Last time we start talking about stages & steps of tooth preparation which (are (initial stage &

final stage Today we'll continue talking about initial stage :Initial stage involves * outline form& initial depth-1 primary resistance form-2 primary retention form-3 convenience form-4

:Primary retention form

The shape or form of the conventional preparation that resist .displacement or removal of the restoration from tipping or lifting forces Which in another word, the form which maintain the restoration inside the tooth by resist the forces in all directions ( torsion, tension ,shear, flexion ) except the compressive force which is the force on the long axis .of the tooth because this force affect the resistance form Actually in real we can't divide them into resistance & retention forms but for teaching purposes we should learn what we mean by each one of .them Resistance form >>>>> resist fracture of both the restoration and the tooth Retention form >>>>> prevent dislodgment of the restoration out of .the cavity

Principles of retention
.Retention depends on the restorative material For amalgam it's mechanical in most class I and class II walls should converge occlusally* Suppose A is the apex of the cavity and B is the base, B should be wider .than A (B>A) in order to prevent displacement of the restoration

"in class II, occlusal dovetail aid in retention "we'll learn about it later* in class V, walls diverge outward to provide strong enamel margin,* .retention obtained by grooves in the dentinal tubules For composite it's micromechanical, micromechanical bond by acid .etching & bonding Let's talk about convenience form Convenience form: the form or the shape of the preparation that provides adequate observation, accessibility and easy of operation in .preparing & restoring the tooth A lot of You observed when we did amalgam restoration in the lab that some of the condensers that you have don't enter the cavity preparation for condensation of the amalgam,, this's what we mean by convenience form: the cavity form & shape that enable us to access the cavity, to see .what we are doing, and we able to insert the material inside the cavity As I told you in the lab "kabrro el cavity 3shan tshofo, kabroha 3shan t2dro t7shoha amalgam",,,, 7ader dr So all parts of the cavity must be visible for examination, be able to seethe cavity, to see if there's remaining caries. Some of the students in 4th year when they do cavity preparation they try to drill down more without being able to see anything & suddenly they end up with pulp exposure because the cavity preparation is too small they can't see what they are .doing This is what we mean by convenience form, it should be as conservative as possible and at the same time we should be able to see what we are .doing Proper convenience form is a requirement for all operative procedures: this's doesn't mean that we should make a wide cavity, this mean we .should be able to see & restore the cavity

"Final tooth preparation stage "the 2nd stage

Removal of any remaining enamel pit or fissure, infected dentin or old" "restorative material if indicated

As We said, at the beginning we make the outlines include all of the carious pit and fissures & make the initial depth of about 1.2_1.8 mm inside dentine after that we make initial resistance and retention forms and the convenience form,,,, then we should remove any undermined enamel or residual carious dentin (infected dentin) and remove any .remaining carious tooth structure If we're preparing a tooth that is already restored with amalgam for example sometimes we should remove all the restoration to be able to see the convenience form and sometimes we shouldn't., just we need to make .our initial outline & initial depth .Removal of remaining enamel pit or fissure * .Removal of defective old restorative material if we have old restoration * removal of infected dentin: we need to check all DEJ regions to look * for any residual carious dentin and in this area the infected dentin should be undermined by enamel, this infected dentin should be always removed . So by this mnkon 3mlna final tooth preparation stage, y3ne 27na msh mn lbdayeh mnshel kol lcaries mnfta7 hl cavity kbereh mn lbdayeh wmnshel kol lcaries Noo!!, 2wal she mn3mal el outline& ideal depth ok b3den 2za fe 3na residual caries mnshelha w2za feh undermined enamel brdo mnshelo ok,, then if we want to increase the depth of the cavity we do it. Agaaaaaaaaaaaaaaain , if we have a large cavity we don't open the entire large cavity from the beginning, firstly we try to deal with the ideal cavity preparation then we remove the infected dentin or residual caries then if we need to enlarge the cavity because of undermined enamel we remove it.

Pulp protection
If we end up with more than the ideal cavity preparation depth (which is important for resistance) &we are close to the pulp, in this case we need to protect the pulp we need to do some kinds of protection to the pulp if we are close to it. The best protection to the pulp is dentin itself, if we have enough dentinal thickness this mean the pulp is protected, there should be 2mm of bulk either remaining tooth structure, or liner, or base between the restoration & the pulp. Sooo
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* Dentin is the best isolator against irritation to the pulp. * The base provides protection against mechanical, thermal and chemical irritants. * For resin composite restorations, calcium hydroxide liner indicated only when the excavation is judged to be within 0.5 mm of the pulp and bases are not included.

Secondary resistance & retention forms

We said that in initial stage we have primary resistance & retention forms that we make them in the cavity walls, sometimes if we have missing walls or a lot of missing tooth structure we have to add another kind of retention we call it secondary resistance and retention forms. This can be achieved by: a- mechanical preparation features: 1- Retention locks, groves, and coves. 2- Groove extension. 3- Skirts 4- Pins, slots, steps & amalgampins. The Dr said that it's not important to know about these things now because in 4th year we'll talk about it in more details, what we have to know now is >> if we don't have enough primary resistance and retention forms we can put secondary retention & resistance forms. b- Placement of etchant, primer, or adhesive on prepared walls: 1-enamel wall etching 2- Dentin treatment. Those two things are special for composite, for amalgam we have what we call bounded amalgam.

