SEMINAR ON

CONTENTS
INTRODUCTION

CAVITY PREPARATION- DEFINITION

HISTORY

OBJECTIVES OF CAVITY PREPARATION

FACTORS AFFECTING CAVITY PREPARATION

CLASSIFICATION

G V BLACK

MODIFICATIONS OF G V BLACK

GRAHAM J MOUNT

VIMAL K SIKRI
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OPERATING SITE

STAGES OF CAVITY PREPARATION

INITIAL STAGE

STEP: 1 OUTLINE FORM AND INITIAL DEPTH

STEP: 2 PRIMARY RESISTANCE FORM

STEP: 3 PRIMARY RETENTION FORM

STEP: 4 CONVENIENCE FORM

REFERENCES

INTRODUCTION

CAVITY Refers to a defect in enamel, or in enamel and dentin, resulting

from the pathologic process, dental caries. Once carious process invaded tooth

tissue, enough produce frank cavitations, only effective treatment for preventing

further progress is complete removal of affected area. Preparation of a cavity

should be accomplished in an orderly sequence. This order meant to serve as a

guide, not as a hard and fast list of directives, provide rationale for

developments of city progression with inter related steps that are, to a degree at

least, mutually supporting.

CAVITY PREPARATION
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STURDEVANT defined as the mechanical alteration of a defective,

injured or diseases tooth in order to best receive a restorative material which

will be establish a healthy state for the tooth including esthetic corrections

where indicated, along with normal form and function. Any remaining infected

or friable tooth structure may result in further carious progression, sensitivity or

pain, or fracture of the tooth and / or restoration.

CHAARBENEAU defined as the performance of dental surgical

procedures, require exposing carious lesion, permitting removal of affected

dentin & enamel as to contribute to biologically & mechanically sound

restoration.

MARZOUK defined as mechanical preparation &/or chemical treatment

of remaining tooth structure, which enables to accommodate restorative

material, without incurring mechanical or biological failure.

HISTORY

Although archeological evidence of dental treatment dates from as early

as 5000 BC, little is known about equipment and methods used through.
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In Early 1800, drills powered by hand for cavity preparation. In 1955, Page-

Chayes handpiece, the first belt driven angle handpiece to operate successfully

at speeds over 100,000 rpm.

In 1957, Borden Air handpiece was the first clinically successful in turbine

handpiece. Then air motor, electric micromotor, straight handpiece, right-angled

handpiece, and contra-angled handpiece mere introduced. At the latest air

abrasion and lasers being used.

During 9th century cavities have been performed for dental inlays. Cavity

preparation techniques have been known for many centuries. Hamelton

Jameson for the first time in 19th Century emphasized the need for organized

cavity preparation. He suggested following steps.

Removal of safe and infected dentin using hand instruments.

Sterilization of dentinal surface

Retention form using dentinal.

Dr. Charles E Woodburry, suggested that labial margin of preparation to

be in harmony with lives of refraction of labial surface.

Henry A. True suggested another inconspicuous type of preparation using a

special “gland technique”. Charles E Woodburry, EK Wedelstaedt, Waldon I

Ferrier and George Hollenback made significant contributors to early

development of operative dentistry. Father of Operative Dentistry G V Black.

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Extension for prevention is the extension of cavity preparation into areas that

are caries susceptible. In principle was conceived by MARSHALL EBB and

later adopted by G V Black.

Preparation of cavity should be carried out in an orderly sequence, suggest by

Black, followed certain principles

In 1930’s GV Black, gave systemic approach to cavity preparation with special

emphasize as retention form, His principles of cavity preparation meant for

metallic restorations.

Simon added 6th classification and many operators, with intention of improving

esthetics, modified some of original suggestions of Black. In 1998 G J Mount

suggested new classification.

OBJECTIVES OF CAVITY PREPARATION

The objectives are to,

 Remove all defects and give the necessary protection to the pulp.

 Locate the margins of the restoration as conservatively as possible.

 Form the cavity so that union the force of mastication the tooth or

restoration or both will not fracture and the restorative will be displaced.
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 Allow for esthetic and functional placement of restorative

materials.

Need for Restoration

 Foremost in the need to repair a tooth after restoration from a

carious lesion, which may be large, extensive or small.

 Replacement or repair of restorations with serious defects (eg)

improper proximal contact gingival excess, caries – risk margins and poor

esthetics.

 To restore the proper form and function to fractured teeth.

 To restore form or function, in congenital malformation.

 To restore on esthetic purpose.

FACTORS AFFECTING CAVITY PREPARATION

GENERAL FACTORS

Diagnosis

Should be proper includes caries, fractured teeth, esthetic needs or

improved forms or formation.

Prevention

Should be disease prevention.

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Interception

Refers to preventing further loss of tooth structure.

Preservation

Have the vitality and important anatomy in remaining sound tooth

structure.

Restoration

Includes restoring function, phonetics, esthetics and stability.

Knowledge Of Dental Anatomy

Dental anatomy of each tooth includes, the direction of enamel rods,

thickness of enamel, the dentin body, the size and position of the pulp, the

relationship of the tooth to investing tissues.

Patients’ factors

The patients knowledge and appreciation of a good dental health and

economic status, age, and (selection) choosing of restorative material.

CLASSIFICATION

 G V Black’s classification

 Modifications of G V Black’s classification

 Graham J Mount (1998)

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 Vimal K Sikri (1999)

G.V. Blacks Classification

Dr. Greene Vardiman Black gave the first classification, which still

being widely used and universally accepted.

Based on the type of treatment and areas involved. He gave

classification.

When Black defined the parameters of his classification the cavity

designs mere controlled by number of factors, many of which no longer supply.

He suggested that it was necessary.

To remove the structure of gain access and visibility

To remove all lace of affected dentine from the floor of the cavity

To make room for the insertion and the restorative material itself.

To provide mechanical interlocking retentive designs

To external the cavity to self cleansing areas to avoid recurrent caries.

Simon Later added class V

Black classification still being followed with slight modifications to it.

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Concepts given by Black because controversial and debatable. Tunnel

preparation and slot preparation introduced to avoid undue cutting of marginal

ridge removal of caries not properly accomplished with these procedures.

With the advent of new adhesive restorative materials, fluorides etc,

clinicians started different cavity designs.

Mechanically retention design in cavities questioned concept E for

prevention questioned.

Though Black’s classification in simple, easily followed and universally

accepted, certain areas of teeth where caries may occur have been overlooked.

Spectrum of individual class is a little longer. E.g. caries lesions at angle

of different teeth not include.

Carious lesion an labial surface of anterior teeth other than cervical third are not

included.

Carious lesion an lingual surface of anterior teeth other than cervical third and

pit not included

Carious lesion an lingual surface of anterior teeth other than cervical third and

pit not included

Proximal lesions, whether at one side or two sides taken in one class MOD

cavities always controversial.

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These were limitation in the available instruments for cavity preparation as well

as in selection of restorative material. By today’s standard, all such restorations

are large. Black showed commendable respect for remaining tooth structure as

well as occlusal and proximal anatomy, but it was necessary to sacrifice

relatively extensive areas to achieve this goal. With modern understanding of

adhesion and remineralization it is no longer necessary to remove all

unsupported demineralized around cavity margin, the concept of self cleaning

areas discarded and removal of all affected dentin from axial wall of cavity is

strictly contraindicated therefore of the potential for remineralization and

healing.

