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CONTENTS
INTRODUCTION
·
Prevention of
dental caries through dental health education – oral hygiene measures.
·
Early and accurate detection of dental caries.
·
Assessment of caries risk factors
·
Biological approach and reminerilisation therapy- anti
microbial therapy, topical fluorides, caries vaccine.
·
Use of tooth conservation techniques for treating
caries
- Ozone gas
- Air abrasion
- Laser
- Chemomechanical caries
removal
- ART
·
Minimally
invasive operative intervention
-
Modern adhesive cavity designs
RECENT
CAVITY CLASSIFICATION SYSTEMS
1.
Based on site and size of lesion
a. Pit and fissure
b. Contact
area
c. Cervical
2.
Based on radiographic changeslinic
E0 : no
carious lesion
E1 :
radiolucency in outer half of enamel
E3 :
radiolucency in inner half of enamel
D1 :
radiolucency in outer third dentin.
D2 :
radiolucency in inner third of dentin.
WHO Scoring
for shape and depth of carious lesions.
D1 :
clinically detectable enamel lesions with intact (non cavitated) surfaces.
D2: clinically
detectable cavities limited enamel.
D3:
clinically detectable lesions on dentin( with/without cavitation of dentin)
D4: lesions
into pulp.
Cavity design modifications
Minimal
intervention cavity designs have been disscussed in earlier days Knight and
Hunt in 1984 and a new classification has been prepared (Mount and Hume in
1997). The gv black classification does not address this new concept. The
proposed classification takes into account the fact that there are only three
surfaces of the crown of tooth that can be subject to caries attacks.
Site 1:
pits and fissure on occlusal surface of posterior teeth and other deflect smooth enamel surface.
Site 2:
contact areas between any pair of teeth, anterior or posterior.
Site 3:
cervical areas related to gingival tissues, including exposed root surfaces.
A neglected lesion continue to extend ,that will
complexities the restoration procedures.
The sites
can readily identified.
Size 0:
initial lesion at any site can be identified
No surface cavitation, can
possibly be heated.
Size
1: smallest minimal lesion. Cavity is
into dentin just beyond heating through remineralization.
Size 2:
moderate size cavity
Still sufficient sound tooth
structure to maintain integrity of remaining crown.
Size 3:
cavity needs to modified and enlarged
Provide
protection jar remaining crown from occlusal load, avoid split occur at the
base of the cusp.
Size 4:
cavity I extensive
Loss of a cusp from posterior
teeth/ incisal edge of an anterior.
Site 1 size
0
Ø Concept of
fissure seal, simonsen (1989) in newly erupted
tooth, sealing a deep fissure before at occluded at plaque and pellicle
, causing demineralizat in dentin.
Ø Earlier fissure sealents were unfilled/
lightly filled resin
Ø Recently
shows, glass ionomer will successfully occlude, if integrity of acid etch union
b/w resin and enamel in doubt,(Wilson and Mclean 1988) --- termed in “fissure
protection” rather than resin seal.
Site 1 size 1
Ø As fissure
walls became demineralized , the dentin
will became involved, which is very difficult to diagnose.
Ø In presence
of strong, f enamel , occlusal surface entry to the linear will remain limited
, bacteria laden plaque can forced down into a defective fissure, that further
complicate dentin involvement before symptoms noticed.
Ø In fissure
systems caries defect often be limited to a very restricted area, leaving the
remaining system sound and uninvolved , means only the carious defect can be
instrumented.
Ø It is suggested that minor apparent defects
should be exposed in a very conservative manner before sealing the fissure system.
Site 1 size
2
Ø In this lesion will either have progressed or
it may represent placement of a failed class1 restoration.
Ø Here also
deal with carious lesion only and there is no need to open up the remaining
fissures any further. If there is any part of fissure system in doubt , it
canexplored very conservatively .
Ø Occlusal
lesions are very extensive, if there is any doubt about the ability of GI to
withstand the occlusal load it can be cut back conservatively and laminated
with resin composite.
Site 1 size
3,4
Ø Replacement
of restoration- requires the cavity to enlarge
Ø Cavity
design removal of all infected tooth structure and softened affected dentine on
the floor of cavity , unscappeled enamel on occlusal surface . consequently the
occlusal contact with opposing tooth is lost.
To avoid such procedures a temporary restorations can given, place over
lesion and decrease pulpal inflammation.
Ø Glass
ionomer can be used, that will band to both enamel and dentine through an
ion-exchange mechanism , ion remineralization
of dentine.
Site 2 size
0
Ø Proximal
lesion progress very slowly because the surface is not under masticatory load.
In the absence of cavitation, only radiographic evidence of demineralization at
contact area, it is often possible to led the lesion.
Ø In contrast
to occlusal fissure lesions, it may take up to 4 year to penetrate fill
thickness of enamel and additional 4 years to progress through dentin into
pulp.
Site 2 size
1,2
Ø Cavitation on proximal surface – require
surgical approach to repair and some alternative methods.
Ø First
determine the position of damage in relation to the crest of marginal ridge, if
it is more than 2.5 mm below the crest, then it may possible to approach the
leniar through occlusal fossa and design a tunnel cavity( hasselrot 1998)
(Wilson ,Mclean :1998)
Ø If it is
less than 2.5 mm, tunnel will undermine the ridge and weaker it , it is better
to design small box or slot cavity begin on outer slope of the ridge ,
retaining as much as of enamel as possible.
TUNNEL CAVITY PREPARATION
Ø Early proximal lesion on a posterior tooth, in
enamel , below the contact area.
