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Medical Forum / General / Dentistry / July 2005Do you allow caries below a restoration?
I have allways had a question, maybe you could give me your opinion... What would you do in the following case: You are removing carious tissue which does not appear radiographically, beneath an amalgam which was broken. However, the carious tissue just keeps getting deeper, and deeper. Before you know it, pulp is less than 1 mm. from where you are working, and you can see the dentin is getting "pink". The pulp is vital, giving excelent results from vitality tests, and there is just one point of caries... My question is, would you place glass ionomer and a restoration, leaving about .5 square mm of caries, or would you treat the root canal? My poing of view is that the caries should not continue if it is properly sealed, and should slow down or stop due to the fluoride liberation of the glass ionomer. I would be glad to hear what you think I would go straight into rootcanal. Tooth will need rootcanal sooner or later, and that tooth will be very sensitive to cold. Chances are that patient will complain that tooth never botherd him/her, they never thank you for trying to avoid rootcanal. The success rate for rootcanal in this case would be higher if you did rootcanal right away instead of waiting for infection to occur. While I agree with you that the patient may be sensitive to cold afterwards and the prognosis for the root canal on a healthy pulp is better, leaving pin point areas of caries is acceptable as long as you do an indirect pulp cap with CaOH, glass ionomer base then restore. The caries would be arrested or slowed down significantly, allowing time for secondary (or is it tertiary?) dentin to form to wall off the encroaching caries. That's what indirect pulp capping is meant to achieve hopefully IMHO. teethdood >I would go straight into rootcanal. Tooth will need rootcanal sooner or > later, and that tooth will be very sensitive to cold. Chances are that > patient will complain that tooth never botherd him/her, they never > thank you for trying to avoid rootcanal. The success rate for rootcanal > in this case would be higher if you did rootcanal right away instead of > waiting for infection to occur. >I have allways had a question, maybe you could give me your opinion... > [quoted text clipped - 9 lines] >leaving about .5 square mm of caries, or would you treat the root >canal? What is the final restoration material ? >My poing of view is that the caries should not continue if it is >properly sealed, and should slow down or stop due to the fluoride >liberation of the glass ionomer. > >I would be glad to hear what you think What about "caries control" ? -- W_B Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com W_B ha escrito: > >I have allways had a question, maybe you could give me your opinion... > > [quoted text clipped - 24 lines] > Take out the G'RBAGE > wubbabubbazG@RBAGEyahoo.com The final restoration material was a targis inlay. By the way, what do you think about Targis? Do you think it has any advantages over Porcelain, or just disadvantages? >> >My question is, would you place glass ionomer and a restoration, >> >leaving about .5 square mm of caries, or would you treat the root [quoted text clipped - 10 lines] >> What about "caries control" ? >> -- >The final restoration material was a targis inlay. By the way, what do >you think about Targis? Do you think it has any advantages over >Porcelain, or just disadvantages? Am not familiar with Targis. Anyone else ? -- W_B Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com >>> >My question is, would you place glass ionomer and a restoration, >>> >leaving about .5 square mm of caries, or would you treat the root [quoted text clipped - 18 lines] > Anyone else ? > -- If I respond, I will just sound like "One Tune Charlie" Targis/Vectris (Ivoclar) is a system to construct indirect restorations with a composite material. I haven't found indirect composites to offer much that I can't deliver with a less expensive direct restoration (in most cases). I know Mancuso uses porcelain with his Cerec, but a lot of guys use composite blocks for their restorations. That doesn't sound to special to me. Fawks > Am not familiar with Targis. > Anyone else ? > -- > > W_B I have only done composite CEREC twice in my career. Both times were instances where I needed to be able to add to it later. A composite crown or onlay will not get paid by the insurance carrier.  Signature~+--~+--~+--~+--~+-- Stephen [What's a Temporary?], D.D.S. Michigan, USA .................................................... This posting is intended for informational or conversational purposes only. Always seek the opinion of a licensed dental professional before acting on the advice or opinion expressed here. Only a dentist who has examined you in person can diagnose your problems and make decisions which will affect your health. ...................... > > Targis/Vectris (Ivoclar) is a system to construct [quoted text clipped - 15 lines] >> >> W_B I have yet to see a serious study which shows FL release from GI to significantly effect anything. I say clean the caries out if the patient is an adult. If you end up in the pulp, no pulp cap would have worked. If the patient is very young, I will consider a temporary (about one year) restoration with an indirect cap. (very seldom) >I have allways had a question, maybe you could give me your opinion... > [quoted text clipped - 15 lines] > > I would be glad to hear what you think |
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