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Caries Management - Science and Clinical Practice - Hendrik Meyer-Lueckel

Caries Management - Science and Clinical Practice

Hardcover Published: 20th March 2013
ISBN: 9783131547118
Number Of Pages: 436

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This systematic approach to modern caries management combines new, evidence-based treatment techniques with the scientific underpinnings of caries formation, providing an in-depth review for both clinicians in daily practice and students advancing in the field.

Beginning with patho-anatomic changes in the dental hard tissues, Dental Caries : Science and Clinical Practice goes on to cover non-invasive, minimally invasive, and more aggressive interventions based on each stage of the disease. From microbiology and histology to visual, tactile and radiographic diagnosis, risk assessment, preventive measures, and tooth preservation and treatment strategies, the book is packed with valuable clinical information for all dental practitioners.

Key Features:

  • Succinctly covers the science behind the disease, with recommendations for treatments based on assessment starting at the microscopic level
  • Written by a team of leading worldwide authorities on caries treatment and management and utilising the International Caries
  • Detection and Assessment System (ICDAS) standard throughout
  • Covers the newest treatment techniques, including adhesion technology, fissure sealing and infiltration, caries removal, tooth-coloured restorations, and more
  • Demonstrates step-by-step caries procedures in striking, full-colour illustrations of adult and pediatric cases
  • Offers the newest thinking on early prevention and behavioral changes in oral health promotion, including the role of diet and nutrition, biofilm management, fluoride use, population-based approaches, and more
Shifting to the new paradigm of heal and seal rather than the more invasive drill and fill, this beautifully illustrated text puts scientific principles into clinical action for the best results. It is an essential resource for a complete, proactive approach to caries detection, assessment, treatment, management, and prevention in contemporary dental practice.

