Preclinical dentistry I. 1.lecture • • •Doc. MUDr. Lenka Roubalíková, Ph.D. •lroubal@med.muni.cz •+420 607 122 064 [USEMAP] 2 Enamel Dentin Cementum Dental pulp Periodontal tisues [USEMAP] Restorative dentistry • •Diseases of hard dental tisues, dental pulp and •periodontal tissues (of pulpal origin) •Aethiology, ,pathogenesis,diagnosis,therapy and •prevention. • • [USEMAP] Diseases of hard dental tissues •Congenital – genetic reasons • •Postnatal -Before eruption - After eruption • [USEMAP] Congenital •Amelogenesis imperfecta • • Enamel is affected • •Dentinogenesis imperfecta • •Dentine is affected • [USEMAP] Before eruption • Hypomineralization (white, brown spots) • •Defects of enamel (hypoplasia) • • Reasons •- local (inflammmation, traumatic dental injuries) -systemic (systemic diseases, antibiotics) • • • [USEMAP] After eruption •Dental caries •Trauma •Attrition, abrasion •Erosion •V-shaped defects • • [USEMAP] Antony van Leeuwenhoek (1632 – 1723) nizozemský přírodovědec a vynálezce. Obchodník v Amsterdamu a vědec samouk, byl členem královské společnosti. Zhotovil jednoduchý mikroskop s jedinou čočkou, který zvětšoval 300krát. Prostudoval řadu mikroorganismů a popsal jejich způsob života. Mj. objevil krevní kapiláry, jako první podal v roce 1683 přesný popis bakterií a prvoků, popsal příčné pruhování svalů. Popisem buněčné stavby rostlin se stal jedním ze zakladatelů rostlinné anatomie. First observation of microbs in oral cavity 17.century [USEMAP] Dental caries •Willoughby Dayton Miller (1853 -1907) • •Explanation – theories • •Miller´s theory: chemical – bacteriogical •explanation C:\Users\Elite\Desktop\2014-03-22\miller.jpg [USEMAP] Origin of dental caries • •Dental caries originates as decalcification of hard dental tissues. This decalcification is caused by microbs that are present on tooth surfaces in the dental biofilm. These microbs utilize sugars. •After this decalcification also the decomposition of organic substances follows due to proteolytic microbs. [USEMAP] • DSC_0237 Dental biofilm – plaque. [USEMAP] Pelicle • A layer of proteins from saliva that precipitate on the tooth C:\Users\Elite\Desktop\2014-03-22\Image (3).jpg [USEMAP] Dental biofilm •Adherence • • C:\Users\Elite\Desktop\2014-03-22\Image (5).jpg C:\Users\Elite\Desktop\2014-03-22\Image (7).jpg [USEMAP] Dental biofilm • Colonization and coaggregation • C:\Users\Elite\Desktop\2014-03-22\Image (10).jpg C:\Users\Elite\Desktop\2014-03-22\Image (11).jpg [USEMAP] Dental biofilm •Maturation • C:\Users\Elite\Desktop\2014-03-22\Image (13).jpg C:\Users\Elite\Desktop\2014-03-22\Image (12).jpg [USEMAP] lenka.roubalikova@tiscali.cz 16 Dental bioífilm • Comunity • • • • • • • • • nemoc002 nemoc002 nemoc002 nemoc002 nemoc002 nemoc002 nemoc002 nemoc002 nemoc002 nemoc002 nemoc002 nemoc002 More species, Better conditions for survival Higher resistancy Higher virulency plak1 plak2 [USEMAP] Mikrobs Hard dental tissues Time Sugars [USEMAP] Metabolic activity lenka.roubalikova@tiscali.cz 18 pH 0 50 min 5,0 Stephan Dissolving of enamel [USEMAP] lenka.roubalikova@tiscali.cz 19 Ca2+ PO43- F- Ca2+ PO4 3- Ca10(PO4)6(OH)2 Ca10(PO4)6F2 OH- inickaz4 [USEMAP] lenka.roubalikova@tiscali.cz 20 Time Irreversibil: non cavitated lesion Reversibil: Initial (non cavitated) lesion inickaz3 inickaz4 kazdentinu kavitovanaleze cervikkavit Non cavitated lesion can be healed Cavitated lesion must be drilled and filled [USEMAP] Dental caries is multifactorial disease • Essential factors •- necessary • • •Co condition factors •- not necesasary but can influence the expansion [USEMAP] Co commitans factoras • •Quality of hard dental tissues and position of teeth •Food – composition and consistency • Systemic health •Age •Heredity (liking of sweetness?) •Climate • [USEMAP] Caries danger areas •Pits and fissures •Proximal