ROOT CARIES PREVALENCE                                               WILL INCREASE BECAUSE …                              ...
ROOT CARIES                                                                        VS.                                    ...
EXPOSED RESORPTIVE DEFECT                                                 •   hard                                        ...
Root Caries Severity Index of Billings            Root Caries Severity Index of Billings     Grade 1    Grade 2        Gra...
CONTROL STRATEGIES     Remineralization Therapy                                       Remineralization Therapy        High...
RECONTOURING• OBJECTIVE: TO REMOVE SOFT,  CARIOUS DENTIN & PROVIDE A  SMOOTH, NON-RETENTIVE ROOT  SURFACE CAPABLE OF RESIS...
ROOT CARIES                                              ROOT CARIES     RESTORATIVE TREATMENT                            ...
RESIN-MODIFIED GLASS IONOMER CEMENTADVANTAGES                 DISADVANTAGES•   CHEMICAL BOND TO       •   REQUIRES STRICT ...
extension on root surfaces                            extension on root surfaces    extension on root surfaces            ...
FACIALDOVETAIL           10
1                2proximal root concavity(radicular groove)                          11
THE SLOT / CLASS V        COMBINATIONINDICATIONS: WRAPAROUND  ROOT CARIES LESIONS  (SOMETIMES SEEN ON  CROWN MARGINS)     ...
#5-M slot#5-M slot            overhang in proximal            root concavity                                              ...
#3 recurrent caries lesiongold onlay margin                             14
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Root caries restoration.07.ppt

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Root caries restoration.07.ppt

