I

The dimensions of everyday class-II cavity preparations

for amalgam
Asbj0rn l okstad
Department of Anatomy, School of Denti stry, University of Oslo, Oslo, and
NIOM, Scandinavian Institute of Dental Materials, Haslum, Norway
Jokstad A. The dimensions of everyday class-II cavity preparat ions for amalgam, Acta
Odontol Scand 1989;47:89-99. Oslo. ISSN 0001 -6357.
Six hundred and ten epoxy plastic models, made from impressions of permanent teeth in
which class-II cavity preparations for amalgam restorations had been prepared by eight
Sl:andinavian dentists, were examined. The outl ines of the cavity preparations were relat ively
large, with mean bucoolingual extensions occlusally of 50% of the intercuspal distance and
proximally of 40% of the length of the circumference of the proximal surface. There was a
gradual increase in the size of the cavities towards the distal part of the dent al arch, measured
both in millimeters and in relation to the anatomic structures . The amount of hard tissue
being removed varied among the operators and was possibly influenced by the ability
to handle the cutting instruments. The large cavity preparations may be the result of using
procedures for cavity which are not adjusted to the tremendous cutting potential
of modern dental instruments to produce stereotyped ' ideally designed' cavities. 0 Ctwily
measurements; operative dentistry; techniques
Asbj.,m Jokswd, Deparfment of Anatomy, Denial Faculty. p, O. Box 1052 Blindem, Universily
of Oslo, N-0316 Oslo 3, Norway
Thc operational steps of cavity preparation
for amalga m restorations are to a large
extent based on the guidelines suggested by
Black (\) at the turn of t he cent ury, These
guideli nes introduced the concept of 'exten-
sion for prevention', This concept stemmed
the current clinical practice of removing
minimal quantities of hard tissue (2, 3).
Although Black later recommcnded smaller
cavity preparations for pat ients wi th im-
proved oral hygiene (4), the concept for
many years for med the basis for operative
techniques.
In the dental literature there are numerous
modi fi cations of Black's cavit y designs (5-
7). Most of the modifications were never
substantiated by clinical research data but
rather by other developmcnts in dent istry:
the invention of restorative materials with
superior physical qualities and handling
properties (8); the advancement of pre-
ventive methods and oral prophylaxis (9-
11); the increased use of fluorides ami bettcr
oral health in the population (J2-15); the
increased knowledge of the biologic effects
of materials on oral ti ssues (16--19); the appli-
cation of biomechanic principles (20, 21); the
improved access to dental services (22); and
the technologic changes of the equipment in
the dent al office (23-28).
The general guideline in the teaching of
operative dentistry today is to maintain a
maximum amount of tissue (29-31). It is not
known to what extent the dentists in gencral
practi ce have adopted the principles of con-
servative opcrative dentistry.
The aim of the present examination was
primarily to assess the morphology of routine
cavities prepared for amalgam restorations .
The physical properties and the chemi cal
stabilit y of amalgam give indications of a
possible extensive function period as a res-
torative material in an oral environment.
Clini cal experience does , however, show
that amalgam restorations after a relatively
short time exhibit properti es not predicted
by the results from the standardized
measurements in the laboratory. It is not
clear to what exte nt the morphology of the
cavit y preparation influences the long-tcrm
prognosis of the restoration. A second aim
of this study was therefore to identify dis-
....... _---_ .. _----

