Cavity Designs For Amalgam

Restoration

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Definition of Operative Dentistry

Operative dentistry is the ART and SCIENCE

of the diagnosis, treatment, prognosis of
defects of teeth which do not require full
coverage restorations for correction, such
treatments should results in the restoration of
proper tooth form, function, and esthetics
while maintaining the physiologic integrity of
the teeth in harmonious relationship with
adjacent hard and soft tissue, all of which
enhance the general health and welfare of the
patient.
Objectives of Cavity Preparation

Remove all defects and give the necessary protection to

pulp.

Locate the margins as conservatively as possible.

Form the cavity so that both the restoration and tooth can
withstand the load of mastication.

Allow for the esthetic and functional placement of a

restorative material.
Factors affecting tooth preparation

1. General Factors
Pulpal & periodontal status
Occlusal relationship

2.Dental anatomy
Direction of enamel rods
Thichness of enamel /dentin
Size and positionof pulp
Relationship of tooth to its supporting tissues
3.Patient factors

Age
Esthetic consideration
Economic status
Patients with high risk caries

4.Affected & infected Dentine

5. Restorative material factors

 Cavity Preparation

The mechanical alteration of a defective,

injured, or diseased tooth in order to best
receive a restorative material which will re-
establish a healthy state for the tooth
including esthetic corrections where
indicated, along with normal form and
function.
Cavity Structure

 walls
 angles
Floor
Cavity

 Simple cavity: only one tooth surface is

involved.
 Compound cavity: two surfaces are involved.
 Complex cavity: three or more surfaces are
involved.
Classification of cavity

 Class I
 Class II
 Class III
 Class IV
 Class V
 Class VI

—G.V.Black in 1908
Nomenclature

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 Cavity Line angle Point angle

 Class l 8 4
 Class 2 11 6
 MOD 14 8
 Class lll 6 3
 Class lV 11 6
 Class V 8 4

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There are many angles in a cavity
prepared cavity such as:

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Cavosurface angle

This refers to the angle

of the tooth structure
formed by the junction
of a prepared wall and
the external tooth
surface.

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Cavosurface margin

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 Principles of
tooth preparation
for amalgam

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Step 1: Outline Form and Initial Depth

Step 2: Primary Resistance Form Step

3: Primary Retention Form Step 4:

Convenience Form
Stages and Steps in Cavity
preparation

•Initial cavity preparation stage

•Final cavity preparation stage

Initial cavity preparation stage
Step 1 Outline form and initial depth

Step 2 Primary resistance form

Step 3 Primary retention form

Step 4 Convenience form

Final cavity preparation stage

Step 5 Removal of any remaining infected

dentin if indicated

Step 6 Pulp protection

Step 7 Secondary resistance & retention form

Step 8 Procedure for finishing external walls

Step 9 Final procedures

Outline Form and Initial Depth

Definition:
placing the cavity margins in the positions they
will occupy in the final preparation.

preparing an initial depth of 0.2~0.8 mm

pulpally of the dentinoenamel junction position or
normal root surface position.
Maxillary Class Ⅰ outline form
Maxillary Class Ⅱ outline form
Mandibular Class Ⅱ outline form
Outline Form and Initial Depth
Principles:

all friable and/or weakened enamel should be

removed

all faults should be included

all margins should be placed in a position to

afford good finishing of the margins of the
restoration.

Margins of the preparation will be located on

finishable, self –cleansing area.
 Outline Form and Initial Depth
Features:
preserving cuspal strength

preserving marginal ridge strength

minimizing facio-lingual extension

using enameloplasty

connecting two close faults or cavities

restricting the depth of the preparation into dentin.

Auxillary Factors

Conservation
Adjacent enamel cracks or decalcification could be
involved in the preparation.
Type of restorative material.
Extension for access.
anatomy and alignment.
If possible, no margins will be in occlusion with opposing
teeth.
Esthetics
Outline Form and Initial Depth for pit and fissure
cavities

Controlled by three factors

1- Extension to which enamel has been involved by caries.

2- Extension to achieve sound and smooth margins.

3- Limited bur depth while extending the preparaton

Rules

Capping of cusp should be done when cavity

extension is two-third from central fissure to cuspal
eminence.

Include all fissures that cannot be eliminated by

enameloplasty.

Restrict the depth.

Join two lesions if they are less than 0.5 mm apart.

Outline Form and Initial Depth for smooth
surface cavities

Extension of cavity.
Sufficient access.
Depth.
Sufficient clearance with adjacent tooth.
Initial cavity preparation stage

Step 1 Outline form and initial depth

Step 2 Primary resistance form
Step 3 Primary retention form
Step 4 Convenience form
 Steps
 establish the external outline form to extend all margins into sound
tooth tissue.

