Dental Caries: The Mild to Moderate Carious Lesion

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  • Topic: Dental composite, Dental restoration, Amalgam
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Dental Caries:
The mild to moderate carious lesion
Presentation: October 29th
Section 3
Carly Grothe, Justin Hagen, Matt Hendrickson, Josh Hiller,
Christy Bulman (Holub), Mike Hom, Jared Homan, Whitney Hustad, Joby Jaberi, Jackie Jensen
There are many restorative materials to choose from when a dentist treats a mild to moderate carious lesion. From amalgam to resin-modified glass ionomer the choices are virtually endless, though not all materials perform the same in lesions of this size. The purpose of this paper is to examine and compare materials such as glass ionomer, resinmodified glass ionomer, compomer, amalgam and of course resin composite. Glass ionomers contain fluoroaluminosilicate glass and aqueous polyacrylic acid. This type of material sets by an acid-base reaction and can deliver fluoride. It is indicated for cervical carious lesions, for pediatric patients, and patients who are susceptible to caries, however, the esthetic properties of this material make it less ideal than resin composite. In addition, this material is sensitive to moisture and desiccation, it has a slow setting time, and the material’s physical properties are not optimal. Over the last few years, the use of this material has declined, as the resin-modified glass ionomers have taken its place (Hildebrandt et al. 2003).

Resin-modified glass ionomers can also be used to restore small lesions with the advantage of delivering fluoride to the tooth being restored, although the amount delivered is less than conventional glass ionomer. This material sets by both a polymerization and an acid-base reaction. One study showed that after two years, 100% retention was maintained using Fujibond LC RMGI, however, only 15% of these restorations still showed perfect marginal adaptation (Peumans 2003). Though resinmodified glass ionomers are a viable option for class V restorations in adult teeth, it may be more advantageous to reserve their use for deciduous teeth that will be exfoliated; this material, although superior to glass ionomer, is more difficult to use and is weaker than resin composite, does not have the ideal esthetics that resin composites have, and the resin-modified glass ionomer adhesion is not as good as that achieved with the use of a resin composite material (Hildebrandt et al. 2003).

Polyacid-modified resin composites, otherwise known as compomers, contain some characteristics of both composite and glass ionomer. The limitations of this material include lower wear resistance than resin composites and less fluoride release than glass ionomers. This material sets by a polymerization reaction and is contraindicated for use in permanent teeth, but may be used in the primary dentition (Hildebrandt et al. 2003). Amalgam is a restorative material that has traditionally been widely used for the treatment of many types of dental lesions. Dispersalloy, a blended high copper amalgam and Tytin, a single composition high copper alloy are the materials currently used. Dental professionals are constantly reminded from various media sources that this material contains mercury. Mercury is a naturally occurring, but inherently toxic substance. Though the pure form of mercury is toxic to humans there currently is no data that supports that it is toxic when mixed with a silver alloy, such as in dental amalgam. However, the clinician must take care in handling, placing and must remove the excess mercury properly. In addition, good ventilation and the monitoring of dental personnel are necessary to reduce the risk of harmful mercury exposure. When a mild to moderate lesion is treated with amalgam certain criteria of this “material-specific” preparation design must be upheld in order to successfully use this material. The general principles that need to be followed are proper outline form, resistance form, retention form, and convenience form (Hildebrandt et al. 2003). Based on the needs for amalgam, the principles listed above create a larger...
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