DENTINE CARIESITS PROGRESSION ANDHOW BEST TO STOP IT   INDIAN DENTAL ACADEMY   Leader in Continuing Dental Education     w...
Dental CariesSugar and plaque, the archcriminals of dental caries
Dental CariesDemineralization, remineralization       Sugar + Dental Plaque            ACID            S        Deminerali...
Dental CariesDemineralization, remineralization          Subsurface    demineralization of              enamel      www.in...
Dental Caries     Demineralization, remineralizationOcclusal lesions can      be arrested by    remineralization
Dental Caries   Demineralization, remineralization   recently cleaned front teeth with signs of demineralization          ...
Dental CariesDemineralization, remineralization                                  No sugar before                          ...
Dental CariesThe Caries BalanceResistance   Plaque  removal   Sugar reduction   Fluoride   Sealants   Chlorhexidine  ...
Dental CariesStructure of dentine   Living tissue   Peritubular dentine   Intertubular dentine   Apatite crystals   I...
Dental CariesDentine Structure
Dental Caries    Progression of dentine caries    Bacterial Invasion12345678          www.indiandentalacademy.com
Dental Caries    Progression of dentine caries       Bacterial Invasion123           Bacteria need to have a source of n...
Dental Caries    Progression of dentine caries    Crystal Removal Process12345678
Dental Caries    Progression of dentine caries    Crystal Removal Process1        Acid from fermentation process penetrat...
Dental Caries    Progression of dentine caries    Crystal Removal Process (cont’d)1         Continuation of acid producti...
Dental Caries    Progression of dentine caries    Defense reaction in dentine12345678
Dental Caries    Progression of dentine caries       Defense reaction in dentine1       A  defence reaction takes place ...
Dental Caries    Progression of dentine caries    Defense reaction in dentine      (cont’d)1      These    crystals origi...
70      Outer Carious Dentine     Inner Carious Dentine                        Dental Caries                              ...
Dental CariesTwo layers of carious dentineOuter (‘infected’)      Inner (‘affected’)   BacterialInvasion      Few   Bact...
Dental CariesRemineralization of inner cariousdentinePrerequisites physiological  remineralization:   Presence  collagen ...
Dental Caries    Characteristics of occlusal caries                     Fissure enamel caries1234
Dental Caries    Characteristics of occlusal caries                       Fissure enamel and1                         dent...
Dental Caries    Characteristics of occlusal caries                         Fissure cavity1234                3.6 mm
Dental Caries    Characteristics of occlusal caries                        Lateral spread of fissure1                     ...
Dental Caries    Dentinal lesion formation and    progression: a summary1      Enamel demineralization follows the       ...
Dental Caries    Dentinal lesion formation and    progression: a summary1      In any pit and fissure system there can   ...
Dental Caries    Characteristics of approximal    caries    1. Subsurface demineralization of enamel.1234           www.in...
Dental Caries     Characteristics of approximal     caries    2. Partial demineralization of dentine directly1      undern...
Dental Caries    Characteristics of approximal    caries    3. The dentine demineralization follows the1      dentine tubu...
Dental Caries    Characteristics of approximal    caries    4. Lateral spread of dentine caries occurs1      mainly in cav...
Dental CariesCharacteristics of approximalcaries : a summary   Progression of approximal caries follows the    same princ...
Dental Caries    Traditional concepts of cavity    design12       GV Black’s cavity preparations followed3       designs ...
Dental Caries    Traditional concepts of cavity    design12    Mechanical retention3      Flatfloors4       Vertical wal...
Dental Caries    Traditional concepts of cavity    design1      Shape of the prepared cavity was not limited to2        t...
Dental Caries    Traditional concepts of cavity    design    ‘The application of a mechanical design on a      biological ...
Dental CariesLongevity of amalgamrestorations   Research findings     survival time single surface: 10 – 8 years     su...
Dental Caries    Repeat restoration cycle12    Repeat restoration cycle3      Occlusal lesion and occlusal restoration   ...
Dental Caries    Repeat restoration cycle       ‘Diagnoses’ are uncertain, with1        considerable variation occurring ...
Dental Caries    Repeat restoration cycle       Dentists have an urge to replace restorations12       Perceived (but err...
Dental Caries    Traditional approach:                           a Summary12       Much sound tooth tissue needs to be   ...
Dental Caries    Traditional approach:                           a Summary       The end result is a tooth that became1  ...
Dental Caries    Biological principals of cavity    preparation1      Cavity cleaning2            Obtaining access      ...
Dental Caries    Biological principals of cavity    preparation12        www.indiandentalacademy.com
Dental Caries    Appropriate instrumentation       Mechanical retention is no longer1        needed with adhesive materia...