90 A. Jol% d ACTA ODONTOL SCAND ' 7 ( 1989)
Table I . The freque ncy amI local ion of 610 examined cavity preparatIOns
Upper
"3
(62.8%)
Molar.; Premolars Premolar.; Molars
Dis Mcs Di s Mts Mcs Di s Mes Di s
12 48 77 44 55 OJ 53 14
Ri ghi
3Q8
(50.5%)
(9.8%) (19.8%) (22. 1%) (11.2%) Left
28 55
(13.6%)
33 I I 15 33 31 21
1Il2
(49.5%)
(7.2%) (7.8%) (8.5%)
l.o,,e r
227
(37.2%)
crepancics belicved to inl1uencc the prog-
nosis of the restorati ons. The rcstorations
arc part of a longitudinal st udy of the cl inical
performance of amalgam.
Materials and methods
Epoxy plaslic models, made from im-
pressions of permanent teeth in which c1ass-
II cavi ti es for amalgam restonl ti ons had been
prepared by eight Scandinavian dentists,
were examined. The clinical experi ence of
the operators varied from 15 to 30 years. A
tOlal of 610 cavity preparations were exam-
ined (Table 1). The number of models re-
turned by each operator vari ed from 19 to
108. The most usual localions of the cavit y
preparati ons among the operators are out -
lined in Table 2.
Each cavity was mcasured wi th a peri-
odontal probe wi th millimelcr marks (COB,
Hilming) and a flexible stri p of squared mi ll i-
meter paper. The mcasurements were made
at va rious prcdclermined locati ons on Ihe
loolh. The occlusal buccolingual width was
calculated as a fraction of the intercuspal
width. The widths we re measured at the
axiopulpal linc angle (isthmus) and at the
dovet;:!il (Fi g. I) . The proximal buccolingual
width was calcul ated as a fraction of the
extent of the proximal surface. This was
defined as Ihc length of the ci rcumfercnce
between the two utmost buccally or lingually
located parts of the cusp. The buccoli ngual
widths we re measured at the axiopulpalline
Table 2. Operators and the location of the cavi ty preparlllions by surface. 15% of the preparations
were MODs. which rount as two cavi ty prepa13tions
Upper UJ"'cr
Premolars Molars Premolars Molars
Operator Mcsial Di stal Mesi al Di stal Mesial Distal Mesial Distal Total
I ]() 33 6 I 6 II 3 2 92
2 7 8 24 2 19 2 62
3 20 31 8 II 8 18 6 5 107
4 J2 22 14 6 3 II 19 16 103
5 8 31
'"
2 I 4 19 5 106
6 18 22 JO 6 4 J2 15 13 100
7 5 I 2 5 6 19
8 4 5
- -
4 6 J9
99 157 JOI 26 26 66 86 49 610
,
I





ACTA SCANI) (!9IW)
Fi g. 1. Meas urement of the mean occlusal bucoolingual
extensions of the cavit y ICW _ int er-
cusp;,1 widt b: I .. widtb t bc A = width in
average : D = width at the dovetail.
angl es (isthmus) and at the gingival margins
(Fig. 2) . The proximal gingi val extension was
measured as the distance betwee n the margin
and the approximat e location of the marginal
ridge. The depth of the cavity was measured
as the distance between the cavosurface mar-
gin and the pulpal floor o r the axial wall.
The age of the pati ents varied from 8 years
to 71 years. with a mean of 28 years. For
Fig. 2. Measureme nt of the mean proximal buccolinguat
exlensions of the cavit y prepar.. tions. PC .. I"ngth of
the proximal ci rcumfe rence; I _ width 31 the isthmus.
Cirus-fl couiry dimensions 9 1
operators 3, 4 and 6 the mean age of the pa-
tients varied from 36 to 40 years: for oper-
ator I it was 31 years; and for operators 2 _
5, 7, and 8 it was 12- 16 years. The operators
were instructed to make an impression
(Optosil/ Xantopre n. Bayer) of the tooth
before condensing amal gam into the cavit y.
No inst ructions on prepar:llion techniques
were issued in advance; thai is. no infor-
mation on the presumed correci size o r mor-
phology of the cavity was presented to the
operators. Although Ihe clinicians knew that
the cavity preparations were to be ex.lmi ned.
they did not know what was to be measured
and how. The cavities arc therefore con-
sidered to refl ect the clinical situation in
everyday dental practice.
The Student- Newrnan- Kcul procedure
for one-way analysis of variance (ANOVA)
was used at a significance level of 0.05. The
procedure determined the extent of the devi -
ation of cavi ty dimensions in the diffe rent
looth categories and betwcc n the operators.
Results
Occlusal surface
The mean buccolingual width was 0.5 (SD.
0.2) of the intercuspal width, varying from
0.1 to 1.0. The width was <0.2 in 4% of
the models, pri marily upper premolars, and
>0.8 in 13% of the models, mainly lower
molars (Fig. 3). Fig. 4 illustrates Ihe occlusal
exte nsions in the differe nt tooth cat egories.
The huccolingual widths we re, in general ,
enlarged in the lower molars (0.7) and the
distal widths in the upper molars (0.6), COm-
pared with in the upper premolars (0.4)
(p < 0.05).
The int rasurface buccolingua l extension
narrowed slight Iy towards the axi opu lpalline
angle in the molars. The nllrrowing was 1110st
obvious mesially in the lower mola rs (Fig. 4).
The extension broadened in the premolars.
especially mcsilllly in the upper premolars.
Proximal surface
The mean gingival extension was 3.6 mm
(SD, 0.8 mm) from the marginal ridge, vary-
ing from I to 7 mm. The gi ngival extension

