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Today we will talk about the well-known classification of caries according to Black in dentistry.

This scientist devoted a lot of time to the study of this disease and, as a result, systematized the knowledge gained and invented his own gradation of this disease, which became popular among practitioners.

The most fundamental is the classification of carious cavities, which Black came up with in 1896. He singled out 6 classes of damage to the teeth by this disease. The purpose of introducing this classification was to standardize the methods of preparation and filling of carious cavities. The filling technique directly depended on the type of caries localization.

The discovery of this system was more than a hundred years ago, therefore it is considered not a complete classifier, since carious lesions of the root system and a secondary nature are not taken into account.

Despite this, the Black classification of caries is still widely used by dentists. After a while, the ranking system for the defeat of this disease was modernized, and an additional 6th class was added to its 5 elements. Let's take a closer look at each class separately!

1st class according to Black

Molars, premolars and anterior teeth suffer from this type of lesion.

This anatomical classification of caries applies to the occlusal, occlusal-alkaline and lingual surfaces of tooth enamel.

Caries is placed on natural fissures.

Thus, seals must be installed in the above places.

2nd class according to Black

This species can affect several places of the tooth at once in different planes.

The location of the pathological lesion is the proximal surface with the transition to premolars and molars.

At contact points on different sides of the tooth, foci of caries may occur. At a minimum, the medial and distal parts of the tooth may be affected.

Thus, a filling according to the second class can be located on the medial-occlusal surface of the premolar or on the medial-occlusal-distal surface of the molar.

3rd grade according to Black

Most often, this type of location occurs on incisors and canines, less often on other types of teeth, but always on their front part.

In this case, there is no violation of the angle of the crown tooth. The integrity of the upper edge of the incisors with such caries is not damaged. Both on the medial and on the distal side of the tooth, this pathology can manifest itself.

4th grade according to Black

In this class, caries damages the proximal surfaces, especially the anterior teeth. This type of carious localization is characterized by a violation of the angle of the crown part of the tooth or its cutting edge.

5th grade according to Black

With this type of lesion, the cervical part of any tooth suffers. Both the vestibular and lingual parts of all types of teeth can accommodate this type of pathology.

6th grade according to Black

The defeat of only the anterior edges of the dental elements by caries distinguishes this subspecies from the rest. It is localized on premolars and molars.

The Black classification of caries is considered one of the most popular among practicing dentists. It simplifies the diagnosis and selection of the necessary methods of filling the affected area.

Classification of caries lesions along the course of the process

In this direction, there are 3 varieties of the dynamics of the course of this disease: fast, slow and stabilized.

Also, this pathogenic process can be considered by the vastness of its localization: caries manifests itself on one tooth, on several elements, or is systemic in nature and affects most of the different teeth in the upper and lower rows.

Classification of caries according to the sequence of occurrence

As in the previous gradation, experts distinguish 3 types of carious lesions.

The first includes caries, which arose on the tooth for the first time.

To the second - a repeated lesion of an already early sealed tooth.

In the vast majority of cases, this disease spreads around or under the filling.

The third is the so-called recurrent caries lesion. It occurs due to insufficient treatment of this area or a poorly installed filling.

Secondary caries are all new carious lesions that develop next to a filling in a previously treated tooth. Secondary caries has all the histological characteristics of a carious lesion.

The reason for its occurrence is a violation of the marginal fit between the filling and the hard tissues of the tooth, microorganisms from the oral cavity penetrate into the resulting gap and optimal conditions are created for the formation of a carious defect along the edge of the filling in the enamel or dentin.

Recurrent caries is the resumption or progression of the pathological process in the event that the carious lesion was not completely removed during the previous treatment. Recurrence of caries is more often detected under the filling during X-ray examination or along the edge of the filling.

There are a large number of systems classifying caries, almost all of them are repeated. Therefore, for an accurate diagnosis, it is very important for a specialist to correctly determine the depth of the cavity, the nature of the course and the main reason for the formation of carious pathology.

The effectiveness of treatment and the absence of recurrent processes in the future will depend on the reliability of the diagnosis in the future.

Topographic classification of the spread of caries

In many countries, this classification is the most widely used.

