Amalgam Tunnel Tooth Restorations.

In an effort to be conservative of tooth structure removal, others

advocate a tunnel tooth preparation. This preparation joins an occlusal lesion with a proximal lesion by
means of a prepared tunnel under the involved marginal ridge. In this way, the marginal ridge remains
essentially intactIn assessing this technique, the adequacy of preparation access may be controversial.
Developing appropriately formed preparation walls and excavating caries may be compromised by lack
of access and visibility. Whether or not the marginal ridge is preserved in a strong state also is
controversial. This technique is controversial and not supported in this textbook

Composite Tunnel Tooth Restorations. The tunnel preparation, as described above, also has been
advocated for composite restorations. Usually it also is advocated to use a glass-ionomer liner under the
composite, and some suggest this preparation design be partially or completely restored with a glass-
ionomer restorative material. The same disadvantages exist as with amalgam tunnel restorations and
therefore this technique is not recommended in this textbook.

 ccess to the lesion through the occlusal surfaces should be limited to the extent required to achieve visibility
and should be undertaken from an area that is not under direct occlusal load (Knight, 1984). Fossa
immediately next to medial marginal ridge is the most suitable position for entry. Glass ionomer is best
suited for such cavities as it readily flows into a small cavity and has the ability to remineralize the enamel
margins and any dentin on axial wall. • Two variations are described: Closed ‘tunnel’ : Which leaves the
demineralized approximal enamel intact Open ‘tunnel’ : Which is accessed from occlusal and exits through
the approximal surface Ref. pg no. 453-454, Nikhil Marwah, 2nd edition
 28. Indications and Contraindications • Use of tunnel preparation can be considered when small, proximal
carious lesions necessitate restoration • Preparation should be avoided: i. large carious lesion are diagnosed,
where access is particularly difficult ii. Overlying marginal ridge is subjected to heavy occlusion or
demonstrates a crack
 29. Advantages of Tunnel Preparation • Preserves the marginal ridge - conservative approach • Less potential
for a restorative overhang • Perimeter of the restoration is reduced, decreasing the potential for micro
leakage. • Potential for disturbance of the adjacent tooth is reduced
 30. Disadvantages of Tunnel Preparation Highly technique sensitive, demanding careful control of the
preparation by the operator Angulations of preparation often passes close pulp Visibility is decreased and
caries removal is more uncertain - caries detecting solution Fragile marginal ridge - at least 2.5 mm apical to
crest of the marginal ridge (Mount 1997)

 SLOT CAVITY PREPARATIONS” It could be used when the lesion is less 2.5 mm below the crest of the
marginal ridge. The basic principles of cavity design remain the same, with the objective of removing only
that tooth structure that has broken beyond the possibility of remineralisation. If this is allowed to dictate
the extent of the cavity, there will many occasions with this design where there is sound contact with the
 adjacent tooth in one or more areas. It is desirable to retain this to ease the problems of maintaining a good,
firm contact area. The outline form will be dictated entirely by the extent of the breakdown of the enamel,
removing only that which is friable and easily eliminated without applying undue pressure . Ref. pg no. 454,
Nikhil Marwah, 2nd edition
 33. Retention will be through adhesion, so it is only necessary to clean the walls around the full
circumference of the lesion, leaving the axial wall because it will be affected by dentin only. For such a
lesion, resin composite may be a useful material because on many occasions there will be a useful material
because on many occasions there will be an enamel margin around the full circumference. However, glass
ionomer is still a sound option because the occlusal load will not be great and the ion exchange will remain
valuable both for adhesion and remineralization. Ref. pg no. 454, Nikhil Marwah, 2nd edition
 Minibox or “slot” preparations These preparation designs have been described as minimally invasive
and relatively successful with a reported 70% success rate over an average of 7 years.

A third modified design for restoring proximal lesions on posterior teeth is the facial or lingual slot
preparation (see Fig. 13-36). In this case, a 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
the marginal ridge from an occlusal direction. Usually a small round diamond stone is used to gain access to
the lesion. The diamond is oriented at the correct occlusogingival height, and the entry is made with the
diamond as close to the adjacent tooth as possible, thus preserving as much of the facial or lingual surface as
possible. The preparation is extended occlusogingivally and faciolingually enough to remove the lesion. The
initial axial depth is 0.2 mm inside the DEJ. The occlusal, facial, and gingival cavosurface margins are 90
degrees or greater. Caries excavation in a pulpal direction is done with a round bur or spoon excavator. This
preparation FIG 11-26 Modified preparation designs for Class III (A and B), Class IV (C and D), and Class V (E
and F) restorations. is similar to a Class III preparation for an anterior tooth

Slot preparation for root caries. Older patients who have gingival recession exposing the cementum may
experience caries on the proximal root surface that is appreciably gingival to the proximal contact (Fig. 17-
62, A). Assuming that the contact does not need restoring, the tooth preparation is usually approached from
the facial and has the form of a slot (see Fig. 17-62, B). A lingual approach is used when the caries is limited to
the linguoproximal surface. Amalgam is particularly indicated for slot preparations if isolation is difficult.'
After anesthesia and isolation of the operating field, prepare the initial outline form from a facial approach
with a No. 2 or No. 4 bur using high speed and airwater spray. Outline form extension to sound tooth
structure is at a limited depth axially (i.e., 0.75 to 1 mm at the gingival aspect [if no enamel is present],
increasing to

1 to 1.25 mm at the occlusal wall [if margin in enamel]) (see Fig. 17-62, B). If the occlusal margin is in enamel,
the axial depth should be 0.5 mm inside the DEJ. During this extension the bur should not remove any
infected carious dentin from the axial wall deeper than the outline form initial depth. The remaining infected
carious dentin (if any) will be removed during final tooth preparation (see Fig. 17-62, C). External walls should
form a 90-degree cavosurface angle. With a facial approach, the lingual wall should face facially as much as
possible. This will aid condensation of amalgam during its insertion. The facial wall must be extended to
provide access and visibility or convenience form (see Fig. 17-62, D). In final tooth preparation use the No. 2
or No. 4 bur to remove any remaining infected carious dentin on the axial wall. If indicated, apply a liner or
base or both (as described for the Class I tooth preparation). Prepare retention grooves with a No. 1/, bur
into the occlusoaxial and gingivoaxial line angles, 0.2 mm inside