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Operative treatment
OPERATIVE TREATMENT
OF CARIES LESIONS OF
CHILDREN’S
PERMANENT TEETH
Modern approach and concepts
MINIMALLY INVASIVE DENTISTRY – MID
Modern approach in the dentistry
Minimally invasive management of caries is
critical to realizing the goal of giving
patients teeth for life.
The effective practice of modern caries
management depends on a shift to a
nonoperative rather than a surgical
approach to prevention and treatment,
combined with good working knowledge
and understanding of state-of-the-art
materials and techniques.
Operative treatment –Then and now
Numerous ultra conservative tooth preparation
procedures have long been introduced to
replace the high speed cutting tool that is
reputed to cut relentlessly;
Air abrasion, chemical removal of caries,
atraumatic restorative technique and lasers are
some of these methods.
The prime objective of these procedures or devices is to be selective in the removal of diseased tissue and preserve majority of the unaffected.
These ultra conservative procedures have re-emerged as novel operative methods, thanks to adhesive dentistry.
They all possess the virtues of being conservative, painless and of being able to produce a rough cavity that is conducive for an adhesive restoration.
Despite these advantages and of being in the field for more than three decades, none of these procedures have completely replaced the high speed drills as routine clinical method.
MID – scientific basis for the last 20
years
Scientific knowledge of the carious
process;
Development of new diagnostic methods;
Progress of restorative dental materials;
Development of new techniques and
methods;
Purpose of MID
Minimal intervention in the structures;
Minimal removal of affected structures;
Minimal pain in the intervention;
Maximum recovery of the affected
structure;
Preventing damage to the new structure;
Treatment of caries process.
Application areas of MID
Cariology;
Endodontics;
Periodontology;
Oral and Maxillofacial Surgery;
Radiographic diagnostics.
Application of MID in cariology
Minimal removal of hard tooth structures
in the cavity preparation;
Refusing the classical cavity forms;
Using a highly adhesive materials for
restorations;
Minimum pain;
Sparingly relation to dentin over the pulp.
The concept of minimal intervention in
cariology includes:
Minimal intervention in the diagnosis;
Minimal intervention in removing of the
affected dentin;
Minimum number of visits;
Minimal intervention in the restoration.
MI required a new term for Restorations -
"preventive resin restoration (PRR)"
Another term for preventive restoration
is "sealant restoration"
Essence:
◦ Minimal removal of caries structures;
◦ Restoration with an adhesive material;
◦ All remaining fissures, pits and grooves are
covered and protected by a sealant.
Early development of preventive
resin restorations
The objective was to make a small cavity
at the site of the carious lesion;
One occlusal surface can have multiple
lesions and separate cavities;
Are considered three types of preventive
restorations:
◦ Only in enamel – sealants;
◦ In the surface of the dentin;
◦ Near the pulp.
Contemporary development of
preventive resin restorations
Transition of smaller restorations to MI
cavity preparation;
Enamel caries can be treated only with
sealant in the fissures, pits and grooves;
Preparation of cavity is made only in dentin
caries;
Modern principles of cavity
preparations Revealing of the lesion is minimal;
Is removed only carious structure;
Do not remove any part of the health
structure;
The straightening of walls is made only at
undermined enamel;
Not expand in any direction;
Not cause any discomfort to the child;
Various forms of MI cavity
preparation
Preventive restoration – I class
Suitable tooth for MI cavity
preparation and for preventive
restoration
Minimally cavity
preparaionSealant
Differences in the classical and
modern concept of operative
treatment
Minimally invasive cavity
preparationConventional cavity preparation
Old way of preventive restoration
elaboration
FOR MI CAVITY
PREPARATION IS
POSSIBLE TO USE
DIFFERENT TECHNIQUES
A variety of potentional substitutes
for round bur excavation
Mechanical excavation: round bur, sono-
abrasion, air-abrasion, air-polishing;
Chemo-machanical excavation;
Enzymatic digestion;
Photo ablation.
