Carte

Textbook of
Preclinical Conservative Dentistry

Textbook of
Preclinical Conservative Dentistry
Second Edition
Editors
Nisha Garg
BDS MDS (Conservative Dentistry and Endodontics)
Professor
Department of Conservative Dentistry and Endodontics
Bhojia Dental College and Hospital
Baddi, Himachal Pradesh, India
Amit Garg
BDS MDS (Oral and Maxillofacial Surgery)
Associate Professor
Department of Oral and Maxillofacial Surgery
Sri Sukhmani Dental College and Hospital
Dera Bassi, Mohali, Punjab, India
Foreword
AP Tikku
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Textbook of Preclinical Conservative Dentistry

First Edition: 2011
Second Edition: 2017
ISBN: 978-93-86056-83-2
Printed at
Dedicated to
Prisha
and
Vedant
Contributors
Ajay Chhabra MDS Gurkirat Singh Grewal MDS
Principal, Professor and Head Senior Lecturer
Department of Conservative Dentistry Department of Conservative Dentistry
and Endodontics and Endodontics
Bhojia Dental College and Hospital Bhojia Dental College and Hospital
Baddi, Himachal Pradesh, India Baddi, Himachal Pradesh, India
Anamika Thakur MDS Harleen Kaur Gill MDS
Senior Lecturer Senior Lecturer
Sri Sukhmani Dental College and Bhojia Dental College and Hospital
Hospital Baddi, Himachal Pradesh, India
Mohali, Punjab, India Jaidev Singh Dhillon MDS
Ankur Vats MDS Principal, Professor and Head
Reader Department of Conservative Dentistry
and Endodontics Gian Sagar Dental College and Hospital
Bhojia Dental College and Hospital Patiala, Punjab, India
Baddi, Himachal Pradesh, India JS Mann MDS
Ashu Jhamb MDS Associate Professor
Reader Department of Conservative Dentistry
and Endodontics Government Dental College
Bhojia Dental College and Hospital and Hospital
Baddi, Himachal Pradesh, India Patiala, Punjab, India
Bhumika Ahuja MDS Madhu Garg MDS
Reader Professor
Department of Pedodontics Department of Pedodontics and
KD Dental College and Hospital Preventive Dentistry
Mathura, Uttar Pradesh, India JCD Dental College
Sirsa, Haryana, India
Damanpreet MDS Mannat Dhillon BDS
Reader Consultant Dental Surgeon
Department of Conservative Dentistry Dental Solutions
and Endodontics Ludhiana, Punjab, India
Bhojia Dental College and Hospital
Baddi, Himachal Pradesh, India
Manoj Hans MDS
Daminder Singh MDS
Professor
Medical Officer (Dental)
Department of Conservative Dentistry
Government Dental College and
and Endodontics
Hospital
KD Dental College and Hospital
Patiala, Punjab, India
Mathura, Uttar Pradesh, India
viii Textbook of Preclinical Conservative Dentistry
Navjot Singh Khurana MDS Savita Thakur MDS

Lecturer Senior Lecturer
Government Dental College Bhojia Dental College and Hospital
and Hospital Baddi, Himachal Pradesh, India
Shital Kumar MDS
Nidhi Rani MDS
Medical Officer (Dental)
Senior Resident
Government Dental College and
Hospital
and Endodontics
Postgraduate Institute of Medical
Education and Research
Chandigarh, India Simran Pal Singh Bindra MDS
Poonam Bogra MDS Department of Conservative Dentistry
Senior Professor and Endodontics
Department of Conservative Dentistry Bhojia Dental College and Hospital
and Endodontics Baddi, Himachal Pradesh, India
DAV Dental College
Yamuna Nagar, Haryana, India Sunila Sharma MDS
Reader
Priya Verma Gupta MDS FPFA Department of Pediatric and Preventive
Professor Dentistry
Department of Pedodontics and Gian Sagar Dental College and Hospital
Preventive Dentistry Jansla, Punjab, India
Divya Jyoti College of Dental Sciences
and Research
Vandana Chhabra MDS
Ghaziabad, Uttar Pradesh, India
Associate Professor
RS Kang MDS HS Judge Dental College
Former Associate Professor Chandigarh, India
and Endodontics
Government Dental College
and Hospital Varun Jindal MDS
Patiala, Punjab, India Reader
Sanjay Miglani MDS Department of Conservative Dentistry
Associate Professor and Endodontics
Faculty of Dentistry Bhojia Dental College and Hospital
Jamia Millia Islamia Baddi, Himachal Pradesh, India
New Delhi, India
Foreword
It gives me immense pleasure to introduce you to the second edition of the Textbook of Preclinical
Conservative Dentistry. Since conservative dentistry is backbone of the dentistry, it is mandatory
to train the undergraduate students for restorative procedures before entering the clinics. For
the second time, Dr Nisha Garg and Dr Amit Garg present their well-known book of preclinical
conservative dentistry, best described in simple and easy language with plenty of diagrams,
keeping in mind the syllabus prescribed by many universities of India. Written by the two
prominent authorities on this important aspect of dentistry, Dr Nisha Garg and Dr Amit Garg
have accumulated a incredible amount of knowledge to summarize this important information
into easy-to-read chapters.
From the introduction to preclinical conservative dentistry in chapter one highlighting the importance of preclinical
conservative dentistry, going through dental anatomy, nomenclature, physiology of tooth form, armamentarium,
dental caries, dental materials, adhesive dentistry, basic fundamentals of tooth preparation and step-by-step tooth
preparation for amalgam and composites make this edition a must have preclinical guide for dental students before
entering their clinics. This edition has plenty of line diagrams and photographs for better understanding of the concept.
The authors have also included the too often neglected aspect of conservative dentistry, i.e. importance, anatomy and
tooth preparation of primary teeth, making it understandable how morphology of teeth affect the tooth preparation.
I am pleased to introduce and recommend this book as an excellent guide for students to understand the subject of
conservative dentistry.
AP Tikku
BSc BDS MDS FICD
Dean
Faculty of Dental Sciences
King George’s Medical University
Lucknow, Uttar Pradesh, India
Preface to the Second Edition
In presenting the second edition of Textbook of Preclinical Conservative Dentistry, we would like to express our appreciation
in the kindly manner in which the first edition was accepted by dental students across the country. We once again thank
Almighty God for His blessings in all our endeavors.
The scope of the second edition of this book is as earlier to be simple yet comprehensive which serve as an introductory
for dental students. This book covers basic tooth anatomy, cutting instruments, principles of tooth preparation, dental
materials and their manipulation so as to have fundamental knowledge before handling patients in the clinics.
Emphasis is laid upon the language which is simple, understandable and exclusively designed for beginners in
conservative dentistry.
The line diagrams are in an expressive interpretation of tooth preparation procedures, which are worked upon and
simplified to render them more comprehensive and comparable with real photographs.
In an attempt to improve the book for better clarification of the subject, many eminent personalities were invited
to edit, write and modify the important chapters in form of text and photographs. We are grateful to Dr Manoj Hans,
Dr Daminder Singh, Dr Shital Kumar and Dr Varun Jindal for providing us photographs related to preclinical and clinical
work for better understanding of the subject.
We fall lack of words to thank Dr RS Kang, Dr JS Mann, Dr Navjot Singh Khurana, Dr Ankur Vats, Dr Ashu Jhamb and
Dr Savita Thakur for critically evaluating the chapters and bringing them in the best form.
We offer our humble gratitude and sincere thanks to Mr Vikram Bhojia (Secretary, Bhojia Trust) for providing healthy
and encouraging environment for our work.
We would like to express our thanks to our colleagues for their ‘ready to help’ attitude, constant guidance and positive
criticism which helped in improvement of the book.
We are grateful to Hu-Friedy, GC Fuji, Coltene Whaledent and Dentsply for using their images in our book.
It is hoped that all these modifications will be appreciated and render the book still more valuable basis for preclinical
dentistry.
We thank Shri Jitendar P Vij (Group Chairman), Mr Ankit Vij (Group President) and Mr Tarun Duneja (Director–
Publishing), Dr Priya Verma Gupta (Editor-in-Chief, Dentistry), Dr Abha Bedi (Development Editor), Seema Dogra (Cover
Designer), Nitesh Jain (Graphics Designer), Deep Kumar Dogra (Operater) of M/s Jaypee Brothers Medical Publishers
(P) Ltd, New Delhi, India for showing personal interest and trying to the level best to bring the book in present form.
We shall be grateful to our readers if they critically analyze the text and send us useful suggestions to improve quality
of the book for next edition.
Nisha Garg
Amit Garg
Preface to the First Edition
Operative dentistry is one of the oldest branches of dental sciences forming the central part of dentistry as practiced in
primary care. It occupies the use of majority of dentist’s working life and is a key component of restorative dentistry. The
subject and clinical practice of conservative dentistry continues to evolve rapidly as a result of improved understanding
of etiology, prevention and management of common dental diseases. The advances and developments within the last
two decades have drastically changed the scope of this subject. But before taking professional training, gathering basic
knowledge along with operating skill is mandatory.
The main objective of this book is to provide students with the knowledge required while they are developing
necessary clinical skills and attitude in their undergraduate training in conservative dentistry and endodontics. We have
tried to cover wide topics like morphology of teeth, cariology, different techniques, instruments and materials available
for restorations of teeth along with the basics of endodontics.
So we can say that after going through this book, the student should be able to:
• Sit properly while operating and be able to organize their operating environment efficiently
• Understand the morphology of teeth and differentiate one tooth from another
• Chart teeth
• Understand basics of cariology, its prevention and conservative management
• Tell indications and contraindications of different dental materials
• Apply modern pulp protective regimens
• Select suitable restorative materials for restoration of teeth
• Understand the basics of endodontic treatment like what are the indications of endodontic treatment, basic
instruments, access preparation, biomechanical preparation and obturation of root canal system.
Nisha Garg
Amit Garg
Contents
1. Introduction to Preclinical Conservative Classification 60
Dentistry��1 Histopathology 65
Nisha Garg 7. Armamentarium��70
Causes of Loss of Tooth Substance 1 Nisha Garg, Amit Garg
Objectives of Operative Dentistry 3
Nomenclature 70
Objectives of Preclinical Conservative Dentistry 3
Parts 71
Armamentarium 3
Instrument Formula 72
Preclinical Tooth Preparations 4
Different Instrument Designs 73
2. Morphology of Permanent Teeth��6 Exploring Instruments 74
Amit Garg, Mannat Dhillon Hand Cutting Instruments 76
Restorative Instruments 79
Definitions 6
Instrument Grasps 81
Maxillary Teeth 7
Finger Rests 82
Mandibular Teeth 15
Rotary Cutting Instruments 84
3. Morphology of Primary Teeth��26 Matrix Retainers and Bands 89
Priya Verma Gupta, Sunila Sharma Wedges 94
Importance 26 8. Principles of Tooth Preparation�� 101
Difference Between Primary and Nisha Garg
Permanent Dentition 27
Purpose of Tooth Preparation 101
Maxillary Teeth 28
Classification 101
Mandibular Teeth 32
Definitions 104
4. Structure, Nomenclature and Tooth Number of Line and Point Angles 105
Physiology��39 Steps 108
Amit Garg, Ajay Chhabra Initial Stage 108
Final Stage 112
Tooth Nomenclature 41
Tooth Notation Systems 42 9. Tooth Preparation for Amalgam and
Nomenclature of Tooth Surfaces 46 Composite Restorations�� 122
Physiology of Tooth Form 46 Nisha Garg, Poonam Bogra
5. Chair Position and Dental Operatory��51 Preparation for Amalgam Restoration 122
Amit Garg, Gurkirat Singh Grewal Tooth Preparation for Composite Restoration 129
Common Positions for Dental Procedures 51 10. Tooth Preparation for Primary Teeth�� 135
Antisepsis in Clinics 53 Madhu Garg, Priya Verma Gupta, Bhumika Ahuja
General Precautions 53
Rationale for Tooth Preparation 135
6. Dental Caries��56 Principles of Tooth Preparation 135
Nisha Garg Classification of Dental Caries 137
Theories 56 Tooth Preparation 137
Etiology 58 Matrix Bands and Retainers 141
Steps for Amalgam Restoration for
Primary Teeth 143
xvi Textbook of Preclinical Conservative Dentistry
11. Dental Materials�� 145 Endodontic Instruments 186

Amit Garg, Vandana Chhabra Access Cavity Preparation 188
Access Cavity of Anterior Teeth 189
Dental Cements 145
Access Cavity Preparation for Premolars 190
Zinc Oxide Eugenol Cement 146
Access Cavity Preparation for Maxillary Molars 190
Zinc Phosphate Cement 149
Access Cavity Preparation for Mandibular
Zinc Silicophosphate Cements 151
Molars 190
Calcium Hydroxide 152
Working Length Determination 191
Zinc Polyacrylate Cement/Zinc Polycarboxylate
Significance of Working Length 191
Cement 152
Irrigation of Root Canal System 192
Glass Ionomer Cement 154
Cleaning and Shaping 192
Pulp Protection Materials 159
Basic Principles of Canal Instrumentation 193
Dental Amalgam 160
Techniques of Root Canal Preparation 193
Dental Casting Alloys 166
Obturation of Root Canal System 194
12. Adhesive Dentistry�� 171 Coronal Restoration 195
Nisha Garg, Jaidev Singh Dhillon, Damanpreet Common Errors During Endodontic Treatment 195
Enamel Bonding 172 14. Examination Spotters�� 198
Dentin Bonding 172 Nidhi Rani, Harleen Kaur Gill
Dentin Bonding Agents 173
Instruments 198
Evolution of Dentin Bonding Agents 173
Materials 202
Dental Composites 177
13. Basics of Endodontics�� 185 Glossary�� 209
Anamika Thakur, Simran Pal Singh Bindra
Nisha Garg, Sanjay Miglani
Etiology of Pulpal Diseases 186
Progression of Pulpal Pathologies 186 Index��215
1
cHAPTER
Introduction to Preclinical
Conservative Dentistry
Nisha Garg
Chapter Outline
Introduction Armamentarium
Causes of Loss of Tooth Substance Preclinical Tooth Preparations
Objectives of Operative Dentistry Viva Questions
Objectives of Preclinical Conservative Dentistry
Introduction order to have proper understanding of anatomical and

dimensional considerations, it is always recommended
“Operative dentistry is science and art of dentistry which to do tooth preparations on artificial acrylic teeth called
deals with diagnosis, treatment and prognosis of defects of typhodont teeth. Typhodont teeth are screwed on to the
the teeth which do not require full coverage restorations for phantom head. By doing tooth preparation in dummy
correction. Such treatment should result in the restoration models, a person is able to juxtapose his acquired skill
of proper form, function and esthetics while maintaining in clinical patient easily. Repeated tooth preparations in
the physiologic integrity of the teeth in harmonious extracted natural teeth increase the skill and efficiency
relationship with the adjacent hard and soft tissues, all of the person. Moreover this training increases the
of which should enhance the general health and welfare confidence and psychomotor skills for handling tissues.
of the patient”. It plays an important role in enhancing Basic purpose of preclinical conservative dentistry
dental health and now branched into dental specialties. is to make the students to gain expertise for restorative
But before practicing operative dentistry, one should procedures before handling the patient. This develops
understand the concept of tooth preparation because confidence in the student before they manage the patient.
operative dentistry deals with diagnosis, prevention,
interception and restoration of the defects of natural teeth. CAUSES OF LOSS OF TOOTH SUBSTANCE
Preclinical operative dentistry is a branch of operative • Dental caries (Fig. 1.1)
dentistry where practical training is given for tooth • Noncarious loss of tooth structure
preparation and restoration of teeth with various materials – Attrition (Fig. 1.2)
on dummy models in simulated oral environment. – Abrasion (Fig. 1.3)
– Erosion (Fig. 1.4)
Need for Preclinical Conservative Dentistry • Traumatized or fractured teeth (Fig. 1.5)
As we know oral cavity is a small area which consist of • Esthetic improvement (Fig. 1.6)
lips, cheeks, palate and a mobile tongue. To do tooth • Replacement or repair of restoration (Fig. 1.7)
preparation in this area, a great skill is required. So in • Developmental defects (Fig. 1.8)
2 Textbook of Preclinical Conservative Dentistry
Figure 1.1: Clinical picture showing pit and fissure caries in premolar Figure 1.4: Clinical picture showing generalized erosion of
maxillary anterior teeth
Figure 1.2: Clinical picture showing generalized attrition of Figure 1.5: Clinical picture showing fractured central incisor
mandibular anterior teeth which can be corrected by esthetic treatment
Figure 1.3: Clinical picture showing generalized abrasion of teeth Figure 1.6: Clinical picture showing spacing between teeth which
can be corrected by restorative procedures
Introduction to Preclinical Conservative Dentistry 3
Figure 1.7: Clinical picture showing fractured amalgam restoration Figure 1.8: Clinical picture showing intrinsic discoloration of teeth
requiring replacement which can be corrected by esthetic restorations
objectives of operative dentistry objectives of preclinical

Following are the objectives of operative dentistry: conservative dentistry
• To have knowledge about anatomy of teeth
Diagnosis • To gain expertise for restorative procedures before
Diagnosis is determination of nature of disease, injury or handling the patient in simulated clinical conditions
other defect by examination, test and investigation. • To gain expertise for restorative procedures before
handling the patient by performing restorative
Prevention procedures in simulated clinical conditions
• To gain expertise for manipulation of different dental
It includes the procedures done for prevention before the
materials
manifestation of any sign and symptom of the disease.
• To have knowledge of different instruments used in
Interception restorative dentistry
• To understand the fundamentals of tooth preparation.
It includes the procedures undertaken to prevent the
disease from developing into a more serious or full extent. Armamentarium
Preservation Armamentarium (instruments) used in preclinical
conservative dentistry should be arranged as following
Preservation of the vitality and periodontal support of
(Fig. 1.9):
remaining tooth structure is obtained by preventive and
• Exploring instruments: Mouth mirror, straight probe,
interceptive procedures.
explorer and tweezers
Restoration • Excavating instrument: Spoon excavator
• Cutting instruments: Chisel, hatchet, gingival marginal
It includes restoring form, function, phonetics and trimmer and hoes
esthetics. • Mixing instruments: Cement mixing spatula, mortar
and pestle
Maintenance
• Filling instrument: Plastic filling instrument, amalgam
After restoration is done, it must be maintained for carrier, teflon-coated instruments
providing service for longer duration. • Condensers: round and parallelogram condenser
Figures 1.9: Photograph showing armamentarium required for restorative procedures
• Carvers: Diamond shaped (Frahm’s), Hollenback’s on typhodonts and extracted teeth. Typhodonts are
carver artificial acrylic teeth mounted on maxillary and
• Ball burnishers mandibular arches which can be fixed to human-shaped
• Others: Glass slab, Ivory no. 1 and 8 retainers and rubber faces to simulate the oral cavities. Typhodonts can
bands, Toffelmire retainer and bands, wedges, dappen also be mounted separately on plaster moulds or blocks
dish (Fig. 1.10D). Typhodonts are advantageous because of
• Contrangle micromotor hand piece, round, straight, their easy accessibility, availability in anatomical forms.
tapered, inverted cone diamond points. But these have disadvantages like:
• There is no separation between enamel and dentin
preclinical Tooth preparations • Because of their softness they get cut very fast.
Tooth Preparations on Plaster Models Tooth Preparations on Extracted Teeth

Before going for tooth preparation on typhodonts or After performing tooth preparations on plaster models and
extracted teeth, it is advisable to practice on plaster models. typhodonts, students are advised to practice on extracted
These plaster models are prepared by pouring plaster natural teeth. These teeth should be mounted in plaster
of paris in readymade tooth moulds. Students practice blocks or phantom jaws. These teeth have advantages
class I to V tooth preparations on these models. Working over typhodonts because being natural, these show
on plaster models have many advantages. Students can differentiation of enamel and dentin. But these teeth carry
understand concept of tooth preparation better on bigger risk of contamination and they are not easily available.
models. Outline form, line and point angles, convergence Shortcomings of Preclinical Practice
of walls, and carving can be understood in a better way on
• Knowledge of saliva control and isolation can not be
plaster models (Figs 1.10A to C). By these, student can
experienced in preclinical work
easily replicate tooth preparations on typhodonts and
• One can not be familiar with tongue interference which
extracted teeth.
is common while working on mandibular arch
Tooth Preparations on Typhodonts • Retraction of soft tissues is completely different in
patients
Before going for tooth preparation in patient’s mouth, it is • Patient anxiety and apprehension can not be
always advisable to practice all types of tooth preparations experienced with mannequins.
Introduction to Preclinical Conservative Dentistry 5
A B C D
Figures 1.10A to D: (A to C) Photograph showing Class I and II tooth preparations on plaster model; (D) Tooth preparation in typhodont
Scope of operative dentistry of the teeth which do not require full coverage
• To have knowledge of dental anatomy and histology restorations for correction.” Such corrections and
• To understand the effect of the operative procedures on restorations result in the restoration of proper tooth
the treatment of other disciplines form, function and aesthetics while maintaining the
• To know condition of the affected tooth and other teeth physiological integrity of the teeth in harmonious
• To examine not only the affected tooth but also oral and relationship with the adjacent hard and soft tissues.
systemic health of the patient Q.3. Why is subject preclinical operative dentistry
• Provide optimal treatment plan to restore the tooth to important?
return to health and function and increase the overall Ans. Since oral cavity is a small area which consist
well being of the patient of lips, cheeks, palate, and a mobile tongue. To
• Thorough knowledge of dental materials which can be do tooth preparation in this area, a great skill is
used to restore the affected areas required. Repeated tooth preparation in extracted
• To understand the biological basis and function of natural teeth increases the skill and efficiency of the
various tooth tissues person.
• To maintain the pulp vitality and prevent occurrence of Q.4. Why should one practice on dummy models
pulpal pathology. before doing patients?
Ans. By doing tooth preparation in dummy models,
Viva Questions a person is able to juxtapose his acquired skill
in clinical patient easily. Moreover this training
Q.1. What is preclinical operative dentistry? increases the confidence and psychomotor skills for
Ans. Preclinical operative dentistry is a branch of handling tissues.
operative dentistry where practical training is given
Q.5. What are different causes of loss of tooth
for tooth preparation and restoration of teeth with
structure?
various materials on dummy models in simulated
Ans. • Caries
oral environment.
• Noncarious loss of the tooth structure
Q.2. Define Operative dentistry? • Malformed, traumatized, or fractured teeth
Ans. According to Sturdvent, “Operative dentistry is • Esthetic improvement
defined as science and art of dentistry which deals • Replacement or repair of restoration
with diagnosis, treatment and prognosis of defects • Developmental defects.
CHAPTER
2
Morphology of Permanent Teeth
Amit Garg, Mannat Dhillon
CHAPTER OUTLINE
Introduction Mandibular Teeth
Definitions t Central Incisor
Maxillary Teeth t Lateral Incisor
t Central Incisor t Canine
t Lateral Incisor t First Premolar
t Canine t Second Premolar
t First Premolar t First Molar
t Second Premolar t Second Molar
t First Molar Viva Questions
t Second Molar
INTRODUCTION distal margins of the lingual surfaces of anterior teeth

(incisors and canines).
As we know there are 32 teeth in permanent dentition
and 20 teeth in deciduous dentition. A tooth has crown Triangular ridges: These descend from the tips of the
and a root portion. Crown part of the tooth is covered cusps of molars and premolars toward the central part of
with enamel and root portion of tooth is covered by occlusal surfaces.
cementum. The crown and root join at cementoenamel Transverse ridge: When both buccal and lingual triangular
junction (CEJ). ridges join, they combine to form a transverse ridge.
DEFINITIONS Oblique ridge: It is a ridge obliquely crossing the occlusal

surfaces of maxillary molars. It is usually formed by the
Cervical line: Each tooth has a crown and root portion. union of triangular ridge of distobuccal cusp and distal
The crown is covered with enamel and the root portion is cusp ridge of the mesiolingual cusp.
covered with cementum. The crown and root join at the
CEJ. This junction is also called the cervical line. Fossa: It is an irregular depression or concavity on lingual
surface of anterior and occlusal surface of posterior teeth.
Cingulum: It is enlargement or the bulge on the cervical Its named according to its shape or location.
third of lingual surface of the crown in anterior teeth
(incisors and canines). Lingual fossae: Occur on lingual surface of incisors.
Central fossae: Occur on occlusal surface of molars.
Ridge: It is linear elevation on the surface of a tooth. Its
named according to its location. Sulcus: It is a long depression on the surface of tooth
ridges and cusps.
Marginal ridges: These are rounded borders of enamel
that form the mesial and distal margins of occlusal surfaces Developmental groove: It is shallow groove between the
of posterior teeth (premolars and molars) and mesial and primary parts of the crown or root.
Morphology of Permanent Teeth 7
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r *ODJTBM PVUMJOF JT BMNPTU TUSBJHIU CVU OFXMZ FSVQUFE
r -BCJBM TVSGBDF BQQFBST CSPBE BOE ëBU XIFSFBT UIF
teeth may show mamelons
lingual portion tapers lingually towards the cingulum.
r $FSWJDBM PVUMJOF GPMMPXT B TFNJDJSDVMBS TIBQF XJUI
convexity towards root surface (Fig. 2.2A). Lateral Incisor
Lingual Aspect Box 2.1: Special features of maxillary lateral incisor
t Most commonly found missing tooth
r .FTJBMBOEEJTUBMPVUMJOFTDPOWFSHFQBMBUBMMZ t Peg-shaped lateral—Common finding
r #FMPXDFSWJDBMMJOF BTNPPUIDPOWFYJUZJTQSFTFOUDBMMFE t Palatogingival groove.
cingulum
Labial Aspect
r 8IFO DPNQBSFE UP DFOUSBM JODJTPS JU IBT NPSF
curvature, rounded incisal edge and rounded incisal
angles, mesially and distally (Box 2.1)
r .FTJPJODJTBM BOHMF DBO CF BT TIBSQ BT UIBU PG DFOUSBM
incisor
r %JTUBMPVUMJOFJTNPSFSPVOEFEUIBODFOUSBMJODJTPS
r $SFTU PG DPOUPVS NFTJBMMZ JT BU QPJOU PG KVODUJPO PG
middle and incisal third and on distal side, it lies more
A B towards cervical aspect
Figures 2.1A and B: Schematic representation showing r -BUFSBM JODJTPS JT OBSSPXFS NFTJPEJTUBMMZ BOE TIPSUFS
cusp and tubercle cervicoincisally than central incisor (Fig. 2.3A).
A B C
D E
Figures 2.2A to E: Schematic representation showing (A) Labial aspect; (B) Lingual aspect; (C) Mesial aspect; (D) Distal aspect;
(E) Incisal aspect of maxillary central incises
Lingual/Palatal Aspect Incisal Aspect

r 1BMBUBMBTQFDUJTOBSSPXFSUIBOMBCJBM r .BZSFTFNCMFDFOUSBMJODJTPSPSDBOJOF
r $JOHVMVN JT QSPNJOFOU XJUI BŁOJUZ UPXBSET EFFQ r -BCJBMTVSGBDFJTNPSFDPOWFYXJUIQSPNJOFOUDJOHVMVN
developmental grooves within lingual fossa r -BCJPMJOHVBM EJNFOTJPOT NBZ CF HSFBUFS UIBO
r .BSHJOBMSJEHFTBSFNPSFQSPNJOFOUUIBOUIBUPGDFOUSBM mesiodistal dimensions (Fig. 2.3E).
incisor
r 8IFODPNQBSFEUPDFOUSBMJODJTPS MJOHVBMGPTTBJTNPSF Canine
concave and circumscribed (Fig. 2.3B).
Labial Aspect
Mesial Aspect r .FTJPEJTUBMEJNFOTJPOTBSFTIPSUFSUIBODFOUSBMJODJTPS
r -BCJBMTVSGBDFJTTNPPUIXJUITMJHIUTIBMMPXEFQSFTTJPOT
r "MNPTUTJNJMBSUPUIBUPGDFOUSBMJODJTPS
r %VFUPNPSFEFWFMPQNFOUPGNJEEMFMPCF MBCJBMSJEHFJT
r $VSWBUVSFPGDFSWJDBMMJOFNPSFPONFTJBMTVSGBDFUIBO
seen
on distal surface (Fig. 2.3C).
r .FTJBMPVUMJOFJTDPOWFYGSPNDFSWJYUPNFTJBMDPOUBDU
area
Distal Aspect
r %JTUBM PVUMJOF JT VTVBMMZ DPODBWF GSPN DFSWJDBM MJOF UP
r 8JEUI PG DSPXO BQQFBST NPSF UIBO PO NFTJBM TVSGBDF distal contact area
because of placement of crown on the root r *ODJTBMFEHFDPNFTUPBEJTUJODUQPJOUJOGPSNPGDVTQ
r $VSWBUVSF PG DFSWJDBM MJOF JT VTVBMMZ MFTT UIBO UIBU PG *UIBTNFTJBMBOEEJTUBMTMPQFT.FTJBMTMPQFJTTIPSUFS
mesial surface (Fig. 2.3D). than distal slope
A B C
D E
(E) Incisal aspect of maxillary lateral incises
r $BOJOFIBTUIFMPOHFTUSPPU3PPUBQQFBSTTMFOEFSGSPN Distal Aspect

the labial aspect (Fig. 2.4A).
It is almost similar to that of mesial aspect except that:
r $FSWJDBMMJOFTIPXTMFTTDVSWBUVSF
Lingual/Palatal Aspect
r %JTUBM NBSHJOBM SJEHF JT IFBWJFS BOE NPSF JSSFHVMBS JO
r $SPXOJTOBSSPXFSPOMJOHVBMTJEF outline (Fig. 2.4D).
r $JOHVMVN JT QSPNJOFOU TPNFUJNFT QPJOUFE BOE NBZ
appear as a small cusp Incisal Aspect
r .BSHJOBMSJEHFTBSFQSPNJOFOU-JOHVBMSJEHFJTGPVOE
r -BCJPMJOHVBMEJNFOTJPOTBSFNPSFUIBONFTJPEJTUBM
below cingulum and between marginal ridges. It
r -BCJBMSJEHFBQQFBSTPOMBCJBMTVSGBDF
divides lingual fossa in mesial and distal lingual fossa
r 0O MJOHVBM TVSGBDF DJOHVMVN NBLFT VQ UIF DFSWJDBM
(Fig. 2.4B).
third of the crown
r $VTQ UJQ BOE DVTQ TMPQFT MJF MBCJBM UP MPOH BYJT PG UIF
Mesial Aspect
root
r 0VUMJOF JT XFEHF TIBQF XJUI HSFBUFTU NFBTVSFNFOUT r %JTUBM DVTQ SJEHF JT MPOHFS UIBO UIF NFTJBM DVTQ SJEHF
towards cervical third (Fig. 2.4E).
r -BCJBM TVSGBDF BQQFBST DPOWFY GSPN DFSWJDBM MJOF
towards cusp tip First Premolar
r -JOHVBM PVUMJOF TIPXT DPOWFYJUZ BU DFSWJDBM BSFB
Buccal Aspect
straight at middle third and again convex at incisal third
r "MJOFCJTFDUJOHUIFDVTQJTMBCJBMUPUIFMJOFCJTFDUJOHSPPU r $SPXO JT SPVHIMZ USBQF[PJEBM XJUI DPOWFY CVDDBM
(Fig. 2.4C). surface and buccal ridge
A B C
D E
(E) Incisal aspect of maxillary canine
r .FTJBMPVUMJOFJTTMJHIUMZDPODBWFGSPNDFSWJDBMMJOFUP Mesial Aspect

the mesial contact area r 3PVHIMZUSBQF[PJEBMJOTIBQFXJUIMPOHFTUTJEFUPXBSET
r %JTUBMPVUMJOFJTTUSBJHIUFSUIBONFTJBMPVUMJOF cervical portion, and shortest towards occlusal portion
r #VDDBM DVTQ JT MPOH BOE TIBSQ BOE UIVT SFTFNCMFTr #VDDBMBOEQBMBUBMPVUMJOFTBSFTNPPUIMZDVSWFEGSPN
canine the cervical line till the tips of buccal and palatal cusps
r .FTJBMDVTQTMPQFJTMPOHFSUIBOEJTUBMDVTQTMPQFǔJT r .FTJBM EFWFMPQNFOUBM EFQSFTTJPO JT GPVOE DFSWJDBM
difference places buccal cusp tip distal to long axis of to mesial contact area bordered by mesiobuccal and
the tooth (Figs 2.5A). mesiolingual line angles. This depression continues
apically beyond cervical line and joins the deep
Palatal Aspect developmental depressions of roots
r %FWFMPQNFOUBM HSPPWF JT GPVOE JO FOBNFM PG NFTJBM
r %VF UP QBMBUBM DPOWFSHFODF DSPXO JT OBSSPXFS PO marginal ridge. This groove is usually continuous with
palatal side than on buccal side central groove of occlusal surface of crown
r 1BMBUBMDVTQJTTNPPUI TIPSUBOECMVOUBTDPNQBSFEUP r 5XPSPPUTPOFCVDDBMBOEPOFQBMBUBMBSFDMFBSMZWJTJCMF
buccal cusp from mesial aspect (Fig. 2.5C).
r .FTJBMBOEEJTUBMTMPQFTPGQBMBUBMDVTQNBLFSPVOEFE
angle at cusp tip Distal Aspect
r 4JODFQBMBUBMDVTQJTTIPSUFSUIBOCVDDBMDVTQ UIFUJQT It is almost similar to mesial aspect except that:
of both cusps with their mesial and distal slopes can be r $POWFY EJTUBM TVSGBDF XJUI OP EFQSFTTJPO BU DFSWJDBM
seen from palatal aspect (Fig. 2.5B). third
A B C
D E
Figures 2.5A to E: Schematic representation showing (A) Buccal aspect; (B) Palatal aspect; (C) Mesial aspect; (D) Distal aspect;
(E) Occlusal aspect of maxillary first premolar
Abbreviations: MBCR, mesiobuccal cusp ridge; MP, mesial pit; MTF, mesial triangular fossa; MMR, mesial marginal ridge; MMDG, mesial marginal
development groove; MLCR, mesiolingual cusp ridge; CDG, central development groove; DBCR, distobuccal cusp ridge; DTF, distal triangular
fossa; DP, distal pit; DMR, distal marginal ridge; DLCR, distolingual cusp ridge
r "CTFODFPGEFFQEFWFMPQNFOUBMHSPPWF deeply pointed and referred as mesial and distal

r $VSWBUVSFPGDFSWJDBMMJOFJTMFTTUIBOPONFTJBMBTQFDU developmental pits
(Fig. 2.5D). r %JTUBM UP NFTJBM NBSHJOBM SJEHF JT B USJBOHVMBS
depression, called mesial triangular fossa
Occlusal Surface r .FTJBM UP EJTUBM NBSHJOBM SJEHF B EFQSFTTJPO DBMMFE
r 3FTFNCMFTBTJYTJEFEIFYBHPO BOEDJSDVNTDSJCFECZ distal triangular fossa is present
cusp ridges and marginal ridges r #uccal and lingual triangular ridges are visible extending
r $SPXOJTXJEFSPOCVDDBMBTQFDUUIBOPOQBMBUBMBTQFDU from center of central groove to their respective cusp
r "OHMF GPSNFE CZ KVODUJPO PG NFTJPCVDDBM SJEHF JT tips.
almost right angle. Whereas angle formed by junction
of distobuccal cusp ridge and distal marginal is acute Second Premolar
(Fig. 2.5E).
Buccal Aspect
r $FOUSBM EFWFMPQNFOUBM HSPPWF EJWJEFT UIF PDDMVTBM
surface buccolingually. This groove extends from distal r $SPXO JT TIPSUFS BQQSPYJNBUFMZ NN
UIBO êSTU
marginal ridge to mesial marginal ridge where it joins premolar
mesial marginal developmental groove r *U JT MFTT QPJOUFE BOE NPSF PCMPOH JO TIBQF XIFO
r .FTJPCVDDBM BOE EJTMPCVDDBM EFWFMPQNFOUBM HSPPWF compared to first premolar
join the central groove just inside the mesial and r .FTJBMTMPQFPGCVDDBMDVTQJTTIPSUFSUIBOEJTUBMTMPQF
distal marginal ridges. The junction of grooves are (reverse is true for first premolar) (Figs 2.6A).
A B C
D E
(E) Occlusal aspect of maxillary second premolar
Abbreviations: DBCR, distobuccal cusp ridge; MBCR, mesiobuccal cusp ridge; DBTG, distobuccal triangular groove; DMR, distal marginal ridge; DTF,
distal triangular fossa; DP, distal pit; DPTG, distopalatal triangular groove; DPCR, distolingual cusp ridge; MBTG, mesiobuccal triangular groove; MMR,
mesial marginal ridge; MTF, mesial triangular fossa; MP, mesial pit; MPTG, mesiopalatal triangular groove; MPCR, mesiopalatal cusp ridge
Palatal Aspect Occlusal Aspect

r #PUIQBMBUBMBOECVDDBMDVTQTBSFPGTBNFEJNFOTJPOT r 0VUMJOFJTSPVOEFEPSPWBM
r 1BMBUBM TVSGBDF JT OBSSPXFS UIBO CVDDBM TVSGBDF r $FOUSBM EFWFMPQNFOUBM HSPPWF JT TIPSUFS BOE NPSF
(Fig. 2.6B). irregular
r .VMUJQMF TVQQMFNFOUBSZ HSPPWFT SBEJBUF GSPN DFOUSBM
Mesial Aspect groove. These groves end in shallow depressions in
the enamel of occlusal surface giving it a wrinkled
r #VDDBMBOEQBMBUBMDVTQTBSFPGBMNPTUTBNFIFJHIU appearance (Fig. 2.6E).
r /P EFWFMPQNFOUBM HSPPWF PS EFQSFTTJPO JT GPVOE PO
mesial surface First Molar (Box 2.2)
r (SFBUFS EJTUBODF CFUXFFO DVTQ UJQT JODSFBTFT UIF Box 2.2: Important features of maxillary first molar
dimensions of occlusal surface buccolingually t 'JSTUQFSNBOFOUUPPUIUPFSVQU
(Fig. 2.6C). t .PTUDBSJFTQSPOF
t -PDBUJPOJTBUDFOUFSPGGVMMZEFWFMPQFEKBXBOUFSPQPTUFSJPSMZ TP
also considered as “corner stones” of dental arches
Distal Aspect
It is almost similar to mesial aspect except that distal Buccal Aspect
root depression is present which is deeper than mesial r $SPXO JT USBQF[PJEBM JO TIBQF UIF DFSWJDBM MJOF
depression (Fig. 2.6D). representing the shorter of uneven sides
A B C
D E
Figures 2.7A to E: Schematic representation showing (A) Buccal aspect; (B): Palatal aspect; (C) Mesial aspect; (D) Distal aspect;
(E) Occlusal aspect of maxillary first molar
Abbreviations: DBCR, distobuccal cusp ridge; CP, central pit; DTF, distal triangular fossa; DMR, distal marginal ridge; DPCR, distopalatal cusp ridge;
DBC, distobuccal cusp; DPC, distopalatal cusp; MPC, mesiopalatal cusp; MBCR, mesiobuccal cusp ridge; BDG, buccal development groove; MTF,
mesial triangular fossa; CDG, central development groove; MMR, mesial marginal ridge; MPCR, mesiopalatal cusp ridge
r 5XPDVTQTNFTJPCVDDBMBOEEJTUPCVDDBMBSFTFFO r " êGUI DVTQ JT BMTP TFFO PO UIF QBMBUBM TVSGBDF PG
r .FTJPCVDDBMDVTQJTCSPBEFSBOEJUTNFTJBMBOEEJTUBM mesiopalatal cusp, it is termed as “Cusp of Carabelli”
slopes meet at an obtuse angle Cusp ridge of this cusp is 2 mm cervical of cusp tip of
r %JTUPCVDDBMDVTQJTMFTTCSPBEBOEJUTNFTJBMBOEEJTUBM mesiopalatal cusp. This cusp is found in 60% of cases
slopes meet at a right angle r .FTJPQBMBUBM DVTQ JT UIF MPOHFTU DVTQ XIFSF BT
r #VDDBMEFWFMPQNFOUBMHSPPWFEJWJEFTUXPCVDDBMDVTQT distopalatal cusp is round and spheroidal in shape
It extends occlusoapically and terminates approximately r "MMUISFFSPPUTBSFWJTJCMFGSPNUIJTBTQFDU(Fig. 2.7B).
half the distance from its origin occlusally to the cervical
line. At this point, a pit is present called buccal pit Mesial Aspect
r .FTJBM PVUMJOF PG DSPXO JT BMNPTU TUSBJHIU XIFSF BT
r $SPXOBQQFBSTBTTIPSUFSBOECSPBEFSCVDDPMJOHVBMMZ
distal outline is convex
r .FTJPCVDDBM NFTJPQBMBUBM BOE êGUI DVQ iUIF DVTQ PG
r .FTJPQBMBUBMBOEEJTUPQBMBUBMDVTQTBSFBMTPTFFO
Carabelli” are seen from this aspect
r "MM UISFF PG SPPUT JF NFTJPCVDDBM EJTUPCVDDBM BOE
r .FTJBM NBSHJOBM SJEHF JT DPOëVFOU XJUI NFTJPCVDDBM
palatal are also seen from buccal aspect (Fig. 2.7A).
and mesiopalatal cusp ridges. It is irregular and curves
Palatal Aspect cervically (Fig. 2.7C).
r *UJTBMNPTUSFWFSTFPGCVDDBMBTQFDU
Distal Aspect
r $SPXOJTCSPBEFSNFTJPEJTUBMMZ
r .FTJPQBMBUBMBOEEJTUPQBMBUBMDVTQTBSFTFFO r *UJTBMNPTUTJNJMBSUPUIBUPGNFTJBMBTQFDU
A B C
D E
(E) Occlusal aspect of maxillary second molar
r 4JODF DSPXO JT OBSSPXFS PO UIF EJTUBM TVSGBDF UIBO r 5XP NBKPS GPTTBF QSFTFOU BSF DFOUSBM GPTTB BOE EJTUBM
mesial surface, most of the palatal and buccal surfaces fossa. Central fossa is present mesial to oblique ridge,
can be seen from distal aspect whereas distal fossa is present distal to oblique ridge
r "MMDVTQTBSFWJTJCMF(Fig. 2.7D). r 5XP NJOPS GPTTBF QSFTFOU BSF NFTJBM BOE EJTUBM
triangular fossae
Occlusal Aspect r 'PVS HSPPWFT BSF QSFTFOU JF DFOUSBM HSPPWF CVDDBM
r "MNPTU SIPNCPJEBM PS QBSBMMFMPHSBN JO PVUMJOF XJUI groove, transverse groove and distal oblique groove
four major cusp ridges and marginal ridges (Fig. 2.7E).
r #VDDPMJOHVBMNFBTVSFNFOUPGDSPXOPONFTJBMTJEFJT
greater than distal side, i.e. distal surface is narrower Second Molar
buccolingually, than mesial surface
r .FTJPQBMBUBM DVTQ JT MBSHFTU DVTQ GPMMPXFE CZ Buccal Aspect
mesiobuccal, distopalatal, distobuccal and fifth cusp in r ǔF DSPXO JT TMJHIUMZ TIPSUFS BOE OBSSPXFS UIBO êSTU
EFDSFBTJOHTJ[F molar
r 3IPNCPJEBMTIBQFIBTUXPBDVUFBOHMFT.FTJPCVDDBM r .FTJPCVDDBMDVTQJTMBSHFSUIBOEJTUPCVDDBMDVTQ
and distopalatal and two obtuse angles, i.e. mesiopalatal r #VDDBM HSPPWF JT QSFTFOU XIJDI TFQBSBUFT UXP CVDDBM
and distobuccal cusps (Fig. 2.8A).
r &BDI DVTQ IBT USJBOHVMBS SJEHF ǔF USJBOHVMBS SJEHFT
of mesiopalatal and distobuccal cusp meet to form Palatal Aspect
oblique ridge
r 4FDPOE USJBOHVMBS SJEHF PG NFTJPQBMBUBM DVTQ BOE It is mainly different from first molar in following respects:
triangular ridge of mesiobuccal cusp meet to form r 4IPSUFSEJTUPQBMBUBMDVTQ
transverse ridge r "CTFODFPGêGUIDVTQ
A B C
D E
(E) Incisal aspect of mandibular central incises
r %JTUPCVDDBM DVTQ DBO CF TFFO UISPVHI UIF TVMDVT r .PSF PG TVQQMFNFOUBSZ HSPPWFT BOE QJUT BSF QSFTFOU
between mesiopalatal and distopalatal cusp (Fig. 2.8B). than first molar (Fig. 2.8E).
Mesial Aspect MANDIBULAR TEETH

$SPXOMFOHUIJTMFTTXIFODPNQBSFEUPêSTUNPMBS.FTJBM
Central Incisor
marginal ridge is located more occlusally than distal
marginal ridge (Fig. 2.8C). Box 2.3: Important features of mandibular central incisor
t 4NBMMFTUUPPUIJOBSDI
Distal Aspect t #JMBUFSBMMZTZNNFUSJDBM
r 4JODF EJTUPCVDDBM DVTQ JT TNBMMFS NFTJPCVDDBM DVTQ

can be seen from this aspect Labial Aspect
r %JTUBM NBSHJOBM SJEHF JT QMBDFE NPSF DFSWJDBMMZ UIBO r Crown is smooth, tapered from incisal ridge to cervical
mesial marginal ridge (Fig. 2.8D). portion (Box 2.3)
r Sharp mesial and distal incisal angles with straight incisal
Occlusal Aspect edge perpendicular to long axis of the tooth (Fig. 2.9A).
It is almost similar to maxillary first molar except that:
r .FTJPEJTUBMEJNFOTJPOTBSFTNBMMFSUIBOêSTUNPMBS Lingual Aspect
r .FTJPCVDDBM BOE NFTJPQBMBUBM DVTQT BSF TBNF BT UIBU r Smooth surface with slight concavity
of first molar, but distobuccal and distopalatal cusps r %VF UP MJOHVBM DPOWFSHFODF DSPXO JT OBSSPXFS PO
are smaller and less well developed lingual side
r 'JGUIDVTQJTNJTTJOH r Small and convex cingulum (Fig. 2.9B).
A B C
D E
(E) Incisal aspect mandibular lateral incisors
Mesial Aspect Lateral Incisor

r Wedge shaped with incisal edge being lingual to long Labial Aspect
axis of the root
r .FTJBM TVSGBDF JT TUSBJHIU BCPWF UIF DFSWJDBM MJOF UJMM r $SPXOJTUJMUFEEJTUBMMZPOUIFSPPU
incisal ridge r .FTJPJODJTBMBOHMFJTTIBSQ XIFSFBTEJTUPJODJTBMBOHMF
r Cervical line is deeply curved (Fig. 2.9C). is slightly rounded (Fig. 2.10A).
Distal Aspect Lingual Aspect

r %JTUBM NBSHJOBM SJEHF JT TIPSUFS UIBO NFTJBM NBSHJOBM
It is almost similar to mesial aspect, except that cervical
ridge
MJOFDVSWFTNNMFTTUIBOPONFTJBMTVSGBDF(Fig. 2.9D).
r $JOHVMVNMJFTTMJHIUMZEJTUBMUPUIFMPOHBYJTPGUIFUPPUI
(Fig. 2.10B).
Incisal Aspect
Mesial Aspect
r #JMBUFSBMMZTZNNFUSJDBM
r Incisal edge is perpendicular to the line bisecting r 4MJHIUMZMPOHFSUIBOEJTUBMBTQFDU
labiolingually r *ODJTBM FEHF TMPQFT EPXOXBSET JO UIF EJTUBM EJSFDUJPO
r -BCJBM TVSGBDF PG DSPXO JT XJEFS NFTJPEJTUBMMZ UIBO due to longer mesial side
lingual surface (Fig. 2.9E). r $VSWBUVSFPGDFSWJDBMMJOFJTEFFQ(Fig. 2.10C) .
A B C
D E
Figures 2.11A to B: Schematic representation showing (A) Labial aspect; (B) Lingual aspect; (C) Mesial aspect; (D) Distal aspect;
(E) Incisal aspect of mandibular canine

r *ODJTBMFEHFJTUXJTUFEEJTUPMJOHVBMMZ JFEJTUBMQPSUJPO r -JOHVBM TVSGBDF JT ëBUUFS JO DPNQBSJTPO UP NBYJMMBSZ
is placed more lingually than mesial portion canine
r $VSWBUVSF PG DFSWJDBM MJOF JT MFTT EFFQ UIBO PO NFTJBM r Cingulum is not very much prominent
surface (Fig. 2.10D). r .FTJBMNBSHJOBMSJEHFJTMPOHFSUIBOUIFEJTUBMNBSHJOBM
ridge (Fig. 2.11B).
Incisal Aspect
Incisal edge is twisted distolingually. This twist corresponds Mesial Aspect
to the curvature of mandibular arch (Fig. 2.10E). r Wedge shaped with cusp tip almost centered over the
root.
Canine r Curvature of cervical line is more in comparison to
Labial Aspect maxillary canine
r %VF UP MFTT QSPNJOFODF PG DJOHVMVN BOE MFTT
r Crown is narrower than maxillary canine
labiolingual thickness of crown, cusp appears more
r Crown appears longer because of its narrowness than
pointed with slender cusp ridge (Fig. 2.11C).
maxillary crown
r .FTJBMPVUMJOFJTBMNPTUTUSBJHIU
Distal Aspect
r .FTJBMTMPQFPGDVTQJTTIPSUFSUIBOEJTUBMTMPQF
r Crown appears to be tilted distally because there is It is almost similar to mesial aspect except that:
more of crown distal to long axis of root than mesial to r $SPXOJTUXJTUFEEJTUPMJOHVBMMZTPEJTUPMJOHVBMBOHMFJT
it (Fig. 2.11A). positioned slightly lingual than cusp tip
A B C
D E
Figures 2.12A to E: Schematic representation showing (A) Buccal aspect; (B) Lingual aspect; (C) Mesial aspect; (D) Distal aspect;
(E) Occlusal aspect of mandibular first premolar
r $VSWBUVSF PG DFSWJDBM MJOF JT MFTT UIBO PO NFTJBM TJEF Lingual Aspect
(Fig. 2.11D).
r #FDBVTFPGMJOHVBMDPOWFSHFODF DSPXOPGêSTUQSFNPMBS
tapers toward the lingual side
Incisal Aspect
r -ingual cusp is small, with pointed tip
r .FTJPEJTUBM EJNFOTJPOT BSF MFTTFS UIBO MBCJPMJOHVBM r .JEEMFCVDDBMMPCFJTXFMMEFWFMPQFENBLJOHJUTNBKPS
dimensions QPSUJPO%VFUPUIJTGFBUVSF JUSFTFNCMFTDBOJOF
r $VTQUJQBOENFTJBMDVTQSJEHFBSFMJOHVBMMZQMBDFE r .FTJPMJOHVBM EFWFMPQNFOUBM HSPPWF JT QSFTFOU XIJDI
r 5PPUIBQQFBSTUPIBWFEJTUPMJOHVBMUXJTU(Fig. 2.11E). demarcates mesiobuccal and lingual lobe. It extends
into the mesial fossa of occlusal surface
First Premolar r " DIBSBDUFSJTUJD GFBUVSF PG UIJT UPPUI JT UIBU NFTJBM
Buccal Aspect marginal ridge is located more cervically than distal
marginal ridge (Fig. 2.12B).
r "QQFBSTCJMBUFSBMMZTZNNFUSJDBM
r #VDDBMDVTQUJQJTMPDBUFEOFBSUIFMPOHBYJTPGUPPUI
Mesial Aspect
r $SPXO BQQFBST USBQF[PJEBM JO TIBQF XJUI DFSWJDBM
margin being the shortest of uneven sides r Crown is rhomboidal in shape with buccal tip centered
r #VDDBMDVTQUJQJTQPJOUFEBOEUIFDVTQTMPQFTNFFUBU over the root
an obtuse angle r Crown is tilted lingually
r .FTJBMDVTQTMPQFJTTMJHIUMZTIPSUFSUIBOEJTUBMDVTQTMPQF r #VDDBM PVUMJOF JT DPOWFY GSPN DFSWJDBM MJOF UP UIF
r #VDDBMSJEHFJTQSFTFOUGSPNDFSWJDBMNBSHJOUPDVTQUJQ cusp tip
(Fig. 2.12A). r -JOHVBMPVUMJOFTIPXTQSPNJOFOUNFTJPCVDDBMMPCF
A B C
D E
Figure 2.13A to E: Schematic representation showing (A) Buccal aspect; (B) Lingual aspect; (C) Mesial aspect; (D) Distal aspect;
(E) Occlusal aspect of mandibular second premolar
r .FTJBMNBSHJOBMSJEHFNFSHFTXJUINFTJPMJOHVBMGPTTB r %JTUBM NBSHJOBM SJEHF JT BU SJHIU BOHMF UP UIF CVDDBM
This houses mesiolingual slopes. surface whereas mesial marginal ridge is at an acute
r #VDDBM USJBOHVMBS SJEHF TMPQFT QBSBMMFM UP NFTJBM angle to buccal surface
marginal ridge. It slopes cervically at 45° from cusp tip r .FTJBM GPTTB DPOUBJOT NFTJBM EFWFMPQNFOUBM HSPPWF
towards center of occlusal surface (Fig. 2.12C). which extends buccolingually (Fig. 2.12E).
Distal Aspect Second Premolar

r %JTUBM NBSHJOBM SJEHF JT IJHIFS BCPWF UIF DFSWJY UIBO Buccal Aspect
mesial marginal ridge
r 4IPSUFSCVDDBMDVTQTUIBOêSTUQSFNPMBS
r ǔFSF JT OP EFWFMPQNFOUBM HSPPWF PO EJTUBM NBSHJOBM
r $SPXOBQQFBSTBTBTRVBSFJOTIBQF
ridge
r 5XPDVTQTNFTJPCVDDBMBOEEJTUPCVDDBMBSFTFFO
r .PTUPGUIFEJTUBMTVSGBDFPGDSPXOBQQFBSTTNPPUIBOE
r $POUBDU BSFBT BQQFBS CSPBE BOE MPDBUFE PDDMVTBMMZ
spheroidal (Fig. 2.12D).
because of short buccal cusp (Fig. 2.13A).
Occlusal Aspect Lingual Aspect
r 3PVHIMZEJBNPOETIBQFE
5XPGPSNTBSFTFFOGSPNUIJTBTQFDU(Fig. 2.13B):
r 5JQPGCVDDBMDVTQJTTMJHIUMZCVDDBMUPDFOUFSPGSPPU
One buccal and one lingual cusp.
r .FTJPCVDDBM BOE EJTUPCVDDBM MJOF BOHMFT BSF r -JOHVBMDVTQJTXFMMEFWFMPQFE
prominent r -JOHVBMDVTQMJFTNFTJBMUPPSBMPOHUIFMPOHBYJTPGUIF
r #VDDBMSJEHFBQQFBSTQSPNJOFOU root
r 4QIFSPJEBM BOE TNPPUI TVSGBDF XJUI DPOTUSJDUFE First Molar

cervical portion.
Buccal Aspect
2. One Buccal cusp and two lingual cusps.
r .FTJPMJOHVBM BOE EJTUPMJOHVBM DVTQT BSF TFFO r 5SBQF[PJEBMJOTIBQF
mesiolingual being higher than distolingual cusp. r 5XPCVDDBMDVTQTBOEUISFFMJOHVBMDVTQUJQTBSFTFFO
r "HSPPWFJTQSFTFOUCFUXFFOUXPMJOHVBMDVTQT CFDBVTFCVDDBMDVTQTBSFVTVBMMZëBUUFOFEBOEMJOHVBM
cusps are higher
Mesial Aspect r 5XP CVDDBM HSPPWFT JF NFTJPCVDDBM BOE EJTUPCVDDBM
When compared with first premolar, second premolar grooves are found which demarcate mesiobuccal
shows following differences: and distobuccal cusp, distobuccal and distal cusp,
r $SPXOJTXJEFSCVDDPMJOHVBMMZ respectively
r #VDDBMDVTQJTOPUTPOFBSMZDFOUFSFEPWFSUIFSPPU r .FTJPCVDDBM DVTQ JT XJEFTU NFTJPEJTUBMMZ BOE EJTUBM
r .BSHJOBMSJEHFJTQFSQFOEJDVMBSUPMPOHBYJTPGUPPUI cusp is smallest of all
r -JOHVBMMPCFJTEFWFMPQFEUPHSFBUFSFYUFOU r 5wo roots, one mesial and one distal are seen from
r "CTFODF PG NFTJPMJOHVBM HSPPWF PO DSPXO QPSUJPO CVDDBM BTQFDU .FTJBM SPPU JT NPSF DVSWFE UIBO UIF
(Fig. 2.13C). distal root (Fig. 2.14A).
It is almost similar to mesial aspect except that: r ǔSFFDVTQT JFNFTJPMJOHVBM EJTUPMJOHVBMBOEMJOHVBM

r $FSWJDBMMJOFDVSWBUVSFJTMFTTUIBOPONFTJBMTVSGBDF portion of distal cusp is seen
r %JTUPMJOHVBM DVTQ JT TNBMMFS UIBO NFTJPMJOHVBM DVTQ r .FTJPMJOHVBMDVTQJTXJEFTUNFTJPEJTUBMMZXJUIJUTDVTQ
(Fig. 2.13D). tip placed higher than distolingual cusp
r -JOHVBM EFWFMPQNFOUBM HSPPWF EFNBSDBUFT
Occlusal Aspect mesiolingual and distolingual and distolingual cusp
r 4VSGBDFPGDSPXOMJOHVBMMZJTTNPPUIBOETQIFSPJEBMPO
One buccal and one lingual cusp.
each cusp
r 3PVOEFEPDDMVTBMPVUMJOF
r .esial and distal roots are seen from lingual aspect
r -JOHVBMDPOWFSHFODFJTTFFO
(Fig. 2.14B).
r #VDDBMDVTQJTCJHHFSJOTJ[FUIBOMJOHVBMDVTQ
r 3PVOEFENFTJPMJOHVBMBOEEJTUPMJOHVBMMJOFBOHMFT
Mesial Aspect
r $FOUSBMEFWFMPQNFOUBMHSPPWFFYUFOETNFTJPEJTUBMMZ*U
terminates in mesial and distal fossa r 3PVHIMZSIPNCPJEBMJOTIBQF
r ǔFSFJTOPDFOUSBMGPTTB r 5XPDVTQT JFNFTJPCVDDBMBOENFTJPMJOHVBMDVTQTBSF
r /PMJOHVBMHSPPWFQSFTFOU seen
r 4JODFNFTJBMQPSUJPOPGUPPUIJTCSPBEFS EJTUBMQPSUJPO
One buccal cusp and two lingual cusps.
of tooth cannot be seen mesial aspect
r 4RVBSF TIBQF XJUI CVDDBM DVTQ CFJOH MBSHFTU JO TJ[F
r $SPXOIBTMJOHVBMUJMUXJUISFTQFDUUPMPOHBYJTPGSPPU
followed by mesiolingual and distolingual
r ǔFSFJTBDVSWBUVSFPWFSUIFDFSWJDBMUIJSEPGUIFDSPXO
r &BDI DVTQ IBT XFMMEFWFMPQFE USJBOHVMBS SJEHFT
buccally termed as buccal cervical ridge
separated by grooves
r .BSHJOBMSJEHFJTDPOëVFOUXJUINFTJBMSJEHFTPGNFTJP
r (SPPWFT KPJO UP GPSN B DFOUSBM QJU BOE :TIBQFE
buccal and mesiolingual cusp (Fig. 2.14C).
appearance
r -JOHVBM EFWFMPQNFOU HSPPWF FYUFOET CFUXFFO UXP
Distal Aspect
lingual cusps and ends on lingual surface of crown
just below convergence of lingual cusp ridges r 4JODF DSPXO JT TIPSUFS PO EJTUBM TVSGBDF NPTU PG UIF
(Fig. 2.13E). crown portion can be seen through distal aspect
A B C
D E
Figure 2.14A to E: Schematic representation showing (A) Buccal aspect; (B) Lingual aspect; (C) Mesial aspect; (D) Distal aspect;
(E) Occlusal aspect of mandibular first molar
r "MMDVTQTDBOCFTFFO to mesial marginal ridge and distal triangular fossa is

r %JTUPMJOHVBMDVTQJTIJHIFSUIBOEJTUPCVDDBMDVTQ present mesial to distal marginal ridge
r %JTUBM DVTQ MPDBUFE PO EJTUPCVDDBM BOHMF PG DSPXO JT r (SPPWFT QSFTFOU BSF DFOUSBM EFWFMPQNFOU HSPPWF
smallest of all cusps mesiobuccal distobuccal and lingual development
r %JTUBMNBSHJOBMSJEHFJTTIPSUBOEJTNBEFVQPGEJTUBM groove (Fig. 2.14E).
cusp ridge of distal cusp and distolingual cusp ridge of
distolingual cusp Second Molar
r 0DDMVTBMTVSGBDFTIPXTEJTUBMUJQQJOH TMPQFTDFSWJDBMMZ
Buccal Aspect
from mesial to distal) (Fig. 2.14D).
r $SPXO JT TIPSUFS DFSWJDPPDDMVTBMMZ BOE OBSSPXFS
Occlusal Aspect
mesiodistally when compared to first molar
r )FYBHPOBMJOPVUMJOF r 'PVS DVTQT TFFO BSF NFTJPCVDDBM EJTUPCVDDBM
r #VDDPMJOHVBMEJNFOTJPOTBSFNPSFPONFTJBMTJEFUIBO mesiolingual and distolingual
on distal side r #VDDBM HSPPWF TFQBSBUFT NFTJPCVDDBM BOE EJTUPCVDDBM
r .FTJPEJTUBM EJNFOTJPOT BSF NPSF UIBO CVDDPMJOHVBM cusp
dimensions r 5wo roots, one mesial and one distal are seen from
r 'JWF DVTQT BSF TFFO JF NFTJPCVDDBM EJTUPCVDDBM buccal aspect (Fig. 2.15A).
mesiolingual, distolingual, distal
r ǔFSFJTPOFNBKPSGPTTBDFOUSBMGPTTBXIJDIJTQSFTFOU Lingual Aspect
between buccal and lingual cusp ridges
r 5XP NJOPS GPTTBF QSFTFOU BSF NFTJBM BOE EJTUBM r .FTJPMJOHVBMBOEEJTUPMJOHVBMDVTQTBSFTFFO
USJBOHVMBSGPTTB.FTJBMUSJBOHVMBSGPTTBJTQSFTFOUEJTUBM r $SPXOTMJHIUMZDPOWFSHFTPOMJOHVBMTJEF
A B C
D E
Figures 2.15A to E: Schematic representation showing (A) Buccal aspect; (B) Lingual aspect; (C) Mesial aspect; (D) Distal aspect;
(E) Occlusal aspect of mandibular second molar
r .FTJPMJOHVBMDVTQJTMBSHFSUIBOEJTUPMJOHVBMDVTQ r .FTJPEJTUBM EJNFOTJPOT BSF NPSF UIBO CVDDPMJOHVBM

r .esial and distal roots are seen from lingual aspect dimensions
(Fig. 2.15B). r #VDDBMTVSGBDFPGNFTJPCVDDBMDVTQTIPXTBQSPNJOFOU
bulge, i.e. mesial cervical bulge
Mesial Aspect r 4JODFOPEJTUBMDVTQJTQSFTFOUEJTUPCVDDBMHSPPWFJTOPU
r "MNPTUTJNJMBSUPêSTUNPMBS there
r .FTJPMJOHVBMDVTQJTUIFMBSHFTUDVTQ r 5SBOTWFSTF SJEHF JT GPSNFE CZ USJBOHVMBS SJEHFT PG
r 0DDMVTBM TVSGBDF JT DPOTUSJDUFE CVDDPMJOHVBMMZ mesiobuccal and mesiolingual cusps, triangular ridges
(Fig. 2.15C). of distobuccal and distolingual cusps
r (SPPWFT NBJOMZ QSFTFOU BSF DFOUSBM HSPPWF CVDDBM
Distal Aspect groove and the lingual groove (Fig. 2.15E).
r"MNPTUTJNJMBSUPêSTUNPMBS
r.FTJPCVDDBMBOENFTJPMJOHVBMDVTQUJQTDBOCFTFFO VIVA QUESTIONS
r%JTUPCVDDBMDVTQJTTIPSUFTUPGGPVSDVTQT Q.1. Which is the largest tooth?
r$SPXO TIPXT EJTUBM UJMU JF EJTUBM NBSHJOBM SJEHF JT Ans. .BYJMMBSZêSTUNPMBS
placed more cervically (Fig. 2.15D).
Q.2. Which tooth has longest root?
Occlusal Surface Ans. .BYJMMBSZDBOJOF
r "MNPTUSFDUBOHVMBSJOTIBQF Q.3. Which tooth is widest mesiodistally?
r $SPXOUBQFSTCPUIMJOHVBMMZBOEEJTUBMMZ Ans. .BOEJCVMBSêSTUNPMBSDBOJOF
Q.4. Which tooth is named as corner stone of mouth? Q.14. What are the differences between right and left
Ans. Canine. maxillary second molar?
Ans. r .FTJPQBMBUBMDVTQJTMBSHFTUPGBMM
Q.5. In which tooth cusp of Carabelli is present?
r 0DDMVTBMTVSGBDFTIPXTUJMUGSPNNFTJBMUPEJTUBM
Ans. .BYJMMBSZêSTUNPMBS
Q.15. Differentiate right and left mandibular lateral
Q.6. In lower arch which tooth has five cusps?
incisor.
Ans. .BOEJCVMBSêSTUNPMBS
Ans. r .FTJBMTJEFMPOHFSUIBOEJTUBM
Q.7. Which is the smallest cusp in mandibular first r *ODJTBMFEHFUXJTUFEEJTUPMJOHVBMMZ
molar? r *ODJTBMFEHFTMPQFTEPXOXBSETJOEJTUBMEJSFDUJPO
Ans. %JTUBM r "EFFQDPODBWJUZJTQSFTFOUPOEJTUBMTJEFBCPWF
the cervical line.
Q.8. Which is the largest cusp of maxillary first molar?
Ans. .FTJPQBMBUBM Q.16. What are the differences between right and left
mandibular canine?
Q.9. How can you differentiate maxillary right and left
Ans. r .FTJBMPVUMJOFJTBMNPTUTUSBJHIUBOEEJTUBMPVUMJOF
central incisor?
is convex
Ans. r .FTJBMPVUMJOFJTTUSBJHIU
r .FTJBM DVTQ SJEHF JT TIPSUFS UIBO EJTUBM DVTQ
r %JTUBMPVUMJOFJTSPVOEFE
ridge.
r .FTJPJODJTBMBOHMFJTTIBSQBOEEJTUPJODJTBMBOHMF
is rounded Q.17. What are the differences between right and left
r $VSWBUVSFPGDFSWJDBMMJOFUPXBSETJODJTBMTVSGBDF mandibular first premolar?
is more on mesial side than on distal side. Ans. r 0DDMVTBMTVSGBDFTMPQFTMJOHVBMMZ
Q.10. Differentiate between right and left first maxillary r 1SFTFODF PG NFTJPMJOHVBM HSPPWF XIJDI FYUFOET
into mesial fossa of occlusal surface.
premolar.
Ans. r .FTJBMDVTQSJEHFJTMPOHFSUIBOEJTUBMDVTQSJEHF Q.18. Differentiate right and left second premolar.
r .FTJBMEFWFMPQNFOUHSPPWFJTQSFTFOUJOFOBNFM Ans. One buccal and one lingual cusp.
of mesial marginal ridge r $VSWBUVSFPGDFSWJDBMMJOFJTNPSFPONFTJBMTJEF
r .FTJBMEFWFMPQNFOUEFQSFTTJPOJTQSFTFOU than on distal
Q.11. How can you differentiate between right and left r %JTUBM NBSHJOBM SJEHF JT QMBDFE NPSF DFSWJDBMMZ
than mesial marginal ridge
maxillary lateral incisor?
r .FTJBMGPTTBJTTNBMMFSUIBOEJTUBMGPTTB
Ans. r %JTUBM PVUMJOF JT NPSF SPVOEFE UIBO NFTJBM
outline One buccal and two lingual cusps
r %JTUPJODJTBMBOHMFJTNPSFSPVOEFEUIBONFTJP r %JTUPMJOHVBM DVTQ JT TNBMMFS UIBO NFTJPMJOHVBM
incisal angle. cusp
r $FOUSBMGPTTBMJFTEJTUBMUPUIFPDDMVTBMTVSGBDF
Q.12. What are differences between right and left
r %JTUBMHSPPWFJTTIPSUFSUIFONFTJBMHSPPWF
maxillary canine?
Ans. r .FTJBMDVTQSJEHFJTTIPSUFSUIBOEJTUBMDVTQSJEHF Q.19. What are the differences between right and left
r $VSWBUVSFPGDFSWJDBMMJOFJTNPSFPONFTJBMTJEF mandibular first molar?
than on distal side. Ans. r .FTJPCVDDBMDVTQJTXJEFTUPGBMMBOEEJTUBMDVTQ
is smallest of all
Q.13. What are the differences between right and left
r 0DDMVTBMTVSGBDFTIPXTEJTUBMUJQQJOH
maxillary first molar?
Ans. r $VTQPG$BSBCFMMJJTQSFTFOUPOQBMBUBMTVSGBDFPG Q.20. Differentiate right and left mandibular second
mesiopalatal cusp molar.
r .FTJPQBMBUBMDVTQJTUIFMBSHFTUDVTQ Ans. r $SPXO TIPXT EJTUBM UJMU NBLJOH PDDMVTBM TVSGBDF
r 0CMJRVF SJEHF FYUFOET GSPN NFTJPQBMBUBM UP to slope cervically from mesial to distal
distobuccal cusp. r $SPXOTIPXTEJTUBMBOEMJOHVBMUBQFS
Q.21. How can you differentiate maxillary first and Q.26. What are the differences between maxillary and
second premolar? mandibular canine?
Ans. .FTJBMDVTQSJEHFJTTIPSUFSUIBOEJTUBMDVTQSJEHF Ans.
Maxillary Canine Mandibular Canine
Q.22. Which tooth is bilaterally symmetrical?
Ans. .BOEJCVMBSDFOUSBMJODJTPS Buccolingual dimensions are Buccolingual dimensions are
more smaller than maxillary canine
Q.23. What are important features of maxillary first
Cingulum is more prominent It is less prominent
molar?
Ans. r 'JSTUQFSNBOFOUUPPUIUPFSVQU Lingual fossa is quite deep It is almost flat
r .PTUDBSJFTQSPOF In mesial and distal aspect Cusp tip lies lingual to line
r -PDBUJPO JT BU DFOUFS PG GVMMZ EFWFMPQFE KBX cusp tip lies labial to long axis passing through cusp tip and
anteroposteriorly, so also considered as “corner of root long axis of root.
stones” of dental arches.
Q.24. What are differences between maxillary first and Q.27. What are the differences between maxillary first
second molar? and second premolar?
Ans. Ans.
First Molar Second Molar First Premolar Second Premolar
Buccal cusp is higher than Both cusps are almost of
Usually five cusps are present Usually four cusps are palatal cusp similar height
present
Mesial and distal surfaces Mesial and distal sides are
Cusp of carabelli is present It is absent converge palatally almost parallel
Mesial cusp slope is larger than Mesial cusp slope is shorter
Buccal cusps are equal in Distobuccal cusp is smaller distal cusp slope than distal cusp slope
height in size
Mesial marginal development It is absent
groove is present
Oblique ridge is prominent It is not prominent
Occlusal outline is almost It is almost rounded or
Distopalatal cusp is large It is smaller in size hexagonal in shape ovoid in shape
Q.25. What are the Differences between central and Q.28. Differentiate mandibular first and second
lateral incisor? premolar.
Ans. Ans.
Central Incisor Lateral Incisor First Premolar Second Premolar
Slightly more in dimensions Smaller in dimensions (smaller Two cusps are present Two or three cusps present
(bigger size) size)
Buccal cusp is prominent Both buccal and lingual are
Mesiodistal dimensions more Mesiodistal and labiolingual equal in size
than labiolingual dimensions dimensions are almost same
Occlusal outline is diamond It is square or triangular in
Palatal fossa is large and Palatal fossa is small and deep shaped shape
shallow
Occlusal surface slopes It is almost horizontal
Palatal pit is not a common Palatal pit is commonly seen
lingually
finding
Mesioincisal angle is sharp It is somewhat rounded Mesiolingual development It is usually not present.
groove is present
Distoincisal angle is slightly It is more rounded
rounded Mesial and distal margins Mesial and distal are
converge lingually margins are parallel
Marginal ridges and Marginal ridge and cingulum
cingulum are moderately are more prominent Central pit is not present Central pit is seen in three
prominent cusp type
Q.29. What are the differences between mandibular Q.30. What are the differences between mandibular
central and lateral incisor? first and second molar?
Ans. Ans.
Central Incisor Lateral Incisor First Molar Second Molar
Bilaterally symmetrical Asymmetrical Usually five cusps are present Four cusps are present
Mesioincisal and distoincisal Distoincisal angle is more
Mesiodistal dimensions are Mesiodistal dimensions are
angles are sharp rounded than mesioincisal
more less
angle
Mesiodistal dimensions are Mesiodistal dimensions are Occlusal outline is almost It is almost rectangular in
less than lateral more hexagonal in shape shape
Incisal edge is at right angle to Incisal edge is twisted Main groove form Y-Shaped Main groove forms + shaped
labiolingual bisecting line distolingually pattern pattern
3
cHAPTER
Morphology of Primary Teeth

