PRINCIPLES OF CAVITY PREPARATION & ITS

MODIFICATIONS IN PRIMARY TEETH

INTRODUCTION
DENTAL CARIES
Infectious, microbiological disease that
results in localized dissolution and
destruction of calcified tissues of the
teeth. ( Sturdevant)
Most restorative treatment was due to caries. The
tooth was cavitated and was referred to as a cavity.
when the affected tooth was repaired, the cutting or
preparation of the remaining tooth structure was
referred to as cavity preparation.

CAVITY PREPARATION

A cavity in the dentistry is defined as a

defect in enamel, detin or cementum
resulting from the pathological processes,
mostly the dental caries.Other processes
such as abrasion, erosion etc.can also
cause such defects (SKIRI)
TOOTH PREPARATION
 It is the mechanical alteration of a
defective, injured or diseased tooth to
receive a restorative material that re-
establishes a healthy state for the tooth
including esthetic corrections where
indicated and normal form and function
(STURDEVANT)
Tooth preparation that require specific
wall form depth and marginal form-
Conventional
Tooth preparation that have less need for
specific depth and wall and marginal
form-modified preparation
OBJECTIVE
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 forces of mastication, the tooth
or the restoration or both will not fracture
and the restoration will not be displaced.
Allow for the esthetic and functional
placement of a restorative material.
 CLASSIFICATION OF CAVITY PREPARATIONS

BLACKS CLASSIFICATION

CLASS I:All pit and fissure lesion on occlusal surface of premolars and molars,
lesion on occlusal 2/3rd of the facial and lingual surface of molars and lesion on
lingual surface of maxillary incisor

CLASS II:Lesion on proximal surface of posterior teeth

CLASS III :Lesion on proximal surface of anterior teeth that do not involve incisal
edge

CLASS IV :Lesion on proximal surface of anterior involving incisal edge

CLASS V :Lesion on gingival third of facial or lingual of all teeth
CLASS VI :Lesion on incisal edge of anterior teeth or occlusal cusp tip of posterior
teeth

FINNS MODIFICATION

CLASS I: Pit and fissure cavities on the occlusal surface of molars and buccal and lingual pits
of all teeth .

CLASS II:Cavities on proximal surface of posterior teeth with access established from
occlusal surface

CLASS III:Cavities on proximal surface of anterior teeth that may or may not involve labial or
lingual extension

CLASS IV:Restoration on proximal surface of anterior teeth that involve the incisal edge.
CLASS V:Cavities on proximal surface where the marginal ridge is not included in cavity
preparation.

CHARBENEUS MODIFICATION

CLASS II: cavities on single proximal surface of bicuspid and molars.

CLASS VI: cavities on both mesial and distal proximal surfaces of posterior teeth that will
share a common occlusal isthmus
Lingual surface of upper anterior teeth
Any other unusually located pit or fissure involved with decay

STURDEVANTS CLASSIFICATION

SIMPLE CAVITY: a cavity involving only one tooth surface

COMPOUND CAVITY: a cavity involving two surfaces of a tooth
COMPLEX CAVITY: a cavity that involves more than two surfaces of a tooth.
BAUMES CLASSIFICATION

Pit and fissure cavity.

Smooth surface cavities.
Margins of cavity preparations should not be in contact with the opposing tooth.
If less than 0.5mm of tooth structure exists between two carious surfaces, then they
should be joined.

Pulpal floor and axial wall should have an average depth of 0.5mm into dentin.

PRIMARY RESISTANCE FORM

This is that shape and placement of cavity walls

that best enables both the restoration and tooth
to withstand without fracture the masticatory
forces delivered principally along the long axis
of the tooth.
FEATURES
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.
Butt joint between tooth and restoration.
90 cavosurface angle.
Adequate depth and width of the cavity.
Gingival cavosurface bevel is given in
case of permanent teeth.
Width of cavity should not be more than
1/4th -1/5th the intercuspal distance.
Cavity wall should be occlusally divergent
at the marginal ridges areas.
Removal of unsupported enamel.
PRIMARY RETNTION FORM

It is that shape or form of tooth

preparation that resist displacement or
removal of restoration from tipping or
lifting force .
Occlusal dovetail prevents tipping of the
restoration by occlusal forces.
 Occlusal convergence of the preparation
walls.
Acid etching and and bonding provide
micromechanical retention.
Enamel bevel also enhance retention

CONVENIENCE FORM

It is that shape or form of the cavity that

provide for adequate
observation accessibility and ease of
operation in preparing and restoring the
tooth.
Features
Providing adequate depth and lateral
extension for tooth preparation of
restorative material
Refining line and point angles as
convenience points for starting
condensation of direct filling gold
Providing proximal clearance from adjacent
tooth enhances convenience form
Occlusal divergence for cast gold inlays
 REMOVING OF ANY REMAINING INFECTED DENTIN

