Features of the preparation of carious cavities using black. About the classification of caries in dentistry: classes according to Black Filling according to Black

There are five classes of defects in the hard tissues of teeth (carious lesions), differing in location. This classification was first proposed by the American dentist J. Black. It guides the preparation and the choice of filling material. There are V classes:

Class I - cavities are localized in fissures, in the blind fossae 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 involves at least two surfaces: the mesial or distal and occlusal surfaces of molars and premolars. Thus, a second class filling can be located For example, on the mesial-occlusal surface (MO) of a premolar or on the mesial-occlusal-distal surface (MOD) of a 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 coronal part of the tooth or its cutting edge

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

Basic principles of preparation of hard dental tissues:

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 exposure of the dental pulp.
• The enamel, devoid of underlying dentin, is removed.
• The filling will last a long time.
• Secondary caries will not occur.

Detection and recording of carious lesions is an important component of the assessment phase of the oral hygiene process. Because of its importance, all dentists must be able to detect and classify tooth decay.

More than 100 years ago, Dr. Black developed a classification of carious cavities based on the location of the affected tooth (front or back teeth) and the location of the hard tissue defect on the tooth itself. The system was described quite a long time ago; in current realities it is considered incomplete, since it does not cover root and secondary caries. However, it is still widely used in dental practice. Classification of caries according to Black includes 5 classes! Over the years, many have tried to modify the classification and still managed to “push” “Class 6 according to Black” into the masses:

Carious cavities are located in the pits and furrows of:

• occlusal surfaces of molars and premolars
• occlusal-buccal and lingual surfaces of molars
• lingual surface of anterior teeth (incisors and canines)

Black class 1 cavity in the molar

2nd class according to Black

Black class 2 cavities are simultaneous lesions of at least two surfaces. Carious cavities are located on the approximal (medial or distal) surface with access to the occlusal surface of molars and premolars.

Black class 2 cavities- damage to two surfaces of molars or premolars

3rd class according to Black

Cavities are placed on the proximal surfaces of the front teeth (incisors or canines), without disturbing the angle of the coronal part of the tooth.

Black class 3 cavities on incisors and canines

4th grade according to Black

A class 4 carious cavity according to Black involves the involvement of all proximal surfaces on the anterior group of teeth, with additional damage to the incisal edge.

Black class 4 cavity - lesions of the anterior interproximal surface of the tooth, including the incisal angle

5th grade according to Black

Cavities are located in the cervical areas of absolutely all groups of teeth.

Carious lesions on the gingival third of the crown of the lingual or vestibular surfaces of the tooth.

6th grade according to Black

Class 6 was never actually described by Black; it was invented later by other scientists. Class 6 - these are cavities on the cutting edges of the front teeth and the tops of the cusps of molars and premolars. This class is used very rarely in making diagnoses!

Black class 6 cavity - carious lesion at the top of the cusps of chewing teeth

Contents [Show]

Dr. Greene Vardiman Black

Greene Vardiman Black (1836-1915) is widely recognized as one of the founders of modern dentistry in the United States. Also known as the father of dental surgery. Born near Illinois on August 3, 1836. Parents William and Mary Black. He spent his childhood on a farm and quickly developed an interest in the natural world. At the age of 17 he began to study medicine, in which his older brother helped him. In 1857 he met Dr. J.C. Speer, who began to teach him practical dentistry.

After Civil War, in which he served as a scout, moved to Jacksonville, Illinois. It was here that he began an active career in the growing field of dentistry. He researched many important topics, including the causes of fluorosis and the development of dental caries.

In addition to developing a standard for cavity preparation, Black also experimented with different amalgam mixtures. After several years of experimentation, he published his balanced amalgam formula in 1895. This formula quickly became the gold standard for the next 70 years!

Black was the second dean of Northwestern University of Dentistry, where his portrait hung until the school closed in 2001. His statue can be found in Chicago's Lincoln Park. He was also inducted into the Pierre Fauchard International Dental Hall of Fame on February 25, 1995.

Carious lesion is the process of demineralization of the tissue structures of the tooth, which leads to the formation of pathological cavities. Patients know little, but caries has several classifications, one of the main ones is according to Black. However, to fully understand the pathology, all types of carious lesions according to various classifications should be mentioned.

Classification of caries according to Black

Classification of caries by depth of lesion

It has been determined that this classification is quite common due to its ease of use in dental practice. Most often used by dentists in the CIS countries.

Attention! Complicated dental caries is accompanied by periodontitis and pulpitis, and therefore requires long-term treatment.

