Definition:

These are pit and fissure type cavities that involve the occlusal surfaces of molars and premolars, the occlusal 2/3 of buccal and lingual surfaces of molars, and the palatal pits in maxillary anterior teeth.

 These are self-cleansable areas.

However, they may get involved by caries due to their inherent defective structure as areas of imperfect coalescence of lobes of calcification of these teeth. These areas are retentive for food and thus invite caries.

These lesions are clinically characterized by:

1. A small surface opening which may remain
unnoticed until the lesion becomes of a considerable size. 2. A conical spread in both enamel and dentin, with the bases of cones at the Amelo-Dentinal Junction, "A. J.D." 3. Its rapid burrowing at the dento-enamel junction. These lesions may involve one or more surfaces and hence a simple or compound cavity should be prepared.

Simple occlusal cavities Designing the Outline Form.

The outline form of a routine class I cavity should describe a symmetrical design running in sweeping curves along all pits, fissures, and angular grooves between the cusps and with a minimum width.

The mesial and distal margins are

placed midway between the bottom of the proximal fossae and the crest of the proximal ridges and in a direction parallel to these ridges.

 The mesial and distal wall should

have a slant or slight divergence from the pulpal floor outward to avoid undermining the marginal ridges.

In a bucco-Iingual direction, the cavity

is extended just sufficient to eliminate the defective and susceptible tissues. The lingual and the buccal wail should be parallel to the respective tooth surface.

 It must be reemphasized that the

outline form for class 1 cavities should be very conservative since they involve cleansable areas. It is governed only by the extent of caries in both enamel and dentin and the amount of extension or need to eliminate pits and fissures to secure smooth margins.

Obtaining the Resistance and Retention Forms

The resistance form here consists
chiefly of a pulpal wall parallel to the occlusal plane with dentin walls at right angles to it., i.e. Boxing the preparation. The form of this cavity provides automatically for effective retention and, therefore, no special retentive features are required.

Removal of Carious Dentin

In small size cavities, the carious dentin
should have been removed during making the cavity extensions. In moderately deep and deep cavities, the carious dentin is peeled off carefully at the sides using large spoon excavators, and then scooped out in few and large pieces. Only light pressure in a direction parallel to that of the pulp is utilized. This is continued until a sound dentin floor is reached.

Planning of Enamel Walls

The enamel walls of the cavity should be
finished free from any loose, short, or undermined enamel, and trimmed to meet the tooth surface at a right cavo-surface angle. This may be done by sharp and regularedged chisels and hatchets, plane fissure burs, stones, or sand-paper discs. All sharp corners in enamel must be rounded, as they may contain short enamel rods.

Performing of the toilet of the cavity

A sharp explorer is then used to check the details of the prepared cavity and to loosen the tooth debris which are then blasted out with warm air.

Operative Procedures
Armamentarium
High speed handpiece Burs #330, 56 Hoe Hatchet R&L Wedel staedt chisel

Procedure
The outline form is performed by first gaining access through the enamel to the carious dentin floor of the cavity followed by making the necessary cavity extensions.

In case of initial carious lesions, access is obtained by employing a small pear but #330. In big carious lesions, access is obtained easily by breaking down the undermined enamel overlying the carious dentin, using a suitable size chisel. In either case, access is started at the most defective area of enamel, i.e., a carious pit or fissure.

 The bur is held at a right angle to

the involved surface of, the tooth and light pressure in an in-and-out direction is exerted. Cutting is continued until the amelo-dentinal junction (A.D.J.) is reached.

 The necessary cavity extensions

through pits, fissures, and deep developmental grooves are made using a #330 pear bur held at right angle to the surface of the tooth.

The bur is rotated, and carefully

introduced through the opening just obtained, so that its weak corners do not touch the enamel and get dulled.

With the bur seated in the cavity just

below the amelo-dential junction 1/z-1 mm. gentle pressure is applied in the direction of required extension.

During cutting, the bur should be kept

moving in-and-out of the cavity and at right angle to the tooth surface. In this way, the bur will undermine and lift the cut enamel, and at the same time unclog itself.

Provision of ample resistance and

adequate retention through boxing of the preparation could be obtained.

This is obtained by using a #56 fissure

bur held perpendicular to the surface of the tooth. All the line angle in dentin must be squared up hoe excavators.

Buccal Pit Cavities

The outline of these cavities usually
describes a triangle with its base faming the gingival wall and its sides forming the mesial and distal walls.

The gingival wall is placed at or

slightly occlusal to the height of contour of the tooth.

All walls are extended just enough

to eliminate defective enamel and dentin.

The enamel walls are planed in the

direction of enamel rods and perpendicular to the axial wall.

Hoe excavators are used to smooth

the axial wall and make it parallel with the external surface of the tooth.

It should be re-emphasize that the

shape of the cavity will be governed by the extension of caries, accordingly the outline of these cavities may be a rounded or oval in shape.

Buccal and Lingual Extensions

In case of occluso-buccal and occlusolingual cavities extensions are made through the fissures and towards the respective surfaces. The cutting is done in dentin at the amelo-dntinal junction using a #56 bur until the ocdusal ridge is undermined and removed.

