Cavity Preparation Fundamentals
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Questions and Answers

Which retentive feature is primarily used in molars to enhance resistance to displacement of restorations?

  • Intra-Radicular Posts
  • Dove-tail lock (correct)
  • Dentin Pins
  • Reverse Bevel

What is the recommended depth of a slot used as a retentive groove in dentin?

  • 0.5mm
  • 0.6mm (correct)
  • 0.4mm
  • 0.7mm

Which factor does NOT influence the selection of retention features in cavity preparation?

  • Size of the cavity
  • Site of the cavity
  • Patient’s age (correct)
  • Type of restoration

What characterizes the Mortise Box or Modified Box Form in cavity preparation?

<p>It neutralizes functional stresses with right angle walls. (D)</p> Signup and view all the answers

What type of dental restoration typically requires more retention due to occlusal stresses?

<p>Class II (A)</p> Signup and view all the answers

What is the role of axial coves prepared with No ¼ bur in dentin?

<p>To provide additional retention. (B)</p> Signup and view all the answers

Acid etching is used primarily for which type of restoration material?

<p>Resin composite (D)</p> Signup and view all the answers

What is a potential consequence of inadequate retention features in cavity preparation?

<p>Fracture of the tooth or restoration. (D)</p> Signup and view all the answers

What is the principal mechanism of retention in restorative dentistry?

<p>Macro-Mechanical Retention (A)</p> Signup and view all the answers

Which of the following describes micro-mechanical retention?

<p>It forms microscopic resin tags from acid etching. (B)</p> Signup and view all the answers

What feature primarily prevents axial displacement of restorations?

<p>Occlusal convergence of cavity walls (A)</p> Signup and view all the answers

Which retention feature allows for a more conservative approach in tooth restorations?

<p>Acid etching (A)</p> Signup and view all the answers

What is the purpose of proximal axial grooves in cavity preparations?

<p>To stabilize the restoration against lateral forces (A)</p> Signup and view all the answers

Which statement is true regarding dentin pins used in restorations?

<p>They can be cemented or threaded and parallel or non-parallel. (D)</p> Signup and view all the answers

What does lateral retention in restorations aim to prevent?

<p>Lateral movement of the restoration (B)</p> Signup and view all the answers

What is the primary role of dentin ledges in cavity preparations?

<p>To prevent pulpward movement of the restoration (D)</p> Signup and view all the answers

What is the primary purpose of cavity preparation?

<p>To create a solid foundation for restoration (B)</p> Signup and view all the answers

What is considered a thermal irritation during cavity preparation?

<p>Cutting at high speed without coolant (B)</p> Signup and view all the answers

Which of the following describes direct restorations?

<p>Restorations applied directly in the patient's mouth during the same visit (A)</p> Signup and view all the answers

What should be limited to ensure protection against mechanical irritation during cavity preparation?

<p>The depth of the cavity being prepared (C)</p> Signup and view all the answers

What is the aim of the 'Thermal Tolerance Zone' (TTZ) in cavity preparation?

<p>To maintain the health of dentin and pulp under cutting conditions (B)</p> Signup and view all the answers

What type of irritation may occur from the use of certain cleaning agents during cavity preparation?

<p>Chemical irritation (C)</p> Signup and view all the answers

Which practice can help prevent the occurrence of caries?

<p>Regular flossing and fluoride applications (B)</p> Signup and view all the answers

What is essential for maintaining a sterile environment during cavity preparation?

<p>Sterilization of instruments and use of rubber dams (C)</p> Signup and view all the answers

Which type of restoration is not categorized under direct restorations?

<p>Cast Gold (D)</p> Signup and view all the answers

What is a key characteristic of amalgam restorations compared to composite restorations?

<p>They undergo corrosion. (B)</p> Signup and view all the answers

What is the first step in cavity preparation?

<p>Obtaining of the outline form (B)</p> Signup and view all the answers

What distinguishes composite restorations from amalgam restorations?

<p>They have a tooth-colored appearance. (C)</p> Signup and view all the answers

Which step must be completed before obtaining resistance and retention forms in the case of deep carious lesions?

<p>Removal of the remaining carious dentin (C)</p> Signup and view all the answers

Which step of cavity preparation involves shaping the internal form of the cavity?

<p>Obtaining of the outline form (C)</p> Signup and view all the answers

What is a notable disadvantage of amalgam restorations?

<p>Corrosion (C)</p> Signup and view all the answers

What does the term 'convenience form' refer to in cavity preparation?

<p>The internal shape for fitting restoration tools (C)</p> Signup and view all the answers

What is the primary purpose of the inverted truncated cone form in cavity preparation?

<p>To provide retention through undercuts while preventing wedging action (D)</p> Signup and view all the answers

Which of the following describes the convenience form in cavity preparation?

