lenka.roubalikova(q)tiscali.cz Chemical equilibrium on the tooth surface demineralization - remineralization Ca10(PO4)6(OH) Ca10(PO4)6F2 Ca2 Ca2+ OH lenka.roubalikova@tiscali.cz Non cavitatated lesion Time lenka.roubalikova(5>tiscali.cz Cavitated lesion Therapeutical consideration Caries lesion Patient Location Degree of demineralization History Cooperation Examination and caries risk Final decision lenka.roubalikova@tiscali.cz Concept of t Non invasive Improvement of oral hygiene Controls Remineralization progra lenkaToubahkova@tiscah.cz he treatment Invasive >Miniinvasive treatment > Conventional treatment Non invasive treatment Middle risk: Dtto plus tooth paste 1000 ppm F Higher risk: Dtto plus 900- 1000 ppm neutral solution of NaF mounth rinse daily. Chewing gum. High risk: 5000 ppm F tooth paste daily (2x) Recaldent (calcium, phosphate) Highest risk: Fluoride varnish, surface treatment with o-l^ss ionomer cements t>lus diet management Ngo 2003 lenka.roubahkova(®tiscali.cz meny . 'cc.' Ě ^B GC ■ ^B Tooth/ ■ ^■Mous< ■ l Top^-í11 cromG wilh ■ ^.a^ailablo calcium and H phosphate. y I 1 H t3hF 1/ ^eca/deíít lenka.roubalikova@tiscali.cz JSt-* Ej*** r * ** ě • CurOzoriť Cíl K Re-Mineratizing A Patient Kit R e-M í ne raKsier u ng-Set 1 3ealO If Kit contains n -..3 E w Hcota/m tDmhwüit V .'.i n ů: Hwa^ojv Oral H ■■■!!■ V -. m o/ HiHiUiiůň* lt»*l Bíjf*v ■~ Psckungeinhalt: tmpNtQ lenka.roubalikova@tiscali.cz Minimally invasive treatment Earlv diaanosis Diagnostic methods (X-ray, infrared lase fluorescency) ______i ,-----------, Illumination Magnificatio lenka.roubalikova@tiscali.cz Minimally invasive treatment Techniques of preparation ^ Mechanical Chemo - mechanical Kinetic Laser Peters MC, Mc Lean ME: Minimally invasive operative care II. Contemporary techniques and materials: An overwiev. JAdhes Dent 2001; 3:17-31. lenka.roubalikova(5>tiscali.cz Mechanical preparation >Rotary power driven preparation >Sonic and ultrasonic preparation >ART lenka.roubalikova@tiscali.cz Filling materials Composites Glass ionomer cements lenka.roubalikova@tiscali.cz reatment of caries in premolars and molars on the o 3 J lenka.roubalikova@tiscali.cz Class I. Non invasive treatment Princiole Ozone plus remineralization iimrasHMii Non cavitated lesion (Diagnodent) Contraindication: Cavitated lesion lenka.roubalikova@tiscali.cz Class I. Minimally invasive treatment Principle: prepare small cavities limited on carious lesion only Adhesive materials - composites Preventive fillings - combination of GIC and composites (lesion is filled with GIC covered with composite and in addition fissures are filled with composite) lenkaToubalikovaKotiscali.cz Class I. Minimally invasive treatment Indication: small cavitated lesion - see next picture Good level of oral hygiene Contraindication: Middle and big cavitated lesion Poor oral hygiene Badly destroyed teeth Periodontal diseases with bad prognosis lenka.roubalikova@tiscali.cz lenka.roubalikova@tiscali.cz Class I. Conventional treatment Indication: middle and big cavitated lesion Contraindication: Non cavitated and small cavitated lesions Badly destroyed teeth Periodontal diseases with bad prognosis Si Class I Choice of materials : small to middle lesions . itive filling, internal remineralization (see next chapters). Amalgam: middle - big lesions, cases where composites are contraindicated. lenka.roubalikova@tiscali.cz Composite Cavity lent of composites - C factor! lenka.roubalikova@tiscali.cz of composites First layer thin - flowable is possible Other layers - free surface as big as possible lenka.roubalikova@tiscali.cz Glass lonomer Cement Preparation of cavity — limited on dental caries Smooth border Conditioning Washing Wet cavity Placement of the cement Varnish Finishing and polishinmg immediately in next appointment if possible lenka.roubalikova@tiscali.cz