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Textbook of Preclinical Conservative Dentistry
Nisha Garg, Amit Garg
CHAPTER 1:
Introduction to Preclinical Conservative Dentistry
INTRODUCTION
Need for Preclinical Conservative Dentistry
CAUSES OF LOSS OF TOOTH SUBSTANCE
OBJECTIVES OF OPERATIVE DENTISTRY
Diagnosis
Prevention
Interception
Preservation
Restoration
Maintenance
OBJECTIVES OF PRECLINICAL CONSERVATIVE DENTISTRY
ARMAMENTARIUM
PRECLINICAL TOOTH PREPARATIONS
Tooth Preparations on Plaster Models
Tooth Preparations on Typhodonts
Tooth Preparations on Extracted Teeth
Shortcomings of Preclinical Practice
CHAPTER 2:
Morphology of Permanent Teeth
INTRODUCTION
DEFINITIONS
MAXILLARY TEETH
Central Incisor
Labial Aspect
Lingual Aspect
Mesial Aspect
Distal Aspect
Incisal Aspect
Lateral Incisor
Labial Aspect
Lingual/Palatal Aspect
Mesial Aspect
Distal Aspect
Incisal Aspect
Canine
Labial Aspect
Lingual/Palatal Aspect
Mesial Aspect
Distal Aspect
Incisal Aspect
First Premolar
Buccal Aspect
Palatal Aspect
Mesial Aspect
Distal Aspect
Occlusal Surface
Second Premolar
Buccal Aspect
Palatal Aspect
Mesial Aspect
Distal Aspect
Occlusal Aspect
First Molar (Box 2.2)
Buccal Aspect
Palatal Aspect
Mesial Aspect
Distal Aspect
Occlusal Aspect
Second Molar
Buccal Aspect
Palatal Aspect
Mesial Aspect
Distal Aspect
Occlusal Aspect
MANDIBULAR TEETH
Central Incisor
Labial Aspect
Lingual Aspect
Mesial Aspect
Distal Aspect
Incisal Aspect
Lateral Incisor
Labial Aspect
Lingual Aspect
Mesial Aspect
Distal Aspect
Incisal Aspect
Canine
Labial Aspect
Lingual Aspect
Mesial Aspect
Distal Aspect
Incisal Aspect
First Premolar
Buccal Aspect
Lingual Aspect
Mesial Aspect
Distal Aspect
Occlusal Aspect
Second Premolar
Buccal Aspect
Lingual Aspect
Mesial Aspect
Distal Aspect
Occlusal Aspect
First Molar
Buccal Aspect
Lingual Aspect
Mesial Aspect
Distal Aspect
Occlusal Aspect
Second Molar
Buccal Aspect
Lingual Aspect
Mesial Aspect
Distal Aspect
Occlusal Surface
CHAPTER 3:
Morphology of Primary Teeth
INTRODUCTION
IMPORTANCE
DIFFERENCE BETWEEN PRIMARY AND PERMANENT DENTITION
Crown
Pulp
Root
MAXILLARY TEETH
Central Incisor
Labial Aspect
Palatal Aspect
Mesial and Distal Aspects
Incisal Edge
Root
Pulp Cavity
Lateral Incisor
Root
Canine
Labial Aspect
Contact Areas
Palatal Aspect
Mesial and Distal Surfaces
Incisal Aspect
Root
Pulp Cavity
First Molar
Labial Aspect
Palatal Aspect
Mesial Surface
Distal Aspect
Occlusal Aspect
Pulp Cavity
Root
Second Molar
Buccal Aspect
Palatal Aspect
Mesial Aspect
Distal Aspect
Occlusal Aspect
Pulp Cavity
MANDIBULAR TEETH
Central Incisor
Labial Aspect
Lingual Aspect
Mesial Aspect
Distal Aspect
Pulp Cavity
Lateral Incisor
Root
Canines
Labial Aspect
Lingual Aspect
Mesial and Distal Surfaces
Incisal Aspect
Pulp Cavity
Root
First Molar
Buccal Aspect
Lingual Aspect
Mesial Aspect
Distal Aspect
Occlusal Surface
Pulp Cavity
Second Molar
Buccal Aspect
Lingual Aspect
Mesial Aspect
Distal Aspect
Occlusal Aspect
Pulp Cavity
CHAPTER 4:
Structure, Nomenclature and Tooth Physiology
INTRODUCTION
Enamel
Dentin
Dental Pulp
Periradicular Tissue
Cementum
Periodontal Ligament
TOOTH NOMENCLATURE
Dental Arches and Quadrants
Classes of Teeth
Incisors
Canines/Cuspids
Premolars/Bicuspids
Molars
Types of Dentition
TOOTH NOTATION SYSTEMS
Zsigmondy–Palmer System/Angular/Grid System/Symbolic System/Quadrant system
Zsigmondy–Palmer system for permanent teeth
Zsigmondy–Palmer system for deciduous teeth
Advantages
Disadvantages
Universal (National) System/ADA System
Modified Version of Universal System Order for Primary Dentition
