Figs 18.1A and B: Conventional class III tooth preparation Fig. 18.
18.3: For initial penetration, entry into tooth should be
for composites
is done in conventional method whereas on the crown
it is prepared in beveled conventional or modified type
(Figs 18.2A and B).
• The extent of lesion determines the outline of tooth
preparation. For penetration into lesion, usually the
direction for entry of bur is from lingual side except
for few cases (Fig. 18.3). This lingual approach helps
in preservation of aesthetics. Following are the
indications for labial approach:
1. Involvement of labial enamel.
2. In cases of rotated teeth where lingual approach is
difficult.
3. In cases of malaligned teeth.
• When the damage is present only on the root surface,
then the conventional preparation is made only on the
root with 90 degree cavosurface margins. In the crown
Textbook of Operative Dentistry
portion of the preparation, the retention is mostly
achieved by adhesive bonding to enamel and dentin.
• The external walls are made perpendicular to the root
surface.
• While preparing, there should be adequate removal
of caries, old restoration or defective tooth structure.
The external walls of the preparation should be located
282
Figs 18.2A and B: When caries extend to root surface,
(A) Conventional tooth preparation is made on root and
(B) Bevelling is done in coronal portion
made from the palatal side so as to preserve aesthetics
on sound tooth structure with a cavosurface angle of
90 degrees for butt joint relation.
• If the carious lesion is not deep, the depth of the
preparation is kept 0.75 mm. After this, it is deepened
wherever caries is present.
• Retention in conventional tooth preparation is attained
by:
– Roughening of the preparation surface
– Parallelism or convergence of opposing external
walls
– Giving retention grooves and coves (Fig. 18.4).
• Grooves can be placed continuous or isolated.
Continuous grol;ove is placed in external walls,
parallel to tooth surface. It should be located atleast 1
mm from the tooth surface and at least 0.5 mm deep
into dentin.
Beveled Conventional Class III
Tooth Preparation
Indications of beveled class III preparation are following:
• For replacing an existing defective restoration on
crown portion of an anterior tooth if a large carious
lesion is present.
Fig. 18.4: Making grooves in class III preparation
for retention
Steps
• Approach the area lingually with a no. ½, 1 or 2 round
bur. Penetrate the lesion and move the bur in
incisogingival direction.
• Entry angle of the bur should be such that it places the
neck portion of the bur far into the embrasure.
• Shape of the tooth preparation should be identical to
the shape of existing carious lesion or the restoration.
• One should take care to include any secondary caries,
friable tooth structure and defects while placing the Fig. 18.6: Beveled class III tooth preparation for composites
external walls on sound tooth structure.
• Initial depth of the axial wall should be 0.75 mm deep
gingivally and 1.25 mm deep incisally. This results
in the axial wall depth of 0.2 mm into the dentin
(Fig. 18.5).
• Shape of the axial wall should be convex outwardly,
that is, it should follow the contour of the tooth.
• In final tooth preparation, remove all the remaining
infected dentin or defective restoration using spoon
excavator or slow speed round bur.
• For pulp protection, place a calcium hydroxide liner if

Tooth Preparation for Composite Restorations

indicated.
• Keep external walls of the tooth preparation
perpendicular to the enamel surface with all enamel
margins beveled (Fig. 18.6). Prepare the bevels using
flat end tapering fissure diamond bur at cavosurface
margins in the areas of centric contacts. The bevel
should be about 0.2 to 0.5 mm wide at an angle of
45 degrees to the external tooth surface (Figs 18.7A
and B).
• Bevels are not given in areas bearing heavy occlusal
forces or on cemental cavosurface margins.
• If required, prepare retentive grooves and coves along
gingivoaxial line angle and incisoaxial line angle,
respectively, with the help of no. 1/4 or 1/2 round
Figs 18.7A and B: Proximal and labial view of beveled
class III tooth preparation for composites
burs. Depth of these grooves should be 0.2 mm into
the dentin.
Modified (Conservative) Class III Tooth
Preparation
• It is the most conservative type of tooth preparation
used for composites. Indication for modified
preparation is small to moderate class III lesion. In this
tooth preparation, basically infected carious area is
removed as conservatively as possible by “scooping”
out. This results in ‘scooped-out’ or ‘concave’
appearance of the preparation (Figs 18.8A and B).