Minimal intervention in carious
dentin removing
Conventional MI treatment - MIT;
Atraumatic restorative treatment - ART;
Chemical removal with "carisolv";
Using laser therapy;
Air abrasion;
Ozone;
Ultrasonic MI caries dentin removing.
Rotary instrumentation
For larger occlusal
defects are
recommended
889B,
838B and 830RB.
Use special design bur:
830B/953B and
953AB. Necks of these extremely fine burs are
covered with diamond
In undermining enamel are used 953B /
953AB, which allow the cavity form as an
ampoule ..
Suitable burs for MI preparatin
Initial state -
opening of the
defect with
smallest bur
For the minimum extension is
used Borer allowing to enter
more deeply into the defect
without broadening. These include
those with marked neck.
In the presence of several carious
lesions of one surface:
Each is formed separately;
They bind only if the
distance between them is
very small (<1mm) and
enamel is not lined with a
dentin.
MI cavity preparationInitial dentine caries of the second
molar
Etche
МI preparation
Etched almost the entire occlusal
surface
Washing and drying
Illumination
bonding system
Placing an adhesive obturation
Illumination
Illumination Sealant at all oclusal surface
The obturation is ready
The patient has to
approve the filling
Minimal intervention against carious
dentin
To distinguish between infected and affected dentin
Infected dentin -irreversibly affected -
remove:
Completely demineralized
dentin;
Digested organic matter;
Plenty of micro-
organisms;
Affected dentin -reversible affected -
retain:
Partially demineralized
Minimum number of
micro-organisms;
Well preserved
organic matter.
CLINICAL CARIES REMOVAL:
The recognized control of cavitated
carious lesions occurs predominantly by
clinical removal of the infected area from
the tooth, and the restoration of the
tooth to optimal form, function, and
esthetics.
Specific clinical treatment depends on the
extent of the destruction that has
occurred.
Clinical terms- we need to determine clinically the difference between dentine types
Non-affected dentin (zone 1) normal dentin
Affected dentin (zones 2 and 3) no bacteria present, dentin demineralized but not denatured, can be remineralized, need not be removed.
Infected dentin (zones 4 and 5) presence of bacteria, dentin (collagen) is irreversibly denatured, unable to remineralize, must be removed.
Methods of clinically detecting
infected vs. affected dentin (difficult)
Degree of discoloration –not all
discolorations are caries;
Hardness (explorer detection) – most
common method;
Caries detect solutions (stains
infected dentin) – probably most
discriminating but not widely used by
dentists.
Clinical Strategy for Caries Removal
Dentin that appears leathery, peels off in small flakes, or can be penetrated by sharp explorer should be removed;
Strategy ◦ aggressive removal of staining at DEJ
◦ less aggressive over pulpal wall
Method ◦ largest round bur that fits slow speed;
◦ light pressure;
◦ spoon excavator and explorer as we get closer to pulp –
◦ after softened dentin removed, carefully evaluate excavated area with explorer to determine if remaining dentin is hard and sound.
Reversibly and irreversibly affected
dentin
External
carious dentin -
collagen
necrosis and
micro-
organisms
Internal carious
dentin -
reversibly
denatured
collagen and
microorganisms
transparent
zone
Crystals in dentin
hardness
Pulp
wall
According to the minimal invasive
concept for restoration of cavities with
dentin involvement, caries-affected dentin
should be left after removal of the
infected tissue;
Therefore, caries-affected dentin is
predominantly the clinical substrate for
bonding in many cavity preparations.
Reversibly denatured collagen
Microbial enzymes attack and break the bonds between tropokolagen microfibrils;
They can be remineralized from the pulp;
It may also be achieved by placing the surface remineralizationof biologically active materials.
Clinical visual assessment of carious
dentin
Irreversibly affected dentin - lightly or
heavily colored softened dentin;
Reversibly affected dentin - medium-hard
and slightly colored;
Healthy dentin - the hard uncolored or
colored dentin.
ATRAUMATICRESTORATIVE TREATMENT
ATR - technic
Atraumatic minimal invasive
excavation
Used a special set of hand tools to
remove irreversibly affected dentin;
This is complemented by chemical
substances dissolving carious dentin.
