Conservative Dentistry

Ace Achievers
Dental Academy
CARIOLOGY
It is defined as the microbial disease of the calcified tissues of teeth, characterized by
demineralization of the inorganic portion and destruction of organic substance of the tooth.
According to WHO, caries is defined as a localized post eruptive, pathological process of
external origin involving softening of the hard tooth tissue and proceeding to the formation
of a cavity.
Theories of Caries
The earliest reference of tooth decay appeared around 14th century B.C.
Worm Theory According to concept of that time, the cause of caries was thought to be
.
Galen hypothetized that the dental caries was produced by the action of acids
Humoral along with corroding humors. The four recognized humors of the body were
Theory blood, phlegm, black bile and yellow bile. The imbalance in these humors
resulted in the disease process.
Dental caries originates within the tooth (similar to bone gangrene),
Vital Theory proposed in end of the eighteenth century remained dominant until
nineteenth century.
Robertson (1835) proposed that acids (formed by fermentation of food
particles) cause dental decay. The exact nature of acids and the exact
mechanism of their formation were not known. Different postulates were
Chemical
suggested. One, putrefaction of protein gave rise to ammonia, which was
Theory
subsequently oxidized to nitric acid. Another postulate was that the food was
decomposed to sulphuric acid. Till then, the activity of bacteria was not
recognized.
Miller (1889) propagated the concept of acid formation in the oral cavity and
attributed the synthesis of acid to the action of micro-organisms. He was of
the view that micro-organisms of the oral cavity, by secretion of enzymes or
by their own metabolites degrade the carbohydrates into acids. The acids
Acidogenic formed were recognized as lactic acid, butyric acid, etc. The carbohydrate
Theory content of food lodged onto the tooth surface is the source of acid
production. The acid demineralized the enamel surface. After the
disintegration of enamel, the organisms along with acids penetrate dentinal
tubules leading to dissolution of dentin. The proteolytic enzymes finally
digest the organic part.
Ace Achievers Dental Academy
Gottlieb (1944) was of the view that instead of decalcification of inorganic
proteolytic enzymes attacking the lamellae, rod sheaths, tufts and walls of
tubules etc, i.e. all organic components. The yellow pigmentation, which he
Proteolytic observed with dental caries was attributed to the pigments produced by
Theory proteolytic organisms. Caries is initiated at a slightly alkaline pH produced
by the proteolytic activity liquefying the organic matrix of enamel. Once the
inorganic part sets free after the dissolution of organic part, these salts are
dissolved subsequently by acidogenic bacteria. He was of the view that the
staphylococci play a vital role in initiating proteolytic activity.
Schatz et al. (1955) hypothetized that the microbial degradation of organic
component by proteolysis followed by dissolution of inorganic part by the
process of chelatio
that are able to bind metallic ions such as calcium, iron, copper, zinc, etc. by
Proteolytic valence bonds. The proteolysis chelation theory considers dental caries to be
Chelation bacterial destruction of organic component of enamel and the breakdown
Theory products of these organic components to have chelating properties and
thereby dissolve the minerals in the enamel even at the neutral/ alkaline pH.
A variety of agents such as amino acids, amines and peptides, etc.
are the breakdown products of organic components of enamel and dentin
which can act as chelates.
Sulfatase Pincus (1949) proposed that proteolytic organisms first attacked the protein
Theory elements such as dental cuticle and then destroyed the prism sheaths.
Sucrose Egglers-Lura (1967) ----- sucrose itself and not the acid derived from it can
chelation theory cause dissolution of enamel by forming an ionized calcium saccharate.
Auto-immunity Burch & Jackson (1970) suggested that genes determine whether or not a
Theory site on the tooth is at risk.
Levine (1977) hypothetized -
movement of minerals from saliva/ plaque to enamel and vice versa. The
Theory mechanism emphasized that the demineralization and remineralization of
enamel is a continuous process.
Hypothesis concerning the etiology of Caries

1. Non-specific Plaque Hypothesis
States that all plaque is pathogenic, which is unrealistic
2. Specific Plaque Hypothesis
The alternative, or specific plaque hypothesis, recognizes plaque as pathogenic only
when signs of associated disease are present.
In other words, Specific pathogen like MS (8 serotypes of strep mutans a h) are
cariogenic while other micro organisms like strep mitis / salivarius are not cariogenic.
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3. Ecological Plaque Hypothesis

In this hypothesis, it was proposed that a change in a key environmental factor(s) will
trigger a shift in the balance of the resident plaque microflora, and this might predispose
a site to disease.
The selection of pathogenic bacteria is directly coupled to changes in the environment.
Diseases need not have a specific cause, any species with relevant traits could contribute
to the disease process.
Contributing Factors in Dental Caries

Dental caries is a multi factorial disease. The four factors contributing to caries
process are explained below:
1) Microflora
2) The Host Factor
a) Substrate or diet
b) Time
3) Saliva
a) Physical nature
b) Chemical nature
4) Tooth
Microbiology
The following factors prove the role of bacteria in caries:
- Caries will not occur in the absence of microorganisms.
- Caries can occur in animals even if kept on single type of bacterial growth.
- All oral organisms are not cariogenic, but histologically majority can be isolated from
carious enamel and dentin.
Type Of Caries Micro Organism Human

S.mutans Very significant
S.sanguis Uncertain
Pit and fissure
Lactobacillus sp Very significant
Actinomyces sp By chance
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S.mutans VS
Smooth surface
S.salivarius By chance
A.viscosus VS
A.naeslundii VS
Root surface
S.mutans S
S.sanguis BY CHANCE
Lactobacillus sp VS
Deep dentinal caries A.naeslundii VS
Other filamentous rods VS
The Host Factors
Tooth
Morphology and position in the arch:
- Tooth morphology is recognized as an important factor for initiation of caries.
- Deep pits and fissures make the tooth susceptible to caries because of food impaction and
bacterial stagnation. That is why the occlusal surfaces are more prone to caries.
- The most susceptible teeth are the mandibular first molars amongst the permanent teeth,
closely followed by maxillary first molars, then mandibular and maxillary second molars
and so on.
- Irregularities in the arch form, crowding and overlapping of the teeth also favour the
development of caries. Partially impacted third molars are more prone to caries and so
are the buccally/lingually placed teeth.
Chemical nature:
- The inorganic constituents, such as dicalcium phosphate dihydrate, and fluoroapatite, etc.
make the enamel resistant to caries attack. It has been established that surface enamel is
more caries resistant than the subsurface enamel.
- The surface enamel has more minerals and more organic matter and relatively less water.
In addition, certain elements such as fluoride, chloride, zinc, lead, etc. accumulate more
on the surface enamel than the subsurface enamel.
- With the passage of time, teeth become more resistant to caries because of decrease in
permeability and increase in nitrogen and fluoride content.
- The increase in concentration of fluoride at the subsurface is because of ingestion of
fluoride with age. It is hypothetized that under practical limits, higher the fluoride
concentration of water, the lower the prevalence of caries
Saliva
Xerostomia
Normal resting/ unstimulated secretion rate in adults is between 0.3 and 0.5 ml per minute.
The normal stimulated secretion rate in adults is 1 2 ml per minute.
The term xerostomia is used to describe the perception of a dry mouth, but 50% of salivary
function must be lost before the subjective changes are recognized.
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Causes of Xerostomia
Medications Systemic Causes

Anticholinergics Drugs,
Antidepressants Psychological factors
Radiation Antiemetics Sjogren syndrome
Antihistamines DM
Antihypertensives Smoking
Antiparkinsonian drugs and many more Hormonal changes
Nutritional deficiencies
Signs and Symptoms
Signs Symptoms
Saliva pool disappear Oral dryness (most common)
Mucosa: dry or glossy Halitosis
Glossitis Burning sensation
Angular cheilitis Loss of sense of taste or bizarre taste
Rampant caries Difficulty in swallowing
Periodontitis
Candidiasis
Composition and Viscosity of saliva

Parotid secretions are watery and clear, whereas the minor glands in the mouth and throat
produce secretions that are more viscous and ropy.
The secretions produced by the submandibular and sublingual glands are respectively two
and three times more viscous than parotid saliva.
Under normal conditions the parotid glands produce 50% of the stimulated saliva and 20%
of the resting saliva. Most of the resting saliva is produced by the submandibular (65%),
sublingual (7 8%) and minor salivary glands (7 8%).
Resting saliva is therefore more viscous than stimulated saliva
IgA molecules are secreted by plasma cells within the salivary glands. The total concentration
of IgA in saliva is inversely related to caries experience. IgA specifically inhibits the
adherence of certain strains of streptococci to human buccal epithelium facilitating their
elimination from the oral cavity by swallowing.
Salivary proteins increase the thickness of the acquired pellicle and retard the movement of
calcium and phosphate ions out of enamel.
Statherins inhibit precipitation of hydroxyapatite crystals in saliva. They facilitate
remineralization of early lesions.
Proline rich proteins: They maintain ionic calcium concentration in saliva.
Salivary oral clearance

The process by which saliva dilutes and eliminates food substances such as sugars and acids
from the oral cavity is referred to as salivary or oral clearance.
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The clearance half time is the time taken for the salivary sugar concentration to reduce to
half of its initial concentration.
Buffers
Buffering capacity of saliva is primarily determined by the concentration of bicarbonate ions.
In addition to buffers, saliva contains molecules that contribute to increasing plaque pH.
These include urea and sialin, which is a tetrapeptide that contains lysine and arginine.
Hydrolysis of either of these basic compounds results in production of ammonia, causing the
pH to rise.
The bicarbonate in saliva is able to diffuse into the dental plaque to neutralize the acid formed
from carbohydrate by the microorganisms. The higher the flow rate, the greater will be its
buffering capacity.
Salivary buffer include:
- Phosphate buffer system (HPO or H PO )
- Bicarbonate buffer system (85%) (HCO / H CO )
- Protein buffer system
pH
The pH at which any particular saliva ceases to be saturated with calcium and phosphate is
referred to as the 'critical pH'; below this value, the inorganic material of the tooth may
dissolve.
Critical pH varies according to the calcium and phosphate concentration, but it is usually
about 5.5. With increasing concentration of hydrogen ions in the plaque, more phosphate
ions will leave the solid apatite phase.
Stephan Curve:
sugar intake to values below critical pH, where after it slowly returns to normal.
Fluoride levels in saliva=0.01-0.03 ppm
Diet/Substrate
Physical form
It has been established that the physical nature of diet indirectly affects caries.
Further, it is observed that the mastication of food reduces the number of microorganisms.
Mechanical rubbing and cleaning definitely has role in caries reduction.
Chemical Nature
The main ingredient, carbohydrate, is accepted as one of the most important factor. Only
refined carbohydrates are effective in caries production; however, following factors also
affect:
i. Type of carbohydrate (monosaccharides, disaccharides or polysaccharides).
ii. Frequency of intake.
iii. Time of stagnation.
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It has been established that sugar given in solution form, is much less capable of producing
caries than the same amount of sugar incorporated in food. Also, caries activity is higher
when sugar is administered in the form of sticky food, which tends to remain on the surface
of teeth. However, when dextranase was incorporated in water, it led to reduction in caries
activity.
Vitamins: Vitamins A, C and K do not have any direct effect on caries production; however,
Vitamin B deficiency- caries protective influence; vitamin B is essential in growth of oral
acidogenic flora. They also serve as components of coenzymes involved in glycolysis.
Vitamin D is necessary for the normal development of teeth. Malformation especially
hypoplasia and an increase caries incidence has been reported in Vitamin D deficiency cases.
Similarly vitamin A deficiency during tooth genesis may lead tooth malformation as Vit A
is important for epithelial differentiation.
Certain minerals such as calcium, phosphorous and trace elements influence dental caries
process. The role of calcium and phosphorous is controversial. That caries is inhibited by
high doses of calcium could not be established. Lower doses of calcium during infancy and
intrauterine life can lead to poor calcification of teeth, whereby caries progress becomes
easier.
Selenium incrases caries while vanadium inhibits caries. Fluoride also inhibits caries.
However, topical and water fluoridation are far more effective compared to dietary fluoride.
Time
The frequency to which teeth are exposed to cariogenic (acidic) environments affects the
likelihood of caries development.
After intake of meals or snacks containing sugars, the bacteria in the mouth metabolize them
resulting in production of acids as by-products which decrease pH and lead to dissolution of
inorganic content of the tooth.
It takes around two hours to return the pH to normal and remineralise the tooth surface
through the buffering capacity of saliva. Since teeth are vulnerable during these periods of
acidic environments, the development of dental caries relies greatly on the frequency of these
occurrences.
Histopathology
Enamel Caries
In longitudinal section, enamel caries appear in four zones:
First recognizable zone of alteration
represents the Advancing front of the lesion
Translucent Half the lesions demonstrate TZ; hence not always present
zone Seen in longitudinal ground sections in clearing (quinoline - RI - 1.62)
TZ appears structureless
Pore volume - I% (compared to 0.1 % of sound enamel
This is a thin band superficial to the translucent zone.
Dark zone Lies adjacent and superficial to the translucent zone
Positive zone; Shows positive birefringence (in contrast to sound enamel)
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Pore volume of 2-4% (polarized light)

