Operative Denti

stry

Definition of Operative Dentistr

y
Operative dentistry is
the ART and SCIENCE of the
diagnosis, treatment, prognosis
of defects of teeth which do not
require full coverage restoration
s for correction.

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Indication of Operative Dentis

try
Caries;

Malformed, discolored,
or fractured teeth;
Restoration replacement.

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Program of Operative Treatme

nt

Patient assessment
Examination and diagnosis
Treatment planning
Pain control: local anesthetic
Isolation of the operating field

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Program of Operative Treatment

Cavity preparation
Matrix application
Preparation of materials
Insertion and carving of materials
Finishing and Polishing
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Cavity Preparation
The mechanical alteration of a def
ective, injured, or diseased tooth in
order to best receive a restorative
material which will re-establish a h
ealthy state for the tooth including
esthetic corrections where indicate
d, along with normal form and func
tion.
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Cavity Structure

walls
angles
cavity

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Classification of cavity

Class
Class
Class
Class
Class
Class

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I
II
III
IV
V
VI
G.V.Black in 1908
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Cavity
Simple cavity: only one tooth surfac
e is involved.
Compound cavity: two surfaces are i
nvolved.
Complex cavity: three or more surfa
ces are involved.

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Let us Classify The Cavities

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Class 1
Class 6
Class 1

Class 4
Class 3

Class 2

Class 2

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Class 5

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Stages and Steps

in Cavity Preparation
Initial cavity preparation stage
Final cavity preparation stage

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Initial cavity preparation stage

Step 1
Step 2
Step 3
Step 4

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Outline form and initial depth

Primary resistance form
Primary retention form
Convenience form

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Final cavity preparation stage

Step 5 Removal of any remaining infected
dentin if indicated
Step 6 Pulp protection
Step 7 Secondary resistance & retention form
Step 8 Procedure for finishing external walls
Step 9 Final procedures

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Initial cavity preparation stage

Step 1
Step 2
Step 3
Step 4

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Outline form and initial depth

Primary resistance form
Primary retention form
Convenience form

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Outline Form and Initial Depth

Definition:
placing the cavity margins in the positio
ns they will occupy in the final preparati
on;
preparing an initial depth of 0.2~0.8 mm
pulpally of the dentinoenamel junction p
osition or normal root surface position.
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Maxillary Class outline form

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Mandibular Class outline form

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Maxillary Class outline form

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Mandibular Class outline form

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Common Error
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Outline Form and Initial Depth

Principles:

without any exception

all friable and/or weakened enamel shou

ld be removed
all faults should be included
all margins should be placed in a positi
on to afford good finishing of
the margins of the restoration.
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Outline Form and Initial Depth

Features:
preserving cuspal strength
preserving marginal ridge strength
minimizing facio-lingual extension
using enameloplasty
connecting two close faults or cavities
restricting the depth of the preparation i
nto dentin.

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Initial cavity preparation stage

Step 1
Step 2
Step 3
Step 4

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Outline form and initial depth

Primary resistance form
Primary retention form
Convenience form

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Primary Resistance Form

Definition:
The shape and placement of the cavity
walls that best enable both the restoratio
n and the tooth to withstand, without fra
cture, masticatory forces delivered princ
ipally in the long axis of the the tooth.

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Primary Resistance Form

Principles:
To utilize the box shape with a relatively
flat floor to resist occlusal loading by vir
tue of being at right angles to masticatio
n force;
To restrict the extension of the external
walls (keep as small as possible) to allo
w strong cusp and ridge areas to remain
with sufficient dentin support;

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Primary Resistance Form

Principles:
To have a slight rounding of internal li
ne angles to reduce stress concentrati
on in tooth structure;
To provide enough thickness of restor
ative material to prevent its fracture un
der load.
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Primary Resistance Form

Feature:
Box shape
Relatively flat floors
Inclusion of weakened tooth structure
Preservation of cusps and marginal ridges
Rounded internal line angles
Adequate thickness of restorative materials
Reduction of cusps for capping if indicated
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Initial cavity preparation stage

Step 1
Step 2
Step 3
Step 4

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Outline form and initial depth

Primary resistance form
Primary retention form
Convenience form

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Primary Retention Form

Definition:
The shape or form of the prepared cavi
ty that resists displacement or removal
of the restoration from tipping or lifting
forces.
In many respects retention and resistance form
are accomplished in the same cutting procedure.
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Primary Retention Form

Principles: depending on the
materials
Amalgam restoration:
developing external cavity walls that co
nverge occlusally and dovetail design

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The devotail design provide retention form

to the occlusal portion of the cavity.
The occlusal convergence of the walls offers
retention in the proximal portion of the cavity
against displacement occlusally.

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Primary Retention Form

Principles: depending on th
e materials
Composite restoration:
a mechanical bond between the material
and conditioned, prepared tooth structur
e.

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Initial cavity preparation stage

Step 1
Step 2
Step 3
Step 4

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Outline form and initial depth

Primary resistance form
Primary retention form
Convenience form

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Convenience Form
Conception:
The shape or form of the cavity that pr
ovides for adequate observation, acces
sibility, and ease of operation in prepari
ng and restoring the cavity.