Table of Contents XIII

Table of Contents

Part 1: Caries-Science

The Disease

1 Ecology of the Oral Cavity

Kim R. Ekstrand, Domenick T. Zero

Teeth............................... 4

Tooth Development and Tooth Emergence....... 4

Macromorphological Terms ................ 4

Occlusal Surfaces ....................... 4

Approximal Surfaces ..................... 7

The Cervical Enamel Line and the Roots ........ 7

Enamel.............................. 7

Chemical Composition and Structure of

Apatite Crystals ........................ 8

The Dentin-Pulp Organ ................... 9

The Cementum ........................ 10

Saliva .............................. 10

Saliva Production, Salivary Glands ........... 10

Function of Saliva ...................... 10

Pellicle ............................. 12

Hyposalivation ........................ 13

Changes in Teeth and Saliva with Aging ...... 13

Dental Plaque or Dental Biofilm? ........... 14

Classifying Oral Microorganisms............. 14

Colonization of the Mouth in the Newborn...... 15

Plaque: Development and Metabolic End Products. 15

Plaque Stagnation Areas .................. 16

Plaque Composition and Structure in

Stagnation Areas ....................... 17

2 Etiology and Pathogenesis of Caries

Peter Shellis

Microbiology of Caries................... 23

Chemistry of Dental Minerals .............. 25

Solubility, Dissolution, and Crystal Growth ...... 25

Minerals of Dental Tissues ................. 26

Fluoride and Calcium Phosphate Chemistry ...... 27

The Cariogenic Challenge................. 28

Chemistry of Caries .................... 33

Enamel Lesion Formation ................. 33

Dentin Lesion Formation.................. 34

Fluoride and Lesion Formation.............. 34

Remineralization and Lesion Arrest........... 34

Dental Erosion........................ 35

3 Histological and Clinical Appearance of Caries

Wolfgang Buchalla

Enamel Caries......................... 40

Location in the Teeth..................... 40

The White Spot Lesion ................... 42

Activity of White and Brown Spot Lesions ....... 42

Transmitted and Polarized Light Microscopy ..... 43

Transverse Microradiography ............... 46

Scanning Electron Microscopy............... 47

Transmission Electron Microscopy............ 48

Dentin Caries ......................... 48

Early Signs of Dentin Reaction .............. 50

Continuing Caries Progression into Dentin....... 51

Spread of Bacteria within Dentin ............ 52

Hardness of Carious Dentin ................ 52

Fluorescence Properties of Carious and

Healthy Dental Hard Tissue ................ 54

Caries of the Exposed Root ............... 55

Caries Arrest and Remineralization.......... 57

Correlation of Histology with Radiography

and Clinical Appearance of Caries........... 58

Erosion-a Noncarious Defect ............. 59

aus: Meyer-Lueckel u. a., Caries Management - Science and Clinical Practice (ISBN 9783131547118) © 2013 Georg Thieme Verlag KGXIV Table of Contents

4 Paradigm Shift in Cariology

Sebastian Paris, Hendrik Meyer-Lueckel

Scientific Paradigms .................... 65

How Paradigms Influence Our Clinical Approach. 65

The Speci?c Plaque Hypothesis .............. 65

The Ecological Plaque Hypothesis ............ 66

A Current Model of Caries ................ 66

Diagnostics and Epidemiology

5 Visual-Tactile Detection and Assessment

Kim R. Ekstrand, Stefania Martignon

General Remarks....................... 70

Histological and Clinical Features of Caries ..... 71

Coronal Caries Lesions.................... 71

Root Caries Lesions...................... 73

Caries Adjacent to Restorations .............. 74

Indices for Clinical Recording of Caries Lesions . . 74

Historical Perspective .................... 74

Correlation between Histology and

Clinical Severity: the ICDAS System .......... 76

Coronal Caries Lesions ................... 76

Root Caries Lesions ..................... 78

Caries Adjacent to Restorations ............. 78

Caries Activity Assessment ............... 79

Coronal Caries Lesions ................... 79

Root Caries Lesions ..................... 79

Caries Adjacent to Restorations ............. 80

The Visual Difference between Caries

and other Dental Hard Tissue Defects........ 82

6 Radiographic and Other Additional Diagnostic Methods

Rainer Haak, Michael J. Wicht

Radiographic Caries Diagnostics ............ 87

Context of Radiographic Caries

Detection ............................ 87

Validity and Reliability of Radiographic

Caries Detection........................ 88

Which Gold Standard? ................. 88

Sensitivity and Speci?city ............... 89

Reproducibility ...................... 89

Conventional and Digital Bitewing X-ray Imaging . . 89

Systems ........................... 89

Advantages of Digital Technologies ......... 89

Tuned-Aperture Computed Radiography and

Digital Volume Tomography ................ 89

Bitewings ............................ 91

Preparations ........................ 91

Taking Bitewing X-ray Photos ............. 91

Reproducible Adjustment................ 92

Documenting the Findings of Bitewing Images ... 93

Radiographic Extension and Clinical Findings

of Approximal Super?cial Lesions .......... 93

Evaluating Occlusal Surfaces ............. 94

The Mach Band E?ect.................. 95

Estimating the Probability of Caries

Progression ........................ 95

Determining the Radiologic Follow-up Interval ... 95

Relevant Factors ..................... 95

Special Considerations for Children and

Adolescents ........................ 96

Other Caries Diagnostic Methods ........... 97

Fiber-optic Transillumination............... 97

Methods Based on Fluorescence............. 97

Electrical Conductivity ................... 98

7 Caries Risk Assessment and Prediction

Cornelis van Loveren

The Dentist's Clinical Judgment............. 103

Crude Hit Rate of a Predictor .............. 103

Utilities of Predictors.................... 105

Objective Predictors .................... 108

ROC curve............................ 110

Cariogram............................ 110

Signs of Past Caries Experience ............. 113

Too Young to Have Past Caries

Experience........................... 114

Active versus Nonactive Lesions ............. 115

The Nexo Model....................... 116

aus: Meyer-Lueckel u. a., Caries Management - Science and Clinical Practice (ISBN 9783131547118) © 2013 Georg Thieme Verlag KGTable of Contents XV