Priya Verma Gupta, Sunila Sharma
Chapter Outline
Introduction • First Molar

Importance • Second Molar
Difference Between Primary and Permanent Dentition Mandibular Teeth
• Crown • Central Incisor
• Pulp • Lateral Incisor
• Root • Canines
Maxillary Teeth • First Molar
• Central Incisor • Second Molar
• Lateral Incisor Viva Questions
• Canine
INTRODUCTION of the child’s most active periods of growth and

development
Primary teeth are often called deciduous teeth. The • Primary dentition is very important for maintenance of
word “deciduous” comes from a Latin word “decidere”— proper diet
meaning, “to fall off”. The shedding of primary teeth is • Maintenance of adequate spacing and arch continuity
caused by resorption of their roots and is called exfoliation. for emergence of permanent teeth is one of the most
Exfoliation begins 2 or 3 years after the deciduous root is important functions of primary teeth
completely formed. At this time the root begins to resorb • Flared roots of primary molars resist mesial
at its apical end and resorption continues in the direction displacement of coronal portion of tooth and helps
of the crown until the entire root is resorbed and the tooth in preserving sufficient space for the premolars and
finally exfoliates. The permanent successor will then take permanent canines
its place. The need for two dentitions exist because with • Primary teeth also perform a function of stimulation
increase in jaw growth, more and bigger teeth are required of growth of jaws through mastication, especially in
for the adult. development of height of dental arches
• Another important function of the primary teeth is
IMPORTANCE development of speech. Early and accidental loss
of primary anterior teeth may lead to difficulty in
• Loss of primary teeth tends to disturb eruption sequence pronouncing the sounds ‘f’, ‘v’, ‘s’, ‘z’, and ‘th’ thus
of permanent teeth requiring speech correction
• Primary teeth are used for performing mastication • Primary teeth also serve a cosmetic function by
of food, digestion and assimilation during one improving the appearance of the child
Morphology of Primary Teeth 27
• Maintains normal facial appearance • Buccolingual diameter of the occlusal surface is much
• Resorption helps in guiding the erupting permanent less than the cervical diameter
tooth into the proper location • Cervical ridge of enamel in the anterior crown labially
• Prevents the migration of adjacent teeth thus, and lingually is much more prominent in primary
maintaining integrity of arch. dentition
• Cervical prominence gives primary crown a bulbous
DIFFERENCE BETWEEN PRIMARY AND appearance and accentuates the narrow cervical
PERMANENT DENTITION portion of deciduous roots
• There is less tooth structure protecting the pulp in
Crown primary teeth
• Primary tooth has shorter crown than permanent • Usually there are no depressions on the labial surface of
tooth (Figs 3.1A and B) the crowns of the incisors, i.e. mamelons are absent
• Enamel and dentin layers are thinner in the primary • Cingulum of anterior teeth is prominent
tooth • Cusps are short, the ridges are not pronounced and the
• Occlusal table of a primary tooth is relatively narrower fossae are correspondingly shallow
than the permanent tooth • Buccal cusps on molars are not sharp, with their cusp
• Primary tooth is much more constricted in cervical slopes meeting at an obtuse angle
portion of the crown giving it a bell-shape appearance • Second primary molars are larger than the first molars
• Enamel rods in the gingival third extend in a slightly • In totality, the crowns of primary teeth are seen short
occlusal direction from the Dentino–enamel-junction when compared with the permanent teeth.
(DEJ) in primary teeth whereas they extend slightly
apically in permanent dentition Pulp
• Contact areas are very broad and flat • Pulp of the primary tooth is larger in relation to the
• Color of the primary teeth is usually whiter than crown size than that of the permanent tooth
permanent teeth • Pulp horns of the primary tooth are closer to the outer
• Crowns of primary anterior teeth are wider mesiodistally surface of the tooth
than cervicoinsical lengths of permanent teeth • Mesial pulp horn appears to be in a closer approximation
• Buccal and lingual surfaces of primary molars are flatter, of the surface than does the distal pulp horn of the
thus providing a broader contact with adjacent tooth primary tooth
• Buccal and lingual surfaces of the molars, especially • Mandibular molar has larger pulp chambers than the
first molar converge towards the occlusal surface maxillary molar in the primary tooth
• Form of the pulp chamber follows the surface of the crown
Root
• Root of the primary anterior tooth is narrower
mesiodistally
• Roots of the posterior primary tooth are longer and
more slender
• Roots of the primary molar flare more as they approach
the apex
• Roots of the anterior teeth bend labially in their apical
one third by as much as 10°
• Second molar roots are spread more widely than the
first deciduous molar
A B • There is absence of a root base in the primary molars
Figures 3.1A and B: Schematic representation showing; • Roots erupt directly from the crown and there is no root
(A) Primary tooth; (B) Permanent tooth trunk
• Position of the apical foramen is variable due to Incisal Edge

resorption.
• Incisal edge is centered over the main bulk and is
It has been thought that the primary teeth are capable
relatively straight
of a greater inflammatory response to insult because of the
• Incisal edge is proportionately long
greater blood supply. They are also considered to be less
• Mesial surface joins the incisal edge at an acute angle
sensitive to pain because of incomplete development of
and the distal surface at a more rounded, obtuse angle
the neural network.
• Incisal edge is formed from one developmental lobe.
MAXILLARY TEETH Root

Central Incisor • Root is S-shaped, bending lingually in the cervical third
• Number of pulp horns—3 (Figs 3.2A and B) to half and labially by as much as 10° in the apical half
• Number of roots—1 • Root is much longer relative to the crown length with
• Number of developmental lobe—1. tapered end.
Labial Aspect Pulp Cavity

• Mesiodistal diameter is greater than its cervicoinsical • Pulp cavity conforms to the general outside surface of
length the tooth
• Mamelons are absent on the deciduous teeth • Chamber tapers cervically in its mesiodistal diameter
• The labial surface is unmarked by grooves, depressions, • It is widest at the cervical ridge labiolingually
or lobes. • Both pulp chamber and canal are large when compared
to permanent tooth
Palatal Aspect • Pulp canal tapers evenly until it ends in the apical
foramen.
• Well-developed marginal ridges
• Highly-developed cingulum
Lateral Incisor
• The depression between the marginal ridges and the
cingulum forms the lingual fossa • Number of pulp horns—3 (Figs 3.3A to D)
• Cingulum is convex and occupies the cervical 1/2 to 1/3 • Number of root—1
of the surface. • Number of developmental lobe—1
• A lateral incisor’s crown is smaller than a central
Mesial and Distal Aspects incisor’s crown in all dimensions
• Only the cervicoincisal length is greater than its
• Crown appears wide in relation to its total length
mesiodistal width
• Labiolingual measurements make the crown appear
• Distoincisal angles of lateral incisors are more rounded
thick
• Labial surface when viewed from the incisal aspect is
• Curvature of cervical line, is distinct, curving towards
more convex
the incisal ridge.
A B A B C D
Figures 3.2A and B: Schematic representation showing; Figures 3.3A to D: Schematic representation showing; (A) Labial
(A) Labial aspect; (B) Lingual aspect of maxillary central incisor aspect; (B) Lingual aspect; (C) Mesial aspect; (D) Incisal aspect of
maxillary central incisor
• Lingual fossa is deeper Contact Areas

• Marginal ridges are more pronounced
• Distal contact areas of primary canines rest against the
• Outline of the crown from the incisal aspect is almost
mesial surfaces of primary molars
circular
• Primary maxillary canines have mesial proximal
• Pulp chamber follows the contour of the tooth, so does
contacts more cervical than the distal proximal
the canal
contacts.
• There is a slight demarcation between the pulp chamber
and the canal.
Palatal Aspect
Root • A tubercle extends from the cusp tip to the lingual ridge
• The lingual ridge extends from the cusp tip to the
• Root appears much longer in proportion to the crown
cingulum
• Root appears constricted at its cervical third
• It divides the lingual surface into mesiolingual and
• There is a mesial concavity on the root surface
distolingual fossae
• Distal surface is generally convex.
• The cingulum on a maxillary canine crown is bulky with
well-developed cusp
Canine
• The lingual surface of the crown may present a slight
• Number of pulp horns—3 (Figs 3.4A to D) concavity called the lingual fossa
• Number of root—1 • Primary canine has a ‘fang-like’ appearance.
• Number of cusp—1
• Number of developmental lobes—4 Mesial and Distal Surfaces
• Canine is much wider at the cervical third of the crown
Labial Aspect
• The crown and the root at the cervical third are wider
• It is bulkier than the primary incisors in every aspect labiolingually
• The crown is more constricted at the cervix • There is increased length of the mesio-incisal edge
• More convex on its mesial and distal surfaces • Labial and the lingual surfaces converge as they
• Root is more slender approach the cervical area
• Canine is greater in mesiodistal diameter • Increase in crown dimension, in conjunction with the
• Crown has a diamond-shaped appearance root width and length permits resistance against forces
• It has a long, well developed, sharp cusp that the tooth must withstand during function
• Maxillary canine cusps are often very sharp with two • Function of this tooth is to punch, tear and apprehend
cusp ridges food material.
• Mesial slopes of the canines are longer than the distal
cusp slopes Incisal Aspect
• These mesial cusp slopes are flat to concave and less
• Crown is rhomboidal, like a square that has been
steeply inclined than the shorter distal slopes which are
slightly shifted
more convex.
• Labial ridge is relatively pronounced
• Cingulum is obvious
• Tip of the cusp is slightly distal to the center of the tooth
• Mesial cusp slope is longer than the distal cusp slope.
Root
• Root is long, thick in diameter and slightly flattened on
proximal surfaces
A B C D • Root is bulky in the cervical and middle third
Figures 3.4A to D: Schematic representation showing; (A) Labial • Tapering occurs mostly in the apical third region where
aspect; (B) Lingual aspect; (C) Mesial aspect; (D) Incisal aspect of the root tip is bent labially.
maxillary canine
Pulp Cavity • Mesial moiety of the crown has a greater height in

consequence of its more cervical projection onto the
• Pulp cavity conforms to the contour of the tooth
root area
• Central pulpal horn is projecting incisally farther than
• Lingual root is positioned exactly midway between the
the remainder of the pulp chamber
two buccal roots
• Distal horn is larger than the mesial projection
• Cervical third of the buccal margin bulges and is called
• Very little demarcation between the pulp chamber and
the buccal cervical ridge.
the canal can be seen.
Palatal Aspect
First Molar
• Crown of a first molar converges towards the lingual
• Number of roots—3 (Figs 3.5A to D)
surface
• Number of pulp horns—3
• Mesiobuccal cusp is always the longest but second
• Number of cusps—3
sharpest
• Number of developmental lobes—4.
• Mesiolingual cusp is the sharpest but second longest
• Distolingual cusp is small and rounded, if present
Labial Aspect
• A tiny tubercle can sometimes be seen on the
• Deciduous maxillary first molar is a blend of premolar mesiolingual cusp
and molar • Shorter diameter of the lingual cusp, leads to a narrower
• It is wider buccoligually than mesiodistally lingual diameter.
• It has two major cusps—a mesio buccal and a
mesiolingual Mesial Surface
• There is a distobuccal cusp which is smallest of the
The mesial surface is greater in diameter at the cervical
entire cusp
border than at the occlusal. This is true for all molar forms,
• Buccal surface is convex in all directions
but it is more pronounced on primary teeth than on
• Buccal surface is divided by the buccal groove
permanent teeth. The mesiobuccal and lingual roots are
• There is a well-developed buccal ridge is present on
visible only from the mesial aspect. The distobuccal root is
mesiobuccal cusp
hidden behind the mesiobuccal root. The mesial marginal
• A less developed ridge is present on the distobuccal
ridge groove is sharp and deep in profile and continues
cusp
in the form of a shallow, narrow depression up the crown
• It is much smaller in all measurements than the second
surface towards the cervical line.
molar
• Its relative shape and size suggest that it was designed
Distal Aspect
to be a “premolar section” of the primary dentition
• In function it acts as a compromise between the size and • Crown appears to be narrower distally than mesially
shape of the anterior primary teeth and the molar area • It is narrow occlusally than cervically. The marginal
• Crown appears squat since the mesiodistal diameter is ridge is fairly well developed and is crossed by a
considerably greater than the crown height prominent distal groove
• All three roots may be seen from this angle, as the
distobuccal root is superimposed on the mesiobuccal
root so that only the buccal surface and the apex of the
latter may be seen.
Occlusal Aspect
• Crown outline converges lingually
A B C D
• The crown converges distally also
Figures 3.5A to D: Schematic representation showing; (A) Labial • The occlusal surface has a central fossa, a mesial
aspect; (B) Lingual aspect; (C) Mesial aspect; (D) Occlusal aspect of
maxillary first molar triangular fossa
• Well-developed buccal developmental groove Second Molar

• Sometimes there is a well-defined triangular ridge—
• Number of roots—3 (Figs 3.6A to D)
oblique ridge
• Number of pulp horns—4 / 5
• Occlusal surface has three pits-central, mesial and
• Number of cusps—4 / 5
distal
• Number of developmental lobes—5
• Mesial pit—Deepest and well defined, distal pit
shallowest, poorly defined
Buccal Aspect
• Distobuccal cusp is separated from the mesiobuccal
cusp by a buccal groove • The tooth resembles a permanent maxillary first molar,
• The occlusal pit—Groove pattern is frequently H-shaped although much smaller in size
• Supplemental grooves can be seen • Two equivalent buccal cusps can be seen from this
• The crown may have three or four cusps aspect with a buccal groove between them
• On the 3-cusp form there is only a central and a • A primary second molar is much larger than a primary
mesial pit and an oblique ridge which often unites the first molar
mesiolingual with the distofacial cusps. The central • Crown is narrower at the cervix
groove connects the two fossa, the central fossa and the • Roots from this aspect appear slender
mesial triangular fossa • They are much longer and heavier than those of the
• Distal, facial and mesial developmental grooves radiate maxillary first molar
from the central pit • Crown of the second primary molar is trapezoidal in
• On the 4-cusp form, there are three fossa—Mesial, outline
central and distal. A small pit is usually present in • A well-defined cervical ridge which extends the full
each fossa. Grooves originating at the distal pit are diameter of the buccal surface
the distofacial triangular, distolingual, and the distal • Buccal surface is divided by the buccal groove into a
marginal grooves mesiobuccal and a distobuccal cusp, the mesiobuccal
• An oblique ridge runs from the distobuccal cusp to the being the larger
mesiolingual cusp. • The morphological concordance between both
maxillary and mandibular second primary molars and
Pulp Cavity first permanent molars has been termed isomorphy.
• Consists of a chamber and three canals
Palatal Aspect
• The chamber consists of three or four pulpal horns and
is more sharply pointed than the outer contour of the • It is convex, inclining slightly as it approaches the
cusp occlusal border
• Mesiobuccal is the largest of all the pulpal horns • It is divided by the lingual groove
• Mesiolingual pulpal horn is angular and sharp • The mesiolingual is higher than the distolingual cusp
• Distobuccal horn is the smallest
• It is sharp and occupies the extreme distobuccal angle.
Root
• They are long and slender and they spread widely
• Roots are three in number—mesiobuccal, distobuccal
and lingual
• Lingual root is the longest and diverges in a lingual
direction A B C D
• Distobuccal root is the shortest
Figures 3.6A to D: Schematic representation showing; (A) Buccal as-
• Trifurcation or bifurcation of roots begin immediately pect; (B) Palatal aspect; (C) Mesial aspect; (D) Occlusal aspects of maxil-
at the site of the cemento-enamel-junction (CEJ). lary second molar
• A fifth cusp, when present, occupies the mesiolingual • Buccal developmental groove extends buccally from
area at the middle third of the crown—referred to as central pit
Carabelli’s cusp • Oblique ridge is prominent and connects the
• A lingual developmental groove separates the mesiolingual with the distobuccal cusp
mesiolingual and distolingual cusps. • Distal to the oblique ridge one finds the distal fossa—
distal developmental groove
Mesial Aspect • Distal groove acts as a demarcation between the
mesiolingual and distolingual cusps
• Crown is 0.5 mm longer and about 2 mm wider
• Occlusal surface has three pits. The central pit is large
buccolingually
and deep which joins the shallow mesial pit and the
• Roots are up to 2 mm longer
distal groove, which traverses the oblique ridge to join
• Cusp of carabelli is visible lingual and apical to the
the distal pit. The distal pit is deep.
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mesiolingual cusp
• Mesiobuccal root from this aspect appears broad and
Pulp Cavity
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flat
• Lingual root has the same curvature as the root of the • They have 3 roots—mesiobuccal, distobuccal and a
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first deciduous molar palatal root
• Mesial surface presents a fairly-high marginal ridge • They are thinner and flare more as they approach the apex
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• Mesiobuccal angle is acute, the mesiolingual angle is • Distobuccal root is the shortest and narrowest of the
obtuse three
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• Surface is convex occlusocervically and less so • Palatal root is the longest
buccolingually. • Point of bifurcation between the mesiobuccal root and
the lingual root is 2–3 mm apical to the cervical line of
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Distal Aspect the crown

• It is convex occlusocervically and flattened in its cervical • Point of bifurcation between the distobuccal and the
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portion lingual root is more apical than any other points of

• Contact with the upper first permanent molar is in the bifurcation
form of an inverted crescent with the convexity towards • Unlike first molar the mesiobuccal root may be as long
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the occlusal surface as the lingual.

• The distal calibration of the crown is less than the mesial
measurement MANDIBULAR TEETH
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• Distobuccal and distolingual cusps are about the same

Central Incisor
length
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• A rather straight cervical line is evident both distally • Number of roots—1 (Figs 3.7A to D)
and mesially. • Number of pulp horns—3
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• Number of developmental lobe—1

Occlusal Aspect
• It has four well-developed cusps—mesiobuccal, Labial Aspect
distobuccal, mesiolingual, distolingual and a cusp of • Labial aspect has a flat face with no developmental
Carabelli grooves
• It is somewhat rhomboidal • Crown is wide in proportion to its length in comparison
• Mesiobuccal cusp is the largest and the distolingual is with that of its permanent successor
the smallest, except for the fifth cusp • It is smaller than the maxillary central incisor
• Occlusal surface has a central fossa with a central pit, a • Tooth resembles the permanent maxillary lateral
well-defined mesial triangular fossa. incisor
• Well–developed groove called the central groove • Proximal sides of the crown taper evenly from the
connecting the mesial triangular fossa with the central fossa contact areas
http://ebooksdental.net
A D
B C D
Figures 3.7A to D: Schematic representation showing; (A) Labial aspect; (B) Lingual aspect; (C) Mesial aspect;
(D) Occlusal aspect of mandibular central incisors
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A B C D
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(D) Occlusal aspect of mandibular lateral incisors
• Root is long, evenly tapered down to the apex Distal Aspect

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• Root is almost twice the length of the crown • Outline is the reverse of that found from the mesial
• Mesio- and distoincisal angles are both sharp forming aspect
almost 90° angles
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• These surfaces are convex labiolingually

• Incisal edge of the newly erupted tooth is perfectly • Contact with the adjacent teeth is on the incisal third
straight in the horizontal plane. • Cervical line is positioned more apically on the lingual
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than on the labial side.

Lingual Aspect
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• On the lingual surface, the marginal ridges and the Pulp Cavity
cingulum may be located easily
• Pulp canal is oval in shape
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• Lingual surface at the middle third and incisal third

• Pulp cavity conforms to the general surface contour of
may have a flattened surface level
the tooth
• It may present a slight concavity called the lingual fossa
• Roof of the pulp chamber is widest mesiodistally
• Cingulum may be extending almost halfway up to the
• Labiolingually the chamber is widest at the cingulum
crown.
• There is a definite demarcation between the pulp
chamber and the canal.
Mesial Aspect
• Shows the typical outline of an incisor tooth Lateral Incisor
• Convexity of the cervical contours presents labially and • Number of roots—1 (Figs 3.8A to D)
lingually and the cervical third is pronounced • Number of pulp horns—3
• Mesial surface of the root is nearly flat and is evenly • Number of developmental lobes—4
tapered • Fundamental outline is similar to those of the primary
• Incisal ridge is centered over the center of the root. central incisor
• Lateral incisor is somewhat larger in all measurements • Labial surface of mandibular cuspid is much flatter
• Cingulum may be a little more developed than that of than the maxillary cuspid
the central incisor • Cervical ridges are not quite as pronounced as maxillary
• Incisal margin slopes downward distally in contrast to cuspid
the central incisor • Labiolingual diameter is much small
• Its distoincisal angle is rounded (obtuse) rather than • Cingulum is much reduced in size and prominent and
sharp occupies less than the cervical third of the height of the
• Distal margin of the crown is more rounded crown
• Slightly greater height and lesser mesiodistal diameter • Mandibular canines are longer incisocervically than
of the crown gives the crown a more rectangular and mesiodistally.
narrow appearance
Lingual Aspect
• Mesioincisal angle is sharp.
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• Lingual surface is made up of three ridges
Root • Marginal ridges are less prominent than on the
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maxillary cuspid
• Root of the primary mandibular lateral incisor is longer, • Distal marginal ridge is slightly longer than the mesial
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narrower • Most obvious difference is the presence of one lingual
• Roots of the mandibular incisors, in general are straight fossa.
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in their cervical half, but then bend labially about 10° in
their apical half Mesial and Distal Surfaces
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• This bend helps in making space for the developing • They are convex in the cervical third
secondary incisors which should be erupting in a • Mandibular canines are not as wide labiolingually
lingual and apical position. resulting in smaller proximal surfaces
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• Contact with the adjacent teeth is on the incisal third of

Canines
the tooth
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• Number of roots—1 (Figs 3.9A to D) • Mesial and distal heights of contour are much nearer
• Number of pulp horns—3 the cervix.
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• Mandibular primary cuspid has the same general Incisal Aspect

contour form as the maxillary cuspid, but is not as • The incisal edge is highest at the apex of the cusp and
bulbous labiolingually or as broad mesiodistally. precedes cervically both mesially and distally
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• From this aspect, the canines have a diamond shape

Labial Aspect • Distal cusp slope is longer than the mesial slope
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• It is convex in all directions • Opposite arrangement is true for maxillary canines.

• It has a central lobe which terminates incisally, extends This makes for proper intercuspation of these teeth
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cervically to the cervical ridge during mastication.
A B C D
(D) Occlusal aspect of mandibular canine
Pulp Cavity • Two buccal cusps are rather distinct; the mesial cusp is
• Pulp cavity conforms to the general contour of the tooth larger than the distal cusp
• There is no differentiation between chamber and canal. • Instead of a groove, a developmental depression is
present between the cusps
Root • Buccal surface presents a prominent cervical ridge
where it joins the mesial surface at an acute angle and
• Roots of the deciduous canines are almost twice as long the distal surface at an obtuse angle
as their crowns and are thicker than the roots of the • Buccolingually the tooth gives a constricted appearance
incisors • Crown is wider mesiodistally than cervicocclusally
• Mandibular root is slightly shorter than the maxillary • Roots are long and slender and they spread greatly at
root and is more tapered the apical third beyond the outline of the crown
• Root is triangular in cross-section • Mesial root curves slightly distally in the apical third.
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• In the apical third root is bent labially, similar to
mandibular incisors. Lingual Aspect
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• Tooth converges lingually to a marked degree on the
First Molar mesial half whereas distally it is opposite
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• Number of roots—2 (Figs 3.10A to D) • Distolingual cusp is rounded
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• Number of cusps—4 • Mesiolingual cusp is long and sharp at the tip
• Number of pulp horns—4 • Mesiolingual cusp almost centered lingually
• Mesial marginal ridge is so well developed that it is
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This tooth does not resemble any of the other teeth, considered to be another cusp
deciduous or permanent. Because it varies so much from all • Lingual surface is traversed by a lingual groove, thus
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others, it appears strange and primitive. Its chief differing dividing the lingual surface into a mesiolingual and a
characteristic is its overdeveloped mesial marginal ridge. distolingual cusp.
This ridge somewhat resembles a fifth cusp. The outline of
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the tooth is rhomboidal. Mesial Aspect

• There is extreme curvature buccally at the cervical third
Buccal Aspect
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• The cervical line slants upward buccolingually

• Mesial outline of the first molar is almost straight from • A transverse ridge, connecting the mesiobuccal and
the contact area to the cervix, constricting the crown mesiolingual cusps can be seen from the mesial aspect
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very little at the cervix • Mesial marginal groove separates the mesial marginal
• Distal outline converges towards the cervix ridge from the mesiolingual cusp ridge
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• Distal portion of the crown is shorter than the mesial • Outline of the mesial root from the mesial aspect does
portion not resemble the outline of any other primary tooth root
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A B C D
Figures 3.10A to D: Schematic representation showing; (A) Buccal aspect; (B) Lingual aspect; (C) Mesial aspect;
(D) Occlusal aspect of mandibular first molar
• Buccal and lingual outlines of the root drop straight down • Mesiobuccal cusp exhibits a well-defined triangular
from the crown tapering only slightly at the apical third. ridge, which terminates in the center of the occlusal
surface buccolingually at the central developmental
Distal Aspect groove
• Cervical line does not drop buccally • Lingual developmental groove extends lingually,
• Length of the crown buccally and lingually is more separating the mesiolingual cusp and the distolingual
uniform cusp
• Cervical line extends almost straight across • Occlusal surface has a small mesial triangular fossa and
buccolingually pit and a larger distal fossa that extends almost into the
• Distal cusps are not long or as sharp as the two mesial center of the occlusal surfaces
cusps • In the distal fossa there is a central pit and a small distal
pit near the distal marginal ridge. There is no central
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• Distal marginal ridge is not as straight and well defined
as the mesial marginal ridge fossa.
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• Distal surface is more convex than the mesial surface
• Distal contact area with the second molar is in the Pulp Cavity
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middle of the crown • Pulp chamber has four pulpal horns
• Mesial contact area is located more cervically • Mesiobuccal horn, occupies a considerable part of the
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• Distal root is rounder and shorter than the mesial root, pulp chamber. It is rounded and connects with the
tapering apically. mesiolingual pulpal horn in a high ridge
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• Distobuccal pulpal horn lacks the height of the mesial
Occlusal Surface horns
• Mesiolingual pulpal horn is long and pointed
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• Occlusal outline is rhomboidal in shape
• Distolingual pulpal horn is the smallest and more
• Prominence of the mesiobuccal surface is evident
pointed than the buccal horns
• Mesiolingual cusp may be seen as the largest and best
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• There are three pulp canals—Mesiobuccal, mesiolin-

developed of all
gual, and distal canal
• Buccal developmental groove divides the buccal cusps
• Distal canal which projects in ribbon fashion is wide
evenly
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buccoligually and may be constricted in its center.

• Buccal developmental groove is short, extending from
the buccal cusp ridges to the central pit
Second Molar
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• Central developmental groove joins it at this point and

extends mesially, separating the mesiobuccal cusp and • Number of cusps—5 (Figs 3.11A to D)
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mesiolingual cusp • Number of roots—2

• Central groove ends in a mesial pit in the mesial • Number of pulp horns—5
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triangular fossa • Number of developmental lobes—5
A B C D
Figures 3.11A to D: Schematic representation showing; (A) Buccal aspect; (B) Lingual aspect; (C) Mesial aspect;
(D) Occlusal aspect of mandibular second molar
Primary mandibular second molar has characteristics • Distal marginal ridge dips down more sharply and is
that resemble those of the permanent first molar, but its shorter buccolingually than the mesial marginal ridge
dimensions differ. The tooth is larger than the first primary • Contact with the first molar (permanent) is not as broad
molar and smaller than the first permanent molar. as contact on the mesial surface, being in the form of
a round contact just buccal and cervical to the distal
Buccal Aspect groove
• Distal root is almost as broad as the mesial root and is
• It has a narrow mesiodistal calibration at the cervical
flattened on the distal surface. The distal root tapers
portion of the crown
more at the apical end than does the mesial root.
• Mesiobuccal and distobuccal developmental grooves
divide the buccal surface of the crown occlusally into
3 cuspal portions almost equal in size mesiobuccal, Occlusal Aspect
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buccal and a distobuccal cusp • Occlusal aspect is somewhat rectangular
• Distobuccal cusp extends lingually at the occlusal • Three buccal cusps are equal in size and so are the
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border more than the buccal cusps to give a smaller lingual cusps. However, the total mesiodistal width of
occlusal area at the distocclusal surface the lingual cusp is less than the total mesiodistal width
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• Roots of a second molar are longer and slender, flaring of the three cusps
mesiodistally at their middle and apical thirds. • Buccal aspect is made up of 3 cusps—a mesiobuccal
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cusp (second in size), a distobuccal cusp (largest) and
Lingual Aspect a small distal cusp
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• Two cusps with equal dimensions are seen between the • Lingual aspect is made up of two cusps of about equal
short lingual groove size, the mesiolingual and distolingual cusps which are
• Arrangement narrows the crown lingually divided by the distolingual groove
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• The cervical line is relatively straight and the mesial • Crown converges both distally and lingually
portion of the crown seems to be a little higher than the • Mesial marginal ridge is better developed and more
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distal portion of the crown from this aspect. pronounced than the distal marginal ridge
• There are three pits on this surface, of which the central
Mesial Aspect pit is the deepest and best defined, followed by he
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mesial pit and the least well-defined distal pit.

• Crest of contour buccally is more prominent on the
primary molar, and the tooth seems to be more constricted Pulp Cavity
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occlusally because of the flattened buccal surface

• Marginal ridge is high, a characteristic that makes the • It is made up of a chamber and usually three pulp canals
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mesiobuccal cusp and the mesiolingual cusp appear • Pulp chamber has five pulpal horns corresponding to
rather short the five cusps
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• Lingual cusp is longer than the buccal cusp • Mesiobuccal and mesiolingual pulpal horns are the
• Contact area with the first primary molar is in the largest, the mesiolingual pulpal horn being slightly less
shape of inverted crescent just below the notch of the pointed
marginal ridge • Distobuccal pulpal horn is not as large as the mesio
• Surface is constricted at the occlusal border. buccal pulpal horn but larger than the distolingual or
distal horns
Distal Aspect • Distal pulpal horn is the shortest and smallest
• Two mesial pulpal horns are the shortest and canals leave
• Crown is not as wide as mesially. It is possible to see the the floor of the pulp chamber through a common orifice
mesiobuccal cusp as well as the distobuccal cusp from that is wide buccolingually and narrow mesiodistally. The
the distal aspect common canal soon divides into a longer mesiobuccal
• Distolingual cusp appears well developed canal and a smaller mesiolingual canal.
Q.4 Which permanent teeth replace primary molars?

VIVA QUESTIONS
Ans. Premolars.
Q.1. what is importance of primary dentition?
Ans. • loss of primary teeth tends to disturb the Q.5. When is the primary dentition completed?
eruption sequence of permanent teeth Ans. About 2–5 years of age. No intraoral changes are
• Primary teeth maintain adequate spacing and seen until the eruption of 1st permanent molar(at
arch continuity for the emergence of permanent around 6 years of age).
teeth Q.6. Which teeth are missing in primary dentition?
• Primary teeth help in stimulation of growth of the Ans. Premolars
jaws through mastication
• help in development of speech Q.7. Which primary tooth does not resemble any
• Maintains a normal facial appearance permanent tooth?
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• Resorption helps in guiding the erupting Ans. Primary mandibular first molar does not resemble
permanent tooth into the proper location. any permanent tooth.
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Q.2. What are differences in crowns of permanent and Q.8. Which is the longest primary tooth?
primary teeth? Ans. Primary maxillary canine.
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Ans. • Primary tooth has a shorter crown than the
permanent tooth Q.9. In which primary tooth cusp of Carabelli is
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• Enamel and dentin layers are thinner in the present?
primary tooth Ans. Cusp of carabelli is present apical to mesiopalatal
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• Primary teeth are more constricted in the cervical cusp in primary maxillary second molar. It is also
portion of the crown called fifth cusp.
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• enamel rods in the gingival third extend in a Q.10. What is the difference between contact areas of
slightly occlusal direction from the DEJ in primary primary and permanent canine?
teeth whereas they extend slightly apically in the Ans. If a line is drawn through contact areas of primary
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permanent dentition. canine, it will bisect a line drawn from cervix to tip of
Q. 3 What are the other names for primary teeth? the cusp but in permanent canine contact areas are
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Ans. Milk teeth or deciduous teeth. not at same level.

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CHAPTER
4
Structure, Nomenclature and Tooth Physiology
Amit Garg, Ajay Chhabra
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CHAPTER OUTLINE
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Introduction Nomenclature of Tooth Surfaces
Tooth Nomenclature Physiology of Tooth Form
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Tooth Notation Systems Viva Questions
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INTRODUCTION Enamel
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Tooth is composed of three hard mineralized tissues viz; r Tooth enamel is the hardest and highly mineralized
enamel, dentin and cementum, and one soft tissue, i.e. tissue which covers crown of the tooth
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pulp (Fig. 4.1). Outermost layer of tooth is enamel which r Composition of enamel mainly shows inorganic content
covers crown of the tooth. Middle layer is dentin, which (hydroxyapatite) and small portion of organic matrix
extends almost the entire length of the tooth, being covered r Structure of enamel consists of enamel rods or prisms
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by enamel on the crown portion and by cementum on as well as sheaths and a cementing inter-rod substance.
the roots. Dentin is nourished by the pulp, which is the Rods are oriented at perpendicular to dentinoenamel
junction. Towards the incisal edge these become
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innermost portion of the tooth.

increasingly oblique and are almost vertical at the
cusp tips. Cervical enamel rods of deciduous teeth are
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inclined incisally or occlusally, while in permanent

teeth they are inclined apically. This change in direction
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of enamel rods should be kept in mind during tooth

preparation so as to avoid unsupported enamel rods at
gingival seat (Fig. 4.2)
r Average thickness of enamel at the incisal edges of
incisors is 2 mm; at the cusp of premolar and molar it
ranges from 2.3 to 3.0 mm
r Enamel is translucent in nature. Color of tooth mainly
depends upon color of underlying dentin, thickness of
enamel and amount of stains in enamel
r Enamel is brittle and has high modulus of elasticity.
Figure 4.1: Schematic representation showing different Enamel has more compressive strength than dentin,
structures of a tooth but due to elasticity of dentin, later acts as a cushion
for enamel when masticatory forces are applied on shows reduction in size due to increase in secondary
it. For this reason, during tooth preparation, for dentin deposition.
maximal strength of underlying remaining tooth Note that cervical enamel rods of deciduous teeth are
structure, all enamel rods should be supported by inclined incisally or occlusally, while in permanent teeth
healthy dentin base. they are inclined apically. Due to this change in direction of
enamel rods, gingival bevel is given in permanent teeth so as
Dentin to avoid unsupported enamel rods at gingival seat (Fig. 4.2).
r Dentin is the most voluminous mineralized connective
Periradicular Tissue
tissue of the tooth covering both crown and root portion
r It contains 70% inorganic hydroxyapatite crystals Periradicular tissue consists of cementum, periodontal
and 30% organic substance and water making it more ligament and alveolar bone (Fig.4.3).
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resilient than enamel
r Dentin thickness is usually more on the cuspal heights Cementum
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and incisal edges and less in the cervical areas of tooth
r Cementum covers roots of teeth. It is light yellow in
With advancing age, thickness of secondary and tertiary
color and can be differentiated from enamel by its lack
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dentin increases
of luster and darker hue
r Dentin consists of dentinal tubules which follow a
r Acellular cementum covers cervical third of the root.
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gentle ‘S’-shaped curve in the tooth crown and are
As the name indicates, it does not contain cells. Its main
straighter in the incisal edges, cusps and root areas.
function is anchorage
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r Cellular cementum is formed after the tooth reaches
Dental Pulp
the occlusal plane. It contains cells. Its main function
Pulp lies in the center of tooth in a space called pulp is adaptation.
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cavity. This pulp cavity is divided into pulp chamber and

root canal (Fig. 4.1). Histologically, it is divided into the Periodontal Ligament
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central and the peripheral region. Central region of both

Periodontal ligament forms a link between the alveolar
coronal and radicular pulp contains nerves and blood
bone and the cementum. Periodontal ligament houses the
vessels. Peripheral region contains odontoblastic layer, cell
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fibers, cells and other structural elements, such as blood

free zone of Weil and cell rich zone. With age, pulp cavity
vessels and nerves.
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A B
Figures 4.2A and B: Schematic representation showing Figure 4.3: Schematic representation showing cementum, periodon-
direction of enamel rods tal ligament and alveolar bone of a tooth
Structure, Nomenclature and Tooth Physiology 41
Box 4.1: Importance of tooth anatomy

It is important to understand anatomy of teeth because of
following reasons:
t Maintenance of supporting tissues in a healthy state
t Restoration of a damaged tooth to its original form
t For maintaining optimal function of teeth
TOOTH NOMENCLATURE
Tooth nomenclature deals with naming of teeth. For easier
recognition of tooth, one needs to mention the particular
tooth, quadrant and dental arch. To list all these for all 32
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teeth becomes cumbersome and time consuming. For
many years, various tooth nomenclature systems have
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been used, but commonly used are Universal, Zsigmondy– Figure 4.4: Photograph showing two arches; maxillary and man-
Palmer and FDI system. dibular and four quadrants
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Dental Arches and Quadrants
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Mouth has two arches; maxillary and mandibular. Each
arch has two quadrants, i.e. right and left. Thus, the set of
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teeth are described into four quadrants (Fig. 4.4):
1. Maxillary right.
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2. Maxillary left.
3. Mandibular right.
4. Mandibular left.
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Classes of Teeth
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Incisors
A
r Four in number; two central and two lateral incisors in
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each arch (Figs 4.5A and B)

r Main function is esthetics, phonetics, cutting and
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shearing of food.
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Canines/Cuspids
r Located at corner of dental arch
r Main function is cutting, piercing and tearing of food
along with aesthetics.
Premolars/Bicuspids
r Present in permanent dentition only B

r Dual function; cutting similar to canines and grinding
similar to molars. Figures 4.5A and B: Photograph showing different classes of teeth
Molars TOOTH NOTATION SYSTEMS

r Multicuspid and multirooted teeth located most There are different tooth notations for identifying a specific
posteriorly in an arch tooth. Among many available tooth notation systems, the
r Main function is chewing and grinding. “Zsigmondy–Palmer”, “Universal (ADA)” and “Federation
Dentaire International (FDI)” are most commonly used.
Types of Dentition The FDI system is used worldwide and the universal is
There are two sets of teeth that develop in a person’s mouth. used predominantly in the USA.
r First set of teeth is termed as “milk”, “baby”,
“deciduous” or “primary” teeth. Maxilla and Zsigmondy–Palmer System/Angular/Grid System/
mandible, each has six anterior teeth, i.e. four incisors, Symbolic System/Quadrant system
two canines and four posterior teeth which include
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r This is the oldest method introduced by Zsigmondy in 1861
molars (Fig. 4.6) r Also known as angular or grid system
The dental formula is r Adult teeth are numbered 1–8, where 1 is central incisor,
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2 1 2 4 is first premolar and 8 is third molar (Fig. 4.8)
1 C M = 10 r Primary teeth are designated as A, B, C, D, E, where A is
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2 1 2
central incisor and E is second molar (Fig. 4.9)
Primary teeth erupt between 6 months and 2 years
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r Each quadrant has unique L-shaped symbol to
of age designate the quadrant to which tooth belongs. For
r Second set of teeth, i.e. permanent teeth, erupt at the
de example, for maxillary right, maxillary left, mandibular
age of six years. There are 32 permanent teeth in an right and mandibular left symbols are , , , ,
adult mouth. Teeth are present in two jaws (arches), i.e. respectively.
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an upper and a lower arch each, being the upper and
lower jaws, respectively. Normally, 16 teeth are found Zsigmondy–Palmer system for permanent teeth
in each complete arch (Fig. 4.7). Maxilla and mandible
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each has six anterior teeth viz; four incisors, two canines 8 7 6 5 4 3 2 1 1 2 3 4 5 6 7 8
and ten posterior teeth which include four premolars 8 7 6 5 4 3 2 1 1 2 3 4 5 6 7 8
and six molars.
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Zsigmondy–Palmer system for deciduous teeth

The dental formula is
2 1 2 3 E D C B A A B C D E
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1 C PM M = 16
2 1 2 3 E D C B A A B C D E
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Figure 4.6: Photograph showing primary maxillary and mandibular Figure 4.7: Photograph showing permanent maxillary and mandibu-
teeth; four incisors, two canines and four molars in each arch lar teeth; four incisors, two canines, four premolars and six molars in
each arch
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A A
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B B
Figures 4.8A and B: Schematic representation and clinical picture Figures 4.9A and B: Schematic representation and clinical picture
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showing tooth numbering system according to Zsigmondy–Palmer showing zsigmondy–Palmer system for primary teeth: Teeth are des-
system. Permanent teeth are numbered 1–8, where 1 is central incisor, ignated as A, B, C, D, E, where A is central incisor and E is second molar
8 is third molar
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Advantages r Universal numbering system uses a unique letter or

number for each tooth
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r Simple and easy to use

r Numbering starts from maxillary right posterior tooth
r Less chances of confusion between primary and
where tooth number 1 is third molar of patient’s upper
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permanent tooth as there is different notation, e.g.

right. It goes clockwise direction on right side to upper
permanent teeth are described by numbers while
left third molar (tooth number 16), then decends to
primary teeth by alphabets.
lower left third molar (number 17), reaching lower right
third molar, tooth 32 (Fig. 4.10)
Disadvantages
r Missing or extracted teeth should also be numbered as
r Difficulty in communication well. For example, if third molar of right upper side is
r Confusion between upper and lower quadrants, while missing, the first number will be 2
communication and transferring a data. r In the original system, primary teeth were numbered in
the same order, except that lower case “d” was added
Universal (National) System/ADA System to each number. So upper right second molar would
r This system was introduced by the American Dental be 1d and the second molar of lower right side would
Association in 1968. It is most popular in the United States be 20d.
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A A
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B B
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showing universal system for permanent teeth: Tooth number 1 is showing universal system for primary dentition: Teeth are indicated
maxillary right third molar of patient, numbering goes in clockwise di- by letters A–T where A is patient’s maxillary right second molar and T
rection to maxillary left third molar (tooth number 16), then decends lower right second primary molar
to mandibular left third molar (number 17), reaching mandibular right
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third molar (tooth 32)

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Modified Version of Universal System Order for Primary Universal/ADA system for deciduous teeth
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Dentition
Upper right Upper left
According to this, primary teeth are indicated by letters
E DCBA ABCDE
A–T instead of numbers 1–20, where A is patient’s
-------------------------------------------
maxillary right second molar and T lower right second
E DCBA ABCDE
primary molar 4.11b and (Fig. 4.11), for example:
Lower right Lower left
A is maxillary right primary second molar
I is maxillary left primary first molar
Advantage
Universal/ADA system for permanent teeth
Unique letter or number for each tooth avoiding
Upper right Upper left confusions.
12345678 9 10 11 12 13 14 15 16
------------------------------------------------------------------
Disadvantage
32 31 30 29 28 27 26 25 24 23 22 21 20 19 18 17
Lower right Lower left Difficult to remember each letter or number of tooth.
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A A
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B B
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showing FDI system for permanent teeth is two-digit combination of showing FDI for primary teeth: Tooth numbers are from 1, 2...5 (1 be-
a tooth and quadrant. Teeth are numbered as 1, 2,….8, and quadrants ing central incisor, 5 as second molar) and quadrants are named as 5,
are designated 1–4 in a clockwise manner; 1 is maxillary right, 2 is max- 6, 7 and 8
illary left, 3 is mandibular left and 4 is mandibular right
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Federation Dentaire International (FDI) System 1 is central incisor, 2—lateral incisor, 3—canine, 4 and
5— 1st and 2nd premolars, respectively and 6, 7, and
r This two-digit system was first introduced in 1971
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8—1st, 2nd and 3rd molars, respectively

and subsequently adopted by the American Dental
r Quadrants are designated 1–4 in a clockwise manner
Association (1996). Also known as international
such that 1 is upper right, 2 is upper left, 3 is lower left
numbering system
and 4 is lower right
r FDI system is known as a ‘Two-Digit’ system because
r It results in two-digit combination of a tooth and
it uses two digits; where the first number represents
quadrant. For example, upper right lateral incisor is
quadrant, and second number tells number of the
‘12’ (one two) and the upper left lateral incisor is ’ 22’
tooth from the midline of the face
(two two) (Fig. 4.12).
r Both digits should be pronounced separately in
communication. For example, the lower right
Deciduous Teeth
permanent first molar is ‘46’; it should not be termed as
‘forty six, but ‘four six’. r In the primary dentition, tooth numbers are given same
but quadrants are named as 5, 6, 7, and 8 (Fig. 4.13)
Permanent Teeth r Teeth are numbered from number 1 to 5, 1 being
r In FDI notation, teeth are numbered as 1, 2,….8 where; central incisor and 5 is second molar.
FDI System for Permanent Teeth Anatomic crown: It is part of tooth that is covered with
enamel (Fig. 4.15). It extends from cementoenamel
18 17 16 15 14 13 12 11 21 22 23 24 25 26 27 28 junction (CEJ) to occlusal or incisal surface.
48 47 46 45 44 43 42 41 31 32 33 34 35 36 35 34
Clinical crown: It is part of tooth that is visible in oral
FDI System for Deciduous Teeth cavity. In newly erupted tooth, clinical crown is shorter
than anatomical crown whereas in case of gingival
55 54 53 52 51 61 62 63 64 65 recession, the clinical crown is longer than anatomical
85 84 83 82 81 71 72 73 74 75 crown (Fig. 4.16).
Advantages
PHYSIOLOGY OF TOOTH FORM
r Simple to understand
Contacts and Contour
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r Simple to learn
r Simple to pronounce Contour is prominence present on mesial, distal, buccal and
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r No confusion lingual surfaces of crowns of teeth (Fig. 4.17). All protective
r Each tooth has specific number
r
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Easy to record on computers
r Easy for charting.
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Disadvantage
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May be confused with universal tooth numbering system.
NOMENCLATURE OF TOOTH SURFACES

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The clinical crown of each tooth is divided into surfaces

that are designated according to their related anatomic
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structures and landmarks (Fig. 4.14).

Buccal surface: Tooth surface facing the cheek.
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Labial surface: Tooth surface facing the lip.

Facial surface: Labial and buccal surface collectively form
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the facial surface. Figure 4.14: Photograph showing different tooth surfaces
Proximal surface: Surfaces of teeth facing towards

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adjacent teeth of same dental arch form the proximal

surfaces.
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Mesial surface: Tooth surface facing towards anterior

midline.
Distal surface: Tooth surface facing away from anterior
midline.
Lingual surface: Tooth surface towards the tongue.
Occlusal surface: Masticating surface of posterior teeth
(in molars and premolars).
Incisal surface: Functioning/cutting edge of anterior
tooth of incisors and canines (cuspids).
Gingival surface: Tooth surface near to the gingiva.
Figure 4.15: Schematic representation showing that anatomical
Cervical surface: Tooth surface near the cervix or neck of crown extends from CEJ to incisal surface and clinical crown is that
the tooth. part which is visible in oral cavity
contours are most functional when teeth are in proper Over-contouring

alignment (Fig. 4.18A). Convexity is generally located at:
r Here restoration contains excessive restorative material
r Cervical third of facial surfaces (all teeth)
which alters normal contour of the tooth. It leads to
r Cervical third of lingual surfaces (anterior teeth)
supra and subgingival plaque accumulation under
r Middle third of lingual surfaces (posterior teeth).
overcontoured restorations. Gingiva appears red,
swollen and inflamed (Fig. 4.18B)
Significance
r Overcontouring causes deflection food, resulting in
r Protects gingival tissue against bruising and trauma under-stimulation of gingiva.
caused from food
r Prevents food being packed into gingival sulcus. Under-contouring
r It means too little contouring, so that a space occurs
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between margins and the cavity walls
r It leads to food impaction and trauma to the attachment
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apparatus (Fig. 4.18C).
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Marginal Ridges
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Marginal ridges are defined as rounded borders of enamel
forming mesial and distal margins of occlusal surfaces
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posterior teeth and mesial and distal margins of lingual
Figure 4.16: Clinical picture showing in case of gingival recession, surfaces of the incisors and canines.
the clinical crown is longer than anatomical crown
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Importance
r Help in balancing of teeth in both the arches
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r Improve the efficiency of mastication

r Prevent food impaction in interproximal areas.
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Embrasures
Embrasures can be defined as V-shaped spaces that
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originate at proximal contact areas between adjacent

teeth. These are named according to the direction into
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which they radiate. These are as follows:

A
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Labial/Buccal and Lingual Embrasures

These are spaces that widen out from the area of contact
labially or buccally and lingually (Fig. 4.19).
Incisal/Occlusal Embrasures
These are spaces that widen out from area of contact
incisally/occlusally.
A Gingival Embrasure
Figures 4.17A and B: Photograph showing contours of anterior and
posterior teeth. Contour (shown by arrow) is prominence present on These are the spaces that widen out from the area of
mesial, distal, buccal and lingual surfaces of crown of a tooth contact gingivally.
A B C
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Figures 4.18A to C: Schematic representation showing; (A) Correct contour prevents food being packed into gingival sulcus; (B) Overcontour-
ing causes deflection food, resulting in under-stimulation of gingiva; (C) Under-contouring causes food impaction and trauma to the attachment
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apparatus
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A B C
Figures 4.19A to C: Schematic representation showing occlusal and gingival embrasures; Buccal and lingual embrasures
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Functions of Embrasure
r 1SPWJEFTBTQJMMXBZGPSGPPEEVSJOHNBTUJDBUJPO
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r Prevents food for being forced through contact area.

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Significance
r Correct relationships of embrasures, marginal ridges,
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contours, grooves of adjacent and opposing teeth

provide escape of food from occlusal surfaces during
mastication
r If embrasure size is decreased/absent, then additional
forces are created in teeth and supporting structures
during mastication
Figure 4.20: Clinical picture showing interproximal space. It is a trian- r If embrasure size is enlarged, food impaction occurs
gular-shaped area filled by gingival tissue. Base of triangle is formed in interproximal space by opposing cusp, resulting in
by alveolar process, sides by proximal surfaces of contacting teeth and
apex by contact area damage to supporting tissues.
Proximal Contact Areas Disadvantages

r %JŁDVMUZJODPNNVOJDBUJPO
Each tooth in the arch has two contacting members
r $POGVTJPOCFUXFFOVQQFSBOEMPXFSRVBESBOUT
adjoining it, one on mesial side and other on distal side.
while communicating and transferring a data.
Proximal contact area denotes area of proximal height of
contour of mesial or distal surface of a tooth that contacts Q.5. What is ADA/Universal system of tooth
its adjacent tooth in the same arch. Interproximal space numbering?
is triangular-shaped area that is usually filled by gingival Ans. r 1FSNBOFOU UFFUI BSF OVNCFSFE m TUBSUJOH
tissue. In this triangular area, the base is formed by alveolar from upper right third molar
process, sides by proximal surfaces of contacting teeth and r %FDJEVPVTUFFUIBSFEFTJHOBUFEBT"m5 JOUIJT"
apex is the contact area (Fig. 4.20). is upper right second molar.
Q.6. What are advantages and disadvantages of ADA
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Importance of Proper Contact Relation system?
r Stabilize the dental arches by combined anchorage Ans. Advantage: Unique letter or number for each tooth
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effect of all the teeth avoiding confusions
r Serves to keep food away from packing between the Disadvantage: Difficult to remember each letter or
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teeth number of tooth.
r Protects interdental papillae. Q.7. What is FDI system of tooth numbering?
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Ans. r '%* TZTUFN JT LOPXO BT B A5XP%JHJU TZTUFN
Improper proximal contact area can result in:
because it uses two digits; where the first number
r Food impaction
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represents quadrant, and second number
r Periodontal disease
represents the number of the tooth from the
r Carious lesions
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midline of the face
r Mobility of teeth.
r #PUI EJHJUT TIPVME CF QSPOPVODFE TFQBSBUFMZ JO
communication. For example, the lower right
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VIVA QUESTIONS permanent first molar is ‘46’; it should not be

termed as ‘forty six, but ‘four six’.
Q.1. What do you mean by nomenclature?
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Ans. Nomenclature means the system of naming things. Q.8. What are advantages and disadvantages of FDI
It is helpful for clarity of thought, communication system?
and better understanding. Ans. Advantages
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r 4JNQMFUPVOEFSTUBOEBOEQSPOPVODF
Q.2. Name different tooth numbering systems?
r &BDIUPPUIIBTTQFDJêDOVNCFS
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Ans. 1. Zsigmondy–Palmer system.

r &BTZGPSDIBSUJOH
2. ADA/Universal system of tooth.
Disadvantage
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3. FDI system.
r .BZCFDPOGVTFEXJUIVOJWFSTBMUPPUIOVNCFSJOH
Q.3. What is Zsigmondy–Palmer system? system.
Ans. r 1FSNBOFOUUFFUIBSFOVNCFSFEmBOEQSJNBSZ
Q.9. What are different surfaces of teeth?
as Roman numerals I, II, III, IV, V from the midline
Ans. r #VDDBM
r 5P BWPJE DPOGVTJPO 1BMNFS DIBOHFE EFDJEVPVT
r -BCJBM
notation to A, B, C, D, E.
r 'BDJBM
Q.4. What are advantages and disadvantages of r -JOHVBM
Zsigmondy–Palmer system? r .FTJBM
Ans. Advantages r %JTUBM
r -FTTDIBODFTPGDPOGVTJPOCFUXFFOQSJNBSZBOE r 0DDMVTBM
permanent tooth as there is different notation, r *ODJTBM
e.g. permanent teeth are described by numbers r (JOHJWBM
while primary teeth by alphabets r $FSWJDBM
r 4JNQMFBOEFBTZUPVTF r 1BMBUBM
Q.10. Does nomenclature (like mesial or distal) change which they radiate. For example; incisal/occlusal,
if tooth is rotated? gingival, labial and lingual embrasures.
Ans. No, nomenclature does not change even in rotated Q.18. What is the importance of embrasures?
tooth. Ans. r 1SPWJEFTQJMMXBZGPSGPPEEVSJOHNBTUJDBUJPO
Q.11. Define clinical crown? r 1SFWFOUT GPPE GPS CFJOH GPSDFE UISPVHI DPOUBDU
Ans. It is part of tooth that is visible in oral cavity. area.
Q.12. What is anatomical crown? Q.19. What is importance of proper contact relation?
Ans. It is part of tooth that is covered with enamel. Ans. r 4UBCJMJ[F UIF EFOUBM BSDIFT CZ DPNCJOFE
anchorage effect of all the teeth
Q.13. What is mesial and distal surface? r 4FSWFTUPLFFQGPPEBXBZGSPNQBDLJOHCFUXFFO
Ans. r .FTJBM5PPUI TVSGBDF UPXBSET UIF BOUFSJPS the teeth
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midline r 1SPUFDUTJOUFSEFOUBMQBQJMMBF
r %JTUBM5PPUI TVSGBDF BXBZ GSPN UIF BOUFSJPS
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midline. Q.20. What are consequences of improper proximal
contact area?
Q.14. What is importance of proper contour? Ans. r 'PPEJNQBDUJPO
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Ans. r *t protects gingival tissue against bruising and r 1FSJPEPOUBMEJTFBTF
trauma caused from food r $BSJPVTMFTJPOT
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r Prevents food being packed into gingival sulcus. r .PCJMJUZPGUFFUI
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Q. 15. What are consequences of an overcontoured Q.21. How can you differentiate enamel from dentin
restoration? during tooth preparation?
Ans. r 4upra- and subgingival plaque accumulation Ans.
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under overcontoured restorations

Enamel Dentin
r 0WFSDPOUPVSJOHDBVTFTEFëFDUJPOGPPE SFTVMUJOH
Color Whitish blue or white Yellowish white or
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in under-stimulation of gingiva.
gray slightly darker than
Q.16. What are consequences of an under contoured enamel
restoration? Sound Sharp, high-pitched Dull or low-pitched
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Ans. r *U MFBET UP GPPE JNQBDUJPO BOE USBVNB UP UIF sound on moving fine sound on moving fine
explorer tip explorer tip
attachment apparatus.
Hardness Hardest structure of the Softer than enamel
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Q.17. Define embrasures. tooth

Ans. Embrasures are V-shaped spaces that originate at Reflectance More shiny surface and Dull and reflects less
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proximal contact areas between adjacent teeth. reflective to light than light than enamel
dentin
These are named according to the direction into
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5
cHAPTER
Chair Position and Dental Operatory

Amit Garg, Gurkirat Singh Grewal
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Chapter Outline
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Introduction General Precautions
Common Positions for Dental Procedures Viva Questions
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Antisepsis in Clinics
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Reclined at 45°
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Introduction
While working on a patient chair, positioning plays an • In this position, chair is reclined at 45°
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important role. One should be sure that clinician should • Here mandibular occlusal surfaces are almost at 45° to
sit with back upright on operating stool to avoid spine and the floor (Fig. 5.2).
back problems. If a patient and clinician maintains proper
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position and posture during treatment, they are less likely Almost Supine
to get strained, fatigued, and shall be more efficient and • In this position, patient is almost in a lying position as
have less chances of getting musculoskeletal disorders.
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the name indicates. Patient’s head, knees and feet are

Patient should be seated so that all his body parts are well approximately at the same level (Fig. 5.3).
supported. Patient’s head should be in line with his back,
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whether the dental chair base is parallel or slightly at an Dentist–Patient Position

angle to the floor. Dental chair should be designed in such
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For better understanding, sitting positions of operator are

a way that it should provide maximum working area to the
related to a clock. In this clock concept, an imaginary circle
operator.
is drawn over the dental chair, keeping the patient’s head
Objectives of accurate operating positions:
at the center of the circle. Then the numbering to circle
• To have accessibility and visibility to operating field
is given similar to a clock with the top of the circle at 12
• To increase the efficiency and decrease strain
o’clock.
• To increase comfort for patient and operator.
Accordingly the operator’s positions (right handed
operator) can be 7 o’clock, 9 o’clock, 11 o’clock, and 12
Common Positions for Dental
o’clock and for left handed operator, it can be 5 o’clock, 3
Procedures o’clock and 1 o’clock (Fig. 5.4).
Upright Position
Right Front Position (7 o’clock)
• This is the initial position of chair from which further
adjustments are made (Fig. 5.1) • It helps in examination of the patient
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Figure 5.1: Photograph showing upright chair position Figure 5.3: Photograph showing almost recline chair position
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Figure 5.2: Photograph showing chair reclined at 45 degrees Figure 5.4: Schematic representation showing positions of operator
is compared to a clock. For right handed operator, positions are 7
o’clock, 9 o’clock, 11 o’clock and 12 o’clock and for left handed operator,
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its 5 o’clock, 3 o’clock and 1 o’clock

• Working areas include— • This is preferred position for most of the dental
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–– Mandibular anterior procedures

–– Mandibular posterior teeth (right side) • Working areas include—
–– Maxillary anterior teeth. –– Palatal and incisal (occlusal) surfaces of maxillary teeth
–– Mandibular teeth (direct vision).
Right Position (9 o’clock)
• In this position, dentist sits exactly right to the patient Direct Rear Position (12 o’clock)
• Working areas include—
–– Facial surfaces of maxillary right posterior teeth
• Dentist sits directly behind the patient and looks down
–– Facial surfaces of mandibular right posterior teeth over the patient’s head during procedure
–– Occlusal surfaces of mandibular right posterior teeth. • Working areas are lingual surfaces of mandibular
anterior teeth.
Right Rear Position (11 o’clock)
Points to Remember while Doing Patients
• In this position, dentist sits behind and slightly to the
right of the patient and the left arm is positioned around • Do not sacrifice good operating posture as it will decrease
patient’s head visibility, accessibility and efficiency (Figs 5.5A and B).
Chair Position and Dental Operatory 53
• Maintain proper working distance during dental

procedure. Operator’s eyes should be 14–16 inches
from the treatment site
• While doing work in maxillary arch, maxillary occlusal
surfaces should be oriented perpendicular to the floor
• In mandibular arch, mandibular occlusal surface
should be oriented 45° to the floor
• Avoid/minimize body contact with patient.
Antisepsis in clinics
Main objective of infection control is elimination
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or reduction in spread of infection from all types of
microorganisms.
A
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Cross-infection, i.e. transmission of infectious agents from
patients to clinician or vice versa can occur via—
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• Patients suffering from infectious diseases
• Patients who are in the prodromal stage of infections
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• Healthy carriers of pathogens. de
general Precautions
It is always recommended to follow some basic infection
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control procedures for all patients, termed as “universal

precautions”.
These are as follows:
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• Immunization: All members of the dental team (who

are exposed to blood or blood contaminated articles)
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should be vaccinated against hepatitis B B

• Use of personal protective barrier techniques, that is Figures 5.5A and B: (A) Clinical picture showing correct posture with
use of protective gown, face mask, protective eyewear, neck and back straight, thighs parallel to floor; (B) Wrong posture
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gloves, etc. These reduce the risk of exposure to showing bent neck and back
infectious material and injury from sharp instruments
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• Maintaining hand hygiene.