It takes into account the depth of the lesion, which is very convenient for the practice of the dentist. There are 4 stages in the development of this disease:

1. The appearance of a carious spot. The focus of demineralization of the tooth element. The process of this harmful phenomenon can last both slowly and quickly, depending on the individual characteristics of the patient's body.
2. Superficial caries is characterized by local damage to the enamel on the tooth.
3. Caries of moderate severity manifests itself in damage to the surface layer of dentin.
4. Deep caries clings to the pulpal dentin and affects the tooth up to the nerve endings.

Differences between chronic caries and acute

Let's take a closer look at the features of the course of the chronic and acute forms of this disease.

The acute form of caries is characterized by the rapid development of destructive changes in the hard tissues of the tooth, the rapid transition of uncomplicated caries into a deep one.

Affected tissues are soft, poorly pigmented (light yellow, grayish-white), moist, easily removed by an excavator.

Chronic caries is characterized as a slowly ongoing process (several years).

The spread of the carious process (cavities) is mainly in the planar direction. The altered tissues are hard, pigmented, brown or dark brown in color.

Classification of caries according to ICD-10

According to this ranking of the affected areas, there are:

• dentine caries;
• tooth enamel;
• cement;
• unspecified caries;
• odontoclasia;
• stopped caries.

A variety of caries according to the degree of activity

There are 3 types of caries in this category: compensation, sub-compensation and decompensation.

Compensatory caries is characterized by a slow current or non-progressive process.

Damage to the surface of the teeth is minor and does not cause discomfort to the patient.

With regular and systematic hygiene procedures, as well as special preventive measures, it is possible to stop the development of the disease at its initial stages.

Subcompensation caries is characterized by an average flow rate at which it can go unnoticed and not cause concern to the patient at all.

Decompensation caries is expressed by the intensive development and dynamics of the course, accompanied by such acute pain that it affects both the ability to work and the daily life of the patient.

Because of this, the disease is often called acute caries. It requires immediate medical procedures, because otherwise the process can spread to third-party teeth, followed by the addition of pulpitis and periodontitis.

Clinical principles for the preparation of carious areas

To carry out all the necessary therapeutic manipulations, many specialists rely in their work on the classification of caries according to Black.

With any of the above types of tooth damage from caries, it is necessary to carry out a full preparation and filling.

The durability of your tooth (or several) depends on the quality of these manipulations.

Experienced dentists may leave deep pigmented elements during the removal of soft carious dentin, in order to avoid damage to the tooth pulp. After carrying out these works, no affected tissues should remain on the walls of the cavity.

At all stages of preparation and filling, the dentist sets the main goal - to destroy the carious areas of the affected tooth, disinfect the remaining parts and apply hermetically constructive material that can restore the structure of the tooth and help it fully perform its functions in the future.

Black's classification of caries - results

There are several classifications of caries, which take into account various factors of its manifestation in their hierarchy.

The most common is the classification of caries according to Black.

It indicates the localization of the affected areas with this disease, which is very helpful for dentists in determining the method of filling this area.

Modern dentists distinguish 6 classes of damage on this scale.

There are also classifications according to the activity of the manifestation of caries, according to the severity and severity of the ongoing processes, according to the scale of distribution, according to the sequence of occurrence of foci, etc.

In any case, no matter what reason affects the occurrence of caries, it is best to urgently contact an experienced specialist in its localization and removal. A neglected disease can develop into pulpitis or periodontitis.

These diseases are extremely difficult to treat and can cause a large number of complications that are dangerous for the full functioning of not only the oral cavity, but the whole organism. The foci of inflammatory processes can spread from the teeth to the jaw bones, nerves, and even the soft tissues of the gums.

With an untimely visit to the dentist, people, at least, may eventually lose a tooth affected by caries. We should also not forget about preventive measures to maintain the oral cavity in a healthy state.

Thorough cleaning of teeth, rinsing them with a special antibacterial solution, regular scheduled check-ups at the dentist, eating foods rich in fluorine and calcium can significantly prolong the full functioning of your teeth and make them healthy and beautiful.

At the first appearance of light or dark spots on the teeth, immediately seek help from a dentist.