If the caries is still gingival to the

level of the pulpal seat, a step is indicated: a #330 or 56 but is used to cut the dentin at the amelodentinal junction, applying pressure in a gingival direction and at the same time moving the bur mesiodistally.

The enamel thus undermined, is broken

down with chisels.

Retention grooves are then cut in

dentin along the axio-mesial and axiodistal line angles. The cavity walls and margins are finished as previously described.

In case of deeply-seated caries,

where removal of the carious dentin will leave a round cavity floor, flattening of which to obtain the required resistance form, will expose the pulp.

The following technique is used:

a) The cavity floor is covered with

a sub base of calcium hydroxide, followed by a base of glass ionomer cement which fills it to the routine cavity depth.

b) A ledge is cut on the expense of

the buccal and lingual side walls of the cavity for obtaining the required resistance in sound dentin.

Principles

Rationale

I. OUTLINE FORM Smooth flowing, regular curves.

Angular irregularities in the outline are susceptible to fracture during condensation a smooth flowing outline is easier to visualize and carve following condensation.

II. EXTENSIONS Conservation of tooth structure is the basis for all cavity preparations in order to preserve the strength of the tooth. However, sufficient extension of cavity preparations is necessary to ensure access (convenience form) for instrumentation, removal of defective tooth structure, insertion and finish of the restorative material, and maintenance of the restoration (prevention).

Principles
A. Extensions circumscribe: 1. Caries and decalcifications 2. Enamel unsupported by sound dentin 3. Pits and fossae 4. Major fissures and grooves 5. Existing restorations

Rationale
eliminates defective tooth structure and eliminates areas (pits, fissures, etc.) which are susceptible to recurrent caries and facilities oral hygiene procedures (extension for prevention).

Principles
B. Bucco lingual extension 1. Extend fully in areas of buccal and lingual grooves to terminate on smooth surfaces.

Rationale

to allow a smooth tooth-restoration margin to be created (easier to finish and keep clean).

Principles
2. Extend minimally in areas of triangular ridges (optimal isthmus width is intercuspal distance or less) terminating on smooth surfaces.

Rationale
to preserve the strength and function of the cups while eliminating susceptible grooves or defective tooth structure (must be wide enough to allow condensation).

Principles
C. Mesio-distal extension 1. Stop short of the marginal ridge crest. 2. Parallel the contour of the marginal ridge.

Rationale

to preserve strength of marginal ridges. to preserve a uniform bulk (strength) to the mariginal ridges.

Principles
3. Groove extensions are kept narrow (mesiodistally) where possible (consistent with access for condensation and outline form), terminating on smooth tooth structure.

Rationale
to preserve strength of cusps while eliminating susceptible grooves and/or defective tooth structure (must be at least as wide as the narrowest condenser).

Principles

Rationale

4. If marginal ridge is unsupported or very thin it should be included, resulting in a Class II preparation.

If not included the marginal ridge may fail (amalgam will be stronger than the unsupported enamel)

Principles

Rationale

III. RESISTANCE/ RETENTION FORM A. Depth = mm into dentin (approx. 2 mm measured at triangular ridges). Minimum depth is required to provide sufficient bulk to prevent fracture and retain the amalgam.

Principles
B. Pulpal floor
1. Smooth and flat 2. Parallel to the occlusal plane

Rationale

Uniform thickness of restorative material. resists occlusal stress (resistance form) and forces of condensation.

Principles
C. Buccal and lingual walls 1. Smooth and curved mesio-distally. 2. Smooth and straight pulpo-occlusally.

Rationale

Facilitates adaptation of amalgam and elimination of weak tooth structure.

Principles

Rationale

3. Converge slightly pulpo-occlusally in areas of triangular ridges (60).

To provide mechanical lock or retention to the occlusal portion and crate bulk at the margins.

Principles

Rationale

4.Diverge slightly pulpo-occlusally in buccal and lingual groove extensions (60).

protects buccal and lingual surfaces from being undermined (RESISTANCE FORM).

Principles
D. Mesial and distal wall 1. Smooth and straight

Rationale

facilitates adaptation of amalgam and elimination of weal tooth structure.

Principles

Rationale

2. Diverges slightly pulpo-occlusally (forms an obtuse angle with pulpal floor).

protects marginal ridge form being undermined or weakened (enamel must be supported be dentin)

Principles
IV. CAVITY FINISH A. Pulpo-occlusal line angle is well defined (no point angles are present) and follows general configuration of cavosurface outline.

Rationale

increases retention of the amalgam restoration and preparation is more easily visualized.

Principles
B. Cavosurface margins

Rationale

1. Sharp (well defined)

2. Sound (well supported)

easier to visualize and carve. provides marginal integrity.

Principles

Rationale

C. Cleanliness cavity is free of debris and moisture.

facilitates adaptation of amalgam to the cavity and improves the physical properties of the restoration by elimination of void or foreign material.

Principles
V. TISSUE RESERVATION A. Rubber dam is intact

Rationale

preserves isolation, eliminates moisture.

conservation of tooth structure. prevention of postoperative pain and inflammation.

B. Adjacent tooth structure and restorations are intact

C. Adjacent soft tissue (perio-dontium) is intact