8 Epidemiology of Caries and Noncarious Defects

Ulrich Schiffner

General Relevance of

Epidemiology ......................... 119

Study Types .......................... 119

Descriptive Epidemiology of Caries and

Noncarious Defects ..................... 120

Epidemiological Identi?cation of Caries......... 120

Indices for Coronal Caries.................. 121

Indices for Root Caries.................... 123

Other Indices for Public Health Needs.......... 124

Indices for Noncarious Defects .............. 124

Developmental Defects of the Dental

Hard Tissues ........................ 124

Acquired Defects of the Dental Hard Tissues ... 125

Occurrence and Distribution of Caries........ 125

Trends in Caries Epidemiology ............. 126

Global Considerations ................... 126

Children and Adolescents ................. 126

Association of Caries and Social Status....... 128

Adults and Seniors...................... 128

Root Caries........................... 129

Occurrence and Distribution of Noncarious

Defects ............................. 129

Developmental Defects................... 129

Acquired Defects of Enamel and Dentin ........ 130

9 From Diagnostics to Therapy

Sebastian Paris, Kim R. Ekstrand, Hendrik Meyer-Lueckel

From Diagnostics........................ 134

Diagnostics at the Individual Level............ 134

Diagnostics at the Tooth Level............... 134

How is Caries Diagnosed? ............... 134

The Truth About Caries ................. 135

Diagnostic Errors and Their Consequences..... 136

The Diagnostic Process ................. 137

Categories and Thresholds ............... 138

...to Therapy ......................... 139

Aim of Treatment....................... 139

Treatment Approaches ................... 140

Noninvasive Measures.................... 140

In?uencing the Bio?lm ................. 140

In?uencing Diet...................... 140

In?uencing Mineralization ............... 141

Microinvasive Measures .................. 141

Sealants........................... 141

In?ltration ......................... 141

(Minimally) Invasive Measures.............. 142

Restoration ........................ 142

Additional Measures .................. 142

Which Measures are Indicated at What Time? . . 142

Individual Level ....................... 142

Tooth Level .......................... 142

Therapeutic Options for Occlusal Caries ...... 143

Therapeutic Options for Approximal Caries.... 143

Therapeutic Options for Caries in Accessible

Smooth Surfaces ..................... 143

Therapeutic Options for Root Caries ........ 144

Noninvasive Therapy

10 Caries Management by Modifying the Bio?lm

Sebastian Paris, Christof Doerfer, Hendrik Meyer-Lueckel

Dental Plaque as a Biofilm ................ 147

Mechanical Biofilm Control................ 148

Correlation between Oral Hygiene and Caries .... 148

Self-Applied Mechanical Bio?lm Control ........ 148

Tooth Brushing ...................... 148

Interdental Hygiene ................... 153

Professional Tooth Cleaning ................ 154

Chemical Biofilm Control ................. 154

Chlorhexidine ......................... 155

Xylitol .............................. 155

Triclosan/Copolymer .................... 155

Essential Oil (Listerine)................... 156

Sodium Lauryl Sulfate ................... 156

Metal Ions ........................... 156

General Considerations................... 156

Biological Biofilm Control ................ 156

Vaccination .......................... 157

Probiotic Therapy ...................... 157

aus: Meyer-Lueckel u. a., Caries Management - Science and Clinical Practice (ISBN 9783131547118) © 2013 Georg Thieme Verlag KGXVI Table of Contents

