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Lecture (7)

Class I cavity preparation for amalgam restoration

done by:
operative dentistry group
( ^_^ )
Summary of
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Indications:
Moderate to large restorations
Restorations are not in a highly esthetic area
Restorations that have heavy occlusal forces
When good isolation can not be achieved
As foundations
As abutments.

Contraindications : " not to be use"
Esthetic areas
Small to moderate cavities which can be well isolated
Small class VI lesions.
Class III, IV and V in anterior teeth.


Class 1 cavity preparation

Characters of caries:
Two opposite cones with their base at the DEJ.
Cone shaped spread in enamel with the base at the DEJ and
small opening.
Cone shaped spread in dentin with base at the DEJ.
Rapid lateral spread at DEJ.










4.Class one
lingual
cavity in
anterior
teeth
2. class 1
extension
cavity

3. class 1
buccal pit
cavity

1. Class 1
simple cavity
Designs of
class 1 cavity
preparation
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Clinical technique/tooth preparation :
Outline form:
Place margins in sound tooth structure
Cavity margins must be placed at contact free areas
Conserve ridges involved in occlusal contacts
Include all defective pits and fissures.

Resistance form
Create flat pulpal floor perpendicular to the long
axis of the tooth.
Prepare walls that create 90 degrees cavo-surface
margins of amalgam
Prepare pulpal floor so that adequate depth exists
for strength of amalgam (1.5mm)
Preserve adequate bulk of mesial and distal
marginal ridges(minimum of 1.6mm width):
FLARED







Extend lateral walls minimally.
Round all internal line angles( prevent stress areas).




Retention form
Create walls that are parallel to each other, or slightly
convergent in an occlusal direction

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Finishing and planing of enamel walls
Remove all unsupported enamel rods
Enamel rods forming Cavo-Surface angle must be full
length rods resting on sound dentin (or shortened
rods resting on sound dentin and covered and
supported by the restoration (Noy's principles)
Place Cavo-Surface margins so that amalgam can be
adequately carved and finished.

Features of prepared cavity :
Outline of the cavity is placed equidistant from the center of the groove.
Buccolingual width of 1.5mm through central groove.
Buccolingual width of 1mm in other extensions.
Pulpal floor is placed in dentin, 1.5mm from the enamel
surface of the central groove or 0.5 to 1mm below DEJ.
Pulpal floor is flat
*Parallel to the occlusal plane of the tooth
*Perpendicular to the long axis of the tooth
Extremities of facial and lingual grooves, and walls adjacent to mesial
and distal marginal ridges are prepared at 95 degrees to the
pulpal floor.
This results in a slight flare in these areas.


Note: Retention for composite is not the same as amalgam ,,,Composite has
(Micromechanical retention by acid etching &bonding that flows in the dentinal
Tubules& attaches the composite to the tooth bulk ) Whereas the Amalgam is
bonded by Mechanical retention.
**The shape of preparation gives stability to the restoration .
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Cavity preparation:
Pencil the defective grooves on the occlusal surface of
the tooth.
Do not include supplemental grooves.
Position the round bur above the central pit so that the bur is
perpendicular to the occlusal surface for gaining access.
Switch to fissure bur (1mm in diameter).
Move the bur along the fissures and grooves where the pencil
markings are, maintaining your depth of 1.5mm, applying
intermittent pressure.




Make sure that the bur is always PERPENDICULAR to the
occlusal surface.
Do not make the cavity wider than the width of the bur.
Do not go deeper than indicated (1.5mm).
Walls must be parallel or convergent occlusaly except at(M&D).......
Eliminate any sharp corners of the cavosurface outline (reduce
the speed of the hp).
Remove any debris.