Principles of ART
The two main
principles are:
1.Ex-cavationonly by hand tools;
2. Resto-ration with adhe-sive
materia.
Today the
method is
supported by:
Use GIC
Advantages of GIC
1. The method
Is appli-cable to
all groups;
2. There is biolo-
gicalaction
3. Low cost of hand tools;
4. No pain and limita-tion of ane-
sthesia;
5. No
psycho-
logical
trauma
.
6. Easy
Indications for ART
In the dentine caries;
In the case of access to the carious defect;
Contraindications:
◦ When there is involvement of the pulp and periapical changes;
◦ When there is exposed pulp and pain symptom;
◦ In obvious dentine caries, but lack of access for hand tools.
When the defect
In the fissures, pits and grooves
Apart from the occlusal surface may
also be used in:Pits on the lingual surfaces
of the upper incisors;
Buccal groove of the
lower molars;
Cervical vestibular defects;
Approximal defects
When multiple defects
II class defects
Occlusal defects with
vestibular grooves
Approximal and vestibular defects –
III class
Conditions for ART
Correct position for access to the defect;
Drying - isolation with cotton rolls and
drying with air;
Availability of the necessary tools.
Basic tools - a probe, tweezers and
a mirror
MOUTH MIRROR. This instrument is used to reflect light onto the field of
operation, to view the cavity indirectly, and to retract the cheek or tongue, as necessary.
EXPLORER. This instrument is used to identify where soft carious dentine is
present.Do not poke the point into very small carious lesions. This may destroy the tooth
surfacand the caries arrestment process. Also do probe into deep cavities where you might
damage or exposure the pulp.
PAIR OF TWEEZERS. This instrument is used for carrying cotton wool rolls,
cotton wool pellets, wedges and articulation paper from the tray to the mouth and back.
SPOON EXCAVATOR
This instrument is used for removing soft carious dentine. There are three sizes:
small. The diameter of the spoon is about 1 mm. This instrument is for use in small
cavities and for cleaning the enamel / dentine junction. As the neck of the instrument is rather
fragile, it can break if too much force is applied whilst excavating.
medium. The diameter of the spoon is about 1.5 mm. - nstrument is mainly used for
removal of soft caries from larger cavities. The rounded surface of the spoon can also be used to
push mixed restorative material into small cavities.
large. The diameter is about 2 mm. This instrument can be used in large cavities and for
removing of excess glass-ionomer material from the restoration.
DENTAL HATCHET.This instrument is used for widening the entrance to the cavity, for
slicing away thin unsupported and carious enamel left after carious dentine has been
removed. The width of the blade of the instrument is approximately 1 mm
Enlarged working blade
of other side of dental
Hatchet.
APPLIER/CARVER
This double-ended instrument has two functions. The blunt
end is used for inserting the mixed glass-ionomer into the
cleaned cavity and into pits and fissures. The sharp end is
designed to remove excess restorative material and to
shape the glass-ionomer.
MIXING-PAD and SPATULA
These are necessary for mixing glass-ionomer.
There are two types of mixing pads; glass-slab and disposable paper
pad. The spatula may be made of metal or plastic. The spatula used
must bend so that it is easy to mix the powder and liquid rapidly
and correctly. Sometimes glass-ionomer is supplied together with a
plastic spatula and the paper pad.
additional materials
Cotton wooll rolls. These are used to absorb
saliva so that the tooth to be treated
is kept dry.
COTTON WOOL PELLETS. These are used for
cleaning cavities. They are available in various sizes.
The smallest, size 4, should be used for small cavities. Size
2 can be used for arger cavities
PLASTIC STRIP. This material is used for contouring
the proximal surface of multiplesurface restorations
WEDGES. These are
used to hold the plastic
strip close to the shape
of the proximal
surface of a tooth so that
restorative material is not
forced between the gums
and teeth These wedges
should be shaped from soft
wood.
Sharpening Dental Instruments
A special flat stone, for
example an 'Arkansas'
stone, is used for
sharpening the hatchet,
carver and spoon
excavator. The
procedure to follow is
described below step-
by-step.