92 A. Jokslud
"
I
D
lew
A
lew
I
lew
ACTA ODONTOI. SCANO ( 7 (15l89)
Fig. 3. The mean and
prevalent occlusal
bucoolinguol ext ensions
of the examined cavity
preparat ions. D/ ICW
- extensions at the
dovetail : A/ ICW ..
extensions on a\e ..... ge;
I/ICW - extensions al
the isthmus; D, _
mean at the
dovctai l; A. _ mean
on a\'erage;
I, '" mean at
the isthmus. All values
arc represented as
fract ions of the
...
- inlcrcuspal widlh
(n = 600) (the difference in the numbt:r of obser,atiom; from n ,. 610 is due 10 model Hl ifa cts).
was <2 mm in 9% of the models. primarily
the lower premolars, and > 6 mm in 2% of
the models ( Fig. 5).
The gingival floor was ei ther curved or
stretched nonpcrpcndicular to the tooth axis
in 42% of the models. The gingiv;11 extension
va ried up to 2 mm for some preparations.
The varia ble inlrasurf ace gi ngival extensions
prevailed on the distal surface of the upper
pre molars.
The mean buccoli ngual width was 0.4 (SD,
0.1) of the length of the proximal ci r-
,
I
(
J1.! I I
1fI '
Fig . .t. Tbe mean occlusal ('xtension of Ihe cavity prep-
arat ions in the diffe rent toot h categories. The bucoo-
lingual extensions arc represented as fractions of Ihe
intercuS!)3.1 width,
cumfercnce, varyi ng from 0. 1 10 1.0. The
width was < 0.2 at the gingival tmrgill in 5%
of the models, primaril y uppe r premolars ,
and > 0.6 at the isthmus in 14% of the
models, mainl y lower molars (Fig. 5).
The intrasurface buccoli ngual extension
narrowed towards the axiopulpall ine angle:
that is. the wall s converged. The angle
between the facial and lingunl walls and the
gi ngiva l floor vari ed on the di ffere nt
surfaces. The wall s we re more parall el on
the mesial surface of the upper molars than
on the proxi mal surfaces of the upper pre-
molars (p < 0. 05).
Figs . 6 and 7 ilIuslnlte the proximal cxten-
ski ns in the different toOlh categories. The
buccolingual width and the gingival exten-
sion were increased on the distal surfaces of
the upper (0.5 and 4.4 mm) and lower (0.5
and 4 mm) molars compared with on the
other surfaces (p < 0.05).
Depth
The mean occlusal depth was 2.2 mm (SD,
0.6 mm) from the cavosurface margi n to the
pulpal fl oor , va rying from 0.5 to 5 mm, The
depth was < I mm in 5% of the modcls,
primarily lower premola rs, and > 5 mm in
one model (Fig. 8).
The mean occlusal depth at the locat ion
of the axiopulpal line angle- that is. the
isthmus-was 2.2 mm (SO, 0.6 mm) . The
intrasurface difference between the dcpth at
--'



ACTA ODONTOL SCAND . 7 (1 989)
Fig. S. 'The mean and
prevalent proximal
eJ\"tensions of the
examinc:d eavit)'
preparations. G/ PC .,
buccolingual extensions
at the gi ngival margin;
I/ PC "" buccol ingual
extensions at the
isthmus; G, "" mean
extcnsion at the
gi ngi va: I, "" mean
extension at the
isthmus. All val ucs are
represented as fract ions
of the proximal
circumference. GI -
gingival extensions.
and GI, - mcan
gingival extension.
measured from the
G.
PC'
marginal ridge to the I .
-<:" ' "'!: , -frdJ =!-! .'--1 ... ""JI:-,I
y
, fl!:
.9 .8 .7 .6 .5 ,t .3 .2 .1
,ox
'"
+H.,.--J '"'
Class-II eauity dimensions 93
G('
gingival margin PC .
(/I = 60S) (the difference in . . .
the number of observations from II - 610 is duc to model artifacts) .
the isthmus and the rest of the pulpal floor
varied from - 3 to 1.5 mm. A shallow depth
al the isthmus re lative to the pulpal floor
was more pronounced mesiall y in the upper
molars than in the other surfaces (p < 0.05).
Fig. 9 illustrates the oeclus.. '11 depths in
the di ffere nt tooth catcgories. An increased
M"

