Tooth Preparation
Definition
•Tooth preparation is called as mechanical
alteration of defective, injured and diseased
tooth such that placement of restorative
material that re-establishes normal form and
function, including esthetic correction where
indicated.
Tooth decay
Tooth surface
Crows of all teeth have five surfaces.
1. Facial Surface
Facial surface can be labial surface or buccal surface.
a) Labial surface. The surfaces of incisors and canines that are
towards the lip.
b) Buccal surface. The surfaces of premolars and molars that
face the cheek.
2. Lingual Surface (Palatal surface)
All surfaces facing towards the tongue.
3. Proximal Surfaces
a. Mesial Surface
All surfaces towards the midline.
b. Distal Surface
All surfaces away from the midline.
Mesial and Distal surface are collectively called Proximal surface.
4. Incisal or Occlusal surface
a. Incisal surface. The surface of incisors and canine that come in
contact with those in the opposite jaws during the act of closure are
called incisal surfaces.
b. Occlusal surface. The surface of premolars and molars that come in
contact with those in the opposite jaws during the act of closure are
called occlusal surfaces.
Tooth surfaces
1. Anterior tooth
a) Labial surface
b) Lingual surface
c) Mesial surface
d) Distal surface
e) Incisal surface
[Link] tooth
a) Buccal surface
b) Lingual surface
c) Occlusal surface
d) Proximal
Terminologies
• Grooves or fissures: Anatomic depression mark the location
of the union of developmental enamel lobes.
• Where such union is complete, this “landmark” is smooth,
hard, shallow, accessible to cleansing, and termed a groove
• Where such union is incomplete, the landmark is
sharply depressed to form a deep narrow, inaccessible
cleft of varying depths in the enamel and is termed a
fissure
• Fossa , which is non defective enamel lobe union
• Pit, which is defective
Enameloplasty: is the removal of a shallow developmental fissure or
pit in enamel to create a smooth, saucer-shaped surface that is self-
cleansing or easily cleaned.
Tooth preparation terminology
1. Simple tooth preparation: Tooth preparation
involving only one tooth surface(mesial/ distal/
occlusal/buccal/ lingual).
2. Compound tooth preparation: involving only two
surfaces(mesial-lingual/disto-buccal).
3. Complex tooth preparation: involving three or more
surfaces(MOD).
Tooth preparation walls
1. Internal wall: An internal wall is a prepared surface
that does not extend to the external tooth surface.
• Axial wall: An axial wall is an internal wall which is
parallel to the long axis of the tooth.
• Pulpal wall( Floor): The pulpal wall is an internal wall
that is perpendicular to the long axis of the tooth and
occlusal of the pulp.
Internal-wall
Axial Wall
Pulpal Wall
[Link] Wall. The external wall is a prepared (cut)
surface that extends to the external tooth surface. Such a
wall takes the name of the respective tooth surface (or
aspect) towards which it is prepared
Eg: mesial wall, distal wall, buccal wall, lingual wall,
gingival floor
Name the walls??
Floor (or Seat). The floor (or seat) is a prepared (cut)
wall that is reasonably horizontal and perpendicular to
the occlusal forces that are directed occlusogingivally
(generally parallel to the long axis of the tooth).
• Examples are the pulpal and gingival walls.
• Provide stabilizing seats for the restoration,
distributing the stresses in the tooth structure, rather
than concentrating them.
• Enamel Wall. The enamel wall is that portion of a prepared
external wall consisting of enamel
• Dentinal Wall. The dentinal wall is that portion of a prepared
external wall consisting of dentin
• mechanical retention features may be located
Tooth Preparation Angles
1. Line angle: A line angle is the junction of two planal
surfaces of different orientation.
Line angle
Point angle
Termed as :
• mesio-pulpal,
• disto-pulpal,
• axio-pulpal,
• axio-lingual,
• axio-gingival
2. Point angle: A point angle is the junction of three
planal surfaces of different orientation
Termed as
• axio-bucco-gingival
• axio-linguo-gingival.
The cavosurface angle is the angle of tooth
structure formed by the junction of a
prepared (cut) wall and the external surface
of the tooth .
The junction is referred to as the
cavosurface margin.
Classification of Tooth Preparation:
Class I: All pits and fissure preparations are termed as Class I
1. Occlusal surface of premolars and molars
2. Occlusal two-thirds of the facial and lingual surfaces of molars
3. Lingual surfaces of maxillary incisors.
Class II Preparations:
Preparations involving the proximal surfaces of posterior teeth .
Class III Preparations:
Preparations involving the Proximal surfaces of anterior teeth that do
not include the incisal angle .
Class IV Preparations:
Preparations involving the Proximal surfaces of anterior teeth that
include the incisal edge .
Class V Preparations :
Preparations on the gingival third of the facial or lingual surfaces of all
teeth .
Class IV Preparations:
Preparations on the incisal edge of anterior teeth or the occlusal cusp
of posterior teeth .
Enamel margin strength:
• Strength at the enamel margin created by 2 significant
feature:
(1) If it is formed by full-length enamel rods whose inner ends
are on sound dentin, and
(2) these enamel rods are buttressed on the preparation side by
progressively shorter rods whose outer ends have been cut off,
but whose inner ends are on sound dentin.
