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G.V. Black Classification

Classes of Cavitated LesionsClass I - pits and fissures

Class II - proximal surfaces of posterior

teeth

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Restorative Materials

Amalgam

Composite

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Lesion-Specific Restoration

vs

Material Specific Restoration

Material-Specific E.g. The use of

amalgam to restoreClass I and II caries

lesion

Cavity form is basedon the physical

properties and the

technique used for

placing the material

Lesion-Specific E.g. The use of

composite resin torestore Class I and II

caries lesion

Cavity form is basedon the location and

size of the lesion

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Advantages (vs amalgam)

Conservation of tooth structure - overall astronger restored tooth

More esthetic

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Cavity PreparationPRINCIPLE

The outline form/extension of thepreparation should bedictated by the size andthe location of the lesion.

Cavosurface margin andall internal surfaces aresmooth

RATIONALE

Conservation of toothstructure

Viscous compositematerial will not adaptwell into rough orirregular surface

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Cavity PreparationPRINCIPLE

All aspects of thepreparation should beaccessible to the curinglight

The preparation shouldbe free of foreign debris

RATIONALE

Direct light contact isrequired for

polymerization of the

resin

Allow for optimalbonding

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Pits and Fissures Caries (Class I)

Cavity Preparation

Locate lesions (diagnosisof lesions)

Use of an appropriatebur (about the size of the

lesion) to gain access to

the lesion through the

groove/pit

Remove lesion and looseenamel

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Diagnosis of Pits and Fissures

Lesions Radiographs - limited

usefulness except for

deep lesions Explorer - limited

usefulness (wedgingeffect)

Visual - primarydiagnostic tool

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Lesions Use an explorer to removeplaque and food debrisfrom the fissure orifice Under good lighting,isolation (dry) andmagnification; visuallyinspect for any damage tothe enamel Look for any subtle colorchanges around the pits andfissures

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Lesions

Enamel is low in opacity, thus anychanges in color (e.g. caries dentin)

in the underlying dentin will showthrough the enamel

Look for a gray shadow or opaquearea around the pits and fissures - a

halo Ignore the color change within thepits and fissures

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Accessing the lesion through

the groove/pit245 fissure bur

Enamel

DEJ

Dentin

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Direct visual access to the

lesion

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Caries removal using a round

bur on a slow speed handpiece

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Unable to remove all the lesion

due to limited access

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Increase access - remove

remaining lesionEnlarge the access

area until you are

able to visually

inspect the DEJ;

Because caries start

spreading laterally atthe DEJ, any

discoloration at DEJ is

an indication of the

presence of caries

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Class I Cavity Preparation

Pre-Op

Preparation

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Preventive Resin Restoration (PRR)

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Diagnosis of Proximal CariesPrimary diagnostic tool

- bitewing radiographs

Secondary diagnostic tool- visual (looking for

changes in the opticalproperities of the marginal

ridge under bright light)

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Proximal Caries (Class II)

Cavity Preparation

Proximal carieslesion is usually

located lingual and

gingival to the

proximal contact

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Class II Composite Restoration

Cavity PreparationPenetrate through the

marginal ridge until you

reach the lesion, then extend

buccally, gingivally andlingually (as needed) to

remove the lesion

Initially leave a thin layer of

enamel at the proximal areato prevent accidental

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Class II Composite Restoration

Cavity Preparation

Due to the shape of

the bur, there will

be loose enamel

at the margin

(buccal and lingual

proximal)

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Matrix

Toffelmire matrix system Dr. Hildebrandts manual pp. 3.C.24 - 3.C.26 .0015 or .001 (ho-band) Good wedging is vital to getting good proximal

contact (if lesion dictate the complete removal of theproximal contact area)

Well burnished Other matrix systems

Palodent System - Bitine ring

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Tofflemire Matrix System

Instruction - Dr.Hildebrandts manual

pp. 3.C.24

Burnish the band usingan egg burnisher on a2x2 gauze (at least 3layers)

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Plugger - for placing posteriorcomposite

SuperPlugger

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Using an explorer, remove excess from the embrasure area before

curing. Avoid direct operatory light.

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Build to slightly overcontour

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After curing of the final increment, ready to

remove the tofflemire band

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Finishing/PolishingTechniques

Finishing burs Needle shape finishing bur (7902) for bulk removal of

excess composite at the embrasures (buccal, lingual

and occlusal) Egg shape finishing bur (7404) for creating occlusal

anatomy and adjusting occlusal contact

#12 Bard-Parker blade for removing gingival overhangand excesses at the buccal and lingual embrasures

Soflex disks for final finishing and polishing at theembrasures (buccal, occlusal, lingual)

Enhance/PoGo composite finishing system (occlusalsurface)

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Soflex Disks

For finishing and polishing Course, medium, fine and

superfine

Course and medium -finishing

Fine - finishing/polishing Superfine - polishing Extra-thin series -

excellent for finishing/polishig embrasures area

Plastic backed; extra

thin series

Paper backed; thicker series

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After removal of matrix band

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#7902 finishing bur for gross removal of excesses on bu, li and occl

embrasures

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#12 Bard-Parker blade for removing gingival overhang

and excesses on buccal/lingual embrasure area

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Alternative instruments to #12 Bard-Parker

2-3 KnifeContour 1-2

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Solflex disks to finish the embrasures/margin area; in

a SLOW/continuously moving motion

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Lesion becoming accessible/visible

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Removal of lesion

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Finished Preparation

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Toffelmire Matrix

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Total Etching

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Remove excess adhesive/composite

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Occlusal adjustment using #7404 finishing bur

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Using the solfex disk for final finishing and polishing

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Final Restoration

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Laboratory exercise

Distal composite on tooth #20 Box form Buccal extension

Buccal wall still in contact Gingival extension

1/2 mm clearance fromadjacent tooth

Buccal-lingual dimension

3 mm

Lingual wall clear contact Mesial-distal dimension

1 to 11/4 mm axial depth

Documents

Class I & II comp-2008