CHANGING

CONCEPTS IN CAVITY
PREPARATION
 CONTENTS
 Introduction
 G.V. Blacks classification
 Shortcomings of blacks classification
 Rationale for introduction of new concept
 Modification in cavity design
 New methods for caries removal
 Conclusion
 The modern concept for restorative dentistry is based on
conservation and has concentrated on the importance of
preservation of the sound tooth structure by taking the measures
to preserve the integrity of teeth from being affected or by
undergoing treatment protocols which involve the minimum
intervention just necessary to restore the tooth as an active
member in the masticatory apparatus and to ensure its future
performance.
 G. V. BLACK’S
CLASSIFICATION
 Black suggested that it was necessary to

1. Remove additional tooth structure to gain access and

visibility

2. Remove all trace of demineralised enamel and dentine from

the floor, walls and margins of the cavity

3. Make room for the insertion of the restorative material in

sufficient bulk to provide strength

4. Provide mechanical interlocking retentive designs

5. Extend the cavity to self-cleansing areas to avoid recurrent

caries
 Shortcomings of G.V. Blacks
Classification
 The classification was designed before the widespread use of radiographs so lesions
were not diagnosed until they were visible to the naked eye and were therefore, by
modern standards, relatively large.

 A further problem was that it was a classification of cavity designs for amalgam a
this was the principal restorative material available. The result was that, regardless
of the size of the lesion, a specific cavity design was required to deal with it.

 Caries was rampant and the role of bacterial flora and the significance of fluoride
were not understood.

 There were limitations in the available instruments for cavity preparation as well as
the selection of restorative materials.
WHY IS A CHANGE
NECESSARY
 Rationale for introduction of new concept

 The understanding of the ion migration that occurs, both out of and
back into tooth structure, as a result of the caries process. It is now
recognised that this is reversible, so the early lesion can be healed and
recognition of the initiation of the disease process is imperative

 It is also apparent that there is a gradation of mineral loss from the

heart of the lesion outwards to the periphery of the lesion. This implies
that, simply because some section of the tooth is partly demineralised,
it does not necessarily have to be removed because remineralisation
may still be possible.
 Rationale for introduction of new concept

 Another discovery is the development of sound long term adhesion

between restorative materials and tooth structure. This not only
reduces the potential for microleakage between restoration and tooth
but also offers the possibility of reinforcing the tooth crown, at least
to the limit of the tensile strength of the material.

 the development of a restorative material that is capable of supporting

an ion exchange within the tooth crown. This not only leads to an ion
exchange mechanism for adhesion but also assists the remineralisation
of demineralised enamel and dentine

 Early diagnosis of caries, preventive measures

MODIFICATIONS IN CAVITY
PREPARATION
Mount G.J & Hume1994
 CLASS-1 Cavities
Conventional Modern
 Extension for prevention  Conservation
 No sweeping curves  Sweeping Curves present
 Wide and shallow cavities  Narrow cavities
 Occlusal convergence of  Initial convergence was given
mesial, distal, buccal & to buccal and lingual walls
lingual walls
 Separate pits
 If cavities are on cusp tips;
cavities were united
 Spread of future decay was  Aim is Conservation of tooth
given importance structure
 CLASS-2 Cavities
Conventional Modern
 Occlusal cutting resembles G.V.Black’s  More conservative approach
i.e. extension for prevention
 Proximal Portion was Box type or
Bilateral truncated appearance  Inverted Unilateral truncated
appearance on the side of marginal
ridge
 Width of Isthmus 1/3rd the intercuspal  1/4th the intercuspal distance
distance
 Sweeping curves are lost
 Since the cavity width is limited a
Universal ‘S’ shaped Sweeping Curve
is given

 Proximal grooves are most often given

 Accessory grooves were not important since occlusal width is less
or critical
 conventional modern
 Cross cut burs were used to give  Nowadays Cylindrical burs are used
rough walls to give smoother walls

