PRINCIPLES OF CAVITY PREPARATION

 Definition of cavity:
 Definition of prepared cavity:
 Definition of cavity preparation
 Objectives of cavity preparation.
 Principles of cavity preparation:
 Biological principles:
 Definition.
 Protection of dentin -pulp organ:
 Mechanical irritation:
 Excessive cutting of enamel (width).
 Overcutting of dentin (depth).
 Unnecessary application of excessive pressure.
 Cutting across the recessional lines of the pulp.
 Thermal irritation:
 Thermal tolerance zone.
 Controlled by:
 Minimizing the frictional heat resulting during cavity preparation, 2 steps.
 Use of coolants:
 Types and best.
 Requirements.
 Chemical irritation:
 Cavity cleansers, cavity sterilizers.
 Acidic dentin conditioners.
 Bacterial irritation:
 Sterilization of instruments.
 Rubber dam.
 Prevention of caries recurrence (control of caries):
 Remove all carious enamel & dentin.
 Extension of the cavity margins.
 Removal of all weak, short, loose or undermind enamel.
 Cavo-surface angle: amalgam (90), composite (45), gold (135).
 Preventive measures.
 Protection of investing tissues & adjacent teeth:
 Rounding and smoothening.
 Excision of the infectious lesions.
 Avoid injudicious subgingival extensions.
 Protect adjacent tooth.
 Proper guide and support for hand and rotary instruments.
 Working with aseptic procedures:
 Use of sterile instruments.
 Isolation of operative field.
 Use of personal protective barriers.
 Mechanical principles:
 Resistance.
 Retention.
 Preservation.
 Esthetic principles
 Symmetrical cavity outlines, sweeping curves.
 Margins.
 Limiting area-display of restorations.
 Elimination of discolored enamel or dentin.

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 Conservative approach in operative dentistry:
 Areas that are less susceptible to decay.
 Extension for prevention or cutting for immunity.
 Conservatism objective.
 Understanding of caries process.
 Consequences of extension for prevention concept
 Shifting to the conservative approach
 Advantages of conservative cavity design.
 Steps of cavity preparation:
 1st STEP: The outline form:
 Definition: External & Internal.
 General factors or fundamental rules:
1. Extension of caries defect in enamel & its lateral spread in dentin.
2. Remove All carious enamel.
3. Apply Conservative approach:
 Enameloplasty: Procedure, Indication, Technique, CSA, Material used.
 Slanting Bur Technique
 Pits & fissure Sealing
4. Eliminate all undermined enamel.
5. Adjacent cavities:
 When to join
 Separate spot preparations are preferable, WHY?
 May be in Oblique, Transverse ridges OR Two surfaces of the same tooth.
6. Cusp Capping: WHEN?
7. Sweeping curves:
8. Pulp protection:
 Depth of penetration into dentin should be kept to a minimum
 (0.5mm) below DEJ, WHY?
9. Cavo-surface angle
10. Age considerations;
11. Oral hygiene, caries susceptibility as well as the esthetic versus mechanical demands.
 Factors affecting the outline form of (Class I):
 Occlusal Table Anatomy:
 Occlusal Contacts: Cavity margins.
 Factors affecting the outline form of proximal cavity preparations:
 Flaring of the Margins.
 Meaning
 WHY?
 In proximal cavity preparation of Posterior teeth (Class II):
 Buccal and lingual walls
 Junction between the occlusal cavity and the proximal surface
 Straight line
 Uniform Curve
 Reverse Curve/ Ingraham Line

 Factors affecting the outline form of (Class III):
 Factors affecting the outline form of (Class IV):
 Factors affecting the outline form of (Class V):
 Position of the gingival tissues
 Margin should be hidden sub-gingivally, WHY?
 Outline form is just limited to the defect
 Anterior region and the incisal wall is beveled, WHY?