11 Caries Management by Modifying Diet

Bennett T. Amaechi

Carbohydrates (Sugars) in the Caries Process ... 162

Conventional Sugars ..................... 162

Sugar Metabolism and Acid Production by

Cariogenic Microorganisms ................ 163

Intracellular Pathway .................. 163

Extracellular Pathway .................. 164

Factors Modifying the Role of Sugars in

Caries Development ..................... 165

Frequency of Sugar Intake ............... 165

Consistency of the Sugary Food............ 165

Amount of Sugar Intake................. 166

Thickness and Age of the Plaque ........... 166

Sugar Alcohols ........................ 167

Xylitol .............................. 167

Sorbitol ............................. 167

Maltitol ............................. 168

Intense Sweeteners ..................... 168

Other Food Components ................. 169

Proteins............................. 169

Fats ............................... 169

Food Preservatives...................... 169

Fresh Fruits, Vegetables,

and Other Dietary Components ............. 170

In?uence of Nutritional De?ciencies in the

Caries Process......................... 170

Population Groups with Raised Caries Risk

Due to Dietary Pattern .................. 170

Children ............................ 170

The Elderly .......................... 171

Dietary Guidance for Prevention of

Dental Caries......................... 171

Snacking Habit ........................ 172

Diet and Erosion ...................... 172

12 Caries Management by In?uencing Mineralization

Svante Twetman, Kim R. Ekstrand

What is Fluorine/Fluoride? ................ 177

Units of Measure ....................... 177

Fluoride in Our Surroundings .............. 177

Fluoride in Humans ..................... 177

Acute Toxicity ......................... 177

Fluoride Absorption and Distribution .......... 178

Fluoride in Teeth ....................... 179

Fluoride in Saliva and in Plaque.............. 179

From Mottled Enamel (Colorado Stained Teeth)

to Dental Fluorosis ..................... 180

Prevalence of Dental Fluorosis .............. 180

Effects of Water Fluoridation on Caries and

Dental Fluorosis: Pre- or Posteruption? ....... 182

How Fluoride Interacts with the Caries Process. . 183

Formation of Calcium Fluoride .............. 183

In?uence of Fluoride on Microbial Metabolism.... 184

Discussion of Classical Data ................ 184

Clinical Effectiveness of Fluoride ............ 185

Systemic and Topical Fluorides .............. 186

Community-Based Fluoride Application....... 186

Water Fluoridation (After Introduction of

Fluoride Toothpaste) .................... 186

Fluoridated Milk and Salt ................. 186

Individual Fluoride Application:

Professionally Applied Fluorides............ 186

Fluoride Varnishes...................... 186

Fluoride Solutions ...................... 187

Fluoride Gels ......................... 188

Individual Fluoride Application:

Self-Applied Fluorides ................... 188

Fluoride Toothpaste ..................... 188

Fluoride Mouth Rinses ................... 189

Fluoride Tablets and Chewing Gums .......... 189

Other Fluoride-Containing Products and Devices . . 189

Safety of Fluorides ..................... 189

Guidelines ........................... 190

Other Remineralization Agents ............ 190

CPP-ACP ............................ 190

13 Oral Health Promotion: Implementation of Noninvasive Interventions

and Health-Related Behaviors to Control the Caries Process

Hendrik Meyer-Lueckel, Sebastian Paris

Implementing Strategies of Prevention ....... 195

Prevention-What Does This Mean?........... 195

Why Do People Get Sick?.................. 195

A Little More Upstream: Setting-Approaches .... 196

Most Upstream: the Population-Based Common

Risk Factor Approach .................... 197

aus: Meyer-Lueckel u. a., Caries Management - Science and Clinical Practice (ISBN 9783131547118) © 2013 Georg Thieme Verlag KGTable of Contents XVII

Contemporary Strategies to Improve Oral Health 197

High-Risk versus Population-Based ........... 197

Noninvasive Interventions versus

Behavioral Change in Caries Prevention ........ 199

Is it Possible to Change Oral Health-Related

Behaviors? ........................... 199

De?nition ............................ 199

Models.............................. 199

Effectiveness of Contemporary Programs for

Caries Prevention ...................... 200

Role of Routine Serial Examinations in

Communities.......................... 200

Population-Based Approaches............... 200

Mass Campaigns to Change Behavior ........ 200

Fluoridated Water .................... 200

Fluoridated Salt ...................... 200

Approaches for Communities: Medical Options ... 201

Fluoride Tablets ..................... 201

Providing Free Fluoride Toothpaste ......... 201

Other Methods of Fluoride Application ...... 201

Approaches for Communities:

