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Class II

SMOOTH surface lesions Occur on PROXIMAL SURFACES of MOLARS & PREMOLARS

Class II SMOOTH surface lesions Occur on PROXIMAL SURFACES of MOLARS & PREMOLARS

SpreadSpreadSpreadSpread ofofofof smoothsmoothsmoothsmooth surfacesurfacesurfacesurface cariescariescariescaries inininin enamelenamelenamelenamel &&&& dentindentindentindentin

In Enamel

Cone shape Base towards outer E surface & apex toward DEJ Base towards outer E surface & apex toward DEJ

In Dentin

Cone shape Base towards DEJ & apex towards the pulp Base towards DEJ & apex towards the pulp

Base towards outer E surface & apex toward DEJ In Dentin Cone shape Base towards DEJ

How to diagnose ??

Tactile ………………by mirror & probe a curved probe is indicated *lesion my appear chalky white *Marginal ridge may be discolored

*lesion my appear chalky white *Marginal ridge may be discolored • Radiographic ………….bite wing radiographs
*lesion my appear chalky white *Marginal ridge may be discolored • Radiographic ………….bite wing radiographs

Radiographic………….bite wing radiographs

*lesion my appear chalky white *Marginal ridge may be discolored • Radiographic ………….bite wing radiographs

It could be

Simple only Mesial (M) or Distal (D)

compound ………

two

surfaces

Mesio-occlusal (MO) or Disto-occlusal (DO)

Complex ……more than surfaces

Mesial-occlusal- Distal (MOD)

Simple class II

Prepared Only when there is direct access to the proximal surface such as:

- an isolated tooth - wide interproximal embrasure Trapezoidal in shape with occlusal,gingival,buccal &lingualwalls located in the embrasures

embrasure • Trapezoidal in shape with occlusal,gingival,buccal &lingualwalls located in the embrasures

But this is not always possible to do a simple class II

So

The proximal surface is ACCESSED through the occlusal surface

proximal surface is ACCESSED through the occlusal surface ExtensionExtensionExtensionExtension forforforfor

ExtensionExtensionExtensionExtension forforforfor convenienceconvenienceconvenienceconvenience

forforforfor convenienceconvenienceconvenienceconvenience CompoundCompoundCompoundCompound orororor

CompoundCompoundCompoundCompound orororor ComplexComplexComplexComplex

CAVITY PREPARATIONS FOR

CLASS II LESIONS

The usual form of a class II cavity preparation comprises three parts:

The occlusal portion

The proximal portion

preparation comprises three parts: The occlusal portion The proximal portion . Connected together by an ISTHMUS
preparation comprises three parts: The occlusal portion The proximal portion . Connected together by an ISTHMUS

. Connected together by an ISTHMUS

preparation comprises three parts: The occlusal portion The proximal portion . Connected together by an ISTHMUS
The occlusal part follows the same fundamentals as for class I • DepthDepthDepthDepth

The occlusal part follows the same fundamentals

as for class I

DepthDepthDepthDepth ………………………………1………………………………11.1 5.555

FFFFllllatatatat pupupupullllpapapapallll flflflflooroorooroor

ParallelismParallelismParallelismParallelism ofofofof adjacentadjacentadjacentadjacent wallswallswallswalls

UndercutsUndercutsUndercutsUndercuts ………………

–––– 22mm22mmmmmm (0.5 mm in dentin)

……………… ……………… ……………… exceptexceptexceptexcept thatthatthatthat thethethethe externalexternalexternalexternal outlineoutlineoutlineoutline isisisis extendedextendedextendedextended

proximallyproximallyproximallyproximally towardtowardtowardtoward thethethethe defectivedefectivedefectivedefective proximalproximalproximalproximal surfacesurfacesurfacesurface

The outline form of the proximal box depends on several factors: more extension ExtentExtentExtentExtent ofofofof
The outline form of the proximal box depends on several factors: more extension ExtentExtentExtentExtent ofofofof

