[...]... patients In a Finnish study, Honkala and Honkala (2002) placed 33 ART restorations and evaluated 25 of them 1 year later Four of the restorations were graded as having an unacceptable marginal defect, and one filling was totally lost This was a short-term study, but they concluded that this was an acceptable survival rate of restorations 2.1 Caries Removal 25 The bond strength of glass ionomer to caries-affected... preventive approach 2.2.2 Caries as a Disease Caries is a transmissible, infectious disease, and the risk of future caries must be eliminated before definitive restorative treatment begins The acidogenic bacteria are S mutans and lactobacilli, and elevated numbers of these bacteria in saliva (> 105 cfu/ml S mutans and > 103 cfu/ml lactobacilli) are indicative of high caries activity A certain salivary concentration... state that bacteria are left in the hand-excavated cavities, which is certainly true, but the total amount of bacteria is much reduced (Bonecker et al 2003) In clinical field studies, restorations performed using this approach tend to wear and fail as a result of loss of the glass ionomer, but have a much reduced rate of secondary caries compared with amalgam restorations (Mandari et al 2003) High wear... created using pressurized air, that impact the caries and abrade it away However, the abrasive particles tend to remove normal dentin more easily than the softer, carious dentin One of the main advantages of the air abrasion technique is that there is less pain associated with cavity preparation than with conventional bur preparation, perhaps because there is less noise and vibration Malmstrom et al... minimal occlusal caries detection (Attrill and Asley 2001), but is better than visual inspection alone Radiography taken on one occasion is unable to distinguish an actively progressing from a passive lesion, or a cavitated from a noncavitated surface Deep dentinal lesions that are visible on a radiograph are more likely to be cavitated Demineralized, noncavitated lesions may be arrested, but the main... instrument tend to be limited to minimal cavity preparation and the removal of surface enamel stain Figure 2.4 shows a typical air-abrasion system (Prep Start, Danville Engineering San Ramon, California, USA) The variable pressure settings and powder flow rates (27-µm or 50-µm diameter alumina particles) ensure that treatment of minor caries lesions can be treated in an ultraconservative manner The handpiece... the amalgam filling Small marginal defects, crevices, and ditches do not give rise to secondary caries The grayish-stained enamel and dentin often seen with secondary caries must be distinguished from the staining that arises from diffusion of amalgam into the surrounding tooth substance, or staining around the margin of a restoration associated with microleakage Staining around the margin of a restoration... round, or a very fine short tapered bur can be used to obtain a definitive diagnosis This can then be restored in an ultraconservative manner The clinician must, of course, assess the potential for caries in a cavity based on a visual examination of the tooth, the patient’s history, and radiographs, but be aware of the limitations of all diagnostic devices The correct treatment appropriate for each patient... have called for ART restorations to be confined to single-surface carious lesions, given the relatively high rate of failure of glass ionomer restorations (Smales and Yip 2002) Single-surface ART restorations have a survival rate similar to that of amalgam restorations over 3 years (Frencken et al 2004) 2.1.8 Caries-Detector Dyes Modern management of caries involves removing infected dentin, but in as... given in Table 1.1 Occlusal caries confined to enamel is not identifiable on radiographs because of the substantial thickness of overlying, sound enamel, which prevents adequate contrast Occlusal caries has to be quite advanced in dentin before enamel radiolucency and cavitation are seen on the radiograph Radiography Table 1.1 Mean sensitivity and specificity associated with radiographic and visual detection . cases, a standard personal computer with an image capture card allows the image to be viewed on a monitor. The carious part of the tooth appears dark against. successfully to detect early secondary caries ar ound amalgam and tooth-colored filling materials (Gonzalez-Cabezas et al. 2003). Demineralization of enamel adjacent