2 principles of tooth prep2

7/25/2019 2 Principles of Tooth Prep2

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TOOTH PREPARATION

Sharon Isidro-Alvarez, DMD, Ph.D.

Our Lady of Fatima University

College of Dentistry

DEPARTMENT OFRESTORAT!E DENTSTR"


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TOOT# PREPARATON

Toot$ %re%aration is de&ned as t$eme'$ani'al alteration of a defective(in!red( or diseasedtoot$ to )est

re'eive a restorative material t$at *illreesta)lis$ a $ealt$y state for t$etoot$( in'luding est$eti' 'orre'tions+


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E,TENSON FOR PRE!ENTON

Sa'ri&'e sound toot$ stru'ture to %la'e'avity margins into self-'leansingareas.'aries immune sites

Resistan'e and retention formsre/uired

0ea1ens toot$ stru'ture

n'reased ris1 of %ul%al involvement


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CONSER!ATON OF SOUND TOOT# STRUCTURE

The s"aller the tooth #re#aration, the

easier it is to retain the restorative"aterial in the tooth.

Small toot$ %re%arations result in restorations t$at $ave

less e2e't on )ot$ intraarch and interarchrelationshi#s, as *ell asesthetics+

Naturally( t$e smaller t$e toot$ %re%aration( t$estron$eris t$e remaining un%re%ared toot$ stru'ture+

%eat!res that s!&ce conservation of so!nd toothstr!ct!re'

345 minimal extensions of the toot$ %re%arations(

es%e'ially fa'iolingually and %ul%ally6


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NDCATONS FOR RESTORAT!E TREATMENT

(ARIES


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'aries

REPLACEMENT OR REPAIR OFRESTORATIONS

)ITH SERIO*S DE%E(TS


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'aries

replacement or repair of restorations

*it$ serious defe'ts %RA(T*RED TEETH


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'aries

replacement or repair of restorations

*it$ serious defe'ts fra'tured teet$

ESTHETI(S


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PRNCPLES OF TOOT# PREP

Initial toot preparation E+tensionand initial desi$n of t$e e8ternal *alls of t$e

%re%aration at a s%e'i&ed( li"ited de#th so as to #rovideaccess to t$e 'aries or defe't( reach so!nd tooth str!ct!re3e8'e%t for later removal of infe'ted dentin on t$e %ul%al ora8ial *alls5( resist fra'ture of t$e toot$ or restorative materialfrom masti'atory for'es %rin'i%ally dire'ted *it$ t$e long a8is

of t$e toot$( and retaint$e restorative material in t$e toot$


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Initial tootpreparation

4+ Outline form andinitial de%t$

7+ Primary resistan'eform

9+ Primary retentionform

:+ Convenien'e form


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4+ Outline form andinitial de%t$


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7+ Primaryresistan'e form

;ul1

Under'uts

Flat


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9+ Primary retentionform


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:+ Convenien'e form


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PRNCPLES OF TOOT# PREP%inal tooth #re#aration

=+ Removal of any remaininginfe'ted dentin and or oldrestorative materials( ifindi'ated

>+ Pul% %rote'tion( ifindi'ated

?+ Se'ondary resistan'e andretention forms

@+ Pro'edures for &nis$inge8ternal *alls

+ Final %ro'eduresB 'leaning(ins%e'ting( sealing


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%inal tooth#re#aration

=+ Removal of anyremaining infe'ted

dentin and or oldrestorative materials(if indi'ated


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>+ Pul% %rote'tion( ifindi'ated


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?+ Se'ondary resistan'eand retention forms


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@+ Pro'edures for&nis$ing of *alls


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+ Final %ro'eduresB'leaning( ins%e'ting(

sealing


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STEP 4+ ESTA;LS# OUTLNE FORM


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RULES FOR ESTA;LS#N OUTLNE FORMFOR PT AND FSSURE TOOT# PREPARATONS

4+ E8tend until so!nd tooth str!ct!reis otained and no unsu%%ortedand.or *ea1ened enamel remains

. Avoid ter"inatin$ t$e margins one8treme eminen'es su'$ as 'us%$eig$ts and ridge 'rests

9+ E8tend to incl!de all ss!res t$at'annot )e eliminated )yenamelo%lasty


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ENAMELOPLAST"

Enamel

Enamel


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ENAMELOPLAST"

removal of a s$allo*( enameldevelo%mental &ssure or %it to 'reate

a smoot$( sau'er-s$a%ed surfa'e t$atis self-'leansing or easily 'leaned


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RULES FOR ESTA;LS#N OUTLNE FORMFOR PT AND FSSURE TOOT# PREPARATONS

:+ Restri't initial #!l#alde#th to /.0 mm from t$e

'avosurfa'e margins=+ (onnect #re#arations

se%arated )y less t$an +=mm of sound toot$stru'ture


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Pulpal floor perpendicular to occlusalforces and long axis of tooth


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RULES FOR ESTA;LS#N OUTLNE FORM

FOR PT AND FSSURE TOOT# PREPARATONS

>+ E8tend to #rovide fors!&cient accessfor

%ro%er toot$ %re%aration(restoration %la'ement and&nis$ing %ro'edures


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RULES FOR ESTA;LS#N OUTLNE FORM FORPRO,MAL SURFACE TOOT# PREPARATONS

