The document discusses secondary caries, which are lesions that develop around existing restorations. It defines secondary caries and explains that their pathogenesis is similar to primary caries, involving demineralization of enamel and dentin. Risk factors include patient factors like a high-caries risk, as well as restoration factors like defective materials, microleakages, and poor marginal adaptation. The management of secondary caries may involve removing stained margins, replacing existing restorations, or repairing defects. Detecting secondary caries clinically or radiographically is important for determining the appropriate treatment approach.

1. SECONDARY CARIES:
OVERVIEW & MANAGEMENT
Mariam Magdy

2. Definition
• Lesions around the margins of
restoration
• Caries Around Restorations and
Sealants
• Complex multifactorial process
combining causes of primary
caries with specific
characteristics of restorations
and restorative material

3. • Its pathogenesis follows the
same process as primary caries
• Demineralization and cavitation of
enamel
• Enzymatic dissolution of dentine
• Pulpal necrosis
• However, it is modified by the
presence of a restoration or
sealant margin

4. Surface (outer) lesion& Wall lesion
• Surface lesion
• Demineralization from the tooth
surface like a primary carious
lesion
• Wall lesion
• Demineralization due to gap in the
Tooth-Restoration interface
leading to new carious lesion

5. Etiology
• Unclear
• Maybe associated with defective restoration
• Due to gaps in Tooth-Restoration interface
• Intact restoration
• Due to low buffering capacity of restoration
• Residual caries left
• Due to un sealed restoration
• A new lesion entirely
• factors relevant to caries development must be present (i.e Oral biofilm,
fermentable carbohydrate, mineral imbalance and hard tissue loss)

6. Gap & Microleakage
• Clinically may show undetectable leakage between cavity wall and
filling
• But Gaps between 60-1000µm have been implicated in microleakage
studies
• Gap size affects SC progression
• Smaller gaps favor remineralization due to saturation with minerals
• Larger gaps favor SC development due bacterial colonisation
• Fluoride releasing materials may resist SC development even with
larger gaps

7. Risk Factors of SC
• Factors that promote
SC formation can be
grouped into 3
• Patient / Caries Risk
Factors
• Restoration Factors
• Material / Operator
Factors

8. Patient / Caries Risk Factors
• The survival time of restorations and teeth are severely shortened in
patients with high caries risk Especially the survival time of the large
restoration. as dry mouth(xerostomia)/Heavily seen plaque /High
carbohydrate diet/smokers
• Prevalence showed that Female seems to have higher SC than males
due more consumption of sweets
45.00%
50.00%
55.00%
Ferquency
Gender
male female

9. Restoration Factors
• Studies showed that the average age of restorations at failure was 7
years. then it may need repair/replacement
• Gingival margins especially of class II, including MOD restorations,
seem to be the place of less resistance to SC development..
0.00%
5.00%
10.00%
15.00%
20.00%
25.00%
30.00%
35.00%
40.00%
Prevalence of
Secondary
Caries
Restoration Class
Class I Calss II
45.00%
46.00%
47.00%
48.00%
49.00%
50.00%
51.00%
Prevalence
Restoration Age
Less than 5 years 5 - 10 years
Location
Gingival Occlusial
Gingival&Occlusial Other

10. Material / Operator Factors
• Sc is associated with quality of restoration so care during placement of restoration will affect its long
term survival
• Operator should know how to detect SC and decide either to repair it by polishing / removal of the over
hang / sealing the margin or just replacing it by new one
• But Bec. there is no specific diagnostic criteria and lack of standardization conflicts and debates were
found about either composite show more prevalence to SC bec. of its low acid buffering capacity or less
prevalence according to its chemical tooth adhesion also does amalgam show high prevalence due to its
mechanical adhesion to tooth or low prevalence according to its corrosion products which seal the
margin by time
0.00%
5.00%
10.00%
15.00%
20.00%
25.00%
30.00%
35.00%
Prevalence of
Secondary Caries
Restorative Material
Amalgam Composite
0.00%
10.00%
20.00%
30.00%
40.00%
50.00%
60.00%
Prevalence of
Secondary Caries
Restorative Material
Amalgam Composite

