MINISTRY of PUBLIC HEALTH of UKRAINE
VINNITSYA NATIONAL MEDICAL UNIVERSITY
by N.I.Pirogov
It is "confirmed"
on a methodical meeting of
department of pediatric dentistry
head-chair
doc. Filimonov Yu.V. _____________
" ______" ______________ in 20
Methodical recommendation for 2d year students
of dental faculty
Educational discipline
Module ¹
Rich in content module ¹
Topic
Propedeutics of pediatric dentistry
1
1
Principles of cavity preparation and nomenclature for 1
and 2 Black class of caries deciduous and permanent
teeth at the children. The choice of instruments.
Course
Faculty
2
Dental
Vinnitsya 2010
1. Actuality of theme: Treatment of caries in deciduous and permanent teeth at
children one of the actual problems of a children's odontology. One of the major
stages of treatment caries is preparing carious cavities. The mineralization of a
teeth lasts 2-3 years after eruption. There are least miniralised fissures and
аproximal surfaces. Therefore, as a rule, these areas are amazed with caries.
2. Concrete aims:
1. To master main principles of preparing of carious cavities 1class of permanent
and deciduous teeth depending on depth of a lesion and a choice of filling
materials.
2. To master main principles of preparing of carious cavities 2 class of permanent
and deciduous teeth depending on depth of a lesion and a choice of filling
materials.
Names of previous disciplines
Skills are got
Normal anatomy
Able defirintiation temporal and permanent teeth.
To know the anatomic features of temporal teeth
depending on the stage of development of tooth.
Therapeutic stomatology
To know basic methods and principles of preparing
of teeth in grown man age. Oriented in the choice of
instruments for realization of that or other
manipulation. Able to pick up stopping material
depending on a situation.
Orthopaedic stomatology
Oriented in materials which are utillized in the
clinic of orthopaedic stomatology.
3. Base knowledges, abilities, habits which are necessary for study the topic.
1. To know the features of anatomy and histology of hard tissues of deciduous
teeth at different stages of development.
2. To know the feature of anatomy and a histology of hard tissues of a permanent
teeth at different stages of development.
3. To know about caries and main principles of the treatment.
4. To know structural components of a carious cavity.
5. To know classification caries cavities by Black.
6. To know the basic dental instruments and their purpose.
5. To know classification of dental burs.
6. To know stages of preparing carious cavities.
4.1. List of basic terms, parameters, descriptions which a student must
learn at preparation to lesson:
4.2. Theoretical questions for lesson:
1. Which general rules of tooth preparation you know?
2. The stages of preparation of carious cavities at 1 class by Black.
3. The stages of preparation of carious cavities at 2 classes by Black.
4. Which rules preparing of walls of carious cavities by Black?
5. Which rules preparing of walls of carious cavities by Lukomsky?
6. Which stages preparing of walls of carious cavities by MIT?
4.3. Practical tasks which are executed on the lesson:
1. To study preparing stages of carious cavities at 1 class of deciduous teeth
depending on a stage of development of a tooth and filling materials.
2. To study stages of preparing of carious cavities at 2 class of deciduous
teeth depending on a stage of development of a tooth and filling a
materials.
3. To study stages of preparing of carious cavities of 1 class of a permanent
teeth depending on a stage of development of a tooth and filling materials.
4. To study stages of preparing of carious cavities of 1 class of a permanent
teeth depending on a stage of development of a tooth and filling materials.
5. Plan and organizational structure of lesson from discipline.
¹
Stages
Distributing Types of control
of time
1.
Preparatory stage
1.11.1Oh
2.
the
Organization
al questions.
Forming of
motivation.
Control
initial
level of
knoweledge .
Basic
stage.
55 min
3.
Final stage
1.2
1.3
3.1. Control of final level
of preparation.
3.2. General estimation of
educational activity
of student.
3.3 Informing of students
is about the topic of
next lesson.
Content of topic:
15 min
20 min
Facilities of
education
practical tasks,
textbooks,
situatioonal
manuals,
tasks, verbal
methodical
questioning, are
recommendations.
after the
standardized lists
of questions.
tests tasks
Preparing of a carious cavity is a surgical operative treatment which provides tool
excision of the tissues of a tooth amazed by caries. Successful cavity preparations
for restorative materials such as dental amalgam, composite, resin, or cast metal
are designed to allow placement and maintenance of each restorative material
and, at the same time, to ensure the preservation of remaining tooth structure.