Central pit
Notes : Before doing the preparation We use the (Waxing paper ) &
ask the patient to Bite ,then the cusps will demark on the paper , So I can
not put the margins of Amalgam in this area .& I avoid this area because the
force consuntrated in this area .
,So We have to be very conservative maintain the main tooth criteria (like
Cusps, transverse &oblique ridges) involve in occlusal contact should be
preserved ,

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Procedures
Gaining access is done using a suitable sized round bur
the direction of cutting is parallel to the long axis of the
tooth until reaching the dentin. The cutting is done
through the weakest portion of the tooth,i.e: Central or
proximal triangular fossa.


Lateral extension of the cavity to include all pits and
fissures is done using inverted cone bur.
Proximally; the extension is done midway between the
marginal ridge and the proximal triangular fossa . Buccally
and lingually , the extension should not exceed the
intercuspal distance. The cutting is performed through
the dentin upward to remove enamel, which becomes
undermined.

Finishing of the cavity walls and margins is performed using a cylindrical
fissure bur . the bucco-lingual dimension of the cavity is 1/4 1/3 the
intercuspal distance . while the depth cavity is from 0.5-1 mm beyond
the DEJ.
The direction of the buccle and lingual walls of the finished cavity are
converging occlusally, while the distal and mesial walls are diverging
occlusally.






parallel or perpendicular All walls in the cavity should be smooth , Notes:
on tooth to prevent analysis of masticatory forces, for instance the pulpal floor
should be perpendicular on to the Long axis of the tooth & Parallel to the occlusal
surface .

** Amalgam is Brittlness that mean its compressive strength High & tensile
strength Low ..,So the Amalgam should put in abulk cavity at least (1.5mm -
2mm).,otherwise ,Amalgam will be Fracture .
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The cavo-surface angle of the finished cavity is 90
- Note :

Cavity wall should follow the enamel rods direction ..
~**What are or( How many factor in the outline forms ??
`-extention of the lesion
- Pits & Fissure which reach to Dentin .
`- Occlusal anatomy.

**Pulp & Dentin ..act as aUNIT.
Resistance form>>it a form given to cavity to prevent tooth fracture of
restoration..

Resistance >>>>buccal -lingual wall (straight or converge) mesial-distal wall
(diverge)

**Class1 cavity preparation is sweeping cures (no sharp angels)(MCQ)













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Lecture (12)

Class I Cavity Preparation for Amalgam (2)
with extension

done by:
operative dentistry group
( ^_^ )
Summary of
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Class I Cavity Preparation for Amalgam



Indications of amalgam restoration:
- Moderate to large restorations.
- Restorations are not in a highly esthetic area.
- Restorations that have heavy occlusal forces.
- When good isolations cannot be achieved.
- As foundations.
- As abutments.








Contraindication of amalgam restoration:
- Esthetic areas (anterior teeth).
- Small to moderate cavities which can be well isolate.
- Small class VI lesions.
- Class III, IV and V in anterior teeth.
- when other dissimilar metallic restoration is present in the oral cavity due
to galvanic action.


Notes :Clinical indications for amalgam : Class I , II & V of lower teeth or upper teeth when
isolation for a composite restoration can't be achieved .

O There is a big controversy about the distal of the canine , Now 80% we use composite , some
use amalgam due to its small size and its location by an angulation that doesnt make amalgam
appear and rune the aesthetic appearance .

O Forces are subjected on the canine by an angulation , so wear of a restoration on the distal side
can occur . If the contact of the canine with the tooth number 4 is not properly closed it may lead
to drifting of the upper teeth , especially when 8 starts to erupt but doesnt find place for its
eruption , so it pushes 7 which pushes 6 --- 5 --- 4 on the canine , If the canine wasnt strong
enough crowding of the anterior teeth will occur .





Notes : The contraindications for the use of amalgam: In any aesthetic area even if it
was on the occlusal side . (Thats why laughter and opening of both male and female patients
mouth should be examined before starting , and dont forget to put it mind the patients
economic state he/she might not be able to pay for the composite).


