SEMINAR TOPIC Class II cavity preparation for restoration [amalgam and metal inlay] cast

Dept.Conservative dentistry & Endodontics

5/5/12

What is 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.
Dept.Conservative dentistry & Endodontics 5/5/12

What are the OBJECTIVES ?????????

is to------(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 5/5/12 restorationDept.Conservative dentistry
& Endodontics

Greene Vardiman Black,

M.D., D.D.S., LL.D., Sc.D. (1836-1915)

Dept.Conservative dentistry & Endodontics

5/5/12

CLASS II AMALGAM RESTORATIONS...........................

Dept.Conservative dentistry & Endodontics

5/5/12

Amalgam restorations that restore one or both of the proximal surfaces of the tooth may provide years of service to the patient
Dept.Conservative dentistry & Endodontics 5/5/12

I NITIAL CLINICAL PROCEDURES..

Dept.Conservative dentistry & Endodontics

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Occlusal contacts should be marked with articulating paper before tooth preparation. The operator should make a mental image of these contacts to serve as guide in tooth preparation and restoration.

Dept.Conservative dentistry & Endodontics

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Any opposing "plunging cusp" or other pointed cusp may need to be recontoured to reduce the risk of fracture of the new restoration or the cusp from occlusal forces.

Dept.Conservative dentistry & Endodontics

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Initial Tooth Preparation

Dept.Conservative dentistry & Endodontics

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Occlusal outline form (occlusal step).

The occlusal outline form of a Class II tooth preparation for amalgam is similar to that for the Class I tooth preparation.

Using high speed with air-water spray, enter the pit nearest the involved proximal surface with a Dept.Conservative dentistry 5/5/12 & Endodontics punch cut using a No. 245 bur.

The long axis of the bur and the long axis of the crown should remain parallel during cutting procedures.

Proper depth of cut is

the initial entry

1.5 to 2 mm (i.e., one half to two thirds the length of the cutting portion of a No. 245 bur). Dept.Conservative dentistry 5/5/12 & Endodontics

Ideally width of isthmus should be the width of the No. 245 bur.

Narrow restorations provide a greater length of clinical service.

Generally the amount of remaining tooth structure is more important to restoration longevity than the restorative material used.

The pulpal floor should be prepared to a uniform depth and is usually flat.
Dept.Conservative dentistry & Endodontics 5/5/12

Reverse curve is usually created in mesio-facial aspect , parallel to enamel rod direction . Lingually, reverse curve is very slight, often unnecessary.
Dept.Conservative dentistry & Endodontics 5/5/12

Proximal outline form (proximal box)..........

Dept.Conservative dentistry & Endodontics

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The objectives for extension of proximal margins are to:

Include all caries, faults, or existing restorative material.

Create 90-degree cavosurface margins (i.e., Dept.Conservative dentistry 5/5/12 butt joint & Endodontics

Isolation of proximal enamel. A, Bur position to begin proximal ditch cut. B, Proximal ditch is extended gingivally to desired level of gingival wall (i.e., floor). C, Variance in pulpal depth of axiogingival line angle as extension of gingival wall varies: a, at minimal gingival extension; b, at moderate extension; c, at extension in cementum,.

Dept.Conservative dentistry & Endodontics

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Proximal ditch cut results in axial wall that follows outside contour of proximal surface. When small lesion is prepared, gingival margin should clear adjacent tooth by only 0.5 mm.

Dept.Conservative dentistry & Endodontics

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Faciolingual dimension of proximal ditch is greater at gingival than at occlusal level. To further isolate and weaken proximal enamel, bur is moved toward and perpendicular to proximal surface .

Dept.Conservative dentistry & Endodontics

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When a rotary instrument is used in a proximal box after the proximal enamel is removed, there is a danger of the instrument either the adjacent proximal surface

marring

Dept.Conservative dentistry & Endodontics

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Removing isolated enamel

Dept.Conservative dentistry & Endodontics

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Using spoon excavator to fracture out weakened proximal enamel Occlusal view with proximal enamel removed.

Proximal view with proximal enamel removed..

