1. PEDIATRIC OPERATIVE DENTISTRY
Saturday, April 15, 2017

2. Acc to AAPD the objectives of restorative treatment are to
repair or limit the damage from dental caries
protect and preserve the tooth structure
re-establish adequate function
restore esthetics ( where applicable)
provide ease in maintaining good oral hygiene.
Saturday, April 15, 2017

3. REASONS FOR PRESERVATION OF PRIMARY TEETH
Necessary till the succedaneous teeth replace them
Mastication of food
Preservation and increase in arch length
Development of speech and phonetics
Prevention of any infection or caries to the permanent teeth
Prevention of malocclusion of permanent teeth
Esthetics
Saturday, April 15, 2017

4. MORPHOLOGIC CONSIDERATIONS FOR DECIDUOUS TEETH
Smaller
More bulbous
Cervical constriction
Narrow occlussal table
Saturday, April 15, 2017

5. Histologic Considerations
Pulpal outline follows DEJ more
closely than in permanent tooth.
Longer & more pointed pulp
horns.
Less bulk/ thickness of dentin
Larger pulp
Thin enamel of uniform
thickness,which is parallel to DEJ
Enamel rods are directed occlusally
at cervical third
Saturday, April 15, 2017

6. sh/be kept more conservative
Occlusal anatomy of primary teeth not well defined & supplemental grooves less common- cavity prep
sh/be kept more conservative
Enamel thinner-cavity prep sh/ be kept shallow
Pulp horns extend a greater distance into crown of
tooth – cavity sh/ be conservative to avoid pulpal
exposure
Exaggerated cervical bulge- matrix adaptation
difficult – construction of a custom matrix to fit the
teeth
Saturday, April 15, 2017

7. Direction of enamel rods in cervical region or
gingival third of primary teeth extend from the
DEJ occlusally or horizontally- eliminates the need
for a gingival bevel in CL II prep.
Interproximal contacts of primary molars are
generally broad, elliptical, flat & cervically placed –
require wide proximal cavity prep.
Saturday, April 15, 2017

8. BLACK’S CLASSIFICATION
All pit and fissure cavities
Occlusal surfaces of posterior teeth
Occlusal 2/3 of buccal and lingual surfaces of
premolars & molars
Lingual surfaces of anterior teeth.
CLASS II-
All proximal surface cavities on the premolars and molars.
Saturday, April 15, 2017

9. CLASS III-
All proximal surface cavities on the incisors and canines which do not involve the removal and restoration of the incisal angle.
CLASS IV-
All proximal surface cavities on the incisors and
canine which involve the removal and restoration
of the incisal angle.
CLASS V-
All gingival cavities located within the gingival one
third of the tooth. These may be either on the
facial or lingual Gingival one third of the tooth
Saturday, April 15, 2017

10. Cavities on the incisal edges and cusp tips of all teeth.
CLASS VI-
Cavities on the incisal edges and cusp tips of all
teeth.
Acc to some authors-MOD cavities are Cl VI
cavities
Saturday, April 15, 2017

11. Mount & Hume (1998) classification The three sites of carious lesions:
Site 1- Pits, fissures and enamel defects on occlusal surfaces of posterior teeth or other smooth surfaces
Site2- Proximal enamel immediately below areas in contact with adjacent teeth
Site3-The cervical one-third of the crown or, following gingival recession, the exposed root. (Australian dental journal 1998)
Saturday, April 15, 2017

12. The four sizes of carious lesions:
Size 1- Minimal involvement of dentin just beyond treatment by remineralization alone.
Size2- Moderate involvement of dentin. Following cavity preparation, remaining enamel is sound, well supported by dentin and not likely to fail under normal occlusal load. The remaining tooth structure is sufficiently strong to support the restoration.
Saturday, April 15, 2017

13. Size 3- The cavity is enlarged beyond moderate
Size 3- The cavity is enlarged beyond moderate. The remaining tooth structure is weakened to the extent that cusps or incisal edges are split, or are likely to fail or left exposed to occlusal or incisal load. The cavity needs to be further enlarged so that the restoration can be designed to provide support and protection to the remaining tooth structure.
Size 4- Extensive caries with bulk loss of tooth structure has already occurred.
Saturday, April 15, 2017

14. Recent Concept CONSTRICTION WITH CONSERVATION
(OLD CONCEPT- EXTENSION FOR PREVENTION)
Cavity design dictated by site & extent of lesion.
No need to extend cavity into the “caries free” area.
Biologically active restorative material which assists remineralization & healing of remaining tooth structure.
ONLY Irretrievable/ degenerated/ broken down tooth surface to be removed.
Completely control plaque accumulation by eliminating surface cavitation as a result of caries.
Saturday, April 15, 2017