Universal/ADA system for permanent teeth
Universal/ADA system for deciduous teeth
Advantage
Disadvantage
Federation Dentaire International (FDI) System
Permanent Teeth
Deciduous Teeth
FDI System for Permanent Teeth
FDI System for Deciduous Teeth
Advantages
Disadvantage
NOMENCLATURE OF TOOTH SURFACES
PHYSIOLOGY OF TOOTH FORM
Contacts and Contour
Significance
Over-contouring
Under-contouring
Marginal Ridges
Importance
Embrasures
Labial/Buccal and Lingual Embrasures
Incisal/Occlusal Embrasures
Gingival Embrasure
Functions of Embrasure
Significance
Proximal Contact Areas
Importance of Proper Contact Relation
CHAPTER 5:
Chair Position and Dental Operatory
INTRODUCTION
COMMON POSITIONS FOR DENTAL PROCEDURES
Upright Position
Reclined at 45°
Almost Supine
Dentist–Patient Position
Right Front Position (7 o'clock)
Right Position (9 o'clock)
Right Rear Position (11 o'clock)
Direct Rear Position (12 o'clock)
Points to Remember while Doing Patients
ANTISEPSIS IN CLINICS
GENERAL PRECAUTIONS
Personal Protection Equipment
Barrier Technique
Hand Hygiene
Steps of Handwashing
CHAPTER 6:
Dental Caries
INTRODUCTION
THEORIES
Acidogenic Theory
Role of Dental Plaque
Role of Carbohydrates
Role of Microorganisms
Role of Acids
Proteolytic Theory
Proteolysis-Chelation Theory
Caries Balance Concept
ETIOLOGY
Primary Factors
Modifying Factors
Tooth
Substrate (Environmental Factors)
Saliva
Diet
Bacteria
Time Period
Modifying Factors
Age
Sex
Race
Hereditary
Systemic Health
Occupation
CLASSIFICATION
According to their Anatomical Site
Pit and Fissure Caries
Smooth Surface Caries
Root Caries
According to New Lesion or Recurrent Lesion
Primary Caries
Recurrent Caries
Residual Caries
According to Speed of Caries Progression
Active Carious Lesion
Inactive/Arrested Carious Lesion
Chronic Caries
Rampant Caries
Based on Treatment and Restoration Design
Class I
Class II
Class III
Class IV
Class V
Class VI
Based on Pathway of Caries Spread
Forward Caries
Backward Caries
Based on Extent of Caries
Incipient Caries
Cavitated Caries
Based on Number of Tooth Surfaces Involved
Simple Caries
Compound Caries
Complex Caries
Graham Mount's Classification
HISTOPATHOLOGY
Enamel Caries
Smooth Surface Caries
Pit and Fissure Caries
Zones in Enamel Caries
Dentinal Caries
Early Dentinal Changes
Advanced Dentinal Changes
Zones of Dentinal Caries
CHAPTER 7:
Armamentarium
INTRODUCTION
NOMENCLATURE
1. Order
2. Suborder
3. Class
4. Subclass
PARTS
Handle or Shaft
Shank
GV Black's Classification of Instruments Based on Number of Shank Angles
Advantages
Blade or Nib
INSTRUMENT FORMULA
Three-number Formula
Example of Three-number Formula
Four-number Formula
Example of Four-number Formula
DIFFERENT INSTRUMENT DESIGNS
Bevels in Cutting Instruments
Single Bevel Instruments
Bibeveled Instruments
Triple-beveled Instrument
Circumferential Bevel
Direct and Lateral Cutting Instruments
Direct Cutting Instruments
Lateral Cutting Instruments
Instruments Ends
Instrument Motions
EXPLORING INSTRUMENTS
Mouth Mirrors
Types
Uses
Explorer
Parts
Types
Uses
Tweezers
Probes
Uses
Types
HAND CUTTING INSTRUMENTS
Chisels
Straight Chisel
Monoangle Chisel
Binangle Chisel
Triple Angle Chisel
Wedelstaedt Chisel
Hatchet
Gingival Margin Trimmer
Uses
Excavators
Ordinary Hatchet
Hoe Excavators
Angle Former
Spoon Excavator
Knives
Files
Cleoid–Discoid
Offset Hatchet
Triangular Hatchet
RESTORATIVE INSTRUMENTS
Cement Spatulas
Plastic Filling Instrument
Condensers
Amalgam Carrier
Carvers
Burnisher
Uses
Composite Resin Instruments/Teflon-coated Instruments
INSTRUMENT GRASPS
Modified Pen Grasp
