The document provides an overview of operative dentistry, emphasizing its role in restoring the functional and aesthetic integrity of teeth affected by decay, trauma, or malformation. It outlines the prevalence of dental caries, the classification of cavities, and the methodologies involved in treatment, including diagnosis, planning, and execution of procedures. Additionally, it discusses the importance of dental materials used in restorations, patient assessment, and the complexities involved in developing treatment plans tailored to individual patient needs.

1. Introduction to OperativeIntroduction to Operative
DentistryDentistry
Dr. Ashraf Y. ShamiaDr. Ashraf Y. Shamia
Al-Azhar University –Gaza
Dr.Haydar Abd El-Shafi Faculty of Dentistry

2.  is that branch of dentistry which deals with the
esthetic and functional restorationof the hard
tissues of individual teeth.

4.  Such 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.

6.  Prevalence in U.S. population for 1988 to 1994
indicated that 45% of children (aged 5 to 17) had
carious teeth. In adults, almost 94% had evidence
of past or present coronal caries. Thus, caries will
be of major importance for the foreseeable future.

7.  Operative dentistry includes:
1. Diagnosis of the original insult of caries,
erosion, attrition, traumatic fracture,
hypoplasia, tissue discoloration, changes of
tooth form, size, position, alignment or
occlusion.
2. Planning of treatment in logical sequential
steps of procedures and determination of
possible cooperation of other allied disciplines
such as endodontics, periodontitics,
orthodontics or maxillofacial surgery.
3. Execution of operative and restorative
procedures.

8.  The indications for operative procedures are
numerous. However, they can be categorized
into three primary treatment needs:
1. Caries.
2. Malformed, discolored, nonesthetic, or fractured
teeth.
3. Restoration replacement or repair.

11.  Dental caries (tooth decay) and periodontal disease
are probably the most common chronic diseases in
the world. Although caries has affected humans
since prehistoric times, the prevalence of this
disease has greatly increased in modern times on a
worldwide basis, an increase strongly associated
with dietary change.

13. The classification devised by G.V. Black, which
is based upon the site of onset of the carious
process, and the relative frequency of the various
sites involved, is most widely adopted. Black
classified cavities into five classes:

14. a) Class I Cavities:
Those cavities originating in anatomical pits and
fissures. They are found in the occlusal surface of
molars and premolars.

18. b) Class II Cavities:
Are smooth surfaces lesions that occur in the
proximal surfaces i.e., mesial or distal of molars
and premolars.

21. c) Class III Cavities:
These cavities occur in the proximal surfaces
(mesial and distal) of incisors and canines; but do
not involve or include the incisal angle.

24. d) Class IV Cavities:
Cavities that originate on the mesial and distal
surfaces of incisor and canine teeth, but caries is so
extensive that the incisal angle is involved.

27. e) Class V Cavities:
Are smooth surface cavities occurring in the
gingival third of the buccal and lingual surfaces of
all teeth, excluding cavities occurring in anatomical
pits in the palatal surfaces of upper incisors, where
they are grouped with Class I cavity.

30.  ENAMEL.
 DENTIN.
 PULP.
 CEMENTUM.

32. 1. Dental Caries.
2. Attrition (wear).
3. Abrasion.
4. Discoloration.
5. Fractures.

33. It is an infectious microbiological disease of the
teeth that results in localized demineralization and
destruction of the calcified tissues.

34. This is the disease that dentists deal with more than
90% of the time in operative dentistry. Several
theories were postulated concerning the cause of
caries, of these theories the acidogenic theory is
considered the most microbial enzymatic action on
ingested carbohydrates. These acids will decalcify the
inorganic portion of the teeth; then the organic portion
is disintegrated. This destructive process progresses
more rapidly in dentin than in enamel.

36. It is surface tooth structure loss resulting from
direct frictional forces between contacting teeth.
It is a continuous, age dependant process, usually
physiological. Attrition is accelerated by
parafunctional mandibular movement noticeably
bruxism. Attrition affects occluding surfaces.

