TOOTH PREPARATION

FOR CLASS II AMALGAM

RESTORATIONS

ELDHO GEORGE
FIRST YEAR JUNIOR RESIDENT
DEPARTMENT OF CONSERVATIVE DENTISTRY& ENDODONTICS
CONTENTS

INTRODUCTION
GV BLACK’S CLASSIFICATION OF DENTAL CARIES
INDICATIONS AND CONTRAINDICATIONS OF AMALGAM RESTORATIONS
ADVANTAGES AND DISADVANTAGES OF AMALGAM RESTORATIONS
PRINCIPLES OF CAVITY PREPARATION
CLASS 2 CAVITY PREPARATION
MODIFICATIONS IN CLASS 2 CAVITY PREPARATION
CONCLUSION
 INTRODUCTIO
N
• Metal like restorative material composed of a mixture of silver, tin, copper alloy and
mercury
• Direct restorative material for almost a century
• High success rate
GV BLACK’S CLASSIFICATION
CLASS 1 CAVITY
CLASS II
CAVITY
CLASS III CAVITY
CLASS IV CAVITY
CLASS V CAVITY
 INDICATIONS
• Heavy occlusal load
• Non esthetics
• Temporary caries control
• Difficult isolation
• Foundations to increase retention and resistance
CONTRAINDICATIONS
• Aesthetics
• Extensive loss of tooth structure
• Small class I and II cavities
ADVANTAGES
• High compressive strength
• Excellent wear resistance
• Favorable long term result
• Lower cost
• Ease of use
• Self sealing ability
DISADVANTAGES

• Less conservative
• Non esthetic
• Tooth weakens
• Non insulating
• Technique sensitive
PRINCIPLES OF TEETH PREPARATION:
FINAL TOOTH PREPARATION
INITIAL TOOTH PREPARATION
• Removal of any remaining infected dentin or old
• Outline form and initial depth restoration or both

• Pulp protection, if required

• Primary resistance form
• Secondary resistance and retention forms

• Primary retention form

• Procedures for finishing external walls

• Convenience form • Final procedures- cleaning, inspecting, sealing

OUTLINE FORM AND INITIAL DEPTH

DEFINITION

It is the placement of the preparation margins in the position they will occupy in the final
preparation,except for finishing the enamel walls and margins. Also includes preparing an
initial depth of 0.2 – 0.5 pulpally beyond DEJ
FEATURES

• Preserving cuspal strength

• Preserve marginal ridge strength
• Minimising faciolingual extensions
• Using enameloplasty
• Connecting two close (<0.5mm apart) faults or tooth preparation
• Restrict depth of preparation into dentin to maximum of 0.2 mm for pit and fissure
caries
• And 0.2 to 0.8mm for the axial wall of smooth surface caries
ENAMELOPLASTY

• Careful removal of sharp and irregular enamel margin

• by rounding or saucering it and converting it into a smooth groove
• making it self cleansable, finishable and allowing conservative placement of margins
Indications 
• • It is done when caries is present in less than one-third thickness of the enamel.
• Presence of a shallow fissure crossing facial or lingual ridge can be removed by
enameloplasty 
PRIMARY RESISTANCE FORM

DEFINITION

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
FEATURES
• Relatively flat floors
• Box shape
• Inclusion of weakened tooth structure
• Preservation of cusps and marginal ridges
• Rounded internal line angles
• Adequate thickness of restorative material (1.5 mm for amalgam)
• Reduction of cusps for capping when indicated
PRIMARY RETENTION FORM

• DEFINITION

• It is the shape or form of the conventional preparation that resists displacement or

removal of the restoration by tipping or lifting forces
FEATURES
• Convergence of facial and lingual walls occlusally in class 1 preparation. In class 2
preparation facial and lingual walls of the proximal portion should also converge in
occlusal direction

• Occlusal dovetail
 CONVENIENCE FORM
• DEFINITION

• 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
FEATURES
• Includes extending the proximal margins to provide clearance from the adjacent
tooth and extension of other walls to provide greater access for caries
excavation

• Features that make the procedure easier and the area more accessible
 FINAL TOOTH PREPARATION STAGES