Dental Caries    Appropriate instrumentation        Question:123       Is a rotary instrument the best tool45           w...
Dental Caries    Appropriate instrumentation1       NO !!!!     A rotary instrument is not2        the best instrument fo...
Dental Caries    Appropriate instrumentation       Hand instrument:1         Dental       hatchet2345678         (e.g., ...
Dental Caries    Appropriate instrumentation       Hand instrument:1         Excavator2345678             (e.g., 153 – 1...
Dental Caries    Appropriate instrumentation       Rotary instruments (only certain circumstances)123        Slow   spee...
Dental Caries    Appropriate instrumentation       Rotary instruments (only certain circumstances)123         High   spe...
Dental Caries    Appropriate instrumentation       Why hand instruments?1         creates   the most ideal (conservative...
Dental CariesCavity restoration:           WHY   To stop the caries process   To facilitate plaque removal   To encoura...
Dental CariesCavity restoration:                  HOW   Application of a material that:     produces    a seal against b...
Dental CariesCavity restoration:           WHICH MATERIAL   Adhesive restorative materials     composite resins and poly...
Dental Caries     Tooth preservation versus     cavity preparation1234        Preservation =    restoration + prevention  ...
Dental Caries        Tooth preservation versus        cavity preparation1234    Sealant      restorations
Dental Caries    Tooth preservation versus    cavity preparation12      For carious lesions in occlusal,3        buccal a...
Dental Caries    Tooth preservation versus    cavity preparation12      For carious lesions in approximal3        surface...
Dental CariesEffect of sealed versus non-sealed restorations   Clinical trial in the USA.     more   sound tooth structu...
Dental Caries    Summary1      The biological principle to the management of a23        dentine lesion is to only remove ...
Dental Caries    Summary1       Since only soft, completely2       demineralized tissue is removed, there3        can be ...
Dental Caries    Summary       The treatment is completed by placing an12        adhesive filling material into the clean...
Dental Caries    Summary1       This treatment modality has the potential2       to:3          control dentine caries4  ...
Dental Caries   Remember:     TO APPLY PREVENTIVE MEASURES     TO ENCOURAGE ORAL HYGIENE AND     TO PROMOTE THE USE OF...
Dental CariesThank you for watching,For more details please visit www.indiandentalacademy.com
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Dental caries progression /certified fixed orthodontic courses by Indian dental academy

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Indian Dental Academy: will be one of the most relevant and exciting training center with best faculty and flexible training programs for dental professionals who wish to advance in their dental practice,Offers certified courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic Dentistry, Periodontics and General Dentistry.

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Transcript of "Dental caries progression /certified fixed orthodontic courses by Indian dental academy "

  1. 1. DENTINE CARIESITS PROGRESSION ANDHOW BEST TO STOP IT INDIAN DENTAL ACADEMY Leader in Continuing Dental Education www.indiandentalacademy.com
  2. 2. Dental CariesSugar and plaque, the archcriminals of dental caries
  3. 3. Dental CariesDemineralization, remineralization Sugar + Dental Plaque ACID S Demineralization Cavities
  4. 4. Dental CariesDemineralization, remineralization Subsurface demineralization of enamel www.indiandentalacademy.com
  5. 5. Dental Caries Demineralization, remineralizationOcclusal lesions can be arrested by remineralization
  6. 6. Dental Caries Demineralization, remineralization recently cleaned front teeth with signs of demineralization and gingivitis after some weeksremineralization has taken place and the gingivitis is healed www.indiandentalacademy.com
  7. 7. Dental CariesDemineralization, remineralization No sugar before sleeping www.indiandentalacademy.com
  8. 8. Dental CariesThe Caries BalanceResistance  Plaque removal  Sugar reduction  Fluoride  Sealants  Chlorhexidine www.indiandentalacademy.com
  9. 9. Dental CariesStructure of dentine Living tissue Peritubular dentine Intertubular dentine Apatite crystals Intermolecular cross-linking www.indiandentalacademy.com
  10. 10. Dental CariesDentine Structure
  11. 11. Dental Caries Progression of dentine caries Bacterial Invasion12345678 www.indiandentalacademy.com
  12. 12. Dental Caries Progression of dentine caries  Bacterial Invasion123  Bacteria need to have a source of nutrients,4 i.e. from the oral environment.567  Bacteria are found mostly in the biomass8 with few being found in the dentine tubules. www.indiandentalacademy.com
  13. 13. Dental Caries Progression of dentine caries Crystal Removal Process12345678
  14. 14. Dental Caries Progression of dentine caries Crystal Removal Process1  Acid from fermentation process penetrates2 the dentine tubules ahead of bacterial34 invasion.5  This softens the dentine matrix.67  The collagen fibres are reversibly damaged8 in the dissolution process. cont’d www.indiandentalacademy.com
  15. 15. Dental Caries Progression of dentine caries Crystal Removal Process (cont’d)1  Continuation of acid production dissolves2 crystals in the peritubular and intertubular34 dentine.5  Further continuation of acid production6 breaks the intermolecular crosslinks of7 collagen fibres irreversibly.8
  16. 16. Dental Caries Progression of dentine caries Defense reaction in dentine12345678
