DR. VIKRAM SHETTY.K.

HEAD OF THE DEPARTMENT

CONSERVATIVE DENTISTRY AND
ENDODONTICS
FACULTY OF DENTISTRY
MELAKA MANIPAL MEDICAL COLLEGE
LEARNING OUTCOMES :
 At the end of the Presentation student is able to :
 1. To differentiate between conventional, Beveled
and Modified cavity preparation in class III, class
IV and class V tooth preparation (C4).
 2.To demonstrate class III, class IV, class V tooth
preparation (A3).
 3.To demonstrate various steps in composite
restoration (A3).
Class III cavities :
CCCCC
 Cavities in the proximal
surfaces of incisors and
canines but not involving the
incisal angle.
PERTINENT MATERIAL QUALITIES AND PROPERTIES :
The specific material qualities or properties that make
composites the best material for Class III, IV and V
restorations are :
 Esthetics
 Adequate strength
 Bonding to tooth structure resulting in less tooth structure
removal
INDICATIONS :
 Anterior restorations – Almost all Class III and IV restorations
are restored with composite .

 Esthetic restorations – Most Class V restorations that are in

esthetic prominent areas are restored with composite.

The operating area must be adequately isolated to attain an

effective bond.
COMPOSITE RESTORATIONS
BEFORE AND AFTER

CLASS III

CLASS IV

CLASS V
CONTRAINDICATIONS :
 An operating area that cannot be adequately isolated.
 Some restorations that extend on to the root surface ,because for
most extensions a V shaped gap (contraction gap) is formed
between the root and composite. This gap occurs because the
force of polymerization shrinkage of the composite is greater
than the initial bond strength of the composite, to the dentin of
the root.

CONTRACTION GAP
A- V SHAPED GAP ON ROOT SURFACE
B- RESTORATION SIDE VECTOR IS
COMPOSITE , ROOT SIDE VECTOR IS
HYBRIDIZIED DENTIN
ADVANTAGES :
The following reasons due to which composite restorations have
become so popular , especially in comparison to non-bonded
amalgam restorations.
Composite restorations are:
1. Esthetic
2. Conservative tooth structure removal (less extension;
uniform depth not necessary; mechanical retention usually not
necessary)
3. Less complex when preparing the tooth
4. Insulative , having low thermal conductivity
5. Used almost universally
6. Bonded to tooth structure, resulting in good retention, low
microleakage , minimal interfacial staining, and increased
strength of remaining tooth structure
7. Repairable
DISADVANTAGES :
Composite restorations:
1. May have a gap formation, usually occurring on root surfaces
as a result of the forces of polymerization shrinkage of the
composite material being greater than the initial early bond
strength of the material to dentin
2. Are more difficult, time-consuming, and expensive (compared
to amalgam restorations) because:
• Tooth treatment usually requires multiple steps.
• Insertion is more difficult.
• Establishing proximal contacts, axial contours, embrasures,
and occlusal contacts may be more difficult.
• Finishing and polishing procedures are more difficult.
3. Are more technique sensitive because the operating site must
be appropriately isolated and the placement of etchant, primer,
and adhesive on the tooth structure (enamel and dentin) is very
demanding of proper technique.
4. May exhibit greater occlusal wear in areas of high occlusal_
stress .
5. Have a higher linear coefficient of thermal expansion,
resulting in potential marginal percolation if an inadequate
bonding technique is utilized.
CLINICAL TECHNIQUE FOR DIRECT CLASS III
COMPOSITE RESTORATIONS :

INITIAL CLINICAL PROCEDURES :

1. Anesthesia may be necessary for patient comfort

2. The area must be isolated to permit effective bonding

TOOTH PREPARATION :

When a proximal surface of an anterior tooth is to be restored and

there is a choice between facial or lingual entry into the tooth, the
lingual approach is preferable.
A small carious lesion should be treated from the lingual approach
unless it would necessitate excessive cutting of tooth structure.

Advantages of restoring the proximal lesion from the Lingual

approach include :
1. The facial enamel is conserved for enhanced esthetics.
2. Color matching of composite is not as critical.
3. Some unsupported , but not friable enamel may be left on the
facial wall of a Class III or Class IV preparation.
4. Discoloration or deterioration of the restoration is less visible.
Indications for a Facial approach include :

1. The carious lesion is positioned facially, such that facial

access would significantly conserve tooth structure.
2. The teeth are irregularly aligned, making lingual access
undesirable.
3. Extensive caries extend onto the facial surface.
4. A faulty restoration that was originally placed from facial
approach needs to be replaced.