Ø There will
be generally be a zone of demineralization enamel surrounding the cavitation,
but as long as the surface is smooth, this remain capable of remineralization
in presence of f.
Ø The contact area may remain sound and the
marginal ridges may be quite strong, provided the more than is 2.5 mm below the
crest of marginal ridge fossa immediately next to medical marginal ridge is the
most suitable position for entry.
Ø GI is the
best suited , readily flows into small cavities and remineralize the enamel
margins.
Procedure
·
Start the cavity preparation in the direction of
lesion
·
After lesion is spotted , use a slow speed round bur
to remove remaining caries.
·
Do not fracture the proximal wall if it is not
involved
·
Remove the remaining caries with span excavator
restore using G.I cement.
SLOT CAVITY PREPARATION
·
It could be used when the lesions is less 2.5 mm below
the crest of marginal ridge.
·
Basic principles of cavity design remain the same,
object of removing only that tooth structure that has broken beyond the
possibility of reminerilisation.
·
The outline form will be dictated entirely by the
extend of break down of enamel, removal only that which is friable and easily
eliminated without applying undue pressure.
·
Here also natural of choice is glass ionomer but
lamination technique can also be done.
Proximal approach
This
is a very conservative approach used
when proximal surface of a tooth become accessible at the time of cavity
preparation in an adjascent tooth. The lesion is revealed through radiograph or
noted only during cavity preparation. It is only necessary to remove the enamel
, that is broken down beyond remeniralizatio. As the entire restoration will be
hidden by adjascent tooth, it is essential to use a radio opaque material. GI
is preferred because the limited access will make it difficult to assure full
polymerization of the resin through light activation.
ATRAUMATIC RESTORATIVE TREATMENT (ART)
This
technique involves the removal of affected tooth tissues with hand instruments
, followed by a restoration of cavities with a specially designed glass ionomer
restorative material( GC Fuji VIII)
Procedure
·
Undermined enamel are broken off with hand
instruments.
·
Soft dentine is excavated.
·
GI material is applied to the cavity and so any
confluent pit and fissures.
·
Vaseline coated finger is pressed over the
restoration.
·
Hand instrument is used to finish the restoration
Advantages
·
No
sophisticated dental equipment is needed
·
Treatment is not depend on electricity
·
Minimal discomfort to patient.
·
Fluoride release from GIC got cariostatic effect
·
Low cost
·
Less chair side procedures ( time consuming is less)
Ozone gas
Ozone is a strong naturally
occurring oxidising agent in nature. It is produced by UV rays on lightning in
atmosphere.
O2 – 2O
O+ O2 ----- O3 (ozone)
Ozone kills
greater than 99% of all bacteria, fungi and viruses as this powerful oxidant
readily penetrate through decayed tissues. Such clean and sterile lesion will
remineralise easily and eliminate the need for placing restoration. FDA
approves this use of ozone in medical field.
Use of ozone maintenance and preventive treatment.
·
Dental cavity disinfection.
·
Root canal disinfection
·
oral candidiasis treatment.
·
Herpetic treatment of apthus ulcer.
·
Stomatitis treatment
·
Cleft lip and palate thereapy
Contraindications
·
Patients using cardiac stimulators ( pace makers)
·
Epileptic patients or suffering from nuerological
illness
·
Patients suffering from psychological problems.
·
Mucous membrane
of infants ( under 1 year old)
OZONE VERSUS CHOLORHEXADINE
-
1.5 times higher oxidizing potential
-
4-5 times lesser contact time.
-
No reported delitorious by products.
-
Efficacy not much affected by change PH
CHEMO MECHANICAL CARIES REMOVAL SYSTEM.
A new
promising method for chemo mechanical removal dental caries is based on the
principle of MID involves the application – carisolve and caridex has been
evaluated and proves to be successful.
The principle mode of action is based on the use of sodium hypo chlorate, a non
specific proteolytic agent , and the effective interactions of 3 amino acids
with caries dentine , remaining organic compartment.
AIR
ABRASION
( Microabbrasion
and kinetic cavity preparation)
It is a
method of tooth structure removal that is considered to be an effective
alternate to the standard dental drill. In 1945, Dr: Robert Black of Corpus
Christy Texas, published a series of articles on the use of air abrasion
technique for cavity preparation and prophylaxis.
Air
abrasion technology is the use of compressed air to propel aluminium oxide
particle with force as to cut tooth structure in simple terms, it is a
precision is blaster. An air abrasive
unit is called Airdent.
Advantages.
·
It is painless
·
Local anesthesia is rarely needed.
·
It works quickly and tooth is ready to restore, with
small lesion in seconds.
·
There is no vibration/pressure to cause microfracture
that weakens tooth.
·
There is no production of heat to damage dental pulp
and lesser sound tooth structure is removed.
Principles
·
Accurate diagnosis of unsound tooth structure and
decay.
·
Accurate removal of unsound tooth structure with
minimal distruction of tooth structure.
·
Restorative treatment planning based on the
probability of longevity of the restorative material.
Procedure
Pre
operative radiograph taken to determine if the interproximal caries is present.
Isolate preferably with rubber dam
Use caries detecting dye for
carious lesion
Using air abrasive unit with high
volume evacuation placed in the proximity of tooth prepared cavity.
·
After a few seconds of initial protection, examine the
preparation for decaying.
·
Reapply caries detecting dye.
·
Complete preparation using caries detecting dye until
all caries is removed.
·
Apply the HN
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