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 2nd STEP: The Resistance & Retention form:
 Resistance Form: Definition
 Factors Influencing Stress Response of Tooth & Restoration:
1. Occlusal loading in terms of:
 Magnitude
 Direction
 Character
2. Cavity design in terms of:
 Direction of walls
 Pulpal Floor:
 Smoothness and flatness of walls: WHY?
 Line and point angles: Rounded, WHY?
 Amount of bulk provided: HOW?
 Cavo-surface angle inclination
 Isthmus portion
 Line and point angles: smooth & rounded.
 Width: ¼ ICD, WHY?
 Axiopulpal line angle: Smooth and rounded.
 The amount of retention.
3. Strength characteristics of the restorative material.
 Retention Form: Definition
 Chemical Retention
1. Primary valence bonding
 Only in GIC, WHY?
2. Vander valls forces
 Mechanical Retention
1. Micro-mechanical retention:
 Most conservative mechanism of retention or attachment
 Material: for resin composite restorations.
 Mechanism: forms microscopic resin tags
 Technique: achieved by Acid etching of enamel and dentin
 Vulnerable to inconsistencies due to:
2. Macro-mechanical Retention:
 Material: for metallic restorations.
 Generally classified according to the possible direction of displacement into:
 Axial Retention:
 Outward:
 Direct: by occlusal convergence.
 Indirect: by the frictional parallelism of walls of the cavity
 Pulpward: Dentin Ledges.
 Lateral Retention:
 Frictional opposing wall parallelism
 Proximal Grooves (Locks)
 Buccal or lingual extensions:
 Dove-tail Lock
 Reverse gingival Bevel
 Dentin Pins
 Slots & Coves
 Special retentive features:
 Acid etching for composite restoration.
 Dowel pin retention → i.e. Post inside the root canal.

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 Factors controlling the selection of retention features:
1. Size of the cavity and remaining amount of tooth structure:
2. Number of missing walls:
3. Site of the cavity and occlusal stresses:
4. Type of restoration:
5. Pulp vitality:
6. Esthetic requirements:
 Box (Mortise) or Modified Box Form:
 Favor neutralization of stresses, HOW?
 Prevents the wedging action of the restoration inside the tooth, WHY?
 Retention by friction due to relative parallelism.
 Retention may partly be provided automatically during making the resistance form and vice versa.
 They are considered interrelated and inseparable forms, HOW?
 A box form preparation
 The inverted truncated cone
 The bulk
 Proximal axial locks
 3 STEP: The convenience form:
rd

 Definition:
 Examples:
 A slight more extension of a cavity outline, HOW?
 Occlusal access to proximal lesions in Class II and the palatal access to class III.
 Proper Visibility.
 4 STEP: Removal of the Remaining Caries Dentin:
th

 Definition
 This inspection may then reveal the cavity floor to be composed of either:
 Hard Sound Dentin
1. In case of adhesive direct resin composite restorations
2. In of amalgam restorations The cavity must extend beyond DEJ. WHY?
 Hard but Discolored dentin
1. NOT considered as carious dentin
2. WHY discolored?
3. in case of anterior teeth
 Soft Carious Dentin
1. May be discolored (chronic caries) or not (Acute caries).
2. Removal of this carious dentin must be done with extreme care, WHY?
3. Affected Dentin & Infected dentin.
4. Managing the remaining caries at the pulpal floor:
 Remove infected dentin
 When it comes to manage deep cavities
 stepwise excavation
 last layer of carious dentine is left
 Materials used, WHY?
 re-entry is made after 6-12 weeks, WHY?
 indirect pulp capping, HOW?
 Techniques of Caries Removal:
 Manual excavation by use of hand instruments (excavators), WHEN?
 Mechanical excavation by Rotary instruments (burs), WHEN?
 Chemo-mechanical debridement, HOW? & WHY NOT?
 Air abrasion, HOW? & WHY NOT?
 Laser debridement, HOW? & WHY NOT?

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 5th STEP: Finishing of the Cavity Walls & Margins:
 Importance.
 Objectives:
 Removal of undermined enamel.
 Adjust cavo-surface angle inclination.
 Give the cavity wall correct inclination.
 Render the walls smooth for better adaptation.
 Make the cavity outline in sweeping curves.
 Roundation of line and point angles.
 Noye’s Principles:
 Enamel should rest on sound dentin.
 Inner end of enamel rods
 Outer end of enamel rods (CSA bevel):
1. Short Bevel:
2. Long bevel:
3. Full bevel
4. Hollow ground bevel:
5. Counter bevel.
 Factors affecting the cavo-surface angle:
1. restorative material
2. stresses
3. location of cavity margin
4. The condition of enamel, friability.
5. Pulp vitality
6. Esthetic demands.
 6th STEP: Toilet of the cavity
 Definition:
 Objectives:
 Technique
 Contraindications:
 Cavity sterilizers (pulp irritation):
 Chemicals as alcoholic: (desiccation of dentin).
 Excessive dryness with air blast: (desiccation of dentin).

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