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