The Management of Approximal Caries

Question 1

What is a class II aproximal caries?

Answer 1

• Caries develops below contact area
• Difficult to detect clinically
• Rely on bite-wing radiographs, as well as clinical examination
• N.B. Caries always underestimated on a radiograph

Question 2

What is class III aproximal caries?

Answer 2

• Much rarer than class II
• Usually develops below contact area
• Easier to detect clinically
• Restoration is by direct access and with composite resin

Question 3

How do you treat class III caries?

Answer 3

• Caries often found close to the gingival margin
• Often the area may be contaminated by blood
• Use dental dam where possible
• Access to caries is from palatal or lingual surfaces where possible as labial enamel maintains better appearance

•Exceptions – overlapping teeth – caries closer to labial surface

• Caries removed as with other carious lesions – round bur, ADJ first then pulpal area
• Leave unsupported enamel, especially on labial aspect
• Restore with composite resin

Question 4

How can u dectect aproximal caries?

Answer 4

• Visual inspection
• Transillumination (especially helpful for anteriors)
• Bitewing radiographs

Question 5

When do you intervene for caries?

Answer 5

• If caries is confined to enamel, leave and apply fluoride.
• If obviously cavitated, restore.
• Visible on a bitewing radiograph but not cavitated? If <50% into dentine, you have the option to leave – prevention and review. If >50% into dentine – restore.

Question 6

How do you Gain Access to Approximal Caries in Posterior Teeth?

Answer 6

• Occlusally, cutting through the marginal ridge – most commonly used method
• Occlusally, buccally or lingually, leaving marginal ridge intact
• Direct access, possible if adjacent tooth missing

Question 7

What must you make sure you involve in Class II Cavity Design for Non-Adhesive Materials (Amalgam).

Answer 7

Resistance and retention form

Question 8

What is outline form?

(first thing you do)

Answer 8

a) gain access occlusally leaving a sliver of enamel at margin
b) Using excavator or gingival margin trimmer, remove remaining ename;
c) Access can be gained to remove caries

Question 9

Step 2 is removing caries how do you do this?

Answer 9

a) Remove caries, being sure to clear the contact point to the adjacent tooth to ensure that a matrix band can fit
b) Margins tidied, remove unsupported enamel, ensure that resistance and retention forms are included

Question 10

Step 3 is restoring how do you do this?

Answer 10

a) Line as necessary
b) Place matrix band round the tooth, pack amalgam in cavity and carve back
c) Completed restoration

Question 11

How do you do a MOD Cavity Preparation?

Answer 11

• Each side should be prepared as separate cavities
• The occlusal part of cavity should be kept as narrow as possible
• Matrix band should be lodged at both sides
• Care taken when removing band

Question 12

What is a Tunnel Preparations?

Answer 12

• Gains access to approximal caries while maintaining the marginal ridge
• Only indicated for small carious lesions
• If lesion is large, marginal ridge may collapse during preparation
• Approach can be occlusally, buccally or lingually
• Material used – composite