The outline form of the proximal box depends on several factors:

more extension
more extension

ExtentExtentExtentExtent ofofofof cariescariescariescaries

mostly caries are around the contact area ConvexityConvexityConvexityConvexity ofofofof thethethethe proximalproximalproximalproximal surfacessurfaces:surfacessurfaces

iiii

::::

ii.ii.ii.ii.

i i i i :::: ii.ii.ii.ii. more convex extension smaller contact area less indices

more convex extension

smaller contact area

:::: ii.ii.ii.ii. more convex extension smaller contact area less indices minimal bucco-lingual width iii.iii.iii.iii.

less

indices minimal bucco-lingual width
indices
minimal bucco-lingual width

iii.iii.iii.iii. CariesCariesCariesCaries &&&& plaqueplaqueplaqueplaque indicesindices:indicesindices

iv.iv.iv.iv.

indicesindices:indicesindices iv.iv.iv.iv. MasticatoryMasticatoryMasticatoryMasticatory

MasticatoryMasticatoryMasticatoryMasticatory

loadload:loadload

load

ObjectivesObjectivesObjectivesObjectives forforforfor extensionextensionextensionextension ofofofof proximalproximalproximalproximal marginsmarginsmarginsmargins

IncludeIncludeIncludeInclude allallallall cariescariescariescaries ,,,, faultsfaultsfaultsfaults ,or,or,or,or existingexistingexistingexisting restorativerestorativerestorativerestorative materialmaterialmaterialmaterial

CreateCreateCreateCreate 90909090°°°° cavosurfacecavosurfacecavosurfacecavosurface marginsmarginsmarginsmargins (((( i.e.i.e.i.e.i.e. buttbuttbuttbutt jointjointjointjoint margins)margins)margins)margins)

EstablishEstablishEstablishEstablish (ideally)(ideally)(ideally)(ideally) notnotnotnot moremoremoremore thanthanthanthan 00.00 5.555

mmmmmmmm

clearanceclearanceclearanceclearance withwithwithwith thethethethe adjacentadjacentadjacentadjacent proximalproximalproximalproximal surfacesurfacesurfacesurface

facially,facially,facially,facially, linguallylingually,linguallylingually,,, &&&& gingivallygingivallygingivallygingivally

((((couldcouldcouldcould bebebebe checkedcheckedcheckedchecked bybybyby thethethethe tiptiptiptip ofofofof aaaa sharpsharpsharpsharp explorer)explorer)explorer)explorer)

TheTheTheThe proximalproximalproximalproximal outlineoutlineoutlineoutline isisisis anananan INVERTEDINVERTEDINVERTEDINVERTED TRUNCATEDTRUNCATEDTRUNCATEDTRUNCATED CONECONECONECONE withwithwithwith

GINGIVAGINGIVAGINGIVAGINGIVA LLLL wallwallwallwall formingformingformingforming thethethethe basebasebasebase

&&&&

FACIALFACIALFACIALFACIAL /BUCCAL/BUCCAL/BUCCAL/BUCCAL

anananandddd

LINGUALLINGUALLINGUALLINGUAL wallswallswallswalls formingformingformingforming itsitsitsits sidessidessidessides

LINGUALLINGUALLINGUALLINGUAL wallswallswallswalls formingformingformingforming itsitsitsits sidessidessidessides

InvertedInvertedInvertedInverted truncatedtruncatedtruncatedtruncated coneconeconecone

ProximalProximalProximalProximal boxboxboxbox isisisis

WiderWiderWiderWider at the gingival area than the occlusal i.e.i.e.i.e.i.e.

