Topic. Classification of cavities by Black. Basic principles of cavities preparation. Stages and features of the conventional preparation of carious cavities depending on the class. Modern methods of cavity preparation for composite materials. Alternative methods of preparation.

Department of Therapeutic DentistryLecturer: Levkiv Mariana

Ternopil State Medical University named by I. Horbachevskyy

Definition

DENTAL CARIES DENTAL CARIES is an irreversible is an irreversible microbial disease of the calcified tissues of microbial disease of the calcified tissues of the teeth that occurs after theirs eruption; the teeth that occurs after theirs eruption; is characterized by demineralization of the is characterized by demineralization of the inorganic portion and destruction of the inorganic portion and destruction of the organic substance of the tooth, which often organic substance of the tooth, which often leads to cavitation. leads to cavitation.

Schematic diagram to demonstrate the requirement for diet, bacteria and dentition to interact together over time to initiate caries.

1. Clinical: -initial (white spot lesion) -superficial (c. superficialis) -medium (c. media) -deep (c. profunda)

2. The anatomical: • -caries of enamel • -caries of dentine • -caries of cement

3. Based on localization: -fissures and pits -proximal -in the cervical part (circulating)

4. Based on a severity of disease: • -acute • -chronic • -plural (rampant) • -secondary • -arrested (stopped)

Chronic course of superficial caries

5. Based on an intensity of lesion: • -a compensated • -a sub-compensated • -a decompensated

6. Based on the presence of complications:

• -simple • -complicated

7. Black’s classification

CavitySimple cavity

Compound cavity

Complex cavity

FeatureA cavity involving only one tooth surface

A cavity involving two surfaces of tooth

A cavity that involves more than two surfaces of a tooth

Simple: cavity involving one tooth surface◦ I: incisal◦ M: mesial◦ D: distal◦ B: buccal◦ O: occlusal◦ F: facial

• Compound: two tooth surfaces• DO: disto-occlusal• MO: mesio-occlusal• MI: mesio-incisal• DI: disto-lingual• LI: linguo-incisal• DL: disto-lingual• OB: occlusobuccal

It was based on the knowledge and evidence available at the time of Black, early 20-th of 20 century and is still used by some people today despite its limitations: it only refers to carious lesions and does not include root or secondary caries.

Class I (Simple)◦ Developmental cavities in

pit and fissures of teeth located in: Occlusal surfaces of posterior

teeth Buccal or lingual pits on the

molars Lingual pit near the cingulum

of the maxillary incisors

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Cavity (Caries) Classifications

• Class II (Compound, Complex)• Proximal surfaces on the posterior teeth

MO restoration MOD restoration

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• Class III (Simple)• Interproximal surface of anterior teeth

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Cavity (Caries) Classifications

• Class IV (Compound)• Interproximal surface of anterior teeth and include the

incisal edge

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Cavity (Caries) Classifications

• Class V (Simple)• Cervical third of the facial or lingual surface of the tooth• Occurs because patient often sucks on sweets

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Cavity (Caries) Classifications

• Class VI ( Simon’s modification) (Simple)• Not part of original standard classification • Later identified in order to more clearly label cavities that

involve the incisal or occlusal surface worn away from abrasion

Black suggested that it was necessary to: ■ remove additional tooth structure to gain access and

visibility; ■ remove all trace of demineralised enamel and

dentine from the floor, walls and margins of the cavity; ■ make room for the insertion of the restorative

material in sufficient bulk to provide strength; ■ provide mechanical interlocking retentive designs; ■ extend the cavity to self-cleansing areas to avoid

recurrent caries.

Preparation is aimed at dissection of decayed dental hard tissues in order to stop further progression of the caries process and the creation of necessary conditions for reliable fixing of filling material, restore anatomical shape and function of the tooth.

Principles of cavities preparation : The principle of "extension for prevention"

(Black) The principle of "biological suitability"

(Lukomskyj).

- Anaesthetizing - Disclosure (opening and extension) of

carious cavity - Necrectomy - Formation of the carious - Finishing (smoothing) the edges of enamel

- transition of the carious cavity bottom (the surface which is turned to a pulp) to the wall should be at right angle

- transition of one wall to another should be at a right angle –the shape of the cavity- is box- shaped form (except the V class)

- enamel edges should be straight and smooth

- bottom of the cavity should be flat or somewhat remind the form of the occlusal surface of the tooth

Non-surgical management of dental caries

Carisolv applicator and Carisolv gel applied to the root lesion.

HealOzone Caries treatment with ozone is based on the fact

that at a certain concentration and exposure time of ozone kills cariogenic bacteria without affecting

healthy cells.