Oral Health Education ................... 202

Supervised Tooth Brushing .............. 202

Programs Relying on Oral Health Education ... 202

Setting-Approaches ................... 203

Approaches for Communities:

Combining Medical Options and Oral Health

Education ........................... 203

One-to-One Situation in Dental Practice........ 204

Adhesion

14 Basics in Adhesion Technology

Bart Van Meerbeek, Yasuhiro Yoshida

Evolution of Adhesive Technology in Generations 209

Early Days............................ 209

Breakthrough in Adhesion Technology ......... 210

No Separate Etching? .................... 210

Modern Classification of Adhesives .......... 210

Interaction with Hydroxyapatite-Based Tissues . . 212

Current Strategies for Bonding to Enamel ..... 212

Obstacles in Bonding to Dentin............. 214

Bonding to Dentin through the Etch-and-Rinse

Approach............................ 214

Shortcomings of Etch-and-Rinse Technology

and Potential Solutions .................. 215

Wet Bonding-How Moist is Wet? ............ 216

Rewetting ........................... 216

Nanoleakage.......................... 217

Recent Developments.................... 217

Bonding to Dentin through the Self-Etch

Approach ........................... 218

Nomenclature......................... 218

Mild Self-Etch Adhesives.................. 218

Mechanisms of Bond Degradation .......... 219

Bonding to Carious Dentin ............... 220

Clinical Performance.................... 220

Epilogue ............................ 221

Microinvasive Therapy

15 Fissure Sealing

Hafsteinn Eggertsson

Caries Prevalence on Occlusal Surfaces........ 226

The Sealant-Restoration Spectrum .......... 226

Epidemiological considerations .............. 227

Fissure Morphology..................... 228

The Fissure as Substrate for Resin Bonding..... 229

Cleaning of Fissures Prior to Sealant Placement . 230

Should Mechanical Preparation Be Routine? .... 230

Glass-Ionomer Sealants .................. 231

Preventive versus Therapeutic Sealants....... 231

Sealing over Caries? .................... 232

Moisture Control ...................... 233

Are Sealants Working Clinically? ........... 233

Sealant Failures and Maintenance........... 234

Cost-Effectiveness of Sealants ............. 234

Widespread Use of Sealants .............. 235

Conclusion .......................... 236

aus: Meyer-Lueckel u. a., Caries Management - Science and Clinical Practice (ISBN 9783131547118) © 2013 Georg Thieme Verlag KG16 Transfer of the Sealing Technique from the Occlusal to the Approximal Surface

