What is the most accurate classification of caries? Common classes. Preparation of cavities of class V according to Black All classifications of caries by depth

FAQ

First of all, one that does not injure 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. Concerning electric brushes, then for uninformed people they are a more preferable option; although you can clean your teeth efficiently with a simple (manual) brush. In addition, a toothbrush alone is often not enough - floss (special dental floss) must be used to clean between the teeth.

Mouthwashes are additional hygiene products that effectively cleanse the entire oral cavity of harmful bacteria. All these products can be divided into two large groups - therapeutic and preventive and hygienic.

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

As for therapeutic and prophylactic ones, these include rinses that have anti-plaque/anti-inflammatory/anti-carious effects and help reduce the sensitivity of hard dental tissues. This is achieved due to the presence of various biologically active components in the composition. Therefore, the rinse aid must be selected for each specific person individually, as well as toothpaste. And since the product is not washed off with water, it only consolidates the effect of the active ingredients of the paste.

This type of cleaning is completely safe for dental tissues and causes less damage to 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 area and cool the tip of the instrument). The cell membranes of pathogenic microorganisms are ruptured by these molecules, causing the microbes to die.

It turns out that ultrasonic cleaning has a comprehensive effect (provided that really high-quality equipment is used) both on the stone and on the microflora as a whole, cleansing it. But the same cannot be said 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 situation. Moreover, a pregnant woman is recommended to visit the dentist every one to two months, because, as you know, when carrying a baby, the teeth are significantly weakened, suffer from a deficiency of phosphorus and calcium, and therefore the risk of developing caries or even tooth loss increases significantly. For the treatment of pregnant women it is necessary to use harmless means anesthesia. The most appropriate course of treatment should be selected exclusively by a qualified dentist, who will also prescribe the required medications that strengthen tooth enamel.

It is quite difficult to treat wisdom teeth due to their anatomical structure. However, qualified specialists successfully treat them. Wisdom teeth prosthetics are recommended when one (or several) adjacent teeth are missing or need to be removed (if you also remove a wisdom tooth, there will simply be nothing to chew). In addition, 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, a lot depends on a person’s taste. 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 bracket systems with colored metal/elastic ligatures. It's really fashionable!

To begin with, it is simply unattractive. If this is not enough for you, we present the following argument - tartar and plaque on the teeth often provoke bad breath. Is this not enough for you? In this case, we move on: if 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 increases, which causes increased dental caries.

The service life of a well-established 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. Typically, this period will depend both on the design of the product and on how carefully the patient cares for 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 dental cyst can be done therapeutically or surgical method. In the second case, we are talking about tooth extraction with further cleaning of the gums. In addition, there are modern methods that allow you to save the tooth. This is, first of all, cystectomy - a rather complex operation that involves 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 (the part) is restored with a crown.

As for therapeutic treatment, it consists of cleaning out the cyst through root canal. This is also a difficult option, especially not always effective. Which method should you 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.

In an effort to systematize knowledge about caries, doctors came up with several classification systems. The authorship of one of the most common belongs to J. Black. Black's classification of caries in pictures became known at the end of the 19th century. The American dentist managed to collect all the symptoms of the disease known at that time and logically distribute them into groups.

The principle of classification of carious lesions

The division of carious lesions and cavities into groups is based on their location:

Black class 1 involves the localization of lesions in the blind fossae of the incisors and in the fissures of molars;
Class 2 according to Black includes carious lesions located on the lateral surfaces of premolars and molars;
Black class 3 indicates lesions that appeared on the canines and incisors, but did not violate the integrity of the cutting edge;
Class 4 according to Black includes destruction of the cutting edges and angles on the fangs and incisors, resulting from the development of caries;
Class 5 according to Black involves localization carious cavities in the cervical region.

Initially, there were five categories of caries in the classification system; later, at the insistence of the WHO, another group was added to them, known as Black class 6. It included damage to the cutting areas of the incisors and fangs, as well as the hard tissues of the molars (cusps) protruding above the tooth surface.

Features of treatment of caries of different classes

The meaning of distribution different forms The classification of diseases into groups is not only about facilitating the doctor’s task when making a diagnosis. Black's classes are very important in dentistry, as they are a “guide” to treatment. Depending on the location and severity of the damage to the tooth tissue, the doctor chooses the method of preparing the cavity and the method of installing the filling material.

I class

Incorrectly performed treatment of group I caries can cause the filling to fall out of the cavity of the diseased tooth when chewing; the risk is determined by the location of the lesion. Therefore, when treating caries, which is included in group 1 of the Black classification, the dentist uses several techniques to prevent such consequences:

reduces the bevel of tooth enamel;
applies the composition parallel to the base of the carious cavity (when working with composites);
lays light-hardening mixtures at an angle in several layers (to change the direction of shrinkage);
produces the final reflection of the filling through the side walls of the tooth.

