Restorative dentistry I. 4 th lecture Dentin hypersensitivity and non carious lesions (defects) DENTIN HYPERSENSITIVITY charakteristics •Sharp intensive pain in response to stimulus, decreasing and stopping immediately with the stimulus. • •Dentin must be exposed,frequently in cervical area • • •Stimuli: thermal, chemical, osmotic, mechanical. • Citlivý zub s obnaženým krčkem Citlivý zub zarodek Enamel Dentin Cementum Dental pulp Periodontal tissues Enamel enaperi 4 adhese1 adheSe5lei Covers the crown 98% inorganic subst. Thin layer in cervical area Cementum •Covers the root 8 jmoobr2a M:\Zalohapc\abstraktaakt\obr.9.tif 50% inorganic substances Insertion of collagen fibers (Sharpey). Thin layer in cervical area Dentin M:\Pcdoma\abstraktaakt\bruges\obrázky\dentinadheseikyselina\dentinadhese\3SEIex.jpg M:\Pcdoma\abstraktaakt\bruges\obrázky\dentinadheseikyselina\dentinadhese\3LEIex.jpg M:\Pcdoma\abstraktaakt\bruges\obrázky\dentinadheseikyselina\dentinadhese\1LEIex.jpg Core of the tooth 75% inorganic substances Collagen fibers incrusted with hydroxyapatite crystals Dentin tubules – Tomes fibres (cytoplasmatic fibres of odontoblasts) Dental pulp dentin5 histol The tisue in the pulp chambre, It contains cells, intercellular substance, vesssels and nerves. Odontoblasts at the periphery. Primary, secondary, terciary, sklerotic dentin. 8 3 9 10 11 12 anatomie2 anatomie3 Sklovina v cervikální oblasti 13 dentin4 Sklovina Dentin Cement Anatomical and clinical crown • klinikcá korunka klinikcá korunka2 Cervical area Ø ØSpecial arrangement of hard dental tissues ØCaries danger area ØGingiva in close proximity ØSpecial loading by elastic deformation of dental crown by occlusal loading. ØIsolation of the operation field is difficult (sulcular liquid, bleeding). 16 Exposure of dentine in cervical area 1 7 17 hydrodynamefekt Hot Cold Dessication Osmotic stimuli –hypertonic solution Tubular liquid Odontoblast Nerv The movement of the tubular liquid – irritation of odontoblasts – transmission on the nerve fibres Hydrodynamic theory 18 smearlayer2 Sharp pain on cold •Cold stimulus –shrinkage of the liquid – higher pressure extrusion- the liquid flows out – pain. •Warm stimulus – expansion of the liquid expans – the liquid flows towards dental pulp – the pain is not so sharp. Dentin exposure • • •Loss of enamel •Gingival recession •Combination • hotovekrcky Loss of enamel •Eroze • •Abraze • •Atrice • •Abfrakce Erosion • •Irreversible loss of hard dental tissue as a consequency of demineralization without participation of microbs. Repeated contact with chemicals of low pH (1-3) is necessary. Acidic food and beverages alimentar source of acids • •Fresh fruit (citrus) •Fresh vegetable •Food with winegar, marinade – pickle •Dressings with winegar •Ketchup •Fruit bonbons • • Acidic food and beverages alimentar source of acids – external sources of acid. Erosion on the vestibular surface • •Fruit juice (citrus) •Vegetable juice •Soft deinks •Limonades •Carbonated beverages •Acidic mineral water •Energetic beverages •Isotonic beverages •Vine, sect •Fruit tea • • Internal sources of acid – erosions on oral surface •Gastric acid •Vomitus, regurgitation, reflux •Anatomic defects (hiat hernia, insuficient function of gastroesophag.sfincter, oesophageal diverticulosis) •Gastrointestinal disorders (gastroesofageal reflux) •Anorexia mentalis • Bulimia nervosa •Hyperemesis gravidarum •Alcoholism •Stress •Diabetes mellitus •Chemoterapy •Peptic cicatrix •Uraemia • 26 kanova3 eroze-abraze eroze C:\Users\Elite\Documents\webovky vše\webovky obrázky\priklady pouziti laseru\osetreni defektu laserem - po preparace.jpg Abrasion •Abrasion is a lost of hard dental tissues caused mechanically with some