The biomechanical principles of cavity
preparation and restoration which seek to ensure prevention of recurrent
caries, retention of the material within the tooth, resistance to
fracture of the restorative material and/or tooth, preservation of
periodontal and pulpal integrity, together with caries removal and
esthetic consideration should be evident.
It should be noted that in certain instances,
restorations exhibiting deficiencies in one or more of the basic
principles, with the exception of caries removal, continue to provide
service many years after placement. It would be unwise and unwarranted
to evaluate such a restoration with the same yardstick as might be
applied to the recently completed treatment.
|
ITEM |
RATING AND EXPLANATION |
|
|
ACCEPTABLE |
NOT ACCEPTABLE |
|
Treatment Plan and Diagnosis |
1.
Diagnostic exam is performed with properly exposed and
developed radiographs.
2.
All areas of proposed treatment visible on radiographs.
3.
Symbolic tooth charting is used to indicate pathological
conditions. Patient is made aware of proposed treatment and
possible alternatives. |
1.
No evidence of pretreatment charting or planning.
2.
Lack of adequate radiographs.
3.
Patient not informed of possible complications or
alternatives in treatment.
|
|
Pain Control |
1.
Attempt made with local anesthesia to prevent a painful
response during operative procedures.
2.
Adequate post-operative instructions, as well as
appropriate provisions for post-treatment professional care. |
1.
Inadequate pain control and resulting patient discomfort.
2.
Lack of adequate post-treatment care for the patient. |
|
Outline Form and Cavity Preparation |
1.
Includes all pits and fissures.
2.
Extends into cleansible areas.
3.
Exhibits retentive design and sufficient bulk to resist
masticatory forces.
4.
Complete caries removal except documented indirect pulp
capping. |
1.
Does not include possible sites of recurrent caries.
2.
Cannot be adequately cleansed by patient in course or
routine acceptable hygiene procedures.
3.
Insufficient extension and depth suggestive of potential
displacement and/or fracture.
4.
Cusps, where involved, not adequately protected.
5.
Incomplete caries removal. |
|
Surfaces and Esthetics |
1.
Surface smooth.
2.
Color esthetics acceptable. |
1.
Surface rough, pitted, no discernible attempt to finish.
2.
Color esthetically unacceptable. |
|
Endodontic Consideration |
1.
Adequate measures taken to prevent over-heating pulp,
i.e. water and/or air spray.
2.
Use of cavity liner and/or medicated base and/or bonding
in deep preparations to aid in prevention of post-op discomfort.
3.
Direct pulp capping performed when there is a pulpal
exposure but no prior evidence of irreversible pulpal pathosis.
4.
Indirect pulp capping when decay is deep, but there is no
evidence of pulpal exposure and no prior evidence of
irreversible pulpal pathosis. |
1.
No indication of bases pulpal protection used under deep
preparations.
2.
Evident that gross decay was not completely removed under
completed restoration. |
|
Anatomic Form and Occlusion |
1.
Contour continuous with existing tooth form.
2.
Cusps, planes, grooves, marginal edges, contact areas,
embrasures restored.
3.
Occlusion harmonious: neither prematurities nor
infraocclusion. |
1.
Little or no attempt at restoring contour.
2.
Marginal ridges higher or lower than adjacent ridges,
except where occlusion warrants.
3.
Contact open.
4.
Embrasures not contoured to allow for integrity of
interproximal issues.
5.
Axial contours flattened or exaggerated.
6.
Restoration not in harmony with occluding teeth. |
|
Periodontal Consideration |
1.
Periodontal health of tooth is such that its loss is not
indicated in the immediate future.
2.
Thorough prophylaxis is performed before operation
procedures are begun. |
1.
Restorations done on teeth considered periodontally
hopeless.
2.
No considerations given to plaque or calculus prior to
cavity preparations. |
|
Marginal Integrity |
1.
No visible marginal defect or defect which can be
detected by an explorer.
2.
No gingival overhang.
3.
No discoloration of margin. |
1.
Marginal tooth structure or restorative material
fractured.
2.
Gingival overhang.
3.
Caries at margin.
4.
Cement lines visible at margins of inlay/only
restorations.
5.
Discoloration at margin. |