Micropore system - gets filled with air and becomes dark
Medium like water may penetrate
Between unaffected, surface and dark zone
Area of greatest demineralization
Body of the Pore volume - 5% in periphery and 25% in centre
lesion Quinoline imbibition - body appears transparent
Water imbibition - positive birefringence compared to sound enamel
Striae of Retzius prominent
This is relatively intact layer of enamel. Mineral loss is less than 4%.
Greater resistance probably due to greater degree of mineralization
and greater fluoride concentration
Its radiopacity is comparable to adjacent enamel.
Surface zone
Quantitative studies - partial demineralization of 1-10%
Pore volume - less than 5% of the spaces
Negative birefringence - water imbibition
Positive birefringence - porous subsurface
Zones of Dentinal Caries

Caries advance in dentin proceeds through three changes:
- Weak organic acids demineralizes the dentin
- The organic material of the dentin, particularly collagen, is degenerated and dissolved;
- The loss of structural integrity is followed by invasion of bacteria.
Five different zones have been described in carious dentin.
The zones are most clearly distinguished in slowly advancing lesions.
In rapidly progressing caries, the difference between the zones becomes less distinct.
It is the deepest area; has normal dentin: tubules with odontoblastic
processes that are smooth, and no crystals are in the lumens.
Zone 1 Intertubular dentin: normal cross-banded collagen / normal dense
Normal Dentin apatite crystals.
No bacteria are in the tubules.
Stimulation of the dentin produces a sharp pain.
Zone of demineralization (by acid from caries)of the intertubular
dentin and initial formation of very fine crystals in the tubule lumen at
Zone 2 the advancing front
Subtransparent Damage to odontoblastic process is evident. However, no bacteria are
Dentin found
Stimulation of the dentin produces pain, and the dentin is capable of
remineralization.
Softer than normal dentin; loss of mineral from the intertubular area
Zone 3
Stimulation produces pain. There are no bacteria present
Transparent
The collagen cross linking remains intact in this zone, can serve as a
Dentin
template for remineralization.
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It is the zone of bacterial invasion; Widening and distortion of the

dentinal tubules which are filled with bacteria
Zone 4 There is very little mineral present and collagen in this zone is
Turbid Dentin irreversibly denatured
No potential for self repair; This zone must be removed prior to
restoration
The outermost zone, infected dentin, consists of decomposed dentin
that is teeming with bacteria
Zone 5
There is no recognizable structure in dentin; Absence of collagen and
Infected Dentin
mineral content
Removal of infected dentin is essential to sound, successful restorative
Clinical Correlation
Pit and Fissure Caries
The shape of the pits and fissures contributes to their high susceptibility to caries lesion. The
long, narrow fissure prevents adequate biofilm removal.
Pit-and-fissure caries lesions typically expand as they penetrate into the enamel. The entry
site may appear much smaller than the actual lesion, making clinical detection difficult.
Caries lesions of pits and fissures develop from demineralization on their walls, known as
wall lesions.
In cross-section, the gross appearance of a pit-and-fissure lesion is an inverted V with a
narrow entrance and a progressively wider area of involvement closer to the DEJ.
Clinical Characteristics of Enamel Caries: Incipient Smooth Surface Lesion

A caries lesion that has not been cavitated
In enamel caries, non-
Enamel loses its translucency because of extensive subsurface demineralization resulting in
porosity
Incipient caries vs Hypocalcified Enamel

When enamel is hydrated(wet)
- Incipient caries partially/ totally disappear visually
- Hypocalcified enamel is relatively unaffected by drying and wetting.
Hypocalcified enamel is more of aesthetic problem
Surface texture of incipient lesion remains unaltered, can be detected by tactile examination
with explorer.
Clinical and Histologic Characteristics of Dentinal Caries, Acid Levels, and Reparative
Responses
Progression of caries in dentin is different from progression in the overlying enamel
Dentin is less mineralised and tubules act as pathway for ingression of acids and egression
of mineral.
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The dentinoenamel junction is least resistant to caries attack and allows rapid lateral
spreading once caries has penetrated the enamel. Because of these characteristics, dentinal
caries is V-shaped in cross-section with a wide base at the DEJ and the apex directed pulpally
Caries advances more rapidly in dentin than in enamel because dentin provides much less
resistance to acid attack because of less mineralized content. Caries produces a variety of
responses in dentin, including pain, demineralization, and remineralization.
Diagnosis
(Discussed in other document)
Criteria for visual examination of caries

Score Criteria
0 No or slight change in enamel translucency after prolonged air drying (>5 s)
Opacity or discoloration hardly visible on the wet surface, but distinctly visible
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after air drying
2 Opacity or discoloration distinctly visible without air drying
Localized enamel breakdown in opaque or discolored enamel and/or grayish
3
discoloration from the underlying dentin
4 Cavitation in opaque or discolored enamel, exposing the dentin
Criteria for the histologic examination of fissure caries

Score Criteria
No enamel demineralization or a narrow surface zone of opacity (edge
0
phenomenon)
1 Enamel demineralization limited to the outer half of the enamel layer
Demineralization involving between half of the enamel and outer third of the
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dentin
3 Demineralization involving the middle third of the dentin
4 Demineralization involving the pulpal third of the dentin
Root Caries
Root surface caries are initiated when there is periodontal attachment loss exposing the root
surface to the oral environment.
Root caries is a soft, irregular, progressive lesion occurring at or apical to the CEJ.
An area where root caries has taken place may appear as round or oval in shape which then
may spread radially and join other areas of root caries.
These areas appear as white or discoloured having irregular outline, with or without a cavity
at an exposed root surface
Root caries are more common in males than females.
Most commonly they are seen in mandibular molars, followed by premolars, canines and
incisors. This order is reversed in the maxilla.
Classification of Root Caries

Grade I: Incipient
Grade II: Shallow, less than 0.5 mm depth with pigmentation;
Grade III: Deep lesions, more than 0.5 mm depth.
Grade IV: Pulpal involvement
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Aids in Diagnosing Caries

Radiographic Methods
Bitewing radiographs are advised for incipient lesions at the proximal
surfaces
For the proximal Lesions: Radiographically, a small radiolucent notch
is evident below the contact area in enamel.
Conventional
For Advancing lesion: Radiographically, diffuse triangle with base at
Radiography
the surface of the tooth.
After the lesion crosses the DEJ and invades into the dentin, it appears
as another triangle with the base at DEJ. Appears as two triangles with
their bases facing towards the external surface
Exposure of the film to the X-rays results in selective discharge of the
particles, forming latent image which is then converted to positive
image development in the processor unit.
Xeroradiography
Advantage: Both positive and negative prints are obtained together.
Edge enhancement: one can differentiate areas of different densities,
especially at margins/ edges; Helps with increased diagnostic quality
Image is represented by a spatially distributed set of discrete sensors
and pixels.
Recorded with non film receptors
Digital Image Receptor (DIR): Charged couple device (CCD), which
Digital Imaging
is electronically connected, to a computer
By digital mode, density and contrast upto 70% can be enhanced.
Digital method is 50% more sensitive in detecting occlusal caries as
compared to conventional films.
Subtraction radiography technique reduces/ subtracts noise
Subtraction
(information/ images not of diagnostic value), thus increases the
Radiography
detectability of changes in the radiographic pattern.
Electrical Resistance
Sound tooth enamel - a good electrical insulator (high inorganic content).
Electrical resistance is measuring the electrical conductivity through these pores.
Van Guard electronic caries detector: Electrical conductivity is numerically detected on the
scale from 0-9, indicating a change from sound tooth to an increased degree of
demineralization.
Fibre Optic Trans Illumination

Principle: Carious lesion has lowered index of light transmission, an area of caries appears
darkened shadow that follows the spread of decay through the dentine.
FOTI was initially designed for the detection of proximal caries.
For examination, the tip of the probe is placed in the embrasure immediately beneath the
contact point of the proximal surface to be examined.
The marginal ridge is viewed from the occlusal surface.
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A shadow extending to the dentino-enamel junction beneath the marginal ridge may be
evident if there is a break in the integrity of the enamel of marginal ridge.
Recent Advances in Caries Diagnosis

A variant of Quantitative Laser or Light Induced Fluorescence
system. Light source - diode laser red light 655 nm.
Red light is transported via an angulated tip with central fibre.
Reflected light is eliminated by and taken up by the photodiode and
Diagnodent
processed and presented on display as 0-99.
5-25 initial lesions in enamel
25-35 initial dentinal caries
>35 advanced dentinal lesion
It had higher sensitivity than laser auto fluorescence alone.
Dye-Enhanced
Dyes used are:
laser
- Pyromethane 556
Fluorescence
- Sodium flurescin
A blue light (400-500nm) is used to excite fluorescence with in the
Endoscope tooth.
Advantage: 5-10 fold magnification
For caries enamel:
- Procion: disadvantage irreversible as dye reacts with nitrogen
and hydroxyl groups of enamel
Dye penetration - Calcein: Complexes with calcium
methods - Flourescent: i. Brilliant blue, ii. Zyg to ZX -22
For caries dentin
- 0.5% basic fuschin in propylene glycol
- 1% acid red in propylene glycol
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Ace Achievers
Dental Academy
CONSERVATIVE ARMAMENTARIUM
History
Dr G.V. Black: First acceptable nomenclature for and classification of hand instruments.
Dr. F.K. Weidelstaedt: Developed Weidelstaedt chisel / curved chisel.
Dr. George Hollenback: Invented pneumatic condenser.
Classification of Instruments
A. According to Sturdevant
Cutting Instruments Non-cutting Instruments

Excavator Chisel Others
Ordinary Straight, Knifes,
hatchet, Hoe, curved, files, Amalgam condenser, mirror,
angle former, Binangled, scalers and explorer, probes
spoon excavator enamel hatchet, gingival carvers
margin trimer
B. According to Marzouk
i. Those used for exploration
ii. for removal of tooth structure.
iii. for restoration of teeth.
Metals used in the Manufacture of Hand Instruments
Carbon Steel Stainless Steel

Carbon steel alloy contains 0.5 to 1.5% Stainless steel alloy contains 72 to 85 percent iron,
carbon in iron. 15 to 25 percent chromium and 1 to 2 percent
Advantage: high hardness and sharpness. carbon.
Disadvantage: increased susceptibility to Instruments made from stainless steel remain
corrosion and the fracture if dropped. shiny bright because of deposition of chromium
They are of two types: oxide layer on the surface of the metal and
Soft steel: It contains < 0.5% carbon chromium reduces the tendency to tarnish and
Hard steel: It contains 0.5-1.5% carbon corrosion.
Problem with stainless steel instruments is that
they tend to lose their sharpness with repeated use,
so they need to sharpened again and again
Stainless Alloys
Stainless steel Monel Metals Nichrome Stellite Tarno

Carbon 6-10% Nickel 67% Nickel 60-80% Cobalt 65-90%
Chromium 12- Chromium 10-
Chromium 18% Copper 28%
20% 35%
Chromium alloy
Tungsten,
Iron 81-81.4% Iron 5% Iron 0-2.6% Molybenum, Iron
or Nickel
Heat Treatment of Steel
Hardening Heat Treatment Tempering Heat Treatment

