OCCLUSAL CARIES

OCCLUSAL CARIES

1. Obvious plaque stagnation area

   • difficult to detect as surface can appear fine
   • OCCULT CARIES (hidden)
   • bacteria enters fissure and spreads laterally at ADJ

2. DIAGNOSIS

   • Radiograph - most reliable
     • Radiolucent area show infected dentine
     • Lesions not visible - Fissure seal
     • BW's at regular intervals
     • Caries always under estimated on radiograph

3. TREATMENT

   • If in doubt - leave wait and watch
     • Apply Fluoride
     • Chlorohexidine
     • Fissure Sealants
     • Sealant Restoration - Preventitive restoration resin
     • Conventional Restoration
   • Improve OH

4. WHEN TO RESTORE

   • Obvious cavity
   • Caries into ADJ
   • When dentine is infected

5. PREVENTIVE RESIN RESTORATION

   • Used when part of fissure system becomes carious
   • restore carious part and FS rest of fissure
   • Prevents secondary caries
   • Resin comp used

6. SEALANT RESTORATION TECHNIQUE

   • Take occ registration
   • Outline form (minimal)
   • Remove caries and add lining if necessary
   • Etch prime bond and place comp
   • Etch remaining fs and apply sealant

7. CONVENTIONAL RESTORATION

   • When cavity involves all of fissure system
   • Amalgam previously used - now comp as preserves tooth sub
   • Occ reg and outline form - keep minimal
   • Remove caries - apply lining
   • Etch, prime, bond apply comp in 2mm increments
     • Oblique layering - comp touches only one wall of cavity
   • CONFIGURATION FACTOR - BONDED OVER UNBONDED SURFACES

8. As much sound tooth preserved as poss

   • undermined enamel can be supported by adhesive material
   • Place comp and cure at 2mm increments!
   • Occlusion checked and adjusted
   • AMALGAM no longer indicated for occ rest