A B C
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Personal Protection Equipment

Barrier Technique
Use of barrier technique is very important, which includes
gown, face mask, protective eyewear and gloves (Fg. 5.6).
Protective Gown
Protective gown should be worn to prevent contamination
of normal clothing and to protect the skin of the clinician
from exposure to blood and body substances
• gown should have a high neck and long sleeves to D E F
protect the arms from splash and splatter
Figures 5.6A to F: Photograph showing barrier technique that in-
• Protective clothing must be removed before leaving the volves use of; (A) Face shield; (B) Eye wear; (C) Head Cap; (D) Protective
workplace clothing; (E) Gloves; (F) Face mask
• Protective clothing should be washed in the laundry conjunctiva. Do not touch the eyewear with ungloved
with health care facility hands, because it can be contaminated with spatter of
• Clinician should change protective clothing when it blood and saliva during patient care.
gets soiled.
Gloves
Facemasks: A facemask that covers both the nose Gloves should be worn to prevent contamination of
and mouth should be worn by the clinician during hands when touching mucous membranes, blood, saliva
procedures. Though facemasks do not provide complete and to reduce the chances of transmission of infected
microbiological protection, they prevent the splatter from microorganisms from clinician to patient. A new pair
contaminating the face. of good quality and sterile gloves should be used for
each patient and may need to be changed during a
Following points should be taken care of while using face
procedure. Overgloves or paper towels must be used for
mask:
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opening drawers, cabinets, etc. Person allergic to latex
• Outer surface of mask can get contaminated with
(polyisoprene) gloves should use latex free (polyurethane
infectious droplets from spray or from touching the
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or vinyl gloves).
mask with contaminated fingers, so should not be
reused Hand Hygiene
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• Masks should be changed regularly and between
patients. Hand hygiene is considered most critical measure for
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reducing the risk of transmitting disease because it reduces
Head Caps
potential pathogens on the hands.
Hair should be properly tied. To prevent hair contamination,
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For routine dental procedures washing hands with
head caps must be used.
plain, nonantimicrobial soap is sufficient. For more
Protective Eyewear invasive procedures, such as cutting of gum or tissue, hand
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Eyewear protects the eyes from injury and from microbes, antisepsis with either an antiseptic solution or alcohol-
such as hepatitis B virus, which can be transmitted through based handrub is recommended.
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A A
B C D
E F G H
Figures 5.7A to H: Photograph showing steps of hand washing
Chair Position and Dental Operatory 55
Handwashing should be done: Preferred operator positions

• At the beginning of patient
• Between patient contacts Right-handed operator— Left-handed operator—
preferred positions preferred positions
• After completion of case
• After glove removal Right front or 7 o’clock Left front or 5 o’ clock
Right or 9 o’clock Left or 3 o’clock
• Before putting on gloves
Right rear or 11 o’clock Left rear or 1 o’clock
• Before touching eyes, nose, face or mouth.
Q.3. What should be the level of mandibular and
Steps of Handwashing
maxillary arch while working?
• Remove rings, jewellery and watches Ans. While doing work in maxillary arch, maxillary
• Clean fingernails with a plastic or wooden stick occlusal surfaces should be oriented perpendicular
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• Scrub hands, nails and forearm using a good quality to the floor.
liquid soap preferably containing a disinfectant In mandibular arch, mandibular occlusal surface
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• Rinse hands thoroughly with running water (Fig. 5.7). should be oriented 45° to the floor.
q.4. what is main objective of asepsis in clinics?
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Viva questions Ans. Infection control is important for elimination or
reduction in spread of infection from clinician to
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Q.1. Which is most commonly used chair position? patient or vice versa.
Ans. Most commonly used chair position is reclined at
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Q. 5. What is meant by barrier technique?
450. Here, chair is reclined at 45° and mandibular
Ans. Barrier technique includes use of gown, face mask,
occlusal surfaces are almost at 45° to the floor.
protective eyewear and gloves so as to prevent
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q.2. what are most commonly used operator positions? spread of infection.
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CHAPTER
6
Dental Caries
Nisha Garg
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CHAPTER OUTLINE
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Introduction Classification
Theories Histopathology
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Etiology Viva Questions
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INTRODUCTION r *O UFFUI XJUI HJOHJWBM SFDFTTJPO PDDVSSJOH CFDBVTF PG
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periodontal disease.
Dental Caries According to Sturdevant, is an infectious
microbiologic disease of the teeth that results in localised
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THEORIES
dissolution and destruction of the calcified tissues.
Dental Caries According to WHO, is defined as a localised As we know, dental caries is a multifactorial disease of
tooth which has been explained by many theories. Though
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pathological process of external origin involving softening

of the hard tooth tissue and proceeding to the formation there is no universally accepted theory of the etiology of
of a cavity”. Caries are commonly seen in the areas which dental caries, but following three theories are considered
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encourage plaque retention and stagnation. For example in etiology of dental caries.
(Figs 6.1A to C): 1. Acidogenic theory.
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premolars 1SPUFPMZTJTDIFMBUJPOUIFPSZ
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r 1BMBUBM QJUT PG NBYJMMBSZ JODJTPST

r #VDDBM QJU PG NBOEJCVMBS NPMBST Acidogenic Theory
r 1SPYJNBM FOBNFM TNPPUI TVSGBDFT BQJDBM UP UIF DPOUBDU r *t is the most accepted theory given by Miller in 1890
point also known as Miller’s chemicoparasitic theory.
A B C
Figures 6.1A to C: Clinical picture showing most common sites of caries development; (A to C) showing deep pits and
fissures of premolars and molars which favor food impaction and thereby dental caries
Dental Caries 57
r .JMMFS TVNNBSJ[FE IJT UIFPSZ i%FOUBM EFDBZ JT B r 1SFTFODF PG PUIFS GPPE DPNQPOFOUT MJLF QSFTFODF PG
chemicoparasitic process consisting of two stages, high fat or proteins makes carbohydrate less cariogenic.
the decalcification of enamel, as a preliminary stage;
followed by dissolution of the softened residue of the Role of Microorganisms
enamel and dentin.
On coronal surface initiation of caries is caused by
Carbohydrates get lodged on the tooth surface,
Streptococcus mutans and on root surface mainly by
their fermentation produces acids which result in
Actinomyces viscosus 1SFTFODF PG IJHI Lactobacillus
EFNJOFSBMJ[BUJPOPGUPPUITUSVDUVSF Flowchart 6.1).
acidophilus count in saliva designates the occurrence of
"GUFS FOBNFM EFNJOFSBMJ[BUJPO CBDUFSJBT QFOFUSBUF
active carious lesion.
dentinal tubules resulting in dissolution of dentin. Final
CSFBLEPXO PG EFOUJO JT DBVTFE CZ QSPUFPMZUJD FO[ZNFT Role of Acids
which digest organic part of dentin.
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So, it shows that etiology of dental caries is related to 'PS JOJUJBUJPO PG EFOUBM DBSJFT QSFTFODF PG BDJET MBDUJD
presence of carbohydrates, microorganisms and plaque. acid, butyric acid) on the tooth surface is necessary.
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All the preventive steps have been based on this theory.
Proteolytic Theory
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Role of Dental Plaque r (PUUMJFC 'SJTCJF /VDLPMMT BOE 1JODVT TVHHFTUFE UIBU
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provides the environment for bacteria to form acid, NJMEBMLBMJOFQ)ǔJTQSPDFTTSFTVMUFEJOMJRVFGBDUJPO
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Role of Carbohydrates caries by proteolytic action by invading the enamel
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structures like enamel lamellae and rods which contain

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r $IFNJDBMDPNQPTJUJPO GPSFYBNQMF NPOPTBDDIBSJEFT
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and disaccharides are more carious than

Proteolysis-Chelation Theory
polysaccharides
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contact time, more caries of organic part by proteolytic process and dissolution of
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JOPSHBOJDQBSUCZDIFMBUJPO*OJUJBMCBDUFSJBMBUUBDLSFTVMUT
Flowchart 6.1: Schematic representation showing
pathogenesis of dental caries
in proteolytic action on organic part of enamel resulting in
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formation of soluble chelates which later on dissolve the

crystalline structure of enamel.
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Caries Balance Concept
r *UXBTQSPQPTFECZ'FBUIFSTUPOFBDDPSEJOHUPUIJTUIFPSZ
caries is not a result from a single acid attack caused by
microbial fermentation of carbohydrates. Rather, it is the
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SFNJOFSBMJ[BUJPOǔJTCBMBODFEFQFOETPOQBUIPMPHJDBM
and protective factors (Fig. 6.2)
r 1BUIPMPHJDBM GBDUPST QSPNPUF EFNJOFSBMJ[BUJPO ǔFTF
are bacteria, poor dietary habits and xerostomia.
1SPUFDUJWF GBDUPST QSPNPUF SFNJOFSBMJ[BUJPO PG UIF
tooth. These are saliva, fluorides, pit and fissure sealants
and fibrous diet
ETIOLOGY
%FOUBM DBSJFT JT B NVMUJGBDUPSJBM EJTFBTF XIFSF EJFU
tooth and microorganisms interact with each other in
a specific period of time in such a way which increases
EFNJOFSBMJ[BUJPO PG UIF UPPUI TUSVDUVSF XJUI SFTVMUBOU
caries formation (Fig. 6.3).
Some races have higher incidence of dental caries, for
example, white American and English people. Some races
FH *OEJBOT BOE CMBDL "NFSJDBOT
EVF UP IFSFEJUBSZ
Figure 6.2: Schematic representation of caries balance concept
showing balance between protective and pathological factors QBUUFSOTIBWFMPXFSJODJEFODFPGEFOUBMDBSJFT*OT
Keyes showed that there are three prerequisite factors
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for the development of dental caries, known as Keyes’
r "OZ DIBOHF JO CBMBODF PG UIFTF GBDUPST DBO SFTVMU JO triad. These factors are plaque, tooth and the diet. Later
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carious lesion. For example, if a person is healthy today on many studies were conducted, which extended Keyes
and develops xerostomia, he can develop severe decay model with many other factors affecting the interplay
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months later. between these primary factors.
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Figure 6.3: Schematic representation showing factors affecting development of dental caries
Dental Caries 59
Primary Factors Substrate (Environmental Factors)

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Saliva
– Variation in morphology
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– Composition
NBUFSJBMTIFMQJOSFNJOFSBMJ[BUJPOPGUIFFOBNFM
m 1PTJUJPO
Calcium, fluorides and phosphate ions of saliva help in
r 4VCTUSBUF &OWJSPONFOUBMGBDUPST
SFNJOFSBMJ[BUJPOPGUIFWFSZFBSMZTUBHFTPGDBSJPVTMFTJPO
– Saliva
r #icarbonate ions present in saliva diffuse in to dental
$PNQPTJUJPO
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Q) This buffering action of saliva affects the progress of
7JTDPTJUZ carious process.
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m %JFU flow), increased food retention occurs. Moreover
1IZTJDBMGBDUPST buffering capacity of saliva is lost, acidic environment
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-PDBMGBDUPST results in growth of aciduric bacteria.
B $BSCPIZESBUF DPOUFOU 1SFTFODF PG SFêOFE
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cariogenic carbohydrate particles on the Diet
tooth surface
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b. Vitamin content Physical nature of diet: More refined and less fibrous
c. Fluoride content foods stick stubbornly to the teeth and are not removed
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d. Fat content easily due to lack of roughage. They favor stagnation of
r .JDSPPSHBOJTNT food on tooth surfaces.
r 5JNFQFSJPE Streptococcus mutans make use of sucrose to produce
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help the Streptococcus mutans to adhere firmly to teeth
Modifying Factors
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and inhibit diffusion properties of plaque.

r "HF Frequency of carbohydrate intake: (SFBUFS UIF UJNF
r 4FY lapse between acid attacks, better are the chances for the
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UPPDDVS
r )FSFEJUBSZ 4UFQIBO DVSWF TIPXT UIF DIBOHFT JO Q) UBLJOH QMBDF
r 4ZTUFNJDIFBMUI
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in dental plaque when it is exposed to cariogenic food

r 0DDVQBUJPO (Fig. 6.4). AGUFS JOUBLF PG GFSNFOUBCMF DBSCPIZESBUF Q)
r (FPHSBQIJDBSFB
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within plaque decreases quickly reaching a minimum in

BCPVU m NJOVUFT ǔJT EFHSFF PG GBMM JO Q) JT EJSFDUMZ
Tooth
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proportional to intake of fermentable carbohydrates. Once

r 4VTDFQUJCMF BSFBT PO UPPUI GPS DBSJFT BSF EFFQ BOE UIF Q) SFBDIFT CFMPX DSJUJDBM Q) EFNJOFSBMJ[BUJPO PG
narrow occlusal fissures, deep buccal or lingual pits, UPPUITUBSUT%VFUPCVŀFSJOHBOEëVTIJOHBDUJPOPGTBMJWB
exposed root surfaces, area immediately gingival to Q)SJTFTSFBDIJOHUPJUTTUBSUJOHWBMVF HFOFSBMMZPWFSm
contact areas and margins of existing restorations minutes. This relationship of shape of Stephan curve to
r -BDL PG FOBNFM NBUVSBUJPO PS QSFTFODF PG DSJUJDBMQ)JTVTFEUPBTTFTTUIFDBSJPHFOJDJUZPGGPPET
developmental defects increase plaque retention, Following factors affect the shape of the Stephan curve:
CBDUFSJBMDPMPOJ[BUJPOBOENBLFUPPUINPSFTVTDFQUJCMF r Microbial content of plaque:1SFTFODFPGBDJEVSJD BOE
UPUPPUIEFNJOFSBMJ[BUJPO BDJEPHFOJDCBDUFSJBJOQMBRVFQSPEVDFTUIFMPXFTUQ)
r 5PPUIQPTJUJPOBMTPBŀFDUTUIFJOJUJBUJPOPGEFOUBMDBSJFT PSFWFOMPXFS
*GBUPPUIJTPVUPGQPTJUJPO SPUBUFEPSJOBOZBCOPSNBM r Nature of fermentable source: Carbohydrate which

position, it becomes difficult to clean, and hence retains JT NFUBCPMJ[FE NPSF TMPXMZ SFTVMUT JO IJHIFS WBMVF PG
more food and debris. UFSNJOBMQ)
Time Period
5JNF QFSJPE EVSJOH XIJDI BMM BCPWF UISFF EJSFDU GBDUPST
JFUPPUI NJDSPPSHBOJTNTBOETVCTUSBUFBSFBDUJOHKPJOUMZ
TIPVMECFBEFRVBUFUPQSPEVDFBDJEJDQ)XIJDIJTDSJUJDBM
for dissolution of enamel to produce a carious lesion.
Modifying Factors
Age
Young and older people are affected more.
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Sex
'FNBMFT BSF BŀFDUFE NPSF UIBO NBMFT EVF UP FBSMZ
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eruption of teeth).
Figure 6.4: Schematic representation showing Stephan curve show-
JOH QMBRVF Q) CFGPSF BOE BGUFS HMVDPTF SJOTF *OJUJBMMZ Q) EFDSFBTFT
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because of acids produced by bacteria and later it increases because Race
PGCVòFSJOHPGQMBRVFBOETBMJWB$BSJPHFOJDBDUJWJUZPGBOJOEJWJEVBMJT
Caries incidence varies in different races because of
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measured by the area of critical pH
cultural and dietary differences.
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Hereditary
r Rate of diffusion of bacterial metabolites from
(FOFUJDTBMTPJOëVFODFTDBSJFTJODJEFODF
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plaque: Rate of diffusion is related to salivary flow and
density of plaque. Rapid exchange of metabolites occur Systemic Health
in less denser plaque with good access to saliva
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r Bicarbonates present in saliva: #JDBSCPOBUF JPOT 1BUJFOUT IBWJOH TZTUFNJD EJTFBTF XIJDI SFTVMUT JO
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BSF NPSF
produced by fermentation of carbohydrates. prone to dental caries. Any problem which leads to poor
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manual dexterity results in dental caries for example in

Type of carbohydrates: patient with mental or motor skill disorder because of their
r .ore refined foods, such as glucose, fructose and inability to maintain good oral hygiene.
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sucrose make the diet cariogenic.

Fibrous foods are less retentive to the tooth structure Occupation
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and less vulnerable to fermentation so they are

considered less cariogenic Workers of bakery shops, truck drivers, confectionery
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r 4PSCJUPM NBOOJUPM BOE YZMJUPM BSF OPU NFUBCPMJ[FE CZ industries are more prone to dental caries because of
bacteria so show reduced cariogenecity. frequent eating and irregular eating schedules.
t %FOUBMDBSJFTEPOPUPDDVSJOBCTFODFPGNJDSPPSHBOJTNT CLASSIFICATION
VIVA VOCE
On coronal surface initiation of caries is caused by

Streptococcus mutans and on root surface mainly by Carious lesions can be classified in different ways.
Actinomyces viscosus
t 1SFTFODF PG IJHI Lactobacillus acidophilus count in saliva
According to their Anatomical Site
indicates the occurrence of active carious lesion
Pit and Fissure Caries
Bacteria This caries is usually seen in pit and fissures on occlusal
Streptococci mutan is considered main causative factor for surface of posterior teeth and buccal and lingual surfaces
caries because of its adhesion to tooth surface, acidogenic of molars and on lingual surface of maxillary anteriors
and acidouric nature. (Fig. 6.5).
Dental Caries 61
Smooth Surface Caries Based on Treatment and Restoration Design

ǔJT JT VTVBMMZ TFFO PO BMM TNPPUI TVSGBDF PG UFFUI WJ[ Class I
gingival third of buccal and lingual surfaces and proximal
1JU BOE êTTVSF DBSJFT PDDVS JO UIF PDDMVTBM TVSGBDFT PG
surfaces (Fig. 6.6).
QSFNPMBST BOE NPMBST UIF PDDMVTBM UXPUIJSE PG CVDDBM
and lingual surface of molars, palatal surface of maxillary
Root Caries
anteriors (Fig. 6.12).
Root caries occurs on exposed root surface (Fig. 6.7).
Class II
According to New Lesion or Recurrent Lesion
Caries on proximal surface of premolars and molars
Primary Caries (Fig. 6.13).
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*UEFOPUFTMFTJPOTPOVOSFTUPSFETVSGBDFT(Fig. 6.8).
Class III
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Recurrent Caries Caries present on proximal surface of anterior teeth, not
involving the incisal angles (Fig. 6.14).
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Carious lesion beneath restoration is termed as recurrent
or secondary caries (Fig. 6.9).
Class IV
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Residual Caries Caries in the proximal surface of anterior teeth involving
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Residual caries are present in the prepared tooth surface the incisal angle (Fig. 6.15).
even after placing the restoration (Fig. 6.10). Sometimes
caries close to pulp are left intentionally so as to prevent Class V
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pulp exposure. Caries on gingival third of facial and lingual or palatal

surfaces of all teeth (Fig. 6.16).
According to Speed of Caries Progression
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Active Carious Lesion Class VI

3BQJEMZ JOWBEJOH DBSJFT JOWPMWJOH TFWFSBM UFFUI *G Caries on incisal edges of anterior and cusp tips of posterior
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VOUSFBUFE BDVUF DBSJFT DBO SFTVMU JO QVMQ FYQPTVSF *U JT teeth without involving any other surface (Figs 6.17).
soft in consistency and light colored.
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Based on Pathway of Caries Spread

Inactive/Arrested Carious Lesion Forward Caries
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by a large open cavity which no longer retains food and present in dentin, it is called as forward caries (Fig. 6.18A).
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CFDPNFTTFMGDMFBOTJOH*UBQQFBSTTPGUJODPOTJTUFODZBOE
light colored. Backward Caries
8IFO TQSFBE PG DBSJFT BMPOH EFOUJOPFOBNFM KVODUJPO
Chronic Caries
exceeds the caries in contagious enamel, extends into this
ǔJTJTTMPXMZQSPQSFTTJOHMPOHTUBOEJOHDBSJFT*UJTIBSEJO FOBNFMGSPNUIFKVODUJPOBOEJUJTDBMMFECBDLXBSEDBSJFT
DPOTJTUFODZBOEEBSLDPMPSFE IFSFDBSJFTFYUFOEGSPN%&+UPFOBNFM
(Fig. 6.18B).
Rampant Caries Based on Extent of Caries
Rampant caries are defined as caries of acute onset involving Incipient Caries
many or all teeth that are usually considered caries free *U JT êSTU FWJEFODF PG DBSJFT BDUJWJUZ *U DPOTJTUT PG
(Fig. 6.11). EFNJOFSBMJ[FE FOBNFM XIJDI IBT OPU FYUFOEFE UP %&+
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Figure 6.5: Clinical picture showing deep pit and fissure caries in Figure 6.8: Clinical picture showing primary caries in premolar
maxillary molars
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Figure 6.6: Clinical picture showing smooth surface caries Figure 6.9: Radiograph showing secondary caries in
in maxillary premolar maxillary 1st molar
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Figure 6.7: Clinical picture showing root caries Figure 6.10: Schematic representation of accidental and
intentional residual caries
Dental Caries 63
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Figure 6.11: Clinical picture showing rampant caries characteristi- Figure 6.14: 1IPUPHSBQITIPXJOHDMBTT***EFOUBMDBSJFTQSFTFOUPO
cally involving maxillary incisors proximal surface of anterior teeth, not involving the incisal angles
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Figure 6.12: $MJOJDBM QJDUVSF TIPXJOH DMBTT * EFOUBM DBSJFT JOWPMWJOH Figure 6.15: 1IPUPHSBQITIPXJOHDMBTT*7EFOUBMDBSJFT
occlusal surfaces of premolars and molars, the occlusal two-third
of buccal and lingual surface of molars, palatal surface of maxillary
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anterior
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Figure 6.13: 1IPUPHSBQITIPXJOHDMBTT**EFOUBMDBSJFTJOWPMWJOH Figure 6.16: 1IPUPHSBQITIPXJOHDMBTT7EFOUBMDBSJFTPOHJOHJWBM

proximal surface of premolars and molars third of facial, lingual or palatal surfaces of all teeth
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Figure 6.17: 1IPUPHSBQITIPXJOHDMBTT7*EFOUBMDBSJFTJOWPMWJOHJODJ- Figure 6.20: Photograph showing compound caries involving two
sal edges of anterior and cusp tips of posterior teeth without involving tooth surfaces
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any other surface
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A B
Figures 6.18A and B: Schematic representation of Figures 6.21: Photograph showing complex caries involving more
(A) Forward caries; (B) Backward caries than two tooth surfaces
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Table 6.1 ¨Showing Graham Mount’s caries classification

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according to location and size of carious lesion
Cavity site Size 1 Size 2 Size 3 Size 4

(Minimal) (Moderate) (Enlarged) (Extensive)
Site 1 1.1 1.2 1.3 1.4

Pit and fissure
Site 2 2.1 2.2 2.3 2.4

Contact area
Site 3 3.1 3.2 3.3 3.4

Cervical region
Figure 6.19: Photograph showing simple caries involving only one

tooth surface
Dental Caries 65
ǔJT MFTJPO DBO CF SFNJOFSBMJ[FE CZ QSPQFS QSFWFOUJWF r &BSMJFTU NBOJGFTUBUJPO PG JODJQJFOU DBSJFT JT TFFO
procedures, hence called as reversible caries. underneath dental plaque as areas of decalcification
XIJUF TQPUT
"T DBSJFT QSPHSFTTFT JU BQQFBST CMVJTI
Cavitated Caries white in color
r 'JSTUDIBOHFTFFOIJTUPMPHJDBMMZJTMPTTPGJOUFSQSJTNBUJD
*O UIJT DBSJFT FYUFOE CFZPOE FOBNFM JOUP UIF EFOUJO
substance with increased prominence of enamel rods
ǔJT MFTJPO DBOOPU CF SFNJOFSBMJ[FE TP BMTP UFSNFE BT
r ǔFOUIFSFPDDVSTBDDFOUVBUJPOPGJODSFNFOUBMMJOFTPG
irreversible caries.
3FU[JVT
Based on Number of Tooth Surfaces Involved r ǔJTJTGPMMPXFECZUIFMPTTPGNVDPQPMZTBDDIBSJEFTJO
organic substance
Simple Caries r "TDBSJFTQSPHSFTTFTUPXBSETEFOUJOJUGPSNTBUSJBOHVMBS
PSDPOFTIBQFEMFTJPOXJUIUIFBQFYUPXBSET%&+BOE
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Caries involving only one tooth surface is termed as simple
caries (Fig. 6.19). base towards the tooth surface
r 'JOBMMZ UIFSF JT MPTT PG FOBNFM TUSVDUVSF XIJDI HFUT
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Compound Caries SPVHIFOFEEVFUPEFNJOFSBMJ[BUJPO BOEEJTJOUFHSBUJPO
of enamel prisms.
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caries (Figs 6.20). Pit and Fissure Caries
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Complex Caries r ǔF TIBQF PG QJUT BOE êTTVSFT DPOUSJCVUFT UP UIFJS
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high susceptibility to caries because of entrapment of
*G NPSF UIBO UXP TVSGBDFT BSF JOWPMWFE JU JT DBMMFE BT bacteria and food debris in them
complex caries (Figs 6.21). r *OJUJBMMZ DBSJFT PG QJUT BOE êTTVSFT BQQFBST CSPXO PS
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black in color and with a fine explorer, a ‘catch’ is felt.

Graham Mount’s Classification Enamel at the margins of these, the pits and fissures
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This classification system is based on two simple BQQFBSTPQBRVFCMVJTIXIJUF

parameters: r $BSJFTCFHJOTCFOFBUIQMBRVFSFTVMUJOHJOEFDBMDJêDBUJPO
1. Location of carious lesion. of enamel
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4J[FPGDBSJPVTMFTJPO r &OBNFM JO UIF CPUUPN PG QJU PS êTTVSF JT WFSZ UIJO TP
)FSF UIFTZTUFNJTEFTJHOFEUPSFDPHOJ[FDBSJPVTMFTJPOT early dentin involvement frequently occurs
CFHJOOJOHBUUIFFBSMJFTUTUBHF JOXIJDISFNJOFSBMJ[BUJPO r )FSFUIFDBSJFTGPMMPXTUIFEJSFDUJPOPGUIFFOBNFMSPET
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is indicated (Table 6.1). r *UJTUSJBOHVMBSJOTIBQFXJUIUIFBQFYGBDJOHUIFTVSGBDF

PGUPPUIBOEUIFCBTFUPXBSETUIF%&+
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HISTOPATHOLOGY r 8IFOSFBDIFT%&+ HSFBUFSOVNCFSPGEFOUJOBMUVCVMFT

are involved
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Enamel Caries r *UQSPEVDFTHSFBUFSDBWJUBUJPOUIBOUIFTNPPUITVSGBDF

Caries of enamel initiates by deposition of dental plaque caries and there is more undermining of enamel
on tooth surface. We will discus the carious process of r 8IFOVOEFSNJOFEFOBNFMGSBDUVSFT JUDBVTFTFYQPTVSF
the enamel according to its location on tooth surface, i.e. of cavitation and caries.
smooth surface caries, and pit and fissure caries (Fig. 6.22).
Zones in Enamel Caries
Smooth Surface Caries %JŀFSFOU [POFT BSF TFFO CFGPSF DPNQMFUF EJTJOUFHSBUJPO
r 4NPPUITVSGBDFDBSJFTPDDVSTPOHJOHJWBMUIJSEPGCVDDBM PGFOBNFM&BSMZFOBNFMMFTJPOTFFOVOEFSQPMBSJ[FEMJHIU
and lingual surfaces and on proximal surfaces below SFWFBMT GPVS EJTUJODU [POFT PG NJOFSBMJ[BUJPO (Fig. 6.23).
the contact point ǔFTF[POFTCFHJOGSPNUIFEFOUJOBMTJEFPGUIFMFTJPO
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Figure 6.22: Schematic representation showing magnified schematic representation of smooth surface and pit and fissure caries
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r Zone 1:5SBOTMVDFOU[POF r Zone 4:4VSGBDF[POF
– Represent the advancing front of the lesion m ǔJT[POFJTOPUPSMFBTUBŀFDUFECZDBSJFT
nt
m 5FOUJNFTNPSFQPSPVTUIBOTPVOEFOBNFM m (SFBUFSSFTJTUBODFQSPCBCMZEVFUPHSFBUFSEFHSFFPG
m /PUBMXBZTQSFTFOU NJOFSBMJ[BUJPOBOEHSFBUFSëVPSJEFDPODFOUSBUJPO
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r Zone 2: %BSL[POF m *UTSBEJPQBDJUZJTDPNQBSBCMFUPBEKBDFOUFOBNFM
m *U MJFT BEKBDFOU BOE TVQFSêDJBM UP UIF USBOTMVDFOU
[POF Dentinal Caries
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m 6TVBMMZQSFTFOUBOEUIVTSFGFSSFEBTQPTJUJWF[POF
8IFOFOBNFMDBSJFTSFBDIFTUIFEFOUJOPFOBNFMKVODUJPO
m $BMMFE EBSL [POF CFDBVTF JU EPFT OPU USBOTNJU
JUTQSFBETSBQJEMZMBUFSBMMZCFDBVTF%&+JTUIFMFBTUSFTJTUBOU
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QPMBSJ[FEMJHIU
area to dental caries.
m 'PSNFEEVFUPEFNJOFSBMJ[BUJPO
When caries attacks the dentin, the following changes
r Zone 3:#PEZPGUIFMFTJPO
occur in dentin:
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– Largest portion of the incipient caries

%FOUJOBMDBSJFTBQQFBSCSPXOCFDBVTFPGDPMPSQSPEVDFECZ
m 'PVOECFUXFFOUIFTVSGBDFBOEUIFEBSL[POF
VIVA VOCE
t 1JHNFOUQSPEVDJOHNJDSPPSHBOJTNT
m *UJTUIFBSFBPGHSFBUFTUEFNJOFSBMJ[BUJPONBLJOHJU
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t $IFNJDBMSFBDUJPOXIJDIPDDVSTXIFOQSPUFJOTCSFBLEPXO
more porous. in the presence of sugar
t &YPHFOPVTTUBJOT
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Early Dentinal Changes

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r *OJUJBM QFOFUSBUJPO PG UIF EFOUJO CZ DBSJFT DBVTFT BO

alteration in dentin, known as dentinal sclerosis.
*U JT NPSF QSPNJOFOU JO TMPX DISPOJD DBSJFT )FSF
calcification of dentinal tubules occurs which prevent
further penetration of microorganisms. Microorganisms
found in tubules are called pioneer bacteria
r 8IFO EFOUJOBM UVCVMFT BSF DPNQMFUFMZ PDDMVEFE CZ
the mineral precipitate, section of the tooth gives a
transparent appearance in transmitted light, this dentin
is termed as transparent dentin
Figure 6.23: Schematic representation of r *O USBOTQBSFOU EFOUJO JOUFSUVCVMBS EFOUJO JT
zones of enamel caries EFNJOFSBMJ[FEBOEMVNFOJTêMMFECZDBMDJêFENBUFSJBMT
Dental Caries 67
which provides softness and transparency to the dentin

compared to sound dentin
r ǔJT JOJUJBM EFDBMDJêDBUJPO JOWPMWFT UIF XBMMT BMMPXJOH
them to distend as the tubules are packed with
microorganisms. Each tubule is packed with one forms
of bacteria, e.g. one tubule packed with coccal forms,
the other tubule with bacilli
r "T UIF NJDSPPSHBOJTNT QSPDFFE GVSUIFS UIFZ BSF
distanced from the carbohydrate substrate that was
needed for the initiation of the caries. Therefore,
proteolytic organisms might appear to predominate in
the deeper caries of dentin while acidophilic forms are
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more prominent in early caries. Figure 6.24: Schematic representation of zones of dentinal caries
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Advanced Dentinal Changes
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r *O BEWBODFE MFTJPO EFDBMDJêDBUJPO PG UIF XBMM PG UIF Table 6.2 ¨Difference between infected and affected dentin
individual tubules takes place, resulting in confluence Affected dentin Infected dentin
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of the dentinal tubules r 4PGU EFNJOFSBMJ[FEEFOUJO r %FNJOFSBMJ[FEEFOUJOCVUOPU
r 4PNFUJNFT UIF TIFBUI PG /FVNBOO TIPXT TXFMMJOH invaded with bacteria invaded by bacteria
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and thickening at irregular intervals in the course of r 4PGUMFBUIFSZUJTTVFXIJDIDBO r %PFTOPUóBLFFBTJMZUIPVHI
dentinal tubules be flaked easily TPGUJOOBUVSF
r %JBNFUFS PG EFOUJOBM UVCVMFT JODSFBTFT CFDBVTF PG r *SSFWFSTJCMFEFOBUVSBUJPOPG r 6OJOUFSSVQUFEDPMMBHFO
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packing of microorganisms collagen cross-linking

r ǔFSF PDDVST UIF GPSNBUJPO PG UJOZ liquefaction foci, r $BOOPUCFSFNJOFSBMJ[FE r $BOCFSFNJOFSBMJ[FE
oo
described by Miller. They are formed by the focal r $BSJFTEFUFDUJOHEZFTDBOTUBJO r %PFTOPUTUBJO

coalescing and breakdown of dentinal tubules. These
are ovoid areas of destruction parallel to the course of
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r Zone 1:/PSNBMEFOUJO
tubules which are filled with necrotic debris. These areas
expand which produce compression and distortion of m ;POFPGGBUUZEFHFOFSBUJPOPG5PNFTêCFST
BEKBDFOUEFOUJOBMUVCVMFT MFBEJOHUPDPVSTFPGEFOUJOBM – Formed by degeneration of the odontoblastic process
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tubules being bent around the liquefaction focus – Otherwise dentin is normal and produces sharp pain
r %FTUSVDUJPO PG EFOUJO CZ EFDBMDJêDBUJPO BOE UIFO on stimulation.
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r Zone 2: Zone of dentinal sclerosis

QSPUFPMZTJTPDDVSTJOOVNFSPVTGPDBMBSFBT*USFTVMUTJO
a necrotic mass of dentin with a leathery consistency m *OUFSUVCVMBSEFOUJOJTEFNJOFSBMJ[FE
ht
r $MFGUTPDDVSJOUIFDBSJPVTEFOUJOUIBUFYUFOETBUSJHIU m %FOUJOBMTDMFSPTJT JFEFQPTJUJPOPGDBMDJVNTBMUTJO

angles to the dentinal tubules. These account for the dentinal tubules takes place
peeling off of dentin in layers while excavating m %BNBHF UP UIF PEPOUPCMBTUJD [POF QSPDFTT JT
r 4IBQFPGUIFMFTJPOJTUSJBOHVMBSXJUIUIFBQFYUPXBSET apparent
the pulp and the base towards the enamel. m ǔFSFBSFOPCBDUFSJBJOUIJT[POF)FODF UIJT[POFJT
DBQBCMFPGSFNJOFSBMJ[BUJPO
r Zone 3: Zone of decalcification of dentin
Zones of Dentinal Caries
m 'VSUIFS EFNJOFSBMJ[BUJPO PG JOUFSUVCVMBS EFOUJO
'JWF [POFT IBWF CFFO EFTDSJCFE JO EFOUJOBM DBSJFT leads to softer dentin.
(Fig. 6.24) ǔFTF [POFT BSF DMFBSMZ EJTUJOHVJTIFE JO r Zone 4: Zone of bacterial invasion
DISPOJDDBSJFTUIBOJOBDVUFDBSJFTǔFTF[POFTCFHJOGSPN – Widening and distortion of the dentinal tubules
the pulpal side: which are filled with bacteria
m %FOUJOJTOPUTFMGSFQBJSBCMF CFDBVTFPGMFTTNJOFSBM Q.6. What are most commonly affected parts of teeth?
content and irreversibly denatured collagen Ans. r %FFQQJUTBOEêTTVSFT
m ǔJT [POF TIPVME CF SFNPWFE EVSJOH UPPUI r (JOHJWBMSFDFTTJPODBTFT
preparation. r #FMPXDPOUBDUBSFB
r Zone 5: Zone of decomposed dentin due to acids and
Q.7. Classify dental caries.
FO[ZNFT
Ans. According to their anatomical site
m 0VUFSNPTU[POF
r 1JUBOEêTTVSFDBSJFT
– Consists of decomposed dentin filled with bacteria
r 4NPPUITVSGBDFDBSJFT
m *UNVTUCFSFNPWFEEVSJOHUPPUIQSFQBSBUJPO
r 3PPUDBSJFT
Table 6.2TVNNBSJ[FTUIFEJŀFSFODFTCFUXFFOBŀFDUFE
and infected dentin. According to whether it is a new lesion or
recurrent carious lesion
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r 1SJNBSZDBSJFT
VIVA QUESTIONS r 3FDVSSFOUDBSJFT
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r 3FTJEVBMDBSJFT
Q.1. Define dental caries.
Ans. *U JT EFêOFE BT NVMUJGBDUPSJBM USBOTNJTTJCMF According to speed of caries progression
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infectious oral disease caused primarily by complex r "DVUFEFOUBMDBSJFT
interaction of cariogenic oral flora with fermentable r 3BNQBOUDBSJFT
nt
dietary carbohydrates on the tooth surface over r $ISPOJDEFOUBMDBSJFT
time.
de Based on treatment and restoration design
r $MBTT*
Q.2. Which bacteria cause dental caries? r $MBTT**
Ans. %FOUBM DBSJFT JT B NVMUJCBDUFSJBM EJTFBTFT JO XIJDI
ks
r $MBTT***
single bacteria cannot be said as the causative factor, r $MBTT*7
though the most commonly associated bacterias r $MBTT7
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with dental caries are S. mutans and L acidophilus. r $MBTT7*

Q.3. What are characteristic features of cariogenic Q.8. What are pit and fissure caries?
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bacterias? Ans. These occur on occlusal surface of posterior teeth

Ans. $BSJPHFOJDNJDSPPSHBOJTNTBSFBDJEVSJD DBQBCMFPG and buccal and lingual surfaces of molars and on
MJWJOHJOBDJEFOWJSPONFOU
BOEBDJEPHFOJD DBQBCMF lingual surface of maxillary incisors.
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of producing acid). Q.9. What are acute and chronic caries?

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Q.4. What is role of plaque in developing dental caries? Ans. Acute caries travel towards the pulp at a very fast
Ans. 1MBRVFJTBUFOBDJPVTNFNCSBOFGPSNFEBSPVOEUIF speed. Chronic caries travel very slowly towards the
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teeth, mainly consisting of microorganisms. These pulp.

NJDSPPSHBOJTNTQSPEVDFBDJETXIJDISFEVDFQ)PG Q.10. What are rampant caries?
plaque, and dissolve mineral content of enamel and Ans. *UJTUIFOBNFHJWFOUPNVMUJQMFBDUJWFDBSJPVTMFTJPOT
thus, initiate caries. occurring in the same patient, frequently involving
surfaces of teeth that are usually caries free.
Q.5. If bacteria are present in mouth, will they initiate
caries? Q.11. What are smooth surface caries?
Ans. For caries to occur, fermentable carbohydrates Ans. These occurs on gingival third of buccal and lingual
need to be present around the teeth so that bacteria surfaces and on proximal surfaces.
DBO VUJMJ[F GPPE QBSUJDMFT GPS FOFSHZ CZ CSFBLEPXO Q.12. What are primary caries?
of carbohydrate molecules. This produces acid Ans. 1SJNBSZ DBSJFT EFOPUFT MFTJPOT PO VOSFTUPSFE
byproducts which initiate the dental caries. surfaces.
Dental Caries 69
Q.13. What are recurrent caries? 1. Location of carious lesion.

Ans. -FTJPOT EFWFMPQJOH BEKBDFOU UP SFTUPSBUJPOT BSF 4J[FPGDBSJPVTMFTJPO
referred to as either recurrent or secondary caries.
Cavity site Size 1 Size 2 Size 3 Size 4
Q.14. What are residual caries (Minimal) (Moderate) (Enlarged) (Extensive)
Ans. Residual caries are those which remains in the Site 1 1.1 1.2 1.3 1.4
Pit and fissure
prepared tooth surface even after placing the
Site 2 2.1 2.2 2.3 2.4
restoration. Contact area
Q.15. What is Graham Mount’s classification of caries? Site 3 3.1 3.2 3.3 3.4
Ans. This classification system is based on two simple Cervical
region
parameters:
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CHAPTER
7
Armamentarium
Nisha Garg, Amit Garg
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CHAPTER OUTLINE
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Introduction Restorative Instruments
Nomenclature Instrument Grasps
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Parts Finger Rests
Instrument Formula Rotary Cutting Instruments
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Different Instrument Designs Matrix Retainers and Bands
Exploring Instruments Wedges
Hand Cutting Instruments Viva Questions
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INTRODUCTION NOMENCLATURE
Hand and rotary instruments are used for tooth Dr GV Black gave following way to describe instruments
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preparations. Rotary instruments are used for cutting and for their easier identification similar to biological
hand instruments are used for exploration, modification classification. These names are combined to give a
of the tooth preparation, insertion, condensation, carving complete description of the instrument. Naming of an
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and finishing of the restoration (Flowchart 7.1 and 7.2). instrument moves from 4 to 1.
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Flowchart 7.1: Classification of instruments by GV Black

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Armamentarium 71
1. Order PARTS
Function or purpose of the instrument, e.g. excavator,
condenser. Each hand instrument is composed of three parts
(Fig. 7.1):
2. Suborder 1. Handle or shaft.
Position, mode or manner of use, e.g. push, pull. 2. Shank.
3. Class 3. Blade or nib.
Design or form of the working end, e.g. hatchet, spoon
excavator. Handle or Shaft
4. Subclass r )andle is used to hold the instrument

Shape of the shank, e.g. binangle, contra-angle. r *UDBOCFTNBMM NFEJVNPSMBSHF TNPPUIPSTFSSBUFEGPS
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better grasping and developing pressure (Fig. 7.2).
Flowchart 7.2: Classification of instruments by Sturdevant
Shank
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r *UDPOOFDUTCMBEFPGJOTUSVNFOUUPUIFIBOEMF
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r ǔFTIBOLNBZCFTUSBJHIUPSBOHMFE
r "ngulation of instrument is provided for access and
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stability
r $MPTFSUIFXPSLJOHQPJOUUPUIFMPOHBYJTPGUIFIBOEMF
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better will be the control on it
r 'PSCFUUFSDPOUSPM UIFXPSLJOHQPJOUTIPVMEQSFGFSBCMZ
be within 3 mm of the center of the long axis of the
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handle (Fig. 7.3).

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GV Black’s Classification of Instruments Based on

Number of Shank Angles
r
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Straight: Shank having no angle (Fig. 7.4A)

r Monoangle: Shank having one angle (Fig. 7.4B)
r Bi-angle: Shank having two angles (Fig. 7.4C)
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r Tripleangle: Shank having three angles (Fig. 7.4D)

r Quadrangle: Shank having four angles (Fig. 7.4E).
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Figure 7.1: Photograph showing parts of hand instrument Figure 7.2: Photograph showing different types
of instrument handles
Advantages r 'PSNVMB VTFT NFUSJD TZTUFN 'PS EFTJHOBUJOH UIF

angulation, centigrades are used
r #FUUFSBDDFTTBOETUBCJMJUZ
r $FOUJHSBEFTBSFCBTFEPOBDJSDMFEJWJEFEJOUPVOJUT
r #FUUFSCBMBODF
SBUIFSUIBOEFHSFFTDJSDMFXIJDIBSFOPSNBMMZVTFE
r $MFBSWJFX
to describe angles. For example, in a centigrade circle,
SJHIUBOHMFIBTDFOUJHSBEFT
Blade or Nib
r #MBEFJTXPSLJOHQBSUPGUIFJOTUSVNFOUXIJDIIBTOJC Three-number Formula
or cutting edge
r *UJTVTFEGPSUIFJOTUSVNFOUTJOXIJDIDVUUJOHFEHFJTBU
r For noncutting instruments, working part is called
right angle to the long axis of the blade
as nib and is used to place, adapt and condense the
r 'JSTUOVNCFSPGUIFGPSNVMBJOEJDBUFTXJEUIPGUIFCMBEF
materials in the prepared tooth
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or primary cutting edge in tenths of a millimeter
r %FQFOEJOHPOUIFNBUFSJBMTCFJOHVTFE UIFTVSGBDFPG
r 4econd number represents the length of the blade in
the nib may be plain or serrated
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millimeters
r For cutting instruments, working part is beveled to
r ǔJSE OVNCFS JOEJDBUFT UIF BOHMF XIJDI CMBEF GPSNT
create the cutting edge
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with long axis of handle or plane of the instrument
r *G JOTUSVNFOU IBT CMBEF PO CPUI UIF FOET PG UIF
r 5P DBMDVMBUF BOHVMBUJPO PG CMBEF GSPN UIF MPOH BYJT PG
IBOEMF JUJTLOPXOBTAEPVCMFFOEFEJOTUSVNFOU*O
nt
the handle, place the instrument on center of circle and
such cases, one end is for the left side and other for
move it until blade coincides with one line on the ruler.
the right
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r *n some instruments, there are three bevels. One is at
Example of Three-number Formula
the end (called primary edge), two bevels are on side
"OJOTUSVNFOUIBWJOHJOTUSVNFOUGPSNVMBPG(Figs
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(called secondary edges).
7.6A and B) indicates following:
INSTRUMENT FORMULA r SFQSFTFOUTUIFXJEUIPGUIFCMBEFJOUFOUITPGBNN
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i.e. 1.5 mm
r (7 #MBDL FTUBCMJTIFE BO JOTUSVNFOU GPSNVMB GPS r SFQSFTFOUTUIFMFOHUIPGUIFCMBEFJONJMMJNFUFST JF
describing dimensions of blade, nib or head of mm
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instrument and angles present in shank of the r SFQSFTFOUTUIFBOHMFXIJDICMBEFGPSNTXJUIUIFBYJT

instrument (Fig. 7.5) PGIBOEMFFYQSFTTFEJOIVOESFEUITPGBDJSDMF*UNFBOT
r 'PSNVMBJTVTVBMMZQSJOUFEPOUIFIBOEMFDPOTJTUJOHPGB PGBDJSDMF"DJSDMFJTEFHSFF5PDPOWFSU
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code of three or four numbers separated by spaces JOUPDJSDMFEFHSFFNFBOT¤EFHSFF

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A B C D E
Figure 7.3: Schematic representa- Figures 7.4A to E: Schematic representation showing Figure 7.5: Schematic representation
tion showing working end of an in- instruments with different shank angles (A) Straight; (B) showing instrument formula
strument should lie within 3 mm of Monoangle; (C) Bi-angle; (D) Triple-angle; (E) Quadrangle
center of the long axis of the handle
Armamentarium 73
Four-number Formula r ǔFTFDBOCFSJHIUPSMFGUCFWFMBOENFTJBMPSEJTUBMCFWFM

instruments (Figs 7.8A).
r *UJTVTFEGPSUIFJOTUSVNFOUTJOXIJDIQSJNBSZDVUUJOH
edge is not at right angle to long axis of the blade Right and left bevel instruments
r 'irst number of the formula indicates width of the blade r 4JOHMFCFWFMFE EJSFDU DVUUJOH JOTUSVNFOUT TVDI BT
or primary cutting edge in tenths of a millimeter enamel hatchets are made in pairs having bevels on
r 4econd number indicates angle formed by primary opposite sides of the blade
cutting edge and long axis of the instrument handle r ǔFTFBSFOBNFEBTSJHIUBOEMFGUCFWFMJOTUSVNFOUT
r ǔJSEOVNCFSJOEJDBUFTMFOHUIPGCMBEFJONJMMJNFUFST r %VSJOH VTF NPWF UIF JOTUSVNFOU GSPN SJHIU UP MFGU JO
r 'PVSUIOVNCFSJOEJDBUFTBOHMFXIJDIUIFCMBEFGPSNT right beveled instrument and from left to right in left
with the long axis of the handle or the plane of the bevel instrument.
instrument in clockwise centigrade. Identification of bevel
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r )PMEUIFJOTUSVNFOUJOTVDIBXBZUIBUUIFQSJNBSZDVUUJOH
Example of Four-number Formula edge faces downwards and pointing away from operator
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*OTUSVNFOU XJUI GPSNVMB (Figs 7.7A and B) r *GCFWFMJTPOUIFSJHIUTJEFPGUIFCMBEF UIFJOTUSVNFOU
represents the following: is right sided and if bevel is on the left side of the blade
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r SFQSFTFOUTXJEUIPGUIFCMBEFJOUFOUITPGBNJMMJNFUFS the instrument is left sided.
i.e. 1.5 mm
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Mesial and distal bevel instruments
r SFQSFTFOUTUIFDVUUJOHFEHFBOHMFJODFOUJHSBEFT r *GXFPCTFSWFUIFJOTJEFPGUIFCMBEFDVSWBUVSFBOEUIF
r SFQSFTFOUTMFOHUIPGUIFCMBEF JFNN
de primary bevel is not visible then the instrument has a
r SFQSFTFOUTCMBEFBOHMFJODFOUJHSBEFT distal bevel and if the primary bevel can be seen from
the similar view point the instrument has a mesial or
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DIFFERENT INSTRUMENT DESIGNS reverse bevel

r 'PMMPXJOH TJOHMFCFWFMFE JOTUSVNFOUT IBWF FJUIFS
Bevels in Cutting Instruments mesial or distal bevels:
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m *OTUSVNFOUTXJUITMJHIUCMBEFDVSWBUVSF FH8FEF
Single Bevel Instruments
lstaedt chisel
r .PTU PG UIF JOTUSVNFOUT IBWF TJOHMF CFWFM UIBU GPSNT m *OTUSVNFOUTXJUIDVUUJOHFEHFQFSQFOEJDVMBSUPBYJT
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the primary cutting edge of the handle, e.g. bin angle chisel.
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A
A
B B
Figures 7.6A and B: Schematic representation of Figures 7.7A and B: Schematic representation of
three-number formula four-number formula
Bibeveled Instruments r 4JODFUIFZIBWFDVSWFECMBEF UIFZBSFUFSNFEBTEPVCMF

plane instruments
r *GUXPBEEJUJPOBMDVUUJOHFEHFTFYUFOEGSPNUIFQSJNBSZ
r ǔFZDBOCFVTFEMBUFSBMDVUUJOHPOMZ
cutting edges, then the instrument with secondary
cutting edges is called bibeveled instrument (Fig. 7.8B)
Instruments Ends
r 0OMZIBUDIFUTBOEIPFTBSFCJCFWFMFEJOTUSVNFOUT
r ǔFTFJOTUSVNFOUTDVUCZQVTIJOHUIFNJOUIFEJSFDUJPO r In single ended-instruments, working end is present
of long axis of the blade. on one side only (Fig. 7.9A)
r In double-ended instruments, working end is present
Triple-beveled Instrument on both sides of the instrument (Fig. 7.9B). They are
used to give mesial and distal or right and left form of
r *G UISFF BEEJUJPOBM DVUUJOH FEHFT FYUFOE GSPN UIF
the instrument in the same handle.
primary cutting edge, then the instrument is called
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triple-beveled instrument
Instrument Motions
r *USFTVMUTJOUISFFEJTUJODUDVUUJOHFEHFT
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r ǔJTJODSFBTFTDVUUJOHFŁDJFODZPGUIFJOTUSVNFOU r In single-ended instruments, working end is present
on one side only (Fig. 7.9A)
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Circumferential Bevel r *OEPVCMFFOEFEJOTUSVNFOUT working end is present
on both sides of the instrument (Fig. 7.9B). They are
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r )FSFJOTUSVNFOUCMBEFJTCFWFMFEBUBMMJUTQFSJQIFSJFT
used to give mesial and distal or right and left form of
for example, spoon excavator.
the instrument in the same handle.
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Direct and Lateral Cutting Instruments
Direct Cutting Instruments EXPLORING INSTRUMENTS
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r *OUIFTFJOTUSVNFOUTGPSDFJTBQQMJFEUIFTBNFQMBOFBT Mouth Mirrors

that of blade and handle
oo
r .PVUINJSSPSJTVTFEBTTVQQMFNFOUUPJNQSPWFBDDFTT
r ǔFZBSFDBMMFEBTTJOHMFQMBOFEJOTUSVNFOU to instrumentation
r ǔFZDBOCFVTFEGPSCPUIEJSFDUBOEMBUFSBMDVUUJOH r *UIBTIBOEMF TIBOLBOEBNJSSPSBUUBDIFEUPBSPVOE
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metal disk at one end (Fig. 7.10).

Lateral Cutting Instruments
r *OUIFTFJOTUSVNFOUTGPSDFJTBQQMJFEQFSQFOEJDVMBSUP Types
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plane of blade and handle .PVUINJSSPSTBSFPGWBSJPVTUZQFT

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1. – Front surface reflecting mirror: Here the coating

is present on front surface of the mirror to prevent
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image distortion. However, surface coating is prone

to degradation
– Rear surface reflecting mirror: *U JT NPTU
DPOWFOUJPOBMMZ VTFE NJSSPS *O UIJT DPBUJOH JT
present on back side of the mirror
2. – Plane or flat surface: *UQSPWJEFTDMFBSJNBHFXJUIPVU
distortion
– Concave surface: *U JT VTFE UP QSPWJEF EJŀFSFOU
degrees of magnification, but it causes image
distortion
A B 3. – One sided:*NBHFPOPOFTJEF
Figures 7.8A and B: Photograph showing different bevels of an in- – Two sided: *NBHF PO FJUIFS TJEF BEWBOUBHF
strument: (A) Straight chisel with single bevel; (B) Bibeveled instrument retraction with indirect vision simultaneously).
Armamentarium 75
et
A B A B
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Figures 7.9A and B: Photograph showing; (A) Single ended; Figures 7.10A and B: Photograph showing; (A) mouth mirror head;
(B) Double-ended instrument (B) Mouth mirror head attached to handle
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Uses
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r %JSFDUWJTJPO
r *OEJSFDUWJTJPO(Fig. 7.11)
de
r 3FUSBDUJPO(Fig. 7.12)
r 5SBOTJMMVNJOBUJPO
ks
Explorer
Explorer is commonly used as a diagnostic aid in evaluating
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condition of teeth especially pits and fissures.
Parts
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r )BOEMFPGFYQMPSFSJTTUSBJHIUXIJDIDPVMECFQMBJOPS
serrated
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Figure 7.11: Photograph showing use of mirror for indirect vision

r 4IBOLPGFYQMPSFSJTDVSWFEXJUIPOFNPSFBOHMF
r 8PSLJOHUJQPGFYQMPSFSJTQPJOUFE
tp
Types
ht
r Straight explorer: *UJTCFOUQFSQFOEJDVMBSUPUIFIBOEMF

This is used for examining occlusal surfaces of teeth
(Fig. 7.13A)
r Shepherd’s hook or curved explore or arch explorer:
*U IBT TFNJMVOBSTIBQFE XPSLJOH UJQ QFSQFOEJDVMBS UP
the handle. This is used for examining occlusal surfaces
(Figs 7.13B)
r Interproximal explorer/Briault explorer/Back
action probe: This explorer has two more angles in the
shank with working tip-pointed towards the handle
(Fig. 7.13C)
r Cow horn/pigtail explorer: *U IBT TNBMMFS BSDI UIBO Figure 7.12: Clinical picture showing use of mouth mirror for retrac-
curved explorer. tion of cheek or tongue
Uses
r &YBNJOBUJPOPGJOUFSQSPYJNBMDBSJFT
r 'PSBTTFTTJOHNBSHJOBMêUPGUIFSFTUPSBUJPO
Tweezers
ǔFTFIBWFBOHMFEUJQBOEBSFBWBJMBCMFJOEJŀFSFOUTJ[FT
(Fig. 7.14). They are used to place and remove cotton rolls
and other small materials to and from the mouth.
Probes
et
Though they almost look like straight explorers but they have
blunt end which is marked with graduations (Fig. 7.15). A B C
.n
Figures 7.13A to C: Photograph showing different types of explorers
Uses Courtesy: Hu-friedy
al
r .BJOMZVTFEGPSNFBTVSJOHQPDLFUEFQUI
r 5PEFUFSNJOFEJNFOTJPOTPGUPPUIQSFQBSBUJPO
Types
nt
de
r 8JMMJBNATQSPCF
r 1$1QSPCF
ks
r 143 QFSJPEPOUBMTDSFFOJOHBOESFDPSEJOHQSPCF

ǔFTFQSPCFTEJŀFSJO
oo
r %JBNFUFS
r 1PTJUJPOPGNBSLJOHT
r 5ZQFPGNBSLJOH QBJOUFEOPUDIFE

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HAND CUTTING INSTRUMENTS Figure 7.14: Photograph Figure 7.15: Photograph showing
://
showing tweezer straight probe with graduations
Box 7.1: Hand cutting instruments

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1. Chisels
i. Chisels
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a. Straight chisel
b. Monoangle chisel
c. Binangle chisel
d. Triple angle chisel
e. Wedelstaedt chisel
ii. Enamel hatchet
iii. Gingival marginal trimmer
2. Excavators
i. Hatchet
ii. Hoe excavator
iii. Angle former
iv. Spoon excavator
3. Others A B C
i. Knives
Figures 7.16A to C: Photograph showing (A) Straight chisel; cutting
ii. Files
edge is perpendicular to plane of the instruments and shank is straight;
iii. Discoid–cleoid
(B) Binangle chisel; two different angles—one at the working end and
iv. Offset hatchet
other at shank; (C) Wedelstaedt chisel; almost similar to straight chisel
v. Hoe chisel
except for slight vertical curvature in its shank
Armamentarium 77
Chisels r )BUDIFUT BSF VTFE GPS DMFBWJOH FOBNFM BOE QMBOJOH

the dentinal walls so as to have sharp outline of the
.BJO QVSQPTF PG DIJTFM JT DMFBWJOH QMBOJOH BOE MBUFSBM
preparation
scraping (Box 7.1). *UJTVTFEXJUIBQVTINPUJPO$IJTFM
r 4PNFIBUDIFUTBSFCJCFWFMFE JFCMBEFIBTUXPCFWFMT
is used to split enamel, smoothen and sharpen tooth
with cutting edge in the center. These bibevelled
preparations.
binangle hatchets are used in a chopping motion to
refine line and point angles.
Straight Chisel
r *O TUSBJHIU DIJTFM UIF DVUUJOH FEHF JT QFSQFOEJDVMBS UP Gingival Margin Trimmer
plane of instrument
r (JOHJWBMNBSHJOUSJNNFS (.5
JTBNPEJêFEIBUDIFU
r )ere chisel has straight shank and blade with bevel
which has working ends with opposite curvatures and
only on one side (Fig. 7.16A)
et
bevels (Fig. 7.18)
r *UJTVTFEXJUITUSBJHIUUISVTUGPSDF QVTINPUJPO
r *UJTBWBJMBCMFJOBTFUPGUXPEPVCMFFOEFETUZMFTBOEJT
r *UJTNBJOMZVTFEGPSDVUUJOHFOBNFM
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used in pairs, constituting a set of four instruments
r *GUIFTFDPOEOVNCFSJOJOTUSVNFOUGPSNVMBJTm
Monoangle Chisel
al
JUJTNFTJBM(.5BOEJGTFDPOEOVNCFSJTm JUJT
r 1SJNBSZDVUUJOHFEHFJTJOBQMBOFQFSQFOEJDVMBSUPUIF EJTUBM(.5
nt
long axis of the shaft and may have either a mesial or r %JTUBM(.5JTVTFEGPSUIFEJTUBMTVSGBDFBOEUIFNFTJBM
distal bevel (.5GPSUIFNFTJBMTVSGBDF
de
r %JTUBMCFWFMMFEDIJTFMJTBMTPDBMMFEBTSFWFSTFCFWFMMFE – (.5JTNFTJBMJGDVUUJOHFEHFUJQGPSNTBOBDVUFBOHMF
or contra-bevelled UPTIBGU*UJTEJTUBMJGBOHMFJTPCUVTF
r *UJTVTFEXJUIBQVTIPSQVMMNPUJPO r (.5JTVTFEJOMBUFSBMTDSBQJOHNPUJPO
ks
r 6TFEGPSTNPPUIFOJOHQSPYJNBMBOEHJOHJWBMXBMMT
Uses
Binangle Chisel
oo
r 1MBOJOHHJOHJWBMDBWPTVSGBDFNBSHJO
r *UIBTUXPEJŀFSFOUBOHMFTPOFBUUIFXPSLJOHFOEBOE r 'PSSFNPWBMPGVOTVQQPSUFEFOBNFM
other at the shank (Fig. 7.16B) r 5P CFWFM BYJPQVMQBM MJOF BOHMF JO UIF DMBTT ** UPPUI
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r *UJTNFTJBMMZPSEJTUBMMZCFWFMMFE preparation
r *UJTVTFEUPDMFBWFUIFVOEFSNJOFEFOBNFM r .FTJBM BOE EJTUBM QBJST BSF JOEJDBUFE GPS JOMBZ
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onlay tooth preparations

Triple Angle Chisel r .FTJBMBOEEJTUBMQBJSTBSFJOEJDBUFEGPSBNBMHBN
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r *UIBTUISFFEJŀFSFOUBOHMFT tooth preparations.

r *UJTNFTJBMMZPSEJTUBMMZCFWFMMFE
Excavators
ht
r *UJTVTFEUPëBUUFOUIFQVMQBMëPPS
Ordinary Hatchet
Wedelstaedt Chisel
r "OPSEJOBSZIBUDIFUFYDBWBUPSJTBCFWFMMFEJOTUSVNFOU
r *U JT BMNPTU TJNJMBS UP TUSBJHIU DIJTFM FYDFQU GPS TMJHIU in which cutting edge of blade is directed in the same
vertical curvature in its shank (Figs 7.16C) plane as that of long axis of the handle
r *UDBOCFNFTJBMMZPSEJTUBMMZCFWFMMFE r 6TFE GPS QSFQBSJOH BOE TIBSQFOJOH MJOF BOHMFT JO
r *UJTNBJOMZVTFEGPSQSPYJNBMTVSGBDFTPGBOUFSJPSUFFUI anterior teeth
r &TQFDJBMMZVTFEJOEJSFDUHPMESFTUPSBUJPOT
Hatchet
r )BUDIFUJTBQBJSFEJOTUSVNFOUJOXIJDICMBEFTNBLFT
Hoe Excavators
mBOHMFUPUIFTIBOL*UMPPLTMJLFBOBYF(Fig. 7.17) r )PFCMBEFTNBLFmBOHMFUPUIFMPOHBYJTPGIBOEMF
r *OQBJSFESJHIUBOEMFGUIBUDIFUT CMBEFTBSFCFWFMFEPO r *UMPPLTMJLFNJOJBUVSFHBSEFOIPF(Fig. 7.19A)
opposite sides to form their cutting edges r *UTTIBOLDBOIBWFPOFPSNPSFBOHMFT
r *UJTBTJOHMFQMBOFEJOTUSVNFOUXIJDIDVUTJOWFSUJDBM
push and pull, right and left motions
r *UJTVTFEUPTIBQFBOETNPPUIFOUIFëPPSBOEGPSNMJOF
BOHMFTJODMBTT***BOE7SFTUPSBUJPOT
Angle Former
r "OHMFGPSNFSJTBUZQFPGFYDBWBUPSXIJDIJTNPOPBOHMFE
with the cutting edge sharpened at an angle to the long
axis of the blade (Fig. 7.19B)
r "OHMFPGDVUUJOHFEHFUPCMBEFBYJTMJFTCFUXFFOBOE
DFOUJHSBEFT
et
r #MBEFPGBOHMFGPSNFSJTCFWFMMFEPOTJEFTBTXFMMBTUIF
end, this forms three cutting edges, thus forms a triple A B C
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bevelled instrument Figure 7.17: Photograph showing hatchet; a beveled instrument with
r *UDVUTJOWFSUJDBMQVTIPSQVMMNPUJPOGPSBDDFOUVBUJOH cutting edge of blade in same plane as that of long axis of the handle
al
line and point angles, to establish retention form in
direct filling gold restoration
nt
r ǔFSFBSFUXPTFUTPGBOHMFGPSNFST NFTJBMBOEUIFEJTUBM
angle former. These are double-ended instruments
de
r .esial angle former is used to plane gingival cavosurface
margin in the mesial proximal box, whereas distal angle
former in the distal proximal box.
ks
Spoon Excavator
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r 4QPPOFYDBWBUPSJTBNPEJêFEIBUDIFU
r *UJTBEPVCMFFOEFEJOTUSVNFOUXJUIBTQPPO DMBX PS
disk-shaped blade (Figs 7.20A to C).
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Spoon excavator is used to: A B

r 3FNPWFDBSJFTBOEEFCSJTJOUIFTDPPQJOHNPUJPOGSPN Figures 7.18A and B: Photograph showing; (A) Distal gingival
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marginal trimmer; (B) Mesial gingival marginal trimmer

the carious teeth
r 'PSDBSWJOHBNBMHBNSFTUPSBUJPOTBOEXBYQBUUFSOT
tp
Knives
ht
r "MTPLOPXOBTêOJTIJOHLOJWFT HPMELOJWFTPSBNBMHBN
knives
r ǔFZ IBWF UIJO LOJGFMJLF CMBEF BOE BSF VTFE GPS
removing excess material and contouring
r 6TFEJOTDSBQFQVMMNPUJPO
Files
r #MBEFTPGêMFTBSFUIJOBOEIBWFTFSSBUJPOT
r 4FSSBUJPOTBSFDBMMFEUFFUIPOUIFDVUUJOHGBDF(Fig. 7.21)
r 'JMFTBSFVTFEJOQVTIQVMMNPUJPO A B
r 'JMFTBSFVTFEGPSUSJNNJOHFYDFTTNBUFSJBMFTQFDJBMMZJO Figures 7.19A and B: Photograph showing; (A) Hoe excavator;
the gingival margins. (B) Angle former
Armamentarium 79
Cleoid–Discoid
r *U JT NPEJêFE DIJTFM XJUI EJŀFSFOU TIBQF PG DVUUJOH
edges
r *ODMFPJE JUJTDMBXMJLFBOEJOEJTDPJEJUJTEJTLMJLF
r ǔFTF JOTUSVNFOUT IBWF TIBSQ DVUUJOH FEHFT BT TQPPO
excavators but blade to shaft relationship is similar to
chisels
r ǔFZBSFVTFEGPSSFNPWJOHDBSJFTBOEDBSWJOHBNBMHBN
or wax patterns.
Offset Hatchet
et
r *USFTFNCMFTIBUDIFUCVUXIPMFCMBEFJTSPUBUFEBRVBSUFS
A B C
of turn, forward and backward around its long axis
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(Fig. 7.22) Figures 7.20A to C: Photograph showing different shapes of excavators
r 4JOHMFQMBOFEJOTUSVNFOUTBSFBWBJMBCMFJOSJHIUBOEMFGU
al
pairs
r ǔFTF BSF VTFE UP GPSN BOHVMBUJPOT JO QSFQBSBUJPO
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walls, specially in areas with poor accessibility. de
Triangular Hatchet
*OUSJBOHVMBSIBUDIFU CMBEFJTUSJBOHVMBSTIBQFEǔFCBTF
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of this triangle is away from the shaft.

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RESTORATIVE INSTRUMENTS
Following are the commonly used instruments when
temporary or permanent restoration is being done.
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Cement Spatulas Figure 7.21: Photograph showing amalgam file

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r 4FWFSBM UZQFT PG DFNFOU TQBUVMBT BSF BWBJMBCMF JO UIF

NBSLFUEJŀFSJOHJOTIBQFBOETJ[F
tp
r 0O UIF CBTJT PG TJ[F DFNFOU TQBUVMB DBO CF DMBTTJêFE
into two types:
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1. Large cement spatula:.JYJOHPGMVUJOHDFNFOUT

2. Small cement spatula:.JYJOHPGMJOFS
$FNFOU TQBUVMB BMTP DBO CF DMBTTJêFE PO UIF CBTJT PG
UIJDLOFTT BT SJHJE BOE ëFYJCMF ǔFJS VTF EFQFOET PO
viscosity of cement and personal preference.
Plastic Filling Instrument

r ǔFTF JOTUSVNFOUT IBWF B TNBMM NFUBM CBMM BU UIF
working end (Fig. 7.23)
r ǔFZBSFEPVCMFFOEFEJOTUSVNFOUT
A B
r 5XPUZQFTBSF
Figures 7.22A and B: Photograph showing offset hatchet. It resem-
i. Flat end/nib with blunt edges on each end, one bles hatchet but whole blade is rotated a quarter of turn, forward and
perpendicular to other backward around its long axis
JJ 0OF JT ëBU FOEOJC BOE PUIFS FOE JT SPVOE
condenser nib.
r ǔFZBSFVTFEUPNJY DBSSZBOEQMBDFDFNFOUT
r 1MBTUJDJOTUSVNFOUJTBMTPVTFEUPDIFDLUIFDPOWFOJFODF
form of tooth preparation.
Condensers
r $POEFOTFST BSF VTF UP EFMJWFS UIF SFTUPSBUJPO UP UIF
tooth preparation and properly condense it
r ǔFZ BSF BWBJMBCMF JO EJŀFSFOUMZ TIBQFE BOE TJ[FE
working ends like round, triangular or parallelogram,
et
which may be smooth or serrated (Fig. 7.24)
r $POEFOTFSTDBOCFIBOEPSNFDIBOJDBMJOOBUVSF A B C
.n
Figures 7.23A to C: Photograph showing different types of plastic
Amalgam Carrier filling instruments
al
r "NBMHBN DBSSJFS JT VTFE UP EFMJWFS GSFTIMZ USJUVSBUFE
amalgam to the prepared tooth (Fig. 7.25)
nt
r #BSSFM PG BNBMHBN DBSSJFST IPMMPX XPSLJOH FOET JO
XIJDI BNBMHBN JT QBDLFE
DPNFT JO B WBSJFUZ PG TJ[FT
de
WJ[TNBMM MBSHFBOEKVNCP
r -FWFS PG BNBMHBN DBSSJFS JT QSFTFOU PO UPQ PG UIF
carrier. On pressing lever, amalgam is transported into
ks
preparation
r " QPPSMZ QBDLFE BNBMHBN DBSSJFS NBZ SFTVMU JO
oo
BNBMHBNGBMMPVUCFGPSFJUJTFKFDUFEJOUPUIFQSFQBSFE
tooth
r "GUFS SFTUPSBUJPO JT DPNQMFUFE SFNBJOJOH BNBMHBN
eb
alloy should be expelled out to avoid hardening of

amalgam alloy in the carrier. A B C
Figures 7.24A to C: Photograph showing different types
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of condensers
Carvers
tp
r $BSWFST BSF EPVCMFFOEFE JOTUSVNFOUT XJUI TIBSQ

cutting edges which are used to carve the tooth anatomy
ht
from a restoration (Fig. 7.26).

5ypes:
B )PMMFOCBDLDBSWFSXBSET$DBSWFS
i. Double ended, binangled instrument.
JJ 6TFEUPDBSWFBNBMHBNBOEJOMBZXBYQBUUFSOT
C %JBNPOE DBSWFS'SBINT DBSWFSIBT CJCFWFMFE
cutting edge.
D *OUFSQSPYJNBMDBSWFSJUIBTWFSZUIJOCMBEFBOEJT
used for carving proximal surfaces.
d. DJTDPJEmDMFPJEDBSWFSJTVTFEGPSDBSWJOHPDDMVTBM
surface. Figure 7.25: Photograph showing amalgam carrier
Armamentarium 81
Burnisher
r #VSOJTIFSTBSFUIFLJOEPGJOTUSVNFOUTXIJDINBLFUIF
surface shiny by rubbing
r ǔey have smooth rounded working ends which are
used to smoothen and polish the restoration (Fig. 7.27).
%JŀFSFOU UZQFT PG CVSOJTIFST BSF BWBJMBCMF CVU NPTU
commonly used are:
– 1,5
- Designed by Peter K Thomas
- Rounded cone-shaped burnisher. A B
– #FBWFUBJMDPOEFOTFSOBSSPXUZQFPGCVSOJTIFS
et
– 0WPJECVSOJTIFSDPNFTJOWBSJPVTTJ[FT TVDIBT

.n
Uses
al
r 'JOBMDPOEFOTBUJPOPGBNBMHBN
r *OJUJBMTIBQJOHPGPDDMVTBMBOBUPNZPGBNBMHBN
nt
r 4IBQJOHPGNFUBMNBUSJYCBOET
r 4IBQJOH PG PDDMVTBM BOBUPNZ JO QPTUFSJPS SFTJO
de
C D
DPNQPTJUFCFGPSFQPMZNFSJ[BUJPOPGSFTJO
Figures 7.26A to D: Photograph showing; (A) Wall's no. 3 carver; (B)
r #VSOJTIJOHNBSHJOTPGDBTUHPMESFTUPSBUJPO Diamond carver; (C) Discoid cleoid carver; (D) Hollenback carver
ks
Composite Resin Instruments/

Teflon-coated Instruments
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r 'PS DPNQPTJUF SFTJO SFTUPSBUJPOT B XJEF SBOHF PG

double-ended instruments are used to transport and
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place resins (Fig. 7.28)

r 8PSLJOHFOEPGUIFTFJOTUSVNFOUTJTDPBUFEXJUIUFëPO
r ǔJT DPBUJOH QSFWFOUT EJTDPMPSBUJPO BOE TUJDLJOH PG
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composite material to the instruments.