I hope you learned something new and interesting on this topic and were able to find answers to your questions! Check out other articles on our blog, there is a lot of information there.

Have a nice day and take care!

Reasons for the development of the disease

The disease develops due to microorganisms in the oral cavity, under the action of which, together

If you do not consult a doctor in a timely manner, the demineralization process will continue and will first lead to the appearance of a deepening (carious cavity), and then to softening of the deep layers of dentin. When the process of destruction of dentin has begun, careful treatment is necessary, otherwise there is a risk of pulpitis and periodontitis, as well as the loss of a healthy incisor.

Treatment of the disease involves the preparation of hard tissues. During the preparation, the affected areas of dentin are removed and a filling is applied.

Disease classification

Caries is classified depending on the degree of damage to the enamel and the development of a carious cavity. At the same time, several different classifications of the disease are given in dentistry:

There are about 20 different classifications, but it is the above that have become widespread in dentistry with the approval of WHO.

Black classification

A well-known dentist from the USA, Black conventionally divided diseases into classes. The classification of the disease according to Black consists of 6 classes and allows you to distinguish between the degree of enamel damage and the development of a carious cavity, depending on the localization of the process.

Black's classification of caries describes the following classes:

Initially, Black's classification of enamel lesions included only 5 classes. The last, grade 6, was added later at the initiative of WHO. This made it possible to supplement the classification and obtain a more detailed picture of the destruction of enamel and dentin.

Black classes are widely used in dentistry. Black also described the preparation of damaged teeth, subsequently approved by WHO.

Black hard tissue preparation involves preparing the tooth before filling, as the filling cannot be placed directly into the damaged cavity. Preparation consists of several stages:

• cleansing the incisor from soft dentin damaged by the disease;
• removal of damaged enamel;
• seal installation.

Such a filling will serve for many years, while the complete removal of softened dentin avoids the development of secondary caries.

WHO classification

The WHO classification of caries in permanent teeth consists of several classes that characterize the disease depending on its location:

The WHO classification also takes into account unspecified types of caries, which can be complicated by other diseases of the oral cavity.

According to the degree of damage, the following classes of caries are distinguished:

• a stain resulting from demineralization of the enamel;
• superficial lesion, in which the border between enamel and dentin is not affected;
• medium lesion that affects the enamel and the top layer of dentin;
• a deep form of the disease, in which the deep layers of dentin are affected and there is a risk of pulp damage.

Localization of the lesion

The classification of caries depending on the localization describes the following classes:

According to the risk of possible complications, the disease is divided into two types - complicated and uncomplicated caries. An uncomplicated disease, according to WHO, does not lead to the development of negative consequences. Complicated caries is an advanced form of the disease, which eventually destroys the pulp and can lead to the development of periodontitis.

Classification of lesions in children

In children who have not yet replaced milk teeth with permanent ones, the development of caries occurs more rapidly than in adults. The classification of caries in milk teeth is given by Vinogradova, subsequently this systematization was approved by WHO and is used in modern dentistry.

There are the following degrees of damage to milk teeth:

The decompensated stage of the disease is not always accompanied by enamel demineralization and the formation of pigmented areas.

Classification of caries by black

Topic of the lesson: Preparation of carious cavities of III and IV classes in temporary and permanent teeth with an unformed root. Choice of tools.

Classification of carious cavities according to Black.

Features of the spread of the carious process.

The spread of the carious process in the tooth depends on the localization of the carious cavities. In enamel, the carious process extends deep into the enamel prisms in the form of a triangle with the apex at the point of origin. In dentin, due to the large amount of organic matter, in comparison with enamel, and the presence of interglobular dentin, caries spreads more actively not only in depth, but also in length. Especially in the area of ​​the enamel-dentine junction. The spread of caries in the dentin occurs in depth along the dentin tubules in the form of a triangle, with the apex directed towards the pulp of the tooth. In this regard, undermined edges of the enamel appear, which do not have dentin support under them, and the destruction defect can remain invisible on the surface, but deep, the layers can be significantly damaged.