Types of caries

International classification

This type of qualification is defined as histological. Caries is classified depending on the level of damage to the dental structure:

• violation of the integrity of the enamel;
• dentin damage;
• damage to cement;
• suspended pathology of dental elements.

The founder of American dentistry in 1896 established a classification of pathological cavities, which is defined by five main classes. 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 secondary nature are not taken into account. Despite this, dentists widely use the Black caries classifier. Over time, the classification system was modernized and an additional class was added.

Classification of carious cavities

1 class

Grooves on the following surfaces of the dental element (molars, premolars, anterior teeth) suffer from carious lesions:

• occlusal;
• occlusive-alkaline;
• lingual

1st class according to Black

Description of the first class of carious cavities according to Black

2nd grade

This class is characterized by damage to several surfaces at once. That is, the location of the pathological lesion is the approximal surface with transition to premolars and molars.

2nd class according to Black

Description of the second class of carious cavities according to Black

3rd grade

The pathology is located directly on the front dental elements. Most often, caries is diagnosed on the canines and incisors (precisely on the proximal surfaces). In this case, there is no violation of the angle of the crown of the tooth.

3rd class according to Black

Description of the third class of carious cavities according to Black

4th grade

The diagnosed process becomes more serious as proximal surfaces are involved in the process. The anterior dental elements are at risk.

4th grade according to Black

Description of the fourth class of carious cavities according to Black

5th grade

Carious pathology threatens the cervical area of ​​the tooth. In this case, a carious lesion can be located on absolutely any dental element.

5th grade according to Black

Description of the fifth class of carious cavities according to Black

6th grade

The sixth class classifier includes carious lesions of the cutting edges of only the anterior dental elements. Also included in this class are the cusps of premolars and molars. At the same time, the sixth grade is almost never used when making a diagnosis.

6th grade according to Black

Attention! The sixth grade was not approved by Dr. Black. It was invented much later by other specialists for the convenience of the classifier.

For the convenience of classifying carious cavities, several different systems have been defined. Thus, according to the development of the pathological process, the following are distinguished:

1. Simple carious lesion (caries occurs without complications and is not characterized by an inflammatory process of soft tissues).
2. Complicated carious lesion (due to the rapid development of pathology, an inflammatory process is observed in the pulp area, as well as in the tissue structure near the dental element). Most often, the complication manifests itself in the form of periodontitis or pulpitis.

Classification of carious cavities according to Black

Particular attention should be paid to the unspoken type of carious lesion that develops in young children. If parents accustom their baby to eating at night, and subsequently to sweet drinks and sweet juices, then the development of carious cavities should be expected. The danger of childhood caries lies in the fact that if the inner part of the incisors is damaged, the pathology long time not noticeable. The rapid development of caries in this case is explained by the deposition of carbohydrates of various sweets on the milk teeth. Moreover, an increase in the viscosity of saliva due to constant contact with the pacifier becomes an accompanying factor for the development of caries.

Three types are defined:

1. Fast.
2. Slow.
3. Stabilized.

Also, when diagnosing carious cavities, the fact of the intensity of the lesion is taken into account:

1. Caries can appear as a single element.
2. These are multiple lesions on several teeth at once.
3. Defined as a systemic lesion.

It is very important to consider the moment when caries began to appear:

• primary phenomenon (the tooth is exposed to carious lesions for the first time);
• secondary phenomenon (a tooth that was previously filled is exposed to caries; caries mainly occurs around the filling);
• recurrent manifestation (when the dental element has not been sufficiently treated, then caries can develop on the dental tissues under the filling).

Exists a large number of caries classification systems, 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 why the carious pathology formed. After all, the effectiveness of treatment and the absence of recurrent carious lesions will depend on the reliability of the diagnosis in the future.

An example of the treatment process for second class caries:

Today we will talk about the Black classification of caries, known in dentistry.

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

The most fundamental is the classification of carious cavities, which was invented by Black in 1896. He identified 6 classes of dental damage from 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 secondary nature are not taken into account.

Despite this, Black's classification of caries is still widely used by dentists. Over time, the system for ranking damage to 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!

Molars, premolars and frontal 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 located on natural fissures.

Thus, seals must be installed in the above locations.

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

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

Foci of caries may appear on contact areas on different sides of the tooth. At a minimum, the medial and distal parts of the tooth may be damaged.

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

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 of the tooth. The integrity of the upper edge of the incisors is not damaged by such caries. Both on the mesial and distal sides of the tooth this pathology can show itself.

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

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.

Damage to caries only at the leading edges of the dental elements distinguishes this subspecies from the rest. It is localized on premolars and molars.

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

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

Also, this pathogenic process can be considered by the extent 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.

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

The first category includes caries that appeared on a tooth for the first time.

