Fillings

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


 * 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

Class I
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)