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1) Class I cavity preparation:
Characters of caries:
- Two opposite cones with their base at the DEJ.
- Cone shaped spread in enamel with the base at the DEJ and small openings.
- Cone shaped spread in dentin with the base at the DEJ.
- Rapid lateral spread at DEJ.
Designs of class I cavity preparation:
It may be:
1. Class I simple cavity.
2. Class I extension cavity (compound).
3. Class I facial pit cavity (simple).
4. Class I lingual cavity in anterior teeth.
Clinical technique / tooth preparation: Outline form:
- Place margins in sound tooth structure.
- Cavity margins must be placed at contact - free areas.
- Conserve ridges involved in occlusal contact.
- Include all defective pits and fissures.

Outline form:
-Should include:
- All carious and undermined enamel.
- All pits & fissures.
-Should be:
- Extended to area self-cleansable.
- Multi curved without any sharp line angles to prevent stress concentration.
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-Bucco - lingually:
- Should not extend beyond the inter-cuspal line except if there is caries.
- Minimal width of the cavity about 1/4 - 1/3 the inter-cuspal distance.
-Mesio - distally:
- Should be extended midway between the triangular and the crest of the marginal
ridge.
Resistance form:
- Maximum conservation of sound tooth structure.
- CSA = 90 degrees.
- Minimal cavity width.
- Flat and smooth pulpal floor parallel to the occlusal plane.
- Roundation of axial line angles.
- Providing bulk through the cavity depth (0.5 - 1mm beyond the DEJ).
- Create flat pulpal floor perpendicular to the long axis of the tooth.
- Prepare walls that create 90 degrees cavosurface margins of amalgam.
- Prepare pulpal floor so that adequate depth exists for strength of
amalgam (1.5mm).
- Preserve adequate bulk of mesial and distal marginal ridges (minimum of
1.6 mm width): flared.
- Extend lateral walls minimally.
- Round all internal line angles (prevent stress areas).
Retention form:
- Only against axial displacement in the form of mechanical undercuts in
dentin by converging the cavity walls.
- Create walls that are parallel to each other, or slightly convergent in an
occlusal direction.

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Convenience form:
- No need for convenience in class I cavity preparation as it is easily seen
and instrumented.
Finishing of enamel wall:

- The enamel wall should take the same direction of enamel rods without
undermining.
- CSA should be 90 degrees.
- Buccal and lingual wall will be converging occlusally.
- Mesial and distal will be diverged occlusally.
- Remove all unsupported enamel rods.
- Enamel rods forming CSA must be full length rods resting on sound dentin
or shortened rods resting on sound dentin and covered and supported by
the restoration (Noy's principles) .
- Place cavosurface margins so that amalgam can be adequately carved and
finished.
Features of prepared cavity:
- Outline of the cavity is placed equidistant from the center of the groove.
- Bucco-lingual width of 1.5 mm through central groove.
- Bucco-lingual width of 1 mm through other extensions.
- Pulpal floor is placed 1.5 mm from the enamel surface.
- Pulpal floor is flat :
- Parallel to the occlusal plane of the tooth.
- Perpendicular to the long axis of the tooth.
- Extremities of facial and lingual grooves and walls adjacent to mesial and
distal marginal ridges are prepared at 95 degrees to the pulpal floor.
- This results in a slight flare in these areas.
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Cavity preparation:
- Pencil the defective grooves on the occlusal surface of the tooth.
- Do not include supplemental grooves.
- Position the round bur above the central pit so that the bur is perpendicular to
the occlusal surface.
- Enter with the bur to approximately 1.5 mm.
- Switch to fissure bur (1mm in diameter).
- Move the bur along the fissures and grooves where the pencil markings are,
maintaining your depth of 1.5mm, applying light intermittent pressure.
- Make sure that the bur is always perpendicular to the occlusal surface.
- Do not make the cavity wider than the width of the bur.
- Do not go deeper than indicated (1.5mm).
- Walls must be parallel or convergent occlusally except at mesial & distal.
- Eliminate any sharp corners of the cavosurface outline (reduce the speed
of the hp).
- Remove any debris.
2) Class 1 extension cavity:
Indications:
- Deep caries in buccal or/and lingual pits.
- Deep fissure or groove extended from the occlusal to the lingual or/and
facial surfaces.
- Fissure crossing the oblique ridge in upper molars.
- When the remaining oblique ridge in upper molars or transverse ridge in
lower premolars is weak it must be included in the cavity outline to avoid
its fracture.