On the contact (lateral) surfaces of the tooth, caries, as well as on the chewing surface, spreads in the form of two cones with a base on the enamel-dentin border. The undermined edges of the enamel are most pronounced in the direction of the chewing surface or incisal edge. In the region of the necks of the tooth, caries occurs more often on the vestibular surface.

Instruments for the treatment of carious cavities

For manual processing of a carious cavity, an enamel knife, a tooth chisel, a trimmer, an excavator are used.

For machining, burs of various shapes are used:

Stages of preparation of carious cavities.

Opening and expansion of the carious cavity. The carious process, in the hard tissues of the teeth, spreads unevenly. In dentin, the carious process spreads faster than in enamel. In this regard, in the acute course of caries, the entrance to the cavity is narrow. The opening of the carious cavity is the removal of the overhanging edges of the enamel, providing free access, visual control of the cavity, and performing the following stages of preparation.

To open the carious cavity, spherical or fissure burs are used. Burs are chosen in such a way that the size of the working part is smaller than the inlet of the carious cavity.

To open carious cavities located on the contact surfaces of the teeth, we first make an approach to us through one of the surfaces of the tooth. It is better to display such a carious cavity on the lingual or palatal surface.

Expansion of the carious cavity leads to apparently healthy tissues. In addition, during expansion, the enamel edge is leveled, sharp corners are smoothed out.

Necrectomy. At this stage, the modified dentin is removed from the carious cavity. Carried out using an excavator and a spherical bur. Manipulation begins with an excavator. Lever-like movements remove the softened layers of dentin. In mantle dentin, the excavator is directed horizontally, in the zone of peripulpal dentin it is immersed deep. Removal of infected but dense dentin is continued with a drill using spherical or fissure burs (diamond, carbide)

Formation of a carious cavity.

The purpose of the stage is to create optimal conditions for fixing the filling. The shape of the cavity depends on: localization, occlusal relationships, the course of the carious process, the selected filling material for a permanent filling.

In the formed cavity, there are:

Bottom - facing the pulp of the tooth;

Walls - located at an angle to the bottom;

The main cavity is at the site of the carious focus, and an additional one is created in healthy tissues for better fixation of the filling.

When the carious process is located on the contact cavities of the teeth, for better fixation of the filling, it is necessary to create an additional area on the palatal or lingual surfaces in the form of a triangle.

For the formation of a carious cavity, fissure, spherical, conical, obverse conical burs are used.

4. Enamel edges are processed with finishers, carborundum heads, diamond heads (with red, yellow, white color coding).

There are five classes of defects in the hard tissues of the tooth of a carious lesion, differing in localization. This classification was first proposed by the American dentist J. Black. It is guided by the preparation and the choice of filling material. There are V classes:

Class I - cavities are localized in fissures, in blind pits of molars, premolars, incisors and canines. Thus, according to the first class, it can be located on the occlusal, buccal or lingual surface.

Class II - the cavity captures at least two surfaces: the medial or distal and occlusal surfaces of the molars and premolars. Thus, a filling according to the second class can be located, for example, on the medial-occlusal surface (MO) of the premolar or on the medial-occlusal-distal surface (MOD) of the molar.

Class III - cavities are localized on the medial and distal surfaces of the incisors and canines.

Class IV - cavities are localized in the same place as class III cavities, but with a violation of the angle of the crown part of the tooth or its cutting edge

Class V - cavities are localized in the cervical region of all groups of teeth.
Thus, a filling according to the fifth class can be located, for example, on the vestibular surface of the incisor of the upper jaw in the cervical region or on the lingual surface of the molar of the lower jaw in the cervical region.

Basic principles of preparation of hard tissues of teeth:

A permanent filling cannot be placed directly into a carious cavity. The cavity must first be prepared to ensure the following:

• All soft carious dentin has been removed from the cavity, however, in some exceptional cases, the deepest pigmented but hard layer of dentin can be left to avoid accidental opening of the tooth pulp.
• Enamel, devoid of underlying dentin, is removed.
• The filling will last a long time.
• There will be no secondary caries.

FAQ

First of all, one that does not hurt the gums during use. At the same time, the quality of oral hygiene depends more on whether the teeth are brushed correctly than on the shape or type of toothbrush. As for electric brushes, for uninformed people they are the preferred option; although you can brush your teeth with a simple (manual) brush. In addition, a toothbrush alone is often not enough - flosses (special dental floss) should be used to clean between the teeth.

