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PubMed1990

Structural events in the caries process in enamel, cementum, and dentin.

The structural events observed in enamel, cementum, and dentin during the caries process have been reviewed. In incipient enamel lesions, the prevailing concept of an almost intact surface layer has been seriously challenged by SEM and TEM observations demonstrating structural pathways (such as enlarged prism junctions or sheaths) from the enamel surface to the sub-surface lesion. The destruction in this latter location consisted of (1) enlarged prism junctions, (2) diffuse mineral destruction in the prism cores, and (3) destruction of the interprismatic substance. In root caries, the destruction of cementum started along junctions between calcified layers of extrinsic (Sharpey) and intrinsic collagen fibers as well as along incremental lines. Invasion of Gram-positive micro-organisms followed these enlarged junctions. Dentin caries was similar in coronal and root caries. It consisted of sclerosis of the lumens of the dentinal tubules, followed by an important gradient of demineralization of intertubular dentin and destruction of occluded tubular lumens and peritubular dentin. Bacterial penetration occurred initially in the dentinal tubules and was followed by bacterial invasion and destruction of the intertubular dentin. Various phenomena of crystalline remineralization were described in enamel and dentin. Whereas in enamel and dentin caries, an important gradient of demineralization was observed before bacterial invasion, a simultaneous destruction of the mineral and organic components seemed to occur in cementum.

Dental Caries↗
PubMed1998

Factors associated with caries incidence in an elderly population.

The purpose of this paper was to identify baseline factors associated with future caries development in older adults (age 60+) during a 3-year study period. Poisson regression analysis was used to determine the association between potential risk factors and disease incidence. The significant factors associated with high coronal caries incidence rates were high baseline root DMFS (P<0.001), high counts of mutans streptococci and lactobacilli (P=0.036), male gender (P=0.007), and Asian ethnicity (P=0.002). These factors had small to moderate effects on incidence rates, with relative risk values of approximately 1.2 to 2. The significant factors associated with higher disease incidence on root surfaces were baseline coronal DMFS (marginally significant, P=0.078), high bacterial counts (P=0.002), and Asian ethnicity (P=0.009). The predictive value of the models was low for both coronal and root caries. This result may be because this population had a higher than usual caries incidence rate, making discrimination among these caries-active individuals difficult. The current study affirmed the value of baseline DMFS and salivary variables to modeling caries incidence and introduced ethnicity as a variable useful for the study of dental caries in older adults.

Aged↗
PubMed1991

Exploration of prediction models for caries risk assessment of the geriatric population.

The purpose of this study was to demonstrate a method for establishing a model designed to predict the caries risk of elderly individuals. Twenty-three patients over the age of 65 and living in a semi-independent retirement center were examined; several variables were collected and analyzed for their ability to predict the development of new carious lesions. The analysis was performed using logistic regression where the proportion of new decay was used as the dependent variable. The model for prediction of combined coronal and root caries included the variables flow rate, gender, and root caries index. The proposed method has the advantages of easily collected data, individualized criteria, and the ability to order patients as to the relative risk of developing decay.

Aged↗
PubMed1998

Cervical root resorption associated with guided tissue regeneration: a case report.

Root surface resorption, ankylosis (replacement resorption) and alveolar bone resorption are not uncommon sequelae to periodontal healing in both animal and human trials whether the treatment objective is regenerative, preventive, or conservative. The present report describes a case with progressive cervical root resorption in a patient who received periodontal regenerative treatment with guided tissue regeneration (GTR). A 46-year-old woman was referred for treatment of severe periodontitis. Remaining radiographic attachment was less than 50%. Following a period of 18 months, during which non-surgical and surgical therapies were performed, angular defects were diagnosed on radiographs and recurrent bleeding periodontal pockets (6 mm) were found in the proximal areas of 24 and 25. Root caries was not present. Periodontal surgery with GTR was performed in this area. No immediate postsurgical complications were noted. Two years later, clinical and radiographic examinations revealed gingival recession with bleeding periodontal pockets (6 mm) which had partly uncovered severe proximal cervical resorptions in 25. Root surface caries was not present. Following surgical inspection, the root of 25 was removed. The root was subsequently prepared for histological analysis. Resorption cavities covered almost the entire cervical proximal surface of the root above intact infracrestal cementum and were covered by numerous CD68+, both mononuclear and multinucleated cells. In a central area as indicated on the radiographs, the cavities penetrated into the root canal. There was no evidence of root caries.

