Conservative diagnosis

  • Caries
  • Amalgam Restorations (i) amalgam ‘blues’, (ii) proximal overhangs, (iii) marginal ditching, (iv) voids, (v) fracture lines, (vi) lines indicating the interface between abutted amalgam restorations placed at separate times, (vii) improper anatomic contours, (viii) marginal ridge incompatibility, (ix) improper proximal contacts, (x) improper occlusal contacts, and (xi) recurrent caries lesions
  • indirect metal restoration
  • composite restoration
  • implants
  • enamel hypoplasia
  • imperfecta

Clinical Examination of Proximal Surface Caries • Early proximal surface caries: This form of smooth-surface caries is usually diagnosed radiographically (Fig. 3.5A and B). It also may be detected by careful visual examination after tooth separation or through fibre-optic transillumination.19 • Cavitated Proximal surface caries: When the caries lesion has progressed through the proximal surface enamel and has demineralized dentine, a white opaque appearance or a shadow under the marginal ridge may become evident (see Fig. 3.2C). Careful probing with an explorer on the proximal surface may detect cavitation, which is defined as a break in the surface contour of enamel. The combined use of all examination methods may be helpful in arriving at an accurate final diagnosis. • Inactive proximal surface caries: Brown spots on intact, hard proximal surface enamel adjacent to and usually gingival to the contact area are often seen in older patients, in whom caries activity is low. These discoloured areas are a result of extrinsic staining during earlier caries demineralizing episodes, each followed by a remineralization episode. These areas are no longer carious and are usually more resistant to caries as a result of fluorohydroxyapatite formation. Restorative treatment of these areas is not indicated. Inactive proximal caries lesions sometimes are difficult to correctly diagnose because of faint radiographic evidence revealing previous mineral loss. • Anterior proximal surface caries: Proximal surface caries in anterior teeth may be identified by radiographic examination, visual inspection (with optional transillumination), or probing with an explorer. In addition to transillumination, tactile exploration of anterior teeth is appropriate to detect cavitation because the proximal surfaces generally are more visible and accessible than in the posterior regions.

Clinical Examination of Smooth Surface Caries

Root Surface Caries

Amalgam Restorations (i) amalgam ‘blues’, (ii) proximal overhangs, (iii) marginal ditching, (iv) voids, (v) fracture lines, (vi) lines indicating the interface between abutted amalgam restorations placed at separate times, (vii) improper anatomic contours, (viii) marginal ridge incompatibility, (ix) improper proximal contacts, (x) improper occlusal contacts, and (xi) recurrent caries lesions.

Indirect Metal Restorations

Composite and Other Tooth-coloured Restorations

Dental Implants and Implant-supported Restorations

Non-hereditary developmental enamel hypo-plasia Amelogenesis imperfecta Dentinogenesis imperfecta Horizontal or vertical fracture