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INSTRUMENT GRASPS A B
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Modified Pen Grasp

r .PTUDPNNPOMZVTFEHSBTQ
r (SFBUFTUEFMJDBDZPGUPVDIJTQSPWJEFECZUIJTHSBTQ
r .PEJêFE QFO HSBTQ JT TJNJMBS UP UIF QFO HSBTQ FYDFQU
the operator uses the pad of the middle finger on the
handle of the instrument rather than going under the
instrument (Fig. 7.29)
r 1PTJUJPOJOH PG UIF êOHFST JO UIJT NBOOFS DSFBUFT B
USJBOHMF PG GPSDFT PS USJQPE FŀFDU XIJDI FOIBODFT UIF C
instrument control Figures 7.27A to C: Photograph showing different
r .PTUDPNNPOMZVTFEGPSNBOEJCVMBSUFFUI shapes of burnishers
Inverted Pen Grasp

r *OJOWFSUFEQFOHSBTQ êOHFSQPTJUJPOTBSFUIFTBNFBT
for the modified pen grasp but palm faces towards the
operator (Fig. 7.30)
r ǔJTHSBTQJTNPTUDPNNPOMZVTFEGPSQSFQBSJOHBUPPUI
in the lingual aspect of maxillary anterior and occlusal
surface of maxillary posterior teeth.
Palm and Thumb Grasp

r ǔJTHSBTQJTTBNFBTGPSIPMEJOHUIFLOJGFGPSQFFMJOH
the skin of an apple
et
r )FSF JOTUSVNFOU JT HSBTQFE WFSZ OFBS UP JUT XPSLJOH
A B C D
end so that thumb can be braced against the teeth so
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Figures 7.28A and B: Photograph showing teflon-coated hand as to provide control during instrument movements
instruments
r 4haft of the instrument is placed on the palm of the
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hand and grasped by the four fingers to provide firm
control, while the thumb is free to control movements
nt
BOEQSPWJEFSFTUPOBOBEKBDFOUUPPUIPGUIFTBNFBSDI
r 5PBDIJFWFUIFUISVTUBDUJPOXJUIUIFêOHFSTBOEQBMN
de
instrument is forced away from the tip of the thumb
which is at the rest position
ks
r ǔJT HSBTQ IBT MJNJUFE VTF POMZ XIJMF PQFSBUJOH PO
maxillary anterior teeth.
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Modified Palm and Thumb Grasp

r *nstrument is held like the palm grasp but the pads of
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all the four fingers press the handle against the palm
BOEQBEBOEêSTUKPJOUPGUIFUIVNC
Figure 7.29: Photograph showing modified pen grasp r )FSFUJQPGUIVNCSFTUTPOUIFUPPUICFJOHQSFQBSFEPS
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UIFBEKBDFOUUPPUI
r .PEJêFEQBMNBOEUIVNCHSBTQQSPWJEFTNPSFDPOUSPM
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to avoid slipping of instrument

r ǔJTHSBTQJTDPNNPOMZVTFEJONBYJMMBSZBOUFSJPSUFFUI
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FINGER RESTS
ǔF êOHFS SFTU IFMQT UP TUBCJMJ[F UIF IBOE BOE UIF
instrument by providing a firm rest to the hand during
operative procedures. Finger rests may be intraoral or
extraoral.
Intraoral Finger Rests

Conventional
Figure 7.30: Photograph showing inverted pen grasp, palm faces *OUIJT UIFêOHFSSFTUJTKVTUOFBSPSBEKBDFOUUPUIFXPSLJOH
towards the operator tooth (Fig. 7.31).
Armamentarium 83
Cross-arch Extraoral Finger Rest

*OUIJT UIFêOHFSSFTUJTBDIJFWFEGSPNUPPUIPGUIFPQQPTJUF *UJTVTFENPTUMZGPSNBYJMMBSZQPTUFSJPSUFFUI
side but of the same arch (Fig. 7.32).
Palm Up
Opposite Arch Here rest is obtained by resting the back of the middle and
fourth finger on the lateral aspect of the mandible on the
*OUIJT UIFêOHFSSFTUJTBDIJFWFEGSPNUPPUIPGUIFPQQPTJUF right side of the face (Fig. 7.33).
arch.
Palm Down
Finger on Finger
Here rest is obtained by resting the front surface of the
*O UIJT SFTU JT BDIJFWFE GSPN JOEFY êOHFS PS UIVNC PG middle and fourth fingers on the lateral aspect of the
et
nonoperating hand. mandible on the left side of the face (Fig. 7.34).
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al
nt
de
ks
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eb
Fig. 7.31: Photograph showing conventional finger rest, rest is just Figure 7.33: Clinical picture showing palm up rest, rest is obtained
near or adjacent to the working tooth by resting the back of the middle and fourth finger on lateral aspect of
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mandible on the right side of the face

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ht
Figure 7.32: Photograph showing cross-arch finger rest, rest is Figure 7.34 Clinical picture showing palm down rest, rest is obtained
achieved from tooth of opposite side but of same arch by resting front surface of middle and fourth fingers on the lateral as-
pect of the mandible on the left side of the face
ROTARY CUTTING INSTRUMENTS

Rotary cutting instruments are those instruments which
rotate on an axis to do the work of abrading and cutting on
tooth structure.
Figure 7.35: Photograph showing airrotor contra-angle handpiece
Types of Rotary Cutting
r Handpiece:*UJTBQPXFSEFWJDF
r Bur:*UJTBDVUUJOHUPPM
Handpieces
et
r )BOEQJFDFJTBEFWJDFGPSIPMEJOHSPUBUJOHJOTUSVNFOU
transmitting power to it and positioning it intraorally
.n
r 'JSTU iEFOUBM FOHJOFu XBT EFWFMPQFE JO CZ %S Figure 7.36: Photograph showing micromotor contra-angle
+BNFT#.PSSJTPO*UXBTBEBQUFEGSPNTFXJOHNBDIJOF handpiece
al
concept
r *O UIF #PSEFO "JSSPUPS was developed as the
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prototype for today’s modern air-turbine handpiece
Electrically driven handpieces were introduced in the
de
T
Types of handpiece according to design
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Contra-angle Figure 7.37: Photograph showing micromotor straight handpiece
r *OUIJT IFBEPGIBOEQJFDFJTêSTUBOHMFEBXBZGSPNBOE
then back towards the long axis of the handle
oo
r #FDBVTFPGUIJTEFTJHO CVSIFBEMJFTDMPTFUPMPOHBYJT r Table 7.1 TIPXT UIF EJŀFSFOU TQFFE SBOHFT XJUI UIFJS
of the handle of handpiece which improve accessibility, uses, advantages and disdvantages.
visibility and stability of handpiece while working.
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Airrotor contra-angle handpiece: Dental Burs

m *U HFUT QPXFS GSPN UIF DPNQSFTTFE BJS TVQQMJFE CZ r i#VS JT B SPUBSZ DVUUJOH JOTUSVNFOU XIJDI IBT CMBEFE
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the compressor DVUUJOHIFBEu

m ǔJT IBOEQJFDF IBT IJHI TQFFE BOE MPX UPSRVF r #VSTSFNPWFUPPUITUSVDUVSFFJUIFSCZDIJQQJOHJUBXBZ
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(Fig. 7.35) or by grinding

m 4QFFESBOHFJT m SQN r 8JMMJBNBOE4DISPFEFSêSTUNBEFEJBNPOEEFOUBMCVS
ht
m 6TFE GPS UPPUI QSFQBSBUJPO BOE SFNPWBM PG PME JO

restorations r .PEFSO EJBNPOE CVS XBT JOUSPEVDFE JO CZ 8)
– Operates with friction grip burs and diamonds. Drendel by bonding diamond points to stainless steel
Micromotor: shanks.
m *UHFUTQPXFSGSPNFMFDUSJDNJDSPNPUPSPSBJSNPUPS
Materials Used for Bur
m *UIBTIJHIUPSRVFBOEMPXTQFFE(Fig. 7.36)
r Stainless steel burs
m 6TFEGPSêOJTIJOHBOEQPMJTIJOHQSPDFEVSFT
– These were the first developed burs
Straight m %FTJHOFEGPSTMPXTQFFESQN
r *OTUSBJHIUIBOEQJFDF MPOHBYJTPGCVSMJFTJOTBNFQMBOF m 6TVBMMZ B CVS IBT FJHIU CMBEFT XJUI QPTJUJWF SBLF
as long axis of handpiece angle for active cutting of dentin. But this makes steel
r $BOCFBUUBDIFEUPNJDSPNPUPSPSBJSNPUPS burs fragile, so they do not have a long life
r *U JT VTFE JO PSBM TVSHJDBM BOE MBCPSBUPSZ QSPDFEVSFT – 6sed for cutting soft carious dentin and finishing
(Fig. 7.37) procedures.
Armamentarium 85
Table 7.1: Rotary speed ranges in operative dentistry

Speed Range Commonly used bur Uses Advantages Disadvantages
(RPM) (with this speed)
Low Less than Steel burs with or r 1PMJTIJOH ñOJTIJOH Good tactile sense r *OFíFDUJWFDVUUJOH
speed 12,000 without lubricant r %SJMMJOHIPMFT r 5JNFDPOTVNJOH
r 'PSJNQMBOUT r 0QFSBUPSGBUJHVF
r &YDBWBUJPOPGDBSJFT r .PSFQBUJFOUEJTDPNGPSU
.FEJVN 20,000 to %JBNPOECVSTXJUI r 5PPUIQSFQBSBUJPOT 'JOFUBDUJMFTFOTF r .PSFIFBUQSPEVDUJPO
speed 2,00,000 lubricant r .BLJOHTNBMMUPPUI r /PUñUGPSMBSHFSQSFQBSBUJPOT
preparations r 1SFQBSBUJPOTDBODBVTF
r 3FñOJOHUPPUI PQFSBUPSGBUJHVF
preparations
r 3FñOJOHPDDMVTJPOT
et
)JHI .PSFUIBO 5VOHTUFODBSCJEF r 5PPUIQSFQBSBUJPOT r &BTFGPSPQFSBUPS r 0WFSDVUUJOHJTQPTTJCMF
speed 2,00,000 burs with lubricant r 3FNPWBMPGPME r 'BTUFSQSFQBSBUJPOUBLFTMFTTUJNF r -FTTUBDUJMFTFOTF
.n
SFTUPSBUJWFNBUFSJBMT r -FTTGBUJHVFGPSQBUJFOUBOEPQFSBUPS r *BUSPHFOJDFSSPSTBSFNPSF
r $SPXOQSFQBSBUJPOT r 2VBESBOUEFOUJTUSZJTQPTTJCMF DPNNPO
GPSñYFEQSPTUIFTJT r #VSMJGFJTFOIBODFE r )BNQFSFEWJTJCJMJUZEVFUPBJSm
al
r -FTTDIBODFTPGBQQSFIFOTJPOBOE XBUFSTQSBZ
TUSBJOGPSQBUJFOU
r Tungsten carbide burs

nt
de – Finishing burs
– Designed to withstand heavy stresses and increase – Polishing burs.
shelf life r "DDPSEJOHUPUIFJSTIBQFT
ks
m 8PSLCFTUCFZPOE – Round bur

– Have six blades and negative rake angle to provide m *OWFSUFEDPOF
better support for cutting edge – Pear-shaped
oo
m $VU NFUBM BOE EFOUJO WFSZ XFMM CVU DBO QSPEVDF m 8IFFMTIBQFE
microcracks in the enamel so weaken the cavosurface m 5BQFSJOHêTTVSF
eb
margins. – Straight fissure

– End cutting bur.
Classifications of Burs
r "DDPSEJOHUPUIFJSNPEFPGBUUBDINFOUUPUIFIBOEQJFDF Parts of a Bur
://
m -BUDIUZQF Following are the parts of a bur (Fig. 7.38):

– Friction grip type.
tp
r "DDPSEJOHUPUIFJSDPNQPTJUJPO
– Stainless steel burs
ht
m 5VOHTUFODBSCJEFCVST
m "DPNCJOBUJPOPGCPUI
r "DDPSEJOHUPUIFJSNPUJPO
– Right bur: " SJHIU CVS JT POF XIJDI DVUT XIFO JU
revolves clockwise
– Left bur: "MFGUCVSJTPOFXIJDIDVUTXIFOSFWPMWJOH
anticlockwise.
r "DDPSEJOHUPUIFMFOHUIPGUIFJSIFBE
m -POH
– Short
– Regular.
r "DDPSEJOHUPUIFJSVTF
m $VUUJOHCVST Figure 7.38: Photograph showing parts of a dental bur
r Shank: Shank is that part of the bur that fits into the
handpiece, accepts the rotary movement from the
handpiece and controls the alignment and concentricity
of the instrument. The three commonly seen instrument
shanks are:
– Straight handpiece shank
m -BUDIUZQFIBOEQJFDFTIBOL
– Friction-grip handpiece shank.
r Neck: The neck connects the shank to the hand.
.BJO GVODUJPO PG OFDL JT UP USBOTNJU SPUBUJPOBM BOE
translational forces to the head
r Head:*UJTXPSLJOHQBSUPGUIFJOTUSVNFOU#BTFEVQPO
et
A B C
their head characteristics, the instruments can be Figures 7.39A to C: Photograph showing; (A) Straight handpiece
CMBEFEPSBCSBTJWFǔFTFBSFBWBJMBCMFJOEJŀFSFOUTJ[FT shank; (B) Latch-type angle handpiece shank; (C) Friction grip hand-
.n
and shapes. piece shank
al
%JŀFSFOUEFTJHOTPGCVSTIBOL OFDLBOEIFBE
r Shank design: Depending upon mode of attachment
nt
to handpiece, shanks of burs can be of following types
(Fig. 7.39):
de
– Straight handpiece shank:
- Shank part is like a cylinder into which bur is held
XJUI B NFUBM DIVDL XIJDI IBT EJŀFSFOU TJ[FT PG
ks
shank diameter.
– Latch type angle handpiece shank:
oo
)FSF QPTUFSJPSQPSUJPOPGTIBOLJTNBEFëBUPO
one side so that end of bur fits into D-shaped
socket at bottom of bur tube
eb
- *nstrument is not retained in handpiece with

A B C D E F
chuck but with a latch which fits into the grooves
Figures 7.40A to F: Photograph showing different types of bur heads
made in shank of bur
://
- These instruments are commonly used in contra-

angle handpiece for finishing and polishing
tp
procedures.
– Friction grip angle handpiece shank:
ht
*UJTJOUSPEVDFEGPSIJHITQFFEIBOEQJFDF
- Here the shank is simple cylinder which is held
in the handpiece by friction between shank and
metal chuck
- Here shank is much smaller than latch-type
instruments.
r Design of neck: /FDL DPOOFDUT IFBE BOE TIBOL *U JT
tapered from shank to the head. For optical visibility A B C D E
BOE FŁDJFODZ PG CVS EJNFOTJPOT PG OFDL TIPVME CF Figures 7.41A to E: Schematic representation of designs of bur heads
Armamentarium 87
small but at the same time it should not compromise r Rounding of sharp tip corners: Sharp tip corners of
the strength burs produce sharp internal angles, resulting in stress
r Design of bur head: The term ‘bur shape’ refers to the concentration. Burs with round tip corners produce
contour or silhouette of the bur head (Figs 7.40 and 7.41) rounded internal line angles and thus lower stress in
r Round in shape restored tooth.
m /VNCFSFEGSPN UP Bur Size
m 6TFEGPS3FNPWBMPGDBSJFT JOJUJBMUPPUIQFOFUSBUJPO #VS TJ[F SFQSFTFOUT UIF EJBNFUFS PG CVS IFBE %JŀFSFOU
placement of retentive grooves. numbers have been assigned to burs which denote bur
r *OWFSUFEDPOFCVS TJ[FBOEIFBEEFTJHO&BSMJFSCVSTIBEBOVNCFSJOHTZTUFN
– Have an inverted cone shape JOXIJDICVSTXFSFHSPVQFECZTIBQFTBOETJ[FT
– /VNCFSFE m But later because of modifications in bur design this
– 6TFEJODBWJUZFYUFOTJPOTUPFTUBCMJTIXBMMBOHVMBUJPOT
et
numbering system was modified. For example, after
BOESFUFOUJPOGPSNT UPëBUUFOUIFQVMQBMëPPSTBOE JOUSPEVDUJPO PG DSPTTDVU CVST OVNCFST XBT BEEFE
for providing undercuts in tooth preparations.
.n
UP UIF CVS FRVJWBMFOU UP OPODSPTTDVU TJ[F BOE XBT
r Pear-shaped bur: BEEFE GPS FOE DVUUJOH CVST ǔVT XF DBO TBZ UIBU OP
– Head is shaped like tapered cone with small end of
al
BOEOPCVSTBMMIBWFTBNFEJNFOTJPOTPGUIFIFBE
cone directed towards shank irrespective of their head design (Tables 7.2 and 7.3).
– 6TFEJODMBTT*UPPUIQSFQBSBUJPOGPSHPMEGPJM
nt
r Straight fissure bur:
– 1BSBMMFMTJEFE DZMJOESJDBM CVS PG EJŀFSFOU MFOHUIT
de
used for amalgam tooth preparations.
Table 7.2 ¨Co-relation of bur head diameter and its respective
r 5BQFSJOHêTTVSFCVS number
ks
– 6TFE GPS QMBOOJOH WFSUJDBM BYJBM TVSGBDFT BOE
Shape of head Head diameter (mm) Number
placement of grooves.
r Plain fissure burs: 3PVOE 0.5 ¼
oo
0.6 ½
– $PNF JO B WBSJFUZ PG TJ[FT CPUI UBQFSFE BOE
1.0 2
cylindrical 1.4 4
– 6TFE GPS HSPPWF QMBDFNFOU BOE êOJTIJOH PG
eb
4USBJHIUñTTVSF 0.6 55½

preparations. 0.8 56
r End cutting bur: 1.0 57
://
– $ZMJOESJDBMJOTIBQF 5BQFSFEñTTVSF 0.9 169

– Just the end carrying blades 1.2 271
tp
– 6TFE GPS FYUFOEJOH QSFQBSBUJPOT BQJDBMMZ XJUIPVU *OWFSUFEDPOF 0.6 33½

axial reduction 0.8 34
ht
– *UJTVTFEGPSDBSSZJOHUIFQSFQBSBUJPOBQJDBMMZXJUIPVU
$SPTTDVU 1.0 557
axial reduction. 1.2 558
Modifications in Bur Design &OEDVUUJOH 1.0 957
Because of introduction of handpieces with high speed
ranges, many modifications have been made in design of
CVS4JODFDVUUJOHFŁDJFODZPGDBSCJEFCVSTJODSFBTFXJUI Table 7.3 ¨Standard bur head sizes
increase in speed, the larger diameter carbide burs have
Head shape Head diameter (mm)
been replaced by small diameter burs.
0.5 0.6 0.8 1.0 1.2 1.4
Other modifications in bur design are as follow: 3PVOE ¼ ½ 1 2 3 4
r Reduced number of crosscuts: Since at high speed, *OWFSUFE 33½ 34 35 36 37
crosscuts tends to produce rough surface, newer burs cone
have reduced number of crosscuts 4USBJHIU 55½ 56 57 58 59
r Extended head lengths: Burs with extended head ñTTVSF
MFOHUIIBWFCFFOJOUSPEVDFETPBTUPQSPEVDFFŀFDUJWF 5BQFSFE 700 701
ñTTVSF
cutting with very light pressure
Bur Design r Radial line: *UJTUIFMJOFDPOOFDUJOHDFOUFSPGUIFCVS

Bur head consists of uniformly spaced blades with concave and the blade
areas in between them. These concave depressed areas are r Land: *UJTUIFQMBOFTVSGBDFJNNFEJBUFMZGPMMPXJOHUIF
DBMMFEDIJQPSëVUFTQBDFT/PSNBMMZ BCVSIBT PS cutting edge
number of blades. r Clearance angle: This is the angle between the
r Bur blade: #MBEFJTBQSPKFDUJPOPOUIFCVSIFBEXIJDI clearance face and the work.
forms a cutting edge. Blade has two surfaces (Fig. 7.42): Significance: $MFBSBODFBOHMFQSPWJEFTBTUPQUPQSFWFOU
– Blade face/Rake face:*UJTUIFTVSGBDFPGCVSCMBEFPO the bur edge from digging into the tooth and provides
the leading edge BEFRVBUFDIJQTQBDFGPSDMFBSJOHEFCSJT
– Clearance face: *U JT UIF TVSGBDF PG CVS CMBEF PO UIF r Blade angle: *UJTUIFBOHMFCFUXFFOUIFSBLFGBDFBOE
trailing edge. the clearance face.
r Rake angle: This is angle between the rake face and the Significance:"NPOHUIFTF SBLFBOHMFJTPOFPGUIFNPTU
et
radial line (Fig. 7.43). important feature of bur blade design. Negative rake
– 1PTJUJWFSBLFBOHMF8IFOSBLFGBDFUSBJMTUIFSBEJBM angle increases the life of bur by reducing fracture of
.n
line cutting edges. Positive rake angle increases the cutting
– /FHBUJWF SBLF BOHMF 8IFO SBLF GBDF JT BIFBE PG FŁDJFODZ CVU TJODF JU SFEVDFT UIF CVML PG CVS CMBEF
al
radial line it becomes prone to fracture. Positive rake angle also
– Zero rake angle: 8IFO SBLF GBDF BOE SBEJBM MJOF causes clogging of debris in the chip space.
nt
coincide each other. Table 7.4 TVNNBSJ[FT *G CMBEF BOHMF JT JODSFBTFE JU SFJOGPSDFT UIF DVUUJOH
definitions related to bur design. edge and thus reduces their fracture. But clearance
de
angle, blade angle and rake angle cannot be varied
independent of each other. For example, increase in
ks
CMBEFBOHMF EFDSFBTFTUIFDMFBSBODFBOHMF6TVBMMZ UIF
DBSCJEFCVSTIBWFOFHBUJWFSBLFBOHMFTBOEPGCMBEF
angle so as to reduce their chances of fracture. For
oo
better clearance of debris, the clearance face of carbide

CVSTBSFNBEFDVSWFEUPQSPWJEFBEFRVBUFëVUFTQBDF
r Concentricity: *UJTBEJSFDUNFBTVSFNFOUPGTZNNFUSZ
eb
PGUIFCVSIFBE*OPUIFSXPSET DPODFOUSJDJUZNFBTVSFT
XIFUIFS CMBEFT BSF PG FRVBM MFOHUI PS OPU *U JT EPOF
://
when the bur is static

Figure 7.42: Schematic representation showing bur design showing r Run out: *U NFBTVSFT UIF BDDVSBDZ XJUI XIJDI BMM UIF
tp
rake angle, clearance angle and edge angle tip of blades pass through a single point when bur is
ht
Table 7.4 ¨Definitions related to bur design
Feature Definition
r 3BLFGBDF #MBEF 4VSGBDFPGCVSCMBEFPOMFBEJOHFEHF

GBDF
r $MFBSBODFGBDF 4VSGBDFPGCVSCMBEFPOUSBJMJOHFEHF
r 3BLFBOHMF "OHMFCFUXFFOSBLFGBDFBOEUIFSBEJBMMJOF
m 1PTJUJWFSBLF 3BLFGBDFUSBJMTUIFSBEJBMMJOF
BOHMF
m /FHBUJWFSBLF 3BLFGBDFBIFBEPGUIFSBEJBMMJOF
A B C
BOHMF
Figures 7.43A to C: Schematic representation showing positive, m ;FSPSBLFBOHMF 3BLFGBDFBOESBEJBMMJOFDPJODJEFFBDIPUIFS
negative and zero rake angles
Armamentarium 89
NPWJOH *U NFBTVSFT UIF NBYJNVN EJTQMBDFNFOU PG Table 7.5 ¨Classification of matrices according to type of tooth
CVS IFBE GSPN JUT DFOUFS PG SPUBUJPO *O DBTF UIFSF JT preparation
USFNCMJOHPGCVSEVSJOHSPUBUJPO UIJTFŀFDUPGSVOPVUJT Types of preparation Matrices and retainers
directly proportional to length of bur shank. r $MBTT*XJUICVDDBMPSMJOHVBM r %PVCMFCBOEFE5PðFNJSFNBUSJY
FYUFOTJPO
MATRIX RETAINERS AND BANDS r $MBTT**UPPUIQSFQBSBUJPO r *WPSZNBUSJYOVNCFS
r /ZTUSPNTSFUBJOFS
Matrix
r $MBTT**NFTJPPDDMVTPEJTUBM r *WPSZNBUSJYOVNCFS
*U JT BO JOTUSVNFOU XIJDI JT VTFE UP IPME UIF SFTUPSBUJPO .0%
UPPUIQSFQBSBUJPO r 5PðFNJSFNBUSJY
within the tooth while it is setting. r 4UFFMFT4JRWFMBOETFMGBEKVTUJOH
NBUSJY
Matricing r "OBUPNJDBMNBUSJYCBOE
*U JT UIF QSPDFEVSF CZ XIJDI B UFNQPSBSZ XBMM JT CVJMU r A5TIBQFENBUSJYCBOE
et
opposite to the axial wall, surrounding the tooth structure r 3FUBJOFSMFTTBVUPNBUSJY
which has been lost during the tooth preparation. r $MBTT***UPPUIQSFQBSBUJPO r A4TIBQFENBUSJYCBOE
.n
r $FMMPQIBOFNBUSJYTUSJQT
r .ZMBSTUSJQT
Parts of Matrix
al
r $MBTT*7UPPUIQSFQBSBUJPO r 1MBTUJDTUSJQT
Retainer r "MVNJOJVNGPJM
nt
r 5SBOTQBSFOUDSPXOGPSN
*UIPMETBCBOEJOEFTJSFEQPTJUJPOBOETIBQF r "OBUPNJDNBUSJY
r $MBTT7UPPUIQSFQBSBUJPO r $VTUPNNBEFQMBTUJDNBUSJY
de
Band r %JSFDUUPPUIDPMPSFEBOEBMM r $FMMPQIBOFNBUSJDFT
PUIFSDPNQMFY r "OBUPNJDNBUSJDFTQSFQBSBUJPOT
r *U JT B QJFDF PG NFUBM PS QPMZNFSJD NBUFSJBM JOUFOEFE r "MVNJOJVNPSDPQQFSDPMMBST
ks
to give support and form to the restoration during its r 5SBOTQBSFOUQMBTUJDDSPXOGPSNT

insertion and setting
r Commonly used materials for bands are:
oo
– Stainless steel ëBUTFNJDJSDMFBSNTIBWJOHBQPJOUFEQSPKFDUJPOBUUIFFOE

– Polyacetate (Fig. 7.44). On other end of matrix band holder, there is
eb
m $FMMVMPTFBDFUBUF a screw which is when rotated clockwise, brings ends of

m $FMMVMPTFOJUSBUF both claws closer to each other. Band used with this matrix
IBTPOFNBSHJOTMJHIUMZQSPKFDUFEJOJUTNJEEMFQBSUǔJT
://
Functions QSPKFDUFE NBSHJO JT LFQU UPXBSET UIF HJOHJWB PO UIF TJEF
of tooth preparation. Keeping the matrix band around
r 5PDPOêOFUIFSFTUPSBUJPOEVSJOHTFUUJOH
tp
the tooth, the screw of the retainer is tightened so that the

r 5PQSPWJEFQSPQFSQSPYJNBMDPOUBDUBOEDPOUPVS
CBOE QFSGFDUMZ êUT BSPVOE UIF UPPUI "GUFS UIJT XFEHF JT
r 5PQSPWJEFPQUJNBMTVSGBDFUFYUVSFGPSSFTUPSBUJPO
ht
placed which also helps in further adaptation of the matrix

r 5PQSFWFOUHJOHJWBMPWFSIBOHT
band to the tooth (Fig. 7.45).
Classification Indication
'PS SFTUPSBUJPOT PG VOJMBUFSBM DMBTT ** UPPUI QSFQBSBUJPOT
Though matrix band and retainers can be classified in many
especially when the contact on the unprepared side is
ways, we will discus types according to tooth preparation
very tight.
for which they are used.
Table 7.5 FOMJTUT EJŀFSFOU UZQFT PG NBUSJDFT VTFE Advantages
according to the type of tooth preparation. r Economical
r 6TFEGPSSFTUPSJOHDMBTT**UPPUIQSFQBSBUJPOT
Ivory Matrix Holder (Retainer) No. 1 r $BOCFTUFSJMJ[FE
*WPSZ NBUSJY IPMEFS OVNCFS JT NPTU DPNNPOMZ Disadvantages
VTFE NBUSJY CBOE IPMEFS GPS VOJMBUFSBM DMBTT ** UPPUI r $VNCFSTPNFUPBQQMZBOESFNPWF
QSFQBSBUJPOT.BUSJYIPMEFSIBTBDMBXBUPOFFOEXJUIUXP r Not used commonly now-a-days.
et
.n
Figure 7.44: Photograph showing Ivory No. 1 matrix retainer and band Figure 7.47: Photograph showing slot in the head area of Toffelmire
retainer
al
nt
de
ks
oo
eb
://
Figure 7.45: Photograph showing Ivory matrix retainer and band no.1 Figure 7.48: Photograph showing large knurnled nut helps in
used in class II restoration adjusting the size of loop of matrix band against the tooth
tp
ht
Figure 7.46: Photograph showing Ivory No. 8 matrix retainer and Figure 7.49: Photograph showing small knurled nut helps in tighten-
bands ing the band to retainer
Armamentarium 91
Ivory Matrix Band Retainer No. 8 r 0QFOTJEFPGUIFIFBETIPVMECFGBDJOHHJOHJWBMMZXIFO

the band is placed around the tooth.
*WPSZ NBUSJY CBOE SFUBJOFS IPMET UIF NBUSJY CBOE UIBU
encircles the tooth to provide missing walls on both Slide (Diagonal slot)
proximal sides. The matrix band is made up of thin sheet r ǔJTQPSUJPOJTMPDBUFEOFBSUIFIFBEGPSJOTUBMMBUJPOPG
of metal so that it can pass through the contact area of band in the retainer, helps in placement of band around
the unprepared proximal side of the tooth (Fig. 7.46). the tooth.
$JSDVNGFSFODF PG UIF CBOE DBO CF BEKVTUFE VTJOH UIF
Knurled nuts
screw present in the matrix band retainer.
r 5XPLOVSMFELOPUTJOSFUBJOFS
Indications J -BSHFLOVSMFEOVU (Fig. 7.48)
r 6OJMBUFSBMPSCJMBUFSBMDMBTT**QSFQBSBUJPOT .0%
a. Helps in adapting the loop of matrix band
r $MBTT*DPNQPVOEUPPUIQSFQBSBUJPOT against the tooth.
et
Advantages C )FMQT JO BEKVTUJOH UIF TJ[F PG MPPQ PG NBUSJY
band against the tooth.
.n
r Economical
r 6TFEGPSSFTUPSJOHDMBTT**UPPUIQSFQBSBUJPOT JJ 4NBMMLOVSMFEOVUIFMQTJOUJHIUFOJOHUIFCBOEUP
retainer (Fig. 7.49).
al
r $BOCFTUFSJMJ[FE
Disadvantages Assembly of Retainer
nt
r $VNCFSTPNFUPBQQMZBOESFNPWF 8IFOCBOEBOESFUBJOFSBSFBTTFNCMFE UXPFOETPGCBOE
r Not used commonly nowadays. must be of same length protruding from the diagonal slot.
de
-PPQFYUFOEJOHGSPNSFUBJOFSDBOQSPKFDUJO GPMMPXJOH
Tofflemire Universal Matrix Band Retainer ways (Fig. 7.50):
(Designed by Dr BF Tofflemire) r 4USBJHIUVTFEOFBSBOUFSJPSUFFUI
ks
r -FGU3JHIUVTFE NPTUMZ JO QPTUFSJPS BSFBT PG PSBM

*U JT BMTP LOPXO BT AVOJWFSTBM NBUSJY CFDBVTF JU DBO CF cavity.
used in all types of tooth preparations of posterior teeth.
oo
Placement of Tofflemire Retainer and Band

Indications r 'JSTUPQFOUIFMBSHFLOVSMFEOVUTPUIBUTMJEFJTBUMFBTU
r $MBTT * UPPUI QSFQBSBUJPOT XJUI CVDDBM PS MJOHVBM inches from the head (Fig. 7.51)
eb
extensions r )PMEUIFLOVSMFEOVU MBSHF

XJUIPOFIBOE PQFOUIF
r 6OJMBUFSBMPSCJMBUFSBMDMBTT** .0%
UPPUIQSFQBSBUJPOT small knurled nut in opposite direction (counter clock-
r $MBTT ** DPNQPVOE UPPUI QSFQBSBUJPOT IBWJOH NPSF wise) for clearance of diagonal slot for reception of
://
than two missing walls. matrix band (Fig. 7.52)

r 5XPFOETPGNBUSJYCBOEBSFTFDVSFEUPHFUIFSUPGPSN
tp
Advantages
r Easy to use loop or either use preformed loop (Figs 7.50A to C)
r Provides good contact and contours r 1MBDFFOETPGCBOEJOEJBHPOBMTMPU
ht
r $BOCFFBTJMZSFNPWFE r ǔFO TNBMMLOVSMFEOVUJTUJHIUFOFEUPTFDVSFUIFCBOE

r $BOCFTUFSJMJ[FE to the retainer
r $BOCFVTFECPUIGSPNGBDJBMBTXFMMBTMJOHVBMTJEF r "GUFSTFDVSJOHUIFCBOEUJHIUMZUPUIFSFUBJOFS JUJTQMBDFE
around the tooth to be restored (Figs 7.53 and 7.54)
Disadvantages r 'PSêOBMBEBQUBUJPOPGNBUSJYCBOEUPUIFUPPUI UJHIUFO
r $BOOPUCFVTFEJOCBEMZCSPLFOUFFUIPSFYUFOTJWFDMBTT the large knurled nut.
**SFTUPSBUJPOT
r %PFTOPUPŀFSPQUJNBMDPOUPVSBOEDPOUBDUGPSQPTUFSJPS $PNNPOFSSPSTJOQMBDFNFOUPGUPŀFMNJSFSFUBJOFS
resin restorations. 8SPOHQMBDFNFOUPGSFUBJOFSXJUIPQFOFOEPGSFUBJOFS
head facing occlusally (Fig. 7.55).
Parts of Tofflemire Retainer
2. Placement of retainer in such a way that small knurled
5PłFNJSFSFUBJOFSDPOTJTUTPGUIFGPMMPXJOHQBSUT
nut faces towards cheek (Fig. 7.56).
Head -JOHVBMMZQMBDFESFUBJOFSIFSFSFUBJOFSDBODBVTFJOKVSZ
r 6TFTTMPUTGPSQPTJUJPOJOHPGNBUSJY(Fig. 7.47) to the tongue (Fig. 7.57).
r 6TIBQFEIFBEXJUIUXPTMPUTJOPQFOTJEF -PPTFMZQMBDFESFUBJOFS (Fig. 7.58).
A B
et
.n
al
nt
de
ks
C
Figures 7.50A to C: Photograph showing that loop extending from retainer can project straight, left or right
oo
eb
://
tp
ht
Figure 7.51: Photograph showing step of opening the large knurled Figure 7.52: Photograph showing the step of holding the large
nut so that slide is at least ¼ inches from the head knurled nut with one hand, to open the small knurled nut in opposite
direction for clearance of diagonal slot
Procedure for Removal of Tofflemire Retainer and Band Removal of retainer

r 4NBMMLOVSMFELOPUJTNPWFEDPVOUFSDMPDLXJTFUPGSFF
This is usually accomplished in two steps: UIFCBOEGSPNUIFSFUBJOFS8IJMFSPUBUJOHUIFTNBMMFS
1. Removal of retainer. knurled knot, hold the larger nut. Keep the index finger
2. Removal of band. POPDDMVTBMTVSGBDFPGUPPUIUPTUBCJMJ[FUIFCBOE
Armamentarium 93
et
.n
Figure 7.53: Photograph showing placement of tightly secured band Figure 7.56: Photograph showing placement of retainer in such a
in the retainer is placed around the tooth way that small knurled nut faces towards cheek
al
nt
de
ks
oo
eb
://
Figure 7.54: Photograph showing Toffelmire retainer, band and Figure 7.57: Photograph showing that lingually placed retainer can
wedge in place cause injury to the tongue
tp
ht
A B
Figures 7.55A and B: Photograph showing wrong placement of retainer with open end of retainer head facing occlusally
Removal of band
r $BSFGVMMZSFNPWFUIFCBOEGSPNFBDIDPOUBDUQPJOU
r 4VQQPSU UIF PDDMVTBM TVSGBDF PG UIF SFTUPSBUJPO 8IJMF
removing the band, a condenser can be held against the
marginal ridge of the restoration
r %POPUQVMMCBOEJOPDDMVTBMEJSFDUJPOSBUIFSNPWFUIF
band in facial or lingual direction
r #BOEDBOCFDVUOFBSUPUIFUFFUIPOUIFMJOHVBMTJEFBOE
then try to pull it from the buccal side.
WEDGES
et
8FEHFTBSFVTFEEVSJOHUPPUIQSFQBSBUJPOBOESFTUPSBUJPO
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Advantages Figure 7.58: Photograph showing loosely placed retainer
r )FMQ JO TUBCJMJ[BUJPO PG SFUBJOFS BOE NBUSJY EVSJOH
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restorative procedures
r 1SPWJEF DMPTF BEBQUBCJMJUZ JO DFSWJDBM QPSUJPOT PG UIF
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proximal restorations, thereby help in achieving correct
contour and shape at cervical area
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r )FMQ JO SFUSBDUJOH BOE EFQSFTTJOH UIF JOUFSQSPYJNBM
HJOHJWBM BSFB UIVT IFMQ JO NJOJNJ[JOH USBVNB UP TPGU
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tissue.
Types of Wedges
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Wooden Wedges
r ǔFTFBSFNPTUDPNNPOMZVTFEBOEQSFGFSSFEBTUIFZ
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can be easily trimmed and fitted in gingival embrasure

(Fig. 7.59)
Figure 7.59: Photograph showing wooden wedges
://
r "EBQUXFMMJOUIFHJOHJWBMFNCSBTVSF
r &BTZUPVTF
tp
r 8PPEFO XFEHFT BCTPSC XBUFS UIVT JODSFBTF UIF

interproximal retention
r 1SPWJEFTUBCJMJ[BUJPOUPNBUSJYCBOE
ht
r "WBJMBCMFJOUXPTIBQFT
5SJBOHVMBS
2. Round.
1. Triangular wedge
J .PTUDPNNPOMZVTFE
JJ *UIBTUXPQPTJUJPOTBQFYBOEUIFCBTF
JJJ "QFY PG UIF XFEHF VTVBMMZ MJFT JO HJOHJWBM
portion of the contact area.
iv. Base lies in contact with gingiva. This helps in
TUBCJMJ[BUJPOBOESFUSBDUJPOPGHJOHJWB
W 6TFEJOUPPUIQSFQBSBUJPOTXJUIEFFQHJOHJWBM
margins. Figure 7.60: Photograph showing plastic wedges
Armamentarium 95
2. Round wedge
i. Not so commonly used.
JJ .BEF GSPN XPPEFO UPPUI QJDLT CZ USJNNJOH
the apical portion.
JJJ *UIBTVOJGPSNTIBQF
JW 6TFEJODMBTT**UPPUIQSFQBSBUJPO
Plastic Wedges
Though commercially available but they are not much
preferred because (Fig. 7.60):
r 5SJNNJOHJTEJŁDVMU A B
et
r "EBQUBCJMJUZJTEJŁDVMUJOTPNFDBTFT Figures 7.61A and B: Schematic representation showing wedge in
place: (A) Correct position; (B) Incorrect position
Important points regarding wedges: Select the type and
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TIBQFBDDPSEJOHUPSFRVJSFNFOUǔFTFBSF
r -FOHUIPGUIFXFEHFTIPVMECFJOUIFSBOHFPGmDN
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r *UTIPVMEOPUJSSJUBUFUPOHVF DIFFLBOEHJOHJWBMUJTTVF
r 8FEHFTIPVMECFJOTFSUFECFOFBUIUIFDPOUBDUBSFBJO
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the gingival embrasure (Figs 7.61A and B)
r 6TVBMMZ JOTFSUFE GSPN MJOHVBM FNCSBTVSF BSFB BT JU JT
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wider than buccal area. Sometimes, when it irritates
UPOHVFJUDBOCFJOTFSUFEGSPNCVDDBMBSFBBMTP
r 8FEHF TIPVME CF êSN BOE TUBCMF EVSJOH SFTUPSBUJWF
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procedure
r 4IPVME OPU CF GPSDJCMZ JOTFSUFE JO UIF DPOUBDU BSFB
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leading to pain and swelling.
Wedging Techniques
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Figure 7.62: Schematic representation showing double-wedging

r 4JOHMFXFEHJOHUFDIOJRVF technique
r %PVCMFXFEHJOH
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r 8FEHFXFEHJOH
r 1JHHZCBDLXFEHJOH
tp
Single Wedging Technique

ht
r 1lace matrix retainer in place

r 5BLFBXFEHFBOEQMBDFUIFQPJOUFEFOEGSPNMJOHVBMPS
buccal embrasure whichever is bigger
r 8FEHFUIFCBOEUJHIUMZBHBJOTUUIFUPPUI
Double Wedging
r 5XPXFEHFTBSFVTFE
– One is inserted from buccal embrasure and another
from lingual embrasure (Fig. 7.62).
r ǔJTUFDIOJRVFJTJOEJDBUFEJOUIFGPMMPXJOHDBTFT
m 4QBDJOHCFUXFFOBEKBDFOUUFFUIXIFSFTJOHMFXFEHF
JTOPUTVŁDJFOU Figure 7.63: Schematic representation showing wedge-wedging
m 8JEFOJOHPGQSPYJNBMCPYJOCVDDPMJOHVBMEJNFOTJPO technique
r Class: Design or form of the working end, e.g.

hatchet, spoon excavator
r Subclass: Shape of the shank, e.g. binangle,
contra-angle.
Q.2. What are different parts of hand instruments?
Ans. r )BOEMFPSTIBGU
r 4IBOL
r #MBEFPSOJC
Q.3. What are different bevels of instruments?
Ans. r 4JOHMFCFWFMJOTUSVNFOUT
– Right and left bevel instruments
et
m .FTJBMBOEEJTUBMCFWFMJOTUSVNFOU
r #JCFWFMFEJOTUSVNFOU
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r 5SJQMFCFWFMFEJOTUSVNFOU
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Q.4. What is 3 number formula?
Figure 7.64: Schematic representation showing piggyback wedging Ans. r 'irst number of the formula indicates width of
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the blade or primary cutting edge in tenths of a
Wedge Wedging millimeter
r 4econd number indicates length of blade in
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r *OUIJTUFDIOJRVF UXPXFEHFTBSFVTFE millimeters
r 0OF XFEHF JT JOTFSUFE GSPN MJOHVBM FNCSBTVSF BSFB r ǔJSE OVNCFS JOEJDBUFT UIF BOHMF XIJDI CMBEF
ks
while another is inserted between the wedge and matrix forms with long axis of handle.
band at right angle to first wedge (Fig. 7.63)
r ǔFTF BSF QSJNBSJMZ JOEJDBUFE XIJMF USFBUJOH NFTJBM Q.5. What is 4 number formula?
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aspect of maxillary first premolar because of presence Ans. r 'irst number of the formula indicates width of
PGëVUFTJOSPPUOFBSUIFHJOHJWBMBSFB the blade or primary cutting edge in tenths of a
millimeter
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Piggyback Wedging r 4econd number indicates angle formed by

primary cutting edge and long axis of the
r *OUIJTUFDIOJRVF UXPXFEHFTBSFVTFE instrument handle..
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r 0OF MBSHFS
XFEHFJTJOTFSUFEBTVTFEOPSNBMMZ XIJMF r ǔJSE OVNCFS JOEJDBUFT MFOHUI PG CMBEF JO
the other smaller wedge (piggyback) is inserted above millimeters
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the larger one (Fig. 7.64) r 'PVSUIOVNCFSJOEJDBUFTBOHMFXIJDIUIFCMBEF

r *U JT JOEJDBUFE JO DBTFT PG TIBMMPX QSPYJNBM CPY XJUI forms with the long axis of the handle or the
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gingival recession plane of the instrument in clockwise centigrade.

r ǔJTUFDIOJRVFQSPWJEFTDMPTFSBEBQUBUJPOBOEDPOUPVS
of the matrix band. Q.6. What are uses of mouth mirror?
Ans. r %JSFDUWJTJPO
r *OEJSFDUJMMVNJOBUJPO
VIVA QUESTIONS
r 3FUSBDUJPO
r 5SBOTJMMVNJOBUJPO
Q.1. What is Black’s system of nomenclature for
instruments? Q.7. What are uses of explorer?
Ans. r Order: Function or purpose of the instrument, Ans. r 'or examining caries on occlusal and
e.g. excavator, condenser interproximal surfaces
r Suborder: Position, mode or manner of use, e.g. r 'PSFYBNJOJOHSFTUPSBUJPOPWFSIBOHTPOQSPYJNBM
push, pull surfaces.
Armamentarium 97
Q.8. What are the uses of tweezers? Q.18. What is amalgam carrier?
Ans. 5XFF[FSTBSFVTFEUPQMBDFBOESFNPWFDPUUPOSPMMT Ans. "NBMHBN DBSSJFS DBSSJFT UIF GSFTIMZ QSFQBSFE
and other small materials. amalgam to the prepared tooth.
Q.9. What are single and double-planed instruments? Q.19. What is burnisher and its use?
Ans. *GUIFTIBOLBOHMFBOECMBEFBSFJOTJOHMFQMBOF JUJT Ans. Burnisher is a single- or double-ended instrument
BTJOHMFQMBOFEJOTUSVNFOU'PSFYBNQMFIBUDIFU with smooth rounded working end.
*GUIFTIBOLBOHMFBOECMBEFBSFOPUJOTBNFQMBOF *UJTVTFEUPTNPPUIFOBOEQPMJTIUIFSFTUPSBUJPOT
it is a double-planed instrument.'PSFYBNQMF(.5
Q.20. What are uses of plastic instrument?
Q.10. What is spoon excavator? Ans. r 5PNJY DBSSZBOEQMBDFDFNFOUT
Ans. *U JT B EPVCMFFOEFE JOTUSVNFOU XIJDI IBT TQPPO r 5P DIFDL UIF DPOWFOJFODF GPSN PG UPPUI
claw, or disk-shaped blade. preparation.
et
Q.11. What are uses of spoon excavator? Q.21. How many types of carvers are there?
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Ans. r 3emove soft caries and debris Ans. r Hollenback carver/wards C carver:
r 'PS DBSWJOH BNBMHBN SFTUPSBUJPOT BOE XBY – Double ended, binangled instrument
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patterns. m 6TFEUPDBSWFBNBMHBNBOEJOMBZXBYQBUUFSOT
r Diamond carver/Frahm’s carver: Has bibeveled
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Q.12. What is straight chisel? cutting edge
Ans. *O TUSBJHIU DIJTFM DVUUJOH FEHF PG DIJTFM JT r Interproximal carver:*UIBTWFSZUIJOCMBEFBOEJT
prependicular to plane of instrument.
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used for carving proximal surfaces
Q.13. What are different bevels of instrument? r Discoid–cleoid carver:*TVTFEGPSDBSWJOHPDDMVTBM
Ans. r Single-bevel instruments: Here single bevel forms surface.
ks
the primary cutting edge Q.22. What do you mean by rotary instruments?
r Bibeveled instrument: *G UXP BEEJUJPOBM DVUUJOH Ans. Rotary cutting instruments are those instruments
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edges extend from the primary cutting edges, which rotate on an axis to do the work of abrading
then the instrument with secondary cutting and cutting on tooth structure.
edges is called bibeveled instrument
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Q.23. What are different parts of a dental bur?

r Triple-beveled instrument: *G UISFF BEEJUJPOBM
Ans. r i#VS JT B SPUBSZ DVUUJOH JOTUSVNFOU XIJDI IBT
cutting edges extend from the primary cutting
CMBEFEDVUUJOHIFBEu
edge, then the instrument is called triple-beveled
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r 1BSUT4IBOL OFDLBOEIFBE
instrument.
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Q.24. What are different types of bur shanks?

Q.14. What is a GMT? Ans. r 4USBJHIUIBOEQJFDFTIBOL
Ans. *UJTBNPEJêFEIBUDIFUXIJDIIBTXPSLJOHFOETXJUI r -BUDIUZQFIBOEQJFDFTIBOL
ht
opposite curvatures and bevels. r 'SJDUJPOHSJQIBOEQJFDFTIBOL

Q.15. Which instrument is used to break the proximal Q.25. What are the uses of round bur?
contact? Ans. 6sed for removal of caries, extension of the
Ans. Enamel hatchet. preparation and for the placement of retentive
Q.16. How do you differentiate mesial and distal GMT? grooves.
Ans. (.5 JT NFTJBM JG DVUUJOH FEHF UJQ GPSNT BO BDVUF Q.26. What is use of inverted cone bur?
BOHMFUPTIBGU*UJTEJTUBMJGBOHMFJTPCUVTF Ans. 6sed for establishing wall angulations and providing
undercuts in tooth preparations.
Q.17. What is angle former?
Ans. *U JT B UZQF PG FYDBWBUPS JO XIJDI DVUUJOH FEHF Q.27. What is use of straight fissure bur?
sharpened at an angle to the long axis of the blade. Ans. 6sed for tooth preparation.
Q.28. What is rake angle? r /POJOUFSGFSJOHUSVFTFQBSBUPS

Ans. *UJTUIFBOHMFCFUXFFOUIFSBLFGBDFBOEUIFSBEJBM – Elliot separator
line. m 8FEHFT
Q.29. What is clearance angle? Q.38. What is Elliot separator?
Ans. *U JT UIF BOHMF CFUXFFO UIF DMFBSBODF GBDF BOE UIF Ans. Elliot separator is used for rapid separation of teeth
work. XIJDIXPSLTPOXFEHFQSJODJQMF*UJTBMTPLOPXOBT
iDSBCDMBXuTFQBSBUPSCFDBVTFPGJUTEFTJHO
Q.30. What is significance of clearance angle?
Ans. $MFBSBODF BOHMF QSPWJEFT B TUPQ UP QSFWFOU UIF Q.39. What is ferrier separator?
bur edge from digging into the tooth and provides Ans. r *UJTVTFEGPSSBQJETFQBSBUJPOPGUFFUIBOEXPSLT
BEFRVBUFDIJQTQBDFGPSDMFBSJOHEFCSJT on the traction principle
r *U IBT CPXT FBDI CPX FOHBHFT UIF QSPYJNBM
et
Q.31. Define concentricity.
DPOUBDUBSFBPGUPPUIKVTUHJOHJWBMUPDPOUBDUBSFB
Ans. *U JT B EJSFDU NFBTVSFNFOU PG TZNNFUSZ PG UIF CVS
of tooth
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head.
r " iXSFODIu TZTUFN JT VTFE GPS UVSOJOH UIF
Q.32. What do you mean by run-out? threaded bars, this helps in causing separation.
al
Ans. *U NFBTVSFT UIF BDDVSBDZ XJUI XIJDI BMM UIF UJQ
of blades pass through a single point when bur is Q.40. What are wedges?
nt
moving. Ans. 8FEHFT BSF VTFE GPS SBQJE UPPUI TFQBSBUJPO ǔFZ
can be made up of wood or plastic.
Q.33. What is tooth separation?
de
Ans. *U JT UIF QSPDFTT PG TFQBSBUJOH UIF JOWPMWFE UFFUI Q.41. What are different types of wedges?
slightly away from each other or bringing them Ans. r 8PPEFOXFEHFT
ks
closer to each other and/or changing their spatial r 1MBTUJDXFEHFT

position in one or more dimensions. r "WBJMBCMFJOUXPTIBQFT
m 5SJBOHVMBS
oo
Q.34. What is purpose of tooth separation? – Round.

Ans. r 'PSFYBNJOBUJPOPGJOJUJBMQSPYJNBMDBSJFT
r 'PS QSPWJEJOH BDDFTTJCJMJUZ UP QSPYJNBM BSFB Q.42. Why are advantages of wooden wedges?
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EVSJOHQSFQBSBUJPOPGDMBTT**BOEDMBTT***UPPUI Ans. r "EBQUXFMMJOUIFHJOHJWBMFNCSBTVSF

preparations r &BTZUPVTF
r .BUSJYDBOCFQMBDFEFBTJMZEVSJOHSFTUPSBUJPOPG r 8PPEFOXFEHFTBCTPSCXBUFS UIVTJODSFBTFUIF
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DMBTT**SFTUPSBUJPO interproximal retention

r *UIFMQTJOSFQPTJUJPOJOHPGTIJGUFEUFFUI r 1SPWJEFTUBCJMJ[BUJPOUPNBUSJYCBOE
tp
Q.35. What are different methods of tooth separation? Q.43. What are functions of wedges?
ht
Ans. r 4MPXPSEFMBZFETFQBSBUJPO Ans. r )FMQJOSBQJETFQBSBUJPOPGUFFUI

r 3BQJEPSJNNFEJBUFTFQBSBUJPO r 1SFWFOUHJOHJWBMPWFSIBOHPGSFTUPSBUJPO
r )FMQJOTUBCJMJ[BUJPOPGSFUBJOFSBOENBUSJYEVSJOH
Q.36. What are different ways of slow separation?
Ans. r 4FQBSBUJOHSVCCFSSJOHCBOET
r )FMQ JO SFUSBDUJOH BOE EFQSFTTJOH UIF JOUFS-
r 3VCCFSEBNTIFFU
QSPYJNBM HJOHJWBM BSFB UIVT IFMQ JO NJOJNJ[JOH
r -JHBUVSFXJSFDPQQFSXJSF
trauma to soft tissue.
r (VUUBQFSDIBTUJDL
r 0WFSTJ[FEUFNQPSBSZDSPXOT Q.44. What are different techniques of wedging?
r 'JYFEPSUIPEPOUJDBQQMJBODFT Ans. r %PVCMFXFEHJOH
Q.37. What are different ways of rapid separation? r 8FEHFXFEHJOH
Ans. r 'FSSJFSEPVCMFCPXTFQBSBUPS r 1JHHZCBDLXFEHJOH
Armamentarium 99
Q.45. Define matricing? Q.52. What are advantages and disadvantages of

Ans. *U JT UIF QSPDFEVSF CZ XIJDI B UFNQPSBSZ XBMM JT Tofflemire retainer?
built opposite to the axial wall, surrounding the Ans. Advantages:
tooth structure which has been lost during the tooth r $BOCFVTFEGSPNCPUIGBDJBMBOEMJOHVBMTJEFT
preparation. r &DPOPNJDBM
r 4UVSEZBOETUBCMFJOOBUVSF
Q.46. What are requirements of a matrix band? r 1SPWJEFTHPPEDPOUBDUBOEDPOUPVST
Ans. r 3JHJEJUZ r $BOCFFBTJMZSFNPWFE
r "EBQUBCJMJUZ r $BOCFTUFSJMJ[FE
r &BTZUPVTF Disadvantages
r /POSFBDUJWF r $BOOPUCFVTFEJOCBEMZCSPLFOUFFUI
r )FJHIUBOEDPOUPVS r %PFT OPU PŀFS PQUJNBM SFTVMUT XJUI SFTJO
et
r "QQMJDBUJPO restorations.
r 4UFSJMJ[BUJPO Q.53. What are indications of Toffeimire retainers?
.n
r *OFYQFOTJWF Ans. r $MBTT*UPPUIQSFQBSBUJPOTXJUICVDDBMPSMJOHVBM
Q.47. What are different materials used for matricing? extensions
al
Ans. r 4UBJOMFTTTUFFM r 6OJMBUFSBM PS CJMBUFSBM DMBTT ** .0%
UPPUI
r 1PMZBDFUBUF preparations
nt
r $FMMVMPTFBDFUBUF r $MBTT ** DPNQPVOE UPPUI QSFQBSBUJPOT IBWJOH
r $FMMVMPTFOJUSBUF more than two missing walls.
de
Q.48. What are functions of matrix band? Q.54. What are different types of Tofflemire bands?
Ans. r 5PDPOêOFUIFSFTUPSBUJPOEVSJOHTFUUJOH Ans. r 'MBUCBOET
ks
r 5PQSPWJEFQSPQFSQSPYJNBMDPOUBDUBOEDPOUPVS r 1SFDPOUPVSFECBOET
r 5PQSPWJEFPQUJNBMTVSGBDFUFYUVSFGPSSFTUPSBUJPO Q.55. What is T-band matrix?
oo
r 5PQSFWFOUHJOHJWBMPWFSIBOHT Ans. *O 5TIBQFE NBUSJY MPOH BSN PG UIF 5 TVSSPVOET
Q.49. What are matrix retainers? UIF UPPUI BOE PWFSMBQT UIF TIPSU BSN PG UIF 5 *t is
Ans. *UIPMETBCBOEJOEFTJSFEQPTJUJPOBOETIBQF JOEJDBUFE JO VOJMBUFSBM PS CJMBUFSBM DMBTT ** .0%

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tooth preparations.
Q.50. What is ivory No. 1 retainer? What are its
advantages and disadvantages? Q.56. What is ‘S’ Shaped matrix?
://
Ans. Here the matrix holder has a claw at one end with Ans. *O UIJT TUBJOMFTT TUFFM NBUSJY CBOE JT UBLFO BOE
UXPëBUTFNJDJSDMFBSNTIBWJOHBQPJOUFEQSPKFDUJPO UXJTUFE MJLF i4u XJUI UIF IFMQ PG B NPVUI NJSSPS
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at the end. Band used with this matrix has one handle. The contoured strip is placed interproximally
NBSHJOTMJHIUMZQSPKFDUFEJOJUTNJEEMFQBSU,FFQJOH over the facial surface of tooth and lingual surface of
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the matrix band around the tooth, the screw of the bicuspid.
retainer is tightened so that the band perfectly fits Q.57. What are the consequences of not restoring
around the tooth. proximal area?
Indication Ans. r 'PPEJNQBDUJPOMFBEJOHUPSFDVSSFOUDBSJFT
'PSVOJMBUFSBMDMBTT**UPPUIQSFQBSBUJPOT r $IBOHFJOPDDMVTJPOBOEJOUFSDVTQBMSFMBUJPOT
Q.51. Describe Ivory No. 8 retainer? r 3PUBUJPOBOEESJGUJOHPGUFFUI
Ans. *WPSZ NBUSJY CBOE SFUBJOFS IPMET UIF NBUSJY CBOE r 5SBVNBUPUIFQFSJPEPOUJVN
that encircles the tooth to provide missing walls on Q.58. What is mylar strip?
both proximal sides. *t is indicated in unilateral or Ans. .ZMBS TUSJQ JT B USBOTQBSFOU NBUSJY TUSJQ VTFE GPS
CJMBUFSBMDMBTT**QSFQBSBUJPOT .0%
UPPUIDPMPSFE SFTUPSBUJPO *U JT CVSOJTIFE PWFS UIF
end of a steel instrument to produce a convexity. BQQMJFE #PUI CBOET DBO CF TUBCJMJ[FE VTJOH B
This convex contoured surface is positioned facing softened compound between the bands.
the proximal surface of the tooth to be restored.
Q. 64: How can you identify mesial and distal GMT?
Q.59. Name different types of wedging techniques? Ans. *G TIBSQ FEHF PG CMBEF QPJOUT UPXBSE UIF IBOEMF JU
Ans. r 4JOHMFXFEHJOHUFDIOJRVF JTBNFTJBM(.5*GTIBSQFEHFPGCMBEFQPJOUTBXBZ
r %PVCMFXFEHJOH GSPNUIFIBOEMF JUJTBEJTUBM(.5
r 8FEHFXFEHJOH
r 1JHHZCBDLXFEHJOH
Q.60. What is double wedging technique?
Ans. r )FSFUXPXFEHFTBSFVTFEPOFJTJOTFSUFEGSPN
buccal embrasure and another from lingual.
et
r *U JT VTFE XIFO TJOHMF XFEHF JT OPU TVŁDJFOU
due to interproximal spacing and widening of
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proximal box is there in buccolingual dimension.
al
Q.61. What is wedge wedging technique?
Ans. r )FSFUXPXFEHFTBSFVTFE POFXFEHFJTJOTFSUFE
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from lingual embrasure area while another is
inserted between the wedge and matrix band at
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right angle to first wedge
r *t is indicated specially for mesial aspect of
Q. 65. Why are some instruments made double ended?
maxillary first premolar because of presence of
ks
Ans. Some instruments are made double ended so that
ëVUFTJOSPPUOFBSUIFHJOHJWBMBSFB
one end can cut from left to right and other end from
Q.62. What is Piggyback wedging technique? right to left. For example spoon excavator.
oo
Ans. r )FSF UXP XFEHFT BSF VTFE MBSHFS XFEHF JT

inserted as used normally, and then smaller
wedge (Piggyback) is inserted above the larger
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one
r *UJTJOEJDBUFEXIFOUIFSFJTTIBMMPXQSPYJNBMCPY
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with gingival recession.

Q.63. What is double matricing technique (Balter’s
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technique).
Ans. *ODBTFPGCVDDBMPSMJOHVBMQSFQBSBUJPOT JUJTEJŁDVMU
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to form cervico-occlusal contour of buccal and

lingual surface because of the convexity of occlusal
UXPUIJSE*OUIFTFDBTFT TFDPOECBOEJTJOTFSUFEUP
cover the occlusal part of buccal or lingual surface
between the tooth and the band which is already
CHAPTER
8
Principles of Tooth Preparation
Nisha Garg
et
CHAPTER OUTLINE
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Introduction Steps
Purpose of Tooth Preparation Initial Stage
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Classification Final Stage
Definitions Viva Questions
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Number of Line and Point Angles
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INTRODUCTION CLASSIFICATION
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Tooth preparation is the mechanical alteration of a Tooth preparation is classified according to location of the
defective, injured or diseased tooth in order to best receive
tooth defect (Fig. 8.1).
a restorative material which will re-establish the healthy Class I is the only pit and fissure preparation whereas
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state of the tooth including esthetic correction when rest are smooth surface preparations.
indicated along with normal form and function. r Class I: Pit and fissure preparations occur on the
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occlusal surfaces of premolars and molars, the occlusal

PURPOSE OF TOOTH PREPARATION two-third of buccal and lingual surface of molars and
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Earlier when the affected tooth was prepared because lingual surface of incisors (Figs 8.2A and B)
of caries, cutting of tooth was referred to as cavity r Class II: Preparations on the proximal surface of
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preparation. But nowadays many indications other than premolars and molars are class II (Figs 8.3A and B)
caries lead to preparation of the tooth. Hence, the term r Class III: Preparations on the proximal surface of anterior
cavity preparation has been replaced by tooth preparation. teeth and not involving the incisal angles are class III
Tooth preparation is done for: (Figs 8.4A and B)
r 5SFBUNFOUPGDBSJPVTUFFUI r Class IV: Preparations on the proximal surface of
r 5SFBUNFOU PG NBMGPSNFE GSBDUVSFE PS USBVNBUJ[FE anterior teeth also involving the incisal angle falls under
teeth class IV (Figs 8.5A and B)
r 3FQMBDFNFOUPGPME EFGFDUJWFSFTUPSBUJPOT r Class V: Preparations on gingival third of facial and
r &TUIFUJD JNQSPWFNFOU GPS EJTDPMPSFE BOE VOFTUIFUJD lingual or palatal surfaces of all teeth came under Class V
teeth. (Figs 8.6A and B)
et
.n
Figure 8.1: Schematic representation showing GV Black’s classification of dental caries
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nt
de
ks
oo
eb
A B
Figures 8.2A and B: (A) Clinical picture of class I lesion; (B) Schematic representation of class I lesion showing caries on occlusal
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surface of molars and premolars, lingual surface of incisors and occlusal third of buccal and lingual surface of molars
tp
ht
A B
Figures 8.3A and B: (A) Clinical picture of Class II lesion; (B) Schematic representation of Class II lesion
Principles of Tooth Preparation 103
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A B
Figures 8.4A and B: (A) Clinical picture of Class III lesion; (B) Schematic representation of Class III lesion
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al
nt
de
ks
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A B
Figures 8.5A and B: (A) Clinical picture of Class IV lesion; (B) Schematic representation of Class IV lesion
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A B
Figures 8.6A and B: (A) Clinical picture of Class V lesion; (B) Schematic representation of Class V lesion
Modification of Black’s classification was made to

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r Class II: Preparations on the single or both proximal
surface of premolar and molar teeth. When there is
involvement of both proximal surfaces, it is called
mesio-occlusodistal (MOD) preparation (Fig. 8.7)
r Class VI: Preparations on incisal edges of anterior and
cusp tips of posterior teeth without involving any other
surface (Figs 8.8A and B) come under Class VI.
DEFINITIONS Figure 8.7: Schematic representation of MOD preparation
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Simple Tooth Preparation
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A tooth preparation involving only one tooth surface
is termed simple preparation (Fig. 8.9), for example,
occlusal preparation.
al
Compound Tooth Preparation
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A tooth preparation involving two surfaces is termed as A B
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compound tooth preparation (Fig. 8.10), for example, Figures 8.8A and B: (A) Clinical picture of Class VI lesion;
mesio-occlusal or disto-occlusal preparation. (B) Schematic representation of class VI lesion
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Complex Tooth Preparation

A tooth preparation involving more than two surfaces
oo
is called as complex tooth preparation (Fig. 8.11), for

example, MOD preparation.
For communication and records purpose, surface
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of tooth preparation is abbreviated by using first letter,

capitalized.
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r 1SFQBSBUJPOPOEJTUBMBOEPDDMVTBMTVSGBDFTBTi%0u A B
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i.0%u showing simple tooth preparation involving one tooth surface only
Walls
Internal Wall
It is a wall in the preparation, which is not extended to the
external tooth surface (Fig. 8.12).
External Wall
An external wall is a wall in the prepared tooth that
extends to the external tooth surface (Fig. 8.13). External
wall takes the name of the tooth surface towards which it A B
is situated. Figures 8.10A and B: Photograph and schematic representation
showing compound tooth preparation involving two surfaces
Facts
When two or more surfaces are combined, the –al ending of the
prefix word is changed to an –o. The angle formed by lingual and
gingival wall is termed as “linguogingival” line angle. An MOD
preparation is called mesio-occlusodistal preparation.
A B
Figures 8.11A and B: Photograph and schematic representation
Pulpal Wall
showing complex tooth preparation involving more than two surfaces A pulpal wall is an internal wall that is towards the pulp
et
and covering the pulp (Fig. 8.14). It may be both vertical
and perpendicular to the long axis of tooth.
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Axial Wall
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It is an internal wall which is parallel to the long axis of the
tooth (Fig. 8.15).
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Floor
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Floor is a prepared wall which is usually flat and
perpendicular to the occlusal forces directed
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Figure 8.12: Schematic representation of internal and occlusogingivally, for example, pulpal and gingival walls
external wall of tooth preparation
(Fig. 8.16).
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Cavosurface Angle Margin

Cavosurface angle is formed by the junction of a prepared
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tooth surface wall and external surface of the tooth

(Fig. 8.17). The acute junction is referred to as preparation
margin or cavosurface margin.
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Line Angle
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It is a junction of two surfaces of different orientations

along the line. Its name is derived from the involved
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Figure 8.13: Schematic representation of

external wall of tooth preparation surfaces.
Point Angle
It is a junction of three plane surfaces or three line angles of
different orientations. Its name is derived from its involved
surfaces or line angles.
NUMBER OF LINE AND POINT ANGLES

Number of line angles and point angles in different tooth
preparations are enumerated in Table 8.1.
Line and point angles of class I to class V tooth
Figure 8.14: Schematic representation of pulpal floor and axial wall preparations are enlisted as following.
Class I Tooth Preparation

For simple class I tooth preparation involving only occlusal
surface of molars eight line angles and four point angles
are named as follows (Fig. 8.18):
Line Angles
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preparation depicting axial wall
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Point Angles
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Class II Tooth Preparation

Figure 8.16: Schematic representation showing pulpal and gingival
floor of class II preparation For class II preparation (mesio-occlusal or disto-occlusal)
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11 line angles and 6 point angles are as follows (Fig. 8.19).

The following is the nomenclature for mesio-occlusal
tooth preparation.
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Line Angles
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face of the tooth
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Table 8.1 ¨Number of line angles and point angles in different r %JTUPQVMQBM
tooth preparation designs r -JOHVPQVMQBM
Type of tooth preparation Line angles Point angles
Class I 8 4 Point Angles
Class II 11 6 r %JTUPGBDJPQVMQBMQPJOUBOHMF
Class III 6 3 r "YJPGBDJPQVMQBMQPJOUBOHMF
Class IV 11 6 r "YJPGBDJPHJOHJWBMQPJOUBOHMF
Class V 8 4 r "YJPMJOHVPHJOHJWBMQPJOUBOHMF
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Figure 8.18: Schematic representation of class I tooth preparation
showing line angles and point angles Figure 8.21: Schematic representation of class IV preparation show-
ing line and point angles
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Figure 8.19: Schematic representation of class II tooth preparation

showing line and point angles
Figure 8.22: Schematic representation of class V preparation show-
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ing line and point angles

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Line Angles
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Point Angles
Figure 8.20: Schematic representation of class III preparation show-
ing line and point angles r "YJPGBDJPHJOHJWBMQPJOUBOHMF
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r %JTUPMJOHVPQVMQBMQPJOUBOHMF r "YJPJODJTBMQPJOUBOHMF
Class III Tooth Preparation Class IV Tooth Preparation

For class III preparation on anterior teeth, 6 line angles For class IV tooth preparation on anterior teeth, 11 line
and 3 point angles are as follows (Fig. 8.20): angles and 6 point angles are as follows (Fig. 8.21):
Line Angles Steps in Tooth Preparation

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r -JOHVPHJOHJWBM – Outline form and initial depth
r .FTJPGBDJBM – Primary resistance form
r .FTJPMJOHVBM – Primary retention form
r .FTJPQVMQBM – Convenience form.
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r "YJPQVMQBM – Secondary resistance and retention form
– Procedures for finishing the external walls of the
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Point Angles tooth preparation
– Final procedures: Cleaning, inspecting and sealing.
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Under special conditions these sequences can be changed.
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r "YJPMJOHVPHJOHJWBMQPJOUBOHMF INITIAL STAGE
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Definition
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Class V Tooth Preparation Outline form means:
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will occupy in the final tooth preparation except for
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as follows (Fig. 8.22):

finishing enamel walls and margins
Line Angles r .BJOUBJOJOHUIFJOJUJBMEFQUIPGmNNJOUPUIFEFOUJO
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internal outline form. External outline form is established

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margins of preparation not only extend into sound tooth

r %JTUPHJOHJWBM tissue but also involve adjacent deep pits and fissures
in preparation. This was referred to as ‘extension for
Point Angles prevention’ by GV Black.
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r "YJPEJTUPJODJTBMQPJOUBOHMF Factors Affecting the Outline and Initial
r "YJPNFTJPHJOHJWBMQPJOUBOHMF Depth form of Tooth Preparation
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STEPS defects
For optimal restoration, tooth preparation involves basic r /FFEGPSFTUIFUJDT
mechanical and physical principles which should be r 3FMBUJPOTIJQXJUIBEKBDFOUBOEPQQPTJOHUFFUI
followed in an orderly sequence. Tooth preparation is r $BSJFTJOEFYPGUIFQBUJFOU
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Principles
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good finishing of the restoration
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Features for Establishing A Proper Outline form

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Figures 8.23A and B: Schematic representation showing initial
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dentin
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connect them
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Outline form for Pit and Fissure Lesions de
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margins to healthy tooth structure
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enamel margins
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Figures 8.24A and B: Schematic representation showing removal of

preparation, otherwise prepared as separate tooth all undermined enamel
preparations
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areas, such as cusp eminences
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fissures which cannot be managed by enameloplasty

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dentin, though the actual depth of preparation may

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slopes and thickness of the enamel.

