CAVITY PREPARATION

PRINCIPLES
Initial tooth prep
 Outline form & initial depth
 Primary resistance form
 Primary retention form
 Convenience form
Final Tooth Prep
 Removal of any remaining carious
tooth structure/restorative material
 Pulp Protection
 Secondary resistance and retention
forms
Important prerequisites
 Isolation
 Check occlusion
 Protection of the contiguous soft
tissues
 Supra gingival margins
Initial tooth Prep – Outline
form & Initial depth
 Place prep margins in the positions
they will occupy in the final prep
except for finishing
 Initial preparation depth of 0.2 –
0.8mm pulpally of the DEJ
Outline Form
 Three general Principles
1) All friable and weakened Enamel
removed
2) All faults removed
3) All margins in positions where they
can be finished
Factors to be Assessed
 Extend to sound tooth structure,
except pulpally
 Esthetic considerations
 Occlusal Relationships
 Adjacent tooth contour
 Cavosurface configuration
Features
 Preserve cusp strength
 Marginal ridge
 Min faciolingual extensions
 Enameloplasty
 Connecting two faults or tooth preps
less than 0.5mm apart
 Restricting the depth of the preparation
Pit & Fissure Lesions
 Factors
1) Extent of caries
2) Extensions along fissures to achieve
sound margins
3) Limiting bur depth
Access to all parts of the
lesion
 Outline form may have to be extended
Smooth surface lesions
 Proximal
 cervical
Proximal
 Prep MGs extended until sound tooth
structure obtained and no unsupported
E remains
 Avoid terminating the prep on extreme
eminences such as cusp heights or
ridge crests
 Restrict prep depth (no. 245 bur
parallel to DEJ)
PROXIMAL
 G MGs of prep extended apically to
provide a clearance of 0.5mm btw G
MG and ADJ tooth. Otherwise G
extension is to sound tooth structure
and no further
 Facial and lingual MGs of prox box
clear of the adjacent tooth(?). Not for
classII & III composite
Cervical lesions
 Governed primarily by the extent of the
lesion
 Reach sound tooth structure incisally,
gingivally, mesially and distally
 Depth 0.8- 1.25mm pulpally
Restricted extensions
 Root proximity
 Esthetic Requirements
 Composite
Increased Extensions
 Mental/ physical Handicaps
 Age of the patient
 PD Abutment or units of a splint
 Need for resistance or retention form
 Need for adjustments for tooth
contours
Enameloplasty
 Reshaping the E surface with suitable
rotary instruments
 Does not extend outline form
 1/3rd or less of the E is faulty
 Can also be done for supplemental
grooves
 Areas should be “saucered”
Primary Resistance Form
 While extending the prep to sound
tooth structure, the shape of the cavity
walls must be made so that the
restoration and the tooth can withstand
masticatory forces which act primarily
along the long axis of the tooth.
 Secondary resistance form helps resist
oblique forces
Principles
 Flat floor – the forces of mastication
can be resisted better when the floor is
perpendicular to the long axis of the
tooth
 Box shape
 Resist extension of the external walls –
strong cusp and ridge areas with
dentine support
 Rounding of internal line angles
Principles (contd.)
 Protect weakened tooth structure in
extensive tooth preparations by cusp
capping or include this weakened
structure in the restoration
 Sufficient thickness of the restorative
material to resist fracture under load.
 Bonding the restorative material to
tooth structure
 Primary Retention Form
 The design of the preparation should
provide for retention of the restorative
material in the tooth for non- bonded
restorations
 Features that enhance retention form of a
preparation often also enhance resistance
form (e.g. pins placed in a manner that
one portion of a too supports another part
of a tooth.
 Definition
 PRIMARY RETENTION FORM:
That shape or form of a conventional preparation
that resists displacement or removal of the
restoration from tipping or lifting forces.