283

Fig. 18.5: Completed class III tooth Figs 18.8A and B: Saucer shaped class III tooth preparation
preparation for composites (A) Mesiodistal view (B) Proximal view
 Steps
• Make initial entry through the palatal surface with a
small round bur in the air rotor handpiece. It is always
preferred to use the lingual approach since it conserves
labial tooth structure which is more aesthetic.
• The bur should be kept rotating when being entered
into the tooth and should not stop rotating until being
removed.
• The design and extent of the preparation is determined
by the extent of the carious lesion (Fig. 18.9).
• Keep all the internal line angles rounded to decrease
internal stresses. It can be done using a half round bur
head.
• This type of preparation may not have any definite
axial wall depth and the walls may diverge externally
from axial depth in a scoop shape.
• In the final stage, remove the remaining infected
dentin using slow speed round bur or spoon excavator.
• Then finally check the preparation after cleaning with
water and air spray and provide pulp protection.
Textbook of Operative Dentistry
Fig. 18.10: Conventional class IV tooth
preparation for composites
• Retention obtained by means of dovetail, or grooves
placed gingivally and incisally in the axial wall using
number 1/4 round bur.
Beveled Conventional Class IV Preparation
A beveled conventional preparation is indicated for
treatment of a large lesion. The initial axial wall depth
should be kept 0.5 mm into dentin. Bevels are prepared
at 45 degree angle to tooth surface with a width of 0.25 to
2 mm, depending on the amount of retention required.
All internal angles should be rounded to avoid any stress
concentration points (Fig. 18.11).
The success of a class IV restoration depends upon
achieving retention other than found within the
preparation itself. Various modes of gaining retention are
placing grooves, coves, undercuts, flares, bevels and pins.
These methods help in providing the additional retention,

however the use of pins for anterior resins has decreased

Fig. 18.9: Extent of preparation is
determined by extent of caries
CLASS IV TOOTH PREPARATION
Class IV restoration is required when anterior tooth has
got incisal angle fracture because of trauma or caries.
significantly because of following reasons:
1. Risk of perforation either into the pulp or through the
external surface.
2. Pins do not enhance the strength of the restorative
material.
3. Pins may corrode because of microleakage of the
restoration, resulting in discoloration of the tooth and
restoration.