BuccalBuccalBuccalBuccal &&&& linguallinguallinguallingual walls are converging occlusally followingfollowingfollowingfollowing thethethethe outerouterouterouter contourcontourcontourcontour ofofofof thethethethe buccalbuccalbuccalbuccal &&&& linguallinguallinguallingual surfacesurfacesurfacesurface

thethethethe buccalbuccalbuccalbuccal &&&& linguallinguallinguallingual surfacesurfacesurfacesurface
thethethethe buccalbuccalbuccalbuccal &&&& linguallinguallinguallingual surfacesurfacesurfacesurface
thethethethe buccalbuccalbuccalbuccal &&&& linguallinguallinguallingual surfacesurfacesurfacesurface

INVERTEDINVERTEDINVERTEDINVERTED TRUNCATEDTRUNCATEDTRUNCATEDTRUNCATED CONECONECONECONE

ContributesContributesContributesContributes

ContributesContributesContributesContributes RESISTANCERESISTANCERESISTANCERESISTANCE

RESISTANCERESISTANCERESISTANCERESISTANCE

&&&& RETENTIONRETENTIONRETENTIONRETENTION totototo thethethethe proximalproximalproximalproximal boxboxboxbox

SOSOSOSO

**** BuccalBuccalBuccalBuccal &&&& linguallinguallinguallingual wallswallswallswalls

BBBB &L&L&L&L proximalproximalproximalproximal marginsmarginsmarginsmargins areareareare extendedextendedextendedextended ::::

ToToToTo includeincludeincludeinclude cariescariescariescaries ExtendedExtendedExtendedExtended totototo BBBB &&&& LLLL embrasuresembrasuresembrasuresembrasures ToToToTo breakbreakbreakbreak contactcontactcontactcontact withwithwithwith thethethethe adjacentadjacentadjacentadjacent toothtoothtoothtooth ((0((00.0 3.33-3--0-00.0 5.55mm)5mm)mm)mm)

TipTipTipTip ofofofof anananan explorerexplorerexplorerexplorer shouldshouldshouldshould passpasspasspass throughthroughthroughthrough easilyeasilyeasilyeasily

((((

iiii

))))

**** GINGIVALGINGIVALGINGIVALGINGIVAL WALLWALLWALLWALL (floor)(floor)(floor)(floor)

locatedlocatedlocatedlocated inininin thethethethe GINGIVALGINGIVALGINGIVALGINGIVAL

jjjj contactcontactcontactcontact areaareaareaarea ((0((00.0 5.55-5--1-11mm)1mm)mm)mm)

EMBRASUREEMBRASUREEMBRASUREEMBRASURE

ustustustust BelowBelowBelowBelow thethethethe

FormedFormedFormedFormed ofofofof bothbothbothboth enamelenamelenamelenamel &&&& dentindentindentindentin

ParallelParallelParallelParallel totototo thethethethe occlusalocclusalocclusalocclusal surfacesurfacesurfacesurface

ParallelParallelParallelParallel totototo thethethethe occlusalocclusalocclusalocclusal surfacesurfacesurfacesurface
WidthWidthWidthWidth aboutaboutaboutabout 00.00 1.11-1--1-11.1 5.55mm5mmmmmm dependingdependingdependingdepending

WidthWidthWidthWidth aboutaboutaboutabout 00.00 1.11-1--1-11.1 5.55mm5mmmmmm dependingdependingdependingdepending onononon thethethethe toothtoothtoothtooth totototo bebebebe preparedpreparedpreparedprepared

onononon thethethethe toothtoothtoothtooth totototo bebebebe preparedpreparedpreparedprepared

sometimessometimessometimessometimes

sometimessometimessometimessometimes • TheTheTheThe gingivalgingivalgingivalgingival wallwallwallwall

TheTheTheThe gingivalgingivalgingivalgingival wallwallwallwall couldcouldcouldcould extendextendextendextend totototo reachreachreachreach cementumcementumcementumcementum

sosososo

cementumcementumcementumcementum sosososo widthwidthwidthwidth ofofofof

widthwidthwidthwidth ofofofof gingivalgingivalgingivalgingival wallwallwallwall willwillwillwill bebebebe lesslesslessless thanthanthanthan 11mm11mmmmmm (approximately(approximately(approximately(approximately 00.00 7.77-7--0-00.0 8.88mm8mmmmmm))))