Retention form developed during initial prep may be

adequate to retain the material in the tooth or
there may still be a requirement for additional
retention features
Retention form for AMALGAM
 Walls which Converge occlusally
 Parallel walls
 Walls which are slightly divergent

Now the amalgam cannot dislodge

without fracture of the restoration
Do nor over-converge; unsupported
Enamel may be left on the cavosurface
margin of the occlusal surface
Ret Fm – AMG (contd)
 Occlusal convergence of the prox box of a
class II cavity:
1) Provides retention
2) Conserves the marginal ridge
3) Allows for slightly greater prep at the
gingival area
4) The cavosurface angle where the proximal,
facial and lingual walls meet the marginal
ridge is 90°.
Ret Fm- AMG (contd.)
 In class V preps, the external walls
diverge because of Enamel rod
direction, so coves or grooves are
prepared in the dentinal walls to
provide retention form (sec)
Ret Fm – AMG: Bonded
Amalgam
 No studies show that bonded amalgam
is strong enough to eliminate the need
of undercuts for macromechanical
retention
Ret Form for COMPOSITE
 Micromechanical retention
 Etching
 Conditioning
 Priming
 Bonding
Ret Fm - Composite
 Mechanical retention form is
sometimes needed when the root
surface is involved
 E bevelling
Cast metal – Intracoronal
restorations
 The restoration must be able to be inserted
and withdrawn
 Near parallel walls - 2°-5°divergence per
wall; the greater the depth of the prep, the
greater the divergence allowed
 In inlay and onlay preparations, the
opposing vertical walls diverge outwardly by
only a few degrees to each other and to a
draw path which is perpendicular to the floor
of the preparation
Cast Metal – Intracoronal
Restorations
 Almost parallel walls allow for enough
frictional resistance and mechanical
locking of the luting agent into minute
irregularities of the prep and
restoration to counteract the pull of
sticky foods.
 Close parallel walls
 Luting agent that bonds to tooth
structure
Occlusal Dovetail in class II
restorations
 Prevents tipping of the restoration.
When need for retention is great, an
occlusal dovetail may be placed
whether or not caries is on the occlusal
surface
Convenience Form
 Adequate observation
 Accessibility
 Ease of operation in preparing and
restoring the tooth
 Convenience Fm
 Extension of Distal, mesial, facial or lingual
walls to gain adequate access to the deeper
caries
 For gold foil restorations, convenience points
are made for starting condensation of gold foil
by deepening or making more acute one or
more point angles of the prep
 Occlusal divergence of class II facial and
lingual walls of the proximal box
Convenience Fm
 Extending proximal preps beyond contact
points to afford better access for finishing of
prep walls and restoration margins
 Cast restorations – clearance with the
adjacent proximal margins is mandatory to
finish the preparation walls, make an
accurate impression and to try in the casting
 FINAL TOOTH PREP
 Step 5 – removal of any remaining pit and
fissure enamel, infected dentin, old restorative
material, if indicated
 Step 6 – Pulp protection
 Step 7 - Secondary resistance and retention
forms
 Step 8 – finishing the external walls of the tooth
prep
 Step 9 – Final Procedures – Cleaning,
inspecting and sealing.
 Step 5 Removal of residual
defects or old restorative material
 Except when performing an indirect pulp cap
 Affected versus infected dentin
 DO not rely on the colour of the dentin to judge
how much tooth tissue to remove – positive
balance between virulence of the invading
microorganisms and resistance of the host for
recovery of the pulp
 Clinical decision – Caries disclosing solutions
are also available
 Do not leave any type of carious dentin at the
DEJ
 Remaining restorative material
on the pulpal/axial walls
 Remove if
1) Aesthetics compromised
2) Need for retention form is greater
3) Recurrent caries radiographically evident
4) Symptomatic tooth preoperatively
5) Periphery of the old restorative material is not
intact and microleakage may have caused
recurrent caries
Do not remove old restorative
material
 If none of the above conditions are
present as this could irritate or expose
the pulp by excavation too near the
pulp
Technique
 After establishing the pulpal or axial
wall initial depth, remove the infected
dentin/old restorative material only,
leaving a concave area in the wall
 Peripheral to this area, the depth of the
wall should not be altered
Large carious lesions with
extensive soft caries
 Achieve removal of infected dentin
early in initial tooth preparation stage
 After removal of caries, the remaining
tooth structure must be assessed for a
suitable restorative material, rather
than preparing a cavity for a
restorative material that is later is
deemed unsuitable
A patient with numerous
carious teeth
 In the first appointment the infected dentin
is removed and temporary restorations are
placed
 Restore permanently each tooth individually
on later appointments
 This is called the CARIES CONTROL
TECHNIQUE
 More teeth remain serviceable than if a
single tooth were to be restored in one visit.
Removal of large areas of
carious dentin
 Use a spoon excavator by flaking up
the soft caries at the periphery of the
lesion and peel it off in layers
 Remove in a few large pieces.
Removal of harder , heavily
discoloured dentin
 Spoon excavators
 Round steel burs at slow speed
 Round carbide burs at high speed
Consider the PULP
 Frictional heat generated by bur
 Infection by forcing microorganisms
into the dentinal tubules with excessive
pressure with a spoon excavator
 Pulp exposure when removing caries
 Best method of removing
caries overlying the pulp
 Minimal pressure
 Minimal heat generation
 Good visibility
 Round carbide bur with high speed
handpiece with air coolant and slow speed
 Examination of the soft dentin with an
explorer can be done but must be
performed judiciously to avoid perforation
into the pulp
How much Dentin to remove?
 Colour
 Feel
 As hard as normal dentin
 Do not apply pressure over a thin layer
of dentin over a healthy pulp – pulp
exposure
Removal of old remaining
restorative material
 Round carbide bur at slow speed with
air or air/water coolant
 Use water spray for amalgam to
reduce mercury vapour
Pulp Protection
 To protect the pulp
 To aid pulp recovery
 Pulpal irritants include
1) Cutting the dentin
 Cutting may result in a pulp burn, abscess or
necrosis
 Therefore use a water coolant with a high speed
handpiece
 If the remaining dentin is more than 1.5mm, the
dentinal odontoblasts which are not previously
irritated degenerate and dead tracts form. The
stimulus may not be intense enough to stimulate
the pulp for replacement odontoblasts to form
Pulpal Irritants

