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[1]

  • 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

GV-BLACK.JPG
  • 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[edit]

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

References[edit]

  1. Ole Fejerskov, Edwina Kidd (2004). Dental caries : the disease and its clinical management. Copenhagen [u.a.]: Blackwell Munksgaard. ISBN 9781405107181.