There are many ways to reduce the risk of a filling falling out. For the treatment of first class dental caries, special algorithms have been developed that take into account the peculiarities of working with different materials. All of them are reflected in curriculum, specialized instructions for dentists.

II class

This class of caries has its own characteristics. The main task of the dentist when treating teeth affected by the disease of the second group is to prevent the edge of the filling from overhanging and to ensure its tight fit to the bottom of the filled cavity.

The process can be complicated by teeth that are too widely or too closely spaced, so one of the stages of treatment may be bringing the contact surfaces closer or apart with the help of wooden wedges and holders.

All procedures, including preparation of the tooth cavity and spreading of contact surfaces, are performed after adequate anesthesia.

III and IV classes

Features of the preparation of carious cavities of the third and fourth categories according to Black do not play such an important role; the competent selection of filling material comes to the fore in the treatment of this type of dental caries. Since darkened areas of enamel are in visible places, it is necessary to use a filling that matches the color.

For this the prepared tooth is filled with a composite of not one, but two shades:

white or milky for dentin restoration;
almost transparent for restoration of tooth enamel.

The main difficulty in treating carious cavities on visible contact surfaces is to correctly assess the transparency of the tooth. There are no exact criteria for this; the dentist is forced to rely on his own feelings. Therefore, it will be better if an experienced specialist undertakes the treatment of caries of class IV and III according to Black.

V class

According to Black's classification of carious cavities, class five lesions are located in close proximity to the gums. This is the main difficulty in their treatment. If the patient is worried about gingival bleeding and noticeable discomfort in the cervical area, the doctor may suspect a deep location of the cavity affected by decay.

In this case, dental care is provided in several stages:

Removing plaque from the surface of a diseased tooth.
Determining the shade of the future filling.
Anesthesia.
Opening the cavity, cleaning out softened tissues.
Correction of the gum edge.
Treatment, placing the filling in the treated medicine cavity.
Polishing.

If the clinic adheres to the Black classification, the doctor will be recommended to use a composite ionomer composition. Due to its properties, this material is ideal for filling large cavities.

Classification of dental caries according to other systems

The classification of dental caries according to the J. Black system is not the only one; there are several dozen other versions in the world. The most common:

WHO classification of caries;
by primacy - the disease that occurred for the first time, or its relapse;
topographical – takes into account the degree of damage to the dental canals;
by intensity - one tooth affected by caries or several;
according to the presence of complications - only the tooth cavity is affected, or the process has spread to the oral cavity, to the gums.

Despite the fact that the Black classifier with pictures, including class VI, has become widespread in the countries of the former Soviet Union, dentists call the WHO system the most convenient (image below). It not only reveals the coordinates of oral caries, but also allows you to clarify its types and features (suspended, unspecified, childhood).

Black classification in pediatric dentistry

The principle of determining the type of disease in children is the same: having established the location of a carious cavity, the doctor can classify the diseased tooth into one category or another. The only difference in the diagnosis is the additional entry that the bite is milky.

This is only a seemingly simple disease known to everyone. For dentists, there is a distinction between its different types, and each of them requires its own special approach to treatment.

Caries comes in different forms

Caries is the most common disease of the oral cavity, developing in different areas of the teeth, and may differ clinical picture progress of the process. For convenience during treatment, the right choice preparation of the tooth and the material used for filling, types of caries are usually classified. Thus, classes are distinguished according to Black, by the depth of the lesion, by the degree of activity of the destruction process, by the presence of complications, by the clinical nature and localization of the lesion.

Particularly popular is the classification proposed back in 1986 by the American dentist J. Black. Its purpose was to systematize the principles of treatment for various types of dental caries.

Black classes

Black identified five classes according to localization on the surface, that is, depending on where exactly the carious cavity is located:

Localization in fissures (depressions and crevices in the enamel of the chewing surface), fossae of molars and premolars (large and small molars), canines and incisors.
Two or more surfaces are affected - the mesial and distal (caries on the front teeth) or occlusal (cutting and chewing surfaces) of molars and premolars are affected.
Development of the disease on the mesial and distal parts of the canines and incisors.
The localization is the same as in the third class, plus the angle of the coronal part or cutting surface is captured.
The cavity occupies the cervical area of any group of teeth.

Classes according to Black systematize all possible options for the development of caries, for each of them a separate treatment is provided, a method for preparing a diseased tooth and installing a filling.