15. Recent Concept- MINIMAL INTERVENTION MINIMALLY INVASIVE TECHNIQUE
PRESERVATIVE DENTISTRY
Saturday, April 15, 2017

16. Principles of cavity preparation
Blacks concept extension for prevention.
Obtaining Outline form
Obtaining Resistance form
Obtaining Retention form
Obtaining Convenience form
Removal of infected dentin
Finishing enamel walls
Debridement /toilet of the cavity
Saturday, April 15, 2017

17. PREPARATION OF CLASS I CAVITY
Saturday, April 15, 2017

18. The maximum inter cuspal cavity width should be
The extension and depth of the cavity will be determined by the amount and location of caries and preoperative occlusal anatomy. Every effort should be made to retain as much well-supported enamel as possible.
The maximum inter cuspal cavity width should be
one-quarter to one-third of the inter cuspal width.
0.5 mm pulpally to the DEJ to provide sufficient bulk of amalgam to with stand occlusal forces.
Pulpal floor should be flat & smooth
Internal line angles should be rounded to reduce any stresses in the set amalgam.
Saturday, April 15, 2017

19. Retention grooves can be place in dentine if considered necessary.
The extension is made, buccal or lingual cavity walls should be straight and either parallel or converging occlusally
The extension should be cut 0.5 mm into dentine and should extend gingivally to include the developmental pits.
Retention grooves can be place in dentine if considered necessary.
The ‘isthmus’ area where the extension meets the occlusal section can be rounded or beveled to increase the bulk of amalgam. as it is subjected to heavy stresses during lateral movements
Saturday, April 15, 2017

20. Class II Cavity
(1) Outline: The outline follows the fissure pattern so as to prevent secondary caries occurring adjacent to the restoration. A smooth flowing outline reduces stress and permits better of the amalgam.
(2) Isthmus: This should be between 1/4 of the inter cuspal distance (approximately 1.5 mm)
Saturday, April 15, 2017

21. (5) Pulpal floor: Pulpal floor should be slightly concave.
(3) Depth: This should be 0.5 mm below dentino-enamel junction or 1.5 mm from the cavosurface (i.e.. 'a'.)
(4) Internal angles: All the internal angles should be rounded so as to limit stress and to ensure that amalgam can be easily packed into these regions.
(5) Pulpal floor: Pulpal floor should be slightly concave.
Saturday, April 15, 2017

22. (6) Buccal and lingual walls: should be converging so making the cavity retentive. Also, the cavosurface angle needs to be a right angle to ensure maximum strength at the enamel-amalgam junction. (7)Gingival floor: should be located just below the contact area with the adjacent tooth. But supragingivally.
Saturday, April 15, 2017

23. (8) Axial wall: The width of the floor of the box should be approximately 1 mm. follows external contour of tooth.
(9) Buccal and lingual walls: These should be convergent, parallel to the appropriate external surface and make a cavo surface angle of 90 degree.
(10) Axio-pulpal line angle: This should be rounded which gives the maximum thickness of amalgam with the minimum of stress in this area.
Saturday, April 15, 2017

24. (11) Retention grooves- made to enhance retention.
(12) Occlusal dovetail -It should be made
including all carious areas and shape
should be such that it locks the occlusal
portion of filling.
Saturday, April 15, 2017

25. PROXIMAL BOX OF DECIDUOUS TEETH Box converges occlusally
Minimal flare to prevent weakening of enamel walls
Isthmus 1/4th to 1/5th inter cuspal
width
Rounded axio-pulpal angle grooved to
increase retention
No bevel in gingival seat
Depth minimal to prevent pulp
exposure at cervial constriction
Wide gingival floor
Saturday, April 15, 2017

26. Saturday, April 15, 2017

27. DIAGRAM ILLUSTRATING THE INCREASED DANGER OF PULP EXPOSURE WHEN THE GINGIVAL WALL IS CARRIED TOO DEEPLY
Saturday, April 15, 2017

28. CLASS III Cavities Shallow groove Cervical seat Labial & lingual locks
Proximal slice
Saturday, April 15, 2017

29. CLASS 1V CAVITY
Saturday, April 15, 2017

30. Matrix bands and retainers
They hold the restorative material in the cavity, restore the tooth to original form and preserve the arch length and anatomic function.
The matrix band should be rigid enough to allow adequate packing pressure, ensuing a well-condensed restoration free from an excessive mercury.
Should also prevent extension of excess restorative material beyond the band into the gingival tissue causing over hanging amalgam restoration.
Saturday, April 15, 2017

