Textbook of Operative Dentistry Nisha Garg, Amit Garg
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Introduction to Operative DentistryCHAPTER 1

operative dentistry is foundation of the dentistry from which other branches have evolved. It plays an important role in enhancing dental health and now branched into dental specialties. Operative dentistry deals with diagnosis, prevention, interception and restoration of the defects of natural teeth. Goal of the operative dentistry is to maintain the health and integrity of teeth and their supporting structures.
Mosby’s dental dictionary—“Operative dentistry deals with the functional and esthetic restoration of the hard tissues of individual teeth”.
Sturdevant—“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 treatment should result in the restoration of proper form, function and esthetics while maintaining the physiologic integrity of the teeth in harmonious relationship with the adjacent hard and soft tissues, all of which should enhance the general health and welfare of the patient”.
Gilmore—“Operative dentistry is that subject which includes diagnosis, prevention, and treatment of defects of the natural teeth, both vital and nonvital, so as to preserve the natural dentition and restore it to the best state of health, function and esthetics.
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,2 because all the dental treatments were considered to be an operation which was performed in the dental ooperating 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.
Table 1.1   Evolution of Operative Dentistry
Major inventions/events
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.
Bartolomeo Eustachius published the first book on dental anatomy, ‘Libellus de dentibus’.
Antonie 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 lecture 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.3
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 (Table 1.1). The recent concept of treatment of dental caries comes under minimally invasive dentistry. 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.
Following are the indications of operative dentistry:
Caries is most common disease affecting the teeth. Dental caries is microbiological disease of the teeth which results in localized dissolution and destruction 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 the following types:
Noncarious Loss of the Tooth Structure
Mechanical wear of opposing teeth commonly seen on contacting occlusal, incisal and proximal surfaces (Fig. 1.4).
Loss of tooth material by mechanical wear other than contacting surfaces. It commonly occurs due to improper brushing and use of abrasive tooth powder ( Fig. 1.5).
Loss of dental hard tissue as a result of a chemical process not involving bacteria.
Malformed, Traumatized, or Fractured Teeth
Traumatic injuries may involve the hard dental tissues and the pulp which require restoration (Figs 1.6 and 1.7).
Esthetic Improvement
Discolored teeth because of staining or other reasons look unesthetic and require restoration (Fig. 1.8).
Replacement or Repair of Restoration
Repair or replacement of previous defective restoration is indicated for operative treatment (Fig. 1.9).
Developmental Defects
Defects like enamel and dentin hypoplasia, hypomineralization, amelogenesis and dentinogenesis imperfecta tetracycline stains, peg-shaped laterals need operative intervention.
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Figure 1.1: Clinical picture showing pit and fissure caries in molars
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Figure 1.2: Clinical picture showing smooth surface caries in maxillary second premolar
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Figure 1.3: Clinical picture showing root caries in 22, 23, 24
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Figure 1.4: Clinical picture showing attrition of mandibular teeth
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Figure 1.5: Clinical picture showing generalized abrasion of upper anterior
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Figure 1.6: Fractured and discolored maxillary tooth
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Figure 1.7: Fractured 11 can be repaired byesthetic composite restoration
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Figure 1.8: Discolored teeth can be corrected by esthetic treatment
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Figure 1.9: Clinical presentation of defective amalgam restoration
Objectives of operative dentistry are as follows:
Diagnosis is 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 the disease.
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.
Preservation of the vitality and periodontal support of remaining tooth structure is obtained by preventive and interceptive procedures.
Includes restoring form, function, phonetics and esthetics.
After restoration is done, it must be maintained for providing service for longer duration.
Earlier concept of tooth preparation was the same as given by GV Black for many decades, that is extension for prevention. But modern concept of operative dentistry is based on the conservation and prevention of the diseases. Many advancements have been made in the area of operative dentistry so as to meet its goals in better ways.
  1. Development in the diagnostic aids
    • Ultrasonic illumination
    • Fiberoptic transillumination (FOTI)
    • Digital imaging
    • Tuned aperture computerized tomography (TACT)
    • Magnetic resonance microimaging (MRMI).
    • Qualitative laser fluorescence
    • Diagnodent (quantitative laser fluorescence)
  2. Recent advances in treatment planning
    • Minimal intervention dentistry
    • Ozone therapy.
  3. 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.
  4. Improvements in adhesive dentistry
    • Introduction of bonded amalgam restorations
    • Packable composites
    • Flowable composites
    • Modifications in glass ionomers cements
    • Compomers
    • Giomers
  5. Recent advances in techniques and equipment
    • Incremental packing and C-factor concept in composites
    • Soft start polymerization
    • High intensity QTH polymerization.
  6. Recent advances in handpieces and rotary instruments
    • Fiberoptic handpiece
    • Smart prep burs
    • CVD burs
    • Fissurite system.
  1. Define operative dentistry. What is the scope of operative dentistry?
  2. List the indications for operative dental procedures.
  3. Discuss various advancements that have revolutionized the current practice of operative dentistry.
  4. Write short notes on:
    1. Scope and purpose of operative dentistry.
    2. Recent advances in operative dentistry.
  1. 1. Berry J.The demographics of dentistry. J Am Dent Assoc. 1996;127:1327–30.
  1. Brown LJ, et al. Dental caries, restoration and tooth conditions in US adults, 1988–1991. J Am Dent Assoc. 1996; 127: 1315–25.
  1. Grainger DA. What are you, operative dentistry, and why are they saying all of those nasty things about you? Amer Aced Gold Foil Oper J. 1972; 15: 67.