First class according to Black

A carious cavity located in this way increases the risk of breaking the edge of the filling due to high pressure on it while chewing. When preparing a tooth, measures are taken to eliminate this possibility. This happens by reducing the bevel of the enamel and applying a thicker layer of filling material. When using a chemically cured composite, it is applied parallel to the bottom of the cavity, since shrinkage will be directed towards the pulp. If light-curing material is used, it is laid in oblique layers. In this case, shrinkage will be directed towards the source of polymerization. The layers should lie from the middle of the bottom to the edge of the cavity, illumination occurs through the side walls, and then perpendicular to the chewing surface. As a result, a tight fit of the filling in the cavity is achieved.

Stages of filling first class cavities

The following actions must be taken by the dentist to treat class 1 according to Black:

numb the pain (use anesthetic gel or
prepare the tooth (preparation involves drilling the area affected by caries deep into the hard tissue),
if necessary, apply an insulating pad (to prevent the composite from affecting the pulp and irritating it),
pickle and wash off acids, dry the cavity,
isolate from saliva,
if necessary, apply a primer (to prepare dentin),
apply an adhesive (a connecting element between the composite and dental tissue or primer),
apply the material layer by layer, cure it,
adjust to the desired shape, finish and polish,
do highlighting (final curing).

Second class according to Black

Class 2 according to Black, which has its own difficulties, involves two main tasks in its treatment - to create strong contact between the teeth and to ensure a tight fit of the composite to the edge of the main cavity. Often the filling process is complicated by the appearance of an overhanging edge of the filling, lack of contact between teeth or lack of material with a carious cavity. To prevent this, thin matrices are used and the tooth is displaced (to the extent possible) using wooden wedges. The matrix is introduced into the interdental space and fixed with a wedge, then moistened with water. The wedge swells and moves the tooth away. When filling, this method allows you to avoid overhanging the edge of the filling, which in turn can cause inflammation of the gums. The tight fit of the material to the cavity ensures the use of an adhesive - a binder, since the composite itself can only be firmly connected to enamel, but not dentin.

Stages of filling cavities of the second class

Black's classes of treatment have similar aspects, but each of them requires special nuances of filling. Here are the steps for second grade:

anesthesia,
preparation,
if necessary, gum correction,
installation of the matrix with the introduction of a wooden wedge or holder,
if necessary, moving teeth apart,
applying an insulating pad (if necessary),
Carrying out the etching procedure, washing off the acid and drying
cavities,
isolation of the tooth from saliva,
applying primer and adhesive,
if necessary, restore the enamel edge (if it is missing),
applying the composite in layers,
removal of the matrix and wedge,
control of interdental contact,
correction, polishing,
final highlight.

Third and fourth grades

Here the main role is played by the selection of color, because in this case caries is localized on the front teeth. Due to the different transparency coefficients of dentin and enamel, it is necessary to use a composite of two different colors during treatment. This is necessary so that the tooth appears uniform and the filling does not look like a patch. To create the most natural effect, white shades of the material are used to imitate dentin, and almost transparent shades are used to recreate enamel. To make the transition invisible, the enamel bevel overlaps by 2-3 mm. It is important that such delicate work is carried out by a good dentist who can correctly determine the transparency of the tooth. There are three degrees of it: opaque (usually a yellowish tint, even the cutting edge is opaque), transparent (yellow-gray tints, the cutting edge is transparent), very transparent (a grayish tint, the transparent edge occupies a third of the tooth).

Stages of filling cavities of classes 3 and 4

To fill the third and fourth classes of cavities according to Black, the dentist must perform the following steps:

clean the surface from plaque,
determine the shade of the tooth,
numb,
prepare the tooth, free it from affected tissues,
install or matrix when necessary (gingival margin is affected),
apply an insulating gasket,
if necessary, restore the contours of the teeth,
wash off the acid and dry the cavity,
isolate saliva,
apply primer (optional) and adhesive,
apply layers of filling material,
removing the matrix and threads, if any,
adjust the edges, give the desired shape to the tooth,
grinding and polishing,
final highlight.

Fifth grade according to Black

In this case, the relationship between the gums and the carious cavity is of primary importance. If there is a deep lesion with the lower edge of the gum closing and bleeding, a good dentist will immediately determine that correction of the gingival edge is necessary. After appropriate manipulations with the gums, they are applied for several days to avoid further difficulties in installing a permanent one. The fifth class involves the use of composite materials and compomers (composite-ionomer compositions). The latter are used for superficial lesions with a significant area of localization. In cases where aesthetic appearance is important (or the lesion affects only the enamel), light-curing composites of a specially selected shade are used.