**** AXIALAXIALAXIALAXIAL WALLWALLWALLWALL

AxialAxialAxialAxial wallwallwallwall isisisis parallelparallelparallelparallel totototo thethethethe longlonglonglong axisaxisaxisaxis ofofofof thethethethe toothtoothtoothtooth gingivogingivo-gingivogingivo--occlusally-occlusallyocclusallyocclusally

withwithwithwith slightslightslightslight slantingslantingslantingslanting towardstowardstowardstowards thethethethe pulpalpulpalpulpalpulpal floorfloorfloorfloor

iiii.e taperedtaperedtaperedtapered occlusallyocclusallyocclusallyocclusally (forming(forming(forming(forming anananan obtuseobtuseobtuseobtuse

angleangleangleangle withwithwithwith thethethethe pulpalpulpalpulpalpulpal floor)……………why?????floor)……………why?????floor)……………why?????floor)……………why?????

e

e.

e

To increase thickness of amalgam At the isthmus portion …… & so increase resistance

e e. e To increase thickness of amalgam At the isthmus portion …… & so increase
• PlacedPlacedPlacedPlaced intointointointo dentindentindentindentin o.o.5o.o.55-5--o.-o.o.8o.888 mmmmmmmm

PlacedPlacedPlacedPlaced intointointointo dentindentindentindentin

o.o.5o.o.55-5--o.-o.o.8o.888 mmmmmmmm fromfromfromfrom DEJDEJDEJDEJ

TheTheTheThe axialaxialaxialaxial wallwallwallwall shouldshouldshouldshould parallelparallelparallelparallel thethethethe faciofacio-faciofacio--lingual-linguallinguallingual contourcontourcontourcontour

thethethethe faciofacio-faciofacio--lingual-linguallinguallingual contourcontourcontourcontour
ConnectsConnectsConnectsConnects thethethethe occlusalocclusalocclusalocclusal &&&&

ConnectsConnectsConnectsConnects thethethethe occlusalocclusalocclusalocclusal

&&&& proximalproximalproximalproximal boxesboxesboxesboxes

WidthWidthWidthWidth ……………………….……………………….……………………….……………………….narrownarrownarrownarrow asasasas possiblepossiblepossiblepossible

--¼--¼¼¼ intercuspalintercuspalintercuspalintercuspal distancedistancedistancedistance

((1((11-1--1-11.1 5.55mm5mmmmmm

wide)wide)wide)wide)

Resistance

The facial (buccal) & the lingual walls of the occlusal cavity at the ISTHMUS portion should approach the proximal surface at a right angle (butt joint)

Resistance

so

These walls may, therefore, be cut into:

11.11 aaaa uniformuniformuniformuniform curvecurvecurvecurve

22.22

straightstraightstraightstraight linelinelineline

3333

reversereversereversereverse "s"s"s"s----curve"curve"curve"curve" (facially)(facially)(facially)(facially)

Depending on:

(facially)(facially)(facially)(facially) Depending on: thethethethe occlusalocclusalocclusalocclusal

thethethethe occlusalocclusalocclusalocclusal anatomyanatomyanatomyanatomy ofofofof thethethethe toothtoothtoothtooth

ii.ii

ii.ii.ii.ii. thethethethe positionpositionpositionposition andandandand sizesizesizesize ofofofof contactcontactcontactcontact areaareaareaarea

iii.iii.iii.iii. thethethethe widthwidthwidthwidth ofofofof thethethethe embrasuresembrasuresembrasuresembrasures

