Operative Dentistry Overview

Operative Dentistry Definition

• Operative dentistry focuses on the diagnosis, treatment, and prevention of hard tooth structure defects.
• It aims to restore teeth to their functional and aesthetic integrity within the chewing system.
• Other names for this specialty include Restorative Dentistry and Conservative Dentistry.

Hard Tooth Structure

• The components of hard tooth structure include: Enamel, Dentin, Cementum

Defects Affecting Hard Tooth Structure

• Defects that affect hard tooth structure include:
  • Caries
  • Attrition
  • Abrasion
  • Erosion
  • Discoloration
  • Hyperplasia
  • Hypocalcification

Dental Caries

• Dental caries is a bacterial infection that dissolves and damages tooth structure.
• Factors contributing to dental caries include:
  • The tooth itself
  • Saliva
  • Oral microbiota
  • Dietary habits

Caries Classification

• According to location:
  • Primary caries: Initial infection
  • Secondary caries: Recurring infection
• According to extent:
  • Incipient caries: Early, reversible stage
  • Cavitated caries: Advanced, irreversible stage
• According to rate:
  • Acute (rampant) caries: Rapid progression
  • Chronic (slow, or arrested) caries: Slow progression

Attrition

• Attrition is the wearing down of the biting surfaces of teeth due to functional or parafunctional movements of the jaw.

Erosion

• Erosion is the loss of tooth surface due to chemical or mechanical action.

Abrasion

• Abrasion is abnormal tooth surface loss caused by friction between teeth and external objects or between contacting teeth components.

Fracture

• Tooth fractures often result from trauma or stress.

Amelogenesis Imperfecta

• Amelogenesis imperfecta is a hereditary condition that affects enamel development, leading to defects in form or calcification.
• The appearance can vary from slightly abnormal to severely disfiguring.

Dentinogenesis Imperfecta

• Dentinogenesis imperfecta is a hereditary condition characterized by defective dentin formation.
• Enamel is often weakly attached and lost early, exposing the abnormal dentin underneath.

Scope of Operative Dentistry

• Operative dentistry has seen a shift in focus from primarily "drill and fill" to a more comprehensive approach.
• While the scope was previously around 90%, it has shifted to approximately 60%.

Phases of Operative Dentistry

• The practice of operative dentistry involves several distinct phases:
  • Diagnosis: Identifying the nature and extent of the dental defect.
  • Treatment planning: Developing a plan for addressing the issue.
  • Operation: Performing the necessary procedures, including tooth preparation and restoration.
  • Restoration: Placing a filling or other restoration to restore tooth function and form.
  • Maintenance: Monitoring the long-term health of the restoration and the tooth itself.

Problems of Hard Tooth Structure Defects

• Pain: Tooth defects can cause pain due to sensitivity or inflammation.
• Other problems:
  • Compromised chewing function
  • Aesthetic concerns
  • Increased risk of further damage
  • Potential for infection