Inverted Pen Grasp
Palm and Thumb Grasp
Modified Palm and Thumb Grasp
FINGER RESTS
Intraoral Finger Rests
Conventional
Cross-arch
Opposite Arch
Finger on Finger
Extraoral Finger Rest
Palm Up
Palm Down
ROTARY CUTTING INSTRUMENTS
Types of Rotary Cutting
Handpieces
Dental Burs
MATRIX RETAINERS AND BANDS
Parts of Matrix
Retainer
Band
Functions
Classification
Ivory Matrix Holder (Retainer) No. 1
Ivory Matrix Band Retainer No. 8
Tofflemire Universal Matrix Band Retainer (Designed by Dr BF Tofflemire)
WEDGES
Advantages
Types of Wedges
Wooden Wedges
Plastic Wedges
Wedging Techniques
Single Wedging Technique
Wedge Wedging
Piggyback Wedging
CHAPTER 8:
Principles of Tooth Preparation
INTRODUCTION
PURPOSE OF TOOTH PREPARATION
CLASSIFICATION
DEFINITIONS
Simple Tooth Preparation
Compound Tooth Preparation
Complex Tooth Preparation
Walls
Internal Wall
External Wall
Pulpal Wall
Axial Wall
Floor
Cavosurface Angle Margin
Line Angle
Point Angle
NUMBER OF LINE AND POINT ANGLES
Class I Tooth Preparation
Line Angles
Point Angles
Class II Tooth Preparation
Line Angles
Point Angles
Class III Tooth Preparation
Line Angles
Point Angles
Class IV Tooth Preparation
Line Angles
Point Angles
Class V Tooth Preparation
Line Angles
Point Angles
STEPS
Steps in Tooth Preparation
INITIAL STAGE
Outline Form and Initial Depth
Definition
Factors Affecting the Outline and Initial Depth form of Tooth Preparation
Principles
Features for Establishing A Proper Outline form
Outline form for Pit and Fissure Lesions
Outline form for Smooth Surface Lesions—Outline form of Proximal Caries (Class II, III and IV lesions)
Rules for Making Outline form for Proximal Preparation
Rules for Class V Cavities
Enameloplasty
Primary Resistance Form
Definition
Features of Resistance Form
Factors Affecting Resistance Form
Primary Retention Form
Definition
Factors Affecting Retention Form
Convenience Form
Definition
Features of Convenience Form
FINAL STAGE
Removal of Any Remaining Caries, Infected Dentin and/or Old Restorative Material, if Indicated
Pulp Protection
Secondary Resistance and Retention Forms
Mechanical Features
Treatment of the Preparation Walls
Procedures for Finishing the External Walls of the Tooth Preparation
Definition
Final Procedures: Cleaning, Inspecting and Sealing
Degree of Smoothness of Walls
Location of the Margins
CHAPTER 9:
Tooth Preparation for Amalgam and Composite Restorations
INTRODUCTION
PREPARATION FOR AMALGAM RESTORATION
Class I Tooth Preparation
Outline Form
Primary Resistance Form
Primary Retention Form
Convenience Form
Final Tooth Preparation
Preparation of Buccal Pit for Mandibular Molars
Class II Tooth Preparation
Outline form
Primary Resistance Form
Primary Retention Form
Convenience Form
Final Tooth Preparation
Secondary retention and resistance form
Modifications in Class II Design
Class V Tooth Preparation
Initial Tooth Preparation
Final Tooth Preparation
TOOTH PREPARATION FOR COMPOSITE RESTORATION
Class III Tooth Preparation
Conventional Class III Tooth Preparation
Beveled Conventional Class III Tooth Preparation
Modified (Conservative) Class III Tooth Preparation
Class IV Tooth Preparation
Conventional Tooth Preparation
Beveled Tooth Preparation
Modified (Conservative) Tooth Preparation
Class V Tooth Preparation
Conventional Tooth Preparation
Beveled Conventional Tooth Preparation
Modified (Conservative) Tooth Preparation
Class I Tooth Preparation
Class II Tooth Preparation
Steps
Features of Class II Composite Tooth Preparation
CHAPTER 10:
Tooth Preparation for Primary Teeth
INTRODUCTION
RATIONALE FOR TOOTH PREPARATION
