engleski

Comprehensive approach in diagnostic and treatment of caries disease

Today dental caries is not considered as an infectious disease, which needs to be managed by removing bacteria. Instead it as a dynamic process between pathological factors causing demineralization and protective factors causing remineralization. If the activity in biofilm resulting in an imbalance in de- and re- mineralization it leads to net mineral loss within dental hard tissues ; the earliest sign and symptom is the carious lesion. In this stage process is reversible and there is no need for the “surgical” approach. Different procedures and materials have become available for prevention and non-surgical treatment of initial caries lesion as well as diagnostic tools for early recognition. The first step is early identification and assessment of caries risk factors by using caries risk assessment. The second step is to diagnose the first signs of demineralization of hard dental tissues. The earliest visual signs are the «white spot lesion» Different remineralization strategies (i.e remineralization with fluoride, CPP- ACP) is proposed. The key of the success is to achieve balance in dental biofilm by modifying its causative factors, that is, the supply of fermentable carbohydrates, the presence and maturation of the bacterially- populated dental biofilms, and right combination of remineralizing agents for remineralization of the lesion. Managment of cavitated lesions is changing as well. Different treatment concepts have been suggested to solve the problem of the cavitated lesions, especially the deep carious lesion. Recent systematic reviews are suggesting that complete removal of carious tissue is not any more treatment of choice. With the development of adhesive bioactive/bio- interactive restorative materials, removal of such large quantities of dental hard tissues is no longer justified. Less invasive procedures like selective removal approaches are focusing on removing only infected dentin while demineralized, deeper layer (affected dentin) is preserved. However, clinically is difficult to determine the border how much dentin should be removed. Several techniques are described as stepwise technique, incomplete removal to firm dentin, incomplete removal to soft dentin and sealing of cavitated carious lesion depending on the size of the lesion. The role of the restoration placed placed in cavitated lesions is to help the patient in plaque biofilm control, to protect the dentine-pulp complex, and to restore the function, form and aesthetics of the tooth. The choice of materials for restoring cavities should be guided by the caries risk of the patient, location, and extent of the lesion, lesion activity, special demands placed on the restoration. Glass-ionomer cement with their potential to release fluoride ions is a good choice for restoring and sealing cavitated lesions, especially in high-risk patients.

caries disease ; diagnostic ; remineralization

Sažeci sa kongresa dostupni u tiskanom obliku.