38. It is surface loss of tooth structure resulting
from direct frictional forces between the teeth and
external objects, or from frictional forces between
contacting teeth components in the presence of an
abrasive medium. Abrasion is a pathologic
process.

42. It is deviation from the normal orthodox tooth
shade. Although it is not destructive, yet it has a far-
reaching effect on the affected individual, both
socially and psychologically. According to its
etiology, discoloration can be either extrinsic due to
surface staining, calculus or surface deposits that can
be removed by proper scaling and polishing - or
intrinsic created from changes in one or more of the
tooth tissues.

43.  Discoloring changes of dentin may result either from
non-vitality or from pigmentation and staining e.g.
metallic restorations, medicaments, microbial
metabolites etc. Tetracycline discoloration
(tetracycline administered during tooth formation) is
a sort of permanent staining of dentin and to some
extent to enamel.

45. It is separation and/or loss of tooth structure as a
result of trauma. Trauma that leads to these
mishaps can be from substantial impact forces
from a fall, a blow or sudden biting on a hard
substance.

46.  Traumatic injuries to natural teeth crowns range
from simple fractures of enamel (chipping), to
fracture of enamel and dentin with or without pulp
involvement, to total loss of crown structures.
Trauma can also lead to total avulsion of the tooth.

47. enamel and dentin without pulp > with pulp Loos of crown structuers

49. According to Black, cavity preparation is outlined
in six steps of procedures based on biological,
physical and mechanical fundamental principles. This
enables systematization and standardization of these
procedures so that each step will be completed
perfectly and consistently thus successful results will
be obtained.

50. 1. Obtaining of the outline form.
2. Obtaining of the resistance and retention forms.
3. Obtaining of the required convenience form.
4. Removal of all carious dentin.
5. Finishing of the enamel walls and margins.
6. Performing of the toilet of the cavity.

54. PostPost

56.  Operative procedures should be performed with
due exactness and refinement because of the
heroic clinical oral conditions to which the
restorations are subjected. Because the extreme
inaccessibility that often exists, and the obligation
of avoiding tissue damage, the operator should
develop a special degree of skill in using the
different instruments. He must also be familiar
with the various types of instruments, their design
and material characteristics, sterilization,
sharpening, and ordering on the instrument table.

64. CarverCarver

66. Rotary Cutting InstrumentsRotary Cutting Instruments

74.  Ideal requirements of base materials:
In order to provide the protective and
medicating effects on the pulp-dentine organ of the
tooth tissue, the following ideal requirements of
these materials should be met.
Although no available material possesses all of
these properties some of them have most of the
properties and can be used effectively. However by
combining materials all ideal requirements can be
achieved.

75. 1. It should improve the marginal sealing and the
adaptation to the cavity walls, preferably having
adhesive potential to tooth structure.
2. It must be non irritant to vital pulpal tissues.
3. It must provide thermal insulation against the
highly conductive metallic restorations.
4. It should reduce the galvanic action of metallic
restorations.

76. 5. It should have minimal effective film thickness
without compromising the bulk needed for the future
restoration.
6. It must be strong enough to withstand condensation
forces and future masticatory forces without
distortion.
7. Compatible with overlying restorative material and
other intermediary base materials, i.e. it should not
react with the material or interfere with its setting
reaction or cause or predispose to its future
deterioration.
8. The material should resist degradation in the oral
fluids.
9. The material should be easy to apply.

79.  Advantages & Disadvantages.
 Indications and Contraindications.
 Classification, Composition and Types.
 Manipulation of Amalgam.

81.  Amalgam has been an accepted part of dental
therapeutics for more than 150 years and is still used
for more than 75% of direct posterior restorations.
The reasons for its popularity lie in its ease of
manipulation, relatively low cost, and long life.
Some concern has been raised about mercury
toxicity from both a biologic and an environmental
point of view; however, it is believed that dental
amalgam presents an acceptable risk-to-benefit ratio
when properly used.