Hand instruments used for cutting hard tooth tissues, the
excavator, dental hatchet and carver, must be sharp to be
effective.
1. Place the flat sharpening stone on a table.
2. Put a drop of oil on the stone.
3. Hold the stone firmly with one hand and rest the middle
finger of the other hand on the stone as a guide.
4. Position the cutting edge of the hatchet or carver in the
oil parallel to the surface of the stone .
5. Slide the instrument back and forth over the stone
several times for maximum sharpness.
Sharpening Spoon Excavator
As for the dental hatchet and carver, a flat
stone is used for sharpening. The procedure
to follow is described below step-by-step:
1. Place the flat sharpening stone on
the table;
2. Put a drop of oil on the stone;
3. Hold the stone firmly with one
hand;
4. Place the round surface of the
excavator in the oil and make small
strokes from the center of the round
surface to the edge of the spoon. Do this in
all directions so that the entire cutting edge
is sharpened.
Treatment Material
The material used for restoring cavities
and sealing pits and fissures is glass-
ionomer. This material must be used
correctly for achieving good results.
Glass-Ionomer as a Restorative
Material - Composition The material is supplied as a powder and
liquid that must be mixed together.
The powder is a glass containing silicon-
oxide, aluminum-oxide and calcium fluoride.
The liquid is either polyacrylic acid or de-
mineralized water.
If demineralized water is the liquid
component, polyacrylic acid is incorporated
into the powder in a dry form.
Clinical Characteristics
- Glass-ionomer bonds chemically to enamel and dentine and provides a good cavity seal.
- One of the most significant characteristics of glass-ionomer is the continued slow release of fluoride from the material after it has set. This helps prevent dental caries developing around the restoration.
- Glass-ionomer is not harmful to the pulp and gingiva. During setting, the material may cause the pulp to feel tender. After 24 hours, when completely set, adverse reactions do not occur anymore.
- Compared to established dental restorative materials, glass-ionomers have higher surface wear and lower strength.
GIC - mixingPlace a spoonful of powder on the glass slab or
mixingpad.
Use the spatula to divide the powder into two equal
portions, then dispense a drop of liquid next to the
powder.
Hold the liquid bottle horizontal for a moment to
allow air to escape from the tip.
Move it to a vertical position and allow one drop of
liquid to fall onto the slab.
Apply a little pressure if necessary, but do not
squeeze the liquid out.
Apply a little pressure if necessary, but
do not squeeze the liquid out.
1. First spread the liquid with the spatula over a surface of about 1.5 cm2. Start mixing by
adding one half of the powder into the liquid using the spatula.
2. Roll the powder into the liquid, gently wetting the particles without spreading them
around the slab.
3. As soon as all powder particles are wetted, the second portion is folded into the mix.
4. Now mix firmly while keeping the mass together. The mixing should be completed
within 20-30 seconds, depending on the brand of glass-ionomer used.
The final mixture should look smooth like chewing gum.
Restoring One-Surface Cavities Using
ART
Circular scooping movements of the excavator.
Fracturing off unsupported enamel with a hatchet.
Removing soft caries from the enamel-
dentine junction may leave enamel that is
unsupported with dentine.
The overhanging of enamel can break
very easily and must be removed.
Do this with the blade of the dental
hatchet.
Place the instrument at the edge of the
enamel and fracture off small pieces.
Repeat this until all the thin unsupported enamel has
been removed and no caries is left in the remaining
enamel. Remember, it is not necessary, and often
not possible, to fracture off all
unsupported enamel.
Ensure that the dental hatchet is well
supported with your fingers.
As a result of removing this enamel,
visibility and accessibility of the cavity is
improved.
Particular care is needed when removing
carious dentine from two places in the
cavity:
The enamel-dentine junction.
The floor in deep cavities.
The enamel-dentine junction.
◦ This part of the dentine is close to the surface
of the tooth. It is also the part where the
restoration must stick very well to the tooth.
If caries is not completely removed at the
junction, a good join is not made.
◦ Then bacteria will be able to penetrate in the
gap between the restoration and the cavity
wall, and caries will develop further.