G V BLACK’S CLASSIFICATION

CLASS I

pit & fissure

occlusal surfaces - premolars & molars

lingual surfaces of maxillary incisors

CLASS II

proximal surfaces of posterior teeth

CLASS III

proximal surfaces of anterior teeth do not involve the incisal edge

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CLASS IV

Proximal surfaces of anterior teeth involve incisal edge

CLASS V

gingival third of facial or lingual surfaces

CLASS VI

incisal edge of anterior / occlusal cusps heights of posterior teeth

Simon - later added

Concepts of Black controversial & debatable:

Tunnel preparations & slot preparations were introduced to avoid undue

cutting of marginal ridge. However, all these procedures were discarded with

time: either because of excessive marginal leakage at the cervical margins or the

weakening of the marginal ridge. Removal of caries was also not properly

accomplished with these procedures.

The mechanical retention designed in cavities has been questioned. The

concept was soon challenged & various studies observed that only etching &

bonding did not provide sufficient retention. Though adhesive restorative

dentistry has markedly improved the marginal adaptability of restorative

materials to cavity walls. But these are not ideal substitutes for retention form of

cavity as given by black.

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The concept of extension for prevention & keeping the proximal

cavosurface margins in self-cleansing areas has also been questioned.

Though Black’s classification of cavities / caries lesions is simple, easily

followed & universally accepted, certain areas of teeth were caries may occur

have been overlooked. Also this spectrum of individual class is a little longer.

For example,

Caries lesions at line angles of different teeth are not included.

Caries lesions on the labial surface of anterior teeth other than in cervical third

of are not included

Caries lesions on the lingual surface of the anterior teeth other than in the

cervical third & pits are not included.

Proximal lesions, whether at one side or 2 sides are taken in one class.. MOD

cavities are always controversial in blacks classification. Few authors have

designated MOD as class VI without any unanimity for its acceptance.

G J MOUNT CLASSIFICATION

G.J. Mount proposed classification is defined to simplifying the

identification of lesions and to define their completing and is expected to

provide benefits for the profession and patients.

G.J. MOUNT CLASSIFICATION

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Cavity Preparation

Pit, fissure and defects an occlusal defects of posterior teeth or other smooth

surfaces.

Approximal immediately below areas in contact with adjacent teeth

Cervical 1/3 of crown /following gingival recession, the exposed root

Classification by sites, then grade them dry size, applies equally anterior and

posterior.

4 Sizes

Minimal involvement of just beyond remineralization done

Moderate involvement

Cavity enlarged beyond moderate involvement

Extensive caries and bulk loss of tooth structure has already occurred

Size 1

New lesion and adhesive restoration materials ideal for restoration.

Size 2, 3, 4

New lesion has progressed to a considerable extent, without patient presenting

for treatment or it may be a breakdown of restorative that requires replacements.

Larger the cavity - greater the problem in restoration

Shorter the cavity - Probable longevity of plastic restorative materials.

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The proposed classification by Mount provides options for treatment

planning, keeping in mind treatment by adhesive restorative materials. Though

this concept is not entirely unfair, but there is subjectivity in deciding the size of

the lesion. Treatment planning varies with operator to operator. The carious

sites mentioned earlier which are missing in blacks classification are also

missing in this classification.

Contact caries whether on one side or two sides is taken as one, which is always

misleading and also clubbing root caries with crown caries create confusion

amongst readers. Keeping in the view, the simplicity & acceptability of blacks

classification it should not be totally changed; however, little modifications will

cover the areas left by black.

So, Vimal K Sikri proposed classification:

VIMAL K SIKRI CLASSIFICATION

Class I

div 1 - pits & fissures of occlusal surfaces

div 2 - B & L pits of postr & antr

Class II

div 1- one proximal surface of postr

div 2 - both proximal surfaces of postr

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Class III

div 1 - one proximal surface of antr

div 2 - both proximal surfaces of antr

Class IV

div 1 - cervical one-third of labial & lingual

div 2 - labial & lingual line angles of all teeth

Class V

div 1 - labial of antr than cervical one-third

div 2 - lingual of antr than pits & cervical 1/3

Class VI

div 1 - incisal tips

div 2 - occlusal cusp tip

STAGES OF CAVITY PREPARATION

Initial stage

Final stage

INITIAL CAVITY PREPARATION

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Is a mechanical alteration of tooth extended to sound tooth structure, in

all directions, while adhering to specific, limited pulpal depth cavity walls

designed to retain restoration & resist fracture.

INITIAL CAVITY PFREPARATION involves

Excavations of remaining, infected dentin

Removal of old restorative materials

Pulp protection

Additional cavity designs - minimize fracture

Finishing preparation walls

Cleaning, Inspecting and Varnishing

STEPS INVOLVED

STEP: 1 outline form and initial depth

STEP: 2 primary resistance form

STEP: 3 primary retention form

STEP: 4-convenience form

FINAL STAGE

STEP: 5 removal of remaining enamel or infected dentin

STEP: 6-pulp protection

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STEP: 7 secondary resistance and retention form

STEP: 8 finishing external walls of cavity preparation

STEP: 9 Cleaning, Inspecting, Varnishing and Conditioning

INITIAL CAVITY PREPARATION

Initial cavity preparation is the extension and initial design of the external walls

of the preparation at a specified, limited depth so as to provide access to the

cavity or defect reach sound tooth structure, resist fracture of the tooth or

restorative material from masticatory forces, principally directed with the long

axis of tooth and retain the restorative material in the tooth.

The preparation is extended internally no deeper than 0.2mm into dentin

for (0.5 mm for gold) pit and fissure cavities and 0.2 to 0.8 mm into dentin for

smooth surfaces cavities.

STEP 1: OUTLINE FORM AND INITIAL DEPTH

Definition

Establishing the outline form means placing the cavity margins in the

positions they will occupy in the final margins and preparing an initial depth of
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0.2 to 0.8mm pulpally of dentino-enamel junction or normal root surfaces

position.

The deeper depth for extensions onto the root surface. Otherwise the

depth into dentin is not to exceed 0.2 to 0.5mm.

Principles

All friable or / and weakened enamel should be removed.

All faults should be included

All margins should be placed in a position to afford good finishing of the

margins of the restoration.

Factors

Extension for prevention

Sufficient enamel & dentin to locate the pulpal & axial walls or preparation

surfaces within 0.5mm from DEJ

extent of carious lesion, defect/ faulty restorations

esthetic considerations

occlusal relationships

adjacent tooth structure

cavosurface margin
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Features

Six features are ;

Preserving cuspal strength

Preserving marginal ridge strength

Minimizing facio-lingual extensions

Using enameloplasty

Connecting to close faults / cavity / preparation

Restricting the depth of the preparation into dentin to a maximum of 0.2mm to

for pit and fissure caries and 0.2 to 0.8mm for the axial walls of smooth surfaces

caries.

Pit and Fissure cavities

Outline form and initial depth for pit and fissure cavities

Controlled by three factors:

The extent to which the enamel has been involved by the carious process.

The extensions that must be made along the fissure to achieve sound and

smooth margins.
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The steady, (un changing) limited bur depth related to the tooth’s original

surface while extending the preparation to the external walls that have a pulpal

depth of 2mm and usually a maximum depth into dentin of 0.2mm.

Rules to follow are:

Extend the cavity margin until sound tooth structure is obtained and no

unsupported and / or weakened enamel remains.

Consideration to be given to the capping the cusp.

This will remove the margination from the area of masticatory stresses.

Extend the cavity margin to include all the fissure that cannot the eliminated by

the appropriate enameloplasty.

To be as conservative as possible, the preparation for an occlusal surface pit and

fissure cavity in prepared to a depth of 1.5mm as measures at the central fissure.

When two pit and fissure cavities have less than 0.5mm of sound tooth structure

between there, should be joined to eliminate a weak enamel wall bet them.

Extend the outline form to provide sufficient access for proper cavity

preparation, restoration placement and finishing procedures.