Steel is heated to 15000 F in oxygen free Cutting edges are tempered to remove brittleness
environment, then quenched in oil. / provide additional hardness.
This hardens the alloy, but also makes it Steel is reheated for one hour at 3500 F and then
brittle, especially when the carbon quenched in oil for 10 minutes, relieves strain /
content is high. increases toughness.
Sterilisation of Instruments
Sterilizing carbon steel instruments by using
- Sporicidal cold disinfection: glutaraldehyde
- Steam under pressure (autoclave)
- Chemical vapour
- Hot air (dry heat).
Sterilizing carbon steel instruments by any of the first three methods causes discoloration,
rust, and corrosion.
Design Characteristics of Hand Cutting Instruments
Most hand instruments, regardless of their use, are composed of three parts blade, shank
and handle.
It is mostly straight and octagonal in cross-section, and may be serrated to increase
friction for hand gripping.
Handle
Handles are available in various sizes and shapes Most instrument handles are
small in diameter (5.5 mm) and light.
The blade is the working end of the instrument and is connected to the handle by
the shank. For many non-cutting instruments, the part corresponding to the blade
is termed as nib.
Blade The end of the nib, or working surface, is known as face
or nib Cutting edge is at 45 with blade for both bulk and sharpness on the edge.
The sides of the blade also can be bevelled and may be used for cutting tooth.
Two additional edges, called secondary cutting edges, extend from the primary
edge for the length of the blade
Connects the handles to the working ends of the instruments.
It is normally smooth, round and tapered.
The shank can be straight, monoangled, binangled, triple angled and quadrangled.
Shank
Term contra-angle refers to a shank in which two or more angles are necessary to
bring the working end into near alignment with (within 2-3mm) the axis of the
handle. The angulation in the shank provides balance, thus no rotation/ twisting of
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the hand occurs so that when force is applied or exerted on the instrument, no
torque should be produced.
Instrument Nomenclature
Black assigned names to cutting instruments based on their appearance
- Hatchet
- Spoon
- Hoe
- Chisel
Dr. G.V. Black established a nomenclature for hand instruments, similar to the biological
classification.
1. Order: Purpose of instrument, e.g. excavator or scaler
2. Suborder: Position or manner of use, e.g. push, pull
3. Class: Form of working end, e.g. hatchet, chisel.
4. Subclass: Shape of the shank, e.g. monangle, binangle
Naming of the instruments usually moves from 4 to 1, e.g. a binangle hatchet push, excavator.
In most cases, the suborder describing the position or manner of use is variable and non-
specific; and for practical purpose it is usually omitted.
Dr. G.V. Black gave an instrument formula that describes the dimension and angulation of
the hand instruments.These are placed on the handle using a code of three or four numbers
separated by dashes or spaces.
The basic formula consists of three units whose measurements are based upon the metric
system:
- The 1st figure represents the width of the blade in tenths of a millimeter.
- The 2nd figure represents the length of the blade in millimeters.
- The 3rd figure represents the angle which the blade forms with the axis of the handle. This
angle is expressed in 100th of a circle or centigrades.
Four Numbered code consists of:
First The first number indicates the width of the blade or primary cutting edge in tenths
Number of a millimetre (0.1 mm)
The second number of a four-number code indicates the primary cutting edge
angle, measured from a line parallel to the long axis of the instrument handle in
Second clockwise centigrade. The centigrade angle is expressed as a percent of 360
Number degrees. The instrument is positioned so that this number always exceeds 50. If
the edge is locally perpendicular to the blade, this number is normally omitted,
resulting in a three-number code.
Third The third number (second number of a three-number code) indicates the blade
Number length in millimetres
The fourth number (third number of a three-number code) indicates the blade
Fourth angle, relative to the long axis of the handle in clockwise centigrade (e.g.
Number 14 = 50.4 degrees). The instrument is positioned such that this number is always
50 or less.
Examples of three number formula instruments are chisels, hatchets and hoes
Examples of four number formula instruments are angle formers, and gingival marginal
trimmers.
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Instrument Designs
Most hand-cutting instruments have a single bevel on the end of the blade that forms the
primary cutting edge.
Two additional bevels form secondary cutting edges and extend from the primary edge for
the length of the blade.
Principle of cutting with hand instrument is concentrate forces on a very thin cross section
of the instrument at cutting edge. Thinner the cross-section, more is the pressure concentrated
and more efficient the instrument will be:
Direct Cutting Instruments Lateral Cutting Instruments

Force is applied in the same plane as that of Force is applied at right angles to the plane of
the blade and handle. the blade and handle
It is single planed instrument. They have curved blades & are double planed
They can be used for lateral cutting if they are instruments.
contra angled. Only used for lateral cutting
Single Bevelled Instruments

Instruments, which have a bevel on only one side of the instrument blade, are known as single
bevelled instruments. The instrument is held such that the instrument blade faces downwards
and away from the operator.
If these are regularly bevelled on the side away from the shaft, they are distally
bevelled these are bevelled on the side of the blade towards the shaft, they are called
mesially bevelled
If the bevel is on the right side of the instrument blade, it is a right-sided instrument and if
the bevel is on the left side of the instrument, it is a left-sided instrument.
When these types of instruments have no angle in the shank or an angle of 12.50 or less they
are used in push (direct cutting) and scraping motions. If this angle in the shank exceeds
12.50, the instruments could be used in pull (distally bevelled) and push (mesially bevelled)
motions.
Bi-bevelled instruments:
Instruments which have two bevels on the opposing side of the instrument blade which meet
together to form the cutting edge are called bi-bevelled instruments, e.g. ordinary hatchet.
Triple-bevelled instruments:
Bevelling the blade laterally, together with the end, forms three distinct cutting edges in a
triple bevelled instrument, e.g. angle former
Circumferentially bevelled instruments:

These are usually double-planed instruments where the blade is bevelled at all peripheries,
e.g. spoon excavator.
Single-ended and double-ended instruments:

Single-ended instruments are confined to only one specific function; while double-ended
instrument incorporates the right and left or mesial and distal forms of the instrument in the
same handle.
4
Applications of Cutting Instruments

Angle formers is a type of excavator which is monoangled with the cutting edge sharpened
at angle to the long axis of the blade. Angle is between 80 to 85 degrees. It is used with a
push or pull motion for accentuating line and point angles, to establish retention form in
direct filling gold restoration.
Gingival margin trimmer (GMT) is a modified hatchet which has working ends with
opposite curvatures and bevels. Distal gingival margin trimmer is used for the distal surface
and mesial GMT is used for mesial surface. If 2nd number in GMT is 75 to 85, it is mesial
GMT, if it 95 to 100 it is distal GMT. It is used for planing of the gingival cavosurface margin
and to bevel axiopulpal angle in Class II tooth preparation.
Rotary Instruments
Classification of Speed
By Sturdevant By Marzouk
Low or slow speed-below 12,000 rpm Ultra low speed-300 to 3000 rpm
Medium /intermediate speed-12,000 to Low speed- 3000 to 6000 rpm
2,00,000 rpm Medium high speed-20,000 to 45,000 rpm
High or ultra-high speed-above 2,00,000 High speed-45,000 to 1,00,000 rpm
rpm Ultra-high speed-above 1,00,000 rpm
Dental Burs
Bur Designs
Blade is a projection on the bur head which forms a cutting edge. Blade has
two surfaces:
Bur blade
Blade face/Rake face: It is the surface of bur blade on the leading edge.
Clearance face: It is the surface of bur blade on the trailing edge.
This is angle between the rake face and the radial line
Positive rake angle: When rake face trails the radial line.
Rake angle
Negative rake angle: When rake face is ahead of radial line.
Zero rake angle: When rake face and radial line coincide each other
Radial line It is the line connecting center of the bur and the blade
This is the angle between the clearance face and the work
Clearance
Clearance angle provides a stop to prevent the bur edge from digging into
angle
the tooth and provides adequate chip space for clearing debris
Blade angle It is the angle between the rake face and the clearance face
It is a direct measurement of the symmetry of the bur head itself i.e. how
Concentricity closely a single circle can be passed through the tips of all of the blades. It
is a static measurement test.
It measures the accuracy with which all the tip of blades pass through a
single point when bur is moving. It measures the maximum displacement
of bur head from its center of rotation. In case, there is trembling of bur
Run out
during rotation, this effect of run out is directly proportional to length of
bur shank.
It is a dynamic test of concentricity.
5
Run out occurs if:

Bur head is off center on axis of the bur.
If bur neck is bent
If bur is not held straight in handpiece chuck
Run out causes:
Increase in vibration during cutting.
Causes excessive removal of tooth structure
Factors affecting the cutting Efficiency of Bur

1. Clearance angle, rake angle and blade angle: Clearance angle reduces the friction between
cutting edge and the work. It also prevents the bur from digging excessively into the tooth
structure. Positive rake angle increases cutting efficiency of bur, but increase in rake angle
causes decrease in bulk of bur blade and clogging of flute space because of production of
larger chips.
2. End cutting or side cutting bur: According to particular task, choice of bur can be end
cutting, side cutting or combination of both. For example, it is preferred to make entry to
enamel by end cutting bur, while for making preparation outline, use side cutting bur.
3. Neck diameter of bur: If neck diameter of bur is large, it may interfere with accessibility
and visibility. But if diameter is too short, it will make bur unable to resist the lateral forces.
4. Spiral angle: Burs with smaller spiral angle have shown better efficiency at high speeds.
5. Linear surface speed: Within the limit, faster the speed of cutting instrument, faster is the
abrasive action and more efficient is the tooth cutting instrument. Bur speed should be
increased in limits because with ultra high speed, centrifugal force comes into the play.
6. Application of load: Load is force exerted by an operator on tool head. Normally for high
speed instruments, load should range between 60-120 gm and for low rotational speeds, it
should range between 1000-1500 gm. Cutting efficiency decreases when load is applied,
there is increase in temperature at work face which results in greater wear and tear of
handpiece bearings.
7. Concentricity and run out: The average clinically acceptable run out is 0.023 mm. Increase
in run out causes increase in vibrations of the bur and excessive removal of tooth structure.
8. Lubrication: Lubricant/coolant applied to tooth and bur during cutting increases the cutting
efficiency and decreases the rise in temperature during cutting.
9. Heat treatment of bur: Heat treatment of bur preserve the cutting edges and increases shelf
life of the bur
10. Number of blades: Usually a bur has 6-8 number of blades. Decrease in number of blades
increases the cutting efficiency due to larger chip size and faster clearance of debris because
6
of larger chip space. Burs with more number of flutes have lesser cutting efficiency, produce
more heat. Such burs are better for polishing and finishing.
11. Presence of Cross cuts: presence of cross cuts on the carbide burs blades/flutes increases
the cutting efficiency. Such burs are very aggressive and usually used to cut through metals.
Mechanism of Cutting of Carbide Burs

Tooth structure, similar to other materials, undergoes brittle and ductile fractures:
- Brittle fracture is associated with crack production usually by tensile forces
- Ductile fracture involves plastic deformation of material usually proceeding by shear
forces
For the blade to initiate the cutting action, it must be sharp, must have a higher hardness and
modulus of elasticity than the material being cut and must be pressed against the surface with
sufficient force.
The high hardness and modulus of elasticity are essential to concentrate the applied force on
a small enough area to exceed the shear strength of the material being cut.
Carbide burs are better for end cutting, produce lower heat and have more blade edges per
diameter for cutting. They are used effectively for punch cuts to enter tooth structure, intra-
coronal tooth preparation, amalgam removal, small preparations and secondary retention
features.
Diamond Abrasives
Cutting occurs at numerous points where individual hard particles protrude from the matrix
rather than along a continuous blade edge.
Individual diamond particles have very sharp edges, are randomly oriented on the surface,
and tend to have large negative rake angles
Diamond instruments consist of three parts:
- Metal blank,
- Powdered diamond abrasive and
- Metallic bonding material that holds the diamond powder onto the blank
Abrasive Cutting
The cutting action of diamond abrasive instruments is similar in many ways to that of bladed
instruments, but key differences result from the properties, size and distribution of the
abrasive
Diamond instruments cutting ductile materials (dentin):
- When diamond instruments are used to cut ductile materials, some material is removed
as debris, but much material flows laterally around the cutting point and is left as a ridge
of deformed material on the surface.
- Repeated deformation work hardens the distorted material until irregular portions
become brittle, break off and are removed.
- This type of cutting is less efficient than that by a blade; burs are generally preferred for
cutting ductile materials such as dentin.
Diamond instruments cutting brittle materials (enamel)
- Diamonds cut brittle materials by a different mechanism.
- Most cutting results from tensile fractures that produce a series of subsurface cracks
- Diamonds are most efficient when used to cut brittle materials and are superior to burs
for the removal of dental enamel.
7
Diamond instruments have higher hardness, and coarse diamonds have high cutting
effectiveness.
Diamonds are more effective than burs for intra-coronal and extra-coronal tooth preparations,
bevelling enamel margins on tooth preparations and enameloplasty.
Diamond Particle Factors

Diamond particle size is commonly categorized for diamond preparation instruments as one
of the following:
i. Coarse (125 150 µm)
ii. Medium (88 125 µm)
iii. Fine (60 74 µm) and
iv. Very fine (38 44 µm)
Diamond finishing instruments use even finer diamonds (10 38 µm) to produce relatively
smooth surfaces for final finishing with diamond polishing pastes
8
Ace Achievers
Dental Academy
Fundamentals Of Cavity Preparation

Definition of tooth preparation
Tooth preparation is the mechanical alteration of a defective, injured, or diseased tooth
to receive a restorative material that re-establishes a healthy state for the tooth,
including esthetic corrections where indicated and normal form and function.
Objective of tooth preparation

1. Remove all defects and provide necessary protection to the pulp.
2. Extend the restoration as conservatively as possible.
3. Form the tooth preparation so that under the force of mastication the tooth or the
restoration or both will not fracture and the restoration will not be displaced.
4. Allow for the esthetic and functional placement of a restorative material.
Terminologies
1. TOOTH PREPARATION WALLS
INTERNAL WALL: An internal wall is a prepared surface that does not extend to
the external tooth surface.
AXIAL WALL: An axial wall is an internal wall parallel with the long axis of the
tooth.
PULPAL WALL: A pulpal wall is an internal wall that is perpendicular to the long
axis of the tooth and occlusal of the pulp.
EXTERNAL WALL: An external wall is a prepared surface that extends to the
external tooth surface.
FLOOR (SEAT): A floor is a prepared wall that is reasonably flat and perpendicular
to the occlusal forces that are directed occlusogingivally.
ENAMEL WALL: The enamel wall is that portion of a prepared external wall
consisting of enamel.
DENTINAL WALL: The dentinal wall is that portion of a prepared external wall
consisting of dentin, in which mechanical retention features may be located.
2. TOOTH PREPARATION ANGLES

