4. Carious cavities classification by Black.

Features of
carious cavities preparation of the 1-st and 5-th Blacks
classes.
It should be borne in mind that normal healthy enamel and dentin
largely depend upon good nutrition during the long formative years of early
childhood when the tooth is being developed. Therefore, nutrition as a
means of developing host resistance is especially important during the
formative years, but it should also be considered in the overall healthy
maintenance of the oral tissues throughout life.
Defects on the crown or root surface of a tooth can arise from one or
more of the following four causes:
. developmental defects in the enamel surface
. bacterial caries
. chemically stimulated dissolution or erosion
. physical abrasion
PROGRESSION OF DENTAL CARIES AND ITS
LOCALIZATION

Superficial dental caries

Medium dental caries
aries starts to develop in fissures, pits, proximal
Once bacteria reach the dentinoenamel junctio
ces of plaque retention, where plaque is undisturbed spread occurs undermining the overlying enamel
progression of carious cavity in dentine.

Deep dental caries

Complication of dental caries (pulp
s reached circumpulpal dentine; thin layer of dentine
a pulp is involved in the inflammation
us cavity from pulp chamber.
progression of carious lesion.

Dental Caries - is a complex pathological process that occurs

after tooth eruption, with subsequent demineralization and softening of
dental hard tissues that leads to cavitation.
Probably the most common problem arises from a combination of
bacterial caries beginning in relation to a developmental defect. This is
confirmed by repeated surveys showing that the most frequent lesion
requiring treatment is occlusal caries, primarily in molars but also in
bicuspids. The next lesion in terms of frequency is bacterial caries
developing in relation to the contact point between pairs of teeth - both
posterior and anterior.
In recent years there has been an increasing problem in relation to
chemical erosion of both enamel and dentine and this can generally be traced
to increased intake of acid food and drink allied to vigorous tooth brushing
shortly after intake. Physical abrasion is generally related to occlusal
irregularities but can often also be related to chemical dissolution at the
same time.
All of these problems can lead to sufficient loss of tooth structure to
require repair or replacement but, at the same time, all can be prevented,
stabilised or healed to some degree. It is important that there is a means of
properly classifying and identifying all these lesions at the time of initial
examination so that a proper logical treatment plan can be formulated to not
only repair the damage but, more importantly, eliminate the cause.

With this approach in mind this material outlines a proposal to

introduce a new classification for lesions of the crown of the tooth and then
goes on to offer some suggestions for repairing the lesions.
It is important to note that the classification does not specify a cavity
design. These essential details must be left to the informed and sound
clinical judgement of the operator whose main aim at all times should be
preservation of as much natural tooth structure as possible.
Eating proper foods for proper health is only a small part of the role
the patient must play in maintaining good teeth and a healthy mouth. His
cooperation and assistance are very important in reducing the effect of oral
microorganisms that contribute to caries. A combined effort on the part of
the patient and the dentist can arrest, delay, and eliminate many of the
carious processes that result in destruction of hard tooth substance. Briefly,
the
roles
of
the
two
might
be
summarized
as
follows:
PATIENT
1. Elimination of foods that serve as nutrients for the microorganisms,
particularly foods ingested between normal meals.
2. Removal of microbial organisms from the teeth (removal of plaque
by brushing, flossing, and so on).
3. Stimulation of circulation of gingival tissues.
4. Use of fluoride-containing dentifrice to make the enamel surface
more resistant to caries.
5. Maintenance of good health with the aid of proper nutrition, and so
on.
DENTIST
1. Periodic cleansing of the teeth.
2. Application of fluoride to the teeth when indicated.
3. Use of sealants on caries-susceptible areas, especially in pits and
fissures, when indicated.
4. Educating, motivating, and assisting the patient in his role of
maintenance and care.
5. Repairing early lesions before substantial destruction has occurred.
Feature of carious cavity forming

Fig. 14.2. A photomicrograph using transmitted light showing the

earliest signs of a caries lesion at the base of an occlusal fissure. Note the
signs of the development of the translucent dentine below the fissure
resulting from the deposition of additional mineral in the lateral tubules as a
result of stimulation of the pulp arising from the presence of the caries.