REMOVAL OF ANY REMAINING ENAMEL PIT OR FISSURE, INFECTED DENTIN OR OLD RESTORATIVE MATERIAL, IF INDICATED

• It is the elimination of any infected dentin or faulty restorative material left in the
tooth after initial tooth preparation
 INFECTED DENTIN AFFECTED DENTIN

1.More superficial layer of carious dentin 1. Deeper layer

2. Light brown in colour
3. Soft and leathery in consistency
4. Collagen is irreversibly denatured
5. Has high concentration of bacteria
6. Not remineralizabla and should be
removed
2. Dark brown in color
3. Hard in consistency
4. Collagen reversibly denatured
5. No bacteria found in this zone
6. Capable of remineralization and should not
be removed

7. Stained by dyes 7. Not stained

PULP PROTECTION

Some of the pulpal irritants that affect operative procedures like

• Thermal changes through materials
• Ingredients of the material
• Forces transmitted to dentin
• Galvanic shock
• Ingress of toxins through microleakage 
• Liner or base: Mechanical, chemical, thermal pulp protection and act as a barrier that
protects the dentin

• Cavity varnish and bonding agents can also be used

 SECONDARY RESISTANCE AND RETENTION
FORMS
• They are of two types:

1. Mechanical preparation features

2. Conditioning of the preparation walls with etching, priming and adhesive

materials
MECHANICAL FEATURES

• Retention locks
• Grooves
• Pins
• Slots
• Amalgapins
CONDITIONING PROCEDURES

• These include etching and bonding employed mainly for composite or

• ceramic restorations

• They may also be employed to bond amalgam or cast metal restorations to

• tooth structure where indicated
 FINISHING THE EXTERNAL WALLS
OF THE PREPARATION

• Finishing the external preparation walls is the further development,

• when indicated, of a specific cavosurface design and degree of
• smoothness or roughness that produces maximum effectiveness of
• the restorative material being used
 CLEANING, INSPECTING AND SEALING:
• Cleaning of visible debris with warm water from the syringe and then to remove the
moisture with a few light surges of air syringe

• Other methods include dry cotton pellets, cavity cleansers like citric acid, ascorbic
acid and acetic acid

• Varnish should be applied on all the preparation walls to prevent the microleakage

• Disinfection of the preparation walls can be done by silver nitrate, phenol, ethyl
alcohol
CLASS 2 CAVITY PREPARATION

• DEFINITION

• Carious lesions occurring on proximal surfaces of premolars and molars

• DIAGNOSIS OF CLASS 2 LESION

• Clinical diagnosis isn’t sufficient, because class 2 can occur with intact marginal
ridges

• IT CAN BE ASSESSED BY
1. History of food lodgement
2. Separation using wedges
3. Floss get frayed due to sharp edges of the cavity
4. Bitewing x ray
• PARTS OF CLASS 2 CAVITY PREPARATION

• 1. Occlusal Step
• 2. Isthmus
• 3. proximal box
• 4. pulpal floor
• 5. axial wall
• 6. gingival seat
 ARMAMENTARIUM
:
• A No. 245 bur with a head length of 3 mm and a tip diameter of 0.8 mm or a smaller No.
330 bur is recommended
HAND INSTRUMENTS

• Enamel hatchet
• Gingival marginal trimmers
• Excavators
• LINE ANGLE

• It is formed by the junction of two surfaces.

• POINT ANGLE

• It is formed by the junction of three surfaces

Tooth preparation walls
 Lingual
 Gingival
 Pulpal
 Axial
 Facial
 Distal / Mesial

Line angles and point angles

 6 point angles
 11 line angles
 DESIGN OF OCCLUSAL STEP
• Proper depth of the initial entry cut is 1.5-2mm

• The pulpal depth is usually 0.1-0.2 mm in to the dentin

• While maintaining the same depth and orientation ,bur is moved to extend the outline to include the
central fissure and opposite pit ,if necessary
• Distal wall can be made occlusaly divergent by tilting the bur ,if extension of distal margin would
reduce the dentinal support of marginal ridge
• Maintaining the bur parallel to long axis of the tooth, creates facial lingual and distal walls occlusaly
convergent

