operative dentistry lecture 1

8/3/2019 Operative Dentistry Lecture 1

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Sensitive things require«.«« Extra Care



OPERATIVE DENTISTRY The branch of Oral Health Services dealing with:

1. Prevention.

2. Restoration. Of the Defects of Natural Teeth



DEFINITION :

Operative dentistry is the science and

art dealing with the ³prevention´ and

³restorations´ of any ³ Defect´ that

occurs in the hard tooth structures.



It occupies about 70% of the dentist time and

necessitates the formation of Cavi t i es of spec i f i c

design and form to receive the ³r estorat iv e material ́

of choice to r estor e the tooth.

THE PRACTICE OF OPERATIVE DENTISTRY



1. Carious Lesions

2. Non-Carious Lesions

a. Att ri t i on b. Abrasi on c . E r osi on d . Hypo-plasia

e. Hypo-c al c i f i c at i on f . Di scol orat i on

g. T rau ma

3. Replacement Needs e.g. Dissimilar metals fillings, fractured filling,recurrent caries etc.



ATTRITION



ABRASSION



EROSION



DISCOLOR TOOTH



Developmental structural defects

Enamel Hypoplasia: Acquired condition



Amelogenesis imperfecta:Hereditary abnormality

Insufficient amount of enamel,

soft enamel, friable and easy lost



Dentinogenesis imperfecta:hereditary conditionTeeth appear yellow-brown to

gray Enamel is fractured easily due topoor support provided by theabnormal dentin



H ereditary

* Peg-shaped lateral incisor

* Hutchinson¶s incisor

* Mulbery molarsSeen with congenital

syphilis



Enamel hypocalcification:

(hypomineralized)



Accidental traumatic fracture of teeth.



Ditched Amalgam Restoration



RESTORATION:

Is an artificial substitute which replace themissing portion of the hard tooth tissues.Restorations must not only retain the tooth to itsnormal form, function, strength, and esthetic, butthey must also provide for the health of the

supporting tissues.Faulty restorations are a common etiologicalfactor of periodontal disease. An unfavorableresponse of the periodontium will result in

occlusal disharmonies.I

f not corrected, thuscausing traumatic occlusion.



AIMS & OBJECTIVEs:RESTORATION OF THE DEFECTS OF TOOTH/TEETH:

Resul ts:1. Proper Tooth Form and shape

2. Proper Functioning of the tooth

3. Improving the strength of the tooth

4. Improving the Esthetic

5. Proper relationship with adjacent teeth and gingiva ,

improving the integrity of the tooth supporting tissues

6. Improving the integrity of stomatognathic system

All of Abov e enhance t he g eneral heal t h and wel f ar e of t he pat i ent .



COMBINATION

SCIENCE ART

1. Basics of Medicine.

2. Basics of Engineering &

Physics.

1. Manual Skill.

2. Artistic approach.

To practice Operative Dentistry, a Dentist should have following

four abilities:

1. To be a g ood doctor²know ing t he Basi c Med i c ine / Appli ed Bi ol og y .

2. Can u se t he basi c princ i pl es of E ngineering and P hysi cs.

3. H ighl y dev el oped Tec hni c al / M anual skill.

4. Can demonst rate Ar t i st i c Abili t i es.



Two Main Braches:1. Preventive dentistry

2. Restorative dentistry

1. Primary Prevention

2. Secondary Prevention

3. Tertiary Prevention

A. Diagnosis

B. Interception

C. Prevention

D. Preservation

E. Restoration



Primary Prevention To prevent the occurrence of carries,need: a. M ul t i pl e f lu ori de t hera py

b. Good O ral Hy gi ene pract i ce

c . P i ts and f i ssur es Sealants

d . Di et C ounseling e. etc .

Secondary Prevention To arrest the carries at its initial stage ,need the measures : a. To arr est t he c arri es

b. For r e-mineralizat i on of inc i pi ent c arri es

c . Lik e minor r emed i es e.g. small pi t f illing s.

d . etc .

Tertiary Prevention

To treat the established form of carries and prevent its spread andrecurrence:

. Dir ect and ind ir ect f illing of t he c avi t i es of t he teet h



D IAGNOSIS

Proper diagnosis of defect include:* history taking

* clinical examination* special investigations/tests

to find out the :

* location of defect

* extension of defect* correct treatment planning

it include:* the design of tooth preparation*

the selection of restorative materials* the selection of restorative procedure



INTERCEPTIONTo prevent further loss of

tooth structure by Halting

active disease.It includes :

Change in Patient¶s

home care habit.

Removal of the Lesion.

Altering Tooth form.

Recontouring of tooth

Correct Occlusion etc.



PREVENTIONPrevention of recurrence of caries

It is possible when the principle of extension forprevention during cavity preparation is applied.For example :Bringing the margins of the final prepared to theself-cleansable areas of the tooth by including thenon self-cleansable areas in the cavity of the tooth



PRESERVATIONDuring the tooth preparation for restoration , itis essential to preserve the: Important anatomy of tooth.

