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. Enamel Dentin Cementum Dental pulp Periodontal tissues Enamel 4 Covers the crown 98% inorganic subst. Thin layer in cervical area Cementum • Covers the root 50% inorganic substances Insertion of collagen fibers (Sharpey). Thin layer in cervical area Dentin Core of the tooth 75% inorganic substances Collagen fibers incrusted with hydroxyapatite crystals Dentin tubules – Tomes fibres (cytoplasmatic fibres of odontoblasts) Dental pulp The tisue in the pulp chambre, It contains cells, intercellular substance, vesssels and nerves. Odontoblasts at the periphery. Primary, secondary, terciary, sklerotic dentin. 8 9 10 11 12 Sklovina v cervikální oblasti 13 Sklovina Dentin Cement Anatomical and clinical crown Cervical area ➢Special arrangement of hard dental tissues ➢Caries danger area ➢Gingiva in close proximity ➢Special loading by elastic deformation of dental crown by occlusal loading. 16 Exposure of dentine in cervical area 17 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 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 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 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. 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 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. Aethiology - abfraction Hard enamel Elastic dentin During the occlusal loading – elastic deformation of dentin - enamel looses the support - fracture of small pieces - abfraction Combination of factors ➢Abrasive effect of tooth brushes and pastes It is not tlikely 36 Caries Cervical defects – erosion+abrasion Gingival recessions • Hard toothbrush • Horizontal technique • Toothpaste with high RDA lroubalikova@gmail.com 42 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 59lroubalikova@gmail.com Laser Biostimulation a analgetic effekt, closure of dentine tubuls • Nd:YAG • Er:YAG • Diodový laser Surgical therapy of exposed necks