Sweet J.A.D.A., Vol. 38, April 1949 . . .

423

The walls of the proximal box were in deciduous molars. The preparation
prepared with just sufficient flare to derived then was analyzed to determine
establish the margins in immune areas, whether or not it met mechanical stand­
but this flare should be kept minimal ards. In certain respects the preparation
always. Decreased flare of the walls failed to conform precisely to mechanical
( i ) increases the retention of the prep­ principles. These variations were de­
aration, (2) provides a greater bulk of scribed and defended. The preparation
filling material in the box area and thus discussed in this paper was based on the
enhances resistance form, and (3) re­ mechanical principles which utilize best
duces concentration of stresses. the favorable properties of silver amal­
gam. Whenever morphology of the tooth,
Sum m ary
comfort of the patient and efficiency of
A detailed outline based on instrumen­ technic warranted, mechanical principles
tation has been presented for the prep­ were violated slightly to meet the situa­
aration of a Class I I amalgam cavity tion.— 725 North University Avenue.

CAVITY PREPARATION IN

DECIDUOUS TEETH

Charles A . Sweet, D.D.S., San Francisco

t is not my intention to minimize the be used, (3) esthetics and (4) economics.

I contribution of numerous dentists who

have added greatly to our knowledge of
cavity preparation in deciduous teeth,
The measurements of deciduous teeth
shown in Figures 1 through 4 are im­
portant in cavity preparation. They have
but rather to explain how this informa­ been taken from drawings and models by
tion should be applied in order to achieve Nuckolls.1 These data have been con­
a finished restoration that will last until firmed by exact measurements of roent­
the tooth is normally exfoliated, with a genograms and ground sections of ex­
minimum of pulpal involvement and tracted teeth. There are occasional slight
maximum resistance to secondary attack variances in individual teeth, not exceed-
by caries. The published works of J . C.
Brauer, F. E. Hogeboom, W. C. McBride
and James Nuckolls should be studied, Read a t the midwinter m eeting o f the Chicago D ental
Society, February 12, 1948.
as much valuable information can be Associate professor of operative dentistry (dentistry
for ch ild ren ), College o f rhysicians and Surgeons, A
obtained from them. School o f Dentistry.
Preparation of cavities in deciduous Figures 5 and 12 are from Grossman, L . I . (ed itor),
L ip p in cotts H andbook o f D ental P ractice . (Sw eet,
teeth should be governed by a scientific C . A ., “ Pedodontics,” p. 303 .) Philadelphia: J . B .
Lippincott Company, 1948.
knowledge of (1) morphology of decid­ 1. f
M cBrid e, W . C ., Juvenile Dentistry ed. 4. (Nuck­
olls, Jam es, Morphology of the Deciduous T eeth,*'
uous teeth, (2) type of filling material to p. 309.) Philadelphia: L e a & Febiger, 1945.
424 The Journal of the American Dental Association