surfaces below the contact point •Cervical third of dental crown (area below the maximum convexity) •Exposed root • •= habitually unclean areas cervikkavit [USEMAP] E:\LRd\d\Moodle\Preklinické zubní Lékařství I\Zubní kaz\Zubní kaz ve fissuře.jpg cervikkavit cahlík [USEMAP] 25 cahlík vychozistav [USEMAP] Habitually clean places •Incisal edges •Cusps and their slopes •Areas above the maximal convexity •Enamel ridges : transverse ridge, • oblique ridge korenovenastavby [USEMAP] Classification of dental caries •Acc to topograpoy •Coronal caries •Root surface caries • •According to affected surfaces •- See classification acc to Black •According to affected tissues •Caries in enamel •Caries in dentin •Caries in cementum • • • • • • [USEMAP] Classification of dental caries • According to its depth • • Surface caries (caries superficialis) • Middle caries (caries media) •Caries next to dental pulp (caries pulpae proxima) •Caries penetrating into dental pulp (caries ad pulpam penetrans) • • • •Deep caries [USEMAP] Surface caries [USEMAP] Middle caries [USEMAP] Caries next to dental pulp [USEMAP] Caries penetgrating into dental pulp [USEMAP] Classification of dental caries • According to history • • Acute •Chronic •Arrested [USEMAP] Classification of dental caries •According to origin •Primary caries •Secondary caries •Recurrent caries • • [USEMAP] Primary caries [USEMAP] Secondary caries [USEMAP] Recurrent caries [USEMAP] Penetrating caries [USEMAP] Undermining caries [USEMAP] black1 Green Vardiman Black (1836 – 1915) American professor Established the scientific bases of dentistry Formulated basic rules of preparation of cavities Developed the guidelines for amalgam fillings including the optimal composition of amalgam (balanced alloy) [USEMAP] Preparation • •Preparation is an instrumental treatment of the tooth that has been damaged by dental caries •in such a way that -the reconstruction of this tooth is possible -the filling does not fall out -the tooth as well as the filling can face up to occlusal forces -the risk of the caries on treated surface si minimal • (Black 1914) black [USEMAP] Preparation • •Preparation is an instrumental treatment of the tooth that has been damaged by dental caries •in such a way that -the reconstruction of this tooth is possible -the risk of the caries on treated surface si minimal- extention for prevention -the filling does not fall out -retention -the tooth as well as the filling can face up to occlusal forces -resistance • (Black 1914) black [USEMAP] • • •After we understand the reasons of dental caries we will be able it to heal it • • (Black 1900) black [USEMAP] lenka.roubalikova@tiscali.cz 44 Classification acc. to Black • Class I. • •Pit and fissure caries kreplová [USEMAP] lenka.roubalikova@tiscali.cz 45 Classification acc. to Black •Class II. •Proximal surfaces in premolars and molars vychozistav [USEMAP] lenka.roubalikova@tiscali.cz 46 Classification acc. to Black •Class III. • •Proximal surfaces of incisors and canines without •lost an incisal ridge daniel9 [USEMAP] lenka.roubalikova@tiscali.cz 47 Classification acc. to Black •Class IV. •Proximal surfaces of incisors and canines with •lost an incisal ridge • • Kopie vychstavmikulov [USEMAP] lenka.roubalikova@tiscali.cz 48 Classification acc. to Black •Class V. cervical lesions • Kopie kaz [USEMAP] Clasification acc. to black •VI. Class •Caries on incisal edges (abraded) [USEMAP] Sequence of operations •Acces to the cavity • •Preparation through the hard dental tissues •Removal the undermined enamel •Separation of teeth •Separation or removal of gingiva [USEMAP] vychozistav Prepration through hard dental tissues preparačni nastroje [USEMAP] zacatekpreparacekavity vylomeni Breaking the enamel [USEMAP] Removal of the undermined enamel • Kopie kaz preparačni