OCCLUSAL TREATMENT TODAY
Today pit and fissure caries can be treated with resin products along a continuum of invasion. Follow the links below to access the topic you are interested in, proceeding along a scale from simplest to most complex.
- Fissurotomy or PRR (Preventive Resin Restoration)
- Class I conservative
- Class I, wide , defined as wider inter-cuspally, involving cusp tip encroachment
- Class I, Deep defined as within 1/2 mm of the pulp
- Class I with MTA Pulpotomy or pulpectomy
- Class VI (cusp tip) defects
NEW BENCHMARKS IN TOOTH STRUCTURE CONSERVATION
Unlike GV Black preps, which featured full entry to the depth of dentin and encouraged extension into all susceptible locations on the occlusal surface, today we can be more selective. Consequently, resins help us to conserve more tooth structure than amalgam.
The Fissure sealant, properly executed, prevents caries in susceptible pits and fissures. It is unfortunate that it is so poorly executed in general today.
The Fissurotomy or PRR (Preventive Resin Restoration) removes caries, at times without extending to dentin and may not require anesthetic to place. Extension into susceptible areas may involve opening fissures see Occlusal plasty. A sealant in another area of the occlusal surface can be placed in conjunction with the sealant to fully obturate susceptible or caries-affected fissures and pits.
The Class I, wide entails new awareness of enamel morphology as one approaches the cusp tip, and an awareness of enamel thickness for adequate lifespan. As well, polymerization contraction management enters the fray.
The Class I, Deep involves considerations of caries removal, pulp protection, dentin desensitization, biocompatibility of composite materials,and long term pulpal health. As well, and restoration of enamel support and biomimetic properties so that the restoration will deliver long service life.
All Class I clinical procedures relate in some way to these links on this site:
- Enamel Preparation Axioms
- Dentin Preparation axioms
- Diamonds versus carbides
- Pre-op occlusal assessment
- Pre-op functional load assessment
- Resin selection
- Shade Selection
- Flexural strength and other invisible resin parameters
- Caries removal
- Initial increments
- Incrementing to finish
- Occlusal adjustment and verification