root caries

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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


Grade 1INCIPIENT

Grade 2SHALLOW

surface defect <0.5mm

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Grade 1INCIPIENT

Grade 2SHALLOW

Grade 3CAVITATED

surface defect >0.5mm


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










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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


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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


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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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Documents

root caries