 Wide & shallow isthmus was  Narrow & deeper isthmus

emphasis
 No bevels were placed in gingival
seat
 Reverse bevels placed in gingival seat

 Bigger & wider restoration  Smaller & narrower restoration

 Gingival seat were taken below the  Gingival seat is always kept supra-
gingival
sub-gingival level
 Reverse curve was not emphasized  Reverse curve is usually given
While cavity preparation
points to remember…..
1. Always follow the philosophy of minimally invasive dentistry.
2. Perform the least amount of dentistry needed in any situation.
3. NEVER ever remove more tooth structure than is absolutely required to
restore teeth to their normal condition.
4. Always use dental materials that conserve maximal tooth structure over
time.
5. Use only the strongest and longest lasting materials to reduce the need
for future repair and replacement.
6. Use dental procedures that minimize the number of necessary
appointments.
7. Select dental laboratories that use minimal invasive materials for the
restoration of teeth
8. Use only restorative materials that do not wear opposing teeth more
than enamel.
Minimally Invasive cavity
preparation procedures

Fissurotomy
Tunnel preparation
Mini-box or slot type preparation
 Fissurotomy
The fissurotomy bur is a new approach to ultra conservative dental treatment

tapered bur

 Fissurotomy bur head length of 2.5mm

prepare conservative cavities

Acid etchant

 Fissurotomy kit Bonding agent

Flowable composite
Various Fissurotomy burs
Conventional bur versus fissurotomy bur
 Steps
 Pit & fissure areas are probed
 Fissures are explored for decay with the bur
Fissurotomy

 Surrounding enamel is contoured to gentle taper

 Width of restoration – 1/8 to 1/10 I.C.D
 Final preparation – very narrow, long & irregularly deep
 Restoration – Flowable composites
 Are U Suspicious if any caries is Left Behind?????
 Caries detector dye is applied
 Washed after 10 seconds
 Any dentin stained RED is removed
 Advantages
 The short head length allows the dentist to control the bur tip to
cut just below the DEJ and no further
Fissurotomy

 The tapered shape of the bur allows the cutting tip to encounter
few dentinal tubules

 The bur also has been designed to minimize heat build up and
vibration

 Patient discomfort is minimized

 Need for local anesthesia eliminated
 Tunnel preparation
Removal of approximal carious tissue via a modest access cavity in the
occlusal surface.

First introduced in Scandinavia 1980 – Hunt & Knight

Also known as:-
Internal oblique preparation
Internal fossa ppn
Internal occlusal diagonal ppn
 Advantages
Tunnel preparation  Preservation of marginal ridge

 Normal contact area is usually not disturbed

 Less potential for microleakage

 Esthetic

 Risk of overhanging is minimal

Disadvantages

 Highly technique sensitive

 Danger of pulpal involvement

 Uncertain – caries removal

 Risk of marginal ridge fracture

 Chances of leakage & sec caries are high

 Marginal adaptability of restoration is poor

 Mini Box or Slot type
Preparation
 Acc to Wilson & McLean-It involves the removal of
marginal ridge, but does not include the occlusal pits and
fissures

Principle
If proximal lesion is close to marginal ridge, entry is made
through the outer slope of the marginal ridge; contacts are
not disturbed as far as possible
Mini Box or Slot type
Technique
 A slot type ppn with an occlusal access involves the carious lesion & extending
it gingivally, facially & lingually
Preparation

 Slow speed hand piece with small diameter round bur used to obtain access

 No.329 bur used – if caries remains pulpally

 Lesion is excavated until spoon rings against dentin

 Finally the cavity is Acid etched, bonded, & filled with composite resin or GIC
Mini box v/s G V blacks method
RESTORATIVE MATERIALS
FOR MINIMAL
INTERVENTION
Adhesion in Restorative

