Caries is a terrible disease. But doctors have developed an effective way to combat this disease. What is the classification of carious cavities in Black? Let's consider this issue in more detail.
"Caries" from Latin translates as "rotting". This is an intricate pathological process, sluggishly flowing in the solid tissues of the tooth. Usually it 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 matrix of enamel and the focal demineralization of its inanimate part. Later, the hard tissues of the tooth decay, cavities appear in the dentin. If the patient does not seek medical help for a long time, inflammatory complications from the periodontal and pulp may appear.
What is the Black classification? This is a grouping of carious formations on the tooth surface. It was introduced in 1896 to determine the standards of healing in each individual clinical case.
This classification includes five classes, each of which has its own scheme for filling and preparation of teeth. A little later, a sixth class was added to this system. Today it looks like this:
- The first class - carious destruction of fissures, pits and natural depressions of cheeks, chewing and palatine tooth surfaces (fissure caries).
- The second is damage to the contact surfaces of premolars and molars.
- The third is the caries of the contact surface of the canines and incisors, not touching their cutting edges.
- The fourth class is the more intense rotting of the incisors and canines, which touched their cutting edges.
- Fifth - cervical caries. In this case, the vestibular surface of all groups of teeth is destroyed.
- The sixth class is the damage placed on the cutting edges of the canines and incisors, the bumps of premolars and molars.
Black's classification of caries localization is presented in several versions. The second modification is as follows:
- The first class includes damage in the fissure area (natural furrows).
- The second is caries, which appeared on the planes of large and small molars.
- The third is the decomposition of the contact faces of the canines and incisors with the remaining cutting edges.
- The fourth is caries of connecting planes of incisors and canines with broken cutting edges.
- The fifth includes cervical injuries.
The third version
Classification by Black is famous for its third version. Today it has the following appearance:
- The first class includes damage in the area of natural depressions of teeth and fissures.
- The second one is depressions that appeared on the contact faces of small and large molars.
- The third class is the cavities located on the contact surfaces of the canines and incisors (the cutting edge is not affected).
- The fourth is the notch that appears on the connecting planes of the canines and incisors (the cutting edge and corners are affected).
- The fifth is the cavity formed in the region of the necks of all categories of teeth.
- Later, a sixth class was created, to which were assigned the notches of atypical concentration: knolls of chewing and cutting edges of frontal teeth.
So, we found out what the classification of cavities is by Black. WHO offers its own sorting. According to the ICD 10, it has the following form:
- decay of tooth enamel;
- damage to the dentin;
- destruction of cement;
- decomposition, stopped as a result of the influence on it of preventive and hygienic sessions;
- odontoclasia, which is characterized by the disappearance of the roots of milk teeth;
- other decomposition;
- unspecified rotting.
Depth of defeat
In fact, the Black classification has found its application throughout the world. By the degree of destruction, caries are divided into the following stages:
- initial decomposition;
- surface destruction;
- caries average;
- deep rotting.
At the initial stage of caries development, a dark or white spot forms on the surface of the tooth. Nevertheless, the enamel here has a smooth surface, since there is as yet no anatomical destruction. The appeared spot doctors are removed with the help of dental equipment. They remineralize teeth, trying to prevent the subsequent development of the disease.
At the next stage, the upper layers of the enamel are destroyed, a reaction to a sharp change in the temperature of water and food, as well as acidic and spicy food. The edges of the tooth become rough. At this point, doctors grind the affected area and then remineralize it. Sometimes superficial caries are treated with preparation and sealing.
Agree, the classification of defects of hard tissues of teeth by Black is an excellent help for dentists. And what is the average caries? In this phase, the enamel layer of the tooth is so destroyed that permanent or intermittent painful sensations arise. In this case, the decomposition process has already reached the upper layers of the dentin.
It is not surprising that the teeth require compulsory medical intervention, during which the doctor removes the affected area and restores it with the help of a filling material.
And now consider the deep caries. This ailment is characterized by an impressive destruction of the dental tissues, which has already affected most of the dentin. If at this stage the treatment is ignored, the pulp can be destroyed. As a result, the patient may develop pulpitis or periodontitis.
Dissection of cavities. Disclosure
Classification by Black formed the basis of dental treatment. The cavity is prepared in five stages. We will study the basic rules on the example of cavities of the first class, proposed by the famous doctor.
At the initial stage, the cavity is opened. Dissection of the tooth begins with the removal of the dirty edges of the enamel, which do not have a healthy, dense dentin. As a result, sheer walls are obtained. The number of excised tissues here is determined by determining the focus of decomposition of dentin. At this stage, the doctor must provide access for a good overview of the cavity and its further processing.
Doctors disclose globular or fissure burs made of diamond or hard alloys. The diameter of the tools corresponds to the size of the opening of the notch. Specialists use turbine tips rotating at enormous speed, and water-air cooling.
Classification of cavities by Black has been used for a long time and it helps dentists in their work. What is a prophylactic extension? At this stage, the carious depression is being identified. With the help of this action, the doctor tries to prevent the occurrence of recurrent decomposition of the tooth. The specialist outlines the outer outline of the cavity.
It should be noted that, in accordance with the method of "biological rationality" of IG Lukomsky, this step is not carried out in the preparation of excavations.
If the doctor is guided by Black's black-hole reaming technology, he performs a radical excision of the areas susceptible to decay to immune areas. The expansion of the carious depression is performed by conical or fissure burs (carbide or diamond). At the same time water-air cooling is used.
Classification of teeth according to Black provides a preventive filling, by which the loss of healthy dental tissues in the occlusal plane is reduced. If in the area of the carious cavity the entire decomposed tissue is removed, then the fissures are excised only within the enamel. The bottom of the notch in this precedent has a nonclassical shape - rounded or stepped.
When the fissure is opened, the doctor does not remove a large number of tissues: it is enough for him to make a groove with a depth of 1-1.5 mm and a width of 0.7-0.8 mm without leaving the enamel boundaries. He also avoids creating sharp corners.
In our country, as a rule, cylindrical narrow burs are used for excision of fissures (fissurotomies). Sometimes this operation is performed by spear-shaped and flame-shaped drills.
The next stage is the removal of caries - a necrotomy. The doctor completely removes the 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 cavity are created in the area of an intact transparent dentin.
Next, the doctor gives the carious cavity a shape that helps to secure the seal securely. It should provide the cured tooth with sufficient resistance and strength at functional loads. At this stage, the final internal and external outlines of the cavity are formed.
Deepening is created by fissure, flame-like, cone-shaped and pear-shaped burrs (carbide and diamond) with obligatory water-air cooling. The specialist makes the turbine tip rotate at a tremendous speed. The necessary form of excavation is obtained taking into account resistance and retention.
After treatment with carbide or diamond burs, the enamel on the edge of the notch acquires contoured curves, it is weakened, its prisms have lost contact with the lower tissues. In the future, this can contribute to a change in the fixation of the filling and the development of putrefactive processes. These nuances dictate the need for finishing - the final treatment of the edges of the cavity, as a result of which the damaged areas of the enamel must be eliminated.
As a result, the doctor achieves the best interaction and reliable edge fit between the dental tissues and the seal. This operation is carried out by 16- and 32-faceted fins or diamond fine-grained heads.
Doctors operate drills at low speed without pressure with mandatory water-air cooling. They also process the edges of the groove with gingiva trim tabs and enamel knives, removing the thin outer layer of the tooth and eliminating the possible negative effects of overheating, vibration and other factors on it.
As you can see, dental treatment is a rather complicated process, but if you turn to a doctor for help in time, you can keep a Hollywood smile for many years.