Treatment of caries: choice of method depending on a clinical case. Remineralizing therapy. Stages of surgical treatment. Features of treatment of deep

Treatment of caries: choice of Treatment of caries: choice of method depending on a clinical method depending on a clinical case. Remineralizing therapy. case. Remineralizing therapy. Stages of surgical treatment. Stages of surgical treatment. Features of treatment of deep Features of treatment of deep

caries. General and local caries. General and local treatment of plural caries. treatment of plural caries.

Medicinal facilities and physical Medicinal facilities and physical methods in complex therapy of methods in complex therapy of

dental caries.dental caries. Therapeutic dentistry department

Types of lesions and choice of treatment Types of lesions and choice of treatment ( high caries risk )( high caries risk )

Smooth surface incipient caries;Smooth surface incipient caries; Sticky pits and fissuresSticky pits and fissures Sticky pits and fissures with Sticky pits and fissures with

incipient cariesincipient caries Small and moderate lesionsSmall and moderate lesions Deep lesionsDeep lesions Root cariesRoot caries


Smooth surface incipient Smooth surface incipient caries: caries: Reminerlize with clinical Reminerlize with clinical

topical fluoride applications topical fluoride applications and home application of and home application of fluoride by various means ; fluoride by various means ; toothpaste, rinses, brush-on toothpaste, rinses, brush-on gels, custom tray-applied gels, custom tray-applied gels, ect.gels, ect.

Sticky pits and fissures: Sticky pits and fissures: Pit and fissure sealantsPit and fissure sealants


Sticky pits and fissures Sticky pits and fissures with incipient carieswith incipient caries Preventive resin/sealants Preventive resin/sealants

(Remove caries, place (Remove caries, place composite in the cavity composite in the cavity and cover all with sealant)and cover all with sealant)

Definitive amalgam Definitive amalgam restorationsrestorations

Small and moderate Small and moderate lesionslesions Definitive amalgam, Definitive amalgam,

composite or glass composite or glass ionomer restorationsionomer restorations


Deep lesion:Deep lesion: Caries control Caries control

restorations with ZnO-restorations with ZnO-eugenol, glass ionomer eugenol, glass ionomer or amalgam, and the or amalgam, and the definitive resotrations definitive resotrations after caries activity has after caries activity has decreaseddecreased

Root caries:Root caries: Fluoride applicationsFluoride applications Glass ionomer Glass ionomer

restorationrestoration

Patients (especially the elderly) with Patients (especially the elderly) with root caries.root caries.

Patients that report a history of a Patients that report a history of a physical condition, medical treatment physical condition, medical treatment (especially radiation therapy), (especially radiation therapy), medication and dietary changes that medication and dietary changes that would influence saliva or oral florawould influence saliva or oral flora

History of continued high quantity History of continued high quantity intake of carbonated beveragesintake of carbonated beverages

Patients with active caries-lesions Patients with active caries-lesions that are unpigmented, of a soft that are unpigmented, of a soft consistency, moist, sensitive to consistency, moist, sensitive to Sweets, cold or excarvation, and Sweets, cold or excarvation, and with depth greater than width. with depth greater than width.

DXDX ACTIVEACTIVE INACTIVEINACTIVE

COLORCOLOR LIGHTLIGHT DARKDARK

CONSISTENCYCONSISTENCY MUSHYMUSHY FIRMFIRM

MOISTUREMOISTURE WETWET DRYDRY

SYMPTOMSYMPTOM SENSITIVESENSITIVE NONENONE

SHAPESHAPE DEPTH>WIDTHDEPTH>WIDTH WIDTH>DEPTHWIDTH>DEPTH

Caries Control RestorationCaries Control Restoration

Indirect pulp capping is often done Indirect pulp capping is often done in conjunction with caries control in conjunction with caries control restorations.restorations. Pulp must show radiographic and Pulp must show radiographic and

clinical signs and symptoms of vitality.clinical signs and symptoms of vitality. All caries is removed at the periphery, All caries is removed at the periphery,

establishing a sound DEJ.establishing a sound DEJ.



Indirect pulp capping is often done Indirect pulp capping is often done in conjunction with caries control in conjunction with caries control restorations.restorations. After 6-8 weeks the entire restoration is After 6-8 weeks the entire restoration is

removed, any remaining caries is removed, any remaining caries is removed and a definitive restoration is removed and a definitive restoration is planned.planned.

Pit & Fissure Sealing Techniques

Glass ionomer sealants Chemical bond to enamel. Fluoride release. New GIC material- Fuji 7 high fluoride release (6 x

more) than other restorative GICs. has good flow properties and flow well into

pits/fissures. moisture tolerant. has a strong fused layer which is acid resistant &

continues to offer protection to occlusal surface even when it appears “visually” lost due to wear.

Restorative GICs tend not to be suited as fissure sealants as are thicker and do not flow well into narrow/deep pits & fissures

Glass ionomer sealants

Diagnosis of pit/fissure caries Diagnosis of pit/fissure caries - can be

very difficult!

3 Possibilities:

1. No caries

2. Definite caries

3. Questionable caries

Is there caries or is this only stain?

