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endo education

1. CHEN ZhiCHEN Zhi
Wuhan University School of StomatologyWuhan University School of Stomatology
Operative Dentistry 2Operative Dentistry 2

2. Definition of Operative DentistryDefinition of Operative Dentistry
Operative dentistry is
the ART and SCIENCE of the
diagnosis, treatment, prognosis
of defects of teeth which do not
require full coverage restorations
for correction.

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

4. Program of Operative TreatmentProgram of Operative Treatment
 Patient assessment
 Examination and diagnosis
 Treatment planning
 Pain control: local anesthetic
 Isolation of the operating field

5.  Cavity preparation
 Matrix application
 Preparation of materials
 Insertion and carving of materials
 Finishing and Polishing
Program of Operative TreatmentProgram of Operative Treatment

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

7. Cavity StructureCavity Structure
 walls
 angles
 cavity

8. Classification of cavityClassification of cavity
 Class I
 Class II
 Class III
 Class IV
 Class V
 Class VI
—G.V.Black in 1908

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

10. QUIZ
TIME

11. Class 1
Class 2
Class 1
Class 2
Class 3
Class 4
Class 5
Class 6

12. Stages and Steps
in Cavity Preparation
Initial cavity preparation stage
Final cavity preparation stage

13. Initial cavity preparation stage
Step 1 Outline form and initial depth
Step 2 Primary resistance form
Step 3 Primary retention form
Step 4 Convenience form

14. Final cavity preparation stage
Step 5 Removal of any remaining infected
dentin if indicated
Step 6 Pulp protection
Step 7 Secondary resistance & retention form
Step 8 Procedure for finishing external walls
Step 9 Final procedures

15. Initial cavity preparation stage
Step 1 Outline form and initial depth
Step 2 Primary resistance form
Step 3 Primary retention form
Step 4 Convenience form

16. Outline Form and Initial Depth
Ⅰ
Definition:
placing the cavity margins in the positio
ns they will occupy in the final preparati
on;
preparing an initial depth of 0.2~0.8 mm
pulpally of the dentinoenamel junction p
osition or normal root surface position.

17. Maxillary Class
Ⅰ
outline form

18. Mandibular Class
Ⅰ
outline form

19. Maxillary Class
Ⅱ
outline form

20. Mandibular Class
Ⅱ
outline form

21. Common Error

23. Outline Form and Initial Depth
Ⅱ
Principles: without any exception
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.

24. Outline Form and Initial Depth
Ⅲ
Features:
preserving cuspal strength
preserving marginal ridge strength
minimizing facio-lingual extension
using enameloplasty
connecting two close faults or cavities
restricting the depth of the preparation i
nto dentin.

28. Initial cavity preparation stage
Step 1 Outline form and initial depth
Step 2 Primary resistance form
Step 3 Primary retention form
Step 4 Convenience form

29. Primary Resistance Form
Ⅰ
Primary Resistance Form
Ⅰ
Definition:
The shape and placement of the cavity w
alls that best enable both the restoration
and the tooth to withstand, without fract
ure, masticatory forces delivered princip
ally in the long axis of the the tooth.

30. Primary Resistance Form
Ⅱ
Primary Resistance Form
Ⅱ
Principles:
To utilize the box shape with a relatively
flat floor to resist occlusal loading by
virtue of being at right angles to
mastication force;
To restrict the extension of the external
walls (keep as small as possible) to
allow strong cusp and ridge areas to
remain with sufficient dentin support;

31. Primary Resistance Form
Ⅲ
Primary Resistance Form
Ⅲ
Principles:
To have a slight rounding of internal
line angles to reduce stress
concentration in tooth structure;
To provide enough thickness of
restorative material to prevent its
fracture under load.

32. Primary Resistance Form
Ⅳ
Primary Resistance Form
Ⅳ
Feature:
Box shape
Relatively flat floors
Inclusion of weakened tooth structure
Preservation of cusps and marginal ridges
Rounded internal line angles
Adequate thickness of restorative materials
Reduction of cusps for capping if indicated

34. Initial cavity preparation stage
Step 1 Outline form and initial depth
Step 2 Primary resistance form
Step 3 Primary retention form
Step 4 Convenience form

35. Primary Retention Form
Ⅰ
Primary Retention Form
Ⅰ
Definition:
The shape or form of the prepared
cavity that resists displacement or
removal of the restoration from
tipping or lifting forces.
In many respects retention and resistance form
are accomplished in the same cutting procedure.

36. Primary Retention Form
Ⅱ
Primary Retention Form
Ⅱ
Principles: depending on the materials
Amalgam restoration:
developing external cavity walls that
converge occlusally and dovetail design

37. The devotail design provide retention form
to the occlusal portion of the cavity.
The occlusal convergence of the walls offers
retention in the proximal portion of the cavity
against displacement occlusally.

39. Primary Retention Form
Ⅲ
Primary Retention Form
Ⅲ
Principles: depending on the materials
Composite restoration:
a mechanical bond between the material
and conditioned, prepared tooth structure.

41. Initial cavity preparation stage
Step 1 Outline form and initial depth
Step 2 Primary resistance form
Step 3 Primary retention form
Step 4 Convenience form

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

43. Convenience Form
Ⅱ
Convenience Form
Ⅱ
Principles:
Allow access for caries removal
Allow access for restoration placement
Allow access to margins for finishing,
evaluation and cleaning

44. Convenience Form

45. Final cavity preparation stage
Step 5 Removal of any remaining infected
dentin if indicated
Step 6 Pulp protection
Step 7 Secondary resistance & retention form
Step 8 Procedure for finishing external walls
Step 9 Final procedures

46. Removal of any remaining infected Removal of any remaining infected
dentin if indicateddentin if indicated
Definition:
The elimination of any infected carious
tooth structure or faulty restorative
material left in the tooth after initial
cavity preparation.