LINE ANGLE: A line angle is the junction of two planal surfaces of different
orientation along a line.
- An INTERNAL LINE ANGLE is a line angle whose apex points into the tooth.
- An EXTERNAL LINE ANGLE is a line angle whose apex points away from the
tooth.
POINT ANGLE: A point angle is the junction of three planal surfaces of different
orientation.
CAVOSURFACE ANGLE AND CAVOSUFACE MARGIN

The cavosurface angle is the angle of tooth surface formed by the junction of a prepared
wall and the external surface of the tooth. The actual junction is referred to as the
cavosurface margin.
ENAMEL MARGIN STRENGTH: One of the most important principles in tooth

preparation is the concept of the strongest enamel margin. It is influenced by two
significant features:
- Formed by full-length enamel rods whose inner ends are on sound dentin.
Because enamel rods are perpendicular to the enamel surface, the strongest
enamel margin results in a cavosurface angle greater than 90 degrees.
- An enamel margin composed of full-length rods that are on sound dentin but are
not buttressed tooth-side by shorter rods also on sound dentin is termed strong.
- Generally, this margin results in a 90 degrees cavosurface angle.
- An enamel margin composed of rods that do not run uninterrupted from the
surface to sound dentin is termed unsupported, and this marginal enamel tends
to split or fracture off, leaving a Vshaped ditch along the margin of a restoration.
Usually, this weak enamel margin either has a cavosurface angle less than 90
degrees or has no dentinal support.
CLASSIFICATION OF TOOTH PREPARATION

I. CLASS I restorations: All pit and fissure restorations are Class I and they are
assigned to three groups.
Restorations on occlusal surface of premolars and molars.
Restorations on occlusal two thirds of the facial and lingual surfaces of
molars.
Restorations on lingual surface of maxillary incisors.
II. CLASS II Restorations: Restorations on the proximal surfaces of posterior teeth
are Class II.
2
III. CLASS III Restorations: Restorations on the proximal surfaces of anterior teeth
that do not involve the incisal angle are Class III.
IV. CLASS IV Restorations: Restoration on the proximal surface of anterior teeth that
do involve the incisal edge are Class IV.
V. CLASS V Restorations: Restorations on the gingival third of the facial or lingual
surfaces of all teeth are Class V.
VI. CLASS VI Restoration:
Restorations on the incisal edge of anterior teeth or the occlusal cusp heights of
posterior teeth are Class VI.
Type of tooth preparation Line angles Point angles

Class I 8 4
Class II 11 6
Class III 6 3
Class IV 11 6
Class V 8 4
STAGES OF TOOTH PREPARATION

INITIAL CAVITY PREPARATION
FINAL CAVITY PREPARATION STAGE
STAGE
Outline form and initial Removal of any remaining enamel
depth pit fissure and or infected dentin
Step-1 Step-5
and /or old restorative material if
indicated.
Step-2 Primary Resistance form Step-6 Pulp protection
Primary Retention form Secondary resistance and retention
Step-3 Step-7
form
Convenience form Procedure for finishing external
Step-4 Step-8
walls
Final procedure; cleaning
Step-9
inspecting; varnishing conditioning
INITIAL TOOTH PREPARATION STAGE

Initial tooth preparation is the extension and initial design of the external walls of the
preparation at a specified limited depth so as to provide access to the caries or defect,
reach sound tooth structure, resist fracture of the tooth or restorative material from
masticatory forces principally directed with the long axis of the tooth and retain the
restorative material in the tooth.
STEPS IN INITIAL TOOTH PREPARATION

Outline form and initial depth
Primary resistance form
Primary retention form
Convenience form
3
OUTLINE FORM AND INITIAL DEPTH

Definition: Establishing the outline form means (1) Placing the preparation margins in
the positions they will occupy in the final preparation except for finishing enamel walls
and margins and (2) Preparing an initial depth of 0.2 to 0.8 mm pulpally of the DEJ
position or normal root-surface position.
PRINCIPLES:
1. All friable or weakened enamel should be removed.
2. All faults should be included.
3. All margins should be placed in a position to afford good finishing of the margins of
the restoration.
Factors affecting outline form:

Extent of the carious lesion, defect or faulty old restoration.
Esthetic and occlusal conditions.
Adjacent tooth contour.
Desired cavosurface marginal configuration of the proposed restoration.
Outline form and initial depth for pit and fissure lesions
Controlled by 3 factors:
1. The extent to which the enamel has been involved by the carious process.
2. The extensions that must be made along the fissures to achieve sound and smooth
margins.
3. The limited bur
Rules
1. Extend the preparation margin until sound tooth structure is obtained and no
unsupported or weakened enamel remains.
2. Avoid terminating the margin on extreme eminences such as cusp heights or ridge
crests.
3. If the extension from a primary groove includes one half or more of the cusp incline,
consideration should be given to capping the cusp.
4. Extend the preparation margin to include all of the fissure that cannot be eliminated
by appropriate enameloplasty.
5. Restrict the pulpal depth of the preparation to a maximum of 0.2 mm into dentin.
First prepared to a depth of 1.5 mm, as measured at the central fissure. Depending
on the cuspal steepness angles, the facial and lingual prepared walls are greater
than 1.5mm.
Cusp capping
Due to caries, preparation may extend on to the cuspal inclines.
As intercuspal width of cavity increases dramatic reduction in cusp strength.
Weakened cusps: unable to bear the masticatory forces.
4
Cusp reduction should be considered when the outline form has extended half the
distance from a primary groove to a cusp tip.
Cusp reduction usually is mandatory when the outline form has extended two thirds
the distance from a primary groove to a cusp tip.
Exception:
- Cusp is unusually large, and the operator judges that adequate cuspal strength
remains.
- When bonded restoration is being used, and the operator judges the bonding to
provide for adequate remaining cuspal strength.
Extend the preparation margin to include all of the fissure that cannot be eliminated
by appropriate ENAMELOPLASTY
ENAMELOPLASTY
Sometimes a pit or groove does not penetrate to any great depth into enamel and does
not allow proper preparation of tooth margins except by undesirable extension.
If such a shallow feature is removed, and the convolution of the enamel is rounded or
-cleansing. This procedure of reshaping the enamel
surface with suitable rotary cutting instruments is termed ENAMELOPLASTY.
Indications
If1/3rd or less of enamel depth is involved: fissure removed by enameloplasty.
When supplemental grooves extend till the cuspal inclines.
Shallow fissure that approaches or crosses a lingual or facial ridge.
PRIMARY RESISTANCE FORM

It may be defined as the shape and placement of the preparation walls that best enable
the restoration and the tooth to withstand, without fracture, masticatory forces
delivered principally in the long axis of the tooth.
Principles: 6 principles
1. To use the box shape with relatively flat floor.
a. Flat pulpal floor: Helps to prevent the movement of the restoration.
b. Rounded pulpal floor: May allow a non-bonded restoration to rock upon,
producing a wedging force which may result in cusp fracture.
5
2. To restrict the extension of the external walls to allow strong cusp and ridge areas
to remain with sufficient dentin support.
3. Rounding off internal line angles- reduce stress concentrations in tooth structures.
4. To cap weak cusps.
5. To provide enough thickness of restorative material to prevent its fracture under
load.
6. To bond the material to tooth structure when appropriate.
Factors
1. Type of restorative material.
2. Occlusal contact on the restoration and the remaining tooth structure.
3. Amount of remaining tooth structure.
PRIMARY RETENTION FORM

The shape or form of the conventional preparation that resists displacement or removal
of the restoration by tipping or lifting forces.
Principles
Retention form for silver amalgam restorations
1. Occlusal Convergence.
2. Occlusal dovetail in class II preparations.
3. Slight undercuts can be given in the dentin.
4. Adhesive systems in amalgam: bond and decrease microleakage.
5. Cavosurface angle :90 degree: butt joint.
Retention form for cast restorations

Parallelism of walls: slight divergence (2° 5°).
- The greater the vertical height of the walls, the more divergence is permitted and
recommended.
Occlusal extension is mandatory even if no occlusal caries is present since it
prevents tilting.
Reverse bevel at the gingival wall: prevent tipping movements.
Wedge retention.
Luting agent: Frictional resistance and mechanical interlocking of luting agent into
minute irregularities.
Minimum Occlusal thickness
Amalgam 1.5 mm
Cast metal 1-2 mm
Porcelain 2 mm
CONVENIENCE FORM
It is the shape or form of the preparation that provides for adequate observation,
accessibility, and ease of operation in preparing and restoring the tooth.
6
Ideally, a tooth preparation fulfilling all requirements for outline, resistance and
retention forms will be convenient to instrumentation.
Modes to obtain convenience form

(i) Modification in tooth preparation:
a. Extending proximal preparations beyond proximal contacts to obtain
clearance with an adjacent proximal surface affords better access to finish
the preparation walls and the restorative material and to place a matrix.
(ii) Instrument modification: Facilitates access and
a. Contra-angling enables force
b. Bayonetting application in the proper
c. Addition of several angles to the shank of an instrument directions.
(iii) Separation:
a. Wedging teeth away from each other can be the most radical way to make
interproximal instrumentation convenient
b. However, the use of wedges interproximally during proximal surface
instrumentation is the most indicated convenience form to be used.
FINAL PREPARATION STAGE

When the extension and wall designs have fulfilled the objectives of initial tooth
preparation, the preparation should be inspected carefully for other needs.
Steps in final tooth preparation

Removal of any remaining enamel pit or fissure, infected dentin, or old restorative
material, if indicated:
- It is the elimination of any infected carious tooth structure or faulty restorative
material left in the tooth after initial tooth preparation
(i) Removal of remaining enamel pit or fissure
- Removal of remaining enamel pit or fissure occurs as a small, minimally
extended excavation on isolated faulty areas on the pulpal floor.
- Lasers, microabrasion units and other technologically advanced systems all
have been proposed but none has shown complete reliability.
- This technology should not be used as the primary diagnostic method but;
1. To help with questionable diagnosis.
2. Indicate potential preventive interventions.
3. Monitor suspicious areas
(ii) Removal of infected dentin
Infected Dentin Affected Dentin

Outer layer Inner layer
Wet aspect and soft consistency Hard and leathery consistency
highly infected by bacterial No bacterial penetration, only toxin
penetration penetration
7
irreversible degradation of collagen partially demineralized, collagen fiber

fibers still intact
no possibility of remineralization can be re-mineralized
stained by caries detector dye Cannot be stained by caries detector dye
Must be removed Can be preserved.
Techniques for caries removal

Large areas of soft caries are best removed with spoon excavators by flaking up the
caries around the periphery of the infected mass and peeling it off in layers. Leaving
carious dentin at the DEJ area is unacceptable.
Regarding the removal of the harder, heavily discoloured dentin:

Use of spoon excavators.
Round steel burs at very low speed.
Round carbide burs rotating at high speeds.
(iii)Removal of remaining old restorative material, when indicated, also is

accomplished with use of a round carbide bur, at slow speed with air or air-water
coolant.
The water spray (along with high-volume evacuation) is used when removing old
amalgam material to reduce the amount of mercury vapor.
Pulp Protection, if Indicated.

Clinical judgement about the need for specific liners and bases are linked to:
1. Amount of remaining dentin thickness.
2. Considerations of adhesive materials.
3. Type of restorative material being used.
Liners Bases
Electrical insulation/Thermal (1-2 MICROMETERS)
protection. Provide thermal protection for the
NEED: Pulpally extended metallic pulp
restorations that are not well bonded Distribute local stresses from the
to the tooth and are not insulating. restoration across the underlying
1. THIN FILM LINERS (1-50 MICRO dentin.
METERS)
- Solution liners (varnishes, 2-5
micro meters)
- Suspension liners (20-25
micro meters)
2. THICK LINERS (200-1000 MICRO
METERS)
In a shallow tooth excavation, there is no need for pulpal protection other than in
terms of chemical protection.
8
For an amalgam restoration, the preparation is coated with two coats of a varnish, a
single coat of dentin or a dentin bonding system, and then restored.
In most cases, a dentin sealer is the material of choice.
In a moderately deep tooth excavation for amalgam that includes some amount of
preparation toward the pulp so that a region includes less than ideal dentin
protection, it is judicious to apply a liner only at that site using ZOE or calcium
hydroxide. A sealer is then applied before placing a final amalgam restoration.
SHALLOW EXCAVATION- Sealer

(RDT greater than 2mm)
MODERATE EXCAVATION- Base/Sealer
(RDT 0.5-2mm)
DEEP EXCAVATION- Calcium Hydroxide/Base/Sealer
(RDT less than 0.5mm)
SECONDARY RESISTANCE AND RETENTION FORMS

Mechanical retention features:
(a) Retention locks, grooves and coves.
Vertically oriented For proximal portions of some

retention locks and conventional tooth preparations (locks for
retention grooves amalgams)
Horizontally oriented Class III and V preparations for amalgam

retention grooves
Retention coves Incisal retention of class III amalgams

(Appropriately placed Occlusal portion of amalgam restorations.
undercuts) Class V amalgams
(b) Pins, Slots, Steps and Amalgampins

