PPDより、２次カリエスで有名そうな人

• Kidd EA. Caries diagnosis within restored teeth.Adv Dent Res. 1990 Jun;4:10-3.

• Elderton RJ. Clinical studies concerning re-restoration of teeth. Adv Dent Res. 1990 Jun;4:4-9.

診断

• Kidd EA.　 Diagnosis of secondary caries.　J Dent Educ. 2001 Oct;65(10):997-1000. Freeで読めます。click
  • Research, Clinical Practice, and Educationのための総論みたいで、臨床的には、それほどの論文。

• R J Elderton. Scope for change in clinical practice.　Journal of the Royal Society of Medicine Supplement No. 7 Volume 78 1985 27（Freeで読める) click より孫引きで、Kiddらは、診断は、困難と言っている。
  • Kidd (1984) and others have drawn attention to the difficulties of diagnosing caries. This problem applies not only to primary caries, but also to secondary caries associated with existing restorations. In a simulated clinical study, Merrett and Elderton (1984) found wide variation among nine dentists as to which teeth were thought to have caries among a set of 228 extracted restored teeth. The individual dentists in this study identified between 11 and 57 of the teeth as having caries, yet there were only two teeth in which all nine dentists were in agreement.

＊定義について

バイブルのDental Cariesをみると、

The term recurrent (secondary) caries refers to caries at athe margin of restrations (Mjor 2005). Hence, recurrent caries reflects the result of unsuccessful plaque control.


とありますね。

前半の文章には、参考文献があるけど、後半の文章には参考文献がありません。よって、本当なのか？と思っていたのですが（＾＾）。←バイブルですら、疑います。

また、二次カリエスの定義が「修復物周辺の1次カリエス」ということは、大切なことですね。

バイブルのギャップが、0.4mm以下と以上でのことが少し（Kiddら）あり、このあたりと、細菌の大きさなど、奥は深いです。

さて、

http://books.google.co.jp/books?id=fZfXWhSmG1UC&pg...

で、当該箇所が読めます。そして、なんと、MJÖRも、よく見たら、JADAです。よって、全文が読めると思って調べると、

http://jada.info/content/136/10/1426.full.pdf+html

J Am Dent Assoc, Vol 136, No 10, 1426-1433. 　2005
Clinical diagnosis of recurrent caries
IVAR A. MJÖR, B.D.S., M.S.D., M.S., Dr.Odont.

です。まあ、いろいろな方が定義するので、これが正解ではないですが、とりあえず、この定義で、議論しないとね。

＊その他

修復物とのギャップが大切ということについて

否定的な論文：
Micromorphological marginal deterioration and clinical gap formation do not necessarily result in a higher risk for secondary caries.

J Oral Rehabil. 2002 Dec;29(12):1131-8.
Secondary caries susceptibility of teeth with long-term performing composite restorations.
Rezwani-Kaminski T, Kamann W, Gaengler P.

これも否定的か？：
A very frequent cause is marginal excess or deficiency; but as these defects are only very slightly connected with the material properties of the amalgam, they will not be the subject of detailed discussion at this time. Contraction of the restoration during setting, with the resulting gap between the filling and the cavity wall, is unlikely ever to have been the direct cause of secondary caries; if however the amalgam margin is not supported by the enamel wall, then this margin if located on a loaded tooth surface will during mastication be deflected in toward the cavity wall; whether marginal fracture then occurs will depend on the relation between the width of the gap and the maximum flexibility of the margin. Calculations have demonstrated that weak amalgam margins can fracture under a very moderate load and even with such a slight deflection as 2 /mi.

Dental materials research: proceedings of the 50th Anniversary Symposium

肯定的だが、フッ素が大切？：
Secondary caries can develop at the tooth - restoration interface , depending on the presence of a gap and its size , but this process could be inhibited by fluoride .

Cenci MS, Pereira-Cenci T, Cury JA, ten Cate JM:
Relationship between Gap Size and Dentine Secondary Caries Formation Assessed in a Microcosm Biofilm Model.
Caries Res 2009;43:97-102

気になる論文：

J Adhes Dent. 2007;9 Suppl 1:117-20.
Prediction of clinical outcomes of a restoration based on in vivo marginal quality evaluation.
Sarrett DC.

フリーでも読めますが（全文を読むには、そのあたりの知識がないと大変そうで、読んでいませんが、アブストに面白い記載が（アマルガムです））。

Earlier clinical investigations and a more recent laboratory study demonstrated a strong correlation between gap size and recurrent caries for a caries-active environment, supporting replacement of defective restorations for preventive reasons. However, more recent clinical data show the complex and equivocal nature of this association. Poor specificity and validity for detection of recurrent caries with an explorer and mirror further complicate interpretation of some trials and decision-making in clinical practice.

Adv Dent Res. 1990 Jun;4:14-8.
Deterioration of restorative materials and the risk for secondary caries.
Goldberg AJ.


予防が大切だが、マージンのフィットも影響する（ブラッシングしにくくなる？）

However , the quality of the restorative material and the skill with which it is handled are also relevant to the prevention of further failure .

Int Dent J. 1992 Jun;42(3):127-38.
Secondary caries.
Kidd EA, Toffenetti F, Mjör IA.

ところで、先ほど、というか、今頃になって気がついたのですが、

バイブルのｐ３４の図３．３８をみていて、コンタクトのカリエスって、コンタクトでなく、ちょっと下なのですよね。以前から、コンタクトのところにはプラークが少ないのにな〜と思っていたのですが、それ以上の疑問と感じてなかったです。

いやはや、こんな初歩的なことに気がついてないとは、情けない・・・。まだまだですね。