The outline form resulting from proper preparation, of this cavity resembles

“Butterfly” in flight is after referred as – “Butterfly” type preparation.

As much of the cusp incline, as possible should be preserved in any preparation

involving occlusal surfaces.

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Principle factors of pit and fissure lesion

Outline form includes:

All enamel directly attacked by decay

All undermined enamel.

Sufficient enamel and dentin to locate the pulpal and axial walls or preparation

surfaces within 0.5mm from the DE junction.

All pits and fissures ending on adjacent inclined planes or smooth surfaces, this

fulfilling the principles of extension for extension.

Outline form and initial depth for smooth surface cavities

Smooth surface cavities are in two different location.

Proximal surfaces

Gingival positions of facial and lingual surfaces.

Rules for establishing outline form for proximal surface cavities

Extend the cavity margins until tooth structure is obtained and no unsupported

enamel and / or weakened enamel remains.

Avoid terminating the margin or extreme eminences such as cusp heights or

ridge cysts.
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Extend the margins to allow sufficient access for proper manipulative

procedures.

Restrict the axial wall, pulpal dept of proximal preparation, a maximum of 0.2

to 0.8 mm into dentin.

Extend the gingival margins of cavities apically to contact to provide a

minimum clearance of 0.5 mm feet the gingival margin of adjacent tooth.

Extend the facial and lingual margins in proximal cavity preparation into the

respective embarrassment to provide specified clearance between the prepared

margins and adjacent tooth.

Class II

Involves two surfaces, the occlusal outline – governed by factors that

determine the placement of margin of pits and fissures and for inlays the

preparation of dovetail on the occlusal pit opposite the involved proximal

surface.

Class III

When extending the proximal surfaces incisally, it is acceptable to

position the incisal margin in the area of contact.

Class V

Is governed by only by the extent of lesion, except pulpally.

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Principally factors of proximal smooth surface cavities:

(Includes all the principal factors of pit and fissures and along with

following factors – will determine the extent into those intra-osseous.

Flare and mesiodistal width of extra-osseous.

Occlusion and mastocatory forces.

Caries index and oral hygiene.

Age

Creation of more convex restoration, proximally than that of original proximal

surface).

Auxillary factors of outline form

Conservation

Adjacent enamel cracks (Crazing) or decalcification could be involved in

preparation.

Type of restorative material.

Extension for access.

Unusual anatomy, malalignment and steep cusps will change the locations and

extent of cleansable and non – self-cleansable areas. Esthetics.Modifications

can be made with outline form. Protect important and critical anatomy.

Tooth preparation for outline form in most of the time should include:
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All surface involvement of enamel from stage of decalcification to stage of

enamel penetration.

All enamel that has been undermined by laterals spread of caries in dentin and

by backward decay.

Extend of an enough on tooth surface so that margins of preparation will be

located on finishable, self – cleansable areas.

Restorative materials are completely chemically bond or adhere to

surrounding tooth. Any restorations will be surrounded by microleakage space

bet. Itself and the adjacent tooth structure space will range bet. 20-120 mm in

width, the “Zuter phase is considered the weakest link against decay recurrence,

it should be placed in areas that re easily cleansable by natural / artificial means.

This principle - “Extension for Prevention” or cutting for immunity.

Gingival Portion Of Facial And Lingual Area

Class v

Extension mesially, gingivally, distally & occlusally (incisally) limited

Bur depth no deeper than 0.8- 1.25mm pulpally from original tooth surface

Axial pulpal depth at occlusal wall- provides 0.5mm into dentin

RESTRICTED & INCREASED EXTENSIONS

RESTRICTED
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proximal contours & root proximity

esthetic requirements

tooth preparations for composite restorations

INCREASED

advanced age of the patient

need for additional retention & resistance form

adjust tooth contours

Outline form and initial depth

It is locations that the peripheries of the completed tooth preparation will

occupy on tooth surfaces

In other words is the perimeter of tooth preparation in width, length and depth

of dimension

Principles

Extension for prevention entered for enough on tooth surface, so that margins

of preparation, will be located on perishable, self clenchable areas.

Any restoration will be surrounded by microleakage space between itself and

adjacent tooth structure space with range between 20 – 120µm in width.

Microorganism accommodate

Conventional Type

Class I for amalgam

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Margins of facial and lingual class I lesions must involve entire

facial/lingual groove in order to avoid feather edged marginal amalgam.

If gingival margin located at occlusal to and contour, facially or lingually.

Ideal and desirable location. If these margins extend gingival to of contour,

they should be handled as gingival margins are in class II cavity preparation.

All class I have

Mortise shape

Conical (hemisphierical in cross section) cavity preparation

Cavosurface angles should be angled to create a chelt joint with the marginal

amalgam.

All clinic and patient analysis should be rounded

Class II

If marginal ridge not involved, a proximal cavity preparation and even

separation proximal and occlusal cavity preparation could be made.

Contact area, marginal ridge, embrasures, and the gingival are essential to

achieve.

To establish this relationship in restoration outline of cavity preparation

may need to be modified by over extension in some areas and under extension

in others.

Class III, IV, V for amalgam

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Esthetic concern – lingual access prefer

Extension for access

Stress considerations

Direct tooth colored restorations

Direct access lingual better

These restorative materials cannot maintain integrity of contact or MD

dimension of tooth for a long time

Ragged peripheries should be smoothened

Gingival margin of any preparation to receive one of there materials should be

located supragingivally

Definite lines with rounded junctions

Modifications

Extension for prevention- not apply

Conservative approach

Not extend f & l more than midway between central grooves & cusp tips

Enameloplasty on terminal ends of shallow fissures

Proximal portion- only a unilateral inverted truncated cone on functional side of

marginal angles

Gingival margin located occlusal to ht of contour

Isthmus- not exceed 1/4 intercuspal distance

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Sweeping curves-exaggerated

Tooth colored restorations

Extension for prevention - not apply

Adhesive restorative material revolutionized the concept of cavity design

Conserve more tooth structure

Floor routinely not placed in dentin- depends on extend & depth of lesion

Bevel on cavosurface margin

Contact area - should be maintained

Butt joint marginal configuration - for retention & beveled the margin

Cast gold restorations

Gingival to occlusal divergence of walls- 2-5 degree taper on each wall

Taper minimum in shallow cavities

More in deeper cavities

Beveling

To obtain Lapp joint at cavosurface margin

20- 30 degree

Increases marginal adaptation

Step 2: Primary resistance form

Definition
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Primary resistance form may be defined as the shape and placement of

the cavity walls that best enable both the restoration and the tooth to withstand,

without fracture, masticatory forces delivered principally in long axis of tooth.

Principles

To utilize the box shape with a relatively flat floor.

To restrict the extension of external walls.

To have a slight rounding of internal line angles to reduce stress.

In extensive cavity preparation, to cap weak cusp and envelope or include

enough of a weakened tooth.

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

Therefore, the pulpal wall, is as flat as the original occlusal surfaces and the

dentinoenamel junction.

Factors

Foremost is the assessment of the occlusal contact potential on both the

restorative and the remaining tooth structure.

Features

Relatively flat floors.

Box shape.

Inclusion of weakened tooth structure.

Preservation of cusp and marginal ridges.

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Rounded internal line angles.

Adequate thickness of restorative material.

Seats an sound dentin peripheral to excavation of infected dentin.

Reduction of cusps for capping, when indicated.

A major principle of primary resistance form is that the restorations should rest

on flat sound tooth structure preferably perpendicular to occlusal forces

directed parallel to the long axis of tooth.