The second is a re-injury to a previously filled tooth.

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

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

Secondary caries is all new carious lesions that develop near 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 seal 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 if the carious lesion was not completely removed during previous treatment. Recurrence of caries is often detected under the filling during an X-ray examination or along the edge of the filling.

There are a large number of caries classification systems, 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 why the carious pathology formed.

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

In many countries, this classification is 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 of development of this disease:

1. The appearance of a carious spot. The source of demineralization of the dental element. The process of this harmful phenomenon can last either slowly or 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. Moderate caries manifests itself in damage to the surface layer of dentin.
4. Deep caries clings to the peripulpal dentin and affects the tooth right down to the nerve endings.

Let's take a closer look at the features of the course of chronic and acute form 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 to deep caries.

The affected tissues are soft, slightly pigmented (light yellow, grayish-white), moist, and can be easily removed with an excavator.

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

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

According to this ranking of affected areas, the following are distinguished:

• dentin caries;
• tooth enamel;
• cement;
• unspecified caries;
• odontoclasia;
• suspended caries.

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

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

Damage to the surface of the teeth is insignificant and does not cause any discomfort in 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.

Subcompensatory caries is characterized by average speed course, in which it can go unnoticed and not cause concern to the patient at all.

Decompensation caries is expressed by intensive development and dynamics of progression, accompanied by such acute pain that this affects both the patient’s ability to work and everyday life.

Because of this, the disease is often called acute caries. It requires immediate medical procedures, since otherwise the process may spread to third-party teeth with the subsequent addition of pulpitis and periodontitis.

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

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

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

Experienced dentists, when removing soft carious dentin, can leave its deep pigmented elements to avoid damage to the tooth pulp. After carrying out this work, there should be no affected tissue left 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 a hermetically sealed structural material that can restore the structure of the tooth and help it fully perform its functions in the future.

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

The most common is the Black classification of caries.

It indicates the location of the affected areas with this disease, which greatly helps 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 caries manifestation, according to the severity and severity of the processes occurring, according to the scale of distribution, according to the sequence of occurrence of lesions, etc.

In any case, no matter what the reason influences the occurrence of caries, it is best to urgently contact an experienced specialist for its localization and removal. An advanced 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 to the full functioning of not only the oral cavity, but the entire body. Outbreaks inflammatory processes can spread from teeth to jaw bones, nerves and even soft fabrics gums.

If you do not contact the dentist in a timely manner, people, at a minimum, may eventually lose a tooth affected by caries. We should also not forget about preventive measures maintaining a healthy oral cavity.

Thorough brushing of your teeth, rinsing them with a special antibacterial solution, regular scheduled dental examinations, and eating foods rich in fluoride 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 materials on our blog, there is a lot of educational stuff there.

Have a great day and stay safe!

Dental caries is pathological process progressive subsurface demineralization of enamel with the future formation of a cavity defect that occurs after teething under the influence of acids produced by microorganisms found in dental plaque.

Dental caries is considered one of the most common diseases. In many countries, the prevalence of caries is 95-98%. Incidence worldwide is trending upward, especially in children.

Predisposition to caries

For the development of caries, various conditions are necessary, in the presence of which the predisposition to this disease increases.

General factors:

• Cariogenic diet with a predominance of carbohydrate foods (cookies, sweets, carbonated drinks);
• Changes in the patient’s physical health (frequent common illnesses) respiratory diseases, FLU, etc.);
• Extreme stress on the body (radioactive radiation);
• Unfavorable heredity.

Local factors:

• Poor oral hygiene (presence of soft plaque and mineralized dental deposits);
• Violation of the qualitative and quantitative composition of saliva (high viscosity, lack of calcium ions);
• Violation of the resistance of mineralized tooth tissues (due to surface changes in structure);
• Changes in the biochemical composition of enamel, dentin and cement;
• Pathological changes in the pulp apparatus of the tooth;
• Disturbances in the formation of the dental system.

The development of caries occurs in several stages:

1. Caries in the spot stage(elementary). It is asymptomatic, the affected area of ​​the tooth loses its shine, becomes dull, and a chalky stain forms. The spot may be pigmented (have yellowish color). White spots usually appear on the teeth of a child or an adult. Probing is painless.
2. Superficial caries. Asymptomatic, sometimes painful sensations from sweet, sour, salty, less often from mechanical irritants. A rough defect up to 1 mm deep is detected on the tooth; a color change to light brown is possible. Probing is painless.
3. Average caries. Complaints of short-term sharp pain from food getting into the tooth, cold or hot, the pain goes away immediately after the irritant stops. A carious cavity in a tooth of small or medium size, up to 1.5-2 mm deep. Probing is painful along the dentinal-enamel junction.
4. Deep caries. Complaints about painful sensations from all types of irritants, from cold, hot, from food getting into the carious cavity. A deep carious cavity filled with softened, necrotic dentin and food debris. Probing along the dentinal-enamel border and the bottom of the carious cavity is painful; there is no communication with the dental pulp.