 Maintain the initial depth of 1.5 mm, this is approximately one-half of

the length of the cutting bur. should be, at least 0.2 to 0.5 mm in dentin
to provide adequate strength to resist fracture due to occlusal
forces

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 Extend the margin mesially and distally but do not involve marginal
ridges. These walls should have dovetail shape to provide retention to
the restoration

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Primary Resistance Form

Definition:

The shape and placement of the cavity walls that best

enable both the restoration and the tooth to withstand,
without fracture, masticatory forces delivered principally
along the long axis of the the tooth.
Primary Resistance Form

Principles:
To utilize the box shape with a relatively flat floor to resist
occlusal loading by virtue of being at right angles to
mastication force.

To restrict the extension of the external walls (keep as

small as possible) to allow strong cusp and ridge areas to
remain with sufficient dentin support.
Primary Resistance Form

Principles:
To have a slight rounding of internal line angles to
reduce stress concentration in tooth structure;
The presence of sharp internal line angles in GOLD
FOIL resist the movement of the restoration
Sharp internal line and point angles in dentin serve
as convenient “starting” points for compacting of
direct gold.
To provide enough thickness of restorative
material to prevent its fracture under load.
Primary Resistance Form

Feature:
Box shape
Relatively flat floors
Inclusion of weakened tooth structure
Preservation of cusps and marginal ridges
Rounded internal line angles
Adequate thickness of restorative materials
Reduction of cusps for capping if indicated
Primary Resistance cont….

Designing the outline form so that minimal of restoration

is exposed to occlusal stress.
Seat on sound dentin.
Reverse curve
Initial cavity preparation stage

Step 1 Outline form and initial depth

Step 2 Primary resistance form
Step 3 Primary retention form
Step 4 Convenience form
Primary Retention Form

Definition:
The shape or form of the prepared cavity that
resists displacement or removal of the
restoration from tipping or lifting forces.
Primary Retention Form

Principles: depending on the materials

Amalgam restoration:
developing external cavity walls that converge
occlusally and dovetail design
PRINCIPLES
For Amalgam restorations : -

 In most class I and all class II preparations, the

amalgam is retained in the tooth by developing
external tooth walls that converge occlusally
 Occlusal convergence of the proximal portion
helps inconserving the marginal ridges
 The cavosurface angle where the proximal facial
and lingual surfaces meet the marginal ridge is a
desirable 90 degrees because of the occlusal
convergence of the preparation
 Adhesive systems provide some retention by
micromechanically bonding amalgam to tooth
structure and reducing or eliminating
microleakage.
The dovetail design provide retention form
to the occlusal portion of the cavity.

The occlusal convergence of the walls offers

retention in the proximal portion of the cavity
against displacement occlusally.
Initial cavity preparation stage

Step 1 Outline form and initial depth

Step 2 Primary resistance form
Step 3 Primary retention form
Step 4 Convenience form
Convenience Form

Conception:
The shape or form of the cavity that provides
for adequate observation, accessibility, and ease
of operation in preparing and restoring the cavity.
Convenience Form

Principles:

Allow access for caries removal

Allow access for restoration placement
Allow access to margins for finishing,
evaluation and cleaning
Convenience Form
Final cavity preparation stage

Step 5 Removal of any remaining infected

dentin if indicated
Step 6 Pulp protection
Step 7 Secondary resistance & retention form
Step 8 Procedure for finishing external walls
Step 9 Final procedures
Removal of any remaining infected dentin if indicated

Definition:
The elimination of any infected carious tooth structure or
faulty restorative material left in the tooth after initial cavity
preparation.
Removal of dentinal caries using round burs and spoon excavators
Pulp protection

 Using liners or bases to protect the pulp or to aid

pulpal recovery or both.
 If the infected dentin more than 2 mm deeper from the
initial pulpal or axial wall then a Liner is indicated.
Final cavity preparation stage…..

Step 5 Removal of any remaining infected

dentin if indicated
Step 6 Pulp protection
Step 7 Secondary resistance & retention form
Step 8 Procedure for finishing external walls
Step 9 Final procedures
Secondary resistance and retention forms

 Most compound and complex cavity preparations

require additional resistance and retention form.

 The exception being those preparations that are very

conservative.
Secondary resistance and retention forms

Mechanical forms

Cavity wall conditioning form

Mechnical form:

 Proximal locks

 Proximal slots
Proximal locks
Final cavity preparation stage….

Step 5 Removal of any remaining infected

dentin if indicated
Step 6 Pulp protection
Step 7 Secondary resistance & retention form
Step 8 Finishing external walls
Step 9 Final procedures
Finishing the external walls

Definition:
Finishing the preparation walls is the further development of a
specific cavosurface design and degree of smoothness that
produces the maximum effectiveness of the restorative
material being used.
Finishing the external walls

Objectives:
 To create the best marginal seal possible
between the restorative material and tooth
structure;
 To afford a smooth marginal junction;
 To provide maximum strength of both the
tooth and the restorative material at and near
the margin.
The strongest enamel margin is that margin which is
composed of full-length enamel rods that are supported
on the cavity side by shorter enamel rods, all of which
extend to sound dentin.
Finishing the external walls

