Recurrent Caries and Periodontal Disease

The patient must have satisfactory oral hygiene before commencing tooth preparation for advanced restorative procedures, otherwise failure is inevitable. The teeth should be examined and the extent of caries and existing restorations noted. The plaque accumulation in the stagnation area around an interproximal caries lesion is often associated with gingivitis (Fig. 4.1). Placing a well-contoured temporary restoration to resolve the gingival inflammation is often a necessary first step (Fig. 4.2). The tooth should undergo a thorough visual examination (Fig. 4.3). A radiographic examination is necessary to ascertain the extent of recurrent caries prior to crown preparation (Fig. 4.4).

Fig. 4.1 Routine operative dentistry should always be completed prior to advanced procedures. Operative intervention allows the assessment of the extent of caries prior to crown preparation

Fig. 4.1 Routine operative dentistry should always be completed prior to advanced procedures. Operative intervention allows the assessment of the extent of caries prior to crown preparation

Interproximal Caries

Fig. 4.2 Interproximal caries lesion may be associated with gingivitis, and a well-contoured temporary restoration can allow healing. This facilitates impression taking for crowns and allows careful planning of the crown margin

Fig. 4.3 A periapical radiograph is essential prior to crown preparation to assess the periodontal bone support, root length, and the extent of caries, if present. However, radiography underestimates the extent of caries
Recurrent Caries Crown

Fig. 4.4 (a) Could this carious cavity on the upper right first molar be repaired with a simple restoration, or would the metal-ceramic crown require replacement? (b) A radiograph revealed that extensive caries was present on the distal interproximal surface, and the metal-ceramic crown therefore required replacement a b

Fig. 4.4 (a) Could this carious cavity on the upper right first molar be repaired with a simple restoration, or would the metal-ceramic crown require replacement? (b) A radiograph revealed that extensive caries was present on the distal interproximal surface, and the metal-ceramic crown therefore required replacement

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