1-Carious Lesion Detection
2-Carious Lesion Assessment
3-Caries Disease Diagnosis
1-recognition of changes in enamel/dentin/cementum that are consistent w/ having been caused by caries process
2-severity/extent---evaulation of characteristics of caries lesion once its been detected. Characteristics= optical, physical, chemical, or bio, color, size
3-caries disease diagnosis= professional summation of all signs/symptoms of disease to arrive at ID
1-Lesion Detection Assessment
2- Diagnostic Tests
1-establish level of destruction present, aid in caries diagnosis, determine treatment decisions
2- Valid-test measures what is intended to measure= white spot lesion
Reliability- test can be repeated w/ same result---same lesion
1- true +
2- false +
3- true -
4- false -
1-caries= present and test identifies it
2- diagnostic test incorrectly IDs when caries is absent
3- test correctly identifies individual as caries free
4-has caries & test incorrectly= caries free
1-Sensitivity
2-Specificity
1-proportion of true positive that are correctly identified
2-proportion of true negatives that are correctly identified
Detection Methods---Ideal Method
-reproducible, accurate
-easy to use/learn
-useful on surfaces
-influence on treatment
Visual Examination of Caries
-widely used, quick, cheap, easy
-dry, clean tooth w/ good light, and mirror
-all surfaces
-occlusal, smooth surface (proximal), root caries
-dichotomous decisions---presence / absence
-Can’t see interproximal so it is absent upon examination
Explorer
-explorer can break off part of the tooth because it is fragily
---doesnt add anything to detection yield
-use it to feel margins/defects
-clean debris from fissures/interproximal spaces and confirm/assess cavitations
-hardness of root/dentin
-texture of white spot
Occlusal Surfaces
-low sensitivity= 0.30 and high spec.
ICDAS
0- sound surface
1-first visual change in enamel
2-distinct visual change in enamel
3-localized enamel breakdown bc of caries w/ no visible dentin
4-non cavitated surface w/ underlying dark shadow from dentin
5-distinct cavity w/ visible dentin
6-extensive distinct cavity w/ visible dentin
Interproximal Detection
-visual inspection via bitewing radiographs
- but doesnt detect early subsurface demineralization or lesion activity
Caries---
- Biofilm
- Pellicle
- Enamel
- Dentin
1-E Classification
2-D1 Classification
3- D2 Classification
1-lesion penetrates through part of the enamel
-radiolucent triangle w/ base at enamel and point to DEJ
2-lesion penetrates into dentin but is less than 1/2 through dentin toward pulp...radiolucent triangular lesion in enamel
3- lesion extends= more than 1/2 but less toward pulp, deeeeep appearance
1-Transillumination
2-DIAGNOdent
1-intense beam of white light, tip on facial surface, caries has lower index of transmitted light, detection of proximal lesions, inexpensive (light through tooth)
2-detection of early occlusal lesions, fluorescence from lesion=produced from bacterial porphyrins, tip on tooth, normal enamel exhibits, intensity=size...drawbacks= heavely stained fissues and false positives
Caries Disclosers
-colored dye stains organix matrix of less mineralized dentin
-drawback= over prep of pulp exposure due to natural differences in colalgen content in diff parts of dentin
Active Lesion
-chalky opaque, white dull
-rought/soft
-plaque stagnation--covered by plaque
-close to gingiva
-high surface porosity
Inactive Lesions
-translucent/white-brown
-shiny surface
-smooth/hard
-non-plaque stagnation
-away from gingiva
-low surface porosity
Active Lesion
Inactive White Spot Lesion-----reversible & stable
Differential Diagnosis
---loss of tooth structure
-Erosion
-Attrition
-Abrasion
----white spot differential
-hypoplasia
-fluorosis
Decalcification
Fluorosis
1- alginate
2-gypsum
3- Dental impression media
1-impression making
2-dental casts
3- used to reproduce accurate replicas of intraoral and extraoral tissues
Impression Making Goals
1-obtain accurate negative images, all anatomic details from patients
2-transform images into positive physical or virtual casts= diagnostic, planning, and treatment
Digital Impression Media
-iTero (cadent)
-E4D (D4D)
-Lava (3M ESPE)
-----we use----CAD---CEREC (sirona)
-digitally imaged impressions to create virtual casts on restorations may be fabricated
Physical Media
1- rigid impression---compounds, impression plaster, zinc oxide
2-flexible impression---agar hydrocolloids (reversible), elastomeric, alginate hydrocolloids(irreversible)
Dental Alginate Impression
-hydrocolloid consisting of a sol of alginic acid having a physical state that is changed by irreversible chemical reaction forming insoluble Ca alginate
Colloids are dual phase
-internal (dispersed) phase contained w/in matrix (dispersion) phase
-dispersed consists of molecules held together by primary/secondary attraction forces w/in matrix (dispersion)
Solid Colloids
-dispersed (internal) phase particles are concentrated enough to form a semi-solid material=gel
Alginate Impression Material
-dispersed phase consists of chains of Ca alginate (micelles) w/in dispersion phase of H2O
-powder(K alginate) and water creates colloidal solution (for setting reaction)
Alginate Impression Material:
1-Potassium Alginate
2- Calcium sulfate
1- source of soluble aginate
2- initiates reaction
---Ca ions reacts w/ the K Alginate sol to create the gel of Ca alginate