When both the facial and lingual surfaces are involved, use
the approach that provides the best access for instrumentation.
1.CONVENTIONAL CLASS III TOOTH PREPARATION :
This design is indicated for root surface lesions
Since it is unusual
In this conventionally prepared area of the tooth, which is
apical to the cervical line, the external walls will be of dentin and
cementum.
These walls must be prepared to a sufficient depth pulpally to
provide for adequate removal of caries , old restorative material
or fault.
Class III conventional tooth preparation for a lesion entirely on root surface. A. Mesiodistal
longitudinal section illustrating carious lesion. B. Initial tooth preparation : Tooth preparation
with infected carious dentin removed. ; Preparing retention form to complete tooth
preparation.
Using a no. ½, 1 or 2 round bur , prepare the outline form on the
root surface, extending the external walls to sound tooth structure
while extending pulpally to an initial depth of 0.75 mm.

When preparing the conventional portion of a preparation (on the

root surface), the form of the preparation walls is the same as that
of an amalgam preparation.
The cavosurface margins exhibit a 90-degree cavosurface angle and
provide butt joints between the tooth and the composite material.
Thus, the external walls are prepared perpendicular to the root
surface forming a 90º cavosurface angle.
•Remove all remaining infected dentin using spoon excavators and
round burs .
•Groove retention may be necessary in root surface
preparations.
For better retention of the composite resin,a continuous retentive
groove is prepared on the internal portion of the external walls using
a No. ¼ round bur.
The groove is located 0.25 mm from the root surface and is
prepared to a depth of 0.25 mm.
2.BEVELLED CONVENTIONAL CLASS III TOOTH PREPARATION :
Indications:
- Replacing an existing defective restoration in the crown portion of
the tooth.
- Restoring a large carious lesion for which the need for increased
retention and /or resistance form is required.
-The tooth preparation takes the shape of the existing restoration with
any extension necessary to include recurrent caries, friable tooth
structure or defects.
-The beveled conventional preparation is characterized by
external walls that are perpendicular to the enamel surface,
with the enamel margin beveled.
-The beveled conventional preparation is characterized by external
walls that are perpendicular to the enamel surface, with the enamel
margin beveled.
-If part of the tooth to be restored is located on the root surface, a
conventional cavosurface configuration should be used in this area,
resulting in a combination of two tooth preparation designs, a
conventional type in the root portion, and a beveled conventional
type in the crown portion.
LINGUAL ACCESS :
- Using a round carbide bur (No. 1/2, 1, or 2) or diamond stone, the
size depending on the extent of the caries or defective restoration,
prepare the outline form.
-Begin the preparation close to the adjacent tooth at the
incisogingival level of caries.
- Direct the bur perpendicular to the enamel surface.
-Extend the preparation similar to the conventional design .
- Here,instead of a butt joint cavosurface margin ,a Bevel is
incorporated.
-This is done using a flame shaped diamond point, producing a
cavosurface angle of 45 degrees.
-The bevel may be 0.25 - 0.5mm in width .
-It is avoided on Gingival margins.
-The axial wall depth is limited to 0.2 mm inside the DEJ.
-When the preparation outline extends gingivally onto the root
surface, the depth of axial wall at the gingivoaxial line angle
should be 0.75 mm.
-Remove any remaining infected dentin, old restorative
material.
A. Small proximal carious lesion on mesial surface of maxillary lateral
incisor.
B. Dotted line indicates normal outline form dictated by shape of carious
lesion.
C. Extension (convenience form) required for preparing and restoring
preparation from lingual approach when teeth are in normal alignment.
Beginning Class III conventional tooth preparation (lingual approach). A.
A round carbide bur or diamond stone is held perpendicular to enamel
surface, and initial opening is made close to adjacent tooth at
incisogingival level of caries. B, Correct angle of entry is parallel to
enamel rods on mesiolingual angle of tooth. C, Incorrect entry
overextends lingual outline. D, Same bur or diamond is used to enlarge
opening for caries removal and convenience form while establishing
initial axial wall depth.
-If retention features are indicated prepare them along
the gingivoaxial line angle and sometimes on incisoaxial
line angle.
-The retention groove on gingivo-axial line angle is
placed 0.2 mm inside DEJ to a depth of 0.25 mm