<p>Extending the cavity outline for better manipulation and visibility (C)</p> Signup and view all the answers

How do proximal axial locks aid in cavity preparation?

<p>By providing additional retention and preventing isthmus fractures (D)</p> Signup and view all the answers

Which of the following tools is emphasized for a conservative approach in cavity preparation?

<p>Micro-sized burs (C)</p> Signup and view all the answers

What does the 'conservative approach' in cavity preparation advocate for?

<p>Minimum cutting while effectively restoring defects (D)</p> Signup and view all the answers

What is one benefit of using fiber-optic handpieces during cavity preparation?

<p>They improve visibility and illumination for precise work (A)</p> Signup and view all the answers

Which feature is NOT associated with the resistance form in cavity preparation?

<p>Eliminating all forms of undercuts (B)</p> Signup and view all the answers

What is the desired outcome of sweeping curves in cavity preparation?

<p>To allow easier restoration of anatomy (B)</p> Signup and view all the answers

What type of dentin must be removed to avoid further bacterial invasion in deep cavities?

<p>Infected dentin (C)</p> Signup and view all the answers

Which type of dentin can potentially be remineralized and saved?

<p>Affected dentin (B)</p> Signup and view all the answers

What is the goal of the complete caries removal strategy established by G.V. Black?

<p>To ensure a hard sound dentin floor (C)</p> Signup and view all the answers

In which situation should hard but discolored dentin be carefully left in place?

<p>In posterior teeth due to low visibility (C)</p> Signup and view all the answers

What happens to dentin when there is significant bacterial invasion?

<p>The organic matrix is destroyed. (A)</p> Signup and view all the answers

Which treatment approach involves leaving affected dentin intact while removing only the infected dentin?

<p>Partial caries removal (C)</p> Signup and view all the answers

What defines infected dentin in terms of consistency and condition?

<p>Soft and infected with bacteria (D)</p> Signup and view all the answers

What is the role of indirect pulp capping material in cavity preparation using the partial caries removal strategy?

<p>To allow pulp to lay down tertiary dentin (B)</p> Signup and view all the answers

Flashcards

Cavity Preparation

A bio-mechanical foundation for restoring a tooth defect.

Mechanical Irritation

Damaging the tooth's structure by excessive cutting of enamel/dentin, or applying too much pressure.

Thermal Irritation

Damaging the tooth's pulp due to heat generated during cavity prep.

Chemical Irritation

Damaging the tooth pulp by using harsh chemicals during cavity cleaning.

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Bacterial Irritation

Bacteria cause caries and cavities, so removal is crucial.

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Direct Restoration

Filling/restoration done directly in the mouth during the same visit as cavity prep.

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Indirect Restoration

Filling/restoration made outside the mouth and placed later.

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Thermal Tolerance Zone

The range of temperature that the dentin-pulp can tolerate without damage to the pulp.

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Cavity Preparation Steps (Amalgam/Composite)

Steps for preparing a tooth cavity for fillings, including outline form, resistance/retention form, convenience form, carious dentin removal, finishing, and cleanup.

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Outline Form (Cavity Prep)

The shape of the cavity's boundaries, external and internal, to fit the restoration.

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Resistance Form (Cavity Prep)

Part of cavity preparation that ensures the filling won't move. A cavity design feature that prevents the restoration from moving, protecting the tooth.

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Retention Form (Cavity Prep)

Feature of the cavity causing the filling to stay in place. The shape of the cavity walls that will give a filling support in its position

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Convenience Form (Cavity Prep)

Design element in cavity prep that improves access when placing a filling.

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Amalgam Restorations

Metallic fillings that use a mixture of mercury and other metals.

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Composite Restorations

Tooth-colored fillings made of resin materials that bond to tooth structure.

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Brittle Materials (Amalgam/Composite)

Materials that tend to break easily.

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Buccal/Lingual Extensions

These extensions are added to the cavity preparation on molars to prevent the restoration from being dislodged.

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Dove-tail Lock

A special shape used in premolar preparations, where the walls are angled to create a tight fit and prevent the restoration from moving.

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Slots

Small grooves in dentin that provide retention for the filling. They are about 0.6mm deep and wide.

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Axial Coves

These are prepared in dentin to provide additional retention by creating a unique shape for the filling.

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Dentin Pins

Small metal pins inserted into dentin to provide extra retention for large fillings.

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Intra-Radicular Posts

These are strong posts placed inside the root canal to support a crown restoration.

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Reverse Bevel

A special angle created in the bottom of the cavity to help retain the filling.

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Mortise Box

A specific type of box-like cavity preparation that provides resistance and retention against forces of chewing.

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Micro-Mechanical Retention

A conservative retention method in composite restorations. Tiny resin tags are formed when resin fills the micro-pores created in enamel and dentin by acid etching.

