DR SUNNY PUROHIT

PEDODONTIA
SDCH
Class I lesion
Lesions that begin in the structural defects of
teeth such as pits, fissures and defective
grooves.
Locations include
• Occlusal surface of molars and premolars
• Occlusal two-thirds of buccal and lingual
surfaces of molars
• Lingual surface of anterior tooth
Class II Lesions

They are found on the proximal surfaces of the

bicuspids and molars.
 Areas for class II decay involve:
 Two-surface restoration of a posterior tooth.
 Three-surface restoration of a posterior tooth.
 Four- or more surface restoration of a posterior
tooth.
Class III lesions

Lesions found on the proximal

surfaces of anterior teeth
that do not involve or
neccesitate the removal of the
incisal angle.
Lesions found on the proximal
surfaces of anterior teeth
that involves the incisal angle.
Class V lesion

Lesions that are found on the gingival third of the

facial and lingual surfaces of the anterior and
posterior teeth.

Class VI

Lesions involving cuspal tips and incisal edges of

teeth.
• Class II: Cavities on single proximal surface of
bicuspids and molars.
• Class VI: Cavities on both mesial and distal
proximal surfaces of posterior teeth that will
share a common occlusal isthumus.
• Lingual surfaces of upper anterior teeth
• Any other usually located pit or fissure
involved with decay.
 CAVITY FEATURE
Simple cavity A cavity involving only one tooth
surface

Compound cavity A cavity involving two surfaces of

a tooth

Complex cavity A cavity involves more than two

surfaces of a tooth.
 Class I: cavities involving the pits and fissures of
the molar teeth and the buccal and lingual pits of
all teeth.
 Class II: cavities involving proximal surface of
molar teeth with access established from the
occlusal surface.
 Class III: cavities involving proximal surfaces of
anterior teeth which may or may not involve a
labial or a lingual extention.
Class IV:
• Cavities of the proximal surface of an anterior
tooth which involve the restoration of an incisal
angle.
Class V
• Cavities present on the cervical third of all
teeth of all teeth including proximal surface
where the marginal ridge is not included in the
cavity preparation.
 Pit and fissure cavities
 Smooth surface cavities
 This new system defines the extent and
complexity of a cavity and at the same time
encourages a conservative approach to the
preservation of natural tooth structure. This
system is designed to utilize the healing
capacity of enamel and dentin.
• SITE I:
• Pits, fissures and enamel defects on occlusal
surfaces of posterior teeth or other smooth
surfaces.
• Proximal enamel immediately below areas in
contact with adjacent teeth.
• The cervical one-third of the crown or
following gingival recession, the exposed root
 Size 1–minimal involvement in dentin just
beyond treatment by remineralization alone
 Size 2-moderate involvement of dentin.
Following cavity preparation, remaining
enamel is sound well supported by dentin and
not likely to fail under normal occlusal load.
The remaining tooth structure is sufficiently
strong to support the restoration.
 Size 3-the cavity is enlarged beyond moderate.
the remaining tooth structure is weakened to the
extent that cusps or incisal edges are split or
are likely to fail or left exposed to occlusal or
incisal load. The cavity needs to be further
enlarged so that the restoration can be
designed to provide support and protection to
the remaining tooth structure.
Size 4-extensive caries with bulk loss of tooth
structure has already occurred.
 Initial Tooth Preparation
 Final Tooth Preparation
1.Gain access to caris
2.Excavate all caries

3.Consider design of cavity in relation to

A-Final choice of the material

B-Retention of the material
C. Protection of remaining tooth structure
D.Optimal strength of restoration
E.Shape & Protection of Cavity Margins
 F.Refine & debride the cavity
 G.Placement of restoration
 BASIC PRINCIPLES IN THE
PREPARATION OF CAVITIES IN
PRIMARY TEETH.
The steps in the preparation of a cavity in a
primary tooth are not difficult but do
require precise operator control
Many authorities advocate the use of
small, rounded-end carbide burs in the
high-speed handpiece for establishing
the cavity outline and performing the
gross preparation.
they are designed to cut efficiently and
yet allow conservative cavity
preparations
with rounded line angles and point
angles.
 The Black’s principles with some
modification are basic principles in
the preparation of the cavities in the
primary teeth. There are two
operative steps with the use of the
high-speed handpiece:
 Opening and conformation of the cavity with
the use of the high-speed handpiece.

