DEFINITION OF TOOTH PREPARATION

Tooth preparation is defined as the

mechanical alteration of a 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. (Sturdevant)
Tooth preparation can be defined as “the
mechanical preparation and / or the chemical
treatment of the remaining tooth structure, which
enables it to accommodate a restorative material
without incurring mechanical or biological failure”.
(Marzouk)
 OBJECTIVES OF TOOTH PREPARATION
1. Remove all defects and provide necessary
protection to the pulp
2. Extend the restoration as conservatively as
possible
3. Form the tooth preparation so that under the
force of mastication the tooth or the
restoration or both will not fracture and the
restoration will not be displaced.
4. Allow for the esthetic and functional
placement of a restorative material.
 FACTORS AFFECTING CAVITY PREPARATION

1. Diagnosis

2. Knowledge of dental anatomy

3. Patient factors - Economic status, age,

Choice of material
 TYPES OF TOOTH PREPARATION
1. Intracoronal
2. Extracoronal
Intracoronal - Cavity preparation that penetrate
into the enamel and dentin substance of the crown
of the tooth, usually box like having both internal
and external preparation walls.
Extracoronal - cavity preparation involve reducing
the tooth dimensions surfacewise to create a space
for the restoration, usually for cast restorations.
 CLASSIFICATION OF TOOTH PREPARATION
According to G.V.Black - Class I, Class II,
Class III, Class IV & Class V.
Additional class has been added - class VI
Class I - All pit and fissure lesions.
- Restorations on occlusal surface
of premolars and molars

- Restorations on occlusal 2/3rds of

the facial and lingual surfaces of
the molars.

- Restorations on lingual surface of

maxillary incisors
Class II - Restorations on the proximal
surfaces of posterior teeth.

Class III - Restoration on the proximal

surfaces of anterior teeth
that do not involve the incisal
angle.
Class IV - Restoration on the proximal surfaces of
the anterior teeth that do involve the incisal edge.

Class V - Restoration on the gingival 3rd of the

facial or lingual surface of all teeth.
Class VI - Restorations on the incisal edge of
anterior teeth or the occlusal cusp heights of
posterior teeth.
 STAGES OF CAVITY PREPARATION
INITIAL STAGE (First Stage) - Mechanical
alternation of the tooth are extended to sound tooth
structure in all directions while adhering to a
specific, limited pulpal or axial depth
FINAL STAGE (Second Stage)
 Excavation of remaining infected dentin
 Removal of old restorative materials
 Pulp protection
 Additional cavity designs- minimize fracture
 Finishing preparation walls
 Cleaning, inspecting, sealing the preparation
before placement of restorative material.
 TOOTH PREPARATION TERMINOLOGY
Simple, Compound, and Complex tooth
preparations
Simple - Only one tooth surface
involved

Compound - two surfaces are

involved
Complex – involving three surfaces

Tooth preparation walls

Internal wall – prepared

surface not extend to
the external tooth
surface.
1. Axial wall – internal
wall parallel with the
long axis of the tooth.
Pulpal Wall – Internal wall both perpendicular to
the long axis of the tooth and occlusal of the pulp.

External Wall - prepared surface extend to the

external tooth surface.

Tooth preparation angles

Line Angle - Junction of two planel surfaces of
different orientation.
Point Angle – Junction of three planel surfaces of
different orientation.
Class I – 8 Line angles, 4 point
angles.

Class II – 11 line angles, 6

points angles
Class III – 6 Line angles, 3
point angles.

Class IV – 11 line angles, 6

points angles
Class V – 8 Line angles, 4
point angles.

CAVOSURFACE ANGLE & CAVOSURFACE

MARGIN

Cavosurface angle – angle of

tooth structure formed by the
junction of prepared wall and the
external surface of the tooth.
Cavosurface Margin – Junction of prepared wall
and external surface of the tooth.

STEPS IN TOOTH PREPARATION

INITIAL TOOTH PREPARATION STAGE

Step 1 - Outline form and initial depth

Step 2 – Primary resistance form
Step 3 – Primary retention form
Step 4 – Convenience form
FINAL TOOTH PREPARATION STAGE

Step 5 – Removal of any remaining infected dentin

and / old restorative material, if indicated.

Step 6 – Pulp protection, if indicated

Step 7 – Secondary resistance & retention forms

Step 8 – Procedures for finishing external walls

Step 9 – Cleaning, Inspecting and Sealing

 INITIAL TOOTH PREPARATION STAGE

OUTLINE FORM

Placing the preparation margins in the

position they will occupy in the final preparation.