  1. 1. ROOT CARIES PREVALENCE WILL INCREASE BECAUSE … • PROPORTION OF ELDERLY INCREASING • TEETH BEING RETAINED LATER IN LIFE • GINGIVAL RECESSION INCREASES WITH AGE • XEROSTOMIC MEDICATIONS ARE NUMEROUS ROOT SURFACE RESTORATION8/17/92 11/9/93 12/20/94 4/15/89 11/10/90 CERVICAL BURNOUT• RADIOGRAPHIC ARTIFACT PRODUCED BY A LOCALIZED RELATIVE RADIOLUCENCY• BOUNDED BY CEJ, CREST OF ALVEOLAR BONE, LIP LINE, OR CALCULUS 1
  2. 2. ROOT CARIES VS. CERVICAL BURNOUT • ACQUIRE RADIOGRAPHS WITH GOOD CONTRAST • ASSESS IF BOUNDARIES OF RADIOLUCENCY CORRESPONDS TO ANY ANATOMICAL FEATURES • INSPECT TEETH CLINICALLY TO BACK UP RADIOGRAPHIC INTERPRETATION Root Caries Differential Diagnosis Diagnostic Criteria• Soft, Leathery, Tacky Area • Active Root Caries Lesion• at CEJ or on Root Surface • Inactive Root Caries Lesion• Discolored (Varying Degrees) • Exposed Resorptive Defect• Undermines Adjacent Enamel • Root Surface Erosion• Usually Asymptomatic • Root Surface Abrasion • Normal Anatomic Features ROOT CARIES ACTIVE INACTIVE • YELLOW TO BROWN • DARK BROWN TO BLACK • SURFACE DEFECT • SURFACE DEFECT POSSIBLE POSSIBLE • TACKY, LEATHERY • HARD, GLASSY 2
  3. 3. EXPOSED RESORPTIVE DEFECT • hard • rough & irregular • majority of lesion usually subgingival • filled with soft tissue • “pink spot” • more common in anterior teeth • history of trauma • usually asymptomatic • ragged radiographic appearance NORMAL ANATOMIC FEATURES THAT MAY MIMIC ROOT CARIES • ROOT CONCAVITIES AND FURROWS • FURCATIONS • INVAGINATED GROOVES Root Caries Severity Index of Billings Root Caries Severity Index of Billings Grade 1 Grade 1 Grade 2 INCIPIENT INCIPIENT SHALLOWno surface defect surface defect <0.5mm 3
  4. 4. Root Caries Severity Index of Billings Root Caries Severity Index of Billings Grade 1 Grade 2 Grade 3 Grade 1 Grade 2 Grade 3 Grade 3 INCIPIENT SHALLOW CAVITATED INCIPIENT SHALLOW CAVITATED PULPAL surface defect >0.5mm carious pulp exposureGrade 1 Grade 2INCIPIENT SHALLOWno surface defect surface defect <0.5mmGrade 3 Grade 3CAVITATED PULPALsurface defect >0.5mm carious pulp exposure 4
  5. 5. CONTROL STRATEGIES Remineralization Therapy Remineralization Therapy High-Intensity Fluoride Treatment Objective: to convert active lesion Xylitol Chewing Gum into inactive lesion and avoid Chlorhexidine invasive procedures Remineralization Rinse Indications: bitewing enamel “notch,” superficial white spot, Grade 1 root surface lesionREMINERALIZATION 0 months REMINERALIZATION 2 monthsOHI, Nyvad & Fejrskov OHI, Nyvad & Fejrskov2 topical NaF, Scand J Dent Res 2 topical NaF, Scand J Dent Res 1986 1986F-dentifrice BID F-dentifrice BIDREMINERALIZATION 6 months REMINERALIZATION 18 monthsOHI, Nyvad & Fejrskov OHI, Nyvad & Fejrskov2 topical NaF, Scand J Dent Res 2 topical NaF, Scand J Dent Res 1986 1986F-dentifrice BID F-dentifrice BID 5
  6. 6. RECONTOURING• OBJECTIVE: TO REMOVE SOFT, CARIOUS DENTIN & PROVIDE A SMOOTH, NON-RETENTIVE ROOT SURFACE CAPABLE OF RESISTING FURTHER CARIOUS ATTACK• INDICATIONS: GRADE 2 (SHALLOW) LESIONS 6
  7. 7. ROOT CARIES ROOT CARIES RESTORATIVE TREATMENT RESTORATIVE DIFFICULTIESOBJECTIVE: TO RESTORE LOST • PERIODONTAL CONCERNS ROOT STRUCTURE, PROTECT THE • ISOLATION PULP, & IMPEDE FURTHER • PULPAL CONCERNS CARIOUS ATTACK • RETENTION • WEAKENING OF TOOTHINDICATIONS: GRADE 3 (CAVITATED) • LATERAL EXTENSION LESIONS & UNESTHETIC SHALLOW • ACCESS LESIONS • VISIBILITY • ANATOMY • RECURRENT CARIES • POST OPERATIVE SENSITIVITY MORTISE & TENON JOINT AMALGAM COMPOSITE RESIN ADVANTAGES DISADVANTAGES ADVANTAGES DISADVANTAGES • LOW LONG-TERM • REQUIRES MECHANICAL • CAN BOND TO ENAMEL & • CONTAMINATION BY MICROLEAKAGE RATES RETENTION DENTIN ORAL FLUIDS CAN • MOST TOLERANT (EVEN BONDED) • REQUIRES NO PREVENT BONDING OF MOISTURE • REQUIRES MORTISE FORM MECHANICAL RETENTION • POST OPERATIVE CONTAMINATION • MOISTURE • DOES NOT REQUIRE SENSITIVITY CONTAMINATION REDUCES MORTISE FORM • REQUIRES ACCESS FOR LONGEVITY LIGHT • ESTHETIC • NOT ESTHETIC • BOND TO DENTIN NOT • BONDING REQUIRES AS STRONG AS ENAMEL STRICT ISOLATION 7
  8. 8. RESIN-MODIFIED GLASS IONOMER CEMENTADVANTAGES DISADVANTAGES• CHEMICAL BOND TO • REQUIRES STRICT DENTIN ISOLATION• REQUIRES NO • NOT AS ESTHETIC AS MECHANICAL RETENTION COMPOSITE RESIN• REQUIRES NO MORTISE • WEAKER THAN FORM COMPOSITE RESIN• FLUORIDE RELEASE• MODERATE ESTHETICS 8
  9. 9. extension on root surfaces extension on root surfaces extension on root surfaces THE SLOT PREPARATION• view cut wall• extend until decalcification superficial INDICATIONS: PROXIMAL• treat superficial decalcification with ROOT CARIES LESION ON recontouring & remineralization POSTERIOR TOOTH APICAL TO SOUND MARGINAL RIDGE OR ADJACENT TO OTHERWISE SOUND CAST CROWN SLOT PREPARATION AT CEJ FOR AMALGAMPROXIMAL VIEW HORIZONTAL CROSS SECTION BUCCAL VIEW 9
  10. 10. FACIALDOVETAIL 10
  11. 11. 1 2proximal root concavity(radicular groove) 11
  12. 12. THE SLOT / CLASS V COMBINATIONINDICATIONS: WRAPAROUND ROOT CARIES LESIONS (SOMETIMES SEEN ON CROWN MARGINS) 12
  13. 13. #5-M slot#5-M slot overhang in proximal root concavity 13
  14. 14. #3 recurrent caries lesiongold onlay margin 14
  15. 15. 15

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