Textbook of Operative Dentistry Nisha Garg, Amit Garg
Chapter Notes

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Introduction to Operative DentistryCHAPTER 1

Chapter Outline
  • • Indications of Operative Dentistry Procedures
    • – Caries
    • – Noncarious Loss of the Tooth Structure due to Attrition, Abrasion, Abfraction and Erosion
    • – Malformed, Traumatized, or Fractured Teeth
    • – Esthetic Improvement
    • – Replacement or Repair of Restoration
  • • Purpose of Operative Dentistry
    • – Diagnosis
    • – Prevention
    • – Interception
    • – Preservation
    • – Restoration
    • – Maintenance
Operative dentistry plays an important role in enhancing dental health and now branched into dental specialities. Today operative dentistry continues to be the most active component of most dental practice. Epidemiologically, demand for operative dentistry will not decrease in the future.
According to Mosby's dental dictionary, “Operative dentistry deals with the functional and esthetic restoration of the hard tissues of individual teeth”.
According to Sturdvent, “Operative dentistry is defined as science and art of dentistry which deals with diagnosis, treatment and prognosis of defects of the teeth which do not require full coverage restorations for correction”.
Such corrections and restorations result in the restoration of proper tooth form, function and aesthetics while maintaining the physiological integrity of the teeth in harmonious relationship with the adjacent hard and soft tissues. Such restorations enhance the dental and general health of the patient.
According to Gilmore, “Operative dentistry is a subject which includes diagnosis, prevention and treatment of problems and conditions of natural teeth vital or nonvital so as to preserve natural dentition and restore it to the best state of health, function and aesthetics.”
The profession of dentistry was born during the early middle ages. Barbers were doing well for dentistry by removing teeth with dental problems. Till 1900 AD, the term ‘Operative dentistry’ included all the dental services rendered to the patients, because all the dental treatments were considered to be an operation which was performed in the dental operating room or operatory. As dentistry evolved dental surgeons began filling teeth with core metals. In 1871, GV Black gave the philosophy of “extension for prevention”, for cavity preparation design. Dr GV Black (1898) is known as the “Father of operative dentistry”. He provided scientific basis to dentistry because his writings developed the foundation of the profession and made the field of operative dentistry organized and scientific. The scientific foundation for operative dentistry was further expanded by Black's son, Arthur Black.
In early part of 1900s, progress in dental sciences and technologies was slow. Many advances were made during the 1970s in materials and equipment. By this time, it was also proved that dental plaque was the causative agent for caries. In the 1990s, oral health science started moving toward an evidence-based approach for treatment of decayed teeth. The recent concept of treatment of dental caries comes under minimally invasive dentistry.2
Prehistoric era
5000 BC
500-300 BC
166-201 AD
A Sumerian text describes “tooth worms” as the cause of dental decay.
Hippocrates and Aristotle, wrote about dentistry, including the eruption pattern of teeth, treating decayed teeth.
The Etruscans practiced dental prosthetics using gold crowns and fixed bridgework.
A medical text in China mentioned the use of “silver paste,” a type of amalgam.
Pre 1700
Artzney Buchlein, wrote the first book solely on dentistry. It was written for barbers and surgeons who used to treat the mouth, it covered topics like oral hygiene, tooth extraction, drilling teeth and placement of gold fillings.
Batholomew Eusttachius published the first book on dental anatomy, ‘Libellus de dentibus’.
Antony van Leeuwenhoek identified oral bacteria using a microscope.
Charles Allen, wrote first dental book in English ‘The operator for the teeth’.
Pierre Fauchard published “Le Chirurgien dentiste”. He is credited as Father of Modern Dentistry because his book was the first to give a comprehensive system for the practice of dentistry.
Claude Mouton described a gold crown and post for root canal treated tooth.
James Rae gave first lectures on the teeth at the Royal College of Surgeons, Edinburgh.
John Hunter published “The natural history of human teeth” giving a scientific basis to dental anatomy.
William Addis manufactured the first modern toothbrush.
John Greenwood constructed the first known dental foot engine by modifying his mother's foot treadle spinning wheel to rotate a drill.
James Snell invented the first reclining dental chair.
The ‘Amalgam War’ conflict and controversy generated over the use of amalgam as filling material.
Robert Arthur introduced the cohesive gold foil method for inserting gold into a preparation with minimal pressure.
Sanford C. Barnum, developed the rubber dam.
James Beall Morrison invented foot engine.
WD Miller formulated his “chemicoparasitic” theory of caries in “Microorganisms of the human mouth”
Lilian Murray became the first woman to become a dentist in Britain.
GV Black established the principles of cavity preparation.
Federation Dentaire Internationale (FDI) was founded.
Charles Land introduced the porcelain jacket crown.
William Taggart invented a “lost wax” casting machine.
Frederick S. McKay, a Colorado dentist showed brown stains on teeth because of high levels of naturally occurring fluoride in drinking water.
Alvin Strock develoed Vitallium dental screw implant.
The first fluoride toothpastes were marketed.
Oskar Hagger developed the first system of bonding acrylic resin to dentin.
Michael Buonocore described the acid etch technique
John Borden introduced a high-speed air-driven contra-angle handpiece running up to 300,000 rpm.