Increases retention and resistance forms.
Amalgam pins and properly positioned steps also improve retention form.
Placement Of Etchant, Primer Or Adhesive on the prepared walls

Enamel wall etching: For bonded restorations that use porcelain, composite or
amalgam materials etch the enamel by an appropriate acid, which causes a
microscopically roughened surface to which the bonding material is mechanically
bonded.
9
PROCEDURES FOR FINISHING THE EXTERNAL WALLS OF THE TOOTH PREPARATION
OBJECTIVES:
Create the best marginal seal possible between the restorative material and the
tooth structure.
Afford a smooth marginal junction.
Provide maximal strength of the tooth and the restoration at and near the margin.
FACTORS:
1. The direction of the enamel rods.
2. The support of the enamel rods at the DEJ and laterally (preparation side).
3. The type of restorative material to be placed in the preparation.
4. The location of the margin.
5. The degree of smoothness or roughness desired.
FEATURES
Degree of smoothness or roughness of
Design of the cavosurface angle
the walls
The restorative material is the Cavosurface angle of produces
primary factor dictating the desired maximal strength for the amalgam
smoothness or roughness of an and the tooth.
enamel wall.
For amalgam restorative materials, a Beveling is contraindicated except on
more rough surface prepared wall the gingival floor of a class
markedly improves resistance to preparation when enamel is still
marginal leakage. present.
Silver amalgam: butt end of the cavosurface margins: poor edge strength.
- Gingival wall is slightly bevelled [15-20 deg]
Gold foil restorations: ultra short bevel.
cast gold restoration: short bevel.
Avoided in porcelain and resin materials.
FINAL PROCEDURES: CLEANING, INSPECTING AND SEALING

Removing all chips and loose debris that have accumulated and drying the
preparation.
Procedure: Free the preparation of visible debris with warm water from the syringe
and then to remove the visible moisture with a few light surges of air from the air
syringe.
The routine use of specific disinfection medicaments is no longer a strong
consideration.
10
Ace Achievers
Dental Academy
ISOLATION IN OPERATING FIELD

GOALS OF ISOLATION:
1. Moisture control: It refers to excluding sulcular fluid, saliva and gingival bleeding
from the operating field. It also refers to preventing the handpiece spray and
restorative debris from being swallowed or aspirated by the patient.
2. Retraction and Access: It involves:
a. Maximal exposure of operating site
b. Maintaining an open mouth
c. Depressing or retracting the gingival tissue, tongue, lips, and cheek
3. Harm prevention: An important consideration of isolating the operating field is
preventing the patient from being harmed during the operation. It includes:
a. Excessive saliva, handpiece spray can alarm the patient.
b. Small instruments, restorative debris can be aspirated.
c. Soft tissue damage.
METHODS OF ISOLATION:
ISOLATION FROM MOISTURE ISOLATION FROM SOFT TISSUES
Direct methods Indirect methods Retraction of the Retraction of gingiva

Rubber dam Comfortable Cheeks, Lips And 1. PHYSICO-
Cotton rolls and position of the Tongue MECHANICAL MEANS
patient and relaxed Rubber dam Rubber dam
cotton roll holder
Gingival retraction cords
Gauze pieces surrounding Cotton rolls
or rolled cotton twills
Absorbent wafers Local anaesthesia Tongue guards
Wooden wedges
Suction devices Drugs: Tongue depressors Cotton twills combined
Gingival Anti-sialogogues Cheek and lip with fast setting zinc-
retraction cord ii) Anti-anxiety retractors oxide cement(Charbenau)
drugs mouth mirrors Gutta-percha or eugenol
Muscle relaxants packs.
2. CHEMICAL MEANS
Vasoconstrictors
Astringents and styptics
3. ELECTROSURGICAL
MEANS
4. SURGICAL MEANS
DIRECT METHODS:
They act as absorbents- as effective as rubber dam.
It can be plain or woven.
Sizes available: No.2 which is small and No. 3- medium.
Usually a single roll is being placed in maxillary teeth-in
the vestibule and for mandibular teeth 1medium sized is
placed in the buccal vestibule and a larger one is placed
1. Cotton rolls between the teeth and tongue.
Cotton roll holders:
Advantages: they may slightly retract the cheeks and
tongue from the teeth, which enhances access and
visibility.
Disadvantages: Need to remove the holding appliance
from the mouth to change cotton rolls
-Inconvenient and time consuming.
Better tolerated by delicate tissues as their adhesion to
2. Gauze pieces
dry tissues is much lesser than cotton rolls.
Indicated for larger areas.
Absorbent pads
Made up of cellulose
3. Cellulose Placed in cheeks to cover the parotid duct
wafers More absorbent than the cotton rolls or gauze pieces.
It is advisable to moisten the cotton rolls and wafers prior
their removal to prevent inadvertent removal of the
epithelium from the cheeks, floor of the mouth, or lips.
Indicated when there is danger of aspirating or
swallowing small objects.
A gauze sponge (2 × 2 inch [5 × 5 cm]) unfolded and
4. Throat shields
spread over the tongue and the posterior part of the
mouth, is helpful in recovering a small object, such as an
indirect restoration, should it be dropped.
Advantages:
1. Cuttings of tooth and restorative material and other
debris are removed from the operating site.
5. High volume
2. A washed operating field improves access and visibility.
evacuators and
3. There is no dehydration of the oral tissues.
saliva ejectors
4. When no anesthetic is being used, the patient
experiences less pain.
5. Precious metals are more readily salvaged.
Most commonly used tongue retraction device.
Vacuum evacuator tube passes anterior to the chin and
mandibular teeth down to the floor of the mouth either
Svedopter left or right of the tongue
Mirror like vertical blade attached to the evacuator tube
to hold the tongue away from field of operation
Adjustable horizontal chin blade: clamps under the chin
to hold the apparatus in place.
2
Hygoformic Saliva Similar to Svedopter; Does not have a reflective blade.

Ejector More comfortable; Lesser traumatic to lingual tissues.
Cotton or synthetic fibres woven in form of cords. It can
be:
Twisted, Knitted, Plain Finished surfaced
Waxed/unwaxed
Plain/ impregnated
Purpose:
Lateral displacement of free gingiva.
Apical positioning of the gingival crest.
Transient dehydration of gingiva-Decreased bleeding.
Provides improved access, visibility.
Protects gingiva from abrasion during cavity
preparation.
Restriction of excess material in the sulcus.
Eversion of the gingival tissue exposing margins of
Gingival retraction
the cavity.
cord
Placement:
Ideal location: Axial angles of tooth where col has
maximum height resulting in better grip and
stabilisation.
Hatchet, Hoe cowhorn explorer orplastic instrument can
be used to place the cord in desired position.
Recent advances:
EXPA SYL
Paste form
Incorporates KAOLIN ,15% aluminum chloride
Is a soft clay based material
MAGIC FOAM CORD:
Non hemostatic system from Coltene Whaledent.
Is an expanding polyvinyl siloxane material.
Rubber dam
History: Dr. Sanford Cristie Barnum: 15th March 1864 in Montecello, New York
introduced the rubber dam into dentistry.
Advantages:
I. Provides dry, clean operative field:
II. Provides Improved access and visibility:
It controls moisture and retracts the soft tissue.
Can retract lips, cheeks, tongue and sometimes marginal gingival to enhance the
visibility and access.
III. Potentially improved properties of dental materials:
Prevents moisture contamination of restorative materials during insertion and
manipulation and thus promotes properties of dental properties.
IV. Protection of patient and operator:
Protects the patient from aspirating/swallowing small instruments.
3
Protects soft tissues from injuries by rotating burs/discs.

Also an effective infection control barrier.
V. Increases Operator efficiency
Disadvantages:
i. Time consuming placement- Average time needed for the rubber dam placement- 3
-5 minutes
ii. Patient objection: Patients might find it obstructive and objects for its placement.
iii. Partially erupted teeth can not support a retainer sufficiently.
iv. Placement is difficult in third Molars and extremely malpositioned teeth.
v. Patients with asthma may not tolerate the rubber dam if breathing through the nose
is difficult.
vi. Patients with some psychologic reasons do not accept rubber dam.
vii. Can not be placed in patients with latex allergy.
Instruments for rubber dam
1. Rubber dam material

Rubber dam is made from natural latex rubber
Latex free dams are also available. (poly vinyl or nitrile rubber)
Dam material is available as pre-cut squares or rolls in sizes of
5x5 inch (12.5x12.5 cm)
6x6 inch (15x15 cm)
Colors: Blue, Green, Black
Dark color is preferred for contrast and to reduce glare from light
It also has Shiny and Dull surfaces: dull is less reflective and thus faces occlusal
surface.
Thickness:
Thicker provides retraction and is resistant to tearing.
Thinner: useful for tighter contacts
4
Available in following thickness:

Thickness Inches Millimetres
Thin 0.006 0.15 mm
Medium 0.008 0.2 mm
Heavy 0.010 inch 0.25 mm
Extra heavy 0.012 inch 0.30 mm
Special heavy 0.014 inch 0.35 mm
Dark,heavy, 6x6 inches preferred
2. Rubber Dam Holders

It maintains the borders of rubber dam in position.
Objectives of the holder:
Keep the peripheries of the dam outside the mouth.
Stretch the applied dam in four directions.
Retraction of tongue, cheek and lips- Clear the operation field.
HOLDER TYPE FEATURES

STRAP TYPE - anchorage.
- Attachments and belts pull the dam towards
occipital parts.
- Convenient
- Eg: Woodburry
Wizard
HANGING FRAME -U shaped Elliptical, Rectangular
HOLDER - Plastic, Metal
- Prongs engage the dam
- Easy to apply
- Minimal skin contact
- Affect the access relatively more
Can be made up of:

Metal: Young frame
Plastic: Nygaard-Ostby, Starlite frame
Built-in foldable holder -
Handidam (Aseptico)
Insti-Dam (Zirc Company)
ARTICULATED FRAME (IRED, France)

Non-irritant plastic material (polysulfone)
A double hinge situated in the vertical axis of the frame, which allows it to be
folded in half in the vertical direction.
5
A brace situated at the bottom of the frame allows turning the dam sheet back
on itself creating a reservoir into which compresses or an aspiration device may
be placed.
Access to the buccal half of the cavity.
This accessibility facilitates proper positioning of the radiographic
film,administration of additional local anesthetic
It has a reservoir at the bottom of the frame that allows the placement of gauze
to compress and an aspiration canula to avoid leakage of fluids such as sodium
hypochlorite onto the patient's clothing.
SAFE T- FRAME (Sigma Dental Systems)

Two hinged frame members whose snap-shut locking mechanism securely clamps
the rubber dam sheet in place
Possible to retain the traditional U-formed frame geometry and dimensions
Raised edges of the frame provide a barrier around the sheet preventing fluids from
escaping on to the patient.
3. RETAINER
Anchors the dam to the most posterior tooth to be isolated.
Retracts gingival tissue minimally.
The rubber dam retainer (clamp) consists of four prongs
and two jaws connected by a bow
When positioned on a tooth, a properly selected retainer
should contact the tooth in four areas two on the facial
surface and two on the lingual surface- This four-point
contact prevents rocking or tilting of the retainer.
Wingless and winged retainers are available.
WINGED WINGLESS
Has anterior and lateral wings No wings on their jaws
Bulkier Smooth
Provides extra retraction of the rubber Preferred while using retainers and
dam from the operating field wedge.
Interferes with matrix band and wedge
placement
6
According to the type and shape of the attaching blades
FOUR POINT CONTACT CIRCUMFERENTIAL

BLADES CONTACT BLADES
1.Retaining curvature of tooth is not

- Less retentive
present or when insufficient amount
- Less traumatic.
of rubber stretching.
1. Axial angles are lost or do not
2. Single tooth isolation no other coincide with the with the corners of
the four point contact clamps.
anchoring mechanism.
2. Axial convexity of the tooth surface
- Traumatic effect on weakened is sufficient for anchorage.
undermined tooth structures. 3. Use in fully erupted teeth.
Suggested Retainers for various anchor tooth applications
RETAINER APPLICATIONS
W56 Molar anchor teeth
W7 Mandibular molar anchor teeth
W8 Maxillary molar anchor teeth
W4 Premolar anchor teeth
W2 Small premolar anchor teeth
Terminal mandibular molar anchor teeth requiring preparations
W27
involving distal surface.
VI. CLAMP FEATURES
Retainers with serrated jaws
TIGER CLAMP
Partially erupted and structurally compromised
SILKER
Anterior extension in this clamp allows for retraction of around severly
GLICKMAN
broken down teethwhile the clamp itself is being placed on a tooth
CLAMP (S-G
proximal to one being treated.
CLAMP)
Specially designed clamps to retract tongue and cheek.
HALLER CLAMP
Cotton rolls can be placed snugly in place
7
increases patient comfort

CUSHEE CLAMP Enhances dam seal
Reduces slippage
Facilitates the isolation of an individual tooth without covering the
Super Clamp
.
Provides maximum retraction without laceration of gingival
BRINKER
tissues while providing secondry retention.
CLAMPS:
Also known as tissue retractors.
4. PUNCH
It is a precision instrument having a rotating metal table (disk) with six holes of
varying sizes and a tapered, sharp-pointed plunger.
The plunger should be centered in the cutting hole so that the edges of the holes
are not at risk of being chipped by the plunger tip when the plunger is closed.
PUNCH
SINGLE HOLE MULTIPLE HOLES
- For endodontic isolation. - More versatile.

