Cavity Prepartion2[1]
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Transcript of Cavity Prepartion2[1]
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Principles of Cavity Preparation II
The doctor talks about the exam which will be in the first 6 lectures (to the end of the amalgam)
so the lecture of next Thursday will be included in the exam.
Last time we talked about the initial stage of cavity preparation which is outline form and
resistances form and now we will talk about other forms of cavity preparation:
Primary Retention Form:
The shape or form of the conventional preparation that resist displacement or removal of the
restoration from tipping or lifting forces.
We seed last time that the restoration inside the oral cavity will be subjected to a number of
forces from different directions which may cause displacement; the retention form is to resistcompression forces (forces that are directed at the long axis of the tooth) when the patient
occludes the restoration will be subjected to the force and we want to prevent dislocation of
the restoration.
The Principles of retention depends on the restorative material that means that the amalgam has
different retention form than composite, in composite we have chemical retention while in amalgam we
have mechanical retention; we need to do something geometry inside the cavity so the amalgam stay
retentive to the tooth structure.
How we can get a retention form???
1- Amalgam:
In Class I and Class II, walls should converge occlusally so the cavity has wider base, and when
we add amalgam it will be one unit inside the cavity which will prevent it from dislocation.
In class II we make what called dovetail to aid in retention and prevent the restoration proximal
dislocation.
In Class V, walls diverge outward to provide strong enamel margin, retention obtained by
grooves in the dentinal walls.
2- Composite:
Micromechanical bond by acid etching & bonding.
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Convenience form:
The form or shape of the preparation that provides adequate observation, accessibility and
ease of operation in preparing & restoring the tooth that means I should be able to see where
I am working and be able to do operation, it should not be too wide nether too narrow it should
be convenient.
Final Tooth Preparation Stage:
Removal of any remaining enamel pit or fissure, infected dentin or old restorative material if
indicated, that mean we should remove any carious part of the tooth and any defective old
restorative material.
Infected dentin: it is the carious part of dentin (invaded by bacteria) and its soft and we should
remove it, especially at the DEJ (dentino- enamel junction) because the spread of the caries at
the DEJ is faster than anywhere in the tooth.
Affected dentin:its the non carious part of the dentin and its hard so we can keep it to beconservative.
Pulp protection:
Dentin is the best isolator against irritation to the pulp, but if you expose the pulp you can
isolate it by a liner or a base; there should be 2.0 mm of bulk (remaining tooth structure, liner,
and/or base),the base provide protection against mechanical, thermal and chemical irritants.
Secondary resistance and retention forms :
When we have large cavity preparation ( we have lots of walls ) so we lose the retention and
resistance forms ( the ordinary ones ) so we have to have the secondary forms of retention and
resistance .
and it can be applied by
a. Mechanical preparation features:
examples ( you should know just the names of them ) :
1. Retention locks, grooves, and coves
2. Groove extension
3. Skirts
4. Pins, slots,, steps, & amalgam pins
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b. Placement of etchant, primer, or adhesive on prepared walls:
1. Enamel wall etching
2. Dentin treatment
*** you should remember that " Placement of etchant, primer, or adhesive on prepared walls
"
considered as primary retention and resistance form for composite and its considered as
secondary retention and resistance form for amalgam .
*** amalgam adhesives was considered as way to have resistance and retention but lately they
found that it doesn't help in resistance and retention so it's no longer used !!!
Procedures for Finishing the External Walls of the Tooth Preparation:
this Procedures is to make sure that we don't have under cusp or unsupported enamel and its
the final check of my cavity .
and it's The further development, when indicated ( we don't always do it ), of a specific
cavosurface design & degree of smoothness or roughness that produces the maximum
effectiveness of the restorative material being used .
so that when I put the restoration it will not be fractured or there will be no micro gap between
the tooth surface and the restorations .
Objectives:
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1. Create the best marginal seal possible between the restorative material & the tooth
structure.
