Cavity Preparation for Class III and
Class V Amalgam Restorations
1
2 Contents
Introduction
Class III Cavity Preparation
1. Indications
2. Contraindications
3. Cavity Preparation
4. Restorative Technique
Sturdevant's Art and Science of Operative Dentistry 5th Edition
3 Contents
Class V Cavity Preparation
1. Indications
2. Contraindications
3. Cavity Preparation
4. Restorative Technique
Conclusion
References
Sturdevant's Art and Science of Operative Dentistry 5th Edition
4 Introduction
Class III restorations are indicated for defects located on the
proximal surface of anterior teeth that do not affect the
incisal edge
Class V restorations are indicated to restore defects on the
facial or lingual cervical one third of the tooth
Sturdevant's Art and Science of Operative Dentistry 5th Edition
5
Cavity Preparation for Class III
Amalgam Restorations
6 Indications
Generally reserved for the Distal Surface of Canines if:
i. The preparation is extensive with only minimal facial
involvement
ii. The gingival margin involves cementum
iii. Moisture control is difficult
Amalgam may be used for any Class III restoration that
does not involve facial surface or undermine incisal corner
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7 Contraindications
Class III Amalgam restorations are usually contraindicated
in aesthetically important areas
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8 Advantages
Class III Amalgam restorations are stronger than the Class
III Direct Composite restorations
Easier to place
Easy to finish and polish without damage to the adjacent
surfaces
Less expensive
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9 Disadvantages
Metallic and unaesthetic
Require 90-degree cavosurface margins, specific and
uniform axial depths – results in less conservation of tooth
structure
Mercury contamination
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10 Line Angle and Point Angles
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Burs Used Dimensions
No. ¼ Round Bur 0.5 mm Diameter
No. ½ Round Bur 0.7 mm Diameter
No. 1 Round Bur 0.8 mm Diameter
No. 2 Round Bur 1.0 mm Diameter
245 Bur 1 mm Diameter 3mm Length
33 ½ Bur Max 1.75 mm Min 0.6 mm
Length 2.33 mm
Sturdevant's Art and Science of Operative Dentistry 5th Edition
12 Class III Cavity Preparation
INITIAL TOOTH PREPARATION:
No. 2 round bur – entry cut
No. ½ or No. 1 bur – tooth/carious lesion is small
Entry for Class III tooth preparation on maxillary canine.
A, Bur position is perpendicular to enamel surface at point of entry.
B, Initial penetration through enamel is directed toward cavitated, carious lesion.
C, Initial entry should isolate proximal enamel, while preserving as much of the marginal ridge as
possible. D, Initial cutting reveals DEJ (arrow)
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Initial Axial depth 0.5 to
0.6 mm inside DEJ
0.75 to 0.8 mm Axial
Depth when the gingival
margin in cementum
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Small Lesion – facial margin is extended 0.2 to 0.3 mm into the
facial embrasure – curved outline from incisal to gingival margin
Lingual outline – blends with incisal and gingival margins in a
smooth curve – preparation with little or no lingual wall
Cavosurface angle 90 degrees at all margins – lingual margin
obtuse
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Lingual wall meets axial wall at an
obtuse angle or may be continuous
with the axial wall
Axial wall should be uniformly deep
into dentin and follow the
faciolingual contour of the external
tooth surface
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Conserve tooth structure at distoincisal corner to reduce
the potential for subsequent fracture
Distofacial (A) and incisal (B) views of canine to show curved proximal
outline necessary to preserve distoincisal corner of tooth.
Incisal margin of this preparation example is located slightly incisally of proximal
contact (but whenever possible, the margin may be in the contact area).
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No. ½ is used to accentuate the axial line angles
This facilitates subsequent placement of retention grooves and
leaves the internal line angles slightly rounded
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FINAL TOOTH PREPARATION:
Remaining infected carious dentin on the axial wall is
removed using No. 2 or No. 4 (at low speed) round or spoon
excavaters
Secondary retention form provided by;
1. Gingival Retention Groove
2. Incisal Cove
3. Lingual Dovetail
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1. Gingival Retention Groove
Preparing gingival retention form.
