Dental Caries Classification PDF

Dental diseases (ASU)  Dental caries Dental caries results from a net mineral loss from the teeth. The disease develops in the crowns and roots of teeth.  Classification of dental caries Various classification methods for dental carious lesions have...

Dental diseases (ASU)  Dental caries Dental caries results from a net mineral loss from the teeth. The disease develops in the crowns and roots of teeth.  Classification of dental caries Various classification methods for dental carious lesions have been developed, each with advantages and limitations. Newer classification systems, like the International Caries Detection and Assessment System (ICDAS) and the American Dental Association Caries Classification System (ADA CCS), have evolved from the traditional Black classification.  G.V. black classification of dental caries.(very old classification) The International Caries Detection and Assessment System (ICDAS) The American Dental Association Caries Classification System (ADA CCS), Imaging modality to diagnose caries 1-2D imaging technique. 2-3D imaging technique.  Types of 2D imaging technique 1-Intra oral Periapical radiograph 2-Intra oral Bitewing radiograph 3-Extra oral bitewing Radiographic classification of Caries 1. Interproximal caries 2. Occlusal caries 3. Buccal/lingual caries 4. Root caries 5. Recurrent caries 6.Rampant caries 7-Radiation caries  1-Interproximal Caries There are 4 classification RA1 RA2 RB4 RA3 1-Zero (no radiolucency) 2-I = Initial (RA) (RA 1, RA2, RA3) 3-M = Moderate (RB) RC5 (RB4) 4-E= Extensive (RC) (RC 5, RC 6) Incipient interproximal caries ( RA1) RA2 (Initial inter proximal) RB4 (Moderate inter proximal) RC5 (extensive inter proximal caries)  fracture overhang open margin Black arrows identifies RC5 inter proximal caries. Red arrows identify restorative problems (fracture, overhang, open margin) Problems of composite restoration  B A A, Periapical image in which a proximal carious lesion involving the distal surface of the cuspid is not apparent. B, Periapical image in which change in the horizontal orientation of the x-ray beam has separated the overlapping images of the opposing surfaces of the premolar and cuspid, revealing the presence of thelesion (arrow).  Radiographic classification of Caries 1. Interproximal caries 2. Occlusal caries 3. Buccal/ lingual caries 4. Root caries 5. Recurrent caries 6.Rampant caries 7-Radiation caries  2-Occlusal Caries Because of the superimposition of the dense buccal and lingual enamel cusps, Occlusal caries is not seen on a radiograph until there is involvement of the DEJ  Occlusal Caries Incipient Occlusal caries Must be detected clinically Can’t be detected radiographically Moderate Occlusal caries May be seen as thin radiolucent line or cup-shaped zone underlying occlusal enamel Severe Occlusal caries Appears clinically as cavitation Extendsinto dentin and appears asa large radiolucency underlying occlusal enamel cup shaped zone Moderate Occlusal caries Moderate occlusal caries (blue) Severe occlusal caries(Red arrow) Moderate occlusal caries(Blue arrow)  Radiographic classification of Caries 1. Interproximal caries 2. Occlusal caries 3. Buccal/ lingual caries 4. Root caries 5. Recurrent caries 6.Rampant caries 7-Radiation caries 3-Buccal/Lingual Caries Use clinical examination Sometimes seen as well-defined circular area in middle of tooth, although it is not very radiolucent Depth can not be determined radiographically  RB4 RA2 RA1 RA3 RC 5 Severe occlusal caries well-defined circular area(buccal / lingual caries)  RC 5 RA2 Buccal/lingual caries  Radiographic classification of Caries 1. Interproximal caries 2. Occlusal caries 3. Buccal/ lingual caries 4. Root caries 5. Recurrent caries 6.Rampant caries 7-Radiation caries  4-Root Caries Saucer-like cratering on the roots of the teeth, involving the cementum. Older patientswith recession or periodontitis Xerostomia may be present due to medications May be confused with cervical burnout  Below CEJ Saucer-like cratering loss of alveolar bone and gingival tissue Saucer-like cratering  Cervical Burnout Cervical burnout is an