Allocate following stages:
1.Gating and extension cavity.
2. Necrotomia, deleting decay tooth structure.
3. Forming retention and resistance form of preparation.
4. Working with edges op preparation.
Gating and extension cavity. It is used high speed handpiece and usual or
miniature diamond round and fissure burs. Round burs input in cavity, then with
interrupting moves (from floor to surface) delete hangin enamel. With the help of
fissure burs, the walls are making plamb.
Necrotomia, deleting decay tooth structure. For removing soft tissue, we used a
sharp excavator. The walls dentine excavate in the axial direction. The deep
(parapulpar) dentin excavate horizontally. For removing hard decay tissue to use
carbide burs. For best result is recommended to use low speed handpiece.
The principles of cavity preparation are now applied uniquely for each restorative
materials and each period of tooth evolution and even the general caries
situation.
For prevention of damaging enamel margins, to cut it under the angle (40-45) to
surface of enamel. Use for this finishing diamond burs (finirs) and air turbine
handpieces.
The principles of cavity preparation devised and published by dr. Black in 1908 are
still appropriate for low-adgesive materials, such as amalgam, phosphate and
selico-phosphate cements.
1.Extension for prevention.
Extension for prevention, to include those pits and fissures adjoining the defects
with active decay, especially should be considered when the patients is young,
has a high caries rate, and /or exhibits poor oralhygiene.
2.Resistance Form
When restorative material is used on stress bearing surface, a minimum depth of
1,5-2mm is recommended due too the briltleness of amalgam (cements) in
thinner layers. Ideally, amalgam meets the unprepared tooth surface at right
angles to provide resistance form.
3.Retention (Class I)
For amalgam and cements, retention is provided in an occlusal preparation
by a slight convergence of the buccal and lingual preparation walls towards the
occlusal surface, which, due to the slope of the triangular ridges, is
coincidentally accomplished by ending the buccal and lingual cavity walls at
right angles to the unprepared triangular ridges.
4.Finiring – All edges prepared with finiring burs for deleting enamel prisms which
have lost a bearing.
Also there are other methods preparation of caries cavity:
1. Method “Biological expediency” devised by Lukomskiy. It provides
sparing removing caries. Ideally for composit, glass ionomers, but not
for amalgam and cements.
2. Method “Prophylactic filling” was designed for glasionomer cements
and composits, which have good adgesive and mechanical properties.
The main principle of this method is preparing up to immune zones.
3. ART-methods (atraumatic restorative treatment) was proposed by dr.Taco
Pilot. The doctor make only necrotomy with the help of the exavater (without
using handpies) end next filling the cavity by glass-ionomer cement (Fuji IX).
This method is painless and can using in all stages of teeth developments.
Features of preparing cavities depends from period of teeth development.
First stage - development (formating) of roots. At this stage the pulp
chamber is big. That is why sparing preparation is needed. Use method of
Prophylactic filling.
Second stage – the generated roots. It is recommended the Black method
of preparation.
Third stage – resorbtion of roots.You can use Lucomskiy’ method.
Features of preparing cavities depends from anatomic srtucture. There are
typical localization at the picture 1.
The vartiants preparing of enamel edges depends from filling materials are
shown at the picture 2.
Pic. 2
1-damadged prism
2- chip of the prism
3- ceramic, amalgam
4- cement
5- inlay
6- composit
Class II Caries. Principles of cavity preparation and terminology.
The preparation for a class II carious lesion can be restored with amalgam,
direct composite, inlays, or onlays (cast metal or tooth-colored). The larger
the preparation (and, therefore, the thinner the remainng tooth structure), the
more appropriate a cast metal onlay might be to protect the remaining thin
tooth and provide adequate resistance form. Recent improvements in
composit restorative materials and techniques have resulted in increased use
of this tooth colored material foc Class II sestorations, especially when
esthetics is an important factor.
a. Extension for prevention (Clas II)
To reach Class II lesions, the dentist must, in most cases, prepare a proximal
box that extends apically through the marginal ridge in order to reach the
decay which forms just cervical to the proximal contact. The Class II
preparation often extends over some of the occlusal surface to include
adjacent occlusal pits and fissures as in Class I preparation, whereas the
proximal box might be compared to a stair-step descending gingivally off of
the occlusal portion. The Class I portions follows the principles for restoring a
Class I lesion already discussed, but the proximal extension (box) adds new
features. For example, the buccal and lingualn walls of the proximal box of
Class II preparations are extended beyond the proximal contact areas just into
the buccal and lingual embrasures. In this way, the margins of the restorations
can be better evaluated by the dentist and kept clean by the patient.