Management of Questionable pit/fissure early caries

Monitor tooth surface over period of time

in conjunction with other caries preventive

measures. Mechanically open up fissures with a

bur/air abrasion and check if carious

(invasive?) Fissure seal with fissure sealant.

Fissure exploration

Bur tip should be as fine as possible.

L 10

L 20

Fissure exploration

Place bur in central fossa of occlusal fissure.

Depth is determined by:

depth of staining present

what is required to alter

the anatomy of the fissure

so that the sealant can

flow to its full depth

(approx 0.5mm).

Avoid cuspal inclines. Note that the depth may therefore vary.

Upright bur so that it is in the long axis of the

tooth; however, bur can be leant towards the

‘direction of travel’ movement, away from the tip.

Demonstrates initial investigation to distal part of occlusal fissure system

Initial investigation into complete fissure system

Completed fissure investigation

1. Wash (5 seconds)

2. Dry with mild air (10 seconds)

Completed fissure investigation (cont.)

Visually check the prepared fissure system:

• Any staining?• Is it clean?(Note that the

depth may vary.)

Fissure sealant materials Select appropriate material to complete the

fissure sealant.

You can use:

resin system

Glass Ionomer Cement

Resin Modified Glass Ionomer Cement (RMGIC

Application of etchant

Apply etchant to fissure system for 15 seconds.

Wash thoroughly for minimum 20 seconds to remove etchant.

Note that natural tooth should have a frosty appearance.

Dry thoroughly.

Applying sealantStep 1

Spread sealant evenly. One can use applicator

or micro-brush, or sealant can be

applied directly to surface.

Avoid porosity (bubbles).

(DO NOT blow air to spread the sealant.)

Applying sealantStep 2

Note that the occlusal fissure system is completely covered with resin material but does not extend up to the cusps.

Light cure resin material for 20 seconds.

Checking the sealant Using explorer:

ensure material is completely cured

check margins ensure material is

bonded to enamel.

Composite resin finishing point

STEPS IN FINISHING A COMPOSITE RESINS

1.Reduction of the material is completed by the use of a white stone or a finishing diamond.2.Fine finishing is done with carbide finishing burs, then with diamond burs.3.Polishing the resin begins with the medium discs and finishing with the superfine discs.4.Finishing strips assist in the polishing of the interproximal surfaces.5.Polishing paste applied to a rubber cup completes the step.

Treatment of dental caries by:AMALGAM.

Properties, indications, inserting, carving, polishing.

Composition The composition of the alloy powder particles

varies from one product to another.

Composition of CONVENTIONAL AMALGAM ALLOY:

Effects on properties of an amalgam restoration

imparted by ingredients.

PROPERTY INGREDIENT

Silver Silver Tin Tin Copper Copper Zinc Zinc

Strength Increases

Durability Increases

Hardness Increases

Expansion Increases Decreases Increases

Flow Decreases Increases Decreases

Color Imparts

Setting time Decreases Increases Decreases

Workability Increases Increases

Cleanliness Increases

TRITURATION

The advantages of mechanical trituration are as follows:

1. A uniform and reproducible mix is produced. 2. A shorter trituration time can be used. 3. A greater alloy/mercury ratio can be used.

Amalgamator

3. CONDENSATION There should be a minimal time

delay between trituration and condensation.

If condensation is commended too late, the amalgam will have achieved a certain degree of set and adaptation, and final mechanical properties are all affected.

There is a good correlation between the quality of an AM restoration and the energy expended by the operator who condenses it.

It needs to use a high condensating force.

Lower forces are required to condense spherical particle amalgams than lathe-cut materials.

Condensing instruments

Amalgam carriers and condensers are used for this purpose.

4. CARVING Soon after condensing the AM, the surface layer ,

which is rich in mercury, is carved away with a sharp instrument.

If carving is delayed too long the material may become too hard to carve and there is a danger of chipping at the margins.

4. CARVING

Amalgam carvers

5. POLISHING Polishing is carried out in order to

achieve a lustrous surface having a more acceptable appearance and better corrosion resistance.

The fillings should not be polished untill the material has achieved a certain level of mechanical strength, otherwisw there is a danger of fracture , particularly at the margins.

Many products require a delay of

24 hours between placing and polishing.

5. POLISHING

Polishing kits

Polishers

BlackDark purpleGreen

Amalgam indications

In primary and permanent dentition

In stress bearing areas of the mouth

In stress bearing areas of the mouth

When moisture control is a problem

When moisture control is a problem

When oral hygiene is bad

When oral hygiene is bad

As a foundation to crownsAs a foundation to crowns

When cost is a concern

Small to moderate – sized cavities in the posterior teeth

Small to moderate – sized cavities in the posterior teeth

Amalgam contraindications

When esthetics is importantWhen esthetics is important

When patient has a history of allergic reactions to the alloy

When cost is not a concernWhen cost is not a concern

Amalgam fillings

Amalgam fillings

Thank you for

attentio

n!

Documents

Treatment of caries: choice of method depending on a clinical case. Remineralizing therapy. Stages of surgical treatment. Features of treatment of deep