Amalgam See preclinical dentistry lenka.roubalikova@tiscali.cz reatment of caries in premolars and molars lenka.roubalikova@tiscali.cz Class II. Non invasive treatment Principle Interdental hygiene plus remineralization Indication: D1 lesion (bite wing) Good level of oral hygiene, low caries risk Contraindication: Cavitated lesion Poor oral hygiene Badly destroyed teeth Periodontal diseases with bad prognosis lenka.roubalikova@tiscali.cz Class II. Minimally invasive treatment Principle: prepare small cavities limited on carious lesion only - slot or tunnel preparation Adhesive materials - composites Amalgam GIC - for middle term temporary treatment only lenka.roubalikova@tiscali.cz Class II. Minimally invasive treatment Indication: Small cavitated lesion (D2 on B^a re\ of oral hyaiene Contraindication: Middle and big cavitated lesion Poor oral hygiene Badly destroyed teeth Periodontal diseases with bad prognosis lenka.roubalikova@tiscali.cz Slot for amalgam \ p? s #p» »j if ^^ 1 Hf ^ . Sedelmayer J. Amalgam - zapomenuté řemeslo. Brno, 2000. Bažant V. lenka.roubalikova(5>tiscali.cz Konservační zubní lékařství, SPN Praha, 1962. 29 Adhesive slot Vertical Horizontal lenka.roubalikova@tiscali.cz Tunnel preparation lenka.roubalikova@tiscali.cz lenka.roubalikova@tiscali.cz Success of tunnel 1. Magnification 2. Smal (mini) instruments 3. GIC 5. BW post op lenka.roubalikova(5>tiscali.cz Success of tunnel 1. Low caries risk 2. Good cooperation of the patient 3. Intact proximal ridge 4. D2 \ 1 \\ 1 1 & '- '• Class II. Conventional treatment Indication: middle and big cavitated lesion Contraindication: Non cavitated and small cavitated lesions Badly destroyed teeth Periodontal diseases with bad prognosis lenka.roubalikova@tiscali.cz Class II Choice of materials : small to middle lesions . itive filling, internal remineralization (see next chapters). Amalgam: middle - big lesions, cases where composites are contraindicated. lenka.roubalikova@tiscali.cz Composite Cavity lent of composites - Contact point and C factor! lenka.roubalikova@tiscali.cz of composites Placement of the matrix and the wedge Proximal layer - contact point First layer thin - flowable is possible Other layers - free surface as big as possible lenka.roubalikova@tiscali.cz Glass lonomer Cement ■ Preparation of cavity - limited on dental caries t Smooth border i Conditioning ■ Washing ■ Wet cavity i Placement of the cement ■ Varnish ■ Finishing and polishinmg immediately in next appointment if possible In class two for temporary filling only - internal remineralization (see next chapters) lenka.roubalikova@tiscali.cz Amalgam See preclinical dentistry lenka.roubalikova@tiscali.cz Treatment of caries in l.MJiM roxima surface without lost o incisal edg Class lenka.roubalikova@tiscali.cz Class Non invasive treatment Princiole Ozone plus remineralization iimrasHMii Non cavitated lesion (Diagnodent) Contraindication: Cavitated lesion lenka.roubalikova@tiscali.cz Class Minimally invasive treatment es the ore Sfl Indication: vitated lesion - in all < limited on defect only Good level of oral hygiene Contraindication: Badly destroyed tee" Periodontal diseases with bad prognosis lenka.roubalikova@tiscali.cz Class Choice of materials ■^^^ralBB , esp. situated in enamel, aesthetic reasons. Glass lonomer Cements: Cemental caries, poor oral hygiene lenka.roubalikova@tiscali.cz Cleaning the tooth lenka.roubalikova@tiscali.cz Preparace kavity . lenka.roubalikova@tiscali.cz Ecid etching, protection of neighbour tooth Enamel 30s, dentin 10s ^ lenka.roul Matrix wedge, bonding lenka.roubalikova@tiscali.cz TÄSTÄhSiiiTíTSk' matrix lenka.roubalikova@tiscali.cz tightem the matris, separate teeth lenka.roubalikova@tiscali.cz Fillings before finishing lenka.roubalikova@tiscali.cz lenka.roubalikova@tiscali.cz Polishing ^M^k.