Stefania Martignon, Kim R. Ekstrand

Transfer of the Sealing Technique from the

Occlusal to the Approximal Surface .......... 240

Clinical Procedure ...................... 240

Which Approximal Lesions Should Be Sealed? .... 240

Techniques for Approximal Sealing ........... 241

Sealing Procedure .................... 241

Patch Technique ..................... 241

Clinical Evidence ...................... 242

17 Caries In?ltration

Hendrik Meyer-Lueckel, Sebastian Paris

Development of Caries Infiltration........... 246

Biological Principles ..................... 246

Principle of Caries In?ltration ............... 248

Infiltration to Prevent Caries Progression...... 249

Clinical E?cacy of In?ltrating

Approximal Surfaces ..................... 250

Indications for Approximal Caries In?ltration..... 250

Clinical Use of Approximal Caries In?ltration .... 253

Follow-up for Approximal Caries ............ 253

Infiltration for Primarily

Esthetic Reasons ...................... 253

Scienti?c Studies ....................... 253

Indication ........................... 254

Follow-up ........................... 255

Invasive Therapy

18 How Much Caries Do We Have to Remove?

David D. J. Ricketts

Historical Perspective ................... 260

When to Remove Caries? ................. 261

Enamel Lesion ......................... 261

Enamel-Dentin Junction .................. 261

Cavitation............................ 261

Microbial Invasion of Dentin................ 262

Dentin Caries ......................... 263

Conventional Caries Removal .............. 264

Caries Removal at the Enamel-Dentin Junction . 264

Contemporary Caries Removal............. 265

Pulp-Dentin Complex................... 265

Deep Caries.......................... 265

Fissure Sealant Studies ................... 266

Stepwise Excavation Studies ............... 266

Systematic Review of the Literature .......... 268

Is ThereaNeed for Cavity Disinfection? ...... 268

19 Minimally Invasive Therapy with Tooth-Colored Direct Restorative Materials

Roland Frankenberger, Uwe Blunck

Indications for Restorative Therapy .......... 272

Posterior Teeth ........................ 272

Anterior Teeth ......................... 272

Cervical Area.......................... 273

Manifestations and Causes ............... 273

Technical Limits to Direct Restorative Materials ... 273

Materials for Tooth-colored

Direct Restorative Therapy................ 275

Overview ............................ 275

Glass-Ionomer Cements................... 275

Composites ........................... 275

Resin-Modi?ed Glass-Ionomer Cements ........ 276

Compomers........................... 276

Choosing Materials for Di?erent Indications ..... 277

Posterior Region...................... 277

Anterior Region ...................... 277

Cervical Defects ...................... 277

Preparation Instruments ................. 277

Excavation ........................... 277

Rotating Preparation .................... 277

Oscillating Preparation ................... 277

Rules for Minimally Invasive Preparation...... 278

General Preparation Rules................. 278

Access Forms ......................... 278

Anterior Region...................... 278

Posterior Region ..................... 278

ClassI(Fissures and Grooves) .............. 278

Class II (Approximal-Occlusal) .............. 279

Class III and Class IV (Anterior Tooth) ......... 279

Class V (Cervical Area) ................... 279

Problems in the Treatment of Cervical Defects . 279

Damage to the Neighboring Tooth in

Approximal Preparations................. 280

XVIII Table of Contents

aus: Meyer-Lueckel u. a., Caries Management - Science and Clinical Practice (ISBN 9783131547118) © 2013 Georg Thieme Verlag KGTable of Contents XIX

Clinical Experience with Minimally Invasive

Restorative Therapy .................... 280

Posterior Teeth ........................ 280

Anterior Teeth ......................... 281

Cervical Area.......................... 281

Repairing Restorations .................. 282

Treatment Decision

20 Decision-Making in Managing the Caries Process

Hendrik Meyer-Lueckel, Martin J. Tyas, Michael J. Wicht, Sebastian Paris

Fundamentals of Evidence-Based Dentistry..... 287

Treatment Recommendations ............... 288

Study Types .......................... 289

Shared Decision-Making.................. 289

The Doctor-Patient Relationship ............. 290

Including the Patient in the Decision-Making

Process............................ 290

Implementing Shared Decision-Making

in Practice.......................... 291

The Nine Steps of Shared

Decision-Making ....................... 291

Decisions, Decisions: Noninvasive, Microinvasive,

or (Minimally) Invasive?.................. 292

When in Rome, Do as the Romans Do.......... 292

Economic Consequences of the Time of Therapy... 293

Consequences on Therapy of "Philosophy"