Beveled conventional
preparation designs
for Class III (A and B)
Large Class III beveled conventional tooth preparation.
Note cavosurface bevel (arrow).
Beveling: Cavosurface bevel is prepared with flameshaped or round diamond
resulting in an angle approximately 45 degrees to the external tooth surface.
Class III initial preparation (facial approach).
A, Large proximal caries with facial involvement.
B, Isolated area of operation.
C, Entry and extension with No. 2 bur or diamond.
D, Caries removal with spoon excavator. E, Explorer point
removes caries at DEJ. This is a beveled conventional preparation
if accessible margins are beveled
3.MODIFIED CLASS III TOOTH PREPARATION :

-This design is indicated for small to moderate carious lesions and

is based on the extent of caries .
-It is made as conservatively as possible and preferably from the
Lingual approach.
-The preparation design is dictated by the extent of the fault or
defect .
-Using a round carbide bur ( No. ½ ,1 or 2 ) or diamond point
approach the lesion from the lingual aspect perpendicular to the
tooth surface.
- Gain access into the preparation , remove caries, complete the
preparation.
- The axial extension is also dictated by extent of defect or fault.
-Weakened, friable enamel is removed while preparing the
cavosurface margins in a beveled or flared configuration with the
round diamond.
-The preparation walls diverge externally from the axial depth in a
concave manner creating a beveled or flared margin as well as
conservation of internal tooth structure.
-The depth is limited to 0.2mm into dentin.
-Usually no groove retention form is indicated because the retention
of the material in the tooth will result from the bond created between
the composite material and the etched peripheral enamel.
- The preparation design appears to be "scooped" or concave.
RESTORATIVE TECHNIQUE :

•The proximal surface of the adjacent unprepared tooth is

protected using a polyester strip.
• Acid Etching : A gel etchant (37 % Phosphoric acid ) is applied
to all of the prepared tooth structure.
•The gel is left undisturbed for 15-30 seconds( 30 seconds for
enamel only preparations and 15 seconds when dentin is
involved)
•The area is thoroughly rinsed with a water spray for 5-15
seconds to remove the etchant.
Syringe used to dispense gel etchant
 When the preparation is only in enamel, the surface can be
dried with clean dry air.
 The etched enamel will appear frosty white due to the removal
of both prism cores and peripheries ,creating microscopic
irregularities.
 When the preparation involves enamel and dentin, the surface
should be dried using cotton pellets so that the dentin is left
visibly moist.
 This is because acid etching of dentin removes the surface
hydroxyapatite from the intertubular and peritubular dentin
thus opening the tubules leaving an interconnected layer of
collagen fibrils.
 If the dentin is overdried it leads to collapse of the collagen
network and thus a poor bond.
Acid-etching.:
A, Enamel rods unetched.

B, Enamel rods etched,

creating numerous
microundercuts.

C, Resin bonding agent

engaging microundercuts,
creating "resin tags" for
mechanical bond
to tooth.
• Bonding : Current Bonding systems combine the primer
and the adhesive in one bottle thus simplifying the
bonding process.
• The bonding agent is applied using a microbrush. Once
applied the adhesive is polymerized with curing light.
The manufacturers instructions are followed
regarding curing time.
• The Bonding agent penetrates the irregularities on
enamel and bonds micromechanically by formation of
resintags.
Applicator tip or microbrush
• On dentin, the bonding agent penetrates the collagen network
and the dentinal tubules forming a hybrid layer consisting of a
resin – dentin interdiffusion zone.
 The bond to dentin is also by resin tag formation Producing
micromechanical bonding.
Matrix Application :
A matrix is a device that is applied to a prepared tooth
before the insertion of the restorative material.
•The matrix is usually stabilized by a wedge.
•The matrix used is a thin material like polyester which can
be contoured easily.
• A wedge is placed using a plier from facial approach for
lingual access preparation and vice versa for facial access
preparation.
•A wedge helps hold the matrix strip in place, provides
slight separation of teeth and helps prevent a gingival
overhang of composite material.
INSERTING AND WEDGING OF POLYESTER STRIP MATRIX

A- STRIP WITH CONCAVE AREA IS POSITIONED NEXT TO

THE PREPARATION IS POSITIONED BETWEEN THE TEETH

B- STRIP IN POSITION WITH WEDGE INSERTED

Inserting and Curing of Composite :
The composite resin is built incrementally using special hand
instruments in 1-2 mm thickness.
The cavity is filled and contoured using the matrix before final
curing.
•Syringe type injectable composites can also be used.
• Once the bonding adhesive is applied cure it with visible
light source for 10 to 20 seconds with the tip near the
preparation.
• Insert the composite into the preparation and cure it for 20
seconds through the matrix strip.
•Do not touch the matrix with the tip
•Cure on the lingual side for another 20 seconds.
Finishing and Polishing the Composite :
The restoration is finished and polished using finishing burs,strips
and stones.

