Principles of Cavity Preparation

Last lecture we stopped at burs , now we will continue :

Burs are composed of three parts :
1) shank : which is fixed on the hand piece.
2) Neck : that connects the head to the shank and transmit the
force to the head.
3) Head : the working part of the bur.
hen we put the bur in the hand piece the force come from the hand
piece to the shank then from the shank to the head b! the neck.
Burs can be classified according to two things :
1) Head of bur : "s we call them in the lab , we ha#e fissure
bur, round bur, pear shaped.
2) Number : unfortunatel! we don$t use the number.
e ha#e a lot of burs but at this picture we %ust ha#e the basic burs that
we use in the clinic and it$s important to know them, and to know that
most of them are made from Tungsten carbide.
&he number of 'ear
shaped bur is 33( .
e ha#e :
1) )ound : we ha#e high*speed and slow*speed + its head is
round )
2) ,n#erted cone : also we ha#e high*speed and slow*speed.
+the tip is larger than the base so we call it in#erted )
3) 'ear shaped : because it looks like the pear.
-) .traight fissure : because it$s straight from both sides.
/) &apered fissure : the base is broad and the apex is tapered.
Recommended burs
0rom left to the right : first four are round but the! are differ from each
other b! the si1e of the head + 2 , 3 , 2 , - , 4, 5 ) .
6umber / is in#erted, number 4 is tapered, number 7 is straight , number
5 is tapered, the last is straight.
888 9on$t care about the number we %ust need the shape.
Finishing burs :
&he! are tungsten carbide also , but we call them finishing burs , we use
them to finish restoration + composite , amalgam) , the! come in se#eral
si1e and shaped , we ha#e :
1) )ound
2) &orpedo
3) &apered
Instrument grasps
*,t$s #er! important because !ou will take the grasp like a habit so !ou
must learn the correct grasp .
*&he more efficient grasp is the pen grasp + we use it as the pen and we
use the rest of our fingers to rest so we will ha#e more support and we
can control the hand pieces better and we will not harm the patient$s oral
ca#it!) .
*e ha#e the palm and thumb grasp but it$s less supporti#e.
.o please an! instrument in the lab use the pen grasp.
6ow we are going to start the new lecture .
Principles of cavity preparation
1* :b%ecti#e of tooth preparation
2* 0actors affecting !our tooth preparation
&he! come in mini;small si1e and ha#e
more blades than normal so cutting
efficienc! is more and we use them in
finishing and polishing.
3* .tages and steps of tooth preparation
tages and steps of tooth preparation
&he doctor now doesn$t follow them because she has the experience but
for us we ha#e to follow them to learn.
0or example in the lab we drill all fissures in tooth preparation but in the
clinic we %ust include the fissures that contain the caries onl! so we will
be more conser#ati#e, but here we learn the ideal ca#it! preparation.
!efinition of tooth preparation : &he mechanical alteration of defecti#e,
in%ured, or diseased tooth to best recei#e a restorati#e material that will
reestablish a health! state for the tooth, including esthetic corrections
where indicated, along with normal form and function.
"hy #e do the cavity preparation $$
&o remo#e the defect from the tooth whether this defect is caries, trauma,
or congenital defect of the tooth , so we want to remo#e this defect, and
put it in a form or a shape that will recei#e the restorati#e materials + like
what we do in amalgam, we prepare the tooth with depth < 1./mm if the
depth is less the amalgam will fracture) so we are prepare a certain shape
to recei#e the restorati#e material to return the tooth to its normal shape
and function + like making fissures, groo#es, slope of the cusps, line of
cusps.. ) and esthetic + when we use composite it$s not %ust for function
but also for esthetic)
The ob%ective :
1* )emo#e all defects = pro#ide necessar! protection to the
pulp.
2* >xtend the restoration as conser#ati#el! as possible
( because once you remove the tooth structure you remove it from
the residual of the tooth and you will in more danger when you are
close to the pulp).
3* 0orm the tooth preparation so that under masticator! forces
the tooth or restoration will not fracture or the restoration will not
be displaced.( when we form tooth preparation we have two forms:
resistance form and retention form )
***Resistance form : to resist fracture of bone, tooth and
restoration.
***Retention form : to avoid removal of the restoration from the
tooth.
-* "llow for functional = esthetic placement of restorati#e
material.
Factors affecting tooth preparation :
&' !iagnosis : , will not hold the burs and start drilling the
tooth without knowing the cause of the problem or knowing the
proper diagnosis of the tooth in the patient$s mouth in the patient
so we are treating the patient.
&he reason for placing the restoration in the tooth :
why we will do this cavity ? I want just to return the
function ? or I care about the esthetic only ? to protect the
pulp ?? you need to kno# the ans#ers for these
(uestions before doing the cavity@
'eriodontal = pulpal status : its very important ( for
example if the tooth has a class caries and needs cavity
preparation and restoration but at the same time this tooth
is hopeless for example it is moving because there is a
periodontal disease and its suppose that it will not last
more than ! months in the patients mouth" so we need to
ma#e $%& after the restoration " we will drill the
restoration again then ma#e $%&. so we need to #now the
status of the tooth before doing the cavity.
>sthetic factor: it depends on the patient.
)elationship with other treatment plans.
&he risk potential of the patient for other dental caries
: some patients we considered them as high ris# of caries
so we place any restoration that could release fluoride li#e