in Cariology .......................... 293

Philosophy "Drill and Fill" ................. 293

A New Philosophy: "Heal and Seal"........... 293

Limits to Noninvasive Therapies............ 294

Micromorphological Aspects ............... 294

Clinical Considerations ................... 294

Radiographic Extension-Cavitation of the

Surface ........................... 294

Cavitation-Bio?lm ................... 295

Bio?lm-Caries Progression .............. 295

Speed of Caries Progression.............. 295

Limits to Microinvasive Therapies........... 296

Avoidance of Overtreatment ............... 297

The Problem of Undertreatment............. 297

Dentin Involvement................... 297

Residual Microorganisms ............... 297

Limits to Invasive Therapies............... 297

Decision Trees and Choice of Therapy ........ 299

Special Aspects in Children and the Young

21 How to Maintain Sound Teeth: an Individualized Population Strategy for Children and

Adolescents

Kim R. Ekstrand

The Multifactorial Concept of Caries ......... 306

Relevant Epidemiology .................. 307

Caries in the Primary Dentition.............. 307

Caries in the Permanent Dentition............ 307

Caries Progression Rate through the Enamel ..... 308

Eruption Time for Teeth in the Two Dentitions ... 308

Diagnostics of Caries in the Child Population .... 308

Individualized Population Strategy .......... 308

Documentation of caries experience......... 310

22 Individualized Caries Management in Pediatric Dentistry

Christian H. Splieth, Mohammad Alkilzy

Deciduous versus Permanent Teeth.......... 314

Anatomy............................. 314

Epidemiology ......................... 314

Function and Longevity ................... 314

Erupting Permanent Teeth ................. 315

Treatment Concepts in Deciduous Teeth....... 315

Buccal Surfaces ........................ 315

Occlusal Surfaces ....................... 316

Approximal Surfaces ..................... 316

Minimum Intervention in Permanent Teeth

in Children and Adolescents .............. 316

Occlusal Surfaces....................... 317

Sealants for Individuals at High Risk of Caries . . 318

Approximal Surfaces .................... 318

aus: Meyer-Lueckel u. a., Caries Management - Science and Clinical Practice (ISBN 9783131547118) © 2013 Georg Thieme Verlag KGXX Table of Contents

A Glimpse into the Future

23 Future Trends in Caries Research

Brian H. Clarkson, Agata Czajka-Jakubowska

Genetic Approaches..................... 321

Genomics-Caries Susceptibility ............. 321

Probiotics-Replacement Therapy with non-AcidProducing Bacteria ...................... 321

Gene Therapy-Repairing Salivary Glands ....... 321

Proteomics........................... 322

Antibody Engineering-Bacterial Adherence...... 322

Enzyme Recognition-Caries Activity Assessment . . 322

Tissue Engineering ..................... 322

The Dentin-Pulpal Complex ............... 322

Nanotechnology ...................... 323

Dendrimers-Antimicrobials/Antiadherents ..... 323

Antibacterial Nanoemulsions ............... 323

Degradable Microspheres-Remineralizing Agents . 323

"Smart" Materials-Responding to Physiological

and Nonphysiological Changes in the Oral Cavity. . 324

Synthetic Enamel ...................... 324

Part 2: Caries-Clinical Practice

24 Diagnostics, Treatment Decision, and Documentation

Sebastian Paris, Rainer Haak, Hendrik Meyer-Lueckel

Caries Diagnostics at the Patient Level........ 330

Determining the Risk Factors ............... 331

Caries Experience..................... 331

Sugar Consumption ................... 331

Frequency of Food Consumption ........... 331

Oral Hygiene ........................ 331

Fluoride Sources...................... 331

Salivary Flow........................ 331

Calculating the Caries Risk and Consequences .... 331

Caries Diagnostics at the Tooth Level......... 333

Visual-Tactile Examination ................ 333

Primary Caries ...................... 333

Caries Adjacent to Restorations ........... 333

Additional Diagnostic Tools ................ 335

Bitewing Radiographs and Fiberoptic

Transillumination .................... 335

Laser Fluorescence.................... 336

Endodontic Findings .................. 336

Additional Diagnostics ................... 336

Diagnosis and Planning a Therapy .......... 337

25 Minimal Interventional Treatment of Caries in the Permanent Dentition: Clinical Cases

Hendrik Meyer-Lueckel, Sebastian Paris, Christian A. Schneider, Leandro A. Hilgert, Soraya Coelho Leal

