These are pit and fissure type cavities

that involve the occlusal surfaces of

molars and premolars, the occlusal 2/3
of buccal and lingual surfaces of molars,
and the palatal pits in maxillary anterior
teeth.
Definition:

These are self-cleansable areas.
However, they may get involved by
caries due to their inherent defective
structure as areas of imperfect
coalescence of lobes of calcification
of these teeth. These areas are
retentive for food and thus invite
caries.
1. A small surface opening which may remain
unnoticed until the lesion becomes of a
considerable size.
2. A conical spread in both enamel and
dentin, with the bases of cones at the
Amelo-Dentinal Junction, "A. J.D."
3. Its rapid burrowing at the dento-enamel
junction. These lesions may involve one or
more surfaces and hence a simple or
compound cavity should be prepared.
These lesions are clinically
characterized by:
Designing the Outline Form.

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

Simple occlusal cavities
The mesial and distal margins are
placed midway between the bottom
of the proximal fossae and the
crest of the proximal ridges and in a
direction parallel to these ridges.

The mesial and distal wall should
have a slant or slight divergence
from the pulpal floor outward to
avoid undermining the marginal
ridges.
In a bucco-Iingual direction, the cavity
is extended just sufficient to eliminate
the defective and susceptible tissues.
The lingual and the buccal wail should
be parallel to the respective tooth
surface.
It must be reemphasized that the
outline form for class 1 cavities
should be very conservative since
they involve cleansable areas.
It is governed only by the extent of
caries in both enamel and dentin and
the amount of extension or need to
eliminate pits and fissures to secure
smooth margins.
The resistance form here consists
chiefly of a pulpal wall parallel to the
occlusal plane with dentin walls at right
angles to it., i.e. Boxing the preparation.
The form of this cavity provides
automatically for effective retention and,
therefore, no special retentive features
are required.
Obtaining the Resistance and
Retention Forms
In small size cavities, the carious dentin
should have been removed during making the
cavity extensions.
In moderately deep and deep cavities, the
carious dentin is peeled off carefully at the
sides using large spoon excavators, and then
scooped out in few and large pieces.
Only light pressure in a direction parallel to
that of the pulp is utilized. This is continued
until a sound dentin floor is reached.
Removal of Carious Dentin
The enamel walls of the cavity should be
finished free from any loose, short, or
undermined enamel, and trimmed to meet the
tooth surface at a right cavo-surface angle.
This may be done by sharp and regular-
edged chisels and hatchets, plane fissure
burs, stones, or sand-paper discs.
All sharp corners in enamel must be rounded,
as they may contain short enamel rods.
Planning of Enamel
Walls
A sharp explorer is then used to check
the details of the prepared cavity and to
loosen the tooth debris which are then
blasted out with warm air.
Performing of the toilet of the
cavity
Armamentarium

High speed handpiece
Burs #330, 56
Hoe
Hatchet R&L
Wedel staedt chisel
Operative Procedures
The outline form is performed by first
gaining access through the enamel to
the carious dentin floor of the cavity
followed by making the necessary
cavity extensions.
Procedure
In case of initial carious lesions, access
is obtained by employing a small pear
but #330.
In big carious lesions, access is
obtained easily by breaking down the
undermined enamel overlying the carious
dentin, using a suitable size chisel.
In either case, access is started at the
most defective area of enamel, i.e., a
carious pit or fissure.

The bur is held at a right angle to
the involved surface of, the tooth and
light pressure in an in-and-out
direction is exerted. Cutting is
continued until the amelo-dentinal
junction (A.D.J.) is reached.

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

The bur is rotated, and carefully
introduced through the opening just
obtained, so that its weak corners do not
touch the enamel and get dulled.
With the bur seated in the cavity just
below the amelo-dential junction 1/z-1
mm. gentle pressure is applied in the
direction of required extension.

During cutting, the bur should be kept
moving in-and-out of the cavity and at
right angle to the tooth surface. In this
way, the bur will undermine and lift the cut
enamel, and at the same time unclog itself.
Provision of ample resistance and
adequate retention through boxing of
the preparation could be obtained.

This is obtained by using a #56 fissure
bur held perpendicular to the surface of
the tooth. All the line angle in dentin
must be squared up hoe excavators.
The outline of these cavities usually
describes a triangle with its base faming
the gingival wall and its sides forming
the mesial and distal walls.

The gingival wall is placed at or
slightly occlusal to the height of contour
of the tooth.
Buccal Pit Cavities
All walls are extended just enough
to eliminate defective enamel and
dentin.

The enamel walls are planed in the
direction of enamel rods and
perpendicular to the axial wall.
Hoe excavators are used to smooth
the axial wall and make it parallel with
the external surface of the tooth.

It should be re-emphasize that the
shape of the cavity will be governed by
the extension of caries, accordingly
the outline of these cavities may be a
rounded or oval in shape.

Buccal and Lingual Extensions
In case of occluso-buccal and occluso-
lingual cavities extensions are made
through the fissures and towards the
respective surfaces.
The cutting is done in dentin at the
amelo-dntinal junction using a #56 bur
until the ocdusal ridge is undermined
and removed.
If the caries is still gingival to the
level of the pulpal seat, a step is
indicated: a #330 or 56 but is used
to cut the dentin at the amelo-
dentinal junction, applying pressure
in a gingival direction and at the
same time moving the bur mesio-
distally.
The enamel thus undermined, is broken
down with chisels.