31. DIFFERENT MATRIX BANDS AND RETAINERS
Saturday, April 15, 2017

32. Saturday, April 15, 2017

33. 1. Matrices for Class I cavity (compound cavity)
Double banded tofflemire
2. Matrices for Class II
Single banded tofflemire
Ivory matrix No. 1
Ivory matrix NO. 8
Black's matrices
Soldered band matrix
Anatomical matrix
Auto-matrix
S-shaped matrix band
T-shaped matrix band
3. Matrices for a cavity preparation for amalgam on distal of cuspid.
S shaped matrix
Tofflemire
Saturday, April 15, 2017

34. 4. Matrices for Class III for tooth coloured restorations
Transparent celluloid strips
5. Matrices for Class IV for tooth coloured restorations
Celluloid strips
Aluminum foil (non-light cure)
Anatomic matrix .
Modified S shaped band of copper, tin, aluminum
foil (non-light cure)
Saturday, April 15, 2017

35. Spot welded matrix band
A stainless steel band material of cm x 1.27cm x 3.81cm (0.002"x 3/6" x 1W') size is taken.
Gripping band material with plier, it is tightly adapted around the tooth for which band has to be formed. In most of the teeth the band should be made buccally, i.e. ends of the band should be buccally
Band is taken out by holding it with pliers. Both the ends of the band material are spot welded.
Saturday, April 15, 2017

36. Wedge should be inserted from the lingual side.
Excess of the material is cut and removed carefully. The band is fitted on the tooth. It should fit tightly on the tooth surface. Mark the band according to the height and contour. Band height should not be above the marginal ridge of the adjoining tooth.
Wedge is inserted in the gingival embrasure for the tight fitting & adaptation of the band
Wedge should be inserted from the lingual side.
Further burnishing of the band provides better adaptation.
Saturday, April 15, 2017

37. T-bands
It is available in two widths, broad and narrow. Broad is used for permanent teeth and narrow is used for deciduous teeth.
They are made up of soft metal strip. This type of band matrix can fit and adapt to most of the teeth properly for proximal surface fillings.
Its use is simple and easy. It can be easily prepared, contoured, placed and removed from deciduous and permanent teeth.
To reduce the chair side time, the loop of approximate size of the diameter of the tooth can be prepared in advance.
Saturday, April 15, 2017

38. Saturday, April 15, 2017

39. Saturday, April 15, 2017

40. Sectional matrix with G-rings (retainers) for postcrior composites
Saturday, April 15, 2017

41. MCQs Q.1) Enamel rods at cervical third in primary teeth are directed
Vertically
Occlusally
Cervically
In any of the above directions
Saturday, April 15, 2017

42. Q. 2) As compared to permanent teeth, supplemental grooves are
More common in primary teeth
Less common in primary teeth
More deep in primary teeth
Both 2) and 3)
Saturday, April 15, 2017

43. Q. 3) While preparing Cl. II Cavity in Primary teeth
1. Gingival bevel should be kept minimal.
2. It is not made at all.
3. It is more pronounced in primary teeth.
4. Modified according to morphology of teeth
Saturday, April 15, 2017

44. Q. 4) As compared to permanent teeth interproximal contacts in primary
teeth are
More pointed and more cervically placed
More pointed and more occlusally placed
Broader and more cervically placed
Broader and more occlusally plced
Saturday, April 15, 2017

45. Q. 5) The maximum inter cuspal cavity width
in Cl II cavity preparation in primary
teeth should be
one-quarter to one-third of the inter cuspal width
one-third to two- third of the inter cuspal width
Half of the inter cuspal width
Half to two- third of the inter cuspal width
Saturday, April 15, 2017

46. Q. 6) According to BLACK’S CLASSIFICATION CLASS II cavity includes
1. All proximal surface cavities on the
premolars and molars.
2. All proximal surface cavities on all the
teeth.
3. All proximal surface cavities on the
incisors and canine which involve the
removal and restoration of the incisal angle.
4. Occlusal 2/3 of buccal and lingual surfaces of
premolars & molars
Saturday, April 15, 2017

47. Q. 7). The purpose of the matrix bands is to
hold the restorative material in the cavity
restore the tooth to original form
preserve the arch length and anatomic function
All of the above
Saturday, April 15, 2017

48. Q. 8) G-Rings are used in maintenance of
1. Proximal contacts for restoration of
posterior teeth with composites
2. Proximal contacts for restoration of
anterior teeth with composites
3. Both of the above
4. None of the above
Saturday, April 15, 2017

49. Answer Key Q.1-2 Q.2-2 Q.3-2 Q.4-3 Q.5-1 Q.6-1 Q.7-4 Q.8-1
Saturday, April 15, 2017