ntroduction to Operative Dentistry

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Sensitive things require. Extra Care


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OPERATIVE DENTISTRYDEFINITION, SCOPE, AND OBJECTIVES


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OPERATIVE DENTISTRYThe branch of Oral Health Services dealing with:

1. Prevention.

2. Restoration. Of the Defects of Natural Teeth


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DEFINITION :

Operative dentistry is the science and

art dealing with the prevention andrestorations of any Defect thatoccurs in the hard tooth structures.


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It occupies about 70% of the dentist time andnecessitates the formation of Cavities of specificdesignand form to receive the restorative material

of choice to restorethe tooth.

THE PRACTICE OF OPERATIVE DENTISTRY


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1. Carious Lesions

2. Non-Carious Lesions

a. Attrition b. Abrasionc. Erosion d. Hypo-plasiae. Hypo-calcification f. Discolorationg. Trauma

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


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ATTRITION


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ABRASSION


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EROSION


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DISCOLOR TOOTH


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Developmentalstructural defects

Enamel Hypoplasia:

Acquired condition


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Amelogenesis imperfecta:Hereditary abnormality

Insufficient amount of enamel,

soft enamel, friable and easy lost


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Dentinogenesis imperfecta:hereditary conditionTeeth appear yellow-brown to

grayEnamel is fractured easily due topoor support provided by theabnormal dentin


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Hereditary

* Peg-shaped lateral incisor

* Hutchinsons incisor

* Mulbery molars

Seen with congenital

syphilis


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Enamel hypocalcification:

(hypomineralized)


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Accidentaltraumatic fracture of teeth

.


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Ditched Amalgam Restoration


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RESTORATION:Is an artificial substitute which replace the

missing 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 inocclusal disharmonies. If not corrected, thuscausing traumatic occlusion.


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AIMS & OBJECTIVEs:RESTORATION OF THE DEFECTS OF TOOTH/TEETH:Results:1. Proper Tooth Form and shape2. Proper Functioning of the tooth

3. Improving the strength of the tooth4. Improving the Esthetic5. Proper relationship with adjacent teeth and gingiva ,

improving the integrity of the tooth supporting tissues6. Improving the integrity of stomatognathic system

All of Above enhance the general healthand welfare of the patient.


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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 good doctorknowing the Basic Medicine / Applied Biology.

2. Can use the basic principles of Engineering and Physics.

3. Highly developed Technical / Manual skill.

4. Can demonstrate Artistic Abilities.


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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


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Primary Prevention To prevent the occurrence of carries,need: a. Multiple fluoride therapy b. Good Oral Hygiene practice c. Pits and fissures Sealants d. Diet Counseling

e. etc.

Secondary Prevention To arrest the carries at its initial stage ,need the measures : a. To arrest the carries b. For re-mineralization of incipient carries c. Like minor remedies e.g. small pit fillings.

d. etc.

Tertiary Prevention To treat the established form of carries and prevent its spread and

recurrence: . Direct and indirect filling of the cavities of the teeth


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DIAGNOSIS

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

INTERCEPTION


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INTERCEPTIONTo prevent further loss oftooth structure by Haltingactive disease.

It includes :

Change in Patients

home care habit.

Removal of the Lesion.

Altering Tooth form.Recontouring of toothCorrect Occlusion etc.


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PREVENTIONPrevention of recurrence of cariesIt 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 the

non self-cleansable areas in the cavity of the tooth

PRESERVATION


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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.


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RESTORATION OF THE DEFECTS OF TOOTH/TEETHThe following aims are expected from the restoration :1. Proper Tooth Form and shape2. Proper Functioning

3. Improving the Esthetic4. Proper relationship with adjacent teeth and gingiva5. Integrity of the tooth supporting tissues6. Integrity of stomatognathic system

All of Above enhance the general healthand welfare of the patient.


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PROGNOSISThe 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 ofthe tooth.


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DENTAL CARIES DEFINITION

It is a disease of the calcified tissues of theteeth, characterized by a demineralization ofthe inorganic portion and destruction of theorganic substance of the tooth


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CAVITY

The term cavity refers to a defect inenamel, or in enamel and dentin, usuallyresulting from the pathologic process ofdental caries.


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Prepared cavitiesThe 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.


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RESTORATIVE MATERIALSThe replacement of lost hard tooth structure cannot be

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


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PERMANENT RESTORATIVE MATERIALS INCLUDE

Metal Polymers

Composite resinGlass-ionomer-cementsAcrylic

Ceramics

porcelainAmalgamGoldNoble metalCobalt-chromium-alloys

Nickel-chromium-alloya


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PERMANENT RESTORATIVE MATERIALSDirect 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


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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.


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Amalgam filled teeth


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Gold filled teeth


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Pins retained restorations


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Multiple Procedures to Conserve the Tooth:2. Conservative esthetic procedures e.g. filling of the cavities in the teeth with

tooth 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..ivAlteration 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. ColourTo 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.


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COSMETIC

RECONTOURING

DIASTIMA CLOSURE


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Alteration of Embrasure


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NEED BLEACHING OR VENEERING


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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 specialrubber 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:


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ntroduction to Operative Dentistry

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