Adobe Systems Restorative dentistry III. 4 th lecture Dentin hypersensitivity and non carious lesions (defects) Adobe Systems 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 Adobe Systems 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 Adobe Systems 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) Adobe Systems 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 Adobe Systems Anatomical and clinical crown ̶ klinikcá korunka klinikcá korunka2 Adobe Systems 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. Ø 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 Adobe Systems 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. Adobe Systems Dentin exposure ̶ ̶ ̶Loss of enamel ̶Gingival recession ̶Combination hotovekrcky Adobe Systems Loss of enamel ̶Eroze ̶ ̶Abraze ̶ ̶Atrice ̶ ̶Abfrakce Adobe Systems 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. Adobe Systems Acidic food and beverages alimentar source of acids ̶Fresh fruit (citrus) ̶Fresh vegetable ̶Food with winegar, marinade – pickle ̶Dressings with winegar ̶Ketchup ̶Fruit bonbons ̶ Adobe Systems 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 ̶ Adobe Systems 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 Adobe Systems 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. Adobe Systems ̶ klinovedef Adobe Systems Abrasion ̶ ̶Demastication (food), parafunctions (biting of various objects e.g. pencil), toothbrushing (abrasive pastes, hard toothbrushes) Adobe Systems Attrition -Loss of hard dental tissues by direct contact of antagonists. Gritting, bruxism. Reasons: - Psychogenic factors (stres,anger) -Physical effort - Complicated intermaxillary relationships cech Adobe Systems 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 Adobe Systems 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 Adobe Systems Combination of factors Ø Ø ØAbrasive effect of tooth brushes and pastes It is not tlikely 36 cahl1 cahl2 cahlhotovo owl cahl3 cahlpo11 Adobe Systems Caries ̶ cahlík V Adobe Systems Cervical defects – erosion+abrasion Adobe Systems Gingival recessions ̶ ̶Hard toothbrush ̶Horizontal technique ̶Toothpaste with high RDA ̶ Adobe Systems M:\Zalohapc\para\kamen.jpg M:\Zalohapc\para\recesy1.jpg lroubalikova@gmail.com IMG_2605 IMG_2607 IMG_2619 42 pospisek Recessions Adobe Systems Strategy of the therapy ̶ - Find the reason ̶Remove the reason - Treatment Adobe Systems 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. Adobe Systems Fluorides Calcium fluoride Precipitates Fluoride reacts with calcium ions in tubular liquid Reversible Adobe Systems 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 Adobe Systems Duraphat® Colgate Oral Pharmaceuticals Fluor - Protector® Ivoclar Vivadent n Flor - Opal® Ultradent Bifluorid 12® VOCO Varnishes with fluorides Adobe Systems Adobe Systems 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. Adobe Systems Recaldent ̶Casein phosphopeptid Closure of dentin tubules Tooth Mousse, MI Paste Plus (GC, Japan) Adobe Systems 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 Adobe Systems 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 Adobe Systems CHitoActive ̶Chitosan, aminfluorid, stannum fluoride Protective film ̶ Elmex Adobe Systems 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 ̶ Adobe Systems Hydroxyapatite and fluorides ̶Remin Pro (VOCO) Adobe Systems Adhesive systems –sealing of dentin tubules HEMA Glutaraldehyd Triclosan Also precipitation of proteins Adobe Systems Filling therapy vacha3 vacha2 ̶ 59 lroubalikova@gmail.com E:\LRd\d\FRC čepy a publikace\Nová složka\obrazkyalegendafrc\obr03.jpg dentintub2 dentintubkom Adobe Systems Adobe Systems Laser Biostimulation a analgetic effekt, closure of dentine tubuls ̶ ̶Nd:YAG ̶Er:YAG ̶Diodový laser obr Adobe Systems Surgical therapy of exposed necks Kopie hromkova1 hromkova2