MINISTRY OF HEALTH OF UKRAINE
BOGOMOLETS NATIONAL MEDICAL UNIVERSITY
Department of Pediatric and Preventive Dentistry
«Approved»
at the methodical meeting of the department
pediatric and preventive
dentistry
Protocol №
2020 y.
Head of the Department__________prof. O.V. Savichuk
GUIDELINES FOR STUDENTS
Academic discipline
Preclinical pediatric operative dentistry
Topic of the lesson
Course
Practical mastering of the technique of
preparation of frontal temporary and permanent
teeth (class III, IV, V).
ІІІ
Faculty
Dental
Hours
Performer: as. Opanasenko O.O.
Reviewer: prof. Bidenko N.V.
KIEV– 2020
1
1. Actuality of theme:
Carious cavities of III, IV and V classes according to Black are located in the
frontal part of the dentition. Increased aesthetic requirements for the restoration
of teeth with carious lesions of this location dictate the need for a responsible
attitude to their preparation. The quality of preparation affects both the quality
of sealing and the durability of the seal.
2. Learning objectives
1. Know the classification of carious cavities according to Black.
2. Know the main stages of preparation of carious cavities.
3. To know and be able to choose the dental tools necessary for the preparation
and formation of carious cavities of III, IV, V class according to Black in
temporary and permanent teeth in children.
4. To be able to dissect carious cavities of III, IV, V class according to Black in
temporary and permanent teeth in children.
5. Be able to form carious cavities of III, IV, V class according to Black in
temporary and permanent teeth in children, taking into account the type of
filling material that will be used for their filling.
3. Educational goals of the lesson.
1. Demonstrate mastery of moral and deontological principles of a medical
specialist and the principles of professional subordination in the clinic of
pediatric therapeutic dentistry.
2. Demonstrate on the phantoms of dental manipulations in the treatment of
teeth in children:
- preparation of carious cavities of III, IV and V class in temporary and
permanent teeth;
4. Interdisciplinary integration.
Дисципліни
1. Normal
anatomy
Отримані знання, вміння, навички
1. Know the anatomical and topographic features of the
structure of temporary and permanent teeth.
2. Be able to distinguish temporary teeth from permanent
ones by anatomical features.
2. Histology
1. Know the structure of enamel and dentin in temporary
teeth and permanent teeth.
2. Know the stages of development of temporary and
permanent teeth.
2
3. Operative
dentistry
1. Know the classification of carious cavities according to
Black, the main stages of preparation of a carious cavity.
2. Be able to dissect carious cavities in permanent teeth.
4. Pharmacology
1. Know the groups of drugs with antiseptic action.
5. Selection of the content of educational material and its structuring
Preparation of cavities of the III class
Possible
options
for cavity
preparatio
n
triangular or
oval in shape
without output
to other
surfaces
with an
additional
platform on
the palatal
(lingual)
surface
with an
additional
platform on
the vestibular
surface
with
additional
sites on the
lingual and
vestibular
surfaces
joining
cavities on
both approximal
surfaces
through the
palatal or
vestibular
surface
Terms of
selection
of each
option
shallow depth
of cavity and
sufficient
access to it (no
tooth nearby)
extensive
cavity in the
absence of
dentinal base
of the lingual
wall;
insufficient
access with
high aesthetic
requirements
(permanent
teeth);
spread of the
carious
process on the
lingual wall
extensive
cavity in the
absence of
dentinal base
of the
vestibular wall
(in permanent
teeth - subject
to the use of
modern
aesthetic
materials);
insufficient
access in the
absence of
high aesthetic
requirements
(temporary
teeth);
extensive
cavity in the
absence of
dentinal base
of the
vestibular and
lingual walls
(in permanent
teeth - subject
to the use of
modern
aesthetic
materials);
the spread of
the carious
process on the
vestibular and
lingual walls
lesions of both
proximal
surfaces of
considerable
size
spread of the
carious
process on the
vestibular wall
3
Preparation of cavities of the IV class
Possible
options for
cavity
preparatio
n
without additional
platform
Terms of
selection of
each
option
sufficient amount of
enamel and small cavity
size;
filling without
reproducing the angle of
the crown;
application of composite
materials with universal
adhesive systems
with additional platform:
along the cutting edge
on the tongue surface
near the tongue roller
(not less than ¼-1/3
area)
wide erased cutting edge
and small size of the
main cavity
large cavity size
In case of significant damage to the hard tissues of temporary incisors,
removable celluloid caps and standard crowns are used to restore them. This requires
special training: shortening the crown of the temporary tooth by dissecting the cutting
edge by 1.5 mm. Form a conical shape of the crown by preparing the proximal
surfaces to a thickness of 0.5-1.0 mm. The vestibular surface is ground by 0.5-1.0
mm, and the lingual - by 0.5 mm. The gingival margin should have a protrusion.