Retention Form (Class II)
For Class II amalgam cavity preparations, the buccal and lingual walls of the
occlusal portion and the proximal boxes are prepared so that are prepared so
that they converge slightly towards the occlusal to prevent the restoration
from dislodging occlusally as in the Class I preparation. Retentive grooves may
be prepared buccally and lingually in a proximal box as extensions of the
internal vertical wall of the box that is aligned along the long axis of the tooth,
and is therefore called the axial wall. These retentive grooves are designed to
prevent the amalgam restoration from dislodging in a proximal direction. They
are located at the axiobccal and axiolingval line angles seen later in figure. For
cast metal inlays, opposing buccal and lingual walls must diverge slightly
towards the occlusal. The two axial walls in a mesio-occlusodistal inlay
preparation must converge slightly towards the occlusal, so that an accurate
wax model (pattern) and subsequent casting can bee seated within the
preparation and than removed while constructing and relining the casting
prior to cementation. Bevels are angular enamel reduction placed at the
cavosurface in order for the margin (or outer edge) of the casting to be thin
enough so the dentist an perfect the adaptation and minimize the cavosurface
gap between tooth and metal. The goal is to minimize the gap between the
casting and tooth since this gap is to be filled with dental cement which is not
as strong or as durable as the metal.
Materials are for self-control:
1. GENERAL RULES OF TOOTH PREPARATION:
1. Pain control, Opening and widening the caries cavity, Necrectomy, Forming
and shaping the cavity, Beveled enamel margins.
2. Opening and widening the caries cavity, Necrectomy, Forming and shaping
the cavity, Beveled enamel margins.
3. Pain control, Opening and widening the caries cavity, Necrectomy, Forming
and shaping the cavity.
4. Pain control, Opening and widening the caries cavity, Forming and shaping
the cavity, Beveled enamel margins.
5. Pain control, Necrectomy, Forming and shaping the cavity, Beveled enamel
margins.
2. Classification of tooth preparations by G.V.Black :
1. is designated as Class I, Class II, Class III, Class IV, and Class V;
2. is designated as Class I, Class II, Class III, Class IV;
3. is designated as Class I, Class II, Class III;
4. is designated as Class I, Class II, Class III, Class IV, V,VI.
3. Class I Restorations:
1) All pit-and-fissure restorations are Class I, and they are assigned to three
groups, as follows: Restorations on Occlusal Surface of Premolars and
Molars;Restorations on Occlusal Two Thirds of the Facial and Lingual Surfaces
of Molars;Restorations on Lingual Surface of Maxillary Incisors.
2) All pit-and-fissure restorations are Class I, and they are assigned to too groups,
as follows: Restorations on Occlusal Surface of Premolars and
Molars;Restorations on Occlusal Two Thirds of the Facial.
3) All pit-and-fissure restorations are Class I, and they are assigned to too groups,
as follows: Restorations on Occlusal Surface of Premolars and Molars
Restorations on Lingual Surface of Maxillary Incisors.
4) All pit-and-fissure restorations are Class I, and they are assigned to too groups,
as follows: Restorations on Occlusal Surface of Premolars and Molars;
Restorations on Lingual Surface of Maxillary Incisors.
Literature.
Basic:
1.Lectures which are read on the department of pediatric dentistry.
2. Л. О. Хоменко, О. І. Остапко, О. Ф. Конанович, та ін. Терапевтична
стоматологія дитячого віку.- Видавництво "Книга плюс", 2007 р.
3. Pediatric dentistry /Ed. R.R.Welbury.- Oxford, 1997 – 584p.
Additional:
1. Боровський Г.В., Барішева Ю.Д., Максимов К. М. и др. Терапевтическая
стоматология. — М.: Медицина, 1997.
2. Pinkham J.R. Pediatric dentistry. – 2nded.- W.B. Sounders Company. – 1994.647 p.