Textbook of

Operative Dentistry

Textbook of
Operative Dentistry
(with MCQs)
Satish Chandra
Best Teacher Awardee
al Council of India
Ex-Member,, Dent
Dental
Ex-Member
Ex- Director and Professor
Sardar Patel Institute of Dental and Medical Sciences, Lucknow
Ex-Professor and Head of the Department and Dean
Dental Faculty, UP KG University of Dental Sciences, (Formerly KG Medical College,
CSM Medical University and KG Medical University, Lucknow)
Ex-Professor, Dean, Head and Principal
DJ College of Dental Sciences and Research, Modinagar, UP
Ex-Professor, Dean, Head and Principal, Institute of Dental Sciences, Bareilly
Ex-Principal, Professor and Head of the Department, Awadh Institute of Dental Sciences, Lucknow
Paper Setter and Examiner for BDS, MDS and PGME Examinations in many Universities

Shaleen Chandra
Professor and Head of the Deptt. Saraswati Dental College and Hospital, 233 Tiwariganj, Faizabad Road, Juggour, Lucknow
Ex-Professor and Head of the Deptt. Sardar Patel Institute of Dental and Medical Sciences, Lucknow
Ex-Assistant Professor, Rama Dental College and Hospital and Research Centre, Kanpur
Ex-Lecturer, UP KG University of Dental sciences, (formerly K.G. Medical College,
CSM Medical University and KG Medical University) Lucknow
Ex-Lecturer, Budha Institute of Dental Sciences, Kankar Bagh, Patna
Paper setter and Examiner of BDS, MDS and PGME Examinations in many Universities

Girish Chandra
Rajendra Nagar Dental Clinic, Lucknow

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Textbook of Operative Dentistry

2007, Satish Chandra, Shaleen Chandra and Girish Chandra
All rights reserved. No part of this publication should be reproduced, stored in a retrieval system, or transmitted in any form or by
any means: electronic, mechanical, photocopying, recording, or otherwise, without the prior written permission of the authors
and the publisher.
This book has been published in good faith that the material provided by authors is original. Every effort is made to ensure
accuracy of material, but the publisher, printer and authors will not be held responsible for any inadvertent error(s). In case
of any dispute, all legal matters are to be settled under Delhi jurisdiction only.
First Edition : 2007
ISBN 81-8061-893-5
Typeset at JPBMP typesetting unit
Printed at Gopsons Papers Ltd., Noida.

To
Students and teachers as a
mark of our gratitude for their
valuable suggestions
inspiration and appreciation

Contribut
or
Contributor
orss
Alok Mishra
Dept. of Conservative Dentistry and Endodontics
Sardar Patel Institute of Dental and Medical Sciences
Lucknow
Anil Chandra
Department of Operative Dentistry and Endodontics
UPKG University of Dental Sciences
Lucknow
KK Dixit
Head of the Conservative Dentistry and Endodontics
Sardar Patel Institute of Dental and Medical Sciences
Lucknow
Neelam Mittal
I/C Division of Operative Dentistry and Endodontics
Dental Department, IMS, BHU
Varanasi
NM Dhanya Kumar
Professor
Dept. of Conservative Dentistry and Endodontics
College of Dental Sciences
Davangere
Pr
omila V
er
ma
Promila
Ver
erma
Assistant Professor
Department of Operative Dentistry and Endodontics
UPKG University of Dental Sciences
Lucknow
R Nageswer Rao
Professor and HOD
Dept. of Conservative Dentistry and Endodontics
SDM College of Dental Sciences
Sattur, Dharwad

Rak
esh K
umar Y
ada
Rakesh
Kumar
Yada
adavv
Lecturer
Department of Operative Dentistry and Endodontics
UPKG University of Dental Sciences
Lucknow
S Balagopal
Head of Conservative Dentistry and Endodontics
Sri Ramachandra Dental College
SRMC & RI (DU), Chennai 600 116
S Ramachandra
Principal and Professor of Conservative Dentistry
and Endodontics
Ragas Dental College and Hospital
2/102 EC Road, Uthandi
Chennai 600 019
Usah Dabas
Dept. of Conservative Dentistry and Endodontics
College of Dentistry, MGNIMS
Sitapura, Jaipur 302 022
Vasundhar
a Shivanna
asundhara
Vice-Principal
Professor and HOD
Dept. of Conservation and Endodontics
College of Dental Sciences, Davangere
VK Dabas
Addl. Principal and HOD
Conservative Dentistry and Endodontics
College of Dentistry, MGNIMS
Sitapura, Jaipur 302 022
WN Ghonmod
Dept. of Conservative Dentistry and Endodontics
Sharad Pawar Dental College and Hospital
Sawangi (Meghe), Wardha 442 001

F or
d
oree w or
ord
DENTAL COUNCIL OF INDIA
(CONSTITUTED UNDER THE DENTISTS ACT 1948)
AiwanEGalib Marg, Kotla Road, New Delhi-110002