Dept.Conservative dentistry & Endodontics

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Removing remaining undermined proximal enamel with enamel hatchet

Dept.Conservative dentistry & Endodontics

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On facial proximal wall

On lingual proximal wall

On gingival wall
Dept.Conservative dentistry & Endodontics 5/5/12

Primary resistance form is provided by:

The pulpal and gingival walls being relatively flat and perpendicular to forces directed with the long axis of the tooth;

Restricting the occlusal outline form (where Dept.Conservative dentistry 5/5/12

& Endodontics

The reverse curve optimizing the strength of both the amalgam and tooth structure at the junction of the occlusal step and proximal box;

Slightly rounding the internal line angles to reduce stress concentration in tooth structure (automatically created by bur design, except for the axiopulpal line angle); and

Providing enough thickness of restorative material to prevent its fracture under mastication

Dept.Conservative dentistry & Endodontics

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Retention form
Dovetail design. Occlusal convergence.

Dept.Conservative dentistry & Endodontics

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Secondary retention and resistance form

Retention locks, groove, rounden axiopulppal angles.

Dept.Conservative dentistry & Endodontics

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modifications
Simple box preparation-only proximal box Slot preparation-similar to cl V but done at

proximal side oblique ridge

Conservative design-preserves tranverse or Modification to preserve esthetics-45 d

rotation of the box.

Adjoining restoration-joining MO with existing

DO

Modifications for abutment teeth for removal

Dept.Conservative dentistry partial dentures & Endodontics 5/5/12

Final cavity preparation

Removal of remaining defective enamel and

infected carious dentin

Pulp protection Secondary retention and resistance forms Finishing the external walls Cleaning the cavity preparation.

Dept.Conservative dentistry & Endodontics

5/5/12

A, Failure caused by weak enamel margin.

B, Failure caused by weak-amalgam Dept.Conservative dentistry margin.

& Endodontics

C, Proper direction to proximal walls results in full-length enamel rods and 90-degree amalgam at preparation margin. Note also th retention locks have been cut 0.2 mm inside D and their direction of depth is parallel to DEJ.

5/5/12

TOOTH PREPARATION FOR CAST METAL INLAY

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Dept.Conservative dentistry & Endodontics

5/5/12

DEFINITION OF INLAY
Inlay is defined as a fixed intracoronal

restoration, a dental restoration made outside of a tooth to correspond to the form of prepared cavity, which is then luted into the tooth (Rosensteil)

Class II inlay involves occlusal surfaces and

proximal surfaces of a posterior tooth and may cap one or more but not all of the cusps (John R.Sturdevant, Clifford M. Sturdevant)

Dept.Conservative dentistry & Endodontics

5/5/12

Indications
It is an alternative to

amalgam and composite when higher strength and superior control of contours & contacts is desired.
Used instead of amalgam in

patients with low caries rate who require class II with ample supporting dentin Dept.Conservative dentistry
& Endodontics

5/5/12

Contraindications
High caries rate Young patients Esthetic concerns Small restorations Unless sufficient bulk of tooth is there to

provide retention and resistance, it is contraindicated

Dept.Conservative dentistry & Endodontics

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Advantages
Strength Biocompatibility Low wear Control of contours & contacts

Dept.Conservative dentistry & Endodontics

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Disadvantages
Higher chair side time & increased

appointments

Temporary required between preparation &

delivery appointments
Cost factor Technique sensitive

Dept.Conservative dentistry & Endodontics

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Basic concepts of cavity design for cast restoration

Preparation path Inlay taper Preparation features of circumferential tie
Occlusal & gingival Bevels
Types Functions

Facial & lingual Flares

Primary Secondary Dept.Conservative dentistry & Endodontics

5/5/12

Preparation path
Single insertion

path

All reductions

oriented towards one path path of removal & re-insertion should be perpendicular to plane across cusp tips or parallel to

The line of draw

Inlay taper
Apico-occlusal

taper
Cavity walls must

diverge from floor outwards

To permit

unobstructed removal & placement of wax pattern & casting

 According to Sturdevant : 2 5 from line of

draw

Short vertical walls : 2 Long vertical walls : > 2

According to Charbeneau : 10 16 of

convergent angle

5 8 on each wall

Taper may be increased or decreased according to following factors :

Wall length 10) Taper required (<

Surface involvement in preparation required (< 10) Need for retention Taper

Dept.Conservative dentistry & Endodontics

5/5/12

Taper

PREPARATION FEATURES OF CIRCUMFERENTIAL TIE

Circumferential tie peripheral marginal anatomy Features :
Margins terminating on enamel should fulfill requirements

advocated by Noy

In an intracoronal cavity, the circumferential tie is in the

form of a bevel, which is a plane of a cavity wall or floor directed away from cavity preparation
Types Functions

Occlusal & gingival Bevels

Facial & lingual Flares

Primary Secondary

Dept.Conservative dentistry & Endodontics

5/5/12

BEVELS
Flexible extentions

of a cavity preparation, allowing the inclusion of surface defects, supplementary grooves, or other areas on tooth surface.