Stress patterns of teeth

Use floors at right angles to direction of loading- to avoid shear stress

Walls parallel

Box / cone / inverted truncated cone

Definite line & point angles

Amalgam & cast gold - approx.1.5mm

Porcelain - 2mm for inlays

1.5mm for crowns

Composite no criteria for resistance form

Class I

Flat floor large restoration, depth increased with increase in diameter

Class II
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Pulpal line angle more rounded- MOD

Class III

Cavity extended lingually as close to incisal edge as possible

Class V

Functional Cusp & fossa relationship dictates stress patterns

Grooves provide resistance to certain degree

Step 3: Primary retention form

Definition

Primary retention form is that shape or form of the prepared cavity that

resists displacement or removal of the restorations form tipping or lifting

forces.

Principles

Retention needs are related to restorative material used, retentions form

vary depending an the material.

II. Obtaining the resistance form

Resistance
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Defined as the architectural form given to a tooth preparation, which

enables both the restoration and the removing tooth to resist structural failure

from occlusal loading stresses.

Following items to be considered

A. Stress patterns of teeth

1. Stress bearing and stress concentration areas in anterior teeth.

a. In between the clinical crown and clinical roots bear shear components of

stresses, together with tension on loading side and compression at the non-

loading side, during extensive mandibular movements.

b. Incisal angles – tensile and shear stresses normal occlusion.

c. Axial angles and lingual marginal ridges will bear concentrated shear

stresses.

d. Slopes of cuspid will bear concentrated stresses.

e. Distal surfaces of a cuspid exhibits a unique stress pattern.

f. Lingual concavity of upper anterior teeth.

g. Incisal edges of lower anterior teeth are subjected to compressive

stresses.

2. Stress bearing and stress concentratious area of posterior teeth.

a. Cusp tips, on functional side, bear compressive stresses.

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b. Marginal and crossing ridges bear tredoundous tensile and compressive

stresses.

c. Axial angles bear tensile and shear stresses on the non – functional side.

d. Junction between the clinical root and clinical crown during function,

bears tremendous shear stresses, in addition to compression on the occlusing

contacting side and tension on non – contacting side.

e. Any occlusal, facial or lingual concavity will exhibit compressive stress

concentrations.

3. Weak areas in the tooth should be identified and recognize before any

restorative attempt, in order to avoid destructive loading.

1. Bi-Tri furcations.

2. Thin dentin bridges in deep cavity preparation.

3. Sub pulpal floors in root canal treated teeth.

4. Cracks or crazing in enamel / and / or dentin.

B. Some applied mechanical / properties of teeth

Compressive strength

Enamel supported by vital dentin – 36-42,000 psi

Vital dentin – 40-50,000 psi

Modulus of resilience

Enamel supported by vital dentin – 60-80 inch / bs / cubic inch.

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Modulus elasticity

Enamel – 7,000,000 psi

Dentin – 1,900,000 psi

Tensile strength of dentin – 10% less than compressive strength.

Shear strength of dentin – 60% less than its compressive strength.

C. Vale Experiments

Experiment involved preparation of occluso-proximal cavities with

different crossing dimensions at the marginal and crossing ridges with a

standard depth. Teeth were there subjected to measured occlusal loads. Load

that split the tooth was recorded and compared to the control, which was the

load that split a round tooth. Later, several investigators using more

sophisticated equipment, than that used by vale repeated the same experiment.

Results are consistent.

D. To best resist masticatory forces, use floors or planes at right angles to

direction of loading to avoid shearing stresses.

E. Walls of preparations should be parallel to the direction of the loading

forces, in order to minimize or avoid shearing stresses.

F. Intra coronal and into a radicular cavity preparation can be done in box,

core, or inverted truncated core shapes.

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G. Definite floors, walls and surfaces into line and point angles are essential

to prevent micro movements of restorations, with concomitant shear stresses on

remaining tooth structures.

H. Increasing the bulk of a restorative material or sufficient bulk of tooth

structure in critical areas is one of the most practical ways of decreasing stresses

per unit volume.

I. Retentive features must cleave sufficient bulk of tooth structure to resist

stresses resulting from displacing forces.

III. Obtaining the Retentive form

Retention form :

Defined as that form given to the tooth preparation, especially in detailed

anatomy and general shape, which enables the restoration, that will

accommodate, to avoid being dislodged by masticatory loading, retention means

are divided into

Principal auxillary types according to their efficiency in retaining the

restoration.

According to their locations – Retention intraoral

Extracoronal

A. Principal means of retention

1. Frictional retention depends on 4 factors

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a. Surface areas of contact between tooth structure and restorative material.

b. Opposing walls or surfaces involved greater frictional components of

retention.

c. Parallelism and non-parallelism a higher degree of parallelism between

opposing walls produces greater frictional components of retention.

Direct restorative material

They are plastic (i.e.) readily deformable (when 1 st mixed then, modeled /

rounded into the cavity

Vary physical properties

Expected to achieve a level of strength sufficient

Indirect

Formed on laboratory bench

Finished restorative luted into the tooth

Principles of retention

Retention through adhesion in available only with

Composite resin to (micro mechanical)

GI to (chemical)

Successful retention

To prevent restoration falling out from occlusal load

To prevent microleakage of bolt

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This type of adhesion requires no mechanical interlocks

Amalgam and rigid restorative material that by indirect technique rely

mainly upon mechanical interlocks, although degree adhesion can be developed

through use of luting agents.

Adhesion with GIC

Adhesion with composite resin (enamel & dentin)

Advantage of direct plastic restorative material

Possible to conserve remaining tooth structure

Simple to place, to repair and to replace

Economical in time and material

Some material often acceptable aesthetics

Some material allow mechanical adhesion to some allow chemical adhesion to

both

Some material release small amo… discourage formation of further caries.

III. Obtaining the convenience form

Definition

Convenience forms defined as that shape given to a tooth preparation or

modifications added to the preparation or its instrumentations, which enable the

operation to be completed conveniently.

 38

Ideally, tooth preparation fulfilling all requirements for outline,

resistance, and retentions, will be convenient to instrumentation.

The most effective way to obtain the convenience from is by proper

control of the field of operation or by adequate tracing and familiarity which

armamentarium.

One of more of the following modes of obtains convenience form.

A. Modifications in tooth preparation for convenience form.

It includes flaring some walls – to distortion errors in intermediate

materials during restoration.

2. Elastic deformation of dentin

Changing the position of dentinal walls and floors microscopically by

using condensation energy within the dentins proportional limit, can add more

gripping action by the tooth on the restorative material. This occurs when

dentin regains its original position while the restorative materials remains rigid,

thereby completely obliterating any remaining space in the cavity preparation.

3. Inverted truncated cones or undercuts

This is done is any direction – improves retention – provided they are

filled with the restorative material and do not interfere with the restoration

fabrication.

4. Dove Tail
 39

This is a purposeful modification in the outline form, in some caries, but

usually extension for prevention will create a dovetail outline.

Auxiliary means of retention

Grooves – are cut is dentin, without undermining adjacent enamel.

Internal boxes- has definite walls and floors.

Posts – are made from wrought or cast metal and placed in root canals.

Pits made from cast or wrought metal may be or non vertical or horizontal.

Triangular areas – placed within dentin without undermining enamel.

Etching or acid conditioning is done with certain acids – It creates mechanical

locks and surface areas of contact between tooth structure and restorative

material.

Cements or luting segments – least effective means of retention.

Auxillary factors of retention form

Amalgam

Restorative in class I and all class II cavity preparation, the material is

retained in the tooth by developing external cavity walls that coverage

occlusally.

In Class III and V external walls diverge outwardly to provide strong

enamel margins and therefore retention coves or grooves, are prepared in the

dentinal walls to provide the retention form.