Dr. ANIL KOHLI, PADMA BHUSHAN

MDS (Lko). DNBE (USA). MNAMS

President

Telephone : 39593629 Direct

23238542, 23236740
Fax: 0091-11-23231252

E-mail : dciindia@hotmail.com
Website : http://www.dciindia.org

I am very happy to write the foreword for the Textbook of Operative Dentistry with MCQs. In the last three
decades the theory and practice of Operative Dentistry have undergone a revolutionary change due to the developments in adhesive dentistry.
In this book a modified, comprehensive and complete classification of cavities has been given. This classification includes classes, divisions, subdivisions and types. A new class VII has been introduced. This classification
gives complete location, size and distance of the pulpal wall from the pulp, which is very useful. The textbook has
well labeled excellent diagrams making the subject very simple and self-explanatory.
This book has comprehensively covered all the topics of the subject with basic fundamentals and recent
advances. Many new chapters have been included in this book which are the direct answers of the questions
usually asked in BDS and MDS university examinations. The language is very simple and clear. The well illustrated and labelled presentations of the topics in this book with basic fundamentals and recent advances have
made the reading very informative and interesting for the undergraduates, postgraduates, teachers and practitioners. For self-evaluation, 550 multiple choice questions have been given in the end. The MCQs cover all the
chapters and are very useful especially to the students preparing for various competitive examinations. This is a
very special feature of the book. Overall this is an excellent book.

Dr
ohli
Dr.. Anil K
Kohli

F or
d
oree w or
ord
Professor AP Tikku

Dept. of Operative Dentistry and Endodontics

U.P.K.G. University of Dental Sciences
Lucknow 226003
Executive Committee member, Dental Council of India

Residence
A-1 River Bank Colony
Lucknow-226018

I am very much delighted to write the foreword for the Textbook of Operative Dentistry with MCQs by Prof.
Satish Chandra. The book contains almost all the latest information on the subject. Recently due to developments
in the tooth colored materials and adhesive dentistry, the theory and practice of Operative Dentistry have made
revolutionary improvements.
This book contains an improved, comprehensive and exhaustive classification of cavities, which includes
seven classes with their divisions, subdivisions and types. This classification gives complete, almost three-dimensional picture of the cavity. The language is very simple. The diagrams are well labeled and self-explanatory. The
subject matter is crystal, clear and very easy to understand.
The book has completely covered all the topics of the subject along with the basic fundamentals and recent
advances. Most of the chapters contain the information, which are the direct answers to the questions usually
asked in UG and PG examinations. The UG and PG students, researchers, teachers and practitioners will find
the book very useful.
The MCQs completely covering the subject, shall be very useful to the students especially those preparing for
various competitive examinations.
I strongly recommend this student-friendly book to all the BDS and MDS students.
Prof. AP Tikku

Pr
ef
ace
Pref
eface
The science and art of Operative Dentistry is ever changing. There has been unprecedented enhancement and
advancement of dental materials and technologies of Operative Dentistry in last few decades. In keeping with
these advances in adhesive dentistry and increased demands of esthetics, the practice and scope of Operative
Dentistry is increasing by leaps and bounds.
Even though Operative Dentistry is the mother of all branches of dentistry, demand of esthetic and adhesive
dentistry and the advances and developments within the last few decades have totally changed the scope and
future of this branch. In clinical sciences the difference of opinion specially in the treatment modality leads to
research. Controversies help the science to grow and flourish more and more through further research.
The original work of GV Black (1898) remains unchallenged as the baseline. In an effort to make the classification
of cavities comprehensive, complete and more useful further modifications in the classification of cavities have
been made including divisions and subdivisions and types in each class of cavity. A new class of cavity, class VII
has been added. These modifications are more appropriate with adhesive restorative materials and new techniques.
These modifications pinpoint the exact location of the cavity with its extensions and the depth towards the pulp,
making the line of treatment and the prognosis almost definite and crystal clear by the classification itself.
An effort has been made to include the maximum possible relevant latest topics and new concepts of the
subject. Nevertheless, the rapidity with which the developments are taking place makes completeness an
impossibility. The syllabi of all the universities as well as recommendations of dental councils of almost all the
countries are fully and completely covered.
This book is intended to teach the principles, practice and recent advances in the field of Operative Dentistry
to undergraduates, postgraduates, researchers and practitioners. Simple and lucid language has been used as
much as possible. Extensively labelled illustrations and photographs have been used to explain the text
wherever required. To further make the book user-friendly, few chapters which directly answer the questions
recently asked in the university examinations have been included. At the end 550 multiple choice questions and
their answers have been given which will be very helpful to the students for recapitulation and for preparation for
various examinations and competitions.
We shall be indebted to the readers for suggestions for further improving the book in the next edition. Such
suggestions may kindly be sent to first author at the address, 250/4-6, Rajendra Nagar, Lucknow- 226004 (U.P.)
India.
Satish
Shaleen
Girish

