Tooth preparation for

Composite
restoration

TOOTH PREPARATION FOR

COMPOSITES
DEFINITION:

Tooth preparation is
defined as the mechanical alteration
of a defective, injured or diseased
tooth to best receive a restorative
material that will reestablish a
healthy state for the tooth, including
aesthetic corrections where indicated
along with normal form and function.

STAGES AND STEPS OF TOOTH PREPARATION

1.
2.
3.
4.

INITIAL TOOTH PREPARATION STAGES

Outline form and initial depth.
Primary resistance form.
Primary retention form.
Convenience form.

FINAL TOOTH PREPARATION STAGES

5. Removal of any remaining infected dentin, or old
restorative material, if indicated.
6. Pulp protection, if needed.
7. Secondary resistance and retention forms.
8. Procedure for finishing external walls.
9. Final procedures: cleaning , inspecting and sealing.

Burs
ADA size
no

Head
Head
diameter length

Taper
angle

shape

0.50

0.40

Round

0.60

0.48

Round

1.00

0.80

Round

1.40

1.10

round

169L

0.90

5.6

Elongate
d taper

330L

0.80

Pear long

Mirror ,Explorer & periodontal probe, Chisels, Hatchet, Gingival

marginal trimmer , Excavators, High & low speed hand piece

Tooth preparation for composites

includes some basic principles like

Removing the fault,defect,old restoration,

or friable tooth structure
Creating prepared enamel margin of 90
degree or greater
Creating 90 degree butt joint on
cavosurface margin on root surface.
Roughening the prepared tooth structure
with a diamond stone.

Objectives
Less

outline extension
Axial or pulpal wall of varying
depth(not uniform)
Incorporation of bevels.
Preparation walls being rough.
Use of diamond stone to increase the
roughness.

Types of composites
preparation
Conventional
Bevelled

conventional

Modified
Box

only
Slot preparation

Conventional

Indication
Preparation located on the root surface(non enamel
areas).
Moderate to large class 1 or class 2 restoration

Conventional tooth preparation are those typical

for amalgam restoration.
An inverted cone no. 245 bur is used to prepare the
tooth resulting in preparation design similar to that
for amalgam but smaller in width and extension.

Bevelled conventional

They are tooth preparation which is

similar to conventional preparation in
that the outline form has external box
like wall but with some bevelled
enamel margin.

Indication
to replace an existing restoration (amalgam)
exhibiting a conventional tooth preparation
design with enamel margin or to restore a
large area.

Beveling

Increase the surface area for bonding

Reduces the marginal leakage.

Types of bevels
Partial bevel : This should involve about 1/3 to of the enamel wall at
45-70 degree to the cavity.
Long bevel : the entire enamel wall is bevelled at at 45-70 degree to
the cavity wall
Hollow ground bevel : about two thirds of the enamel wall thickness is
ground in concave manner so the cavity margin will have right angled
cavosurface angle with butt joint between the restorative material and
the enamel margin.
Scalloping the margin : this feature can be used in conjunction with a
partial or long bevel, in order to further increase the surface area and
irregularities of the enamel that is conditioned.
Skirting : this feature is used if conditioned enamel will be the main
retentive mode for resinious material .

Cavity designs for composites resins

Based on the dye penetration test and the

quantitative analysis of the
micromorphplogy of the margin
adaptation, the experimental cavity and
cavities with a long bevel showed better
margins than cavities with right- angled
butt joints or cavities with concave bevels.

A Porte.F Lutz et al; operative dentistry, 1983

Modified

They are indicated for the initial restoration of

smaller cavitated ,carious lesion usually surrounded
by enamel and for correcting the enamel defect.
Objectives of this preparation design are to remove
the fault as conservatively as possible. preparation
appears to have scooped out rather than distinct
internal line angles.

Box only

This design is indicated only when the proximal

surface is faulty with no lesion present on the
occlusal surface.

Facial / lingual slot

In

this case the lesion is detected on

the proximal surface but the operator
believes that access to the lesion can
be obtained from either a facial or
lingual direction rather than through
marginal ridge from an occlusal
direction.

Class 3 tooth preparation

When proximal surface of an anterior tooth

to be restored ,there is a choice between
facial or lingual entry into the tooth.
Advantages from lingual approach
facial enamel is conserved for enhanced
esthetics
Some unsupported but not friable enamel
may be left on the facial walls
Color matching of composites is not critical
Discoloration of restoration is less visible.

Indication for facial approach

Carious lesion is positioned facially such

that facial access would significantly
conserve tooth structure
Teeth irregularly aligned, making the
lingual access undesirable.
Extensive caries extend onto the facial
surface.
Faulty restoration which needs to be
replaced.

Tooth preparation methods

Bur size depends on the size of the lesion, mainly no.1/2, 1 or 2

size round bur or diamond , prepare the outline form on the
root surface extending the external walls to sound tooth
structure while extending pulpally to an initial depth of
0.75mm.
Initial entry penetrates the carious lesion as close to the
adjacent tooth without contacting it.
Cutting instruments held perpendicular to the enamel surface .

Axial wall depth initially is limited to 0.2 mm

inside the DEJ.
Axial wall should be outwardly convex following
normal external tooth contour and DEJ.

If preparation is on the root ,the external walls

should be perpendicular to the root surface
forming a 90 degree cavosurface angle.

Gingival retention groove-prepare this groove

appox 0.2 mm inside DEJ to a depth of 0.25mm
(half the diameter of no.1/4 bur).

The depth wise direction of the groove is an

angle that bisect the junction of axial wall and
external walls.

Incisal retention cove - no.1/4 bur is

used at the axioincisal point angle
with the bur oriented in similar
angle ,0.2 mm inside DEJ and 0.25
mm depth. then extend it slightly into
the facioaxial line angle where it
fades out.

Cavosurface bevel or flare is best

prepared with either a flame shaped
or round diamond instrument
resulting in an angle appox 45 degree
to the external tooth surface. A bevel
width of 0.25 to 0.5 mm is considered
sufficient.

Facial access same as the lingual ,the

procedure is simplified because of direct
vision.
Final tooth preparation accomplished by
removing any remaining dentin with a
round bur rotating at low speed or a
spoon excavator.

Outline form should

not include
Entire proximal contact area
Extend onto the facial surface
Extended subgingivally

Class 4 composite
restoration

Conventional preparation has

minimal clinical class 4
application except in those
areas that have margins
located on root surface.

In addition to the etched

enamel ,retention of
composites restoration material
in bevelled conventional class 4
preparation may be obtained
by groove or other shaped
undercuts, dovetail extension
,threaded pins.

Dovetail extension into the lingual

surface of the tooth may enhance both
the restoration strength and retention
but it is less conservative and therefore
not used.

Pin retention discouraged

risk of perforation into pulp or
external surface.
Pins do not enhance the strength of
restorative material
Some pins corrode due to microlekage
resulting in discoloration.

 Appropriate

size round carbide /

diamond at high speed with air
water coolant prepare outline form.
Remove all weakened enamel and
establish the initial axial wall depth
at 0.5mm in dentin
Bevel width 0.25 2 mm
Gingival retention groove given.

Class 4 preparation and a pin channel placed

into the dentin 1 mm from the dentinoenamel junction using a #330 bur with a high
speed hand piece with water spray.
The resultant pin channel was appox 0.8 mm
in diameter by 1.00 mm deep.
The mean fracture load of teeth with the
resin composite pin channel was significantly
greater than that of the teeth without pin.

HW Roberts et al ;operative dentistry, 2000, 25,270-273

Class 5 composite
restoration

Located in the gingival 1/3 of the

facial and lingual tooth surface.

Tapered fissure carbide bur

(no.700,701,271) or similarly
shaped diamond is used along
with air water spray

Entry at 45 degree angle to the

tooth surface

As the cutting progress maintain

the burs long axis perpendicular
to the external surface of the
tooth during preparation of the
outline form which would result
in 90 degree cavosurface
margin.

 0.75

axial wall depth will provide

adequate external wall width for
Strength of the preparation wall
Placement of a retention groove
Strength of the composite

Axial wall should follow the contour of the facial surface

which is convex outwardly mesiodistally.
Final tooth preparation remove remaining infected
dentin/old restorative material
_ apply calcium hydroxide
-- prepare groove retention form

Class 1 composite
restoration

Conventional preparation- enter

the tooth in the distal pit area of
the faulty occlusal surface with
the inverted cone diamond
positioned parallel to the long axis
of the crown.

Prepare the pulpal floor to an

initial depth of 1.5 mm as
measured from the central groove.