PRINCIPLES OF TOOTH PREPARATION
Basic Differences in Primary and Permanent Dentitions Affecting Tooth Preparation in Primary Teeth
CLASSIFICATION OF DENTAL CARIES
Black's Classification
Finn's Modification
TOOTH PREPARATION
Class I Tooth Preparation
Outline Form
Primary Resistance Form
Primary Retention Form
Convenience Form
Final Tooth Preparation
Primary Mandibular First Molar
Primary Mandibular Second Molar
Primary Maxillary Second Molar
Class II Tooth Preparation
Occlusal Preparation
Preparation of Proximal Box
Primary Resistance Form
Primary Retention Form
Convenience Form
Final Tooth Preparation
Class III
Class IV
Class V
MATRIX BANDS AND RETAINERS
Spot Welded
Steps of Fabrication
T-band Matrix
Preformed Spot Welded Matrix Bands
Toffelmire Retainer and Band
STEPS FOR AMALGAM RESTORATION FOR PRIMARY TEETH
CHAPTER 11:
Dental Materials
INTRODUCTION
Classification of Dental Materials
Properties of Dental Materials to be Considered
DENTAL CEMENTS
Uses of Dental Cements
Factors Determing the use of Dental Cements
Classification of Dental Cements
Based on Composition
Classification Based on Uses
ZINC OXIDE EUGENOL CEMENT
Composition
Setting Reaction
Composition of Modified Zinc Oxide Eugenol Cements
Manipulation of ZOE Cement
Working Time and Setting Time
Advantages
Disadvantages
ZINC PHOSPHATE CEMENT
Types
Composition
Setting Reaction
Manipulation
Properties
Mechanical Properties
Biocompatibility
Uses
Advantages
Disadvantages
ZINC SILICOPHOSPHATE CEMENTS
Composition
Properties of Zinc Silicophosphate Cements
CALCIUM HYDROXIDE
Mixing Calcium Hydroxide Cement
ZINC POLYACRYLATE CEMENT/ZINC POLYCARBOXYLATE CEMENT
Composition
Manipulation
Setting Reaction
Working Time and Setting Time
Properties
Adhesion
Mechanical Properties
Solubility
Biological Considerations
Uses
Advantages
Disadvantages
GLASS IONOMER CEMENT
Classification
Composition
Conventional
Liquid
Modified Glass Ionomer Cements
Metal Reinforced Glass Ionomer Cement
Cermet Cements
Resin-modified Glass Ionomer Cement
Manipulation
Setting Reaction
Setting Reaction of Autocure Glass Ionomer Cement
Setting Reaction of Resin-modified Glass Ionomers
Properties
Physical
Biocompatibility
Water Sensitivity
Adhesion
Fluoride Release
Esthetics
Margin Adaptation and Leakage
Advantages
Disadvantages
Indications
Contraindications
PULP PROTECTION MATERIALS
Objectives
Classification
Varnish
Advantages
Indications
Contraindications
Resin Bonding Agents
Indications
Liners
Indications
Materials
Bases
Classification
Materials
DENTAL AMALGAM
Advantages
Disadvantages
Classification
Composition
Types
Proportioning
Setting Reaction
For Lathe-cut Low-copper Alloys
For Admixed High-copper Alloys
For Unicompositional Silver Alloy
Structure of Set Amalgam
Manipulation
Selection of Amalgam Alloy
Mercury Alloy Ratio
Trituration
Mulling
Insertion of Amalgam
Condensation
Precarve Burnishing
Carving
Postcarve Burnishing
Finishing and Polishing
Physical Properties
Dimensional Change
Strength
Plastic Deformation (Creep)
Corrosion
Thermal Conductivity
Coefficient of Thermal Expansion
Indications
Contraindications
DENTAL CASTING ALLOYS
Requirments of Dental Casting Alloys
Classification and Composition
CHAPTER 12:
Adhesive Dentistry
INTRODUCTION
Definitions
Adhesion
Adherend
Adhesive/Adherent
Indications for Use of Adhesives
Advantages
ENAMEL BONDING
Steps for Enamel Bonding
Effects of Etching
DENTIN BONDING
Problems Encountered during Dentin Bonding
Moist vs Dry Dentin
DENTIN BONDING AGENTS
Mechanism of Bonding
Ideal Requirements of Dentin Bonding Agent