Chandra
Chandra
Chandra

Acknowledgements
Many specialists have contributed their time, talents and knowledge to help in the completion of this book. We
extend our thanks to them. All our family members and friends have been a constant source of inspiration, a
special thanks is offered to them.
We are grateful to Dr Anil Kohli, President, Dental Council of India, New Delhi and Prof AP Tikku, (EC
member DCI), Professor UPKG University of Dental Sciences, Lucknow, for their forewords.
Our special thanks are due to Dr Anil Kohli (New Delhi) and Dr Neelam Mittal (BHU Varanasi) for photographs and X-rays of their patients and other contributors for their valuable contributions.
Our deep appreciation is due to a number of persons, specially Dr Mohit Chandra, and Mr. Shyamendra
Srivastava for correcting proofs, preparing diagrams and computer CDs and printouts.
We bow in gratitude to the Almighty God for His blessings.
Finally we acknowledge our sincere thanks to Shri J.P. Vij, Chairman and Managing Director, M/s Jaypee
Brothers Medical Publishers (P) Ltd., New Delhi and their General Manager (Publishing) Mr. Tarun Duneja, his
secretary Ms. Bano and their devoted staff, for their acceptance and endeavor to bring out this text in a book form.

Cont
ents
Contents
1 . Introduction,

Aims

and

Scope

of

Operative

Dentistry ............................................ 1

2 . Clinical Aspects of Dental Anatomy, Histology and Physiology in Operative

D e n t i s t r y ......................................................................................................................................................... 8
3 . Occlusion

and

Operative

4 . Clinical

Aspects

5 . Patient

Evaluation,

6 . Primary
7 . Color

of

Shade

8 . Nomenclature,
70

Caries ........................................................................................ 2 9

Dental
Diagnosis

Considerations
and

Dentistry ........................................................................................ 2 0

for

and

Planning ....................................... 4 5

Treatment

Operative

Procedures .................................................... 5 9

Matching ............................................................................................................... 6 3

Classification

and

Fundamentals

in

Cavity

(Tooth)

Preparation

Materials .................................................................................................................................. 1 0 0

9 . Dental
1 0 . Selection

of

1 1 . Isolation

of

1 2 . Instruments
1 3 . Matrices,

the
and

Operating

Field ......................................................................................... 1 1 2

Equipment

Retainers

1 4 . Infection

Materials ................................................................................... 1 0 7

Restorative

and

for

Tooth

Wedges

Preparation .................................................. 1 2 1

(Separators) ............................................................ 1 3 9

Control ................................................................................................................................ 1 5 1

1 5 . Pain

Control ............................................................................................................................................. 1 5 6

1 6 . Pulp

Protection ..................................................................................................................................... 1 5 9

17.

Periodontal

1 8 . Amalgam
1 9 . Pin

Aspects

of

Operative

Dentistry ............................................................ 1 6 5

Restorations ........................................................................................................................ 1 7 1

Retained

Restorations ........................................................................................................... 1 9 9

2 0 . M i c r o l e a k a g e ............................................................................................................................................. 2 0 6
2 1 . Finishing
2 2 . Interim

and

Polishing

of

Restorations ...................................................................... 2 1 1

Restorations ........................................................................................................................ 2 1 6

2 3 . B o n d i n g .......................................................................................................................................................... 2 2 0
2 4 . Introduction
232

to

Composite

and

Other

2 5 . Direct
Tooth-Colored
Restorations
Classes III, IV
vit
epar
ations
IV,, V and VII Ca
Cavit
vityy Pr
Prepar
eparations

Direct

Tooth-Colored

Restorations

for ............................................................................ 2 4 5

vit
epar
ations .................................... 2 5 9
ations ffor
26. Dir
ect Com
posit
es
Cavit
vityy Pr
Prepar
eparations
Direct
Composit
positee R
Res
esttor
orations
or Classes I, II and VI Ca
2 7. Glass Ionomer Cement .................................................................................................................................. 2 6 5

xvi Textbook of Operative Dentistry

2 8 . Indirect
2 9 . Cast

Tooth-Colored
Metal

Restorations ................................................................................................................ 2 8 4

3 0 . Restoration

of

3 1 . Conservative
3 2 . Direct

3 4 . Emergencies

Cervical
Esthetic

Gold

3 3 . Restorations

Restorations ................................................................................. 2 7 3
Lesions ........................................................................................... 3 0 4
Procedures ......................................................................................... 3 1 1

Restorations ............................................................................................................. 3 2 7

of

Badly

and

Decayed

Postoperative

3 5 . Restoration

of

Endodontically

3 6 . Restoration

of

Noncarious

3 7 . Restorations

and

3 8 . Management

of

and

Down

Teeth ....................................... 3 3 6

Complications ............................................................ 3 4 5
Treated

Teeth ............................................................ 3 4 9

Defects ...................................................................................... 3 5 8

Stomatognathic
Discolored

Broken

System ......................................................................... 3 6 5

Teeth .............................................................................................. 3 7 0

3 9 . Various Designs and Shapes of Margins of Tooth Preparations and Restorations

378

Multiple Choice Questions ................................................................................................................................ 383

Index ....................................................................................................................................................................... 421