Accurate and consistent punch point. -Allow holes to be punched in range of sizes
from 0.7 to 2 mm in diameter.
Ivory Punch:
Self-centering coned piston or punch point
Prevents partially punched holes
Ash or Anisworth pattern:

Traditional punch for making holes.
Incorporates a rotating wheel, which allows the selection of different sized holes.
HOLE POSITIONING
FEATURES
GUIDE
Precise positioning of marks even in malaligned teeth
TEETH AND CASTS Time consuming
Cannot punch till patient is seated.
8
Easier
TEMPLATE
Takes lesser time.
Prestamped -Imprints both permanent and primary arch
forms in the rubber dam
RUBBER DAM STAMP Marks for maxillary incisors are 0.9 inches from the top of
the dam
5. RETAINER FORCEPS Used for the

Placement of retainer
Adjustment of retainer
Removal of retainer
FORCEPS
IVORY STOKES
- Stabilise/ prevent, Notches near beak tips

rotation on the beaks
Allows range of rotation
- Teeth with normal
angulation Mesially and distally teeth
6. NAPKIN
Placed between rubber dam and skin.
Prevents skin contact to prevent allergic reactions in sensitive patients.
Absorbs saliva seeping at corners of mouth by capillary action.
Acts as a cushion.
Also useful for .
7. LUBRICANT
A water soluble lubricant is applied in the area of punched holes.
Facilitates passing dam across the proximal contacts when applied on the area
of the punched holes.
Usually commercially available, but other lubricants can also be used such as:
- Soap Slurry
- Shaving cream
9
- Cocoa butter/ Petroleum jelly Not satisfactory rubber dam lubricants

because both are oil based and not easily rinsed from the dam when the dam
is placed.
ANCHORS OTHER THAN RETAINERS

Proximal Contacts
Modelling Compound
Dental Floss/Tape
Rubber Dam Material
Rubber Wedjets
SUPPLEMENTAL AIDS
(i) MODELING COMPOUND: Low-fusing modeling compound is sometimes used to
secure the retainer to the tooth to prevent retainer movement during the
operative procedure.
(ii) DENTAL FLOSS:
Floss can be tied for retreival of retainer or broken parts.
Prevents aspiration of these parts.
Also required for testing the interdental contacts.
(iii) WEDJETS (HYGENIC)
Stretchable elastic stabilizing cords made up of natural latex rubber.
Faster and easier as compared to placing clamps.
It is placed like dental floss over the rubber dam in the interproximal areas of the
teeth.
Reduces patient trauma and discomfort caused by metal clamps.
Used in the isolation of anterior teeth.
Techniques of applying Rubber Dam
A. APPLYING DAM AND RETAINER SIMULTANEOUSLY

Reduce the risk of retainer being swallowed or aspirated before dam is placed.
Solves the occasional difficulty of trying to pass the dam over a previously placed
retainer, whose bow is pressed towards the tissues.
B. APPLYING THE DAM BEFORE THE RETAINER

Dam stretched over the anchor tooth before placing the retainer.
Advantage: No need of manipulating the dam over the retainer.
Disadvantage: Reduction in visibility of underlying gingival tissue, which may
become impinged on by the retainer.
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C. SPLIT DAM TECHNIQUE

Used in cases of fractured crowns or anteriors with ceramic crowns or veneers to
prevent chipping of the crown margins.
Also used to isolate abutment teeth on a bridge, those that have been prepared for
crown restorations or teeth that are not fully erupted.
Technique:
2 overlapping holes are punched on the dam or slit cut between the holes for the
2 adjacent teeth.
The dam is stretched over the tooth to be treated and 1 adjacent tooth on each
side
It is essential that the sealing material is applied to prevent leakage and
contamination.
REMOVAL OF RUBBER DAM

1. Cutting the septa:
Stretch the dam facially, pulling the septal rubber away from the gingival tissues
and tooth.
Clip each septum with blunt-tipped scissors, freeing the dam from the
interproximal spaces, but leave the dam over the anterior and posterior anchor
teeth.
2. Removing the retainer: Engage the retainer with retainer forceps.
3. Removing the dam: After the retainer is removed, release the dam from the anterior
anchor tooth, and remove the dam and frame simultaneously.
4. Wiping the lips:
and frame are removed.
face and is comforting to the patient.
5. Rinsing the mouth and massaging the tissue: Rinse the teeth and mouth using the
airwater spray and the high-volume evacuator. To enhance circulation, particularly
around the anchor teeth, massage the tissue around the teeth that were isolated.
6. Examining the dam: Determine in operating light that no portion of rubber dam has
remained between or around the teeth.
ERRORS IN APPLICATION AND REMOVAL OF RUBBER DAM

1. Off Centre arch form:
If rubber dam is punched off centre- lead to escape down the foreign material
If this happens, the superior border of the dam can be folded under or cut from
2. Inappropriate distance between the holes:

Too little distance between holes- precludes adequate isolation because the
hole margins in the rubber dam are stretched and do not fit snugly around the
necks of the teeth.
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Too much distance - excess septal width, causing the dam to wrinkle between
the teeth, interfere with proximal access, and provide inadequate tissue
retraction.
3. Incorrect Arch Form of Holes:
If the punched arch form is too small- leads to leakage.
If the punched arch form is too large- the dam wrinkles around the teeth and
may interfere with access.
4. Inappropriate Retainer:
Occasional breakage when the jaws are overspread.
Can be unstable on anchor tooth.
Impinge soft tissue.
Impede wedge placement.
5. Retainer pinge tissue: Can slightly depress the tissue but should not impinge the
tissue.
6. Incorrect technique for cutting septa
7. Incorrect location for class V lesion
RECENT ADVANCES
I) INSTI DAM (ZIRC)
In-built flexible radiolucent nylon frame.
Translucent natural latex- stretchable, tear-resistant.
Radiographs can be taken: bending the frame without removing the dam.
Minimal pull on clamp.
II) DRY DAM
Small rubber sheet set in the centre of an absorbent paper with light elastics on
either side to pass over the ears.
It fits like a face mask with an absorbent lining.
It is useful for quickly isolating anterior teeth.
Disadvantage: bleaching procedure due to the absorbent nature of the paper.
III) FRAMED FLEXI DAM (COLTÈNE/WHALEDENT)
The Hygenic non-latex flexi dam.
The smooth surface of the plastic frame helps to maximize patient comfort when
positioned against their skin.
IV) HANDI DAM (ASEPTICO)
Pre-framed rubber dam
Quick, Easy placement.
V) OPTI DAM (KERR)
First rubber dam with 3-dimensional shape and design matching contour of
mouth.
Less preparatory work. No hole-punching procedures.
No marking of the tooth position because of outward orientation.
Allows patient to breath with no pressure around the nasal area.
12
VI) OPTRA DAM (IVOCLAR VIVADENT, USA)

Combining the benefits of a lip and cheek retractor (Optra Gate), with the rubber
dam.
Anatomical shape with high flexibility.
Patented inner-ring design allows it to be placed without the need for clamps.
VII) KOOL DAM (PULPDENT CORPORATION)
light cured material. Form of a liquid rubber dam.
Applied on gingiva or tooth surfaces prior to power bleaching, sand blasting.
A similar resin product: OPALDAM (ULTRADENT INCORPORATION).
Disadvantages: Produces heat when cured.
VIII) ISOLITE
Continuous throat protection;Provides Illumination, retraction and isolation.
Unique soft, flexible mouthpiece: isolates maxillary and mandibular quadrants
simultaneously.
Retracts and protects the soft tissues from accidental damage from high speed
turbines.
A similar device: ISODRY
INDIRECT METHODS
1. Comfortable and It reduces the anxiety levels of the patient and aids in
relaxed position of reducing the saliva.
the patient.
Helps in reducing the discomfort associated with the
treatment.
2. Local anesthesia
Vasoconstriction caused by vasoconstrictor in local
anesthetic helps in reducing hemorrhage.
Can reduce salivation but are rarely indicated.
Include
Antisialogogues, Anticholinergic, Atropine.
- Premedication may be indicated using an
anticholinergic agent to depress salivation.
- Atropine can be given half an hour before the
appointment, but should be avoided in patients with
3. Drugs
high ocular pressure or with cardiovascular
problems.
Antianxiety, barbiturates, sedatives: Diazepam

- Because of psychological dependence on these
drugs these should be given only for short periods
and in selected patients.
13
RETRACTION OF GINGIVA
Used only when the gingiva is healthy with a very good
vascular supply.
Copper Bands
PHYSICOMECHANICAL Rubber dam: Heavy, extra heavy and special heavy
MEANS Retraction cords
Rolled cotton twills:
Wooden wedges:
Guttapercha or eugenol packs.
Vaso Constrictors:
Decrease hemorrhage, tissue fluid seepage, and hence
the size of free gingiva.
Epinephrine and nor-epinephrine.
Astringents And Styptics:

Biologic fluid coagulants- alum, aluminium potassium
sulphate, aluminium chloride and tannic acid.
Tissue coagulants- zinc chloride and silver nitrate.
Merocel
CHEMICOMECHANICAL
Retraction strips made of biocompatible polymer
MEANS
(hydroxyl polyvinyl Polyacetate).
Matrix Impression System

Polyether occlusal registration
Elastomeric material made over the preparation.
Retraction Capsule
15% aluminum chloride
Uses extra-fine tip that fits directly into the sulcus.
50% faster- risk of bleeding and/or hemorrhage is less
on removal
Used when access to the working area is not available
by the more conservative methods.
Causes Minimal haemorrhage
Principle:
Alternating electric current passed through an
apparatus to increase its frequency (60-120 million or
more per second).
ELECTROSURGICAL Four actions can be seen depending on the amount of
MEANS energy produced:
Cutting: uses Unipolar tip
Coagulation: Surface coagulation of tissues, oozed
fluids and blood. overdose Carbonisation: Bulky
unipolar
Fulguration: Has deeper tissue involvement. It is
always associated with carbonization and may have
comparatively more after effects.
14
Dessication: Most dangerous action because of the

uncontrolled and unlimited nature. Causes massive
destruction of the tissues both in depth and width.
LASERS
Controls hemorrhage; Removes epithelial attachment
and periodontal ligament.
Used with a feather light stroke; Kept moving.
Specific Laser types
Diode laser:
Wavelength: 655-980nm
Tissue penetration-0.5-5mm
Air is used as a coolant; used in contact mode
Most highly absorbed in pigmented tissues.
Relatively inexpensive as compared to other lasers.
Nd: YAG Laser
Wavelength- 1064nm
Tissue penetration-2 to 5mm or greater
Used in non-contact mode with target tissues
Also highly absorbed by pigmented tissues.
Er: YAG laser
Wavelength: 2940nm
Tissue penetration: Because the primary target
chromophore is water, tissue penetration is very
shallow at approximately 1 micron.
Use in close proximity with target tissues
Water along with air is used as a coolant
The wavelength characteristics are most highly
absorbed by water and hydroxyapatite. Hence, the
Er:YAG laser is effective for both soft and hard
tissues.
Er,Cr: YSGG laser
Wavelength: 2780nm
Similar to the Er:YAG laser, tissue penetration is very
shallow, from 1 to several microns
Water is used along with air as a coolant.
Effective for both hard and soft tissue.
15
Ace Achievers
Dental Academy
DIRECT FILLING GOLD

Pure gold is the noblest of all dental metals, rarely tarnishing or corroding in the oral cavity.
It is inactive chemically, and air, heat, moisture, or most solvents do not affect it.
Pure gold is very soft (22 VHN), and the most ductile and malleable metal used in restorative
dentistry.
Classification
Electrolytic Granulated Gold
Foil(Fibrous gold) Precipitate (Encapsulated Powdered
(Crystalline Gold) Gold)
Sheets can be cohesive or Mat gold
noncohesive Mat foil
Ropes Gold calcium alloy
Cylinders
Laminated gold
Platinized gold
Manufactured by beating pure gold into thin sheets

