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

• 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

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)