Alternatives to conventional cavity preparation in paedodontics

Presentor:

Sana Mateen Munshi

Use of high speed followed by low speed hand pieces with different types of

burs available.

» Atraumatic restorative technique (ART).

» Simple and modified atraumatic restorative technique (SMART).

Chemomechanical caries removal (CMCR).

Ozone therapy.

Tooth preparation using air abrasion.

Air Polishing.

Tooth preparation using lasers.

Caries infiltration.

“Minimum (or minimal) intervention dentistry (MI) can be

defined as a philosophy of professional care concerned with

the first occurrence, earliest detection, and earliest possible

cure of disease on micro (molecular) levels, followed by minimally invasive and patient-

friendly treatment to repair irreversible damage caused by

such disease.”

Ref: Amercian Academy of Pediatric Dentistry

Atraumatic Restorative Treatment is a method to remove caries using only hand instruments and fill it with glass ionomer cement, can be applied to restorative treatment of primary teeth.

Minimally invasive procedures

The method is showed to obtain sufficient effect comparable to composite resin fillings and amalgam fillings , without inducing fear of children.

Application in developing countries.

ADVANTGES OF ART:

Non painful.

Biological approach with minimum cavity preparation.

It is simple to practice.

It is more effectively reached to the community.

And can prevent extraction in most cases.

Low cost.

Gain all the advantage of GIC as a restorative material.

INDICATIONS OF ART:

Great technique for root caries.

Good alternative in outreachprograms.

Excellent for fearful children.

Good alternative in medically compromised patients.Good alternative in mentally compromised patients.

Cannot be used in deep carious lesions as well as teeth that are painful and pulp is exposed.

MOUTH MIRROR

PROBE

PAIR OF TWEEZERS

To reflect light onto the field

of operation

To view cavity indirectly and

to retract

To retract cheek and tongue

To identify where soft caries

dentin is present

DONOT poke into small

lesions

DONOT poke into deep lesions

To carry cotton wool rolls and

wedges.

• This instrument is used to remove soft carious dentine.

• Small Excavator have a diameter of 1mm. Used in small cavities and for cleaning the enamel/dentin junction.

• The diameter of medium is 1.5mm, It is used for removing soft caries from large cavites.

• Rounded surface is used to push the material in small cavities.

• This instrument is used for widening the entrance to the cavity.

• For slicing away the unsupported and carious enamel left.

http://www.youtube.com/watch?v=Dntaxz7yNAwANIMATION:

• There has recently been resurgence of interest in air abrasion technology with several different commercial units available.

• With air abrasion machines, aluminum oxide particles (27 or 50 um) are blasted against teeth under a range of pressures (30-160 psi) with variable particle flow rates.

INDICATIONS OF AIR ABRASION

Cleaning and removing stains and incipient caries from pits and fissures prior to sealant and PRRs.

Small class I, III, IV and V cavity preparations and selected class II preparations.

Repair and removal of composites, glass ionomer and porcelain restorations.

Cleaning and preparation of castings, orthodontic bands and brackets prior to cementation.

ADVANTAGES DISADVANTAGES

Elimination of vibration, less voice and decreased pressure.

Dust is a practical problem. Control of dust containing free aluminum oxide is an ongoing challenge.

Reduction in pain during cavity preparation, 85% of patients do not require local analgesia.

The technique cannot remove leathery dentinal caries or prepare extensive cavities requiring classical retentive form.

Less damaging pulpal effects than conventional hand pieces.

The tip does not touch the tooth and there is no tactile sensation.

Less fracture and crazing of enameland dentine during cavity preparation.

Ability to remove sound structure rather than carious substrate.

Root canal access through porcelain crowns without fracturing porcelain.

Potential risk of inhalation of aluminum particles.

In the preparation of PRRs, this technique gives good result than conventional methods.

Air-polishing is another technique utilizing a mixture of water-soluble sodium bicarbonate and tricalcium phosphate particles that is applied onto the tooth surface using air pressure and shrouded in a concentric water jet.

http://www.youtube.com/watch?v=MQzVPshI6LcANIMATION:

ADVANTAGES DISADVANTAGES

The water jet helps the abrasive not to escape far from the operating field.