Fig. 14.3. A scanning electron micrograph of the same lesion shown in

Figure 14.2. Note the level of development of the lesion in the enamel
without overt signs in the dentine. However, the dentine is already involved
as demonstrated in the previous figure.
Classification of dental caries.
Clinical classification of dental caries of teeth is the most
widespread, that takes into account the depth of caries process
distribution. Distinguish thus:
a) an initial caries is the stage of spot;
b) superficial caries is a defect, localized within the limits of enamel;
c) middle caries is the defect, located in
the peripheral dentine, e.g. enamel-dentine junction is ruined;
d) a deep caries is the defect of deep layers of dentine(circumpulpal
dentine), e.g. above the tooth cavity there is an insignificant layer of the
softened and infected dentine

Classication of cavities
Blacks classication

Table.

CA

RIOUS CAVITIES CLASSIFICATION

Sim
ons
modificati
on

CLASSIFICATION BY BLACK(I - V)
Cla

Class II

Cla

Cla

Cl

Clas

ss I

Car
ies
affecting
pits and
ssures;
commonl
y used to
refer to
caries
affecting
the
occlusal
surfaces
ofpremol
ars and
molars.

ss III

ss IV

ass V

s VI

Caries
Cari
Cari
Car
Carie
affecting the
es
es
ies
s-resistant
proximal (contact) affecting affecting affecting (immune)
surfaces of
the
the
the
zones of
posterior
proximal proximal cervical teethteeth (molars and surfaces of surfaces surfaces. cusps
premolars).
anterior of anterior
andequator
teeth(incis teeth and
of the
ors,
also
tooth.
canines). including
the incisal
angle (cutt
ing edge).

G.V. Black was an American dentist who wrote text-books on

dentistry in the early 20th century in which he outlined principles for cavity
preparation. He also described a classication for carious lesions. This
was based on the knowledge and evidence available at the time and is still
used by some people today despite its limitations: it only refers to carious
lesions and does not include root or secondary caries.

Blacks classication is as follows:

 Class I: caries affecting pits and ssures; commonly used to refer to

caries affecting the occlusal surfaces of premolars and molars.
Class II: caries affecting the proximal(contact) surfaces of posterior
teeth(molars and premolars).
Class III: caries affecting the proximal surfaces of anterior
teeth(incisors, canines).
Class IV: caries affecting the proximal surfaces of anterior teeth and
also including the incisal angle(cutting edge).
Class V: caries affecting the cervical surfaces.
Simons modification - Class VI caries-resistant zones of teethcusps and equator of the tooth.
Current methods of cavity classication
Cavities or lesions in teeth are described by the cause of the cavitation
or lesion and by the surface(s) affected.
Nowadays dentist use method of cavity preparation that is calledmethod of biological suitability
Development and distribution of carious in a tooth depending on the
histological features of enamel and dentine
Most often a caries arises up at back fissure molars. In the enamel of
masticatory surface a caries develops depthfirst in the form of triangle with a
top and point of origin. In this connection the defect of destruction on-thespot long time can remain unnoticeable, in spite of that defeat of deep layers
can be considerable.
In a dentine because of large maintenance of organic matters as
compared to an enamel a caries spreads more active not only into depth but
also sideways, especially in area of dentinoenamel connection. Carious
cavity has the edges of enamel, that donot have support of dentine
under itself.
Distribution of caries in a dentine into depth takes place also in the
form of triangle, but with the top directed toward an endodontium.
On the contact (lateral) surfaces of teeth a caries arises up more
frequent. Similarly as well as on a masticatory surface, in the cavities of the
II class a caries spreads as two cones with basing on dentinoenamal
connections. However much character of direction of enamel prisms
determines more wide ingate. The undermined edges of enamel are most
expressed in the direction of masticatory surface and cutting edge.

Distribution of caries is sdws hindered more massive and caries resistance

lateral verges of crown of the tooth. A caries on contact surfaces has a
tendency to distribution in the near neck region of crown. Most carious
cavities of the II class on occasion present difficulties for the exposure and
differentiation because of their hidden localization.
In area of necks of teeth a caries arises up mainly on a vestibular
surface. Its development in the teeth of permanent bite takes place in a near
gum region to the lateral verges of tooth.