Size: 4*4 inches
Weight: 4 grams No: 4 foil
Minimum thickness which can be achieved 0.6um
Each sheet is rolled into cylinders or pellets before insertion into tooth
preparations
Cohesive Non-cohesive
Gold with anatomically clean Adsorbed protective gas film, ammonia
surface will cohere & chlorine (temp protective covering) -
Gold foil
Gold foil free of surface To minimize adsorption of other less
contaminants: cohesive foil volatile substances
Prevents premature cohesion of sheets
that may come into contact
Platinised Gold Foil:
Layer of platinum foil between 2 sheets of no.4 foil hammered to obtain
thickness of no. 4 foil
Available as no. 4 sheet form
Addition of Platinum Increases hardness and wear resistance of restorations
Electrolyte Precipitated Gold
This is precipitated through electrodeposition and is accumulated in the form
Mat Gold
of strips or cones. These strips are cut by the dentist into desired sizes
Mat gold is placed in a mold at room temperature to become compacted and is

then sintered in an oven.
Advantages: It is of sponge type and adapts well to cavity walls.
Uses: It is used for building up the internal bulk of the restoration.
Sandwich of mat gold between sheets of No. 3/4 gold foil.
Sandwich is sintered by heating below melting point of gold and cut into strips
of differing widths.
Advantages:
Mat Foil
1. Ease of placing gold in retention forms.
2. Reduction in placement time especially in larger preparations
Disadvantage: Greater tendency for voids, which show as pits on outer surface
of the restoration
Electralloy is a combination of gold and calcium; calcium content is 1%.
Advantage: Product form provides stronger restoration by dispersion
strengthening.
Electralloy Disadvantages:
1. Inharmonious color
2. High conductivity
3. Difficulty in manipulation
Powdered gold is also known as E-Z gold. It is a blend of atomized and
precipitated powder embedded in a wax-like organic matrix. It is available in
Powdered
pellets of various sizes which are enclosed in gold foil wrappers and packaged
Gold
for use. Prior to its condensation, the matrix is burned away leaving only pure
gold to be packed in the cavity
Precipitated Alloy
Gold is melted sprayed into inert atmosphere Precipitates as spherical particles

Particles passed through layers of sieve
Larger particles precipitate at the top while Smaller particles precipitate at bottom of the
compartment
Range of particle diameter is 5 to 75 µm
Indications and Contraindications of DFG

1. Incipient carious lesions
- Class I lesion in premolar teeth and other accessible
developmental pits.
- Class V gingival lesions
- Class III lesions in maxillary and mandibular anterior teeth
- Class II lesion(small) in premolar teeth
Indications
- Class II lesions mesial surfaces of molars
2. Erosions
3. Teeth with no enamel crazing and microcracks
4. Lesions in which enamel margins can be located on sound tooth
structure.
5. A defective margin of an otherwise acceptable cast gold restoration
Specific 1. Class I - small carious lesions in pits and fissures (posterior teeth),
Applications lingual surfaces of anterior teeth.
2
2. Class III, VI restorations

3. Class II restorations where small / marginal ridges are not
subjected to heavy occlusal forces.
Inaccessible areas such as DO prep in molars
Where control of moisture is not possible
Large amount of tooth destruction; unsupported enamel
Contraindications Where Esthetics is of primary importance
High occlusal stress
Periodontally compromised tooth
Immature teeth (predisposition to fracture)
Characteristics of DFG
Cohesion
At room temperature, two thin sheets of atomically clean pure gold can be welded under
pressure. The procedure is also called cold welding because it is conducted at room
temperature.
When the gold segments (like increments of amalgam or composite) are compacted with
designated instruments to build up the bulk of material, the segments are bonded by metallic
bonds (cold welding), and the bulk of material is work-hardened by the pressure. Therefore,
the final restoration retains characteristics of a wrought metal. The process of gold
compacting is also known as condensation.
For successful welding:
- The gold must be in a cohesive state before compaction, and
- A suitable, biologically compatible compacting force must be delivered
In non-cohesive direct gold, surface impurities or wax are present, which prevent one
increment from cohering to another.
Degassing
Prior to placing direct filling gold in the cavity preparation, the material is heated to remove
the protective coating or wax introduced by the manufacturer, or contaminants on the surface
acquired during storage and packaging.
Individual pellets can be held over an open flame of pure alcohol, or a group of pellets or
other gold forms can be placed on a so-called annealing plate heated by electricity. This step
is commonly called annealing, heat treatment, or degassing. A more appropriate term would
be desorption.
Heating times vary depending on the size and configuration of the gold segment. Powdered
gold pellets may take 15 to 20 seconds, whereas gold foil pellets and electrolytic gold pellets
may require only 1 or 2 seconds.
The annealing temperature ranges from 650°C to 700°C depending on the selection method
and heating time.
Regardless of the type of direct gold used, flame desorption of surface contaminates will
occur when the gold segment has exhibited a dull-red glow. Degassing is accomplished by
heating the gold foil on a mica tray over a flame or on an electric annealer or by heating each
piece of gold over a pure ethanol flame.
The fuel for the flame may be alcohol or gas, but alcohol is preferred because there is less
danger of contamination. The alcohol should be pure methanol or ethanol without colorants
3
or other additives. Advantages of flame desorption include the selection of a piece of

appropriate size, desorption of only those pieces used, and reduced exposure to
contamination.
Bulk Method Piece Method

Electric or gas
Advantages: Advantages
- No need of assistant - More practical
- Time saving - No wastage
- Choice of selecting correct size
Disadvantages Disadvantages
- Wastage - Need of assistant
- Inability to select proper size which
fits into cavity
- Danger of over annealing
- Convection air currents cause
inadequate heating of the tray thus
poor welding properties
Condensation/Compaction
Condensation is a procedure used to condense and harden gold inside the cavity preparation.
Objectives of Condensation
Wedging initial pieces between dentinal walls, especially at starting points
Weld the gold pieces together by complete cohesion of their space lattices
Minimize the voids in general and eliminate them from critical areas such as the margin and
surfaces
Strain hardening of gold materials that is accomplished due to cold working during
condensation
Adapt gold materials to the cavity walls and floors
Modes of Condensation
Hand instrument condensation
Pneumatic condensation vibrating condensers energised by compressed air.
Electronic condensation most efficient & controlled
Hand condensation and Mallet oldest way
Gold Condensers
The condenser can be straight, curved, angled, round, square, or rectangular, and the surface
of the tip can be smooth or serrated. The tip can be flat-faced or convex-faced. The condenser
tip should also be kept atomically clean
Principles of Condensation
15 lb/sq inch of force should be exerted on the condenser nib; less force is needed for small
condenser nibs than for larger ones.
Force of condensation must be at 45° to cavity walls and floors.
Stepping procedure for compaction of gold should be carried out. The successive points of
condensation always overlap the previous one by atleast half of the nib-face diameter. That
4
is, the point is moved one-half the diameter of its nib and the procedure is repeated in an
orderly fashion, continuing in this manner until a layer of gold is condensed. This overlapping
of successive condensation points is known as stepping motion of gold
Use the maximal thickness of pellets possible provided that the condenser will not penetrate
it. The thin cross-section of each increment will facilitate easy condensation. This will
prevent crazing of enamel rods.
When inserting DFG, condensation should be either from one periphery of the increment to
the other or from the center to the periphery.
The condensation of precipitated types of direct gold should be started by hand.
Marginal Integrity
As a comparison, average marginal gaps are 0 micrometre with respect to DFG.
DFG allows less opportunity for continued degradation, stain, and caries.
Principles of Tooth preparation for DFG

The ideal depth of the preparation should be 2 3 mm and into dentin. The shape of the
preparation could be circular, pear shaped, or
The ideal depth is then made using a flat-ended bur; the walls are smoothed and retention is
achieved using a 34 inverted cone bur at the base of the preparation.
The finalstep of the preparation is to use a 7901 finishing bur to smooth the outline and
remove any unsupported enamel rods. This step also places a very small bevel and helps
create a sharp cavosurface margin.
This allows the operator to visualize the margin as the excess gold foil is removed and gives
the preparation a smooth and flowing outline form.
If after removal of the existing restoration the depth of the cavity is deeper than 3 4 mm, a
base should be placed to protect the pulp, limit the amount of gold foil utilized, and allow the
ideal depth to be achieved.
General Steps of Insertion

3 step build up for the restoration
Tie formation connecting two opposing point angles or starting point filled with gold with
a transverse bar of a gold.
Banking of the walls - this consists of covering each wall from its floor or axial wall to the
cavosurface margin with direct gold material.
Shoulder formation - Connecting two opposing walls with the direct gold material to
completely fill up the restoration.
Finishing and polishing
- Finishing: Direct gold restorations require very little finishing if the previous steps are
properly done. Finishing can be done using tin oxide powder on soft bristle brushes or
rubber cups.
- Polishing: Application of flour of pumice and tin oxide or white rouge These powdered
abrasives are applied dry, with a webless, soft rubber cup in a low speed handpiece. Care
is taken to use light pressure. Gentle blasts of air cool the surface during polishing.
- Final burnishing this is done after polishing to make the surface of the restoration
smooth and free from voids.
5
Ace Achievers
Dental Academy
CAST GOLD RESTORATIONS

DEFINITION:
Inlay: A restoration which is constructed out of the mouth from materials like gold
alloy, composite and porcelain and then cemented back into the prepared cavity of
the tooth.
Onlay: An onlay is a combination of intracoronal and extracoronal cast restoration
which covers one or more cusps.
INDICATIONS
1. Large restorations: The cast metal inlay is an alternative to amalgam or composite
when:
- The higher strength of a casting alloy is needed.
- The superior control of contours and contacts.
- Crown of a tooth that have been greatly weakened by large failing restorations.
2. Endodontically treated teeth.
3. Teeth at risk for fracture: Fracture lines in enamel and dentin, especially in teeth
having extensive restorations, should be recognized as cleavage planes for possible
future fracture of the tooth. Restoring these teeth with a restoration that braces the
tooth against fracture injury may be warranted sometimes. Such restorations are
cast onlays (with skirting) and crowns.
4. Dental rehabilitation: When cast metal restorations have been used to restore
adjacent or opposing teeth, the continued use of the same material may be
considered to eliminate electrical and corrosive activity that sometimes occurs
between dissimilar metals in the mouth.
5. Diastema closure and occlusal plane correction: when extension of the mesiodistal
dimension of the tooth is necessary to form a contact with an adjacent tooth.
6. When tooth is to be used as Removable prosthodontic abutment
CONTRAINDICATIONS
1. High caries rate.
2. Younger patients: Direct restorative materials are indicated unless the tooth is
severely broken.
3. Esthetics: Composite and porcelain restorations are alternatives in esthetically
sensitive areas as alternative to cast metal restorations.
4. Small restorations: Amalgam and composite restorations are usually indicated.
ADVANTAGES
1. Strength: The inherent strength of dental casting alloys allows them to restore large
damaged or missing areas and be used in ways that protect the tooth from future
fracture or injury.
2. Biocompatibility: Unreactive in oral environment.
Can be used in patients who have allergies to other restorative materials.
3. Low wear: Because of their low wear, castings are able to withstand occlusal loads
with minimal changes specially in large restorations.
4. Control of contours and contacts: Through the use of the indirect technique, the
dentist has great control over contours and contacts.
DISADVANTAGES
1. Number of appointments and higher chair time: Requires atleast 2 appointments;
much more than a direct restoration.
2. Temporization: patient requires temporary restoration which might loosen or break
requiring additional visits.
3. Cost: usually on a higher side as compared to direct restorations
4. Technique sensitive: Errors at any part of the multistep process tend to be
compounded, resulting in suboptimal fits.
5. Splitting forces: Small inlays may produce a wedging effect on facial or lingual tooth
structure and increase the potential for splitting the tooth. Onlays do not have this
disadvantage.
Why inlays:
Has better inherent strength- 5 times the ultimate strength of amalgam.
Operator has better control on contacts and contours.
Traditional high-gold alloys are unreactive in the oral environment and are some of
the most biocompatible materials available to the restorative dentist.
Although individual casting alloys vary in their wear resistance, castings are able to
withstand occlusal loads.
As compared to an incremental buildup in amalgam- there are lesser chances of
formation of intermittent voids.
Most of the casting alloys are inert in nature- not significantly affected by tarnish
and corrosion processes.
MATERIAL FOR CAST RESTORATION

The American Dental Association Specification No. 5 for Dental Casting Gold Alloys
requires a minimum total gold-plus-platinum-metals content of 75 weight%.
CLASSIFICATION:
Gold & Platinum based alloys. Type I, II, III & IV
Class I: Composition: 70-75% Gold,1-5% Platinum &/or Palladium,20-25% Silver,

Copper, Zinc and /or Indium.
4 Types:
2
1. Type I: Soft gold.

Most plastic.
Highest content of gold -80%.
Most ductile.
Lower hardness and proportional limit.
Indications:
Low stress bearing area.
Direct method of inlay fabrication.
Metal can be polished or finished upon the tooth
2. Type II: Medium hard.
Contains 75-80% gold.
Indications:
Indirect method of inlay fabrication.
Crowns supported by single teeth.
Finishing and polishing can be performed outside the
mouth on the tooth model or die.
3. Type III: Hard alloys.
Contains 65-75% gold.
Greater tensile strength and hardness.
Indications:
Single tooth restoration.
Abutment crowns for fixed prosthodontic restoration.
Three quarter and complete crowns
4. Type IV Extra hard alloy.
<75% gold.
Least deformable with lowest content of gold.
Indications:
Removable prosthodontic appliances with clasps or
precision attachment.
No ADA specification.
Economy gold alloy- Gold content less than Class I, Palladium
substitutes gold.
Class II
Composition:
60% palladium.
Gold <5%.
Copper silver zinc 25-30%.
Non-gold palladium based alloys.
Class III Composition:

Palladium and silver 80-90%.
Indium, copper, tin 10%.
Nickel-chromium based alloys.
Class IV
Composition:
3
Nickel-chromium with chromium content <30%.