Micro-mechanical attachment – Composite Resins

Dentistry

True Chemical Union – Glass Ionomer Cement

Other materials:-

Resin-mod GIC

Advances in composites - Antibacterial composite, Smart composite,

Flowable composite, Ormocers, Giomers etc
Biomimetic Restorative
Biomimetic - - - - - - “imitation of nature”

Properties:-
Materials

 Bio active or bio mimetic – healing and remineralization

 Fluoride releasing property to reverse demineralization
 Therapeutic or anti microbial activity – No secondary caries
 Flowability and wettability for effective bonding
 Improved mechanical or physical and esthetic properties
NEW DEVELOPMENTS IN
CARIES REMOVAL
NEW DEVELOPMENTS IN
CARIES REMOVAL
 Rational behind New Developments
 Removal of only infected dentin
 Reduce patients anxiety
 Provide favorable surface features for bonding
 Reduce contamination and cross-infection
 Reduce the need for anesthesia
 Easier recognition between infected and uninfected dentin
 Provide equal or superior efficiency compared to conventional
methods
 Reduce cost.
Micropreparation Burs
 Fissurotomy Burs (SS White,USA) allow
exploration of the fissures with minimal removal
of enamel.
 It is 1.5-2.5 mm in length and tapers to fine
carbide tip.
 Other burs such as Brassler 889M-007 bur and
Microdiamond 838M-007 burs are used for
minimal preparation.
 Microinstruments (Micropreparation set) requires
low contact pressure (< 2N)
 Polymer Bur
 Described by Boston (2000).
 Made of a softer polyamide/imide polymer material.
 Remove infected dentine only
 Manufacturer: SmartPrep (SS White, USA)
 Harder than carious dentine and softer than healthy
dentine
 Designed for single use on slow-handpiece
 Remove caries from central of lesion to periphery
 Less effective than carbide bur in caries removal
(Dammaschke et al, 2006)
Polymer burs SmartPrep before (1a) and after (1b) use
(Dammaschke et al, 2006)
 Caries Detection Dyes
 Dyes such as 1.0% acid red in propylene glycol.
 They stain infected dentine and organic matrix of
demineralised of carious dentin that should not be
removed.
 They stain dentin naturally with low minerals such
as circumpulpal dentin and enamel-dentin junction
 Result in overpreparations.
 Not useful in detecting pt and fissure caries
because they stain food debris and other organic
materials in the fissure
 They are not recommended
Chemo-mechanical method of
Caries removal
Principle:-
Application of a solution that selectively softens the carious dentin;
thus facilitating its removal

Advantages:-
 Limits the removal of sound tooth structure
 Limits the cutting of open dentinal tubules
 Limits pulpal irritation & pain
 Carisolv Gel
 Carisolv s a chemomechanical method for caries
removal.
 It is a mixture of amino acids and 05% sodium
bicarbonate
 The resultant high-pH chloramines reacts with
denatured collagen in carious dentin
 Softened dentin is removed with special hand
instruments
 Caridex v/s Carisolv
Chemo-mechanical
method of Caries

Caridex (1980,USA) Carisolv

(sweden 1998)
removal

solution 1%Naocl 0.5%Naocl

glycine, amino butyric acid, Glutamic acid, leucine,

NaoH, Nacl lysine, NaoH, Nacl

dye ---- Erythrocin (GEL)

pH 11 11
Volume 200-500ml 0.2-1ml
time 10-15 min 10-15 min

stable 1 hr 20min
 Steps
Chemo-mechanical

 Gel should be freshly mixed

method of Caries

 Uniform color (dappen dish)

 Left in place for 30 seconds

removal

 Rapid light pressure with Whisking

Or curreting motion is applied

 Gel becomes clouded with debris

 Caries is removed
 Dried surface of dentin “frosted & irregular
appearance”

 Restore with Restorative material

Special hand instruments used
with Carisolv Gel
 Clinical Indications For Carisolv Gel
 Removal of root and coronal caries where access is
easily obtained

 Due to selective removal of carious dentine, the need

for anesthesia is reduced , thus the technique is
indicated in children, dental-phobic patients and special
needs patients
Advantages of Carisolve Gel
 Selective removal of carious dentine.
 The reduced need for anesthesia
 Does not affect the bonding to composite.
 Removes smear layer
 Does not cause adverse effect on the pulp.
 Disadvantages of Carisolv
Gel
 Technique requires longer time than conventional
method.