When demineralisation becomes dominant and remineralisation fails,

a carious lesion will develop on the enamel or the root surface of a tooth.
Once the lesion has progressed into the dentine there is a need for some level
of surgical intervention to remove the infected dentine, to eliminate surface
cavitation and avoid further accumulation of plaque. In most situations this
will involve removal of a certain amount of enamel to achieve access but it
must be noted that both enamel and dentine are capable of being
remineralised and therefore conserved. The principle of minimal
intervention operative dentistry is based upon maximum preservation of
natural tooth structure to maintain the strength and integrity of the tooth
crown.
Up to the present time the profession has used a classification of
cavities proposed by G. V. Black over one hundred years ago. The
classification was designed before the widespread use of radiographs so
lesions were not diagnosed until they were visible to the naked eye and were
therefore, by modern standards, relatively large.
A further problem was that it was a classification of cavity designs for
amalgam as this was the principal restorative material available. The result
was that, regardless of the size of the lesion, a specific cavity design was
required to deal with it. Today current knowledge offers many alternatives
ranging from earlier diagnosis of caries activity, along with effective
methods of control, to the application of adhesive and bioactive restorative
materials. If our patients are to reap the full benefit of these advances it is
necessary to review both the classification and the approach to the surgical
treatment of lesions when they progress beyond remineralisation alone.
PRINCIPLES OF CAVITY PREPARATION

Basic principles of cavity preparation were developed by Dr. G.V.

Black in the early 1900s and are uniquely applied to each class of caries and
type of restorative material. Today, the application of his principles has been
modified due to the introduction of new dental restorative materials that
were not available in his day. A dentist still needs to consider each principle
when preparing a tooth for a conservative operative restoration.
A. ESTABLISH AN OUTLINE FORM
The outline form of a preparation is the external shape of the
preparation where prepared tooth meets unprepared tooth. It is developed by
removing the least amount of tooth structure possible, yet adhering to the
following principles:
1. EXTEND THE PREPARATION TO SOUND ENAMEL
The dentist enlarges the preparation outline so that it extends to
enamel that has no signs of active decay. Also, when the dentist ends the
preparation on enamel margins, the enamel must be able to withstand the
forces required when placing the restoration and the forces applied during
tooth function. In many cases, this involves extending the preparation to
enamel that is supported by, or resting on, sound dentin that is not
undermined by the spread of caries within the dentin. Since enamel is brittle,
if it is not sufficiently supported by sound dentin and/or bonding techniques,
the unsupported, brittle enamel rods may fracture, leaving a gap between the
tooth and the restorative material.
2. EXTEND THE PREPARATION FOR PREVENTION
The dentist evaluates the need to enlarge the preparation within
enamel beyond the specific area of decay in order to include adjacent tooth
structure felt to be prone to the development of future decay. For example,
when treating a carious pit and fissure lesion, it may be advisable to include
adjacent deep pits and fissures thought to be caries prone, even though they
have not yet become carious. Similarly, when developing the cavity
preparation for smooth surface carious lesions, the outline of the preparation
may be extended to include adjacent smooth surface areas likely to become
carious. The dentist must determine whether or not to extend the outline
based on a risk assessment of that patient. Over the past 35 years, there has
been a tremendous increase in the use of fluoride (in community water,
toothpaste, rinses, and topical applications applied periodically in the dental
office), as well as improved efforts by dental professionals to educate the