ing 0.3 mm., which can be disregarded 9. Mouth mirror, cotton pliers and ex­
in designing cavities. In Figure 1, right, plorer.
one drawing serves for the lower decidu­
ous central and lateral incisors, as they C lass I Cavities
are approximately equal in size, with a
variance of only 0.1 mm. Type A.— Beginning Cavities. — 1. A No.
Silver amalgam is an ideal filling ma­ 33/2 inverted cone bur in the Contra
terial for deciduous teeth when cavities angle handpiece is used to enter the pit
are properly prepared to receive this type or fissure, and all faulty or precipitous
of restoration. It will stand the stress of grooves are carried out to areas of smooth
mastication and last as long as the de­ enamel.
ciduous tooth is normally retained. When 2. A No. 35 inverted cone bur is used
properly contoured and highly polished, in the contra angle handpiece to enlarge
restorations of silver amalgam are en­ the grooves and establish a pulpal wall
tirely acceptable esthetically (Fig. 5 ). conforming to the contour of the occlu­
Cast restorations are equally successful sal surface.
in deciduous teeth when cavities are prop­ 3. The grooves are widened and the
erly prepared to receive them, but silver cavity outline established with a No. 701
amalgam meets the average person’s tapered fissure bur in the contra angle
economic situation and reduces the cost handpiece. The lateral walls should not
of dental services for the child. parallel each other but should parallel
The morphology of deciduous teeth the external surface of the tooth (Fig.
should determine the size of instruments 6, le ft).
to be used and the type of cavity prepara­ 4. All remaining carious material is
tion to be made in order to minimize pul- removed with the small spoon excavator.
pal" involvement and insure a long-lasting 5. Peripheral smoothness is obtained by
restoration. using a tapered mounted stone in the
To obtain the desired results, careful contra angle handpiece, being careful not
positioning of the patient is advisable, to bevel the cavity outline.
and proper equipment, operative skill
and control of the patient are essential. Type B.— Deep Cavities.—1. A No. 35 in­
verted cone bur in the contra angle
Instrumentarium handpiece is used to eliminate all faulty
or precipitous grooves.
1. No. 33^2, 35 and 36 inverted cone 2. Further enlargement of these
burs for the contra angle handpiece. grooves is accomplished with a No. 36
2. No. 33/2 and 35 inverted cone burs inverted cone bur in the contra angle
for the straight handpiece. handpiece and a pulpal wall is estab­
3. No. 1, 6, 7 and 8 round burs for the lished conforming to the contour of the
contra angle handpiece. occlusal surface. The lateral walls should
4. No. 700, 701 and 702 tapered fis­ not parallel each other but should paral­
sure burs for the contra angle handpiece. lel the external surface of the tooth if
5. Small right and left spoon exca­ possible.
vators. 3. The outline form for the carious
6. Medium right and left spoon exca­ area and the rest of the cavity is best
vators. completed with a No. 702 tapered fissure
7. Medium binangle or Wedelstaedt bur in the contra angle handpiece (Fig.
chisel. 6, right).
8. Small tapered mounted stone for the 4. All remaining carious material is re­
contra angle handpiece. moved with the medium sized spoon ex-
Sweet J.A.D.A., Vol. 38, A p ril 1949 . . . 425

Fig. I. — L e ft : U p p er d ecidu ou s incisors. R ig h t: L ow er decidu ou s incisors

MCOT1IR1 tnnviKCTUH nanam am mm tm oim nmw non tuffH

occiim
{¡ami

nmnsjrt -.'/-'i
FMH.HBIH OBBS^ECTKW FH&UMLCROaSDCTlPK
« 5 0 f f t * . TO UNBUrL liW it j

Fig. s . — L e ft : U pper a n d low er decidu ou s cuspids. R ig h t: U pper first decidu ou s m olar

N
UCKat-J;

KCtUW
L
its aib'n. rfinam fta
OOUfiflL

rwom
ir!wr'i W7.armi
BBTa-ftClflTOtlHSmtfij rtso-frra. hi uwufitM ttm m inw nM jentl
ntSOffltlff TQPb!0-L»apLi|^

Fig- 3■— L e ft : L o w er first decidu ou s m olar. R ig h t: U p p er secon d decidu ou s m olar

426 The Journal of the American Dental Association

cu t from sound tooth structure toward

caries (F ig . 7, le ft).
3. W ith a No. 36 inverted cone bur
in the contra angle hand piece, th e o cclu ­
sal step is fully prepared. T h e op erator
axujfi' fta m m tia a B i r o t nanm; should cut no deeper than ju s t b eneath
ww mm. the dentino-enam el ju n ctio n , so th a t th e
finished preparation of the occlusal step
will follow the inclined planes of the
original occlusal surface. In this way, the
horns of the pulp under the cusps will
m m m i to neot«haIS |
not be endangered (F ig . 7, r ig h t).
I t must be emphasized th a t the o cclu ­
Fig. 4 .— L o w er secon d decidu ou s m olar
sal step should a tta in the m axim um
w idth possible where it jo in s the proxim al
cavator or a No. 6 to No. 8 round bur, portion o f the cavity preparation.
even though the pulp m ay be exposed. 4. T h is occlusal step is un dercu t to the
5. Peripheral smoothness is obtained depth of the cu ttin g blades of th e N o. 36
by using a tapered m ounted stone in the inverted cone bur, or 0.5 m m .
con tra angle hand piece, being careful 5. T h e b u ccal and lingual walls o f the
not to bevel the cavity outline. occlusal step should n ot parallel each
other but should parallel the bu ccal and
lingual extern al surfaces.
Class II Cavities
6. I f ad ditional bulk of filling m aterial
Occlusal Step.— 1. An opening is m ade in is deem ed necessary, a deeper cu t is m ade
sound tooth structure in one of the pits in the cen tral portion of the step w ith a
w ith a No. 1 round bur or No. 33/2 in ­ No. 35 inverted cone b u r in deciduous
verted cone bur in th e con tra angle h and ­ first m olars or a No. 3 6 inverted cone bur
piece, to a depth slightly b eneath the in deciduous second m olars. T h is cut
dentino-enam el ju nction . should be th e exact width o f th e cu tting
2. A straight cu t is m ade fro m this pit blades and one-h alf their depth. T h is step
into the proxim al carious area w ith a No. w ithin the occlusal step will n ot endanger
35 inverted cone bur. I t is less painfu l to the pulp o f the tooth (F ig . 8, le ft ).

