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جامعة كركوك > كلية طب الأسنان > المرحلة الثالثة

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Operative Dentistry

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Proper diagnosis is vital for treatment planning.

DIAGNOSIS:
PREVENTION:
To prevent any recurrence of the
causative disease and their defect.
INTERCEPTION:
Preventing further loss of tooth structure
by stabilizing an active disease process.
PRESERVATION:
Preservation of the vitality and
periodontal support of remaining tooth structure.
RESTORATION:
Includes restoring form, function, phonetics, and esthetics.
Purposes of Operative Dentistry


Indication of Operative Dentistry
Caries;
Malformed, discolored,
or fractured teeth;
Restoration replacement.

Program of Operative Treatment

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

Cavity preparation

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

Program of Operative Treatment


Cavity Preparation
The mechanical alteration of a defective, injured, or diseased tooth in order to best receive a restorative material which will re-establish a healthy state for the tooth including esthetic corrections where indicated, along with normal form and function.

Cavity Structure

walls
angles
cavity
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Classification of cavity

Class I
Class II
Class III
Class IV
Class V
Class VI

—G.V.Black in 1908

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Cavity

Simple cavity: only one tooth surface is involved.
Compound cavity: two surfaces are involved.
Complex cavity: three or more surfaces are involved.


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Class 1

Class 2
Class 1
Class 2
Class 3
Class 4
Class 5
Class 6

Stages and Steps in Cavity Preparation

Initial cavity preparation stage
Final cavity preparation stage


Initial cavity preparation stage

Step 1 Outline form and initial depth

Step 2 Primary resistance form
Step 3 Primary retention form
Step 4 Convenience form

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

Initial cavity preparation stage

Step 1 Outline form and initial depth
Step 2 Primary resistance form
Step 3 Primary retention form
Step 4 Convenience form


Outline Form and Initial Depth Ⅰ
Definition:

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placing the cavity margins in the positions they will occupy in the final preparation;

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preparing an initial depth of 0.2~0.8 mm pulpally of the dentinoenamel junction position or normal root surface position.


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Maxillary Class Ⅰ outline form

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Mandibular Class Ⅰ outline form

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Maxillary Class Ⅱ outline form


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Mandibular Class Ⅱ outline form

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Common Error

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Outline Form and Initial Depth Ⅱ

Principles: without any exception

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all friable and/or weakened enamel should be removed


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all faults should be included

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all margins should be placed in a position to afford good finishing of
the margins of the restoration.

Outline Form and Initial Depth Ⅲ

Features:

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preserving cuspal strength

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preserving marginal ridge strength

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minimizing facio-lingual extension

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using enameloplasty


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connecting two close faults or cavities

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restricting the depth of the preparation into dentin.


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Initial cavity preparation stage

Step 1 Outline form and initial depth
Step 2 Primary resistance form
Step 3 Primary retention form
Step 4 Convenience form

Primary Resistance Form Ⅰ

Definition:
The shape and placement of the cavity walls that best enable both the restoration and the tooth to withstand, without fracture, masticatory forces delivered principally in the long axis of the the tooth.

Primary Resistance Form Ⅱ

Principles:


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To utilize the box shape with a relatively flat floor to resist occlusal loading by virtue of being at right angles to mastication force;

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To restrict the extension of the external walls (keep as small as possible) to allow strong cusp and ridge areas to remain with sufficient dentin support;

Primary Resistance Form Ⅲ

Principles:

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To have a slight rounding of internal line angles to reduce stress concentration in tooth structure;

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To provide enough thickness of restorative material to prevent its fracture under load.

Primary Resistance Form Ⅳ

Feature:

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Box shape


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Relatively flat floors

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Inclusion of weakened tooth structure

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Preservation of cusps and marginal ridges

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Rounded internal line angles

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Adequate thickness of restorative materials

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Reduction of cusps for capping if indicated


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Initial cavity preparation stage

Step 1 Outline form and initial depth
Step 2 Primary resistance form
Step 3 Primary retention form
Step 4 Convenience form

Primary Retention Form Ⅰ

Definition:
The shape or form of the prepared cavity 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.

Primary Retention Form Ⅱ

Principles: depending on the materials

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Amalgam restoration:
developing external cavity walls that converge occlusally and dovetail design



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 Ⅲ

Principles: depending on the materials

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Composite restoration:
a mechanical bond between the material
and conditioned, prepared tooth structure.


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Initial cavity preparation stage

Step 1 Outline form and initial depth
Step 2 Primary resistance form
Step 3 Primary retention form
Step 4 Convenience form

Convenience Form Ⅰ

Conception:
The shape or form of the cavity that provides for adequate observation, accessibility, and ease of operation in preparing and restoring the cavity.

Convenience Form Ⅱ

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

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

Removal of any remaining infected dentin if indicated

Definition:
The elimination of any infected carious tooth structure or faulty restorative material left in the tooth after initial cavity preparation.


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Removal of dentinal caries using round burs and spoon excavators

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

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

Secondary resistance and retention forms Ⅰ


Most compound and complex cavity preparations require additional resistance and retention form.

The exception being those preparations that are very conservative.

Secondary resistance and retention forms Ⅱ

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Mechanical forms


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Cavity wall conditioning form

Mechnical form:

Proximal locks
Proximal slots


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Proximal locks


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Slot on gingival wall

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

Finishing the external walls Ⅰ

Definition:
is the further development of a specific cavosurface design and degree of smoothness that produces the maximum effectiveness of the restorative material being used.

Finishing the external walls Ⅱ

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 near the margin.

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 Ⅲ

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The design of the cavosurface angle

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The degree of smoothness of the wall

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

Final procedures

cleaning
inspecting
varnishing
conditioning



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Cavity preparation

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

Program of Operative Treatment

Matrix Application
Tofflemire Matrix System
Ivory Matrix System



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Matrix retainer, Band & Wedge

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Contour Matrix

Rounded instrument
such as a spoon
excavator


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Matrix in Retainer

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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

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

Program of Operative Treatment


Program of Operative Treatment
Amalgam Capsule
Amalgamator
Squeeze Cloth
Amalgam carrier


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Activate Mercury

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Amalgamator



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Amalgam carrier

Squeeze Cloth


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Amalgam carrier

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Amalgam plugger

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


Program of Operative Treatment


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Insertion and carving

Class Ⅱ
Class I

Amalgam Restorative Instruments

Amalgam Condensers

Anatomic Burnishers

CarversCleoid 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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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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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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Cavity preparation

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

Program of Operative Treatment

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Polishing kit

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Polishing

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


Evaluate the restoration Class II
Check proximal contact
Check flash and overhangs proximally
Check underfill proximally
Check outline form

Check Occlusion

Evaluate carefully with marking paper
or ribbon in Miller forceps
Check gently in centric occlusion
Check all excursive movement

How to Place Matrix Band in Tofflemire Retainer

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Tofflemire retainer with Matrix band placement on Tooth

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matrix

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Thanks




رفعت المحاضرة من قبل: Mohammed Nehad
المشاهدات: لقد قام 17 عضواً و 980 زائراً بقراءة هذه المحاضرة








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