population in prevention techniques. Therefore, the need for preventive

extension on smooth surface lesions must be weighed against the possibility
that excellent hygiene and fluoride could stop or even reverse the decay
process, especially if the decay has not progressed too far.
The degree of extension should be based on factors such as the age of
the patient (younger enamel is more susceptible to caries than mature
enamel), the persons rate of caries activity, personal oral hygiene, and
dietary habits. For example, extension for prevention for a tooth preparation
on a younger patient with multiple areas of active decay, poor oral hygiene,
and frequent intake of high-sugar snacks and sugar-containing carbonated
beverages who is unwilling or unable to change is more appropriate than it
would be in an older patient with a lower caries rate, better eating habits,
and good or improving oral hygiene.
3. PROVIDE ADEQUATE ACCESS
A restoration outline must be large enough for the dentist to ensure
that all carious tooth structure has been removed and that instruments
required to insert the filling material will fit. A small, narrow initial cut
through the enamel might not permit the dentist to confirm the removal of
all caries that may have spread laterally at the DEJ. Further, even when the
removal of all caries can be verified visually or by probing, the initial
preparation might be too small to place the restoration without voids.
4. PROVIDE RESISTANCE FORM
The dentist must design a preparation to ensure room for an adequate
thickness of restorative material for strength, and sufficient remaining solid
tooth structure to withstand or resist occlusal forces. This is known as
resistance form. If the preparation depth is inadequate for the material of
choice to withstand occlusal forces, the restoration could break. If the
remaining tooth structure is too thin or undermined, it could fracture.
B. PROVIDE RETENTION FORM
Retention form is the design of a preparation that prevents the
restoration from falling out. The methods for providing retention differ
depending on the restorative material and on the location of the carious
lesion. Retention for amalgam restorations is provided by internal retentive
features, such as retentive grooves, and by the convergence of some
preparation walls. Retention for composite resin restorations is provided by
acid etching the enamel to produce microscopic irregularities (minute

undercuts) on the surface. Then, a first layer of flowable resin (bonding

agent) can flow into the irregularities forming retentive resin tags that, when
hardened, mechanically lock into the microscopic retentive features of the
etched enamel (Fig. 10-8). Layers of the stronger composite resin can
subsequently be chemically bonded to the initial flowable resin layer to
complete the restoration. When using newer adhesive agents, additional
retention is gained by chemical bonds formed between tooth and resin.
C. REMOVE CARIES AND TREAT THE PULP
All principles of the cavity preparation described up to this point
assume that caries has spread just beyond the DEJ into dentin. The dentist
usually prepares the outline form and retention for a cavity preparation to a
depth just beyond the DEJ with a high-speed dental handpiece using carbide
or diamond burs that cut quickly, minimizing the potentially damaging heat
by use of an effective water coolant spray. When removing carious lesions
that have progressed deeper into dentin, the dentist uses slowly rotating
round burs in slow-speed handpieces, or hand instruments. The slow-speed
handpiece, or hand instruments, permit the dentist to differentiate between
the softer carious dentin and the harder healthy or non-carious dentin.
When caries extends close to the pulp, it may be advisable to protect
the vital tissues of the tooth (odontoblasts, blood vessels, and nerves within
the pulp) with dental liners and cement bases prior to placing the final
restoration (Fig. 10-9). Various dental materials have been developed for this
purpose. When used in the appropriate combination and in the correct order,
they can prevent bacterial penetration, provide thermal insulation, sedate the
pulp, or stimulate the production of secondary dentin.
D. FINISH THE PREPARATION WALLS
This step involves using a handpiece with appropriate burs or hand
instruments (chisel type) designed to smoothly plane the walls while
removing unsound enamel (i.e., enamel that is crazed or cracked, or not
supported by sound dentin).
E. CLEAN THE PREPARATION
Prior to the restoration of any cavity preparation, the operator must
remove tooth debris, hemorrhage, saliva, and any excess cement base. In
this way, the restorative material will contact only sound, clean tooth
structure.
F. FINAL EVALUATION OF THE PREPARATION