 May be inefficient for removing caries at enamel-dentin

junction.

 Caries under overhanging enamel may go unnoticed.

 Large lesions needs to be accessed using rotary bur.
Carie- carie
Papa carie
 Enzymes
 Studies have examined the possibility that carious dentine might be
able to be removed by using certain enzymes. In 1989, Goldberg and
Keil successfully removed soft carious dentine using bacterial
Achromobacter collagenase, which did not affect the sound layers of
dentine beneath the lesion.

 Also, a more recent study has used the enzyme pronase, a non-specific
proteolytic enzyme originating from Streptomyces griseus, to help
remove carious dentine.

 This might have significant clinical implications but further

laboratory research is required for validation of this technique.
 Air - Abrasion
Utilizes kinetic energy from alumina particles entrained in high velocity
stream of air to remove tooth structure

Development:-
 1940 - Robert Black
 1950 - Tim Rainey, Father of concept of air abrasive micro
dentistry.
 1951- S.S White technology introduced AIR- DENT,
 1990’s- New technology
Air abrasion
Handpiece

Air Abrasion Unit

 Air Abrasion
(Kinetic Cavity Preparation)
 This technique uses a pressurized stream of small
aluminum oxide particles to abrade carious lesion.

 Typical Air Abrasion system:

- Particle diameter 27-50 µm.

- Powder flow rate 0.7-4.2 g/min

- Air pressure 40-160 psi

- Operating distance from tooth 0.5-2 mm

 Indications
 Removal of superficial enamel defects
 For detection pit and fissure caries by removal of organic
debris.
 Removal of enamel surface stains.
 Removal of localized minimal carious lesion
 Surface preparation of abfractions and abrasions to brake
the glaze of the surface for better bonding.
 Removal of existing restorations.
 The need for anesthesia may be avoided because of the
cooling effect of the high pressure air
 Contraindications
Air - Abrasion

 Chronic pulmonary diseases - Asthma patients

 Severe dust allergy
 Recent extraction
 Any open wound / cut
 Sub gingival caries removal.
 Principle
Air abrasion is a form of kinetic energy & is an end-cutting
apparatus
Air - Abrasion

E = ½ m V2
Kinetic energy can be increased by increasing the velocity or
increasing the mass

Note:-
Rotary instrumentation – Mechanical Energy
Air Abrasion – Kinetic Energy
 Tools
 Abrasive particle – Al2O3
Air - Abrasion

 Particle type & Size – 10 – 75 micro m

27 micro m – more comfortable; less effective in cutting
75 micro m – more aggressive cutting; more discomfort

 Nozzle diameter – 0.011 – 0.032 inch

0.018 inch – to remove large lesions & existing restorations
0.014 inch – to remove small lesions
0.011 inch – small Class II & Class III lesion; refining
Class IV & Class V restorations
  Nozzle Angulation – 458, 678, and 908 angles

458 – most preparations

678 or 908 – allow better access to max molar occlusal

Air - Abrasion

surface & lingual surface of max .ant. Teeth

 Air Pressure – 40 – 140 psi

Lowest air pressure must always be used

If higher than 80 psi – use with Caution

Possible complication - Emphysema

 Cutting Rate – 40 – 60 psi & 2.5 gm/min powder flow

 Tip size – 0.015” – 0.027”

 Tip distance - <2mm

 Tip angle – 40-1200

 Technique
 Stain the groove
Air - Abrasion

 Start with 0.0 11” tip to abrade

superficial stain.