47. Removal of dentinal caries using round burs and spoon excavators

48. Final cavity preparation stage
Step 5 Removal of any remaining infected
dentin if indicated
Step 6 Pulp protection
Step 7 Secondary resistance & retention form
Step 8 Procedure for finishing external walls
Step 9 Final procedures

49. Pulp protectionPulp protection
Using liners or bases
to protect the pulp or
to aid pulpal recovery or both.

54. Final cavity preparation stage
Step 5 Removal of any remaining infected
dentin if indicated
Step 6 Pulp protection
Step 7 Secondary resistance & retention form
Step 8 Procedure for finishing external walls
Step 9 Final procedures

55. Secondary resistance and Secondary resistance and
retention forms
Ⅰ
retention forms
Ⅰ
Most compound and complex cavity
preparations require additional
resistance and retention form.
The exception being those preparations
that are very conservative.

56. Secondary resistance and Secondary resistance and
retention forms
Ⅱ
retention forms
Ⅱ
Mechanical forms
Cavity wall conditioning form

57. Mechnical form:
 Proximal locks
 Proximal slots

58. Proximal locks

61. Slot on gingival wall

62. Final cavity preparation stage
Step 5 Removal of any remaining infected
dentin if indicated
Step 6 Pulp protection
Step 7 Secondary resistance & retention form
Step 8 Finishing external walls
Step 9 Final procedures

63. Finishing the external walls
Ⅰ
Finishing the external walls
Ⅰ
Definition:
is the further development of a specifi
c cavosurface design and degree of s
moothness that produces the maximu
m effectiveness of the restorative mat
erial being used.

64. Finishing the external walls
Ⅱ
Finishing the external walls
Ⅱ
Objectives:
 To create the best marginal seal possible
between the restorative material and tooth
structure;
 To afford a smooth marginal junction;
 To provide maximum strength of both the
tooth and the restorative material at and
near the margin.

65. The strongest enamel margin is that margin
which is composed of full-length enamel rods
that are supported on the cavity side by shorter
enamel rods, all of which extend to sound dentin.

66. Finishing the external walls
Ⅲ
Finishing the external walls
Ⅲ
The design of the cavosurface angle
The degree of smoothness of the wall

67. The design of the cavosurface angle:
depending on the material
 amalgam: 90°
 composite: beveling 30°~ 40°

71. Final cavity preparation stage
Step 5 Removal of any remaining infected
dentin if indicated
Step 6 Pulp protection
Step 7 Secondary resistance & retention form
Step 8 Procedure for finishing external walls
Step 9 Final procedures

72. Final proceduresFinal procedures
 cleaning
 inspecting
 varnishing
 conditioning

75.  Cavity preparation
 Matrix application
 Preparation of materials
 Insertion and carving of materials
 Finishing and Polishing
Program of Operative TreatmentProgram of Operative Treatment

76. Matrix Application
Tofflemire Matrix System
Ivory Matrix System

77. Matrix retainer, Band & Wedge

79. Matrix in Retainer

80. Contour Matrix
Rounded instrument
such as a spoon
excavator

81. Matrix on Tooth

82. Occlusal View

83. Wedge place

84. Contour Band

85. Ready for restoration

86.  Cavity preparation
 Matrix application
 Preparation of materials
 Insertion and carving of materials
 Finishing and Polishing
Program of Operative TreatmentProgram of Operative Treatment

87. Armamentarium
 Amalgam Capsule
 Amalgamator
 Squeeze Cloth
 Amalgam carrier

88. Activate Mercury

91.  Cavity preparation
 Matrix application
 Preparation of materials
 Insertion and carving of materials
 Finishing and Polishing
Program of Operative TreatmentProgram of Operative Treatment

92. Insertion and carving
Class
Ⅰ
Class
Ⅱ

93. Armamentarium
 Amalgam Condensers
 Anatomic Burnishers
 Carves
— Cleoid or Discoid

94. Check condenser fit

95. First increment

96. Start with the smallest condenser

97. Step condenser over mass

98. Continue adding increment

99. Condense toward walls

100. Use alternative instruments

101. Overpacked

102. Create initial grooves

103. Create initial grooves

104. Carve to margin

105. Enhance grooves

106. Remove flash

107. Final shape and burnishing

108. Completed restoration

109. Initial Increment

110. Initial Condensation

111. Lateral Condensation

112. Overpacking

113. Marginal Ridge Condensation

114. Condense to Margins

115. Create Occlusal Embrasure

116. Occlusal Embrasure

117. Occlusal Embrasure

118. Occlusal Embrasure

119. Removing Ridge

120. Removing Band

121. Flash & Excess

122. Moving Excess

123. Check with interproximal carve

124. Instrument on Tooth Structure

125. Completed Restoration

126. Rubber dam removal

127.  Cavity preparation
 Matrix application
 Preparation of materials
 Insertion and carving of materials
 Finishing and Polishing
Program of Operative TreatmentProgram of Operative Treatment

128. Polishing

129. Evaluate the restoration Class I
 Verify that cavosurface margin can be seen
— Flash
— Underfilled
— Voids
 Check the overall shape of the anatomy
— Look for bulky ridges that might be high
in occlusion

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

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

132. Strasbourg