CAVITY PREPARATION IN PRIMARY TEETH

Index –
1. Definition and classification of tooth preparation
2. Basic Steps of tooth preparation
3. Principles of tooth preparation
4. Class 1 cavity preparation
5. Class 2 cavity preparation
6. Class3 cavity preparation
7. Class 4 cavity preparation
8. Class 5 cavity preparation
9. References

Definition of cavity preparation-

Tooth preparation is the mechanical alteration of a defective,injured, or diseased tooth to
receive a restorative material that re-establishes a healthy state for thee tooth, including
esthetic correction where indicated and normal form and function.

Black's classification

Class I lesion

• Lesions that begin in the structural defects of teeth such as pits, fissures and
defective grooves.
• Locations include
 Occlusal surface of molars and premolars
 Occlusal two thirds of buccal and lingual surfaces of molars and
 Lingual surfaces of anterior tooth

Class II lesions

They are found on the proximal surfaces of the bicuspids and molars.

Class III lesions

• Lesions found on the proximal surfaces of anterior teeth that do not involve or
necessitate the removal of the incisal angle.

Class IV lesions

Lesions found on the proximal surfaces of anterior teeth that involve the incisal
angle.

Class V lesions
 Lesions that are found at the gingival third of the facial and lingual surfaces of the
anterior and posterior teeth.

Class VI (Simon's modification)

Lesions involving cuspal tips and incisal edges of teeth.

Finn’s modification

Class I

Cavities involving the pit and fissures of the molar teeth and the buccal and lingual
pits of all teeth.

Class II

Cavities involving proximal surface of molar teeth with access established from the
occlusal surface

Class III

Cavities involving the proximal surfaces of the anterior teeth which may or may not
involve a labial or a lingual extension

Class IV
A restoration of the proximal surface of an anterior tooth which involve the incisal
angle

Class V

Cavities present on the cervical third of all teeth, including proximal surface where
the marginal ridge is not included in the cavity preparation

Sturdevant’s 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

Principles of cavity preparation

Outline form

The locations that the peripheries of the completed tooth preparation will occupy on
tooth surfaces.

- Internal outline form

- External outline form

Features

• Extend cavity margins to sound tooth structure

• Margins should be extended to include all defective enamel
• Cavity margins should be placed in self-cleansable areas
• Include all the pits and fissures
• Extend outline form to provide sufficient access
• The pulpal floor and axial wall should have an average depth of 0.5 mm into the
dentin.
• 0.2 - 0.3 mm clearance from the adjacent tooth while preparing the proximal box
in class II cavities.
• Margins of the cavity preparation should not be in contact with the opposing
tooth.
• If less than 0.5mm of the tooth structure exists between two carious surfaces, then
they should be joined.

Resistance form

• It is the shape given to the cavity to enable the tooth as well as the restoration to
withstand the stresses of mastication.
Features
• Flat pulpal and gingival walls
• Utilizing box form of cavity preparation
• Cavity prepared in such a way that strong cusp and ridge areas remain with
adequate dentin support
• Rounded internal line angles to avoid stress concentrations.
• Butt joint between the tooth and restoration
 • Removal of unsupported enamel
• 90 degree cavo-surface angle
• Adequate bulk of the restorative material
• Adequate depth and width of the cavity
• The width of the cavity should not be more than 1/4th - 1/5th the intercuspal
distance.
• The pulpal floor should be 0.5mm below the dentino-enamel junction

Retention form

• It is comprised of those factors of cavity design that prevent the restoration from
being displaced.
Features
• Retention grooves are used in class III and Class V cavities.
• Occlusal dovetail in the case of proximo occlusal cavities where only one
proximal surface is involved.
• Pins placed into the dentin
• Acid etching of the enamel
• The proximal box of class II design is divergent gingivally to contribute to the
retention form.

