Fissure caries is a carious damage to the tooth tissues, localized in the fissures of the teeth. Under the fissures should be understood as natural grooves on the surface of the teeth, usually in the form of grooves. Most of the fissures are chewing surfaces of large molars.
Fissures can be divided into "open" and "closed". Open fissures should be understood as deepening, the bottom of which is visually visible. The closed fissures resemble a bottle. Outside, when viewed, only a narrow furrow (bottleneck) is visible, but deep down the fissure expands to form a cavity.
Fissure caries: photo
In Figure 3 (cutting a tooth) you can see what caries means in a closed fissure - the entrance to the fissure is very narrow, but under it is a massive carious lesion. To diagnose caries in such closed fissures is very difficult.
Fissure caries: causes
Fissures are a great place where food remains after eating. Accordingly, if you do not brush your teeth after eating, then food debris in fissures turns into an excellent nutrient medium for cariogenic microorganisms. These microorganisms multiply vigorously in food debris and destroy teeth in the places of their accumulation. Therefore, the reason for the appearance of fissure caries is only one - insufficient oral hygiene.
Fissure caries: diagnosis
- Visual inspection -
Inspection easily helps to identify caries in open-type fissures, especially if there is a probe in the hands of a doctor. However, neither the doctor's gaze nor the probe can penetrate the "closed-type" fissures, and here auxiliary diagnostic methods come to the rescue.
- Radiodiagnosis -
This diagnostic method is an important aid since roentgenogram can reveal a carious lesion in the complete absence of its clinical manifestations. We are talking about "closed" type fissures. However, X-ray examination very often cannot detect carious lesions in the early stages.
- Apparatus for the diagnosis of caries fissures -
The most effective method for determining fissure caries is laser fluorescence. This method is not particularly replaceable in the presence of "closed" type fissures. An example of such a device is the "Diagnodent" (Fig. 6).
Fissure caries: treatment
Treatment of fissure caries can be made by two methods:
either with the help of filling materials, or by making tabs made of ceramic, gold or semi-precious metals.
- Sealing with light-polymer filling materials -
the method consists in drilling caries using a drill and diamond burs, followed by sealing of defects with modern filling materials - light-cured composites or glass ionomer cements.
In Figure 7-11, you can see the main stages of the treatment of fissure caries by filling. Explanations for each photo appear when you click on the photo.
Treatment with restorative tabs −
The restorative tab is a tooth microprosthesis, which, unlike the filling, is not made in the patient’s oral cavity, but in the dental laboratory. To do this, all carious tissues must also be drilled out first (fig.13), after which the doctor removes the cast from the tooth and makes a plaster tooth model on it (fig.14). For this gypsum model, the dental technician will make a tab that will replenish the lost part of the tooth (fig.15-16). And only after that the tab is fixed on the tooth on a special cement (Fig. 17).
In fig.12-17 you can see the main stages of the treatment of fissure caries by making a tab of gold. Tabs can also be made of silver-palladium alloy, gold-platinum, or ceramics. The latter make it possible to achieve even better aesthetics.
What is better - seals or tabs?
Undoubtedly tabs! Most often, caries occurs at the border of the filling / tooth, because There is always a small gap between them. This gap between the insert and the tooth tissues is measured in microns, and between the filling and the tooth tissues - it is ten times more. Therefore, secondary caries next to the tabs occurs much less frequently. Conclusion - tabs have a much longer lifespan.
Tabs made of ceramics - have not only a long service life, but also aesthetics are much better than those of any fillings. In addition, ceramics do not tarnish over time. In turn, the seals of light composites darken over several years and require replacement.
Fissure caries: prevention
- Preventive Fissure Sealing -
The risk of fissure caries is always when hygiene is not 100%. Caries develops especially rapidly in deep fissures, since in this case, more conditions for the retention of food residues. Therefore, dentists are always advised to seal deep fissures with a sealant (special filling material). This method is used in both children and adults. The effectiveness of the method is very high.
- Adequate oral hygiene -
This is the easiest and most effective method of caries prevention. Teeth should be cleaned after each meal, and before that you need to use dental floss.
That includes good hygiene and which hygiene products are best used. - read the article: "How to brush your teeth"
Remineralization of teeth -
uhThis method is very useful, because increases enamel resistance to microbial plaque and food debris. Various lacquers based on fluorine, calcium hydroxide slurry, etc. are used for processing. Examples of good home remedies are R.O.C.S remineralizing gel. Medical Minerals and Elmex-gel with fluorine, which are successfully used for the remineralization of enamel and fluoridation of enamel in the treatment of initial caries in the stage of white spot.
Author: dentist Kamensky K.V., 19 years experience.