Last time we covered the topic of ICD 10 dentistry - international classification dentistry, dividing caries into categories.

What features are inherent in the Black classification?

In 1891 A. Black, based on patterns of distribution and typical localization, systematized all cavities, dividing them into 6 classes. The proposed classification is convenient for choosing tooth treatment tactics depending on the location of the defect. The purpose of this classification is to standardize methods for filling and preparing various carious cavities.

Classification of caries according to Black:

• 1 class– carious cavities located in the area of ​​fissures and natural depressions of the chewing group of teeth and in the area of ​​the blind fossa of the lateral incisor.
• 2nd grade– cavities on the mesial and distal surfaces of premolars and molars, limited by tooth tissue on three sides.
• 3rd grade– cavities on the medial and distal surfaces of the anterior group of teeth with no destruction of the cutting edge.
• 4th grade- cavities on the medial and distal surfaces of the anterior group of teeth with a violation of the cutting edge.
• 5th grade– cavities in the neck area of ​​all groups of teeth.
• 6th grade– cavities on immune zones (tubercles of teeth, enamel ridges)

To reduce the risk of caries development, its prevention and treatment is required.

Standard treatment includes:

• Examination, questioning, diagnosis, drawing up a treatment plan.
• Anesthesia.
• Opening a carious cavity (removing overhanging edges of enamel that do not have a dentin base).
• Expanding the cavity (improving visibility).
• Necrectomy (removal of softened dentin).
• Formation of a cavity (creation necessary conditions for filling).
• Finishing the edges of the enamel (creating a better fit of the filling to the tooth).
• Filling (using composite materials and cements).

Filling teeth restores their 5 main functions: speech, chewing, aesthetics, maintaining the soft tissues of the face, creating an occlusal plane.

Methods for treating hard dental tissues:

• Mechanical- using rotary burs and hand tools).
• Chemical-mechanical- usage chemicals to soften non-viable tooth tissues with their subsequent removal.
• Pneumokinetic- the impact of directed supply of an abrasive substance in the form of an aerosol under pressure.
• Acoustic- ultrasonic.
• Laser preparation. Based on microexplosions of water contained in the hard tissues of the tooth under the influence of laser irradiation.

If the tooth is too badly damaged and it is not possible to restore it with filling materials, then it is necessary to use orthopedic treatment (artificial crowns, inlays for the tooth under the crown).

Search effective methods Caries prevention is one of the main directions of modern dentistry. Caries prevention consists of a set of measures and its effectiveness depends on the interaction of dentists and dental hygienists with the population.

Prevention includes:

1. Regular visits to the dentist at least once every six months.
2. Carrying out professional oral hygiene.
3. Brushing your teeth at least 2 times a day.
4. The use of additional hygiene products (gum rinses, dental floss, toothpicks, irrigators).
5. Mouth rinse with remineralizing and fluoride-containing preparations.
6. If the fluoride content in water is insufficient, it is necessary to compensate for the lack of fluoride by consuming fluoridated milk.
7. The use of fluoride-containing gels for the prevention of caries.
8. Dentists conducting hygiene lessons in schools and preschool institutions with demonstrations of teeth brushing techniques on models.
9. Conducting lectures on oral care, risk factors for dental diseases and their prevention.
10. Drug therapy (fluoride tablets).

• Category:

Caries - terrible disease. But the doctors developed effective method fight against this disease. What is Black's classification of carious cavities? Let's consider this issue in more detail.

Tooth decay

“Caries” is translated from Latin as “rotting.” This is an intricate pathological process that sluggishly flows in the hard tissues of the tooth. It usually develops due to the complex influence of harmful internal and external causes.

At the initial stage of development, caries is determined by the destruction of the organic enamel matrix and focal demineralization of its non-living part. Later, the hard tissues of the tooth disintegrate and 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 Black classification? This is a grouping of carious formations on the tooth surface. It was introduced in 1896 to determine the standards of treatment 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 depressions of the buccal, chewing and palatal 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 more intense rotting of the incisors and fangs, affecting their cutting edges.
• The fifth is cervical caries. In this case, the vestibular surface of all groups of teeth is destroyed.
• Sixth class - damage located on the cutting edges of canines and incisors, cusps of premolars and molars.