External outline form
r Consists of smooth curves, straight lines and rounded
line and point angles (Fig. 8.25)
r Weak unsupported enamel should be removed since it
is liable to fracture.
Figure 8.25: Clinical picture showing that outline form should con-
Internal outline form
sist of smooth curves, rounded line and point angles
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cavosurface angle to the pulpal floor
Outline form for Smooth Surface Lesions—Outline form
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of Proximal Caries (Class II, III and IV lesions)
from the cavosurface margin to the pulpal floor and at
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strength to resist fracture due to masticatory forces r 0DDMVTBMTFHNFOU
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Rules for Making Outline form for

Proximal Preparation
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structure is reached (Fig. 8.27)
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(Fig. 8.28)
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tooth (Fig. 8.29)
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to the contact but occlusal to gingival margin and have
UIFDMFBSBODFPGNNGSPNUIFBEKBDFOUUPPUI(Figs
et
Figure 8.26: Schematic representation showing that preparation
8.30 and 8.31).
depth should be at least 1.5–2 mm from the cavosurface margin and
To Recapitulate at least 0.2–0.5 mm into dentin
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Axial wall should
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r Follow curvature of dentinoenamel junction
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r Follow curvature of dentinoenamel junction
occlusogingivally.
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Rules for Class V Cavities
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occlusally and gingivally till sound tooth structure is
Figure 8.27: Schematic representation showing that outline form
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reached should include all the carious lesion and undermined enamel
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Enameloplasty
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enamel margins of the enamel surface by ‘rounding’

or ‘saucering’ it and converting it into a smooth groove
making it self-cleansable area.
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Indications
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thickness of the enamel
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ridge can be removed by enameloplasty.
Figure 8.28: Schematic representation showing that depth of axial
Significance wall should be restricted 0.2–0.8 mm into dentin
r Enameloplasty does not extend the outline form. This
procedure should not be used unless a fissure can restoration to withstand, without fracture, the stresses of
be made into a groove with a saucer base with mild masticatory forces delivered principally along the long
removal of enamel. axis of the tooth.
Primary Resistance Form Features of Resistance Form
Definition r Box-shaped preparation with flat pulpal and gingival floor:

This helps the tooth to resist occlusal loading by virtue of
Primary resistance form is that shape and placement being prepndicular to the masticatory forces directed
of preparation walls to best enable both the tooth and along the long axis of the tooth (Figs 8.32A and B)
A B
Figure 8.29: Schematic representation showing that axial wall Figures 8.32A and B: Schematic representation showing (A)
should be parallel to external surface of tooth Resistance form of tooth provided by flat pulpal and gingival floor;
(B) In case of rounded pulpal floor, the rocking motion of restoration
results in wedging force which may result in failure of restoration
et
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Box 8.1: Minimum occlusal thickness for various type of
restoration
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Type of restoration Minimum occlusal thickness
Cast metal 1–2 mm
Amalgam restorations 1.5 mm
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Ceramics 2 mm
Composite 1–2 mm
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marginal ridge areas with sufficient dentin support
(Fig. 8.33)
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Figure 8.30: Schematic representation showing that proximal tooth
under masticatory forces
preparation, gingival margin should clear adjacent tooth by 0.5 mm
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concentration points in tooth preparation (Fig. 8.34)
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amount of remaining tooth structure.
Factors Affecting Resistance Form

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Primary Retention Form

Definition
Figure 8.31: Schematic representation showing 0.5 mm Primary retention form is that form, shape and configuration
clearance from adjacent tooth of the tooth preparation that resists the displacement or
r "EFRVBUF UIJDLOFTT PG SFTUPSBUJWF NBUFSJBM EFQFOEJOH removal of restoration from the preparation under lifting
on its respective compressive and tensile strengths and tipping masticatory forces (Box 8.2).
to prevent the fracture of both the remaining tooth
Factors Affecting Retention Form
structure and restoration (Box 8.1)
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width of anterior teeth, to establish the resistance restoration
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masticatory forces
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Convenience Form
Definition
The convenience form is that form which facilitates and
provides adequate visibility, accessibility and ease of
operation during preparation and restoration of the tooth.
Features of Convenience Form
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Figure 8.33: Schematic representation showing restriction of the
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related to the selected restorative material for the
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purpose of convenience and marginal adaptation
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de surface for convenience form
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tooth during class II tooth preparation
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the proximal caries in posterior teeth is approached
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through a tunnel initiating from the occlusal surface

Figure 8.34: Schematic representation showing sharp line angle and and ending on carious lesion on the proximal surface
cavosurface margins can lead to poor resistance form because of con-
without cutting the marginal ridge
centration of stresses at that point
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divergence is one of the features of convenience form.
Box 8.2: Retention form for different restorations
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Restoration Primary retention form FINAL STAGE

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Amalgam class I t 0DDMVTBMDPOWFSHFODFPGFYUFSOBMXBMMT Removal of Any Remaining Caries, Infected Dentin

and II (about 2°–5°)
t $POTFSWBUJPOPGNBSHJOBMSJEHFT
and/or Old Restorative Material, if Indicated
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t 0DDMVTBMEPWFUBJM r "TNBMMJTPMBUFEDBSJPVTMFTJPOTIPVMECFFMJNJOBUFECZ
Amalgam class III t "TUIFFYUFSOBMXBMMTEJWFSHFPVUXBSE a conservative preparation. After the establishment of
and IV retention grooves/coves are the primary
pulpal and axial wall, if a small amount of carious lesion
retention forms
Cast metals t 1BSBMMFMMPOHJUVEJOBMXBMMTXJUITMJHIU
remains, only this lesion should be removed, leaving
occlusal divergence of 2–5° concave, rounded area in the wall
t 0DDMVTBMEPWFUBJM r 6TFMPXTQFFEIBOEQJFDFXJUIUIFSPVOECVSPSTQPPO
t 4FDPOEBSZSFUFOUJPOJOUIFGPSNPGDPWFT excavator with light force and a wiping motion. Use of a
skirts and dentin slot
large spoon excavator decreases the chance of a pulpal
Composites t .JDSPNFDIBOJDBMCPOEJOHCFUXFFOFUDIFE
and primed surface with composites exposure
t &OBNFMCFWFMT r 4UBSU SFNPWBM PG DBSJFT GSPN UIF MBUFSBM CPSEFST PG UIF
Direct filling gold t &MBTUJDDPNQSFTTJPOPGEFOUJOBOETUBSUJOH lesion. Force for removal of infected dentin should be
point in dentin provides retention by proper directed laterally and not towards the center of the
condensation
carious lesion
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(Table 8.2). under various restorative materials depending upon
remaining dentin thickness.
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Secondary Resistance and Retention Forms
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r 5PPUIJTTZNQUPNBUJD This step is needed in complex and compound tooth

r *UDPNQSPNJTFTOFXSFTUPSBUJPO preparations where added preparation features are used to
r .BSHJOBMEFUFSJPSBUJPOPGPMESFTUPSBUJPO improve the resistance and retention form of the prepared
tooth. These are as follows:
Pulp Protection
Mechanical Features
Pulp protection is a very important step in adapting the
et
preparation for final restoration although actually it is Many mechanical features are added in the tooth
not a step of tooth preparation. When remaining dentin preparation to provide additional retention and resistance
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thickness is less, pulpal injury can occur because of heat form. These can be:
production, high speed burs with less effective coolants,
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Grooves and Coves
irritating restorative materials, galvanic currents due to Coves are small conical depressions prepared in healthy
restoration of dissimilar metals, excessive masticatory
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dentin to provide additional retention. These are normally
forces transmitted through restorative materials to the prepared in the proximal walls of class II preparations at
dentin and ingress of microorganisms and their noxious
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the axiofacial and axiolingual line angles, thus reducing
products through microleakage. proximal displacement of the restoration. More than one
Pulp protection is achieved using liners, varnishes and groove per wall should be avoided as they may weaken the
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bases depending upon— wall. Grooves are especially useful for cast restorations.
r ǔFBNPVOUPGSFNBJOJOHEFOUJOUIJDLOFTT(Table 8.3) Table 8.4 enlists type of tooth preparation and location
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Liners and varnishes are used where preparation depth

is shallow and remaining dentin thickness is more than Slot or Internal Box
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– Barrier to protect remaining dentin and pulp dentin to increase the surface area. These are prepared in
– Galvanic and thermal insulation. occlusal box, buccoaxial, linguoaxial and gingival walls
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Table 8.2 ¨Difference between infected and affected dentin

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Table 8.3 ¨Showing methods of pulp protection under different

Infected dentin Affected dentin restorative materials
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r *UJTBTVQFSñDJBMMBZFSPG r *UJTBEFFQFSMBZFS Types of Shallow Moderately deep Deep (RDT <0.5 mm)
EFNJOFSBMJ[FEEFOUJO restoration (RDT> (RDT >0.5–2 mm)
2.0 mm)
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JPOPNFS SFRVJSFE MJOFS
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BHFOU JPOPNFSBTCBTF
m QSPQZMFOFHMZDPM TPMVUJPO
m BDJESFETPMVUJPO $BTUHPME /PU #BTF $BMDJVNIZESPYJEFBT
m CBTJDGVTDIJO SFTUPSBUJPOT SFRVJSFE MJOFSXJUICBTFPWFSJU
(Fig. 8.35). For cast restorations these are prepared by

tapered fissure bur to avoid undercuts and for plastic
restorative materials like amalgam, these are prepared by
inverted cone bur to create slight undercuts in dentin.
Locks
Locks are usually prepared for class II amalgam
restorations for increasing resistance and retention form
(Fig. 8.36).
Pins
%JŀFSFOUUZQFTPGQJOTPGWBSJPVTTIBQFTBOETJ[FTBSFVTFE Figure 8.35: Schematic representation of slot
to provide additional retention in amalgam, composite
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and cast restorations.
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Skirts
Skirts are prepared for providing additional retention in
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cast restorations. They increase the total surface area of the
preparation. Skirts can be prepared on one or all four sides
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of the preparation depending upon the required retention
(Fig. 8.37). Skirts have shown to improve both resistance
and retention form.
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Amalgapins
Amalgapins are vertical posts of amalgam anchored in
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Figure 8.36: Schematic representation of retention locks

dentin. Dentin chamber is prepared by using inverted
DPOF CVS PO HJOHJWBM ëPPS NN JO EFOUJO XJUI UP
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NN EFQUI BOE UP NN XJEUI (Fig. 8.38). Amalgam
pins increase the retention and resistance of complete
restoration.
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Treatment of the Preparation Walls

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Treatment of the preparation walls by beveling, etching

and priming increases the adhesive property of tooth
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preparation.
Beveled Enamel Margins
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Beveling of preparation, margins increases the surface

area and thus, the retention in composite restorations. Figure 8.37: Schematic representation of skirt in cast restoration
Enamel Wall Etching helps in increasing retention
Etching results in microscopic roughness, which increases
the surface area and thus helps in enhancing the
micromechanical retention.
Table 8.4 ¨Location of retention grooves for different tooth
preparations
Type of tooth preparation Location of retention grooves
$MBTT**QSFQBSBUJPO 1SPYJNBMXBMM BUUIFBYJPGBDJBMBOE
BYJPMJOHVBMMJOFBOHMFT
$MBTT***QSFQBSBUJPO "YJPHJOHJWBMMJOFBOHMFPSBYJPGBDJPHJOHJWBM
QPJOUBOHMFBOEMJOHVBMEPWFUBJM
Figure 8.38: Schematic representation showing amalgapins increase
$MBTT7QSFQBSBUJPO "YJPJODJTBMBOEBYJPHJOHJWBMMJOFBOHMF
retention of the restoration
Dentin Conditioning (Etching and Priming)

Etching and priming of the dentin surface increases the
retention.
Adhesive Luting Cements
Adhesive luting cements increase the retention of indirect
restorations.
Procedures for Finishing the External

Walls of the Tooth Preparation Figure 8.39: Schematic representation showing that at the margins,
all the enamel walls should have full length rods supported by dentin
Definition
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Finishing of a tooth preparation walls is further
Table 8.5 ¨Showing differences between butt joint and lap joint
development of a specific cavosurface design and degree
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of smoothness which produces maximum effectiveness of Butt joint Lap/Slip joint
the restorative material being used. $BWPTVSGBDFNBSHJO BUNBSHJO BUNBSHJO
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r #FUUFS NBSHJOBM TFBM CFUXFFO SFTUPSBUJPO BOE UPPUI XBMMT
nt
structure
*OEJDBUJPOT r 1SFGFSSFEJOBNBMHBN r *OEJDBUFE
r *ODSFBTFE TUSFOHUI PG CPUI UPPUI TUSVDUVSF BOE SFTUPSBUJPOTBTJU JODBTUBOE
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restoration at and near the margins QSPEVDFTNBYJNBM DPNQPTJUF
r 4USPOHMPDBUJPOPGUIFNBSHJOT TUSFOHUIGPSCPUI SFTUPSBUJPOT
r *ODSFBTFJOEFHSFFPGTNPPUIOFTTPGUIFNBSHJOT UPPUIBOEBNBMHBN
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r "MTPHJWFOJODFSBNJD
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Final Procedures: Cleaning, Inspecting and Sealing
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&TUIFUJDT r -FTTFTUIFUJD r .PSFFTUIFUJD

Final step in tooth preparation is cleansing of the
preparation. This includes the removal of debris, drying
for proper finishing of the preparation margins. At the
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of the preparation, and final inspection before placing

margins, all the enamel walls should have full length rods
restorative materials.
supported by dentin (Fig. 8.39). To remove unsupported
r $MFBOJOHPGUPPUIQSFQBSBUJPOVTJOHXBSNXBUFS
enamel rods near gingival margins, it should be slightly
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r %SZJOH UIF UPPUI QSFQBSBUJPO VTJOH BJS ESZ DPUUPO

beveled. In case of cast gold restorations, a short bevel is
pellets
given and an ultrashort bevel is given in case of gold foil.
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r 4UFSJMJ[BUJPO PG QSFQBSBUJPO XBMMT VTJOH WFSZ NJME

Table 8.5 shows differences between butt joint and lap
alcohol free disinfectant: Use of mild disinfectant in
joint.
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tooth preparation serves the purpose of disinfection.
Degree of Smoothness of Walls VIVA QUESTIONS

It depends upon type of restoration used. For example, Q.1. What is tooth preparation?
for cast metal restorations, a very smooth surface is Ans. It is a mechanical alteration of a defective, injured or
required whereas for direct gold, amalgam and composite diseased tooth in order to best receive a restorative
restorations, slight roughness is needed in the preparation material which will re-establish the healthy state
walls. of the tooth including esthetic correction when
indicated along with normal form and function.
Location of the Margins
Q.2. What are different causes of loss of tooth
During finishing of the preparation walls and margins, one structure?
should follow the principles of paralleling the direction of Ans. Most common cause is dental caries. Other causes
enamel wall. The knowledge of enamel rods is necessary can be trauma resulting in tooth fracture, attrition,
abrasion, erosion, tooth malformation, hypoplasia, Ans. r #VDDBM

tooth resorption, etc. r -JOHVBM1BMBUBM
r .FTJBM
Q.3. What is simple, compound and complex tooth
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preparations?
r "YJBMXBMM
Ans. A tooth preparation involving only one tooth surface
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is termed as simple preparation. For example,
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mesial, distal, occlusal, buccal, lingual tooth
r (JOHJWBMTFBU
preparation.
A tooth preparation involving two surfaces Q.11. Who is father of modern operative dentistry?
is termed as compound tooth preparation. For Ans. GV Black.
example, mesio-occlusal (MO), disto-occlusal
Q.12. What is floor of the cavity?
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(DO), mesiolingual (ML), or distobuccal (DB) tooth
Ans. Floor is the flat surface of prepared cavity which
preparation.
is perpendicular to the occlusal forces which are
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A tooth preparation involving more than two
directed occlusogingivally.
surfaces is called as complex tooth preparation.
'PSFYBNQMFQVMQBMBOEHJOHJWBMëPPST
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For example, mesio-occlusodistal (MOD), facio-
occlusolingual (FOL) or mesioincisodistal (MID) Q.13. What should be the isthmus width of amalgam
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tooth preparation. cavity?
Ans. 1/4th of intercuspal disatance.
Q.4. Define class I tooth preparation.
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Ans. Class I preparations occur on the occlusal surfaces Q.14. What is ideal depth of amalgam cavity?
of premolars and molars, the occlusal two-third of Ans. mNNUPUBMEFQUImNNJOUPUIFEFOUJOF
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buccal and lingual surface of molars and lingual Q.15. Define a line angle.
surface of incisors. Ans. It is a junction of two surfaces of different
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Q.5. Define class II tooth preparation. orientations along the line. Its name is derived from
Ans. Preparations on the proximal surface of premolars the involved surfaces.
and molars are class II. Q.16. What is a point angle?
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Q.6. Define class III tooth preparation. Ans. It is a junction of three plane surfaces or three line
Ans. Preparations on the proximal surface of anterior angles of different orientations. Its name is derived
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teeth and not involving the incisal angles are class from its involved surfaces or line angles.
III. Q.17. Do we have line angle at cavosurface margin?
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Q.7. Define class IV tooth preparation. Ans. No, because line angle is the junction between two
Ans. Preparations on the proximal surface of anterior prepared parts of tooth preparation. Cavosurface
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teeth also involving the incisal angle falls under margin is the junction of prepared tooth with
class IV. unprepared tooth surface.
Q.8. Define class V tooth preparation. Q.18. If class II tooth preparation involves only proximal
Ans. Preparations on gingival third of facial and lingual surface, why do we make occlusal preparation
or palatal surfaces of all teeth came under Class V. also?
Ans. Occlusal preparation is done for convenience form.
Q.8. Define class VI tooth preparation.
Since directly reaching the affected area with bur is
Ans. Preparations on incisal edges of anterior and cusp
difficult because of close proximity of the adjacent
tips of posterior teeth without involving any other
tooth therefore an occlusal preparation is made
surface come under Class VI.
through which proximal surface is reached.
Q.10. What are different walls and floors of a tooth
Q.20. Why is class VI added to Black’s classification?
preparation?
Ans. Black classified the cavities according to some order 3

FNPWBM PG BOZ SFNBJOJOH DBSJFT JOGFDUFE
and pattern of caries in affected teeth. But he did not dentin and/or old restorative material, if
include the areas which he assumed might not be indicated.
attacked by caries, though in reality they might be 6. Pulp protection, if indicated.
affected. Simon later modified Black’s classification 7. Secondary resistance and retention form.
and added class VI. The class VI are the tooth 8. Procedures for finishing the external walls of
preparations which occur in the areas not covered the tooth preparation.
by any of the other five classes like cusp tips, incisal 9. Cleaning, inspecting and sealing.
two-third of anterior teeth, etc.
Q.28. Define outline form. List the factors influencing
Q.21. What is enamel and dentinal wall? the outline form?
Ans. Enamel wall is portion of prepared external wall Ans. The outline form means:
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consisting of enamel. r 1MBDJOHUIFQSFQBSBUJPONBSHJOTUPUIFQMBDFUIFZ
Dentinal wall is portion of prepared external wall will occupy in the final tooth preparation except
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consisting of dentin. for finishing enamel walls and margins
r .BJOUBJOJOHUIFJOJUJBMEFQUIPGmNNJOUP
Q.22. What will be the treatment if caries involve
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the dentin.
proximal surface of anterior tooth without
involving incisal edge and caries at palatal pit? Factors affecting outline form:
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Ans. If lesions are not interconnected they are treated as r &YUFOTJPOPGDBSJPVTMFTJPO
separate preparations. r 1SPYJNJUZ PG UIF MFTJPO UP PUIFS EFFQ TUSVDUVSBM
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But if they are connected, the preparation is class surface defects
III with lingual extension. r 3FMBUJPOTIJQXJUIBEKBDFOUBOEPQQPTJOHUFFUI
r $BSJFTJOEFYPGUIFQBUJFOU
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Q.23. What is treatment for caries present on buccal r /FFEGPSFTUIFUJDT

surface and proximal surface of a molar? r 3FTUPSBUJWFNBUFSJBMUPCFVTFE
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Ans. If lesions are not interconnected and small, they are

treated as separate class II and class I preparations. Q.29. What is extension for prevention?
But if lesions are large and interconnected, it is Ans. This concept was given by GV Black which advocated
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treated as proximo-occlusobuccal preparation. involvement of all pits and fissures even if they are
unaffected by caries.
Q.24. What is similarity between class II, III, IV and V
Q.30. What do you mean by breaking the contact?
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preparations?
Ans. All occur on smooth surfaces. Ans. In case of class II, and III and IV caries, there is always
a contact with the adjacent tooth. In these cases,
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Q.25. What is common between class II, III, IV whether caries are below or above the contact, the
preparations? contact has to be broken so as to bring preparation
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Ans. All these occur on proximal surfaces. margins into the embrasures for easy cleansability.
Q.26. How is tooth preparation done? If preparation margins end in non-cleansable
Ans. It is done by use of hand and rotary instruments. areas, food stagnation in those areas may result in
secondary caries.
Q.27. What are different steps of tooth preparation?
Ans. A. Stage I Q.31. What should be ideal depth of the preparation?
Initial tooth preparation steps: Ans. *EFBMEFQUITIPVMECFNNCFMPX%&+ FTQFDJBMMZ
1. Outline form and initial depth. for non-adhesive materials. Since enamel is
1SJNBSZSFTJTUBODFGPSN inelastic, it cannot be used for providing retentive
3. Primary retention form. and resistance form. So depth of preparation
4. Convenience form. should be increased till elastic dentin is reached.
B. Stage II Preparation should not end at dentinoenamel
Final tooth preparation steps:
junction. This area is sensitive because of lateral *OIPSJ[POUBMTFDUJPO FOBNFMSPETëBSFPVUGSPN

branching of dentinal tubules and cytoplasmic %&+UPXBSETPVUFSTVSGBDF
extensions of odontoblasts. Because of the direction of enamel rods, following
walls are flared externally:
Q.32. How does convenience form affects outline from?
1. Buccal and lingual walls of proximal box.
Ans. This is specially seen in case of class II, III and IV
.FTJBM BOE EJTUBM XBMMT PG CVDDBM BOE MJOHVBM
preparations where adjacent tooth is present. In
boxes of class I extensions.
these cases it is impossible to reach the proximal
3. All walls of class V preparation.
area without cutting occlusal surface, otherwise
If these walls are made to converge towards each
adjacent tooth is cut.
other, this will result in unsupported enamel rods
But if adjacent tooth is missing, one can gain entry
which may fracture later on.
to proximal box without cutting the occlusal surface.
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Q.37. How does esthetics affect outline form?
Q.33. What is meant by cuspal contour?
Ans. r 'PS DMBTT *** QSFQBSBUJPO MBCJBM FOBNFM JT LFQU
Ans. Cuspal contour means making preparation at
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intact
uniform depth providing equal dentin thickness
r 1SFQBSBUJPO NBSHJOT TIPVME CF LFQU JOUP
between pulp and the preparation. Since cusps are
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embrasures for better esthetics
conical in shape, if pulpal floor is made straight it
r 3FWFSTFDVSWFJTHJWFOJONBYJMMBSZQSFNPMBST
may result in uneven dentin thickness. The areas
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where less of dentin is present, preparation will be Q.38. How does age affect outline form?
closer to pulp, resulting in its damage. Ans. Because of presence of deep pits and fissures, young
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teeth are more caries prone, therefore for a young
Q.34. Why should not preparation have sharp angles?
patient, a conventional preparation is indicated.
Ans. If preparation has sharp angles, it leads to
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For older patients, a conservative preparation
concentration of stresses at those areas which
is indicated. In these patients teeth become less
may fracture the restoration. So to avoid stress
susceptible to caries because of following reasons:
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concentration, preparation should have gentle

a. Attrition of teeth.
curves and smooth walls.
b. Cumulative effect of fluoride from food, water
Q.35. What is significance of stress bearing areas? supply, dentifrices, etc.
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Ans. When opposing teeth come in contact, they contact c. Older patient may follow oral instructions better.
only some areas of occlusal surfaces. These areas
Q.39. Define resistance form.
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where they contact are stress bearing areas.

Ans. It is that shape and placement of preparation
Significance: Preparation margins should not end
walls to best enable both the tooth and restoration
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at stress bearing areas otherwise stresses are met

to withstand, without fracture the stresses of
partially by the tooth and partially by restoration
masticatory forces delivered principally along long
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resulting in separation between the two. This can

axis of the tooth.
fracture the restoration or may result in marginal
leakage. So preparation margin should be avoided Q.40. What are factors affecting resistance form?
at stress bearing areas. They should be kept entirely Ans. r "NPVOUPGPDDMVTBMTUSFTTFT
either on tooth surface or on restorative material. r 5ZQFPGSFTUPSBUJPOVTFE
r "NPVOUPGSFNBJOJOHUPPUITUSVDUVSF
Q.36. How is outline form affected by direction of
enamel rods? Q.41. What is extension for resistance?
Ans. &OBNFM SPET FYUFOE QFSQFOEJDVMBS GSPN %&+ UP Ans. When outline is extended for reinforcing the
enamel in a slightly wavy course. In vertical direction, weakened tooth structure, it is referred as extension
UIFZ BQQFBS UP DPOWFSHF UPXBSET B QJU GSPN %&+ for resistance. For example, when preparation
whereas they diverge as they move towards cusp tip involves more than one-half of the cusp, outline
GSPNUIF%&+ is extended in which cusp is reduced and cuspal
coverage is done.
Q.42. Why is floor of preparation made perpendicular Ans. r *OUSBDPSPOBM

to occlusal forces? r &YUSBDPSPOBM
Ans. When masticatory forces are applied perpendicular
Q.50. What are factors affecting retention form?
to floor, there is equal and opposite force offered by
Ans. r 1SPYJNJUZCFUXFFOUPPUIBOESFTUPSBUJPO
preparation floor to resist the masticatory forces.
r 1BSBMMFMJTNPGPQQPTJOHXBMMT
If pulpal floor is made at an angle, it will split
r 5PUBMTVSGBDFBSFBPGDPOUBDU
occlusal forces into two components:
a. Perpendicular component which is resisted Q.51. What area different modes of retention?
by occlusal forces, this helps in seating of the Ans. r 1SPWJEJOHPDDMVTBMDPOWFSHFODF
restoration. r 1SPWJEJOHPDDMVTBMEPWFUBJM
b. Lateral component of force along the surface of r $MPTFQBSBMMFMJTNPGUIFPQQPTJOHXBMMT
floor. r 6TFPGTFDPOEBSZSFUFOUJPOJOUIFGPSNPGDPWFT
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skirts and dentin slot
Q.43. Is pulpal floor always horizontal?
r 6TFPGCFWFMT
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Ans. No the mandibular premolar has a lingual tilt, so the
pulpal floor is also made with lingual tilt. Q.52. How is retention achieved in amalgam
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restoration?
Q.44. Why should a restorative material have bulk?
Ans. r 0DDMVTBM DPOWFSHFODFJOWFSUFE USVODBUFE
Ans. To have resistance form a restorative material should
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shape
have sufficient bulk, for example for amalgam, at
r 0DDMVTBMEPWFUBJM
MFBTUmNNPGEFQUIJTSFRVJSFE
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r 6OEFSDVUT
Q.45. Why should be unsupported enamel removed
Q.53. What is meant by inverted truncated shape of the
from the preparation?
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cavity?
Ans. If enamel is not supported by dentin, it can fracture
Ans. r *U NFBOT JOUFSOBM PVUMJOF GPSN JT HSFBUFS UIBO
by masticatory forces because of its brittle nature.
external outline form with pulpoocclusal
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Q.46. What is as isthmus and its significance? convergence of the preparation walls
Ans. Isthmus is the narrow connection between two r *U JT JOEJDBUFE GPS JODSFNFOUBMMZ BEEFE EJSFDU
portions of a preparation (occlusal and proximal). restoration material like amalgam.
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Most of the restoration failures occur at isthmus

Q.54. How does dentin help in retention?
area. If it is very narrow, restoration will be very weak
Ans. Due to elastic nature of dentin, there is microscopic
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at that area. If isthmus is very wide, the remaining

movement of dentinal walls (away from each other)
tooth structure will become very weak.
when a restorative material is being condensed in
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Q.47. When should two adjacent preparation be the preparation. Once the restorative material sets,
connected?? dentin comes back to its original position resulting
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Ans. If healthy tooth structure between two preparations in better retention and more gripping action.
JTMFTTUIFONN UIFUXPBEKBDFOUQSFQBSBUJPOT
Q.55. What is significance of dovetail?
are joined to form one large preparation. For
Ans. It helps in retention in proximal direction. In other
example, mesial and distal pits of maxillary first
words, dovetail holds the proximal restoration from
molar.
dislodging proximally.
Q.48. What is retention form?
Q.56. What is undercut?
Ans. It is that form, shape and configuration of the tooth
Ans. Undercut is a mode of retention which is prepared
preparation that resists the displacement or removal
with an inverted cone bur in line angles of the
of restoration from the preparation under lifting and
preparation. While preparing undercut, one should
tipping masticatory forces.
take care to make the cut in the wall and not into the
Q.49. Classify retention form floor. While restoration, one should take care that
only the restorative material should be filled in the m BDJESFETPMVUJPO

undercut area, and not the base. m CBTJDGVTDIJO
Q.57. What are secondary means of retention? Affected dentin:
Ans. r (SPPWFTBOEDPWFT r *UJTBEFFQFSMBZFS
r 4MPUT MPDLTBOEQJOT r *OUFSNFEJBUFEFNJOFSBMJ[FEEFOUJO
r *OUFSOBMCPY r $BOCFSFNJOFSBMJ[FE
r 4LJSUT r *UJTTFOTJUJWF
r "NBMHBNQJOT r *O UIJT JOUFSUVCVMBS MBZFS JT POMZ QBSUMZ
r #FWFMFEFOBNFMNBSHJOT EFNJOFSBMJ[FE
r %JTUJODUDSPTTCBOETBSFQSFTFOU
Q.58. What is convenience form? r *UDBOOPUCFTUBJOFEXJUIBOZTPMVUJPO
Ans. The convenience form is that form which facilitates
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and provides adequate visibility, accessibility and Q.63. What precautions should be taken while removing
ease of operation during preparation and restoration deep carious lesion?
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of the tooth. Ans. Use slow-speed handpiece with the round bur or
spoon excavator that will fit in the carious lesion
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Q.59. What is meant by convenience for access? used with light force and a wiping motion.
Ans. In case of class II and III preparations, due to Forces for removal of infective dentin should be
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presence of adjacent tooth, one has to cut the directed laterally and not towards the center of the
occlusal or labial surface. This outline for gaining carious lesion.
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access to carious lesion is called as convenience for
access. Q.64. Which instrument is used for removal of
unsupported enamel rods ?
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Q.60. What do you mean by removal of remaining Ans. Chisel, hoe or hatchet is used for removal of
caries? unsupported rods.
Ans. In some teeth, if any caries remain on the deeper part
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of preparation after gaining resistance and retention Q.65. For smoothening the gingival seat which
form, these are removed carefully without causing instrument is used?
any harm to pulp. If attempts are made for complete Ans. GMT is used for making gingival seat.
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caries removal at the initial stages only, one might Q.66. How do you check convenience form?
end up for over cutting so it is always advised to Ans. After tooth preparation, insert the small amalgam
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incorporate retentive and resistance features before condenser into all parts of preparation. If even the
complete caries removal is done. small instrument does not enter some parts of tooth
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Q.61. Which instrument is used for removal of preparation, tooth preparation is widened.
remaining caries? Q.67. Is breaking of contact also required for insertion
ht
Ans. r -PXTQFFEIBOEQJFDFXJUIUIFSPVOECVS of matrix band?

r 4QPPOFYDBWBUPS Ans. No, the main reason for breaking a contact is to bring
Q.62. Difference between affected and infected dentin? the preparation margins in self cleansable area.
Ans. Infected dentin: For matrix band insertion, teeth can be separated
r *UJTBTVQFSêDJBMMBZFSPGEFNJOFSBMJ[FEEFOUJO using separators rather than cutting natural teeth
r $BOOPUCFSFNJOFSBMJ[FE structure.
r -BDLTTFOTBUJPO Q.68. For preparations near gingival margins, where
r *O UIJT JOUFSUVCVMBS MBZFS JT EFNJOFSBMJ[FE XJUI should be gingival seat located?
irregularly scattered crystals Ans. As we know gingival area is a delicate area, any
r $PMMBHFOêCFSTBSFCSPLFOEPXO BQQFBSBTPOMZ irritant present at tooth–gingival interface can
indistinct cross bands cause inflammation of soft tissue and epithelial
r *UDBOCFTUBJOFEXJUI attachment. One should always try to keep
m QSPQZMFOFHMZDPM the gingival margins supragingivally for easy
cleansability. Subgingival margins are given only Ans. Because of branching of dentinal tubules and
when: cytoplasmic branches, this area is very sensitive, so
1. Decay extends subgingivally. QVMQBMëPPSTIPVMECFBWPJEFEPO%&+
0MESFTUPSBUJPOJTQSFTFOUTVCHJOHJWBMMZ
Q.76. What should be the width of gingival seat?
3. A biocompatible restorative material is used for
Ans. NNNNJOFOBNFMBOENNJOEFOUJO
esthetic concerns.
Q.77. What is ideal depth of tooth preparation for
Q.69. Where is gingival seat prepared for class II amalgam restoration? What happens with
preparation? increase or decrease in depth?
Ans. +VTUCFZPOEUIFDBSJFTPSDPOUBDUQPJOUXIJDIFWFSJT Ans. mNN *G NN *OBEFRVBUF TQBDF GPS
more. amalgam: poor resistance and retention form If
NN 3FTVMUT JO EFDSFBTFE SFNBJOJOH EFOUJO
et
Q.70. Why are marginal ridge/transverse or oblique
ridges preserved during tooth preparation? thickness: increased sensitivity and post operative
pain.
.n
Ans. Since ridges are the strongest areas with high density
of dentin as compared to others, these act as stress Q.78. What is ideal width of tooth preparation for
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bearing areas and thus, need to be preserved. amalgam restoration? What happens with
Q.71. What is minimal gingival clearance between teeth increase or decrease in width?
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in class II tooth preparation? Ans. SEmUIPGJOUFSDVTQBMEJTUBODF*GSEmUI
Ans. NN of intercuspal distance: reduces convenience form
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i.e. accessibility for the instruments. If >1/3rd–1/4th
Q.72. What is minimal facial and lingual clearance of intercuspal distance: undermine cuspal strength:
between teeth in class II tooth preparation? poor resistance and retention form
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Ans. mNN
Q.79. What is ideal width of marginal ridge?
Q.73. Why should be the contact point broken in class II Ans. NNGPSQSFNPMBSTNNGPSNPMBST.BSHJOBMSJEHF
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preparation? width lesser than 1.6mm results in undermining of

Ans. Contact has to be broken so as to bring cavity the marginal ridge and reduced resistance form.
margins outside the contact area into the embrasure
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Q.80. Where should be the gingival seat placed in class

both occlusogingivally and buccolingually for easy
II tooth preparation?
cleansability. If contact area is not broken, it can
Ans. It is placed below contact point so as to break contact
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lead to debris accumulation and therby secondary

with the adjacent tooth and to have restoration with
caries.
self cleansable margins.
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Q.74. What are stress bearing areas in cavity Q.81. What will happen if gingival seat is placed very
preparation? shallow at the same level with pulpal floor?
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Ans. During occlusion, some areas of occlusal surface Ans. Inadequate removal of the proximal carious lesion
come in contact either in centic or eccentric and inadequate retention form.
position, these are stress bearing areas.
Significance: Cavity margins should not be placed Q.82. What should be the clearance from adjacent tooth
on stress bearing areas as this may lead to stress in class II tooth preparation?
distribution both to tooth and restoration resulting Ans. NN $MFBSBODFNN FYDFTTJWF MPTT PG UPPUI
in their separation. structure, unesthetic display of amalgam facially
and chances of damaging interdental gingival
Q.75. Why should not the pulpal floor be placed on $MFBSBODFNNJOBEFRVBUFDBSJFTSFNPWBMBOE
DEJ? difficulty in placement of matrix band.
CHAPTER
9
Tooth Preparation for
Amalgam and Composite Restorations
Nisha Garg, Poonam Bogra
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CHAPTER OUTLINE
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Introduction t Class III Tooth Preparation
Preparation for Amalgam Restoration t Class IV Tooth Preparation
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t Class I Tooth Preparation t Class V Tooth Preparation
t Class II Tooth Preparation t Class I Tooth Preparation
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t Class V Tooth Preparation t Class II Tooth Preparation
Tooth Preparation for Composite Restoration
de Viva Question
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INTRODUCTION line angles and convergent external walls (due to pear

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shape with rounded corners of the bur) (Fig. 9.1)

As we know tooth preparation is mechanical alteration of r Keep 245 bur parallel to the long axis of the tooth
a defective, injured or diseased tooth structure to receive structure to make a ditch in carious lesion (Figs 9.2
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a restorative material which will best return the tooth and 9.3)
and area to proper form, function and esthetics. We have
already discussed fundamentals of tooth preparation in
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chapter 9. In this chapter, we will discuss class I to V tooth

preparation for amalgam and composite.
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PREPARATION FOR AMALGAM

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RESTORATION
Class I Tooth Preparation
Class I caries are caries occurring in pits and fissures of the
occlusal surfaces of premolars and molars, the occlusal
two-third of buccal and lingual surfaces of molars and
lingual surface of incisors.
Outline Form
r Take No. 245 bur for tooth preparation. Its dimensions
help in guiding ideal tooth preparation, i.e. depth of Figure 9.1: Photograph showing No. 245 bur. It’s dimensions and
shape guide the tooth preparation viz; depth of 1.5 mm (half the
tooth preparation 1.5 mm (half the length of bur, i.e. length of bur), marginal ridge width of 1.6–2 mm (double the width),
3mm), to preserve marginal ridge width 1.6–2 mm rounded internal line angles and convergent external walls (due to
(double the width of bur, i.e. 0.8mm), rounded internal pear shape with rounded corners)
Tooth Preparation for Amalgam and Composite Restorations 123
et
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Figure 9.2: Schematic representation showing no. 245 bur oriented Figure 9.5: Schematic representation showing mesiodistal section
parallel to long axis of tooth crown for entry. Dotted line indicates the depicting flat pulpal floors but may follow the rise and fall of the oc-
al
long axis of tooth crown and the direction of the bur clusal surface
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Figure 9.3: Schematic representation of punch cut of 1.5–2 mm Figure 9.6: Schematic representation of tooth preparation showing
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into the central fissure convergent buccal and lingual walls for retention form
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A B
Figure 9.4: Schematic representation showing that minimal Figures 9.7A and B: Schematic representation showing removal of
width of the marginal ridge should be 1.6mm. Incline the bur dis- remaining caries. Remove only deep carious lesion with the help of
tally to establish proper occlusal divergence to proximal wall to pre- spoon excavator or round bur instead of deepening of whole floor
vent removal of the dentin supporting the marginal ridge enamel
r Initial punch cut should be 1.5 mm deep. While Preparation of Buccal Pit for Mandibular Molars
maintaining the same depth and bur orientation, move
r Keep no. 245 perpendicular to the tooth surface (Fig. 9.8)
the bur to extend the outline to include the central
r Make a depth cut 1.5 mm deep into the dentin
fissure. Width of the cavity should be 1/3rd–1/4th of
r Extend the outline form for convenience form and to
intercuspal distance
remove remaining caries, if present
r Extend the margin mesially and distally but do not
r Prepare undercut in dentin using no.1/4 bur
involve marginal ridges. While working towards mesial
r In case of occlusobuccal or occlusopalatal extension,
and distal surface, orient the bur towards respective
after completing the occlusal preparation, the
marginal ridge. This results in slight divergence of
inclination of bur is changed to establish the correct
mesial and distal walls which helps to provide dentinal
axial wall depth.The axial wall depth should be 0.2–0.5
support for marginal ridges (Fig. 9.4).
mm into the dentin (Fig. 9.9)
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r Figures 9.8 to 9. 16 are showing class I tooth prepara-
Primary Resistance Form
tions on plaster models.
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Check for following features to have resistance form for
amalgam restoration. Class II Tooth Preparation
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r Box-shaped preparation with flat floor (to resist
Class II restoration involves the proximal (mesial or distal)
occlusal masticatory forces without any displacement)
surfaces of premolars and molars.
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(Fig. 9.5)
r Minimum depth of preparation 1.5–2.0 mm
Outline form
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r Rounded internal line angles
r 90° cavosurface angle (butt joint) Occlusal Preparation
r Strong marginal ridge areas with sufficient dentin r Occlusal portion is prepared same as that for pit and
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support fissure caries except that outline is extended proximally

r Inclusion of all weakened tooth structure towards defective proximal surface (Fig. 9.17)
r Prepare occlusal dovetail in unaffected proximal
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r Cusp capping for preserving cuspal strength.

margin. It prevents displacement of the restoration to
Primary Retention Form the affected proximal side.
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Check for following features to have retention form for Preparation of Proximal Box
amalgam restoration. r While maintaining established pulpal depth, extend the
preparation towards proximal surface of tooth, ending
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r Occlusal convergence of buccal and lingual walls

(Fig. 9.6) 0.8 mm short of cutting through affected marginal ridge
r Slight undercut in dentin near the pulpal wall r Keep the bur on DEJ in the pulpal floor adjacent to
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r Occlusal dovetail. affected proximal side. It should be placed 2/3rd in dentin

(0.5 mm) and 1/3rd in enamel (0.3 mm) (Fig. 9.18)
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Convenience Form r Prepare reverse curve specially in teeth with broader

contacts. It is given to the proximal walls by curving
It is checked by moving a condenser in the cavity. It should
them inwards towards the contact area. Reverse curve
be able to pass the preparation even in its narrowest
helps in conserving the tooth structure. Moreover, flare
portion.
of the proximal wall leaves tangent to that outer tooth
surface at 90° angle, this further increases the resistance
Final Tooth Preparation
form
To remove remaining caries, use spoon excavator or slow- r Create a proximal ditch cut by moving the bur gingivally.
speed round bur. Remove only that portion of the tooth Keep a small slice of enamel at the contact area to
which is affected by caries leaving the remaining floor prevent accidental damage to adjacent tooth (Fig. 9.19)
untouched (Fig. 9.7).
A B C A B
Figures 9.8:A to C: Photograph showing (A) Mandibular molar show- Figures 9.11A and B: Photograph showing (A) Outline form of class
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ing carious buccal pit; (B) Position of bur perpendicular to the tooth I preparation in mandibular premolar; (B) Tooth preparation in man-
surface for entry; (C) Outline form of buccal pit dibular premolar
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A B
Figure 9.9: Schematic representation showing that in occlusobuccal Figures 9.12A and B: Photograph showing; (A) Carious palatal pit;
tooth preparation, after occlusal preparation, inclination of the bur is (B) Outline form of palatal pit in maxillary lateral incisor
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altered to establish the correct axial wall depth (0.2–0.5 mm into the
dentin)
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A B A B
Figures 9.10A and B: Photograph showing (A) Outline form of class I Figure 9.13: Photograph showing (A) Outline form of conservative
preparation in mandibular molar; (B) Class I tooth preparation in man- tooth preparation of mandibular premolar (B) Outline form of conven-
dibular molar tional tooth preparation of mandibular premolar
r Move the bur faciolingually to just clear the contact

areas and diverge the proximal cut gingivally. It results in
greater faciolingual dimension at gingival surface than
occlusal surface (provide retention and conservation of
marginal ridge) (Fig. 9.20)
r Gingival floor should be located below contact point
so as to have clearance from the adjacent tooth and
to have margins of restoration self cleansable. Ideal
clearance of facial and lingual margins of the proximal
box should be 0.2–0.5 mm from the adjacent tooth (Fig.
A B C 9.21). Wedge is kept in the gingival embrasure area
Figures 9.14A to C: Photograph showing maxillary first molar while preparing proximal box to protect interdental
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(A) Outline form for conservative tooth preparation; (B) Outline form
for conventional tooth preparation involving oblique ridge; (C) Out-
gingival tissue
r Fracture the slice of enamel in the region of the contact
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line form for conventional class I involving palatal fissure
area with a small chisel or enamel hatchet
r With the help of gingival marginal trimmer round off
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the axiopulpal line angle (to avoid stress concentration)
and bevel the gingival margin (to remove unsupported
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enamel margins) (Fig. 9.22).
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Include following features to have retention form for
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amalgam restoration:
r Box-shaped preparation with flat pulpal and gingival
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floor
r Rounded axiopulpal angle
r Bevelled gingival margin
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r Reverse curve
r Inclusion of all weakened tooth structure
r Cusp capping for preserving cuspal strength.
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Figure 9.15: Photograph showing outline form of maxillary first

molar with carious distal pit involving palatal fissure Primary Retention Form
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r Occlusal convergence of buccal and lingual walls
r Occlusal dovetail.
Convenience Form
r It is checked by moving a condenser in the cavity.
It should be able to pass the preparation even in its
narrowest portion.

A B r To remove remaining caries, use spoon excavator or
Figures 9.16A and B: Photograph showing (A) Outline form of buc- slow-speed round bur. Remove only that portion of the
cal pit extension of mandibual molar; (B) Photograph showing tooth tooth which is affected by caries leaving the remaining
preparation of buccal pit extension of mandibular first molar floor untouched.
Secondary retention and resistance form r Extent of caries: For extensive caries, complex amalgam
restorations and full coverage restorations are indicated
r Place retention grooves and locks in the proximal box
In small proximal caries, only proximal box can do
(Fig. 9.23)
r Esthetic requirement: In maxillary premolars, minimal
r If required, place slots and pot holes in gingival floor.
facial extension is done so as to display less amalgam
r Relationship with adjacent tooth: If adjacent tooth is
Modifications in Class II Design
missing, slot preparations can be done
Factors affecting modifications in Class II preparations: r Rotated teeth: Here preparation is modified according
to contact with adjacent tooth.
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A B
Figures 9.17A and B: Schematic representation showing that Class II
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Figure 9.20: Schematic representation showing that greater facio-
preparation outline form of the cavity is similar to class I. Make entry with lingual dimension at gingival surface than occlusal surface provides
no.245 bur parallel to long axis of the tooth and prepare class I cavity retention form
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Figure 9.18: Schematic representation showing how bur is to be kept Figure 9.21: Schematic representation showing that there should be
DEJ, 0.5 mm in dentin 0.3 mm in enamel to create a proximal ditch cut 0.2–0.5 mm clearance of facial and lingual margins of the proximal box
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by moving the bur gingivally from the adjacent tooth
A B
Figure 9.19: Schematic representation showing that a small slice of Figures 9.22A and B: Schematic representation showing rounding
enamel is to be kept at the contact area to prevent damage to adjacent off of the axiopulpal line angle and bevelling of gingival margin
tooth
Following modifications can be made in class II design

(Fig. 9.24):
r Slot preparation
r Simple box preparation
r Tunnel preparation.
Figures 9.25 to 9.28 are showing class II tooth
preparation on plaster models.
Class V Tooth Preparation

Class V lesion is present on the gingival third of facial and
lingual surfaces of all teeth. Amalgam is not indicated for
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anterior teeth except when esthetics is least concerned.
A B
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Initial Tooth Preparation Figures 9.25A and B: Photograph showing (A) Outline form of class II
tooth preparation of maxillary premolar; (B) Class II tooth preparation
r Outline form is dictated by extension of caries. Outline
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of maxillary premolar
resembles kidney or bean shape (Fig. 9.29)
r Preparation is started using 169L or 271 tapered-fissure
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bur keeping perpendicular to long axis of tooth
r Initial axial wall depth is maintained 0.5 mm into the
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dentin. Axial wall depth at the occlusal wall should be
more than that at the gingival wall. This results in a
convex axial wall as the contour of tooth
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A B
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A B
Figures 9.26A and B: Photograph showing (A) Outline form of class
Figures 9.23A and B: Schematic representation showing the II tooth preparation of mandibular molar; (B) Class II tooth preparation
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retention grooves and locks in the proximal box of mandibular molar
A B C
Figures 9.24A to C: Schematic representation of modifications in class II design; (A) Slot preparation; (B) Simple box preparation;
(C) Tunnel preparation
r Extend the preparation incisally, gingivally, mesially

and distally till the cavosurface margins are placed on
sound tooth structure.

r Remove any remaining caries using a round bur
r Retention is achieved by giving grooves incisally and
gingivally along axioincisal and axiogingival line angles
using an inverted cone bur
r Use hoe and chisel to finish the mesial, distal and
gingival walls.
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Figure 9.27: Photograph showing; (A) Outline form of class II cavity in
maxillary 1st molar; (B) Class II tooth preparation of maxillary 1st molar TOOTH PREPARATION FOR COMPOSITE
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RESTORATION
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Things to be kept in mind while doing tooth preparation
for composite restoration:
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r Retention comes primarily from micromechanical
mode of retention (bonding to enamel and dentin)
r Flat pulpal floor, or wall surfaces not as critical as for
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amalgam restoration
r Retention grooves not necessary unless margin is on
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root surface or preparation is very large

r 90 degree or greater (beveled) cavosurface margins
r Isolation is extremely important. Use rubber damn
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especially when restoring.

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Class III Tooth Preparation

A B
Class III preparations are present on proximal surface of
Figures 9.28A and B: Photograph showing (A) Outline form of MOD anterior teeth and not involving the incisal angles.
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tooth preparation of mandibular molar; (b) MOD tooth preparation of

mandibular molar For gaining entry into the lesion, bur is entered from
palatal side.
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Advantages of palatal access:

r Preservation of esthetics
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r Color matching not critical

r Unsupported facial enamel can be preserved for
bonding with composite resin.
Indications for labial approach
r Involvement of labial enamel
r Rotated teeth where lingual approach is difficult
r Malaligned teeth.
Conventional Class III Tooth Preparation

Indication
r Lesion present on the root surface
r Tooth preparation on root is done in conventional
Figure 9.29: Photograph showing kidney-shaped class V tooth method whereas on the crown, it is prepared in beveled
preparation of mandibular incisor conventional or modified type.
Steps r Initial depth of axial wall should be 0.75 mm deep

gingivally and 1.25 mm deep incisally. This results
Outline form
in the axial wall depth of 0.2–0.5 mm into the dentin.
r Outline form depends on extent of caries and
Axial wall should follow the contour of tooth, i.e. shape
convenience form
of axial wall should be convex outwardly
r Approach carious area palataly with no. ½, 1 or 2
r In final tooth preparation, remove all remaining
round bur and move the bur in incisogingival direction
infected dentin or defective restoration using spoon
(Fig. 9.30). Initial depth of axial wall should be 0.75
excavator or slow-speed round bur
mm deep gingivally and 1.25 mm deep incisally. This
r Keep external walls of tooth preparation perpendicular
results in the axial wall depth of 0.5 mm into the dentin.
to the enamel surface with all enamel margins beveled.
Primary Resistance and Retention form Prepare bevels using flat end tapering fissure diamond
r Conventional preparation is done with 90 degrees bur at cavosurface margins. Bevel should be 0.2–0.5
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cavosurface margins (Fig. 9.31) mm wide at an angle of 45 degree to external tooth
r If required, prepare retentive grooves and coves along surface (Fig. 9.32)
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gingivoaxial line angle and incisoaxial line angle, r Bevels are not given in areas bearing heavy occlusal
respectively, with the help of no. 1/4 or 1/2 round burs. forces or on cemental cavosurface margins
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Depth of these grooves should be 0.2–0.5 mm into the r If required, prepare retentive grooves and coves along
dentin. gingivoaxial line angle and incisoaxial line angle,
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Retention in conventional tooth preparation is attained respectively, with the help of no. 1/4 or 1/2 round burs.
by— Depth of these grooves should be 0.2 mm into the
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r Roughening of the preparation surface dentin.
r Parallelism or convergence of opposing external walls
r Giving retention grooves and coves
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r Grooves should be located at least 1 mm from tooth

surface and at least 0.5 mm deep into dentin.
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Beveled Conventional Class III Tooth Preparation

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Indications
r For replacing an existing defective restoration on crown
portion of an anterior tooth
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r For restoration of large preparations.

Steps
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r Approach carious area lingually with a no. ½, 1 or 2

round bur and move the bur in incisogingival direction
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Figure 9.31: Schematic representation showing that conventional

r Shape of the tooth preparation should be identical to
preparation is done with 90 degrees cavosurface margins. Axial wall
the shape of existing carious lesion should be 0.2 mm into the dentin
A B
Figure 9.30: Schematic representation showing presentation with Figures 9.32A and B: Schematic representation showing bevelled
round bur palataly and movement of the bur in incisogingival direction preparation: Bevel should be 0.2–0.5 mm wide at an angle of 45 de-
gree to external tooth surface
Modified (Conservative) Class III Tooth Preparation

It is the most conservative type of tooth preparation used
for composites.
Indication
r Small to moderate class III lesion
r 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 (Fig. 9.33).
Figure 9.33: Schematic representation showing modified tooth
Steps
preparation: ‘Scooped-out’ appearance
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r Make initial entry through palatal surface with a small
round bur
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r Design and extent of preparation is determined by
extent of carious lesion
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r Modified preparation does not have definite axial wall
depth and walls diverge externally from axial depth in a
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scoop shape
r Finally check the preparation after cleaning and provide
pulp protection.
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A B
Class IV Tooth Preparation Figures 9.34A and B: Schematic representation showing beveled
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Class IV preparations are present on proximal surface of Class IV preparation

anterior teeth involving the incisal angles.
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Conventional Tooth Preparation

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Features of Conventional Class IV Preparation for

Composites
r Box-like preparation with facial and lingual walls
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parallel to long axis of tooth

r Retention obtained by means of dovetail or grooves
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placed gingivally and incisally in the axial wall using

A B
number 1/4 round bur.
Figures 9.35A and B: Schematic representation showing conserva-
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tive class IV tooth preparation for composite

Beveled Tooth Preparation
Beveled preparation is indicated for treatment of a large
lesion. 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 0.25–2 mm, depending on the
amount of retention required (Fig. 9.34).
Modified (Conservative) Tooth Preparation

Modified class IV preparation is done in small class
IV lesions or for treatment of small traumatic defects.
Preparation for modified class IV preparation should be
done conservatively without removing the normal tooth Figure 9.36: Schematic representation showing conventional class V
structure (Fig. 9.35). tooth preparation for composites
Class V Tooth Preparation – Roughen the dentin with diamond bur to provide
mechanical retention.
Conventional Tooth Preparation
Indication Modified (Conservative) Tooth Preparation
r If caries is present completely or mainly on root surface
Indications
r If lesion is partly on crown and partly on root, then
1. Restoration of small and moderate carious lesions and
crown portion is prepared using beveled conventional
defects.
or modified preparation design and the root surface
2. Small enamel defects like decalcified and hypoplastic
lesion is prepared by conventional method.
areas present in cervical third of the teeth.
Steps of Tooth Preparation Modifed class V tooth is prepared as discussed in the
In conventional class V tooth preparation, shape of the previous modified preparation. Final tooth preparation
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preparation is kidney shaped (Fig. 9.36). should have ‘scooped out’ appearance with divergent
1. Isolate the area and use tapered fissure bur to make walls and axial wall either in enamel or dentin (Fig. 9.38).
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entry at 45 degree angle to tooth surface initially.
2. After this, keep long axis of bur perpendicular to the Class I Tooth Preparation
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external surface in order to get a cavosurface angle of 90
r Fundamentals of tooth preparation are similar to that
degree.
of amalgam except for following differences (Fig. 9.39)
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3. During initial tooth preparation, keep the axial depth of
r Small faciolingual dimensions of preparation (¼th of
0.75 mm into the dentin.
intercuspal distance)
4. After achieving the desired distal extension, move the
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r No need to prepare dovetail or other retention features
bur mesially, incisally (occlusally) and gingivally for
r Flame-shaped diamond instruments are used to bevel
placing the preparation margins onto the sound tooth
the enamel cavosurface margins. Bevel is 0.5 mm wide
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surface while maintaining a cavosurface margin of 90

placed at 45 degrees to external enamel surface
degree.
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5. Axial wall should follow the contour of facial surface

incisogingivally and mesiodistally.
6. During final tooth preparation, remove any remaining
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infected dentin, restoration material using spoon

excavator or slow-speed round bur.
7. If additional retention is required, place retention
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grooves all along the whole length of incisoaxial and

gingivoaxial line angles using a no. 1/4 or 1/2 round
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bur 0.25 mm deep into the dentin. At this stage, all the
external walls appear outwardly divergent.
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Figure 9.37: Schematic representation showing beveled class V

Beveled Conventional Tooth Preparation tooth preparation
Indications
1. For replacing defective existing restoration
2. For restoring a large, carious lesion.
– 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 retention groove is placed
– After this, bevel the enamel margins 0.25–0.5 mm
wide at 45 degree to external surface. When class
V lesion extends onto the root surface, gingival
preparation has conventional class V design with the
initial axial depth of 0.75 mm. Beveling is done only
Figure 9.38: Schematic representation showing modifed class V
on enamel cavosurface margins (Fig. 9.37) tooth preparation
Figure 9.39: Schematic representation of class I tooth preparation Figure 9.40: Schematic representation showing class II tooth prepa-
for composite restoration ration for composites
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r If the marginal ridge is not supported by dentin, r Occlusal and proximal walls converge occlusally and
remaining weakened enamel may be left, provided provide additional retention form
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there is no heavy centric contact on this area r Proximal box preparation has cavosurface angle at right
r Unsupported marginal ridge will be strengthened by angles to the enamel surface facially and lingually
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composite restoration. r Gingival floors should clear the contact apically and
they should be butt joined.
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Class II Tooth Preparation
Steps VIVA QUESTIONS
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r Use No. 330 or 245 pear-shaped bur parallel to long axis
Q.1. What is class I tooth preparation?
of the tooth to start preparation in a pit opposite to the
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Ans. Class I preparations occur on the occlusal surfaces
affected proximal side
of premolars and molars, the occlusal two-third of
r Keep the outline as conservative as possible. Maintain
buccal and lingual surface of molars and lingual
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the depth of pulpal floor 1.5 mm from central groove

surface of incisors.
area. Make the occlusal walls converging and occlusal
cavosurface obtuse (Fig. 9.40) Q.2. What is class II tooth preparation.
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r For proximal box preparation, extend the occlusal Ans. Class II preparations occur on the proximal surface
preparation using straight fissure bur into marginal of premolars and molars.
ridge. Keep bur perpendicular to the pulpal floor
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Q.3. Define class III tooth preparation.

r Thin out the marginal ridge and deepen the preparation
Ans. Preparations on the proximal surface of anterior
towards the gingival direction as to give proximal ditch
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teeth and not involving the incisal angles are class

cut. This will form the width of 1.0–1.5 mm
III.
r For small carious lesion, proximal walls can be left in
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the contact but for large carious lesion, contact area is Q.4. Define class IV tooth preparation.
broken Ans. Preparations on the proximal surface of anterior
r Keep gingival floor flat with butt joint cavosurface angle. teeth also involving the incisal angle falls under
Whether or not to give gingival beveling, depends on class IV.
location and the width of gingival seat. If gingival seat Q.5. Define class V tooth preparation.
is supragingival and above cementoenamel junction, Ans. Preparations on gingival third of facial and lingual
beveling can be done but if gingival seat is close to or palatal surfaces of all teeth came under Class V.
cementoenamel junction, beveling is avoided so as to
preserve the enamel present in this area. Q.6. What is ideal depth of amalgam cavity?
Ans. 1.5–2.0mm total depth. 0.2–0.5mm into the dentin.
Features of Class II Composite Tooth Preparation Q.7. What should be the isthmus width of amalgam
r Decreased pulpal depth of axial wall which allows cavity?
greater conservation of tooth structures Ans. 1/4th of intercuspal distance.
Q.8. What is extension for prevention? Q.18. How is convenience form checked?
Ans. Given by GV Black, it advocates involvement of all Ans. Insert the small end of amalgam condenser into
pits and fissures to bring the preparation margins prepared tooth. It should be able to enter all parts of
into self cleanseable areas. the preparation.
Q.9. Why should preparations not have sharp angles? Q.19. What is the main reason for breaking a contact in
Ans. Sharp angles of preparation lead to stress class II preparation?
concentration at these areas which may result in Ans. To bring the preparation margins in self cleansable
restoration fracture. area.
Q.10. What is resistance form. Q.20. Where is gingival seat prepared for class II
Ans. It is that shape and placement of preparation preparation?
walls to best enable both the tooth and restoration Ans. Just beyond the caries or contact point whichever is
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to withstand, without fracture the stresses of more.
masticatory forces delivered principally along long
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Q.21. What is minimal gingival clearance between teeth
axis of the tooth.
in class II tooth preparation?
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Q.11. Why should a preparation have flat floor? Ans. 0.5mm.
Ans. When masticatory forces are applied perpendicular
Q.22. What should be the width of gingival seat?
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to floor, there is equal and opposite force offered by
Ans. 0.8mm.i.e. 0.3 mm in enamel and 0.5mm in dentin.
preparation floor to resist the masticatory forces.
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Q.23. What are differences in cavity preparation for
Q.12. What is an isthmus?
amalgam and composite resin
Ans. Isthmus is the narrow joint between occlusal and
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proximal part of tooth preparation. Features Amalgam Composite
Q.13. What is retention form? Outline form r *ODMVEFBMMQJUTBOE r *ODMVEFGBVMUTCVUOFFE

ñTTVSFTBOEBEKBDFOU OPUUPCFFYUFOEFE
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Ans. It is that form, shape and configuration of the tooth TVTQJDJPVTBSFBT UPBEKBDFOUQJUTBOE
preparation that resists the displacement or removal r 'PSDMBTT**UPPUI ñTTVSFT
of restoration from the preparation under lifting and QSFQBSBUJPO QSPYJNBM r 'PSDMBTT**UPPUI
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DPOUBDUIBTUPCF QSFQBSBUJPOT QSPYJNBM

tipping masticatory forces.
CSPLFO DPOUBDUOFFEOPUCF
Q.14. How is retention achieved in amalgam CSPLFOJOBMMUIFDBTFT
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restoration? 1VMQBMEFQUI r 4IPVMECFNBJOUBJOFE r /FFEOPUCFVOJGPSN

Ans. r 0DDMVTBM DPOWFSHFODFJOWFSUFE USVODBUFE uniform
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r 0DDMVTBMEPWFUBJM NBSHJO BUNBSHJO
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retention CPOEJOH
Q.15. What is importance of dovetail? form
Ans. Dovetail holds the proximal restoration from 3FTJTUBODF #PYTIBQFEQSFQBSBUJPO /PUJOEJDBUFE
dislodging proximally. form 'MBUQVMQBMBOEHJOHJWBM 'PSTNBMMUPNPEFSBUF
floor QSFQBSBUJPOT
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1VMQ #ZVTFPGWBSOJTI MJOFS 7BSOJTIOPUJOEJDBUFE
tooth? QSPUFDUJPO #BTF(M$ DBMDJVN
Ans. With the help of low-speed handpiece using round BOECBTF IZESPYJEFMJOFS
bur and spoon excavator in lateral scrapping
motion. Q.24. What are indications of bevelled tooth preparation
for composites?
Q.17. Which instrument is used for smoothening of
Ans. 1. For replacing defective existing restoration.
gingival seat?
2. For restoring a large, carious lesion.
Ans. Gingival marginal trimmer.
10
cHAPTER
Tooth Preparation for Primary Teeth

Madhu Garg, Priya Verma Gupta, Bhumika Ahuja
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Chapter Outline
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Introduction Tooth Preparation
Rationale for Tooth Preparation Matrix Bands and Retainers
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Principles of Tooth Preparation Steps for Amalgam Restoration for Primary Teeth
Classification of Dental Caries Viva Question
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Introduction Restoration of deciduous teeth is a challenge for the
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dentist because of the following reasons:

According to American Academy of Pediatric Dentistry
• Compromised retention form: Early spread of caries
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(AAPD) guidelines, tooth preparation should include

in primary teeth leads to loss of major part of tooth
the removal of caries or improperly developed or
structure. This compromises retention form
unsound tooth structure to establish appropriate outline,
• Modifications in cavity designs: Different anatomical
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resistance, retention and convenience form compatible

and morphological features make cavity preparation
with the restorative material to be utilized. The decision
different
to use amalgam should be based upon the needs of each
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• Behaviour management: Children in dental operatory

individual patient. Amalgam restorations often require
behave differently. Therefore, behavior problems can
removal of healthy tooth structure to achieve adequate
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result in inefficient dental care.

resistance and retention. Glass ionomer or resin restorative
Usually, a primary tooth is smaller form of its counterpart
materials might be a better choice for conservative
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permanent tooth, but there are some anatomic and

restorations, thereby retaining healthier tooth structure.
histological differences between the two which demand
special type of restorative care.
Rationale for tooth preparation
• Restoration of carious teeth Basic Differences in Primary and Permanent
• Treatment of malformed, fractured or traumatized teeth Dentitions Affecting Tooth Preparation
• Replacement of old, defective restorations in Primary Teeth
• Esthetic improvement for discolored and unesthetic teeth.
• Shorter clinical crown: Cervicoincisal length is smaller
Principles of Tooth Preparation than mesiodistal diameter in primary teeth, whereas
the converse is true in permanent teeth (Fig. 10.1).
• Removal and inclusion of carious areas Clinical significance: It affects the ability of primary
• Susceptibility of remaining tooth structure to be involved teeth to adequately support and retain intracoronal
• Preservation of sound tooth structure. restorations.
• Thin enamel: Enamel has around 1 mm thickness in

primary teeth as compared to 2–3 mm in permanent
teeth.
Clinical significance:
–– Small burs used
–– Less pressure is applied during tooth preparation.
• High pulp horns:
Pulp horns in primary teeth are more near to the surface
than permanent teeth (Fig. 10.2).
–– Spread of dental caries is faster with early pulpal A B
involvement Figures 10.1A and B: Schematic representation showing mesiodistal
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–– Tooth preparation has to be more conservative to dimensions of primary teeth (A) are more than permanent teeth (B)
avoid pulp involvement
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–– Isthmus must be narrow to avoid pulp exposure
–– To reduce failure of restorative material, pulpoaxial
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line angle is deepened to increase bulk of material.
• Less mineralized enamel and dentin: Enamel
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and dentin are less mineralized in primary teeth as
compared to permanent teeth
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Clinical significance: More time is needed for acid-etching
of primary teeth. Time is 45–60 seconds in primary teeth
B
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as compared to 15–20 seconds in permanent teeth. A
• Direction of enamel rods: Enamel rods of primary Figures 10.2A and B: Schematic representation showing primary
teeth in cervical third of the crown extend in an occlusal teeth (A) have high pulp horns as compared to permanent teeth (B)
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direction from DEJ, whereas in permanent teeth, rods

incline in apical direction (Figs 10.3A and B).
Clinical significance: In case of permanent teeth,
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gingival bevel is given in class II restoration to remove

unsupported enamel rods but there is no requirement
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of a gingival bevel in primary teeth, since there is little

danger of rods being unsupported.
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• marked cervical constriction: There is a marked

cervical constriction in primary teeth (giving them bell A B
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shaped appearance) which is lacking in permanent Figures 10.3A and B: Schematic representation showing cervical
teeth (Fig. 10.4). third of the crown: (A) Enamel rods are inclined occlusally in primary
teeth; (B) Rods incline apically in permanent teeth
–– Tendency to make floor of box too deep
–– Forces to re-establish floor by moving axial wall
towards pulp
–– Due to exaggerated cervical bulge, matrix adaptation
is difficult. It requires the construction of a custom
matrix to fit the teeth.
• Broad, flat proximal contact areas: Primary teeth have
broad, flat proximal contact areas. Moreover, contact
areas are situated gingivally.
Clinical significance: A B
–– Proximal box has to be wider so as to make buccal and Figures 10.4A and B: Schematic representation showing primary (A)
lingual line angles of the proximal box self-cleansable tooth with prominent cervical bulge than permanent teeth (B)
Tooth Preparation for Primary Teeth 137
Finn’s Modification
Class I: Cavities involving the pits and fissures of molar
teeth and buccal and lingual pits of all teeth.
Class II: Cavities involving proximal surfaces of molars
with access established from occlusal surfaces.
Class III: Cavities involving proximal surfaces of anterior
A
teeth which may or may not involve a labial or lingual
B
extension.
Figures 10.5A and B: Schematic representation showing primary
tooth (A) has narrow occlusal table than permanent tooth (B) Class IV: Cavities of proximal surface of an anterior tooth
which involve restoration of an incisal angle.
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–– Proximal box is to be extended far gingivally, so as to
Class V: Cavities present on the cervical third of all teeth,
clear the contact.
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including proximal surface where the marginal ridge is not
• Narrow occlusal table: Occlusal table is somewhat
included in the cavity preparation.
narrower in primary teeth. Occlusal surfaces are much
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flatter than permanent teeth (Fig. 10.5).
Clinical significance: Tooth preparation
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To avoid weakening of cusps by overextending bucco- Class I Tooth Preparation
lingual dimensions, conservative tooth preparation is
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desirable. Class I caries are caries occurring in pits and fissures of the
Young permanent teeth also exhibit characteristics occlusal surfaces of premolars and molars, the occlusal
that need to be considered in restorative procedures, such two-third of buccal and lingual surfaces of molars and
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as large pulp chambers and broad contact areas that are lingual surface of incisors.
proximal to primary teeth.
Outline Form
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Classification of Dental Caries • Take no. 330 bur for tooth preparation. Keep it parallel
to the long axis of the tooth structure to make a ditch
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Black’s Classification
in carious lesion. Initial punch cut should be 1.5 mm
Class I: (All pit and fissure restorations) deep. Use No. 330 bur’s shank as depth marker. It is
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• Restorations on occlusal surface of premolars and approximately 1.5 mm from the bur tip to the shank
molars • While maintaining the same depth and bur orientation,
move the bur mesial and distal to extend the outline to
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• Restorations on occlusal two-thirds of the facial and

lingual surfaces of molars include the central fissure. Width of the cavity should
• Restorations on lingual surface of maxillary incisors. be 1/3rd of intercuspal distance
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• Extend the margin mesially and distally but do not

Class II: Restorations on the proximal surfaces of posterior
involve marginal ridges.
teeth.
Class III: Restorations on the proximal surfaces of anterior Primary Resistance Form
teeth that do not involve the incisal edge.
• Use No. 330 bur for rounding of the internal line angles.
Class IV: Restorations on the proximal surfaces of anterior These rounded line angles are easier to condense
teeth that involve the incisal edge. amalgam into and reduce the stress concentration
• Slightly concave or round the pulpal floor
Class V: Restorations on the gingival third of the facial or
• Minimum depth of preparation should be 1.5 mm (0.5
lingual surfaces of all teeth.
mm into the dentin)
Class VI: (Simon’s modification) Restorations on the • Establish sharp 90° cavosurface angle in lateral walls
incisal edge of anterior teeth or the occlusal cusp heights using No. 169L bur. Watch the tip of 169 L bur to prevent
of posterior teeth. scoring the floor of preparation
• Keep strong marginal ridge areas with sufficient dentin • Oblique ridge of the maxillary second primary molar is
support. not crossed when treating small lesions (Figs 10.10A
and B)
Primary Retention Form • Cavity walls should be straight or converging
(Fig. 10.10C).
• Occlusal convergence of buccal and lingual walls.
Convenience Form
• It is checked by moving a condenser in the cavity.
narrowest portion.
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• To remove remaining caries, use spoon excavator or
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slow speed round bur
• Remove only that portion of the tooth, which is affected
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Figure 10.6: Schematic representation showing external outline
by caries leaving the remaining floor untouched. form of class I cavity of primary teeth
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Figures 10.6 and 10.7 are showing external and internal
outline form of class I cavity in primary teeth.
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Primary Mandibular First Molar
• Central pit of mandibular primary first molar is more
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frequently involved than the mesial pit. So the outline

form should include central pit with adjacent buccal
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and lingual grooves and distal triangular fossa. It

is not advised to cross the enamel ridge joining the
mesiobuccal and mesiolingual cusps (Figs 10.8A and
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B) because of proximity of mesiobuccal pulp horn and

strength imparted by intact central ridge. Figure 10.7: Schematic representation showing internal outline
form of class I cavity of primary teeth
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Primary Mandibular Second Molar

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• When buccal or lingual fissures are carious then buccal

or lingual extension is required. Here the buccal
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or lingual walls of the cavity should be straight and

converging occlusally (Figs 10.9A and B).
Primary Maxillary Second Molar

• Usual areas of involvement are central pit, distal pit, A B
lingual pit and the groove that separates the cusp of Figures 10.8A and B: Schematic representation showing (A) Occlusal
Carabelli from the mesiolingual cusp anatomy of primary mandibular 1st molar; (B) While tooth prepara-
tion enamel ridge joining the mesiobuccal and mesiolingual cusps
• Distal developmental groove sometimes extends
should not be crossed
through to the lingual surface. Its continuity with lingual
Abbreviations: MBC, mesiobuccal cusp; CDG, central developmental
developmental groove and distal pit make the area groove; DBC, distobuccal cusp; BDG, buccodistal groove; CP, central
susceptible to caries. This demands lingual extension of pit; DLC, distolingual cusp; LDG, linguodistal groove; MLC, mesiolin-
class I cavity gual groove; MP, mesial pit
Class II Tooth Preparation surface than occlusal surface (provide retention and
conservation of marginal ridge)
Occlusal Preparation
• Axial wall should follow the contour of the tooth to
• Prepare the occlusal portion using No.330 bur same as avoid pulp exposure
that for pit and fissure caries. • Gingival seat should be located below contact point so
as to have clearance form the adjacent tooth and to have
preparation of Proximal Box margins of restoration self-cleansable. Ideal clearance
of facial and lingual margins of the proximal box should
• Extend occlusal outline to the marginal ridge using
be 0.2–0.5 mm from the adjacent tooth. Keep a wedge in
No. 330 bur. Sweep the bur buccolinually in pendulum
the gingival embrasure area while preparing proximal
motion and in gingival direction
box to protect interdental gingival tissue
• Move the bur faciolingually to just clear the contact
• In cervical area, direction of enamel rods is horizontal
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areas and diverge the proximal cut gingivally. It
or occlusal. So to have fully supported enamel rods with
results in greater faciolingual dimension at gingival
dentin, gingival seat should not be beveled
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• Fracture the slice of enamel in the region of the contact
area with a small chisel or enamel hatchet. Rinse and
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clean the cavity.
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A B • Rounded axiopulpal angle
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Figures 10.9A and B: Schematic representation showing (A) Occlusal • Sharp cavosurface angle of 90°
anatomy of primary mandibular 2nd molar; (B) Class I tooth prepara- • Isthmus of 1/3rd of intercuspal width
tion in primary mandibular 2nd molar
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• Inclusion of all weakened tooth structure

Abbreviations: MBC, mesiobuccal cusp; DBC, distobuccal cusp; CP, • Proximal box in occlusogingival direction roughly
central pit; DC, distal cusp, DBDG, distobuccal developmental groove; parallel to the long axis of tooth.
DP, distal pit; CDG, central developmental groove; DLC, distolingual
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cusp; LDG, linguodistal groove, MLC, mesiolingual groove; MP, mesial

pit; MBDG, mesiolingual developmental groove. Primary Retention Form
• Occlusal convergence of buccal and lingual walls.
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Convenience Form
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• It is checked by moving a condenser in the cavity.