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Outline form:
The same as simple class | cavity preparation in addition to :
-Extension to include the carious or retentive area.
Notes: Class I extension cavities :
1) Pits and fissures on the occlusal surface ( center or in the occ. 2/3 coming from the buccal or
lingual , and this is a COMPOUND cavity )
2) Buccal pit or lingual pit of anterior teeth


Notes :O The step is mainly to protect the pulp from exposure .
O The extension buccaly or lingual is with step or with out

depends on the caries , if it was near the cervical we will need to do a step , If the caries was at
the height of contour step is not needed.
The extension buccaly or lingual is with step or with out

eans that when we are cutting we should not hurt the gingiva m Biological concept O : Notes
nor the pulp HOW ?? By cutting in an ( in-out , in-out )way for cooling , use a coolant
ex.water , use new burrs if the burr was blocked it will regenerate heat which leads to formation
of dead tracts and death of the pulp afterward and the patient goes into irreversible pulpitis ,

as the outline ex. in lower 6 the occlusal outline is the same as class I , Mechanical concepts O
the extension is between the mesial and central cusp with parallel walls when there is no step
(when the caries is at the same level as the height of contour )

happens when microns of the dentin is removed and the pulp tissue Exposure of the pulp O
becomes impact ( The pressure of the pulp is lower than the pressure of the atmosphere so any
exposure of the pulp even if it was microscopicly it will increase the pressure on the pulp and
nourishment does not reach the odontoblasts and the tooth starts to enter the sequence of the
degeneration , necrosis and abscess formation


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-it may be extended : a)with step forming axial wall and gingival floor.
b)without step: in cases showing extended caries or fissure at the level
of the pulpal floor.
** the formed step will provide :including the caries or retentive area
without endangering the pulp.
Resistance form:
The same as simple class I cavity in addition to:
- Roundation ofAxio-pulpal line angle to:
1. Prevent stress concentration.
2. Provide bulk to the restoration.
-The axial wall direction should be parallel to the corresponding external
tooth surface, i.e. convex (mesio - distally), in order to:
1. Prevent pulp exposure.
2. Provide uniform thickness of the restoration.










Retention form:
The same as simple class I cavity in addition to:
- Parallel mesial and distal walls (coefficient of friction).
: Notes
: its the form given to the teeth to resist and prevent mainly fracture of the Resistance form
tooth than fracture of the restoration Remember the "" Luggage and home ""
OAll the walls of the cavity should be parallel or perpendicular to the long axis of the tooth
WHY ?? So analysis of the forces does not occur. And they should be smooth and flat .
O When the analysis occur that mean there is a high destructed force has component more than
descending force
O The concentration of the stress occurs when we have rough surface ,
inclination also leads to fracture of both the tooth and restoration (due to disturbans of the force)
.
O The bulk should be at least 2 mm in amalgam to prevent fracture .
No undermined enamel ( Has no SOUND dentin under it ) and no loose enamel rods the rods
should be resting on sound dentin ( we get rid of the loose enamel rods by using the hatchet and
the gingival marginal trimmer)



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- Occlusal lock against lateral displacement.
- Extension for retention to the other opposing surface to provide
lateral retention in extensive cavities. Efficient.