To provide lap joint

Types & design features of occlusal & gingival bevels

According to their shapes & types of tissue

involvement there are 6 types of bevels :

Partial bevel Short bevel Long bevel Full bevel Counter bevel Hollow ground (concave) bevel
Dept.Conservative dentistry & Endodontics 5/5/12

Partial bevel
Involves : part of

enamel wall ; not exceeding 2/3 of its dimension

Use : to trim weak

enamel rods from margin peripheries

Short bevel
Involves : entire

enamel wall ; but not dentin Class I alloys specially type 1 & 2

Use : mostly with

Long bevel
Involves : all

enamel wall & up to of dentinal wall frequently used for Class I,II & III alloys preserves internal boxed-up resistance &

Use : most

Advantage :

Full bevel
Involves : all the

dentinal & enamel walls of cavity wall or floor impossible to use other bevels deprives the preparation of its internal resistance & retention features

Use : only if

Disadvantage :

Counter bevel
Use : when

capping cusps ; to protect & support them an axial cavity wall on facial or lingual surface of tooth gingival inclination facially

Used opposite to

It will have

Hollow ground (concave) bevel

Any bevel

prepared in concave form

Allows

space for cast material bulk ; improves retention & resistance & V cast materials

Ideal for Class IV

Function of Bevels
Satisfies Noys

requirements
Creates obtuse

angled marginal tooth structure strongest configuration of marginal anatomy

Creates acute angled

marginal cast alloy most amenable to

Function of Bevels
Reduces error

factors (space between cast & tooth substance)

Bevel major

retention form ; here direct retentive frictional component exists between casting & tooth

Types & design features of facial & lingual flares

Flares flat or

concave peripheral portions of facial & lingual walls

2 types :
Primary flare Secondary flare

Primary flare
Conventional & basic part of circumferential tie

facially & lingually

Similar to long bevel Always have specific angulation : 45 to the inner

dentinal wall proper

Functions : (Same as bevels) + they bring proximal margins

to cleansable - finishable areas

Indication : Facial & lingual proximal wall Note :

5/5/12 If theyDept.Conservative dentistry do not fulfill the objectives of preparation & Endodontics

SECONDARY FLARE

Flat plane superimposed peripherally to a primary flare

Solely in enamel ; sometimes may contain dentin

May have different angulations, involvement & extent Functions :

In very widely extended lesions buccolingually

In very broad or malposed contact areas

In ovoid teeth with undercuts at facial & lingual peripheries

Tooth preparation for class II cast metal inlays

Dept.Conservative dentistry & Endodontics

5/5/12

Tooth preparation for class II cast metal inlays

Class II inlay involves

occlusal surfaces and proximaal surfaces of a posterior tooth and may cap one or more but not all of the cusps

Steps :
Initial preparation
Occlusal step Proximal box

Final preparation
Removal of infected

carious dentin & pulp

Initial preparation
Plane cut tapered fissure carbide burs are used to prepare vertical internal walls of the preparation

Throughout the preparation, the cutting instrument used are oriented to a single draw path Gingival to occlusal divergence of walls : 2 5 from line of draw

Dept.Conservative dentistry & Endodontics

5/5/12

Occlusal step

With No. 271 bur enter the fossa / pit to an initial depth of 1.5mm

General rule : long axis of bur parallel to long axis of tooth crown
5/5/12

In mandibular molar & premolar -5 to 10 lingually tilted

Dept.Conservative dentistry & Endodontics

Extend to uninvolved fossa/pit keeping faciolingual width minimum & marginal ridge strong

Dept.Conservative dentistry & Endodontics

5/5/12

If a fissure extends on the mesial marginal ridge, it is treated by :

Enameloplast y

Bevel

Extension to include faulty facial & lingual fissures radiating from mesial pit

& Endodontics

Slender No. 169L bur is used so that tooth structure can be conserved Dept.Conservative dentistry

This provides the desired Dovetail retention form which resists distal displacement of 5/5/12 inlay

The occlusal step is extended distally into distal marginal ridge sufficiently to expose junction of proximal enamel & dentin
Dept.Conservative dentistry & Endodontics

As the preparation is extended distally, the faciolingual width is progressively widened till 5/5/12 proximal

Proximal box

Continuing with 271 bur the distal enamel is isolated by cutting a proximal ditch