FINISHING AND POLISHING

A- FLAME SHAPED FINISHING BUR IS

USED TO REMOVE EXCESS AND
CONTOURING

B- RUBBER POLISHING POINT

C- ALUMINIUM OXIDE POLISHING

PASTE USED FOR FINAL POLISHING

D- COMPLETED RESTORATION
Class IV cavities :
 Cavities in the proximal
surfaces of incisors and
canines involving the
incisal angle.
 Traumatic injuries also
result in class iv defects.
 These are usually seen in
 Children and young
adults.
CLINICAL TECHNIQUE FOR CLASS IV COMPOSITE
RESTORATION :
The conventional design for Class IV cavity preparation for
composite resins is used in the folowing clinical situations :
a.High stress areas
b.Margins on root surfaces.

Mesioincisal angle fractured on

central incisor.
 1.Conventional Class IV Tooth Preparation :
 The cavity preparation is done using a round diamond
abrasive at high speed with air water spray.
 The preparation is box like with facial and lingual walls
parallel to the long axis of the tooth.
 The gingival floor is prepared perpendicular to the long
axis.
 All weakened enamel is removed and the initial axial
depth is maintained at 0.5mm into dentin.
 In case of deep caries, the remaining caries is excavated
and the pulp can be protected with a calcium hydroxide
liner and glass ionomer base.
 In the past retention was
provided by dovetail
extensions placed
lingually or by the use of
retentive pins.
 Currently,retention can
be provided by retention
grooves placed incisally
and gingivally in the
axial wall,using a no ¼
round bur.
2.Beveled Conventional Class IV Tooth Preparation.
Indications: For restoring large proximal areas that also include
the incisal surface of an anterior tooth or replacing an old defective
restoration placed in a conventional cavity preparation.
A Maxillary right central incisor has a large defective Class III
restoration and a fractured mesioincisal corner, which upon removal
necessitates a Class IV restoration.
Using an appropriate size round carbide bur or diamond instrument
at high speed with air-water coolant, prepare the outline form.
Remove all weakened enamel and establish the initial axial wall
depth at 0.5 mm into dentin.
Prepare the walls as much as possible parallel and perpendicular to
the long axis of the tooth.
Excavate any remaining infected dentin as the first step of final
tooth preparation.
If necessary, apply a calcium hydroxide liner.
Bevel the cavosurface margin of all accessible enamel margins
of the preparation.
The bevel is prepared at a 45-degree angle to the external tooth
surface with a flame-shaped or round diamond instrument.
The width of the bevel should be 0.25 to 2 mm.
 If retention undercuts are deemed necessary, prepare a
gingival retention groove using a No. 1/4 round bur.
 It is prepared 0.2 mm inside the DEJ at a depth of 0.25mm
(half the diameter of the No. 1/4 bur)
Class IV beveled conventional tooth preparation.
A, Large defective Class III restoration with resulting fractured
incisal angle.
B, Beveling cavosurface.
C, Gingival retention groove.
D, Completed Class IV beveled conventional tooth preparation.
Modified Class IV Tooth Preparation :
Indications: For small or moderate Class IV lesions or traumatic
injuries resulting in incisal edge fractures.
Remove any existing lesion or defective restoration with a
suitable size round bur or diamond instrument and prepare the
outline form to include weakened, friable enamel.
The axial depth is dependent on the extent of the lesion,
previous restoration, or fracture, but initially no deeper than
0.2 mm inside the DEJ.
Retention is provided by placing bevels using a flame shaped
diamond.The width of the bevel may be 1-2mm.
Usually no groove retention form is indicated. The
retention is obtained primarily from the bonding strength of the
composite to the enamel and dentin.
RESTORATIVE TECHNIQUE :
Acid Etching and Bonding :
The etching and bonding are the same as described for the Class
III composite restoration.
Matrix Application :
The polyester strip matrix also can be used for most Class IV
preparations, although the strip's flexibility makes control of the
matrix difficult.
The matrix is positioned and wedged as described for the
Class III composite.
Inserting and Curing the Composite :
Following application of the bonding adhesive insert the
composite either with a hand instrument or syringe as described
earlier for Class III restorations.
Light-cured composite is inserted and cured in 1- to 2-mm
increments.
Finishing and Polishing the Composite :
Finishing and Polishing the Class IV composite is similar to
that described for a Class III composite, except that it is more
difficult.
It requires close assessment of the incisal edge length and
