Course Schedule:
You can insert additional rows or columns, or paste your own course schedule.
Week
28 /10/2013
31 /10/2013
24 /02/2014
27/02/2014
10/03/2014
13/03/2014
Topic/Session
Required Reading
Caries diagnosis and risk assessment
Operative
Management of deep carious lesions
Operative/ Endo
Restoration of endodontic treated teeth
Operative/Endo
Basis for Final Grading - Assessment Schedule and Course Grading:
Assessment Task
1-Case presentation
a-Treatment planning10
b-Final case presentation 40
2-Annotated bibliography
a- Preparation 30
b- Presentation 20
3- Active learning
a-Personnel participation 40
b-Group participation 20
4- MPEs
5- Clinical competency exams
a- Large Class III direct
esthetic restoration 20
b- Timed Class II composite
restoration 20
6-Written competency exam:
a-Problem solving(PS)
b- Objective structural clinical
examination (OSCE)
c-Objective structured practical
examination(OSPE)
d- Multiple choice questions.
Week
Due
Feedback Mechanism/Time
Grade
50
50
60
40
40
Refer to
general
CCC
exam
Proportion of Final
Assessment
(MCQ)
Final Note:
For Detailed Course Description and Specific Lecture Objectives please contact course director or visit website: ____________
Title:
Caries diagnosis and risk assessment (6th Year)
Date of lecture:
28th and 31st of October 2013.
Lecturer:
Prof. Dalia Abu ElMagd.
Objectives:
1- Recognize abnormal tooth tissue and differentiating between carious and non-carious hard tissue
changes.
2- Assess activity status for different stages of the caries process.
3- Evaluate clinical and radiographic caries diagnosis
4- Appraise novel technology for caries diagnosis.
5- Reason caries risk assessment factors
6- Formulate caries management plans
7- Judge the importance of dietary factors
Work groups:
1- Clinical (Visual tactile) and radiographic caries diagnosis
a. Visual-tactile caries diagnosis and assessment criteria
b. Validity and reliability versus Specificity and sensitivity
c. Conventional versus digital radiography
2- Novel technology in caries diagnosis
a. Advanced methods for caries diagnosis
b. Compare caries detection techniques including visual, tactile, radiographic, FOTI,
DIFOTI, laser fluorescence, diagnodent….
3- Caries risk assessment factors (Female: 3 and 4)
a. Patient assessment(group 3)
b. Clinical assessment (group 4)
4- Caries management plans (Female: 5 and 6)
a. New trends in caries management (group 5)
b. The modes of action of various agents used to arrest or reverse demineralization (
fluoride and non-fluoride) (group 6)
Outline:
Traditional caries detection:
Differentiate between diagnosis, detection, assessment and monitoring
Diagnostic values:
 Visual-tactile caries diagnosis and assessment criteria
 Validity and reliability versus Specificity and sensitivity
 Sensitivity (SE): the probability that a test will correctly identify demineralization
 Specificity (SP): the probability that the test will correctly identify sound enamel
 Reliability (R): the dependability or consistency of a measurement method
 Low sensitivity can miss significant amounts of decay
 Low specificity produces numerous false positives
Traditional detection techniques:



Visual
Tactile (Explorer ‘‘stick’’)
Radiographic



Color
Translucency
Texture
Visual
International Caries Detection and Assessment System (ICDAS):
 www.icdas.org
 Grades numerically ranging from 0-6.
Lesion activity

Differentiate between active and inactive lesions (arrested lesions)
Explorer (Tactile)
 62% sensitivity
 Eliminates potential for lesion reversal by disrupting the intact surface layer
 Recommended usage is to remove plaque and assess surface roughness by gently
scraping shaft of explorer
Radiographic





Low sensitivity: 39% occlusal 50% interproximal
40 – 60% demineralization required to produce visible image
Insufficient to determine activity level
Digital enhancements, such as contrast adjustment, may offer small gain in sensitivity
Digital bitewing for proximal caries detection
Advanced methods for caries diagnosis
 Digital Fiber Optic Transillumination
 Quantitative light fluorescence
 Infrared fluorescence
 Electrical conductance
Risk assessment factors
 Patient assessment
 Clinical assessment
Management plans
Management by risk assessment (CAMBRA):
 Treat patients by risk rather than all the same (one size fits all)
 Identify cause of disease by assessing risk factors & disease indicators for each individual
patient
 Correct the problems by managing/manipulating risk factors to alter the Caries Balance to
favor health
 Limit the unnecessary removal of tooth structure.
ICDAS II