Classification of Modern Adhesives
Based on Generations
EVOLUTION OF DENTIN BONDING AGENTS
First Generation Dentin Bonding agents
Disadvantages
Second Generation Dentin Bonding Agents
Disadvantages
Third Generation Dentin Bonding Agents
Advantages
Disadvantages
Fourth Generation Dentin Bonding Agents
Advantages
Disadvantages
Fifth Generation Dentin Bonding Agents
Advantages
Disadvantage
Sixth Generation Dentin Bonding Agents
Advantages
Disadvantage
Types of Sixth Generation Bonding Agents
Seventh Generation Dentin Bonding Agents
DENTAL COMPOSITES
Composition of Dental composites
Organic Matrix
Fillers
Coupling Agents
Initiator Agents
Inhibitors
Coloring Agents
Ultraviolet Absorbers
Classification
Macrofilled Composite Resin/Conventional/Traditional
Small Particle Composite Resins
Microfilled Composites Resins
Hybrid Composite Resins
Properties of Composite
Coefficient of Thermal Expansion
Water Absorption
Wear Resistance
Surface Texture
Radiopacity
Modulus of Elasticity
Solubility
Polymerization Shrinkage
Esthetics of Composites
Indications
Contraindications
Advantages
Disadvantages
Steps of Clinical Procedure for Composite Placement
Tooth Preparation
Bonding
Composite Placement
Polymerization of Composite Resins
Final Contouring, Finishing and Polishing of Composite Restorations
CHAPTER 13:
Basics of Endodontics
INTRODUCTION
ETIOLOGY OF PULPAL DISEASES
PROGRESSION OF PULPAL PATHOLOGIES
ENDODONTIC INSTRUMENTS
Standardization of Instruments Given by Ingle and Levine
Modifications from Ingle's Standardization
Broach
Reamer
Files
K-file
K-flex File
Hedstroem File (H-file)
NiTi Rotary Instruments
ACCESS CAVITY PREPARATION
ACCESS CAVITY OF ANTERIOR TEETH
ACCESS CAVITY PREPARATION FOR PREMOLARS
ACCESS CAVITY PREPARATION FOR MAXILLARY MOLARS
ACCESS CAVITY PREPARATION FOR MANDIBULAR MOLARS
WORKING LENGTH DETERMINATION
Definitions Related to Working Length
SIGNIFICANCE OF WORKING LENGTH
Radiographic Method of Length Determination
IRRIGATION OF ROOT CANAL SYSTEM
Functions of Irrigants
Commonly used Irrigating Solutions
CLEANING AND SHAPING
BASIC PRINCIPLES OF CANAL INSTRUMENTATION
TECHNIQUES OF ROOT CANAL PREPARATION
Step Back Technique
Phase I
Phase II
Crown Down Technique
OBTURATION OF ROOT CANAL SYSTEM
Purpose of Obturation
Materials used for obturation
Obturation Techniques
Lateral Compaction Technique
CORONAL RESTORATION
COMMON ERRORS DURING ENDODONTIC TREATMENT
CHAPTER 14:
Examination Spotters
INSTRUMENTS
Spotter 1: Mouth Mirror
Spotter 2: Explorer
Spotter 3: Tweezer
Spotter 4: Chisel
Spotter 5: Gingival Margin Trimmer
Spotter 6: Excavators
Spotter 7: Burnisher
Spotter 8: High-speed Diamond point
Spotter 9: Slow-speed Dental Bur
Spotter 10: Wedges
Spotter 11: Tofflemire Retainer
Spotter 12: Ivory No. 1 Matrix Retainer
Spotter 13: Ivory No. 1 Matrix band
Spotter 14: Ivory No. 8 Matrix retainer
Spotter 15: Ivory No. 8 Matrix band
Spotter 16: Mylar Strips
Spotter 17: Amalgam Polishing Kit
MATERIALS
Spotter 18: Amalgam Alloy Powder
Spotter 19: Mercury
Spotter 20: Amalgam Capsule
Spotter 21: Dentin Bonding Agent
Spotter 22: Etchant
Spotter 23: Light-cured Composite Resin
Spotter 24: Varnish
Spotter 25: Zinc Oxide Eugenol Cement
Spotter 26: Intermediate Restorative Material (IRM)
Spotter 27: Zinc Phosphate Cement
Spotter 28: Zinc Polycarboxylate Cement
Spotter 29: Calcium Hydroxide
Spotter 30: Type 1 Glass Ionomer Cement
Spotter 31: Type 2 Glass Ionomer Cement
Spotter 32: MTA
Spotter 33: Base-metal Alloy pellets
Spotter 34: Inlay wax
Glossary
INDEX
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