Low percentage of molybdenum, tungsten and aluminium.
Berrylium in low percentage; Gallium substitutes Berrylium
Castable moldable ceramics.
Composition:
Class V
Aluminium trioxide 50%.
Magnesium oxide 15%.
0.5% wax or stearate.
Basic concepts of inlay cavity design

Initial procedures
1. Occlusion: An extensive evaluation must be carried out to check if the existing
occlusal relationships can be improved with the cast metal restoration.
2. Anesthesia: Local anesthesia of the tooth usually is recommended.
3. Preoperative impression should be done to provide temporary restoration until final
restoration is cemented.
Tooth preparation
Initial preparation:
- Occlusal step
- Proximal box
Final preparation:
- Removal of Infected Carious Dentin and Pulp Protection.
- Preparation of Bevels and Flares.
I. Initial preparation
- Carbide burs used to develop the vertical internal walls of the
preparation for cast metal inlays and onlays are plane cut,
tapered fissure burs.
- No. 271 and the No. 169L are recommended.
- Preparation path: Throughout preparation for a cast inlay, the cutting
instruments used to develop the vertical walls are oriented
path, usually the long axis of the tooth crown, so that the completed preparation
has no undercuts.
1. Occlusal portion:
Constituting about pulpal two third of facial or lingual walls; Formed completely
on dentin
Walls taper from each other on average of 20- 50. Parallel walls provide maximum
retention.
Taper can be decreased or increased according to length of the preparation wall.
Occlusal bevel-long bevel. Angulation of the bevel should decrease with increase
steepness of the cusp.
Pulpal floor should be flat if not at least peripheral portion should be flat.
4
Pulpal floor should meet all surrounding walls in a definite line angle except its
junction with axial wall.
The occlusal dovetail prevents proximal displacement of the restoration.
2. Proximal portion:
Axial wall should either be flat or rounded in bucco-lingual direction, and either
vertically or slightly divergent (5-100) towards the pulpal floor in gingivo-occlusal
direction.
Axial wall should meet the pulpal floor in an extremely rounded junction.
Facial and lingual walls are comprised of two planes:
- Axial half
- Proximal half
Gingival Floor
Proximally should be flat in bucco-lingual direction.
The junction between occlusal bevel and the secondary or primary flare proximally
should be rounded.
Retentive grooves: May be given in the bucco-axial and linguo-axial line angles.
The grooves should be in sound dentin near dentino-enamel junction.
The depth of the groove (0.3 mm) should be more than the width (1.5 mm).
Circumferential tie refers to the design of cavosurface margins of an inlay cavity

preparation. It is of two types:
Bevels
Flares
Bevels
Can be proximal, occlusal or gingival.
Create obtuse-angled marginal tooth structure, which is the bulkiest and the
strongest configuration of any marginal tooth anatomy: 140-150 deg.
Produce an acute angled marginal cast alloy substance, which in such configuration
is most amenable for burnishing: 40 deg.
The different types of bevels are:

Partial: It involves part of enamel wall and indicated in direct filling gold.
Short: It involves entire enamel. This type of bevel best suited in cast gold inlays.
Long bevel: This includes all of the enamel wall, & one-half of the dentinal wall. Its
major advantage is that the internal box resistance & retention features are
preserved in this bevel. Indicated in first three classes of cast materials
Full bevel: it includes all of the dentinal and enamel walls of the cavity walls or floor.
Counter Bevel
is used -opposite to an axial cavity wall, on the facial or lingual surface of the tooth,
which will have a gingival inclination facially or lingually.
Hollow Ground (concave) Bevel : This is the only form which is not in flat plane form.
This allows more space for cast material bulk, a design feature needed in special
preparations to improve materials castability retention and better resistance to
stresses. These bevels are ideal for class IV and V cast materials.
5
Occlusal bevel: It creates obtuse angled marginal tooth structure. It produces acute
angled marginal cast alloy substance which makes it most amenable to burnishing.
This design employs the principle of the cone to provide a snug fit of the casting
against the surrounding walls of the preparation.
Functional Cusp Bevel: A wide bevel placed on the functional cusp provides space
for an adequate bulk of metal in an area of heavy occlusal contact.
- Given at an angulation of 45 degrees.
- Prepared on the palatal cusps of maxillary teeth and buccal cusps of mandibular
teeth.
- Lack of functional cusp bevel may result in Over contouring and poor occlusion.
- Over inclination of the buccal surface- will destroy excessive tooth structure
reducing retention.
Gingival bevel: A 30 degrees angle is given at the gingival marginal seat to remove
the weakened enamel which is burnishable because of its angular design.
- A lap sliding fit is produced at the gingival margin which help in improving the fit
of casting in this region.
Functions of bevels
Creates obtuse angle, marginal tooth structure and acute angle marginal cast alloy
substance.
Marginal bevel: reduce the space between cast and tooth substance three or more
fold at the margins.
Provide retention to the cast restoration.
Hollow ground and counter bevels are used for resistance form of the tooth
restoration complex by encompassing cusps.
Gingival bevels can bring the gingival margins to the cleansable and protected area.
Flare
These are the flat or concave peripheral portions of the facial & lingual proximal walls.
They are of 2 types:
1. Primary flare
- Conventional and basic part of circumferential tie. It is similar to Long bevel.
- Angle is 45° to inner dentinal wall proper.
- Brings the proximal facial and lingual margins of the cavity preparation to
cleansable and finishable areas.
- Indicated when the normal contacts are present and there is minimal extension
of caries in buccolingual direction. It is prepared on enamel and dentin.
2. Secondary flare:
- A flat plane superimposed peripheral to the primary flare and usually prepared in
enamel.
Indications & function
- Broad or malposed contact areas- cleansable & finishable areas.
- When caries extent is wide buccolingually remove thin unsupported enamel.
- Include the surface defects which are beyond primary flares.
- To overcome the undercuts in the cervical aspects.
- Not given in esthetic cases.
6
ENHANCEMENT OF RESISTANCE AND RETENTION FORMS
A. Reverse secondary flare: extension of secondary flare

Indications
To include facial or lingual defects beyond the axial angle of the tooth.
To eradicate severe peripheral marginal undercuts which have not been removed by
the maximum angulation & extent of a secondary flare.
Features:
It ends on the facial and lingual surface with a knife edge finish line, its extent should
not exceed the height of contour in mesio-distal direction & tip of the cusps.
The reverse angulation of this flare has no limitation till it does not create any
undercuts in the occluso apical path of the cavity.
B. Skirt: This is more extensive surface extension than the reverse secondary flare.
Indications:
To involve defects with more dimensions (depth) than those that can be involved in
a reverse secondary flare.
To impart resistance & retention on a cast restoration instead of missing or
shortened opposing facial or lingual walls.
In facial & lingual tilted tooth, in order to restore the occlusal plane. They will allow
for the bulk, resistance, & retention of the additional occlusal cast material required
in building the occlusal table. In such condition skirt is prepared at the side towards
which teeth is tilted.
Features
Prepared to include facial & lingual surfaces near the axial angle to a depth of:
- 0.5-1mm- class I & II alloy
- 1.5-2mm- class III, IV, V alloy
C. Collar: This type of extension involves more surface area and depth. It is of 2 types:
1. Cuspal collar: Involves facial or lingual surfaces of one cusp only in a
multicusped tooth.
2. Tooth collar involve entire facial or lingual surfaces of the tooth.
Indications
Help in retention and resistance when entire cusp is lost prior to tooth preparation
or when it is necessary to remove it due to excessive undermining.
Helps in retention in shortened teeth.
Help in enhancing the support for endodontically treated teeth.
Used in places where pins are contraindicated.
For cast material with low castability.
Used for areas in a cast alloy restoration to be veneered by fused porcelain, a collar
can accommodate both porcelain and alloy and facilitates marginal seating of
castings circumferential tie.
7
Features:
With the depth of 1-2mm, collar ends gingivally in a bevelled shoulder finish line.
Class IV bevelled portion should be hollow ground & for ceramics bevelled in
rounded & exaggerated fashion or have no bevel.
There should be definite line angle gingivally, at the junction of the bevelled shoulder
with the axial collar. Shoulder portion of the collar should be parallel to the long axis
of the tooth. Bevel is given to the shoulder for better marginal seating of the cast
restoration.
D. Reverse Bevel
It is placed at the dentinal portion of the cervical wall towards the axio gingival line
angle.
Reverse bevel at gingival wall will prevent tipping movements.
The hydrostatic pressure during cementing a cast restoration can produce a
rotational displacement of the castings with flat gingival walls. This effect is resisted
by the reverse bevel resulting in even seating of the cast restoration.
E. Slots
It is an internal cavity within a floor of preparation having a continuous surrounding
walls & floors. The junction between the floor & surrounding walls is round.
Slot should have a 2 to 3 mm depth.
The slot is cut in dentin so that if it were to be extended gingivally, it would pass
midway between the pulp and the DEJ.
FINAL PREPARATION
Removal of infected carious dentin and pulp protection
The remaining caries, if any, should be removed using small round burs or with hand
excavators. The excavated regions can be filled with the base material to the level
of the required depth of the cavity.
Deep caries with residual dentin thickness of less than 1.0 mm should be excavated
slowly.
Calcium hydroxide is preferred as sub-base followed by a base of suitable cement.
Finishing enamel walls and margins

The marginal fit of a cast restoration depends upon the approximation of cast metal
to tooth tissue surfaces.
The walls should be smooth and even for proper withdrawal of wax pattern.
If coarse or medium grit diamond points have been used during cavity preparation,
the walls and margins should be finished with 16 24 fluted carbide-finishing burs
followed by plain carbide bur.
8
Differences in cavity preparation for silver amalgam and cast restorations
Silver Amalgam Cast Restorations

Intercuspal width is 1/4th of intercuspal Intercuspal width is 1/3rd of intercuspal
distance (outline form is narrow) distance (outline form is wide)
Cavity depth is more Comparatively less
Cavity walls are kept convergent Cavity walls are kept parallel (no
occlusally (minor undercuts) undercuts)
Buccal and lingual proximal walls are Buccal and lingual proximal walls are
convergent occlusally parallel
Cavosurface angle is contraindicated Cavosurface bevel is given
(butt joint is preferred)
All line angles and point angles are All line angles and point angles are well
rounded and axiopulpal line angle is defined and axiopulpal line angle is
beveled. slightly rounded
No reverse bevel is given Reverse bevel is indicated
Grooves are not given, only locks are Grooves are given, locks are not given
given

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Ace Achievers

Gottlieb (1944) was of the view that instead of decalcification of inorganic

Hypothesis concerning the etiology of Caries

3. Ecological Plaque Hypothesis

Contributing Factors in Dental Caries

Type Of Caries Micro Organism Human

Medications Systemic Causes

Signs and Symptoms

Composition and Viscosity of saliva

Salivary oral clearance

Fluoride levels in saliva=0.01-0.03 ppm

Pore volume of 2-4% (polarized light)

Zones of Dentinal Caries

It is the zone of bacterial invasion; Widening and distortion of the

Clinical Characteristics of Enamel Caries: Incipient Smooth Surface Lesion

Incipient caries vs Hypocalcified Enamel

Criteria for visual examination of caries

Criteria for the histologic examination of fissure caries

Classification of Root Caries

Aids in Diagnosing Caries

Fibre Optic Trans Illumination

Recent Advances in Caries Diagnosis

Cutting Instruments Non-cutting Instruments

Metals used in the Manufacture of Hand Instruments

Carbon Steel Stainless Steel

Stainless steel Monel Metals Nichrome Stellite Tarno

Hardening Heat Treatment Tempering Heat Treatment

Direct Cutting Instruments Lateral Cutting Instruments

Single Bevelled Instruments

Circumferentially bevelled instruments:

Single-ended and double-ended instruments:

Applications of Cutting Instruments

Run out occurs if:

Factors affecting the cutting Efficiency of Bur

Mechanism of Cutting of Carbide Burs

Diamond Particle Factors

Fundamentals Of Cavity Preparation

Objective of tooth preparation

2. TOOTH PREPARATION ANGLES

CAVOSURFACE ANGLE AND CAVOSUFACE MARGIN

ENAMEL MARGIN STRENGTH: One of the most important principles in tooth

CLASSIFICATION OF TOOTH PREPARATION

Type of tooth preparation Line angles Point angles

STAGES OF TOOTH PREPARATION

INITIAL TOOTH PREPARATION STAGE

STEPS IN INITIAL TOOTH PREPARATION

OUTLINE FORM AND INITIAL DEPTH

Factors affecting outline form:

PRIMARY RESISTANCE FORM

PRIMARY RETENTION FORM

Retention form for cast restorations

Minimum Occlusal thickness

Cast metal 1-2 mm

Modes to obtain convenience form

FINAL PREPARATION STAGE

Steps in final tooth preparation

Infected Dentin Affected Dentin

irreversible degradation of collagen partially demineralized, collagen fiber

Techniques for caries removal

Regarding the removal of the harder, heavily discoloured dentin: