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Internal Wall - Is a prepared (cut) surface that does not extend to the external tooth surface

a. axial wall parallel to the long axis of the tooth. b. pulpal wall perpendicular to the long axis of the tooth.

External wall - is a prepared (cut) surface that extends to the external tooth surface.

1.

2.
3. 4.

Distal wall Facial wall Lingual wall Gingival wall

Enamel wall Portion of the wall that consists of enamel. Dentin wall Portion of the wall that consists of dentin. Floors Refers to those portion of the preparation which are almost at right angles to the surrounding walls. Pulpal and gingival floors

Enamel wall

Dentin wall

Line angle

Formed by the junction of two walls along a line. Formed by the junction of three walls at a common point. Formed by the junction of a prepared wall and the external surface of the tooth Is the area formed by the cavity wall and the external tooth surface

Point angle

Cavosurface angle

Cavosurface margin

Tooth preparation involving two surfaces ex: mesial and occlusal surfaces mesio occlusal preparation Tooth preparation involving three surfaces ex: mesial, occlusal and distal surfaces mesio occluso distal preparation or MOD

Enamel margin strength


1.

2.

It is formed by fulllength enamel rods whose inner ends are on sound dentin Enamel rods are supported on the preparation side by shorter rods and whose outer ends have been cut off but whose inner ends are on sound dentin.

Fundamentals in Tooth Preparation

Tooth preparation
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 esthetic corrections where indicated, along with normal form and function.

Need for restorations


Reasons: 1. Caries 2. Fractured teeth 3. Esthetic needs 4. Needs for improved form or function

Objectives of tooth preparation:


1.

2.

3.

4.

Remove all defects and provide necessary protection to the pulp Extend the restoration as conservatively as possible Form the tooth preparation so that under the force of mastication the tooth or the restoration or both will not fracture and the restoration will not be displaced Allow for esthetic and functional placement of a restorative material

Stages and steps of tooth preparation

Two stages in tooth preparation:


1. 2.

Initial stage Final stage

Stages and steps in tooth preparation:


Initial tooth preparation stage: Step 1: Outline form and initial depth Step 2: Primary resistance form Step 3: Primary retention form Step 4: Convenience form

Final tooth preparation stage Step 5: Removal of any remaining infected dentin and/or old restorative material if indicated Step 6: Pulp protection, if indicated Step 7: Secondary resistance and retention forms Step 8: Procedures for finishing external walls Step 9: Final procedures: cleaning, inspecting, sealing

Initial preparation stage:


First stage Mechanical alterations to the tooth are extended to sound tooth structure in all directions while adhering to a specific limited pulpal or axial depth. Preparation walls are designed to resist fracture of the tooth or restorative material from masticatory forces principally directed with the long axis of the tooth and retain the restorative material in the tooth Pit and fissure lesions preparation is extended internally no deeper than 0.2 mm (0.5 mm restoring direct gold) Smooth surface lesions 0.2 - 0.8 mm into dentin

Step 1: outline form and initial depth


Outline form

Placing the preparation margins in the position they will occupy in the final preparation, except for finishing enamel walls and margins Preparing an initial depth of 0.2 to 0.8 mm pulpally of the DEJ position or normal root-surface position

Principles:
1.

2.
3.

All friable and/or 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.

Features:
1. 2.

3.
4. 5. 6.

Preserving cuspal strength Preserving marginal edge strength Minimizing faciolingual extensions Using enameloplasty Connecting two close faults or tooth preparations Restricting the depth of the preparation into dentin to a maximum of 0.2 for pit and fissure caries and 0.2 to 0.8 mm for the axial wall of smooth surface caries

Outline form and initial depth for pit and fissure

Factors that controlled the outline form & initial depth of pit & fissure lesions:
1.

2.

3.

Extent to which the enamel has been involved by the carious process Extensions that must be made along the fissures to achieve sound and smooth margins Limited bur depth related to the tooths original surface while extending the preparation to sound external walls that have a pulpal depth of 1.5 to 2 mm and a maximum depth into dentin of 0.2 mm

1. 2.

Extent to which the enamel has been involved by the carious process Extensions that must be made along the fissures to achieve sound and smooth margins

1.5 mm

0.2 mm

Limited bur depth related to the tooths original surface while extending the preparation to sound external walls that have a pulpal depth of 1.5 to 2 mm and a maximum depth into dentin of 0.2 mm

Outline form and initial depth for smooth surface lesions


Smooth surface lesions

Locations of smooth surface lesions:


Proximal surfaces Gingival portion of the facial and lingual surfaces

Step 2: Primary resistance form

Resistance form

Shape and placement of the preparation walls that enables the restoration and remaining tooth structure to withstand masticatory stress.

Principles:
relatively flat pulpal and gingival wall - help resist forces in the long axis of the tooth and prevent tooth fracture 2. Maintaining as much strength of the remaining tooth structure as possible 3. Internal and external angles are slightly rounded.
1.

Rounding internal line angles


- Reduces stress on the tooth; resistance to fracture of the tooth is increased

Rounding external angles


- Reduces the stress on some restorative materials; increasing resistance to fracture of restorative materials

4.

5.

Capping weakened cusps provides resistance both to forces in the long axis of the tooth and to those obliquely directed. Restorative material thickness
Minimal occlusal thickness for amalgam to resist fracture 1.5 mm Cast metal 1 to 2 mm Porcelain 2 mm Composite 1 to 2 mm

Factors:
1. 2.

3.

Amount of remaining tooth structure Type of restorative material Enhancement of resistance form by bonding a restoration to the tooth

Features:
1. 2. 3. 4. 5. 6. 7.

Relatively flat floors Box shape Inclusion of weakened tooth structure Preservation of cusps and marginal ridges Rounded internal line angles Adequate thickness of restorative material Reduction of cusps for capping when indicated

Basic rule for reduction of cusps


1.

OK
to 2/3 consider capping 2/3 or more recommend capping

2.

Cusp reduction should be considered when the outline form has extended half the distance from a primary groove to a cusp tip Cusp reduction usually is mandatory when the outline form has extended 2/3 the distance from a primary groove to a cusp tip.
Central groove

2/3
1/2 Primary groove Cusp tip

Facial groove

Step 3: Primary retention form


Retention form

Shape or form that resists displacement or removal of the restoration from tipping or lifting forces

Principles: 1. Frictional wall retention


Inclination of the wall and the surface area- the more area covered by the restoration, the greater the retention. Conversely, the greater the inclination or taper of the tooth preparation wall, the lower the retention value. Amalgam restorations occlusal convergence 2. Undercuts Small mechanical means of making retention Placed in the point angles of the tooth preparation

3.

Accessory retention forms with grooves, posts and dovetails


Prepared in the dentinal walls to provide the retention form

Step 4: Convenience form:

Shape or form of the preparation that provides for adequate observation, accessibility, and ease of operation in preparing and restoring the tooth.

Final tooth preparation stage


Second stage Completion of the tooth preparation

Includes excavating any remaining infected carious dentin; removing old restorative material if indicated; protecting the pulp; incorporating additional preparation design features that both minimize the tooth and restoration fracture against oblique forces and maximize the retention of the material in the tooth; finishing preparation walls; and performing the final procedures of cleaning, inspecting and sometimes sealing the preparation before placement of restorative material.

Step 5: removal of any remaining enamel pit or fissure, infected dentin, and/ or old restorative material if indicated

Removal of any remaining pit or fissure, infected dentin, and/or old restorative material is the elimination of any infected carious tooth structure or faulty restorative material left in the tooth after initial tooth preparation.

Step 6: pulp protection, if indicated

Reason for using traditional liners or bases: protect the pulp or to aid pulpal recovery or both

Step 7: secondary resistance and retention forms

Two types:
1.

2.

Mechanical preparation features Treatments of the preparation walls with etching, priming, and adhesive materials

Mechanical features: a. retention locks, grooves, and coves b. Groove extensions c. Skirts d. Beveled enamel margins e. Pins, slots, steps and amalgampins

Placement of etchant, primer, or adhesive on prepared walls a. Enamel etching consists of etching the enamel by an appropriate acid, resulting in a microscopically roughened surface to which the bonding material is mechanically bonded b. Dentin treatment dentinal surfaces may require etching and priming when using bonded porcelain, composite or amalgam restorations

Step 8: procedure for finishing the external walls of the tooth


Finishing the preparation walls is the further development, when indicated, of a specific cavosurface design and degree of smoothness or roughness that produces the maximum effectiveness of the restorative material being used. Objectives: 1. Create the best marginal seal possible between the restorative material and the tooth structure 2. Afford a smooth marginal junction 3. Provide maximum strength of both the tooth and the restorative material at and near the margin.

Step 9: final procedures: cleaning, inspecting and sealing

Include the cleaning, inspecting the preparation and applying a sealer when indicated. Removing all chips and loose debris that have accumulated, drying the preparation ( do not desiccate), and making a final complete inspection of the preparation for any remaining infected dentin, unsound enamel margins, or any condition that renders the preparation unacceptable to receive the restorative material.

General sequence of cavity preparation:


1.

Establish the outline form Circumscribe the area of the prepared cavity to include:
a) b)

c)

The area of the carious lesion The adjacent dep, non coalesced enamel defects (grooves, pits and fissures) All undermined, unsupported enamel

2. Obtain resistance form. the shape given to the preparation to prevent fracture of either the restoration or tooth during insertion of the material or during function. 3. Obtain retention form. The shape of the internal aspect of a prepared cavity to prevent displacement of the restorative material.

4. Obtain convenience form. The shape or form of the cavity that allows adequate vision, accessibility, and ease of instrumentation during preparation as well as during insertion of the restorative material. 5. Remove caries. Removal of remaining caries, usually those found in the deep portions of the axial or pulpal floor.

6. Finish cavity walls. Removal of any loose or friable enamel rods from the cavosurface margins. 7. Clean the cavity preparation. Final step involving the use of explorer, air and water spray, and cotton pellets to remove debris from the cavity preparation

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