1. معالجة / د . عبد العظيم (م 1)
رابع اسنان
17 / 10 / 2016
Introduction to
Operative Dentistry

2. DEFINITION
Operative dentistry is the art and science dealing with the restorations of any fault “Defect” that occurs in the hard tooth structures.
It necessitates the formation of Cavities of
specific design and form to receive the filling “restorative material” of choice

3. SCOPE
Operative dentistry consists of all procedures including preventive measures by which teeth may be conserved and thus maintain the natural masticating mechanism in such a state that the general health will not be endangered

4. Goal of Dental Sciences
• Elimination of disease and restoration of oral health, form and function.

5. The placement of a restoration in a tooth requires the dentist to:
• Practice applied human biology + microbiology
• Possess highly developed technical skills
• Demonstrate artistic abilities

6. THE DEFINITION OF OPERATIVE DENTISTRY includes the following:
Defects which affect the teeth
Restoration

7. 1. DEFECTS WHICH AFFECT THE TEETH
A. Pathologic:
I. Dental caries

8. II. Developmental structural defects
Enamel Hypoplasia: Acquired condition
Causes:
Infections disease in childhood ”fever”
Trauma
Abscess to developing crown

9. III. Hereditary
Amelogenesis imperfecta: Hereditary abnormality
Insufficient amount of enamel, soft enamel, friable and easy lost

10. III. Hereditary
Dentinogenesis imperfecta: hereditary condition
Teeth appear yellow-brown to gray
Enamel is fractured easily due to poor support provided by the abnormal dentin

11. Seen with congenital syphilis
III. Hereditary
* Peg-shaped lateral incisor
* Hutchinson’s incisor
* Mulberry molars
Seen with congenital syphilis

12. IV. Nutritional
* Enamel hypocalcification: incomplete calcification or Hardening of enamel (hypomineralized)

13. V. Formative
* Dens invaginatus and dens evaginatus or tooth within a tooth exaggeration or accentuation of the lingual pit. The cause is unknown

14. VI. Acquired tooth wear A. Attrition
– Mechanical wear between opposing teeth
• Causative agent abrasive diet , bruxism, (clenching and grinding, age)
• Affected area occlusal or incisal surface

15. B. Abrasion
–Wearing away of tooth substance by mechanical means other than by opposing teeth:
• Causative agent over vigorous tooth
brushing., biting pen or hard object, pipe smoking
• Affected area buccally at cervical margin.
Dish-shaped or V-shaped

16. C. Erosion:
– Loss of dental hard tissue as a result of a chemical process not involving bacteria.
• Causative agent ⇒ acid
• Source of acid ⇒ dietary (citrus fruits, acid containing drinks) , stomach
• Affected area ⇒ palatal surface ant., facial surface.

17. Pathologic
B. discoloration
- extrinsic e.g. external stain(food, drinks, smoking)
- intrinsic e.g. dental fluorosis

18. traumatic fracture of teeth.
C. Accidental
traumatic fracture of teeth.
• Traumatic injuries are acquired suddenly.
• May involve the hard dental tissues and the pulp requiring immediate operative management.
• Local injuries:
– Laceration of the lip, tongue, and gingival tissue
– Fracture – alveolar bone, root, crown
– Subluxation of a tooth

19. 1. Defects which affect the teeth 2. RESTORATION:
Is an artificial substitute which replace the missing portion of the hard tooth tissues.
Restorations must not only retain the tooth to its normal form, function, strength, and esthetic, but they must also provide for the health of the supporting tissues.
Faulty restorations are a common etiological factor of periodontal disease. An unfavorable response of the periodontium will result in occlusal disharmonies. If not corrected, thus causing traumatic occlusion.

20. DENTAL CARIES DEFINITION
“ It is a disease of the calcified tissues of the teeth, characterized by a demineralization of the inorganic portion and destruction of the organic substance of the tooth”

21. CAVITY
The term cavity refers to a defect in enamel, or in enamel and dentin, usually resulting from the pathologic process of dental caries.

22. Prepared cavities The performance of those dental surgical procedures required to expose the carious lesion, permit removal of affected tissues, and to shape the remaining dentin and enamel as to contribute to biologically and mechanically sound restoration.

23. RESTORATIVE MATERIALS
The replacement of lost hard tooth structure cannot be achieved without using the proper restorative dental materials. This include:
Temporary restorative materials
Permanent restorative materials

24. Metal Polymers Ceramics PERMANENT RESTORATIVE MATERIALS INCLUDE
Composite resin
Glass-ionomer- cements
Acrylic
Ceramics
porcelain
Amalgam
Gold
Noble metal
Cobalt-chromium- alloys
Nickel-chromium- alloys

25. PERMANENT RESTORATIVE MATERIALS
Direct restorative materials
* Esthetic restorative materials (composite resin, Glass- ionomer cements and compomer)
* Metalic restoration (amalgam, gold foil)
Indirect restorative materials
* Cast gold restoration
* Castable ceramic restoration

26. OBJECTIVE OF OPERATIVE DENTISTRY
Operative dentistry has five fundamental aims
Diagnosis
Prevention
Interception
Preservation
Restoration

27. Proper diagnosis of lesions including their * location * extent
Correct treatment planning including
* the design of tooth preparation
* the selection of restorative materials and procedure

28. PREVENTION
The ultimate aim regarding dental caries is its prevention, therefore, every step of an operative procedure must emphasize this. For example,
* Location of the margins
* The shape (contour) of the final restoration
* Sealing of enamel faults- pits and fissures
Prevents any recurrence of decay and their defects

29. INTERCEPTION
This procedure in operative dentistry refers to preventing further loss of tooth structure by stabilizing an active disease process

30. PRESERVATION
This includes
* The vitality of the affected tooth
* Re establishing of the important anatomy in remaining sound tooth structure

31. RESTORATION
The ultimate goal of operative dentistry treatment should be restoration of health. This will include
Restoring and maintaining form, function, phonetics and esthetics
Occlusal re establishment and stability
Not only to the teeth themselves, but also to their surrounding supporting tissues and to the entire stomatognathic system and to the welfare of the whole patient.

32. To achieve the ultimate goals of operative dentistry, any restorative performance requires
Sound clinical judgment in both mechanical and biological aspects based on scientific and artistic knowledge
A high level of psychomotor skill “Precision”.
Operative dentistry demands a unique combination of psychomotor and affective skills.