UsuallyUsuallyUsuallyUsually

TheTheTheThe linguallinguallinguallingual embrasureembrasureembrasureembrasure isisisis widerwiderwiderwider thanthanthanthan thethethethe buccalbuccalbuccalbuccal embrasureembrasureembrasureembrasure

SoSoSoSo inininin suchsuchsuchsuch casescasescasescases

TheTheTheThe extensionextensionextensionextension ofofofof thethethethe buccobuccobuccobucco –––– proximalproximalproximalproximal wallwallwallwall intointointointo thethethethe embrasureembrasureembrasureembrasure leadsleadsleadsleads totototo excessiveexcessiveexcessiveexcessive cuttingcuttingcuttingcutting ofofofof thethethethe buccalbuccalbuccalbuccal cuspcuspcuspcusp

cuttingcuttingcuttingcutting ofofofof thethethethe buccalbuccalbuccalbuccal cuspcuspcuspcusp

ToToToTo avoidavoidavoidavoid thisthisthisthis

AAAA

mademademademade inininin thethethethe buccalbuccalbuccalbuccal proximalproximalproximalproximal wallwallwallwall sosososo asasasas totototo ::::

reversereversereversereverse curvecurvecurvecurve (S(S(S(S shapeshapeshapeshape curve)curve)curve)curve) isisisis

HaveHaveHaveHave aaaa buttbuttbuttbutt jointjointjointjoint withwithwithwith thethethethe cavosurfacecavosurfacecavosurfacecavosurface marginmarginmarginmargin

HaveHaveHaveHave aaaa dentindentindentindentin supportedsupportedsupportedsupported buccobuccobuccobucco –––– proximalproximalproximalproximal wallwallwallwall

buccobuccobuccobucco –––– proximalproximalproximalproximal wallwallwallwall • Resistance

Resistance

Ideal extension
Ideal extension
Ideal extension
Ideal extension

EachEachEachEach partpartpartpart ofofofof thethethethe cavitycavitycavitycavity shouldshouldshouldshould havehavehavehave itsitsitsits ownownownown resistanceresistanceresistanceresistance andandandand retentiveretentiveretentiveretentive featuresfeaturesfeaturesfeatures (self(self(self(self dependent)dependent)dependent)dependent)

HowHowHowHow totototo prepareprepareprepareprepare ????????

Prepare occlusal box

Extension to the involved proximal surface

PreparePreparePreparePrepare thethethethe axialaxialaxialaxial wallwallwallwall uniformlyuniformlyuniformlyuniformly 0000

ExtendExtendExtendExtend cavitycavitycavitycavity buccal,buccal,buccal,buccal, linguallinguallinguallingual &&&& gingivalgingivalgingivalgingival

mmmmmmmm inininin dentindentindentindentin

5555

ResistanceResistanceResistanceResistance andandandand retentionretentionretentionretention areareareare

achievedachievedachievedachieved by…………

?????by…………

?????

?????by…………

?????by…………

Extra means of retention……… ???

FinishingFinishingFinishingFinishing ofofofof enamelenamelenamelenamel
FinishingFinishingFinishingFinishing ofofofof enamelenamelenamelenamel
margins…………how.???????margins…………how.???????margins…………how.???????margins…………how.???????
• A type of preparation which preserves as much tooth structure as possible • Access

A

type of preparation which

• A type of preparation which preserves as much tooth structure as possible • Access is

preserves as much tooth structure as possible

Access is also gained through the marginal ridge of the affected mesial or distal surface & no further extension to the occlusal surface

The buccal & lingual walls & meet the surface

of the tooth at
of the tooth at
• The buccal & lingual walls & meet the surface of the tooth at to provide

to provide

• The buccal & lingual walls & meet the surface of the tooth at to provide
• The buccal & lingual walls & meet the surface of the tooth at to provide

lingoaxially

• The buccal & lingual walls & meet the surface of the tooth at to provide

bucccoaxially &

• The buccal & lingual walls & meet the surface of the tooth at to provide