Definujte zápatí – název prezentace nebo pracoviště1 Preparation techniques and their clinical consequences – preparation trauma Preparation Power driven - Rotary - Alternative Hand - Excavator - Chisel Definujte zápatí – název prezentace nebo pracoviště2 Preparation techniques ̶ Pressure – max hand preparation – risk of excavators ̶ Vibrations ̶ Heat – due to friction - increases with rpm (turbine max) Definujte zápatí – název prezentace nebo pracoviště3 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 pracoviště4 Prevention ̶ Gentle interrupted preparation ̶ Sharp instruments, well centered ̶ Sufficient watercooling by using highspeed rpm (50ml/min) ̶ The biggest preparation instruments for the excavation of carious dentin Definujte zápatí – název prezentace nebo pracoviště5 From extension for prevention to prevention of extension ! Primum non nocere ! Minimal intervention = Approach Non invasive Minimally invasive ? Prevention od extension ❑ Ethiology and patogenesis of dental caries ❑ Biomechanical properties of the tooth ❑ Diagnosis ❑ Filling materials ❑ Preparations techniques Changes in the treatment concepts, size and shape of cavities Biomechanics MOD - 63% Endodontics - 9% Dehydratation -14% Ferrari M, Scotti R. Fiber posts. Characteristics and clinical applications. Milano: Masson,2002.c Illumination, magnification Clean surfaces Dry field Dry field Miniinvasive treatment - techniques ❑ Mechanical ❑ Chemo – mechanical ❑ Kinetic ❑ Laser ❑Mechanical preparation ➢Rotary ➢Sonic , ultrasonic ➢ART ➢Rotary (micro and miniinstruments) Minicavities Fissure opening Sedelmayer Sedelmayer J. Amalgám – zapomenuté řemeslo. Brno, 2000. Bažant V. Konservační zubní lékařství, SPN Praha,1962. Slot preparation with macroretention Sedelmayer Adhesive slot Tunnel preparation 1. Low caries risk 2. Compliance 3. Marginal ridge without infraction 4. D3 1. Magnification 2. Miniinstruments 3. Disinfection of cavities 4. GIC or composite 5. BW post op Success? ➢Sonic and ultrasonic preparation – oscillating instruments Ultrasonic preparation ✓Walls are smoother in comparison to rotary preparation ✓Time of the preparation is significant longer ✓Exkavation of carious dentin is nor sufficient ✓Marginal adaptation of composite filling is not significantgly better Roubalíková L. Ultrasonická preparace v ošetření zubního kazu , PDD 2004. ➢ART ➢ART ➢ART –atraumatic restorative technique ART ✓Miniinvasive ✓Remineralization ✓Large lesions ✓Children ✓Disabled patients ➢ Chemomechanical preparation ➢Chemo – mechanical preparation ✓No anesthesia needed ✓Smell of chlor ✓No noise ✓For anxious and disabled patients ✓Time consuming Rafique S, Banerjee A, Fiske J. Clinical trial of an air-abrasion/Carisolv gel regimen for restorative treatment for dentally anxious patients. Caries Res 2002; 186 (Suppl.3)36:39. ➢Kinetic preparation – sandblasting – air abrasion ✓Good accepted by patients ✓Time consuming ✓Excavation of dentine is not sufficient ✓Rough borders ✓Dust Pietrini DR. Air abrasion for 21st century. Dent Today 2000;19:106-108 ➢ Laser Er,Cr:YSGG Laser Er: YAG Roubalíková L, Wilhelm Z, Bilder J. : Use of Er:YAG laser in non carious cervical lesions. Clin Oral Invest, v tisku, 2004. Adhesive preparation Sklovina Adhesive preparation Dentin Lenka Roubalikova, CZ ✓Good accepted ✓Time consuming ✓Antimicrobial effect ✓Risk of perforation of pulp chambre ✓Price lenka.roubalikova@tiscali.cz 43 Thank you !