Tooth Preparation for Conventional Class IV

Preparation (Fig. 18.10)
Conventional type of class IV design is primarily
indicated in those areas that have margins on root surface
284
and where restoration is to be placed in high stress
bearing area.
Features of conventional class IV preparation for
composites:
• Box like preparation with facial and lingual walls
parallel to long axis of tooth.
Fig. 18.11: Beveled class IV tooth preparation for composites
Modified (Conservative) Class IV Preparation
Modified class IV preparation is done in small class IV
lesions or for treatment of small traumatic defects.
Objectives, technique, procedure and instruments used
for this preparation are identical to class III preparation.
Preparation for modified class IV preparation should be
done conservatively without removing the normal tooth
structure (Fig. 18.12).
Fig. 18.12: In case of fracture of teeth or small carious
lesion, only removal of defect and beveling is required
CLASS V TOOTH PREPARATION
Composites are material of choice for restoration of class
V lesions which are aesthetically prominent. Among
composites, microfill composites are material of choice
because they provide better and more smooth surface and
have sufficient flexibility to resist stresses caused by
cervical flexure, when tooth flexes under heavy occlusal
forces.
Conventional Class V Preparation
Conventional class V preparation is indicated if it is
present completely or mainly on root surface (Fig. 18.13).
If the lesion is partly on crown and partly on root, then
the crown portion is prepared using beveled conventional
or modified preparation design and the root surface lesion
is prepared in conventional method.
In conventional class V tooth preparation, shape of
the preparation is a “box” type. Isolate the area well and
use a tapered fissure (no. 700, or 701) bur to make entry
at 45 degree angle to tooth surface initially. After this
keep long axis of bur perpendicular to the external surface
in order to get a cavosurface angle of 90 degrees.
During initial tooth preparation, keep the axial depth
of 0.75 mm into the dentin.
After achieving the desired distal extension, move the
bur mesially, incisally (occlusally) and gingivally for
Fig. 18.13: Conventional tooth preparation is indicated if
caries are present mainly on root surface
placing the preparation margins onto the sound tooth
surface while maintaining a cavosurface margin of 90
degrees.
The axial wall should follow the contour of facial
surface incisogingivally and mesiodistally.
During the final tooth preparation, remove any
Tooth Preparation for Composite Restorations
remaining infected dentin, restoration material using
spoon excavator or slow speed round bur.
For pulp protection, use calcium hydroxide liner, if
necessary.
If additional retention is required, place retention
grooves all along the whole length of incisoaxial and
gingivoaxial line angles using a no. 1/4 or 1/2 round bur
0.25 mm deep into the dentin (Fig. 18.14). At this stage,
all the external walls appear outwardly divergent. Finally
clean tooth preparation with water and air dry it
(Fig. 18.15).
Beveled Conventional Class V Tooth
Preparation
Beveled conventional class V preparation is indicated for
replacing defective existing restoration or for restoring a
large, carious lesion.
The initial axial wall depth should be limited to only
0.25 mm into the dentin, when retention grooves are not
placed and 0.5 mm when a retention groove is placed.
Place a mechanical retention groove inside the gingival
cavosurface margin.
After this, bevel the enamel margins at an angle of 45 285
degrees to the external surface and to a width of 0.25 to
0.5 mm (Fig. 18.16). When the class V carious lesion is
large enough to extend onto the root surface, the gingival
part is prepared in the conventional class V tooth
preparation design with the initial axial depth of 0.75 mm.
Beveling is done only on enamel cavosurface margins
(Fig. 18.17).
 Fig. 18.14: Placing retention grooves in class V preparation Fig. 18.17: Beveling is done on enamel surface

Roughen the dentin with a medium size diamond bur

to provide mechanical retention and thus increasing the
bond strength.

Modified (Conservative) Class V Tooth

Preparation
Modified class V design is indicated for
• Restoration of small and moderate carious lesions and
defects.
• Small enamel defects like decalcified and hypoplastic
Textbook of Operative Dentistry

areas present in cervical third of the teeth (Figs 18.18A

and B).
Modifed class V, tooth is prepared as discussed in
previous modified preparation.
Fig. 18.15: Conventional class V tooth preparation The final tooth preparation should have ‘scooped out’
appearance with divergent walls and axial wall either in
enamel or dentin (Fig. 18.19).

286

Fig. 18.16: Beveling of preparation using a flame shaped bur Figs 18.18A and B: Modified class V tooth preparation is
indicated only in cases when small lesion is present in cervical
third of the teeth