Retention grooves are then cut in
dentin along the axio-mesial and axio-
distal line angles. The cavity walls and
margins are finished as previously
described.
In case of deeply-seated caries,
where removal of the carious dentin
will leave a round cavity floor,
flattening of which to obtain the
required resistance form, will expose
the pulp.
The following technique is
used:
The cavity floor is covered with
a sub base of calcium hydroxide,
followed by a base of glass
ionomer cement which fills it to
the routine cavity depth.

A ledge is cut on the expense of
the buccal and lingual side walls
of the cavity for obtaining the
required resistance in sound
dentin.
I. OUTLINE FORM
Smooth flowing,
regular curves.
Angular irregularities in
the outline are
susceptible to fracture
during condensation a
smooth flowing outline is
easier to visualize and
carve following
condensation.
Principles Rationale
II. EXTENSIONS Conservation of tooth
structure is the basis for all cavity preparations
in order to preserve the strength of the tooth.
However, sufficient extension of cavity
preparations is necessary to ensure access
(convenience form) for instrumentation, removal
of defective tooth structure, insertion and
finish of the restorative material, and
maintenance of the restoration (prevention).

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


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

1. Extend fully in areas of
buccal and lingual grooves
to terminate on smooth
surfaces.
to allow a smooth
tooth-restoration
margin to be created
(easier to finish and
keep clean).
Principles Rationale
2. Extend minimally in areas
of triangular ridges
(optimal isthmus width is
intercuspal distance or
less) terminating on
smooth surfaces.
to preserve the
strength and function
of the cups while
eliminating susceptible
grooves or defective
tooth structure (must
be wide enough to allow
condensation).
Principles Rationale
C. Mesio-distal extension

1. Stop short of the
marginal ridge crest.

2. Parallel the contour of
the marginal ridge.

to preserve strength of
marginal ridges.

to preserve a uniform bulk
(strength) to the mariginal
ridges.
Principles Rationale
3. Groove extensions are
kept narrow (mesio-
distally) where
possible (consistent
with access for
condensation and
outline form),
terminating on
smooth tooth
structure.
to preserve strength of
cusps while eliminating
susceptible grooves
and/or defective tooth
structure (must be at
least as wide as the
narrowest condenser).
Principles Rationale
4. If marginal ridge is
unsupported or very
thin it should be
included, resulting in
a Class II
preparation.
If not included the
marginal ridge may fail
(amalgam will be
stronger than the
unsupported enamel)
Principles Rationale
A. Depth = mm into
dentin (approx. 2 mm
measured at triangular
ridges).
Minimum depth is
required to provide
sufficient bulk to
prevent fracture and
retain the amalgam.
Principles Rationale
III. RESISTANCE/ RETENTION FORM

B. Pulpal floor

1. Smooth and flat

2. Parallel to the occlusal
plane
Uniform thickness of
restorative material.

resists occlusal stress
(resistance form) and
forces of condensation.
Principles Rationale
C. Buccal and lingual walls

1. Smooth and curved
mesio-distally.

2. Smooth and straight
pulpo-occlusally.
Facilitates adaptation
of amalgam and
elimination of weak
tooth structure.
Principles Rationale
3. Converge slightly
pulpo-occlusally in
areas of triangular
ridges (6
0
).
To provide mechanical
lock or retention to the
occlusal portion and crate
bulk at the margins.
Principles Rationale
4.Diverge slightly
pulpo-occlusally in
buccal and lingual
groove extensions
(6
0
).
protects buccal and lingual
surfaces from being
undermined (RESISTANCE
FORM).
Principles Rationale
D. Mesial and distal wall

1. Smooth and straight
facilitates adaptation
of amalgam and
elimination of weal
tooth structure.
Principles Rationale
2. Diverges slightly
pulpo-occlusally
(forms an obtuse
angle with pulpal
floor).
protects marginal ridge
form being undermined or
weakened (enamel must
be supported be dentin)
Principles Rationale
IV. CAVITY FINISH

A. Pulpo-occlusal line
angle is well defined
(no point angles are
present) and follows
general
configuration of
cavosurface outline.
increases retention of the
amalgam restoration and
preparation is more easily
visualized.
Principles Rationale
B. Cavosurface margins

1. Sharp (well defined)

2. Sound (well supported)
easier to visualize and
carve.

provides marginal
integrity.
Principles Rationale
C. Cleanliness cavity
is free of debris
and moisture.
facilitates adaptation of
amalgam to the cavity and
improves the physical
properties of the
restoration by elimination of
void or foreign material.
Principles Rationale
V. TISSUE RESERVATION

A. Rubber dam is intact

B. Adjacent tooth structure
and restorations are
intact

C. Adjacent soft tissue
(perio-dontium) is intact
preserves isolation,
eliminates moisture.

conservation of tooth
structure.

prevention of post-
operative pain and
inflammation.
Principles Rationale