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PreclinicalPreclinical DentistryDentistry
I. I. Dental Dental CariesCaries
Non Non cariouscarious lesionslesions : trauma, : trauma, erosionerosion . . abrasionabrasion , , wedgewedge shapedshaped
defectsdefectsLenka Lenka RoubalíkováRoubalíková
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UnderstandingUnderstandingdental dental cariescaries
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crown
neck
root
pulp chamber
root canal
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Dental Tissues
Enamel
Dentin
Cementum
Periodontal ligament
Alveolar bone
Pulp
Gingiva
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tooth
microbs
sugar
time
Dental caries
caries
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Dental Dental CariesCaries
InfectiousInfectious microbiologicalmicrobiological diseasedisease ofof thethe teethteeth thatthat
resultsresults in in localizedlocalized dissolutiondissolution andand destructiondestruction ofof
thethe calcifiedcalcified tissuestissues
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BiofilmBiofilm –– Dental Dental PlaquePlaque
ComplexComplex communitycommunity
SimpleSimple circulationcirculation
Better conditions to survive
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Dental Dental BiofilmBiofilm –– Dental Dental PlaquePlaque
A A gelatinousgelatinous massmass ofof bacteriabacteria adheringadhering to to thethe
toothtooth surfacesurface. .
No shedding
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Dental Dental biofilmbiofilm
�� AdhesionAdhesion
�� ColonisationColonisation
�� MaturationMaturation
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SugarSugar
FermentableFermentable (mono(mono --, , didi -- tritri -- sacharidessacharides ))
Sucrose, glucose, lactose Acids
Demineralization
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Dissolution–demineralization
Time
Cavitated lesion
Non – cavitated lesion
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SalivaSaliva
�� PlaquePlaque formationformation
�� MicrobialMicrobial sourcesource
�� MineralMineral sourcesource
�� MicrobialMicrobial clearenceclearence
�� BufferBuffer capacitycapacity
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PredictablePredictable dirtydirty placesplaces
�� PitsPits andand fissuresfissures
�� ProximalProximal surfacessurfaces
�� CervicalCervical areaarea
No No selfself cleaningcleaning
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PredictablePredictable cleanclean placesplaces
�� CuspsCusps
�� ProximalProximal ridgeridge
�� IncisalIncisal edgeedge
�� BuccalBuccal oror oral oral surfacesurface uponupon thethe maximalmaximalconvexityconvexity
�� ProximalProximal surfacesurface uponupon tjetje
SelfSelf cleaningcleaning
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CariesCaries -- depthdepth
�� SurfaceSurface cariescaries ((cariescaries superficialissuperficialis))
�� MiddleMiddle cariescaries ((cariescaries media)media)
�� CariesCaries closeclose to pulp (to pulp (cariescaries pulpaepulpae proximaproxima))
�� CariesCaries penetratingpenetrating intointo thethe pulp (pulp (cariescaries ad ad pulpampulpampenetranspenetrans))
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CariesCaries -- TopographyTopography
�� CoronalCoronal cariescaries
�� RootRoot surfacesurface cariescaries
�� EnamelEnamel cariescaries
�� Dentin Dentin cariescaries
�� CementumCementum cariescaries
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CariesCaries
�� AcuteAcute
�� ChronicChronic
�� ArrestedArrested
�� PenetratingPenetrating
�� UnderminingUndermining
Acc to its history
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PrimaryPrimary cariescaries
SecondarySecondary cariescaries
RecurrentRecurrent cariescaries
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Patient Patient assesmentassesment
Clinical examinationClinical examination
DiagnosisDiagnosis
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DiagnosisDiagnosisofof dentaldental cariescaries
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InvestigationInvestigation
�� MirrorMirror
�� Sharp Sharp ProbeProbe
�� IllimunationIllimunation
�� MagnificationMagnification
�� XX-- rayray , , otherother methodsmethods i.e. i.e. transilluminationtransillumination , , infraredinfraredlaser laser fluorescencyfluorescency
Dark spot, hole, defect
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Dental Dental CariesCaries -- TreatmentTreatment
�� Non Non cavitatedcavitated lesionlesion::
On On molecularmolecular basisbasis
-- Dental Dental hygienehygiene
-- FluoridesFluorides, , CalciumCalcium, , PhosphatesPhosphates
-- DietDiet
-- AntimicrobialAntimicrobial agentsagents
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Dental Dental CariesCaries -- TreatmentTreatment
�� CavitatedCavitated lesionlesion::
PreparationPreparation
FillingFillingDrill anf fill
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PreparationPreparation
InstrumentalInstrumental treatmenttreatment
RemoveRemove cariescaries
LeaveLeave thethe rest rest ofof thethe dental dental tissuestissues
-- to to bebe restoredrestored
-- to to bebe resistentresistent againstagainst thethe bite bite forcesforces
-- to to bebe preventedprevented againstagainst thethe recurrentrecurrent cariescaries
((BlackBlack 1914)1914)
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ClassificationClassification ofof cavitiescavitiesaccordingaccording to to BlackBlack
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ClassClass I.I.