 40

Adhesive systems

Not only provide retention by micro-mechanically bonding amalgam to

tooth structure, but also for reducing eliminating microleakage.

Composite

Are retained in the tooth by a mechanical bound that develops between

the material and conditioned, prepared tooth structure.

Because of the strong bond that is developed between etched enamel and

composites, the initial cavity preparation of many composite restorations results

in a beveled enamel marginal configuration that is ready to etched. This would

be considered the modified composites cavity preparations. Over conventional

type, requires separate enamel beveling procedure, which could be, dove in final

cavity preparation.

Cast metal

Intracoronal restorations almost parallel longitudinal (Vertical) walls to

provide retentions of the casting in the tooth. “Parallelism” in the periapical

from in this.

Gold Foil:

One form of retention that is inherent in gold foil restorations is the

elastic compression developed in the dentin as a result of condensation of the

foil.
 41

Step 4: Convenience form

Definition

Convenience form is that shape or form of the cavity that provides for

adequate observations, accessibility, and case of operative in preparing and

restoring the cavity.

shape/ form of cavity that provide adequate observation & accessibility

ease of operation in preparing & restoring the cavity

modifications in tooth preparation

Flaring

lingual / labial access

instrument modifications

contra-angling

bayoneting

separation

wedging of teeth

Cavosuface angles

amalgam -90 degree

inlay beveled- 20-40 degree

margins located on self-cleansing areas

smooth curves
 42

Final cavity preparation stage

Step 5

Removal of any remaining enamel pit / fissure and / or infected dentin and /

or old restorative material, if indicated.

Definition

It is the eliminate of any infected carious tooth structure or faculty

restorative material left in the tooth after initial cavity preparation.

The exception to the removal of infected carious tooth structure is when it

is decided to perform indirect pulp capping.

Removal of remaining, pit /fissure typically occurs as small, minimally

extended excavations on isolated faulty areas of the pulpal floor.

Removal of carious dentin even at the dentino-enamel junctions.

Any remaining old restorative material should be removed, if any of the

following conditions are present:

The old material may affect negatively the esthetic, result of the new restoration

(ie) (old amalgam left under the new composite restoration).

The old material may compressive the amount of anticipated needed retention

(ie) glass ionomer having a weaken bond to the tooth than the new composite

restorations using enamel and dentin conditioning.

 43

Radiographic evidence of caries under the old material.

Tooth pulp was symptomatic.

Periphery of remaining old material in not intact (ie) there is a breech in the

junction of material with adjacent tooth structure, which may indicate caries

under old material.

If none of these conditions is present, the operator may elect to leave the

remaining old material to serve as a base or a lines, rather than risk unnecessary

excavation nearer to the pulp, which may result in pulpal irritation or exposures.

Affected dentin and infected dentin

In dentin, as caries progressive, an area of decalcification proceeds the

penetration of microorganisms. This decalcified areas appears discolored in

comparison with undisturbed dentin, yet does not exhibit the soft texture of

caries. This conditions of dentin affected dentin.

Microorganisms have not significantly invaded infected dentin.

Technique for Step 5

When a pulpal or axial wall has been established at the proper initial

cavity preparation and a small amount of infected caries remains, this should be

removed, learning a rounded, concave area in the wall. The level or positioning

of the wall peripheral to the caries removal depression should not be altered.
 44

In large cavities with extensive soft caries the removal of infected dentin

may be accomplished in initial cavity preparation. When the extensive caries is

removed, the condition of both pulp and remaining tooth structure has a definite

bearing on the type of restorative placed.

Removal of caries indicated in early cavity preparation is when a patient

has numerous teeth with extensive caries. In one seating infected dentin is

removed from several teeth and temporary restoration are placed. After all the

teeth containing extensive caries are so treated, then individual teeth are

restored as definitively planned. This procedure strops the progression of caries

and referred as caries control technique.

Spoon excavators

Are used for the removal of soft caries in large area, by flaking up the

caries around the periphery of the infected mass and peeling it off in layers.

Removal of harder, heavily discolored dentin: consideration in the

removal of caries in deep-seated cavities, the primary concern is for the pulp.

Pulp may become infected by form micro organisms into the dentinal tubules

through the excessive pressure with a spoon excavator or it may be exposed

when either instrument used or due to the creation of frictional heat with a use

of a bur.

Ideal method of removal is:

 45

Minimal pressure is excested

Frictional heat is minimized.

Complete control of instrument

Considering the factors favours the use of round carbide bur, with a air coolant

and a slow speed.

Examination of the area with an explorer following the removal of infected

dentin is admirable, but should be done to avoid perforation of the pulp, and

heavy pressure by avoided with explorer.

Infected dentin is removed until the remaining dentin feels as hard as

normal dentin.

Removal of remaining materials is done with a round carbide bur:

At a slow speed (just above stall out).

With air or air water coolant

Use of water spray (along with high volume excavators)

Is used for amalgam removal, to reduce the amount of Mercury vapor.

Step 6: Pulp Protection

Placement of cavity liners and bases are not a stop in cavity preparation,

it is a step in adapting the preparation for receiving the final restorative material.

Use of liners or bases is to protect the pulp or to aid pulpal recovery or

both.
 46

When the thickness of remaining dentin is less than 2mm, heat generated

by injudicious cutting can result in

-Pulpal burn lesion

-Abscess formation

-Death of the pulp

So, water spray must be used as coolant with high speed rotary

instrument cutting of dentinal odontoblastic fibrils will result in degeneration

and death of affected primary odontoblast and their extensions. The involved

tubules become open, dead tracts.

If remaining dentin thickness is 1.5mm or more, and cutting done

atraumatically with high speed with water spray, pulp is not irritated enough to

form replacement odontoblast and therefore no reparative dentin is formed to

seal the pulpal side of dead tracts.

So place it with liner or base to protect the pulp.

Other pulpal irritant that affect procedures ;

Some ingredients of various materials.

Thermal changes conducted through restorative materials.

Forces transmitted through materials to the dentin.

Galvanic shock

Ingress of noxious produced and bacteria through microleakage.

 47

So, there should be complete sealing of prepared dentinal tubules.

Dentin bonding agents are being recognized as beneficial for dentinal

sealing under any type of restorative material.

Now presented by the use of liners bases and varnishes.

Liners

Volatile or aqueous suspensions or dispersions of zinc oxide or calcium

hydroxide that can be applied to a cavity surface in a relatively thin film and are

used to effect the particular pulpal response. It provide

A barrier, which protects the dentin from noxious agents from either the

restorative material or oral fluids.

Initial electrical insulation and / or thermal protection.

Thermal protection.

Bases

Are considered to be those cements used in thicker dimensions beneath

permanent restorations to provide for mechanical, chemical and thermal

protection of pulp.

(ie) Zinc phosphate

Zine oxide eugenol

Calcium hydroxide

Poly carboxylate
 48

Glass ionomer

Liners used to medicate the pulp when suspected trauma has occurred.

Gives the desired pulpal effect which includes

Sedation

Stimulation

Results in reparative dentin formation

If removal infected dentin does not extents deeper than 1mm from the initially

prepared pulpal or axial wall, no liner is indicated.

If excavation extends very close to pulpal tissue, calcium hydroxide liner,

to stimulate reparative dentin.

If excavation depth is between the above examples, Zinc-oxide eugenol

liner is selected, (not for composite restorative) where it impede

polymerization), to provide palliative, sedative pulpal response, thus reduces the

post-operative sensitivity.

Zinc oxide eugenol and calcium hydroxide liners, thickness of 0.5mm or

greater have adequate strength to provide the support for consideration forces of

amalgam, and protection against short-term thermal changes.

