2000-12-1-37-47 - Saudi Dental Journal

ISSN (Print) 1013-9052
EISSN 1658-3558

The Saudi Dental Journal,
P.O. Box 52500,
Riyadh 11563,
Kingdom of Saudi Arabia

Tel.	966-1-467-7328
Fax.	933-1-467-7308 / 966-1-467-7534
Email	saudidj@ksu.edu.sa

Management of the pre-cavitation lesion

Shashi Patel, DDS, MSc, BDS, FAGD, FRACDS, DDPH, LDS

Preventive measures against dental caries are so successful today in certain countries and regions within countries, that the need for operative intervention has decreased and the primary responsibility of preventing dental caries and managing early lesions has been assigned to the patient. The dentist should only intervene with restorative treatment when specific criteria, including some of those listed in this paper, have been satisfied.

In the interest of conservation of tooth structures, the preventive dentistry restoration - the preventive resin restoration (PRR), (composite resin-sealant concept) or the glass ionomer/composite resin laminate (the so called "sandwich" or "laminated" technique) should be considered as an alternative to traditional Class I amalgam restorations. The PRR or sandwich technique concept can be used when the carious lesion is judged to be deeper into the dentin than is appropriate for management by fissure sealant alone, especially if no restoration exists in the tooth surface in question.

The use of sealants has spawned an entirely different concept of conservation of occlusal tooth structure in the management of deep pits and fissures early in caries involvement.

The preventive dentistry restoration embodies the concepts of both prophylactic odontotomy (enameloplasty) and extension for prevention, yet requires only a minimum or no cutting of tooth structure at the carious site. Pain and apprehension are slighi, and aesthetics and tooth conservation are minimized. Several options are available in selecting preventive dentistry restorations, depending on the professional's judgement.

The first option is to simply place a conventional sealant over the incipient lesion as well as over the remaining occlusal fissure system.

The second option, advocates the use of the smallest cavity preparation, but to remove the carious material from the bottom of a pit or fissure and then use an appropriate instrument to place either sealant or composite. Sealant is then placed over the polymerized material as well as flowed over the remaining fissures. Aside from protecting the fissures from future caries, it also possibly protects the composite from abrasion.

A third option reported involves the use of a glass ionomer cement as the preventive glass ionomer restoration (PGIR). The glass ionomer cement is used only in the cavity preparation involving dentin. The occlusal surface is then etched with a gel etchant, (avoiding etching the glass ionomer, if possible). The conventional resin sealant is placed over the glass ionomer and the entire occlusal fissure system. In the event that the sealant is lost, the fluoride content of the glass ionomer will help prevent future primary and secondary caries formation.

Each of these options requires a judgement decision by the dentist. That judgement can well be based on the criterion than if an overt lesion cannot be visualized, it should be sealed, if it can be visualized, the smallest possible preventive dentistry restoration should be used along with its required sealant "topping." It was pointed out that the first option could provide the preferred model for conservative treatment of incipient and minimal, overt pit-and-fissure caries. These options would be especially valuable in areas of the world with insufficient professional dental personnel and where preventive dentistry auxiliaries have been trained to place sealants under supervision. In all cases, the preventive dentistry procedure should be considered as an alternative to the traditional Class I amalgam with its accompanying extension for prevention that often includes the entire fissure system.

Saudi Dental Journal 2000;12(1):37-47.