substance or objects. Abrasion is often combined with erosion. Typical location – cervical area of canines and premolars. • • klinovedef Abrasion • •Demastication (food), parafunctions (biting of various objects e.g. pencil), toothbrushing (abrasive pastes, hard toothbrushes) Attrition -Loss of hard dental tissues by direct contact of antagonists. Gritting, bruxism. •Reasons: • - Psychogenic factors (stres,anger) • -Physical effort •- Complicated intermaxillary relationships • • cech V-shaped defects •Typical defects V – shaped in cervical area •Smooth bottom, no pain, teeth with atypical position •(rotation) or atypical loading, •sometimes without any reason. kliny Aethiology - abfraction st_6_2013-56.jpg Hard enamel Elastic dentin During the occlusal loading – elastic deformation of dentin -enamel looses the support -fracture of small pieces -abfraction Combination of factors Ø Ø ØAbrasive effect of tooth brushes and pastes • • •It is not tlikely • 36 cahl1 cahl2 cahlhotovo owl cahl3 cahlpo11 Caries • cahlík V Cervical defects – erosion+abrasion Gingival recessions • •Hard toothbrush •Horizontal technique •Toothpaste with high RDA • • M:\Zalohapc\para\kamen.jpg M:\Zalohapc\para\recesy1.jpg lroubalikova@gmail.com IMG_2605 IMG_2607 IMG_2619 42 pospisek Recessions Strategy of the therapy • •- Find the reason • •Remove the reason • •- Treatment Strategy of the therapy of dentin hypersensitivity •Physical •- Closure of dentin tubules •Chemical •Coagulation of proteins in dentin tubules, creation of non soluble complex of calcium, interferention with the sensoric activity. Fluorides Calcium fluoride Precipitates Fluoride reacts with calcium ions in tubular liquid Reversible Fluoride gels •1 g Elmex Gelee obsahuje: aminfluorida mixta 33,19 mg (olaflurum 30,32 mg, dectaflurum 2,87 mg), natrii fluoridum 22,10 mg (odpovídá 12,5 mg fluoridu). •1x týdně Duraphat® Colgate Oral Pharmaceuticals Fluor - Protector® Ivoclar Vivadent n Flor - Opal® Ultradent Bifluorid 12® VOCO Varnishes with fluorides Other chemicals •Potassium oxalate – closure of dentin tubules and depolarization of nerve fibres • •Strontium chloride - closure of dentin tubules • •Resins – chemicals similar to adhesives: hybrid layer formation. Recaldent •Casein phosphopeptid •Closure of dentin tubules •Tooth Mousse, MI Paste Plus (GC, Japan) NovaMin •Syntetic mineral containing natrium, calcium,phosphates,silica particles (sodiumcalciumphosphosilicat) •In contact with saliva calcium, sodium and phosphates are releasing. Good adhesion to the tooth surfaces and long term remineralization. Sensodyne Pro - Argin™ •Arginin bicarbonáe - complex of aminoacid and calciumcarbonate. •Good adhesion and closure of dentin tubules. • • Colgate NovaMin Pro-Argin Recaldent Comparison of NovaMin and other Calcium Phosphate technologies, Dentist. Net CHitoActive •Chitosan, aminfluorid, stannum fluoride •Protective film • Elmex MICROREPAIR® •Hydroxyapatite and zink ions • •Zink ions: •Activation of hydroxyaatite •Antibacterial effect •Hydroxyapatit -Support of hard dental tissues -Effect against halitosis (absorbtion of sulphate compounds) -Účinný proti halitóze. •Biorepaire Plus Sensitivity, Biorepair Total Night Protection, Biorepaire Total Plus Protection • Hydroxyapatite and fluorides •Remin Pro (VOCO) Adhesive systems –sealing of dentin tubules • • •HEMA •Glutaraldehyd •Triclosan • •Also precipitation of proteins Filling therapy vacha3 vacha2 • 59 lroubalikova@gmail.com E:\LRd\d\FRC čepy a publikace\Nová složka\obrazkyalegendafrc\obr03.jpg dentintub2 dentintubkom Laser •Biostimulation a analgetic effekt, closure of dentine tubuls • •Nd:YAG •Er:YAG •Diodový laser obr Surgical therapy of exposed necks Kopie hromkova1 hromkova2