Stages of filling cavities of the fifth class

Necessary actions for fifth grade:

clean the tooth surface from plaque,
determine the shade
administer anesthesia,
perform preparation, removal of softened tissue,
adjust the gingival margin, if necessary,
insert a retraction thread,
apply a gasket for insulation if necessary,
wash off acids, dry,
isolate from saliva,
apply primer and adhesive,
laying the material, lighting,
grinding and polishing,
final highlight.

Sixth grade

The famous American dentist, after whom this classification is named, identified five classes of carious cavities. For a long time his system was used in its original form. But later, at the initiative of the World Health Organization, Black classes underwent minor changes - a sixth was added to them. It describes the localization of caries on the sharp edge of the incisors and on the cusps of the chewing teeth.

Carious lesion begins demineralization of enamel followed by penetration pathological processes into internal tissues, destructive changes of which lead to the formation of an internal cavity.

During a dental examination, the doctor assesses the condition and extent of the lesion, focusing on the typification systems accepted in practice.

According to the intensity of the lesion

Taking into account the number of teeth affected by pathology, the following forms are distinguished:

individual tooth- pathological foci are located within one tooth;
multiple- defects form on several teeth against the background of reduced immunity or relapse of the disease in the chronic stage.

Clinical or topographic classification of caries

Clinicians often operate on grounds that take into account the degree of penetration of pathological destruction inside.

According to this clinical (topographic) system distinguish between caries:

elementary- the appearance of a stain on the enamel, which is also distinguished by color (unpigmented white, gray, light shades of yellow-brown palette, brown, black);
surface- demineralization and destruction of enamel;
average— carious cavity affects dentin;
deep— the base of the cavity is located in close proximity to the nerve.

Reference. Concepts in pediatric dentistry "deep caries" does not exist. This is explained by the specific structure of the temporary occlusion - when carious pathology penetrates deep inside the tooth, they place diagnosis of chronic pulpitis.

According to the nature of the flow

The rate of spread of carious lesions in the mouth allows us to highlight the following: forms of pathology:

spicy- occurrence of defects simultaneously on two and more teeth;
chronic- prolonged destruction with darkening of the cavity and surrounding areas;
blooming (sharp)- metamorphoses on different teeth and in places atypical for carious lesions;
recurrent- formations under fillings or near them.

Attention! Acute and chronic processes can transform one into another, taking into account general condition body, relapse of other diseases, that makes diagnosis difficult.

According to ICD-10 according to WHO

The World Health Organization operates an international classification of diseases, according to which this dental pathology can be following forms:

enamel caries— pathology affects the outer layer;
dentin— destruction is diagnosed below the enamel border;
cement— the cavity is localized in close proximity to the pulp;
odontoclasia— destruction of the roots of the temporary bite;
suspended;
another;
unspecified.

Important! Exactly this classification is the basis for determining the tactics of subsequent treatment and cavity filling.

Class division according to Black

This system evaluates the topographic location carious formations:

1st class- chewing, buccal or palatal surface of molars;
2nd- lateral surfaces of molars;
3rd— side surfaces of the front elements without changing the cutting surface;
4th- if the cutting surface of the central and lateral incisors or fangs is damaged;
5th- carious cavity in the cervical area.

Photo 1. The picture shows Dr. Green Vardimar Black founder modern dentistry and creator of the widely used classification of dental caries.

According to the depth of the lesion

Assessing the intensity of destruction allows us to outline personal plan therapeutic and preventive procedures. According to this classification, the following are distinguished: pathological forms:

very weak- damage to the fissures of molars;
weak- pronounced pathology of the closure surfaces of molars;
average- not only the chewing surfaces suffer, but also the lateral surfaces;
heavy (extensive)- the process affects the cutting edge of the front teeth;
very heavy- pathological metamorphoses in the cervical areas.

According to the presence of complications

Taking into account the depth of penetration of destructive processes secrete caries:

uncomplicated — simple form, without affecting internal soft tissues;
complicated — inflammatory processes affect the pulp and/or soft tissue surrounding the tooth with the development of the following diseases: pulpitis, periodontitis, granuloma, gumboil, phlegmon, osteomyelitis.

Important! At timely treatment the forecast will be favorable, otherwise complications lead to tooth loss or complete destruction and intoxication of the body.

By degree of activity

When calculating the caries activity index, the number of affected, filled and extracted teeth in the oral cavity is taken into account. This indicator allows us to highlight the following forms of the disease:

compensated- single colored carious formations with dense tissues of the walls and base;
subcompensated— partial pigmentation of dentin;
decompensated- multiple localization of light carious cavities with soft tissues walls and base.