The design of the cavosurface angle

The degree of smoothness of the wall

The design of the cavosurface angle depending
on the material:

 Amalgam: 90°

 Composite: beveling 30°~ 40°

Final cavity preparation stage……..
Step 5 Removal of any remaining infected
dentin if indicated
Step 6 Pulp protection
Step 7 Secondary resistance & retention form
Step 8 Procedure for finishing external walls
Step 9 Final procedures
Final procedures

 cleaning
 inspecting
 varnishing
 conditioning
Class l designs

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Class l, design 1
 Caries penetration into dentin does
not exceed 0.5-1mm
 Width- I/4 intercuspal distance
 Low caries index

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 General shape

Molar outline Premolar outline

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Mesio distal cross section
• Pulpal Floor mesio-distally is flat and
perpendicular to the long axis of the tooth

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Out line form
• Extent of caries
• Extent for convenience
• Location of gingiva
• Convexity of proximal surface
• Location and extent of contact areas

Resistance form
Occlusal loading and its effects

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 Tensile stress

Compressive stress

Small cusps

Large cusps 46
Reverse curve

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90
 Class ll, Design 1
Conventional design

Indications

Moderate to large size proximal

Lesion with occlusal surface cavity
promotes the cavity width of cavity to
exceed 1/4 0f intercuspal distance

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 Proximal box

Inverted truncated shape

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Tunnel preparation

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Class ll, Design 2 (moderate design )
Indications
•Moderate to small sized proximal lesions
•In stress concentration area
•Width not exceeding 1/4 of intercuspal distance

General shape width 53

Bucco lingually

Mesiodistally 54
 Class ll, Design 3 (conservative design )
•Involves primarily proximal surface and very limited part
of occlusal Surface, not extending beyond adjacent
triangular fossa
•Sound occlusal crossing ridges
•Minimal loading areas

Internal anatom55y
General shape
Gingival margin

Middle third Gingival third

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 Class ll, Design 4 (Simple design )
•Proximal surface only
• Indications; Decay restricted to contacting or proximal
surface without undermining marginal ridges
Diastema or adjacent tooth is missing

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Bucco-lingual
Cross section
Occlusal-gingival
Cross section
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 Class ll, Design 5
Part of proximal surface ,with a limited access area on facial
or lingual surface
Indications •:1)Preparation will have 4 surrounding walls
•small proximal lesions
•Marginal ridge intact
•Does not involve contact area

2) Preparation will not

have surrounding walls

•medium proximal lesion

1)Do not have dovetail 59

2) Have dovetail
 Class ll, Design 6
The occlusal ,proximal and part of the facial or lingual
surfaces
Indications ; Cusp is missing
Badly broken down teeth

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 Class ll, Design 7
(Combinations of class ll with class V )
Shape A : junctions between the class ll and class V via,the
Proximal , crossing the axial angles
Shape B : via buccal / lingual groove

ShapeA Shape B
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 Class ll, Design 8

Two or more surfaces of an endodontically treated tooth

does not require post retention

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 Class lll
Amalgam is usually not indicated for anterior teeth due to
its esthetic , but distal surface of the cuspid is a unique
location

General principles a r e similar to class ll

cavity
preparation but with emphasis laid on in
a r e a s of preparation
1 esthetic concern
2 extension for a c c e s s
3 s t r e s s consideration enamel rod direction
Incisal a c c e s s
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 Designs of cavity preparation at the distal slope of
the cuspid

Indications;
1 The lesion does not involve or undermine the distal
slope of cuspid
2bulky walls will remain, incisally, after removal of
Undermine tissues
3 the labials axial angle is intact
4the restoration will be directly loaded by vertical
forces

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Internal anatomy ;

Axial convex
Depth - .5
from DEJ

Rete ntion
points :
Depth 1 to
2 mm in
dentin
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 Class lV
Indications :
•Incisal angle is undermined
•Labial and lingual walls intact

Labio lingual cross section

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Modifications

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 Class V cavity
Involvement :smooth surfaces apical to height of contour
on facial and lingual surfaces of all teeth eg ; erosion,
abrasion , hypoplasia, aplasia

 Resistance and retention

 To minimize the effects of displacing
forces forces grooves occlusal and
gingival walls are essential
- cementum completely removed
- Gingival margins follow the curvature of
the furcation
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 Class V design 1

•lesion are confined to

gingival third of the
facisal or lingual third
of the facial or lingual
surface
- axial angles intact
- no furcation
involvement
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 Class V Design 3
Indications;
Lesion on gingival third facially or linguallly is continuous
with isolated decalcifications or lesions occlusal to height of
contour

Bilateral extension 73
Class VI

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Retention coves

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Retention locks

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Tooth preparation for pin amalgam

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Pin location

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Cavosurface angle

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 Conclusion
Although composite resins and crown and bridge
restorative dental techniques receive much attention,
amalgam was once most extensively used restorative
material.
If it is used with care in minimal cavities, the restoration,
the tooth and the occlusion will all last longer!

TOXICITY reported.

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Thank you