Second version

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

• The first class includes damage in the area of ​​fissures (natural grooves).
• The second is caries that appears on the planes of large and small molars.
• The third is the decomposition of the contact faces of the canines and incisors with preserved cutting edges.
• The fourth is caries of the connecting planes of the incisors and canines with broken cutting edges.
• The fifth involves cervical injuries.

Third version

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

• The first class includes damage in the area of ​​natural grooves of teeth and fissures.
• The second is the depressions that appear on the contact faces of the small and large molars.
• The third class is cavities located on the contact surfaces of the fangs and incisors (the cutting edge is not affected).
• The fourth is notches that appear on the connecting planes of the fangs and incisors (the cutting edge and corners are affected).
• Fifth - cavities formed in the area of ​​the necks of all categories of teeth.
• Later, a sixth class was created, which included notches of atypical concentration: masticatory tubercles and cutting edges of the frontal teeth.

WHO

So, we found out what Black’s classification of cavities is. WHO offers its own triage. According to ICD 10, it looks like this:

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

Depth of lesion

In fact, Black's classification has found its application throughout the world. Based on the degree of destruction, caries is divided into the following stages:

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

On initial stage During the 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. Doctors remove the resulting stain using dental equipment. They remineralize the teeth in an attempt to prevent the subsequent development of the disease.

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

Agree, Black’s classification of defects in hard dental tissues is an excellent help for dentists. What is 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 dentin.

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

Now let's look at deep caries. This disease is characterized by significant destruction of dental tissue, 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.

Preparation of cavities. Disclosure

Black's classification formed the basis for dental treatment. Cavity preparation is performed in five stages. Let's study the basic rules using the example of 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 underneath. The result is sheer walls. The amount of tissue excised here is determined by determining the focus of dentin decomposition. At this stage, the doctor must provide access for good review cavity and its further processing.

Doctors perform the opening with spherical or fissure burs made of diamond or hard alloys. The diameter of the tools corresponds to the size of the inlet opening of the recess. Specialists use turbine tips that rotate at high speeds and water-air cooling.

Extension

Black's classification of cavities has been used for a long time and greatly helps dentists in their work. What is a preventive extension? At this stage, the identification of the carious cavity continues. With this action, the doctor tries to prevent the occurrence of recurrent tooth decay. The specialist outlines the external 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 performs a radical excision of areas susceptible to decay to immune areas. The expansion of the carious cavity is carried out using 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 tissue on the occlusal plane. If all decomposed tissue is removed in the area of ​​the carious cavity, then the fissures are excised only within the enamel. The bottom of the recess in this precedent has a non-classical shape - rounded or stepped.

When opening the 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 boundaries of the enamel. It also avoids creating sharp corners.

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

Necrectomy

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

Formation

Next, the doctor gives the carious cavity a shape that helps secure the filling. 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 tip rotate at high speed. The required shape of the recess is obtained taking into account resistance and retention.

Finishing

After processing with carbide or diamond burs, the enamel on the edge of the recess acquires crooked outlines, 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 filling and the development of putrefactive processes. These nuances dictate the need for finishing - final processing of the edges of the cavity, as a result of which damaged areas of enamel must 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 treat the edges of the socket with edge trimmers and enamel knives, removing the thin outer layer of the tooth and eliminating the possible negative effects of overheating, vibration and other factors.

As you can see, dental treatment is a rather complex process, but if you consult a doctor in time for help, you can save Hollywood smile long years.

Dentistry is constantly improving, but the foundation for theoretical findings and the daily work of doctors remains the ideas proposed decades ago. For example, many practicing dentists today classify caries according to Black, adhering to the system that was created in 1896. Over the course of its existence, it has been modernized, but the basis has remained unchanged.

What is the essence of Black’s classification of caries and why is it popular among dentists to this day, read the article.

Who is Dr. Black

In his homeland, the American doctor Greene Vardiman Black is rightfully considered one of the fathers of modern dental science. The future scientist was born in 1836 and grew up on a modest farm near the city of Winchester, Illinois. Previous acquaintance with nature played a role: the boy often observed animals, and at the young age of 17 he became interested in medicine.

For four years, Black has been studying anatomy and other medical sciences at a local hospital. The young man’s interests also included dentistry - he became an assistant to the then famous dentist D.S. Spira. At 21, Green Vardiman opens own practice in Jacksonville.

In the United States of the mid-19th century, dentistry was considered not a science, but rather a craft. Black's undoubted merit lies primarily in the fact that he reversed this idea and became the first to look at the work of a dentist from a scientific point of view, and then describe medical skills.