modified glass ionomer cement .
)' *no#ledge of !ental +natomy:
hen !ou prepare the ca#it! we need to know the
dental anatom! + enamel , dentin , pulp) , we need to know
that the thickness of enamel in the occlusal part is thicker
than in the cer#ical part, so when we are drilling 1./mm in
the occlusal surface ma!be we are not in the dentin but in the
cer#ical part we are sure that we are in the dentin and close
to the pulp.
"lso when we prepare a tooth we will consider a
!oung patient differs from an old patient #hy$$ Because
with age we will ha#e Recession for the pulp + decreasing in
the si1e of the pulp) because we are ha#ing secondar!
dentin, tertiar! dentine so !ou are ha#ing more tooth
structure to work with in old patient because of the thickness
of dentin and the height of the pulp will be changed.
,' Patient Factors:
The patient kno#ledge - appreciation for good dental
health. ( if the patient has more #nowledge about oral hygiene
so we will thin# about using a good restorative material which
could be expensive" but if the patient doesnt brush his teeth or
doesnt #now about the oral hygiene we will use a less
expensive material) .
Patient.s economic status : you shouldnt ma#e any
treatment or restoration before as#ing the patient and telling
him how much it will cost.
Aross picture of the tooth both
internall! and externall! must
be #isuali1ed.
&he thickness of enamel,
dentin and position of the
pulp.
)elation to other supporting
tissues + when we prepare tooth
near the supporting tissue like
deep class 2 or deep class / ) .
The patient age: related to the anatomy and to the life
expectancy" for example if the patient is very old and has a lot
of health disease so we put a good restoration but not very
expensive and could be for a short time ( for example if I have a
patient ('( years old) and has many medical problems and
needs )*+ restoration so Ill not ma#e a crown for him or use
amalgam" I just use ,I% because its less expensive and can be
useful for him and will not ta#e a long time to use it ).
/' 0onservation of Tooth tructure:
"e #ant to make the cavity in a form that is proper for the
material but #e should be conservative.
'reser#ation of the #italit! of the tooth b! a#oiding
the application of poor or careless operati#e procedures on
the tooth .
)estorations should be made as small as possible :
( should be convenient and restorative - I mean as small as
possible and in the form of retention and restoration)
.mall tooth preparations result in restorations that
has little effect on both inter/arch 0 intra/arch relationships
as well as esthetics. : when we ma#e a restoration as small
as possible it affects the adjacent teeth(adjacent teeth
:intra/arch relationship )" the opposing teeth(apposing teeth
: inter/arch relationship) and on the esthetic. when we drill
the occlusal surface we remove the fissures and grooves" so
it has a little effect than if we replace a cusp- because as
much as we do we will not return it to the normal shape of
the tooth . we try to do that but we cant do it ((1 . In
intra/arch when we do class ! cavity then it will affect the
adjacent tooth " if it is small the effect will be less but if its
big the interference will be large. So hen you ma!e a
restoration ma!e it small as possible as you can to ma!e
the interference less .
1' Restorative 2aterial Factors:
Bainl! we are talking about direct restorati#e materials.
"malgam Cs resin composite. &o some extend glass
ionomer cement. + demands for ca#it! preparation for amalgam
will differ from the composite because the amalgam has a
mechanical retention but the composite has a micromechanical
retention + can adhere to the tooth) so the criteria for preparing
the ca#it! will differ)
&he abilit! to isolate the operating field.
&he extension of the problem +i.e. caries).
tages and teps of Tooth Preparation
.tages and steps of tooth preparation
,nitial .tage
:utline form = initial
depth.
'rimar! resistance form.
'rimar! retention form.
Don#enience form.
final .tage
/. )emo#al of an! remaining
infected dentin.
4. 'ulp protection if indicated
7. .econdar! resistance =
retention forms.
5. 'rocedures for finishing
external walls .
E. 0inal procedures: cleaning,
inspecting = sealing.
Fou ha#e to follow
these stages because
!ou are still a
student so when !ou
are doing the ca#it!
!ou need to #isuali1e
these steps.
a'Initial Tooth Preparation tage:
&. 3utline form - initial depth:
4ach cavity has its o#n out line form
'lacing the preparation margins in the positions the!
will occup! in the final preparation : ,$m drawing the outline
and he borders + where ,$m going to stop)
'reparing an initial depth of (.2 to (.5 mm pulpall! of
the 9>G position : , don$t go to the full depth at the
beginning, , should go to the initial depth and this initial
depth is different when ,$m doing class 1 or class / because
the thickness of enamel is different, so in class 1 most of m!
ca#it! preparation will be in the enamel but in class / it will
be in dentin.
"hy #.$ to #.% &&
(.2mm inside 9>G when ,$m going to make class1 occlusal!,
(.5mm in class /, that$s mean ,$ll be in dentin in class / for
(.5mm but in class1 ,$ll be slightl! in the dentine %ust for
(.!mm. + look at the picture below)
, principles to put the initial depth and the outline :
&. +ll #eakened enamel should be removed.+ because this
enamel ma!be break in the future )
2. +ll faults should be included.+ all groo#es and fissure )
,. +ll margins should be placed in position to afford
good finishing of the margins of the restoration + ,$ll not
lea#e the border of m! ca#it! at a fissure but at smooth
surface so the finishing will be easier)
The end
Done by : Haneen Zuhdi Al-kwamleh
Thx a lot Walaa Khdour for the help

Walaa and Eman : Best

friends are like diamonds,
precious and rare.