Pulp vitality.

Health of Supporting Tissue.Health of Oral Tissues.

Health of Entire Masticatory

System.



RESTORATION OF THE DEFECTS OF TOOTH/TEETHT he foll ow ing ai ms ar e expected f r om t he r estorat i on :1. Proper Tooth Form and shape

2. Proper Functioning3. Improving the Esthetic

4. Proper relationship with adjacent teeth and gingiva

5. Integrity of the tooth supporting tissues

6. Integrity of stomatognathic system

All of Abov e enhance t he g eneral heal t h and wel f ar e of t he pat i ent .



PROGNOSIS

The prognosis of the restoration depends on the:a. Status of the pulp.

b. Status of the periodontium.

c. The extent of lost structure of the tooth.

The pulp and periodontium should beVital and healthy after the restoration of

the tooth.



D ENTAL C ARIES D EFINITION ³ It is a disease of the calcified tissues of theteeth, characterized by a demineralization of the inorganic portion and destruction of theorganic substance of the tooth´



C AVITY

The term cavity refers to a defect inenamel, or in enamel and dentin, usually resulting from the pathologic process of

dental caries.



P repared cavities The performance of those

dental surgical procedures required to expose thecarious lesion, permit removal of affected tissues,and so shape the remaining dentin and enamel asto contribute to biologically and mechanically sound restoration

.



RESTORATI VE MATER I ALSThe replacement of lost hard tooth structure cannot be

achieved without using the proper restorative dentalmaterials. This include:a. Temporary restorative materials

b. Permanent restorative materials



PERMANENT RESTORATI VE MATER I ALS INCLUDE

Metal Polymers

Composite resinGlass-ionomer-cements

Acrylic

Ceramics

porcelain AmalgamGoldNoble metalCobalt-chromium-alloys

Nickel-chromium-alloya



PERMANENT RESTORATI VE MATER I ALSDirect restorative materials

* Esthetic restorative materials (composite resin,Glass- ionomer cements and compomer)

* Metalic restoration (amalgam, gold foil)

Indirect restorative materials* Cast gold restoration

* Porcelain* Castable ceramic restoration



Multiple Procedures to Conserve the Tooth:.1Cavity preparation.

1. Filling with plastic materials (e.g. Amalgam, Composite etc.

2. Filling with Casts (e.g. Inlay, Onlay)

3. Fillings using pins & posts.4. Filling with Gold.



Amalgam filled teeth



Gold filled teeth



Pins retained restorations



Multiple Procedures to Conserve the Tooth:

2. Conservative esthetic procedures e.g. filling of the cavities in the teeth withtooth coloured materials.

3.Additional Conservative Esthetic Procedures (Cosmetic Dentistry).

TO IMPROVE:

a. Shape and Form of teeth..iCosmetic Contouring (masculine smile feminine smile)

.iiLaminate veneers.

.iiiDiastima Closure.

.iv Alteration of Embrassures..vetc.

b. Symmetry and proportionality of teeth Composite build up.

c. Position and alignment Composite build up / veneers.

d. Surface Texture.To reproduce pit & fissures, prominences, facets etc.

(to proper reflection of light).

e. Colour To match the discoloured teeth with adjacent teeth:

i.Accurate shade selection of the restorative materialii.Bleaching treatment

f. Translucency. (Degree of translucency is related how deeply light penetrate into tooth or restorationbefore it is reflected outward).

Different procedures to restore the translucency of the teeth:e.g. a color modifier is appliedunder direct composite veneer on a discolored tooth,color modifiers are incorporated in therestoration to match the lines or spotes (e.g. white patches) of the adjacent teeth.



COSMETIC

RECONTOURING

DIASTIMA CLOSURE



Alteration of Embrasure



NEED BLEACHING OR VENEERING



Multiple Procedures to Conserve the Tooth:

4. Conservative alterations of tooth contours and contacts:a.alterations of shape of natural teeth.

b.alteration of Embrasures.

c.correction of Diastemas.

5. Microabrasion and Macroabrasion:

Microabrasion:

To remove intrinsic stains-------which extend 0.2 to 0.3 mm down deep in enamelsurface--------by appling a paste containing an acid and abrasive particles-------using special

rubber cup with fluted edges in slow motor handpiece.Macroabrasion:

To remove the intrinsic stains or defects-------using 12-fluted composite finishingbur or

a fine grit finishing diamond stone in a high speed handpiece------no use 30-fluted composite finishing bur-----final polishing with an abrasive rubber point

6. veneer: A veneer is a layer of tooth-colored material that is a plied on the surface of the tooth to

restore localized or generalized defects,intrinsic discoloration and male formed tooth.

I. Partial veneer ii.Full veneer

7. Acid-Etched,Resin-Bonded Splints:

operative dentistry lecture 1

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