12. Case Management Secondary Caries
Stained margins visible
around composite
restorations.
Removal of stained
margins by refinishing
and polishing of
restoration

13. Case Management Secondary Caries
Class V composite restoration
with a localized discolored. soft
carious lesion gingivally. The
entire cavosurface margin is
discolored.
The restoration has been removed. Most
of the base material is still intact. There
was light brown, soft tissue present
gingivally is well localized and is a
characteristic surface lesion adjacent to a
restoration. No wall lesion was seen.

14. Case Management Secondary Caries
The cavity preparation has
been completed and acid
etched..
1
The restoration was removed
without touching the cavosurface
margin. Stained but hard tissue
remains on the surface beyond
the cavosurface margin. Some
base material remains, but there
is no sign of a wall lesion.
2
Class V composite restoration
with a stained gingival margin,
suspected to be carious.
3
A new Class V composite
restoration has replaced
4

15. Case Management Secondary Caries
Class Ill composite restoration
extending into the Class V
area of the maxillary right
canine. The localized stained
margin can be penetrated by
a sharp explorer.
1
The resin composite adjacent to
the stained margin was removed.
resulting in the complete removal
of the stain. No wall lesion was
seen, and the stain did not extend
deep into the tooth-restoration
interface
2
The small defect has been
repaired. 3
The final result 4

16. Case Management Secondary Caries
Mesial and distal
discolored composite
restorations in 2 incisors,
both with suspected
gingival secondary caries.
Both restorations shown have been
carefully removed, No carious lesions
was shown gingivally. Some base
material remains in the lateral incisor.
The stained dentin enamel junction
and stained dentin on the gingival and
pulpal floor of the central incisor are
hard and considered to be arrested
caries.

17. Case Management Secondary Caries
Class Ill resin composite
restoration in the canine that
causes a "catch" with the
explorer and Secondary
caries is suspected
The composite restoration
shown has been carefully
removed. No carious tissue
can be detected gingivally
then replacement of new
restoration.

18. Case Management Secondary Caries
Radiograph Of a maxillary molar
and premolar region of a patient
who complained of sensitivity in
the second premolar and first
molar region. The radiograph
indicates possible secondary
and/or remaining caries in the
second premolar and a probable
primary lesion mesially on the
first molar
1
Clinical situation of the region
shown. The bluish-gray
discoloration on the
mesiobuccal aspect of the
second premolar may be
indicative of secondary caries
or discoloration of the tissues
by the amalgam.
2
Removal of the amalgam
restoration in the second
premolar reveals a narrow line of
demineralized (opaque white)
enamel on the gingival floor and
soft carious tissue in the distal box
of the Class Il preparation,
indicative of remaining caries and
development of a carious lesion
gingivally.
3
Later stage of the operative
procedure of the teeth
presented Note the distinct
carious lesion on the first
molar and a small lesion just
reaching into dentin in the
distal box of the premolar. The
second lesion was not
detected radiographically
4

19. Case Management Secondary Caries
Class Ill composite
restoration in the rotated
lateral incisor, diagnosed
as having secondary
caries gingivally..
The composite restoration
shown has been removed.
NO caries is noted on the
gingival margin.

20. Case Management Secondary Caries
The restoration has been removed
so that some amalgam on the
occlusal cavosurface margin and part
of the base material are left soThere
is no indication of spread of the
carious tissue below to the
restoration but Gingivally the carious
lesion extended to the full depth of
the restoration.
Class V amalgam restoration
with extensive secondary caries
gingivally which is yellowish
brown and soft.

21. Case Management Secondary Caries
10-year old posterior composite restoration with a
limited fracture of the marginal ridge and a cervical
radiolucency indicative of secondary caries.
,, Restoration following repair, including extension to
manage the cervical secondary caries diagnosed
radiographically

22. Thank you