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Convenience Form
Principles:
Allow access for caries removal
Allow access for restoration placement
Allow access to margins for finishing,
evaluation and cleaning

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Convenience Form
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Final cavity preparation stage

Step 5 Removal of any remaining infected
dentin if indicated
Step 6 Pulp protection
Step 7 Secondary resistance & retention form
Step 8 Procedure for finishing external walls
Step 9 Final procedures

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Removal of any remaining infect

ed dentin if indicated
Definition:
The elimination of any infected cario
us tooth structure or faulty restorativ
e material left in the tooth after initial
cavity preparation.

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Removal of dentinal caries using round burs and spoon excavators

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Final cavity preparation stage

Step 5 Removal of any remaining infected
dentin if indicated
Step 6 Pulp protection
Step 7 Secondary resistance & retention form
Step 8 Procedure for finishing external walls
Step 9 Final procedures

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Pulp protection
Using liners or bases
to protect the pulp or
to aid pulpal recovery or both.

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Final cavity preparation stage

Step 5 Removal of any remaining infected
dentin if indicated
Step 6 Pulp protection
Step 7 Secondary resistance & retention form
Step 8 Procedure for finishing external walls
Step 9 Final procedures

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Secondary resistance and retenti

on forms
Most compound and complex cavity pre
parations require additional resistanc
e and retention form.
The exception being those preparations
that are very conservative.
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Secondary resistance and retenti

on forms
Mechanical forms
Cavity wall conditioning form

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Mechnical form:
Proximal locks
Proximal slots

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Proximal locks

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Slot on gingival wall

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Final cavity preparation stage

Step 5 Removal of any remaining infected
dentin if indicated
Step 6 Pulp protection
Step 7 Secondary resistance & retention form
Step 8 Finishing external walls
Step 9 Final procedures

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Finishing the external walls

Definition:
is the further development of a spec
ific cavosurface design and degree
of smoothness that produces the m
aximum effectiveness of the restorat
ive material being used.

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Finishing the external walls

Objectives:

To create the best marginal seal possible

between the restorative material and tooth
structure;
To afford a smooth marginal junction;
To provide maximum strength of both the
tooth and the restorative material at and n
ear the margin.
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The strongest enamel margin is that margin

which is composed of full-length enamel rods
that are supported on the cavity side by shorter
enamel rods, all of which extend to sound dentin.
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Finishing the external walls

The design of the cavosurface angle
The degree of smoothness of the wa
ll

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The design of the cavosurface angle:

depending on the material
amalgam: 90
composite: beveling 30~ 40

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Final cavity preparation stage

Step 5 Removal of any remaining infected
dentin if indicated
Step 6 Pulp protection
Step 7 Secondary resistance & retention form
Step 8 Procedure for finishing external walls
Step 9 Final procedures

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Final procedures

cleaning
inspecting
varnishing
conditioning

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Program of Operative Treatment

Cavity preparation
Matrix application
Preparation of materials
Insertion and carving of materials
Finishing and Polishing
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Matrix Application

Tofflemire Matrix System

Ivory Matrix System

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Matrix retainer, Band & Wedge

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Matrix in Retainer
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Rounded instrument
such as a spoon
excavator

Contour Matrix
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Matrix on Tooth
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Occlusal View
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Wedge place
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Contour Band
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Ready for restoration

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Program of Operative Treatment

Cavity preparation
Matrix application
Preparation of materials
Insertion and carving of materials
Finishing and Polishing
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Armamentarium

Amalgam Capsule
Amalgamator
Squeeze Cloth
Amalgam carrier

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Activate Mercury

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Program of Operative Treatment

Cavity preparation
Matrix application
Preparation of materials
Insertion and carving of materials
Finishing and Polishing
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Insertion and carving

Class

Class
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Armamentarium

Amalgam Condensers
Anatomic Burnishers
Carves
Cleoid or Discoid

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Check condenser fit

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First increment
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Start with the smallest condenser

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Step condenser over mass

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Continue adding increment

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Condense toward walls

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Use alternative instruments

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Overpacked
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Create initial grooves

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Create initial grooves

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Carve to margin
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Enhance grooves
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Remove flash
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Final shape and burnishing

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Completed restoration
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Initial Increment
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Initial Condensation
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Lateral Condensation
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Overpacking
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Marginal Ridge Condensation

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Condense to Margins
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Create Occlusal Embrasure

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Occlusal Embrasure
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Occlusal Embrasure
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Occlusal Embrasure
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Removing Ridge
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Removing Band
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Flash & Excess

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Moving Excess
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Check with interproximal carve

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Instrument on Tooth Structure

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Completed Restoration
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Rubber dam removal

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Program of Operative Treatment

Cavity preparation
Matrix application
Preparation of materials
Insertion and carving of materials
Finishing and Polishing
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Polishing
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Evaluate the restoration Class

I
Verify that cavosurface margin can be seen
Flash
Underfilled
Voids
Check the overall shape of the anatomy
Look for bulky ridges that might be high
in occlusion
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Evaluate the restoration Clas

s II
Check proximal contact
Check flash and overhangs proximally
Check underfill proximally
Check outline form
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Check Occlusion
Evaluate carefully with marking paper
or ribbon in Miller forceps

Check gently in centric occlusion

Check all excursive movement

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