Convenience form

• It includes shaping the cavity to facilitate access for instrumentation, for

condensation, adaptation and finishing.
Features
• Modifications of cavosurface margins for ease of placement of restorative
material.
• Extension of buccal and lingual walls for visibility and access to deeper portions
of the cavity.
• The proximal lesion can be instrumented from the facial, or lingual embrasures in
a tooth with wide, accessible embrasures and intact marginal ridges.

Removal of any remaining infected dentin

• small carious lesion, the infected dentin can be completely removed.

• In large carious lesion if infected dentin still remains inspite of following the
above procedures it is removed using a round bur in slow speed handpiece or
using spoon excavator

Finishing the enamel walls

• It is the further development of specific cavosurface design and degree of

smoothness that will bring about the maximum effectiveness of the restorative
material being used.
Cleansing of the cavity

• The operating field should be kept clean and adequately isolated by the use of
rubberdam, cotton rolls, and high vacuum evacuation equipment.
• Conditioning of the cavity may be done in certain cases like bonding systems for
amalgam and composite restorations

Modifications of Cavity Preparation in Primary Teeth

Few factors have to be taken into consideration while restoring the primary teeth. These
include:
• The smaller tooth dimension of the deciduous dentition
• The thin enamel covering the teeth
• Broad contact areas
• Proximity of the pulp chamber to outer tooth surface
• Narrow occlusal table

Class I cavities

• Due to the narrow occlusal table present the isthmus should not be more than
1/3rd the intercuspal distance
• The depth should not be more than 0.5 mm into dentin
• The pulpal floor should be flat.
• Any remaining caries lesion should be removed using round burs.

Class II cavities

• Due to the presence of broad contact gingival floor of the proximal box should be
wide so as to place the margins in self cleansing areas
• The box should converge occlusally with the buccal and lingual wall paralleling
the external tooth surface.
• The proximal walls should not be flared as it would lead to unsupported enamel.
• The axiopulpal line angle must be rounded, tunneled or grooved for sufficient
bulk of the restoration.
 • Retention can be improved by a 'U' shaped retention groove along the
amelodentinal junction of the proximal box
• When the cavity margins exceeded that of an ideal preparation particularly in the
case of a mandibular first primary molar, an overlay of the distobuccal cusp is
prepared
• Since the enamel rods, at the cervical area of the tooth, are oriented occlusally the
gingival seat should not be beveled,
• The proximal box should allow the passage of an explorer tip between its margins
and adjacent tooth in all three directions, buccally, gingivally and lingually.

Class III cavity

• 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 axiobucco gingival and axio linguo gingival
point angles.
• A dovetail may be placed in the middle 1/3 of the lingual surface of the tooth.

Class I cavity preparation

External outline form

• Start preparation by penetrating the occlusal surface with the No. 330 bur.
• Go from distal to mesial surface. Include all deep and defective grooves in the
preparation.
• Blend the outline to form smooth-flowing arcs and curves. This blending
establishes the walls of the cavity preparation
• Contour the outline parallel to the mesial and distal marginal ridges.
• Maintain a bulk of tooth structure on the marginal ridges.
• Maintain a width approximately one third the width of the occlusal table.

Internal outline form

• Penetrate 0.50 to 1.0 mm into the dentin. Dentin is much softer to the touch, is not
as shiny as enamel, and usually is yellow.
• The No. 330 bur shank is a good depth marker. It is approximately 1.5 mm from
the bur tip to the shank.
• Round line angles with the No. 330 bur. Round line angles are easier areas to
condense amalgam into, and they reduce internal stress on the amalgam
restoration.
• The walls are wider at the pulpal floorthan at the occlusal opening. This
convergence aids in retention of the restorative material.
• Slightly round the pulpal floor. All internal line angles should be rounded.
• Establish a sharp cavosurface angle in the lateral walls with the No. 169L bur.
The walls are parallel or slightly undercut to the external surfaces of the tooth.
The sharp cavosurface angle is an asset to improve carving and polishing, and
reduce marginal failure.
 • If the active caries has not been removed during cavity preparation, do so now.
Use a NO.4 or 6 round bur in a slow-speed handpiece. A large spoon excavator
works as well. Rinse the preparation with water. Inspect for caries removal, sharp
cavosurface margins, and retention.

