INTRODUCTION TO

OPERATIVE DENTISRY

DEFINITION

“ Operative dentistry is the art and science of the diagnosis ,treatment and prognosis of the defects of teeth that do not require full coverage restorations for correction. Such treatment should result in the restoration of proper tooth 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 ”

History

17th century “Barber- dentists” sent from England to US.(tooth extractions mainly)Dental caries= “gangrene-like disease”

Treatment of defective part of tooth by removal of cavity &replacement of missing tooth structure by “filling” with some type of material.

1840 ,Baltimore college of dental surgery.Amalgam as restorative material.

1867,First university-affiliated dental program, Harvard university.

G.V Black related clinical practice of dentistry to a scientific basis.

1999,Periodic examinations,bite-wing radiographs and prophylactic procedures

Louis Pasteur discovered role of microorganisms in disease.

Modern operative dentistry includes diagnosis &treatment of many problems not just caries.Terms “Tooth preparation” &“restoration”.

Factors affecting operative treatment

INDICATIONS: Caries Malformed, discolored, nonesthetic

or fractured teeth & Restoration ,replacement or repair.

Considerations Infection control. Thorough examination of oral and systemic

health of patient. A diagnosis of dental problem that recognizes

interaction of affected area with other body tissues.

A treatment plan that has the potential to return the affected area to a state of health and function, enhancing the overall health and well-being of the patient.

An understanding of the material to be used to restore the affected area,including a realization of the material’s limitations and techniques involved in using it.

An understanding of the oral environment into which the restoration will be placed.

An appreciation for and knowledge of correct dental anatomy.

An understanding of the effect of the operative procedure on other dental treatments.

Conservative Approach

• Earlier concept of “extension for prevention.”

• Increased knowledge of prevention methods, advanced clinical techniques, and improved restorative materials have provided a more conservative approach to the restoration of teeth.

More conservative approaches are available for

(1) many typical restorative procedures (Classes I, II, III, IV, and V)

(2) diastema closure procedures(3) esthetic or functional correction of

malformed, discolored, or fractured teeth; and

(4) actual replacement of teeth.

The primaryresults of conservative treatment are

retention of more intacttooth structure and less trauma to the

pulp tissue andcontiguous soft tissue.

Dynamics of Operative Dentistry

• The development of the high-speed handpiece played a dramatic role in the more conservative and efficient removal of tooth structure for restorative procedures.

• Mechanical bonding by etching enamel and dentin and use of bonding systems have led to the development of many new composite restorative materials and conservative restorative bonding techniques.

• Benefits of sealants are becoming more widely accepted for the prevention of pit-and-fissure caries.

• Increased knowledge about the carious process and the beneficial effects of multiple fluoride applications has resulted in a decrease in caries incidence.

• Increased research on biomaterials has led to the introduction of vastly improved dental materials.

• All of the above mentioned factors have played an important role in the development of operative dentistry.

• Ultimate result is improved oral health for all populations.

FACTORS AFFECTING FUTUREDEMAND FOR OPERATIVE DENTISTRY DEMOGRAPHICS

US POPULATION (increase by 146 million)

050

100150200250300350400450

248

394

19902050

• Percentage of older adults in the population and also life expectancy will increase substantially in the future.

• Emphasis will shift from the needs of young to concerns and demands of middle-aged individuals & older adults.

Economic Factors

• With more discretionary income and more health care benefits for the adult segment of society, the demand for future dental services should increase.

General and Dental Health ofthe U.S. Population

• The general health of the U.S. population is good.

• Americans generally have good dental health.

• Incidence of caries has decreased ;primarily due to increased exposure to fluoride.

• Fluoridation of community water systems began in Grand Rapids, Michigan, in 1945.

• Caries remains the most common chronic childhood disease.

• Missing teeth : In last several decades, there has been a steady reduction in edentulism and numbers of teeth lost per person.

• Edentulism and the number of teeth present are strongly influenced by age

Dentulous indi-viduals

0

20

40

60

80

100

120100

56 Age 18-24yrsAge >75 yrs

• Periodontal Status: periodontal Attachment loss (number of affected people and severity) increased with age.

• Gingival recession also increased with age.

• Oral Cancer: Oral and pharyngeal cancer is the sixth most common neoplastic disease.

Dental Manpower

• The number of total “active private practitioners” is expected to increase from 156,921 in 2002 to 172,097 in 2020.

• There will be fewer dentists treating more patients who will have retained more teeth.

Projected Need for Operative Dentistry

• Increased need of operative dentistry in future :i. restorations for teeth with new carious

lesions;ii. restorations for teeth with root caries;iii. restorations to replace existing, faulty

restorations; andiv. restorations to enhance the esthetic

appearance of patients.

Public’s Perception of Dentistry

• The public’s perception of dentistry is another factor that will influence whether the increased numbers of teeth and increased need for operative services will be converted to increased demand.

Patient Visits• The number of dental visits has

increased in the past several years.• Recent surveys shows that New older

adults and future older adults not only will possess positive perceptions about dentistry and dental health, but also will have the economic means to secure the dental care they need.

FUTURE OF OPERATIVE DENTISTRY• Research in operative dentistry is now

occurring in many fields. • Use of lasers in dentistry may lead to a new

mechanism for welding dental alloys or altering tooth structure in tooth preparation.

• Improvements in composites, adhesive systems, castable ceramics, and computer-generated restorations could result in significant decrease in the use of metal alloy systems in operative dentistry.

• Efforts also are being made to develop an anticaries vaccine.

SUMMARY• The future of operative dentistry

is good.• The emphasis of the profession

will shift to care for the senior adult segment of the population and also to nonsurgical treatments for caries.