apparent radiolucency found just below the CEJ on the root due to anatomical variation (concave root formation posteriorly) or a gap between the enamel and bone covering the root (anteriorly) Mimics root caries Posteriorly, this radiolucency usually disappears when another film of the region is examined Caries does not occur on the root of the tooth unless there is loss of alveolar bone and gingival tissue due to recession or periodontitis  Anterior Cervical Burnout Anterior cervical burnout. The space between the enamel and the bone overlying the tooth will appear more radiolucent than either the enamel or the bone-tooth combination. Cervical burnout in the anterior region due to gap between enamel (red arrows) and alveolar bone over root (white arrows).  Posterior Cervical Burnout Cross-section (red line at right) Posterior cervical burnout. The invagination of the proximal root surfaces allow more x-rays to pass through this area, resulting in a more radiolucent appearance on the radiograph. X-rays directed at a different angle usually pass through more tooth structure and the radiolucency disappears. Radiolucency seen at left (arrow) disappears on periapical film of same tooth.  Cervical Burnout Root Caries Located at neck of teeth , No apparent upper and demarcated above by lower demarcating borders enamel cap & below by alveolar bone level Triangular-Shaped Saucer- shaped Usually, all the teeth are Localized affected good alveolar bone height usually preceded by bone enhances the cervical and gingival tissue loss burn out  Radiographic classification of Caries 1. Interproximal caries 2. Occlusal caries 3. Buccal/ lingual caries 4. Root caries 5. Recurrent caries 6.Rampant caries 7-Radiation caries  5-Recurrent Caries Found around the margins of existing restorations May be due to high caries rate, poor oral hygiene, failure to remove all the caries, defective restoration or a combination. Composite recurrent caries Amalgam recurrent caries Glass ionomer recurrent caries  Caries under prosthodontic restoration Caries under inlay restoration  Radiographic classification of Caries 1. Interproximal caries 2. Occlusal caries 3. Buccal/ lingual caries 4. Root caries 5. Recurrent caries 6.Rampant caries 7-Radiation caries  6-Rampant Caries Rapidly progressing caries usually found in children and teens with poor diet and inadequate oral hygiene  (C) an anterior occlusal image of a 4- year-old patient with multiple carious lesions (rampant caries). Bitewing images (A and B)  Radiographic classification of Caries 1. Interproximal caries 2. Occlusal caries 3. Buccal/ lingual caries 4. Root caries 5. Recurrent caries 6.Rampant caries 7-Radiation caries  7-Radiation Caries Found in head/neck radiation therapy patients with xerostomia Fluoride used for control Before radiation After radiation Extraoral bitewing In specific cases, EBWs can play a vital role in dental caries assessment and are becoming increasingly accessible in general dental practice. EBWs can be useful when intra-oral bitewing views are not possible or appropriate due to compliance issues. 1. Carious regions are usually larger clinically 2. Exposure factors affect overall contrast (Kvp & mA) 3. Superimposition in 2-D image cannot determine : Buccolingual extent of lesion (buccal / lingual caries) Distance between carious lesion and pulp horn Presence of recurrent caries Technique variations in film (paralling / bisecting tech.) & x-ray beam position affect image of carious lesion A; B.W radiograph with correct vertical and horizontal angulation B; BW radiograph with incorrect horizontal angulation C; PA radiograph with incorrect vertical angulation causing an overlap of the coronal restoration with a portion of the root and hiding the carious lesion.  3D (CBCT) Thediagnosis of dental caries ondental CBCTimages should only be performed during a review for “incidental findings” which means that under normal conditions the primary reason for ordering a dental CBCT would not be to detect dental caries. The main limitation in using CBCT in caries detection is metal artifact. what is the type of caries? what is the type of caries?