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narrowest portion.
Figures 10.11 and 10.12 showing characteristic features
of external and internal outline form of class II preparation
A B C of primary teeth.
Figures 10.10A to C: Schematic representation showing (A) Occlu-
sal anatomy of primary maxillary 2nd molar; (B) Conservative class I Final Tooth Preparation
tooth preparation in primary maxillary 2nd molar (C) Schematic rep-
resentation showing walls of tooth preparation should be straight or • To remove remaining caries, use spoon excavator or
converging slow speed round bur. Remove only that portion of the
Abbreviations: DBC, distobuccal cusp; CDG, central developmental tooth which is affected by caries leaving the remaining
groove; MBC, mesiobuccal cusp; BDG, buccodistal groove; MTF mesial
triangular fossa; MP, mesial pit; MLC, mesiolingual groove; CP, central floor untouched.
pit; DLC, distolingual cusp; DTF, distal triangular fassa; DDG, distal Figures 10.13A and B show class II tooth preparation
development groove for maxillary and mandibular primary molars.
Class III
The most common area for class III in primary dentition is
mesial surface of the primary incisors. (Fig. 10.14)
• Pear shaped bur (No.330) is used for cavity preparation
• Outline form should be triangular with the base of the
triangle at the gingival aspect of the cavity
• Buccal and lingual walls of the cavity should parallel the
Figure 10.11: Schematic representation showing external outline external surfaces of the tooth
form of class II preparation • Gingival cavity wall is inclined occlusally to form
parallelism with direction of enamel rods
• Depth of cavity into dentin is 0.5-1 mm
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• If contact area is open, there is no need of dovetail lock,
caries is accessed labially
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In case of closed contact, a dovetail lock is made to
facilitate access and retention. dovetail extends to the
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middle of the tooth cervicoincisally.
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Class IV
Cavity outline is similar to class III.
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• Sometimes, along with the proximal surface, labial
or lingual surfaces also show carious involvement,
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Figure 10.12: Schematic representation showing internal outline

form of class II preparation
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A B
Figures 10.13A and B: Schematic representation showing class II Figure 10.15: Schematic representation showing class IV tooth
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preparation; (A) Primary maxillary 2nd molar; (B) Primary mandibular preparation in primary teeth
2nd molar
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Figure 10.14: Schematic representation showing class III tooth Figure 10.16: Schematic representation showing class V tooth
preparation in primary teeth preparation
i.e. class IV and V lesions exist simultaneously. This Follwing types of matrices are used for primary teeth:
forms the indication for full coverage restorations. • Spot welded
For example pedo-strip crown, light-cure crown, etc • T- band
(Fig. 10.15). • Preformed spot welded matrix bands
• Toffelmire retainer.
Class V
Spot Welded
• These cavities are more frequently present on the
buccal surfaces of primary canines (Fig. 10.16) Steps of Fabrication
• Tooth preparation is limited to the carious portion and
• Cut about 5 cm length of band material and weld the
2 mm farther for extension for prevention
ends together forming a loop (Fig. 10.17)
• Preparation is either kidney-shaped or square form
• Place loop around the tooth. Hold it firmly at lingual
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with sharp outline on mesial and distal margins
surface with index finger. Using plier pinch together
• A retentive groove may be placed at occlusoaxial or
buccal portion till the band snuggly fits around the
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gingivoaxial line angle.
tooth (Fig. 10.18)
• Remove the band and weld. Cut off excess band 1mm
Matrix bands and retainers
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beyond welding joint (Figs 10.19 and 10.20)
Matrix bands and retainers are used in class II amalgam • Using plier, round off the cut edges of the band
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restorations. The difficulties encountered while application • Place band on the tooth and contour it at cervical and
of matrix band and retainers are because of cervical contact area using plier (Fig. 10.21)
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constriction, broad contact and prominent enamel buccal • Place wedge to further stabilize the band. Using
and cervical ridges. explorer, confirm the fit of band at gingival margins and
wall of the preparation (Fig. 10.22).
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A B
Figures 10.17A and B: Schematic representation showing cutting of the band and welding it Figure 10.20: Schematic representation
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to form the loop showing removal of excess band material

and bonding of remaining band
Figure 10.18: Schematic repre- Figure 10.19: Schematic representation showing spot Figure 10.21: Schematic representation
sentation showing adaptation welding of band showing contouring of the band
of the band on tooth
A B
Figure 10.22: Schematic representation showing adapta- Figures 10.24A and B: Schematic representation showing (A) Copper band
tion of band on the tooth and placement of wedge covers are circular band materials; (B) Cut around 3cm piece, form and weld loop
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A B C
Figure 10.23: Schematic representation showing T-band: (A) T band; (B) Fold the T-wings and form circle so as to adapt on the tooth; (C) Hold
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band with one finger and pull the tab tight using plier to adapt the band snugly over the tooth
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Figure 10.25: Schematic representation Figure 10.26: Schematic representation Figure 10.27: Schematic representation show-
of placement and condensing of first showing precarve burnishing to improve ing sharp explorer is used to carve the marginal
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increment of amalgam in the deepest marginal integrity ridge and occlusal embrasure
proximal box
T-band Matrix • Apply wedge

• For removal, raise the tab over the joint and loosen the
• Using plier, make circle by bending flanges of the T
T part of the band. Remove wedge and slide the band
around mirror handle
occlusally.
• Fold the T-wings over the circle formed. Adjust the band
to a size smaller than the prepared tooth (Fig. 10.23)
Preformed Spot Welded Matrix Bands
• Place it on the tooth with folded joint facing buccal side
• Hold band with one finger and pull the tab tight using • Use copper band storage box cover. These covers are
plier and fold it over the joint circular forms
• Remove band, flatten the joint using plier and place it • Cut about 3cm long piece and form a loop by single
back on the tooth weld only
Figure 10.28: Schematic representation showing small finishing bur Figure 10.29: Schematic representation showing slow-speed bur for
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to finish grooves polishing of amalgam
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• Place loop around the tooth. Using plier, adapt the with a sharp carver like Hollenback. Define marginal
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band snuggly around the tooth (Fig. 10.24). Weld it ridge and occlusal embrasure using a sharp explorer
twice to form a band (Fig. 10.27). It is done after carving so as to remove any
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• Cut off excess band beyond welding joint areas left high in the final restoration. Ask the patient to
• Using plier, round off the cut edges of the band and close the mouth so that the teeth meet lightly.
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store bands in a box. 7. Do post carve burnishing using light strokes to improve
the smoothness of the restoration (Fig. 10.28).
Toffelmire Retainer and Band
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8. Finish the restoration after 24 hours using finishing
burs and stones (Fig. 10.29).
Toffelmire retainer and band is not used very commonly
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for primary teeth. Because of presence of prominent

cervical ridge and constriction, it becomes difficult to QUESTIONS
adapt the band snuggly around the tooth.
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Q.1. What is significance of less enamel thickness in

STEPS for amalgam restoration for primary teeth?
Ans. One has to use small burs, and apply less pressure
primary teeth
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during tooth preparation.

1. Take amalgam alloy, triturate it and do mulling to
Q.2. What is Significance of high pulp horns in primary
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squeeze out excess mercury.

teeth?
2. Use amalgam carrier to carry amalgam alloy into the
Ans. Tooth preparation has to be more conservative to
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preparation. Place first increment of amalgam in the

avoid pulp involvement.
deepest proximal part of preparation and condense it
with flat surface of condenser (Fig. 10.25). After it, add Q.3. What is clinical significance of less mineralized
next increment and again condense it. When level of enamel and dentin in primary teeth?
amalgam reaches preparation margins, continue the Ans. It needs more etching time (45–60 seconds as
packing of preparation to allow an excess to build up compared to 15–20 seconds in permanent teeth).
for better finishing.
Q.4. What is Finn’s modification of cavity classification
3. Condense continuously, laterally as well as apically.
for primary teeth:
4. Do precarve burnishing after condensation to improve
Ans. Class I: Cavities involving the pits and fissures of
marginal adaptability of restoration and remove excess
molar teeth and buccal and lingual pits of all the
mercury from overpacked amalgam (Fig. 10.26).
teeth.
5. Carve the amalgam.
Class II: Cavities involving proximal surfaces of molars
6. In proximal tooth preparation, carve the cervical margins
with access established from occlusal surfaces.
after removal of matrix band. Carve the occlusal surface
Class III: Cavities involving proximal surfaces of Q.9. What are morphologic considerations for
anterior teeth which may or may not involve a labial deciduous teeth?
or lingual extension. Ans. • Smaller in size
Class IV: Cavities of proximal surface of an anterior • More bulbous
tooth which involve restoration of an incisal angle. • Cervical constriction
Class V: Cavities present on the cervical third of all • Narrow occlusal table.
teeth, including proximal surface where the marginal
Q.10 What are histologic considerations for deciduous
ridge is not included in the cavity preparation.
teeth?
q.5. Which bur is used for class I tooth preparation of Ans. • Longer and more pointed pulp horns
primary teeth? • Less bulk/thickness of dentin
Ans. No. 330 (instead of no. 245 used in permanent teeth) • Pulpal outline follows DEJ more closely than in
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permanent tooth
Q.6. Why gingival seat is not beveled in primary teeth?
• Thin enamel of uniform thickness which is
Ans. In primary teeth, direction of enamel rods is
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parallel to DEJ
horizontal or occlusal in cervical area. This avoids
• Enamel rods are directed occlusally at cervical
need of beveling of gingival seat so as to have fully
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third.
supported enamel rods with dentin.
Q.11. What are modifications in tooth preparation for
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q.7. What are features of proximal box of primary
primary teeth in comparison to permanent teeth?
teeth?
Ans. • Occlusal anatomy of primary teeth is not well
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Ans. • Box converge occlusally.
defined and supplemental grooves are less
• Isthmus 1/4th–1/3rd of intercuspal distance
common—Cavity preparation must be kept more
• No bevel in gingival seat
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conservative
• Minimum axial wall depth to prevent pulp
• Enamel thinner—Cavity preparation should be
exposure at cervical constriction
kept shallow
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• Wide gingival floor

• High pulp horns—Cavity should be conservative
• Rounded axiopulpal angle grooved to increase
to avoid pulpal exposure
retention.
• Exaggerated cervical bulge—matrix adaptation
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Q.8. What are the reasons for preservation of primary difficult, construction of a custom matrix to fit
teeth? the teeth
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Ans. • They are needed till succedaneous teeth replace • Direction of enamel rods in cervical region or
them gingival third of primary teeth extend from DEJ
• For mastication of food
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occlusally or horizontally, eliminates the need

• Development of speech and phonetics for a gingival bevel in class II preparation
• Esthetics
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• Interproximal contacts of primary molars are

• Prevention of malocclusion in permanent teeth. generally broad, flat and cervically placed—Need
for wide proximal cavity preparation.
CHAPTER
11
Dental Materials
Amit Garg, Vandana Chhabra
et
CHAPTER OUTLINE
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Introduction Zinc Polyacrylate Cement/Zinc Polycarboxylate Cement
Dental Cements Glass Ionomer Cement
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Zinc Oxide Eugenol Cement Pulp Protection Materials
Zinc Phosphate Cement Dental Amalgam

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Zinc Silicophosphate Cements Dental Casting Alloys
Calcium Hydroxide
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INTRODUCTION Properties of Dental Materials to be Considered

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Dental materials are especially fabricated materials which 1. Physical properties

are designed to be used in dentistry. Many metals, non – Coefficient of thermal expansion
– Opacity
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metals, resins, ceramics, organic and inorganic materials

– Translucency
are used to replace or alter the tooth structure in form of
– Thermal and electrical conductivity
dental materials. – Hue, value and chroma.
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Classification of Dental Materials 2. Mechanical properties

– Compressive strength
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Classification according to use: – Tensile strength

r Preventive (materials which primarily prevent or inhibit – Shear strength
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tooth decay) – Malleability and ductility

– Pit and fissure sealants – Hardness.
r Restorative (materials used to repair or replace the 3. Biological properties
tooth structure) – Allergy
– Cements – Toxicity
– Composites – Biocompatibility.
– Amalgam 4. Chemical properties
– Ceramics – Setting reaction
– Cast metals. – Tarnish and corrosion
r Auxillary (used for fabrication of prosthesis or – Chemical solubility and disintegration
appliances but don’t become part of these devices) – Galvanic reaction.
– Etchants
– Waxes DENTAL CEMENTS
– Impression materials
– Bleaching trays Dental cement is the dental material which forms a
– Gypsum products. hardened mass by mixing two components. These
components are available as powder and liquid or as two r Temporary restorative materials
paste system. – ZOE (reinforced) type III.
Dental cements can be used for luting purpose, as r Bases
temporary and permanent restorations. – Bases under amalgam:
- Zinc phosphate
- Zinc silicophosphate
- Zinc polycarboxylate
- Reinforced ZOE (type III)
- GIC (type II).
Uses of Dental Cements – Bases under composites
Dental cements are used as follows: - Zinc polycarboxylate
- GIC type II.
r As temporary restorations
– Bases under gold
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r As permanent restorations - Zinc phosphate
r For temporary luting - Zinc polycarboxylate
r For permanent luting
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- GIC type II.
r As root canal sealers Pulp capping agents
r For pulp protection:
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– Indirect pulp capping agents
– Liners - Ca(OH)2
– Bases.
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- ZOE.
– Direct pulp capping agents
Factors Determing the use of Dental Cements - Ca(OH)2
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r Cavity liners
r Composition
– Under amalgam
r Compressive strength - Ca(OH)2
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r Modulus of elasticity – Under composite

r Film thickness - Ca(OH)2
r
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Solubility - GIC Type II

r Biocompatibility. - Varnishes.
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Classification of Dental Cements ZINC OXIDE EUGENOL CEMENT

Based on Composition Zinc oxide eugenol cement is one of the oldest used cements
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(Fig. 11.1). It has soothing action on pulpal tissues and

r Conventional cement
– Zinc oxide eugenol (ZOE) cement eugenol has topical anesthetic properties, therefore, it is
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– Zinc phosphate cement also termed as an obtundent material. Though other

– Glass ionomer cement
– Polycarboxylate cement.
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r Resin–base cement
– Resin cement
– Resin-modified glass ionomer cement.
Classification Based on Uses

r Permanent luting cements
– Zinc phosphate
– Zinc silicophosphate
– Zinc polycarboxylate cement
– Modified ZOE Type-2
– Glass ionomer cement.
r Temporary luting cements
– ZOE Type I.
r Permanent restoratives
– Silicates
– GIC type II. Figure 11.1: Photograph showing zinc oxide eugenol cement
Dental Materials 147
cements are also used for temporization, but it is used most r 8JUIJO UIJT NBUSJY VOSFBDUFE [JOD PYJEF QPXEFS
commonly because of being less irritating to the pulp. particles are embedded
r 'JSTUSFBDUJPO
Composition ZnO + H2O o Zn(OH)2
r Powder r 4FDPOESFBDUJPO
– Zinc oxide (ZnO) 69.0%—Reactive ingredient
Zn(OH)2 + 2HE o ZnE2 + 2H2O
– White rosin 29.3%—Reduces brittleness
– Zinc stearate 1.0%—Catalyst r 8BUFSJTOFFEFEGPSUIFSFBDUJPOBOEJUJTBMTPCZQSPEVDU
– Zinc acetate (acts as accelerator) 0.7%— Accelerator. of the reaction. So, reaction progresses more rapidly in
r Liquid humid conditions
– Eugenol 85.0%—Reactor r Since zinc eugenolate rapidly hydrolyzes to form free
– Olive oil 15.0%—Plasticizer. eugenol and zinc hydroxide, it is one of the most soluble
et
Types cements. To increase the strength of the set material,
changes in composition can be made to the powder
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Type I—Temporary luting
Type II—Long-term luting and liquid
Type III—Temporary restoration and thermal insulating r For modification of ZOE cements, orthoethoxybenzoic
al
bases acid is added to the liquid or alumina or polymethyl
methacrylate powder to the powder.
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Type IV—Intermediate restoration
Type I: Main features: Composition of Modified Zinc Oxide Eugenol Cements
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r Strength of the cement is low so it can be easily removed
r It is used for short-term restorations Ethoxybenzoic acid reinforced cement (EBA)
r Free eugenol interferes with the setting of resin-bonded r 1PXEFS
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composites so carboxylic acids can be used to replace – Zinc oxide 70%

eugenol making it non-eugenol cement. – Alumina 30%
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or
Type II: Main features: – Zinc oxide 70%
r ǔJT DFNFOU IBT JNQSPWFE TUSFOHUI BOE BCSBTJPO – Fused quartz and calcium 30%
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resistance r -JRVJE
r *OUIJTDFNFOUUIFQBSUPGFVHFOPMMJRVJETVCTUJUVUFECZ – Orthoethoxybenzoic acid 62.5%
orthoethoxybenzoic acid (EBA) and alumina is added – Eugenol 37.5%
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to powder r *O UIJT DFNFOU &#" DIFMBUFT XJUI [JODGPSNJOH [JOD

or benzoate (Fig. 11.3)
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r 1PXEFS JT NBEF VQ PG m XU PG êOF QPMZNFS
particles and zinc oxide particles that have been surface
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treated with carboxylic acid, in this the liquid remains

eugenol.
Type III: It is used for temporary restorations which last for
a few days to few weeks.
Type IV: It lasts for at least up to 1 year. In this more powder
has to be added for achieving better strength.
Setting Reaction
r 0ONJYJOHQPXEFSBOEMJRVJE UIF[JODPYJEFIZESPMZTJT
and subsequent reaction take place between zinc Figure 11.2: Schematic representation showing that on mixing zinc
oxide powder and eugenol liquid, hydrolysis of zinc oxide takes place.
hydroxide and eugenol to form a chelate, zinc Zinc hydroxide reacts with eugenol to form zinc eugenolate matrix
eugenolate (Fig. 11.2) into which unreacted zinc oxide powder particles are embedded
r "EEJUJPO PG GVTFE RVBSU[ BMVNJOB BOE EJDBMDJVN

phosphate has also shown to improve mechanical
properties of cement.
Effect of EBA on eugenol cement
r *ODSFBTFJODPNQSFTTJWFBOEUFOTJMFTUSFOHUI
r .PSFQPXEFSDBOCFJODPSQPSBUFEUPBDIJFWFTUBOEBSE
consistency
r %FDSFBTFJOTFUUJOHUJNF JGDPODFOUSBUJPOJT

r &#"EPFTOPUTIPXBEWFSTFFŀFDUTPOQVMQ
Polymer-reinforced zinc oxide eugenol cement: In this
mixture, resin helps in improving strength, smoothness of
et
the mix and decreases flow, solubility and brittleness of
the cement. Figure 11.3: Photograph showing modified zinc oxide eugenol
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r 1PXEFS cement (IRM)
– Zinc oxide 80%—Reactive ingredient
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– Polymethyl methacrylate 20%—Increases strength
– Traces of zinc stearate, zinc acetate
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r -JRVJE
– Eugenol 85%—Reactor
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– Acetic acid 15%—Accelerator
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Manipulation of ZOE Cement
ZOE cement is available as:
r 1PXEFSBOEMJRVJETZTUFN
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Figure 11.4: Schematic representation of increments of ZOE powder.

r 1BTUFmQBTUFTZTUFN Powder is divided in main bulk increment, followed by smaller incre-
ments
Manipulation of powder and liquid system
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r 1PXEFS JT NFBTVSFE BOE EJTQFOTFE XJUI B TDPPQ

whereas liquid is dispensed as drops on glass slab
Paste–paste System
r 1PXEFS JT EJTQFOTFE BU POF FOE PG HMBTT TMBC VTJOH
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In this, two pastes are dispensed in equal lengths on paper

cement spatula
QBE5XPQBTUFTIBWFEJŀFSFOUDPMPST NJYJOHJTEPOFUJMMB
r 1PXEFSJTEJWJEFEJONBJOCVMLJODSFNFOU GPMMPXFECZ
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homogeneous color is obtained.

smaller increments (Fig. 11.4)
r 8IJMFEJTQFOTJOHMJRVJE CPUUMFTIPVMECFIFMEUPUIF
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Working Time and Setting Time

mixing pad. It lets the fluid fall under its own weight
r 4UBSUUIFNJYJOHCZJODPSQPSBUJOHIBMGPGUIFQPXEFSJOUP r )JHIFSUIFQPXEFSMJRVJESBUJP GBTUFSUIFNBUFSJBMTTFU
the liquid with a heavy folding motion and pressure r $PPMJOH PG HMBTT TMBC TMPXT EPXO UIF TFUUJOH SFBDUJPO
r 8IFOQPXEFSQBSUJDMFTBSFXFUXJUIUIFMJRVJE BEEUIF (unless the temperature is below the dew point)
remaining powder to the mix and continue to use a r 4FUUJOH UJNF PG UIJT DFNFOU JT MPOH CVU TJODF XBUFS
heavy folding motion to attain a putty consistency accelerates the setting reaction, it sets faster in mouth
r 'PSCBTF XIFONJYJOHJTEPOF CSJOHUIFNJYUPHFUIFS than outside.
and roll it. One should be able to pick up the mix without
deformation (Fig. 11.5) Advantages
r 'PSMVUJOHDPOTJTUFODZ iJODIuTUSJOHTIPVMECFGPSNFE r Least irritating cement (pH is 7). Because of this, it is best
when flat surface of spatula is pulled from the mixed known obtundent
cement. r (PPETIPSUUFSNTFBMJOH
Disadvantages
r Highly soluble
r Low strength
r Long setting time
r Low compressive strength.
ZINC PHOSPHATE CEMENT

Zinc phosphate cement is one of the oldest and most
extensively used cements. It was first introduced in 1878
and still used today because of excellent clinical track
et
record (Fig. 11.6). Its ADA specification number is 8.
Figure 11.5: Photograph showing final mix of ZOE cement for
Types
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restoration and for luting
r Type I: It forms the film thickness of less than 25
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microns. Used for luting purposes
r Type II: It results in film thickness between 25 and 40
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microns. Used as base. de
Composition
r 1PXEFS
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– ZnO—90.2%
– MgO—8.2%—Condenses the ZnO during the
sintering process
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– SiO2—1.4%—Acts as an inert filler

– Bi2O3—0.1%—Imparts smoothness to the mixed
cement
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– Miscellaneous—(BaO, Ba2SO4, CaO)—0.1%

– All the ingredients are sintered at temperatures Figure 11.6: Photograph showing zinc phosphate cement
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CFUXFFO $ BOE $ JOUP B DBLF UIBU JT

subsequently ground into fine powder.
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r -JRVJE
– Phosphoric acid – 38.2%
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– Water – 36.0%
– Aluminum or zinc phosphate – 16.2%
– Zinc – 7.1%
– Aluminum – 2.5%
#PUI BMVNJOVN BOE [JOD BDU BT CVŀFST UP SFEVDF UIF
reactivity of the powder and liquid.
Setting Reaction
r 1IPTQIPSJD BDJE BUUBDLT TVSGBDF PG UIF QBSUJDMFT BOE
releases Zn ions into the liquid
r "MVNJOVN XIJDI BMSFBEZ GPSNT B DPNQMFY XJUI UIF
phosphoric acid reacts with zinc and yields a zinc Figure 11.7: Schematic representation showing aluminum ions form
complex with phosphoric acid which reacts with zinc forming alumi-
aluminophosphate gel (Fig. 11.7) nophosphate gel
r *O TFU DFNFOU VOSFBDUFE [JOD PYJEF QPXEFS QBSUJDMFT r 4JODF TFUUJOH SFBDUJPO JT BO FYPUIFSNJD UZQF UIF IFBU
are embedded in zinc phosphate matrix (Fig. 11.8) liberated while setting further accelerates the setting
r On the surface of set cement, crystals of tertiary zinc rate. So, it is very important to dissipate this heat which
phosphate/hopeite are found. can be done by:
– Using chilled glass slab
Manipulation – Using smaller increment for initial mixing of cement
– Mixing on large area of glass slab.
r 8PSLJOHUJNF_NJOVUFT
r 1PXEFSJTEJWJEFEJOUPmJODSFNFOUT(Figs 11.9 and
r 4FUUJOHUJNF_mNJOVUFT
11.10A) in which initial two increments are smaller,
r 1PXEFSJTNFBTVSFEBOEEJTQFOTFEXJUITDPPQ BMJRVJE
third and fourth increments are bigger one and after
is dispensed as drops. Cement mixing should be done
that increments are again smaller in size
on cool glass slab with a narrow-bladed stainless steel
r *OJUJBMJODSFNFOUTBSFTNBMMFSJOTJ[FTPBTUP
et
spatula
– Achieve the slow neutralization of the liquid
r Working time of cement is inversely related to
– Control the reaction.
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temperature of the glass slab. So using a cool glass slab
r .JEEMFJODSFNFOUTBSFMBSHFSJOTJ[F
increases the mixing time. It also allows incorporation
– To saturate the liquid to form zinc phosphate
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of more powder into the liquid, resulting in greater
– Because of presence of less amount of unreacted
compressive strength and lower solubility of the final
BDJE UIJTTUFQJTOPUBŀFDUFECZIFBUSFMFBTFEGSPNUIF
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cement
reaction.
r *OUIFFOE UIFTNBMMFSJODSFNFOUTPGQPXEFSBSFBEEFE
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so as to:
– Achieve optimum consistency.
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r "GUFSEJWJEJOHQPXEFS EJTQFOTFMJRVJEPOUIFHMBTTTMBC
r 8IJMF EJTQFOTJOH UIF MJRVJE CPUUMF TIPVME CF IFME
vertical and close to the powder
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r 3FQFBUFE PQFOJOH PG UIF MJRVJE CPUUMF PS EJTQFOTJOH

of liquid before mixing should not be done because
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evaporation of liquid can result in changes in water/

acid ratio which can further result in decrease in pH
and an increase in viscosity of mixed cement
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r 'PSCBTFPSUFNQPSBSZSFTUPSBUJPO DPOTJTUFODZTIPVME
be such that it can be rolled into a ball without sticking
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Figure 11.8: Schematic representation showing that set cement con- (Fig. 11.10B)
sists of zinc phosphate matrix in which unreacted ZnO powder par- r 'PSMVUJOH NJYJOHJTDPOUJOVFEVOUJMBiJODITUSJOHuJT
ticles are embedded
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formed when spatula is pulled away from the glass slab

(Fig. 11.10C)
r 8IJMF TFUUJOH PG DFNFOU JT UBLJOH QMBDF XBUFS
contamination should be avoided because on moisture
contamination, phosphoric acid leaches out of cement
resulting in its increased solubility.
Properties
Mechanical Properties
r 4USFOHUIEFQFOETPOQPXEFSUPMJRVJESBUJPNPSFJTUIF
Figure 11.9: Schematic representation showing that powder of zinc powder liquid restoration, greater is the strength
phosphate cement is divided in 5–8 increments in which initial 2 incre-
ments are smaller, 3rd and 4th are bigger in size and rest of increments r $PNQSFTTJWFTUSFOHUIPGDFNFOUJT.QB
are again smaller in size r 5FOTJMFTUSFOHUI.QB
r .PEVMVT PG FMBTUJDJUZ JT HJHBQBTDBMT (QB

ǔJT
IJHINPEVMVTPGFMBTUJDJUZNBLFTUIFDFNFOURVJUFTUJŀ
and resistant to elastic deformation
r 3FUFOUJPOPGDFNFOUCZNFDIBOJDBMJOUFSMPDLJOHJTOPU
chemical interaction.
Biocompatibility
r #FDBVTF PG QSFTFODF PG QIPTQIPSJD BDJE BDJEJUZ PG
cement is quite high making it irritable
r Q)PGDFNFOUMJRVJEJT
r 5XPNJOVUFTBGUFSNJYJOH UIFQ)JTBMNPTUBOEBGUFS
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48 hours, it is 11.5.
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Uses
Figure 11.10A: Photograph showing dispensing of
r -VUJOHBHFOUGPSDSPXOT JOMBZT zinc phosphate powder
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r *OUFSNFEJBUFCBTF
r 5FNQPSBSZSFTUPSBUJPO
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r -VUJOHPSUIPEPOUJDTCBOE de
Advantages
r High compressive strength
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r Thin film thickness

r Long record of clinical acceptability.
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Disadvantages
r Lack of adhesion to tooth structure
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r Low initial pH Figure 11.10B: Photograph showing for temporary restoration, consis-
r -BDLPGBOUJDBSJPHFOJDFŀFDU tency should be such that it can be rolled into the ball without sticking
r Soluble in water.
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ZINC SILICOPHOSPHATE CEMENTS

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Zinc silicophosphate cements (ZSPC) consist of a mixture

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of silicate glass and zinc phosphate cement.
Composition
r 1PXEFS DPOUBJOT BO BDJETPMVCMF TJMJDBUF [JOD BOE
magnesium oxides
r -JRVJEDPOTJTUTPGQIPTQIPSJDBDJE
Properties of Zinc Silicophosphate Cements

r 5SBOTMVDFOU BOE NPSF FTUIFUJD UIBO [JOD QIPTQIBUF
cement
r "OUJDBSJPHFOJD CFDBVTF PG ëVPSJEF SFMFBTF GSPN UIJT Figure 11.10C: Photograph showing for luting, the consistency
cement should be such that "1 inch" string should be formed when spatula is
r )BTTVŁDJFOUTUSFOHUI taken away from glass slab
CALCIUM HYDROXIDE
Calcium hydroxide has high alkaline pH (12.5). Its
alkaline pH helps in neutralization of acids produced by
the microorganisms and irritating acidic component of
restorative base and materials. Calcium hydroxide also
provides antibacterial properties.
Calcium hydroxide is available in:
r 1PXEFSGPSN(Fig. 11.11)
r 2VJDLmTFUUJOHQBTUFGPSN %ZDBM
(Fig. 11.12).
Mixing Calcium Hydroxide Cement
et
r %JTQFOTF FRVBM BNPVOU PG CBTF BOE DBUBMZTU POUP UIF
Figure 11.12: Photograph showing paste form of calcium hydroxide
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mixing pad
r Using calcium hydroxide applicator or spoon excavator,
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mix the cement for 10–15 seconds until a uniform color is
achieved. Place the cement in the deepest portion of cavity.
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Uses of calcium hydroxide:
– As liner and sub base
– In indirect pulp capping
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– In direct pulp capping
– In pulpotomy
– For apexification
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– As root canal sealer.

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ZINC POLYACRYLATE CEMENT/ZINC

POLYCARBOXYLATE CEMENT
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It was one of the first chemically adhesive dental cements

(Fig. 11.13). It binds to tooth structure due to chemical
bonding between carboxyl groups of cement and calcium
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Figure 11.13: Photograph showing zinc polycarboxylate cement

ions present in tooth structure.
Its ADA specification number is 96.
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ht
Figure 11.11: Photograph showing powder form of Figure 11.14: Photograph showing that while dispensing, the liquid,
calcium hydroxide bottle should be held vertical and close to the powder so that liquid
falls under its own weight
Composition If excess cement is removed at this stage, it can cause

pulling of some cement leaving a void. So, the excess
r Powder: It is similar to that of zinc phosphate cement
cement should be removed once it is set
powder
r ;JOD QPMZDBSCPYZMBUF DFNFOUT TIPX QTFVEPQMBTUJD
r Liquid: It is an aqueous solution of 32–43% polyacrylic
behavior (initial viscosity of polycarboxylate cements is
acid.
more immediately after mixing).
– Liquid has tendency to become viscous because it is
a partially polymerized polyacrylic acid
Working Time and Setting Time
– Even though it is quite viscous after mixing but it
can attain a satisfactory film thickness because of r 8PSLJOHUJNF_NJOVUFT
pseudoplasticity and decrease in viscosity when r 4FUUJOHUJNF_mNJOVUFT
sheared.
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Properties
Manipulation Adhesion
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r 6TVBMMZJUJTQPXEFSUPMJRVJESBUJP Bonding of polyacrylate cement to tooth structure is
r $FNFOUTIPVMECFNJYFEPOTVSGBDFUIBUXJMMOPUBCTPSC
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because:
liquid like glass slab or paper pads r ǔF QPMZBDSZMJD BDJE JT CFMJFWFE UP SFBDU XJUI DBMDJVN
r -JRVJE JT EJTQFOTFE KVTU CFGPSF NJYJOH PG UIF DFNFOU
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ion via the carboxyl group
as the loss of water from liquid can result in increase in r ǔF BEIFTJPO EFQFOET PO UIF VOSFBDUFE DBSCPYZM
its viscosity. While dispensing, the liquid bottle should
de group.
be held vertical so that liquid comes out under its own
weight (Fig. 11.14) Mechanical Properties
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r .JYêSTUIBMGPGQPXEFSUPMJRVJEUPPCUBJOUIFNBYJNVN
length of working time $PNQSFTTJWFTUSFOHUI_m.1B
r .JYFEDFNFOUTIPVMECFBEBQUFEUPUPPUIUJMMJUJTHMPTTZ 5FOTJMFTUSFOHUI_m.1B
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in appearance. Loss of gloss makes it nonadhesive

r #FGPSF BQQMJDBUJPO PG DFNFOU POUP UIF UPPUI Solubility
conditioning of prepared tooth surface is recommended.
eb
It is low in water. But in acidic environment with pH of less

Conditioning is done with an organic acid (polyacrylic than 4.5, solubility increases. Reduction in P:L ratio also
acid 10–20%) for 10–20 sec, after this tooth is rinsed for increases solubility.
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20–30 sec and dried.

Biological Considerations
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Setting Reaction
pH of the liquid is 1.7 but increases rapidly after mixing.
r 8IFOQPXEFSBOEMJRVJEBSFNJYFE TVSGBDFPG[JODBOE
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Zinc polycarboxylate is biocompatible because of the

magnesium powder particles is attacked by H+ ions
following reasons:
formed from ionization of the acid
r 4J[F PG QPMZBDSZMJD BDJE NPMFDVMF JT CJHHFS UIJT
r This reaction releases zinc and magnesium ions forming
makes it less favorable to disperse into the dentinal
polycarboxylates that crosslink the polymer chains
tubules
r 'JOBM TFU DPOTJTUT PG VOSFBDUFE [JOD PYJEF QBSUJDMFT
r Q)PGUIFDFNFOUSJTFTNPSFSBQJEMZXIFODPNQBSFEUP
surrounded by zinc polycarboxylate crosslinked
that of zinc phosphate.
polymer matrix
r -PXFSJOH UIF UFNQFSBUVSF JODSFBTFT XPSLJOH UJNF
Uses
Since, cooling glass slab causes thickening of polyacrylic
acid, this further increases viscosity so only powder r $FNFOUJOMBZTPSDSPXOT
should be refrigerated for increasing working time r 6TFEBTCBTF
r 8IJMF TFUUJOH UIF DFNFOU QBTTFT UISPVHI UIF SVCCFSZ r 5FNQPSBSZSFTUPSBUJPOT
stage which makes it difficult to remove the cement. r -VUFUIFTUBJOMFTTTUFFMDSPXO
Advantages Composition
r Adhesion to tooth structure Conventional
r Rapid rise in pH upon cementation
r Biocompatible. GIC Powder
Powder
Disadvantages r "MVNJOB 'PSNTTLFMFUBM
structure)
r Short working time (2–3 minutes)
r 4JMJDB *ODSFBTFT
r Does not resist plastic deformation under high
transleucency)
masticatory stresses.
r "MVNJOVNëVPSJEF
r $BMDJVNëVPSJEF "DUTBTëVY JODSFBTFT
GLASS IONOMER CEMENT
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opacity)
Glass ionomer cement (GIC) was introduced to dentistry r 4PEJVNëVPSJEF
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in 1972 by Wilson and Kent. Extensive use of GIC to replace r "MVNJOVNQIPTQIBUF *ODSFBTFT
EFOUJO IBT HJWFO JU EJŀFSFOU OBNFT %FOUJO TVCTUJUVUF translucency,
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man-made dentin and artificial dentin. First commercial decreases melting
glass ionomer was known as aluminosilicate polyacrylate temperature)
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(ASPA). It was composed of ion-leachable alumino-silicate Powder is formed by fusing silica, alumina, calcium
glass and aqueous polyalkenoic acid, such as polyacrylic ëVPSJEF NFUBM PYJEFT BU m $ BOE UIFO QPVSJOH
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acid. the melt onto the water. The mass is crushed and ground
Glass ionomer cement is considered as hybrid of silicate to form powder.
cement and zinc polycarboxylate where phosphoric acid
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of silicate cements is replaced by polyacrylic acid of zinc Liquid

polycarboxylates (Fig. 11.15). r 1PMZBDSZMJDBDJE
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(Itaconic acid, maleic acid) 40–55%

Classification r 5BSUBSJDBDJE m
Classification (based on application): r 8BUFS
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r 5ZQF*-VUJOHDFNFOUT
r 5ZQF**3FTUPSBUJWFDFNFOUT
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– 1—Restorative esthetic
– 2—Restorative reinforced
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r 5ZQF***-JOFSPSCBTF
Classification of GICs according to their use:
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r Type 1 : Used for luting purpose

r Type 2 : Used as restoration
r Type 3 : Used as liner and base
r Type 4 : Used as fissure sealant
r Type 5 : Used for orthodontic purpose
r Type 6 : Used as core build up material
r Type 7 : Fluoride releasing command set GIC
r Type 8 : Used for atraumatic restoration technique (ART) Figure 11.15: Schematic representation of powder and liquid com-
r Type 9 : High-strength GIC used for pediatric purpose. ponents of different cements
Original liquid for GIC was aqueous solution of 40–50%

polyacrylic acid. It was quite viscous with a tendency to
gel over time. To overcome this, liquid was modified by
adding itaconic and tri-carboxylic acids. Addition of these
acids causes:
r %FDSFBTFJOWJTDPTJUZ
r *ODSFBTFJOSFBDUJWJUZCFUXFFOQPXEFSBOEMJRVJE
r 3FEVDFEHFMBUJPOPGMJRVJE
Modified Glass Ionomer Cements

Metal Reinforced Glass Ionomer Cement
et
r i.JSBDMF NJYu JT QSFQBSFE CZ QIZTJDBM CMFOE PG TJMWFS
alloy powder to GIC. Simmons introduced miracle
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mix in 1983. These cements show poor esthetics Figure 11.16: Photograph showing miracle mix
and resistance to burnishing and poor resistance to
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abrasion.
Powder: Physical blend of silver alloy and glass powder
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in 1:7 ratio.
Liquid: Glass ionomer cement liquid (Fig. 11.16).
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Cermet Cements
r *UJTJOUSPEVDFECZ.D-FBOBOE(BTTFSJO$FSNFU
ks
is manufactured by sintering compressed pellets made

from fine silver powder and glass ionomer powder at
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UFNQFSBUVSFPG$ǔFTJOUFSFENFUBMBOEHMBTTêUJT
then ground into fine powder form.
Powder: Sintering of silver powder and glass powder
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5% Titanium oxide.
Liquid: Glass ionomer cement liquid.
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Resin-modified Glass Ionomer Cement

Figure 11.17: Photograph showing resin-modified glass ionomer
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Powder: Fluoroaluminosilicate glass particles along with cement

photoinitiator or chemical initiator (Fig. 11.17).
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Liquid: 15–25% resin component in the form of HEMA.

Polyacrylic acid copolymer along with photoinitiator
and water (Fig. 11.18).
Water-mixed GICs/Water Hardening Glass Ionomer
Cements
Polyacid in solution form has shown an increase in
viscosity of the liquid, making the manipulation of cement
EJŁDVMU 5P TPMWF UIJT QSPCMFN iXBUFS NJYFEu PS iXBUFS
IBSEFOFEuIBTCFFOEFWFMPQFE
Powder: Freeze-dried polyacid powder mixed with glass
Figure 11.18: Schematic representation showing resin-modified
powder.
glass ionomer cement consists of fluoroaluminosilicate glass particles
Liquid: Water or water with tartaric acid. and photo or chemical initiator
When powder is mixed with water, acid powder

dissolves to reconstitute the liquid acid and this process is
followed by the acid–base reaction.
Manipulation
r .JYJOHPGDFNFOUTIPVMECFEPOFVTJOHQPXEFSMJRVJE
ratio as recommended by manufacturer
r *U TIPVME CF EPOF BU SPPN UFNQFSBUVSF GPS m
seconds on a cool and dry glass slab or paper pad with
the help of a flat and firm plastic spatula
r 'PSNJYJOH EJWJEFEJTQFOTFEDFNFOUQPXEFSJOUPUXP
et
equal portions (Fig. 11.19A). Mix first portion into the
liquid in 20 seconds and then add the remaining powder
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and mix for another 20 seconds in folding motion A
r .JYJOHTIPVMECFDPNQMFUFEXJUIJOmTFDPOET
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r 8PSLJOH UJNF GPS HMBTT JPOPNFS DFNFOU JT m
seconds Loss of gloss on the surface of mixed cement
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shows end of working time and start of setting reaction
r $FNFOUTIPVMECFVTFECFGPSFJUMPTFTJUTHMPTTJOFTT*G
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gloss is lost, the cement would not wet the tooth surface
well and bond strength will be reduced
r 'PSSFTUPSBUJPO CSJOHUIFNJYUPHFUIFS0OFTIPVMECF
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able to pick up the mix without sticking to the instrument

(Fig. 11.19B)
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r 'PSMVUJOHDPOTJTUFODZ iJODIuTUSJOHTIPVMECFGPSNFE
when flat surface of spatula is pulled from the mixed
cement (Fig. 11.19C).
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B
Setting Reaction
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Setting Reaction of Autocure Glass Ionomer Cement

It is an acid–base reaction between powder and liquid
tp
(Fig. 11.20).
Powder and liquid are mixed
ht
p
Surface of glass ionomers is attacked by H+ions.
Polyacid attacks the glass particles to release Ca2+ and
Al3+, F– and Na+
p
Initially, calcium ions and later aluminium ions cross-link
with polyacrylic acid to form calcium and aluminium
C
polysalts
p Figure 11.19A to C: Photograph showing (A) Powder is dispensed in
two equal portions and mixed with liquid in folding motion; (B) For
Acid attacks Ca-rich sites and metal ions migrate into restoration, one should be able to pick up the mix without sticking
aqueous phase of cement towards polyacrylic acid chains to the instrument; (C) For luting consistency, “1 inch” string should be
formed when flat surface of spatula is pulled from the mixed cement
p
et
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al
nt
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Figure 11.20: Schematic representation showing ion exchange of conventional and resin-modified glass
ionomers during setting stage
ks
Cross linking of chains occur resulting in gelation and Setting Reaction of Resin-modified Glass Ionomers
formation of calcium polyacrylate
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Two types of setting reactions occur in resin modified glass

p ionomers:
The salts hydrate to form gel matrix and surround the 1. Acid–base neutralization reaction.
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unreacted part of glass particles 2. Free radical methacrylate cure.

p When powder and liquid are mixed and light is
Final set cement consists of unreacted glass surrounded activated, a photoinitiated setting reaction starts.
://
by silica gel bound together by matrix of hydrated calcium Methacrylate group of polymer grafts into polyacrylic
and aluminium polysalts (Fig. 11.21). acid chain and methacrylate groups of HEMA. This
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crosslinking of HEMA and of methacrylate group of

polymer causes hardening of the cement. But acid–base
ht
reaction continues for some days.
Properties
Physical
High compressive strength and modulus of elasticity but
low fracture toughness and flexure strength make GIC a
hard but brittle material.
Biocompatibility
Glass ionomer cements are biocompatible because:
r 1PMZBDSZMJDBDJEQSFTFOUJOUIFMJRVJEJTBXFBLBDJE
Figure 11.21: Schematic representation of set glass r -POH QPMZNFS DIBJOT UBOHMF JO POF BOPUIFS ǔJT
ionomer cement prevents their penetration into dentin tubules.
Water Sensitivity r Esthetic

r Low solubility.
r .PJTUVSF DPOUBNJOBUJPO JO êSTU IPVST SFTVMUT
leaching of calcium and aluminum ions. This prevents
Disadvantages
formation of polycarboxylates, resulting in low surface
hardness, chalky and eroded appearance of restoration r Brittle and low fracture resistance
r *GEFTJDDBUJPOPDDVSTEVSJOHJOJUJBMTFUUJOHPGDFNFOU JU r Low wear resistance
retards the setting reaction (water plays an important r Sensitivity to both moisture contamination and
role in setting reaction) desiccation during setting phase.
r *GEFTJDDBUJPOPDDVSTJOMBUFSTUBHFT JUQSFWFOUTJODSFBTF
in strength of cement due to lack of hydration of silica Indications
based hydrogel and polycarboxylates. It can also result r Restoration of class V, III, and small class I tooth
et
in crazing, decreased esthetics and early deterioration preparations
of the cement. r Restoration of abrasion/erosion
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r Restoration of class I to class VI tooth preparations of
Adhesion deciduous teeth
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Adhesion of glass ionomers is because of chemical r For luting or cementation of extracoronal restorations
bonding between carboxyl groups of cement and calcium (inlay, onlay, crowns), veneers and orthodontic bonds
nt
of the tooth structure. Since enamel has higher percentage and brackets
of inorganic content, bonding of GIC to enamel is stronger r As preventive restorations
de
than to dentin. r As protective liner and base under composite, amalgam
and cast restorations.
ks
Fluoride Release
Contraindications
GIC contains 10–23% fluoride which lies free in the matrix.
r *OTUSFTTCFBSJOHBSFBTMJLFDMBTT* DMBTT**BOEDMBTT*7
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It is released from the glass powder at the time of mixing.

Fluoride release shows peak in first 24 hours after the preparations
mixing. After this, rate of fluoride release decreases over r *ODVTQBMSFQMBDFNFOUDBTFT
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weeks and finally it stabilizes at a constant level in 3–4 r *OQBUJFOUTXJUIYFSPTUPNJB

months. r *O NPVUI CSFBUIFST CFDBVTF SFTUPSBUJPO NBZ CFDPNF
opaque, brittle and fracture over time
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Esthetics r *O BSFBT SFRVJSJOH FTUIFUJDT MJLF WFOFFSJOH PG BOUFSJPS

teeth.
(MBTT JPOPNFST BSF FTUIFUJD BOE BWBJMBCMF JO EJŀFSFOU
tp
shades due to presence of metal oxides, ferric oxide.

ht
Margin Adaptation and Leakage

Coefficient of thermal expansion of GIC is almost similar
to that of tooth. This is responsible for good marginal
adaptation of glass ionomer restorations.
Advantages
r Adhesion to tooth structure because of chemical
bonding to enamel and dentin
r Biocompatible
r Anticariogenic because of fluoride release
r Conservative tooth preparation because of its adhesive Figure 11.22: Schematic representation of various irritants
nature and protection required for pulp
et
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Figure 11.23: Photograph showing various agents used Figure 11.24: Photograph showing bonding agent is used to seal
for pulp protection dentinal tubules
al
nt
PULP PROTECTION MATERIALS tooth surface the organic solvent evaporates leaving
behind a protective film. Two coats of varnish are applied
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Various pulpal irritants can be (Fig. 11.22): using a small cotton pellet for sufficient wetting of cavity
r #BDUFSJB PS UIFJS QSPEVDUT XIJDI NBZ FOUFS QVMQ CZ walls.
caries, accidental exposure, fracture, extension of
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infection from gingival sulcus, periodontal pocket and Advantages

anachoresis
r It is used to reduce microleakage
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r "DVUFUSBVNBMJLFGSBDUVSFPGUPPUI
r In case of amalgam restoration, varnish improves
r *BUSPHFOJD MJLF UIFSNBM DIBOHFT HFOFSBUFE EVSJOH
sealing ability of amalgam
cutting and restorative procedures, microleakage
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r Reduces postoperative sensitivity

occurring along the restorations, etc.
r Prevents discoloration of tooth by checking migration
Objectives of ions into the dentin.
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r 5PJOTVMBUFQVMQ Indications
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r 5PQSPUFDUQVMQJODBTFPGEFFQDBSJPVTMFTJPO
r To seal the dentinal tubules
r "DUBTCBSSJFSTUPNJDSPMFBLBHF
r To act as barrier to protect the tooth from chemical
ht
r 5PQSFWFOUCBDUFSJBBOEUPYJOTGSPNBŀFDUJOHUIFQVMQ
irritants from cements
Classification r To reduce microleakage around restorations.
Many materials are used for pulp protection (Fig. 11.23). Contraindications
They can be classified as following:
r Under glass ionomers because varnish interferes
r $avity sealers
chemical bonding of tooth and cements
– Varnish
r With restorative resins because varnish liners dissolve
– Resin bonding agents
in monomer of the resin and it also interfere with the
r Liners
polymerization of resins.
r Bases.
Varnish Resin Bonding Agents

Varnish is an organic copal or resin gum suspended in An adhesive sealer is commonly used under composite
solutions of ether or chloroform. When applied on the restorations (Fig. 11.24). For application, cotton tip
Figure 11.25: Schematic representation showing calcium hydroxide Figure 11.26: Schematic representation showing sequence of ap-
liner is applied in an attempt to stimulate reparative dentin formation plication of liner, base and varnish in a deep cavity
et
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applicator is used to apply sealer on all areas of exposed liner, base and varnish are applied to protect the pulp (Fig.
dentin. 11.26).
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Indications Classification
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r To seal dentinal tubules r Protective bases: They protect the pulp before
r To treat dentin hypersensitivity.
de restoration is placed
r Sedative bases: They help in soothing the pulp which
Liners has been irritated by mechanical, chemical or other
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means
Liners are typically fluid materials that, because of their
r Insulating bases: They protect the tooth from thermal
rheology, can adapt more readily to all aspects of a tooth
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shock.
preparation. They can be used to create a uniform, even
surface that aids in adaptation of more viscous filling
Materials
materials, such as amalgams or composites (Fig. 11.25).
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Liners usually do not have sufficient thickness, hardness r Polycarboxylate cement

and strength to be used alone in the deep preparation. r Glass ionomer cement
r Zinc oxide eugenol
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Indications r Zinc phosphate cement.

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r To protect pulp from chemical irritants by sealing ability

r To stimulate formation of reparative dentin. DENTAL AMALGAM
ht
Dental amalgam is an alloy of mercury with silver, tin,

Materials and varying amounts of copper, zinc and other minor
r Zinc oxide eugenol constituents. Dental amalgam alloys are silver–tin alloys
r Calcium hydroxide with varying amounts of copper, zinc and other metals.
r Flowable composites
r Glass ionomer cements Advantages
r Light-cured resin-modified glass ionomers (RMGIs).
r Amalgam is easier to manipulate and less technique
sensitive
Bases
r Self sealing ability due to formation of corrosion
Bases are used as pulp protective materials since they products at interface of amalgam restoration and tooth
QSPWJEFUIFSNBMJOTVMBUJPO FODPVSBHFSFDPWFSZPGJOKVSFE r High compressive strength
pulp from thermal, mechanical or chemical trauma, r Biocompatible
galvanic shock and microleakage. When cavity is deep, r Economical.
Disadvantages Out of these, quaternary alloys are most acceptable.

r Based on whether alloy is unmixed or admixed
r Unesthetic
– Single composition or unicompositional: Each
r Need extensive tooth preparation for retention
particle of alloy has same chemical composition
r Corrode or tarnish overtime, causing discoloration
– Admixed alloys: These are physical blend of lathe cut
r Brittle material because of low tensile strength
and spherical particles.
r Results in galvanic current in association with gold
restoration.
Composition
Classification Amalgam consists of amalgam alloy and mercury.
Amalgam alloy is composed of silver–tin alloy with
r Based on shape of particles
varying amounts of copper, zinc, indium and palladium
– Irregular: In this, shape of particles is irregular, may
et
(Fig. 11.27).
be in the shape of spindles or shavings
Table 11.2 TVNNBSJ[FT UIF EJŀFSFODFT CFUXFFO IJHI
– Spherical: In this, shape of particle is spherical with
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and low-copper amalgam alloys.
smooth surface
– Spheroidal: In this, shape of particle is spheroidal
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Types
with irregular surface.
r Based on copper content Lathe-cut is made by cutting fillings of alloy from a
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– Low copper alloy: Copper is in range of 2–6% QSFIPNPHFOJ[FEJOHPUXIJDIXBTIFBUUSFBUFEBU$GPS
– High copper alloy: Copper is in the range of 6–30%. NBOZIPVST'JMMJOHTBSFUIFOSFIFBUFEBU$GPSIPVS
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r Based on zinc content for aging of the alloy.
– Zinc containing alloys: Zinc is in range of 0.01–1% Spherical (spheroidal) alloy is formed when molten
alloy is sprayed into a column filled with inert gas, this
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– Zinc free alloys:;JODJTJOUIFSBOHFPG
r Based on presence of alloyed metals molten metal solidifies as fine droplets of alloy.
– Binary alloys: Contains two metals, i.e. silver and tin Admixed alloy JT UIBU XIFO EJŀFSFOU TJ[F PS TIBQF PG
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– Tertiary alloys: Contain three metals, i.e. silver, tin amalgam powder is mixed together to increase filling
and copper efficiency.
– Quaternary alloys: Contain four metals, i.e. silver, tin, Single composition is that alloy in which every particle
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copper and zinc of alloy is having same shape, size and composition.
Dispersion modified, high copper alloys is that in
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which high-copper alloy is mixed with conventional alloy.
Proportioning
tp
Usually alloy/mercury ratio ranges between 5:8 and 10:8.

ht
But to achieve optimum properties of the amalgam,

mercury should be less than 50%. For lathe-cut alloys,
it is 45% and for spherical alloys, it is 40%. Disposable
Figure 11.27: Schematic representation of silver, tin, copper capsules containing preproportioned aliquots of mercury
and zinc in amalgam alloy powder are available. To prevent any amalgamation during storage
Table 11.2 ¨Composition of amalgam alloys (percentage of elements by weight)

Alloy Particle Silver Tin Copper Zinc Palladium Indium
1. Low copper Lathe cut or 65–77 26–28 2–5 0–2 0 0
Spherical
2. High copper
i. Admixed a. Lathe cut 40–70 26–30 13–30 0–1 0 0
ii. Unicompositional b. Spherical 40–70 0–30 20–30 0 0 0
Spherical 40–60 22–30 15–30 0–1 0–4 0
mercury and alloy are physically separated from each Ag-Sn-Cu + Hg o Ag2Hg3 + Cu6Sn5 + (Unconsumed
other. (alloy particles) (J1) (K) alloy particles)
Final phase formed is Cu6Sn5 (K). There is no Ag2Hg3
Setting Reaction
(J2) phase.
For Lathe-cut Low-copper Alloys Table 11.3 TIPXT EJŀFSFOU QIBTFT PG TJMWFS BNBMHBN
setting reaction.
On mixing amalgam alloy with mercury, the alloy particles
get dissolved in the mercury. Mercury reacts with alloy
Structure of Set Amalgam
particles to form two products, i.e. the silver–mercury
phase and tin–mercury phase. After this reaction, the Set amalgam mass consists of unreacted alloy particles
unreacted particles are embedded in the matrix of reaction surrounded by a matrix of the reaction products (Fig.
products with mercury. The reaction is as follows: 11.28).
et
Ag3Sn + Hg o Ag2Hg3 + Sn7–8Hg3 + Ag3Sn
Manipulation
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(J) (J1) (J2) (J)
Selection of Amalgam Alloy
In lathe-cut low-copper amalgams both J1 and J2 form
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a continuous network. Since J2 phase is least corrosion r 5ZQFTPGBMMPZ
resistant phase, its distribution in reaction product is – High-copper or low-copper alloys
nt
important. – Zinc-free or zinc-containing alloys
– Size and shape of the particles.
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For Admixed High-copper Alloys Factors affecting selection of alloy:
'PSIJHIDPQQFSBMMPZT UIFSFBDUJPOJTEJŀFSFOU*UPDDVSTJO r 1BUJFOUTXJUIQTZDIPMPHJDBMQSPCMFNTPSSFRVJSJOHFBSMZ
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two phases. Initial reaction is similar to that of low-copper disposal, indicate the use of fast-setting alloy
alloys, i.e. r *O XJEFS BOE CSPBEFS QSFQBSBUJPOT QSFGFS BMMPZ XJUI
low creep values
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Ag3Sn + Ag-Cu + Hg o Ag2Hg3 + Sn7–8Hg3 + Ag3Sn +

r *GJUJTEJŁDVMUUPDPOUSPMNPJTUVSF JUJTQSFGFSSFEUPVTF
Ag-Cu
zinc-free alloy to avoid delayed expansion.
(J) (eutectic) (J1) (J2) (J)
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(unreacted) Mercury Alloy Ratio

Second phase of reaction involves the silver–copper r &BNFT QSFGFSSFE SBUJP PG BMMPZNFSDVSZ GPS CFTU
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phase (Ag-Cu). results. Generally, it is 5:8 or 5:7 ratio. Lathe-cut

It reacts with J (Ag3Sn) and mercury to form Ag2Hg3, amalgam alloys require more mercury than spherical
tp
Sn7-8Hg and Cu6Sn5 phase. The mercury released from alloys

Sn7-8Hg (J2 phase) reacts with silver to form Ag2Hg5 (J1) r *f mercury content is more than required amount,
ht
phase. resultant mix will be weaker

Sn7–8Hg + Ag-Cu o Cu6Sn5 + Ag2Hg3 + Ag-Cu
(J) (eutectic) ( K) ( J )
Table 11.3 ¨Phases of silver amalgam
This reaction goes on. After one week, the J2 phase reacts
Code Component
completely with eutectic and replaces all the J2 phase by J
and J1 phase. (J) gamma Ag3Sn (silver–tin phase) strongest phase
(J1) gamma 1 Ag2Hg3(silver–mercury phase) noblest phase

For Unicompositional Silver Alloy
(J2) gamma 2 Sn7-8Hg3 (tin–mercury phase)—Least resistant to
%JŀFSFODFJOBENJYUZQFBOEUIFVOJDPNQPTJUJPOBMBMMPZT tarnish and corrosion
is that in latter the eutectic phase, i.e. Ag-Cu phase is
(H) epsilon Cu3Sn (copper–tin phase)
absent and the reaction is directly with silver, copper and
tin phases. In these, only silver reacts with mercury and (K) eta Cu6Sn5 (copper–tin phase). More corrosion
resistant and stronger than gamma 2 phase
the tin remains bound to copper.
r *G NFSDVSZ JT MFTT JU NBZ OPU TVŁDJFOUMZ XFU UIF BMMPZ
particles
r $BQTVMFT XJUI QSPQPSUJPOFE BNPVOUT PG BMMPZ BOE
mercury are made available.
Trituration
Trituration removes oxide layer from alloy particles so as to
coat each alloy particle with mercury.
Method
Mechanical: It is done with the help of automatic amalgama-
tor (Figs 11.29)
et
Manual: It is done with the help of mortar and pestle
(Fig. 11.30).
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Objectives Figure 11.29: Photograph showing amalgamator for mechanical
r *ODSFBTF EJSFDU DPOUBDU CFUXFFO QBSUJDMF BOE NFSDVSZ trituration of amalgam
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by removing oxides from powder
r )FMQJOEJTTPMWJOHQPXEFSQBSUJDMFTJONFSDVSZ
nt
r 3FEVDFUIFBNPVOUPGHBNNBBOEHBNNB
r Normal trituration
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– Good shiny mix
– Convenient to handle
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– Mix is plastic in consistency
– Homogeneous mass which adheres together
(Fig. 11.31).
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r Over-trituration
– Mix is ‘warm’
– Mix sticks to the capsule which is difficult to remove
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– Shiny, wet and soft (Fig. 11.32).

r Under-trituration
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– Dry and crumbly mix that is very weak (Fig. 11.33)

– Low tensile and compressive strength values Figure 11.30: Photograph showing mortar and pestle for manual
triturition
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– Increase in creep.
Mulling
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Mulling is continuation of trituration which can be done

manually or mechanically.
Figure 11.31: Photograph showing optimally triturated amalgam. It

Figure 11.28: Schematic representation of set amalgam showing is a homogeneous mass which adheres together. It appears shiny and
unreacted alloy particles surrounded by matrix of reaction products is easy to handle
Manually, it is done by squeezing the freshly mixed amal- Postcarve Burnishing

gam collected in the chamois skin. Mechanically, mulling is
done in the amalgamator by triturating it for one to two sec- It is done after completion of carving using burnisher
onds. Mulling results in formation of coherent, consistent and with light strokes to improve the smoothness with shiny
a homogeneous mix. appearance (Fig. 11.37).
Objectives
Insertion of Amalgam
r 3FEVDFTOVNCFSPGWPJETPOTVSGBDFPGSFTUPSBUJPO
Use amalgam carrier to carry amalgam alloy into the r *NQSPWFTNBSHJOBMTFBM
preparation and condense it with flat surface of condenser. r *ODSFBTFTTVSGBDFIBSEOFTT
After it, add next increment and again condense it r %FDSFBTFTSBUFPGDPSSPTJPO
(Fig. 11.34). When level of amalgam reaches preparation
margins, continue the packing of preparation to allow an Finishing and Polishing
et
excess to build up for better finishing.
Polishing is done to achieve a smooth, shiny luster on
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surface of amalgam restoration (Fig. 11.38). Finishing is
Condensation
done before polishing by using abrasive agents, which are
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DJŀFSFOUTIBQFT USJBOHVMBS SPVOE FMMJQUJDBM USBQF[PJEBM coarse enough to remove bulk from the surface.
and rectangular) and sizes of condensers are used for Finishing and polishing should be done after 24 hours
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amalgam condensation. Working end of a condenser is of placement of amalgam restoration. Premature finishing
serrated (Fig. 11.35). and polishing will interfere with crystalline structure
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of hardening amalgam, resulting in weakening of the
Objectives
r Brings excess mercury on the surface of restoration restoration.
r Reduces the number and size of voids in the restoration
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r Adapts amalgam to the preparation walls and floors.