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Macro-Mechanical Retention

A retention method typically used in metal restorations, utilizing features created within the cavity.

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Axial Retention

Prevents displacement of a restoration parallel to the tooth's long axis (up-down or front-back).

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Axial Retentive Features (Direct Restorations)

Occlusal convergence, proximal undercuts, internal outline larger than external outline are features that prevent occlusal displacement.

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Lateral Retention

Prevents restoration displacement perpendicular to the tooth's long axis.

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Lateral Retentive Features

Features like frictional opposing wall parallelism and proximal axial grooves to resist side-to-side movement.

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Dentin Bridge

The dentin thickness between the floor of the cavity and the roof of the pulp chamber.

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Resistance Form

The shape of a prepared cavity that resists forces like biting and prevents the restoration from dislodging. It involves features like parallel walls, convergence, and undercuts.

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Retention Form

The design of a prepared cavity that helps the filling stay put and keeps it from falling out. It relies on friction, undercuts, and occlusal locks.

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How does the inverted cone shape help?

The inverted cone form helps both with resistance and retention. It prevents the restoration from being wedged out by biting forces (resistance) while creating undercuts for a secure fit (retention).

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Convenience Form

The design of a prepared cavity that makes it easier for the dentist to see, reach, and fill the tooth.

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What are some features of the convenience form?

It includes extensions to improve visibility, easier access, and restoration placement. It also helps to eliminate weakened enamel and provide a smooth surface for the filling.

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What are some ways to achieve a more conservative approach to cavity prep?

Modern dentistry strives to preserve as much tooth structure as possible. Techniques like micro-sized burs, magnification with loupes and microscopes, fiber-optic handpieces, and advanced restorative materials help achieve this.

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Micro-sized Burs

Smaller-sized, specialized drills used to prepare cavities in a less invasive way, preserving more tooth structure.

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Magnification tools in dentistry

Dental loupes and microscopes enhance vision for minute details, enabling precise preparation and minimizing overcutting.

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Cavity Floor Options

The bottom surface of a prepared cavity can be composed of different types of dentin, each with varying hardness and health.

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Hard Sound Viable Dentin

Healthy, firm dentin that is strong enough to support a restoration, located at least 0.5mm away from the enamel.

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Hard But Discolored Dentin

Dentin that is firm but stained, acceptable in molars, but may need removal or masking in front teeth for aesthetics.

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Carious Dentin

Soft, infected dentin that is weak and needs to be removed, especially in deep cavities to prevent further damage.

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Affected Dentin

Demineralized dentin that is firm but susceptible to further decay, can be remineralized and saved.

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Infected Dentin

Demineralized and bacteria-infected dentin that is soft and must be completely removed.

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Complete Caries Removal

Traditional approach where all carious dentin, both infected and affected, is removed to create a healthy base for a restoration.

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Partial Caries Removal

Conservative approach where only infected dentin is removed, leaving affected dentin to be remineralized, minimizing pulp damage.

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Study Notes

Fundamentals of Cavity Preparation

  • Fundamentals: Basic principles, rules, and laws forming the groundwork of a system.
  • Standardization: Process of conforming something to a standard.
  • Cavity: Defect in hard tooth structure caused by dental caries.
  • Prepared Cavity: Bio-mechanical foundation for a restoration.
  • Direct Restorations: Applied directly in the patient's mouth during cavity preparation.
  • Indirect Restorations: Fabricated outside the mouth (lab), then cemented to the prepared cavity.

I- Protection of Dentin and Pulp

  • Mechanical Irritation:
    • Excessive enamel cutting exposes more dentin, weakening the remaining tooth structure.
    • Overcutting dentin (depth) weakens the protective dentin bridge, potentially injuring the pulp.
    • Unnecessary pressure on the base of a deep cavity can injure the pulp.

Thermal Irritation

  • Maintaining temperatures within the physiological tolerance zone (85-132°F / 29-56°C) of dentin-pulp organ during procedures.
  • Minimizing frictional heat by decreasing pressure area and cutting time.
  • Using high-efficiency cutting tools and air-water spray during procedures.

Chemical Irritation

  • Using chemical agents (e.g. phenolic agents) during cleaning can cause chemical irritation.
  • Acidic dentin conditioners used with bonded restorations can cause chemical irritation.

Bacterial Irritation

  • Remove bacteria causing caries during preparation.
  • Use antimicrobial agents (e.g., chlorhexidine) to prevent cross-infections.
  • Sterilize instruments, burs, and armamentarium to avoid cross-infection.
  • Use rubber dam to isolate the operative area.

II- Control of Caries

  • Prevent Caries Recurrence:

    • Prevent food accumulation in pits and fissures by preparing or sealing them.
    • Remove weak or undermined enamel to prevent fracture.

