Clinical Corner: Information on Dental Procedures

Articles

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Combating Hidden Decay with Early Detection
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Balancing: The Art, Science and Business of Dentistry
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Direct Preparation Of Preexisting Implant Abutments For Case Rehabilitation
Flextime Xtreme: The 80/20 Rule
Fast and Smooth - Efficient Crown Preparation With Carbide Instruments
When Advancing the Bur, One Can Feel the Presence of Dentinal Caries
Precision Trimming and Finishing of Current Dental Restorations Using the Safe End Bur System
Indirect Restorative Tooth Preparation: Extreme Efficiency and Accuracy
Creating Maximum Efficiency and Accuracy In Indirect Restorative Tooth Preparation
Preparation Protocol To Ensure Predictable Aesthetic Restorations
Tooth Preparation Mastering Quality and Efficiency
Fissurotomy: Proactive Treatment for Incipient Decay
Anatomically Adapted Carbide Finishing Burs - Creating Super-Smooth Composite Surfaces in Two Steps
Directions for Use: Dr. David Clark Kit
Placing Traditional Sealants with Enhanced Magnification: Methodology to Increase Both Short-term and Long-term Success - David Clark, DDS
How to Quickly and Conservatively Restore a Natural Shine after Orthodontic Bracket Removal
SS White Surgical Length Oral Surgery Burs: Atraumatic Removal of Teeth for Maximum Bone Preservation

“When Advancing the Bur, One Can Feel the Presence of Dentinal Caries”

Dr. Alexander Fumig  

Fissure caries is a treacherous thing. Even with state-of-the-art equipment, it cannot always be reliably diagnosed, especially if the enamel surface is intact.

In most cases, however, visual inspection, radiography and laser fluorescence will help to reach a decision. If caries is diagnosed, the dentist will open the fissure as conservatively as possible. The minimally invasive Fissurotomy® carbide instruments by SS White Burs, Inc., Freiburg (Germany), are ideally suited for this purpose.

The increased use of fluoride has reduced the incidence of open carious defects. Under an intact enamel layer, caries usually proceeds slowly and is therefore often overlooked.

Up to 50 percent of all permanent molars may be affected by hidden fissure caries, depending on age. It is advisable to perform a precise visual inspection of cleaned and dried occlusal surfaces and pits. Small cavitations and wide, brown and whitish discolorations of dry fissures are indicative of dentinal caries.

The suspected diagnosis can be supported by the use of bitewing radiographs and laser fluorescence (Diagnodent, KaVo) or electric resistance measurement (ECM, Lode Diagnostics). The patient’s history of caries and the assessment of the caries risk will also play a substantial role in reaching a decision.

If dentinal caries is diagnosed or strongly suspected, the fissure has to be opened. The Fissurotomy Kit by SS White Burs is very well-suited for this purpose. These durable carbide burs enlarge entrances to fissures by a maximum of 0.6 to 1.1 millimeters. The length of their working parts is approximately equal to the thickness of the enamel layer, down to the dentin-enamel junction.

The base of the working part is designed in such a way that the cavity floor can be optimally inspected with a probe after preparation. The fine instrument tip opens the fissure in a particularly conservative manner.

Figure 1 In addition to the Fissurotomy Original bur, other and even finer instruments for premolars and deciduous molars are available. The working part geometry is always adapted to the enamel thickness. As compared to instruments with round working parts and undercut preparation, the Fissurotomy burs permit maximum conservation of tooth structure.	Figure 2 Despite proper oral hygiene, tooth 47 of a 12-year-old female patient seems to be affected by fissure caries. This suspected diagnosis is not clearly confirmed by the radiograph. Because of the patient’s history of caries, the dentist decides to carefully open the fissure.	Figure 3 The fissure is carefully opened with a Fissurotomy Original carbide bur. The fissure system is “inspected” step by step, and exploratory enlargement is at first restricted to the fissure entrance.
Figure 4 The suspected diagnosis is verified. In the entire fissure system, the caries has already extended into the dentin. The incidence of hidden caries is very high, according to the literature and Dr. Fumig’s own experience.	Figure 5 Result of the application of a fissure sealant (Conseal f, light gray, SDI, Cologne, Germany). Depending on the degree of enlargement, a flowable composite may also be indicated.	Figure 6 This extracted premolar clearly shows how conservative a preparation with a Fissurotomy STF bur, for example, can be.

The opening procedure begins in the area most frequently affected by caries, namely the central pit. “When advancing the bur, one can exactly feel the hardness of the enamel. One can sense whether the caries is only superficial or extends into the dentin,” says Dr. Alexander Fumig, Freising (Germany), the dentist who treated the case presented in this article and took the photographs. Since its tip cuts more conservatively than its lateral blades, the Fissurotomy bur does not advance too fast. “As if on an invisible thread, the instrument is guided through the fissure system.”

When using Fissurotomy burs, dentists should apply only light pressure and avoid any jamming. This applies especially to the fine Fissurotomy NTF and STF burs. The best method is to use a red-ring handpiece, beginning at a low speed and gradually increasing it to a maximum of 50,000 min 1.

The burs create a cavity shape with divergent walls, allowing the dentist to optimally restore the defect with a fissure sealant or a flowable composite. In comparison with burs featuring round working parts, the Fissurotomy burs conserve a large amount of tooth substance. If undermining caries is present, it is excavated with the aid of round burs, as usual.

Hidden fissure caries is difficult to diagnose, and its incidence is often underestimated. In the case of a positive caries diagnosis, the fissures are opened with Fissurotomy carbide instruments, developed specifically for this purpose. The design of the working parts allows the dentist to feel the presence of dentinal caries when advancing the bur through the enamel. The cavity created is highly conservative and can easily be restored with flowable composites, thanks to divergent cavity walls.

Reprint from: Die Zahnarzt Woche (DZW) Spezial 2004 (6-7), Germany

Translation of Fissurotomy article – DZW journal, Germany

Originally Published in The ZMK December 2005 Issue