2) Ingredients of various materials

3) Thermal changes conducted through
restorative materials
4) Forces transmitted through materials
to the dentin
5) Ingress of noxious products and
bacteria through the tubules by
microleakage
Sealing the Tubules
 Calcium hydroxide
 Resin bonding agent
 CaOH overlaid by a resin bonded GI
How to choose a liner/ base
 Select on the basis of
 1) anatomy, physiology and biologic
responses of the pulp
 2) properties of the restorative material
 Liner
 Volatile or aqueous suspensions or dispersions of
ZnO or CaOH which can be applied to a tooth
surface in a relatively thin layer and are used to
 1) affect a particular pulp response
 2) barrier to protect the dentin from noxious
agents from either the restorative material or oral
fluids
 3) Initial electrical insulation
 4) Some thermal protection
Base
 Those cements used in thicker
dimensions to provide for mechanical,
chemical and thermal protection of the
pulp
 Eg ZnPO4, ZnO Eugenol, CaOH, Zn
polycarboxylate, GI
Use of liners
 1-2mm of remaining dentin- do not use
 Sedation and stimulation of the pulp
for reparative dentin formation
 For an excavation very close to the
pulp tissue, use CaOH to stimulate
reparative dentin
 ZnO Eugenol is now rarely used,
CaOH is overlaid with GI
 Compressive strength of
CaOH and ZnO Eug
 In thicknesses of 0.5mm or more, can resist the
compressive forces of condensation of amalgam
and provide insulation against short term thermal
changes
 In a very deep excavation, overlay CaOH with a
stronger base material
 2mm bulk of btw pulp and metallic restorative
material- dentin, liner, base
 For composites, which are passively inserted and
insulators, apply CaOH only when the excavation
is within 0.5mm of the pulp. Bases are not
indicated
Very deep excavations
 Microscopic pulp exposures not visible
to the naked eye
 Evidence of vital pulp exposure -
hemorrhage
 Microscopic exposures allow the
ingress of bacteria and oral fluids
 In such areas, liners should be placed
without pressure. Use 1mm thickness
Bases
 Consider tooth prep depth and
properties of the base
 Take care not to force material into the
pulp cavity:
 CaOH liner or non- pressure technique