Procedures for finishing the external walls of the tooth preparation "The further development, when indicated, of a specific cavosurface
design & degree of smoothness or roughness that produces the maximum effectiveness of the restorative material being used" Cavosurface angle: angle between the prepared cavity and unprepared tooth surface. For amalgam cavosurface angle should be 90 to prevent fracture of the amalgam and easy finishing the amalgam, in contrast, in composite the
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cavosurface angle should be more than 90 (beveled) to aid in retention, better acid etching & bonding of composite. ^_^ objectives ^_^ 1- Create the best marginal seal possible between the restorative material & the tooth structure: For amalgam the best marginal seal is achieved when the cavosurface angle is 90 this will provide strong margins of the amalgam at the cavosurface angle. For composite: the best seal that give the better retention is achieved when the cavosurface angle more than 90. 2- Afford a smooth marginal junction between the restoration & the tooth structure. 3- Provide maximum strength for both tooth structure & restorative material:

All enamel walls must consist of either full-length Enamel rods on sound dentin (a) or full-length enamel rods on Sound dentin supported on preparation side by shortened rods Also on sound dentin (b).

* for amalgam 2tf2na 2no el cavosurface angle lazm tkon 90 ok, in class V this angle will be achieved when the occlusal surface divergent a little pit upward " toward the occlusal" , in class I it should be converge a little pit occlusaly to give 90 degree cavosurface angle.
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* The best strength for enamel "tooth structure" is achieved when enamel prisms occur in full length at the cervical region (buccal, lingual, or proximal surfaces). In class I the best strength for tooth structure when full length enamel prisms supported by shortened prisms y3ne some of the prisms occur with full length. * The design of our cavity preparation reflect the anatomy of both enamel & dentin occlusaly or cervically

Final procedures: cleansing, inspecting, and sealing

We have to inspect the walls of the cavity to make sure that we don't have any undermined enamel & to make sure that cavosurface margins is ok and the smooth angles all over the cavity preparation & rounded internal line angles. - cleansing & dryness of the cavity for inspection. - Sometimes, certain medicaments can be applied to the cavity prior to the restorative step: when we carve the dentin we open dentinal tubules & in order to seal them we use anti-sensitive agent before we put the final restoration.

Sequence of caries removal

Now how we should apply these stages and steps on real life when we ??have a carious tooth At the beginning, we predict that we have a natural carious tooth *?What is the first step in cavity preparation outline form and initial depth So the first step we inter with a high speed fissure bur and make the outline form and the initial depth and if the enamel is existed we should to remove it sometimes in extensive caries and the enamel is broken then we have , no enamel so we dont need to inter by high speed bur so we go directly to remove the caries , but here in our example there is a moderate carious
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lesion so we want to remove enamel to get access to the caries sooooooooooooooooo We inter with a high speed fissure bur and make the ideal depth and .1 width regardless the carious area, we dont start with high speed fissure bur to remove all caries "we only do with a high speed fissure bur the "outline form and the initial depth Then the caries that extend beyond the initial depth we remove it by .2 large round slow speed fissure bur we should use the largest bur ??Why we dont use the high speed fissure bur to remove the caries ** the carious dentin is very soft and there is possibility to remove tooth -structure more than we need and expose the pulp if we still using high fissure bur , the possibility of exposing the pulp will be decreased when . we use a slow speed fissure bur then we go peripherally to DEJ, removing of caries should start from .3 ,the walls of prepared cavity and avoiding areas of possible exposure so the axial and pulpal wall should be remove last to avoid exposing of pulp , pulpal wall in the class 1 should be done last and axial wall in class 2 or 5 should be done last Finally we remove axial or pulpal wall .4

??Now when we should stop removing of caries The carious dentine is yellowish or brownish in color but the color isnt an indicator not every brownish or yellowish discoloration we remove ...it So we stop when we feel the tooth structure is hard by spoon excavator (or prop, this means that we remove all infected dentine (soft dentine Infected dentine: it contains the bacteria we call it infected zone or ** zone of penetration and it should be remove affected dentine : it contains the stains of bacteria and its near to the ** pulp we call it affected zone or zone of demineralization , this zone is brownish or yellowish but still hard bcz bacteria its not penetrate it, so we should not remove it

So the indictor for removing caries it's not the color, its the soften of .dentine, so we remove only the soften areas After we remove all caries, we remove all unsupported enamel by high .5 speed fissure bur and we should make the resistance and retention form The pulpal floor should be flat on only an ideal depth for the resistance, if there is area extend beyond ideal depth, we should not reduce all the depth of cavity preparation to this area, and then we will deal with this area by base and liners ??why we shouldnt extend the cavity preparation beyond ideal depth** Bcz if we reduce the ideal depth we loose more tooth structure and more retention and resistance and we will be closer to the pulp and as we said the best protection to the pulp is dentine.

Done by: Noor Ta'ani & Randa al Esaa Thxxxx randoooosh 4 helping me :D wk wk thxxx :P Special thxx to Abeer hamraneh (27la Cr w27la zameleh) & 2 my lovely friends Aya homran (yb3tlk 7mma ya JAW :P), shahed hatamleh, walaa bataineh, Ayat almomani, Bayan alshar'e, Areej Al lama', walaa al laymoun & to whom who deserve it BEST Wishes :D :D :D