  • III. Protection of Investing Tissues and Adjacent Teeth:

    • Avoid improper subgingival extensions.
    • Maintain a smooth, caries-free gingival margin.
    • Protect adjacent teeth during proximal preparations with metal bands.
    • Avoid injuring gingival tissues during procedures.

B- Mechanical Fundamentals

  • Preserve the structural integrity of both the tooth and restoration (prevent fracture).
  • Retain the restoration within the cavity (prevent displacement).
  • Design cavities to maximize tooth structure conservation.

C- Esthetic Fundamentals

  • Use symmetrical cavity outlines with smooth, sweeping curves.
  • Minimize visible restoration areas using conservative designs.
  • Eliminate discolored areas of enamel or dentin, especially in anterior cavities.

Conservative approach in Operative Dentistry

  • Minimally invasive approach focused on detecting, diagnosing, and removing only the damaged tooth structure while preserving healthy structure.
  • Emphasize concepts of prevention and remineralization during restorative procedures.
    • Aim to preserve tooth and masticatory system integrity.
    • Emphasize prevention as the main goal now, rather than extension.
    • 'Sealing for prevention': examples are pit and fissure sealants.
  • Advantages of conservative cavity design:
    • Preserves healthy tooth structure.
    • Decreases irritation of dentin-pulp complex, and investing tissues
    • Reduces fractured teeth and/or restorations
    • Shorter, simpler treatments
    • Simpler standardized procedures

Restorations

  • Amalgam is brittle and non-bonded to tooth structures and suffers from corrosion and aesthetic issues.
  • Composite restoration is more resilient than amalgam/bonded and esthetic/tooth colored.

Cavity Preparation - STEPS

  • Step 1: Outline form: Include all carious enamel and dentin. Include pits and fissures deeper than one-third of enamel. Remove weak enamel.
  • Step 2: Resistance & retention form: Design the cavity to withstand the stresses of mastication. Increase depth, smooth preparation.
  • Step 3: Convenience form: Make cavity accessible for work. Make walls smooth
  • Step 4: Remove remaining carious dentin: Remove soft and infected damaged dentin.
  • Step 5: Finish cavity walls and margins: Remove undermined enamel to ensure even surface for proper adaptation with restorative materials. Correctly shape walls. Smooth walls.
  • Step 6: Toilet of the cavity: Clean and dry the cavity and remove debris so restorative material can fit securely and last

5. Finishing of Cavity Walls and Margins

  • Remove remaining undermined enamel.
  • Adjust the cavo-surface angle inclination.
  • Ensure the walls have correct inclination for adaptation.
  • Make smooth walls for proper adaptation.
  • Smooth rounding of line and point angles.
  • Finishing can be accomplished with hand instruments

6. Toilet of the Cavity

  • All procedures to prepare the cavity to receive the restorative material.
  • No medicaments to be used during the procedure.
  • Cavity must be clean and completely dry
  • Cavity lined to provide pulp protection.
  • Objectives include removing bacteria, debris (and saliva), remnants of dentin chips, and temporary restoration materials. The goal is to create a healthy environment for the new restoration and minimize the chance of recurrence of decay.

Techniques for Caries Removal

  • Manual Excavation (soft carious dentin) by hand instruments
  • Mechanical Excavation round Burs (harder carious dentin)
  • Air Abrasion: tiny aluminum oxide particles, compressed air
  • Laser Debridement: using thermal energy, water coolant
  • Chemo-Mechanical Debridement (combination of acids and sodium hypochlorite)
  • Enzymes: those that dissolve carious parts (e.g., Pronase)

Factors Affecting Cavity Outline

  • Occlusal Cavities: Caries extent, occlusal table anatomy (upper/lower, individual tooth), unusual anatomy, steep cusps. Important locations for contacts are contact-free or non-stress-bearing areas

  • Proximal Cavities: Size/position of contact area, width of embrasures, position/health of gingival tissues

  • Posterior Teeth (Class II): The intersection of the occlusal cavity and the proximal surface, including Ingerham´s lines

Factors Controlling Selection of Retention Features

  • Size and amount of tooth structure remaining
  • Missing Walls: The greater the missing walls, the greater the need for retention
  • Cavity Site & Occlusal Stress: Locations and stress factors (e.g., class II vs class V)
  • Restoration Type (e.g., composite vs. amalgam affect retention needs).
  • Pulp Vitality (e.g., vital pulp vs. non-vital pulp affect restorative considerations)
  • Esthetic Requirements: Important for selecting location and shape of retention features

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Fundamentals of Cavity Preparation PDF

Description

This quiz covers the essential principles of cavity preparation in dentistry. It includes topics on the protection of dentin and pulp, standardization in procedures, and distinctions between direct and indirect restorations. Test your knowledge on the mechanical and thermal irritations associated with cavity preparation.

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