  17. 17. Dental Caries Progression of dentine caries  Defense reaction in dentine1 A defence reaction takes place in the2 dentine.34  Dissolution alters the hydroxyapatite crystals.5  Crystals with a lower hardness and a lower67 calcium density (= whitelockite) remain.8  The dentine tubules are blocked by precipitated intratubular whitelockite crystals. cont’d
  18. 18. Dental Caries Progression of dentine caries Defense reaction in dentine (cont’d)1  These crystals originate from the2 peritubular and intertubular dentine.34  This process is known as TUBULAR5 SCLEROSIS.6  It is seen clinically as yellow-brownish78 discoloration of the dentine. www.indiandentalacademy.com
  19. 19. 70 Outer Carious Dentine Inner Carious Dentine Dental Caries - bacterial invasion - minimal bacterial invasion 60 - unremineralizable - remineralizableKnoop Hardness Number - dead - alive - without sensation - sensitive 50 40 30 transparant zone 20 10 zone of almost total zone of partial demineralization Sound Dentine demineralization E-D Junction 1000 2000 3000 µm Crystals in Tubule Lumen Peritubular dentine Intertubular dentine Bacteria Odontoblast Process
  20. 20. Dental CariesTwo layers of carious dentineOuter (‘infected’) Inner (‘affected’)  BacterialInvasion  Few Bacterial  Unreminerizable  Reminerizable  Dead  Alive  Without sensation  Sensitive www.indiandentalacademy.com
  21. 21. Dental CariesRemineralization of inner cariousdentinePrerequisites physiological remineralization:  Presence collagen fibers  Living odontoblastic processExternal remineralization:  Saliva , calcium and phosphate  Exposure bio-active agents
  22. 22. Dental Caries Characteristics of occlusal caries Fissure enamel caries1234
  23. 23. Dental Caries Characteristics of occlusal caries Fissure enamel and1 dentine caries234
  24. 24. Dental Caries Characteristics of occlusal caries Fissure cavity1234 3.6 mm
  25. 25. Dental Caries Characteristics of occlusal caries Lateral spread of fissure1 cavity234 3.6 mm
  26. 26. Dental Caries Dentinal lesion formation and progression: a summary1  Enamel demineralization follows the enamel rods.2  Initial dentine demineralization does not spread along the Enamel Dentine Junction (EDJ) beyond the periphery of the lesion in the enamel.  This leads to a cone shape lesion with the base at the EDJ. www.indiandentalacademy.com
  27. 27. Dental Caries Dentinal lesion formation and progression: a summary1  In any pit and fissure system there can be multiple lesions in different stages of2 progression. (Stages A, B and C.)  Only when there is frank cavitation and a cariogenic environment, will dentine demineralization spread in a lateral direction. (Stage D)
  28. 28. Dental Caries Characteristics of approximal caries 1. Subsurface demineralization of enamel.1234 www.indiandentalacademy.com
  29. 29. Dental Caries Characteristics of approximal caries 2. Partial demineralization of dentine directly1 underneath enamel lesion234
  30. 30. Dental Caries Characteristics of approximal caries 3. The dentine demineralization follows the1 dentine tubules234
  31. 31. Dental Caries Characteristics of approximal caries 4. Lateral spread of dentine caries occurs1 mainly in cavitated lesions234
  32. 32. Dental CariesCharacteristics of approximalcaries : a summary Progression of approximal caries follows the same principles as for occlusal caries. It follows the enamel rods, but because of the curved shape of the approximal tooth surface, the lesion does not lead to a cone shape at the EDJ as present in an occlusal fossa. www.indiandentalacademy.co
  33. 33. Dental Caries Traditional concepts of cavity design12  GV Black’s cavity preparations followed3 designs that were largely dictated by the4 physical properties of the filling materials (e.g., amalgam and silicate cement).  These materials needed mechanical retention
  34. 34. Dental Caries Traditional concepts of cavity design12 Mechanical retention3  Flatfloors4  Vertical walls  Triangular retention niches  Undercut areas
  35. 35. Dental Caries Traditional concepts of cavity design1  Shape of the prepared cavity was not limited to2 the tooth destruction caused by caries.34  The preparation did not follow the way a dentine lesion progresses.  Blacks principles could be considered as: the application of a mechanical design on a biological process www.indiandentalacademy.com
  36. 36. Dental Caries Traditional concepts of cavity design ‘The application of a mechanical design on a biological process1234
  37. 37. Dental CariesLongevity of amalgamrestorations Research findings  survival time single surface: 10 – 8 years  survival time multiple surface: 8 - 6 years Reasons for failures  secondarycaries  marginal breakdown www.indiandentalacademy.com
  38. 38. Dental Caries Repeat restoration cycle12 Repeat restoration cycle3  Occlusal lesion and occlusal restoration  2-Surface restoration  Extended restoration  Crown or Extraction
  39. 39. Dental Caries Repeat restoration cycle  ‘Diagnoses’ are uncertain, with1 considerable variation occurring between dentists.23  Extensive cavity preparations (Black) in the name of outline form and extension for prevention result in restorations with weak margins, leading to marginal breakdown and ‘ditching’. www.indiandentalacademy.com
  40. 40. Dental Caries Repeat restoration cycle  Dentists have an urge to replace restorations12  Perceived (but erroneous) requirement to3 ‘freshen up’ the cavity walls and margins.  The teeth inevitably become weaker, thereby reducing their prognosis.  The complexity of the restorations increases or  Tooth needs to be extracted.