The locations that the peripheries of the

completed tooth preparation will occupy on tooth

surfaces.
PRINCIPLES
 Include all surface involvement of the enamel
 Include all undermined enamel
 Leave margins in finishable self cleansable
areas
 Depth of preparation at 0.5mm into the dentin
a. DEJ very sensitive
b. To give bulk for restorative material
c. To take advantage of dentin’s elasticity
FEATURES
 Preserving cuspal strength
 Preserving marginal ridge strength
 Minimizing faciolingual extensions
 Using enameloplasty
 Connecting two close (<0.5mm) faults or
tooth preparation
 Restricting depth of preparation into dentin
to maximum of 0.2mm for pit and fissure and
0.2 – 0.8mm for smooth surface caries.
Application of Principle Factors
Pit and fissure lesions (Outline form include)
a. All enamel directly attacked by decay
b. All undermined enamel
c. Pulpal floor and axial wall about 0.5mm within
dentin
d. All pits and fissures as cutting for immunity
Proximal smooth surface cavities (outline form
include)
a. All enamel directly attacked by decay
b. All undermined enamel
c. Pulpal floor and axial wall about 0.5mm within
dentin
d. Gingival margin 0.5 – 1mm apical to the crest
of healthy free gingiva within the gingival
crevice (crevicular fluid is alkaline, knife edge
gingiva discourage food accumulation).
e. Facial and lingual walls should be placed in
the respective embrasures. Not within contact
area or near approach area.
f. Caries index, age and occlusal loading guides
the extend of the proximal preparation.

Facial and lingual gingival 1/3rd smooth surface

lesion (outline form include)

a. All enamel directly attacked by decay

b. All undermined enamel

c. Axial wall 0.5mm into dentin
d. Gingival wall within the gingival sulcus
e. Occlusal wall apical to the height of contour or
cervical ridge and the facial and lingual
surface
 PRIMARY RESISTANCE FORM

 Defined as the shape & placement of the

cavity walls best enables both restorations & the
tooth to withstand, without fracture, masticatory
forces delivered in long axis of tooth

 Architectural form given to a tooth , which

enables both restoration & remaining tooth to resist
structural failure from occlusal loading stresses
PRINCIPLES
 Utilize box shape with a flat floor
 Restrict extension of external walls
 Slight rounding of internal line angles - reduce
stress
 Cap weak cusps & envelope / include enough
weakened tooth
 Provide enough thickness of restorative
material - prevent fracture
Factors Governing Resistant form
 Stress pattern of teeth
 Mechanical properties of teeth
 Keep floors perpendicular to direction of
loading
 Walls kept parallel
 Prepare to receive sufficient bulk of restorative
material
 Round line and point angles
 Enamel wall supported by dentin
 PRIMARY RETENTION FORM

Shape or form of conventional preparation that

resists displacement or removal of the restoration
from tipping or lifting forces.
Form given to the tooth preparation which
enables the restoration that it will accommodate, to
avoid being dislodged by masticatory loading.
PRINCIPLES
 Frictional retention
a. Greater surface area
b. More opposing walls
c. Higher degree of parallelism
d. Proximity of restoration to tooth
 Elastic deformation of dentin
 Inverted truncated cones
 Undercuts
 Dovetails

Amalgam Inlay
 CONVENIENCE FORM

Shape or form of the preparation that provides

for adequate observation, accessibility, and ease of
operation in preparing and restoring the tooth.
Modifications in tooth preparation
 Flaring
 lingual / labial access
Instrument modifications
 contra-angling
 bayoneting
Separation
 wedging of teeth
 FINAL TOOTH PREPARATION STAGE

Removal of any remaining enamel pit or

fissure, infected dentin, and / old restorative material
if indicated.

 Elimination of any infected caries tooth

structure or faulty restorative material left in the tooth
after initial tooth preparation.
 Caries left in pulpal / axial floor excavated

 0.75-1mm of dentin cover the pulp

 When affects esthetically

 Weakened tooth- given retention

 Secondary caries , if present

 Periphery of old restorative material not intact

 PULP PROTECTION
Pulpal injury
Heat generated while cutting
Restorative material with good thermal
conductivity
Chemicals from restorative material
Galvanic currents
Microleakage
 Placement of cavity liners / bases / varnish
 It is the step in adapting the preparation for
receiving the final restorative material
 Mechanical, chemical & thermal protection of
pulp
SECONDARY RESISTANCE & RETENTION FORM
Two Types
 Mechanical Features
 Cavity wall conditioning
Mechanical Features
 Retention locks
 Grooves & coves
 Skirts
 Beveled enamel margins
 Pins
 Slots
Cavity wall conditioning features
 Enamel, dentinal wall conditioning
 For bonded restorations
 FINISHING THE EXTERNAL WALLS OF THE
TOOTH PREPARATION

Finishing the preparation walls is the further

development, when indicated, of a specific
cavosurface design and degree of smoothness or
roughness that produces the maximum
effectiveness of the restorative material being used.
Objectives
 Create the best marginal seal possible
between the restorative material and the tooth
structure.
 Afford a smooth marginal junction
 Provide maximum strength of both the tooth
and the restorative material at and near the margin.
Features
 Design of the cavosurface angle
 Degree of smoothness or roughness of the
wall.

CLEANING, INSPECTING, VARNISHING AND

CONDITIONING
 Removing debris, chips
 Dry the cavity