lenka.roubalikova@tiscali.cz 1 Preclinical Dentistry I. Dental Caries Non carious lesions: trauma, erosion, abrasion,V. shaped defects Lenka Roubalíková lenka.roubalikova@tiscali.cz 2 Understanding dental caries lenka.roubalikova@tiscali.cz 3 crown neck root pulp chamber root canal lenka.roubalikova@tiscali.cz 4 Dental Tissues Enamel Dentin Cementum Periodontal ligament Alveolar bone Pulp Gingiva Dental caries lenka.roubalikova@tiscali.cz 5 tooth microbs sugar time Dental caries caries Factors that are necessary for origin of dental caries lenka.roubalikova@tiscali.cz 6 Dental Caries Infectious microbiological disease of the teeth that results in localized dissolution and destruction of the calcified tissues. lenka.roubalikova@tiscali.cz 7 Biofilm – Dental Plaque Complex community Simple circulation Better conditions to survive lenka.roubalikova@tiscali.cz 8 Dental Biofilm – Dental Plaque A gelatinous mass of bacteria adhering to the tooth surface. lenka.roubalikova@tiscali.cz 9 Dental biofilm  Adhesion  Colonisation  Maturation lenka.roubalikova@tiscali.cz 10 Sugar Fermentable (mono-, di- tri- sacharides) Sucrose, glucose, lactose Acids Demineralization Demineralization Time Cavitated lesion Non cavitatated lesion lenka.roubalikova@tiscali.cz 12 Saliva  Plaque formation  Microbial source  Mineral source  Microbial clearence  Buffer capacity lenka.roubalikova@tiscali.cz 13 Caries danger areas habitually (predictable) dirty areas  Pits and fissures  Proximal surfaces  Cervical area No self cleaning lenka.roubalikova@tiscali.cz 14 Predictable (habitually) clean areas  Cusps  Proximal ridge, oblique, transverse ridge  Incisal edge  Buccal or oral surface upon the maximal convexity  Proximal surface upon the contact point Self cleaning lenka.roubalikova@tiscali.cz 15 Caries - depth  Surface caries (caries superficialis)  Middle caries (caries media)  Caries close to pulp (caries pulpae proxima)  Caries penetrating into the pulp (caries ad pulpam penetrans) Deep caries lenka.roubalikova@tiscali.cz 16 lenka.roubalikova@tiscali.cz 17 lenka.roubalikova@tiscali.cz 18 Caries - Topography  Coronal caries  Root surface caries  Enamel caries  Dentin caries  Cementum caries lenka.roubalikova@tiscali.cz 19 Caries  Acute  Chronic  Arrested  Penetrating  Undermining Acc to its history lenka.roubalikova@tiscali.cz 20 Primary caries Secondary caries Recurrent caries lenka.roubalikova@tiscali.cz 21 Patient assesment Clinical examination Diagnosis lenka.roubalikova@tiscali.cz lenka.roubalikova@tiscali.cz 22 Diagnosis of dental caries lenka.roubalikova@tiscali.cz 23 Investigation  Mirror  Sharp Probe  Illimunation  Magnification  X- ray, other methods i.e. transillumination, infrared laser fluorescency Dark spot, hole, defect 24 lenka.roubalikova@tiscali.cz 25 Dental Caries - Treatment  Non cavitated lesion: On molecular basis - Dental hygiene - Fluorides, Calcium, Phosphates - Diet - Antimicrobial agents lenka.roubalikova@tiscali.cz 26 Dental Caries - Treatment  Cavitated lesion: Preparation Filling Drill anf fill lenka.roubalikova@tiscali.cz 27 Preparation Instrumental treatment Remove caries Leave the rest of the dental tissues - to be restored - to be resistent against the bite forces - to be prevented against the recurrent caries (Black 1914) lenka.roubalikova@tiscali.cz 28 Classification of cavities according to Black lenka.roubalikova@tiscali.cz 29 Class I. Caries in fissures and pits – occlusal surfaces of premolars and molars lenka.roubalikova@tiscali.cz 30 Class II. Proximal surfaces of molars and premolars lenka.roubalikova@tiscali.cz 31 Class III. Proximal surfaces of incisors and canines without loss of the incisal edge lenka.roubalikova@tiscali.cz 32 Class IV Proximal surfaces of incisors and canines with the loss of incisal edge lenka.roubalikova@tiscali.cz 33 Class V. Cervical area lenka.roubalikova@tiscali.cz 34 Classification acc. to Black  Class I. Pit and fissure caries lenka.roubalikova@tiscali.cz 35 Classification acc. to Black  Class II. Proximal surfaces in premolars and molars lenka.roubalikova@tiscali.cz 36 Classification acc. to Black  Class III. Proximal surfaces of incisors and canines without lost an incisal ridge lenka.roubalikova@tiscali.cz 37 Classification acc. to Black  Class IV. Proximal surfaces of incisors and canines with lost an incisal ridge lenka.roubalikova@tiscali.cz 38 Classification acc. to Black  Class V. cervical lesions lenka.roubalikova@tiscali.cz 39 Charting and records the most important notation  Caries /  Filling P  Tooth for extraction X  Extracted tooth +  Crown  Pontic  Tooth in removable denture 0 lenka.roubalikova@tiscali.cz lenka.roubalikova@tiscali.cz 40 Instruments for investigation – investigative instruments Explorer (probe): Sharp, straight or bow shaped: Caries detection – lght motion without any pressure: dental surfaces, fillings. Periodontal explorer (probe): not sharp, calibrated, investigation of