This is the elimination of any infected

carious tooth structure or faulty
restorative material that is left in the
tooth after tooth preparation
Infected dentin-superficial layer which is
soft and leathery in consistency and light
brown in color. It has a high concentration
of bacteria and collagen is irreversibly
denatured .This layer is not
remineralizable and must be removed
Affected dentin-this is the deeper layer
which is hard in consistency and dark
brown in color. It does not contain
bacteria and is reversibly denatured.
Therefore this layer preserved
PULP PROTECTION

It is the step in adapting the preparation

for receiving the final restorative material
Liners or bases is used to protect the
pulp or to aid pulpal recovery
 Pulp protection is mandatory for
successful restoration of tooth.
Examples of liners are:
aqueous suspension of zinc oxide or
calcium hydroxide.
Resin modified glass ionomer used with
composite restorations.
Examples of bases are:
Zinc phosphate
Zinc oxide eugenol
Zinc polycarboxylate
Calcium hydroxide
Some types of glass ionomer (usually
RMGI)

SECONDARY RESISTANCE AND RETENTION FORM

Many preparation require additional

retentive features .When the tooth
preparation include both occlusal and
proximal surfaces each of those area
should have independent retention and
resistance features
Mechanical features
Retention locks, grooves and coves
Grooves extension
Skirts
Beveled enamel margins
Pins, slots, steps and amalgam pins.
Conditioning procedures-etching and
bonding

FINISHING EXTERNAL WALLS AND MARGINS

It is the further development when

indicated of a specific cavosurface design
and degree of smoothness that produces
maximum effectiveness of the restorative
material used.
Objective-to allow smooth marginal
junction and close adaptation between
the restoration and the tooth structure, to
provide maximum strength for tooth and
restorative material.
Rotary, hand cutting instrument, cut fissure
burs etc
 FINAL PROCEDURE

It include removing all chips and lose

debris that have accumulated ,drying the
preparation and making a final complete
inspection of the preparation for any
remaining infected dentin or any
condition that renders the preparation
unacceptable to receive the restorative
material.
Washing with saline or warm water under
pressure
Squeezing the cavity wall with cotton
Enamel should be dried with oil free air
without pressure
Enamel margin smoothened with hand
cutting instrument

RECENT CONCEPT

PRINCIPLES OF RECENT CONCEPT

 Cavity design should be dictated under the
site and extent of the lesion
Should not be in expectation of extending
cavity out to the caries free area.
Restorative material should be one that
displays some degree of biological activity
Only that part of the tooth crown that is
irreversibly degenerated and broken down
should be removed

Martin et al have applied the term minimal

intervention, minimally invasive or
preservative dentistry
Minimal intervention is therefore based on
biological or therapeutic approach with
following principles.
- Remineralization of early lesions.
- Reduction in cariogenic bacteria.
- Repair rather than replacement of defective
restorations.
- Disease control.
MODIFICATION OF CAVITY PREPARATION IN PRIMARY
TEETH

Factors to be considered while

restoring primary teeth
The smaller tooth dimension of
the deciduous dentition
The thin enamel covering the
teeth
Broad contact area
Proximity of the pulp chamber
Narrow occlusal table

CLASS I CAVITIES
Due to narrow occlusal table isthmus
should not be more than 1/3rd the
intercuspal distance in the case of small
carious lesion
The depth should not be more
than 0.5 mm into the dentin
The pulpal floor should be flat
Use of preventive resin restoration is
advocated rather than the conventional
cavity preparation which include all pit
and fissure.
CLASS II CAVITIES
Due to presence of broad contact area,
the gingival floor of the proximal box
should be wide
The box should converge occlusally with
the buccal and lingual wall paralleling the
external tooth surface .the walls of
proximal box should meet the occlusal
wall in a straight line
The wall of proximal box should not
flared
Isthmus should not exceed 1/3rd of the
intercuspal width in primary molars
Sharp cavosurface angle
Rounded/beveled/grooved/axiopulpal
line angle to reduce stresses on this
point
Greater width of the proximal box, more
buccolingual extension of the gingival
floor
Occlusal convergence
Axial wall should follow the contour of
the external surface
 Retention growth should not be given
Avoid the mesiobuccal pulp horn from
exposure in case of small first molar

CLASS III CAVITIES

When the contact is open the outline is
triangular with base towards the gingival
aspect of the cavity
Gingival cavity wall is inclined occlusally to
parallel the enamel rod direction
Retention pits can be placed at the
axiobuccogingival and axiolinguogingival
point angles
A dove tail may be placed in the middle
1/3rd of the lingual surface of the tooth