.
Preparation of cavities of the V class
Possible
options for
the
formation of
the cavity
Oval or
Class III and IV defect
filamentous
associations
(without extension
beyond the right
third)
Terms of
selection of
each option
Small cavity size
Extensive cavity in the
absence of the dentinal
base of the proximal walls
4
Forms of prepared cavities of class III in temporary incisors
Variants of cavity formation with an auxiliary pad on the vestibular surface (A), without pad
(Б), with a pad in the cervical area in the presence of decalcified enamel (B) are presented.
The central axis of the formed proximal cavity when it is brought to the vestibular surface
should be perpendicular to the line tangent to this surface (Г).
Forms of prepared cavities of class III in temporary canines
The auxiliary site is usually formed on the palatal surface of the upper canines and on the
vestibular - lower. The central axis of the formed proximal cavity when it is brought to the
vestibular or oral surface should be perpendicular to the line tangent to the surface of the
formation of the auxiliary platform.
5
Tools used in preparation and sealing with composite materials and glass ionomer
cements:
a) to open and form a cavity (black and green markings);
b) to remove altered dentin;
c) for the formation of the walls of the cavity and the enamel seam (red marking);
d) for grinding seals (yellow and white markings);
f) for the formation of fissures;
f) for pre- and final polishing.
Algorithm for preparation of carious cavity of III and IV class in
dentin caries (acute or chronic) in a temporary tooth (on a phantom) for
further filling with glass ionomer cement
№ Sequence of actions
1. Separate of teeth (in case of close
contact between them) with the help of
wooden or plastic wedges.
2. Installation of a metal matrix (to protect
the proximal surface of the adjacent tooth
from
accidental
damage
during
preparation).
3. Opening of a carious cavity.
The overhanging edges of the enamel are
Criteria for proper performance
A small gap was formed between
the proximal surfaces of the teeth.
The proximal surface of the
adjacent tooth is protected by a
metal matrix.
No overhanging edges of the
enamel, sufficient inspection of
6
cut with a turbine drill with a fissure or the carious cavity.
spherical diamond bur. Work with boron,
the diameter of which corresponds to the
diameter of the inlet of the carious cavity.
Vestibular access can be used when
opening a carious cavity, because it is
technically simpler. The opening of the
carious cavity is performed due to an
enamel defect on the vestibular surface of
the crown, while only the affected,
demineralized enamel is removed.
Externally unchanged enamel, which
does not even have a subordinate dentin,
is maximally preserved.
4. Necrectomy of a carious cavity.
Use a mechanical drill, spherical boron or
excavator to remove cariously affected
dentin.
When working with an excavator, it is
deepened into the softened dentin with a
lever-like movement: in the mantle
dentin, the deepening is carried out along
the axis of the tooth, in peri-pulpal dentin
- by transverse movements of the tool.
In the case of deep caries, the bottom of
the carious cavity is carefully dissected
with an excavator or mechanical drill at
low speed, it is also allowed to leave a
layer of pigmented dense dentin at the
bottom of chronic caries or softened
dentin that has not lost contact with the
underlying tissues at the bottom of the
caries. ).