By process localization

The formation of plaques occurs first in those areas where it is more difficult for a toothbrush and saliva to reach, which leads to accumulation of food particles And cellular breakdown products.

A favorable environment for the life of cariogenic bacteria develops in the following areas:

fissures— natural depressions on the surface of the closure of molars;
contact (side) sides - between adjacent teeth;
cervical region- the place of transition of the crown to the root, especially when this part is exposed.

Reference. Characteristic for temporary teeth ring lesion cervical region, which makes it possible to distinguish a separate form of annular (circular) caries.

Classification of caries according to MMSI

IN Moscow Medical Dental Institute was developed own system dental pathology, taking into account the shape, location, rate of formation and intensity of development of the cavity inside the tooth.

Clinical forms

The pigmentation of the spot on the enamel and the depth of penetration of the carious defect are taken into account.

Spot stage:

progressive- plaque of white and yellow color;
intermittent- spots of a yellow-brown palette;
suspended- dark brown mark.

Carious defect:

surface- destruction of enamel;
dentin caries- the lesion affects the enamel and the dentin located underneath it;
cement caries— destructive metamorphoses pass to tissues in the root area.

Photo 2. The left photo shows dentin caries with destroyed enamel from above. On the right in the picture there is a similar lesion, but only from the inside.

By localization

Spots with the subsequent formation of a cavity are diagnosed in certain places of the tooth, which makes it possible to identify such forms:

fissure— on the closure surface in natural depressions (fissures);
contact- on the lateral surfaces between adjacent teeth;
cervical— the area of transition of the crown to the root closer to the gum.

Useful video

Watch the video, which will demonstrate the main symptoms of caries and its classification.

Oral hygiene is the main assistant in caries prevention

By using existing classification systems carious lesion, the dentist determines the depth of the changes and the nature of the process. It is equally important to establish and the cause of the defect.

Yes, availability bad habits or the anatomical specificity of the structure of teeth requires different approaches and preventive recommendations.

One One of the most popular reasons provoking the reproduction and vigorous activity of cariogenic bacteria is unsatisfactory compliance with hygiene rules oral cavity.

Themselves hygienic rules simple and easy to implement:

mouth rinse after every meal;
affecting during morning and evening cleaning not only teeth, but also language, buccal surface;
dental selection brushes taking into account the age and sensitivity of the gums;
regularity performing hygiene procedures;
usage dental floss.

Eliminate the cause the occurrence of caries is much easier than to carry out subsequent treatment procedures.

– this is a local lesion of the teeth, which is accompanied by demineralization of the hard tissues of the tooth with the subsequent formation of a carious cavity.

Today there are several dozen classifications of caries, although only a few of them have become widespread.

Classification by depth of lesion

This classification is quite convenient from a clinical point of view, and therefore has become widespread in the CIS countries.

1. Uncomplicated caries

Caries in the spot stage is initial stage caries and is characterized by the formation of a focus of demineralization on the enamel;
Superficial caries - the carious cavity does not reach the enamel-dentin border;
Medium caries - with this form there is damage to both tooth enamel and dentin, but a fairly thick layer of dentin remains before the pulp;
Deep caries - this form is not similar to the previous one, but unlike it, the pulp is covered with a thin layer of dentin;

2. Complicated caries

Pulpitis;
Periodontitis;

International (histological) classification

Carious lesion of enamel;
Carious lesion of dentin;
Carious damage to cement;
Suspended dental caries;

In 1896, Black proposed his classification carious cavities, in which he divided all carious cavities into 5 classes. The purpose of introducing this classification was to standardize the methods of preparation and filling of carious cavities. Those. each class had to have its own strictly defined shape of the prepared cavity and filling technique.

Later, a new sixth class was added to Black's classification, which was never described by Black himself. Thus, today, the classification of carious cavities according to Black is as follows:

1 class– Carious lesions in the area of natural fissures and blind pits of all teeth;

2nd grade- Carious lesions of the contact surfaces of molars and premolars;

3rd grade- Carious lesions of the contact surfaces of the fangs and incisors without compromising the integrity of the cutting edge;

4th grade- Carious lesions of the contact surfaces of the fangs and incisors with a violation of the integrity of the cutting edge;

5th grade– Carious lesions of the vestibular surfaces of all groups of teeth;

6th grade– Carious lesions located on the cutting edges of the fangs and incisors, as well as on the tubercles of the molars;

WHO (World Health Organization) classification

K02.0 Enamel caries;

K02.1 Dentin caries;

K02.2 Cement caries;

K02.3 Suspended dental caries;

K02.4 Odontoplasia;

Children's melanodentia;
Melanoplasia;

K02.8 Other specified dental caries;

K02.9 Dental caries, unspecified;