57Naghman Zuberi

Mechnical form:

Proximal locks Proximal slots

Page 58: Cavity Preparation and Fillings

58Naghman ZuberiProximal locks

Page 59: Cavity Preparation and Fillings

59Naghman Zuberi

Page 60: Cavity Preparation and Fillings

60Naghman Zuberi

Page 61: Cavity Preparation and Fillings

61Naghman Zuberi

Slot on gingival wall

Page 62: Cavity Preparation and Fillings

62Naghman Zuberi

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

Page 63: Cavity Preparation and Fillings

63Naghman Zuberi

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.

Page 64: Cavity Preparation and Fillings

64Naghman Zuberi

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.

Page 65: Cavity Preparation and Fillings

65Naghman Zuberi

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.

Page 66: Cavity Preparation and Fillings

66Naghman Zuberi

Finishing the external walls Ⅲ

The design of the cavosurface angle

The degree of smoothness of the wall

Page 67: Cavity Preparation and Fillings

67Naghman Zuberi

The design of the cavosurface angle: depending on the material

amalgam: 90°

composite: beveling 30°~ 40°

Page 68: Cavity Preparation and Fillings

68Naghman Zuberi

Page 69: Cavity Preparation and Fillings

69Naghman Zuberi

Page 70: Cavity Preparation and Fillings

70Naghman Zuberi

Page 71: Cavity Preparation and Fillings

71Naghman Zuberi

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

Page 72: Cavity Preparation and Fillings

72Naghman Zuberi

Final procedures

cleaning inspecting varnishing conditioning

Page 73: Cavity Preparation and Fillings

73Naghman Zuberi

Page 74: Cavity Preparation and Fillings

74Naghman Zuberi

Page 75: Cavity Preparation and Fillings

75Naghman Zuberi

Cavity preparation Matrix application Preparation of materials Insertion and carving of materials Finishing and Polishing

Program of Operative Treatment

Page 76: Cavity Preparation and Fillings

76Naghman Zuberi

Matrix Application

Tofflemire Matrix System

Ivory Matrix System

Page 77: Cavity Preparation and Fillings

77Naghman Zuberi

Matrix retainer, Band & Wedge

Page 78: Cavity Preparation and Fillings

78Naghman Zuberi

Page 79: Cavity Preparation and Fillings

79Naghman Zuberi

Matrix in Retainer

Page 80: Cavity Preparation and Fillings

80Naghman Zuberi

Contour Matrix

Rounded instrumentsuch as a spoon excavator

Page 81: Cavity Preparation and Fillings

81Naghman Zuberi

Matrix on Tooth

Page 82: Cavity Preparation and Fillings

82Naghman Zuberi

Occlusal View

Page 83: Cavity Preparation and Fillings

83Naghman Zuberi

Wedge place

Page 84: Cavity Preparation and Fillings

84Naghman Zuberi

Contour Band

Page 85: Cavity Preparation and Fillings

85Naghman Zuberi

Ready for restoration

Page 86: Cavity Preparation and Fillings

86Naghman Zuberi

Cavity preparation Matrix application Preparation of materials Insertion and carving of materials Finishing and Polishing

Program of Operative Treatment

Page 87: Cavity Preparation and Fillings

87Naghman Zuberi

Armamentarium

Amalgam Capsule Amalgamator Squeeze Cloth Amalgam carrier

Page 88: Cavity Preparation and Fillings

88Naghman Zuberi

Activate Mercury

Page 89: Cavity Preparation and Fillings

89Naghman Zuberi

Page 90: Cavity Preparation and Fillings

90Naghman Zuberi

Page 91: Cavity Preparation and Fillings

91Naghman Zuberi

Cavity preparation Matrix application Preparation of materials Insertion and carving of materials Finishing and Polishing