The floor in deep cavities.
When removing carious dentine near the pulp there is a risk of damagingor exposing the pulp.
So it is important to remove no more dentine than really essential, in the deepest part of a cavity.
If during cavity preparation the pulp is exposed there will be bleeding in most cases, in the bottom of the cavity.
Then special treatment of the pulp or removal of the tooth is required.
The excavated carious dentine can be placed on the cotton wool roll, positioned alongside the tooth or held by an assistant.
Excavation is easier done when the tooth is dry.
Therefore, change saturated cotton wool rolls for dry ones.
After all caries is removed, the cavity is cleaned with wet cotton wool pellets.
Cleaning the Prepared Cavity
There are two possibilities:
- a dentine conditioner or tooth cleaner, especially developed for this purpose or
- the liquid supplied with the glass-ionomer itself.
The dentine conditioner is usually a 10% solution of polyacrylic acid. Apply
one drop of the conditioner on a pad or the slab.
Dip a cotton wool pellet in the drop and then clean the entire cavity and adjacent
fissures for 10-15 seconds.
Do this holding the cotton wool pellets with a pair of tweezers.
Then, immediately, wash the cavity and fissures at least twice with cotton wool
pellets, dipped in clean water
The glass-ionomer liquid
The glass-ionomer liquid can be used for cleaning the cavity if it contains the same acid as is used for conditioning.
Usually the liquid is too strong and needs to be diluted.
This is done by placing one drop of liquid on a pad or slab.
Then moisten a cotton wool pellet by dipping it in
water.
Remove the excess water by lightly touching the pellet against a dry cotton wool roll, a tissue or gauze.
Dip the moist pellet in the glass-ionomer liquid and then use it as a dentine conditioner in the way described above.
The restorative process of a one-surface
cavity in various stagesThe cavity and adjacent pits and fissures are
overfilled;
Press the restorative material with gloved finger.
Excess material is visible;
Removal of excess material by the carver blade
of the applier/carver
A restored one surface cavity.
Preventive restoration with ARTA cavity is restored and theadjacent fissures are sealed with glass-ionomer at the same time.This
is called a 'sealed restoration‘ or “priventive restoration”
Caries in occlusal surface of the molar;
Prepared cavity ready for applying ART restoration
material;
Cavity filled.
Restoring Multiple-Surface Cavities
Using ART
Using the spoon excavator to remove carious
dentine in a multiple-surface cavity
The position of the dental hatchet for
smoothing the proximal outline.
Restoring a proximal surface cavity in
various stages
Positioning of the strip between the teeth
Manipulations during the filling
Insertion of a wedge;
The strip is pulled around the tooth while the
mixture is setting;
A straight instrument is pressed against the
strip to shape the restoration.
Restorative procedures for multiple surface
cavities in posterior teeth
Plastic strip and wedge in position
Restorative material pushed into place under
unsupported enamel;
Slightly overfilled sealed restoration.
Complete obturation and covered
with sealant
It may be used GIC for coating the healthy fissures instead of
sealant
Finished sealed restoration
What not to Forget
Restoration of decayed teeth is part of a
total package of oral care which should
always be based on preventive measures,
health education and health promotion
activities.
That means prevention and cure should
go hand in hand. In other words, neither
prevention nor cure should be presented
to the people separately.
This manual emphasises ART as a combined
preventive and curative oral care procedure.
Treating dental caries using the ART
approach without emphasis on preventive
measures is a job only half done;
◦ 1. removal of plaque,
◦ 2. counselling on proper diet,
◦ 3. application of fluorides,
◦ 4. application of antimicrobial agents.
◦ 5. application of sealants
CHEMICAL REMOVAL OF CARIOUS DENTIN
Constitutes a gel of two parts:
◦ Amino acids - glutamine, leucine, lysine;
◦ Sodium hypochlorite;
Tools for excavation.
