classification of cavity preparation
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This document discusses various restorative and aesthetic dental procedures. It begins by defining different types of dental cavities and restorations such as Class I-V. It then discusses cavity preparation and the use of pins, bases and liners. Tooth whitening procedures and the dental assistant's role are also outlined, including taking impressions and instructing patients. Complex restorations involving multiple surfaces are addressed. The principles of direct veneers and intermediate restorations are presented along with indications for their use.
classification of cavity preparation
- 1. General Dentistry Chapter 48 Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights
- 2. Chapter 48 Lesson 48.1 Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights
- 3. Learning Objectives Define, spell, and pronounce the Key Terms. Describe the process and principles of cavity preparation. Discuss the differences between assisting with an amalgam and with a composite restoration. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights
- 4. Introduction Restorative and aesthetic dentistry is focused on the general dental needs of the patient. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights
- 5. Restorative Dentistry Specific conditions that initiate a need for restorative dental treatment are: Initial or recurring decay. Replacement of failed restorations. Abrasion or the wearing away of tooth structure. Erosion of tooth structure. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights
- 6. Esthetic Dentistry Specific conditions requiring aesthetic dental treatment: Discoloration due to extrinsic or intrinsic staining Anomalies due to developmental disturbances Abnormal spacing between teeth Trauma Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights
- 7. Terminology in Cavity Preparation Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights
- 8. Initial Cavity Preparation Outline form Resistance form Shape and placement of cavity walls Retention form Design and initial depth of sound tooth structure To resist displacement or removal Convenience form Provides accessibility in preparing and restoring the tooth Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights
- 9. Final Cavity Preparation Removal of decayed dentin or old restorative material Insertion of resistance and retention with the use of hand cutting instruments and burs. Placement of protective materials (liners, bases, desensitizing, or bonding) Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights
- 10. Patient Preparation for Restorative Procedures Inform the patient what to expect throughout the procedure. Position the patient correctly for the dentist and the type of procedure. Explain each step to the patient as the procedure progresses. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights
- 11. Responsibilities of the Chairside Assistant Prepare the setup for the procedures. Know and anticipate the dentist’s needs. Provide moisture control. Transfer dental instruments and accessories. Mix and transfer dental materials. Maintain patient comfort. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights
- 12. Steps in the Restorative Procedure The dentist evaluates the tooth to be restored. The dentist administers local anesthesia. The assistant readies the chosen means of moisture control. The dentist prepares the tooth. The dentist determines the type of dental materials. The assistant mixes and transfers the dental materials. The dentist burnishes, carves, or finishes the dental material. The dentist checks the occlusion of the restoration. The dentist finishes and polishes the restoration. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights
- 13. Class I Restorations These restorations are used in class I lesions, affecting the pits and fissures of the teeth. The following surfaces are involved: Occlusal pits and fissures of premolars and molars Buccal pits and fissures of mandibular molars Lingual pits and fissures of the maxillary molars Lingual pits of maxillary incisors, most frequently in the pit near the cingulum Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights
- 14. Fig. 48-5 Class I restorations. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights
- 15. Class II Restorations A class II lesion is the extension of a class I lesion into the proximal surfaces of premolars and molars. The following surfaces are involved: Two-surface restoration of posterior teeth Three-surface restoration of posterior teeth Four-surface (or more) restoration of posterior teeth Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights
- 16. Fig. 48-7 Class II restorations. (From Baum L, et al: Textbook of operative dentistry, ed 3, Philadelphia, 1995, Saunders.) dentistry, Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights
- 17. Class III and IV Restorations Class III lesion Affects the interproximal surface of incisors and canines Class IV lesion Involves a larger surface area, including the incisal edges and interproximal surface of incisors and canines Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights
- 18. Fig. 48-9 Class III composite restoration. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights
- 19. Fig. 48-10 Class IV composite restoration. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights
- 20. Class V Restorations Class V restoration Classified as a smooth-surface restoration. Decayed lesions occur at: Gingival third of the facial or lingual surfaces of any tooth Root of a tooth, near the cementoenamel junction Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights
- 21. Fig. 48-13 A, Class V conventional tooth preparation. B, Schematic representation illustrating tooth preparation. (From Roberson T, et al: Textbook of operative dentistry, ed 4, Philadelphia, 2006, Elsevier.) dentistry, Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights
- 22. Chapter 48 Lesson 48.2 Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights
- 23. Learning Objectives Discuss why retention pins would be selected for a complex restorative procedure. Describe the need for placement of an intermediate restoration. Describe the procedure of composite veneers. Describe tooth-whitening procedures and the role of the dental assistant. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights
- 24. Complex Restorations Such restorations are required when decay has extended beyond the normal size or shape. Retention pins Decay has extended into the cusp of a tooth and undermined the enamel and dentin. General understanding when using retention pins: One pin is placed for each missing cusp. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights
- 25. Fig. 48-14 Retention (retentive) pins placed in tooth structure to help retain and support a restoration. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights
- 26. Intermediate Restorations Restoration placed for a short term. Primary factors for placement Health of the tooth A wait to receive a permanent restoration Financial reasons Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights
- 27. Procedure 48-5 Placement of intermediate restorative material. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights
- 28. Direct Bonded Veneers Veneer Thin layer of tooth-colored material, applied to the facial surface of a prepared tooth Used to improve the appearance of teeth that are: Abraded Eroded Discolored with intrinsic stains Darkened after endodontic treatment Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights
- 29. Fig. 48-15 Veneers placed to reduce discoloration and cover stain. (From Roberson T, et al: Sturdevant’s art and science of operative dentistry, ed 4, St Louis, 2002, Mosby.) dentistry, Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights
- 30. Fig. 48-16 Veneers placed to close diastema. (From Roberson T, et al: Sturdevant’s art and science of operative dentistry, ed 4, St Louis, 2002, Mosby.) dentistry, Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights
- 31. Tooth Whitening Known as vital bleaching, tooth whitening is a noninvasive method of lightening dark or discolored teeth. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights
- 32. Indications for Using a Tooth Whitener Indications for Procedure Extrinsic stains from foods, cigarette smoking, coffee, or tea Aged, discolored teeth Intrinsic stains, such as mild tetracycline stains and mild fluorosis Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights
- 33. Fig. 48-17 Before-and-after photos of tooth whitening used for extrinsic stains. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights
- 34. Fig. 48-18 Before-and-after photos of tooth whitening used for intrinsic stains. (From Roberson T, et al: Sturdevant’s art and science of operative dentistry, ed 4, St Louis, 2002, Mosby.) dentistry, Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights
- 35. Whitening Products Chemical makeup Active ingredient • Either carbamide peroxide or hydrogen peroxide Gel base • With one or a mixture of propylene glycol, glycerin, and water Thickener • Carbopol Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights
- 36. At-Home Tooth-Whitening Procedure Material is placed in a thermoplastic custom tray that the patient wears for a designated period. With the 10% to 16% carbamide peroxide gels, the wear schedule is 1 hour twice a day for the first week and once a day for the second week. The 20% to 22% mixture is used for 1 hour a day for 2 weeks. Hydrogen peroxide is used for 15 to 30 minutes, two or three times a day, for 2 weeks. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights
- 37. Tooth-Whitening Strips Thin, flexible strips are coated with an adhesive hydrogen peroxide whitening gel. Application The patient peels off the backing like a Band-Aid and presses the strip to the facial anterior teeth. The remaining portion of the strip is folded onto the lingual surface. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights
- 38. Possible Complications to Tooth Whitening Thermal hypersensitivity Patient may experience sensitivity to heat and cold after removal of the tray and material. The use of toothpaste for sensitive teeth is recommended. Tissue irritation Gingival tissue exposed to excess gel as a result of improper tray fit may become irritated. Tell the patient not to overfill the tray with material and to remove any excess after seating the tray. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights
- 39. Dental Assistant’s Role in Tooth-Whitening Procedure Aid in recording the medical and dental history. Assist in making shade selection. Take intraoral photographs before and after whitening. Take and pour up preliminary impressions for the tray. Fabricate and trim the tray. Provide postoperative instructions. Assist in weekly or biweekly clinical visits. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights
- 40. Patient Instructions for Tooth-Whitening Procedure Brush and floss before tray placement. Place equal amounts of gel in tray. Seat tray. Do not eat or drink when wearing the tray. Wear tray for the recommended time. If the patient experiences any problems, discontinue use and discuss with the dentist. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights
Editor's Notes
- #5: Restorative dentistry is also called operative dentistry.
