Pit and fissure caries
Occlusal surfaces of premolars and
molars
Foramina coeca
All pit and fissure restorations
(fillings)
They are assigned in to three groups.
R. on occlusal surface of premolars and molars
R. in foramina coeca – usually on occlusal two thirds
of the facial and lingual surfaces of molars.
R.on lingual surface of maxillary incisors.
Pits and fissures
 Caries danger areas – plaque
accumulation due to morphology of
fissures
 Structure of hydroxyapatit (carbonated
HA) – enamel does not mature
completely
Morphology
of fissures
Biofilm
Diagnosis
 Visual diagnosis – ICDAS, UNIWISS
 Infrared laser fluorescency (uncertain)
 Radiogram – if it spreads to dentin
 Diagnocam (uncertain)
Clinical picture
 Dark colour
 White colour (undermined enamel) around
cavitation
Caries
ICDAS 2
ICDAS 1
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
Pit and fissure caries
Treatment
 Non invasive ICDAS 0,1
 Minimally invasive ICDAS 2
 Invasive ICDAS 3,4
Fillings – small to medium
lesions
 Composite – small to medium lesion (if
indication)
 Amalgam is a material of second choice
 Metal or adhesive inlay is nit be used in
medium lesions.
Fillings – large defects
 Adhesive inlay, metal inlay or onlay
 Amalgam filling with replacement of cusps
 Composit is not indicated (contraindicated)
Access to the cavity
 From the occlusal surface using the
fissure bur (or diamond burs, pear
formed bur or cylinder).
Cavosurface margin for amalgam
 Ideal outline includes all occlusal pits
and fissures. If crista transversa (1st
lower premolar)or obliqua (1st and 2nd
upper molar)are not affected, it is
strongly recommended no to prepare
them.
Box with undercut
Retention principles
 Prepare the box – the bottom is in
dentin
 Undercuts can be prepared!
Principles of resistance
 No undermined enamel left (proximal ridge
shoule not be undermined!!!)
 No sharp edges
 The thickness of amalgam 2 mm
Margin too next to cup
Sharp edges
The pulpal wall and pulp chamber
Pulpal wall is parallel to the pulp chamber
Removal of carious,
infected, dentin
 Spoon excavator or a slowly revolving ,
round carbid bur of appropriate size.
lenka.roubalikova@ti
scali.cz
28
Protection of dentin wound
 Dentin wound should be covered –
protection of dental pulp against irritation
Physicial
-thermal
-osmotic
Chemical
Combination
lenka.roubalikova@ti
scali.cz
29
Protection of dentin wound
Isolation
Filling (small cavities)
Base (moderate – large cavities- depth 2mm and
more approx.)
For amalgam – zinkoxidphosphate cement
30
When amalgam is used:
Base is made usually
of zinkoxidphosphate cement
It is placed only on pulpal wall
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Filling
 Filling replaces lost hard dental tissue
anatomically and functionally
 Always different properties in
comparison to hard dental tissues.
Composit material
 Small cavities – preparation is limited on
caries lesion only, small instruments no
extention, fissure sealing around and sealant
also covers the filling. This is preventive
filling.
 Medium cavities – preparation is limited on
caries lesion, undermined enamel can be
left, GIC replaces lost entin, composite
filling on the top.
Box (remember rounded edges)
Adhesive preparation in a fissure
opening of fissures
Adhesive preparation
Excavation of carious dentin
Preventive filling
Preparation of enamel borders
In smal – medium cavities no
bevel
Preparation
45°
1
2
3
Placement of the material
Cavities have high C-factor.
Layering of composite material
with regard to C-factor of each place.
Freee surafce as big as possible.
Finishing and polishing
 Fine grit diamond bur or special
instruments for polishing (metal and
rubber).
Final control
 Wash and dry the cavity
 Check the praparation in good illumination