Primům non nocere! Minimal intervention Non invasive Approach < 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 J □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 9' -"*'" ; __ _ --:-- ——» Success? ----* ' 1 * • -A 1. Loupes or microscope 2. Mini instruments 3. Capsulated GIC A / 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. M Kinetic preparation • Principally sandblasting • Irregular cavosurface margin • No excavation of carious dentin • Suitable for composite materials Ultrasound in dentistry Piezoelektric generators 10 W/cm2 lenka.roubalikova@tiscali.cz Ultrazvuk v zubním lékařství Oral hygiene - prophylaxis Subgingival treatment Preparation of cavities Endodontics Prosthetics Surgery lenka.roubalikova@tiscali.cz 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 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 36 Preparation in enamel Preparation in dentin Proximal caries Sonická aproximální preparace LASER • LIGTH AMPLIFICATION BY STIMULATED EMISSION OF RADIATION Maiman 1960 Basov, Prokhorov, Townes, lenka.roubalikova@tiscali.cz Light • Elektromagnetic wave lenka.roubalikova@tiscali.cz 44 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 Wave velength: 2940 nm Er,Cr:YSGG laser Active medium: Erbium a Chromium Yttrium - Scandium - Gallium - Garnet Wave velength: 2780 nm Principle of action Mechanismus účinku Indications > Preparation > Mucogingival surgery ^Endodontics Pulse regime Preparation Cavities Adhesive preparation - laser etching lenka.roubalikova@tiscali.cz Results Enamel Roubalikova L., Neděla V., Polenik P.: Adhesive Preparation. baiikova@tiscaii.cz A Comparison of Various Methods ESOLA, Bruges, 2006 Results 151 LEI 7.0kV X(f ISI LEI 5.0kV X5.000 1jum WD 8.6mm itiscali.cz Roubalikova L, Neděla V., Polenik P.: Adhesive Preparation. A Comparison of Various Methods ESOLA, Bruges, 2006 61 Laser- benefits > Minimally invasive treatment > No anaesthesia > No smear layer > Dentine tubules are open > Antimicrobial effect lenka.roubalikova@tiscali.cz 64 Gingivektomie Gingivoplastika