Convenience form:
The same as simple class I cavity.
Finishing of enamel wall:
The same as simple class I cavity in addition to:
- The mesial and distal walls of the extension will be completely parallel
to each other and to the long axis of the tooth.
- The gingival floor will be slightly slanting gingivally to be in the same
direction as the enamel rods.
Note: class I extension can be: with step or without step (done in practical).










in its place screwing ( dont move right holding the restoration : Retention form = Notes
or left or rotate )to prevent entry of food & axial dislodgment
retention . prevent difference between the tooth & restoration Coefficient of friction O
retention . provide ls of the wal parallism In proximal portion The O
retention . provide ) Locking Occlusal restoration ( O

:O (Latrel desplacment is always the proplem in restoration such as amalgam .
O (the is NO undercut in buccal extantion because ,if we do the undercut the undermind
enamel will occur so the tooth will be fracture .
O ( the undercut in class I )


Notes :
why we said " pulpal floor is placed 1.5 mm from the enamel surface "?? O
Because thiknes of enamel in gingival floor toward the cervical will decres =0.5 ,, with 1mm
below DEJ =1.5mm which give enough bulk to amalgam .
O The buccal extantion should be Equedistance between M& D cusps ) : Notes
= That mean the distance from the M =the distance from the D ) this distance = 1.5
mm.
e Very Very IMP in MCQ the axial wall in class I with step should be slitly
Convex " mesio distaly "..(why??) to give thiknes to dentin bridge "" dentin bridge
mean the amount of dentin which protect the pulp ..

.. "
.. ..
( +DEJ
( )



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3) Class I facial pit cavity:
-Buccal pit mostly occur in lower mandibular molars.
-It is designed as a simple oval cavity limited to the carious pit and having
the following features:
1. Walls of the cavity slight converge buccally to provide retention.
2. Axial wall parallel to the facial surface of the tooth in mandibular
molars , convex mesio-distally.







4) Class I lingual pit cavity:
- While lingual pit mostly occurs in maxillary molars.
- It is designed as a simple round cavity limited to the carious pit and having
the following features:
1. Walls of the cavity slight converge lingually to provide retention.
2. Axial wall parallel to the lingual surface of the tooth, convex mesio-
distally.


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Lecture (18)
Class V cavity preparation

done by:
operative dentistry female group
(^_^)
Summary of
DENT11
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Class V Cavity Preparation





Characters of caries:
-Starts as white or chalky line near the center of the gingival third.
(Persisting white chalk = CARIES NOT INCIDEOUS!)
-Marked sensitivity.
-Tendency to spread mesially and distally near the axial line angles of the
tooth.
-Teeth with marked convexity are more susceptible for caries , due to food
accomulation.
-Less frequent than other types of caries.
-Usually affects multiple teeth not like other classes they may affect one
teeth only.
-More frequent among old aged patients and is called "senile caries".








Notes: Introduction :
Nowadays Class V is usually used in anterior.
Class V can be used in posterior restoration in some situations such as bad oral hygiene ,
First we have to treat patients with bad oral hygiene by : going on a special diet ,close & seal all
the cavities , seal pits & fissures and use fluoride .
If the hygiene is better we use aesthetic restorations , If not (if its still bad) we use amalgam
restorations.
e How do we know if the oral hygiene is better or not ? By the count of streptococcus meatus
lactobacilli ( which lead to caries).
Notes :White legion(=sensitive tooth) starts at the cervical region facially and
lingualy of all teeth .
The free gingiva acts as a shelf for food and it might extend to the proximal : its
called unilateral extension if it was from one side & Bilateral extension if it was
from both sides. Class V and extension occurred .
Frequent among old age WHY ? due to recession of the gingiva (it loses its cells) ----
The root is rough ---- which leads to food accumulation and dental plaque.
Fibers (in elderlies) which is hard
& difficult to repair , it takes time . While in young individuals cells are repaired
fast and easily.

