DEFINITION, SCOPE, AND OBJECTIVE OF OPERATIVE

DENTISTRYBy Dr.Wedad Awliya

DEFINITIONOperative dentistry is the science and art dealing with the restorations of any fault “Defect” that occurs in the hard tooth structures. It occupies about 70% of the dentist time and necessitates the formation of Cavities of specific design and form to receive the filling “restorative material” of choice

SCOPEOperative dentistry consists of all procedures including preventive measures by which teeth may be conserved and thus maintain the natural masticating mechanism in such a state that the general health will not be endangered

THE DEFINITION OF OPERATIVE DENTISTRY includes and scope the following

1. Defects which affect the teeth

2. Restoration

DEFECTS WHICH AFFECT THE TEETHPathologic:

i. Dental caries

ii. Developmental structural defects

Enamel Hypoplasia: Acquired condition

Causes:

Infections disease in childhood ”fever”

Trauma

Abscess to developing crown

iii. Hereditary

Amelogenesis imperfecta: Hereditary abnormality

Insufficient amount of enamel, soft enamel, friable and easy lost

iii. HereditaryDentinogenesis imperfecta: hereditary conditionTeeth appear yellow-brown to grayEnamel is fractured easily due to poor support provided by the abnormal dentin

iii. Hereditary

* Peg-shaped lateral incisor

* Hutchinson’s incisor

* Mulbery molarsSeen with

congenital syphilis

iv. Nutritional

* Enamel hypocalcification: incomplete calcification or Hardening of enamel (hypomineralized)

V. Formative* Dens invaginatus and dens evaginate or dens in dente or tooth within a toothExaggeration or accentuation of the lingual pitThe cause is unknown

Vi. Acquired tooth wear

* attrition(clenching and grinding, age)

* abrasion( mechanical wear, wrong brushing technique, biting pen or hard object)

* erosion (citrus fruits, acid containing drinks)

discoloration

- extrinsic e.g. external stain(food, drinks, smoking)

- intrinsic e.g. dental fluorosis

Accidental traumatic fracture of teeth.

2. RESTORATION:Is an artificial substitute which replace the missing portion of the hard tooth tissues.Restorations must not only retain the tooth to its normal form, function, strength, and esthetic, but they must also provide for the health of the supporting tissues. Faulty restorations are a common etiological factor of periodontal disease. An unfavorable response of the periodontium will result in occlusal disharmonies. If not corrected, thus causing traumatic occlusion.

DENTAL CARIES DEFINITION“ It is a disease of the calcified tissues of the teeth, characterized by a demineralization of the inorganic portion and destruction of the organic substance of the tooth”

CAVITYThe term cavity refers to a defect in enamel, or in enamel and dentin, usually resulting from the pathologic process of dental caries.

Prepared cavities The performance of those dental surgical procedures required to expose the carious lesion, permit removal of affected tissues, and so shape the remaining dentin and enamel as to contribute to biologically and mechanically sound restoration.

RESTORATIVE MATERIALSThe replacement of lost hard tooth structure cannot be achieved without using the proper restorative dental materials. This include:a. Temporary restorative materialsb. Permanent restorative materials

PERMANENT RESTORATIVE MATERIALS INCLUDE

Metal PolymersComposite resinGlass-ionomer- cementsAcrylic

Ceramicsporcelain

AmalgamGoldNoble metalCobalt-chromium- alloysNickel-chromium- alloya

PERMANENT RESTORATIVE MATERIALSDirect restorative materials

* Esthetic restorative materials (composite resin, Glass- ionomer cements and compomer)

* Metalic restoration (amalgam, gold foil)

Indirect restorative materials* Cast gold restoration* Porcelain* Castable ceramic restoration

OBJECTIVE OF OPERATIVE DENTISTRY

Operative dentistry has five fundamental aims

1. Diagnosis2. Prevention3. Interception4. Preservation5. Restoration

DIAGNOSISProper diagnosis of lesions including their

* location* extent

Correct treatment planning including* the design of tooth preparation* the selection of restorative

materials and procedure

PREVENTIONThe ultimate aim regarding dental caries is its prevention, therefore, every step of an operative procedure must emphasize this. For example,

* Location of the margins* The shape (contour) of the final

restoration* Sealing of enamel faults- pits and

fissuresPrevents any recurrence of decay and their defects

INTERCEPTION

This procedure in operative dentistry refers to preventing further loss of tooth structure by stabilizing an active disease process

PRESERVATIONThis includes

* The vitality of the affected tooth* Re establishing of the important anatomy

in remaining sound tooth structure

RESTORATIONThe ultimate goal of operative dentistry treatment

should be restoration of health. This will include•Restoring and maintaining form, function,

phonetics and esthetics•Occlusal re establishment and stability

Not only to the teeth themselves, but also to their surrounding supporting tissues and to the entire stomatognathic system and to the welfare of the whole patient.

To achieve the ultimate goals of operative dentistry, any restorative performance, requires

• Sound clinical judgment in both mechanical and biological based on scientific and artistic knowledge

• A high level of psychomotor skill “Precision”.Operative dentistry demands a unique combination of psychomotor and affective skills.