In deep excavations, use of liner with a stronger base material is

admirable, at least a 2mm bulk between pulp and a metallic restorative material.
 49

For composite restorative materials, which are thermal insulators and

passively inserted, a liner of calcium hydroxide is indicated only when there is a

pulpal exposure or the excavation judged to be within 0.5 mm of pulp.

Calcium hydroxide is a choice of material for deep excavation and a

known pulpal exposure.

Microscopic pulp exposures not visible by naked eye. Hemorrhage is the

visual evidence of vital pulp exposures.

Liners and bases in exposure areas should be applied without pressure.

At least 1mmof thickness of calcium hydroxide there is overlaid with a base.

Deep excavations where no exposure or suspicious of exposure exists are

appropriately lined with zinc-oxide eugenol material, has anaesthetical effect

mildly on pulp.

The level to which the base is built should never compromise the desired

cavity preparation depth resulting in inadequate restorative material thickness.

Cavity Varnish

Is a solution liner, which seals most of the dentinal tubules and placed on

all cavity preparations walls for amalgam and the dentinal walls of cavity

preparation for cast gold, but not for composites.

Two coats of cavity varnish should be applied to the prepared surfaces of

amalgam.
 50

Varnish

Prevents the penetration of materials into the dentin

Prevents the microleakage

Reduces the postoperative sensitivity, by reducing the infiltration of fluids and

salivary components at the margins of newly placed restorations.

Two coats of cavity varnish are applied to dentin surface (not on enamel) of

cavity preparation of cast gold restorations. Varnish helps to reduce pulpal

irritation from the luting cement.

Cavity varnishes should not be used under composites because the solvent in the

varnish may react with or softer the resin component in the composite,

adversely affecting polymerization.

Step 7: Secondary resistance and retention forms

Two types are,

Mechanical features

Cavity wall conditioning features

Mechanical Features

Variety of mechanical alterations are as follows :

Retention locks, grooves and coves

Longitudinally oriented retention locks and retention grooves are used to

provide retention for proximal portians of cavity preparations.

 51

-Locks are for amalgams

-Grooves are for cast metal restorations.

Transversely oriented retention grooves are prepared in Class III and V

cavity preparation for amalgam.

In root surface cavity preparation for composites.

Retention coves are placed under cuts for the incisal retention of Class

III amalgams, - occlusal posterior of some amalgam.

- Some Class V amalgams.

- Rarely for facilitating the start of desertion of certain gold foil

restorations.

Retention locks in Class II preparation

- To increase retention of the proximal posterior against movement

proximally due to creep.

- To increase the resistance focus of restoration against fracture at the

junction of proximal and occlusal portions.

They are recommended for extensive cavity preparations for amalgams

involving (Eg) wide proximal bases facio-lingually and / or cusp capping.

Groove extensions
 52

- For additional retention of restorative material by extending the cavity

preparations for molars onto the facial or lingual surfaces to include facial or

lingual groove.

- Enhances the resistance, for the remaining tooth structure.

Skirts: are the preparations used in cast gold restorations that extend the

preparation around some, if not all, of the transitional longitudinal angles of the

tooth.

- gives additional retention to the longitudinal walls.

- increases resistance form by envelopment of tooth, there by resisting

fracture of remaining tooth from occlusal forces.

Beveled enamel margins:

Utilized in both cast gold metal / and composite restorations.

It improves retention form when there are opposing bevels, but they are used to

afford functional relationship between the metal and the tooth.

For composite restorations-used to increase both the surface area of etch able

enamel as well as.

To maximize the effectiveness of bond by etching more enamel rod ends.

Pins, slots, steps and amalgapins:

Used when there is a need of unusually large need for increased retention

form, especially for amalgam restorations.

 53

Use of pins and slots increases the retentions and resistance forms.

Cavity wall conditioning features:

Increases retentions as well as resistance to fracture.

Enamel wall conditioning

Dentin cautioning

Enamel Wall conditioning:

Enamel walls are conditioned for bonded restorations which utilize

porcelain composite, amalgam or glass ionomer restoration materials

Conditioning consists of etching in which the bounding material is

mechanically bound.

Dentin Conditioning

Used when using bonded porcelain, compo rice, Amalgam or glass

ionomer.

Mostly dentin bonding agent is recommended

Sometimes glass ionomer as dentin condition

Retention of indirect restorations in enhanced by the luting agent used.

Step 8: Procedures for finishing the external walls of the cavity

preparations:

Definition:
 54

It is the further development, when indicated, of a specific cavosurface design

and degree of smoothens that produces the maxi Manu effectiveness of

restorative material being used.

Objectives:

of finishing the cavity walls are

To create the best marginal seal possible between the restorative material and

the tooth structure.

To afford a smooth marginal junction.

Provide the maximum strength of both the tooth and the restorative material at

and near the margins.

Factors:

that are to be considered are

Direction of enamel rods

Support of enamel rods both at the dentinoenamel junction and laterally.

Type of restorative material to be placed in the preparation.

Location of the margin.

Degree of smoothness desired.

Strongest enamel margin is that margin which is composed of full-length

enamel rods that are supported on the cavity side by shorter enamel rods, all of

which extend to sound detain.

 55

Live angles formed by the junction of enamel walls, should be slightly

rounded whether they are obtuse or acute.

Features:

Two primary features to the fines of the external walls.

The design of the cavosurface angle

Degree of smoothness of the wall.

Design of the cavosurface angle:

Depends on the restorative material used. When extending the facial and

lingual walls in treating extending occlusal caries, tilting the bur is often

indicated to conservatively extend the margins and provide a 90° to 100°

cavosurface angle. The extent of this alteration in bur orientation is dictated by

inclination of contiguous unprepared enamel surfaces.

Beveling the external walls serve four purposes.

Produces a stronger enamel margin

Permits marginal metal that is more easily burnished and adapted

Permits marginal seal in slightly undersized castings

Assists in adaptation of gingival margins of castings that fail to seat by a very

slight amount

The bevel of the cavity margins in a preparation for castings should produce a

cavosurface angle that will result in 30° to 40° marginal metal.

 56

If the angle of the gold bevel is less than 30°, gold alloy will be thin.

It if is greater than 40°, the marginal gold alloy will be thick.

When amalgam is used, beveling contraindicated except on gingival floor of a

class II cavity preparations when enamel is still present.

Bevel (approximately 15° to 20°) only on the enamel portions of the wall in

order to remove the unsupported enamel rods.

If the angle of marginal amalgam is less than 80° to 90°, it likely to fracture,

because it has low edge strength.

Beveling contraindicated in porcelain and silicate cements.

Degree of Smoothness

The advent of high speed cutting procedures has produced two pertinent

factors relate to finishing enamel walls

-Lessening of tactile sense.

-Rapid removal of tooth structure.

One high speed, can dead to over extension of margins grooved walls, and / or

rounded cavosurface angles, on proximal margins.

It thin method used, plain cut fissure burs produce the finest surface.

-Proximal margins are left at minimal extension for esthetic reasons,

-Rotating instruments not to be used, because of lack of proper access.

-Hand instruments must be used, in such cases.

 57

-Razor sharp hand instrument can result in smooth enamel wall

-Hatchet and margin thickness used for planning enamel walls, cleaning enamel

and enamel bevels.

Desired fitness or smoothness of enamel wall is dictated primarily by restorative

material being used.

Step 9: Final Procedures cleaning, Inspecting, Varies and conditioning

-Removing all debris, chips

-Visible debris removal with warm water from the syringe

-Drying the cavity, by the use of from syringe

-Take care, tooth not be dehydrated by the overuse of air or by application of

alcohols

-Visually inspected to confirm the cavity preparation

-Two coats of varnish liners applied, when amalgam is used, to avoid

microleakage to seal the dentinal tubules.

