Primům non nocere!
Minimal intervention
Non invasive
Approach
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Minimally invasive
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. JAdhes Dent 2001; 3:17-31.
lenka.roubalikova@tiscali.cz
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□Mechanical preparation
> Rotary
> Sonic and ultrasonic >ART
lenka.roubalikova@tiscali.cz 4
Adhesive slot preparation
Success?
Low caries risk Cooperation of the patient Intact proximal ridge D2
Success?
1. Loupes or microscope
2. Mini instruments
3. Capsulated GIC 5. BW post op
lenka.roubalikova@tiscali.cz
Caries detector
Can diferenciate carious dentin with destroyed and intact collagen network
lenka.roubalikova@tiscali.cz
Chemomechanical preparation
Chemomechanical preparation
SSodium hypochlorite + triaminoacids Removal of carious dentin, non active in enamel GIC is the suitable material
lenka.roubalikova@tiscali.cz
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.
Kinetic preparation
• Principally sandblasting
• Irregular cavosurface margin
• No excavation of carious dentin
• Suitable for composite materials
Ultrasound in dentistry
• Piezoelektric generators
• 10 W/cm2
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Ultrazvuk v zubním lékařství
• Oral hygiene - prophylaxis
• Subgingival treatment
• Preparation of cavities
• Endodontics
• Prosthetics
Ultrazvuk v zubním lékařství
• 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
lenka.roubalikova@tiscali.cz 31
Preparation
Oscillation of the instrument
No risk of the damage of the neighborough tooth
Mini and microcavities, slots and tunnels, preparation of cavosurface margins
lenka.roubalikova@tiscali.cz
Preparace kavit
33
reparation in enamel
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Preparation in enamel
Preparation in dentin
Proximal caries
LASER
• LIGTH AMPLIFICATION BY STIMULATED EMISSION OF RADIATION
Maiman 1960
Basov, Prokhorov, Townes.
lenka.roubalikova@tiscali.cz 43
Light
• Elektromagnetic wave
lenka.roubalikova@tiscali.cz
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Natural light
Hickel, 2004
Polychromatic
Divergent
Incoherrent
lenka.roubalikova@tiscali.cz
Laser light
Active medium
> Argon - Fluor UV
> Krypton- Fluor UV
> Helium - Kadmium UV, VIS
> Argon VIS
> Rubin VIS
> Nd:YAG VIS.IR
> Helium - Neon VIS, IR
> Diode lasers VIS, IR
> Erbium IR (Er:YAG, Er,Cr:YSGG)
> Oxid uhličitý IR
lenka.roubalikova@tiscali.cz 49
Er:YAG laser
Active medium: Erbium Yttrium -Aluminium - Garnet
Er,Cr:YSGG laser
Active medium: Erbium a Chromium Yttrium - Scandium - Gallium - Garnet
Principle of action
Mechanismus účinku
Indications
> Preparation
> Mucogingival surgery ^Endodontics >Analgezia, biostimulation
Pulse regime
Preparation
• Cavities
• Adhesive preparation - laser etching
Results
Enamel
Results
ISI
LEI       7.0kV xl
ISI
LEI       5.0kV     X5.000      1,um      WD 8.6mm
5tiscali.cz
Roubalíkova L, Neděla V., Polenik P.: Adhesive Preparation. A Comparison of Various Methods ESOLA, Bruges, 2006
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Laser- benefits
> Minimally invasive treatment
> No anaesthesia
> No smear layer
> Dentine tubules are open
> Antimicrobial effect
Roubalíková L, Wilhelm Z, Bilder J. : Use of Er: YAG laser in non carious cervical lesions. Clin Oral Invest, 2003.
Gingivektomie Gingivoplastika
lenka.roubalikova@tiscali.cz