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, 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.
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:
- Identify—identify and assess risk factors early.
- Prevent—prevent disease by eliminating risk factors.
- 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:
- Pit and fissures carious lesions (Fig. 1.1)
- Smooth surface carious lesions (Fig. 1.2)
- Root caries (Fig. 1.3).
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).
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).
Defects like enamel and dentin hypoplasia, hypomineralization, amelogenesis and dentinogenesis imperfecta tetracycline stains, peg-shaped laterals need operative intervention.
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.
- 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)
- 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.
- Improvements in adhesive dentistry
- Introduction of bonded amalgam restorations
- Packable composites
- Flowable composites
- Modifications in glass ionomers cements
- Recent advances in techniques and equipment
- Incremental packing and C-factor concept in composites
- Soft start polymerization
- High intensity QTH polymerization.
- Recent advances in handpieces and rotary instruments
- Fiberoptic handpiece
- Smart prep burs
- CVD burs
- Fissurite system.
EXAMINER’S CHOICE QUESTIONS
- Define operative dentistry. What is the scope of operative dentistry?
- List the indications for operative dental procedures.
- Discuss various advancements that have revolutionized the current practice of operative dentistry.
- Write short notes on:
- Scope and purpose of operative dentistry.
- Recent advances in operative dentistry.
- 1. Berry J.The demographics of dentistry. J Am Dent Assoc. 1996;127:1327–30.
- Brown LJ, et al. Dental caries, restoration and tooth conditions in US adults, 1988–1991. J Am Dent Assoc. 1996; 127: 1315–25.
- 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.