83. CapsulesCapsules

84.  Amalgam could be defined as an alloy of mercury
together with one or more metallic elements.
Dental amalgam is a metallic alloy that results
from mixing mercury together with a specially
formulated alloy that is based on the silver-tin
compound. Mercury has a unique characteristic; It
is the only metal which is liquid at room
temperature. It is thus used to liquefy and react
with dental amalgam alloy constituents producing
a workable plastic mass that solidifies at body
temperature maintaining the form and size of the
restoration.

85.  The high rate of success and longevity of
amalgam restorations is owed to its inherent
superior characteristics which comply, to a great
extent, with the rigid requirements of the oral
environment. Its performance is considered to be
a standard for comparison of new materials.

88.  Importance of proper position
Operator posture during work whether
standing or sitting provides correct performance
and influences operator's health. Improper chair
adjustment leads to loss of patient's cooperation
and comfort with reduction of his resistive
powers before the completion of work.

89.  Patient Assessment:
All the collected data from the patient must be
registered in the patient chart which should be
uncomplicated, comprehensive, accessible and
current update. The chart is divided into sections
deals with:
1. Personal data of the patient (name, age, sex,
occupation, address and telephone number).
2. Past and present medical history.
3. Past dental history.
4. Current dental problems and chief complaint.

90. LoupesLoupes

91. Dental MicroscopesDental Microscopes

92. Intraoral CameraIntraoral Camera

96.  General considerations:
A sound treatment plan depends on thorough
patient evaluation, dental expertise, understanding
of indications and contraindications, and prediction
of the patient's response to treatment. Basically
there are two types of treatment plans: an ideal plan
and an optimal plan.

97.  Ideal Treatment Plan:
It is developed for situations in which patient
constraints or dentist limitations do not
compromise treatment and the best forms of
treatment available are delivered. In reality,
however, ideal treatment plans rarely occur.
Instead they are modified by patient motivation,
systemic health, priorities, emotional status, and
financial capabilities.

98.  Also the dentist's knowledge, experience, and
training, laboratory support, dentist-patient
compatibility, and the availability of specialists,
and other functional, esthetic, and technical
demands modify treatment plans. Clearly, one or
more of these modifiers act to change an ideal plan
to an optimal treatment plan.

99.  Optimal Treatment Plan:
Even when modification is necessary, the
practitioner is ethically and professionally
responsible for providing the best level of care
possible. For example, if a tooth ideally should be
treated with a cast restoration, but the patient is
unable to afford this care, then optimal treatment
would consist of a large, complex, amalgam
restoration.

100. Sterilization

103. Moisture Control of the Operative
Field

106. Management of Deep Carious

109. 1. It should stop further progress of the
present lesion such as caries, abrasion,
attrition or fracture.
2. It should restore normal function of the
affected tooth which may be cutting,
tearing or mastication of food.
3. It should restore any speech defects due to
missing parts of the hard tooth structures.
4. It should restore normal esthetic.

110. 5. It should restore and maintain the integrity of
the dental arch and its surrounding
periodontium.
6. It should sustain the normal physiologic
occlusal load without fracture and it should
protect the remaining hard sound tooth
structures from fracture.
7. It should protect and maintain pulp vitality.

111.  Dental fear refers to the fear of dentistry and of
receiving dental care. A pathological form of this
fear is variously called dental phobia,
odontophobia, dentophobia, dentist phobia, or
dental anxiety.

115.  Temporary restorations are those restorations,
which are inserted into the prepared cavity, only
for a certain period of time till replaced by a
permanent restoration. In indirect restorations, it
serves as a substitute restoration while a
permanent restoration is being fabricated in the
laboratory. They can be also called intermediate
or provisional restorations.