Physical Properties
Dimensional Change
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Precarve Burnishing
Small amount of contraction occurs in first half an hour
Burnishing is process of rubbing of amalgam surface to BGUFS USJUVSBUJPO CFDBVTF NFSDVSZ EJŀVTFT JOUP TJMWFS
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make it shiny. and tin and the mix dissolves in the mercury. After this,
It is done after condensation when amalgam is expansion occurs because of crystallization of new phases.
overfilled. Restoration is burnished immediately with According to ADA specification no. 1 dimensional change
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heavy strokes so as to improve its marginal adaptability

and remove excess mercury from overpacked amalgam.
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Carving
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It is done to produce anatomical contours and functional

occlusion for the restoration. Amalgam should not be
carved until it is sufficiently firm. Larger instrument is
used first, followed by smaller instruments.
In proximal tooth preparation, carving of cervical
margins should begin following the removal of matrix band.
Trim the axial margins towards the gingiva in downward
direction with a sharp carver. Carve the occlusal surface
with a sharp carver like Hollenback. Hold the carver in such
a way that its blade lies across the margin of restoration,
half on tooth and half on restoration (Fig. 11.36). Define
marginal ridge and occlusal embrasure using a sharp Figure 11.32: Photograph showing over-triturated amalgam. It
explorer. sticks to the capsule which is difficult to remove
should be limited to 20 microns/cm measured between 5 Strength

minutes and 24 hours after trituration.
r Compressive strength of amalgam is seven times
Factors Affecting Dimensional Changes of Amalgam more than its tensile or shear strength making it
r More mercury removed from alloy, more it will contract brittle material. Being a brittle material, it is weak in
r Overtrituration causes contraction thin sections, thus unsupported edges of restoration
r If zinc-containing amalgam comes in contact with GSBDUVSFGSFRVFOUMZ5PBWPJEUIJT BCVUUKPJOUBOHMF
moisture or saliva during condensation or trituration, of amalgam is required at the margins
it can result in delayed expansion after 3–5 days of r Increase in mercury content decreases the strength.
restoration. This occurs due to formation of zinc oxide
and hydrogen gas when zinc reacts with water. This Plastic Deformation (Creep)
expansion can result in extrusion of restoration beyond
r $SFFQ JT UJNFEFQFOEFOU SFTQPOTF PG BO BMSFBEZ TFU
et
preparation margins and pulpal pain.
material to stress in form of plastic deformation
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nt
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Figure 11.33: Photograph showing dry and crumbly under-triturat- Figure 11.35: Photograph showing that amalgam is condensed with
ed amalgam the help of condenser. Working end of a condenser should be serrated
://
tp
ht
Figure 11.34: Photograph showing amalgam is carried into the Figure 11.36: Photograph showing carving of the occlusal surface with
prepared tooth with the help of amalgam carrier a sharp carver like Hollenback, keeping it parallel to the cuspal inclines
r #Z"%"TQFDJêDBUJPOOP DSFFQJTMJNJUFEUPJOTFU Indications

amalgam
r Moderate to large class I preparations
r $SFFQJTVOEFTJSBCMFCFDBVTFJUDBVTFTBNBMHBNUPëPX
r In large preparations especially in patients with:
out over the margins resulting in marginal deterioration
– Extension on the root surface
and fracture. – Problem of isolation.
Factors Affecting Creep r Class V preparations when esthetic is not a problem
r Low-copper alloys have higher creep than high-copper r Amalgam is used as postendodontic restoration.
alloys
r Residual mercury is directly proportional to creep Contraindications
r Increased condensation pressure reduces creep r Where esthetics is required
because it reduces residual mercury level r Small class I preparations should be restored with
et
r Delay between trituration and condensation increases composite rather than amalgam
creep. r In grossly decayed teeth, because it does not reinforce
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the remaining tooth structure.
Corrosion
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Amalgam restoration shows tarnish and corrosion DENTAL CASTING ALLOYS
over a period of time. Advantage of corrosion is that its
nt
Casting is most commonly used methods for the fabrication
by-products seal the preparation margin, resulting in self-
of metal structures like crowns, inlays and denture bases.
sealing of amalgam.
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Pattern of the structure is made in wax which is then
surrounded by investment material. After the investment
Thermal Conductivity
hardens, wax is removed by burn out leaving a space.
ks
Because of good thermal conductivity, amalgam can Molten metal is then forced into this space resulting in
transmit temperature changes readily to the pulp. Hence, formation of desired structure.
its closeness to pulp should be avoided without adequate
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For dental use, metals are subdivided into two

pulp protection. NBKPS HSPVQT OPCMF NFUBMT BOE CBTF NFUBMT /PCMF
metals are defined by their resistance to corrosion even
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Coefficient of Thermal Expansion under extreme conditions that occur in the oral cavity.
Coefficient of thermal expansion of amalgam is three Commonly used noble metals in dental casting alloys are
UJNFT NPSF UIBO UIBU PG EFOUJO ǔJT MBSHF EJŀFSFODF JT gold, palladium, and platinum. In dental casting alloys,
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responsible for microleakage. other than noble metals are the base metals. Common
tp
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Figure 11.37: Photograph showing postcarve burnishing Figure 11.38: Photograph showing carved amalgam restoration
base metals are titanium, nickel, copper, silver, cobalt, and r Type I: (soft)
zinc. Base metals have a greater tendency to corrode in the – Soft, weak and ductile
oral environment than noble metals. For this reason, pure – Used in low-stress areas
– Simple inlays in class I, III or V cavities
base metals are almost never used for dental restorations.
– Highly burnishable.
We will discus ideal requirements, clasification and uses of
r Type II: (medium)
dental casting alloys. – Harder and stronger than type I
– Ductility same as type I though yield strength high
Requirments of Dental Casting Alloys – Used in moderate-stress areas
– Thick three quarter crowns, pontics and full crowns
Dental casting alloys should:
– Less burnishable.
r Be biocompatible
r Type III: (hard)
r Have high wear resistance – Used in high stress areas
et
r Have high density so as to allow them to flow easily into – Less burnishable than type I and II
the mold space before it cools and solidifies
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r Have high strength
Table 11.4 ¨Classification by American Dental Association (1984)
r Be able to be soldered using gold solders with few
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failures Alloy type Noble metal content
r Be easy to finish and polish. High noble Contains ≥ 40 wt% gold and ≥ 60 wt% of noble
nt
metal metal elements
Classification and Composition
Noble metal Contains ≥ 25 wt% of noble metal elements
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In 1927, the Bureau of Standard divided gold casting alloys
Predominantly Contains ≤ 25 wt% of noble metal elements
into type I to IV, according to their use (Table 11.4). base metal
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tp
ht
Figure 11.39: Schematic representation of different uses of metals and alloys in dentistry
– High-stress inlays, full crowns, pontics, short-span r Type II: Used as base. It results in film thickness
FPD’s. between 25 and 40 microns.
r Type IV: (extra hard)
– Used in very high-stress areas Q.8. What is composition of zinc phosphate cement?
– Lowest gold content Ans. r 1PXEFS
– Least ductile. – ZnO—90.2%.
Figure 11.39 TIPXJOH EJŀFSFOU VTFT PG NFUBMT BOE – MgO—8.2%
alloys in dentistry. – SiO2—1.4%
– Bi2O3—0.1%
– Miscellaneous—BaO, Ba2SO4, CaO
VIVA QUESTIONS
r -JRVJE
Q.1. Define dental cements – Phosphoric acid – 38.2%
et
Ans. These are the materials made from two components, – Water – 36.0%
powder and liquid, mixed together. – Aluminum or zinc phosphate – 16.2%
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Q.2. What are uses of dental cements? – Zinc – 7.1%
Ans. r "TUFNQPSBSZSFTUPSBUJPO – Aluminum – 2.5%
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r 'PSMVUJOH Q.9. Why zinc phosphate powder is mixed in
r "TSPPUDBOBMTFBMFS increments?
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r 'PSQVMQQSPUFDUJPO Ans. Powder is divided into 5–8 increments.
– Bases r *OJUJBMJODSFNFOUTBSFTNBMMFSJOTJ[FTPBTUP
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– Liners. – Achieve the slow neutralization of the liquid
Q.3. What is composition of ZOE cements? – Control the reaction.
ks
Ans. r 1PXEFS r .JEEMFJODSFNFOUTBSFMBSHFSJOTJ[F

– Zinc oxide (ZnO)—69.0% – To saturate the liquid to form zinc phosphate
– Because of presence of less amount of
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– White rosin—29.3%
– Zinc stearate—1.0% VOSFBDUFEBDJE UIJTTUFQJTOPUBŀFDUFECZIFBU
– Zinc acetate (acts as accelerator)—0.7% released from the reaction.
r *OUIFFOE UIFTNBMMFSJODSFNFOUTPGQPXEFSBSF
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r -JRVJE
– Eugenol—85.0% added so as to:
– Olive oil—15.0% – Achieve optimum consistency.
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Q.4. Why is ZOE not used with resins? Q.10. What is composition of zinc polycarboxylate
Ans. Zinc oxide eugenol is not used with resins because cement?
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eugenol interferes with polymerization process of Ans. Powder is similar to that of zinc phosphate cement
resins. powder.
ht
Liquid is an aqueous solution of 32–43%

Q.5. How does setting of ZOE cement take place? polyacrylic acid.
Ans. On mixing powder and liquid, the zinc oxide
hydrolysis and subsequent reaction take place Q.11. Why is zinc polycarboxylate cement
between zinc hydroxide and eugenol to form a biocompatible?
chelate, zinc eugenolate. Ans. r 4J[F PG QPMZBDSZMJD BDJE NPMFDVMF JT CJHHFS UIJT
makes it less favorable to disperse into the
Q.6. Why should the liquid bottle be kept perpendicular dentinal tubules
to glass slab/paper pad while dispensing? r Q) PG UIF DFNFOU SJTFT NPSF SBQJEMZ XIFO
Ans. It lets the fluid fall under its own weight. compared to that of zinc phosphate.
Q.7. What are types of zinc phosphate cement? Q.12. Why GIC is called hybrid cement?
Ans. r Type I: Used for cementation. It forms the film Ans. Glass ionomer cement is also described as hybrid
thickness of less than 25 microns of dental silicate cements and zinc polycarboxylates
where phosphoric acid of silicate cements is replaced r -POHQPMZNFSDIBJOTUBOHMFJOPOFBOPUIFSǔJT

by polyacrylic acid of zinc polycarboxylates. prevents their penetration into dentin tubules.
Q.13. What is composition of glass ionomer cement? Q.20. What will happen if GIC is exposed to air/
Ans. r 4JMJDB desiccation after mixing?
r "MVNJOB Ans. r *G EFTJDDBUJPO PDDVST EVSJOH JOJUJBM TFUUJOH PG
r "MVNJOVNëVPSJEF cement, it retards the setting reaction since water
r $BMDJVNëVPSJEF plays an important role in setting reaction
r 4PEJVNëVPSJEF r *G EFTJDDBUJPO PDDVST JO MBUFS TUBHFT JU QSFWFOUT
r "MVNJOVNQIPTQIBUF increase in strength of cement because hydration
r 1PMZBDSZMJDBDJE of silica-based hydrogel and polycarboxylates
(itaconic acid, maleic acid) 40–55% cannot occur. It can also result in crazing,
et
r 5BSUBSJDBDJE m decreased esthetics and early deterioration of the
r 8BUFS cement.
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Q.14. What is composition of miracle mix? Q.21. How does GIC adheres to tooth structure?
Ans. Powder: Physical blend of silver alloy and glass Ans. GIC bonds to tooth structure by chelation of
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powder in 1:7 ratio. carboxyl groups of the cement and calcium of the
Liquid: Glass ionomer cement liquid. tooth structure.
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Q.15. What is composition of ceremet cement? Q.22. Why GIC bonds better to enamel than dentin?
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Ans. Powder: Sintering of silver powder and glass Ans. Since enamel has higher percentage of inorganic
powder, 5% titanium oxide. content, bonding of GIC to enamel is stronger than
Liquid: Glass ionomer cement liquid. to dentin.
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Q.16. What is composition of resin-modified GIC? Q.23. What are advantages of GIC?
Ans. Powder: Fluoroaluminosilicate glass particles along Ans. r "EIFTJPO
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with photoinitiator or chemical initiator. r #JPDPNQBUJCMF

Liquid: 15–25% resin component in the form of r "OUJDBSJPHFOJD
HEMA r $POTFSWBUJWFUPPUIQSFQBSBUJPO
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Polyacrylic acid copolymer along with r &TUIFUJD

photoinitiator and water. r -PXTPMVCJMJUZ
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Q.17. How does setting of glass ionomer take place? Q.24. What are different pulpal irritants?
Ans. *UPDDVSTJOUISFFEJŀFSFOUCVUPWFSMBQQJOHTUBHFT Ans. r #BDUFSJBM
tp
1. Ion-leaching phase. r 5SBVNBUJD

2. Hydrogel phase. r *BUSPHFOJD
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3. Polysalt gel phase. r *EJPQBUIJD

Q.18. What are mechanical properties of GIC? Q.25. What are factors affecting pulp while tooth
Ans. Glass ionomer cements have high compressive preparation?
strength, high modulus of elasticity but low fracture Ans. r 1SFTTVSF
toughness, flexure strength and wear resistance. All r )FBU
these make GICs hard but brittle material. r 7JCSBUJPO
r 3FNBJOJOHEFOUJOUIJDLOFTT
Q.19. What makes the GIC biocompatible?
r 4QFFE
Ans. r 1PMZBDSZMJD BDJE QSFTFOU JO UIF MJRVJE JT B XFBL
r /BUVSFPGDVUUJOHJOTUSVNFOUT
acid
r %JTTPDJBUFE IZESPHFO JPOT QSFTFOU JO (*$ Q.26. What are uses of varnish?
are further bound to the polymer chains Ans. r 3FEVDFTNJDSPMFBLBHF
electrostatically
r *ODBTFPGBNBMHBNSFTUPSBUJPO WBSOJTIJNQSPWFT Q.35. What should be the thickness of base?

the sealing ability of the amalgam Ans. 0.5–2.0 mm.
r 3educes postoperative sensitivity Q.36. Which materials are used as bases?
r 1SFWFOUTEJTDPMPSBUJPOPGUPPUI Ans. Zinc oxide eugenol, zinc phosphate cement, GIC
Q.27. Why do we use varnish? and calcium hydroxide.
Ans. r 5PTFBMUIFEFOUJOBMUVCVMFT Q.37. Should base be applied to gingival seat?
r 5P BDU BT CBSSJFS UP QSPUFDU UIF UPPUI GSPN Ans. No. Since it will be open to external margin, the
chemical irritants from cements base might get dissolved/disintegrated because of
r 5PSFEVDFNJDSPMFBLBHFBSPVOESFTUPSBUJPOT action of saliva resulting in microleakage and thus,
Q.28. Which materials are used for varnish? secondary caries.
Ans. Varnish is an organic copal or resin gum suspended Q38. Where should be the varnish applied?
et
in solutions of ether or chloroform. Ans. 2-3 coats of varnish should be applied on all the
QSFQBSFE TVSGBDFT WJ[ XBMMT BOE ëPPST JODMVEJOH
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Q.29. How is varnish applied?
margins of preparation.
Ans. Varnish is applied on cavity walls using a small
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cotton pellet. Q.39. What is the film thickness of varnish?
Ans. 5-10 Micrometers
Q.30. Where is use of varnish contraindicated?
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Ans. r #FOFBUI(*$BTWBSOJTIJOUFSGFSFTUIFCPOEJOH Q.40. What is a sub-base?
r 8JUISFTUPSBUJWFSFTJOTCFDBVTFWBSOJTIEJTTPMWFT Ans. It is given at the deepest portion of the tooth
de
in monomer and also interfere with the preparation for reparative dentin formation.
polymerization of resins. Commonly used material as sub-base is calcium
hydroxide.
ks
Q.31. What are functions of cavity liners?

Q.41. Name tooth colored restorations.
Ans. r 1rotect pulp from chemical irritants by sealing
Ans. GIC, Composites and ceramic restorations.
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ability
r 4UJNVMBUFGPSNBUJPOPGSFQBSBUJWFEFOUJO Q.42. Where is calcium hydroxide used?
Ans. Direct pulp capping.
Q.32. Which materials are used as cavity liners?
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1. Indirect pulp capping.

Ans. r ;JODPYJEFFVHFOPMMJOFST 2. Pulpotomy.
r $BMDJVNIZESPYJEF 4. Apexogenesis.
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r 'MPXBCMFDPNQPTJUFT 5. Apexification.
r (MBTTJPOPNFST 6. As root canal sealer.
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Q.33. What are bases? 7. Intracanal medicament.

Ans. Bases are used as pulp protective materials and they Q. 43. Where should be base applied?
ht
provide thermal insulation, encourage recovery of Ans. On pulpal floor and axial wall.
JOKVSFEQVMQGSPNUIFSNBM NFDIBOJDBMPSDIFNJDBM Q.44. What are adhesive cements?
trauma, galvanic shock and microleakage. Ans. Cements which form chemical bonding to tooth
Q.34. What is pH of calcium hydroxide? structure are called adhesive cements. For example
Ans. 12.5. GIC and zinc polycarboxylate cement.
CHAPTER
12
Adhesive Dentistry
Nisha Garg, Jaidev Singh Dhillon, Damanpreet
et
CHAPTER OUTLINE
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Introduction Evolution of Dentin Bonding Agents
Enamel Bonding Dental Composites
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Dentin Bonding Viva Question
Dentin Bonding Agents
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INTRODUCTION Indications for Use of Adhesives
Adhesive dentistry allows the dentist to restore the teeth r 5P SFTUPSF FSPTJPO BCSBTJPO PS BCGSBDUJPO MFTJPOT JO
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in the most conservative manner. Restorative materials cervical areas

which are adhesive in nature (i.e. bonded to enamel or r 'PSQJUBOEêTTVSFTFBMBOUT
dentin), not only replace the missing tooth structure (due r 5PCPOEDPNQPTJUFSFTUPSBUJPOT
eb
to decay or trauma) but also strengthens and support the r 5PMVUFDSPXOT

remaining tooth structure without removal of healthy r 5PDPSSFDUTIBQF TJ[FBOETIBEFPGUFFUI
tooth structure. r 'PS UIF SFQBJS PG GSBDUVSFE QPSDFMBJO BNBMHBN BOE
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resin restorations
Definitions r 5PCPOEPSUIPEPOUJDCSBDLFUT
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r 5PUSFBUEFOUJOIZQFSTFOTJUJWJUZ
Adhesion
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Forces or energies between atoms or molecules at an Advantages

interface that hold two phases together.
r .JOJNJ[FTSFNPWBMPGTPVOEUPPUITUSVDUVSF
Adherend r 3FJOGPSDFTXFBLFOFEUPPUITUSVDUVSF
r Repair of porcelain or composite restorations
Surface or substrate that is adhered.
r Bonding amalgam restorations to tooth
r Management of dentin hypersensitivity
Adhesive/Adherent
r 3FEVDFTNJDSPMFBLBHFBUUPPUISFTUPSBUJPOJOUFSGBDF
A material that can join substances together, resist r Bonding of porcelain restorations, e.g. porcelain inlays,
separation and transmit loads across the bond. onlays and veneers
ENAMEL BONDING r &YQPTFTNPSFSFBDUJWFTVSGBDFMBZFS UIVTJODSFBTJOHJUT

wettability.
#VPOPDPSF JO XBTUIFêSTUUPSFWFBMUIFBEIFTJPOPG
acrylic resin to acid etched enamel. Standard treatment DENTIN BONDING
protocol for etching is use of 37% phosphoric acid for 15–20
seconds. Problems Encountered during Dentin Bonding
r %FOUJODPOUBJOTNPSFXBUFSUIBOEPFTFOBNFM
Steps for Enamel Bonding r 8IFO B UPPUI TVSGBDF JT BMUFSFE VTJOH IBOE PS SPUBSZ
r 8BTIBOEESZUIFUFFUI instruments, cutting debris are gathered on enamel and
r "QQMZQIPTQIPSJDBDJEFUDIBOUJOUIFGPSNPGMJRVJE dentin surface, forming a smear layer
or gel for 10–15 seconds r %FOUJO DPOUBJOT EFOUJOBM UVCVMFT XIJDI DPOUBJO WJUBM
QSPDFTTFT PG UIF QVMQ PEPOUPCMBTUT ǔJT NBLFT UIF
et
r 8BTIUIFFUDIBOUDPOUJOVPVTMZGPSmTFDPOET
r /PUF UIF BQQFBSBODF PG B QSPQFSMZ FUDIFE TVSGBDF *U dentin a sensitive structure
r 'MVJE QSFTFOU JO EFOUJOBM UVCVMFT DPOTUBOUMZ ëPXT
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should give a frosty white appearance on drying
r *G BOZ TPSU PG DPOUBNJOBUJPO PDDVST SFQFBU UIF outwards which interferes with the adhesion of the
composite resin.
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procedure
r /PXBQQMZCPOEJOHBHFOUBOEMPXWJTDPTJUZNPOPNFST
over the etched enamel surface. Commonly used Moist vs Dry Dentin
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bonding agent contains Bisphenol glycidyl methacrylate By etching dentin, the smear layer and minerals from it are
#JT(."
BOE6SFUIBOFEJNFUIBDSZMBUF 6%."

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SFNPWFE FYQPTJOHUIFDPMMBHFOêCFST(Fig. 12.1)*ONPJTU
EFOUJO BSFBTGSPNXIFSFNJOFSBMTBSFSFNPWFEBSFêMMFE
Effects of Etching XJUI XBUFS ǔJT XBUFS BDUT BT B QMBTUJDJ[FS GPS DPMMBHFO
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Etching of enamel: LFFQJOHJUJOBOFYQBOEFETPGUTUBUFǔVT TQBDFTGPSSFTJO

r $MFBOTFTEFCSJTGSPNFOBNFM JOêMUSBUJPO BSF BMTP QSFTFSWFE #VU UIFTF DPMMBHFO êCFST
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r *ODSFBTFTUIFFOBNFMTVSGBDFBSFBBWBJMBCMFGPSCPOEJOH DPMMBQTFXIFOESZBOEJGUIFPSHBOJDNBUSJYJTEFOBUVSFE
r 1SPEVDFT NJDSPQPSFT JOUP XIJDI UIFSF JT NFDIBOJDBM (Fig. 12.2). This obstructs the resin from reaching the
JOUFSMPDLJOHPGUIFSFTJO dentin surface and forming a hybrid layer.
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Figure 12.1: Schematic representation showing etching of dentin Figure 12.2: Schematic representation showing in dehydrated den-
causes exposure of collagen fibrils. Interfibrillar water acts as plasti- tin, loss of water causes collapse of collagen fibrils which prevent pen-
cizer and keeps the fibers open etration of monomer
Adhesive Dentistry 173
Therefore, presence of moist dentin is needed to achieve Classification of Modern Adhesives

successful dentin bonding.
Based on Generations
DENTIN BONDING AGENTS r 'JSTUHFOFSBUJPOCPOEJOHBHFOU
r 4FDPOEHFOFSBUJPOCPOEJOHBHFOU
Mechanism of Bonding
r ǔJSEHFOFSBUJPOCPOEJOHBHFOU
%FOUJOBEIFTJWFNPMFDVMFIBTBCJGVODUJPOBMTUSVDUVSF r 'PVSUIHFOFSBUJPOCPOEJOHBHFOU
.39 r 'JGUIHFOFSBUJPOCPOEJOHBHFOU
8IFSF r 4JYUIHFOFSBUJPOCPOEJOHBHFOU
.JTUIFEPVCMFCPOEPGNFUIBDSZMBUFXIJDIDPQPMZNFSJ[FT r 4FWFOUIHFOFSBUJPOCPOEJOHBHFOU
with composite resin.
3 JTUIFTQBDFSXIJDINBLFTUIFNPMFDVMFMBSHF
et
9 JT B GVODUJPOBM HSPVQ GPS CPOEJOH XIJDI CPOET UP
EVOLUTION OF DENTIN BONDING
inorganic or organic portion of dentin. AGENTS
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*EFBMMZ B EFOUJO CPOEJOH BHFOU TIPVME IBWF CPUI
)JTUPSJDBMMZ %#"T IBWF CFFO DMBTTJêFE CBTFE PO
hydrophilic and hydrophobic ends. The hydrophilic
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chemistry and the manner in which they treat the smear
FOE EJTQMBDFT UIF EFOUJOBM ëVJE UP XFU UIF TVSGBDF ǔF
layer.
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hydrophobic end bonds to the composite resin (Fig. 12.3).
Bonding to the inorganic part of dentin involves ionic
JOUFSBDUJPOBNPOHUIFOFHBUJWFMZDIBSHFEHSPVQPO9 GPS
First Generation Dentin Bonding agents
de
FYBNQMF QIPTQIBUFT BNJOPBDJETBOEBNJOPBMDPIPMT PS These were developed in 1960s.
EJDBSCPYZMBUFT
BOE UIF QPTJUJWFMZ DIBSHFE DBMDJVN JPOT Mechanism of adhesion was deep penetration of the
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Bonding to the organic part of dentin involves interaction SFTJOUBHTJOUPUIFFYQPTFEEFOUJOBMUVCVMFTBGUFSFUDIJOH
XJUIBNJOP m/)
IZESPYZM m0)
DBSCPYZMBUF m$00)
and the chelating component which could bond to the
BNJEF m$0/)
HSPVQTQSFTFOUJOEFOUJOBMDPMMBHFO
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calcium component of dentin (Fig. 12.4). Since they

could chelate with calcium ions of the tooth structure,
Ideal Requirements of Dentin Bonding Agent
they formed stronger bonds with enamel than dentin
eb
*EFBMSFRVJSFNFOUTPGEFOUJOCPOEJOHBHFOU %#"T
BSF but these products ignored the importance of smear
r 1SPWJEFPQUJNBMCPOETUSFOHUITJNJMBSUPCPOETUSFOHUI layer.
of composite to resin
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r #JPDPNQBUJCJMJUZ Disadvantages
r -POHUFSNTUBCJMJUZ
tp
r "UUBJOIJHICPOETUSFOHUIFBSMZ r -PXCPOETUSFOHUI JOUIFPSEFSPGm.1B

r #FFBTZUPBQQMZBOEOPUCFUFDIOJRVFTFOTJUJWF r -PTTJOCPOETUSFOHUIPWFSUJNF
ht
Figure 12.3: Schematic representation showing that in a bonding Figure 12.4: Schematic representation showing that in first genera-
agent, hydrophilic end displaces the dentinal fluid to wet the surface tion bonding agents bonding occurred because of deep penetration
and hydrophobic end bonds to the composite resin of resin tags into open dentinal tubules
Second Generation Dentin Bonding Agents UIFQSPDFTTPGIZCSJEJ[BUJPOBUUIFJOUFSGBDFPGUIFEFOUJO

and the composite resin. )ZCSJEJ[BUJPO JT UIF QSPDFTT PG
They were introduced in the late 1970s. Most of the second
SFTJO JOUFSMPDLJOH JO UIF EFNJOFSBMJ[FE EFOUJO TVSGBDF
generation bonding agents leave the smear layer intact
(Fig. 12.7) ǔJT DPODFQU XBT HJWFO CZ /BLBCBZBTIJ JO
when used but some of them employed the use of mild
'PVSUIHFOFSBUJPOBEIFTJWFTJOWPMWFVTFPGFUDIBOUT
cleansing agents to remove the smear layer (Fig. 12.5).
MJLF QIPTQIPSJD BDJE QSJNFST DPOTJTU PG NPOPNFST
They achieved the bond strengths ranging from about
MJLF )ZESPYZFUIZM NFUIBDSZMBUF )&."
BOE .FUI
m.1B
BDSZMPYZFUIZM USJNFMMJUBUF BOIZESJEF .&5"
BOE
adhesive resin.
Disadvantages
r -PXCPOETUSFOHUI Advantages
r -PTTJOCPOETUSFOHUIPWFSUJNF
et
r Ability to form a strong bond to both enamel and dentin
r )JHICPOETUSFOHUIUPEFOUJO m.1B

Third Generation Dentin Bonding Agents
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ǔJSEHFOFSBUJPO%#"BUUFNQUFEUPEFBMXJUITNFBSMBZFS Disadvantages
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BOE EFOUJOBM ëVJET ǔF BQQMJDBUJPO PG UIJSEHFOFSBUJPO
r 5JNFDPOTVNJOH
dentin bonding agents involves three steps: Etching with
r More number of steps.
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an acidic conditioner, priming with a bifunctional resin in
BWPMBUJMFTPMWFOUBOECPOEJOHXJUIBOVOêMMFEPSQBSUJBMMZ Fifth Generation Dentin Bonding Agents
de
êMMFESFTJO
*O UIFTF BHFOUT UIF QSJNFS BOE BEIFTJWF SFTJO BSF JO
Advantages POF CPUUMF #BTJD EJŀFSFODFT CFUXFFO GPVSUI BOE êGUI
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generation is the number of basic components of bottles.
r )JHIFSCPOETUSFOHUI m.1B
Fourth generation bonding system is available in two
r 3FEVDFENJDSPMFBLBHF CPUUMFT POF QSJNFS BOE PUIFS BEIFTJWF êGUI HFOFSBUJPO
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dentin bonding agents are available in one bottle only

Disadvantages (Fig. 12.8).
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r %FDSFBTFJOCPOETUSFOHUIXJUIUJNF
r *ODSFBTFJONJDSPMFBLBHFXJUIUJNF Advantages
r )JHI CPOE TUSFOHUI BMNPTU FRVBM UP UIBU PG GPVSUI
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Fourth Generation Dentin Bonding Agents HFOFSBUJPOBEIFTJWFT JFm.1B

r -JUUMFUFDIOJRVFTFOTJUJWF
They were made available in the mid 1990s. These agents are
tp
r Reduced number of steps.

CBTFEPOUPUBMFUDIUFDIOJRVFBOENPJTUCPOEJOHDPODFQU
(Figs 12.6A to C)'PVSUIiHFOFSBUJPOuJTDIBSBDUFSJ[FECZ Disadvantage
ht
r -FTTFS CPOE TUSFOHUI UIBO GPVSUI HFOFSBUJPO CPOEJOH

agents.
Sixth Generation Dentin Bonding Agents

*O TJYUI HFOFSBUJPO FUDIBOU QSJNFS BOE CPOEJOH BHFOUT
are available in single solution. Because of the presence
PG BO BDJEJD QSJNFS TJYUI HFOFSBUJPO CPOEJOH BHFOUT EP
OPU IBWF B MPOH TIFMGMJGF BOE UIVT IBWF UP CF SFGSFTIFE
GSFRVFOUMZ
*OUIFTFBHFOUTBTTPPOBTUIFEFDBMDJêDBUJPOQSPDFTTTUBSUT
Figure 12.5: Schematic representation showing how second genera- JOêMUSBUJPO PG UIF FNQUZ TQBDFT CZ UIF EFOUJO CPOEJOH
tion bonding agents employ use of mild cleansing agents to remove agent is initiated (see Figs 12.6D to F).
the smear layer so that resin penetrates in open tubules
et
A D
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B E
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C F
Figures 12.6A to F: Schematic representation showing total etch vs self-etch systems. Total etch technique involves complete removal of smear
layer by simultaneous acid etching of enamel and dentin. After total etching, primer and adhesive resin are applied separately or together. Acid
removes the dentin smear layer, raises surface energy and modifies the dentin substrate so that it can be infiltrated by subsequently placed primers
and resins. In self etch system, self etching primer is applied on prepared tooth surface. Then demineralized dentin and smear layer is infilterated by
resin during etching process. In this, smear layer is not removed and there is formation of continuous layer incorporating smear plugs into resin tags
Advantages 4FMGFUDIJOHQSJNFSBOEBEIFTJWF

r "WBJMBCMFJOUXPCPUUMFT
r *U FUDIFT UIF EFOUJO MFTT BHHSFTTJWFMZ UIBO UPUBM FUDI
m 1SJNFS
products – Adhesive
r %FNJOFSBMJ[FEEFOUJOJTJOêMUSBUFECZSFTJOEVSJOHUIF r 1SJNFSJTBQQMJFEQSJPSUPUIFBEIFTJWF
etching process r 8BUFSJTUIFTPMWFOUJOUIFTFTZTUFNT
r .VDIGBTUFSBOETJNQMFSUFDIOJRVF 4FMGFUDIJOHBEIFTJWF
r -FTTUFDIOJRVFTFOTJUJWFBTGFXFSOVNCFSPGTUFQTBSF r "WBJMBCMFJOUXPCPUUMFT
JOWPMWFEGPSUIFTFMGFUDITZTUFN m 1SJNFS
– Adhesive
Disadvantage r "ESPQGSPNFBDICPUUMFJTUBLFO NJYFEBOEBQQMJFE
r Q)JTJOBEFRVBUFUPFUDIFOBNFM IFODFCPOEUPFOBNFM UPUIFUPPUITVSGBDF GPSFYBNQMF 1SPNQU-QPQ
et
JTXFBLFSBTDPNQBSFEUPEFOUJO
Seventh Generation Dentin Bonding Agents
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Types of Sixth Generation Bonding Agents ǔFZ BDIJFWF UIF TBNF PCKFDUJWF BT UIF TJYUI HFOFSBUJPO
TZTUFNT FYDFQU UIBU UIFZ TJNQMJêFE NVMUJQMF TJYUI
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4JYUI HFOFSBUJPO CPOEJOH BHFOUT BSF PG UXP UZQFT
(Fig 12.8): generation materials into a single component, single
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Figure 12.7: Schematic representation of fourth generation bonding agents show adhesion by formation of hybrid layer
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Figure 12.8: Schematic representation showing fourth generation

bonding system which is available in two bottles, one primer and Figure 12.9: Schematic representation showing number of compo-
other adhesive resin, while in fifth generation bonding agents, prim- nents of bonding agents. Compare the number of steps from 4th to
er and adhesive are combined in one bottle only 7th generation bonding agents
CPUUMF POFTUFQ TFMGFUDI BEIFTJWF UIVT BWPJEJOH BOZ Advantages

NJTUBLFTJONJYJOH(Fig. 12.9). r 3FEVDFTUIFDPFŁDJFOUPGUIFSNBMFYQBOTJPO
r 3FEVDFTQPMZNFSJ[BUJPOTISJOLBHF
DENTAL COMPOSITES r *ODSFBTFTBCSBTJPOSFTJTUBODF
r %FDSFBTFTXBUFSTPSQUJPO
Composite is a compound composed of at least two
r *NQSPWFTIBOEMJOHQSPQFSUJFT
different materials with properties which are superior or
intermediate to those of an individual component.
Coupling Agents
Composition of Dental composites $PVQMJOH BHFOU CJOET êMMFS QBSUJDMFT UP UIF PSHBOJD SFTJO
*OUFSGBDJBMCPOEJOHCFUXFFOUIFNBUSJYQIBTFBOEUIFêMMFS
r 0SHBOJDNBUSJYPSPSHBOJDQIBTF
QIBTFJTQSPWJEFECZDPBUJOHUIFêMMFSQBSUJDMFTXJUITJMBOF
r 'JMMFSPSEJTQFSTFEQIBTF
et
DPVQMJOHBHFOUT0SHBOPTJMBOFTMJLFHBNNBNFUIBDSZMPYZ
r $PVQMJOHBHFOUPSBOPSHBOPTJMBOF
QSPQZMUSJNFUIPYZTJMBOFJTDPNNPOMZVTFEJOXIJDITJMBOF
r "DUJWBUPSmJOJUJBUPSTZTUFN
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HSPVQTJTBUPOFFOE JPOCPOEUP4J02) and methacrylate
r *OIJCJUPST
groups at the other.
r $PMPSJOHBHFOUT
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r 6MUSBWJPMFUBCTPSCFST Functions of Coupling Agents
r #POEJOHPGêMMFSBOESFTJONBUSJY
nt
Organic Matrix r 5SBOTGFSGPSDFTGSPNëFYJCMFSFTJONBUSJYUPTUJŀFSêMMFS
particles
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3FTJONBUSJYSFQSFTFOUTUIFCBDLCPOFPGDPNQPTJUFSFTJO
r 1SFWFOUQFOFUSBUJPOPGXBUFSBMPOHêMMFSSFTJOJOUFSGBDF
system.
thus provide hydrolytic stability.
Most preferred monomer is:
ks
r #JTQIFOPM"HMZDPMEJNFUIBDSZMBUF #JT(."
Initiator Agents
r 6SFUIBOFEJNFUIBDSZMBUF6%."
ǔFTF BHFOUT BDUJWBUF UIF QPMZNFSJ[BUJPO PG DPNQPTJUFT
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r $PNCJOBUJPOPG#JT(."BOE6%."
– Since this resin is very viscous, to improve handling, .PTU DPNNPO QIPUPJOJUJBUPS VTFE JT DBNQIPSRVJOPOF
to control viscosity, it is diluted with low viscosity *OJUJBUPSWBSJFTXJUIUZQFPGDPNQPTJUFTXIFUIFSJUJTMJHIU
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NPOPNFST MJLF CJTQIFOPM " EJNFUIBDSZMBUF #JT cured or chemically cured.

%."
FUIZMFOF HMZDPM EJNFUIBDSZMBUF &(%."
Tables 12.1 to 12.3 show differences between
USJFUIZMFOFHMZDPMEJNFUIBDSZMBUF 5&(%."
NFUIZM DIFNJDBMMZBOEMJHIUDVSFEDPNQPTJUFT EJŀFSFOUJOJUJBUPSm
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methacrylate (MMA). activator systems used for various systems and differences
between visible light and ultraviolet light curing.
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Fillers
Inhibitors
*UJTUIFEJTQFSTFEQIBTFPGDPNQPTJUFSFTJOT$PNNPOMZ
ht
VTFEêMMFSTBSFTJMJDPOEJPYJEF CPSPOTJMJDBUFTBOEMJUIJVN These agents inhibit the free radical generated by

aluminum silicates. Filler content ranges from 30 to 50% by TQPOUBOFPVT QPMZNFSJ[BUJPO PG UIF NPOPNFST 'PS
WPMVNFBOEUPCZXFJHIU FYBNQMF CVUZMBUFEIZESPYZMUPMVFOF

Table 12.1 ¨Comparison of components of dentin bonding agents

Step Fourth generation Fifth generation Sixth generation Sixth generation Seventh generation
(self-etch primer) (self-etch adhesive)
1. Etching of enamel and Etchant Etchant Self-etching primer Self-etching, self- Self-priming sealer
dentin priming sealer
2. Priming of dentin Primer Self-priming Self-etching primer Same Same
sealer
3. Bonding/sealing of enamel Bonding agent Self-priming Bonding agent Same Same
and dentin sealer
Table 12.2 ¨Initiator–activator system used in various types of *U FYIJCJUT B SPVHI TVSGBDF UFYUVSF CFDBVTF PG UIF
composites SFMBUJWFMZ MBSHF TJ[F BOE FYUSFNF IBSEOFTT PG UIF êMMFS
S. No. Type of composite Initiator Activator particles.
1. Chemically cured Benzoyl peroxide N Dimethyl- Advantage
composites p-toluidine r 1IZTJDBM BOE NFDIBOJDBM QFSGPSNBODF JT CFUUFS UIBO
2. Light cured 0.1% benzoin Tertiary amine VOêMMFEBDSZMJDSFTJOT
composites methyl ether
3. i. Ultraviolet light 0.06% Dimethyl Disadvantages
activated composite camphorquinone aminoethyl r 3PVHITVSGBDFêOJTI
ii. Visible light cured methacrylate r 1PPSQPMJTIBCJMJUZ
composite
r More prone to staining.
et
Table 12.3 ¨Difference between visible light and ultraviolet Small Particle Composite Resins
light curing
"WFSBHF QBSUJDMF TJ[F PG TNBMM QBSUJDMF DPNQPTJUF SFTJOT
.n
Features Visible light curing UV light curing
Wavelength r 8BWFMFOHUISFRVJSFE r 8BWFMFOHUISFRVJSFE
SBOHFTGSPNUPN4NBMMQBSUJDMFTJ[FSFTVMUTJOTNPPUI
QPMJTIFE TVSGBDF XIJDI JT SFTJTUBOU UP QMBRVF EFCSJT BOE
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for activation is 400– for activation is
500 nm 360–400 nm TUBJOT'JMMFSDPOUFOUJTCZXFJHIUBOECZWPMVNF
nt
Depth of curing r (SFBUFSEFQUIPG r -JNJUFEQFOFUSBUJPO
Advantages
curing is possible (up (up to 1–2 mm)
to 3 mm) r 4VQFSJPSQPMJTIJOHBOEUFYUVSJOHQSPQFSUJFT
de
Intensity r *OUFOTJUZSFNBJOT r *OUFOTJUZEFDSFBTFT r (PPEFTUIFUJD
constant with usage r (PPEBCSBTJPOBOEXFBSSFTJTUBODF
ks
Harmful effects r -FTTTJEFFíFDUUP r )BSNGVMUPPQFSBUPS Disadvantages
operator and patient’s and patient’s eyes,
r -POHUFSN EVSBCJMJUZ PG UIFTF DPNQPTJUF SFTJOT JT
eye can cause corneal
burns RVFTUJPOBCMFEVFUPQSFTFODFPGIFBWZNFUBMHMBTTêMMFST
oo
Color stability r #FUUFSDPMPSTUBCJMJUZ r -FTTUIBOWJTJCMFMJHIU CFDBVTFUIFTFêMMFSTBSFTPGUFSBOEQSPOFUPIZESPMZTJT

Warmup time r /PXBSNVQUJNF r 6OJUTOFFEXBSNVQ
Microfilled Composites Resins
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required time of 5 minutes

4NBMMQBSUJDMFTJ[FSFTVMUTJOTNPPUIQPMJTIFETVSGBDFXIJDI
Coloring Agents JT SFTJTUBOU UP QMBRVF EFCSJT BOE TUBJOT "WFSBHF QBSUJDMF
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.PTUMZNFUBMPYJEFT TVDIBTUJUBOJVNPYJEFBOEBMVNJOVN TJ[F SBOHFT GSPN UP NJDSPNFUFS 'JMMFS DPOUFOU JT
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anterior teeth and cervical abfraction lesions.

Ultraviolet Absorbers Advantages
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67 BCTPSCFST BSF BEEFE UP QSFWFOU EJTDPMPSBUJPO FH r )JHIMZQPMJTIBCMF

CFO[PQIFOPOF r (PPEFTUIFUJD
Disadvantages
Classification r 1PPSNFDIBOJDBMQSPQFSUJFTEVFUPMFTTFSêMMFSDPOUFOU
r According to Skinner: r 1PPSDPMPSTUBCJMJUZ
m 5SBEJUJPOBMPSDPOWFOUJPOBMDPNQPTJUFmN r -PXXFBSSFTJTUBODF
m 4NBMMQBSUJDMFêMMFEDPNQPTJUFTmN r -FTTNPEVMVTPGFMBTUJDJUZBOEUFOTJMFTUSFOHUI
m .JDSPêMMFEDPNQPTJUFTmN r More water absorption
m )ZCSJEDPNQPTJUFTmN r )JHIDPFŁDJFOUPGUIFSNBMFYQBOTJPO
Macrofilled Composite Resin/Conventional/Traditional Hybrid Composite Resins
These were developed during early 1970s. Average particle )ZCSJE DPNQPTJUFT BSF DPNQPTFE PG HMBTTFT PG EJŀFSFOU
TJ[FPGNBDSPêMMDPNQPTJUFSFTJOTSBOHFTGSPNUPN DPNQPTJUJPOT BOE TJ[FT XJUI QBSUJDMF TJ[F EJBNFUFS PG
'JMMFSDPOUFOUJTBQQSPYJNBUFMZUPCZXFJHIU MFTTUIBONBOEDPOUBJOJOHNTJ[FEGVTFETJMJDB
'JMMFS DPOUFOU JO UIFTF DPNQPTJUFT JT m CZ XFJHIU Microhybrid composites
ǔJT NJYUVSF PG êMMFST JT SFTQPOTJCMF GPS UIFJS QIZTJDBM Filler content in microhybrids are 56–66% by volume with
properties similar to those of conventional composites BWFSBHFQBSUJDMFTJ[FPGmN
XJUIUIFBEWBOUBHFPGTNPPUITVSGBDFUFYUVSF #FDBVTFPGQSFTFODFPGMBSHFêMMFSDPOUFOU NJDSPIZCSJE
Advantages composites have improved physical properties and better
r &YDFMMFOUQPMJTIJOHBOEUFYUVSJOHQSPQFSUJFT XFBSSFTJTUBODFUIBONJDSPêMMFEDPNQPTJUFT
r (PPEBCSBTJPOBOEXFBSSFTJTUBODF
Advantages
r (PPEFTUIFUJDT
r #FUUFSQPMJTIBOETVSGBDFêOJTI
r %FDSFBTFEQPMZNFSJ[BUJPOTISJOLBHF
r Easy handling
Disadvantages r *NQSPWFEQIZTJDBMQSPQFSUJFT
r /PUIJHIMZQPMJTIBCMFBTNJDSPêMMFECFDBVTFPGQSFTFODF r (PPEXFBSSFTJTUBODF
et
PGMBSHFSêMMFSQBSUJDMFTJOCFUXFFOTNBMMFSPOFT
r -PTT PG HMPTT PDDVST XIFO FYQPTFE UP UPPUICSVTIJOH
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Properties of Composite
with abrasive toothpaste.
Coefficient of Thermal Expansion
5XPOFXHFOFSBUJPOTPGIZCSJEDPNQPTJUFSFTJOTBSF
al
/BOPêMMBOEOBOPIZCSJET $PFŁDJFOU PG UIFSNBM FYQBOTJPO PG DPNQPTJUFT JT
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2. Microhybrids. BQQSPYJNBUFMZ UISFF UJNFT IJHIFS UIBO OPSNBM UPPUI
Nanofill and Nanohybrid Composites TUSVDUVSFǔJTSFTVMUTJONPSFDPOUSBDUJPOBOEFYQBOTJPO
de
/BOPêMMBOEOBOPIZCSJEDPNQPTJUFTIBWFBWFSBHFQBSUJDMF than enamel and dentin when there are temperature
TJ[FMFTTUIBOUIBUPGNJDSPêMMFEDPNQPTJUFT(Fig. 12.10). changes resulting in loosening of the restoration
6TF PG UIFTF FYUSFNFMZ TNBMM êMMFST BOE UIFJS QSPQFS (Fig. 12.11).
ks
BSSBOHFNFOUXJUIJOUIFNBUSJYSFTVMUTJOQIZTJDBMQSPQFSUJFT
FRVJWBMFOUUPUIFPSJHJOBMIZCSJEDPNQPTJUFSFTJOT Water Absorption
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Advantages Composites have tendency to absorb water which can lead

r )JHIMZQPMJTIBCMF UPUIFTXFMMJOHPGSFTJONBUSJY êMMFSEFCPOEJOHBOEUIVT
r 5PPUIMJLFUSBOTMVDFODZXJUIFYDFMMFOUFTUIFUJDT
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SFTUPSBUJPO GBJMVSF $PNQPTJUFT XJUI IJHIFS êMMFS DPOUFOU

r 0QUJNBMNFDIBOJDBMQSPQFSUJFT FYIJCJUMPXFSXBUFSBCTPSQUJPO
r )JHIXFBSSFTJTUBODF
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Figure 12.11: Schematic representation coefficient of thermal expan-

sion can result in dimensional change in restoration which can cause
Figure 12.10: Photograph showing nanofill composite resin gap between tooth and the restoration
Wear Resistance r 3FTUPSBUJPO PG DMBTT *** *7 BOE 7 QSFQBSBUJPOT PG BMM
teeth especially when esthetics is important
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r 'PS FTUIFUJD JNQSPWFNFOU MJLF MBNJOBUFT WFOFFST
loss as a result of abrasives contact with opposing tooth
treatment of tooth discolorations and diastema
TUSVDUVSF SFTUPSBUJWFNBUFSJBMPSUPPUICSVTIJOH FUD
closures.
Surface Texture
Contraindications
4J[F BOE DPNQPTJUJPO PG êMMFS QBSUJDMFT EFUFSNJOF
r 8IFO JTPMBUJPO BOE BDDFTTJCJMJUZ PG PQFSBUJOH TJUF JT
UIF TNPPUIOFTT PG TVSGBDF PG B SFTUPSBUJPO .JDSPêMM
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composites offer the smoothest restorative surface.
r 8IFSFWFSZIJHIPDDMVTBMGPSDFTBSFQSFTFOU
r $MBTT7MFTJPOTXIFSFFTUIFUJDTJTOPUUIFQSJNFDPODFSO
Radiopacity
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3FTJOTBSFJOIFSFOUMZSBEJPMVDFOU1SFTFODFPGSBEJPQBRVF Advantages
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êMMFST MJLF CBSJVN HMBTT TUSPOUJVN BOE [JSDPOJVN NBLFT
r 4JODF DPNQPTJUF SFTUPSBUJPO SFRVJSFT NJOJNBM UPPUI
UIFDPNQPTJUFSFTUPSBUJPOSBEJPQBRVF
QSFQBSBUJPO NBYJNVNDPOTFSWBUJPOPGUPPUITUSVDUVSF
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is possible
Modulus of Elasticity
r Esthetically acceptable
nt
Modulus of elasticity of a material determines its rigidity r Mechanical bonding to tooth structure
PS TUJŀOFTT .JDSPêMM DPNQPTJUFT IBWF HSFBUFS ëFYJCJMJUZ r *NNFEJBUFêOJTIJOHBOEQPMJTIJOHBGUFSDVSJOH
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than hybrid composite since they have lower modulus of r Restoration can be completed in single visit.
elasticity.
Disadvantages
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Solubility
r 1PMZNFSJ[BUJPOTISJOLBHF
$PNQPTJUFNBUFSJBMTEPOPUTIPXBOZDMJOJDBMMZTJHOJêDBOU r EYQFOTJWFUIBOBNBMHBN
oo
TPMVCJMJUZJOPSBMëVJET r MPSFUFDIOJRVFTFOTJUJWFUIBOBNBMHBN
r -PXXFBSSFTJTUBODFUIBOBNBMHBN
eb
Polymerization Shrinkage
$PNQPTJUFNBUFSJBMTTISJOLXIJMFDVSJOHXIJDIDBOSFTVMU
Steps of Clinical Procedure for Composite
JOGPSNBUJPOPGBHBQCFUXFFOSFTJOCBTFEDPNQPTJUFBOE Placement
://
UIFQSFQBSBUJPOXBMM *O MJHIU DVSFE DPNQPTJUFT r 5PPUIQSFQBSBUJPO

TISJOLBHFPDDVSTJOUIFEJSFDUJPOPGMJHIU r &UDIJOHBOECPOEJOH
tp
'PSDIFNJDBMDVSFEDPNQPTJUFTTISJOLBHFPDDVSTTMPXMZ r $PNQPTJUFQMBDFNFOU
and uniformly towards the center of restoration. r 1PMZNFSJ[BUJPOPGDPNQPTJUFSFTJOT
ht
1PMZNFSJ[BUJPOTISJOLBHFDBOSFTVMUJO r 'JOBMDPOUPVSJOH êOJTIJOHBOEQPMJTIJOHPGDPNQPTJUF

r 1PTUPQFSBUJWFTFOTJUJWJUZ restoration.
r 3FDVSSFOUDBSJFT
Tooth Preparation
r 'BJMVSFPGJOUFSGBDJBMCPOEJOH
Following three types of designs or their combination are
Esthetics of Composites most commonly prepared for composites.
Composites have shown good esthetics because of their 1. Conventional.
property of translucency. Composites are available in 2. Beveled conventional.
different opacities and shades for their use. .PEJêFE DPOTFSWBUJWF

Conventional
Indications Conventional design is similar to the tooth preparation
r 'PSSFTUPSBUJPOPGNJMEUPNPEFSBUFDMBTT*BOEDMBTT** GPSBNBMHBNSFTUPSBUJPO FYDFQUUIBUUIFSFJTMFTTPVUMJOF
UPPUI QSFQBSBUJPOT BT QJU BOE êTTVSF TFBMBOUT BOE BT FYUFOTJPO BOE JO UPPUI QSFQBSBUJPO XBMMT BSF NBEF
preventive restorations of all teeth rough.
Indications for Conventional Tooth Preparation Syringe

r 1SFQBSBUJPOTMPDBUFEPOSPPUTVSGBDF Composite syringe usually carries the low viscosity
r .PEFSBUFUPMBSHFDMBTT*PSDMBTT**SFTUPSBUJPOT DPNQPTJUFXIJDIDBOFBTJMZëPXUISPVHIOFFEMF
*SSFTQFDUJWF PG MPDBUJPO PG SFTUPSBUJPO DPNQPTJUFT
Features
TIPVME CF QMBDFE BOE QPMZNFSJ[FE JO JODSFNFOUT &BDI
r #VUUKPJOUDBWPTVSGBDFNBSHJOJTNBEFPOSPPUTVSGBDFT
JODSFNFOU TIPVME OPU CF NPSF UIBO NN JO UIJDLOFTT
Beveled Conventional Tooth Preparation otherwise it becomes difficult to cure and result in more
This design is almost similar to conventional design but QPMZNFSJ[BUJPOTISJOLBHFTUSFTT
some beveled enamel margins are incorporated.
Indications Polymerization of Composite Resins
r 8IFO SFTUPSBUJPO JT CFJOH VTFE UP SFQMBDF BO FYJTUJOH "DDPSEJOH UP QPMZNFSJ[BUJPO NFUIPE DPNQPTJUF SFTJOT
SFTUPSBUJPOFYIJCJUJOHBDPOWFOUJPOBMEFTJHO
et
can be divided into two main categories:
r 5PSFTUPSFBMBSHFQSFQBSBUJPOBOEFTQFDJBMMZJOEJDBUFE 4FMGDVSJOHDPNQPTJUFT
GPSDMBTTFT*** *7 7BOE7*SFTUPSBUJPOT
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-JHIUBDUJWBUFEDPNQPTJUFT
Modified (Conservative Tooth Preparation) Self-curing Composite Resin
al
*UJTNPSFDPOTFSWBUJWFJOOBUVSFTJODFSFUFOUJPOJTBDIJFWFE $BUBMZTUBOECBTFNBUFSJBMTBSFNJYFEJOBSBUJPPGBCPVU
by micromechanical bonding to the tooth. 0ONJYJOH UIFJSQPMZNFSJ[BUJPOQSPDFTTJTDIFNJDBMMZ
nt
Indications activated.
For initial or small carious lesions.
de
Light-activated Composite Resins
Features -JHIUBDUJWBUJPOJOWJTJCMFMJHIUDVSJOHSBOHFTCFUXFFO
r 1SFQBSBUJPOIBTTDPPQFEPVUBQQFBSBODF BOE ON XBWFMFOHUI 0O BDUJWBUJPO QIPUPJOJUJBUPS
ks
r *UEPFTOPUIBWFTQFDJêFEXBMMDPOêHVSBUJPOPSQVMQBM DBNQIPSRVJOPOF
DPNCJOFTXJUIBNJOFBDDFMFSBUPSBOE
BOEBYJBMXBMMEFQUI SFMFBTFTGSFFSBEJDBMTXIJDITUBSUUIFQPMZNFSJ[BUJPO
r &YUFOUBOEEFQUIPGUIFQSFQBSBUJPOEFQFOETVQPOUIF
oo
Curing Lamps
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r 5VOHTUFORVBSU[IBMPHFO 52)
DVSJOHVOJU
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Bonding r 1MBTNBBSDDVSJOH 1"$

VOJU
Adhesion of composites to tooth structure can be attained r -JHIUFNJUUJOHEJPEF -&%
VOJU
r "SHPOMBTFSDVSJOHVOJU
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with any of the following methods:

r 5PUBMFUDI JOWPMWJOH TUFQ BEIFTJWFT UIBU JT FUDIJOH
priming and bonding Final Contouring, Finishing and
tp
r 5PUBMFUDI JOWPMWJOH TUFQ BEIFTJWFT UIBU JT FUDIJOH Polishing of Composite Restorations
and bonding
ht
For composite restorations, the amount of contouring

r 4FMGFUDI QSJNFST JOWPMWJOH TUFQ BEIFTJWFT UIBU JT SFRVJSFE BGUFS êOBM DVSJOH DBO CF NJOJNJ[FE CZ DBSFGVM
priming and bonding. QMBDFNFOUUFDIOJRVF
%FDSFBTFEOFFEPGDPOUPVSJOHPGUIFDVSFEDPNQPTJUF
Composite Placement ensures that margins and surface of composite restoration
Instruments used for Composite Insertion SFNBJOTFBMFEBOEGSFFPGNJDSPDSBDLTUIBUDBOCFGPSNFE
while contouring.
Hand Instruments
'PS SFNPWBM PG DPNQPTJUF FYDFTT VTVBMMZ CVST
)BOEJOTUSVNFOUTVTFEGPSQMBDJOHDPNQPTJUFTBSFVTVBMMZ
and diamonds are used (Fig. 12.12). For areas which
NBEF VQ PG DPBUJOH XJUI UFëPO TP BT UP BWPJE TUJDLJOH PG
have poor accessibility, composite strips can be used
composite to the instrument.
(Fig. 12.13) $POUBDU BSFBT NBZ CF êOJTIFE CZ VTJOH B
Composite Gun TFSJFT PG BCSBTJWF êOJTIJOH TUSJQT UISFBEFE CFMPX UIF
'PSVTF DPNQPTJUFDPNQVMFTBSFêUUFEJOUIFHVOBOEUIF contact point so as not to destroy the contact point.
pressure is applied so that composite comes out from the Figures 12.14 A to O shows clinical case of composite
ampule. SFTUPSBUJPOJONBYJMMBSZDFOUSBMJODJTPST
et
.n
Figure 12.12: Photograph showing abrasive diamonds for removal Figure 12.13: Photograph showing finishing strips for
of excess composite material interproximal areas
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A B C D E
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F G H I J
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K L M N O
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Figures 12.14 A to O: Clinical picture showing case of composite restoration in maxillary central incisors; (A) Fractured 11 and 21; (B) Rubber
dam isolation of 11 and 21; (C) Tooth preparation of 11 and 21; (D) Apply etchant for 20 seconds; (E) Wash and dry; (F) Apply bonding agent; (G)
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Cure the bonding agent; (H) Apply composite resin on 11 and 21; (I) Cure it; (J) Apply another layer of composite resin; (K) Cure it; (L) Remove
rubber dam; (M) Remove excess of composite using finishing bur; (N) Polish it using soflex disc; (O) Restored 11 and 21
Q.2. What are advantages of adhesive restorations?

VIVA QUESTIONS
Ans. r .JOJNJ[FTSFNPWBMPGTPVOEUPPUITUSVDUVSF
Q.1. What are indications for use of adhesives? r "EIFTJPO SFEVDFT NJDSPMFBLBHF BU UPPUI
Ans. r 5PUSFBUDBSJPVTBOEGSBDUVSFEUPPUITUSVDUVSF restoration interface
r 5PSFTUPSFFSPTJPOPSBCSBTJPOEFGFDUTJODFSWJDBM r #POEJOH PG DBTU BOE DFSBNJD SFTUPSBUJPOT FH
areas porcelain inlays, onlays and veneers
r 'PS UIF SFQBJS PG GSBDUVSFE QPSDFMBJO BNBMHBN r 3FJOGPSDJOHPGXFBLFOFEUPPUITUSVDUVSF
and resin restorations r 'PSSFQBJSPGQPSDFMBJOPSDPNQPTJUF
r 'PSQJUBOEêTTVSFTFBMBOUT
r 5P CPOE DPNQPTJUF SFTUPSBUJPOT BOE BNBMHBN Q.3. What are different means of adhesion?
restorations r .icromechanical
r 5PCPOEPSUIPEPOUJDCSBDLFUT r "dsorption
r %JŀVTJPO r 5PUBMFUDIJOHSFTVMUTJOIZCSJEJ[BUJPOBOEIZCSJE
r Combination. layer formation
r *U JOWPMWFT UISFF TUFQT BQQMJDBUJPO JF UPUBM
Q.4. What are steps of enamel bonding?
etching + application of primer + application of
Ans. r $MFBOBOEXBTIUIFUFFUI
bonding agent
r "QQMZBDJEFUDIBOUGPSTFDPOETBOEXBTIJU
r "EWBOUBHFJTIJHICPOETUSFOHUI
r " QSPQFSMZ FUDIFE TVSGBDF TIPVME HJWF B GSPTUZ
white appearance on drying Q.8. What are the reasons for failure of dentin
r *G BOZ TPSU PG DPOUBNJOBUJPO PDDVST SFQFBU UIF
bonding?
procedure Ans. r $POUBNJOBUJPO PG EFOUJO XJUI TVMDVMBS ëVJE PS
r /PX BQQMZ CPOEJOH BHFOU BOE MPX WJTDPTJUZ saliva
monomers over the etched enamel surface. r $POUBNJOBUJPO PG UPPUI TVSGBDF CZ MVCSJDBOUT
used in handpieces
Q.5. What are effects of etching?
r "OZ DPOUBDU PG UPPUI TVSGBDF XJUI CMPPE DBO
Ans. r *ODSFBTFT UIF FOBNFM TVSGBDF BSFB BWBJMBCMF GPS
result in decrease in bond strength
bonding
r ǔJDLFOJOH PG CPOEJOH BHFOU CFDBVTF PG
r $MFBOTFTEFCSJTGSPNFOBNFM
evaporation of solvent reduces the penetration of
r 1SPEVDFT NJDSPQPSFT JOUP XIJDI UIFSF JT
the bonding agent.
NFDIBOJDBMJOUFSMPDLJOHPGUIFSFTJO
r &YQPTFT NPSF SFBDUJWF TVSGBDF MBZFS UIVT Q.9. What is composition of composites?
increasing its wettability. Ans. r 0SHBOJDNBUSJYPSPSHBOJDQIBTF
r *OPSHBOJDNBUSJY
r 'JMMFSPSEJTQFSTFEQIBTF
r $PVQMJOHBHFOU
r "DUJWBUPSmJOJUJBUPSTZTUFN
r *OIJCJUPST
B r $PMPSJOHBHFOUT
Q.10. What are advantages of filler?

Ans. r 3FEVDFTUIFDPFŁDJFOUPGUIFSNBMFYQBOTJPO
r 3FEVDFTQPMZNFSJ[BUJPOTISJOLBHF
r *ODSFBTFTBCSBTJPOSFTJTUBODF
r *ODSFBTFTUFOTJMFBOEDPNQSFTTJWFTUSFOHUIT
r *ODSFBTFTGSBDUVSFUPVHIOFTT
A C r 1SPWJEFTSBEJPQBDJUZ
Schematic representation showing difference in appearance of
etched and unetched enamel rods Q.11. What is role of coupling agent?
Ans. *UJTVTFEUPCPOEUIFêMMFSUPUIFPSHBOJDSFTJO
Q.6. Why bonding to dentin is difficult than enamel?
Ans. r %FOUJODPOUBJOTNPSFXBUFSUIBOEPFTFOBNFM Q.12. What are advantages of hybrid composites?
r 1SFTFODF PG TNFBS MBZFS NBLFT XFUUJOH PG UIF Ans. r &YDFMMFOUQPMJTIJOHBOEUFYUVSJOHQSPQFSUJFT
dentin by the adhesive more difficult r (PPEBCSBTJPOBOEXFBSSFTJTUBODF
r 'MVJEQSFTFOUJOEFOUJOBMUVCVMFTDPOTUBOUMZëPXT r "CJMJUZUPJNJUBUFUIFUPPUITUSVDUVSF
outwards which reduces the adhesion of the r %FDSFBTFEQPMZNFSJ[BUJPOTISJOLBHF
composite resin. r -FTTXBUFSBCTPSQUJPO
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agents. Ans. r #FUUFSQPMJTIBOETVSGBDFêOJTI
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moist bonding concept r *NQSPWFEQIZTJDBMQSPQFSUJFT
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Ans. -PXWJTDPTJUZJTEVFUPMFTTêMMFSMPBEJOH Ans. r *ODSFBTJOHNPOPNFSNPMFDVMBSXFJHIU
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r )JHI ëFYJCJMJUZ TP MFTT MJLFMZ UP CF EJTQMBDFE JO preparations?
stress concentration areas Ans. r 1SFQBSBUJPOTMPDBUFEPOSPPUTVSGBDF
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Q.16. What are disadvantages of flowable composites? for composite restoration in class III cases?
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the surface.
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viscous? lesions?
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Q.18. Where are packable composites indicated? for composites?
r FPSTUSFTTCFBSJOHBSFBT Ans. For lesion present on root surface.
r *ODMBTT**SFTUPSBUJPOT Q.25. What are the indications of beveled class V tooth
Q.19. What are effects of polymerization shrinkage? preparation for composites?
Ans. r 1PTUPQFSBUJWFTFOTJUJWJUZ Ans. 'PS SFQMBDJOH EFGFDUJWF FYJTUJOH SFTUPSBUJPO PS GPS
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13
cHAPTER
Basics of Endodontics
Nisha Garg, Sanjay Miglani
Chapter Outline
Introduction Significance of Working Length

Etiology of Pulpal Diseases Irrigation of Root Canal System
Progression of Pulpal Pathologies Cleaning and Shaping
Endodontic Instruments Basic Principles of Canal Instrumentation
Access Cavity Preparation Techniques of Root Canal Preparation
Access Cavity of Anterior Teeth Obturation of Root Canal System
Access Cavity Preparation for Premolars Coronal Restoration
Access Cavity Preparation for Maxillary Molars Common Errors During Endodontic Treatment
Access Cavity Preparation for Mandibular Molars Viva Question
Working Length Determination
Introduction • Pulp is composed almost entirely of simple connective

tissue. At its periphery there is a layer of highly
Endo is a Greek word for “inside” and odont is Greek word specialized cells, the odontoblasts. Secondary dentin
for “tooth”. Endodontic treatment deals inside of the tooth. is gradually deposited as a physiological process which
Endodontics is the branch of clinical dentistry reduces the blood supply and therefore, the resistance
associated with the prevention, diagnosis and treatment to infection or trauma
of pathosis of the dental pulp and their sequelae.
Thus, the main aim of the endodontic therapy involves
to:
• Maintain vitality of the pulp
• Preserve and restore the tooth with damaged and
necrotic pulp
• Preserve and restore the teeth which have failed to the
previous endodontic therapy.
Features of pulp which distinguish it from tissue found
elsewhere in the body:
• Pulp is surrounded by rigid walls and so is unable
to expand in response to injury as a part of the
inflammatory process. Therefore, pulpal tissue is
susceptible to change in pressure affecting the pain
threshold (Fig. 13.1)
• There is minimal collateral blood supply to pulp tissue Figure 13.1: Schematic representation showing pulp,
which reduces its capacity for repair following injury enclosed in hard shell of dentin
• Innervation of pulp tissue is both simple and complex. Table 13.1: Grossman’s classification of endodontic instruments
Simple in that there are only free nerve endings and Function Instruments
consequently the pulp lacks proprioception. Complex
Exploring Smooth broaches and endodontic
because of innervation of the odontoblast processes explorers (to locate canal orifices and
which produces a high level of sensitivity to thermal determine patency of root canal)
and chemical change. Debriding or extirpating Barbed broaches (to extirpate the pulp
and other foreign materials from the root
canal)
Etiology of Pulpal Diseases
Cleaning and shaping Reamers and files (Used to shape the canal
• dental caries space)
• Trauma like fracture, or avulsion of tooth Obturating Pluggers, spreaders and lentulospirals
• Pathologic wear, e.g. attrition, abrasion, etc. (To pack gutta-percha points into the root
• Thermal injury like heat generated by cutting and canal space)
• Microleakage around a restoration
• Periodontal pocket and abscess
• Anachoresis.
PROGRESSION OF PULPAL PATHOLOGIES

Pulpal reaction to microbial irritation
Carious enamel and dentin contain numerous bacteria
↓
Bacteria penetrate in deeper layers of carious dentin Figure 13.2: Schematic representation showing structure of an
endodontic instrument (file, reamer or broach)
↓
Pulp is affected before actual invasion of bacteria via for having uniformity in instrument diameter and taper
their toxic byproducts (Fig. 13.2). The guidelines were:
↓ • Instruments are numbered from 10 to 100. There is
Byproducts cause local chronic cell infiltration increase in 5 units up to size 60 and in 10 units till they
↓ are size 100. this has been revised to include numbers
When actual pulp exposure occurs, pulp tissue gets from 6 to 140
locally infiltrated by PMNs to form an area of liquefaction • Each number should represent diameter of instrument
necrosis in 100th of millimeter at the tip. For example, a No. 25
at the site of exposure reamer shall have 0.25 mm at D1 and 0.57 mm (0.25 +
↓ Eventually necrosis spreads all across the pulp and 0.32) at D2. These sizes ensure a constant increase in
periapical tissue resulting in severe inflammatory lesion taper, i.e. 0.02 mm/mm of the instrument regardless of
the size
Endodontic Instruments • Working blade shall begin at tip (D1) and extend 16 mm
up the shaft (D2). D2 should be 0.32 mm greater than D1,
Although variety of instruments are used in general dentistry,
ensuring that there is constant increase in taper, i.e 0.02
are applicable in endodontics, yet some special instruments
mm per mm of instrument
are unique to endodontic purpose (Table 13.1).
• Instrument handles should be color coded for their
Standardization of Instruments Given by Ingle easier recognition (pink, gray, purple, white, yellow,
and Levine red, blue, green, black, white………….) (Table 13.2 and
Fig. 13.3)
Ingle and Levine using an electronic microcomparator • Instruments are available in following length: 21 mm,
found variation in the diameter and taper for same size of 25 mm, 28 mm, 30 mm and 40 mm. 21 mm length is
instrument. They suggested few guidelines for instruments commonly used for molars, 25 mm for anteriors, 28
Basics of Endodontics 187
Table 13.2: Color coding of endodontic instruments

Color code Instrument number
Pink 06
Gray 08
Purple 10
White 15
Yellow 20
Red 25
Blue 30
Green 35
Black 40
White 45
Yellow 50
Red 55
Blue 60
Green 70
Black 80
White 90
Yellow 100
Red 110
Blue 120
Green 130
Black 140 Figure 13.3: Schematic representation showing color coding of
endodontic instruments
and 30 mm for canines and 40 mm for endodontic

implants.
Modifications from Ingle’s Standardization Figure 13.4: Photograph showing broach has barbs which help in
removing pulp or cotton from the canal
• An additional diameter measurement point at D3 is 3
mm from the tip of the cutting end of the instrument at
D0 (earlier it was D1) and D2 was designated as D16
• Tip angle of an instrument should be 75° ± 15°
• Greater taper instruments (0.04, 0.06, 0.08, 0.10, 0.12)
have also been made available
• Instruments available in length 21, 25, 28 and 30 mm A
are used for root canal therapy, and those of 40 mm size
are used in preparing root canals for the endodontic
implants.
B
Broach
Broach is of two types:
1. Smooth broach: It is free of barbs, used as pathfinder.
2. Barbed broach C
• Broach is short handled instrument meant for single Figures 13.5A to C: Photograph showing (A) Reamer
use only (B) K-File; (C) H-File
• Here smooth surface of wire is notched to form barbs • When used in torquing motion, its edges can engage in
bent at an angle from the long axis (Fig. 13.4) the dentin of root canal wall, causing H-files to fracture
• Broach does not cut the dentin but can effectively be • Hedstroem file should be used to machine the straight
used to remove cotton or paper points which might canal because it is strong and aggressive cutter. Since
have lodged in the canal. it lacks the flexibility and is fragile in nature, the H-file
tends to fracture when used in torquing action.
Reamer
NiTi Rotary Instruments
• Reamer is used to ream the canals. It cuts by inserting
into the canal, twisting clockwise one quarter to half NiTi is also known as the NiTinol (NiTi Navol Ordinance
turn and then withdrawing, i.e. penetration, rotation Laboratory in US). In endodontics, commonly used NiTi
and retraction alloys are called 55 NiTinol (55% weight Ni and 45% Ti) and
• Reamer has triangular blank and lesser number of 60 NiTinol (60% weight of Ni, 40% Ti) (Fig. 13.6).
flutes than file (Fig. 13.5A) Advantages of NiTi alloys
• Reamer tends to remain self-centered in the canal • Shape memory
resulting in less chances of canal transportation. • Superelasticity
• Low modulus of elasticity
Files • Good resiliency
• Corrosion resistance
Kerr manufacturing company was first to produce files, so
• Softer than stainless steel.
these were also called K-files.
Disadvantages of NiTi files
Files are predominantly used with filing or rasping
• Poor cutting efficiency
action in which there is little or no rotation in the root
• NiTi files do not show signs of fatigue before they
canals. It is placed in root canal and pressure is exerted
fracture.
against the canal wall and instrument is withdrawn while
Types of rotary instruments:
maintaining the pressure.
• Profiles, Protapers, K3, single wave, etc.
K-file
access cavity preparation
• It is triangular, square or rhomboidal in cross-section,
manufactured from stainless steel wire, which is Access cavity preparation is defined as an endodontic
grounded into desired shape coronal preparation which enables unobstructed access to
• K-file has 1½–2½ cutting blades per mm of their the canal orifices, a straight line access to apical foramen,
working end (more than reamer) (Fig. 13.5B).
K-flex File
• K-flex file is rhombus in cross-section having two acute
angles and two obtuse angles
• Two acute angles increase sharpness and cutting
efficiency of the instrument
• Two obtuse angles provide more space for debris
removal. Also the decrease in contact of instrument
with canal walls provides more space for irrigation.
Hedstroem File (H-file)

• Hedstroem file has flutes which resemble successively
triangles set one on another (Fig. 13.5C)
• Hedstroem file cuts only when instrument is withdrawn
because its edges face the handle of the instrument Figure 13.6: Photograph showing rotary NiTi files
complete control over instrumentation and accommodate

obturation technique (Fig. 13.7 and Box 13.1).
Box 13.1: An ideal access preparation should have following
qualities
• An unobstructed view into the canal
• A file should pass into the canal without touching any part of
the access cavity
• No remaining caries should be present in access cavity
• Obturating instruments should pass into the canal without
touching any portion of the access cavity.
Figure 13.8: Schematic representation showing starting point of

Access Cavity of Anterior Teeth entry of bur, which is at the center of lingual surface of incisors
• Remove all the caries and any defective restorations so

as to prevent contamination of pulp space and have a
straight line access into the canals
• Access opening is initiated at the center of the lingual
surface (Fig. 13.8)
• Direct a round bur perpendicular to the lingual surface
at its center to penetrate the enamel. Once enamel is
penetrated, bur is directed parallel to the long axis of
the tooth, until ‘a drop’ in effect is felt (Fig. 13.9)
• Now when pulp chamber has been penetrated, the
remainder of chamber roof is removed by working a Figure 13.9: Schematic representation showing that once enamel is
penetrated, bur is directed parallel to long axis of tooth
round bur from inside to outside. This is done to remove
all the obstructions of enamel and dentin overhangs
that would entrap debris, tissues and other materials
• Now locate the canal orifices using endodontic explorer.
Sharp explorer tip is used to locate the canal orifices,
to penetrate the calcific deposits if present, and also to
evaluate the straight line access
• Once the canal orifices are located, remove the lingual
shoulder using Gates–Glidden drills or safe-tipped
diamond or carbide burs
• Finally smoothening of the cavosurface margins of
access cavity is done to allow better and précised
Figure 13.10: Schematic representation showing outline of access
cavity of maxillary incisor
A B
Figure 13.7: Schematic representation showing that access cavity Figures 13.11A and B: Schematic representation showing outline of
should have an unobstructed access to the canal orifices and straight access cavity of premolars
line access to apical foramen
placement of final composite restoration with minimal • Now penetrate the enamel with No. 4 round bur in
coronal leakage (Fig. 13.10). the central groove directed palatally and prepare an
external outline form
Access Cavity Preparation for • Penetrate the bur deep into the dentin until the clinician
Premolars feels “drop” into the pulp chamber. Now remove the
complete roof of pulp chamber using tapered fissure,
• Site of access opening in premolars is in center of the round bur, safety tip diamond or the carbide bur
occlusal surface between buccal and the lingual cusp working from inside to outside
tips (Fig. 13.11) • Explore the canal orifices with sharp endodontic explorer.
• Penetrate the enamel with No. 4 round bur in high-speed After the canal orifices has been located, remove any
contra-angle handpiece. The bur should be directed cervical bulges, ledges or obstruction, if present
parallel to the long axis of tooth and perpendicular to • In maxillary first molar, shape of pulp chamber is
the occlusal table. External outline form for premolars is rhomboid. Palatal canal orifice is located palatally.
oval in shape with greater dimensions on buccolingual Mesiobuccal canal orifice is located under the
side mesiobuccal cusp. Distobuccal canal orifice is located
• Once the clinician feels “drop” into the pulp chamber, slightly distal and palatal to the mesiobuccal orifice. A
penetrate deep enough to remove the roof of pulp line drawn to connect all three orifices (i.e. MB, DB and
chamber without cutting the floor of pulp chamber. To palatal) forms a triangle, termed as molar triangle
remove the roof of pulp chamber place a bur (round, • A second mesiobuccal canal, i.e. MB2 is present in first
tapered fissure or safety tip) alongside the walls of pulp maxillary molars, which is located palatal and mesial to
chamber and work from inside to outside the MB1. Because of presence of MB2, the access cavity
• After removal of roof of pulp chamber, locate the canal acquires a rhomboid shape with corners corresponding
orifices with the help of sharp endodontic explorer to all the canal orifices, i.e. MB1, MB2, DB and palatal
• Walls of access cavity are smoothened and sloped (Fig. 13.13).
slightly towards the occlusal surface.
Access Cavity Preparation for
Access Cavity Preparation for Mandibular Molars
Maxillary Molars
• Penetrate the No. 4 round bur on the central fossa
• Determine the starting point of bur into the enamel. It midway between the mesial and distal boundaries. The
is determined by mesial and distal boundary. Mesial mesial boundary is a line joining the mesial cusp tips
boundary is a line joining the mesial cusps and the and the distal boundary is the line joining buccal and
distal boundary is the oblique ridge. The starting point the lingual grooves (Fig. 13.14)
of bur penetration is on the central groove midway • Once the “drop” into pulp chamber is felt, remove the
between mesial and distal boundaries (Fig.13.12). roof of pulp chamber working from inside to outside
Figure 13.12: Schematic representation of outline of access cavity of Figure 13.13: Schematic representation of position of root canal
maxillary molars is determined by mesial and distal boundary. Mesial orifices of maxillary first molar
boundary is a line joining the mesial cusps and the distal boundary is
the oblique ridge
with the help of round bur, tapered fissure, safety tip cementodentinal junction is the region where cementum
diamond or the carbide bur and dentin are united, the point at which cemental surface
• Explore canal orifices with sharp endodontic explorer terminates at or near the apex of tooth. Location of CDJ
and finally finish and smoothen the cavity with slight ranges from 0.5 to 3 mm short of anatomic apex.
divergence towards the occlusal surface
• In mandibular first molar, orifices of all the canals are SIGNIFICANCE OF WORKING LENGTH
usually located in the mesial two-thirds of the crown.
• Working length determines how far into canal
The mesiobuccal orifice is under the mesiobuccal cusp,
instruments can be placed and worked
mesiolingual orifice lies in a depression formed by
• Failure to accurately determine and maintain working
mesial and the lingual walls and distal orifice lies distal
length may result in length being over than normal
to the buccal groove.
which will lead to postoperative pain, prolonged healing
time and lower success rate because of incomplete
Working length determination regeneration of cementum, periodontal ligament and
Working length is defined as “the distance from a coronal alveolar bone
reference point to a point at which canal preparation and • When working length is made short of apical
obturation should terminate” A reference point is chosen constriction, it may cause persistent discomfort because
which is stable and easily visualized during preparation. of incomplete cleaning and underfilling. Apical leakage
Reference point is that site on occlusal or the incisal may occur into uncleaned and unfilled space short of
surface from which measurements are made. Usually, it is apical constriction. It may support continued existence
incisal edge of anterior teeth and buccal cusp of posterior of viable bacteria and contributes to the periradicular
teeth (Figs 13.15 and 13.16). lesion and thus, poor success rate.
Definitions Related to Working Length Radiographic Method of Length Determination

