Outline form???

The first step in initial tooth preparation is

determining and developing
the outline form while establishing the
initial depth.


The outline form must be visualized before any
mechanical alteration to the tooth is begun.


Extensive caries, fractured enamel, and other
conditions may prevent an accurate
preoperative mental visualization at the onset
of tooth preparation
Establishing the outline form
means:

(1) Placing the preparation margins in the positions they
will occupy in the final preparation, except for
finishing enamel walls and margins, and





(2) Preparing an initial depth of 0.2 to 0.8 mm pulpally of
the DEJ position or normal root-surface position
No deeper initially whether in tooth structure, air,
old restorative material, or caries
unless the occlusal enamel thickness is
minimal and greater dimension is
necessary for strength of the restorative
material
0.2 to 0.8 mm pulpally of the DEJ
ALWAYS??????
1. Extend the preparation margin until sound tooth
structure is obtained and no unsupported and/or
weakened enamel remains.
2. Avoid terminating the margin on extreme
eminences such as cusp heights or ridge crests
Rules for establishing outline form
for pit and fissure
tooth preparation
3. Extend the preparation margin to include all
of the fissure that cannot be eliminated by
appropriate enameloplasty


4.If the extension from a primary groove includes one
half or more of the cusp incline, consideration should
be given to capping the cusp.
If the extension is two thirds, the cusp-capping procedure is
most often theproper procedure which removes the margin
from the area of masticatory stresses.


5. Restrict the pulpal depth of the
preparation to a maximum of 0.2 mm into
dentin
(except when preparing a tooth for a gold foil
restoration, in which case the initial depth is 0.5
mm into dentin)
6. When two pit-and-fissure preparations have less than
0.5 mm of sound tooth structure between them, they
should be joined to eliminate a weak enamel wall
between them.




7. Extend the outline form to provide sufficient access for
proper tooth preparation, restoration placement, and
finishing procedures
The procedure of reshaping the enamel surface
with suitable rotary cutting instruments so as
to make it less caries prone
ENAMELOPLASTY
Smooth-surface lesions occur in two
different locations:
(1) proximal surfaces or
(2) the gingival portion of the facial and lingual
surfaces
Outline form and initial depth for smooth-
surface lesions.
1. Extend the preparation margins until sound
tooth structure is obtained and no
unsupported and/or weakened enamel
remains.

Rules for establishing outline forms for
proximal
surface tooth preparations

2. Avoid terminating the margin on extreme
eminences such as cusp heights or ridge crests.


3. Extend the margins to allow sufficient access for proper
manipulative procedures

4. Restrict the axial wall pulpal depth of the
proximal preparation to a maximum of 0.2 to
0.8 mm into dentin


5.Gingival margins of the tooth
preparation
Should be placed apically of the proximal contact
to provide a minimum clearence of 0.5mm
between the gingival margin and the adjacent
tooth


Removal of Any Remaining Enamel Pit or
Fissure, Infected Dentin, and/or Old Restorative Material....
if Indicated
Removal of any remaining enamel pit or

fissure, infected dentin, and/or old

restorative material is the elimination of

any infected carious tooth structure or

faulty restorative material left in the

tooth after initial tooth preparation.

Definition
In teeth in which the carious lesion is minimal, the carious
enamel and dentin are probably removed in completing the
initial tooth preparation.

If.... however, carious infected dentin remains after completion
of the previous steps, it should be removed now.

The exception to the removal of infected carious tooth structure
is when it is decided to perform an indirect pulp capping
Removal of remaining enamel pit or fissure typically
occurs as small, minimally extended excavations on
isolated faulty areas of the pulpal floor.
As caries progresses... an area of decalcification precedes the
penetration of microorganisms.
This area of decalcification often appears discolored in comparison
with undisturbed dentin, yet it does not exhibit the soft texture of
caries.
In dentin.....
Affected dentin differs from infected dentin in that it has not
been significantly invaded by microorganisms.
.It is accepted and appropriate practice to allow affected
dentin to remain in a prepared tooth.


The use of color alone to determine how much dentin to
remove is unreliable.
Chances of either leaving infected dentin behind or overcutting
into the affected dentin
A clinical description of exactly where infected dentin stops and
affected dentin begins is practically impossible.
Caries Disclosing Dyes "may aid that decision.


After initial tooth preparation, the initial depths may
result in old restorative material remaining on the pulpal
or axial walls.


The old material may affect negatively the esthetic result of the
new restoration (i.e., old amalgam material left under a new
composite restoration)
The old material may compromise the amount of anticipated
needed retention (i.e., old glass-ionomer material having a
weaker bond to the tooth than the new composite restoration
using enamel and dentin bonding),
Any remaining old restorative material should be removed if
any of the following conditions are present:
Radiographic evidence indicates caries is under the old material
The tooth pulp was symptomatic preoperatively,
The periphery of the remaining old restorative material is not intact (i.e.,
there is some breach in the junction of the material with the adjacent
tooth structure that may indicate caries under the old material).


REFERENCE
Sturdevant's Art and Science of Operative
Dentistry

ANY DOUBTS???