Visual quality control: no
pigmentation, dentin surface
gloss. Instrumental (using a
probe): the walls and bottom of
the carious cavity are solid.
In the case of deep caries, the
presence of softened dentin is
allowed, which has not lost
contact with the underlying
tissues at the bottom of the
carious cavity.
5. Formation of a carious cavity
For further filling with glass ionomer
cement is not carried out.
Note
When carious lesions of class IV
and V are combined, they are combined
on the vestibular surface.
The carious cavity has a rounded
or pear-shaped shape, smoothed
contours, smooth transitions
between the bottom and walls.
6. Enamel edge treatment.
Visual quality control - smoothed
Smooth the enamel edge with veneers or enamel edge.
diamond using a turbine drill.
7
Algorithm for preparation of carious cavity of class III in a permanent
tooth (on a phantom) for further filling with composite material, using
adhesive systems
№ Sequence of actions
1. Wedging of teeth (in case of close
contact between them) with the help of
wooden or plastic wedges.
2. Installation of a metal matrix (to protect
the proximal surface of the adjacent tooth
from
accidental
damage
during
preparation).
3. Opening of a carious cavity by means of
fissure or spherical burs in a high-speed
drill with water cooling. The opening is
performed from the oral surface of the
tooth with the maximum preservation of
the enamel of the vestibular surface, it is
possible to open the carious cavity
through the vestibular surface, while
removing all the enamel, which is devoid
of dentinal base.
4. Necroectomy in unformed permanent
teeth is performed carefully, using an
excavator, spherical burs in a low-speed
(mechanical) drill. The preparation is
performed on unchanged (healthy)
dentin.
When excavated by necroectomy, it is
sunk into the softened dentin with a
lever-like motion. In mantle dentin, the
indentations are made along the axis of
the tooth, in peripulpar dentin - by
transverse movements of the tool.
In the case of preparation of deep carious
cavities in case of acute caries at the
bottom of the carious cavity it is allowed
to leave softened dentin with mandatory
application of a medical pad, in case of
chronic deep caries at the bottom of the
cavity it is allowed to leave pigmented
dense dentin.
5. The formation of a carious cavity is not
performed.
6. The edges of the enamel are treated with
Criteria for proper performance
A small gap was formed between
the proximal surfaces of adjacent
teeth.
The proximal surface of the
adjacent tooth is protected by a
metal matrix.
There is a wide access to a
carious cavity, sufficient review
of an operating field.
Visual
quality
control
of
necrectomy - no pigmentation on
the walls of the cavity,
Instrumental, when probing - a
hard, smooth surface of dentin.
The contours of the carious cavity
- smoothed, rounded.
The enamel has a seam.
8
fissure, conical or flame-like diamond
heads or finishing drills. It is necessary to
form an enamel seam at an angle of
45º(for class III, IV, V). In the adjacent
area, it is formed deeper, on the entire
thickness of the enamel, in the direction
of the cutting edge, the depth of the bevel
decreases.
Note:
In the case of a carious cavity near or
below the gingival margin, it is necessary
to retract with the help of retraction
threads.
Algorithm for preparation of carious cavity of class IV in dentin caries
(acute or chronic) in a permanent tooth (on a phantom) for further filling
with composite material using adhesive systems.
№ Sequence of actions
1. Wedging of teeth (in case of close
contact between them) with the help of
wooden or plastic wedges.
2. Installation of a metal matrix (to protect
the proximal surface of the adjacent tooth
from
accidental
damage
during
preparation).
Opening of a carious cavity.
3. The turbine drill with the help of a
fissure or conical boron through the
lingual (vestibular) surface trepan hard
tooth tissue in the projection of the
carious cavity.
Work with boron of appropriate
diameter.
Criteria for proper performance
A small gap was formed between
the proximal surfaces of adjacent
teeth.
The proximal surface of the
adjacent tooth is protected by a
metal matrix.
4.
Visual quality control - no
pigmentation, gloss of the dentin
surface.