Fig. 18.19: Scooped out appearance of tooth preparation
TOOTH PREPARATION FOR POSTERIOR
COMPOSITE RESTORATION
Indications for Use of Composites for Class
I, II and VI Preparations
• Small to moderate sized lesions in posterior teeth.
• Incipient lesions.
• In premolars and first molars where aesthetics is the
main concern.
• When moisture control of operating site is possible.
• When tooth being restored, does not experience
occlusal stresses.
• In patient with low caries risk.
• As a core foundation for full crown restoration.
Contraindications for Use of Posterior
Composite Restorations
• When it is difficult to achieve moisture control.
• When large lesion is present extending onto the root
surface.
• When restoration is subjected to high occlusal stresses.
• When heavy contacts are present on the restoration.
• In patients with high caries risk and poor oral hygiene.
• In patients with parafunctional habits like clenching
and bruxism.
Advantages of Posterior Composite
Restoration
1. Good aesthetics.
2. Conservation of tooth structure because of adhesive
tooth preparation.
3. Low thermal conductivity of composites provide
insulation to thermal changes.
4. Because of their micromechanical bonding, tooth
preparation is easier, simple and less complex.
5. Economically cheap when compared to indirect
restorations and crown forms.
6. Because of adhesion to tooth, there is increased
retention and strengthening of remaining tooth
structure.
7. Composites have adequate radiopacity to be seen in
the radiographs.
8. Since it does not contain metal, so no risk of
galavanism.
Disadvantages
1. Polymerization shrinkage occurring after
polymerization of composites can lead to—
• Postoperative sensitivity
• Secondary caries
• Discoloration.
2. More technique sensitive than amalgam.
3. Less resistance to wear especially in microfilled
composites.
Tooth Preparation for Composite Restorations
4. Takes more time for placement.
5. Expensive in comparison to amalgam restoration.
CLASS I TOOTH PREPARATION
Composite is preferred in small pit and fissure lesions in
conservative modified preparations. Concept of
ultraconservative restoration, also known as ‘conser-
vative composite restoration’ was given by Simonsen in
1978. It is also referred to as ‘preventive resin restorations’.
This preparation precede diagnosis of cavitation, instead
of frank carious lesion.
Depending on the extent of preparation to be restored,
there are three designs (1) conventional, (2) beveled
conventional and (3) modified.
Conventional Design for Class I Tooth
Preparation
For moderate sized lesions, conventional design is
preferred for composite restorations. Fundamentals of
tooth preparation are similar to that of amalgam except
for few differences. Gain entry into lesion with small
round bur keeping the bur parallel to tooth structures 287
and then extend the preparation using flat fissure bur,
keep the minimal depth (1.5 mm) throughout the
preparation (Figs 18.20A to C).
Differences from Tooth Preparation for Amalgam
1. Faciolingual dimension of preparation are kept as
small as possible (¼th of intercuspal distance).