Lasers were developed.
Rafael Bowen developed Bis-GMA.
The first commercial home tooth bleaching product was made available.
New advances in esthetic dentistry including tooth-colored restorative materials, bleaching materials, veneers and implants.
In December 1999, the World Congress of Minimally Invasive Dentistry (MID) was formed. Initially MI dentistry focused on minimal removal of diseased tooth structure but later it evolved for preventive measures to control disease.
Current minimally intervention philosophy follows three concepts of disease treatment:
  1. Identify—identify and assess risk factors early.
  2. Prevent—prevent disease by eliminating risk factors.
  3. Restore—restore the health of the oral environment.
Indications for operative procedures are divided into the following main sections:
Dental caries is an infectious microbiological disease of the teeth which results in localized dissolution and 3destruction of the calcified tissue, caused by the action of microorganisms and fermentable carbohydrates.
Based on anatomy of the surface involved dental caries can be of following types:
Noncarious Loss of the Tooth Structure due to Attrition, Abrasion, Abfraction and Erosion
Mechanical wear between opposing teeth commonly due to excessive masticatory forces (Fig. 1.4).
Loss of tooth material by mechanical means other than by opposing teeth (Fig. 1.5).
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Figure 1.1: Pit and fissure caries
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Figure 1.2: Smooth surface caries
Loss of dental hard tissue as a result of a chemical process not involving bacteria.
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Figure 1.3: Root caries
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Figure 1.4: Attrition of teeth
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Figure 1.5: Abrasion of teeth
Malformed, Traumatized, or Fractured Teeth (Fig. 1.6)
Traumatic injuries may involve the hard dental tissues and the pulp which require restoration.
Sometimes teeth do not develop normally and there are number of defects in histology or shape which occur during development and become apparent on eruption. These teeth are often unattractive or prone to excessive tooth wear.
Esthetic Improvement (Figs 1.7 and 1.8)
Discolored teeth because of staining or other reasons look unesthetic and require restoration.
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Figure 1.6: Fractured and discolored tooth
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Figure 1.7: Discolored teeth requiring esthetic improvement
Replacement or Repair of Restoration
Repair or replacement of previous defective restoration is indicated for operative treatment (Fig. 1.9).
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Figure 1.8: Discolored teeth needing esthetic treatment
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Figure 1.9: Defective amalagam restoration requiring replacement
Purpose of operative dentistry basically is:
Proper diagnosis is vital for treatment planning. It is the determination of nature of disease, injury or other defect by examination, test and investigation.
To prevent any recurrence of the causative disease and their defects, it includes the procedures done for prevention before the manifestation of any sign and symptom of disease.
Preventing further loss of tooth structure by stabilizing an active disease process. It includes the procedures undertaken after signs and symptoms of disease have appeared, in order to prevent the disease from developing into a more serious or full extent. Here teeth are restored to their normal health, form and function.
Preservation of the vitality and periodontal support of remaining tooth structure. Preservation of optimum health of teeth and soft tissue of oral preparation is obtained by preventive and interceptive procedures.
Includes restoring form, function, phonetics and aesthetics.
After restoration is done, it must be maintained for providing service for longer duration.
Basically advances in operative dentistry has occurred in following areas:
  • Advances in diagnosis
    • Advances in visual method
      1. Ultrasonic illumination
      2. Ultrasonic imaging
      3. Fiberoptic transillumination (FOTI)
      4. Digital imaging fiberoptic transillumination (DIFOTI)
      5. Caries detecting dyes
    • Recent advances in radiographic techniques
      1. Digital imaging
      2. Computerized image analysis
      3. Tuned aperture computerized tomography (TACT)
      4. Magnetic resonance microimaging (MRMI).
    • Electrical conductance measurement
    • Lasers
      1. Qualitative laser fluorescence
      2. Diagnodent (quantitative laser fluorescence)
      3. Optical coherence tomography
      4. Computerized occlusal analysis
  • Recent advances in treatment planning
    • Minimal intervention dentistry
    • Ozone therapy.
  • Recent advances in tooth preparation
    • Use of air abrasion technique
    • Chemomechanical caries removal
    • Use of lasers in tooth preparation
    • Use of ultrasonics in tooth preparation
    • Management of smear layer.
  • Recent advances in restorative materials
    • Modification in silver amalgam:
      1. Mercury free alloys6
      2. Gallium-based silver alloy
      3. Bonded amalgam restorations
    • Advances in other restorations:
      1. Packable composites
      2. Flowable composites
      3. Modifications in glass ionomers cements
      4. Compomers
      5. Giomers
      6. Ormocers
      7. Ceromers
      8. Tooth colored inlays.
  • Recent advances in techniques and equipment
    • Incremental packing and C-factor concept in composites
    • Soft start polymerization
    • High intensity QTH polymerization.
  • Recent advance in handpieces and rotary instruments like
    • Fiberoptic handpiece
    • Smart prep burs
    • CVD burs
    • Fissurite system.
  1. Define operative dentistry. What is scope of operative dentistry?
  2. Write short notes on:
    1. Scope and purpose of operative dentistry.
    2. Recent advances in operative dentistry.
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