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challenges of patients with advanced carious lesions

  • complicated and long treatment plans
  • confusing to patients
  • uncertain prognosis
  • disease continues, no reduction
  • multi-discipline treatment
  • pulpal complications delay progress


Carious Lesions control

  • Aka Caries management; Caries control
  • Temporary (sometimes permanent) restoration of multiple teeth
    • have advanced carious lesions


Answers to give patients when they ask "Why are we doing temporary Restorations?"

  • Need to get dental disease under control quickly and stabilize your oral health
  • We can only tell so much about certain teeth with an x-ra and an examination of the surface. We need to remove the decay and evaluate what is left o



Atraumatic Restorative Treatment

  • hand instruments only
  • restore with Glass ionomer


Glass Ionomer

  • Bonds directly to tooth
    • no bonding agent required
  • Bonds to moist tooth
  • fluoride protection/remineralization
  • Bacteriall reduciton within dentin/oral enviroment
  • excellent marginal seal
    • no shrinkage
  • Thermal expansion=tooth
  • Biocompatable
    • ideal match for dentiin



Silver Modified Atraumatic Restorative Treatment

  • SDF is placed and immediately restored or sealed with Glass ionomer
  • patient returns for subsequent dental treatment
  • underserved populatioins or long wait times for hospital dentistry


Selective removal to firm dentin?

  • pulpal-remova until leathery or firm dentin 
  • periphery: clean to hard dentine


Step Wise Removal

AKa: Indirect pulp capping; 2 step caries removal

  • all carious dentin removed in periphery
  • small amount of demineralized dentin is left over the pullp
  • calcium hydroxide liner placed to cover demineralized dentin
  • sealing liner/restoration placed to seal bacteria 
    • resin modified glass ionomer


Calcium Hydroxide

  • Liner of choice
  • excellent pulp compatability
  • stimulates formation of reparative dentin
  • antimicrobial
  • Dycal=common brand
  • requires placement of a base


Resiin-Reinforced Glass Ionomer

  • Liner/Base of choice
  • bonds chemically t tooth
  • fluoride release
    • anti cariogenic
  • high elasticity
  • improved resistance to acid solubility 
  • take in fluoride from adjacent tooth
  • Vitrebond=common brand