Case 1: A 30-year-old Woman with

Low-to-Medium Caries Risk................ 339

Hendrik Meyer-Lueckel, Sebastian Paris

Anamnesis ........................... 339

Clinical Findings (Tooth Level) .............. 339

Caries Risk Assessment (Individual Level) ....... 341

Diagnoses and Treatment Plan .............. 342

Individual Level ...................... 342

Tooth Level ......................... 342

Clinical Aspect at the End of the Treatment...... 348

Follow-up............................ 348

Case 2: A 22-year-old Man with

Medium Caries Risk..................... 351

Hendrik Meyer-Lueckel, Sebastian Paris

Anamnesis ........................... 351

Clinical Findings (Tooth Level) .............. 351

Caries Risk Assessment (Individual Level) ....... 352

Diagnosis and Treatment Plan............... 353

Individual Level ...................... 353

Tooth Level ......................... 353

Clinical Aspect at the End of the Treatment...... 360

Follow-up............................ 360

Case 3: Minimally Interventional

Anterior Restorations ................... 361

Christian A. Schneider, Hendrik Meyer-Lueckel

Anamnesis ........................... 361

Clinical Findings ....................... 361

Caries Risk ........................... 361

Diagnosis and Treatment Plan .............. 362

Individual Level ..................... 362

Tooth Level ........................ 362

Case 4: Infiltration to Mask Caries Lesions..... 367

Leandro A. Hilgert, Soraya Coelho Leal

Anamnesis ........................... 367

Clinical Findings ....................... 367

Caries Risk ........................... 368

Diagnosis and Treatment Plan .............. 368

Individual Level ..................... 368

Tooth Level ........................ 369

Clinical Aspect at the End of the Treatment ..... 370

Case 5: Stepwise Caries Excavation.......... 371

Hendrik Meyer-Lueckel, Sebastian Paris

aus: Meyer-Lueckel u. a., Caries Management - Science and Clinical Practice (ISBN 9783131547118) © 2013 Georg Thieme Verlag KGTable of Contents XXI

26 Minimal Interventional Treatment of Caries in Young Children: Clinical Cases

Vera Mendes Soviero, Soraya Coelho Leal, Christian Splieth, Mohammad Alkilzy

Case 1: A 6-Year-Old Boy with High Caries Risk . . 374

Mohammad Alkilzy, Christian Splieth

Anamnesis ........................... 374

Clinical Findings (Tooth Level) .............. 374

Caries Risk Assessment (Individual Level) ....... 375

Diagnosis and Treatment Plan............... 376

Individual Level ...................... 376

Tooth Level ......................... 377

Clinical Aspect at the End of the Treatment...... 380

Follow-up.......................... 380

Case 2: A 7-Year-Old Girl with

Medium Caries Risk..................... 381

Vera Mendes Soviero, Soraya Coelho Leal

Anamnesis ........................... 381

Clinical Findings (Tooth Level) .............. 381

Caries Risk Assessment (Individual Level) ....... 381

Diagnosis and Treatment Plan............... 383

Individual Level ...................... 383

Tooth Level ......................... 383

Follow-up............................ 385

Case 3: A 6-Year-Old Girl with

Very High Caries Risk ................... 385

Vera Mendes Soviero, Soraya Coelho Leal

Anamnesis ........................... 385

Clinical Findings (Tooth Level) .............. 385

Caries Risk Assessment (Individual Level)....... 386

Diagnosis and Treatment Plan .............. 388

Individual Level ..................... 388

Tooth level......................... 389

Clinical Aspect at the End of the Treatment ..... 393

Follow-up ......................... 393

Case 4: An 8-Year-Old Boy with

Medium Caries Risk .................... 394

Vera Mendes Soviero, Soraya Coelho Leal

Anamnesis ........................... 394

General Findings ....................... 394

Oral Health Indices ..................... 394

Clinical Findings (Tooth Level) .............. 394

Caries Risk Assessment (Individual Level)....... 397

Diagnosis and Treatment Plan .............. 397

Individual Level ..................... 398

Tooth Level ........................ 398

Monitoring and Recall ................... 399

27 Appendix

Dental examination form................. 401

Caries risk analysis ..................... 402

Treatment plan........................ 403

Index...................................................................... 405

 

ISBN: 9783131547118
ISBN-10: 3131547111
Audience: General
Format: Hardcover
Language: English
Number Of Pages: 436
Published: 20th March 2013
Publisher: Thieme Publishing Group
Country of Publication: DE
Dimensions (cm): 27.0 x 19.4  x 3.18
Weight (kg): 1.54

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