 Eliminating the caries of the buccal, lingual,

mesial and distal walls with the use of the
high-speed handpiece. Eliminate the caries of
the pulpal wall with the use of the lower-speed
handpiece.
CLASS I CAVITIES

 Incipient carious lesion in child under 2 years

old should be eliminated. Small cavity
preparation may be made with a No.329 or
No. 330 pear-shaped bur. We should open the
decayed area and extend the cavosurface
margin only to the extent of the carious lesion.
The preparation can be completed in a few
seconds.
 The outline form should include all pits,
fissures and grooves into which a sharp
explorer can penetrate.
 The pulpal floor should be flat or slightly
concave throughout to allow for greater
depth of the filling material, for better
distribution of stress in the restoration
and to avoid endangering the high
pulpal horns.
 The depth of pulpal floor should be
established just beneath the
dentinoenamel junction (0.5 mm) to
avoid pulp exposure.
 All the internal line angles should be
rounded.
 The side walls should slightly converge
towards occlusal so that the preparation
will follow the outer form of the crown.
 Beside the regular class I cavity
preparations done in primary molars,
occlusal spot preparations have been
recommended.
In such preparations only the carious pits
or groove is prepared and the tooth is
restored in the usual manner. These
preparations are applicable in any of the
primary molars with exception of the
lower second primary molars in which
extension for prevention including all
deep pits and fissures is recommended
above all, if the child has high caries
index
 cavity should be covered with calcium
hydroxide . A base of polycarboxlate, glass
ionomer or rapid-setting zinc-oxide-eugenol
cement may then be placed over the calcium
hydroxide material to provide adequate
thermal pulp protection.
 Do not cross the oblique ridge in the upper
second primary or first permanent molars and
the transverse ridge of the lower first primary
molar unless they are undermined with caries.
These heavy ridges add support to the tooth.
CLASS II CAVITIES.

 These preparations include an occlusal, an

isthmus and proximal portion. The outline
form of the occlusal step
should be dovetail-shaped
including all carious pits,
fissures, and developmental
grooves.
 The side walls of the occlusal step should
converge from the pulpal wall to the occlusal
surface.
 The pulpal floor should be established just
beneath the dentinoenamel junction.
 The axio-pulpal line angle should be beveled
to reduce the concentration of stresses and
provide grater bulk of material in the isthmus
area, which is liable to fracture
 The greater constriction of primary teeth
increases the danger of damaging the
interproximal soft tissues during cavity
preparation.

 Extreme care must be taken when

breaking through the marginal ridge to
prevent damage to the adjacent proximal
surface, especially when the bur is
revolving at high speed.
 The bur is used in a pendulum-swinging
fashion to undermine the marginal ridge and
at the same time to establish the gingival
depth.
 The gingival seat should be of sufficient depth
to break contact with the adjacent tooth.
 A liner or intermediate base should be placed
before the insertion of the silver amalgam.
 The amalgam restoration in the Class II cavity
needs the use of a matrix retainer. The matrix
should be rigid enough to allow adequate
packing pressure, ensuring a well-condensed
restoration free from an excess of residual
mercury.
 If the primary molars have an extensive
carious lesions, especially first primary molars,
should be used a stainless steel crowns, above
all, in the first primary molar of a 3 years old
child
Indications for use Stainless Steel Crown
 Restoration of primary molars requiring
large multisurface restoration.

 Restorations in disabled persons or others

in whom oral hygienic is extremely poor
and failure of other materials is likely.
 Restorations of teeth in children with rampant
caries.
 Restoration of teeth after pulp therapy
 Restoration of teeth with developmental
defects
 Restoration of fructured primary molar
 As abutment for space maintainer
CLASS III CAVITIES
 Carious lesions on the proximal surfaces of
anterior primary teeth sometimes occur in
children whose teeth are in contact and in
those children who have evidence of arch
inadequacy or crowding.
 If caries is not extensive, disking by sand paper
disc is performed to remove the decay, and
then fluoride is applied topically
 If the carious lesion not involves the incisal
angle, a small conventional Class III cavity
may be prepared and the tooth may be
restored with glass ionomer or composite
resin.
The same basic principles for permanent
anterior teeth should be considered in a
primary teeth, modified, of course, by
the size of the pulp and the relative
thinness of the enamel. If it is necessary
we modify the Class III cavities with the
use of dovetail on the lingual or
occasionally on the labial surface of the
tooth.
Because of the narrow labiolingual width
of the primary incisor teeth, the Class III
preparation is very difficult to perform
and often needs a labial or lingual
dovetail to gain access and aid in
retention of the restoration.
CLASS IV CAVITIES
 In these cavities caries involves the incisal
proximal angle of the anterior teeth. The
principles in the cavity preparation are the
same of the cavity preparation in permanent
teeth
 In regular class IV cavity preparations,
composite resin material can be used for
restoration.
CLASS V CAVITIES
 The Class V cavities are realized more
frequently in buccal surface of the primary
canines.

