Minimal intervention Dentistry

To access case histories for the treatment of each type of lesion click on the 'Back to Grid' button at the top of this page.

The Site 1 lesion is confined to fissures on the occlusal surface and other enamel defects on otherwise smooth surfaces of all teeth. Cingulum pits on upper

laterals and erosion lesions on cusp tips are typical examples and of course all of these can progress from

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the initial lesion to the very advanced lesion with considerable destruction of tooth structure. Occlusal fissures on molars are a constant problem and sealing of these with a resin sealant has been the profession’s best defence for many years. The reason for their susceptibility to caries is quite apparent, because they represent a deep and convoluted fault in the enamel at the time of eruption and are subject to heavy occlusal load during mastication. It is easy to see how bacteria laden plaque or biofilm can be trapped within the faults and then forced deep into the fissure under heavy masticatory load. Removal of that plaque is virtually impossible. Diagnosis of active caries is difficult in the early stages because the lesion does not show radiographically (see Abseil section) until there has been considerable penetration into the dentine. There are now diagnostic aids based upon the use of lasers (Ref #4, Chapt 3, P.32) to assist in diagnosis. They demonstrate a reasonable level of accuracy but prior training in their use is desirable.
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In fact, it is not unusual to have an entire crown collapse dramatically with no prior symptoms as a result of advanced caries within the dentine.


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The average fissure system is very complex and varies along its length from
		very shallow to very deep so it is quite possible to treat only that part of the fissure that is carious and the rest can simply be sealed. At the same time, the construction of the enamel walls is of significance in selecting the material to use as a sealant.

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There appears to be an amorphous layer of enamel on the surface of the walls of most fissures that will not accept the good etch pattern that is required for a resin seal to bond to the enamel.
However, glass-ionomer will develop the usual ion exchange adhesion regardless of the enamel pattern. To fulfil the requirements of minimal intervention it is suggested that glass-ionomer be used as a fissure seal on all Site 1, Size 0 lesions – that is, any fissure that appears to be deep and/or stained, particularly in a patient who is judged to be at risk of active caries. From that point it is left to clinical judgementto decide if the fissure has advanced to a Size 1 or beyond and then to decide the most suitable material to be placed.
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