CLASS I RESTORATIONS

OCCLUSAL TREATMENT TODAY

Pit and fissure caries occur along a continuum. Follow the links below to access the topic you are interested in, proceeding along a scale from incipient lesions with simple resolution  to advanced and needing complex treatment.

• Sealants
• 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

GV Black preps required full entry to the depth of dentin and encouraged extension into all susceptible locations on the occlusal surface. Today, however, using adhesive materials we can be more selective. Composite resin materials 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. It may not require anesthetic to place.   A sealant in another area of the occlusal surface can be used, while resin is used to restore caries-affected pit and fissures.

The Class I conservative restoration entails new modes of preparation following enamel axioms to ensure sound marginal adhesion, and a number of other departures from amalgam method.

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.

LINKS

All Class I clinical procedures relate in some way to these links on this site:

• Enamel Preparation Axioms
• Dentin Preparation axioms
• Diamonds versus carbides
• Isolation
• Pre-op occlusal assessment
• Pre-op functional load assessment
• Resin selection
  • Opacity
  • Shade Selection
  • Polishability
  • Flexural strength and other invisible resin  parameters
• Caries removal
• Bonding
  • etch
  • primer
  • adhesive
• Cure
• Initial increments
  • Flowable resin
  • DC Flowable resins
  • Bulk Fill resins
• Incrementing to finish
• Occlusal adjustment and verification
• Polishing

GO BACK TO HANDBOOK OF COMPOSITE TECHNIQUE