Interesting fact! Dr. Black is responsible for several inventions. Among them is a drill controlled by a foot drive. In addition, the scientist devoted many years to developing the composition of the filling gold amalgam. The formula proposed by Black is still used today.

The most famous work of an American doctor is the classification of carious cavities according to anatomical characteristics. In addition, he owns several works on the topic of caries, which became real textbooks for dentists of that time. Dr. Black has chaired the National Dental Association and a number of other professional associations, as well as taught. His contribution to the development of dentistry was recognized with the Miller Prize.

What is the essence of the Black system

It is called a process in which hard tissues The teeth gradually lose minerals and decay. As a result, free cavities appear. Dr. Black proposed to classify the disease based on their location. His system includes six classes of dental caries. Five of them were identified by the American scientist himself, and the last one was later added by the World Health Organization, which considered the classification incomplete. So, Black and his followers highlighted:

1. Class 1 caries: concentrated in the fissures of small and large molars - that is, in the natural grooves on their chewing, external and lingual (lingual) surfaces. In addition, this variety affects the lingual surface of the canines and frontal units: in the latter, more often in the area of ​​blind fossae - depressions near the neck of the tooth,
2. Class 2 caries: affects areas between molars and premolars - localized on their contact surfaces. May affect one surface or both,
3. Class 3 caries: also typical for contacting surfaces, but here we are talking about canines and incisors. Dr. Black clarified that in this case, the corners of the crowns and the cutting edges remain unharmed,
4. class 4 caries: lesions appear in the same places as in class 3 caries, but now both the cutting edge of the crown and its corners are subject to destruction,
5. caries class 5: in the affected area - the cervical area of ​​the teeth. This type of disease can be found on absolutely any element of the dentition,
6. caries class 6: destructive processes affect the cutting edges of the frontal units and canines, as well as tubercles on the chewing surfaces of the molars and lateral elements.

How teeth are treated using the Black system

The practical value of the classification proposed by the American doctor is that it greatly simplifies diagnosis and helps choose the correct tooth preparation technique and filling material. This allows you to ensure the durability of the filling, as well as protect the patient from the development of secondary or recurrent carious lesions.

Treatment of caries according to Black has its own characteristics for each class:

• Class 1: in this case we are talking about the chewing surface, which is under serious load. Therefore, it is important to eliminate the risk of the filling breaking off. When preparing, that is, drilling out a cavity for a filling, not only the depth of the fissures is taken into account, but also their individual characteristics. The doctor reduces the bevel of the enamel and forms a cavity, usually in the shape of an oval or cylinder. It is then covered with a chemically cured composite, laying it parallel to the bottom of the cavity. Another option is to use a material that cures under a lamp. It is laid in oblique layers. Both methods make it possible to achieve a tight fit of the filling to the cavity,

Important! If there are 2 or several carious lesions in a tooth, then the cavities are most often combined into one, especially if the layer of healthy tissue between them is thin and fragile.

• Class 2 caries: the cavity is most often drilled from the chewing surface. Since the carious lesion is located in the side of the tooth, an additional platform is usually formed at the top of the crown for better penetration of the filling material into the problem area and its fastening. Sometimes the diseased tooth is so destroyed that there is no contact between it and the neighboring one. Then the filling will “overhang.” To avoid this, the carious tooth is wrapped in a matrix, creating a clear boundary. The tooth is slightly shifted using special wedges. In order for the composite to be tightly connected to the cavity, an adhesive material is first applied to it,
• Class 3: since we are talking about the smile zone, it is important here not only to fill the tooth well, but also to maintain its aesthetics. Therefore, drilling is performed from the lingual, that is, “wrong” side, and for filling only composites are used, the color of which is close to the patient’s natural enamel. Moreover, two types of material are used: the desired shade and transparent,

“I started having caries on my front teeth, right in the middle, that is, in the most visible place. I was very worried that it would not be possible to return them to a healthy appearance without darkening. But my dentist did everything right top level– I sealed everything neatly, and in color my front ones are no different from the others. Thank you doctor!”

Natalya, patient at a Moscow dental clinic

• Class 4: the dentist faces the same tasks as when treating a disease of class 3. Plus the need to make the restored tooth so strong that it can withstand the chewing load. If the canine or incisor is damaged by less than one third, then restoration with composites is performed. If the destruction is 50%, installation will be required; fixation is also possible. If the damage is even larger, only an artificial crown will save the situation.
• Class 5 caries according to Black: one of the most complex species disease, because the lesion is located at the edge of the gum or even hidden under it. Therefore, soft tissues have to be adjusted. In addition, preparation must be performed with extreme care to avoid damaging the pulp. As a rule, they are first installed, then replaced with a permanent one made of composite. If we are talking about the front part of the dentition, then light-curing materials are used, carefully selecting them by color,
• Grade 6: often accompanied by malocclusion or pathological abrasion of the enamel. May be a consequence of poorly installed prostheses. Therefore, when treating a disease of this type, it is especially important to establish the cause in order to eradicate it in the future. With normal tooth height, carious cavities are prepared and covered with composite. In some cases, it is reasonable to use it in the smile area to straighten the dentition. If the bite height is insufficient, then installing an artificial crown will help.