CariesCaries in in fissuresfissures andand pitspits –– occlusalocclusal
surfacessurfaces ofof premolarspremolars andand molarsmolars
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ClassClass II.II.
ProximalProximal surfacessurfaces ofof molarsmolars andand premolarspremolars
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ClassClass III.III.
ProximalProximal surfacessurfaces ofof incisorsincisors andand caninescanines
withoutwithout lossloss ofof thethe incisalincisal edgeedge
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ClassClass IVIV
ProximalProximal surfacessurfaces ofof incisorsincisors andand caninescanines
withwith thethe lossloss ofof incisalincisal edgeedge
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ClassClass V.V.
CervicalCervical area area
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Charting and recordsCharting and recordsthethe most most importantimportant notationnotation
�� Caries Caries //
�� FillingFilling PP
�� ToothTooth forfor extractionextraction XX
�� ExtractedExtracted toothtooth ++
�� CrownCrown
�� PonticPontic
�� ToothTooth in in removableremovable denturedenture 00
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Instruments Instruments forfor investigationinvestigation ––investigativeinvestigative instrumentsinstruments
Explorer (Explorer (probeprobe): ): Sharp, Sharp, straightstraight oror bowbow shapedshaped::CariesCaries detectiondetection –– lghtlght motionmotion withoutwithout anyanypressurepressure: dental : dental surfacessurfaces, , fillingsfillings..
PeriodontalPeriodontal explorerexplorer ((probeprobe): not ): not sharpsharp,,calibratedcalibrated, , investigationinvestigation ofof periodontalperiodontalpocketspockets
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Instruments Instruments forfor investigationinvestigation ––investigativeinvestigative instrumentsinstruments
�� MirrorMirror –– flatflat oror concaveconcave
�� To To seesee lessless availableavailable regionsregions
�� To To illuminateilluminate
�� To To movemove offoff soft soft tissuestissues ((cheekscheeks, , tonguetongueetcetc.).)
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Instruments Instruments forfor investigationinvestigation ––investigativeinvestigative instrumentsinstruments
TweezerTweezer
To To gripgrip variousvarious instrumentsinstruments andand suppliessupplies. .
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Instruments Instruments forfor cavitycavitypreparationpreparation
HandHand instrumentsinstruments forfor cuttingcutting
TwoTwo mainmain materialsmaterials: :
StainlessStainless steelsteel ((losesloses keenkeen edgeedge))
CarbonCarbon steelsteel ((corrodecorrode))
ExcavatorExcavator
ChiselChisel-- cleavercleaver
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Instruments Instruments forfor cavitycavitypreparationpreparation
PowerPower drivendriven instrumentsinstruments forfor cuttingcutting
-- RotaryRotary instrumentsinstruments
ComonComon design design characteristicscharacteristics
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shank neck head
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ShankShank
�� TheThe part part thatthat fitsfits intointo thethe handpiecehandpiece
�� AcceptsAccepts thethe rotaryrotary motionmotion fromfrom thethe
�� handpiecehandpiece
�� ProvidesProvides a a bearingbearing surfacesurface to to controlcontrol thethe
�� alignmentalignment andand concentricityconcentricity ofof thethe
�� instrumentinstrument
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StraightStraight handpiecehandpiece shankshank
�� SimpleSimple cylindercylinder
�� heldheld in in thethe handpiecehandpiece in a metal in a metal chuckchuck
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LatchLatch angleangle handpiecehandpiece shankshank
�� ShorterShorter lengthlength –– accessaccess to to posteriorposterior regionsregions
HandpieceHandpiece –– contracontra angleangle, metal , metal burbur tube.tube.
TheThe endend ofof thethe instrument instrument fitsfits intointo DD--shapedshaped
socketsocket atat thethe bottombottom ofof thethe burbur tube. tube. TheThe
instrumentinstrument retainedretained by a by a retainingretaining latchlatch thatthat
slidesslides intointo thethe groovegroove foundfound atat thethe shankshank endend ofof
thethe instrumentsinstruments. . Low and medium speed
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FrictionFriction gripgrip handpiecehandpiece shankshank
SmallerSmaller design, design, simplesimple cylindercylinder..