Detrimental surface of such restoration and sound tooth structure could be the result of non selected abrasive characteristic of such method.

INDICATIONS:

Indicated in coronal polishing, a cosmetic procedure designed to remove extrinsic stains from the enamel surfaces of teeth.

Several researchers suggested the use of that technique only for removing carious dentin at the end of cavity preparation.

The technique uses laser detection of caries and Ozone treatment for less than two minutes. Ozone readily penetrates through decayed tissue, eliminating the ecological niche of cariogenic microorganisms as well as priming the carious tissue for remineralization.

ADVANTAGES DISADVANTAGESThis simple approach avoids need of local anesthesia, drilling and filling.

Remineralization takes place with the aid of topically applied fluoride and rinses.

Restricted to treat superficial enamel androot caries

Hand pieces are still indicated for deep carious lesions.

“It is clear that, among complementary approaches, ozone therapy has emerged as the one that is well explainable with classical biochemical, physiological, and pharmacological knowledge.”

(Velio Bocci- Ozone, a new medical drug)

Ref: American College of Integrative Medicine and Dentistry (ACIMD) -“Ozone in Dentistry”

NaOCl was diluted and buffered with sodium hydroxide, sodium chloride and glycine producing a solution of 0.05% N-monochloroglycine (NMG) having a pH of 11.4. This solution is commercially known as GK101.

The GK101 material is found to be more effective if glycine is replaced by amino-butyric acid. The product is then known as N-monocholo D2 amminobytyrate (NMAB) and named as GK101E.

ADVANTAGES DISADVANTAGES

The results indicated noremnants of the demineralizeddentine were detected aftertreatment and the remaining dentinewas chemically and clinically sound

Lengthy procedure is the only apparent drawback.

reducing the use of conventionaldrilling and the need for localanesthesia

unpleasant tasteindicated by few patients

nominated system for treatinganxious, medically compromised andpediatric dental patients.

Provides efficient removal of dental carieswith no harm expected either on thehealthy dentine or the pulp tissues.

Carbon dioxide lasers

• Soft tissue incision• Aesthetic contouring of gingivae• Treatment of ulcers• Fraenectomy and gingivectomy• De-epithelization of gingival

tissue during periodontal regenerative procedures.

Neodymium: YAG

• Similar to above plus removal of incipient caries but because of depth of penetration there is greater risk of collateral damage than with dioxide lasers.

Erbium: YAG

• Caries removal • Cavity preparation in both

enamel and dentine.• Preparation of root canals

Argon lasers

Resin curingTooth bleachingTreatment of ulcersAesthetic gingival contouringFranectomy and gingivectomy

ADVANTAGES DISADVANTAGES

Laser use results in clean sharp margins in enamel and dentine.

Cost.

The pulp is protected and safe as the depth of energy penetration is negligible.

The laser tip does not impinge dental tissue so there is no proprioceptive feedback.

Patients report little or no pain.

Technique sensitive.

Time taken for cavity preparation is short.

Erbium lasers are used for cavity preparation.

“Icon represents a new category of dental products,” says Tim Haberstumpf, DMG America Director of Marketing. “It is the first product to bridge the gap between prevention (fluoride therapy) and caries restoration. Icon’s micro-invasive infiltration technology can be used to treat smooth surface and proximal carious lesions up to the first third of dentin (D-1). In just one patient visit, Icon can arrest the progression of early enamel lesions and remove white spot lesions.”

Incipient caries before treatmentCariogenic acids attack the enamel and draw out minerals. The tooth becomes porous.

After treatmentBy sealing the pore system, acids can no longer penetrate into the lesion, thus stopping the progression of the caries at an early stage.

Treat earlier - preserve longer• Esthetic results on smooth surfaces• Caries arrest at an early stage• Preservation of healthy tooth structure• Pain-free method, without anesthesia, or

drilling

Bridging the gap between prevention and restoration.

White spot lesions dectected

Application of Icon Etch

Rinse remaining etchant

Dry with air

Applying Icon infiltrate

Light cure

Effectiveness of air abrasion, chemomechanical is less than that of conventional drilling.

Majority of patients preferred the alternative means.

Laser treatment for caries removal is an effective substitute for air- rotary hand pieces yet its effectiveness is limited by equipment cost and treatment time.