For composite restorations, conditioning may require, which includes,

etching of enamel 2 placing dentin bonding agent or applying glass ionomer

liner.

-Sterilization of the cavity is needed.

 58

G J MOUNT’S CLASSIFICATION

3 SITES

SITE 1: pit fissure & enamel defects on occlusal of postr or other smooth

surface

SITE 2: approximal enamel immede. below areas in contact with adjacent teeth

SITE 3: cervical 1/3 of crown / following gingival recession, exposed root

4 SIZES

SIZE 1: minimal involvement of dentin- just beyond treatment by

remineralization

SIZE 2: moderate involvement of dentin

SIZE 3: cavity enlarged beyond moderate

SIZE 4: unnecessary to remove affected, dentin-floor but walls clean

Site 1 Lesions

Commence in fissures on occlusal surface of fresh tooth (not previously sealed)

Pits and lingual upper anterior teeth – not uncommon

Buccal surface of lower molars and

Lingual extension of disto-occlusal groove of upper molars

 59

Erosion /Attrition on occlusal surfaces of posterior

Incisal edges of anteriors included

Size 1

Small defect in one section of pit and fissure

Often combined with placement of fissure seal on the remainder of the fissure

system

Size 2

Moderate with most fissures involved or replacement of an existing black class I

restoration.

Size 3: larger requires protection for one or more cusps in design

Size 4: extensive with one or more cusps already missing

Preparation

Lesion an occlusal surface of posterior tooth or in a relation to a pit an

otherwise smooth surface identified clinical / radio/transillumination as dentine

involvement below enamel in particular section of pit and fissure system.

Lesion extent in limited, other suctions free from caries.

 60

Other fissures may be deep (convoluted – subjected to later attack, they require

protective through sealing at this time).

Using very finest tapered diamond point (# 200)

Enter fissure in the region of lesion

Open enamel far enough to determine the full extent of lesion

Development only sufficient access to clean cavity walls of all of infected layer

of dentine

Unnecessary to remove the affected, demineralized dentine an the face of the

cavity, but essential that the walls are completely clean and free of caries.

Enamel margins should be sound and free of microcracks and loose enamel rods

Using small round burs (# 008, + 012) clean walls of infected enamel

No need to penetrate full depth of enamel and retention some enamel the base of

fissure will assist in maintaining the strength and structural integrity and crown

of a tooth.

Erosion / Abrasion lesion on occlusal surface of posterior and incisal edge of

anterior.

As surface free of caries not be instrumented and a lamination technique

prepared restoration conditioned GIC occlusal load heavy laminate with

composite resin.

# 1.2 (G.V. Black Class I)

 61

Bur (140TC) – remove old restoration / care not extent the cavity

Parallel sided cylinder - explore the extent of problem

Small round bur (012 MS, #016) remove remaining caries from the walls, but

removal of all affected dentin from the floor not required. Occlusal enamel

should retained, through unsupported, margins are sound, no microcracks.

Remaining fissures explored with fine tapered diamond (# 200)

# 1.3 (G.V. Black Class I)

When cavity reaches this size, there will be extensive undermining or

breakdown of atleast one cusp with the possibility of a split developing at the

base.

Involving entire dentin of crown / old restoration may be recurrent

# (140 TC) – remove any old restorative material, # 156 diamond bur – to open

enamel determine extent of problem, # 012 / 016 round bur remove infected

dentin from walls. Care not to remove all infected dentin on floor of cavity

New cavity resulting from active caries indirect pulp capping

Open cavity - # 156

Clean the walls - # 012/016

Check all remaining cusp to need to protect from

 62

If a cusp has a column of sound dentin with adequate support for enamel and

there is more than one half of medially facing cuspal incline still present, remain

standing without protection.

If a cusp is undermined and the medial incline is subject to occlusal load,

requires protection – if not split base will occur. Need for retentive grooves and

ditches use # 168MS.

# 1.4 (G.V. Black)

Extensive cavity likely molar tooth complete loss of one or more cusps and full

restoration with plastic material will be complex.

Amalgam material of choice

# 156 remove infected dentin, # 140 TC old restoration removal

Highly caries active, desirable to have indirect pulp capping

# 168 diamond 168 MS.

If amalgam is choice, mechanically interlocks with remaining tooth structure

essential, using ditches and grooves placed in the gingival area.

Remaining cusps one or more protected for loss of D lining with GIC – 0.5mm

thick acts as a thermal barrier.

 63

Step 2: Proximal surface of anterior / posterior beginning immediately below

the contact area.

Site 2, Size 1: Minimal involvement of dentin healing the remineralization.

2.2 Extensive involvement of dentin with marginal ridge weakened or broken

down, but still sufficient tooth structure remaining do support the restoration.

(Replacement of small Black Class II Restoration).

2.3. Posterior tooth – considerable involvement of dentin with a split at the

base of a cusp or at least the potential for a split.

Need to protect 1 more cuspal inclines from. Anterior teeth extensive

proximal caries with loss of support for the incisal corner which will be deeply

undermined.

2.4. Complete loss of at least one cusp from posterior/ anterior incisal edge –

result of either caries/trauma.

2.1. No equivalent in GV Black classification

3 different approaches can be considered for these lesions depending their

position in relation to the marginal ridge presence of lesion in adjacent tooth.

Internal occlusal fossa - Tunnel

Slot cavity

Proximal
 64

Internal occlusal fossa or Tunnel Preparation

When enamel lesion atleast 2.5mm apical to the crest of marginal ridge.

Simplest, most conservative approach through occlusal fossa fast medial to

marginal ridge using IOF / Tunnel approach.

Initial access as small as possible preserve natural tooth structure

Maintenance of original proximal contour, with a normal contact area, so

removal of should be minimal.

Entry just medial to marginal ridge with careful preservation of remaining

enamel.

Preparation

168 Diamond bur small tapered cylinder

Begin in occlusal fossa just mediated to marginal ridge

Enter towards expected carious lesion

Turn the bur into more upright position, encroaching into marginal ridge area to

a minimum extent, to enlarge cavity and improve visibility

Lean the bur facially and lingually create a funnel shaped access cavity to the

lesion.

Entry now is in outline with apex towards central occlusal fossa and base along

medial aspects of marginal ridge.

Carious dentin visible removed by round bur #008/012

 65

Extent of proximal enamel defect – clear and this point decision made on the

presence / absence of cavitation

If enamel only demineralized, not cavitated left above to be supported and

remineralized the cement

If e cavitated, needs to break through a short length of standard metal matrix

placed I proximally and wedge to protect adjacent tooth

But access to occlusal margin is more difficult

No specific retentive design adhesive restoration material used.

If this point, marginal ridge is cracked / severely compromised – remove

marginal ridge – now cavity is 2.2

In Anterior teeth

Access joined through labial / lingual

Better lingual pressure labial enable

Labial approach when there is a crowding no access lingually.

# 108 medial to marginal ridge

Conservatively incisally gingivally #008 remove carious lesion

If proximal enamel not cavitated in initial lesion leave intact so it can

remineralize

If cavitation, do it like as said before

 66

# 2.1 Slot Cavity

Lesion close to marginal ridge

Tunnel likely to leave the side too weak to be maintained so access gained

through marginal ridge

Called “Slot cavity

Occasions lesions commences on proximal surface posterior tooth leaving less

than 2.5mm of marginal ridge occluso- gingivally or may be cracked / very

weak

Lesion through marginal ridge, produce a small box form cavity sufficient to

eliminate lesion, but not extended beyond demineralized

Maintain contact with adjacent tooth an facial margin, lingual margin or both,

facilitating maintenance of relatively normal contact area between two teeth

Preparation # 168 - open into lesion

Careful extension without damage to adjacent tooth #008/012 remove caries

Do not extend medially more than half way through marginal ridge or cavity

design may have to be modified further.