Finally, it is critical to evaluate the finished preparation to ensure that

all of the principles of cavity preparation have been addressed.
A New Cavity Classification
Dr G. V. Black. The centenary for the introduction of this
classification is well past and there have been many changes and much
progress in the understanding of caries, as well as other forms of progressive
loss of tooth structure. The inherent limitations of the present classification
are far too rigid for simple modification and it is suggested that it is time to
get serious about reviewing the concept.
Probably the most significant discovery that has had a major impact
on the practise of operative dentistry is the understanding of the ion
migration that occurs, both out of and back into tooth structure, as a result of
the caries process. It is now recognised that this is reversible, so the early
lesion can be healed and recognition of the initiation of the disease process
is imperative. After all, a cavity (loss of tooth substance) is an advanced
symptom of a bacterial disease (or chemical dissolution) that has been in
progress for some time. It is also apparent that there is a gradation of mineral
loss from the heart of the lesion outwards to the periphery of the lesion. This
implies that, simply because some section of the tooth is partly
demineralised, it does not necessarily have to be removed because
remineralisation may still be possible.
The second significant discovery is the development of sound long
term adhesion between restorative materials and tooth structure. This not
only reduces the potential for microleakage between restoration and tooth
but also offers the possibility of reinforcing the tooth crown, at least to the
limit of the tensile strength of the material.
A third innovation is the development of a restorative material that is
capable of supporting an ion exchange within the tooth crown. This not only
leads to an ion exchange mechanism for adhesion but also assists the
remineralisation of demineralised enamel and dentine.These three
discoveries alone significantly undermine the original precepts behind the G.
V. Black classification and suggest that there should be change. One of the
greatest advantages of introducing a new classification is the possibility of
recognising all new lesions from the very earliest stage and treating them in
the most conservative minimally invasive manner possible.

At the same time it is necessary to accept that all restorative dentistry

up to the time of the introduction of change will have been carried out using
Blacks principles. In other words, it is essential to take both concepts into
account at the same time because it is not possible to carry out a simple
substitution of one for the other. Breakdown of old restorations needs to be
recognised separately as replacement dentistry. And there is little or nothing
that can be done for these apart from minimising the loss of further tooth
structure.
The following apologia to G. V. Black is offered to assure the reader
that the authors understand the historical significance of a great man and a
leader of the profession.
The G. V. Black Concept
When Black defined the parameters for his classification, the cavity
designs were controlled by a number of factors many of which no longer
apply. Caries was rampant and the role of bacterial flora and the significance
of fluoride were not understood. Radiographs were not in general use so, on
average, a cavity was not diagnosed until it was large enough to be identified
with a sharp probe or seen by the naked eye. By modern standards that
meant it was well advanced. There were limitations in the available
instruments for cavity preparation as well as the selection of restorative
materials. The classification offered a series of cavity designs related to the
site of the lesion but the list was then modified to suit the intended
restorative material. Because all cavities, by todays standards, were large he
did not take into account the increasing dimensions of a cavity, nor the
varying complexity of the method of restoration. Black suggested that it was
necessary to:
remove additional tooth structure to gain access and visibility;
. remove all trace of demineralised enamel and dentine from the floor,
walls and margins of the cavity;
. make room for the insertion of the restorative material in sufficient
bulk to provide strength;
. provide mechanical interlocking retentive designs;
. extend the cavity to self-cleansing areas to avoid recurrent caries.
In his designs Black showed commendable respect for remaining
tooth structure as well as occlusal and proximal anatomy but it was
necessary to sacrifice relatively extensive areas of enamel and dentine to

achieve his goals. Other far more effective methods of dealing with a carious
lesion are now available. With modern understanding of adhesion and
remineralisation it is no longer necessary to remove all unsupported
demineralised enamel around the cavity margin, the concept of selfcleansing areas has been discarded and removal of all affected dentine from
the axial wall of the cavity is strictly contraindicated because of the potential
for remineralisation and healing.
Many of the old limitations no longer apply and it is now appropriate
to think again about the problems presented by a carious lesion. Without in
any way denigrating the achievements due to Blacks concepts and work, the
following thoughts are offered and a new approach to the definition of cavity
design is outlined. The proposed classification is designed for the
identification of lesions from the very earliest stage of demineralisation and
to define their increasing complexity as the lesion extends. It is expected to
provide benefits for both the profession and their patients.