Anatomic apex is “tip or end of root determined • Measure the estimated working length from
morphologically”. preoperative periapical radiograph
Radiographic apex is “tip or end of root determined • Adjust stopper of instrument to this estimated working
radiographically”. length and place it in the canal up to the adjusted
Apical foramen (major diameter) is main apical opening stopper
of the root canal which may be located away from anatomic • Take the radiograph
or radiographic apex. • On the radiograph, measure the difference between the
Apical constriction (minor diameter) is apical portion of tip of the instrument and root apex. Add or subtract this
root canal having narrowest diameter. It is usually 0.5–1 length to the estimated working length to get the new
mm short of apical foramen. working length
Figure 13.14: Schematic representation of outline of access prepara- Figure 13.15: Schematic representation of working length distance
tion of mandibular molars. Mesial boundary is a line joining the mesial which is defined as the distance from coronal reference point to a
cusp tips and the distal boundary is the line joining buccal and the point where canal preparation and obturation should terminate
lingual groove
• Correct working length is finally calculated by Commonly used Irrigating Solutions

subtracting 1 mm from this new length (Fig. 13.17).
• Saline
• Sodium hypochlorite 0.5–5.25%
IrrigatION OF ROOT CANAL SYSTEM • Ethylene diamine tetra acetic acid (EDTA)
Every root canal system has spaces that cannot be cleaned • Hydrogen peroxide
mechanically. The only way we can clean webs, fins and • Chlorhexidine.
anastomoses is by effective use of an irrigation solution .
cleaning and shaping
Functions of Irrigants
Cleaning and shaping is one of the most important step
• Irrigants perform physical and biologic functions. in the root canal therapy for obtaining success in the
Dentin shavings get removed from canals by irrigation root canal treatment. Cleaning comprises removal of
• Instruments are less likely to break when canal walls all potentially pathogenic contents from the root canal
are lubricated with irrigation system.
• Irrigants help in removing the debris from accessory Shaping is establishment of a specifically shaped cavity
and lateral canals where instruments cannot reach. which performs dual role of three dimensional progressive
A B A B
Figures 13.16A and B: Schematic representation showing reference Figures 13.18A and B: Schematic representation showing methods
point which is highest point on incisal edge of anterior teeth and cusp used for cleaning and shaping of root canals; (A) Step back technique,
tip of posterior teeth (B) Crown down technique
A B C D
Figures 13.17A to D: Schematic representation of radiographic method showing length determination
access into the canal and creating an apical preparation 3. Making the canal narrower apically and widest
which permits obturation. coronally: To create a continuous taper up to apical
third which creates the resistance form to hold gutta-
BASIC PRINCIPLES OF CANAL percha in the canal.
INSTRUMENTATION 4. Avoid transportation of the foramen: There should be
gentle and minute enlargement of the foramen while
• there should be a straight line access to the canal maintaining its position.
orifices. Creation of a straight line access by removing 6. Keep the apical opening as small as possible: This is
overhang dentin influences the forces exerted by a file done to avoid number of iatrogenic problems.
in apical third of the canal
• Files are always worked with in a canal filled with TECHNIQUES OF ROOT CANAL
irrigant. Therefore, copious irrigation is done in
between the instrumentation, i.e. canal must always be
PREPARATION
prepared in wet environment There are two approaches used for biomechanical
• Canal enlargement should be done by using instruments preparation, either starting at the apex with fine
in the sequential order without skipping sizes instruments and working up to the orifice with progressively
• All the working instruments should be kept in confines larger instruments, this is step back technique or starting
of the root canal to avoid any procedural accidents at the orifice with larger instrument and working up to apex
• Recapitulation is regularly done to loosen debris by with larger instruments, this is crown down technique
returning to working length. The canal walls should not (Fig. 13.18).
be enlarged during recapitulation
• Over preparation and too aggressive over enlargement Step Back Technique
of the curved canals should be avoided
Basically this technique involves the canal preparation
• Never force the instrument in the canal. Forcing or
into two phases; phase I involves the preparation of apical
continuing to rotate an instrument may break the
constriction and phase II involves preparation of the
instrument.
remaining canal (Fig. 13.19).
Schilder’s objectives for cleaning and shaping of root
canal system: Phase I
1. Root canal preparation should develop a
continuously tapering cone: This shape mimics the • Prepare the access cavity, locate the canal orifices and
natural funnel-shaped preparation of canal. establish the working length
2. Making the preparation in multiple planes which • Now insert the first instrument into the canal with
introduces the concept of “flow”: It preserves the watch winding motion. In watch winding motion, a
natural curve of the canal.
A B C D E F G
Figures 13.19A to G: Schematic representation showing step back technique (A) Place file to working length; (B) 25 No. file at working length;
(C) 30 No. file 1 mm short of working length (D) 35 No. file 2 mm short of working length; (E) 40 No. file 3 mm short of working length; (F) 45 No.
file 4 mm short of working length; (g) 50 No. file for canal preparation
gentle clockwise and anticlockwise rotation of file with smaller number files deeper into the canal in sequential
minimal apical pressure is given order and prepare the apical part of the canal.
• Remove the instrument and irrigate the canal 4. Final apical preparation is prepared and finished along
• Place the next larger size file to the working length in with frequent irrigation of the canal system.
similar manner and again irrigate
• Recapitulate the canal with previous smaller number Obturation of Root Canal System
instrument. This breaks up apical debris which are
washed away with the irrigant
Purpose of Obturation
• Repeat the process until a size 25 K-file reaches the To achieve total obliteration of the root canal space so as to
working length. Recapitulate between the files by prevent ingress of bacterias and body fluids into root canal
placing a small file to the working length. space as well as egress of bacterias which are left in canal.
Phase II Materials used for obturation

• Place next file in the series to a length 1 mm short of • Plastics: Gutta percha, resilon
working length. Insert the instrument into the canal • Solids or metal cores: Silver points, gold, stainless
with watch winding motion, remove it after filing, steel, titanium and irridio-platinum
irrigate and recapitulate • Cements and pastes:
• Repeat the same procedure with successively larger –– MTA
files at 1 mm increments from the previously used file –– Gutta flow.
• Similarly mid canal area and coronal part of the canal is
prepared and shaped with larger number files Obturation Techniques
• Finally refining of the root canal is done by master
apical file with push-pull strokes to achieve a smooth Lateral Compaction Technique
taper form of the root canal. Technique
1. Select the master gutta-percha cone whose diameter
Crown Down Technique
is consistent with largest file used in the canal up to
1. First step in the crown down technique is the access the working length. One should feel the tugback with
cavity preparation with no pulp chamber obstructions. master gutta-percha point (Fig. 13.21).
Locate the canal orifices with sharp explorer which 2. Select the size of spreader to be used for lateral
shows binding in the pulp chamber. compaction of that tooth. It should reach 1–2 mm of
2. Now fill the access cavity with an irrigant and start true working length.
preflaring of the canal orifices (Fig. 13.20A to D). 3. apply sealer in the prepared root canal.
3. Introduce larger files to coronal part of the canal and 4. Now coat the premeasured cone with sealer and place
prepare it. Subsequently introduce progressively into the canal. Then place spreader into the canal
A B C D
Figures 13.20A to D: Schematic representation showing crawn technique (A) Establishing working length using a small instrument; (B) Use of
larger files to prepare coronal-third; (C) Preparation of canal at middle-third; (D) Apical preparation of canal
alongside the cone. Spreader helps in compaction of CORONAL RESTORATION

gutta-percha (Fig. 13.22).
5. Remove the spreader by rotating it back and forth. This After obturation, it is very important to seal the root canal
compacts the gutta-percha and creates a space lateral system by coronal restoration. Commonly used materials
to the master cone. for temporary restoration of endodontically treated tooth
6. Place an accessory cone into this space and repeat during or after treatment are IRM and Cavit.
the above procedure until the spreader no longer Coronal restoration temporarily seal the tooth during
penetrates beyond the cervical line. or after the treatment. Even a well-done endodontic
7. Now sever the protruding gutta-percha points at canal treatment can get infected due to poor quality of
orifice with hot instrument (Fig. 13.23). temporary restoration or delay in permanent restoration
after completion of endodontic treatment. Permanent
restoration is done by placing crown or other restoration
(like amalgam or composite resin) so as to restore the
tooth to full function.
COMMON ERRORS DURING ENDODONTIC

TREATMENT
• During access cavity preparation (Fig. 13.24)
• During cleaning and shaping (Fig. 13.25)
• During working length determination (Fig. 13.26)
• Obturation related errors (Figs 13.27 and 13.28).
Figure 13.21: Schematic representation showing checking of the
fit of gutta percha cone
Figure 13.22: Schematic representation showing compaction of Figure 13.24 Schematic representation showing perforation caused
gutta percha using spreader during access cavity preparation in anterior tooth by not keeping bur
parallel to long axis of the tooth
A B C D
Figures 13.25A to D: Schematic representation showing file not
reaching to full working length because of (A) Presence of dentin
chips; (B) Wrong angulation of instrument; (C) Using instrument larger
Figure 13.23: Schematic representation showing complete obtura- than canal diameter; (D) Restriction to instrument in canal making it
tion of the canal using accessory cones short of apex
Viva Question
Q.1. What is the main aim of the endodontic therapy ?

Ans. • To maintain vitality of the pulp
• To preserve and restore the tooth with damaged
and necrotic pulp.
Q.2. How is pulp different from other dental tissues?
Ans. • It has minimal collateral blood supply, it reduces
its capacity for repair following injury
• Pulp is surrounded by rigid dentin so is unable
to expand in response to injury as a part of the
inflammatory process.
Q.3. What are the causes of pulpal diseases?
Figure 13.26 Radiograph showing apical root perforation, i.e. Ans. 1. Dental caries.
instrument is going beyond confines of root canal 2. Trauma like fracture, or avulsion of tooth.
3. Pathologic wear, e.g. attrition, abrasion, etc.
4. Periodontal pocket and abscess.
Q.4. What is barbed broach used for?
Ans. Barbed broach is used to remove pulp, cotton or
paper points which might have lodged in the canal.
Q.5. What are the differences between a reamer and a
file?
Files Reamers
• Flutes More (1½–2/mm) Less (½–1/mm)
• Cutting motion Rasping and penetration Rotation and
(push and pull) retraction
• T ransport of Poor because of tighter Better because of
debris flutes space present in
flutes
Q.6. What are the advantages of NiTi alloys?

Figure 13.27: Radiograph showing incomplete obturation
(short of the apex)
Ans. • Superelasticity
• Good resiliency
• Corrosion resistance
• Softer than stainless steel.
Q.7. What is the shape of access cavity of maxillary
incisors?
Ans. It is triangular in shape with base towards incisal
surface.
Q.8. What is the shape of access cavity of premolars?
Ans. It is oval in shape with greater dimensions on
buccolingual side.
Figure 13.28 Schematic representation showing gutta Q.9. What is the shape of access cavity of maxillary
percha filled beyond apex first molar?
Ans. It is rhomboid in shape. Ans. It involves two phases. Phase I, involves the
preparation of apical constriction and phase II
Q.10. What is the shape of access cavity of mandibular
involves preparation of the remaining canal.
molar?
Ans. It is trapezoidal or rhomboidal in shape. Q.15. What is the purpose of obturation?
Ans. To achieve three dimensional seal of the root canal
Q.11. Why do we measure working length?
space so as to prevent ingress of bacterias and body
Ans. It determines how far into canal instruments
fluids into root canal as well as egress of bacterias
should be placed and worked. If not properly
which are left in canal.
calculated, it can get short of the apex or may go
beyond apex. Q.16. Name commonly used materials used for
obturation?
Q.12. What are the functions of irrigants?
Ans. Gutta percha, silver points, MTA.
Ans. Irrigants help in removing the debris from accessory
and lateral canals where instruments cannot reach. Q.17. Name commonly used techniques for obturation?
Instruments are less likely to break when canal walls Ans. • Lateral compaction technique
are lubricated with irrigants. • Vertical compaction technique.
Q. 13. Name commonly used irrigating solutions? Q.18. Why is postendododntic coronal restoration
Ans. • Saline important?
• Sodium hypochlorite (0.5–5.25%) Ans. Without coronal restoration, even a well-done
• Hydrogen peroxide root canal treatment can get infected. Permanent
• Chlorhexidine. restoration like crown or other restoration (like
amalgam or composite resin) is done to restore the
Q.14. How is step back technique performed?
tooth to full function.
CHAPTER
14
Examination Spotters
Nidhi Rani, Harleen Kaur Gill
INSTRUMENTS
Spotter 1: Mouth Mirror
r *U JT VTFE BT EJBHOPTUJD JOTUSVNFOU BOE UP JNQSPWF
BDDFTTUPJOTUSVNFOUBUJPO
r *UIBTIBOEMF TIBOLBOEBNJSSPSBUUBDIFEUPBSPVOE
NFUBMEJTLBUPOFFOE
r *U JT VTFE GPS %JSFDU WJTJPO JOEJSFDU WJTJPO SFUSBDUJPO
USBOTJMMVNJOBUJPO
Spotters: 1
Spotter 2: Explorer
r &YQMPSFSJTVTFEBTBEJBHOPTUJDBJE
r *UIBTTUSBJHIUIBOEMFXIJDIDBOCFQMBJOPSTFSSBUFE
r 4IBOLJTDVSWFEXJUIPOFPSNPSFBOHMFT
r 8PSLJOHUJQJTQPJOUFE
r 6TFEGPSFYBNJOJOHQJUBOEêTTVSFDBSJFT
Spotters: 2
r *OUFSQSPYJNBM FYQMPSFS JT VTFE GPS FYBNJOBUJPO PG
JOUFSQSPYJNBM DBSJFT BOE BTTFTTJOH NBSHJOBM êU PG UIF
SFTUPSBUJPO
Spotter 3: Tweezer
r 5XFF[FSIBTBOHMFEFOEXJUIJOOFSTFSSBUJPOT
r *UIBTJOOFSHVJEFQJOXIJDIQSPWJEFTTUBCJMJUZ
r *UJTBWBJMBCMFJOEJŀFSFOUTJ[FT
r 6TFEUPQMBDFBOESFNPWFDPUUPOSPMMTBOEPUIFSTNBMM
NBUFSJBMTUPBOEGSPNUIFNPVUI
Spotters: 3
Spotter 4: Chisel
r 4USBJHIUDIJTFMIBTTUSBJHIUTIBOLBOECMBEFXJUICFWFM
POMZPOPOFTJEF
r $VUUJOHFEHFJTQFSQFOEJDVMBSUPQMBOFPGJOTUSVNFOU
r 6TFEXJUITUSBJHIUUISVTUGPSDFBOEQVTINPUJPO
r *U JT NBJOMZ VTFE GPS DVUUJOH FOBNFM TNPPUIFO BOE
Spotters: 4
TIBSQFOUIFUPPUIQSFQBSBUJPOT
Examination Spotters 199
Spotter 5: Gingival Margin Trimmer

r *U JT B NPEJêFE IBUDIFU XIJDI IBT XPSLJOH FOET XJUI
PQQPTJUFDVSWBUVSFTBOECFWFMT
r "WBJMBCMFJOBTFUPGUXPEPVCMFFOEFETUZMFTBOEJTVTFE
JOQBJST DPOTUJUVUJOHBTFUPGGPVSJOTUSVNFOUT
r "WBJMBCMFBTNFTJBMBOEEJTUBMHJOHJWBMNBSHJOUSJNNFS
A
r %JTUBM(.5JTVTFEGPSEJTUBMTVSGBDFBOENFTJBM(.5JT
VTFEGPSNFTJBMTVSGBDF
r 6TFEJOMBUFSBMTDSBQJOHNPUJPO
r 6TFEGPS
– 1MBOJOHHJOHJWBMDBWPTVSGBDFNBSHJO
– 3FNPWBMPGVOTVQQPSUFEFOBNFM
B
– 5P CFWFM BYJPQVMQBM MJOF BOHMF JO UIF DMBTT ** UPPUI
QSFQBSBUJPO
Spotters: 5
Spotter 6: Excavators
r "EPVCMFFOEFEJOTUSVNFOUXJUIBTQPPO DMBX PSEJTL
TIBQFECMBEF
r $VUUJOHFEHFPGCMBEFJTEJSFDUFEJOUIFTBNFQMBOFBT
UIBUPGMPOHBYJTPGUIFIBOEMF
r 6TFE
– 5PSFNPWFTPGUDBSJFTJOTDPPQJOHNPUJPO
Spotters: 6
– 'PSDBSWJOHBNBMHBNSFTUPSBUJPOTBOEXBYQBUUFSOT
Spotter 7: Burnisher
r #VSOJTIFS JT B EPVCMF FOEFEJOTUSVNFOU XIJDI IBT
TNPPUISPVOEFEFOETBWBJMBCMFJOEJŀFSFOUUZQFT
r 6TFT
– 5PTNPPUIFOBOEQPMJTIUIFSFTUPSBUJPO
– 'PSHJWJOHJOJUJBMPDDMVTBMBOBUPNZ
Spotters: 7 – 'PSêOBMDPOEFOTBUJPOPGBNBMHBN
– 'PSCVSOJTIJOHNBSHJOTPGDBTUHPMESFTUPSBUJPO
– 4IBQJOHNBUSJYCBOETBDDPSEJOHUPUPPUIBOBUPNZ
Spotter 8: High-speed Diamond point

r 6TFEXJUIIJHITQFFEBJSPUPSIBOEQJFDF
r )BTIFBE OFDLBOEGSJDUJPOMPDLUZQFTIBOL
r 6TFE GPS UPPUI QSFQBSBUJPOT BOE SFNPWBM PG PME
SFTUPSBUJWFNBUFSJBMT
r /BNFE PO UIF CBTJT PG TIBQF PG IFBE MJLF SPVOE
JOWFSUFE TUSBJHIU UBQFSFE FUD
Spotters: 8
Spotter 9: Slow-speed Dental Bur

r 4MPXTQFFEEFOUBMCVSVTFEXJUINJDSPNPUPSIBOEQJFDF
r )BTIFBE OFDLBOEMBUDIUZQFTIBOL
r 6TFEGPSêOJTIJOHBOEQPMJTIJOHQVSQPTFT
r /BNFE PO UIF CBTJT PG TIBQF PG IFBE MJLF SPVOE
JOWFSUFE TUSBJHIU UBQFSFE FUD
Spotters: 9
Spotter 10: Wedges

r 6TFEGPSBEBQUBUJPOPGNBUSJYCBOEDMPTFMZUPUIFUPPUI
r 1SFWFOUTPWFSIBOHJOHPGUIFSFTUPSBUJPO
r 6TFEGPSSBQJETFQBSBUJPOEVSJOHUPPUIQSFQBSBUJPOBOE
SFTUPSBUJPO
r "WBJMBCMFBTUSJBOHVMBSBOESPVOETIBQFT USJBOHVMBSJT
QSFGFSSFEPWFSSPVOETIBQF
Spotters: 10
r "WBJMBCMF BT QMBTUJD BOE XPPEFO XFEHFT XPPEFO BSF
QSFGFSSFENPSFUIBOQMBTUJD
Spotter 11: Tofflemire Retainer

r "MTPLOPXOBTAVOJWFSTBMNBUSJYCFDBVTFJUDBOCFVTFE
JOBMMUZQFTPGUPPUIQSFQBSBUJPOTPGQPTUFSJPSUFFUI
r )BT IFBE TMPU TNBMM BOE MBSHF LOVSMFE OVUT BT JUT
DPNQPOFOUT
r 6TFEGPSDMBTT*UPPUIQSFQBSBUJPOTXJUICVDDBMPSMJOHVBM
FYUFOTJPOTBOEDMBTT** .0%
UPPUIQSFQBSBUJPOT
Spotters: 11
r &BTZUPVTF QSPWJEFTHPPEDPOUBDUBOEDPOUPVST
Spotter 12: Ivory No. 1 Matrix Retainer

r .PTUDPNNPOMZVTFENBUSJYCBOEIPMEFSGPSVOJMBUFSBM
DMBTT**UPPUIQSFQBSBUJPOT
r *U IBT B DMBX BU POF FOE XJUI UXP ëBU TFNJDJSDMF BSNT
IBWJOHBQPJOUFEQSPKFDUJPOBUUIFFOE
r 0O PUIFS FOE UIFSF JT B TDSFX XIJDI JT XIFO SPUBUFE
DMPDLXJTF CSJOHTFOETPGCPUIDMBXTDMPTFSUPFBDIPUIFS
Spotters: 12
r ,FFQJOH UIF NBUSJY CBOE BSPVOE UIF UPPUI TDSFX JT
UJHIUFOFETPBTUPêUUIFCBOETOVHMZBSPVOEUIFUPPUI
r 6TFE GPS SFTUPSBUJPOT PG VOJMBUFSBM DMBTT ** UPPUI
QSFQBSBUJPOT FTQFDJBMMZ XIFO UIF DPOUBDU PO UIF
VOQSFQBSFETJEFJTWFSZUJHIU
Spotter 13: Ivory No. 1 Matrix band

r 6TFEXJUINBUSJYSFUBJOFSOP
r #BOEJTTMJHIUMZDPOWFYJOJUTNJEEMFQBSU
r ǔJTQSPKFDUFENBSHJOJTLFQUUPXBSETUIFHJOHJWBPO
UIFTJEFPGUPPUIQSFQBSBUJPO
r *U IBT IPMFT JOUP XIJDI SFUBJOFS JT JOTFSUFE BOE
BEKVTUFEBDDPSEJOHUPUIFUPPUI
Spotters: 13
Spotter 14: Ivory No. 8 Matrix retainer

r *U IPMET UIF NBUSJY CBOE UIBU FODJSDMFT UIF UPPUI UP
QSPWJEFNJTTJOHXBMMTPOCPUIQSPYJNBMTJEFT
r $JSDVNGFSFODF PG UIF CBOE DBO CF BEKVTUFE VTJOH UIF
TDSFXQSFTFOUJOUIFNBUSJYCBOESFUBJOFS
r 6TFEGPS
– 6OJMBUFSBMPSCJMBUFSBMDMBTT**QSFQBSBUJPOT .0%
Spotters: 14
– $MBTT**DPNQPVOEUPPUIQSFQBSBUJPOTIBWJOHNPSF
UIBOUXPNJTTJOHXBMMT
Spotter 15: Ivory No. 8 Matrix band

r 6TFEXJUIJWPSZNBUSJYCBOESFUBJOFSOP
r *UJTNBEFVQPGUIJOTIFFUPGNFUBMTPUIBUJUDBOQBTT
UISPVHI UIF DPOUBDU BSFB PG UIF VOQSFQBSFE QSPYJNBM
TJEFPGUIFUPPUI
r 6TFEGPSDMBTT**SFTUPSBUJPOT
Spotters: 15
Spotter 16: Mylar Strips

r $FMMPQIBOF $FMMVMPTFBDFUBUF
TUSJQTBSFVTFEEVSJOH
UPPUIDPMPSFESFTUPSBUJPOT
r 4QFDJBMMZ VTFE EVSJOH $MBTT *** BOE *7 DPNQPTJUF
SFTUPSBUJPOTCFDBVTFUIFZBMMPXMJHIUUPCFUSBOTNJUUFE
EVSJOHQPMZNFSJ[BUJPO
Spotters: 16
Spotter 17: Amalgam Polishing Kit

r $POTJTUTPGQPMJTIJOHTUPOFTPGEJŀFSFOUTJ[FTBOEHSBEFT
GSPNêOFUPDPBSTF
r 6TFE UP êOJTI BNBMHBN SFTUPSBUJPO BGUFS IPVST CZ
BUUBDIJOHJUJODPOUSBBOHMFNJDSPNPUPSIBOEQJFDF
Spotters: 17
MATERIALS
Spotter 18: Amalgam Alloy Powder
r "WBJMBCMFJOGPSNPGQPXEFS
r $POTJTUTPGTJMWFS UJO DPQQFS [JODBOEQBMMBEJVN
r $BO CF DMBTTJêFE BT IJHI BOE MPXDPQQFS BMMPZ
BDDPSEJOHUPDPQQFSDPOUFOU
r $MBTTJêFEBTMBUIFDVUBOETQIFSJDBMBDDPSEJOHUPTIBQF
PGBMMPZ
r .JYFEXJUINFSDVSZUPGPSNEFOUBMBNBMHBN
Spotters: 18
Spotter 19: Mercury

r "WBJMBCMFJOMJRVJEGPSN
r "DDPSEJOH UP &BNFT UFDIOJRVF JU TIPVME CF NJYFE JO
SBUJPXJUITJMWFSBMMPZQPXEFS
r .PSFNFSDVSZJOBMMPZSFTVMUTJO
– .PSFDPOUSBDUJPOPGTFUBNBMHBN
– .PSFDSFFQ
– %FDSFBTFJOTUSFOHUI
r 4IPVME CF SFNPWFE GSPN NJYFE BNBMHBN CZ NVMMJOH
BGUFSUSJUVSBUJPO
Spotters: 19
Spotter 20: Amalgam Capsule

r *U JT QSPQPSUJPOFE DBQTVMF DPOUBJOJOH BNBMHBN BMMPZ
BOENFSDVSZ
r 5PQSFWFOUBOZBNBMHBNBUJPOEVSJOHTUPSBHF NFSDVSZ
BOEBMMPZBSFQIZTJDBMMZTFQBSBUFEGSPNFBDIPUIFS
r *UJTUSJUVSBUFENFDIBOJDBMMZJOBNBMHBNBUPS
r 1SFWFOUTTQJMMBHFPGNFSDVSZBOEQSPWJEFTQSPQFSSBUJP
PGBNBMHBNBMMPZBOEQPXEFS
Spotters: 20
Spotter 21: Dentin Bonding Agent

r "WBJMBCMFJOMJRVJEGPSN
r .BJOMZDPOTJTUTPG)&."BOE#JT(."
r *UIBTBCJGVODUJPOBMTUSVDUVSF
r *U IBT CPUI IZESPQIJMJD BOE IZESPQIPCJD FOET
)ZESPQIJMJDFOECPOETUIFJOPSHBOJDQBSUPGEFOUJOBOE
IZESPQIPCJDFOECPOETUPUIFDPNQPTJUFSFTJO
r *U QFOFUSBUFT JO FUDIFE NJDSPQPSFT PG UPPUI TVSGBDF
GPSNJOHUIFIZCSJEMBZFS
Spotters: 21
Spotter 22: Etchant

r "WBJMBCMFBTQIPTQIPSJDBDJEJOGPSNPGMJRVJEPSHFM
r "QQMJFEGPSmTFDPOETPOUPPUIBOEUIFOXBTIFEPŀ
UPHJWFBGSPTUZXIJUFBQQFBSBODF
r JUDMFBOTFTEFCSJTGSPNFOBNFMBOEQSPEVDFTNJDSPQPSFT
JOUPXIJDIUIFSFJTNFDIBOJDBMJOUFSMPDLJOHPGUIFSFTJO
r *ODSFBTFTUIFFOBNFMTVSGBDFBSFBBWBJMBCMFGPSCPOEJOH
r &YQPTFTNPSFSFBDUJWFTVSGBDFMBZFS UIVTJODSFBTJOHJUT
XFUUBCJMJUZ
Spotters: 22
Spotter 23: Light-cured Composite Resin

r 3FTUPSBUJWFSFTJOQPMZNFSJ[FECZBMJHIUTPVSDF
r $POTJTUTPGPSHBOJDQBSU êMMFST DPVQMJOHBHFOU BDUJWBUPS
mJOJUJBUPSTZTUFN JOIJCJUPSTBOEDPMPSJOHBHFOUT
r "WBJMBCMFJOEJŀFSFOUTIBEFGPSFTUIFUJDT
r "WBJMBCMFBTNJDSPêMMFE IZCSJEBOEOBOPêMMFEUZQF
r 6TFEGPSSFTUPSBUJPOPG
Spotters: 23
– .JMEUPNPEFSBUFDMBTT*BOEDMBTT**UPPUIQSFQBSBUJPOT
– $MBTT*** *7BOE7QSFQBSBUJPOT
Spotter 24: Varnish

r *U JT BO PSHBOJD DPQBM PS SFTJO HVN TVTQFOEFE JO
TPMVUJPOTPGFUIFSPSDIMPSPGPSN
r "QQMJFEPOQSFQBSFEUPPUIXBMMTBOEëPPSTJOmDPBUT
VTJOHBTNBMMDPUUPOQMFEHFU
r 8IFOBQQMJFEPOUIFUPPUITVSGBDFUIFPSHBOJDTPMWFOU
FWBQPSBUFTMFBWJOHCFIJOEBQSPUFDUJWFêMN
r 6TFEUPSFEVDFNJDSPMFBLBHF QPTUPQFSBUJWFTFOTJUJWJUZ
BOEJNQSPWFTFBMJOHBCJMJUZPGUIFBNBMHBN
r 1SFWFOUTEJTDPMPSBUJPOPGUPPUICZDIFDLJOHNJHSBUJPO
PGJPOTJOUPUIFEFOUJO
r /PU VTFE VOEFS HMBTT JPOPNFST CFDBVTF JU JOUFSGFSFT
DIFNJDBMCPOEJOHPGUPPUIBOEDFNFOUT
Spotters: 24
Spotter 25: Zinc Oxide Eugenol Cement

r 4VQQMJFEBTQPXEFSBOEMJRVJE
r 1PXEFSDPOUBJOT[JODPYJEF XIJUFSPTJO [JODTUFBSBUF
BOE[JODBDFUBUF-JRVJEDPOUBJOTFVHFOPM
r "WBJMBCMF BT 5ZQF * UFNQPSBSZ MVUJOH
5ZQF ** MPOH
UFSNMVUJOH
5ZQF*** UFNQPSBSZSFTUPSBUJPO
BOE5ZQF
*7 JOUFSNFEJBUFSFTUPSBUJPO
r 6TFE BT TFEBUJWF DFNFOU GPS UFNQPSBSZ MVUJOH BOE

SFTUPSBUJWFQVSQPTF
Spotters: 25
Spotter 26: Intermediate Restorative Material

(IRM)
r 3FJOGPSDFE[JODPYJEFFVHFOPMDFNFOU
r 1PXEFSSFJOGPSDFECZBEEJOHQPMZNFUIZMNFUIBDSZMBUF
r 3FTJOIFMQTJO
– *NQSPWJOHTUSFOHUIBOETNPPUIOFTTPGUIFNJY
– %FDSFBTJOH ëPX TPMVCJMJUZ BOE CSJUUMFOFTT PG UIF
DFNFOU
r 6TFEBTUFNQPSBSZSFTUPSBUJPO
Spotters: 26
Spotter 27: Zinc Phosphate Cement

r 1PXEFS DPOUBJOT [JOD PYJEF NBHOFTJVN PYJEF BOE
CJTNVUIPYJEF-JRVJEDPOUBJOTQIPTQIPSJDBDJE XBUFS
BOEBMVNJOB
r "WBJMBCMFBTUXPUZQFT
– 5ZQF*VTFEGPSMVUJOHQVSQPTF
– 5ZQF**VTFEBTCBTF
r )BTIJHIDPNQSFTTJWFTUSFOHUIBOEUIJOêMNUIJDLOFTT
r 6TFEGPSMVUJOHDSPXOT JOMBZTBOEPSUIPEPOUJDTCBOET
r 6TFE BT JOUFSNFEJBUF CBTF BOE UFNQPSBSZ SFTUPSBUJPO
NBUFSJBM
Spotters: 27
Spotter 28: Zinc Polycarboxylate Cement

r 1PXEFSDPOUBJOT[JODPYJEFBOENBHOFTJVNPYJEF
r -JRVJEDPOUBJOTQPMZBDSZMJDBDJE
r #POET DIFNJDBMMZ UP UIF UPPUI TUSVDUVSF 1PMZBDSZMJD
BDJESFBDUTXJUIDBMDJVNJPOPGUFFUIWJBDBSCPYZMHSPVQ
BOEGPSNDIFNJDBMCPOE
r #JPDPNQBUJCJMJUZ CFDBVTF PG CJHHFS TJ[F PG QPMZBDSZMJD
BDJE NPMFDVMF VOBCMF UP QFOFUSBUF JOUP EFOUJOBM
UVCVMFT
BOESJTFPGQ)PGUIFDFNFOUPONJYJOH
r 6TFEUPDFNFOUJOMBZTPSDSPXOT
r 6TFEBTCBTFBOEUFNQPSBSZSFTUPSBUJPO
Spotters: 28
Spotter 29: Calcium Hydroxide

r 4VQQMJFEBTCBTFBOEDBUBMZTU
r *UT IJHI BMLBMJOF Q)
IFMQT JO OFVUSBMJ[BUJPO PG
BDJETQSPEVDFECZUIFNJDSPPSHBOJTNT
r 1SPWJEFTBOUJCBDUFSJBMQSPQFSUJFT
r 1SPNPUFTSFQBSBUJWFEFOUJOGPSNBUJPO
r 6TFEBTTVCCBTFBOEMJOFS
Spotters: 29 r 6TFEJOQVMQPUPNZBOEQVMQDBQQJOHQSPDFEVSFT
Spotter 30: Type 1 Glass Ionomer Cement

r 6TFEGPSMVUJOHQVSQPTF
r 1PXEFS DPOUBJOT DBMDJVN ëVPSPBMVNJOPTJMJDBUF HMBTT
BOE MJRVJE DPOUBJOT QPMZBDSZMJD BDJE JUBDPOJD BOE
UBSUBSJDBDJE
r #POETDIFNJDBMMZUPUPPUITUSVDUVSF
r #JPDPNQBUJCMF
r -PXTPMVCJMJUZ
Spotters: 30
Spotter 31: Type 2 Glass Ionomer Cement

r 6TFEBTSFTUPSBUJWFDFNFOU
r 1PXEFS DPOUBJOT DBMDJVN ëVPSPBMVNJOPTJMJDBUF HMBTT
BOE MJRVJE DPOUBJOT QPMZBDSZMJD BDJE JUBDPOJD BOE
UBSUBSJDBDJE
r #POETDIFNJDBMMZUPUPPUITUSVDUVSF
r "OUJDBSJPHFOJDDFNFOUEVFUPSFMFBTFPGëVPSJEFT
r #JPDPNQBUJCMF FTUIFUJDJOOBUVSFBOEIBTMPXTPMVCJMJUZ
r 4FOTJUJWF UP CPUI NPJTUVSF DPOUBNJOBUJPO BOE
EFTJDDBUJPOEVSJOHTFUUJOHQIBTF
r *OEJDBUFE GPS DMBTT 7 *** BOE TNBMM DMBTT * UPPUI
QSFQBSBUJPOT
Spotters: 31
Spotter 32: MTA

r #JPNBUFSJBM VTFE JO QVMQ DBQQJOH QVMQPUPNZ BOE
BQFYJêDBUJPO
r .BJOMZDPOTJTUTPGUSJDBMDJVNTJMJDBUF EJDBMDJVNTJMJDBUF
USJDBMDJVN BMVNJOBUF CJTNVUI PYJEF UFUSBDBMDJVN
BMVNJOPGFSSJUF
Spotters: 32
r 4FUT JO QSFTFODF PG NPJTUVSF .JYFE XJUI TBMJOF BOE
DBSSJFEXJUIBNBMHBNDBSSJFS
Spotter 33: Base-metal Alloy pellets

r .BJOMZDPOTJTUTPGOJDLFM DISPNJVNBOEDPCBMU
r $MBTTJêFE BT 5ZQF * TPGU
5ZQF ** NFEJVN
5ZQF ***
IBSE
BOE5ZQF*7 FYUSBIBSE
BDDPSEJOHUPUIFJSVTF
r 6TFE GPS GBCSJDBUJPO PG JOMBZT POMBZT DSPXOT CSJEHFT
BOEQBSUJBMEFOUVSFT
Spotters: 33
Spotter 34: Inlay wax

r 6TFEGPSNBLJOHQBUUFSOTGPSJOMBZT POMBZTBOEDSPXOT
r $POUBJOTQBSBŁOXBY DBSBOVCBXBY DFSFTJOBOEHVN
EBNNFS
r "WBJMBCMFBT
– 5ZQF*.FEJVNXBYGPSEJSFDUUFDIOJRVF
– 5ZQF**4PGUXBYGPSJOEJSFDUUFDIOJRVF
r "WBJMBCMF JO EJŀFSFOU DPMPST UP DPOUSBTU XJUI EJF GPS
CFUUFSEFNBSDBUJPOBOEêOJTIJOHPGNBSHJOT
Spotters: 34
Glossary
Anamika Thakur, Simran Pal Singh Bindra
Abfraction: Recently, it has been proposed that the Amalgam: Technically means an alloy of mercury (Hg)
predominant causative factor of some of the cervical, with any other metal.
wedge-shaped defects is a strong (heavy) eccentric occlusal Amelogenesis Imperfecta: In amelogenesis imper-
force (shown as an associated wear facet) resulting in fecta, the enamel is defective either in form or calcification
microfractures or abfractures. as a result of heredity and has an appearance ranging from
Abrasion: Abrasion is abnormal tooth surface loss essentially normal to extremely unsightly.
resulting from direct friction forces between the teeth ANATOMIC TOOTH CROWN: It is the portion of the tooth
and external objects or from frictional forces between covered with enamel.
contacting teeth components in the presence of an
APEX: Refers to tip or most superior point of the structure.
abrasive medium.
Tip of root of the tooth is also known as apex.
ACCESS CAVITY: It is defined as endodontic coronal
APICAL DENTAL FORAMEN: It is the main apical open-
preparation which enables unobstructed access ing on the surface of root canal through which blood ves-
to the canal orifices, a straight line access to apical sels enter the canal.
foramen, complete control over instrumentation and to
Attrition: Attrition is mechanical wear of the incisal or
accommodate obturation technique.
occlusal surface as a result of functional or parafunctional
Acid-Etching: Process of roughening a solid surface by movements of the mandible (tooth-to-tooth contacts).
exposing it to an acid and thoroughly rinsing the residue to
Axial wall: An axial wall is an internal wall parallel with
promote micromechanical bonding of an adhesive to the
the long axis of the tooth.
surface.
Backward Caries: When spread of caries along
Acute (Rampant) Caries: Acute caries, often termed
DEJ exceeds the caries in surface enamel, it is termed as
rampant caries, is when the disease is rapid in damaging
backward caries.
the tooth.
BALANCE: It is achieved by designing the angles of the
Adherend: A material substrate that is bonded to
shank so that the cutting edge of the blade lies within the
another material by means of an adhesive.
projected diameter of the handle and nearly coincides
Adhesion: A molecular or atomic attraction between with the projected axis of the handle.
two contacting surfaces promoted by the interfacial
BAND: It is a piece of metal or polymeric material, intended
force of attraction between the molecules or atoms of
to give support and form to the restoration during its
two different species; adhesion may occur as physical
insertion and setting.
adhesion, chemical adhesion, mechanical adhesion
(structural interlocking) or a combination of all types. Bases: Bases (cement bases, typically 1–2 mm) are used to
provide thermal protection for the pulp and to supplement
Adhesive Bonding: Process of joining two materials
mechanical support for the restoration by distributing
by means of an adhesive agent that solidifies during the
local stresses from the restoration across the underlying
bonding process.
dentinal surface.
Adhesive: Substance that promotes adhesion of one
BEVELS: Bevel are “flexible extensions” of a cavity
substance or material to another.
preparation, allowing the inclusion of surface defects,
Affected dentin: Softened dimeralized dentin not yet supplementary grooves, or other areas on the tooth surface.
invaded by bacteria. Bevels require minimum tooth involvement, and do not
sacrifice the resistance and retention for the restoration. CLASS III RESOTRATIONS: Restorations on the proximal
BLADE ANGLE: It is the angle between the rake face and surfaces of anterior teeth that do not involve the incisal
the clearance face. angle are Class III.
BLADE: It is the working end of the instrument. CLASS IV RESTORATIONS: Restorations on the proximal
surfaces of anterior teeth that do involve the incisal edge
BUR BLADE: Blade is a projection on the bur head which are Class IV.
forms a cutting edge. Blade has two surfaces:
1. Blade face/Rake Face: It is the surface of bur blade CLASS V RESTORATIONS: Restorations on the gingival
on the leading edge. third of the facial or lingual surfaces of all teeth (except pit
2. Clearance face: It is the surface of bur Blade on the and fissure lesions) are Class V.
trailing edge. CLEANING AND SHAPING: Use of rotary and /or hand
Butt joint: When cavosurface margin is 90 degree, it is instruments to expose ,clean, enlarge and shape the pulp
a butt joint. It is generally given for amalgam restorations. canal space, usually in conjunction with irrigant.
Cavitated Caries (Nonreversible): In cavitated CLINICAL TOOTH CROWN: It is the visible part of a tooth
caries, the enamel surface is broken (not intact), and above the gum line.
usually the lesion has advanced into dentin. COLLAR PREPARATION: To increase the retention and
Cavosurface Angle and Cavosurface Margin: resistance forms when preparaing a weakened tooth for
Cavosurface angle is angle formed by junction of a a mesioocclusodistal onlay to cap all cusps, a facial or
prepared wall and the external surface of the tooth. Actual lingual “collar” or both may be provided.
junction is referred to as the cavosurface margin. CONCENTRICITY: Direct measurement of the symmetry
Cement liners: Thicker liners that are selected of the bur head itself.
primarily for pulpal medication and thermal protection. Condensation: Process of packing the triturated mass
CEMENTOENAMEL JUNCTION: It is the junction of into the cavity.
enamel of crown and cementum of the root. CONTACT AREA: Area of mesial or distal surface of a
tooth that touches to its adjacent tooth in the arch is called
Chronic (Slow or Arrested) Caries: Chronic
contact area.
caries is slow, or it may be arrested following several active
phases. CONVENIENCE FORM. Convenience form is that shape
or form of the preparation that provides for adequate
CINGULUM: It is the lingual lobe of an anterior tooth
observation, accessibility, and ease of operation in
making bulk of the cervical third of palatal surface.
preparing and restoring the tooth.
CLASS I RESTORATION: All pit and fissure restorations
Creep: Amalgam creep is defined as the time dependent
are Class I. Assigned to three groups
plastic deformation of Zinc containing amalgam alloys
• Restorations on lingual surface of maxillary incisors
principally resulting from slow metallurgic phase
• Restorations on occlusal surface of premolars and
transformation that involve diffusion controlled reactions
molars
and produces volume increase.
• Restorations on occlusal two thirds of the facial and
lingual surfaces of molars. CUSP: A cusp is an elevation on the crown of a tooth
making up a divisional part on the occlusal surface.
CLASS II INLAY: Is an intracoronal cast metal restoration
Delayed expansion: Zinc containing low copper
that involves the occlusal and proximal surface of a
or high copper amalgam alloys which get contaminated
posterior tooth.
by moisture during manipulation results in delayed
Class Ii Onlay: It is a cast metal restoration that involves expansion or secondary expansion. This occur 3–5 days
the occlusal and proximal surface of a posterior tooth and after insertion and continues for months. This type of
caps all of the cusps. expansion can reach values greater than 400 mm (4%).
CLASS II RESTORATIONS: Restorations on the proximal DENTAL AMALGAM: Is a metallic restorative material
surfaces of posterior teeth. composed of a mixture of silver-tin-copper alloy and mercury.
Glossary 211
DENTAL BUR: Bur is a rotary cutting instrument which a wall takes the name of the tooth surface (or aspect) that
has bladed cutting head. the wall is toward.
Dentin Bonding Agent: A thin layer of resin between FACE: The end of the nib or working surface is known as
conditioned dentin and the resin matrix of a composite. face.
Dentin Bonding: The process of bonding a resin to Floor (or Seat): A floor (or seat) is a prepared (cut) wall
conditioned dentin. that is reasonably flat and perpendicular to those occlusal
Dentin Conditioner: An acidic agent that dissolves forces that are directed occlusogingivally (generally
the inorganic structure in dentin, resulting in a collagen parallel to the long axis of the tooth).
mesh that allows infiltration of an adhesive resin. Forward Caries: Forward caries is wherever the caries
Dentinal Wall: The dentinal wall is that portion of cone in enamel is larger or at least the same size as that in
a prepared external wall consisting of dentin, in which dentin.
mechanical retention features may be located. FOSSA: It denotes an irregular depression or concavity on
DENTINOENAMEL JUNCTION: It is the interface of the tooth.
enamel and dentin of a tooth crown. Hybrid Layer: An intermediate layer of resin, collagen,
Dentinogenesis Imperfecta: Dentinogenesis im- and dentin produced by acid, etching of dentin and resin
perfecta is a hereditary condition in which only the dentin infiltration into the conditioned dentin.
is defective. Normal enamel is weakly attached and lost Incipient Caries (Reversible): Incipient caries is
early. the first evidence of caries activity in the enamel.
DEVELOPMENTAL GROOVE: It is a shallow groove Infected dentin: It is softened demineralized dentin
between primary parts of crown or the root. containing bacteria.
DOUBLE WEDGING: Here two wedges are used—one is INITIAL TOOTH PREPARATION: Initial tooth preparation
inserted from buccal embrasure and another is inserted is the extension and initial design of the external walls
from lingual embrasure. of the preparation at a specified, limited depth so as to
Dovetail: Auxiliary retention feature given in the provide access to the caries or defect, reach sound tooth
occlusal part of a class II cavity. structure (except for later removal of infected dentin on
the pulpal or axial walls), resist fracture of the tooth or
EMBRASURES (SPILLWAYS): When two teeth of same restorative material from masticatory forces, principally
arch contact, their curvatures adjacent to the contact areas directed with the long axis of the tooth, and retain the
are called embrasures. Spaces which widen out buccally, restorative material in the tooth (except for the Class V
lingually, occlusally or gingivally are called buccal, lingual, preparation).
occlusal or gingival embrasures respectively.
Internal line angle: It is a line angle whose apex
Enamel Wall: The enamel wall is that portion of a points into the tooth.
prepared external wall consisting of enamel.
Internal Wall: An internal wall is a prepared (cut)
Enameloplasty: Enameloplasty is removal of a shal-
low enamel developmental pit or fissure to create a surface that does not extend to the external tooth surface.
smooth, saucer-shaped self- cleansing area. IRREVERSIBLE PULPITIS: It is the persistent inflamma-
ENDODONTICS: Branch of clinical dentistry associated tory condition of the pulp, symptomatic or asymptomatic,
with the prevention, diagnosis and treatment of the caused by a noxious stimulus.
pathosis of the dental pulp and their sequelae. Isthmus: The part of class II cavity preparation that
Erosion: Erosion is the wear or loss of tooth surface by connects the occlusal preparation to the proximal box.
chemicomechanical action. Line Angle: A line angle is the junction of two planal
External line angle: It is a line angle whose apex surfaces of different orientation along a line.
points away from the tooth.
LINERS: Are relatively thin layers of material used
External Wall: An external wall is a prepared (cut) primarily to provide a barrier to protect dentin from
surface that extends to the external tooth surface, and such residual reactants diffusing out of a restoration or from oral
fluids (or both) that may penetrate leaky tooth restoration and soft tissues, all of which should enhance the general
interfaces. health and welfare of the patient.
MAJOR APICAL DIAMETER: It is the apical part of root OUTLINE FORM: Establishing the outline form means:
canal having the narrowest diameter short of the apical • Placing the preparation margins in the positions they
foramen or radiographic apex. It may or may not coincide will occupy in the final preparation, except for finishing
with (CDJ). enamel walls and margins, and
MARGINAL RIDGES: These are the rounded borders of • Preparing an initial depth of 0.2–0.8 mm pulpally of the
enamel that form mesial and distal margins of posterior DEJ position or normal root-surface position (no deeper
teeth and mesial and distal margins of lingual surfaces of initially whether in tooth structure, air, old restorative
anterior teeth. material, or caries unless the occlusal enamel thickness
is minimal and greater dimension is necessary for
MATRICING: It is the procedure by which a temporary wall strength of the restorative material).
is built opposite to the axial wall, surrounding the tooth
structure which has been lost during the tooth preparation. PARTIAL ONLAY: Is cast metal restoration that involves
the occlusal and proximal surface of a posterior and covers
MATRIX: It is an instrument which is used to hold the and restores at least one but not all of the cusp tips of
restoration within the tooth while it is setting. posterior tooth.
Mercuroscopic expansion: Mercury from Sn-Hg of
PERIAPICAL ABSCESS(PERIRADICULAR ABSCESS): A
set amalgam re-reacts with Ag-Sn particles and produce
further expansion during new reaction. This mechanism is localized collection of pus within the periradicular tissues.
called as mercuroscopic expansion. PERIODONTITIS (PERICEMENTITIS): Inflammation of
Microleakage: Flow of oral fluid and bacteria into the periodontium.
microscopic gap between a prepared tooth surface and a PIGGYBACK WEDGING: In this technique, one (larger)
restorative material. wedge is inserted as used normally, while the other smaller
wedge (piggyback) is inserted above the larger one.
Mulling: It is a continuation of trituration, to increase
the homogeneity of the amalgam mass. PITS: These are small pinpoint depressions located at the
junction of developmental grooves.
NIB: For noncutting instruments, part corresponding to
the blade is termed as nib. Point Angle: A point angle is the junction of three
planal surfaces of different orientation.
Nonhereditary Enamel Hypoplasia: Nonheredi-
tary enamel hypoplasia occurs when the ameloblasts are Primary Caries: Primary caries is the original carious
injured during enamel formation, resulting in defective lesion of the tooth.
enamel (diminished form and/or calcification). PRIMARY FLARE: First Flare that brings proximal
OBLIQUE RIDGE: It is a ridge obliquely crossing the preparation out of contact area.
occlusal surface of maxillary first molar and is formed by PRIMARY RESISTANCE FORM: Primary resistance
union of triangular ridges of distobucal cusp and distal form may be defined as that shape and placement of the
cusp ridge of mesiopalatal cusp. preparation walls that best enable both the restoration
OBTURATION: To fill the shaped and debrided root canal and the tooth to withstand, without fracture, masticatory
space with a temporary or permanent filling material. forces delivered principally in the long axis of the tooth.
OPERATIVE DENTISTRY: Operative dentistry is the art PRIMARY RETENTION FORM: Primary retention form
and science of the diagnosis, treatment, and prognosis is that shape or form of the conventional preparation that
of defects of teeth that do not require full coverage resists displacement or removal of the restoration from
restorations for correction. Such treatment should result tipping or lifting forces.
in the restoration of proper tooth form, function, and Primer: A hydrophilic, low viscosity resin that promotes
esthetics while maintaining the physiologic integrity of the bonding to a substrate, such as dentin. Resin tag-extension
teeth in harmonious relationship with the adjacent hard of resin that has penetrated into etched enamel or dentin.
Glossary 213
Prophylactic Odontotomy: Prophylactic odon- SECONDARY FLARE: Is given to provide marginal metal
totomy is presented only as a historical concept character- angle of 40 degree.
ized by minimally preparing and filling with amalgam, de- SHANK: Shank connects handle to working end of the
velopmental, structural imperfections of the enamel, such instrument.
as pits and fissures, to prevent caries originating in these
sites. SKIRT PREPARATION: Skirts are thin extension of facial
or lingual proximal margins of the cast metal onlay that
PULP CAVITY: The pulp cavity lies within the tooth and is extend from primary flare to a termination just past the
enclosed by dentin all around, except at the apical foramen, transition line angle of the tooth.
Pulpal wall: A pulpal wall is an internal wall that Smear Layer: Poorly adherent layer of ground dentin
is both perpendicular to the long axis of the tooth and produced by cutting a dentin surface.
occlusal of the pulp.
Solution liners: Any liner based on nonaqueous
Residual Caries: Residual caries is caries that remains solvents that rely on evaporation for hardening is
in a completed tooth preparation, whether by operator designated as a solution liner (or varnish).
intention or by accident.
Strongest enamel margin: The strongest enamel
RETAINER: It holds a band in desired position and shape. margin is one that is composed of full-length enamel rods
REVERSE BEVEL OR COUNTER BEVEL: It is a bevel of supported on the preparation side by shorter enamel rods,
which is prepared on the facial (lingual) margin of a reduced all of which extend to sound dentin.
cusp with a flame-shaped, fine-grit diamond instrument. Suspension liner: Liners based on water have many
REVERSIBLE PULPITIS: Is the general category which of the constituents suspended instead of dissolved and are
histologically may represent a range of responses varying called suspension liners.
from dentin hypersensitivity without concomitant TOOTH PREPARATION is defined as the mechanical
inflammatory response to anearly phase of inflammation. alteration of a defective, injured, or diseased tooth to
RIDGE: It is any linear elevation on the surface of a tooth best receive a restorative material that will re-establish a
and is named according to its location. For example buccal healthy state for the tooth, including esthetic corrections
or marginal ridge. where indicated, along with normal form and function.
ROOT CANAL SYSTEM: The entire space in the dentin TRIANGULAR RIDGE: It descends from tip of cusp of
where the pulp is housed is Called the root canal system molar and premolar towards central part of occlusal
Root Surface Caries: Root surface caries may occur surface.
on the tooth root that has been both exposed to the oral Trituration: Process to bring the particles of the alloy
environment and habitually covered with plaque. in contact with mercury.
RUNOUT: Dynamic test measuring the accuracy Unsupported enamel margin: An enamel margin
with which all blade tips pass a single point when the composed of rods which do not run uninterrupted from
instrumented is rotated. the surface to the sound dentin is termed as unsupported
Sclerotic/eburnated dentin: An arrested, enamel margin.
dentinal lesion typically is “open” (allowing debridement WEDGE WEDGING: In this technique, two wedges are
from tooth brushing), dark and hard, and this dentin is used, one wedge is inserted from lingual embrasure area
termed sclerotic or eburnated dentin. while another is inserted between the wedge and matrix
Secondary (Recurrent) Caries: Secondary caries band at right angle to first wedge.
occurs at the junction of a restoration and the tooth and WORKING LENGTH: Defined as distance from a coronal
may progress under the restoration. It is often termed reference point to a point at which canal preparation and
recurrent caries. obturation should terminate.
Index
Page numbers followed by f refer to figure and t refer to table.
Black’s classification 137 in premolar, primary 62f

A of dental caries 102f incipient 61
Acids, role of 57 Buccal aspect 9, 11, 12, 14, 18-21, 31, 35, pit 60, 65
Alloy 161 37 primary 61
admixed 161 Buccal embrasure 48f progression 61
high-copper 162 Buccal pit 125f rampant 61
binary 161 Buccal surface 46 residual 61
metals 161 Bur 84 smooth surface 61, 65
pellets, base-metal 207 blade 88 spread, pathway of 61
quaternary 161 classifications of 85 Carious buccal pit 125f
tertiary 161 design 87, 88, 88t Carious lesion 61
Aluminophosphate gel 149f gingivally 127f active 61
Amalgam head size of 64t
capsule 202 design of 86f, 87 Carious palatal pit 125f
carrier 80, 80f, 165f sizes 87t Cavity 189
changes of 165 types of 86f designs 135
file 79f materials for 84 Cement 194
insertion of 164 parts of 85 adhesive luting 115
mechanical trituration of 163f size 87 cermet 155
over-triturated 164f stainless steel 84 spatulas 79
polishing kit 201 Burnishing Cementodentinal junction 191
silver 162t postcarve 164, 166f Cementoenamel junction 6
structure of set 162 precarve 164 Cheek, retraction of 75f
Amalgam alloy 162 Butt joint 115t Chisel 77, 198
powder 202 straight 76, 77
copper in 161f triple angle 77
C Cingulum 6
silver in 161f
tin in 161f Calcium hydroxide 152, 152f, 160f, 205 Collagen fibrils 172f
zinc in 161f cement 152 Composite resins, light-activated 181
Amalgam restoration Canal instrumentation 193 Condensers, types of 80f
carved 166f Canine 8, 17, 29, 34, 41 Conservative dentistry, preclinical 1, 3
for primary teeth 143 Carbohydrate Coronal restoration 195
fractured 3f intake, frequency of 59 Crown down technique 192f, 194, 194f
preparation for 122 role of 57 Cuspids 41
Amalgapins 114 Caries 61
American Dental Association, backward 61
D
classification of dental casting balance concept 57
alloys 167t cavitated 65 Deciduous teeth 45, 46
Anatomic crown 46 chronic 61 palmer system for 42
Armamentarium 3, 70 complex 65 system for 44
compound 65 Dental
extent of 61 amalgam 160
B fissure 60, 65 arches 41
Bacteria 60 in maxillary casting alloys 166, 167
Ball burnishers 4 first molar 62f operatory 51
Binangle chisel 76, 77 premolar 62f plaque, role of 57
procedures 51 caries 65 Hand hygiene 54

pulp 40 zones in 65, 66f Hand instrument 181
Dental bur 84 margins, beveled 114 parts of 71f
parts of 85f rods, direction of 136 Head cap 53f
slow-speed 200 thin 136 Hedstroem file 188
Dental caries 56, 56f, 63f, 64f wall etching 114 Hoe excavator 77, 78f
classification of 137 Enameloplasty 110 Hybrid composite resins 178
pathogenesis of 57 Endodontic 185
Dental cements 145, 146 instrument 186, 186f, 186t, 187t
I
classification of 146 treatment 195
uses of 146 Etching, effects of 172 Incisal aspect 7-9, 16-18, 29, 34
Dental composites 177 Ethoxybenzoic acid reinforced Incisal edge 28
Dental materials 145 cement 147 of anterior teeth 192f
classification of 145 Extraoral finger rest 83 Incisal embrasure 47
properties of 145 Eye wear 53f Incisal surface 46
Dentin 40 protective 54 Inlay wax 207
affected 67t, 113f Instrument
causes of 172f designs 73
F
dehydrated 172f handles, types of 71f
dry 172 Face left bevel 73
hard shell of 185f clearance 88 right bevel 73
infected 67t, 112, 113t mask 53f, 54 Intraoral finger rests 82
moist 172 shield 53f Ivory matrix
Dentin bonding agent 173, 174, 177t, 203 Facial surface 46 band retainer 91
fourth generation 174 Filling instrument 3 holder 89
requirements of 173 Finn’s modification 137
seventh generation 176 Fluoride release 158
sixth generation 174
J
Foramen 193
Dentin conditioning 115 Joint, lap 115t
etching 115
G
priming 115
K
Dentinal caries 66, 67f Gingiva 48
zones of 67 Gingival embrasure 47, 48f Keyes’ triad 58
Dentinal changes Gingival floor of class II preparation K-flex file 188
advanced 67 106f
early 66 Gingival margin 111f
L
Dentinal tubules 173f distal 78f
Dentistry trimmer 77, 199 Lathe-cut low-copper alloys 162
adhesive 171 Gingival recession 47f Lingual aspect 7, 15-21, 33-35, 37
conservative 1 Gingival surface 46 Lingual embrasure 47, 48f
operative 3, 5 Gingival tissue 48f
ranges in operative 85t Glass ionomer cement 154, 155, 157f
M
uses of autocure 156
alloys in 167f type 1 206 Macrofilled composite resin 178
metals in 167f type 2 206 Mandibular
Dentition Graham Mount’s classification of carious anterior teeth 2f
primary 27, 44 lesion 65 canine 17f, 34f
types of 42 Grossman’s classification of endodontic central incisor 15, 33f
Direct cutting instruments 74 instruments 186t incisor 129f
Double-wedging technique 95f Gutta percha 195f, 196f lateral incisors 16f, 33f
cone 195f Mandibular first
GV Black’s classification of molar 21f, 35f, 126f
E instruments 71 premolar 18f
EBA on eugenol cement, effect of 148 Mandibular molar 125f, 126f
Enamel 39 buccal pit for 124
H
bonding 172 cavity preparation for 190
steps for 172 Hand cutting instruments 76 preparation of 191f
Index 217
Mandibular premolar, class I preparation Occlusal aspect 12, 14, 15, 19-21, 30, 32, perforation, apical 196f
in 125f 33f, 34f, 37 Rotary cutting
Mandibular second Occlusal embrasure 47, 48f instruments 84
molar 22f, 36f Occlusal preparation 124, 139 types of 84
premolar 19f Oral cavity 46f
Mandibular teeth 15, 32
S
Matrices, classification of 89t
P
Maxillary anterior teeth, erosion of 2f Saliva 59
Maxillary canine 10f, 29f Palatal fissure 126f bicarbonates in 60
Maxillary central incisor 8f, 28f, 182f Palatal pit 125f Shepherd’s hook 75
Maxillary first Periodontal ligament 40 Silver alloy 162
molar 12, 13f, 30f, 126f, 190f Periradicular tissue 40 Single wedging technique 95
premolar 11f Permanent dentition 27, 135 Step back technique 192f
Maxillary incisor 63f Permanent mandibular teeth 42f
cavity of 189f Permanent maxillary teeth 42f
T
lateral 7, 125f Permanent teeth 27f, 36f, 42, 43f, 44f, 45,
Maxillary molars 45f, 46, 136f, 137f Teflon-coated
cavity 190f morphology of 6 hand instruments 82f
preparation for 190 Palmer system for 42 instruments 81
fissure caries in 62f system for 44 Temporary restoration 151f
Maxillary second Piggyback wedging 96 Thermal expansion 166, 179
molar 14f, 31f Pigtail explorer 75 Thumb grasp 82
premolar 12f Pioneer bacteria 66 Toffelmire retainer 143, 200
Maxillary teeth 7, 28 Plastic deformation 165 and band
Mercury 202 Plastic filling instrument 79 procedure for 92
alloy ratio 162 types of 80f removal of 92
Mesial bevel instruments 73 Plastic wedges 95 Tongue, retraction of 75f
Mesial gingival marginal trimmer 78f Premolar 41, 63f Tooth 59
Metabolites from plaque 60 cavity 189f abrasion of 2f
Metal cores 194 preparation for 190 anatomy 41
Metal reinforced glass ionomer first 9, 18 anterior 47f, 189
cement 155 fissure 56f class I cavity of primary 138f
Microhybrid composites 179 caries in 2f classes of 41, 41f
Microorganisms, role of 57 occlusal surface of 102f combination of 45f
Modern adhesives, classification of proximal surface of 63f crown of 47f
173 Proteolysis-chelation theory 57 cusp tip of posterior 192f
Molar 42, 63f Pulp 27 external surface of 111f
first 12, 20, 30, 35 cavity 28, 30-33, 35, 36, 37 form, physiology of 46
fissures of 56f protection 113, 159f morphology of primary 26
lingual surface of 102f materials 159 nomenclature 41
occlusal surface of 102f Pulpal diseases 186 notation systems 42
proximal surface of 63f Pulpal floor of class II preparation 106f physiology 39
second 14, 21, 31, 36 Pulpal pathologies, progression of 186 posterior 47f
Monoangle chisel 77 Pulpal wall 105 preparation 101, 104, 108, 115, 124,
Mount’s caries classification 64t 126f, 131f, 132, 135, 137, 180, 181
Mouth mirror 74, 75f axial wall, class III 106f
R beveled 131
Resin bonding agents 159 class 5f, 106, 107, 107f, 108, 122,
N Resin-modified glass ionomer 157 128-133, 137, 140f
Nanofill composite 179, 179f cement 155 complex 104
Nanohybrid composite 179 Root 27-29, 31, 34, 35 compound 104
Neck design of burs 86 canal 192f, 196f conservative 181
Noble metal content 167t orifices 190f conventional 131, 132
preparation 193 designs 106t
system 192, 194 external wall of 105f
O techniques of 193 final 124, 126, 129, 138, 139
Obturation techniques 194 caries 61, 62f for amalgam 122
for composite restoration 129 premolar, class II 128f hardening glass ionomer cements 155
internal wall of 105f primary 27f, 136f, 137f sensitivity 158
kidney-shaped class V 129f proximal surface of anterior 63f Wedelstaedt chisel 76, 77
on extracted teeth 4 substance Wedge-wedging technique 95f
on plaster models 4 causes of 1 Wedging techniques 95
on typhodonts 4 loss of 1 Wooden wedges 94
preclinical 4 surface 46, 46f, 64f, 106f, 125f
proximal 111f number of 65
Z
purpose of 101 Triple-beveled instrument 74
retention grooves for 114t Tungsten carbide burs 85 Zinc
steps in 108, 132 containing alloys 161
type of 89t content 161
U
preparation for composite free alloys 161
class 131f, 133f Urethane dimethacrylate 172 oxide eugenol cement 146, 146f, 147,
restoration 133f 148f, 204
preparation in mandibular phosphate
V
molar 129f cement 149, 149f, 205
premolar 125f Varnish 159 powder 151f
preparation in primary teeth 135 polyacrylate cement 152
preparation in typhodont 5f polycarboxylate cement 152, 152f,
preparation of buccal pit 126f
W 205
preparation of maxillary Water silicophosphate cements 151
first molar, class II 129f absorption 179 ZOE cement, manipulation of 148

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Textbook of

Preclinical Conservative Dentistry

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Textbook of Preclinical Conservative Dentistry

Navjot Singh Khurana MDS Savita Thakur MDS

11. Dental Materials������������������������������������������������� 145 Endodontic Instruments 186

Introduction order to have proper understanding of anatomical and

objectives of operative dentistry objectives of preclinical

Figures 1.9: Photograph showing armamentarium required for restorative procedures

Tooth Preparations on Plaster Models Tooth Preparations on Extracted Teeth

INTRODUCTION distal margins of the lingual surfaces of anterior teeth

DEFINITIONS Oblique ridge: It is a ridge obliquely crossing the occlusal

MAXILLARY TEETH Distal Aspect

Lingual/Palatal Aspect Incisal Aspect

r $BOJOFIBTUIFMPOHFTUSPPU3PPUBQQFBSTTMFOEFSGSPN Distal Aspect

r .FTJBMPVUMJOFJTTMJHIUMZDPODBWFGSPNDFSWJDBMMJOFUP Mesial Aspect

r "CTFODFPGEFFQEFWFMPQNFOUBMHSPPWF deeply pointed and referred as mesial and distal

Palatal Aspect Occlusal Aspect

Mesial Aspect MANDIBULAR TEETH

r 4JODF EJTUPCVDDBM DVTQ JT TNBMMFS NFTJPCVDDBM DVTQ

Mesial Aspect Lateral Incisor

Distal Aspect Lingual Aspect

Distal Aspect Lingual Aspect

Distal Aspect Second Premolar

r 4QIFSPJEBM BOE TNPPUI TVSGBDF XJUI DPOTUSJDUFE First Molar

Distal Aspect Lingual Aspect

It is almost similar to mesial aspect except that: r ǔSFFDVTQT JFNFTJPMJOHVBM EJTUPMJOHVBMBOEMJOHVBM

r "MMDVTQTDBOCFTFFO to mesial marginal ridge and distal triangular fossa is

r .FTJPMJOHVBMDVTQJTMBSHFSUIBOEJTUPMJOHVBMDVTQ r .FTJPEJTUBM EJNFOTJPOT BSF NPSF UIBO CVDDPMJOHVBM

Morphology of Primary Teeth

 Introduction • First Molar

INTRODUCTION of the child’s most active periods of growth and

• Position of the apical foramen is variable due to Incisal Edge

MAXILLARY TEETH Root

Labial Aspect Pulp Cavity

• Lingual fossa is deeper Contact Areas

Pulp Cavity • Mesial moiety of the crown has a greater height in

• Well-developed buccal developmental groove Second Molar

Distal Aspect the crown

portion lingual root is more apical than any other points of

the occlusal surface as the lingual.

• Distobuccal and distolingual cusps are about the same

• Number of developmental lobe—1

(D) Occlusal aspect of mandibular lateral incisors

• Root is long, evenly tapered down to the apex Distal Aspect

• These surfaces are convex labiolingually

than on the labial side.

• Lingual surface at the middle third and incisal third

• Contact with the adjacent teeth is on the incisal third of

• Mandibular primary cuspid has the same general Incisal Aspect

• From this aspect, the canines have a diamond shape

• It is convex in all directions • Opposite arrangement is true for maxillary canines.

cervically to the cervical ridge during mastication.

the tooth is rhomboidal. Mesial Aspect

• The cervical line slants upward buccolingually

• There are three pulp canals—Mesiobuccal, mesiolin-

buccoligually and may be constricted in its center.

• Central developmental groove joins it at this point and

mesiolingual cusp • Number of roots—2

11. Dental Materials�� 145 Endodontic Instruments 186

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