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Primum non nocere !
Minimal intervention
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Approach
Non invasive
Minimally invasive
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Miniinvasive treatment
Preparation techniques
 Mechanical
 Chemo – mechanical
 Kinetic
 Hydrokinetic (Laser)
Peters MC, Mc Lean ME: Minimally invasive operative care II.
Contemporary techniques and materials: An overwiev.
J Adhes Dent 2001; 3:17-31.
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Mechanical preparation
Rotary
Sonic and ultrasonic
ART
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Rotary – special burs and diamonds
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Minikavity
Otevírání fissur
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Sedelmayer
Sedelmayer, Bažant
Slot peparation
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Sedelmayer
Adhesive slot preparation
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Tunnel preparation
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1. Low caries risk
2. Cooperation of the patient
3. Intact proximal ridge
4. D2
1. Loupes or microscope
2. Mini instruments
3. Capsulated GIC
5. BW post op
Success?
Success?
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ART
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ART
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ART
Excavation of carious dentin
Clean borders
GIC
Recall
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Caries detector
Can diferenciate carious dentin with destroyed
and intact collagen network
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Chemomechanical preparation
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Sodium hypochlorite + triaminoacids
Removal of carious dentin, non active in enamel
GIC is the suitable material
Chemomechanical preparation
Rafique S, Banerjee A, Fiske J.
Clinical trial of an air-abrasion/Carisolv gel regimen
for restorative treatment for dentally anxious patients.
Caries Res 2002; 186 (Suppl.3)36:39.
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Kinetic preparation
Kinetic preparation
• Principally sandblasting
• Irregular cavosurface margin
• No excavation of carious dentin
• Suitable for composite materials
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Ultrasound
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Ultrasound in dentistry
• Piezoelektric generators
• 10 W/cm2
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Ultrasound in dentistry
• Oral hygiene - prophylaxis
• Subgingival treatment
• Preparation of cavities
• Endodontics
• Prosthetics
• Surgery
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Ultrasound in dentistry
• Odstranění biofilmu a zubního kamene –
profesionální hygiena
Robustní koncovky pracovní řady streamline.
Orientace:
Magnetostrikční: Delší osa elipsy(osmičky) směřuje tangenciálně k povrchu zubu
Piezoelektrické: Dráha pohybu koncovky je tangenciální k povrchu zubu
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Preparation
Oscillation of the instrument
No risk of the damage of the neighborough
tooth
Mini and microcavities, slots and tunnels,
preparation of cavosurface margins
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Preparation
• Typy instrumentů. Speciální kleštiny.
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Preparation in enamel
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Excavation of carious dentin is
unsufficient
Preparation in enamel Preparation in dentin
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Proximal caries
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LASER
• LIGTH AMPLIFICATION BY STIMULATED EMISSION
OF RADIATION
Maiman 1960
Basov, Prokhorov, Townes.
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Light
• Elektromagnetic wave
-Wavelenght
-Amplitude
- Photons
Natural light
• Polychromatic
• Divergent
• Incoherrent
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Hickel, 2004
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Laser light
Monochromatic
Coherrent
Colimated
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Principle
Resonator
Laser beam
Kvantum of energy
Photon
Active medium
Atom
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Active medium
Wavelength
Energy
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Active medium
 Argon – Fluor UV
 Krypton- Fluor UV
 Helium – Kadmium UV, VIS
 Argon VIS
 Rubín VIS
 Nd:YAG VIS,IR
 Helium – Neon VIS, IR
 Diode lasers VIS, IR
 Erbium IR (Er:YAG, Er,Cr:YSGG)
 Oxid uhličitý IR
Er:YAG laser
Active medium: Erbium Yttrium - Aluminium - Garnet
Wavelength: 2940 nm
Er,Cr:YSGG laser
Active medium: Erbium a Chromium Yttrium Scandium
- Gallium - Garnet
Wavelength: 2780 nm
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Er,Cr:YSGG Laser System
Waterlase (Biolase,USA)
Principle of action
Thermomechanical efffect
Principle of action
Hydrokinetic effect
Indications
Preparation
Mucogingival surgery
Endodontics
Analgezia, biostimulation
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Laser - benefits
Minimally invasive treatment
No anaesthesia
No smear layer
 Dentine tubules are open
Antimicrobial effect
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