Class V Lesions Flashcards

Questions and Answers

Where are Class V lesions located?

Gingival third on the buccal and lingual surfaces

Class V lesions can be BOTH carious and noncarious.

True

Where is the most common spot for Class V lesions?

Buccal

What is the incidence of noncarious cervical lesions (NCCLs)?

Increases with age Signup and view all the answers

NCCL from loss of structure by chemical dissolution is called?

Erosion Signup and view all the answers

NCCL from loss of structure by mechanical or frictional forces is called?

Abrasion Signup and view all the answers

NCCL from stress corrosion is called?

Abfraction Signup and view all the answers

According to the abfraction theory, what initiates cervical lesions?

Tooth flexure causes loosening of enamel rods Signup and view all the answers

Occlusal loading can cause loss of cervical tooth structure.

False Signup and view all the answers

Match the types of lesions with their associated shapes:

Abrasion = Deep cup Abfraction = Wedge Erosion = Shallow saucer Signup and view all the answers

How are Class V lesions prevented?

Adequate salivary flow and pH for the promotion of remineralization Signup and view all the answers

What can cause decreased salivary flow?

Xerostomia caused by meds and dehydration Signup and view all the answers

What can cause decreased salivary pH?

Extrinsic and intrinsic acids Signup and view all the answers

Examples of extrinsic acids?

Overconsumption of acidic food and drink, acidic meds, and environmental factors (chlorinated pools) Signup and view all the answers

Examples of intrinsic acids?

GERD, bulimia, and alcoholism Signup and view all the answers

How are NCCLs prevented?

Cessation of harmful habits Signup and view all the answers

When is a restoration recommended for a NCCL?

Inability to eliminate or reduce lesion progression through elimination of etiologic factors, unacceptable esthetics, excessive sensitivity, and excessive weakness Signup and view all the answers

What is an option for the treatment of abfraction?

Bite guard therapy Signup and view all the answers

Class V carious lesions sometimes occur due to alone.

plaque retention Signup and view all the answers

A Class V carious lesion is considered a 'mixed lesion' when?

Plaque retention and cavitation occur in a NCCL Signup and view all the answers

Smooth surface lesions that have not yet penetrated the enamel appear?

Chalky, opaque and rough Signup and view all the answers

When is a restoration almost ALWAYS recommended?

Lesion that is of carious origin or is a mixed lesion Signup and view all the answers

How is the type of material determined?

Diet and habits of the patient, health history and side effect of any meds - management by risk assessment Signup and view all the answers

What is used when esthetics are a consideration but only when isolation can be accomplished and caries risk is low?

Composites Signup and view all the answers

What is used for high caries risk patients, when lesions are exclusively located on the root or when complete isolation is questionable and is in an esthetic zone?

Glass ionomers Signup and view all the answers

What is used when a lesion cannot be completely isolated and use is contraindicated in xerostomic patients?

Amalgam Signup and view all the answers

Chlorhexidine and fluoride are both effective agents for caries lesions, sometimes preventing the need for a restoration...known as?

Chemotherapy Signup and view all the answers

What is the importance of the cord?

Improve access and visibility Signup and view all the answers

What are the required dimensions of amalgam prep for a Class V?

Axial depth of 0.5mm inside the DEJ (1-1.25mm in the crown) and 0.75mm inside the cementum Signup and view all the answers

Describe appropriate cavosurface margins.

Will be 90 degrees, parallel to enamel rods, and on sound tooth structure Signup and view all the answers

What bur is used to enter a Class V?

Tapered fissure bur or a #2 or #4 round bur Signup and view all the answers

How do the walls of a Class V amalgam diverge?

Diverge toward the surface Signup and view all the answers

Where must retention grooves of a Class V amalgam be located?

Must be in dentin - do NOT undermine enamel Signup and view all the answers

How is a Class V amalgam polished?

Minimal polishing with a slightly moistened cotton pellet - final polishing MUST NOT be done on day of placement Signup and view all the answers

Why are glass ionomers a good choice for restorations?

Release high levels of fluoride, chemically bond to tooth structure, and have CTE similar to that of tooth structure Signup and view all the answers

What is a negative of conventional glass ionomers?

Needs to be protected from salivary contamination for several hours and water loss for several months Signup and view all the answers

What happens if conventional glass ionomer is exposed to saliva within the first few hours or water within the first several months?

Hours - surface becomes weak and opaque; Months - material shrinks and cracks and may debond Signup and view all the answers

What is different about resin modified glass ionomer?

Part of GI formulation with alternative filler to make them more like composite Signup and view all the answers

Characteristics of resin modified glass ionomer?

Normally light-cured, less technique sensitive, and finished at time of placement Signup and view all the answers

Why are resin modified glass ionomer known as 'dual-cure'?