I
,
_.
Fig. 6. 'The mean proximal eJ\"tension of the
prepared in the premolar.>. The buccolingual utensions
are represented as fractions or the proximal ci rcum-
ference. The gingival extension is measured from the
margi nal ridge to the gi ngival margin.
depth was observed in the upper molars
(2.3 mm mesiall y. 2.5 mm distall y) and
distall y in the lower molars (2.4 mm) w m-
pared wit h in the lower premolars ( 1.8 mOl)
(p < 0.05).
The mean proximal depth was 1.7 mm
(SD, 0.5 mm) from the eavosurfaee margi n
10 the axial wa ll . varyi ng from 0.5 to 3.5 mm.
The depth was < I mm in 17% of the models.
mostl y premolars. and >2 mm in the pre-
molars and > 2.5 mm in the molars in 4% of
the models (Fig. 8) .
Fig. 9 illustrates the proximal depth in the
different toot h categories. The depth was
greater in the lower (1.8 nun) and upper
(1.9 mm) molars than mesially in the lower
(1.4 mm) and uppe r ( 1.6 mm) premolars
(p < 0.05).
Operator variance
Signifi cant differences from the average
for cert ai n variables was observed between
the operators: operators 4 and 5 prepared
large and deep cavi ti es. and operators 6 and
8 prepared small cavities (p < 0.05). Broad-
ening of the occlusal buccol ingual ext e nsion
towards the axi opulpal line angle was
observed for operators 5 and 8 (p < 0.05).

94 A. JoIW(ld
Convergi ng proximal wall s were seen for
operator 6 (p < 0.05). Operator 2 provided
most of the cavity preparations with a shal-
low occlusal depth at the isthmus relative to
the pulpal RooT. Fig. 10 illustrates the outline
of the mean cavity preparation of a few
operators.
Discussion
Vale (32) suggested, aft er strengt h measure-
ments on premolars, that the occlusal buc-
Od ,
,
'"'
'"'

Fig. 8. The mean and prevalent depths of the examined
cavity preparations . OD '" occlusal depths; PD '"
proximal depths; 00, '" mean occlusal depth; PO, '"
mean proximal depth. All depths measured from the
cavosurface margin to the pulpal or axial wall (n = 6(4)
(the diffcrence in the number of observations from 11 =
610 is due to model artifacts).
Dis
ACTA ODQNTOL SCAt.'O 47 (1989)
Fig. 7. The mean
proxima! extension of
the cavilies prepared in
the molars , The
bucculingual extensions
arc represented as
fractions of the
proximal
circumference , The
gingival extt:nsion is
measured from the
marginal ridge to the
margin .
colingual width should not exceed one-
fourt h of the intercuspal extent. Later inves-
tigations have shown that in vi tro cusp frac-
tures are caused by a complex interaction
among the load application, the occlusion,
the tooth type, and the extent of the cavity
preparation (33- 35). The relat ionship
between cusp fractures in vivo and occlusal
and proximal widths and depths is unclear
(36). It is therefore questionable to assume
that the clinical prognoses of the restorations
placed in these cavities are reduced because
of the relatively large extensions. On the
,
I
,
,
,
,
/ 1.8
\.
I
I
I ' 19"' \
. \,
/ \"'.
Fig. 9. The mean of the cavity preparation, in the
diffcrenttooth categories. The depth is measured from
the margin to pulpal or axial wall.
-
-
-
'"



