1. Operative Dentistry

2. Purposes of Operative Dentistry
Proper diagnosis is vital for treatment planning.
DIAGNOSIS:
To prevent any recurrence of the
causative disease and their defect.
PREVENTION:
Preventing further loss of tooth structure
by stabilizing an active disease process.
INTERCEPTION:
Preservation of the vitality and
periodontal support of remaining tooth structure.
PRESERVATION:
RESTORATION:
Includes restoring form, function, phonetics, and esthetics.

3. Indication of Operative Dentistry
Caries;
Malformed, discolored,
or fractured teeth;
Restoration replacement.

4. Program of Operative Treatment
Patient assessment
Examination and diagnosis
Treatment planning
Pain control: local anesthetic
Isolation of the operating field

5. Program of Operative Treatment
Cavity preparation
Matrix application
Preparation of materials
Insertion and carving of materials
Finishing and Polishing

6. Cavity Preparation
The mechanical alteration of a defective, injured, or diseased tooth in order to best receive a restorative material which will re-establish a healthy state for the tooth including esthetic corrections where indicated, along with normal form and function.

7. Cavity Structure
walls
angles
cavity

8. Classification of cavity
Class II
Class III
Class IV
Class V
Class VI
—G.V.Black in 1908

9. Cavity Simple cavity: only one tooth surface is involved.
Compound cavity: two surfaces are involved.
Complex cavity: three or more surfaces are involved.

10. Class 1
Class 6
Class 1
Class 4
Class 3
Class 2
Class 2
Class 5

11. Stages and Steps in Cavity Preparation
Initial cavity preparation stage
Final cavity preparation stage

12. Initial cavity preparation stage
Step 1 Outline form and initial depth
Step 2 Primary resistance form
Step 3 Primary retention form
Step 4 Convenience form

13. Final cavity preparation stage
Step 5 Removal of any remaining infected
dentin if indicated
Step 6 Pulp protection
Step 7 Secondary resistance & retention form
Step 8 Procedure for finishing external walls
Step 9 Final procedures

14. Initial cavity preparation stage
Step 1 Outline form and initial depth
Step 2 Primary resistance form
Step 3 Primary retention form
Step 4 Convenience form

15. Outline Form and Initial Depth Ⅰ
Definition:
placing the cavity margins in the positions they will occupy in the final preparation;
preparing an initial depth of 0.2~0.8 mm pulpally of the dentinoenamel junction position or normal root surface position.

16. Maxillary Class Ⅰ outline form

17. Mandibular Class Ⅰ outline form

18. Maxillary Class Ⅱ outline form

19. Mandibular Class Ⅱ outline form

20. Common Error

22. Outline Form and Initial Depth Ⅱ
Principles: without any exception
all friable and/or weakened enamel should be removed
all faults should be included
all margins should be placed in a position to afford good finishing of
the margins of the restoration.

23. Outline Form and Initial Depth Ⅲ
Features:
preserving cuspal strength
preserving marginal ridge strength
minimizing facio-lingual extension
using enameloplasty
connecting two close faults or cavities
restricting the depth of the preparation into dentin.

27. Initial cavity preparation stage
Step 1 Outline form and initial depth
Step 2 Primary resistance form
Step 3 Primary retention form
Step 4 Convenience form

28. Primary Resistance Form Ⅰ
Definition:
The shape and placement of the cavity walls that best enable both the restoration and the tooth to withstand, without fracture, masticatory forces delivered principally in the long axis of the the tooth.

29. Primary Resistance Form Ⅱ
Principles:
To utilize the box shape with a relatively flat floor to resist occlusal loading by virtue of being at right angles to mastication force;
To restrict the extension of the external walls (keep as small as possible) to allow strong cusp and ridge areas to remain with sufficient dentin support;

30. Primary Resistance Form Ⅲ
Principles:
To have a slight rounding of internal line angles to reduce stress concentration in tooth structure;
To provide enough thickness of restorative material to prevent its fracture under load.

31. Primary Resistance Form Ⅳ
Feature:
Box shape
Relatively flat floors
Inclusion of weakened tooth structure
Preservation of cusps and marginal ridges
Rounded internal line angles
Adequate thickness of restorative materials
Reduction of cusps for capping if indicated

33. Initial cavity preparation stage
Step 1 Outline form and initial depth
Step 2 Primary resistance form
Step 3 Primary retention form
Step 4 Convenience form

34. Primary Retention Form Ⅰ
Definition:
The shape or form of the prepared cavity that resists displacement or removal of the restoration from tipping or lifting forces.
In many respects retention and resistance form
are accomplished in the same cutting procedure.

35. Primary Retention Form Ⅱ
Principles: depending on the materials
Amalgam restoration:
developing external cavity walls that converge occlusally and dovetail design

36. The devotail design provide retention form
to the occlusal portion of the cavity.
The occlusal convergence of the walls offers
retention in the proximal portion of the cavity
against displacement occlusally.

38. Primary Retention Form Ⅲ
Principles: depending on the materials
Composite restoration:
a mechanical bond between the material
and conditioned, prepared tooth structure.

40. Initial cavity preparation stage
Step 1 Outline form and initial depth
Step 2 Primary resistance form
Step 3 Primary retention form
Step 4 Convenience form

41. Convenience Form Ⅰ Conception:
The shape or form of the cavity that provides for adequate observation, accessibility, and ease of operation in preparing and restoring the cavity.

