Management of Occlusal Caries

Question 1

What is ‘Occult’ caries?

Answer 1

•‘Occult’ (hidden) caries – when occlusal surface appears intact, but carious underneath

-Due to bacteria entering via deepest part of fissure and rapidly spreading along ACJ

Question 2

How is Occlusal Caries Diagnosed?

Answer 2

•Radiographs the most reliable source

• Radiolucent areas show infected dentine
• Lesions not visible radiographically harbour few bacteria and can be fissure sealed

•Bitewings at regular intervals very important

Caries always under-estimated radiographically

Question 3

What treatment options are there for occlusal caries?

Answer 3

Prevention:

• If in doubt, leave, wait, watch
• Improve oral hygiene
• Fluoride treatment only
• Chlorhexidine
• Fissure sealants

Not Prevention:

• Sealant restoration
• Conventional restoration

Question 4

When is a sealant restoration used and what does it prevent?

Answer 4

• Used when part of a fissure system becomes carious
• In addition to restoring the carious part of the tooth, the remaining fissure system is sealed thus preventing secondary caries

Question 5

What is the sealant restoration technique?

Answer 5

• Outline form (minimal) - access to the caries
• Remove caries along ADJ first then deal with caries overlying pulp. can use slow speed and sharp excavator
• Acid etch, prime and bond applied to cavity walls and margin
• Build up cavity with composite resin
• Apply acid etch to remaining fissures
• Apply fissure sealant to remaining fissures
• Check occlusion

Question 6

What are Conventional Restorations?

Answer 6

•When cavity is large enough to involve most of fissure system.

so conventional restoration insteaad of sealant restoration will be used

• Previously amalgam would be used and therefore retentive cavities would need to be cut.
• Nowadays adhesives/composite resin are ALWAYS indicated for occlusal restorations, as they do not involve as much tooth destruction.

Question 7

What is the Conventional Restorations Technique?

Answer 7

•Outline form - gaining access to caries with high speed diamond bur

-Keep as minimal as possible

•Remove caries - ADJ first then after its caries free then deal with caries overlying pulp

-Apply lining in base of cavity as necessary (if 0.5mm or less away from pulp)

• Apply etch, prime and bond
• Restore with 2mm increments of composite

Question 8

How do you avoid shrinkage in composite filling?

Answer 8

Incremental Placement of Composite - Oblique Layering

Question 9

What is C-Factor?

How do you work it out?

Answer 9

configeration factor.

can demonstrate how much stress is in a tooth when dental material shrinks

C-factor= bonded surfaces/unbonded surfaces

• so occlusal cavity will have a C-factor of 5 so it is CLASS 1*
• look at photo*

Question 10

What is the max curing depth of composite?

Answer 10

Resin composite can only be cured to a depth of 2mm

Question 11

What must you do following any restoration involving occlusal surface?

Answer 11

the occlusion must be checked and adjusted if necessary.