Operative Dentistry

Cavity Preparations

Indication of Operative Dentistry

Caries; Malformed, discolored, or fractured teeth; Restoration replacement.

Tooth-colored restoration
For Class and Esthetic Dentistry
For Class and

What are Tooth-colored materials?

What is their working mechanism?

What are the cavity preparation futures for tooth-colored restoration?

What are steps for tooth-colored restoration? What are the advantage & disadvantage of tooth-colored restoration?

Tooth-Colored Materials
Composite resin

Glass ionomer cement

Compomer

Composite Resin
Traditional composites

Hybird composites
Flowable composites Condensable composites Universal composites

Packable

Glass Ionomer

Chemical adhesion to dentin Release Fluoride

Compomer

Compomer =

Composite + Ionomer

Dental Adhesion or Dental Bonding

Adhesion is a process of solid and/or liquid interaction of one material with another at a single interface.

Enamel bonding system Enamel bongding depends on resin tags becoming interlocked with the surface irregularities created by etching.

Macrotags: form between enamel rod peripheries. Microtags: smaller tags form across the end of each rod.

Macrotags and microtags are the basis for micro-mechanical bonding.

Dentin bonding system The difficulties of dentin bonding:

More water---wet bonding Lower calcification Richer organic---collagen network Smear layer

The bond strength is primarily related to micro-mechanical bonding to the intertubular dentin which occures between tubules along the cut dentin surface.

Dentin Bonding Agent, DBA

Early DBA were hydrophobic, bonded directly to the dentin smear layer. Bond strengths6MPa. Later DBA removed the smear layer but tended to over-etch dentin. Bond strengths10~12MPa.

DBA were chemically modified to be more hydrophilic. Bond Strengths18~20MPa.

Careful dentin conditioning, Coupled with hydrophilic primer, Bond Strength22~35MPa.

The Development of DBA

Enamel etch (1955) Dentine etch (1960) Treatment of smear layer (1980) Wet Bonding technique(1990)

First generation

Second generation
Third generation

Fourth generation: Total etch technique

Fifth generation: One bottle system Sixth generation: All in one,2000 Seventh generation

Cavity Preparation
Three designs of cavity preparation: 1.Conventional

2.Beveled conventional
3.Modified

Beveled conventional cavity preparations are similar to conventional preparation, in that the outline form has external, box-like walls, but with beveled enamel margin.

Beveled enamel margin

Beveled conventional cavity designs for Class , and preparations

The advantages : The ends of enamel rods are more etched

The increase in etched surface results in a stronger bond Increase the retention and reduce marginal leakage and discoloration. More esthtically

Modified cavity preparation Have neither specified cavity wall structure nor specified pulpal depth, and have enamel margins.

Conserve more tooth structure.

Modified cavity preparation

Initial Clinical Procedure

Local anesthesia Preparation of the operating site Shade selection Isolation of the operating site with rubber dam or cotton rolls

Rubber dam

Clinical Procedure
Cavity preparation

Acid etching enamel & conditioning dentin Matrix application Application of bonding agent Insertion of composite Finishing procedures

Matrix application

Final procedures

Cases

Conservative Operative Dentistry

Minimal intervention dentistry

is regards as a main stream in caries treatment in the 21st century.

Principles of Minimal Intervention dentistry

Remineralization of early lesions Reduction in cariogenic bacteria, to elminate the risk of further demineralization and cavitation Minimum surgical intervention of cavitated lesions Repair rather than replacement of defective restorations

The day is surely coming, and perhaps within the lifetime of you young men before me, when we will be engaged in practicing preventive, rather than reparative, dentistry.

GV Black in 1896