Caries Management ( Diagnosis & Treatment strategies).

1. Caries Management ( Diagnosis & Treatment strategies). Professor Dr. Inas Al- Rawi

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

3. Abrasion - well-defined margins - hard smooth surfaces - normally free of plaque • 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

4. Erosion. these cases the oral lesions generally present a rounded-cupped out defects Erosion in enamel – Obvious loss of enamel – Dentine not exposed Erosion in dentine – Dentine involved:

5. Erosion: Simple advice for patients Drink water (or milk) ! Avoid/limit intake of very acidic drinks and food Finish meals with neutral food, e.g. cheese Use a straw, do not rinse mouth with acidic drinks Do not brush teeth right after acidic drinks/food, rinse with water before brushing Use a soft toothbrush and toothpaste with low abrasive effect Regular local F-treatment (↑ F-conc. if active, sensitive lesions)

6. (Abfraction) • Cervical lesions caused by abnormal occlusal loading leading to mechanical andchemical wear • Under large occlusal forces or offaxis loading of tooth cusps, the teeth experience microscopic levels of bending at the CEJ, leading to concentration of stress and microcrack formation • These areas are more susceptible to mineral loss in connection with abrasion and erosion • Clinicalfeatures – Wedge-shaped non-carious defects that look like abrasion lesions Abfraction: Consequences • Sensitivity • Weakening of the tooth • Reduced lifetime of restorations (GIC, ceramics) • PossibleTMD(temporomandibular dysfunction) • Tooth fracture and wear • Residual endo/perio lesions

7. Note same notch - Proof it is the same tooth. Half of the notch is below the gum level. It would be impossible for toothbrushing to cause this abfraction.

8. 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

10. 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).

11. 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.

12. 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.