Mesiodistal width of ditch : 0.8mm 2/3 at expense of dentin & 1/3 at expense

While penetratin g gingivally, the proximal ditch is extended

Facio & linguoaxial line angles should clear adjacent tooth by 0.2-0.5mm

Make 2 cuts at facial & lingual limit of proximal ditch

Until the bur is nearly through the marginal ridge enamel

Dept.Conservative dentistry & Endodontics

If the wall of enamel is still present, it is broken away using a spoon excavator 5/5/12

Proximal & gingival walls are planed using hand instruments to remove all remaining enamel

Modified palm & thumb grasp used in chisel like motion in occluso gingival direction

No. 15 Straight chisel / Binangle chisel/ Enamel hatchet Dept.Conservative dentistry may be & Endodontics

Gingival wall is planed using a hoe in lingual to facial scraping direction ; Axial wall may be planed with 5/5/12 secondary edge

Shallow (0.3mm) retention grooves may be cut on the facioaxial & linguoaxial line angles with Dept.Conservative dentistry No.169L bur Endodontics &

5/5/12

Final preparation

Removal of infected carious dentin & pulp

protection

Preparation of bevels & flares

Dept.Conservative dentistry & Endodontics

5/5/12

Removal of infected carious dentin & pulp protection

If infected shallow / moderate carious dentin (>= 1mm RDT)

-

Satisfactory isolation

Small round bur(No. 2 or 4) / spoon excavator used Light cure GIC placed as base & excess trimmed with No. Dept.Conservative dentistry 271 bur & Endodontics
-

5/5/12

Preparation of Bevels & Flares

Dept.Conservative dentistry & Endodontics

5/5/12

Preparation of Bevels

Slender flame shaped fine grit diamond is used to bevel

Gingival retraction cord widens sulcus to 0.5mm results in open sulcus improves visibility & prevents injury to gingival

The cavosurface design helps seal & protect margins & results in strong enamel margin with an angle on 140 150 To place gingival bevel - The instrument is held parallel to gingival third of proximal surface of adjacent tooth If the bur is tilted lingually / buccally, undercut will Dept.Conservative dentistry of5/5/12 be created at corners the & Endodontics box (commonly seen fault) The bevel should result in 30 40marginal metal on inlay

Preparation of Flares

Dept.Conservative dentistry & Endodontics

5/5/12

Distolingual wall extends into lingual embrasure in 2 planes : 1st termed lingual primary flare

No. 169L or paper disc Slender flame shaped fine grit diamond

2nd termed can be used to prepare lingual Dept.Conservative dentistry 5/5/12 secondary flare secondary flareEndodontics &

Secondary flare are directed to result in 40 marginal metal & 140 marginal enamel

The lingual secondary flare is prepared approaching from lingual embrasure moving the instrument mesiofacially

Dept.Conservative dentistry & Endodontics

5/5/12

Preparation of facial secondary flare

Long axis of instrument is along the line of draw with only small tilting mesially & facially

& Endodontics

To prevent abrasion to adjacent tooth the instrument may be raised occlusally Dept.Conservative dentistry

40 marginal metal should result

Completed 5/5/12 facial

Gingival bevel Should result in 30 marginal metal Instrument is tilted slightly mesially 0.5-1mm wide Should blend with lingual secondary flare

Dept.Conservative dentistry & Endodontics

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Difference between preparation for amalgam and inlay

Dept.Conservative dentistry & Endodontics

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INLAY PREPARATION May Support tooth

AMALGAM PREPARATION Preparation supported by tooth

Retention achieved by nearly parallel From parallel walls & undercuts opposing walls ; close adaptation of casting ; cementing medium Good Resistance to occlusal forces Narrower Isthmus width All Margins beveled No Reverse Curve Requires right angle margins Present Poor resistance to occlusal forces

More extensive Proximal outline (0.50.5mm clearance 1mm) [access for disking, finishing, home [access for finishing, home care ] care ] Rounded Gingival cavosurface point anglesDefinite angle [for ease of [for ease of finishing gold] condensing amalgam]
Dept.Conservative 5/5/12 Proximal outline diverges occlusally dentistry Converges & Endodontics

INLAY PREPARATION

AMALGAM PREPARATION

Preparation must draw ; no undercuts Gingival wall in 2 planes

Preparation must not draw ; retentive undercuts placed Flat gingival wall

Axiopulpal line angle is Axiopulpal line angle is rounded to prevent voids in the rounded to prevent stress on working die amalgam All margins are beveled No cavosurface bevels

Dept.Conservative dentistry & Endodontics

5/5/12

Thank you

Dept.Conservative dentistry & Endodontics

5/5/12