Rinses are additional hygiene products that effectively clean the entire oral cavity from harmful bacteria. All these funds can be divided into two large groups - therapeutic and prophylactic and hygienic.

The latter include rinses that eliminate unpleasant odors and promote fresh breath.

As for therapeutic and prophylactic, these include rinses that have an anti-plaque / anti-inflammatory / anti-caries effect and help reduce the sensitivity of hard dental tissues. This is achieved due to the presence in the composition of various kinds of biologically active components. Therefore, the rinse must be selected for each individual on an individual basis, as well as toothpaste. And in view of the fact that the product is not washed off with water, it only consolidates the effect of the active components of the paste.

Such cleaning is completely safe for dental tissues and less injures the soft tissues of the oral cavity. The fact is that in dental clinics a special level of ultrasonic vibrations is selected, which affects the density of the stone, disrupts its structure and separates it from the enamel. In addition, in places where tissues are treated with an ultrasonic scaler (this is the name of the device for cleaning teeth), a special cavitation effect occurs (after all, oxygen molecules are released from water droplets, which enter the treatment zone and cool the tip of the instrument). The cell membranes of pathogenic microorganisms are torn by these molecules, causing the microbes to die.

It turns out that ultrasonic cleaning has a complex effect (provided that really high-quality equipment is used) both on the stone and on the microflora as a whole, cleaning it. And you can't say the same about mechanical cleaning. Moreover, ultrasonic cleaning is more pleasant for the patient and takes less time.

According to dentists, dental treatment should be carried out regardless of your position. Moreover, a pregnant woman is recommended to visit a dentist every one to two months, because, as you know, when carrying a baby, the teeth are significantly weakened, they suffer from a deficiency of phosphorus and calcium, and therefore the risk of caries or even tooth loss increases significantly. For the treatment of pregnant women, it is necessary to use harmless anesthesia. The most suitable course of treatment should be selected exclusively by a qualified dentist, who will also prescribe the required preparations that strengthen tooth enamel.

Treating wisdom teeth is quite difficult due to their anatomical structure. However, qualified specialists successfully treat them. Prosthetics of wisdom teeth is recommended when one (or several) neighboring teeth are missing or need to be removed (if you also remove a wisdom tooth, then there will simply be nothing to chew on). In addition, the removal of a wisdom tooth is undesirable if it is located in the correct place in the jaw, has its own antagonist tooth and takes part in the chewing process. You should also take into account the fact that poor-quality treatment can lead to the most serious complications.

Here, of course, much depends on the taste of the person. So, there are absolutely invisible systems attached to the inside of the teeth (known as lingual), and there are also transparent ones. But the most popular are still metal braces with colored metal / elastic ligatures. It's really trendy!

Let's start with the fact that it's just unattractive. If this is not enough for you, we give the following argument - the stone and plaque on the teeth often provoke bad breath. And that's not enough for you? In this case, we move on: if the tartar “grows”, this will inevitably lead to irritation and inflammation of the gums, that is, it will create favorable conditions for periodontitis (a disease in which periodontal pockets form, pus constantly flows out of them, and the teeth themselves become mobile). ). And this is a direct path to the loss of healthy teeth. Moreover, the number of harmful bacteria at the same time increases, due to which there is an increased cariousness of the teeth.

The service life of an accustomed implant will be tens of years. According to statistics, at least 90 percent of implants function perfectly 10 years after installation, while the service life is on average 40 years. Tellingly, this period will depend both on the design of the product and on how carefully the patient takes care of it. That is why it is imperative to use an irrigator during cleaning. In addition, it is necessary to visit the dentist at least once a year. All these measures will significantly reduce the risk of implant loss.

Removal of a tooth cyst can be performed by a therapeutic or surgical method. In the second case, we are talking about the extraction of a tooth with further cleaning of the gums. In addition, there are those modern methods that allow you to save the tooth. This is, first of all, cystectomy - a rather complicated operation, which consists in removing the cyst and the affected root tip. Another method is hemisection, in which the root and a fragment of the tooth above it are removed, after which it (part) is restored with a crown.