Management of sound surfaces
Management of initial caries
Management of moderate caries
Management of severe caries
Management of root caries
Fluoride and non-fluoride protective factors
Fluoride
 Fluoride sources
 Fluoride dentifrices
 Fluoride rinses and gels (Remin pro)
 Professional fluoride treatments
Calcium phosphate technologies
 Casein phosphopeptide amorphous calcium phospate( CPP-ACP) (Recaldent)
 Calcium sodium phosphosilicate(CSP)( Novamin)
 Tricalcium phosphate( TCP)( Vanish XT, Clinpro 5000)
Pit and fissure sealants
 Indications
 Technique of application
 ADA recommendations
References:
1. Braga MM, Mendes FM, Kim R. Ekstrand KR. Detection Activity Assessment and Diagnosis of
Dental Caries Lesions. Dent Clin N Am 54 (2010) 479–493
2. Should a dental explorer be used to probe suspected carious lesions? Hamilton JC. JADA;
135;1526-1532;2005.
3. Young DA, Featherstone JDB. Implementing Caries Risk Assessment and Clinical Interventions.
Dent Clin N Am 54 (2010) 495–505.
4. Fontana M, Zero DT. Assessing patients’ caries risk. JADA 2006;137(9):1231-9.
5. Reis A, Mendes FM, Angnes V, Angnes G, Miranda Grande RH, Loguercio AD. Performance of
methods of occlusal caries detection in permanent teeth under clinical and laboratory conditions.
Journal of Dentistry (2006) 34, 89–96.
6. ZhangW, McGrath C , Edward C.M. A comparison of root caries diagnosis based on visual-tactile
criteria and DIAGNOdent in vivo. J of Dent 37 ( 2009 ) 509 – 513
7. Pretty IA. Caries detection and diagnosis: Novel technologies. J of Dent 34 ( 200 6 ) 72 7 – 73 9
8. Dome´jean-Orliaguet S, Le´ger S, Auclair C, Gerbaud L , Tubert-Jeannin S. Caries management
decision: Influence of dentist and patient factors in the provision of dental services. J of Dent 37 (
2009 ) 827 – 834
9. Lingstrom L et al. Dietary factors in the prevention of dental caries: a systematic review. Acta
Odontol Scand 61 (2003) 331-340
10. Mitropoulos P, Rahiotis C, Stamatakis H, Kakaboura A. Diagnostic performance of the visual
caries classification system ICDAS II versus radiography and micro-computed tomography for
proximal caries detection: an in vitro study. J of Dent 38(2010) 859-867
11. Hara AT, Zero DT. The Caries Environment:Saliva, Pellicle, Diet, and Hard Tissue Ultrastructure.
Dent Clin N Am 54 (2010) 455–467
12. Nakano K, Okawa R, Miyamoto E, Fujita K, Nomura R, Oshima T. Tooth brushing and dietary
habits associated with dental caries experience: Analysis of questionnaire given at recall
examination. Ped Dent J 18 (2008) 74-77
13. Ismail AI et al. Caries management pathways preserve dental tissues and promote oral health.
Community Dentistry and Oral Epidemiology 41(1), 2013
14. Rethman MP et al. Nonfluoride caries-preventive agents: executive summary of evidence-based
clinical recommendations. J Am Dent Assoc. 2011 Sep;142(9):1065-1071.
15. Zandona AF and Domenick TJ. Diagnostic tools for early caries detection. JADA;137:16751684;2006.
16. Diniz MB et al. The performance of conventional and fluorescence-based methods for occlusal
caries detection . An in vivo study with histologic validation. JADA 143(4): 339-350; 2012
17. The effectiveness of a calcium sodium phosphosilicate desensitizer in reducing cervical dentin
hypersensitivity: A pilot study. Narongdej et al. JADA 2010; 141(8): 995-999
18. Sealants and dental caries : Dentists'perspectives on evidence-based Recommendations. Marisol
Tellez, S. Lauren Gray, Sarah Gray, Sungwoo Lim and Amid I. Ismail. JADA;142(9):10331040;2011.
19. Clinical Efficacy of Casein Derivatives : A Systematic Review of the Literature. Amir
Azarpazhooh and Hardy Limeback. JADA; 139(7):915-924;2008
20. Recommendations for fluoride varnish use in caries management. Autio-Gold J. A peer reviewed
CE activity by Dentistry Today from June 2006 to May 2009.
21. Comparative study of the effect of direct and indirect digital radiography on the assessment of
proximal caries. Aghmasheh F. Indian J of Dent 4 (2013) 83-87

Selected Books
Dental caries The disease and its clinical management 2nd edition.
MULTIDISCIPLINARY SESSION (6TH YEAR)
MANAGEMENT OF DEEP CARIOUS LESIONS
Prof. Ahmed Hamed Zaki & Dr. Hadeel Edrees
(24th and 27th February 2014)
OBJECTIVES:
After completion of the topic, each student should be able to:
1.
Discuss the drawbacks of uncontrolled management of deep carious lesions.
2.
Order the cavity depth.
3.
Illustrate the different treatment options of deep carious lesions.
4.
Illustrate the rationale, indications and the technique of stepwise excavation of deep carious lesions.
5.
Compare between the different methods of caries removal.
6.
Correlate between the use of caries disclosing dyes and excavation of carious dentin.
7.
Evaluate the concept of sealing in dentinal caries.
8.
Illustrate the rationale, indications, technique and criteria of success of indirect pulp capping.
9.
Interpret the intent, mechanism and inclusion criteria of direct pulp capping.
10. Assess the factors affecting the outcome of pulpal exposure.
11. Discuss the procedure of direct pulp capping.
12. Revise the different materials that could be used in vital pulp therapy and the latest available scientific studies on each
material.
13. Evaluate the importance of follow-up and the evaluation methods used to assess the tooth after vital pulp therapy.
14. Conclude the strength of the available evidence on the outcome of each treatment option for deep carious lesion.
---------------------------
Restoration of endodontically treated teeth
Dr. Khalid Merdad & Dr. Helal Sonbol
10th and 13th March 2014
----------------------------------------------------------------------------------------------
Objectives:
Each student should be able to:
Group 1
 Define the goal of endodontic treatments and the goals of coronal
restorations
 Correlation between endodontic treatment and restoration
 Understand the importance of coronal leakage, what are the factors
influence leakage and how to prevent them?
Group 2
 Treatment outcome in endodontics
 Endodontic considerations before and after final restoration
Group 3
 Restorability evaluation from Endodontic, periodontic and prosthetic
prospective?
Treatment planning: Endodontic treatment or Crown lengthening:
which one is first?
Group 4
 Effect of Endodontic Materials on Bonding
Group 4
 Post and Core: Indication and types of posts.
 The ferrule effect
Group 6
Case scenario