42. Convenience Form Ⅱ Principles: Allow access for caries removal
Allow access for restoration placement
Allow access to margins for finishing,
evaluation and cleaning

43. Convenience Form

44. Final cavity preparation stage
Step 5 Removal of any remaining infected
dentin if indicated
Step 6 Pulp protection
Step 7 Secondary resistance & retention form
Step 8 Procedure for finishing external walls
Step 9 Final procedures

45. Removal of any remaining infected dentin if indicated
Definition:
The elimination of any infected carious tooth structure or faulty restorative material left in the tooth after initial cavity preparation.

46. Removal of dentinal caries using round burs and spoon excavators
A: use of a round carbide bur, with air coolant and slow speed.
B: use of spoon excavators.
Removal of dentinal caries using round burs and spoon excavators

47. Final cavity preparation stage
Step 5 Removal of any remaining infected
dentin if indicated
Step 6 Pulp protection
Step 7 Secondary resistance & retention form
Step 8 Procedure for finishing external walls
Step 9 Final procedures

48. Pulp protection Using liners or bases to protect the pulp or
to aid pulpal recovery or both.

53. Final cavity preparation stage
Step 5 Removal of any remaining infected
dentin if indicated
Step 6 Pulp protection
Step 7 Secondary resistance & retention form
Step 8 Procedure for finishing external walls
Step 9 Final procedures

54. Secondary resistance and retention forms Ⅰ
Most compound and complex cavity preparations require additional resistance and retention form.
The exception being those preparations that are very conservative.

55. Secondary resistance and retention forms Ⅱ
Mechanical forms
Cavity wall conditioning form

56. Mechnical form:
Proximal locks
Proximal slots

57. Proximal locks

60. Slot on gingival wall

61. Final cavity preparation stage
Step 5 Removal of any remaining infected
dentin if indicated
Step 6 Pulp protection
Step 7 Secondary resistance & retention form
Step 8 Finishing external walls
Step 9 Final procedures

62. Finishing the external walls Ⅰ
Definition:
is the further development of a specific cavosurface design and degree of smoothness that produces the maximum effectiveness of the restorative material being used.

63. Finishing the external walls Ⅱ
Objectives:
To create the best marginal seal possible between the restorative material and tooth structure;
To afford a smooth marginal junction;
To provide maximum strength of both the tooth and the restorative material at and near the margin.

64. The strongest enamel margin is that margin
which is composed of full-length enamel rods
that are supported on the cavity side by shorter
enamel rods, all of which extend to sound dentin.

65. Finishing the external walls Ⅲ
The design of the cavosurface angle
The degree of smoothness of the wall

66. The design of the cavosurface angle:
depending on the material
amalgam: 90°
composite: beveling 30°~ 40°

70. Final cavity preparation stage
Step 5 Removal of any remaining infected
dentin if indicated
Step 6 Pulp protection
Step 7 Secondary resistance & retention form
Step 8 Procedure for finishing external walls
Step 9 Final procedures

71. Final procedures
cleaning
inspecting
varnishing
conditioning

74. Program of Operative Treatment
Cavity preparation
Matrix application
Preparation of materials
Insertion and carving of materials
Finishing and Polishing

75. Matrix Application
Tofflemire Matrix System
Ivory Matrix System

76. Matrix retainer, Band & Wedge

77. Rounded instrument
such as a spoon
excavator
Contour Matrix

79. Matrix in Retainer

80. Matrix on Tooth

81. Occlusal View

82. Wedge place

83. Contour Band

84. Ready for restoration

85. Program of Operative Treatment
Cavity preparation
Matrix application
Preparation of materials
Insertion and carving of materials
Finishing and Polishing

86. Program of Operative Treatment
Amalgam Capsule
Amalgamator
Squeeze Cloth
Amalgam carrier

87. Activate Mercury

88. Amalgamator

89. Amalgam carrier
Squeeze Cloth

90. Amalgam carrier
Amalgam plugger

91. Program of Operative Treatment
Cavity preparation
Matrix application
Preparation of materials
Insertion and carving of materials
Finishing and Polishing

92. Insertion and carving
Class Ⅱ
Class I

93. Amalgam Restorative Instruments
Amalgam Condensers
Anatomic Burnishers
CarversCleoid or Discoid

95. Check condenser fit

96. First increment

97. Start with the smallest condenser

98. Step condenser over mass

99. Continue adding increment

100. Condense toward walls

101. Use alternative instruments

102. Overpacked

103. Create initial grooves

104. Create initial grooves

105. Carve to margin

106. Enhance grooves

107. Remove flash

108. Final shape and burnishing

109. Completed restoration

110. Initial Increment

111. Initial Condensation

112. Lateral Condensation

113. Lateral Condensation

114. Overpacking

115. Marginal Ridge Condensation

116. Condense to Margins

117. Create Occlusal Embrasure

118. Occlusal Embrasure

119. Occlusal Embrasure

120. Occlusal Embrasure

121. Removing Ridge

122. Removing Band

123. Flash & Excess

124. Check with interproximal carve

125. Instrument on Tooth Structure

126. Completed Restoration

127. Rubber dam removal

129. Program of Operative Treatment
Cavity preparation
Matrix application
Preparation of materials
Insertion and carving of materials
Finishing and Polishing

131. Polishing kit

132. Polishing

133. Evaluate the restoration Class I
Verify that cavosurface margin can be seen
Flash
Underfilled
Voids
Check the overall shape of the anatomy
Look for bulky ridges that might be high
in occlusion

134. Evaluate the restoration Class II
Check proximal contact
Check flash and overhangs proximally
Check underfill proximally
Check outline form

135. Check Occlusion Evaluate carefully with marking paper
or ribbon in Miller forceps
Check gently in centric occlusion
Check all excursive movement

136. How to Place Matrix Band in Tofflemire Retainer

137. Tofflemire retainer with Matrix band placement on Tooth

138. matrix

139. Thanks