Instrumental - with the help of an
excavator: hard walls and the
bottom of the carious cavity, in
the case of deep caries, the
presence of softened dentin is
Necrectomy of a carious cavity.
Using a mechanical drill, remove the
cariously altered dentin from the walls of
the carious cavity completely with a
spherical boron. The bottom of the
carious cavity should be carefully
prepared with an excavator or
mechanical drill at low speed.
Sufficient examination of the
carious cavity.
9
When working with an excavator, it is allowed, which has not lost
immersed in the softened dentin with a contact with the underlying
lever-like motion. In mantle dentin, tissues at the bottom.
indentations are made along the axis of
the tooth, in peripulpar dentin - by
transverse movements of the tool. It is
allowed to leave a layer of pigmented
dense dentin on the bottom in chronic
caries, and softened demineralized dentin
on the bottom in acute caries, followed
by the use of a medical pad.
5.
Formation of a carious cavity.
The contours of the carious cavity
the formation of a carious cavity is not - smoothed, rounded.
carried out
6.
Formation of an additional cavity.
At considerable defects of a crown part
of a tooth formation of an additional
platform is expedient
on the lingual surface of the tooth in the
area of the blind fossa. The gingival wall
of the additional site is formed, receding
by 1-1.5 mm from the edge of the gums.
The angle between the bottom of the
main cavity and the additional site is
formed rounded.
Enamel edge treatment.
Finish the edges of the carious cavity
with veneer or diamond using a turbine
drill, creating an enamel bevel 45 °.
Note: When caries affects the contact
surfaces of the teeth located nearby, it is
desirable to dissect the carious cavities of
both teeth in one visit.
In the case of the location of the carious
cavity near the gingival margin or below
it, it is necessary to retract with the help
of retraction threads
7.
The width of the additional site is
1.5-2.0 mm, the optimal depth is
1-1.5 mm.
Visual quality control - the
area of the rebate should be twice
the area of the defect.
Algorithm for preparation of carious cavity of class V in dentin caries
(acute or chronic) in a temporary tooth (on a phantom) for further filling
with glass ionomer cement, with composite material using adhesive
systems.
.
10
1.
2.
3.
4.
Sequence of actions
Opening of a carious cavity.
The overhanging edges of the
enamel are cut with a turbine drill
with a fissure or spherical diamond
bur.
Necrectomy of a carious cavity.
Use a mechanical drill, spherical
boron or excavator to remove
cariously affected dentin.
When working with an excavator, it
is immersed in the softened dentin
with a lever-like motion. In mantle
dentin, indentations are made along
the axis of the tooth, in peripulpar
dentin - by transverse movements of
the tool.
In the case of deep caries, the bottom
of the cavity is carefully prepared
with an excavator or mechanical drill
at low speed
Formation of a carious cavity.
the formation of a carious cavity is
not carried out
Criteria for proper performance
Work with boron, the diameter of which
corresponds to the diameter of the inlet of
the carious cavity.
No overhanging edges of the enamel,
sufficient inspection of the carious cavity.
Visual quality control (absence of
pigmentation, gloss of the dentin surface).
In the case of deep caries, it is permissible
to leave a layer of pigmented dense dentin
on the bottom in chronic caries or softened
demineralized dentin on the bottom of the
carious cavity in acute caries).
Instrumental - with the help of a probe
(hard walls and the bottom of the carious
cavity).
In the case of deep caries, the presence of
softened dentin at the bottom of the cavity
is allowed, which has not lost contact with
the underlying tissues.
Enamel edge treatment.
Grind the edges of the carious cavity
with veneers or carborundum heads
using a turbine drill.
When filling with glass ionomer cement smooth the enamel edge.
when filling with composites along the enamel edge a bevel is formed at
an angle of 45 degrees, its width is 1.5-2
mm.
6. List of recommended reading
Basic literature:
1. Sturdevant’s Art and Science of Operative Dentistry Seventh Edition |André V.
Ritter, Lee W. Boushell, Ricardo Walter-Elsevier,2019.- 699p.