2.1 Proximal Approach

 67

Occasional if adjacent tooth already has site 2, size 3 or 4 lesion, prepared in it

with entire proximal surface missing there may be direct access to size, through

proximal approach.

Occlusal remain intact, conservative cavity to remove caries

Marginal ridge will not involved or weakened

Good access and visibility

Restoration in straight forward without need to involvement marginal ridge or

approach through occlusal fossa

Preparation

#168 – for Access to lesion

Degree by the cavity in adjacent tooth # round bur (#008/012) remove caries

# 2.2

GV Black classification – Class II

Preparation

#156 medial to marginal ridge toward lesion.

Extent F lingually medially with same bur expose extent of caries

If Amalgam

Extent preparation full extent of occlusal fissure system

Produce extension 1mm wide to full depth of and just into D with walls for

adequate condensation of amalgam.

 68

If composite #200 fine diamond bur, open lesion – ensure there is no further

carious lesion No need to remove make room for composite.

#008/012 remove caries clean facial, lingual walls, gingival leave affected

dentin an axial wall to remineralize

Walls need not be free from contact with adjacent tooth

Retain gingival

#140 removes old restoration – not enlarge cavity remove caries, ditch metal

and break into pieces. If amalgam – mechanical retention provided, in the

gingival one third of cementum, using a 168 if composite mechanical retention

not required.

#2.3

GV Black class II (Anterior) class II posterior lesion in anterior

Preparation

#168 – conservatively

#140 TC - remove old restoration

No need to remove affected dentin from axial wall

No mechanical retention (dovetail, interlocks)

#223 smooth margins, remove friable E rods

Pins contraindicate

Bevel as required to enhance retention with composite resin

 69

Posterior

Preparation

#156 open cavity conservatively

#140 remove old restoration

#012, 016 remove caries

Identify a split at the base of a cusp, it is

For a cusp that is split or at risk, modify the cavity outline by leaning the facial

or lingual wall outwards in a straight line from gingival to

Support for one half of a cusp or single cusp is straightforward but all 4 cusps

on a molar can be protected.

Maintenance of full it on at least one cusp gives indication of original occlusal it

is simplifies replacement of remainder to normal occlusal anatomy

Refine margins #223.

Site 2 # 2.4

GV Black class IV (Anterior)

Preparation

With a loss of major section of incise half of crown

Occlusal load will not be heavy

After therapeutic little, preparation, required, margins beveled

 70

For extensive caries or replacement of old restoration

#156/#168 access achieved

Unsupported E can be supported with GIC

Margins trimmed to smooth finish

Posterior

#156 open cavity remove old restoration

Remain conservative, retain affected an axial and pulpal wall

Retain any cusp based on sound D

Cusps split 2.3

Retention developed in gingival using ditches

Site 3

Gingival one 3rd of crown or exposed root surface

On open surfaces (F or lingual) in relation to contours of gingival tissue or inter-

proximally, well below the contact area following gingival recession.

Caries occur anywhere around full circumference of a tooth

Caries may have an margin around full circumference but usual cavity in this

area has occlusal (incisal) margin in E and a gingival margin in D

Root surface caries anywhere an root surface following gingival recession

Abrasion / Erosion included

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#3.1 GV Black class V

Preparation

Caries found in gingival margin associated with high caries rate and poor oral

hygiene

#008 / 012, if restoration required to remove caries only

If friable removed, occasionally

No instrumentation for erosion

#3.3 Class V GV Black

Approximal lesions that have developed either as primary surface caries after

gingival recession or recurrent caries at gingival margin of an existing

restoration.

Preparation

There is risk to root surface of the adjacent tooth

#168 approach the lesion from the most occlusal posterior of caries aiming

gingivally towards most gingival extent cavity

Open conservatively

#012, 016 remove caries

#3.4 Class V GV Black

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Two or more caries around cervical margin of any tooth

Preparation

#168, #012, 016

Maintain axial wall

Relationship between Black’s Classification and modern site size concept

Site 1, Size, 1, 2, 3 & 4 – Pit & Fissure caries

On occlusal surface and posterior /any simple defect/ smooth surface of any

tooth.

Black class I smaller site 1 count not be carried out suitable restorative materials

not available. Black classification begins with site 1, size 2 (i.e.) 1.2

Site 2, Size 1, 2, 3 & 4 - Approximal lesion (contact area)

Approximal surface anterior, posterior any tooth immediate below the contact

area

Black class II occurs between posterior teeth only

No equivalent of size 1

Blacks begins with site 2, size 2 (2.2)

Black class III occurs between anterior teeth only.

No equivalent of size 2

Blacks classification begins with site 2, size 2 (2.2)

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Black class IV extension of class II involving incisal corners / edge of anterior

teeth

Cause could be traumatic and incisal corner

Classified site 2, size 4 (2.4)

Site 3, size 1, 2, 3 & 4: Gingival 1/3 of clinical crown or exposed root surface

following recession.

Black Class V does not differentiate lesion on gingival 1/3 of approximal

surface (particularly root surface caries) from class II lesions.

Erosion / Abrasion cavity could be (3.1, 3.2, 3.3, 3.4)

Cavity Preparation

Black classification did not allow for the size 1 lesion the either site 1, 2.

absence of adhesive restorative materials difference in restorating new lesion,

replacing a failed restoration.

New Active Caries

Cavity is conservative possible to remineralize both E and D that is only

demineralized, net cavitated.

Margins extended only to smooth surfaces that are capable of remineralizing

and the concept of extension for prevention no longer applies.

Possible to maintain tooth-to-tooth contact interproximally and cavity outline

form dictated by cavitation only.

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Replacement of failed restoration

Cavity outline already defined will often be more extensive than ideal.

Replacement of restoration

Black will still apply

Tooth structure cannot be replaced

CONCLUSION

With the better understanding of caries process and the present improved

knowledge of function of fluoride, limits size of cavity and aids in retaining

atleast some demineralised enamel & dentin heal through remineralization.

This retains more of natural tooth structure.

REFERENCES
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Sturdevant’s Art & Science Of Operative Dentistry; Theodore M Roberson,

Harald O Heyman, Edward J Swift Jr – 4TH Edition, Mosby Publications

Operative Dentistry, Modern Theory & Practice; M A Marzouk, A L Simonton,

R D Gross – 1st Edition, Ishiyaku Euroamerica, Inc. Publishers, Tokyo, St.

Louis, All India Publishers & Distributors, Chennai

Textbook of Operative Dentistry; Vimal K Sikri – 1st Edition, CBS Publishers &

Distributors

Principle & Practice of Operative Dentistry; Charbeneau – 2nd Edition, KM

Varghese Company

Fundamentals of Operative Dentistry: A Contemporary Approach; James A

Summit, J William Robbins, Richard S Schwartz, Jose Dos Santor – 2 nd edition,

Quintessence Publishing co.Inc.

Operative Dentistry; Gilmore, Lund, Bales, Vernetti – 4th Edition, B I

Publications Pvt.Ltd

Operative Dentistry; McGehee, True, Inskippp – 4th Edition, M C Books, Inc.

Textbook of Operative Dentistry; Lloyd Baum, Ralph W Phillips, Melvin R

Lund – 3rd Edition, B Saunders Company

Hampson’s Textbook of Operative Dentistry; E L Hampson – 4th Edition

Preservation & Restoration Of Tooth Structure, G J Mount, w R Hume 1st

Edition, Mosby Publications

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