Program of Operative Treatment

Page 92: Cavity Preparation and Fillings

92Naghman Zuberi

Insertion and carving

Class Ⅰ

Class Ⅱ

Page 93: Cavity Preparation and Fillings

93Naghman Zuberi

Armamentarium

Amalgam Condensers Anatomic Burnishers Carves— Cleoid or Discoid

Page 94: Cavity Preparation and Fillings

94Naghman Zuberi

Check condenser fit

Page 95: Cavity Preparation and Fillings

95Naghman Zuberi

First increment

Page 96: Cavity Preparation and Fillings

96Naghman Zuberi

Start with the smallest condenser

Page 97: Cavity Preparation and Fillings

97Naghman Zuberi

Step condenser over mass

Page 98: Cavity Preparation and Fillings

98Naghman Zuberi

Continue adding increment

Page 99: Cavity Preparation and Fillings

99Naghman Zuberi

Condense toward walls

Page 100: Cavity Preparation and Fillings

100Naghman Zuberi

Use alternative instruments

Page 101: Cavity Preparation and Fillings

101Naghman Zuberi

Overpacked

Page 102: Cavity Preparation and Fillings

102Naghman Zuberi

Create initial grooves

Page 103: Cavity Preparation and Fillings

103Naghman Zuberi

Create initial grooves

Page 104: Cavity Preparation and Fillings

104Naghman Zuberi

Carve to margin

Page 105: Cavity Preparation and Fillings

105Naghman Zuberi

Enhance grooves

Page 106: Cavity Preparation and Fillings

106Naghman Zuberi

Remove flash

Page 107: Cavity Preparation and Fillings

107Naghman Zuberi

Final shape and burnishing

Page 108: Cavity Preparation and Fillings

108Naghman Zuberi

Completed restoration

Page 109: Cavity Preparation and Fillings

109Naghman Zuberi

Initial Increment

Page 110: Cavity Preparation and Fillings

110Naghman Zuberi

Initial Condensation

Page 111: Cavity Preparation and Fillings

111Naghman Zuberi

Lateral Condensation

Page 112: Cavity Preparation and Fillings

112Naghman Zuberi

Overpacking

Page 113: Cavity Preparation and Fillings

113Naghman Zuberi

Marginal Ridge Condensation

Page 114: Cavity Preparation and Fillings

114Naghman Zuberi

Condense to Margins

Page 115: Cavity Preparation and Fillings

115Naghman Zuberi

Create Occlusal Embrasure

Page 116: Cavity Preparation and Fillings

116Naghman Zuberi

Occlusal Embrasure

Page 117: Cavity Preparation and Fillings

117Naghman Zuberi

Occlusal Embrasure

Page 118: Cavity Preparation and Fillings

118Naghman Zuberi

Occlusal Embrasure

Page 119: Cavity Preparation and Fillings

119Naghman Zuberi

Removing Ridge

Page 120: Cavity Preparation and Fillings

120Naghman Zuberi

Removing Band

Page 121: Cavity Preparation and Fillings

121Naghman Zuberi

Flash & Excess

Page 122: Cavity Preparation and Fillings

122Naghman Zuberi

Moving Excess

Page 123: Cavity Preparation and Fillings

123Naghman Zuberi

Check with interproximal carve

Page 124: Cavity Preparation and Fillings

124Naghman Zuberi

Instrument on Tooth Structure

Page 125: Cavity Preparation and Fillings

125Naghman Zuberi

Completed Restoration

Page 126: Cavity Preparation and Fillings

126Naghman Zuberi

Rubber dam removal

Page 127: Cavity Preparation and Fillings

127Naghman Zuberi

Cavity preparation Matrix application Preparation of materials Insertion and carving of materials Finishing and Polishing

Program of Operative Treatment

Page 128: Cavity Preparation and Fillings

128Naghman Zuberi

Polishing

Page 129: Cavity Preparation and Fillings

129Naghman Zuberi

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

Page 130: Cavity Preparation and Fillings

130Naghman Zuberi

Evaluate the restoration Class II

Check proximal contact

Check flash and overhangs proximally

Check underfill proximally

Check outline form

Page 131: Cavity Preparation and Fillings

131Naghman Zuberi

Check Occlusion

Evaluate carefully with marking paper or ribbon in Miller forceps

Check gently in centric occlusion

Check all excursive movement

Page 132: Cavity Preparation and Fillings

132Naghman Zuberi