ACfA ODOt-lTOL SCANO (1989)
,
1-8
Fig. 10. The outlines of the preparat ions
of opcfiti ors 4, S. 6, and S.
other hand, the risk of macro- and mi cro-
fractures of the restorati on increases if the
occl usal width is enl arged (37- 39). Wide
cavi ti es render the remaining tooth strUClUre
more suscepti ble to strain during the cavit y
pre parati on (40) , the placement of the
matrix band (4 1-43) , or the condens:Hion o f
amalgam (44,45). Stress generated in the
tooth OI l thi s stage may later cause fract ures
of the remaining tooth (46-51).
The occlusal and proximal bulk fraclUrcs
of amalgam restorations th<lt develop after
some years occur most oft en in the lower
mo lars (52). This may be ca used by a dif-
feren t cusp morphology, hi gher functional
forces in the molars, or the lateral move-
me nts o f the jaw. In the prese nt study the
mean buccolingual extension was larger in
the lower mol ars than in the ot he r teeth. The
occlusal willis al so converged more di stinctly
towll rds the isthmus. A decrease of the buc-
colingual extension towards the isthmus
reduces the strength of the restorati o n at this
point. It is therefore possible Ihut the high
preval ence of bulk amalgam fract ures ill the
lower mo lars can be explained by the ge n-
erall y higher frequency of large resto ratio ns
wit h the affiliated narrow isthmus parts.
The extent of the cari es determines pri-
marily the dimension of the prepared cavity.
If the patient s, as in the present study, arc
checked regularly, Ihe cari es is usually
minimal. The proximal extensions arc in
these cases gove rned mainly by the anatomy
of the proximal surface of the adjacent
CItl.U 1I c:aui ry dimerui()fl$ 95
tooth- that is, the margi ns are locat ed free
from conlact with the surface. The charac-
teristic morphology of the proxi mal surfaces
in the different tooth categori es may explain
the observed vari ation in cavity outlines. The
increased buccolingual ext ension in the pos-
terior teeth may be explained by the broad-
ened contact areas (53). This is in agreement
with the prevalent cavi ty preparations, with
parall el proximal wall s on the relative ly Hat
mesial surface o f the upper molars. The
mean gi ngival extension increased in the
mo lars. This is ;n harmony with a decreased
axiogi ngival convexit y but in conAict with
the shorter clinical crowns throughout the
arch (53).
The axiogingivul convexity is more pro-
nounced and also 10Cllled more gi ngivall y on
the distal surface. On the other hand, the
di stal surface is usuall y lowe r (53). The ident-
ical mesi al and distal extensions in the pre-
molars are therefore expected. However , the
diffe rence between the mesial and distal
extensions in the molars ca nnol be explained
by the surface anatomy. Assuming that the
extent of the cari o us lesions gove rned the
extensions insignifi cantl y, factors other t han
the surface analOmies influenced the amount
of ti ssue removal.
It is not possible o n models to assess the
posi tion of the margins in relation to the
adjace nt toot h o r in relati on to the ana-
tomical root. The probability of contact
between the proxi mal margi ns and the neigh-
boring tooth can therefo re o nly be assumed .
Tentative minimum mean val ues arc < 2 mm
from the marginal ridge or a buccoli ngual
width < 0.20% of the length of the proxima l
circumference. Ten percent of the cavi ty
preparations in the present material include
margins that are, according to these values.
in cont act with the adjace nt tooth.
The di stance between the marginal ridge
and the cementoenamel junction is approxi-
mat ely 6 mm for premo lars and mol ars (54).
The distance from the alveolar crest to the
gingiva l sulcus is 0.7 mOl and to the den-
.tinoenamel juncti on 2 mm (55) . On the basis
of these val ues, 2% of the gi ngival margins
arc placed on the anatomical root , 4% within
the junctional epi thelium, 19% in the sulcus,
and 84% supragingivally. This differs from

