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Dep. of Operative Dentistry 369(9555):51-9. Biological basis of Operative Dentistry Dentinogenesis Primary dentinogenesis Secondary dentinogenesis Tertiary dentinogenesis Reactionary dentinogenesis Reparative dentinogenesis Dentinogenesis Primary dentinogenesis before completion of root formation Secondary dentinogenesis after completion of root formation Tertiary dentinogenesis at specific foci in the tooth in response to various stimuli Dentine matrix secreted by surviving odontoblasts in response to an appropriate stimulus. Reactionary dentinogenesis Dentine matrix secreted by a new generation of odontoblast- like cells in response to an appropriate stimulus, after the death of the original odontoblasts. Reparative dentinogenesis Operative Dentistry Cavity Classification I: Beginning in pits and fissures. II: Beginning in the proximal surfaces of the premolars and molars. III: Beginning in the proximal surfaces of the incisors and canines. IV: Beginning in the proximal surfaces of the incisors and canines and involving the incisal angle. V: Beginning in the gingival third of the labial, buccal or lingual surfaces. Fundamental Principles Removal of the caries lesion clearly Conservation of the health dentine APAC Protection of the dental pulp APAC Cavity preparation Procedures 1. Gain access and obtain outline form 2. Obtain the required resistance form 3. Obtain the required retention form 4. Obtain the required convenience form 5. Remove any remaining caries dentine 6. Finish the enamel walls and margins 7. Perform cavity cleansing and medication Biological and conservative approach rather than simple physical and mechanical one. A synthetic enamel for rapid tooth repair Seamless fixing of an early caries lesion can be achieved without prior excavation. Yamagishi K, Onuma K, Suzuki T, Okada F, Tagami J, Otsuki M, Senawangse P Nature. 2005 Feb 24;433(7028):819 Paste = H2O2 + H3PO4 +fluorized apatite Original 3min later 15min later acidic phosphate fluoride (NaF) Paste SEM photograph of longitudinal section of paste-treated tooth after 10,000 times of brushing. Loss of re-grown layer by brushing is less than 10 %. Self-assembling peptide scaffolds promote enamel remineralization J Dent Res. 2007 May;86(5):426-30 Kirkham J, Firt