|Year : 2020 | Volume
| Issue : 1 | Page : 24-27
A New Cavity Classification LOV/DD: An Original Hypothesis
Oleksandr Bulbuk1, Olena Bulbuk2, Mykola Rozhko2
1 Department of Prosthetic Dentistry, Ivano-Frankivsk National Medical University, Ivano-Frankivsk, Ukraine
2 Dentistry PE Department, Ivano-Frankivsk National Medical University, Ivano-Frankivsk, Ukraine
|Date of Submission||26-Oct-2019|
|Date of Decision||13-Nov-2019|
|Date of Acceptance||05-Dec-2019|
|Date of Web Publication||11-Apr-2020|
Department of Prosthetic Dentistry, Ivano-Frankivsk National Medical University, Ivano-Frankivsk
Source of Support: None, Conflict of Interest: None
Introduction: Previous research have established – in the problem solving of diagnosis and treatment of hard tissues defects, a significant role belongs to the choice of tactics treatment tooth destruction. This work aims to study the diagnosis problems and cavity classification, what will facilitate objectification of diagnostic and therapeutic approaches in the dental treatment of patients with this disease. For differential estimation of defects in teeth and for a precise assessment of the strength of the composition “tooth-restoration”, we conducted a mechanic-mathematical modeling of contact interaction of restoration with tooth tissues. We also conducted anthropometric studies cavities all kinds and different groups of teeth. The Hypothesis: The first division of the cavities we have conducted in depth lesions: depth of destruction (DD). The next division we conducted on several parameters: Location of defects, Occlusion load, Volume of defects (LOV). As a result of the study, was proposed the cavity classification LOV/DD, is offered the method choice algorithm of treatment hard tissues defects, which is based on classification LOV/DD, and can serve as a selection criterion in the treatment of such pathologies. Evaluation of the Hypothesis: The proposed classification fills the obvious gap in academic representations of hard tissue defects, suggests the prospect of reaching a consensus on differentiated diagnostic and therapeutic approaches in the treatment of patients with this disease.
Keywords: Cavity classification, diagnostics, restoration, algorithm of treatment
|How to cite this article:|
Bulbuk O, Bulbuk O, Rozhko M. A New Cavity Classification LOV/DD: An Original Hypothesis. Dent Hypotheses 2020;11:24-7
| Introduction|| |
Since the complications arising after various types of restoration are often caused by mistakes made by doctors at the stage of choosing a treatment method, the problem of choosing a method for treating hard tissue defects (cavities) requires a thorough study and development of new approaches in accordance with the principles of evidence-based medicine.,,
When choosing the method of restoring the damaged crown of the tooth and making the diagnosis, one can consider the index of destruction of occlusal surface of tooth (IDOST) proposed by Milikievich for Class I and II carious lesions. To date, the determination of the degree of the destruction of the occlusal surface of the tooth is one of the most important factors in choosing a treatment method (fillings, onlays, or crowns). This index is used today in the post-Soviet countries for the diagnosis and choice of a method for treating cavities. The global dental community relies on other indicators: “intercuspal distance”, SI/STA.
At the current stage of dentistry development, the dynamic growth of new knowledge, technologies, and materials has significantly changed the methods of treating cavities.
Based on the meta-analysis of literature, it was concluded that complications arising after various types of restorations are often associated with mistakes made by doctors at the stage of choosing a treatment method. Thus, the problem of choosing a method for treating cavities requires a thorough study and development of new approaches in accordance with the principles of evidence-based medicine.
The objective of the study is to develop anatomical and functional classification cavities, as a basis for the application of differentiated diagnostic and therapeutic approaches in dental treatment.
| Methods|| |
For differential assessment of the extent of cavities and precise estimation of the strength of the composition “tooth-restoration”, we conducted mechanical and mathematical modeling of contact interaction of restoration with dental tissues. We conducted anthropometric studies using methodology proposed by us. Anthropometric study of all types of cavities of different groups of teeth was carried out as well.,
We relied on the well-known prototypes of SI/STA classification proposed by Mount and Hume and modified by Lasfargues et al. On the basis of conducted experimental researches, own scientific hypotheses, meta-analysis of scientific literature, clinical experience, we have developed the cavity classification.
The first division was made according to the depth of destruction (DD):
- 0–the cavity is not determined (demineralization, discolorite, changes in the anatomical shape of the tooth).
- 1–defeat of enamel and initial defeat of dentin, cavity depth within the outer 1/3 dentin.
- 2–moderate defeat of dentin, depth of cavity in the middle third of dentin.
- 3–deep dentin damage, depth of the cavity within the circle of the pulp dentin.
- 4–teeth after endodontic treatment.
The next division we conducted on several parameters: location of defects (L), occlusion load (O), volume of cavity (V). All the cavities were divided into four groups (LOV) [Figure 1].