thickness.
Class v cavities :
 Cavites in the gingival
third of the buccal and
lingual surfaces of all the
 teeth.
CLINICAL TECHNIQUE FOR CLASS V COMPOSITE
RESTORATIONS :
Indications: Isolation of the operating site may be very difficult
in cervical areas, esthetically prominent teeth may be more
appropriate for composite use than nonesthetic areas.
Microfilled composites may be selected for restoring Class V
defects because their composition results in:
(1) increased restoration smoothness
(2) restoration flexibility when the tooth undergoes cervical
flexure.
TOOTH PREPARATION :
Conventional Class V Tooth Preparation :
Indication: For that portion of a carious lesion or defect entirely
or partially on the facial or lingual root surface of
a tooth.
•A tapered fissure carbide bur (No. 700, 701, or 271) or
similarly shaped diamond is used at high speed with
air-water spray , make entry at a 45-degree angle to the
tooth surface by tilting the handpiece distally which should
result in 90-degree cavosurface margins.
At this initial tooth preparation stage, the extensions in every
direction are to sound tooth structure, except the axial depth
should only be 0.75 mm.
Conventional Class V tooth preparation.
A, Lesion entirely on root surface.
B, Initial tooth preparation with 90-degree cavosurface margins and axial
wall depth of 0.75 mm.
C, Remaining infected dentin excavated and incisal and gingival retention
form prepared.
•If retention grooves are necessary, they are prepared
with a no. 1/4 bur along the full length of the gingivoaxial
and incisoaxial (occlusoaxial) line angles.
•These grooves are prepared 0.25 mm in depth into the external
walls and next to the axial wall.
2.Beveled Conventional Class V Tooth Preparation :
The beveled conventional Class V tooth preparation
has beveled enamel margins and is indicated either for:
(1) the replacement of an existing, defective Class V
restoration that initially used a conventional preparation
or (2) for a large, new carious lesion.
Prepare the outline form with the initial axial wall depth
only 0.2 mm into dentin .
Complete the following steps of final tooth preparation :
(1) remove any remaining infected dentin, and, if
indicated, remove any old restorative material;
(2) apply a calcium hydroxide liner, if necessary;
(3) usually prepare a gingival retention groove if either the
gingival margin is located on the root surface or the preparation
is large enough to warrant groove retention form;
(4) bevel the enamel margin s- The bevel on the
enamel margin is accomplished with a flame-shaped or
round diamond instrument, prepared to a width of 0.25 to 0.5
mm.
A, Class V caries. B, Typical outline form.
Initiating a beveled conventional Class V tooth preparation.
A, Operating position and equipment. Entry with No. 701 bur or tapered
diamond held at 45-degree angle to tooth surface.
B, As cutting proceeds distally (0.2 mm into dentin), bur shank is held
perpendicular to enamel surface.
C, Mesial extension, keeping bur shank perpendicular to surface and
maintaining initial depth.
Completed large beveled conventional
Class V preparation.
3.Modified Class V Tooth Preparation :
Indications: For the restoration of small and moderate Class V
lesions or defects.
Prepare initial tooth preparation with a round or elliptical
diamond instrument eliminating all of the enamel lesion or
defect.
• The preparation is only extended into dentin and is prepared no
deeper than 0.2 mm into dentin (because no groove retention
form will be used).
•The cavity preparation appears “scooped out” with divergent
walls and axial depth is only to the extent of the caries.
•If infected dentin remains, it is removed with a round
bur or spoon excavator.
-Apply a calcium hydroxide liner, but only if indicated.
Modified Class V tooth preparation.
A, Small cavitated Class V lesion.
B, Surrounding enamel defect is prepared with
round diamond instrument.
C, Completed modified tooth preparation after
acid-etching.
RESTORATIVE TECHNIQUE :
-No matrix is needed for restoring preparations for which the
contour can be controlled as the composite restorative material is
being inserted such as in the Class V restoration.
- This is especially true when using a light cured material that has
an extended working time, which permits the operator to initiate
contouring of the restoration in the unpolymerized state.
Etching and Bonding : The etching, bonding, and placement of
adhesive techniques are the same as previously described.
Inserting and Curing the Composite : A light-cured composite
can be inserted with a hand instrument or syringe, microfilled
composites also may be recommended for Class V restorations.