Preparation is aimed at dissection of pathologically altered dental

hard tissues in order to stop further progression of the caries process and the
creation of necessary conditions for reliable fixing of filling
material, restore anatomical form and function of the tooth.
There are several principles of cavities preparation:
The principle
of "extension for prevention" (Black)- preventive extension of the cavity
boundaries, is aimed to dissect caries- unstable areas (pits and fissures) to
the so-called immune zones that are relatively rare is affected by dental
caries (cusps, smooth convex surface equator).
The principle of "biological suitability" (Lukomskyj) - the dissection
of tooth tissue is sparing, preparation is finished within the visibly healthy
tissue. Thus, the basic principle that should be guided: during the carious
cavity preparation the full dissection of pathologically
altered tissue and sparing treatment of not decayed tissues of
enamel anddentin is preferable.
During the preparation of dental hard tissues, the Blacks
classification is used by clinician.
However, regardless of cavity location, there are common stages
of dental hard tissues preparation, which are come to:
Anaesthetizing
Disclosure(opening and expansion(extension)) of cavity ( is
conducted by using round-shaped, fissures burs, burs that is chosen,
should have the size of the working end not bigger than the entrance
aperture of this cavity)
-

Necrectomy

Formation the cavity for fillings (is conducted with fissures,

inverted-cone and cone-shaped burs)
-

Smoothing the edges of enamel

Necrectomy - is a removal of the decayed tissues from carious cavity.

There are total and partial necrectomy. Total -is a complete removal
of necrotic dentin from the walls and bottom of
the cavity. Partial - is complete removal of necrotic dentin from walls

and partly from the bottom of the cavity. Partial necrectomy is allowed in the
case of deep dental caries, when the layer of dentine in the bottom of
the cavity is very thin and there is a danger of the pulp horn disclosure. In
this case is permitted to leave on the bottom of the carious cavity a layer of
dense pigmented dentin, and in the course of acute deep caries is allowed
to leave a thin layer of softened dentin on the bottom of the cavity with the
next remineralization influence on it. Necrectomy is conducted with the
help of round-shaped burs and the excavator.
Elements of the cavity: floor, walls, corners, edges. There are terms
such as main and additional cavity.
The main cavity is created in the place of pathological focus,
additional cavity is created within the healthy tissues, for the better retention
of the filling material.
Features of cavity formation, mainly, depend on the localization
of the pathological process and the group of teeth.
However, there are general rules for the preparation of cavities,
namely they are:
transition of the carious cavity bottom (the surface which
is turned to a pulp) to the side wall should be at right angle
transition of one wall to another should be at a right angle the
form of the cavity- is box- shaped form (except the V class)
-

enamel edges should be straight and smooth

bottom of the cavity should be flat or somewhat remind

the form of the occlusal surface of the tooth
Dissection of tooth tissues for filling with composites materials is
slightly different from the traditional preparation by Black. This is because
the traditional preparation is used for mechanical retention of fillings in the
carious cavity. Composite materials have an ability to bind chemically
to the tissues, so there is no need to prepare walls at right angles.
However, you must create enamel bevel at an angle of 45 degree, around
the edge of the cavity to increase the adhesion and to mask the line
of transition "enamel-composite material".

PECULIARITIES OF BLACKS PREPARATION

1. According to Blacks preparation, a cavity of the I class should
be: with straight walls at right angle to the bottom, a shape of the cavity
could be cylindrical, square, rhombic, X-like;
2. According to Blacks preparation, a cavity of the II class should
be: if there is no neighbouring tooth and the carious cavity is localised below
the equator, it is formed on the proximal surface; when an access is
complicated, a cavity is extended to the occlusal surface and an additional
cavity is formed there, additional cavity occupies the 1/3 1/4 length of the
occlusal surface. Peculiarities of a carious cavity disclosure of the II class
according to Black preparation: an access is gained from unaffected occlusal
surface.
3. According to Blacks preparation, a cavity of the III class should
be: with a shape of triangle; if teeth are stand tightly one to another it is
extended to the lingual surface, and an additional cavity is formed there;
disclosure of a carious cavity of the III class according to Black preparation
is done: an access is gained from a lingual surface, in some rare cases, from
a labial surface.
4. According to Blacks preparation, a cavity of the IV class should
be: an additional cavity is formed either in the area of incisal edge (when it
is wide) or on the palatal (lingual) surface within the limits of dentin.
5. According to Blacks preparation, a cavity of the V class should
be: in an oval shape, walls and the bottom should be at the right angle,
bottom is convex, because of pulp proximity at cervical area, thus preventing
pulp exposure.
BASIC PRINCIPLES AND SEQUENCE OF LOCAL
TREATMENT OF DENTAL CARIES
AT CARIOUS CAVITIES OF I CLASS
1. Anaesthetizing. One of basic terms, co - operant to correct
implementation of the requirements produced to every stage of treatment,