Interesting fact! Dr. Black advocated the removal of tissue affected by caries to the maximum extent and even a little “with reserve”. The scientist called this “extension for prevention,” meaning the prevention of recurrence of lesions under the filling. When drilling, large cavities were most often given a box-like shape. Modern dentistry has moved away from this principle and gives preference to gentle preparation, which allows preserving as much living tissue as possible.

What other classifications of the disease exist?

In addition to Dr. Black's system, diseases have also been developed. One of the most common is topographic, which takes into account the depth of tooth damage. This system is widely used by dentists in Russia and the CIS. Here are the highlights:

1. spot stage: the appearance of a small, barely noticeable area of ​​demineralized enamel. The initial stage of destruction,
2. superficial carious lesion: the damaged area is clearly visible upon examination. But caries has not yet reached the dentin,
3. medium degree of damage: bacteria have destroyed the enamel and have already “attacked” the dentin. At this stage, the disease is still easily treatable,
4. deep lesion: dentin is so destroyed that only a thin layer of it protects the pulp. Last chance to cure caries if you don’t want to get periodontitis.

This system is only relevant for permanent dentition. In baby teeth, the nerve is located closer to the surfaces of the tooth. Therefore, if a deep cavity has formed, then the lesion is either considered average, or is already treated as pulpitis, depending on the specific case.

Here it is appropriate to talk about the second classification, which is similar in meaning to the previous one. According to the development of pathology, caries occurs:

• uncomplicated: occurs without inflammation of the pulp and periodontium,
• complicated: inflammation spreads to soft tissues, leading to pulpitis and.

Important! It is worth mentioning about caries in children - it is classified into a separate type called “bottle caries”. It develops in infants who are frequently fed at night and are pampered with sugary bottle drinks. Particles of food, especially sweet ones, immediately settle on baby teeth. If the baby is then given a pacifier, the saliva becomes viscous, which increases the risk of bottle tooth decay. Its danger is that bacteria primarily affect the lingual surface of the incisors, where it is difficult to notice damage.

In practice, another classification of the disease is quite often used - according to the intensity of development. She divides the disease into 3 types:

1. single: the lesion is noted on only one tooth,
2. multiple: the disease affects several elements,
3. systemic: caries has spread very widely.

The next division of the disease is related to the speed of its development, or the nature of the course. Caries can be:

• fast developing,
• slowly flowing
• stabilized: the development of the disease stops.

Carious lesions also differ in the sequence of occurrence. Here the following types of illness are distinguished:

1. primary: affects the tooth for the first time,
2. : develops on a previously filled tooth, around or under a filling,
3. recurrent: occurs under a filling due to the dentist’s shortcomings during treatment.

She proposed her classification of the disease World organization healthcare. This system is called international. Its other name is histological. The classification considers the following main types of pathology:

• destruction of enamel,
• dentin damage,
• penetration into cement,
• paused process.

There is another common typology of the disease - by localization. She distinguishes fissure, contact and cervical caries. As you can see, this division is very close to Dr. Black's system. Most classifications use repeated parameters, so there is no point in listing them all. In practice, it is important for the doctor to determine the main indicators of the disease: these include the depth of the lesion and the nature of the course, as well as to establish its cause.

Video on the topic

Caries is the most widespread among all types of oral lesions. The development of this disease is described in dentistry as intense destruction of the enamel and dentin of the crown. In the process of development, caries goes through two stages: the first is a carious stain, the second is the thinning and abrasion of hard tooth tissues. Abundant human consumption of carbohydrates contained in thermal foods and intensive formation of soft plaque lead to the rapid proliferation of harmful bacteria that damage the integrity of the dental crown.

In dentistry, there are a number of factors that enhance the destructive effect of carious formations: oral hygiene, the consequences of certain diseases, lack of vitamins and minerals in the body, a persistent state of stress.

The danger of caries lies in its widespread manifestation- from fissures to the gingival areas of the teeth. Depending on the location of the carious cavity, the process varies of this disease. To standardize treatment methods for each practical case in dentistry, a classification of carious formations is carried out.