2. Afford a smooth marginal junction.
3. Provide maximum strength for both the tooth structure & restorative material.
Final Procedures: Cleaning, Inspecting, and Sealing:
the purpose of this procedures is to prepare the cavity to receive the restoration .
* Cleansing & dryness of the cavity for inspection.
* Sometimes, certain medicaments can be applied to the cavity prior to the restorative
step.
Sequence of Caries Removal
1. Entry is made in conventional manner
with a high speed fissure bur.
The first thing you should have access
to the caries so we start with removal
of the enamel we cannot remove
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we use low speed round bur and it should be
large that fit the cavity because if we
used the small one we may have pulp
exposure .
First stip I will do my out line first , intial depth with high speed fissure bur , then I will change and use a
round bur in order to remove caries in carious dentin
4. The caries removal process should begin peripherally in the DEJ areas
its mean I will not move all the way into the pulp removing first form the pulp. First step of removing
the caries is to remove form the DEJ peripheral, lateral wall we clean the lateral wall
for example in class I, Ill clean mesial , lingual , buccal ,distal walls in leave pulpal wall this dont mean
we will leave caries in the pulpal floor I will remove caries but this will be the final step .
Why ?
Because of two reason
A] To make sure to remove caries from the most important place the DEJ dentino enamel junction
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B] And if I I am too deep pulb exposure may occur although I made all procedure to avoid pulp
exposure , but if it occur I will know how to deal with it , we can avoid
Some time ican avoid rct treatment I leave it like this in order to have pulbal recovery
So fo these thing I shold clean the lateral walls then go to the pulb
Clean the lateral wall then go pulbaly minute 33:00
In class ii for example I will clean buccal lingual gingival then I go axialy
Caries in areas involving potential exposures, such as the axial and pulpal walls should be removed
last
How much dentin should I remove ? as we said we have something call infected dentin and
something called affected dentin ,,,,,, in order to be more conservative I should not remove all dentin
colored dentin
We will learn to differentiate between sound dentin and carious dentin ,,,,, some time the color is not
indicator when I look for example I see brownish discoloration of the dentin or yellowish discoloration of
the dentin Other than the normal color of dentin this dose not mean it might be carious
Primary criteria is the hardnessand for this we have an instrument call spoon excavator its for removal
of caries
Spoon excavator is used also for detecting if this dentin is soft or not .
If the dentin can be removed by excavator it means its soft we have to remove it ,,if its hard to spoon
excavator then we have to leave it its affected dentin not infected dentin
So the color is not usually our criteria for removal of dentin our indicator of carious dentin is
softness of the dentin how we can check this with the spoon excavator
Only those areas that are soft should be removed
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6. After all caries have been removed ,the preparation is re-evaluated for any undermined enamel ,
resistance for ,retention form .
This is under mind enamel the dentin below the enamel was removedbecause its carious leaving me
with under mind enamel , so the final stage I have to remove this under mind enamel because its un
supported by dentine it will fracture
When I remove the caries a large part of the tooth will be removed when I remove caries so I should
reevaluate my cavity preparation do is still have a flat floor , I have retention form , resistance form and
if I have any under mind enamel for example this pic below
usually what we do we do it step by step . ya3ni I open the axis as we said , start to remove the caries
out peripheral at the DEJ with a round bur the I reevaluate if I have undermid enaml I will remove it
To remove the under minde enamel I have to return back to the high speed fissure bur and remove any
un supported enamel and make if I need ,retention , resistance , adjustment of the wall I should do
them with high speed fissure bur
Always when we make class I we emphasis on the box shape and flat pulpal floor here in this pic we can
end up with this un flat pulpal floor
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So dose this mean I have to reduce the pulpal floor to this level to make it flat ? in this way we might
endanger the pulp and we loss unnecessary tooth structure we want to conserve more tooth structure
not to loss it .. when we remove more of the tooth structure we lose more of the resistance of the tooth
so the tooth may fracture later ! so in this case NO its not necessary to make it flat
Some time we have to put some liner here liner material in the deepest area to be away from the
pulp and to make it little pit flat
Done by:- Abdallah Zireeni and Mohammad F. elwir