 Large amounts of soft decay may be removed by

a spoon or small round bur in slow speed.

 Alternatively, the caries can be desiccated

by laser and then air abraded.

 Restoration done by - GIC, Compomers, Composites

 Check occlusion
 Advantages
 No shattering of enamel or micro fracture as with bur
Air - Abrasion

 Most procedures can be performed without anesthesia

 It is silent, fast and no heat is produced
 Less discomfort to the patient
 Less invasive procedure; preserves more tooth structure
 Non-traumatic treatment
 Can remove old composites easily; clean up cements
 Disadvantages
 Not cost effective
Air - Abrasion

 Lack of tactile sensation

 Non contact based modality - inadequate carious removal.
 Mess & spread Al oxide around the dental operatory.
 Impaired direct view- abrasive particles collect on the mirror rapidly blocking the viewing surfaces.
 There is little tactile sensation
 Unable to remove gross caries.
 Removes normal and relatively hard dentin.
 Remove exposed cementum and root dentin.
 Splattering f powder-risk of ingestion.
 Unable to prepare well-defined cavity margins.
 Does not obviate the need for acid etching.
 May lacerate soft tissues
 Removal of large amalgam causes release of mercury
 Mandatory need for rubber dam, high velocity evacuation and protective eyewear
 Air polishing
 Air-polishing is the process by which watersoluble particles of sodium
bicarbonate, to which has been added tricalcium phosphate (0.08% by
weight) to improve the flow characteristics, are applied onto a tooth
surface using air pressure, shrouded in a concentric water jet

 The fact that the abrasive is water soluble means it does not escape
too far from the operating field. The bombardment of the hard tooth
surfaces by these particles results in a continuous mechanical abrasive
action which removes surface deposits.
 this technique is to remove surface enamel stains, plaque and calculus
well away from the gingival margins of healthy teeth.

 However, due to the non-selective, abrasive, detrimental surface

attack of restorations and sound enamel and dentine, overzealous use
could easily remove a considerable amount of healthy tooth structure
especially at the cervical margin. It has been suggested that air-
polishing could be used for the removal of carious dentine at the end
of cavity preparation.
 Ultrasonic instrumentation
 Investigation of this technique has been confined to work carried out in the 1950s where
studies by Nielsen et al. indicated the possibility of using an ultrasonic instrument to cut
tooth tissue.

 He designed a magnetostrictiv instrument with a 25 kHz oscillating frequency.

 This, used in conjunction with a thick aluminium oxide and water slurry, created the cutting
action, the mechanism of which was the kinetic energy of water molecules being transferred
to the tooth surface via the abrasive through the high speed oscillations of the cutting tip

 It was found that the harder the tissue, the easier it was to cut. Soft, carious dentine
apparently could not be removed, but the harder, leathery, deeper layer was more susceptible.
 ‘Sono-abrasion’

 A recent development from the original

 Sono-abrasion
ultrasonics mentioned above is the use of

 high-frequency, sonic, air-scalers with

 modified abrasive tips – a technique known

 as ‘sono-abrasion’. The Sonicsys micro unit,

 designed by Drs Hugo, Unterbrink and

 Mösele in a venture between Ivoclar-

 Vivadent and KaVo (KaVo Dental Ltd,

 Amersham, Bucks, UK), is based upon the

 Sonicflex 2000L and 2000N air-scaler handpieces

 that oscillate in the sonic region

 (< 6.5 kHz — see Figure 2). The tips

 describe an elliptical motion with a transclinically

 Lasers
Light Amplification by Stimulated Emission Radiation

What’s Special About it ?????????