One of the most successful classifications to date was proposed by dentist J. Black. It allows you to highlight the peculiarities of the process for each class, select the appropriate method of filling a carious tooth, and most accurately characterize the position of the painful area on the tooth surface.

Classification of carious formations proposed by J. Black

In total, Black identified five classes. The main condition for their separation is the localization of the carious area on the surface of the tooth. The defeat can be recorded in one area - in premolars, fissures, molar fossae, canines and incisors; in two or more areas - the occlusal, mesial or distal surface of molars, premolars, canines and incisors.

First grade

According to Black, in this case, the formation of carious cavities occurs in the fissures - in the chewing, buccal and palatal recesses. During dental treatment it is necessary to take into account the risk of breaking the seal as a result high pressure at her. In this case, dentists apply an additional layer of filling material.

The method of laying the composite differs for different curing materials: for light curing material laid in oblique lines in relation to the bottom of the affected area, for chemical - the composite is applied parallel to the bottom. The superimposed layers correspond to the direction from the middle of the carious cavity to its edge, and the reflection is realized along the side walls and perpendicular to the chewing surface. Thanks to such operations, the filling fits tightly.

Stages of filling - I class.

• drilling the area to be filled until it reaches hard tissue
• applying primer if necessary
• applying adhesive
• composite curing
• processing and polishing of fillings
• final cure

Second class

According to Black, in this case, the formation of carious cavities occurs in molars and premolars on their contact surface. Certain difficulties arise in the treatment of second class diseases associated with the application of filling material. Due to the resulting overhang of the filling, the gums may become inflamed. In this case, Black provides for the use of dental instruments - a matrix and wedges - to prevent painful contact. The matrix is ​​installed between the teeth adjacent to the affected area. The wedges that secure the matrix are moistened with water to move the tooth.

Another difficulty is that the strength of the composite is determined by the position of the caries in the cavity, and if the area with dentin is damaged, the composite loses its adhesive properties. Then the use of adhesive is highly recommended.

Stages of filling - class II:

• anesthesia of carious cavity
• initial preparation,
• gum correction, if necessary
• installation of the matrix and holding wedges,
• moving teeth apart if necessary
• isolation of the pulp from the composite, if necessary
• exclusion of acids and saliva from the prepared area
• primer application
• applying adhesive
• restoration of enamel when it is removed, if necessary
• carrying out the main procedure: applying layers of curing material
• removal of the matrix and wedge,
• composite curing
• processing and polishing of fillings
• final cure

Third and fourth grades

According to Black, in this case, the formation of carious cavities occurs on the surface of the incisors and canines, as well as their cutting edges. The main difficulty is represents the choice of color for the composite, because we are talking about the preparation of the front teeth, and therefore the area that is most noticeable to others. The dentist needs to have an idea of ​​the degree of transparency of enamel and dentin in order to impart uniformity to the natural tissue and filling.

Stages of filling - III and IV classes:

Fifth grade

According to Black, in this case, the formation of carious cavities is localized in the area located in the cervical (gingival) part of the tooth. The main problem for the dentist when curing a disease of the fifth class, it will be necessary to determine the depth of the carious lesion relative to the gums. A serious lesion complicates the treatment procedure by adjusting the gingival edge of the tooth. A pre-sealing operation is added to the main process of installing the curing material. According to Black's recommendations, a composite is selected depending on the location of the affected area.

Stages of filling - V class:

Sixth grade

To the standard Black classification initiated by WHO a new class was introduced localization of caries - tubercles of molars, cutting edges of fangs and incisors. The introduction of the sixth grade was preceded by cases in dental practice when a patient experienced pathological abrasion of tooth enamel on the protruding surfaces of the crown.

Thus, it is not recommended to limit yourself to conventional filling, which is applicable in the cases described by Black. Curing pathology requires specialist intervention, capable of correcting a patient’s defective bite and introducing artificial crowns into the cavity. After such manipulations, the following problem may occur: the filling molar loses contact with the antagonist tooth, which disrupts the natural occlusion of the jaws, therefore, during preparation, a composite veneer should be used, which will fill the gaps between the affected area and the adjacent and opposite teeth.

Tasks assigned to the specialist in the process of caries treatment

In practice as a dentist it is necessary to adhere to a number of rules related to the treatment and prevention of caries. Below are the main tasks that set the specialist the goal of eliminating the negative consequences of treatment:

• The filling cannot be placed in the affected tooth without pre-cleaning carious cavity
• Damaged dentin is removed completely unless exceptional practical circumstances prevent this.
• Damaged enamel is completely removed
• The affected tissue is removed to exclude infection of the oral cavity
• The cavity is exposed to boron to ensure retention of the filling and resistance of dental tissues
• Prevention of recurrence of caries