1. Introduction to operative dentistry
Dr. Ahmed Jawad

2. Introduction, Aims and Scope of Operative Dentistry
DEFINITION According to Mosby’s dental dictionary, Operative dentistry deals with the functional and esthetic restoration of the hard tissues of individual teeth.

3. More appropriately Operative dentistry is defined as that
branch of the science and art of dentistry
which deals with diagnosis, treatment, and prognosis
of defects of hard tissues of the teeth (enamel, dentin
and cementum) which do not require full coverage
restorations for correction.

4. HISTORY
The profession of dentistry was born during the early middle ages. Barbers were doing well for dentistry by removing teeth with dental problems.

5. In 1871, GV Black gave the philosophy of“extension for prevention,” for cavity preparation design. Dr GV Black (1898) is known as the “Father of Operative dentistry”.

6. He provided scientific basis to dentistry because his writings developed the foundation of the profession and made the field of operative dentistry organized and scientific.
The scientific foundation for operative dentistry was further expanded by Black’s son, Arthur Black.
In early part of 1900s, progress in dental sciences and technologies was slow. Many advances were made during the 1970s in materials and equipments. By this time, it was also proved that dental plaque was the causative agent for caries.

7. In the 1990s, oral health science
started moving toward an evidence-based approach for treatment of decayed teeth.
The recent concept of treatment of dental caries comes under minimally invasive dentistry.
In December 1999, the World Congress
of Minimally Invasive Dentistry (MID) was formed.

8. Current minimally intervention philosophy follows three concepts of disease treatment:
Identify—identify and assess risk factors early
2. Prevent—prevent disease by eliminating risk factors
3. Restore—restore the health of the oral environment

9. CONSIDERATIONS AFFECTING OPERATIVE TREATMENT
Indications
Indications for operative procedures can be broadly
divided into the following five headings.
Caries
2. Loss of the tooth structure due to attrition, abrasion,
abfraction and erosion.

10. 3. Malformed, discolored, or fractured teeth. 4. Esthetic improvement

11. 5. Restoration replacement or repair.

12. Factors
The following are the important factors which require serious consideration before undertaking any operative procedure.
The condition of the affected tooth, other teeth and the oral and general health.
2. The diagnosis of the dental problem and the interaction of the affected area with other bodily tissues.

13. 3. A treatment plan that can restore the tooth with all its functions
3. A treatment plan that can restore the tooth with all its functions. 4. Thorough knowledge of properties of the materials which can be used to restore the affected areas to proper shade, shape with functions, with a realization of limitations of materials and requirement of the patient. 5.The oral environment, like caries susceptibility of the patient.

14. 6. Biological basis and function of the various tooth tissues and supporting tissues. 7. The knowledge of dental morphology, anatomy and histology. 8. Infection control methods to safe guard dental personnel and the patients.

15. AIMS OF OPERATIVE DENTISTRY
There are six fundamental aims of operative dentistry, which are as follows: 1. Diagnosis 2. Prevention 3. Interception 4. Preservation 5. Restoration 6. Maintenance

16. Diagnosis It is the determination of nature of disease, injury or congenital defect by examination, test and investigation. Proper diagnosis of lesions, including their locations and extent, is vital for planning the treatment including the design of the tooth preparation and the selection of restorative materials and procedures.

17. Prevention It includes the procedures undertaken for prevention before the appearance of any sign and symptom of disease. There are two main diseases usually managed in dental practice (1) caries (2) periodontitis.

18. Dental caries is most significantly prevented by community water fluoridation. By community water fluoridation dental caries can be reduced by 55 to 60%.
Use of sealing materials, for pits and fissures, can also reduce dental caries.
By regularly following meticulous oral hygiene
instructions and dietary counseling, dental caries can be prevented to some extent.

19. Interception
It includes the procedures undertaken after some signs and symptoms of disease have appeared, in order to prevent the disease from developing into a more serious or full extent. Interception is a procedure, by which the teeth are restored to their normal health, form and function.

20. Tooth loss occurs due to dental caries, trauma, attrition, erosion, abrasion and malformation.
Altering tooth form by restoration, selective re-contouring, enhancing occlusal stability and changes in the patient’s home care habits (i.e. proper tooth brushing and flossing) are also included in interception.
By interceptive procedures, esthetics can be improved and it can prevent long-term psychological problems.

21. Preservation
One of the important concepts of operative dentistry is preservation of what has remained along with an effort to restore what has been lost. Preservation of optimum health of teeth and soft tissue of oral cavity is obtained by preventive and interceptive procedures.

22. Restoration Maintenance
The ultimate goal of restorative treatment is re-establishment and maintenance of health, form, functions and esthetics.
Successful placement of any restoration requires sound clinical judgment, both biological and mechanical.
Maintenance
After restoration is done, it must be maintained for longer useful service.