 The principles in the cavity preparation are the

same of the cavity preparation in permanent
teeth, although the depth is not carried more
than 1.5 mm.
 Walls of preparation converge toward buccal
surface of tooth for retention of restoration.

 When a necessary, retentive groove can be

placed along the gingivoaxial and occlusoaxial
line angles. Use round bur at slow speed.

 Glass ionomer cement could be used

effectively for restoring these cavities.
• Inform the patient of the procedure to be
performed and what to expect during the
treatment.
• Position the patient correctly for the dentist
and the type of procedure.
• Explain each step as the procedure
progresses.
 PRIMARY TEETH
DEPTH OF THE CAVITY Less
OCCLUSAL TABLE Occlusal table is narrow as
the buccolingual width of
the tooth is less
CONTACT POINT /POINT Because of the presence of
contact area, buccal and
lingual margins of the
interproximal box must
extend far enough towards
the embrasure at the
gingival margin to make
them accessible for
cleaning.
PERMANENT TEETH
More
Occlusal table is wider than
the primary teeth
Because of the presence of
contact area, buccal and
lingual margins of the
interproximal box don’t
have to extend too far into
the embrasure.
MARKED CERVICAL Because of the marked
CONSTRICTION cervical constriction the
floor of the cavity can
become too narrow if
placed more gingivally
ISTHUMUS OF THE Isthumus is narrow because
CAVITY the buccolingual width of
the tooth is less.cavities
with wide isthumus can
lead to fracture of the tooth.
BEVEL IN CAVOSURFACE Bevel is not given in the
MARGIN OF GINGIVAL cavosurface margin of
SEAT gingival seat
OCCLUSAL ASPECT OF Must be kept narrow to
THE PROXIMAL BOX prevent weakening of the
cusp
The cervical constriction is
not that marked therefore
sufficient width of the
floor of interproximal box
can be maintained.
Isthumus is wider
compared to primary teeth.
Bevel is given in the
gingival seat
Its not that narrow
GINGIVAL SEAT They are placed clear of
PLACEMENT contact with the adjacent
tooth, so that the margins
of the restorations can be
cleaned.
BUCCAL AND LINGUAL Because of the wider
WALLS OF THE contact area the buccal and
PROXIMAL BOX the lingual walls of the
interproximal diverge
buccally and lingually to
clear the contact area.
MOD CAVITY Should not be restored for
amalgam alone.
It is not that wide.
Because of the presence of
contact point the buccal
and the lingual walls of the
interproximal need not be
diverged towards the
embrasure.
It may be restored with
amalgam.
 Historically, the management of dental caries was based on the
belief that caries was a progressive disease that eventually
destroyed the tooth unless there was surgical and restorative
intervention.

 It is now recognized that restorative treatment of dental caries

alone does not stop the disease process
and restorations have a finite lifespan,
 some carious lesions may not progress and, therefore, may not
need restoration.
 Consequently, management of dental caries includes
1)identification of an individual’s risk for caries progression,
2)understanding of the disease process for that individual, and
3)active surveillance to assess disease progression and manage
with appropriate preventive services, supplemented by restorative
therapy when indicated
 Recommendations: 1. Management of dental caries
includes identification of an individual’s risk for caries
progression, understanding of the disease process for
that individual, and active surveillance to assess
disease progression and manage with appropriate
preventive services, supplemented by restorative
therapy when indicated.
 2. Decisions for when to restore carious lesions should
in- clude at least clinical criteria of visual detection of
enamel cavitation, visual identification of shadowing
of the enamel, and/or radiographic recognition of
enlargement of lesions over time.
1. Complete Excavation

2.Incomplete Excavation
A)One Step
B)Two Step

3. No Excavation
Recommendations
 1. There is evidence from randomized controlled trails
and systematic reviews that incomplete caries
excavation in primary and permanent teeth with
normal pulps or reversible pulpitis, either partial (one-
step) or stepwise (two-step) excavation, results in fewer
pulp exposures and fewer signs and symptoms of
pulpal disease than complete excavation.
 2. The rate of restoration failure in permanent teeth is
no higher after incomplete rather than complete caries
excavation.
 3. Partial excavation (one-step) followed by placement
of final restoration leads to higher success in
maintaining pulp vitality in permanent teeth than
stepwise (two-step) excavation.
Open Apex
Incomplete
Rhizogenesis