• Dovetail prevents the proximal displacement of the restoration

• Dovetail is not required in outline form of single step proximal box ,unless a fissure is radiating from
the occlusal pit
ISTHMUS

• Narrowest portion connecting occlusal step and proximal box. Should be kept narrowest as
possible

• WIDTH OF THE ISTHMUS AND TYPE OF RESTORATION

• 1. Width less than ¼ th of the intercuspal distance – Amalgam

• 2. More than ¼ th but less than 1/3 rd of the intercuspal distance - Inlay
• 3. More than 1/3 rd of the intercuspal distance - Onlay
DESIGN OF PROXIMAL BOX
• The initial procedure in preparation of outline form is the isolation of the proximal enamel by giving the
proximal ditch cut

• Allow the end of the bur to cut a ditch gingivally along the exposed DEJ, two thirds at the expense of dentin and
one third at the expense of enamel

• The 0.8-mm diameter bur end will cut approximately 0.5 to 0.6 mm into dentin and 0.2 to 0.3 mm into enamel

• The ditch is extended gingivally just beyond the caries or the proximal contact, whichever is greater
1. WIDTH OF THE PROXIMAL BOX

a. Depends on the buccolingual contacts and extension of caries

b. The margins of the preparation should have a proximal clearance of 0.2 to 0.3 mm
with the adjacent teeth

c. Clearance can be checked by passing the tip of the explorer in the middle
3rd where contacts are located
2. DEPTH OF THE PROXIMAL BOX GINGIVALLY

• Depends on the occlusogingival contact and caries

• Gingival seat should be placed below the contact,to have a 0.5 mm clearance with the adjacent teeth.

• Occlusal convergence is given for the proximal box as a retentive feature

3. AXIAL DEPTH AND PULPAL FLOOR

• Axial wall and pulpal floor are always kept in the dentin (elastic recoil)

• Pulpal floor is kept 0.2 mm into the dentin from DEJ and Axial wall is kept 0.5 -0.8 mm into the
dentin ( 2/3rd of bur head on dentin and 1/3rd on enamel)
GINGIVAL SEAT
• External cavity wall that is perpendicular to the long axis of the tooth

• Made flat and extended beyond the contact area or upto the proximal lesion
whichever is more.

• 0.5 mm clearance from the adjacent tooth and 0.75 mm in caries susceptible
individuals

• Width of the seat- 0.6 to 0.8mm for premolars and 0.8 to 1 mm for molars
Removing the remaining undermined proximal enamel with an enamel hatchet on the facial proximal wall,
the lingual proximal wall and gingival wall
AXIAL WALL:
• It is an internal wall parallel to the long axis of the tooth
• It is kept in dentin to obtain resistance of dentin, bulk of the restoration and for the placement of
retentive locks
• Length of the wall- 0.4 to 0.6mm from the axio gingival line angle
• Should be straight or convex but never concave and should follow the contour of the proximal
surface
 ROUNDING OF AXIOPULPAL LINE ANGLE:
• Is done to reduce stress concentration and also to increase the thickness of restorative
material in the area (resistance feature)
BEVELS IN CLASS 2 CAVITY PREPARATION
• The only place to give a bevel in the class 2 preparation is the gingival cavosurface margin (15-20)
due to the apically directed enamel rods

• Absence of bevel creates fracture of enamel and progression of the secondary caries

• Bevel is given with Gingival Marginal Trimmer

• No bevel is required in the gingival cavosurface margin if the gingival seat is located on the root
surface
REVERSE S CURVE

• Resistance form

• Depends on the position of buccolingual contact area

• It is created to provide butt joint in the preparation margin for prevention of unnecessary tooth
structure

• Reverse curve is usually given in the buccal wall of the cavity in order to preserve the cuspal integrity
SECONDARY RESISTANCE AND RETENTION
FORMS
RETENTION GROOVES
• Placed on axiofacial and axiolingual line angle terminating at axiopulpal point angle