HeldHeld in in thethe handpiecehandpiece by by frictionfriction in in plasticplastic oror
metal metal chuckchuck. .
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NeckNeck designdesign
IntermediateIntermediate portionportion ofof anan instrument instrument thatthat
connectsconnects thethe headhead to to thethe shakshak
TaperedTapered, , shortershorter oror longerlonger. .
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HeadHead designdesign
Burs Burs –– cutcut ofof steelsteel oror tungstentungsten carbidcarbid
DiamondDiamond ((diamonddiamond burs)burs)–– coveredcovered withwith thethediamonddiamond bortbort
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HeadHead designdesign
Burs Burs classificationclassification systémsystém
RoundRound
InvertedInverted conecone
PearPear shapedshaped
StraightStraight fisurefisure
TaperedTapered fissurefissure
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BurBur bladeblade designdesign
�� RakeRake face (face (towardstowards thethe directiondirection ofofcuttingcutting))
�� ClearenceClearence faceface
RakeRake angleangle –– slightlyslightly negativenegativeEdgeEdge angleangle –– apprappr 90°90°ClearenceClearence angleangleClearenceClearence face face roundedrounded oror twotwo surfacessurfaces. .
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HeadHead designdesign
DiamondDiamond classificationclassification systémsystém
RoundRoundInvertedInverted coneconePearPear shapedshapedCylinderCylinderTaperTaperLensLensNeedleNeedle etcetc. .
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DiamondDiamond abrasiveabrasive instrumentsinstruments
DiamondDiamond bort bort –– smallsmall aharpaharp particlesparticles inin
softersofter matrix. matrix. CuttingCutting occursoccurs atat a a largelarge
numbernumber ofof pointspoints. .
Metal Metal blankblank
DiamondDiamond powderpowder
MetallicMetallic bondingbonding materialmaterial
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PreparationPreparation speedspeed
�� LowLow ((slowslow) ) speedsspeeds –– belowbelow 12.000 12.000 rpmrpm
�� Medium Medium oror intermediateintermediate speedsspeeds 12.000 12.000 ––200.000 200.000 rpmrpm
�� HighHigh oror ultrahighultrahigh speedsspeeds aboveabove 200.000 200.000 rpmrpm
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1 : 1 Gear assembly
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1:4 až 1:5Speed increasing gear
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1 Green ring: 2,7:1
2 Green rings: 7,4:1 Speed decreasing gear
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Spitting box with amalgam separator
Light
Driving system
Tray
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Hoses lower leading
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Hoses – uper leading
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CavityCavity preparationpreparation
�� PowerPower drivendriven
�� HandHand
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400.000 400.000 rpmrpm
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Electromotors – maximum 40.000/min
Airmotors – maximum 20.000/min
Gearing to fast speedGearing to slow speedOscillation
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1 : 1 as far as 40.000 rpm
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RedRed codedcoded handpiecehandpiece
1:4 až 1:5 as far as 160.000 – 200.000 rpm
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Preparace strojová Preparace strojová -- pohonypohony
2,7:1 7,4:1
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BlueBlue andand green green codedcoded handpiecehandpiece
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HanpiecesHanpieces combinedcombined
1:1
2:1
nerotuje
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ISO6360
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FillingFilling materialsmaterials
TemporaryTemporary
ZinkoxidsulphateZinkoxidsulphate cementcement
OneOne componentcomponent cementscements basedbased on on gypsumgypsum andand
organicorganic lutelute
ZinoxidphosphateZinoxidphosphate cementcement
DefinitiveDefinitive
AmalgamAmalgam
CompositesComposites
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FillingFilling materialsmaterials
Amalgam:Amalgam:
MercuryMercury
PowderPowder –– metal metal alloyalloy::
SilverSilver
TinTin
CopperCopper
ZincZinc
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ChiselChisel –– forfor enamelenamel
CleaverCleaver
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ChiselChisel forfor enamelenamel
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ExcavatorExcavator
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FillingFilling instrumentsinstruments
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BurnisherBurnisher --planeplane
AngularAngular-- troughtrough edgeedge troughtrough faceface
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BurnisherBurnisher –– angularangular threethree faceface
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CondensorCondensor andand burnisherburnisher combinedcombined
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Amalgam Amalgam carriercarrier
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CondensorCondensor forfor amalgamamalgam
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CondensorCondensor forfor guttaprechaguttaprecha -- hoofhoof
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BallBall condensorcondensor
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CondensorCondensor ––stamenstamen
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FosterflaggFosterflagg
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FrahmFrahm
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CarverCarver: : DiscoidDiscoid -- CleoidCleoid