Ordinary light – photons travel in all directions
LASER – Monochromatic, Coherent & Collimated

These properties allow the concentration of a tremendous amount energy to

a small area

Hard tissue Laser – cuts enamel, dentin, decay & soft tissue
 Commonly used LASERS
 Er:YAG (erbium: yttrium-aluminiumgarnet) and Nd:YAG (neodymium:
YAG) —mid-IR to IR emission
 Carbon dioxide lasers (CO2) — IR emission
 Excimer lasers (ArF (argon:freon) and XeCl (xenon:chlorine) — UV
Lasers

emission
 Holmium lasers
 Dye-enhanced laser ablation –— exogenous dye, indocyanine green in
conjunction with a diode laser
Wavelengths:-

 Er:YAG – 2940nm
 Er, Cr:YSGG – 2780nm
 Principle

Deflected
When light encounters matter
Absorbed
Energy not destroyed; used to increase the energy level of the absorbing
Lasers

atom or molecule

In this excited state – Atom is unstable – spontaneously decay back to

ground state – Releasing stored energy
“Spontaneous Excision”

Process of Lasing – Excited atom can be stimulated to emit a photon

 Procedure
Isolation – Rubber dam or metal matrix

Gently touch target tissue with tip end

Lasers

Direct water stream to target tissue

Keep tip moving – effective ablation and cooling

Wide cut – constantly move tip over surface

Deep cut- move tip up and down

Cavity – ‘Irregular fashion’ – GIC or Composite Resin

 Points to Remember:-
 Always lowest possible power setting is used
 The operation area must always be kept wet
Lasers

 If during procedure, patient becomes uncomfortable,

pulses per second are decreased, energy is decreased or
cutting tip is moved from the contact mode to a non-
cutting mode
 The LASER system also gives auditory feed back to the
operator by which different tissues can be recognized by
the characteristic ‘popping’ sounds, the sound of
ablation
 Advantages
 Restorative procedure more conservative and more precise.
 Less traumatic to patients and also the operative time is reduced.

 Since anesthetic is not used most of the time, there are no numb lips or
tongue, which is often disliked by the patients.
Lasers

 Multiple restorations in different quadrants can be done easily.

 No vibrations, no smell and so maximum patient co-operation is achieved.

 The intermittent, light contact mode is short and effortless; the dentist
can see what he or she is doing, and the preparation is clean.

 Lasers offer little chance of mechanical trauma such as cracks, reduce

bacterial counts and in some areas sterilize the field as well.

 It is a most gentle modality to pulpal tissue, proven to have no adverse

pulpal reactions.
 Advantages
 In addition to caries removal, lasers may have other properties. An in vitro
study has demonstrated the significant killing of the cariogenic organism
Streptococcus mutans by low-power laser light in the presence of a
photosensitiser.

 This was possible even when the bacteria were embedded in a collagen
matrix and when the light passed through a zone of demineralised dentine .

 Lasers can also be used to cut and seal dentinal tubules, reducing the
possibility of postoperative sensitivity. Further, the patient acceptance of
the muted (popping) sound of lasers is likely to be much better than the
infamous sound of the dental drill dreaded by most patients.
 Limitations
 The foremost drawback is the cost effectiveness, the
treatment being expensive.
 Lasers cannot produce the uneven edges carved
intentionally with a drill, so that dental amalgam or
Lasers

other such materials can be retained properly.

 Lasers cannot be used to repair existing amalgam
fillings either, because they vaporize mercury, making
it highly toxic.
 One additional drawback of Erbium family of lasers is
inability to remove metallic and cast porcelain
defective restorations.
 Safety Measures
 Everyone in the room must wear protective glasses – dark
green tinted for Argon and YAG lasers; and clear for CO2
laser.
 Wet gauze pads must be placed in patient’s mouth
surrounding the treated area.
Lasers

 Reflecting surfaces such as instruments and mirrors should

be covered so that stray light beams cannot ricochet around
the room.
 It is very important that all anesthetic gases be removed
from the room. They are explosive and could be ignited by a
laser beam.
 The dentist must also suction off vaporized soft tissue, and
the smoke or laser plume emitted during procedures. The
plume can carry viruses.
 Erbium Lasers…MOST
PREFERRED
 Erbium yttrium aluminum garnet (Er:YAG, 2.94 µm
wavelength)

 Erbium chromium yttrium scandium gallium garnet

(Er,Ch:YSGG, 2.78 µm wavelength)

 This wavelength is highly absorbed in water so … can

be used for cavity preparation
 Mechanism of ablation by erbium lasers

 Thermomechanical Ablation
 High absorption coefficient in water and high affinity for
hydroxyapatite.

