Class II Tooth Preparation For Amalgam

Class II Tooth Preparation for Amalgam
Usually caries occurs in the contact area, because of difficulty to clean

this area by dental brush. This leads to food accumulation and
development of caries. When the lesion present in the proximal surface
of premolars and molars, this requires class II tooth preparation, which is
either MO, DO or MOD. If the carious lesion is present only in proximal
surface and do not involve the occlusal surface, the class II tooth
preparation should include all pits and fissures in the occlusal surface in
addition to the proximal surface (Extension for prevention).
Note: nowadays, if the patient has low caries index and a good oral
hygiene, in countries with high preventive measures, class II cavity
could include only the proximal surface. This is called (box Design) and
then we do Enameloplasty to the non-coalesced pits in the occlusal
surface.
Simple box restoration without occlusal step is permissible when restoring small proximal lesion in tooth without
either occlusal fissures or previously inserted occlusal restoration and when involved marginal ridge does not
support occlusal contact. Note that proximal locks extend to occlusal surface.
Steps of Class II Tooth Preparation:
Outline form:
First of all, we do class I tooth preparation on the occlusal surface by
applying all Black’s principles of tooth preparation. Because class I will
give us enough vision and proximity to reach the caries in the proximal
contact area easily.
One of the most important point in class II cavity is the we should not hit
the adjacent tooth by rotary bur. Since the proximal surface of the
adjacent tooth is intact and smooth. So, any cut will produce a rough
surface and this will facilitate food and bacterial accumulation, which
will cause caries to the sound tooth. To avoid hitting the adjacent tooth,
we can depend on one of the following methods:
1. Using a matrix band:
Place a matrix band between the two adjacent teeth. Then we place the
fissure bur at the same depth of class I cavity and continue cutting
towards the proximal marginal ridge until we reach the end of the tooth
(the opening has the width of the bur and the same depth of class I).
Then we place the fissure perpendicular to the occlusal surface, and then
we go gingivally to create a STEP (to reach the caries in the proximal
contact area).
We continue cutting to remove all caries and extend the base of the box
just beyond the proximal contact area (0.5 mm below the contact area)
so that the margin of the restoration will be in a cleansable area. Then
we move the fissure bur buccolingully until the buccal and lingual walls
of the box will be free from the contact area (0.5 mm out of the proximal
contact) to be in a cleansable area. The contact should be opened 0.5 mm
gingivally, buccally and lingually (palatally) so that the tip of the probe
can pass freely between the two teeth.
2. Leaving a thin shell of the marginal ridge:
Placing the fissure bur at the same depth of class I cavity and continue
cutting towards the proximal marginal ridge, leaving a thin shell of
marginal ridge. After that we move a round bur gingivally to create a
STEP beyond the contact point. Then we move the fissure bur
buccolingually. After that we remove the thin shell by a chisel or a
hatchet. Finally, we finish the enamel walls by chisel or hatchet to
remove any undermined enamel, and free the contact gingivally,
buccally and lingually.
At the end we will have a proximal box with the following walls:
- Axial wall: parallel with the long axis of the tooth.
- Gingival seat: perpendicular with the long axis of the tooth.
- Buccal wall
- Lingual wall.
And the following line angles:
- Axiogingival line angle.
- Axiobuccal line angle.
- Axiolingual (palatal) line angle.
- Axiopulpal line angle.
Retention form: Is the shape of the cavity that permits the restoration
to resist the displacement through the tipping or lifting force. To provide
retention the cavity has the following:
1. In addition to the convergence of the buccal and lingual walls of
the occlusal class I cavity (5° or parallel to each other) and the
dovetail, we do convergence of the buccal and lingual walls of the
box occlusally.
2. Flat gingival wall (seat) to prevent dislodgement of the restoration,
in addition to flattening of pulpal floor of class I.
3. Retentive grooves: by using small round bur no. ¼ or fissure bur to
make retentive grooves on axiobuccal and axiolingual line angles.
They should be placed in dentine because of the resiliency of the
dentine.
Resistance form:
1. Width of the cavity ¼ of intercuspal distance (ICD).
2. Cavosurface line angle (90°-110°).
3. Axiopulpal line angle is beveled to eliminate the stress
concentration on the restoration.
4. Gingival cavosurface line angle is beveled to remove the
unsupported enamel.
5. Rounded internal line angle.
6. Removal of the unsupported enamel.
Note: although the buccal and lingual walls of the box are diverging
proximally to free them from the contact and to remove the unsupported
enamel. The restoration will not be dislodged proximally due to the
retention means on the occlusal cavity, i.e. the occlusal dovetail will act
as a lock, preventing the restoration from being dislodged proximally
(prevent lateral displacement of the restoration), in addition to the
retention grooves.
Isthmus: is the area present at the junction between the occlusal and
proximal part of the cavity (proximal box). It should be as narrow as
possible (1/4 of ICD) to reduce the force on it and prevent fracture of the
restoration. The depth of the isthmus is 1.5-2 mm to have a good bulk of
the restoration at this area and prevent fracture of the restoration.
Convenience form:
The axial wall should be parallel to the long axis of the tooth to have a
good accessibility to the deepest point of the cavity.
Removal of the remaining caries:
Deep dentinal caries can be removed by using spoon excavator or large
round bur with slow speed hand piece.
Finishing of the cavity walls:
Involve making the walls smooth and removing of unsupported enamel.
Cleaning the preparation:
Removal of all debris by washing the cavity and drying it.

Class II Tooth Preparation For Amalgam

Uploaded by

Copyright:

Available Formats

Class II Tooth Preparation For Amalgam

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Class II Tooth Preparation For Amalgam

Uploaded by

Copyright:

Available Formats

Class II Tooth Preparation for Amalgam

Usually caries occurs in the contact area, because of difficulty to clean

You might also like