code 4 icdas

CODE 4 ICDAS

FEATURES

Features• Shows shadow of discolored dentin with

or without localized enamel breakdown• Shadow appearance seen easily when

tooth is wet - Grey, blue or brown.• For pits and fissures, smooth surface

(mesial and distal), and free smooth surface

DIAGNOSIS

DIAGNOSISVisual inspection• Teeth must be cleaned (plaque and biofilm), air-

dried and well illuminated.• Teeth must be sufficiently dried so changes can

be seen properly (remove saliva that obscure lesion)

• Fibre optic Trans illumination- lesions appear as dark shadow. Normally used for anterior teeth

Radiograph • Bite wing radiograph typical method for proximal

smooth surface• Dimineralized dentin shows white chalky

appearance/ shadow under enamel.• To determine the depth of carious lesion.

bitewing radiograph

TREATMENT

TREATMENT• Minimal invasive restoration–Removing carious lesion & infected dentin as

minimally as possible• Aim: to arrest the caries process• Conservative – does not require retention and

resistance features

TREATMENT• Methods: –Box only preparation – dark shadows in proximal

side–Tunnel preparation – dark shadows under pits

• Materials that can be used:–Flowable composite–GIC

TREATMENT

Composite GICAdvantages - High strength

- High wear resistance

- Better finishing and esthetics

- Bonds chemically to tooth

- Releases fluoride- Good marginal

seal

Disadvantages - Technique sensitive- High polymerization

shrinkage (light cure)

- Less esthetic - Brittle

FLOW CHART 1: DECISION TREE FOR PRIMARY CORONAL CARIES

DETECTION

TUNNEL AND BOX PREPARATION

GIC RESTORATION

COMPOSITE RESTORATION