• If the enamel rods are not supported at inner ends by sound
dentin--- called as unsupported enamel
Conventional vs modified preparation
• Conventional requires uniform depth and particular
wall forms and specific margins of cavity ---especially
required for amalgam restoration
• Modified preparation does not require uniform depth,
wall form. It depends on the shape of carious lesion or
defect or injury---especially required for composite
restorations.
Objectives of tooth preparation:
1. Remove all defects
2. Extend preparation margins as conservatively as
possible
3. Prepare tooth such that tooth as well as restoration
does not fracture under masticatory load and will not
be displaced
4. Provide necessary protection to pulp
5. Esthetics and functionality of tooth is to be restored.
Factors affecting tooth preparation:
Determined by :
• General factor
• Conservation of tooth structure
• Restorative material factor
1. General factor
• Diagnosis:
• Careful examination: dental caries, fracture, esthetic need area
• Assessment of pulpal and periodontal status
• Assessment of occlusal relationships
• Knowledge of dental anatomy:
• Thickness of enamel and dentin
• Direction of enamel rods
• Size and position of pulp
• Affected and infected dentin
• Relationship of tooth to supporting tissues
• Patient factor:
• Economic status
• Medical condition
• Esthetic concern
2. Conservation of tooth structure
3. Restorative material factor Amalgam restoration
Cast metal restoration such as inlay and onlay
Adhesive restoration such as composite
Principles of tooth preparation
Initial tooth preparation stage
• Step 1: Outline form and initial depth
• Step 2: Primary resistance form
• Step 3: Primary retention form
• Step 4: Convenience form
Final tooth preparation stage
• Step 5: Removal of any remaining infected dentin or
old restorative material (or both), if indicated
• Step 6: Pulp protection, if indicated
• Step 7: Secondary resistance and retention forms
• Step 8: Procedures for finishing external walls
• Step 9: Final procedures—cleaning, inspecting, sealing
Initial tooth preparation :
is the extension and initial design of external walls of
preparation at a specified limited depth so as to provide
access to the caries or defect, reach sound tooth
structure, resist fracture of the tooth and restorative
material from masticatory forces principally directed
with the long axis of the tooth, and retain the restorative
material in the tooth
STEP 1: OUTLINE FORM AND INITIAL DEPTH
Def:Establishing the outline form means
(1) placing the preparation margins in the positions
they will occupy in the final preparation except for
finishing enamel walls and margins
(2) preparing an initial depth of 0.2 to 0.8 mm
pulpally of the DEJ
Determines shape and
boundaries of preparation
Principles
1. All friable or weakened enamel usually should be
removed.
2. All faults should be included.
3. All margins should be placed in a position to afford
good finishing of the margins of the restoration.
Objectives /features…
1. Preserving Cuspal strength
2. Preserving marginal ridge strength
3. Minimizing Faciolingual extension ( extension—1/3rd to
1/4th ICD)
4. Connecting two close faults or tooth preparation
5) Restricting the depth of the
preparation into dentin to a
maximum of 0.2- 0.5mm
pulpally of DEJ in pit and
fissure caries or 0.8mm pulpally
of normal root surface position.
6. Using enameloplasty
Enameloplasty is prophylactic removal of a shallow,
enamel developmental fissure or pit to create a smooth,
saucer shaped surface that is self-cleansing or easily
cleaned
STEP 2. PRIMARY RESISTANCE FORM
• Primary Resistance form may be defined as the shape and
placement of 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:
1) Relatively flat floors
2) Box shape and
3) Inclusion of weakened tooth structure
4) Preservation of cusps & marginal ridges
5) Rounded internal as well as external line angles
6) Adequate thickness of restorative material
7) Reduction of cusps for capping when indicated
1. Box shape and relatively flat floors
5) Rounded internal as well as external line angles
6) Reduce the cusp to cap weak cusps
7) Provide enough thickness of restorative material to
prevent its Fracture under load (for amalgam thickness
is 1.5mm)
STEP3: PRIMARY RETENTION FORM
Primary Retention form is the shape or form of the
conventional preparation that resists displacement or removal
of restoration by tipping or lifting forces.
Features:
1)Occlusal convergence of facial and lingual walls.
2)Occlusal dovetail preparation
STEP4: CONVENIENCE FORM.
Convenience form is the shape or form of preparation that
provide for adequate observation, accessibility and ease of
operation in preparing & restoring the tooth.
Final tooth preparation:
Step 5: Removal of any remaining Enamel pit or
Fissure, Infected Dentine, or Old Restorative Material,
if indicated.
Def: Removal of any remaining enamel pit or fissure, infected
dentin, or old restorative material is the elimination of any
infected carious tooth structure or faulty restorative material
left in the tooth after initial tooth preparation.
Step 6: Pulp protection if indicated
Step 7: Secondary Resistance and Retention forms:
Step 8: Procedure for Finishing the External Walls of
the Tooth Preparation:
Def: Finishing the preparation walls is the further
development, when indicated, of a specific cavosurface design
and degree of smoothness or roughness that produces the
maximum effectiveness of the restorative material being used.
Objectives:
• Create the best marginal seal possible between the restorative
material and the tooth structure
• Smooth marginal junction
• Provide maximal strength of tooth and the restorative material at and
near the margin
Principle :
• Allow access to caries removal
• Allow access for finishing margins
• Allow access for restoration placement