Carisolv - chemo-mechanical system for
minimally invasive cavity preparation
Mechanism of Action of Carisolv
The sodium hypochlorite reacted with alkaline amino acids;
Is forming mono- and di-chloramine;
Chloramine reacts with collagen and dissolves the torn collagen fibrils;
Retained in the cavity for 30 seconds;
Then starts carious mass excavation;
The remaining collagen fibrils are stable to bundles and become nuclei of mineralization;
Alkaline environment favors remineralization;
LASER THERAPY
- Lasers are used to remove decay within a tooth and prepare the surrounding enamel for receipt of the filling.-All lasers work by delivering energy in the form of light. -- When used for surgical and dental procedures, the laser acts as a cutting instrument or a vaporizer of tissue that it comes in contact with.
Nd:YAG laser
Er:YAG
Action: wavelength of 2.94 μm. FDA approved it for use:
Removal of caries;
Cavity preparation.
Advantages:
A clean and clear cut edge in enamel and dentin;
Protects the pulp due to shallow depth of action;
No pain in cavity preparation;
Has antibacterial activity;
The vibrations are smaller than conventionally excavation ;
Сarbon dioxide lasers
Recent studies show that carbon dioxide
lasers using pulsed CO2 laser radiation
with 9.32-μm to 10.49-μm and energy
from 10 to 50 J.cm-2 provides:
Surface penetration;
Inhibition of progression;
Enhances the binding of dentin to
composite.
Application of the Er, Cr: YSGG
laser for hard tooth structure
On enamel etching;
Removal of caries;
For cavity preparation;
Does not violate the Ca/P ratio;
For the preparation of the root canal.
Advantages:
Obtained rough enamel and dentin
surface without cracks;
In dentin is not a smear layer, which
increases the connection;
The Er, Cr: YSGG laser protects the pulp;
No need for anesthesia;
Disadvantages:
The main disadvantages come from
etching;
Obtained very wide surface of etching;
It can be combined with an acid etching.
Cavity preparation with Er:YAG-
Laser
AIR ABRASION
- Air-abrasion is a pseudo-mechanical, non-rotarymethod of cutting and removing dental hard tissue,originally conceived in 1945.- Recent advances in adhesive dentistry have, however,called for changes to concepts in cariesremoval, cavity design and preparation and air abrasionhas, once again, come to the forefront ofclinical operative dentistry.
„Air abrasio”
In 1940. Dr. Robert Black began studying the use of air-abrasion technology for dental applications;
Disadvantages of using this technology in the past:
◦ Can not be provide cavity for amalgam, which is the main tool for filling in the 50s;
◦ Can not provide adequate dust removal.
Modern technology "Air abrasio"
Preserves healthy tooth structure;
Enhances the binding of polymer fillings to enamel and dentin;
Apply less dust and ensure its adequate removal.
Principle of operation
Used stream with small particles of aluminum oxide, driven by means of compressed air;
The abrasive particles strike the surface of the tooth at high speed and remove smaller particles from the damaged tooth structure.
Air-abrasion is essentially a pseudo-mechanical, non-rotary method of cutting dental hard tissues utilizing the transfer of kinetic energy from a stream of desiccated abrasive particles bombarding the tooth surface at high velocity.
The abrasive employed for cutting tooth structure is aluminum oxide (Al2O3: α-alumina) with an average particle size of 27.5μm and possessing a hardness of 9 on Mohs’ scale.
SandmanTM Futura
Principle of operation of the Sandman
Dental
Causes rotary atomization,
which ensures precise and well-
controlled operation at low
pressure with precisely
measured amounts of dust.
Components
Specially calibrated particles of aluminum
oxide powder
The speed of the striking of the particles with the tooth
depends on pressure;
-on their diameter;
- On distance to the surface (should be 0.5 to 2 mm);
Greater distance causes scattering of the flow.
Advantages
An entirely different system of action;
Special Tips provide exceptional accuracy
for targeting aluminum oxide powder;
Low working pressure - between 1 ½ - 3
bars.
Before and after preparation
Preparation and restoration with
flow composite without etching
Before and after preparation
Before and after praparation
After restoration
Occlusal enamel fissure prepared
using air-abrasion (27.5μm). Cavity
width is approximately 500μm.
