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
RESTORATION
8/17/92 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. 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. 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 SHALLOW
no surface defect surface defect <0.5mm
3

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 exposure
Grade 1 Grade 2
INCIPIENT SHALLOW
no surface defect surface defect <0.5mm
Grade 3 Grade 3
CAVITATED PULPAL
surface defect >0.5mm carious pulp exposure
4

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 lesion
REMINERALIZATION 0 months REMINERALIZATION 2 months
OHI, Nyvad & Fejrskov OHI, Nyvad & Fejrskov
2 topical NaF, Scand J Dent Res 2 topical NaF, Scand J Dent Res
1986 1986
F-dentifrice BID F-dentifrice BID
REMINERALIZATION 6 months REMINERALIZATION 18 months
OHI, Nyvad & Fejrskov
OHI, Nyvad & Fejrskov
2 topical NaF, Scand J Dent Res 2 topical NaF, Scand J Dent Res
1986 1986
F-dentifrice BID F-dentifrice BID
5

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. ROOT CARIES ROOT CARIES
RESTORATIVE TREATMENT RESTORATIVE DIFFICULTIES
OBJECTIVE: TO RESTORE LOST • PERIODONTAL CONCERNS
ROOT STRUCTURE, PROTECT THE • ISOLATION
PULP, & IMPEDE FURTHER • PULPAL CONCERNS
CARIOUS ATTACK • RETENTION
• WEAKENING OF TOOTH
INDICATIONS: 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. RESIN-MODIFIED GLASS IONOMER CEMENT
ADVANTAGES 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. 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 AMALGAM
PROXIMAL VIEW HORIZONTAL
CROSS SECTION
BUCCAL VIEW
9

10. FACIAL
DOVETAIL
10

11. 1
2
proximal root concavity
(radicular groove)
11

12. THE SLOT / CLASS V
COMBINATION
INDICATIONS: WRAPAROUND
ROOT CARIES LESIONS
(SOMETIMES SEEN ON
CROWN MARGINS)
12

13. #5-M slot
#5-M slot
overhang in proximal
root concavity
13

14. #3 recurrent caries lesion
gold onlay margin
14

15. 15