:+ Restri't initial a+ial de#th of the #ro+i"al#re#aration to a "a+i"!" of 1. 2 1.3 ""into dentin

=+ E8tend *alls of %ro8imal )o8 3'ervi'al( fa'ialand lingual5 1.0 "" o!t of contact


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STEP 7+ ESTA;LS# RESSTANCEFORM


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RESSTANCE FORM

De&nitionB

t$e s$a%e and %la'ement

of t$e 'avity *alls t$at)est enales thetooth and restorationto 4ithstand occl!sal

forces 4itho!tfract!rin$


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FRACTURE OF T#E TOOT# SPRE!ENTED ;"B

4+ ;o8 form *it$ 5at #!l#al5oore8'e%t lo*er :s

7+(onservative

%re%arations

9+ Re"oval of

!nder"ined enamel andfragile 'us%s

:+ Ro!ndedinternal line

angles


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FRACTURE OF T#E RESTORATON SPRE!ENTED ;"B

4+ Ade/uate !l6of restoration

. 7eveledA-Pline angle

9+ Corre't carvin$and %ro%eroccl!sion

:+ 7!tt-oint"ar$ins for

amalgam


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RETENTON FORM

De&nitionBt$at s$a%e or form of

t$e toot$ %re%aration

t$at )est %ermits t$erestoration to resistdis#lace"ent


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RETENTON FORM S AC#E!ED;"B

Pro%er relationshi# of 4alls

Dovetails

Retention $rooves, dentinal slots, #inholes

PinsB fri'tion lo'1( 'emented and self-t$reading

Acid etchin$


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AU,LAR" RETENTON

Pins

Dentinal Slot

Retention groove Amalgam %ins


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PNS

Self-t$reading %ins

Fri'tion lo'1 %ins

Cemented %ins


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SELF-T#READN PNS3E++ T#READ MATE S"STEM( COLTENE.0#ALEDENT5

Minuta +9@ mm

Mini1in - +:@

Minim +>4

Regular +?@


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T#NS TO REMEM;ER 0#EN USN PNS

More %ins( t$e )etter t$e retention+

Ho4ever,

fra'turein'reases

'raing of dentin and %otential for amount of dentin

)et*een %ins de'reases strengt$of amalgam restoration de'rease

As a r!le, !se one #in for ever8 "issin$ a+ial 4all


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Lo'ationB Pin$ole must )e %ositioned1.0-/.1 "" inside the DE9 or /.1-/.0 "" fro" the e+ternal tooth

s!rface,*$i'$ever distan'e is greater


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Lo'ationB Pin$ole must )e %ositioned+=-4+ mm inside t$e DEG or 4+-4+=mm from t$e e8ternal toot$ surfa'e(

*$i'$ever distan'e is greater


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OrientationB As a rule( t$e %in s$ould )eoriented %arallel to t$e adHa'ente8ternal surfa'e of t$e toot$


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DENTN SLOT

3PREPARED ;" A I99 J ;UR5

E

n

a

m

el

Dentin

0.5 -1.0 mm from the DEJ


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AMALAM PN3PREPARED ;" A I7:= ;UR5

E

n

a

m

el

Dentin

0.5 -1.0 mm from the DEJ


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ORDER OF DECREASN RETENTON

Self-t$reading and dentin slot Fri'tion lo'1

Cemented and amalgam %in


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CON!ENENCE FORM

De&nitionB

t$at s$a%e or form of t$e 'avity t$at%rovides for ade:!ateoservation, accessiilit8, and

ease of o#erationin %re%aringand restoring t$e teet$


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CON!ENENCE FORM SAC#E!ED ;"B

Sacricin$ so!nd tooth str!ct!retogain a''ess to %ro8imal 'aries

E+tendin$ #ro+i"al 4alls out of 'onta't


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REMO!AL OF AN" REMANN PT AND FSSURE( NFECTEDDENTN AND.OR OLD RESTORAT!E MATERAL( F NDCATED


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REMO!E AN" REMANN RESTORATON F AN" OFT#E FOLLO0N CONDTONS ARE PRESENTB

Old restoration 'an a2e't

esthetics

f it a2e'ts retention Radiogra%$i' or 'lini'al eviden'e

of caries

Pul% s8"#to"atic%reo%eratively Peri%$ery of old restorations not

intact


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PULP PROTECTON( F NDCATED


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PROPER PLACEMENT OF ;ASEMATERAL

Calciumhydroxide

liner

Tooth prep with

ideal depth and

cervical floor

width


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RESTORED TOOT#

Calciumhydroxide

liner

GC !a"e

#ermanent

re"toration


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O;GECT!ES OF FNS#N 0ALLS AND MARNS

4+ Create t$e )est marginal seal

%ossi)le

7+ A2ord a smoot$ marginal Hun'tion

9+ Provide ma8imum strengt$ fortoot$

and restoration


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4+ Outline form

7+ Resistan'e form

9+ Retention form

:+ Convenien'e form=+ Removal of any remaining non-

'oales'ed %its and &ssures( infe'teddentin and.or old restorative material(if indi'ated

>+ Finis$ing of e8ternal *alls andmargins

2 principles of tooth prep2

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