- Cavities in the area of natural pits and fissures.
- Cavities with one and two-sided defects on incisors and fangs up to ½ of the length of the cutting edge with the preserved vestibular surface and the optimum amount of dentin on it.
- Cavities cervical area of all groups of teeth and free operational access to them.
- Cavities on molars and premolars of type O, with a preserved wall not less than 20% of the diameter of the crown of the tooth.
- Cavities on molars and premolars of the type OM (OD) and MOD without damage to the supporting humps and the thickness of the retained walls of not less than 20% of the diameter of the crown of the tooth.
- Cavities on incisors and fangs with a lesion of the vestibular surface to one third.
- Cavities type O in premolars and molars with a wall thickness of less than 20% of the diameter of the crown of the tooth.
- Cavities type OM (OD), MOD with a defeat of one supporting cusp in molars.
- Cavities type OM (OD), MOD in premolars and molars with preservation of wall thicknesses less than 20% of the diameter of the crown of the tooth.
- Cavities on incisors with a lesion of 1/3 to ½ length of the cutting edge.
- Cavities on incisors and fangs with lesion of the vestibular tooth surface up to 1/2 of the crown width.
- horizontal tooth defeat to 1/3 crown height.
- Cavities on premolars of type OM (OD), MOD with a lesion of one cusp.
- Cavities of molars of type OM (OD), MOD with lesions of two or more cusps.
- Cavities on incisors with a lesion of the cutting edge more than ½ its width.
- Cavities on fangs with a lesion of more than ½ crown width.
- Horizontal tooth defeat at ½ and more crown height.
We called our classification LOV/DD (it is an abbreviation: Location, Occlusion, Volume, and Depth of Destruction). The next division we conducted on several parameters. After removal of the affected tissues, we measured using a micrometer in the front group of teeth of the width of the preserved vestibular surface, and in the lateral group of teeth, the thickness of the preserved wall. Based on these measurements, we performed the diagnosis using LOV/DD [Figure 2].
Evaluation of the hypothesis
We propose to write it in the form of a fraction, where the numerator indicates the location of defects, LOV, and the denominator indicates the depth of decay, DD, for example: 1/0, 1/1, 1/2, 1/3, 1/4, 2/0, etc. For all types of cavities localized in the cervical margin of a tooth, we used the classification being previously described by us, where the numerator indicated the level of the cervical location of the cavity. To describe the depth of the location of the cavity margin line towards the gingival level, we used the index, the value of which was equal to the distance (expressed as an integer in millimeters) from the level of the epithelial attachment to the deepest point of the cavity margin line. If the bottom of the cavity was located supragingivally, we put the “+” sign in front of the index; if the bottom of the cavity was located subdingivally, we put the “−” sign in front of the index; if the bottom of the cavity was located at the level of the epithelial attachment, we used the “0” index.
If the cavity had marginal decay of two or more sides—we chose the deepest cavity for our classification, for example: 2+1/3, 30/4 etc.
According to our research, we proposed an algorithm for choosing a method dental treatment, based on the classification we proposed [Table 1].
In the available medical literature, we did not find any works devoted to the questions of clear cavity classification. At the present stage of the development of dentistry, the dynamic growth of new knowledge, technologies, and materials significantly changed the methods of treating defects of dental hard tissues. In clinical cases where the cavity is located subdingivally, the “Cervical Margin Relocation” (CMR) can be used. During the period of dentistry development, various CMR techniques have been developed and studied gaining popularity among dental practitioners; however, there is no clear classification of gingival cavities.,,,,
The importance of dental restoration using fiber posts is being discussed as well. After endodontic treatment of teeth, it is recommended to use a fiber post, as there is a greater loss of dental tissue, that is the decisive factor in choosing the method of treatment is the amount of lost hard tissue. ,,,,
In the SI/STA classification system, there is no clear distinction between isolated carious cavities, located on one tooth surface, and combined lesions that involve several surfaces. The disadvantage of this classification is the characteristics of mainly chewing teeth, without involving the anterior ones.,
The choice between direct and indirect restoration is complicated by the fact that it does not depend on the objective factors. It depends on the dentist’s knowledge, habits, preferences, and stereotypes concerning the treatment of such pathologies; the patient’s consent, financial capabilities, and other factors that have nothing to do with the methods of evidence-based medicine, i.d. the absence of a cavity classification formed a methodological gap in treatment of this pathology.
| Conclusions|| |
In our opinion, the proposed classification filled the obvious gap in academic ideas of cavities, suggested the prospect of reaching a consensus on differentiated diagnostic and therapeutic approaches in treatment of patients with this disease. The algorithm we developed for choosing a method for treating cavities based on the classification we proposed can serve as a criterion for choosing the treatment of this pathology.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2]