Restorative dentistry I. 5 th lecture 1. Periodontal diseases related to restorative treatment 2. Preparation trauma 3. Importance of the x-ray investigation in restorative dentistry Restorative dentistry I. 5 th lecture 1. Periodontal diseases related to restorative treatment Mistakes of making filling can cause periodontal diseases ̶ Reconstruction of the contact point: ̶ Contact point – contact area! ̶ The space below the contact area is a caries danger area – plaque accumulation! ̶ The interdental papilla is retracting during ageing – interdental oral hygiene is important! Definujte zápatí – název prezentace nebo pracoviště3 Mistakes of making filling can cause periodontal diseases ̶ Reconstruction of the contact area is very important! ̶ Remember – by reconstruction the contact area remember that: ̶ Contact area is made of the filling material only. The axial walls are situated 0,5mm from the natural contact area. ̶ By reconstruction is important to study the contact area! Definujte zápatí – název prezentace nebo pracoviště4 Definujte zápatí – název prezentace nebo pracoviště5 Clinical conseqences of the most common mistakes – the contact point is missing The contact area is missing Retention of food Plaque accumulation Inflammation Bone resorption Periodontal pocket Definujte zápatí – název prezentace nebo pracoviště6 Definujte zápatí – název prezentace nebo pracoviště7 Bad contour, overhang Contact area too narrow Definujte zápatí – název prezentace nebo pracoviště8 Clinical conseqences of the most common mistakes – the overhang Retention of food Plaque accumulation Inflammation Bone resorption Periodontal pocket Mechanic irrtiation Secondary caries Definujte zápatí – název prezentace nebo pracoviště9 Clinical conseqences of the the other mistakes – trauma Separation ring Matrix band Preparation instruments Wedges Necrotizing agent – necrosis of papilla od bone. Definujte zápatí – název prezentace nebo pracoviště10 Restorative dentistry I. 5 th lecture 1. Management of deep caries Deep caries – D4 ̶ Caries pulpae proxima ̶ Caries ad pulpam penetrans Definujte zápatí – název prezentace nebo pracoviště12 Caries pulpae proxima ̶ Dentine between the caries lesion and dental pulp ̶ No symptoms ̶ Indirect pulp therapy: indirect pulp capping Calcium hydroxide cement, premanent filling. Definujte zápatí – název prezentace nebo pracoviště13 Caries ad pulpam penetrans ̶ No symptoms ̶ Symtomatic (pulpitis?) Definujte zápatí – název prezentace nebo pracoviště14 Caries ad pulpam penetrans ̶ No symptoms Vitaliy +: 1. Indirect pulp capping (intermittent excavation) 2. Pulpotomy (aseptic approach, rubber dam) Definujte zápatí – název prezentace nebo pracoviště15 Caries ad pulpam penetrans ̶ Symptoms Vitaliy +: 1. Pulpotomy (aseptic approach, rubber dam) - Partial - Coronal - Deep Definujte zápatí – název prezentace nebo pracoviště16 Caries ad pulpam penetrans ̶ No symptoms Vitality - : Root canal treatment Definujte zápatí – název prezentace nebo pracoviště17 Definujte zápatí – název prezentace nebo pracoviště18 Preparation techniques and their clinical consequences – preparation trauma Preparation Power driven - Rotary - Alternative Hand - Excavator - Chisel Definujte zápatí – název prezentace nebo pracoviště19 Preparation techniques ̶ Pressure – max hand preparation – risk of excavators ̶ Vibrations ̶ Heat – due to friction - increases with rpm (turbine max) Definujte zápatí – název prezentace nebo pracoviště20 Consequences in enamel, dentin, cementum ̶ Rotary preparation with high speed handpiece, turbine: ̶ Enamel :shattered borders, cracs. Prevention: gentle interrupted preparation, water cooling. ̶ Dentine: burnt areas, denaturation of protein. ̶ Dental pulp: aspiration of odontoblasts into dentine tubules, hyperaemia, infiltration, inflammation. Definujte zápatí – název prezentace nebo pracoviště21 Postoperative sensitivity ̶ Pain occuring after the placement of composite restoration ̶ Studies have reported the frequency of postoperativr sensitivity to be low 5% and high 30% Definujte zápatí – název prezentace nebo pracoviště22 Postoperative sensitivity - reasons ̶ Polymerization shrinkage ̶ Marginal gap ̶ Suboptimal adhesion ̶ Inadequate polymerization ̶ Unvfavourable C- factor and residual dentin thickness ̶ Pre-existing tooth relatefd factors, such as cracks Definujte zápatí – název prezentace nebo pracoviště23 Postoperative sensitivity ditching marginal discoloration gap cracks Versluis 2000 Secondary caries Postoperative sensitivity prevention ̶ Correct indication ̶ Excellent isolation ̶ Careful investigation using magnification and illumination ̶ Proper etching ̶ Proper drying ̶ Proper curing Definujte zápatí – název prezentace nebo pracoviště25 Postoperative sensitivity strategy ̶ Perfect investigation - Check occlusion - Check margins (sealing?) - Check tooth structure If some reason is found: remove it Definujte zápatí – název prezentace nebo pracoviště26 Postoperative sensitivity strategy - If the symptoms are getting worse - remove the filling, check the tooth structure carefully, - use calcium hydroxide with the temporary filling material or bioactive materiál (Biodentine), - Make a new filling. Definujte zápatí – název prezentace nebo pracoviště27 Importance of x-ray in restorative dentistry Radiography ̶ Roentgen tube – x- ray tube: Cathode – anode – tension Catode (heated) - electrons –against anode – brake - x ray radiation originates Radiography ̶ Imaging method completing clinical examination of patients Radiography Principle: X- rays going through various materials (tissues) are absorbed – image on the film (a special suspension AgBr – silver bromide) or digital receptors Rigid CCD Digital Sensor Sirona Dental Systems, LLC Digital Phosphor Plate Air Technique, Inc. F-Speed Dental Film Kodak Dental Systems Roentgen tube X ray tube Anode Cathode wolfram (tungsten) filament inside (heated – brought to white heat) Focus – made of wolfram Extraoral and intraoral radiography ̶ Extraoral: The film is placed outside of oral cavity - OPG (orthopantomography) - Teleradiography - Special projections of a skull (posteriorly – anteriorly) - Half axial - Side projection (TMJ,mandible) - CT Extraoral and intraoral radiography Intraoral – the film is placed in the oral cavity – a special x-ray apparatus. - Teeth - Alveolar bone - Periodontal space - Fillings - Caries - Level of endodontic treatment OPG Side Posteriorly-anteriorly Posteriorly-anteriorly Half axial CT OPG Half axial Posteriorly-anteriorly Side CT CT CT, 3D possibility Radiography important for the restorative procedures ̶ Intraoral ̶ OPG ̶ CBCT Definujte zápatí – název prezentace nebo pracoviště40 Intraoral radiography Film or recepotor placed in oral cavity Special apparatus - Teeth - Alveolar bone - Periodontal space - Fillings - Caries - Impacted teeth - Level of endodontic treatment Position of the tube ̶ In vertical plane ̶ In horizontal plane In vertical plane Paralleling technique Film or receptor in a special holder Parallel to long axis of teeth If paralleling technique is not possible use the bisecting angle technique Bisecting angle technique – isometric radiogram The x-ray beam Angle between the beam and axis of the angle The long axis of the tooth The tooth The angle betwen the long axis of the tootn and the film Film Alveolar bone and surrounding tissues The axis of the angle Hypometric and hypermetric picture Central beam goes perpendiculary on the tooth Hypermetric picture – the picture is bigger – central beam goes perpendiculary to the film paprsek goes perpendiculary to the film. Hypometric – the picture is smaller The tubus can have various position ̶ Apical projection: the central beam goes through the apex area ̶ Periodontal projection: the central beam goes through the uper third of the root ̶ Coronal projection: the central beam goes through the crown. Marginal – limbal position (projection) Apical position - projection In horizontal plane Orthoradial and excentric projection ̶ Orthoradial – the central beam goes parallel to interdental septa ̶ Excentric– the central beam goes from distal or mesial side. (Useful for endodontics or impacted teeth esp. canine) Bitewing Film or receptor is placed in a special holder, patient bites into The central beam goes parallel to interdental septa Crowns of teeth are well seen – good for early diagnosis of dental caries in posterior area Principle of imaging ̶ Irradiation is absorbed in various materials esp. in hard tissues. Accc to amount of absorbed irradiation radioopacity or radiolucency can be seen. Radiolucency – dark Radioopacity - white ̶ Rtg status LR i.o. LR LR OPG radioopacity radiolucency CBCT Bite Wing The sensor is situated in a special holder on the oral side of teeth, the patient bites to the plate. The central beam goes parallel to interdental septa Maxillary and mandibulary premolars and molars are seen. 2 -4 radiograms are needed acc.to the size of the sensor 67 D4 D3D1 Detection of dental caries Gap, inhomogenityD3 Gap, Bad contact point Investigation of quality of fillings Bad contour of the filling 70 D2 Alveolar bone Definujte zápatí – název prezentace nebo pracoviště71 Excentric projection Orthoradial projection, Bis. Angle, apical position Definujte zápatí – název prezentace nebo pracoviště72 Overlapping D1, D2 Bite wing Intraoral radiogram – marginal position of the tube Paralleling or bissecting angle technique The tube is situated coronally The level of alveolar bone is well seen 73 Resorption of alveolar bone Defects in cervical area – resorptions, roor surface caries Traumatic defects Definujte zápatí – název prezentace nebo pracoviště74 OPG ̶ Overview – both dental arches. ̶ Positions of teeth, ̶ Fillings ̶ Periapical pathology, pathological processes in the bone ̶ Resorption of the bone ̶ Traumatology Definujte zápatí – název prezentace nebo pracoviště75 Definujte zápatí – název prezentace nebo pracoviště76 Intraoral radiogram – apical position of the tube Paralleling or bissecting angle technique The tube is situated apically Periapical area is well seen 77 Periodontal space in apical area Periapical pathology Root canal morphology Quality of the endodontic treatment Fractures of root CBCT Root canal and pulp chamber morphology Apical pathology Pathology of surrounding structures 78