Facial and lingual measurement is

1.75mm which depends on the
steepness of the cuspal inclines

Initial depth 0.2mm inside the DEJ

Facial ,lingual,extention and width are dictated

by the caries ,old restorative material.

Extension into marginal ridge should result in

appox 1.6mm thickness of remaining tooth
structure for premolar and 2mm for molars.

Pulpal floor should be flat and follow the rise

and fall of the DEJ.

Final cavity procedure are carried out.

Beveling on the occlusal margin may result in

thin composites where heavy occlusal force are
being acted upon.
Convergence of the occlusal wall
Marginal form of the groove extension on the
facial or lingual surface may be beveled with the
diamond resulting in a 0.25-0.5mm width bevel
at a 45 degree angle to prepared wall.

Class 2 composite
restoration

No.330 or 245 shaped diamond is used to

enter faulty pit opposite the proximal
surface.
Diamond positioned parallel to the long
axis of the tooth.
Pulpal depth 1.5mm as measured from the
central groove.
Facio-lingual width should be as narrow as
possible
Pulpal floor should is relatively flat

Occlusal wall generally converge occlusally because

of the inverted shape of the diamond.
Proximal box once the diamond has extended
through the marginal ridge ,care should be taken
not to cut the adjacent tooth.
Proximal ditch cut is initiated hold the diamond
over the DEJ with tip directed gingivally - cut that
will be 0.2 mm inside the DEJ.

For a no. 245 diamond instrument with a tip

diameter of 0.8mm this would require 1/4th of the
diamond tip positioned over the side of the DEJ and
other 3/4th of the tip over the enamel.

Diamond extended facially,lingually, gingivally to

include all the fault ,caries and old material.

Occlusal wall- converge occlusally

Proximal wall may be parallel or convergent

occlusally.

Modified class 2 tooth

preparation

Small round or inverted cone diamond

may be used for this preparation to scoop
out the carious or faulty material.

Pulpal floor and the axial depth are

dictated only by the depth of the lesion.

Axial wall extension onto the root surface if caries is found below
CEJ the axial wall is prepared with diamond in same axis but the
diamond is tilted toward adjacent tooth to create approximate 0.75 to
1 mm axial wall depth on root surface.

COMPOSITE VENEERS

These can be placed either directly or

indirectly
3 basic preparation designs exist

a window preparation without extension sub-gingivally

or involving incisal angle

window preparation that extends to gingival crest and

terminates at the facio-incisal angle.

veneers with incisal overlapping with sub-gingival

extension

Three basic designs

window preparation design is recommended

for most direct and indirect composite
veneers.

such a preparation, preserves tooth structure,

prevent significant occlusal loading and
reduced potential for wear of opposing tooth.

an incisal overlapping preparation is indicated

when an tooth being restored needs
lengthening or when an incisal defect warrants
restoration.

DIRECT COMPOSITE
VENEERS

The outline is dictated

solely by the extent of the
defect and should include
all discolored areas.

Using a coarse ,elliptical or

round diamond bur a depth
of about 0.5 to 0.75 mm is
prepared.

Usually it is not necessary

to remove all discolored
enamel but it should be
extended to sound,
unaffected enamel.

Difference between tooth

colored composites and the
gold inlays or onlays
The

tooth preparation walls must be

more divergent than those commonly
used with alloys.
Bevels are not present on inlay
occlusal surfaces.
Bevels may be present on the
proximal box forms of inlay or onlay.
Bevels may or may not be necessary
on the gingival areas.
Gordon J .Christensen et al esthetic dentistry JADA 1988

Onlay preparation may have bevel present

on the nonstress-bearing facial and lingual
surface to provide better esthetics
appearance by blending colors, and
additional retention because of more
enamel surface available for etching.
Box forms may present but rounded
internal forms are better than sharp or
square box forms.
Groves are to be avoided if possible.

Gordon J .Christensen et al esthetic dentistry JADA 1988

With regard to onlay preparation the cusps

to be covered ,in particular functional cusps
be reduced by 1.5mm to 2.0mm .

The preparation of the groove in the dentin

exposed by reducing cusps or the
incorporation of the pins channel in the
preparation may be desirable to limit and to
counter the substantial shear forces along
the composites- tooth interface during heavy
loading in particular in lateral excursion.

F J T Burke et al B D J April 6 1991