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Introduction to Operative Dentistry

Definition (3 parts)
1st part Art and science of the DIAGNOSIS, TREATMENT, and PROGNOSIS of defects of teeth that do not require full coverage restoration for correction.


2nd Part Treatment should result in the restoration of proper tooth form, function, and esthetics, while maintaining the physiologic integrity of the teeth in harmonious relationship with the adjacent hard and soft tissues.

3rd part All of which should enhance the general health and welfare of the patient

Terms used for operative dentistry
Operative Dentistry Restorative Dentistry Conservative Dentistry

Indications for Operative Treatment

Caries, Malformed, discolored, non esthetic, or fractured teeth, Wearing of teeth (attrition, abrasion, etc.) Restoration replacement or repair.


Pit and fissure caries
Rampant smooth surface caries

Crevical Abrasion

Attrition in Anterior Teeth
Attrition in Posterior Teeth


Type of Lesion in Tooth Destruction• Dental caries• Tooth wear• Trauma• Developmental defect

Dental Caries• Dental caries is an infectiousmicrobiological disease of the teeththat results in localized dissolutionand destruction of the calcifiedtissue, caused by the action ofmicroorganisms andfermentable carbohydrates.

Dental CariesCharacterized by :– Demineralization of the mineral portion of enamel+ dentine.– Disintegration of their organic material.– As the disease approach the pulp may result indeath of the pulp.– It can be arrested or prevented.

Caries

Classification of Decay• Based on anatomy of the surface involved• Pit and fissures carious lesions–Class I – begin in the depth of pits andfissures in enamel–Occur:•Occlusal surface of post. teeth• Lingual fossa of maxillary incisors

Smooth Surface Carious Lesions• Occur on the smooth surface of theanatomic crown of a tooth in area thatare most inaccessible to the naturalcleansing action of the lips, cheeks andtongue.– Proximal surfaces – class II– Facial and lingual surfaces –class III, IV, V– Root caries on cementum



• Maybe defined as the surface loss of dental hard tissues other than by caries or trauma.• Erosion:– Loss of dental hard tissue as a result of a chemical process not involving bacteria.• Causative agent ⇒ acid• Source of acid ⇒ dietary stomach• Affected area ⇒ palatal surface ant. Teeth.buccal surface post. Tooth Wear


• Attrition:– Mechanical wear between opposing teeth commonly occurs in combination with erosion.• Causative agent ⇒abrasive diet , bruxism• Affected area ⇒occlusal or incisal surface Tooth Wear


• Abrasion:–Wearing away of tooth substance by mechanical means other than by opposing teeth:• Causative agent ⇒over vigorous toothbrushing• Affected area ⇒ buccally at cervical margin.Dish-shaped or V-shaped Tooth Wear


• Traumatic injuries are acquired suddenly.• May involve the hard dental tissues and the pulp ⇒ required immediate operative management.• Local injuries:– Laceration of the lip, tongue, and gingival tissue– Fracture – alveolar bone, root, crown– Subluxation of a tooth Trauma

Treatment Procedures

They are:Direct restoration – Amalgam, Composite resin, GIC.Indirect restoration – Inlay, onlay, crowns (base metal, precious metal, porcelain fused to metal, or metal free ceramic)Veneers – Direct or indirect

Direct Restoration After tooth preparation, the restoration is placed in a moldable stage in the prepared tooth to recreate normal contours.Adv. – easy to place, less time consumed, and cost effective.Disadv. – compromised mechanical properties


Indirect Restoration After tooth preparation, it involves making of impression, pouring of cast, die preparation, wax pattern, investing, casting, finishing, polishing and cementing (or luting) of restoration. (restoration is fabricated outside and cemented to prepared tooth)



Advantages. provide better mechanical properties better stress distribution Disadvantages. time consuming, expensive, more technique sensitive

Veneers

INDICATIONS: Caries Malformed, discolored, nonesthetic or fractured teeth Restoration replacement or repair.

Considerations Infection control. Thorough examination of oral and systemic health of patient. A diagnosis of dental problem that recognizes interaction of affected area with other body tissues. A treatment plan that has the potential to return the affected area to a state of health and function, enhancing the overall health and well-being of the patient.

An understanding of the material to be used to restore the affected area,including a realization of the material’s limitations and techniques involved in using it. An understanding of the oral environment into which the restoration will be placed.An appreciation for and knowledge of correct dental anatomy.An understanding of the effect of the operative procedure on other dental treatments.