Class II cavity preparation

• Complete a Class I cavity outline as described.

• Use a No. 330 bur to extend the occlusal outline through the marginal ridge. If
two primary molars are being done together back to back, extend the proximal
box into self-cleaning areas. Attempt to leave 90° cavosurface margins. The
isthmus) is approximately one half to one third the width of the occlusal surface.
• Extend the No. 330 bur into the proximal surfaces.
• Keep the bur parallel to the long axis of the tooth. Move the bur in a pendulating
motion from lingual to buccal.
• Extend the proximal box gingivally beneath the contact area to the interproximal
area. This area is determined by the clearance of an explorer tip.
• The axial wall, as determined by carious lesion depth, should follow the contour
of the tooth.
• Use the enamel hatchet to remove any overhanging enamel in the proximal box

Occlusal view

• Form the isthmus so that it is one half the width of the occlusal table and connects
the proximal with the occlusal dovetail.
• Curve the proximal wall gently, creating an angle 90° to the axial surface of the
tooth, if possible.

Cross-section proximal box area

• In establishing the gingival floor, keep in mind that (a) it is even with or slightly
below the gingiva, as determined by the carious lesions; (b) it is perpendicular to
the long axis of the tooth; and (c) it has rounded line angles.
• Keep the proximal box in an occlusogingival direction roughly parallel to the long
axis of the tooth.

Occlusal and internal views

The proximal box area:
• Gently curves buccolingually to follow the contour of the proximal surface.
• Extends so an explorer tip can pass through the embrasure.
• Has gently rounded axiopulpal line angles, as do all line angles.
• Has no bevel at the gingival margin.

Class III cavity preparation for primary incisors

 Class III cavity preparation for primary canines

Maxillary primary canines:

Lingual outline form
• Use a No. 330 bur to place the mesial wall along a line ofthe
tooth parallel to its long axis.
• Contour the pulpal wall so that it corresponds to the external
lingual surface of the tooth.
• Leave adequate tooth structure incisal to the dovetail.
• Maintain the gingival wall parallel to, and 1 to 2 mm above
the dentinoenamel junction
Proximal outline form

• Maintain the labial wall parallel to the external labial surface, governing the
extension by the adjacent tooth, with adequate clearance for carving with an
explorer.
• Extend the preparation incisally to remove the contact point, being careful to
leave adequate tooth structure.
• Place the gingival wall below the gingival crest, following the contour of the
dentinoenamel junction.
• Slightly round all internal line angles; make sharp cavosurface angles and smooth
them with a No. 169L

Modified Class III cavity preparation

• The modified Class III preparation is indicated in the presence of an incipient

lesion with no proximal contact and excel lent access:
• Use a No. 330 bur to form a triangular preparation with gently rounded curves.
• Penetrate about 0.5 to 1.0 mm beyond the dentinoenamel junction.
• Retention is optional with the half-round bur at pulpal and incisal line angles.
• Restore with a composite restorative material.
 Class IV cavity preparation

• For class IV fractured incisal edges, use a tapered diamond bur to obtain a bevel
on the entire incisal & gingival cavosurface margin.
• The bevel extending about 2mm or at least 1mm beyond the fractured margin &
tapered.
• Additional retention, if needed, may be obtained by the use of the lingual dovetail.

Class V cavity preparation

• The outline form should be limited to the carious lesion & any adjacent
decalcified areas.
• Cavity may be kidney shaped.
• The no.330 bur can be used to cut the cavity.
• Dentinal undercuts for mechanical retention will be placed if the pear shaped bur
is used.

References –
1. The art and science of operative dentistry. Sturdevant . 5th edition
2. Clinical pedodontics-Finn – 4th edition
3. Manual of pedodontics – Andlaw – 3rd edition
4. Pediatric operative dentistry – kennedy – 4th edition