A, Position of No. ¼ bur in axiofaciogingival point angle.
B, Advancing bur lingually to prepare groove along axiogingival line
angle.
C, Completed gingival retention groove
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Vimal Sikri Pre-Clinical Conservative Dentistry Second Edition Pg No.186
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2. Incisal Cove
Preparing incisal retention cove.
A, Position of No. ¼ bur in axioincisal point angle
B, Completed incisal cove.
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3. Lingual Dovetail
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Used in large preparations – especially preparations with
excessive incisal extension
Should be conservative – not extending beyond
mesiodistal midpoint of the lingual surface
Axial depth – 1mm – axial wall parallel to the lingual
surface of the tooth
May or may not be in dentin
No. 245 bur is used
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A, Bur position at correct depth and angulation to begin cutting.
B, Initial cut in beginning dovetail.
C, Bur moved to most mesial extent of dovetail.
D, If possible, cutting should not extend beyond midlingual position.
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E, Bur cutting gingival extension of dovetail.
F, Incisal and gingival extensions of dovetail.
G, Completing isthmus. Proximal and lingual portions are connected by incisal and gingival walls in smooth curves.
H, Completed lingual dovetail
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Retention coves – incisal corner and
gingival corner of the dovetail –
enhances retention
Coves are prepared with No. 33 ½
bur in dentin that does not
immediately support lingual enamel
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25 Restorative Technique
1. Matrix Placement:
Wedged, compound supported matrix – used for Class III
Amalgam Restorations
5/16 inch (8mm) wide, 0.002 inch (0.05mm) thick, stainless
steel strip matrix material
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Strip matrix – covers 1/3 of the facial surface – extends
through proximal to lingual surface
Lingual portion is trimmed by cutting the strip at an angle –
corresponds to the slope of the lingual surface
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The strip is contoured to approximate the circumferential
contour of the tooth
Strip – burnished using an egg-shaped burnisher – impart
desired contact and contour form
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Strip positioned, wedge placed, facial portion
of the strip is stabilized with low fusing
compound
Small amount of compound may be used
lingually to position and stabilize matrix
against linguogingival corner
Precontoured metallic matrices may also be
used
Small preparation – matrix is sufficiently rigid –
compound may not be used
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2. Condensation and Carving:
Condensation and Carving of Amalgam – similar to the
techniques of the posterior teeth
Condensers – chosen that are best suited in each part of
the tooth without binding
Condensation is carried in 1mm increments
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Carving – remove excess amalgam – the matrix retainer
and band and wedges are removed
The proximal surface should require minimal carving and
establish proper contact with the adjacent tooth
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Cavity Preparation for Class V
Amalgam Restorations
32 Indications
Nonaesthetic areas
Areas where moisture control is difficult
Areas that are significantly deep gingivally
Carious lesion extending gingivally – requiring soft tissue
flap reflection
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Summitt’s Fundamentals of Operative Dentistry A Contemporary Approach, Fourth Edition Pg 793 and
33 Contraindications
Aesthetically important areas
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34 Advantages
Class V Amalgam restorations are stronger than the Class V
Direct Composite restorations
Easier to place
Easy to finish and polish without damage to the adjacent
surfaces
Less expensive
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35 Disadvantages
Metallic and unaesthetic
Require 90-degree cavosurface margins, specific and
uniform axial depths – results in less conservation of tooth
structure
Mercury contamination
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36 Line Angles and Point Angles
Sturdevant's Art and Science of Operative Dentistry 5th Edition Pg No. 299
37 Class V Cavity Preparation
Initial Preparation:
Entry into the carious lesion – Tapered Fissure bur –
limited initial axial depth of 0.5 mm into the DEJ
Total axial depth is 1 to 1.25 mm
Preparation in the root surface – axial depth 0.75 mm
Sturdevant's Art and Science of Operative
Dentistry 5th Edition Pg No. 797-798
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When extending incisally (A), gingivally (B), mesially (C), and
distally (D), position the bur to prepare these walls perpendicular to external tooth surface
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Axial wall – convex mesiodistally and incisogingivally
(occlusogigivally) as it follows the contours of the facial
surface of the tooth
Axial wall deeper at the incisal wall – (1-1.25mm) – more
enamel
Axial wall depth at the gingival wall – (0.75-1mm) – less
enamel
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40 Final Preparation:
Any remaining infected axial wall dentin – removed – No.