- #6: What type of materials would be used for restorative dentistry?
- #7: What type of materials are used for aesthetic dentistry? Why are aesthetics important?
- #8: Understanding the terminology will help dental assistants prepare the correct instruments for a procedure.
- #9: Initial cavity preparation is the first of two stages of cavity preparation and has a set number of steps that the dentist follows in an exact order. This process is performed to gain access to the decay or defect.
- #10: Final cavity preparation is the second stage of cavity preparation. This procedure is followed after the steps in the initial cavity preparation have been completed.
- #11: What is the correct position of a patient during the procedure? How would the dental assistant explain the procedure to the patient?
- #12: What are the appropriate setup items needed for an amalgam restoration? What are the appropriate setup items needed for a composite restoration? How can the dental assistant provide moisture control?
- #14: Why are class I restorations so common? What are pits and fissures? Where are they located?
- #15: Which anterior teeth would have class I restorations?
- #16: What accessory items would be needed for a class II restoration? (Matrix system.) Why would this be needed?
- #17: Which teeth are involved in this example? Which surfaces are involved in this example?
- #18: What accessory items would be needed for class III and class IV restorations? (Mylar-strip matrix system.) Why is this needed? Can a metal matrix system be used?
- #19: Which teeth are involved in this example? What surfaces are involved in this example? Why would a dental dam be needed in this procedure?
- #20: How does a Class IV restoration differ from a Class III restoration? Why would a dental dam be used?
- #21: Class V lesions tend to occur in older patients. Why are older people more susceptible to this type of decay? What material is generally used for this type of restoration?
- #22: What could be used to help reflect the tissue away from the preparation?
- #25: Retention pins are commonly used in a tooth for retaining and supporting a restoration. Multiple pins may be placed in one tooth. Pins are available in different widths and are supplied in a kit.
- #26: A “drill” is used to place the pin in a prepared tooth. No cementation of the pin is required. The extended portion of the retention pin is open to adhere to the restorative material that is to be placed. Why is it important to use a dental dam when preparing and placing pins? (Because the pins are so small, they are easily dropped or misplaced.)
- #27: Intermediate restorations are not meant to be permanent. An intermediate restoration is a preliminary step before a final restoration is placed. Why has this procedure been approved as an expanded function of the dental assistant?
- #28: What is the appropriate consistency of the intermediate restorative material?
- #29: Direct veneers are not fabricated by the dental laboratory technician. Direct veneers are made of a resin composite material. What are some examples of intrinsic stains?
- #30: Which teeth may have been involved in this procedure? Are posterior teeth fitted with veneers? Why or why not?
- #31: What is a diastema?
- #32: How many students know of someone who is currently using a bleaching system? What does the term “vital” mean?
- #33: Patients should be advised that bleaching is neither guaranteed nor permanent.
- #34: How long do the effects of most whitening systems last? (Between 3 and 5 years.)
- #35: What causes intrinsic stains? Intrinsic stains are harder to bleach.
- #36: Whitening product is only applied to the facial surface of the tooth.
- #37: What type of impression is taken? What symptoms would a patient who wore the bleach tray longer than recommended experience? Many patients do not see the effects of bleaching if they do the maxillary and mandibular arches at the same time.
- #38: Extra-strength whitening strips are dispensed by dental offices only.
- #39: Why do patients undergoing tooth whitening need to schedule follow-up dental appointments?
- #40: What is the purpose of taking a preshade? Why are photographs taken before and after the tooth-whitening process?
- #41: Why shouldn’t patients eat or drink while wearing the bleaching trays? What sort of problems may a patient experience during tooth whitening?