Caries Management

( Diagnosis & Treatment strategies).

Professor Dr. Inas Al- Rawi

Cervical lesions

Class V lesions are those carious and non carious defects found in the gingival third of the facial and lingual tooth surfaces.

- well-defined margins- hard smooth surfaces- normally free of plaque

Abrasion

• Abrasion lesions are worsened in an acidic oral environment→ the abrasive object can more readily remove tooth mineral that is softened by acid

Abrasion: Treatment• Identify the cause• Modify habits (oral hygiene, diet)• Fluoride, especially if the oral cavity is acidic (active)• Consider restoration of lesions

Erosion in enamel– Obvious loss of enamel– Dentine not exposed

Erosion in dentine– Dentine involved:

Erosion. these cases the oral lesions generally present a rounded-cupped out defects

Erosion: Simple advice for patientsDrink water (or milk) !Avoid/limit intake of veryacidic drinks and foodFinish meals with neutralfood, e.g. cheeseUse a straw, do not rinsemouth with acidic drinksDo not brush teeth rightafter acidic drinks/food,rinse with water beforebrushingUse a soft toothbrush andtoothpaste with lowabrasive effectRegular local F-treatment(↑ F-conc. if active,sensitive lesions)

(Abfraction)• Cervical lesions caused byabnormal occlusal loading leading to mechanical andchemical wear• Under large occlusal forces or offaxisloading of tooth cusps, the teethexperience microscopic levels ofbending at the CEJ, leading toconcentration of stress and microcrackformation• These areas are more susceptible tomineral loss in connection withabrasion and erosion• Clinicalfeatures– Wedge-shaped non-carious defectsthat look like abrasion lesions

Abfraction: Consequences• Sensitivity• Weakening of the tooth• Reduced lifetime ofrestorations (GIC, ceramics)• PossibleTMD(temporomandibular dysfunction)

• Tooth fracture and wear• Residual endo/perio lesions

Note same notch - Proof it is the same tooth.Half of the notch is below the gum level.

It would be impossible for toothbrushingto cause this abfraction.

Treatment – General guidelines

Non-carious lesions should be considered for restoration

when the lesions are:• carious• deep enough that tooth integrity or pulp are in danger• sensitive (conservative desensititizing methods do not help)• aesthetically unacceptable• involved in a partial prosthesis design

Restorative materials used in class V restorations:

1-Non esthetic materials.

2-Esthetic materials:

-Resin composite.

-Resin composite with glass-ionomer base GIC(sandwitch technique.)

-Flowable resin composite.

-Glass ionomer cement.

-Porcelain inlay(not widely used).

Sandwich technique (laminated technique):

This technique is useful combining the advantages of both GIC and composite resin. GIC, is used as intermediate layer between dentin and resin composite, it replaces the missing dentin and reduce micro leakage and increase retention.This technique could be open or closed ,open technique in which the GIC at the gingival margin is exposed to oral cavity, while in closed technique the GIC is completely covered by resin composite to enhance esthetic and polishability and increase abrasion resistance of the restoration.

Dentinal sensitivity:

It is a problem often associated with gingival recession and non-carious cervical lesions.

Treatment:

Dentinal hypersensitivity secondary to gingival recession is best treated surgically.

-Treatment or prevention of hypersensitivity is accomplished by the use of some method to occlude the open dentinal tubules by

1-Dentin adhesives.

2-Oxalate solutions.

3-Stanous fluoride.

4-Potassium nitrate available in dentifrices or as agel for application in the dental office.