As for the therapeutic treatment, it consists in cleaning the cyst through the root canal. It is also a difficult option, especially not always effective. Which method to choose? This will be decided by the doctor together with the patient.

In the first case, professional systems based on carbamide peroxide or hydrogen peroxide are used to change the color of teeth. Obviously, it is better to give preference to professional whitening.

Caries is a terrible disease. But doctors have developed an effective way to deal with this disease. What is the classification of carious cavities according to Black? Let's consider this question in more detail.

Tooth decay

"Caries" from Latin is translated as "rotting". This is an intricate pathological process, sluggishly flowing in the hard tissues of the tooth. It usually develops as a result of the complex influence of harmful internal and external causes.

At the initial stage of development, caries is determined by the destruction of the organic matrix of enamel and focal demineralization of its inanimate part. Later, the hard tissues of the tooth disintegrate, cavities appear in the dentin. If the patient does not seek medical help for a long time, inflammatory complications from the periodontium and pulp may appear.

First version

What is the Black classification? This is a grouping of carious formations on the tooth surface. It was introduced in 1896 to determine the standards of healing in each individual clinical case.

This classification includes five classes, each of which has its own scheme for filling and preparing teeth. A little later, a sixth grade was added to this system. Today it looks like this:

• The first class is carious destruction of fissures, pits and natural cavities of the buccal, chewing and palatine dental surfaces (fissure caries).
• The second is damage to the contact surfaces of premolars and molars.
• The third is caries of the contact surface of the canines and incisors, not touching their cutting edges.
• The fourth class is a more intense decay of the incisors and canines, which touched their cutting edges.
• Fifth - cervical caries. In this case, the vestibular surface of all groups of teeth is destroyed.
• Grade 6 - injuries located on the cutting edges of canines and incisors, tubercles of premolars and molars.

Second version

Black's classification according to the localization of caries is presented in several versions. The second modification looks like this:

• The first class includes damage in the area of ​​fissures (natural furrows).
• The second is caries that appeared on the planes of large and small molars.
• The third is the decomposition of the contact edges of the canines and incisors with preserved cutting edges.
• Fourth - caries of the connecting planes of incisors and canines with broken cutting edges.
• The fifth includes cervical lesions.

Third version

The Black classification is famous for its third version. Today it looks like this:

• The first class includes damage in the area of ​​natural depressions of teeth and fissures.
• The second is the depressions that appeared on the contact faces of small and large molars.
• The third class is cavities located on the contact surfaces of canines and incisors (the cutting edge is not affected).
• Fourth - notches that appeared on the connecting planes of the canines and incisors (the cutting edge and corners are affected).
• Fifth - cavities formed in the region of the necks of all categories of teeth.
• Later, the sixth class was created, to which recesses of atypical concentration were assigned: mounds of chewing and cutting edges of the frontal teeth.

WHO

So, we found out what the Black classification of cavities is. WHO offers its own triage. According to ICD 10, it has the following form:

• decay of tooth enamel;
• dentin damage;
• destruction of cement;
• decomposition that has stopped as a result of the influence of preventive and hygienic sessions on it;
• odontoclasia, characterized by the disappearance of the roots of milk teeth;
• another decomposition;
• unspecified decay.

Depth of defeat

In fact, the Black classification has found its application all over the world. According to the degree of destruction, caries is divided into the following stages:

• initial decomposition;
• surface destruction;
• caries average;
• deep decay.

At the initial stage of development of caries, a dark or white spot forms on the surface of the tooth. Nevertheless, the enamel here has a smooth surface, since there is no anatomical destruction yet. The resulting stain is removed by doctors using dental equipment. They remineralize the teeth in an attempt to prevent further development of the disease.

At the next stage, the upper layers of enamel are destroyed, a reaction appears to a sharp change in the temperature of water and food, as well as sour and spicy foods. The edges of the teeth become rough. At this point, doctors grind the affected area and then remineralize it. Sometimes superficial caries is treated with preparation and filling.

Agree, Black's classification of defects in hard tissues of teeth is a great help for dentists. And what is the average caries? In this phase, the enamel layer of the tooth is so destroyed that constant or intermittent pain occurs. In this case, the decomposition process has already reached the upper layers of the dentin.