96 A. Jok.rrlld
surveys indicating that gingival margins
mostly are located subgi ngivall y (56-59) .
The vari at ion may be explained by a dif-
ferent mean age of the patients or a diffe rent
proport ion of restorati ons due to primary
caries versus secondary cari es.
Proximal secondary cari es and marginal
crevices deve lop primaril y in the line poi nt
angles (60-63) . The detecti on of these
defects depends to a large extent on the use
of bitewing radiographs. It is recognized that
gingival defects wil l appear on the film at an
early stage if the gingival margin is parall el
to the X-ray beam. It was therefore unex-
pected 10 discover that 40% of the cavity
preparations included a gingival margin with
a vari able cxtension. The restorati ons placed
in these cllvity preparations wi ll project
potential defects only at the most gingival
section of the margin onto the fil m, owing to
the radiopaque shadowing of the amalgam.
The influence of a variable gingival floor
on the radiographic diagnosis of secondary
caries should be assessed . This woul d es-
peciall y be peninent for the new fill ing ma-
teri als, since these entail new radiographic
opacities and cavity preparation designs.
Depth
The e namel thickness and the cemento-
enamel juncti on cannot be detected on
plastic models. The relationshi p between the
pulpal and axial walls and the pulp can there-
fore only be assumed. The mean thickness of
enamel occlusally is 2- 2.5 mm. The distance
between the occlusal fi ssures and the pulp is
5 mm for premolars and molars (64) .
The mini mum thickness of amalgam to
withstand the chcwi ng forces has previously
been set at I mm (65). Most textbooks rec-
ommend a depth to the dent inoenamel
border. although it has also been proposed
that restorat ions may be p];lced ent irely in
the enamel (66). The clinical minimum
occlusal depth is also influenced by the
occlusal and proximal buccolingual widt hs,
the form of the antagonist , and the patient's
bite force. It is the refore di.fficult to anti ci-
pate the prognosis of the 5% of the resto-
rations placed in cavities prepared wi th an
occlusal dept h < 1 mOl .
AcrA ODOl'lTOL $CANO ~ 7 (1989)
One-third of the models displayed a vari-
able occlusal depth . This should be avoided ,
according to data from in vitro studi es. The
clinical signifi cance of this cavit y feature
remains unknown, however. except when
the re in addition is no doveta il, conve rging
occlusal wall s, or a sloping pulpal floor
towards thc isthmus.
The thickness of the ename l proximall y.
and the in-depth anatomy of the occlusal
fi ssures, is identical in premolars and mola rs
(54,64). Moreover, the etiology and the pro-
gress, and the detection of caries, are pre-
sumably ide ntical in the toot h categories.
This contrasts wi th the observed increase of
the cavity depth in t he more di sta l teeth.
OperalOr
In the presc nt material the morphology of
the cavity preparat ions varied among the
operators. Although some C<1n be attributed
to the differcnt age composi tions of the
patient groups. certain C<lVity fea tures could
be recognized as characteristi c for the indi-
vidual operator. Variations were noted for
grooves axiogingivally and/ or proximall y,
parall el or converging proximal wall s,
rounded or acute internal line angles. and
cavity extensions. It is possible that the
nume rous publications of more or less cl ini-
cally successful modifications of design have
made the profession reluctant to adopt new
techniques in operative denti stry. It could
also be observed that to various extents the
operators prepared large r and more uncon-
ve ntiona ll y designed cavities posteriorly.
The amount of hard ti ssue removed is thus
infl uenced by the dentist' s abi lit y to handle
the cutti ng instruments. This factor can par-
all el the observations of variable det ection
capabilities and caries treatment decisions
among operators (67- 70).
The reason for the cavi ty preparations-
that is, primary caries or the failure of a
previous restoration- was not registered .
Nor was the extent of the caries or the dimen-
sions of any previous restomtions registered .
It is the refore imprecise to describe the cavity
preparat ions as overextended. The gene ral
impression was, however. that a consider-
able amount of hard tissue was being
"
-
,
\


ACTA ODONTOL SCAND . ' {1989)
removed in thc postcri or tceth . This con-
trasts wit h the gcncral guidcline in modern
operative dentistry. whi ch is to preserve as
much tissue as possible (71, 72) . Perhaps the
treme ndous cutt ing potcnt ial of modern den-
tal instruments (73-75) has made the
' inhe ri ted' procedures for preparing cavi t ies
inappropriate.
Many of today's procedures for cavit y
preparat ion we re developed at a time when
dental instruments rotated relati vely slowly.
A reasonable cutti ng efficiency coul d the re-
fore onl y be obtained by a large di ameter of
the bur (76). Using these la rge burs ofte n
resulted in an excessive removal of sound
tissue (77). The observa tion that the exten-
sion coul d be reduced by init iall y completing
the outline of the cavity before removing
thc cari es was all importanl consideration in
Bl ack's textbook (78). Today, a hi gh per-
ipheral speed of the bur can be obtai ned,
and the size of the burs has decreased
radi cally. Yet dental st udcnts and dentists
conti nue to prepare the outline form initially
instead of focusing on the removal of caries
(6.72.79).
During the predinic courses at mall Y den-
tal schools the stude nts are taught to prepare
cavi ties with ' ideal designs' (80). The training
of students to prepare ideal cavities may
be valuable for educational purposes. It is
possible. however, that instructors have
focused too much on tcaching stereotyped
idea l designs. instead of teaching pri nci ples
to meet certain physical requi rements of the
material. The t raining in operati ve de ntistry
may thus have created the be li ef Ihat the
cavit y pre pared with an ide:ll design is with-
out exception the optimal cavit y prep-
arati on.
Using Black's sequence of opcrative pro-
cedures with high-speed burs together wi th
the concept of ' ideal design' will result in
largc cavities even after moderat e caries
att acks. A preferable approach would be
initiall y to remove the clIrious tissue. fol -
lowed by a ' locking' of thc cavity and fin -
ishing of the margins (8 1). Thi s method wi ll
result in ti ssue-conservat ive cavity prep-
arat ions (82). The appro,teh is furt hermore
logical and thus easie r to apply on smalle r or
modifi ed cavit y preparati ons and for various
C/uss-/l c(Jui ry dimeruions 97
restorat ive materials. Focusing on t he caries
and then adjusting as li tt le as possible after
it has been removed should be the goal for
the future educat ion in cavity preparat ion
techni ques.
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