Fig. 5 .— A m algam restorations in decidu ou s m olars, properly contoured an d highly p olished

Sweet J.A.D.A., Vol. 38, April 1949 . . . 427

Fig. 6.— L e ft : Class I cavity with latera l walls parallelin g th e extern al su rface o f th e tooth.
R ig h t: C o m p leted outlin e form o f Class I cavity

Fig. 7 .— L e ft : In itial cut in Class I I cavity prep aration . R ig h t: O cclusal step p rep aration
follow in g th e in clin ed plan es o f the cusps

Fig. 8.— L e ft : A step w ithin th e occlu sal step fo r a d d ition al bu lk o f filling m aterial.
R ig h t: C orrect d ep th o f gingival wall
428 The Journal of the Am erican Dental Association

Fig. 9.— L e ft : R eten tion pit in bu ccogin gival angle. R ig h t: A x iopu lpal line angle rou n d ed
fo r a d d ition al bulk o f am algam

Proximal Preparation. — 1. O verhanging n ot attem p t to b ring the buccogingival

enam el on the b u ccal and lingual aspects and linguogingival angles to th e level o f
is chipped o ff w ith the binangle or the cen ter o f th e gingival m argin, fo r
W edelstaed t chisel. caries always penetrates deepest in the
2. W ith a No. 36 inverted cone bur in cen ter portion o f th e proxim al surface,
the co n tra angle hand piece, the gingival unless the cavity is very shallow. T h e gin­
w all is p rep ared ; the b u r is moved buc- gival w all should b e no deeper axially
colingually u n til sound tooth structure th an the w idth o f the cu ttin g blades of
has been reached. T h e op erator should th e N o. 35 inverted cone b u r in deciduous
first m olars or th e N o. 36 inverted cone
bur i'n deciduous second m olars (F ig . 8,
rig h t).
3. All carious dentin is rem oved, even
though th e pulp may be exposed, w ith the
m edium sized right and left spoon e x ca ­
vators or No. 6 to No. 8 round bur.
4. W ith the No. 702 tapered fissure bur
in th e co n tra angle hand piece, th e buccal
and lingual em brasures are opened up.
T h e b u cca l and lingual walls o f the
proxim al portion of the cavity should not
p arallel each other b u t should parallel
the b u cca l and lingual external surfaces.
5. Added retention is obtained by cu t­
ting a small pit a t the buccogingival and
linguogingival angles, using about 1 mm .
of the tip of a No. 700 tapered fissure bur
(F ig . 9 , le ft).
6. A dditional bulk o f filling m aterial
fo r strength is obtained by rounding the
step a t the axiopulpal line angle w ith a
No. 702 tapered fissure bur (F ig . 9,
r ig h t).
Fig. 1 0 .— R eten tion pits at bu ccogin gival an d
linguogingival angles 7. Peripheral smoothness is obtained by
Sweet J.A.D.A., Vol. 38, A p ril 1949 . . . 429

Fig. n . — A : R eten tion p it at incisal angle. B : B u ccal d ov etail utilized on low er cuspid.
C : L in g u al d o v etail p osition ed gingivally with p ro p er d ep th . D : Class V cavity in decidu ou s
cen tral incisor