there is painlessness of manipulations. Therefore along with the observance

of complex of methodical receptions diminishing influence of mechanical,
temperature and chemical irritants, it is necessary to apply one of methods of
anaesthetizing. Stomatological practice disposes by the great enough choice
of medications and methods of warning and removing pain:
premedykatsyya, electro-anaesthetizing, use of appliques facilities,
toponarcosis, common anaesthetizing and other
2. Opening of carious cavity. Sizes of hearth of defeat of dentine on
the masticatory surface of molars and premolars, as a rule, more area of
defeat of enamel, in this connection the overhanging edges of enamel appear.
Opening of carious cavities in frontal teeth

Opening carious cavities in back group teeth

The stage of opening of carious cavity foresees the delete such
overhanging edges of enamel, not having under itself supports of dentine,
that is accompanied by expansion of narrow ingate in a carious cavity. It
allows in future to apply the bur of largeness, possessing the best cuttings
properties, it is good to review a cavity and freer to manipulate in her by
instruments.
On this stage it is expedient to use the cylindrical (fissural) or
spherical burss of small size in accordance with the sizes of ingate of carious
cavity or even a few less .
3. Expansion of carious cavity. At expansion of carious cavity align
the edges of enamel, excise staggered fissural, round acute angles. Extend a
cavity by the fissural bur of middle and large size.
4. Necrectomy. On this stage finally the staggered enamel and
dentine delete from a carious cavity. The volume of necretomy concernes
by the clinical picture of caries, localization to the carious cavity, by its
depth. It is necessary to carry out preparing of bottom of carious cavity
within the limits of area of the hypercalcinated (transparent) dentine. It
concernes by the method of sounding of bottom of cavity by an instrument
(probe, power-shovel). On a day it is possible to abandon the dense
pigmented layer of dentine only. At the sharp flow of carious at children, if

there is the danger of dissection of cavity of tooth and injuring

of pulp, on occasion possibly maintainance of small layer of the softened
dentine.
It is necessary to mean during the leadthrough of necretomy, that in
area of dentynoenamel connection in areas interglobular and near pulp
dentine there are areas very sensible to the mechanical irritation.
A necretomy is conducted through power-shovels or spherical bur.
Application of back conical or fissural bur during treatment of bottom of
cavity at a deep caries is eliminated, because dissection and infecting of
endodontium is here possible.
5. Forming of carious cavity. Purpose of this stage to create
favourable terms co - operant to the reliable fixing and protracted
maintainance of the permanent filling.
At a superficial and middle caries a cavity is most rational with
sheer walls, direct corners, flat bottom. The form of cavity can be threecornered, rectangular, cruciform, to correspond to the anatomic form of
fissure.
During forming of bottom of cavity at a deep caries it is necessary to
take into account the topographical features of cavity of tooth. Because of
the near liking of horns of pulp for the corners of cavity a bottom is formed
as the small deepening in safe done.
For the best fixing of filling in the better saved walls of cavity it is
necessary to create strong points as ditches, deepenings, notches or form a
cavity with the gradual narrowing toward an ingate. Back conical uses at
forming to the cavity, by the spherical, wheel-shaped burss.
6. Smoothing (finiring) out of edges of enamel. Duration of
maintainance of the permanent filling in a great deal concernes by correct
implementation of the stage of smoothing out of edges of enamel.