Figs 18.20A to C: Conventional class I tooth preparation for
composite restoration (A) Preparation of outline using round
bur (B) Excavation of caries, keeping the pulpal floor shallow
(C) Completed class I tooth preparation
2. No need to prepare dovetail or other retention features
3. Preparation floor need not be kept perpendicular.
Modified Design for Class I Tooth
Preparation (Fig. 18.21)
Textbook of Operative Dentistry
Features of modified preparation design for class I
composite restoration:
• Preparation has scooped out appearance extended to
only the extent of caries. Preparation is done using
rounded corner inverted cone bur so as to:
a. Prepare walls converging occlusally.
b. Prepare rounded line angles.
c. Provide flat floor.
d. Produce minimal width faciolingually.
e. Provide occlusal marginal configuration.
The initial enamel depth of preventive resin restoration
is kept as 1 mm. Flame shaped diamond instruments are
288
Fig. 18.21: Modified class I tooth preparation
for composite restorations
used to bevel the enamel cavosurface margins
approximately. Usually the cavosurface bevel is 0.5 mm
wide and placed at an angle of 45 degrees to the external
enamel surface. If the marginal ridge is not supported by
dentin, remaining weakened enamel may be left, provided
there is no heavy centric contact on this area (Fig. 18.22).
The unsupported marginal ridge will be strengthened by
composite restoration. Shallow fissures radiating from pits
and fissures are treated by enameloplasty.
Beveling of the enamel margin results in
• Increased retention (beveling increases the surface for
bonding)
• Reduction in microleakage
• Improvement in aesthetics since bevel enables the
restoration to blend more aesthetically with surrounding
tooth structure
• Increase in bond strength
• Conservation of tooth structure since the need for grooves
for additional retention can be avoided.
Fig. 18.22: Modified class I preparation
CLASS II TOOTH PREPARATION
Composites if manipulated properly can be successfully
used in Class II restorations.
The advantages of using composites in class II are
• Better aesthetics
• Conservative tooth preparation
• Strengthening of remaining tooth structure
• Bonding of tooth by composite.
Problems with Composites for Use in Class
II Restorations
• Difficult to achieve moisture control
• In deep subgingival extension cases
• In teeth with heavy occlusal contact on the composites.
Although features for class II restoration are similar
to those used for amalgam preparations were suggested
in the past, but nowadays, a more conservative tooth
preparation is commonly recommended today.
 Before initiating tooth preparation for composite,
proper isolation of the operating field by means of rubber
dam placement is compulsory. Since composites bond
better to enamel than to dentin, there is no need to prepare
into dentin if lesion has not penetrated.
Steps
• Prepare the occlusal part of the tooth preparation
similar to class I (Fig. 18.23), but the proximal box
preparation depends upon extent of caries, contour of
the proximal surface and masticatory stresses to which
restoration will be subjected.
• For proximal box preparation, extend the occlusal
preparation using straight fissure bur onto the
marginal ridge (Fig. 18.24). Keep the bur perpendicular
to the pulpal floor.
• Thin out the marginal ridge and deepen the
preparation towards the gingival direction as to give
proximal ditch cut. This will form the width of 1.0–1.5
mm (Fig. 18.25).
Fig. 18.23: Make the occlusal outline
as done for class I tooth preparation
Fig. 18.24: Extension of occlusal step to the marginal ridge
• For small carious lesion, proximal walls can be left in
the contact but for large carious lesion, contact area is
broken.
• Keep the gingival floor flat with butt joint cavosurface
angle. Whether or not to give gingival beveling,
depends on location and the width of gingival seat. If
gingival seat is supragingival and above cemento-
enamel junction, beveling can be done, but if gingival
seat is close to cementoenamel junction, beveling is
avoided so as to preserve the enamel present in this
area (Fig. 18.26).
• The final conventional tooth preparation for composite
is more conservative than for traditional amalgam
restoration (Fig. 18.27).
Tooth Preparation for Composite Restorations
Fig. 18.25: Completed class II tooth
preparation for composites
289
Fig. 18.26: If sufficient enamel is present, the beveling can
be done so as to increase the composite seal
 3. When proximal caries can be approached from facial
or lingual side rather than occlusal surface, slot
preparation is indicated (Figs 18.30A and B). In this,
bur is kept perpendicular to long axis of the tooth and
entry to lesion is made through facial or lingual surface.
Here preparation has cavosurface angle of 90°.

Fig. 18.27: Conservative outline of composite resin in

comparison to traditional amalgam restoration

Modification for Class II Composite

Restoration
1. When minimal caries are present, saucer shaped class
II preparation is done. Here the preparation is
deepened only to the extent where caries are present.
The scooped out preparation does not have uniform
depth (Fig. 18.28). Figs 18.30A and B: Slot preparation
2. When caries are present only on proximal surface, box
only preparation is indicated. In this, proximal box is Features of class II composite tooth preparation
prepared without the need of secondary retention
features (Fig. 18.29). • Tooth preparation for class II has decreased pulpal depth
of axial wall which allows greater conservation of tooth
structures.
Textbook of Operative Dentistry

• Occlusal and proximal walls converge occlusally and

provide additional retention form.
• Proximal box preparation has cavosurface angle at right
angles to the enamel surface facially and lingually.
• Bevels on occlusal surface are optional due to direction
of enamel rods whereas on proximal surface, beveling
must be done prudently.
• Gingival floors should clear the contact apically and they
should be butt joined.

RESTORATIVE TECHNIQUE FOR

COMPOSITES (FIGS 18.31A TO F)
Fig. 18.28: Saucer shaped class II tooth preparation
Matrix Application
A matrix helps in confining the excess restorative material
and in development of appropriate axial tooth contours.
It also helps in isolation of the prepared tooth. The matrix
should be applied and stabilized by a wedge before
290 applying etchant, primer and adhesive to protect the
adjacent teeth from being etched and bonded. The matrix
should extend 1 mm beyond the incisal and gingival
cavosurface margins.

Matrix used for composite resin

1. Mylar strip matrix
Fig. 18.29: ‘Box shaped’ tooth preparation 2. Compound supported metal matrix.