2. Pediatric Dentistry. Third Edition/Edited by Göran Koch,Sven Poulsen,Ivar
Espelid,Dorte HaubekJohn. -Wiley & Sons.-2017.-407p
3. 3.
Pediatric Dentistry: Infancy Through Adolescence: Sixth edition/ Edited
by Arthur Nowak. -2018.-407p.
Techniques in Pediatric Dentistry. John Wiley, 2015. - 207 p.
4.
Dentistry: A Clinical Approach. 3rd Ed. - Wiley Blackwell, 2017. - 407 p.
5.
, Avery DR, Dean JA. McDonald RE. and Avery’s Dentistry
11
for the child and adolescents. 10 th Edn, St Louis: Mosby, 2016.
Other resources:
Link to the website of the Department of Pediatric and Preventive Dentistry of
Dental Diseases of NMU:
https://drive.google.com/drive/u/1/folders/0Bx6kh6nZHTcaTFVHVHZXSHps
SHc
7. Approximate map for the organization of independent work of the
student with educational literature on the topic
The main tasks
Describe the main stages of
preparation of carious cavities of
III, IV, V classes in temporary
teeth for further filling with glass
ionomer cement.
Describe the main stages of
preparation of carious cavities of
III, IV V classes in permanent
teeth for further filling with
composite materials.
Define the auxiliary site and
name the possible options for its
formation and the conditions of
choice
in
temporary
and
permanent
teeth
in
the
preparation of carious cavities of
III and IV classes.
Instructions
Specify the sequence of actions of
preparation of carious cavities of
III, IV, V classes for further filling
with glass ionomer cement.
Answers
Specify the sequence of actions of
preparation of carious cavities of
III, IV, V classes for further filling
with composite materials.
Specify the forms of auxiliary
sites.
Materials for self-control of students at the pre-classroom stage:
А. Theoretical questions for self-control.
1. In what cases in temporary and permanent teeth in children it is necessary to bring the
cavity of the third class on the vestibular or oral surface?
2. What are the requirements for the size of additional sites in the preparation of carious
cavities of class IV in temporary and permanent teeth in children?
3. In what cases is it possible to form a retention site on the cutting edge of the tooth during
the preparation of carious cavities of class IV in temporary and permanent teeth in
children?
4. What are the features of the preparation of carious cavities of III, IV, V classes in
temporary teeth in children compared to permanent teeth?
5. What are the features of preparation of carious cavities of III, IV, V classes in children
for glass ionomer cements?
12
6. What are the features of preparation of carious cavities of III, IV, V classes in children
for composite materials?
В. Tests for self-control.
1. On the mesial surface of the temporary canine - carious cavity of class III
within the mantle dentin. The vestibular enamel wall has no dentinal base, the palatal
- has. Which variant of carious cavity formation should be chosen for the subsequent
filling of the cavity with glass ionomer cement?
A. Formation within the proximal surface.
B. Excretion on the vestibular surface.
C. Excretion to the palatal surface.
D. Formation of an auxiliary platform.
E. The formation of a cavity under this material is not carried out
2. In the permanent upper central incisor of a 13-year-old child - a carious cavity within
the mantle dentin, localized on the distal surface with the transition to the palatine and the
lesion of the distal corner of the crown. It is planned to restore the tooth with a lighthardening composite material with an adhesive system to enamel and dentin. Which variant
of carious cavity formation should be chosen? (2 from.)
A. Formation of an additional site on the palatal surface.
B. Formation of additional sites on the palatal and vestibular surfaces.
C. Formation of a retention groove on the cutting edge of the tooth.
D. Removal of affected tissues without the formation of additional sites.
E. Forming with maximum preservation of enamel.
3. In the temporary incisor of the upper jaw, both proximal surfaces are affected by
caries. Choose a possible option for the formation of a carious cavity with subsequent
filling with glass ionomer cement.
A. Oval shape without output to other surfaces.
B. With an additional area on the palatal surface.
C. With an additional site on the vestibular surface.
D. With additional sites on the palatal and vestibular surfaces.
E. Joining the cavity on both proximal surfaces through the palatal or
vestibular surface.
