Fillings

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This is a learning resource about dental fillings.

Caries diagnosis

• Clean tooth (water + air)
• Dry (air)
• Bright light
• Magnification?
• Sharp / Blunt probe (international variation). Better tactile feedback with sharp probe, but more likely to cause cavitation of lesions which were not cavitated before.
• Trans-illumination (caries shows up as shadow)
• X-ray
• Clinical experience. Not an exact science, much variation with regards caries diagnosis from one clinician to the next

Management algorithm

• Active or inactive caries? Soft, sticky – active, hard, smooth – arrested
• Cavitated or non-cavitated? Probe “catching” - cavity

No carious lesion			No treatment
Carious lesion	Inactive lesion		No treatment
	Active lesion	Non-cavitated lesion	Non-operative treatment
		Cavitated lesion	Operative treatment
Existing filling	No defect		No replacement
	Defective filling	Ditching, overhang	No replacement
		Fracture or food impaction	Repair or replacement of filling
	Inactive lesion		No treatment
	Active lesion	Non-cavitated lesion	Non-operative treatment
		Cavitated lesion	Repair or replacement of filling

• Non-operative treatment: requires patient education and motivation, fluoride (toothpaste, mouthrinse, topical), plaque control, dietary modification (decrease frequency of sugar)
• If non-operative management is not working, caries will progress
• Dentin cannot remineralize if enamel is present over the dentin
• In the real world, patient's cosmetic concerns often demand restoration even if a cavity is arrested

GV Black classification

• Class I - pit and fissure caries (anterior or posterior teeth)
• Class II - approximal surfaces of posterior teeth
• Class III - approximal surfaces of anterior teeth without incisal edge involvement
• Class IV - approximal surfaces of anterior teeth with incisal edge involvement
• Class V - gingival/cervical surfaces on the lingual or facial aspect (anterior or posterior)
• Class VI - incisal edge of anterior teeth or cusp heights of posterior teeth

Class I

Minimally invasive operative intervention

• Enamel biopsy (start cavity, if no caries in fissure, abort and fill with fissure sealant)
• Preventative resin restoration (remove enamel caries in fissures, fill with fissure sealant alone, or with glass ionomer/composite then fissure sealant)

Caries has been removed from this cavity but there remains unsupported enamel. Enamel is very brittle and without any underlying dentin it will quickly fracture off during function