Outside of enamel prisms at an ingate in a carious cavity, as a rule,

does not have support from the side of subject dentine and is the area of the
least resistance to masticatory pressure. Break of undermined edges of
enamel quite often conduces to appearance of relapse of caries.
Smoothing out of edges of enamel is made carborundums stone. To
form on the edge of cavity of slant (falts) is thus foreseen under the corner of

45. Got falts like the hat of nail protects filling from axial displacement
under the action of masticatory pressure. The edge of enamel after
smoothing out must be even and to have not notches.
It is necessary to underline that at filling by an amalgam falts is
formed on all depth of enamel a metallic deposit in the superficial layer
of enamel, and at the use of polymeric materials falts is not needed, the
edges of enamel smooth out only. Smoothing out of edges of enamel under
the corner of necessary for materials not possessing adhesion.
7. Washing of cavity. Carious cavity after preparing and forming
release from dentinal sawdust by the stream of air, waters or wash at
wave the waddings marbles moistened in solution of weak antiseptic. The
matters
applied here not must render irritating operating on mash.
8.
Medicinal treatment of cavity. On all stages of preparing of
carious cavity instrumental treatment must combine with medicinal for
rendering harmless of the infected dentine, To that end apply weak
solutions of disinfectant preparations (3% peroxide, 1% solution of
chloramine, 0,1 % solution of furatsilin and other).
Use of drastic and irritating matters impermissible.
Medicinal treatment is completed by the careful drying of cavity by
warm air (at a superficial and middle caries it is possible before it to process
a cavity by an ethyl spirit, and then ether).
9. Imposition of medical paste.
At treatment of deep caries in the formed cavity it is necessary to
create the depot of medicinal preparations for diminishing of
pathogenicity of bacteria of infactioned dentine, liquidation of reactive
displays from the side of pulp, calciphylaxis of bottom of cavity and
stimulation of deposit of subtitutable dentine. Pastes are prepared on water
or oily basis, bring in a cavity through a small flatter and carefully make
more compact on a day.
10. Imposition
of the insulating
linings. With the purpose of
prevention of alteration of medicinal preparations, office workers as the
medical lining, paste with the medicinal matter is covered by the layer of
artificial dentine which executes the function of the insulating lining.
Over lining from a dentine place a phosphate-cement. Lining must evenly
cover a bottom and dentine of walls of cavity, on possibility to change not its

form and close not additional strong points. On occasion fixative lock
likeness points form linings in walls.
Lining material is brought in a cavity through flatters and pluggers,
distribute him on a bottom and walls by the indicated instruments or powershovel.
11. Imposition of the permanent filling. The prepared filling material
is brought in the treated cavity through a plugger or flatter, is carefully
ground in to the bottom and walls of cavity, turning the special collection on
the complete closing of lining from phosphat-cement. Make more compact
filling a capitate plugger, form by a flatter. At filling by amalgam with
the same purpose use the different pluggers of the special construction.
At forming of the permanent filling pay attention to renewal of
anatomic form of crown of the tooth.
For renewal of functional ability of tooth of him it is necessary to
enter in the contact with an antagonist. To that end to the moment of the
complete hardening of filling it is offered to the patient carefully and not
strongly to close teeth (in ortognatic or bite usual for him) and do lateral
masticatory motions. The surplus imposed filling material is deleted by a
flatter, wadding tampon (filling from an amalgam) or carborundums stone
(fillingss from cements and plastics).

Teeth after treatment

12. Polishing of filling.

After the complete hardening of the permanent filling make its

polishing and polishing. For this purpose by the bur or karborundums stone
smooth out burries and roughnesses on-the-spot fillings. Polishing of fillings
is carried out through finires, polishers and rubbers circles. At the final
finishing of fillings contiguities of hard fabrics of crown of the tooth pay the
special attention to the scopes with fillings material.
Outline form of a cavity preparation.

Resistance form of a cavity preparation.

Retention form placed in the cavity preparation

Convenience form is used for easy access to tooth decay.

Cavity wall: Side or surface of a tooth prepared

for restoration.
Internal wall: Cavity wall that does not extend
to the external tooth surface.
External wall: Portion of the tooth preparation
that extends to the external tooth surface,
named according to the tooth surface involved:
distal, mesial, facial, lingual, and gingival.
Axial wall: Internal wall of prepared tooth that
runs parallel to the long axis of the tooth.
Pulpal wall: Internal wall of prepared tooth that
is perpendicular to the long axis of the tooth;
also known as the pulpal floor.
Line angle: Angle formed by the junction of two
walls in a cavity preparation (similar to the angle
formed where-two walls of a room meet to form
a corner). To identify a line angle, the names of
the two involved walls are combined.*

Information was prepared by Levkiv M.O.