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
Indications:
Restoration of carious lesions
Dental staining
Replacement of failed restoration
Operative process:
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 palatally using a tungsten carbide bur, diamond bur +/- remove existing failed restoration
If feasible, preserve labial enamel surface to improve aesthetic outcome
Remove peripheral soft caries-infected dentine with excavator or carbide rose head bur
Remove deep caries infected dentine, especially when in close proximity with the pulp, ensuring to take great care as to not expose the pulp
(In anterior dentition, removal of both caries infected and affected dentine if feasible, is essential to provide optimal aesthetic outcomes)
Cavity Modification
Ensure sound enamel margins are achieved and create light bevel of margins using fine diamond bur
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