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
Extensive occlusal wear
Tooth fracture
Replacement of defective restorations
Due to the high occlusal forces posteriorly, restorations must have high strength, wear resistance and durability. Possible restorative materials include;
Resin composite
GIC
RMGIC
Amalgam
Procedural Steps:
Preoperative
Review occlusion with articulating paper prior to commencing to identify occlusal contacts and guide cavity preparation
Select composite shade utilising Vita guides under natural light prior to commencing the procedure
Administer local anaesthetic for deep carious lesions or patient discomfort expected
Isolate tooth using clamps and rubber dam, however, if incomplete visualisation of lesion, consider continual aspiration without isolation.
Caries Removal
Access carious lesion with tungsten carbide bur
Remove peripheral infected dentine with excavator or carbide rose head bur
Remove deep infected dentine with excavator, with great care taken when in close proximity to the pulp to prevent pulpal exposure
Cavity Modification
Ensure sound enamel margins are achieved and
Round off any remaining sharp angles at cavity edges and create a light bevel of enamel margins using a fine diamond bur
Smooth cavity walls with slow speed carbide rose head bur
Wash and dry thoroughly to remove any remaining debris
Once cavity prepared, prior to etching, place either a matrix band and secure in place with wedges or a sectional matrix