Restorative & Materials · single question
An elderly patient with a zirconia crown on tooth #18 is taking bisphosphonates and has caries extending below the crown margin to the gingiva. What is the treatment of choice?
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Correct answer: A. Silver Diamine Fluoride (SDF)
✓ A) Silver Diamine Fluoride (SDF) is correct.
SDF (38% silver diamine fluoride) is the ideal treatment here because: (1) the patient is on bisphosphonates — any surgical intervention risks bisphosphonate-related osteonecrosis of the jaw (BRONJ/MRONJ); (2) SDF is non-invasive, arrests caries chemically (silver = antimicrobial, fluoride = remineralization); (3) it is ideal for high-risk, medically compromised elderly patients who cannot tolerate invasive procedures. Fluoride varnish alone is insufficient for active caries at the margin.
SDF (38% silver diamine fluoride) is the ideal treatment here because: (1) the patient is on bisphosphonates — any surgical intervention risks bisphosphonate-related osteonecrosis of the jaw (BRONJ/MRONJ); (2) SDF is non-invasive, arrests caries chemically (silver = antimicrobial, fluoride = remineralization); (3) it is ideal for high-risk, medically compromised elderly patients who cannot tolerate invasive procedures. Fluoride varnish alone is insufficient for active caries at the margin.
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