nastroje [USEMAP] kavitankavitasklinkem Separation with wooden wedge [USEMAP] daniel8 pristup do kavity Removal of the old filling [USEMAP] M:\obrazové a případové případové studie\pripad 02\DSC_0355.JPG Removal of the ingrown gingiva [USEMAP] Sequence of operations •Acces to the cavity •Establishment of the cavosurface margin - •extention for prevention •Retention of the filling •Resistance of the restored tooth ( the filling •as well as the restoration) •Excavation of carious dentin •Protection of dentin wound •Finishing of the walls •Final control (light, miror, magnification) • [USEMAP] Sequence of operations •Preparation of cavity borders and extention •for prevention (Cavosurface margin) • •Depends on •Dental material •Oral hygiene • •Precautions of secondary caries • [USEMAP] Sequence of operations • •Retention of the filling • •Precautions of its lost •Macromechanical retention •Micromechanical retention •Chemical retention [USEMAP] Sequence of operations •Resistance of the restored tooth • •Against occlusal and other forces • •Depends on -Material -Individual occlusal forces • [USEMAP] Sequence of operations • •Excavation of carious dentin • •Necessary (risk of recurrent caries) • •Ball shaped (spheric) bur - slow speed (3000 rpm) •or •Excavator (hand instrument) • [USEMAP] Sequence of operations •Finishing of the walls • •Depends on the kind of material -Bevel or without bevel -Fine diamond bur • [USEMAP] Protection of dentin wound • • •Filling itself • •Base (below the filling – protection against thermal exposure ot toxiccity of dental materials) [USEMAP] Sequence of operations •Final control • •Direct or indirect view •Good illumination •Magnification • • [USEMAP] Preparation •Hand •Excavator, cleaver • •Power driven •Rotary •Non standard preparation •Burs, diamonds [USEMAP] Chisel – for enamel Cleaver Black_dlátko_na_sklovinu [USEMAP] Chisel for enamel Black_dlátko_na_sklovinu_zahnuté [USEMAP] Excavator • [USEMAP] zelenekolenko Motors and handpieces Turbine Micromotor Handpiece [USEMAP] Turbine turbina [USEMAP] Turbine •300.000 - 400.000 rpm • •Big force, les control, small torque [USEMAP] Motors – micromotors Electromotors – maximum 40.000/min Air motors – maximum 20.000/min Gear to fast Gear to slow 1: 1 Blocked rotation [USEMAP] Gear kolenko modre Blue coded handpiece 1:1 [USEMAP] Gear kolenkocervene Red coded handpiece 1:5 to fast [USEMAP] Gear zelenekolenko Green coded handpiece – to slow 2,7 :1 7,5 :1 [USEMAP] Hendpieces contraangle straight zelenekolenko kolenko modre preparačni nastroje [USEMAP] Cutting instruments •Burs • •Steel •Tungsten carbide • •Diamonds [USEMAP] Cutting instruments •Power driven (powered) instruments for cutting -Rotary instruments •Comon design characteristics • shank neck Head (cutting part) ISO [USEMAP] ISO1 Head (cutting part) neck shank diambrouskytvary [USEMAP] ISO ISO1 [USEMAP] konusek kulicka hruška fissurka1 fissure bur , round (ball) bur pear formed bur,, inverted cone bur Burs • [USEMAP] Konu Cutting instruments – diamonds head shape •Ball, pear, cylinder,taper,flame, torpedo, lens and others….. • • diambrouskytvary [USEMAP] Cutting instruments – diamonds •Extra coarse – black • •Coarse – green • •Standard – blue or without any marker • •Fine - red • •Extra fine - yellow • •Ultrafine - white • • [USEMAP] Diamonds • Blue –standard (90 – 120 mm) ISO 524 •Universal [USEMAP] Diamonds • Extra coarse (150 – 180 mm) ISO 544 • •Cutting of crowns, old fillings [USEMAP] Diamonds •Removal of old fillings, some preparations in prosthetic [USEMAP] Diamanonds • Red fine ( 20 – 40 mm) ISO 514 •Finishing of borders of cavities [USEMAP] Diamanonds • Extrafine (12 – 22mm) ISO 504, finifshig of composite fillings [USEMAP] Diamonds •Ultrafine – polishing of composite fillings (6-12 mm) ISO 494 [USEMAP] Thank you! •