periodontal pockets lenka.roubalikova@tiscali.cz lenka.roubalikova@tiscali.cz 41 Instruments for investigation – investigative instruments  Mirror – flat or concave  To see less available regions  To illuminate  To move off soft tissues (cheeks, tongue etc.) lenka.roubalikova@tiscali.cz lenka.roubalikova@tiscali.cz 42 Instruments for investigation – investigative instruments Tweezer To grip various instruments and supplies. lenka.roubalikova@tiscali.cz lenka.roubalikova@tiscali.cz 43 Cavity preparation  Power driven  Hand lenka.roubalikova@tiscali.cz 44 Instruments for cavity preparation Hand instruments for cutting Two main materials: Stainless steel (loses keen edge) Carbon steel (corrode) Excavator Chisel- cleaver lenka.roubalikova@tiscali.cz 45 Instruments for cavity preparation Power driven instruments for cutting Rotary instruments Comon design characteristics lenka.roubalikova@tiscali.cz shank neck head lenka.roubalikova@tiscali.cz 46 Shank  The part that fits into the handpiece  Accepts the rotary motion from the  handpiece  Provides a bearing surface to control the  alignment and concentricity of the  instrument lenka.roubalikova@tiscali.cz lenka.roubalikova@tiscali.cz 47 Straight handpiece shank  Simple cylinder  held in the handpiece in a metal chuck lenka.roubalikova@tiscali.cz 48 Latch angle handpiece shank  Shorter length – access to posterior regions Handpiece – contra angle, metal bur tube. The end of the instrument fits into D-shaped socket at the bottom of the bur tube. The instrument retained by a retaining latch that slides into the groove found at the shank end of the instruments. Low and medium speed lenka.roubalikova@tiscali.cz 49 Friction grip handpiece shank Smaller design, simple cylinder. Held in the handpiece by friction in plastic or metal chuck. lenka.roubalikova@tiscali.cz lenka.roubalikova@tiscali.cz 50 Neck design Intermediate portion of an instrument that connects the head to the shak Tapered, shorter or longer. lenka.roubalikova@tiscali.cz lenka.roubalikova@tiscali.cz 51 Head design Burs – cut of steel or tungsten carbid Diamond (diamond burs)– covered with the diamond bort lenka.roubalikova@tiscali.cz lenka.roubalikova@tiscali.cz 52 Head design Burs classification systém Round Inverted cone Pear shaped Straight fisure Tapered fissure lenka.roubalikova@tiscali.cz 53 Bur blade design  Rake face (towards the direction of cutting)  Clearence face Rake angle – slightly negative Edge angle – appr 90° Clearence angle Clearence face rounded or two surfaces. Fissure bur Burs Blades are cutting the material Material is removing through spaces between blades Diamonds – a bur covered with the diamond particles lenka.roubalikova@tiscali.cz 57 Diamond abrasive instruments Diamond bort – small aharp particles in softer matrix. Cutting occurs at a large number of points (grinding). Metal blank Diamond powder Metallic bonding material lenka.roubalikova@tiscali.cz 58 Preparation speed  Low (slow) speeds – below 12.000 rpm  Medium or intermediate speeds 12.000 – 200.000 rpm  High or ultrahigh speeds above 200.000 rpm lenka.roubalikova@tiscali.cz 59 400.000 rpm lenka.roubalikova@tiscali.cz 60 1 : 1 Gear assembly lenka.roubalikova@tiscali.cz 61 Electromotors – maximum 40.000/min Airmotors – maximum 20.000/min Gearing to fast speed Gearing to slow speed Oscillation Blue code – gear 1:1 1:5 2,7 :1 or 7,4 :1 lenka.roubalikova@tiscali.cz 62 Red coded handpiece 1:4 až 1:5 as far as 160.000 – 200.000 rpm lenka.roubalikova@tiscali.cz 63 Green coded handpiece 2,7:1 7,4:1 lenka.roubalikova@tiscali.cz 64 Hanpieces combined 1:1 2:1 nerotuje lenka.roubalikova@tiscali.cz 65 1 : 1 as far as 40.000 rpm lenka.roubalikova@tiscali.cz 66 Blue and green coded handpiece lenka.roubalikova@tiscali.cz 67 ISO 6360 lenka.roubalikova@tiscali.cz 68 lenka.roubalikova@tiscali.cz 69 Filling materials Temporary Zinkoxidsulphate cement One component cements based on gypsum and organic lute Zinoxidphosphate cement Permanent Amalgam Composites lenka.roubalikova@tiscali.cz 70 Filling materials Amalgam: Mercury Powder – metal alloy: Silver Tin Copper Zinc lenka.roubalikova@tiscali.cz 71 Chisel – for enamel Cleaver lenka.roubalikova@tiscali.cz 72 Chisel for enamel lenka.roubalikova@tiscali.cz 73 Excavator lenka.roubalikova@tiscali.cz 74 Filling instruments lenka.roubalikova@tiscali.cz 75 Burnisher -plane Angular- trough edge trough face lenka.roubalikova@tiscali.cz 76 Burnisher – angular three face lenka.roubalikova@tiscali.cz 77 Condensor and burnisher combined lenka.roubalikova@tiscali.cz 78 Amalgam carrier lenka.roubalikova@tiscali.cz 79 Condensor for amalgam lenka.roubalikova@tiscali.cz 80 Condensor for guttaprecha - hoof lenka.roubalikova@tiscali.cz 81 Ball condensor lenka.roubalikova@tiscali.cz 82 Condensor with straight front lenka.roubalikova@tiscali.cz 83 Fosterflagg lenka.roubalikova@tiscali.cz 84 Frahm lenka.roubalikova@tiscali.cz 85 Carver: Discoid - Cleoid