Antigens, CD↗
PubMed2002

Coverage of previously carious roots is as predictable a procedure as coverage of intact roots.

BACKGROUND: Coverage of roots exposed by gingival recession is one of the main objectives of periodontal reconstructive surgery. A variety of highly predictable and esthetically acceptable mucogingival grafting procedures are available for treating intact root surfaces. One of the indications for root coverage procedures is prevention of root caries. However, little is known about the ability to treat previously carious roots by mucogingival grafting, and even less is known about the outcome of such treatment. METHODS: Sixty patients with gingival recession were treated with subepithelial connective tissue grafts. During initial examination, 33 intact teeth with longstanding gingival recessions of 4.09 +/- 0.16 mm (mean +/- SEM) and 27 teeth with carious roots (restored and unrestored) and longstanding gingival recessions of 3.44 +/- 0.22 mm (mean +/- SEM) were found. Prior to grafting, any carious dentin and plastic restorations were removed. The exposed roots were thoroughly planed and covered by a subepithelial connective tissue graft without any further root treatment or conditioning. Patients were evaluated periodically between 1 and 6 years. Residual recession, defect coverage, and caries incidence were assessed. RESULTS: Recession was reduced to a similar extent on all teeth whether root caries was present (0.31 +/- 0.11 mm) or not (0.15 +/- 0.04 mm). This resulted in comparable defect coverages of 92.41 +/- 2.38% for previously carious roots and 97.46 +/- 0.79% for intact roots. In 44 cases, complete coverage of the recession was achieved. The results were stable, and no further recessions or recurrent caries were found during the periodic evaluations. CONCLUSIONS: These results indicate that coverage of previously carious roots with subepithelial connective tissue grafts is a very predictable procedure with results similar to those found on intact roots. This procedure may provide a definitive biological alternative for conventional restorative treatment modalities for root caries. Moreover, the results are more esthetic, biologically acceptable, and maintainable.

Adult↗
PubMed1991

Clinical evaluation of a dentinal adhesive system: three-year results.

The dentinal adhesive Scotchbond 2 was evaluated with the microfilled composite resin Silux in cervical and root caries lesions for up to 3 years. Clinical criteria evaluated included retention, marginal integrity, marginal discoloration, color match, anatomic form, recurrent caries, gingival response, and postoperative sensitivity. Overall, the adhesive demonstrated improved performance over earlier dentinal adhesive systems. Retention was greatest at 3 years when available enamel margins had been etched (93%) and when root caries lesions (97%) had been restored. Other criteria were reported as generally favorable. Early findings suggest that the level of development of sclerotic dentin may influence behavior of the adhesive. The greatest difficulty was noted in lesions presenting with heavy sclerotic dentin.

Acid Etching, Dental↗
PubMed2000

[The dynamics of pH, free calcium and total proteins in root plaque fluid and their relationships to the cariogenic potential].

OBJECTIVE: To enhance knowledge of root caries by analysis of the dynamics of dental plaque fluids on root surface and their relationships with the caries history. METHODS: The pH, free calcium and total proteins of dental plaque fluids on sound root surfaces were analyzed before and after the sucrose challenge. Subjects were either root caries-free (RCF) or caries-positive (RCP). RESULTS: After a sucrose challenge, the pH of plaque fluids dropped significantly and the concentration of free calcium increased significantly. There were no statistical differences in pH (RCF group 6.24 +/- 0.74, RCP group 5.96 +/- 0.70) and free calcium [RCF group (0.60 +/- 0.46) mmol/L, RCP group (0.89 +/- 0.54) mmol/L] between RCF and RCP group before sucrose challenge. Following sucrose exposure, pH (5.14 +/- 0.19) and free calcium [(1.73 +/- 0.74) mmol/L] in RCP group were significantly lower than RCP group [(pH 5.28 +/- 0.16), free calcium (2.73 +/- 1.25) mmol/L]. No interrelationship has been found between the amount of total proteins and free calcium. Components (contents, change trend) in root plaque were strongly related to that in coronal plaque. CONCLUSIONS: The process of root caries may be consistent to coronal caries regarding to the acid production of bacteria after a sucrose challenge. Plaque compositions show a stronger cariogenic potential in RCP group.

Calcium↗