Classification of carious

lesions and tooth preparation

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 Definition
Dental caries is an irreversible bacterial
disease of the calcified tissues of the teeth.

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 Classification of Dental Caries

(1) Depending on nature of Attack.

(2) Depending on progression of caries.
(3) Depending on surface involved.
(4) Based on direction of attack.
(5) Based on number of surfaces involved.
(6) Based on location of lesion.
(7) Based on tissue involved.
(8) GV Black classification based on
treatment and restoration design.
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 nature of Attack

Primary caries:
- initial.
- first attack on tooth
surface.
Secondary
Caries:
- recurrent.
- occurs on margins or
walls of existing
restoration.
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 progression of caries
Acute:
- rapidly invading process.
- involves several teeth.
- usually pulp is involved at early stag
- Radiation caries.

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 surface involved

- Pit and fissure.

- Smooth surface caries.

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 Direction of caries attack
Forward Caries:
- Proceeds from enamel to dentin.
- Lesion is triangle in shaped with base of
triangle at enamel surface + apex toward
dentin

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Backward Caries:

- Proceeds from DEJ towards enamel

surface
- also triangle shaped with base at DEJ +
apex towards enamel surface

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 Number of surfaces involved

Simple:
- only one surface is involved
by caries.

Compound:
- 2 surfaces are involved.

Complex:
- more than 3 surfaces involved.
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 Location of the lesion

Pit and Fissure caries:

- occlusal
- Buccal or lingual pit

Smooth surface caries:

- proximal
- Buccal or lingual surface

Root caries:
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 Tissue involved

- Enamel Caries.
- Dentinal Caries.
- Cemental Caries.

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 GV Black Classification

Black organized a classification system with

five categories for different patterns of tooth
decay which is still in use today. Since that
time, only one more category has been added
to his classification system.

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Class (I) lesions:
- pits and fissures of posterior teeth.

- Facial &lingual pits of posterior teeth.

- Palatal pit if present in the upper incisors.

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Class (II) lesions:
Caries affecting proximal surfaces of
posterior teeth (molars and premolars).

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Class (III) lesions:
Caries affecting proximal surfaces of anterior
teeth (1, 2, 3, teeth).
- Class 3 cavities do not involve an incisal
angle

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 Class 4(IV) lesions:
Caries affecting proximal
surfaces of anterior teeth
when the incisal angle
requires restoration.

- the angle may have to be

removed because its weak
or for proper placement of
the restoration.
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Class 5(V) lesions:
occur on smooth facial
and lingual surfaces in
gingival third of teeth .

- Class 5 cavities begin

close to gingiva and may
involve a cementum or
dentinal surface as well
as enamel.
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Class 6(VI) lesions:
Lesions found on the incisal edges of
anterior teeth or the cusp tips of posterior
teeth.

This Class was not developed by G.V. Black

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The Man behind the Name:
History:
Greene Vardiman Black (1836
- 1915), commonly known as
G.V. Black, is known as one of
the founders of modern dentistry
in the USA. He was born near
Winchester, Illinois on, 1836 .
and began studying medicine
with the help of his brother, Dr.
Thomas G. Black. In 1857, he
met Dr. J.C. Speer, who taught
him the practice of dentistry.
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 G.V. BLACK
- Who is known as the father of operative
dentistry, he classified carious lesions into
groups according to their locations in
permanent teeth .
- The same classification is used to refer to
cavity preparation.

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He researched many important topics to
dentistry, including the best composition for
dental amalgams, and the cause of dental
fluorosis.

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One of his many inventions was a foot-driven
dental drill.

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" He is also known for his principles of tooth
preparations, The phrase, "extension for
prevention," is still famous in the dental
community today and represents Black's idea
that dentists should follow preventive
measures to aid patients from developing
tooth decay.

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 G . V. B l a c k ’ s P r i n c i p l e s
- Steps of cavity preparation involve the removal
of carious tooth structure and restoration of the
tooth to its original anatomic form with a
suitable restorative material.

- The design of the cavity preparation is

determined first by the location of the caries
lesion in the tooth.

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Although the technology of bonding
restorative materials to enamel and dentin
was not available to black, his steps of cavity
preparation are generally as appropriate today
as they were when he formulated them.

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 G . V. B l a c k ’ s P r i n c i p l e s
Outline form: The shape or outline of the cavity
preparation.
Convenience form: The need to obtain access for the
instruments as the operator is preparing the cavity or
placing the restoration.
Retention form: The need to provide retention for the
restorative material.
Resistance form: Resistance to stress on the
restoration and the tooth to the forces of biting and
chewing.

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 Outline Form
It is defined as the shape of the
boundaries of the completed
cavity. And it is based on the
location and extent of the carious
lesion, tooth fracture, or erosion..

Final outline form is not

established until the carious
dentin and, usually, its overlying
enamel has been removed.

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 Principles of outline form

- All caries should be removed.

- All weakened enamel should be removed to avoid

marginal ditching.‫تجوف‬

- All margins should be placed in a position to afford

good finishing of the margins of the restoration.

- Giving the Cavo surface angle the correct

angulations according to the restorative material
(90˚ for amalgam )

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 RESISTANCE & RETENTION
FORM
They are two faces for the same coin

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 Resistance form

Resistance form refers to design

features in the cavity preparation
which allows tooth and restoration
to resist the masticatory stresses
without fracture.

- Resistance form is obtained by

giving the cavity (box form)

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 Retention Form
Retention may be obtained through mechanical
shaping of the preparation to retain the restoration
and / or via bonding procedures that attach the
restorative material to tooth structure and allows
the restoration to retain securely during function.

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 Convenience Form
It describes those features in the prepared cavity
which improves visibility and accessibility during
preparation and restoration

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 Steps of Cavity preparation

- Initial tooth preparation.

- Final tooth preparation.

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Initial tooth preparation stages

1. Exploration of carious lesion.

2. Outline form and initial depth.
3. Primary resistance and retention form.
4. Convenience form.

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 Final tooth preparation stages
1. Removal of remaining infected dentin
or old restorative material.
2. Pulp protection (if indicated).
3. Secondary resistance and retention form.
4. Procedures for finishing external walls
(smooth surface).
5. Cleaning.

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Removal of remaining caries

It is the removal of any remaining caries left in the

tooth after initial preparation.

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 Removal of remaining caries

Manual excavation Mechanical

excavation by burs

Chemico-mechanical (carisolv)
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 Finishing enamel walls and cavo
surface margins:
It is the development of a specific surface
design and degree of smoothness that
produce:
- maximum effectiveness of the restoration.
- Remove unsupported enamel.
- make the margins smooth and continuous
to facilitate finishing of the restoration.

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For indirect restorations those requiring the
making of an impression of the preparation,
finishing involves making the walls
relatively smooth.

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For direct and indirect restorations not
utilizing bonding, finishing involves
removing any unsupported, weak enamel
and making the cavo surface margin
smoot and continuous to facilitate
finishing of restoration margins.

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For bonded resin composite
restorations, enamel that is
not supported by dentin and is
not going to be exposed to
significant occlusal loading is
frequently allowed to remain
in place and is reinforcing by
bonding to its internal surface.

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 Clean the preparation
BLACK referred to this step as, (performing the
toilet of the cavity) that is mean the cavity should
be clean and dry before insertion of the final
restoration.

• It is aimed to:
-Remove debris, dentin chips, saliva.
-Improve adaptation of final restoration.
-Hinder recurrence of decay.

* This is done using air water spry.

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