using a m ounted stone in the co n tra angle in the con tra angle hand piece, beginning
hand piece, being carefu l n o t to bevel the in the proxim al cavity halfw ay betw een
cavity outline. th e gingival and incisal aspects and ex­
tending fro m th e proxim al cavity to th e
Class III Cavities m edian line. I t should b e only as deep as
the cu ttin g blades o f th e bur.
Class I I I cavities are m ade accessible
2. T h is original cu t is extended entirely
by using the N o. 33^2 and N o. 35 in ­
gingivally w ith a No. 35 inverted cone
verted cone burs in th e straight hand ­
b u r in th e co n tra angle handpiece. In
piece. T h e op erator m ust take advantage
order to ob tain sufficient w idth o f the
o f all slight undercuts bu t should n ot en ­
labial or lingual dovetail, the preparation
cro ach axially deeper th an the w idth o f
must always be carried to or b eneath the
the cu ttin g blades o f th e bur.
m argin of the gingiva. T h e dovetail
1. W ith th e N o. 33/2 inverted cone
should be as wide as possible a t its ju n c ­
bur, a sm all p it 0.5 m m . deep is placed
tion w ith th e proxim al cavity. I t should
at the linguogingival and buccogingival
be n o deeper than the cu ttin g blades of
angles p arallel to the axial w all (F ig .
a No. 35 inverted cone b u r (F ig . 11, C ) .
1 0 ).
2. A sm all p it 0 .5 m m . deep is placed
a t th e incisal angle also (F ig . 11, A ) .
3. A ll rem aining carious m aterial is
rem oved w ith the sm all righ t and left
spoon excavators, even though th e pulp
m ay be exposed. T h e enam el is smoothed
by use o f the m edium binangle or W edel-
staedt chisel.

Modified Class III and Class IV Cavities

T o produce a satisfactory cavity p rep­

aration in m odified Class I I I and Class
I V cavities, ad vantage m ust be taken of
the lingual dovetail fo r the upper teeth
or th e labial dovetail fo r th e lower teeth
(F ig . 11, B and C ) .
1. T h e labial or lingual dovetail cu t is
Fig. i a . — U pper cen tral incisors restored with
m ade w ith a No. 33/2 inverted cone bur am algam
 430 The Journal of the American Dental Association

3. The proximal portion of the cavity erator should take advantage of the slight
is now prepared the same way as in the undercuts caused by the cutting blades of
Class I I I cavity, with the No. 33/2 and the inverted cone burs in order to secure
No. 35 inverted cone burs in the contra sufficient retention. All remaining carious
angle handpiece, except that the incisal material is removed with the small or
pit or hole is omitted because it would medium right and left spoon excavators
perhaps dangerously undermine the in­ (Fig. 11, D ). Smoothness of the periph­
cisal edge. eral enamel is obtained by using the me­
4. All remaining carious material is dium binangle or Wedelstaedt chisel and
removed with the small or medium right the mounted stone.
and left spoon excavators, even though
the pulp may be exposed. The enamel is Com m ent
smoothed by use of a medium binangle
These cavity preparations have been
or Wedelstaedt chisel and the tapered
engineered to give adequate retention
mounted stone.
and to allow sufficient bulk of silver
C lass V C avities
amalgam to withstand the stress of mas­
tication. The preparations are designed
Class V cavities are entered with an to avoid endangering the pulp, and they
inverted cone bur and are generally en­ are extended far enough to protect the
larged to a reasonable size with the larger teeth from further attacks by caries
inverted cone and fissure burs. The op­ (Fig. 12).

TOPICAL FLUORIDE SOLUTIONS FOR CONTROL

OF DENTAL CARIES: CONSIDERATIONS

PERTINENT TO THEIR CLINICAL APPLICATION

H . Berton M cC a uley, D.D.S., Bethesda, M d .

d e q u a teconfirmation of the effective­ mum results can be expected only

A ness of topically applied fluoride solu­

tions in limiting dental caries in chil­
dren renders available to the profession
through the practice of a well defined
technic of administration and course of
treatment that are adequately supported
a useful means for controlling at least by clinical evidence.
partially this hitherto practically uncon­ Evidence for the efficacy of topically
trolled disease. Properly and intelligently
utilized, fluorine constitutes an important ' T his article wag prepared a t the request of the Coun­
and greatly needed instrument of preven­ cil on D ental Therapeutics and is officially authorized
for publication in t h e j o u r n a l o f j h e a m e r i c a n d e n ­
tion. Such utilization requires that the t a l a s s o c i a t i o n by the director o f the National Insti­
tutes o f H ealth. T h e opinions expressed are those of
dentist familiarize himself with fluoride the author and do not necessarily reflect the opinions
of the Council on D ental Therapeutics.
solutions, their application to the teeth Senior assistant dental surgeon (R K U . S . Public
H ealth Service, N ational Institu te o f D ental Research,
and their therapeutic limitations. Maxi­ National Institutes o f H ealth, Bethesda, M d.