Class V Cavity

Preparation for
Amalgam

Class V
Smooth

surface lesions
located on the gingival third
of labial, buccal and lingual
surfaces of all teeth.

Always simple lesions as it involves

one surface of a tooth.

Characteristics of these
:lesions

Caries is not only the reason of . 1

.1
cavitation, abrasion and erosion may also
.responsible for their occurrence
The carious lesion usually starts as. 2
a white or chalky line or area near the
center of the gingival 1/3 of the labial or
. buccal surfaces of teeth

.2

3. Marked sensitivity.
4. Tendency to spread mesially and
distally near the axial angles of teeth, it
may pass the axial angle of the tooth
and unite with a Class II, III or IV cavity.
More convex is the surface. 5
.more susceptible to this type of caries

6. It is usually affects multiple teeth.

This indicates that the patient has a
high caries susceptibility and requires
careful extensions of cavity outline.

7. It is more frequent among oldaged patients and is called senile

caries, yet it is not uncommon in
childhood and adolescence and is
often associated with improper
oral hygiene and presence of
bacterial plaque.

:The Outline Form

conventional design:

The outline form for the class V amalgam

tooth preparation is primarily determined
by the location and size of the caries or
old restorative material.
Generally the classical class V cavity
usually describe a trapezoidal outline
with straight margins and round
corners, with the short arm being the
gingival.

Rounded trapezoid in gingival 1/3.

Conforms to the tooth shape,
In accordance with typical caries
location, and site of plaque
accumulation.

Location of margins
Occlusally: It has to be at, but not
including the height of contour of the tooth
or just include the defective area of the
tooth.
Gingivally: At the occlusal portion of the
gingival sulcus space. In cases of gingival
recession, the gingival margin should be
located supragingivally.

A. Occlusal /incisal outline is straight and

parallel to the occlusal plane.
B. Gingival outline is straight & parallel to
occlusal plane at the gum margin.
more esthetic and harmonious.

 Proximally:
cavity margins extend mesially and
distally to include only the defective areas,
but not encroaching on the axial angles of
the tooth, and placed just opposite the
axial angles of the tooth.

If the caries extends past the height

of contour or the axial angle of a
tooth, it is necessary to extend only
part of the cavity preparation to
include this area, without extending
the entire occlusal or proximal
margin.

Internal anatomy
Mesial & distal walls are divergent
outwards ( flare mesially & distally )

Follow the direction of enamel rods.

Form 90 cavo-surface angle.
Prevent undermined enamel walls.
Provide strength for the tooth & amalgam.

 Axial wall

Mesio-distaly:
The axial wall is smooth and slightly
curved mesiodistally, following the curvature
of the facial or lingual surface.
provide resistance to the forces of
condensation and to provide a maximal pulp
protection.

Occluso-gingivaly:
Axial wall is flat to slightly convex
occluso-gingivally depending on the extent
of the preparation occluso-gingivally.
provide maximal pulp protection,
while maintaining a uniform minimum
depth of 0.5 m in dentin.

:Occlusal or incisal wall

Smooth and straight forming a 90
cavo-surface angle following the direction
of enamel rods.
to facilitates condensation and the
adaptation of the amalgam restoration
to prevents undermining of enamel
rods.

:Gingival wall
Vary in appearance, depending on its
location, if it is located on enamel, it
requires a small cavo-surface bevel.
Protect the very short gingival enamel
rods from fracture during condensation.
Terminates the gingival wall with its
enamel wall parallel to the direction of the
enamel rods, thus, eliminates the
unsupported rods.

Resistance Form
These preparation are not subjected to
direct functional loading.
Features:
A minimum dept of 0.5 mm in dentin
is required for a uniform bulk of
amalgam for strength of the material.
Definite line & point angles

All internal line angles in dentin must be

squared up except those on the corners,
they must be rounded. Also, all point
angles must be rounded.

This is to facilitate condensation of

amalgam.

Class V restoration however, is not totally

free of mechanical problems.
During lateral excursion of the mandible,
flexure at the cervical region of the teeth may
make a v-shape opening at the restoration/
tooth margin (usually the occlusal one),
driving the restoration facially.

Retention form

So, Retentive features are placed in

the occlusal and gingival walls in the
form of grooves or retentive holes.

:Convenience form

The trapezoidal shape with rounded

corners and the isolation of the field
of operation using the rubber dam will
provide a better convenience for
cavity preparation and restoration.

Finishing of enamel walls

:and margins

Enamel margins should be smooth and

should be provided with 90 cavo-surface
angle.
The gingival bevel is to be placed on the
gingival walls that are terminated by enamel
and not where the preparation terminates in
cementum.

:Operative procedures

Using a tapered fissure bur of suitable size,

enter the carious lesion to a limited initial
axial depth of 0.5 mm inside the DEJ . This
depth is usually 1 to 1.25 mm total axial
depth, depending on the occlusogingival
location. (The enamel is considerably thicker
occlusally and incisally than cervically).
However, if the preparation is on the root
surface, the axial depth is approximately 0.75
mm.

Use the edge of the end of the bur to

penetrate the area; this is more
efficient than using the flat end of the
bur, reducing the possibility of the
bur's crawling."
Once the entry is made, the bur is
maintained to ensure that all external
walls are perpendicular to the
external tooth surface and thereby
parallel to the enamel rods.

Extend the preparation occlusally,

gingivally, mesially, and distally until the
cavosurface margins are positioned in
sound tooth structure to establish an initial
axial depth of 0.5 mm inside the DEJ (if on
the root surface, the axial depth is 0.75
mm).
A depth of 0.5 mm inside the DEJ
will permit placement of necessary
retention grooves without undermining the
enamel.

In areas inaccessible to a fissure bur

that is held perpendicular to the tooth
surface, suitably sized, round carbide
burs (usually a No. 2 or 4) may be
used for the initial tooth preparation.

If needed, smaller round burs may be

used also to define internal angles in
these preparations, enhancing proper
placement of the retention grooves.

.Final Tooth Preparation

Removal of any remaining infected dentin,

Pulp protection,
Retention form,
Finishing external walls, and
Final procedures of cleaning.

Remove any remaining infected axial wall

dentin with a No. 2 or No. 4 bur.

If needed, apply an appropriate liner or base

Use a No. 1/4 bur to prepare two retention

grooves, one along the occlusoaxial line
angle and the other along the gingivoaxial
line angle.

The handpiece is positioned so that the

No. 1/4 bur is directed generally to bisect
the angle formed at the junction of the
axial wall and the occlusal wall.

Ideally the direction of the occlusal groove

is slightly more occlusal than axial, and
the direction of the gingival groove is
slightly more gingival than axial.
The depth of the grooves should
approximate 0.25 mm (half the diameter of
the bur).

Alternatively, four retention coves may be

prepared, one in each of the four axial point
angles of the preparation. Using four coves
instead of two full-length grooves conserves
dentin near the pulp, reducing the possibility of a
mechanical pulp exposure.
Generally, the rounded retention form placed
with the No. 1/4 bur is generally preferred,
because amalgam can be condensed into
rounded areas better than into sharp areas,
resulting in better adaptation of the amalgam
into the retention grooves.

If necessary, use suitable hand instruments

(e.g., chisels, margin trimmers) to plane the
enamel margins, verifying soundness and 90degree cavosurface angles.

Finally, clean the preparation using air-water

spray and evacuation.