Dental carries

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Dental carries

  1. 1. Dental carries Islam KassemConsultant oral & maxillofacial surgeon ikassem@dr.com
  2. 2. CariesBitewing Film primarilyPeriapical film also usedLow kVp, high contrast (short scale)
  3. 3. Proximal caries susceptible zone cariesApproximately 50 % demineralization is required forradiographic detection of a lesion.The thickness of the tooth buccolingually masks thecarious lesion when it is small.The actual depth of penetration of a carious lesion isdeeper clinically than radiographically.
  4. 4. Factors affecting caries diagnosis:Buccolingual thickness of toothTwo-dimensional filmX-ray beam angleExposure factors
  5. 5. Radiographic CariesI M A A I = Incipient M = Moderate A = Advanced S S = Severe
  6. 6. IncipientInterproximalCaries ICone-shaped radiolucent areaUp to half the thickness ofenamel Treat or no treat ?
  7. 7. IncipientInterproximal ICariesUsually not restored:* Unless patient has high caries activity
  8. 8. Incipient
  9. 9. ModerateInterproximal MCaries More than half-way through the enamel (up to DEJ)
  10. 10. Moderate
  11. 11. AdvancedInterproximalCaries A A From DEJ to half-way through the dentin
  12. 12. Advanced
  13. 13. Advanced
  14. 14. Advanced
  15. 15. Advanced
  16. 16. IncipientModerateAdvanced
  17. 17. SevereInterproximalCaries S More than halfway through the dentin
  18. 18. Severe
  19. 19. TransilluminationAnterior interproximal caries canusually be diagnosed by directingbright light through the contactareas.
  20. 20. Occlusal CariesMust have penetrated into dentinDiagnosed from clinical examRadiographs are not a reliablediagnostic aid for the detection ofocclusal caries.
  21. 21. Occlusal CariesThe apex of the triangle is toward theouter surface of the tooth and thebase is at the dentino-enameljuncition.
  22. 22. Occlusal
  23. 23. Occlusal
  24. 24. Buccal/Lingual CariesUse clinical examCan’t determine depthAppears as round dots
  25. 25. Buccal/lingual
  26. 26. Root CariesOlder patients with recession orperiodontitis
  27. 27. Root caries
  28. 28. Root caries
  29. 29. Root caries may be confused with cervical burnoutCervical burnout appears as a collar or wedge-shaped radiolucency on themesial and distal root surfaces near the CEJ of a tooth. The tissue density at the cervical region of the tooth is less than the regionsabove and below it. (variable penetration of X-ray)Burn-Out:*Mainly located at the neck of the tooth (Demarcated aboveby enamel cap or restoration and below by the alveolarbone)**Usually all teeth are affected esp. smaller premolars.***it is more obvious when the exposure factors areincreased!
  30. 30. Anterior Cervical Burnout bone level cervical burnout area
  31. 31. Cervical burnoutRadiolucency seen above left (arrow) disappears onperiapical film of same tooth (above right).
  32. 32. Cervical burnout in theanterior region due to gapbetween enamel (redarrows) and alveolar boneover root.
  33. 33. Recurrent CariesMay be due to high caries rate, poororal hygiene, failure to remove all thecaries, defective restoration or acombination.
  34. 34. Recurrent Caries Is not always easy to detect radiographically:1. Location of caries lesion relative to restoration.2. Angulation of X-ray beam.
  35. 35. Recurrent caries(red arrows)
  36. 36. Recurrent caries
  37. 37. Recurrent caries
  38. 38. Rampant Caries* Usually found in children and teens withpoor diet and inadequate oral hygiene.* Patients with xerostomia
  39. 39. Radiation CariesFound in head/neck radiation therapypatients with xerostomiaFluoride used for control
  40. 40. Before radiation
  41. 41. 1 year after radiation
  42. 42. Thank you ikassem@dr.com

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