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Outline form:
-Usually described as trapezoidal outline with rounded corners , which may
be modified by an added box extension to involve proximal caries.
(Class V has 4 point angles + 8 line angles)
Occlusal wall: Parallel to the occlusal plane and placed at or
just occlusal to the height of contour
.


Gingival wall: Straight and parallel to the occlusal plane
placed just beneath the gingival margin.








Proximal walls (Mesial & Distal) : Straight and parallel to the
direction of the corresponding proximal.
placed at the line angles of the tooth.



Axial wall (from inside) : 1 mm beyond (=bellow) the DEJ.
convex mesio-distally.
straight occluso-gingivally.



Notes: The location of the gingival wall of Class V : Above the cervical (free
gingiva) by 1-2mm.
O In Class II : Above the crest of the ridge by 0.5 mm.
O RULE: in any class with a gingival floor near the free gingiva it should be
beneath (=at the top of the crest or 0.5mm above the crest of the ridge ; in class
II restorations ) Why dont we put the restoration lower ?? Because
restorations are considered as a foreign body which may lead to irritation on
free gingival rescission chemicals
or its a rough surface
O Parallel to the occlusal plane , parallel to the occ. Wall
Notes: The location : Bellow the height of contour or at the height of
contour or maximum at the height of contour.

Notes:Just before the line angles of the tooth , between the faciodistal line angle &
faciomesial line angles of the surface of the tooth .
*Diverge occlusaly (because the line angles are diverge .

Notes: All axial walls are always CONVEX why?? Because if it was straight the
dentin bridge will have less and uneven (Not even) thickness of the restoration than if
it was convex , this may lead to fracture of the restoration (this is in resistance) .
OThe convexity provides even thickness of the restoration .

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Resistance form:
CSA 90.
Bulk of restoration.
No need for additional resistance, as the force applied on this area is
only the lip and cheek musculature force.





Retention form:
-Grooves in the occluso-axial and gingivo-axial line angles are
placed in the expense of the occlusal and gingival walls rather
than the axial wall. (axio-occlusal and axio-cervical line angles)







Convenience form:
-No need for convenience in class cavity preparation.






Notes : Remember the story of the house & luggage,
, Luggage = the Restoration )
(house = Structure of the tooth ,which is the more important
O If we increase the amalgam depth the tensile strength multiply by 2 )
( (Tension
Notes :Retention = to retain the restoration in stability form )
To prevent the retention in class V Retentive groove . : O
OThere is something called 'flexural stresses !! that mean when the
restoration put in class V it press on enamel then dentin but the dentin
have "Visco elasticity property" which help dentin to push the
restoration out of the cavity (Lateral displacement )
O If we put the retentive groove in M or D walls the enamel in M
& D walls become under mind So the tooth may be fracture


Notes : the aim of convenience form is : (:
excitability & workability.
e Which classes have Convenience form ?? +e IMP
O-Class II O -Class III O -may be class IV
eIn class VThe occlusal or incisive wall should be parallel to occlusal or
incisive Why ??
To prevent force analyses -
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Finishing of the enamel wall:
-CSA 90.
-Occlusal and gingival walls will be straight and parallel to the occlusal plane.
-Proximal walls will be slightly diverging outwards to outward (follow the
enamel rods)



class V cavity preparation:
1- Access to dentin is gained by a round bur, then the cavity outline is
extended using an inverted
cone bur or fissure to a trapezoidal shape with rounded corner of a
width just enough to include the lesion.
2- The walls are flared and finished parallel to the enamel rods with a
fissure bur.
The floor is made convex in all directions following the pulpal anatomy by
an inverted cone.
3- An small round bur is used to place incisal and gingival retentive
grooves in dentin at the
pulpal line angles and below the DEJ.
e Attention plz (the doctor said in any grooves we use small round
bur & tapered bur but in class V we will use small round bur )



Note :
class V have:
line 8 Walls ., & 5 ., wall axial at point angles 4 O
angles
Notes :
If the material Brittle like amalgam the CSA should be 90 degree .