 Absorbed heat cause microexplosions and

 microfragmentataion of target issue.
 Irradiated surface demonstrate microirregularities, absence of smear
layer, open tubules, absence of extensive thermal effects.
Advantages of erbium lasers
 No thermal effect on target tissues and pulp.
 Noiseless, no vibrations.
 No harmful effect on the pulp.
 Distinguishing between infected and uninfected
dentine might be possible.
 Various clinical applications: periodontics,
endodontics, operative dentistry.
 Disadvantages of erbium
lasers
 Cost
 Erbium laser preparations must be followed by acid etching for reliable
bonding to resin composite
 May weaken the irradiated surface
(lower microhardness)
 Defocusing effect due to water spray
 Tissues can be only removed when it is visible to operator’s line of sight.
 Lack of tactile sensation
 Large devices
 Soft tissue may also be cut
 Ozone
 First discovered & named by C.F. Schonbein in 1840
 Its natures most powerful oxidants
 Its 1.6 fold denser & 10 fold more soluble in water than oxygen

Structure:-
Its made up of 3 atoms of oxygen with a cyclic structure & is very reactive
towards biomolecules

Ultraviolet rays from the sun

Production
Artificially by an ozone generator
 Indications
 Primary root carious lesions
 Primary pit and fissure caries
 Early carious lesions around crowns and bridges
Ozone

Mechanism of Action ozoniser

O2 O3

Live bacteria and fungi

Dead bacteria and fungi+H2O+CO2

 Steps
 Polymer cup is adapted to primary carious lesion

 Ozone gas delivered (10sec) – into cup

Ozone

 Gas passed through Activated carbon filter

 Fluid(2% naf+5% xylitol) is pumped for 5sec

 Recall – 3months
 Advantages
 Kills > 99% micro organisms
 Oxidizes caries, speeds up remineralisaion
 Remove organic debris, volatile sulphur compounds
Ozone

 Whitens discolored caries

 Decreased time, painless, noiseless
 No allergic reaction

Adverse Effects
‘Respiratory Distress’
Caries detecting dyes stains demineralised matrix of carious
dentin that should not be removed
 Conclusion
 In general, the development of caries removal techniques in
restorative dentistry is progressing towards a more biological and
conservative direction. This has been made possible with better
understanding of the aetiology, development and prevention of dental
caries, the emergence of new caries removal techniques and
advances in dental restorative materials. In particular, the
development of reliable adhesive technology in the oral cavity, which
led the way to a minimal cavity preparation concept, has given a great
impetus to the current thinking in this area. The coming decades will
continue to see shifts in the approach to caries removal techniques,
cavity preparation and restoration techniques based on rational
clinical and scientific principles.
“the loss of even a part of human tooth tissue should be considered a
serious injury and dentistry’s goal should be to preserve healthy,
natural tooth structure.”

Dr. Miles Markley

 References
 Minimally Invasive Dentistry – The management of Caries –
Nairn H F Wilson
 Preparation and restoration of tooth structure- G.J mount
 James B. Summitt. Conservative cavity preparations. Dental
clinics of North America 2002, 46: 2, 171- 184.
 J. Tim Rainey. Air abrasion: an emerging standard of care in
operative dentistry. Dental clinics of North America 2002, 46:
185-209.
 David Block. Minimal invasive dentistry for 21st century.
Dental success 2004.
 White JM, Eakle WS.Rationale and treatment approach in
minimally invasive dentistry. Journal of American dental
association 2000, 131: 13S- 19S.
THANK YOU