4. On the proximal surface of the temporary incisor there is a carious cavity with a
lesion of the cutting edge of small size and with a sufficient amount of enamel on the
vestibular surface. Choose a possible option for the formation of a carious cavity with
subsequent filling with glass ionomer cement.
A. With an additional platform along the cutting edge.
B. With an additional area on the tongue surface near the tongue roller.
C. Without additional platform and filling without reproducing the angle of the
crown.
D. With an additional site on the vestibular surface.
13
5.
On the proximal surface of the temporary canine is a carious cavity of
considerable size in the absence of the dentinal base of the palatal wall. Choose a
possible option for the formation of a carious cavity with subsequent filling with
glass ionomer cement.
A. Oval shape without output to other surfaces.
B. With an additional area on the palatal surface.
C. With an additional site on the vestibular surface.
D. With an additional area on the palatal and vestibular surfaces.
E. Joining the cavity on both proximal surfaces through the palatal or vestibular
surface.
6.
On the proximal surface of the temporary incisor is a cavity within the mantle
dentin. The entrance of the carious cavity goes to the vestibular surface, the
enamel wall of the lingual surface has a dentinal base. Which variant of carious
cavity formation should be chosen for the subsequent filling of the cavity with
glass ionomer cement?
A. Formation within the proximal surface.
B. Excretion on the vestibular surface with preservation of the lingual
surface.
C. Output to the tongue surface.
D. The formation of a cavity under this material is not carried out.
7. In the formed carious cavity of the V class the gingival wall and the bottom
of the carious cavity should form an angle:
А 45
B 90
C 85
D 100
8.
A small carious cavity is located on the proximal surface of the
permanent incisor, there is no access to it. Which variant of carious cavity
formation should be chosen for the subsequent filling of the cavity with a lightcured composite material with an adhesive system to enamel and dentin?
A. Oval shape with output to the palatal surface.
B. Formation with an additional site on the palatal surface.
C. Oval shape with output to the vestibular surface.
D. Formation of an additional site on the vestibular and palatal surface.
9. On the proximal surfaces of the temporary canine are small carious cavities,
without spreading to other surfaces. Which variant of carious cavity formation should
be chosen for the next filling of the cavity?
14
A. Individual cavities without removal to other surfaces.
B. With an additional area on the palatal surface.
C. With an additional site on the vestibular surface.
D. With an additional area on the palatal and vestibular surfaces.
E. Joining the cavity on both proximal surfaces through the palatal or
vestibular surface.
10. What features of the anatomical structure of temporary teeth should be taken
into account when preparing carious cavities of III and IV classes? (2 answ.)
A. The pulp spurs are closer to the chewing surface.
B. The pulp chamber is relatively larger than in permanent teeth.
C. Pulp spurs are closer to the proximal surface.
D. The presence of pathological three, diastema.
Відповіді:
№
1
2
3
4
5
Відповідь
B
А.D
E
C
B
№
6
7
8
9
10
Відповідь
B
C
А
А
B, C
The list of educational practical tasks that must be performed in a
practical lesson.
1. Be able to dissect a carious cavity of class III in a temporary tooth for
further filling with glass ionomer cement.
2. Be able to dissect a class IV carious cavity in a temporary tooth for further
filling with glass ionomer cement.
3. Be able to dissect the carious cavity of class III in a permanent tooth for
further filling with composite material.
4. Be able to prepare a carious cavity of IV class in a permanent tooth for
further filling with composite material.
5. Be able to dissect a carious cavity of class V in a temporary tooth for
further filling with glass ionomer cement.
6. Be able to dissect a class V carious cavity in a permanent tooth for further
filling with composite material.
Ensuring independent work of students at the main stage of practical
training
15
a) - dental units and micromotors.
b) - phantoms with temporary and permanent teeth.
c) - forests of different types and sizes.
d) - dental drills.
e) - models with different types of formation of carious cavities of III, IV and V
class.
16