• Prepared with No 169L bur or No ¼ bur

RETENTION LOCKS
• Vertically oriented

• POSITION: It is the axiofacial and axiolingual line angles of initial

tooth preparation. It should be placed 0.2 - 0.5 mm inside the DEJ
• TRANSLATION: refers to the direction of the movement of the axis of the bur which is parallel to
the DEJ

• DEPTH: Extent of translation (0.5mm at gingival level)

• OCCLUSOGINGIVAL ORIENTATION: The tilt of No.169 L bur which dictates the occlusal height
of the lock, given at a constant depth
REVERSE BEVEL
• Flat junction between the bevels

• Given with GMT

• Prevent proximal displacement

 RETENTION
COVES
• Small retentive grooves placed on the floor or wall of the preparation into the dentin

• Dimension are around 1mm in depth as well as height

 AMALGAPIN AND BONDING AGENTS
• AMALGAPIN
Modified amalgam inserts
Inverted cone burs are used to create retentive features with 1-2 mm in depth and 0.5
-1 mm in width in the preparation
Into this, restoration will flow and creates a lock

• BONDING AGENTS:
• All bond 2, Amalgam bond plus etc
FINISHING EXTERNAL WALLS
• There should be no unsupported enamel and marginal irregularities

• Butt joint relation between the tooth and amalgam

• Cavosurface bevel 20 degrees at the gingival margin can be given by GMT to ensure full length
enamel rods forming gingival margin

• The sharp angles at the linguogingival and faciogingival corners are rounded by rotational sweeping
with a GMT
DEBRIDEMENT AND INSPECTION
• To remove all debris after the cavity preparation

• Avoid overdrying of teeth, as it can cause pain and sensitivity due to dentinal fluid movements
 MODIFICATIONS OF CLASS 2
CAVITY PREPARATION
1. MODIFICATION IN MANDIBULAR FIRST PREMOLAR

• Due to diminished size of lingual cusp

• And lingually tilted crown

• 2. MODIFICATION IN MAXILLARY FIRST MOLAR

• Due to the presence of

• a. Oblique Ridge
• b. Caries involvement in buccal and lingual fissure

• Oblique ridge should be spared as it provide strength to the tooth when the caries is not extensive
3. MODIFICATION IN MAXILLARY FIRST PREMOLAR

• Due to esthetics ,buccal wall of the proximal box should be kept inside the contact

• Buccal wall of the proximal box should be kept along the long axis of the teeth rather than the usual
convergence due to esthetic concerns.
4. BOX PREPARATION

• When restoring a small, cavitated, proximal lesion in a tooth with neither occlusal
fissures nor a previously inserted occlusal restoration, a proximal box preparation
without an occlusal step has been recommended
5. FOR PRESERVING THE MARGINAL RIDGE

a. SLOT PREPARATION

Indications

• In old age people,as there is gingival recession

• Missing adjacent teeth

 b. TUNNEL PREPARATION

Material of choice for restoration in here is GIC

• 6. ADJOINING RESTORATION

• It is permissible to repair or replace a defective portion of an existing amalgam restoration if the

remaining portion of the original restoration retains adequate resistance and retention form

• The intersecting margins of the two restorations should be at right angles as much as possible
• 7. ROTATED TEETH

• Tooth preparation for rotated teeth follows the same principles as

for normally aligned teeth

• When the tooth is rotated 90 degrees and the "proximal“ lesion is

on the facial or lingual surface and orthodontic correction is
declined or ruled out, the preparation may require an isthmus that
includes the cuspal eminence
 CONCLUSION

• Thorough understanding of the tooth anatomy and the various steps of tooth preparation is essential
for the success of the amalgam restorations

• Nowadays, concerns for mercury toxicity and other hazards of amalgam has reduced the wide use of
amalgam despite its long clinical success.
 REFERENCE
• Theodore M. Roberson, Harald O. Heymann, Edward J. Swift, Sturdevant’s Art and
Science of Operative Dentistry; Fifth edition
• Phillips science of dental materials 12th edition
• James B Summit, J.W. Robbins, Richard S Schwartz, Fundamentals of operative
Dentistry a contemporary approach; Second Edition