The most common among all types of lesions of the oral cavity received caries. The development of this disease is described in dentistry as an intensive destruction of enamel and dentine crowns. In the process of caries development, there are two stages: the first is a carious stain, the second is thinning and erasing the hard tissues of the tooth. Abundant human consumption of carbohydrates contained in thermal food, and the intensive formation of a soft plaque lead to the rapid reproduction of harmful bacteria that damage the integrity of the dental crown.
In dentistry, there are a number of factors that increase the destructive effect of carious formations: oral hygiene, the consequences of the transfer of certain diseases, lack of vitamins and minerals in the body, a steady state of stress.
The danger of caries lies in his ubiquitous manifestation - From the fissure to the gill areas of the teeth. Depending on the localization of the cavity, the process of the disease is different. To standardize the treatment methods of each practical case in dentistry, a classification of carious structures is carried out.
One of the most successful classifications to date. was offered by dentist J. Black. It allows you to identify features of the process for each class, to choose the appropriate method of filling carious tooth, most accurately characterize the position of the painful area on the tooth surface.
Content
Classification of carious formations proposed by J. Black
Total Blek was allocated five classes. The main condition for their separation is the localization of the carious area on the tooth surface. Defeat can be fixed in one area - in premolars, fissures, dimples of molars, canines and incisors; on two or more sites, the occlusal, medial or distal surface of molars, premolars, canines and incisors.
First grade
According to Blek in this case, the formation of carious cavities occurs in the fissures - in the chewing, cheek and palatal cavities. With dental treatment It is necessary to consider the risk of breaking the seal as a result of high pressure on it. In this case, dentists use the imposition of an additional layer of filling material.
The method of laying the composite for different curing materials differs: for light curing the material fit oblique lines in relation to the bottom of the affected area, for the chemical - the composite is applied parallel to the bottom. The superimposed layers correspond to the direction from the middle of the cavity to its edge, and the luminescence is realized along the side walls and perpendicular to the chewing surface. Thanks to such operations there is a tight fit of the seal.
Stages of sealing - I class.
- anesthesia of the cavity
- drilling a sealable area to reach hard tissue
- isolation of the pulp from the composite, if necessary
- exclusion from the prepared site of acids and saliva
- primer overlap if necessary
- applying adhesive
- carrying out the main procedure: the imposition of layers of curing material
- composite curing
- processing and polishing seals
- final cure
Second class
According to Blek, in this case the formation of carious cavities occurs in molars and premolars on their contact surface. There are certain difficulties in the treatment of diseases of the second class associated with the application of filling material. Due to the resulting overhang, the gums may undergo inflammation. In such a case, Black provides for the use of dental instruments — matrices and wedges — to prevent painful contact. The matrix is set between the teeth adjacent to the affected area. The wedges fixing the matrix are moistened with water to displace the tooth.
Another difficulty lies in the fact that the strength of the composite is determined by the position of caries in the cavity, and if the area with dentine is affected, the composite loses its adhesive properties. Then use of the adhesive is highly recommended.
Stages of sealing - Class II:
- anesthesia of the cavity
- initial preparation,
- gum correction if necessary
- installation of the die and retaining wedges,
- teething if necessary
- isolation of the pulp from the composite, if necessary
- exclusion from the prepared site of acids and saliva
- primer overlay
- applying adhesive
- restoration of enamel when it is removed, if necessary
- carrying out the main procedure: the imposition of layers of curing material
- matrix and wedge extraction,
- composite curing
- processing and polishing seals
- final cure
Third and fourth grades
According to Bleck in this case, the formation of carious cavities occurs on the surface of the incisors and canines, as well as their cutting edges. The main difficulty is is the choice of colors for the composite, because we are talking about the preparation of the front teeth, and therefore, the area most remarkable to others. The dentist needs to have an idea about the degree of transparency of enamel and dentin to impart a uniformity of natural tissue and filling.
Stages of filling - III and IV classes:
- exclusion from the cavity of a raid
- definition of enamel and dentin transparency
- anesthesia of the cavity
- setting the matrix if the gingival margin is affected
- isolation of the pulp from the composite, if necessary
- restoration of tooth contours, if necessary
- exclusion from the prepared site of acids and saliva
- primer overlap if necessary
-
applying adhesive - carrying out the main procedure: the imposition of layers of curing material
- extraction of the matrix, if used
- composite curing
- processing and polishing seals
- final cure
Fifth grade
According to Blek in this case, the formation of carious cavities is localized in the area located in the cervical (gum) part of the tooth. The main problem for the dentist when curing a disease of the fifth class will be the determination of the depth of carious lesions relative to the gums. Serious damage complicates the treatment procedure by adjusting the gingival margin of the tooth. A pre-sealing operation is added to the basic installation process of the curing material. According to the recommendations of Black, a composite is selected depending on the location of the affected area.
Stages of filling - class V:
- exclusion from the prepared area of the raid,
- definition of enamel and dentin transparency
- anesthesia of the cavity
- removing softened tissue
- adjustment of the gingival margin of the tooth, if necessary
- setting the matrix if the gingival margin is affected
- isolation of the pulp from the composite, if necessary
-
exclusion from the prepared site of acids and saliva - primer overlap if necessary
- applying adhesive
- carrying out the main procedure: the imposition of layers of curing material
- extraction of the matrix, if used
- composite curing
- processing and polishing seals
- final cure
Sixth grade
In the standard classification Bleka initiated by WHO a new class was introduced localization of caries - mounds of molars, cutting edges of canines and incisors. The introduction of the sixth class was preceded by cases in dental practice, when the patient had a pathological abrasion of the tooth enamel on the protruding surfaces of the crown.
Thus, it is not recommended to be limited to the usual filling, applicable in cases described by Blek. The cure of pathology requires expert interventionable to correct the defective bite of the patient and introduce artificial crowns into the cavity. After such manipulations, the following problem may appear: the molar that is being sealed loses contact with the antagonist tooth, causing the natural occlusion of the jaws to be disrupted, so composite veneer should be used during preparation, which will allow to fill the gaps between the affected area and adjacent and opposite teeth.
Tasks assigned to a specialist in the process of caries treatment
In practice, the dentist must adhere to a set of rulesrelated to the treatment and prevention of dental caries. Below are the main tasks for the specialist to eliminate the negative effects of the treatment:
- The seal does not fit into the affected tooth without first cleansing the carious cavity
- Damaged dentin is removed completely, if this is not prevented by an exceptional practical case.
- Damaged enamel is removed completely.
- The affected tissue is removed due to the exclusion of infection of the oral cavity.
- The cavity is exposed to boron in order to ensure the retention of fillings and the resistance of dental tissue
- Prevention of recurrence of caries
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