2/ No. 4 round bur
No inherent retention – as the cavity walls diverge facially
No. ¼ bur used to prepare two retention grooves
a] at incisoaxial line angle
b) at gingivoaxial line angle
Grooves are placed 0.2 mm inside DEJ and 0.25 mm deep
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Vimal Sikri Pre-Clinical Conservative Dentistry Second Edition Pg No.188
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Sturdevant's Art and Science of Operative Dentistry 5th Edition Pg No. 800
Vimal Sikri Pre-Clinical Conservative Dentistry Second Edition Pg No.188
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Alternatively, 4 retention
coves may be prepared, 1
each at 4 axial point angles
Conserves dentin near the
pulp
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Large Preparations that include line angles:
Maxillary 2nd molars most commonly affected
Tooth preparation on maxillary molar.
A, Caries extending around distofacial corner of tooth.
B and C, Distal extension is accomplished with round bur
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D-F, Gingival margin trimmer may be useful in completing distal half of
preparation when handpiece access is limited
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G, Gingival margin trimmer may be used to provide retention grooves.
H, Angle-former chisel may be used to prepare retention grooves in distal portion
of preparation.
I, Completed tooth preparation.
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Class V outline approaches existing proximal
restoration – extend slightly into the bulk of
the proximal restoration
Class II and Class V restorations on the same
tooth – Class II is completed before initiating
Class V
Done to avoid damage to the Class V
restoration by matrix band and wedge
needed for Class II restoration
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47 Restorative Technique
1. Matrix Placement:
Most Class V Restorations are placed without the use of
matrix band
When axial wall is convex mesiodistally, condensation
is difficult
Preferred method of application of matrix that confines
amalgam in mesial and distal portions of the
preparation
Sturdevant's Art and Science of Operative Dentistry
5th Edition Pg No. 802
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Conventional Tofflemire band and retainer may be used with a
window cut into the band allowing access to the preparation for
condensation
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2. Condensation and Carving:
Inserting amalgam. A, Place amalgam into preparation in small increments.
B, Condense first into retention grooves with small condenser.
C, Condense against mesial and distal walls.
D, Overfill and provide sufficient bulk to allow for carving
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Carving may begin immediately after insertion of amalgam
Carving is done with Hollenback carver held parallel to the
margins
Side of the carver should always rest on unprepared tooth surface
adjacent to prepared cavosurface margin – prevents overcarving
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Carving and contouring restoration
A, Begin carving procedure by removing excess and locating incisal margin. B and C, Explorer
may be used to remove excess and locate mesial and distal margins.
D, Remove excess and locate gingival margin
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3. Finishing and Polishing:
Slightly moistened cotton pellet may be used to smooth
the carved restoration further
Polishing restorations of high copper amalgam is
unnecessary as it is less prone to corrosion and marginal
deterioration
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53 Conclusion
Class III and Class V Amalgam Restorations are stronger
than direct restorations
They can be placed in areas where moisture control is
difficult
However, Class III and Class V Amalgam Restorations are
not popular as adhesive restorations as they offer a more
aesthetically acceptable choice for patients
Sturdevant's Art and Science of Operative Dentistry 5th Edition
54 References
Sturdevant's Art and Science of Operative Dentistry 5th Edition
Summitt’s Fundamentals of Operative Dentistry A Contemporary
Approach, Fourth Edition
M.A. Marzouk Operative Dentistry Modern Theory and Practice
Vimal Sikri Pre-Clinical Conservative Dentistry Second Edition
55
Thank You
