What is the role of preventive measures, and what procedures and materials should be used for preventing, arresting and reversing root caries lesions?
This question is pivotal to managing the caries process, emphasising the importance of prevention. Once these lesions form, they become challenging to treat, underscoring the need to prevent their development. Additionally, the distinction between preventing, arresting and reversing is crucial. We’ve also addressed this in guideline papers developed in collaboration with the European Organisation for Caries Research (ORCA) and the European Federation of Conservative Dentistry (EFCD).

Our mouths are in a state of demineralisation and remineralisation owing to the presence of biofilm and consumption of carbohydrates. To prevent the caries process from becoming active, we must disrupt or modulate the biofilm through non-operative interventions, such as oral hygiene and dietary control.

While societal shifts towards health consciousness are helping people become more aware of the importance of adhering to healthy oral health behaviours, ensuring patients maintain oral hygiene remains a challenge for many oral healthcare teams. By approaching oral care positively and leveraging positive motivational messaging from professionals to the wider public, we can encourage better oral health habits. Products such as GC Tri Plaque ID Gel and GC’s Saliva-Check BUFFER are very helpful in targeted and personalised communications and shared-decision making between the oral healthcare practitioner and the patient, and of course, remineralising agents and varnishes (e.g. GC’s MI Paste Plus and MI Varnish) are great aids to restore the mineral balance at the susceptible tooth surfaces.

What is the best material for restoring root caries after selective caries removal?
It is challenging to pinpoint one material. However, glass ionomers have emerged as a group that tends to be highly effective, supported by numerous clinical trials. Resin composites can also be effective under optimal conditions, but their use is limited owing to challenges related to moisture control and the nature of the substrate in root caries lesions. Attempting to layer multiple materials in such lesions is clinically challenging and may weaken the restoration’s interface. High-viscosity glass ionomers, resin-modified glass ionomers and glass hybrids are often preferred choices, based on clinical evidence from the past decade.

Ultimately, no trial will definitively prove one material’s superiority over another, as success relies heavily on operator technique and patient adherence to effective biofilm control measures. While some materials may exhibit longer-lasting results, all materials can be effective when applied correctly.Nevertheless, practical considerations and clinical judgement are of great importance here. Over the years, I’ve observed that there are instances where clinicians may not fully adhere to the instructions for use for certain materials. These instructions are based on years of intensive research and are heavily regulated for good reason. While flexibility can be beneficial in some cases, it’s essential to strike a balance and to follow the manufacturer’s instructions closely to ensure optimal outcomes. A good example would be GC’s EQUIA Forte HT system. If the clinician used EQUIA Forte HT Fil without EQUIA Forte Coat, he or she would not be making use of the full benefits of the material. In turn, this would have an impact on the quality of the clinical result. Again, these same factors come into play: knowledge of how the material works and clinical judgement.

In cases where resin composite is used for restoration of root caries, how can the best adhesion be achieved?
Again, having good judgement is crucial. Knowledge of the material highlights the significance of moisture control, which is essential for successful outcomes. Ideally, enamel would be present for proper adhesion. When encountering sclerotic dentine with higher mineral content, it’s important to consider the best etching system for optimal results. It’s based on an intricate decision-making process that includes all variables of the specific case, so putting forward just one approach seems inappropriate.