Contraindications
It can not be used for removal of
amalgam;
Do not use in large cavities.
OZONOTHERAPY
Ozonotherapy - a new method for
the treatment of caries Ozone is a penetrating gas with a specific smell which
is found in a small quantities in the atmosphere;
It is a very strong oxidant, an oxidising almost all metals;
Reacts with many inorganic and organic compounds;
It kills microorganisms;
It is used for purification of drinking water and for sterilization;
It destroys the microbial cell membrane;
In the treatment of dental caries is used its ability to kill the microorganisms.
HealOzone®
Developed by Curozone Inc., Canada, it is produced by KaVo Dental Ltd;
The unit produces ozone from oxygen;
Ozone is adjusted to a silicon tip with different shapes for the various tooth;
It is approaching to the tooth for at least 10 seconds;
Ozone treatment of caries finishis for 2-3 min;
Then, the tooth was washed with a solution of 2% NaF, and 5% xylitol solution for carrying out the remineralization;
indications
In the non-operative treatment of caries
on smooth surfaces;
Before sealants;
To sterilize all cavities;
To sterilize all endodontic cavities and
channels.
HealOzone®
Vacuum system at the tip of the
instrument
1. Removes microorganisms from the treated
structure;
2. Removes them from all the hidden niches;
3. Enters 4-5 mm in infected dentin tubules
and his
4. For remineralization the surface is rinsed
with mineral liquid;
5. Was observed remineralization for 4-6
weeks;
USE OF ULTRASOUND FOR MINIMALLY INVASIVE EXCAVATION
Ultrasonic instruments for
minimally invasive cavity
Ultrasound has long been used in
dentistry mainly for removing tartar and
cleaning;
Recently there improved apparatus that
can be used for minimally invasive cavity
preparation.
piezon ® master 600
It is used for cleaning, in periodontal therapy and for minimally cavity
preparation.
The tips are coated with diamond for minimally
invasive cavity preparation
Ultrasonic tips allow
to eliminate only
affected structure;
Unilateral placement
of a diamond at the
tips does not allow
at appproximal
approach to damage
healthy teeth;
Ideal cavity is rarely achieved with conventional excavation.
Usually the preparation is wider than is needed.
In approximal areas can easily take healthy structures even affect
adjacent healthy teeth.
THE MOST MODERN FORM OF MINIMALLY INVASIVE TREATMENT "INFILTRATION TECHNIQUE"
Bridge between non-operative and minimally invasive preventive treatment of dental caries is:
Infiltration technique is:
More aggressive than remineralization;
But more conservative than obturation
technique.
The new revolutionary system for
infiltration of early carious lesions
ICONsystem for caries treatment
Indication
Enamel caries– D1a, D1b, D2;
Noncavitated dentine caries, affected the
dentin under the DEJ - D3a.
◦ Contraindication:
◦ Cavitated dentine caries;
◦ Carious lesions D3b.
1. In these lesions have mineral
loss with seemingly preserved
surface;
2. The pores in the lesion
increased to 30%;
3. Acids diffuse easily and
deepen the process.
Lesion suitable for infiltration
Process of demineralization
Lesions in enamel should
not be left untreated
Before treatment After treatment
White lesions should not be left
without treatment;
Remineralization is the treatment, but
the process is slowly;
Infiltration occurs in one session.
Quick and easy treatment in one
procedure
How it works
The surface was treated with 10% HCL gel for opening pore system of the lesion body;
Pore system is drying with ethanol;
ICON is infiltrate on the lesion;
This is a liquid material with extremely high penetration potential allowing entry into the internal pores;
Excess material is removed;
Overall treatment is completed in 15 minutes;
At approximal lesions is opening the space using a wedge.
We need of a new term - approximal
penetration - "approxivention"
This term illustrates the penetration of the solution through the small pores in the depth of the lesion;
Permeated solution is compacted in the demineralized body of the lesion;
The method is a border between non-operative treatment and minimally invasive treatment;
It is a new opportunity has not existed before, for the treatment of approximalnoncavitated lesions without surgical remouval