Conservative ApproachEarlier concept of “extension for prevention.”Increased knowledge of prevention methods, advanced clinical techniques, and improved restorative materials have provided a more conservative approach to the restoration of teeth.

Available conservative approaches are: many typical restorative procedures (Classes I, II, III, IV, and V) diastema closure procedures esthetic or functional correction of malformed, discolored, or fractured teeth actual replacement of teeth.

The primary results of conservative treatment are: retention of more intact tooth structure less trauma to the pulp tissues less trauma to contiguous soft tissue.

Dynamics of Operative Dentistry

The development of the high-speed handpiece played a dramatic role in the more conservative and efficient removal of tooth structure for restorative procedures.



Mechanical bonding by etching enamel and dentin and use of bonding systems have led to the development of many new composite restorative materials and conservative restorative bonding techniques. Benefits of sealants are becoming more widely accepted for the prevention of pit-and-fissure caries. Increased knowledge about the carious process and the beneficial effects of multiple fluoride applications has resulted in a decrease in caries incidence.

Increased research on biomaterials has led to the introduction of vastly improved dental materials. All of the above mentioned factors have played an important role in the development of operative dentistry. Ultimate result is improved oral health for all populations.

DEMOGRAPHICS

Percentage of older adults in the population and also life expectancy will increase substantially in the future. Emphasis will shift from the needs of young to concerns and demands of middle-aged individuals & older adults.

Economic Factors

With more income and more health care benefits for the adult segment of society, the demand for future dental services should increase.

General and Dental Health ofthe U.S. Population

The general health of the U.S. population is good. Americans generally have good dental health. Incidence of caries has decreased ;primarily due to increased exposure to fluoride. Fluoridation of community water systems began in Grand Rapids, Michigan, in 1945. Caries remains the most common chronic childhood disease.


Missing teeth : In last several decades, there has been a steady reduction in edentulism and numbers of teeth lost per person. Edentulism and the number of teeth present are strongly influenced by age

Periodontal Status: periodontal Attachment loss (number of affected people and severity) increased with age. Gingival recession also increased with age. Oral Cancer: Oral and pharyngeal cancer is the sixth most common neoplastic disease.


Dental Manpower
The number of total “active private practitioners” is expected to increase from 156,921 in 2002 to 172,097 in 2020.There will be fewer dentists treating more patients who will have retained more teeth.

Projected Need for Operative Dentistry

Increased need of operative dentistry in future : restorations for teeth with new carious lesions; restorations for teeth with root caries; restorations to replace existing, faulty restorations; and restorations to enhance the esthetic appearance of patients.


Public’s Perception of Dentistry The public’s perception of dentistry is another factor that will influence whether the increased numbers of teeth and increased need for operative services will be converted to increased demand.

Patient Visits

The number of dental visits has increased in the past several years. Recent surveys shows that New older adults and future older adults not only will possess positive perceptions about dentistry and dental health, but also will have the economic means to secure the dental care they need.


Research in operative dentistry is now occurring in many fields. Use of lasers in dentistry may lead to a new mechanism for welding dental alloys or altering tooth structure in tooth preparation. Improvements in composites, adhesive systems, castable ceramics, and computer-generated restorations could result in significant decrease in the use of metal alloy systems in operative dentistry. Efforts also are being made to develop an anticaries vaccine.

Cavity Preparation

Is the mechanical alteration of: a defective tooth injured tooth diseased tooth to receive a restorative material that re establish a healthy state for the tooth, including: esthetic correction normal form function.

Purpose of cavity preparation To remove carious or diseased portion of tooth and to avoid further progression or recurrence of it. Caries might have progressed in an irregular shape, but one must prepare the tooth in an appropriate shape to obtain best mechanical properties of restorative material

How is cavity preparation doneWith diamond or TC (Tungsten Carbide) burs attached to hand held device called hand piece at high speed (20,0000 rpm) for gross cutting.With finishing burs attached to slow speed hand piece (30000 – 40000 rpm) or hand cutting instruments for finer adjustments


Pre clinical Operative Dentistry
Is a branch of operative dentistry where in practical training is given in cavity preparation and restoration of teeth with various materials in dummy models ( phantom ) in simulated oral environment