Acid-base reaction followed by a light-activated polymerization reaction Signup and view all the answers

How much of the resin modified glass ionomer is GI?

80% Signup and view all the answers

Where is glass ionomer indicated?

Low-stress areas where caries activity potential is of significant concern Signup and view all the answers

What is the primary indication for glass ionomer restoration?

Root caries lesions in older patients or high caries activity (xerostomic patients) Signup and view all the answers

What is the prep design for a glass ionomer restoration entirely on the root surface?

Resembles amalgam prep Signup and view all the answers

What are the advantages of glass ionomer over amalgam?

Smaller prep, fluoride release (rechargeability), esthetics, and may be used in xerostomic patients Signup and view all the answers

When should resin modified glass ionomer be used?

Class V restorations in adults and Class I restorations in primary teeth Signup and view all the answers

When should resin modified glass ionomer not be used?

In occlusal load-bearing areas Signup and view all the answers

When is a second bevel created?

If there is adequate enamel Signup and view all the answers

What helps to determine the treatment of a Class V lesion?

RISK ASSESSMENT Signup and view all the answers

What is the 'sandwich technique'? When is it used?

Combines a glass ionomer base with a veneer of resin composite; Depth is close to pulp, cervical margin on root surface Signup and view all the answers

What is used if the depth is close to the pulp and all margins are on the root surface?

RMGI Signup and view all the answers

Study Notes

Class V Lesions Overview

Class V lesions are located on the gingival third of buccal and lingual surfaces.
They can manifest as both carious and noncarious lesions.
The most common site for Class V lesions is the buccal surface.

Noncarious Cervical Lesions (NCCLs)

Incidence of NCCLs increases with age.
Types of NCCLs include:
- Erosion: Loss of structure via chemical dissolution.
- Abrasion: Loss of structure due to mechanical or frictional forces.
- Abfraction: Microfractural loss from occlusal stress in an acidic environment.
According to the abfraction theory, cervical lesions are initiated by tooth flexure loosening enamel rods.
Occlusal loading does not lead to cervical tooth structure loss unless acid is present.

Prevention and Management

Prevention of Class V lesions relies on adequate salivary flow and pH for remineralization.
Decreased salivary flow can be caused by medications or dehydration (xerostomia).
Decreased salivary pH may result from extrinsic acids, such as acidic foods, drinks, or medications, and intrinsic acids like GERD and alcoholism.
NCCLs can be prevented by stopping harmful habits.
Restoration is recommended for NCCLs when lesion progression cannot be controlled or if esthetic concerns arise.

Treatment Options

Bite guard therapy can be used for abfraction treatment.
Class V carious lesions can occur from plaque retention alone and are deemed mixed lesions when both plaque retention and cavitation are present.
Non-penetrating smooth surface lesions appear chalky, opaque, and rough.

Restoration Materials

Choice of restoration material is influenced by patient dietary habits and health history.
Composites: Used for esthetic concerns, requiring isolation, and low caries risk.
Glass Ionomers: Suitable for high caries risk, exclusively root lesions, and uncertain isolation conditions.
Amalgam: Used when isolation is not possible; not recommended for xerostomic patients.
Chemotherapy: Chlorhexidine and fluoride can sometimes prevent the need for restoration.

Class V Amalgam Preparation

Required dimensions for amalgam prep include:
- Axial depth of 0.5mm inside the DEJ and 0.75mm inside the cementum.
Appropriate cavosurface margins should be at 90 degrees, parallel to enamel rods, and on sound tooth structure.
A tapered fissure bur or #2/#4 round bur is utilized for entering Class V.
Class V amalgam walls diverge toward the surface, and retention grooves must be in dentin without undermining enamel.

Polishing and Properties of Glass Ionomers

Class V amalgam polishing involves minimal polishing with a moistened cotton pellet, with final polishing postponed.
Glass Ionomers release high fluoride levels, bond chemically to tooth structure, and have similar CTE to tooth structure.
Potential issues arise if conventional GI is exposed to saliva or water during curing, leading to weakening or cracking.

Resin Modified Glass Ionomers (RMGI)

RMGIs contain 80% GI and are typically light-cured, less technique sensitive, and finished at placement.
Known as "dual-cure" because they undergo both acid-base and light-activated polymerization reactions.
RMGIs are recommended for Class V restorations in adults and Class I in children, but not in occlusal load-bearing areas.

Special Considerations

A second bevel may be created if sufficient enamel is present.
Risk assessment is crucial for determining Class V lesion treatment.
The "sandwich technique" combines GI base with a resin composite veneer, appropriate for deep lesions close to pulp with margins on root surfaces.
RMGI is used for deep restorations when all margins are located on root surfaces.

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Test your knowledge about Class V lesions with these flashcards. Learn about their location, incidence, and characteristics. Perfect for those studying dental anatomy or preparing for exams.