It is not surprising that the teeth require mandatory medical intervention, during which the doctor removes the affected area and restores it with the help of filling material.

Now consider deep caries. This disease is characterized by an impressive destruction of dental tissues, which has already affected most of the dentin. If treatment is ignored at this stage, the pulp may be destroyed. As a result, the patient may develop pulpitis or periodontitis.

Cavity preparation. Disclosure

Black's classification formed the basis of dental treatment. Cavity preparation is performed in five stages. Let's study the basic rules using the example of the first class cavities proposed by the famous doctor.

At the initial stage, the cavity is opened. Tooth preparation begins with the removal of undermined enamel edges that do not have healthy, dense dentin under them. The result is sheer walls. The amount of excised tissues is set here by determining the focus of dentin decomposition. At this stage, the doctor must provide access for a good overview of the cavity and its further processing.

Opening doctors produce spherical or fissure burs made of diamond or hard alloys. The diameter of the tools corresponds to the size of the recess inlet. Specialists use turbine tips rotating at high speed and water-air cooling.

Extension

The Black classification of cavities has been used for a long time and is of great help to dentists in their work. What is a prophylactic extension? At this stage, the identification of a carious depression continues. With this action, the doctor tries to prevent the occurrence of recurrent tooth decay. The specialist outlines the outer final outlines of the cavity.

It should be noted that, in accordance with the method of "biological rationality" of I. G. Lukomsky, this step is not carried out when preparing recesses.

If the doctor is guided by Black's safety reaming technology, he makes a radical excision of areas susceptible to putrefaction, down to immune areas. In this case, the expansion of the carious depression is performed with cone-shaped or fissure burs (carbide or diamond). At the same time water-air cooling is used.

Black's classification of teeth provides for preventive filling, which reduces the loss of healthy dental tissues on the occlusal plane. If all decomposed tissue is removed in the region of the carious cavity, then the fissures are excised only within the limits of the enamel. The bottom of the recess in this case has a non-classical shape - rounded or stepped.

When opening fissures, the doctor does not remove a large amount of tissue: it is enough for him to make a groove 1-1.5 mm deep and 0.7-0.8 mm wide, without going beyond the borders of the enamel. He also avoids creating sharp corners.

In our country, as a rule, cylindrical narrow burs are used for excision of fissures (fissurotomy). Sometimes this operation is performed with spear-shaped and flame-shaped drills.

necrectomy

The next step is the removal of caries - necrectomy. The doctor completely removes the softened and pigmented dentin from the carious depression. The zone of destruction and demineralization, from a morphological point of view, is being liquidated at this stage. The margins of the notch are created in the area of ​​intact transparent dentin.

Formation

Next, the doctor gives the carious cavity a shape that contributes to the reliable fixing of the seal. It should provide the healed tooth with sufficient resistance and strength under functional loads. At this stage, the final internal and external outlines of the cavity are formed.

The recess is created by fissure, flame-shaped, cone-shaped and pear-shaped burs (carbide and diamond) with mandatory water-air cooling. The specialist makes the turbine handpiece rotate at high speed. The necessary shape of the notch is obtained taking into account resistance and retention.

Finishing

After processing with carbide or diamond burs, the enamel on the edge of the recess becomes curved, it is weakened, its prisms have lost contact with the lower tissues. In the future, this may contribute to a change in the fixation of the seal and the development of putrefactive processes. These nuances dictate the need for finishing - the final treatment of the edges of the cavity, as a result of which the damaged areas of enamel should be eliminated.

As a result, the doctor achieves the best interaction and reliable marginal fit between the dental tissues and the filling. This operation is carried out with 16- and 32-sided finishers or fine-grained diamond heads.

Doctors work with drills at low speed without pressure with mandatory water-air cooling. They also finish the edges of the cavity with gum trimmers and enamel knives, removing the thin outer layer of the tooth and eliminating the possible negative effects of overheating, vibration and other factors on it.

As you can see, dental treatment is a rather complicated process, but if you seek help from a doctor in time, you can maintain a Hollywood smile for many years.