Black's classification of carious lesions:
Class I - Restorations of the occlusal surface of premolar and molars or lingual surface of anterior teeth
Class II - Restorations of the proximal surfaces of posterior teeth
Class III - Restorations of the proximal surfaces of anterior teeth without incised edge involvement
Class IV - Restorations of proximal surfaces of anterior teeth with incised edge involvement
Class V - Restorations of the cervical margin
Indication:
Restoration of carious lesions
Traumatic fracture of coronal enamel/dentine
Restoration of incised tooth wear with superimposed caries
Dental staining
Replacement of failed restoration
Procedural steps:
Preoperative
Check palatal guiding occlusion with articulating paper
Select enamel and dentine composite shade utilising Vita guides under natural light prior to commencing the procedure
Administer local anaesthetic for deep carious lesions or patient discomfort expected
Place rubber dam utilising clamps, wedgets and floss to ensure dental dam is securely placed at the cervical margin fully exposing carious lesion
Caries removal
Access carious lesion using a tungsten carbide bur, diamond bur or bioactive glass/ alumina air +/- remove existing failed restoration
Remove soft caries-infected dentine with excavator or carbide rose head bur
(In anterior dentition, removal of both caries infected and affected dentine if feasible, is essential to provide optimal aesthetic outcomes)
Remove any additional extrinsic staining with sodium bicarbonate air polishing or bioactive glass air abrasion
Cavity Modification
Create long undulating enamel margin bevel labially using a fine diamond bur with a short bevel palatally/lingually
Round off any remaining sharp angles at cavity edges
Wash and dry thoroughly to remove any remaining debris
Once cavity prepared, prior to etching, place a clear matrix strip interproximally securing in place with wedges