____ Old filling lenka.roubalikova@tiscali.cz Polishing lenka.roubalikova@tiscali.cz Leštění plstěným kotoučem lenka.roubalikova@tiscali.cz Leštění plstěným kotoučem lenka.roubalikova@tiscali.cz Fillings after polishing lenka.roubalikova@tiscali.cz Treatment of defects i incisors and ca BBTRB ce wi osto incisal edg Class I m Principle of the treatment Minimally invasive only - do not remove More than dental caries and damaged ename1 The material: composite only, other materials are contraindicated (mechanical properties) lenka.roubalikova@tiscali.cz Retentive border lenka.roubalikova(5>tiscali.cz lenka.roubalikova@tiscali.cz lenka.roubalikova@tiscali.cz lenka.roubalikova@tiscali.cz Y If Matrix strip, wedge lenka.roubalikova(5>tiscali.cz Class V and cemental caries lenka.roubalikova(q)tiscali.cz Cervical area Caries risk place Nearness of the gingival border - possibility of its raB^ciinn. iriTirirnrriririfj Specific ordering of the hard dental tissues Difficulties with the maintenance of dry operation field The pulp chamber can be opened easi1" lenka.roubalikova@tiscali.cz Dentin Cementům lenka.roubalikova(5>tiscali.cz . Anatomical x clinical crown DEJ lenka.roubalikova@tiscali.cz lenka.roubalikova@tiscali.cz Class I. Non invasive treatment Princiole Ozone plus remineralization iimrasHMii Non cavitated lesion (Diagnodent) Contraindication: Cavitated lesion lenka.roubalikova@tiscali.cz Cavitated lesion Non cavitated lesion lenka.roubalikova(5>tiscali.cz Class V. Minimally invasive treatment Principle: prepare small cavities limited on carious lesion only Adhesive materials - composites Glass ionomer cements Combination of GIC and composites (lesion is filled with GIC and covered with composite - sandwich filling) HBBHBBMBHBBBBIIMHBB1 lenka.roubalikova@tiscali.cz lenka.roubalikova@tiscali.cz Principle Elimination of the undermined enamel Burs or diamonds (pear), tapered fissure br Separation of the gingiva-temporary filling guttapercha, fermit, clip, zinkoxidsulphate cement, cavit, provimat). Ablation of ingrowing gingiva-surgical(scalpel laser, highfrequency current) WE lenka.roubalikova@tiscali.cz lenka.roubalikova@tiscali.cz Matrices Important for the correct shape of fillings For good curing of materials or a st orm lenka.roubalikova@tiscali.cz Soft aluminium matrix for GIC Secondary caries lenka.roubalikova@tiscali.cz Class V. - Sandwich principle (combination of GIC and composite) Base of glassionomer - a replacement of the lost dentin Thin layer of composite -a replacement of the lost enamel lenka.roubalikova@tiscali.cz Base of a glasionomer lenka.roubalikova@tiscali.cz Bond: GIC -tooth chemical Composite-tooth micromechanical Composite-GIC micromechanical lenka.roubalikova@tiscali.cz Choice of material - 1st choice GIC Sandwich Composite lenka.roubalikova(5>tiscali.cz Posterior area Conventional preparation lenka.roubalikova(5>tiscali.cz - amalgam B. lenka.roubalikova@tiscali.cz Secondary caries ■ Secondary caries - on the border, reasons: bad preparation - damaged enamel during preparation, borders are nit smooth enough, bad acid etching technique, no extention for prevention in patients with poor oral hygiene. Diagnosis Visual, probe, good illumination, magnification. Usually mistakes of dentists. lenka.roubalikova@tiscali.cz Recurrent caries, In the cavity, usually at the bottom or walls Reasons: casious dentin has been left in the cavity. Diagnosis: X ray, usually BW: cleamesss under the filling. Transillumination - diaphanoscopy. Mistakes of dentists. lenka.roubalikova@tiscali.cz Subgingival caries The border of cavity is situated subgingivally, or gingiva is overgroving into the cavity. Solution: Rem ' J overgroving gingiva (see above Temporary filling Matrix esp. Belvedere matrix. Fundamental recommendation: The control of border i: necessary! Dry field !!! lenka.roubalikova@tiscali.cz