root caries
DESCRIPTION
root cariesTRANSCRIPT
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ROOT
SURFACE
RESTORATION
ROOT CARIES PREVALENCEWILL INCREASE BECAUSE …
• PROPORTION OF ELDERLY INCREASING• TEETH BEING RETAINED LATER IN LIFE• GINGIVAL RECESSION INCREASES WITH AGE• XEROSTOMIC MEDICATIONS ARE NUMEROUS
8/17/92 11/9/93 12/20/94
11/10/904/15/89
CERVICAL BURNOUT
• RADIOGRAPHIC ARTIFACTPRODUCED BY A LOCALIZEDRELATIVE RADIOLUCENCY
• BOUNDED BY CEJ, CREST OFALVEOLAR BONE, LIP LINE, ORCALCULUS
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ROOT CARIES VS.
CERVICAL BURNOUT
• ACQUIRE RADIOGRAPHS WITH GOODCONTRAST
• ASSESS IF BOUNDARIES OFRADIOLUCENCY CORRESPONDS TOANY ANATOMICAL FEATURES
• INSPECT TEETH CLINICALLY TO BACKUP RADIOGRAPHIC INTERPRETATION
Root CariesDiagnostic Criteria
• Soft, Leathery, Tacky Area• at CEJ or on Root Surface• Discolored (Varying Degrees)• Undermines Adjacent Enamel• Usually Asymptomatic
Differential Diagnosis
• Active Root Caries Lesion• Inactive Root Caries Lesion• Exposed Resorptive Defect• Root Surface Erosion• Root Surface Abrasion• Normal Anatomic Features
ROOT CARIES
• YELLOW TO BROWN• SURFACE DEFECT
POSSIBLE• TACKY, LEATHERY
• DARK BROWN TO BLACK• SURFACE DEFECT
POSSIBLE• HARD, GLASSY
ACTIVE INACTIVE
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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 FEATURESTHAT MAY MIMIC ROOT CARIES
• ROOT CONCAVITIES AND FURROWS• FURCATIONS• INVAGINATED GROOVES
Root Caries Severity Index of Billings
Grade 1INCIPIENT
no surface defect
Root Caries Severity Index of Billings
Grade 1INCIPIENT
Grade 2SHALLOW
surface defect <0.5mm
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Root Caries Severity Index of Billings
Grade 1INCIPIENT
Grade 2SHALLOW
Grade 3CAVITATED
surface defect >0.5mm
Root Caries Severity Index of Billings
Grade 1INCIPIENT
Grade 2SHALLOW
Grade 3CAVITATED
Grade 3PULPAL
carious pulp exposure
Grade 1INCIPIENTno surface defect
Grade 2SHALLOWsurface defect <0.5mm
Grade 3CAVITATEDsurface defect >0.5mm
Grade 3PULPALcarious pulp exposure
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Remineralization Remineralization TherapyTherapy
High-Intensity Fluoride Treatment
Xylitol Chewing Gum
Chlorhexidine
Remineralization Rinse
CONTROL STRATEGIES
Objective: to convert active lesion
into inactive lesion and avoid
invasive procedures
Indications: bitewing enamel “notch,”
superficial white spot, Grade 1 root
surface lesion
Remineralization Remineralization TherapyTherapy
Nyvad & FejrskovScand J Dent Res1986
0 monthsREMINERALIZATION
OHI, 2 topical NaF, F-dentifrice BID
Nyvad & FejrskovScand J Dent Res1986
2 monthsREMINERALIZATION
OHI, 2 topical NaF, F-dentifrice BID
Nyvad & FejrskovScand J Dent Res1986
6 monthsREMINERALIZATION
OHI, 2 topical NaF, F-dentifrice BID
Nyvad & FejrskovScand J Dent Res1986
18 monthsREMINERALIZATION
OHI, 2 topical NaF, F-dentifrice BID
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RECONTOURING
• OBJECTIVE: TO REMOVE SOFT,CARIOUS DENTIN & PROVIDE ASMOOTH, NON-RETENTIVE ROOTSURFACE CAPABLE OF RESISTINGFURTHER CARIOUS ATTACK
• INDICATIONS: GRADE 2(SHALLOW) LESIONS
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ROOT CARIESRESTORATIVE TREATMENT
OBJECTIVE: TO RESTORE LOSTROOT STRUCTURE, PROTECT THEPULP, & IMPEDE FURTHERCARIOUS ATTACK
INDICATIONS: GRADE 3 (CAVITATED)LESIONS & UNESTHETIC SHALLOWLESIONS
ROOT CARIESRESTORATIVE DIFFICULTIES
• PERIODONTAL CONCERNS• ISOLATION• PULPAL CONCERNS• RETENTION• WEAKENING OF TOOTH• LATERAL EXTENSION• ACCESS• VISIBILITY• ANATOMY• RECURRENT CARIES• POST OPERATIVE SENSITIVITY
MORTISE & TENON JOINT
AMALGAM
• LOW LONG-TERMMICROLEAKAGE RATES
• MOST TOLERANTOF MOISTURECONTAMINATION
• REQUIRES MECHANICALRETENTION(EVEN BONDED)
• REQUIRES MORTISE FORM• MOISTURE
CONTAMINATION REDUCESLONGEVITY
• NOT ESTHETIC• BONDING REQUIRES
STRICT ISOLATION
ADVANTAGES DISADVANTAGES
COMPOSITE RESIN
• CAN BOND TO ENAMEL &DENTIN
• REQUIRES NOMECHANICAL RETENTION
• DOES NOT REQUIREMORTISE FORM
• ESTHETIC
• CONTAMINATION BYORAL FLUIDS CANPREVENT BONDING
• POST OPERATIVESENSITIVITY
• REQUIRES ACCESS FORLIGHT
• BOND TO DENTIN NOTAS STRONG AS ENAMEL
ADVANTAGES DISADVANTAGES
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RESIN-MODIFIED GLASS IONOMER CEMENT
• CHEMICAL BOND TODENTIN
• REQUIRES NOMECHANICAL RETENTION
• REQUIRES NO MORTISEFORM
• FLUORIDE RELEASE• MODERATE ESTHETICS
• REQUIRES STRICTISOLATION
• NOT AS ESTHETIC ASCOMPOSITE RESIN
• WEAKER THANCOMPOSITE RESIN
ADVANTAGES DISADVANTAGES
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extension on root surfaces extension on root surfaces
extension on root surfaces
• view cut wall• extend until decalcification superficial• treat superficial decalcification with
recontouring & remineralization
THE SLOT PREPARATION
INDICATIONS: PROXIMALROOT CARIES LESION ONPOSTERIOR TOOTH APICALTO SOUND MARGINALRIDGE OR ADJACENT TOOTHERWISE SOUND CASTCROWN
PROXIMAL VIEW
SLOT PREPARATION AT CEJ FOR AMALGAM
BUCCAL VIEW
HORIZONTALCROSS SECTION
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FACIALDOVETAIL
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1
2
proximal root concavity(radicular groove)
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THE SLOT / CLASS VCOMBINATION
INDICATIONS: WRAPAROUNDROOT CARIES LESIONS(SOMETIMES SEEN ONCROWN MARGINS)
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#5-M slot
#5-M slotoverhang in proximalroot concavity
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#3 recurrent caries lesiongold onlay margin
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