  41. 41. Dental Caries Traditional approach: a Summary12  Much sound tooth tissue needs to be removed.  Traditionally placed restorations, on average, do not last long.  The replacement restorations, in many cases, last for less time. www.indiandentalacademy.com
  42. 42. Dental Caries Traditional approach: a Summary  The end result is a tooth that became1 weaker and weaker each time a replacement was made.2  The weaker the tooth becomes, the more likely the restoration will fail, resulting in a vicious cycle and termed the ‘repeat restoration cycle’.
  43. 43. Dental Caries Biological principals of cavity preparation1  Cavity cleaning2  Obtaining access  Removal of dead dentine and enamel  Anatomy determines the shape  No preconceived cavity design  Blacks principles are redundant www.indiandentalacademy.com
  44. 44. Dental Caries Biological principals of cavity preparation12 www.indiandentalacademy.com
  45. 45. Dental Caries Appropriate instrumentation  Mechanical retention is no longer1 needed with adhesive materials.2345  Shape of the cavity is determined by the6 anatomy of the lesion.78
  46. 46. Dental Caries Appropriate instrumentation  Question:123 Is a rotary instrument the best tool45 when the cavity is determined by6 the anatomy of the lesion ?78 www.indiandentalacademy.com
  47. 47. Dental Caries Appropriate instrumentation1  NO !!!! A rotary instrument is not2 the best instrument for:345  removing only soft, completely6 demineralized tooth tissue and78  preserving as much as possible remineralizable enamel and dentine.
  48. 48. Dental Caries Appropriate instrumentation  Hand instrument:1  Dental hatchet2345678 (e.g., 10 – 6 - 12) www.indiandentalacademy.com
  49. 49. Dental Caries Appropriate instrumentation  Hand instrument:1  Excavator2345678 (e.g., 153 – 154)
  50. 50. Dental Caries Appropriate instrumentation  Rotary instruments (only certain circumstances)123  Slow speed drill4  with straight bur for further opening of dentinal lesions5 that have a very small entrance6  with round bur for gentle removal of dead tissue.78 www.indiandentalacademy.com
  51. 51. Dental Caries Appropriate instrumentation  Rotary instruments (only certain circumstances)123  High speed drill4  onlyfor opening cavities that are inaccessible56  removal of failed restorations.78
  52. 52. Dental Caries Appropriate instrumentation  Why hand instruments?1  creates the most ideal (conservative) cavity23 shape4  gives the operator improved tactile sense56  does not damage surfaces adjacent to the7 lesion, in the case of approximal lesions and8  therefore, does not promote caries development. www.indiandentalacademy.com
  53. 53. Dental CariesCavity restoration: WHY To stop the caries process To facilitate plaque removal To encourage remineralization of inner carious dentine To restore function To restore aesthetics.
  54. 54. Dental CariesCavity restoration: HOW Application of a material that:  produces a seal against bacterial invasion  encourages remineralization  is sufficiently durable  maintains function. www.indiandentalacademy.com
  55. 55. Dental CariesCavity restoration: WHICH MATERIAL Adhesive restorative materials  composite resins and polyacid-modified composite resins (‘compomers’)  glass-ionomers and resin-modified glass- ionomers. Non-adhesive restorative materials  amalgam
  56. 56. Dental Caries Tooth preservation versus cavity preparation1234 Preservation = restoration + prevention www.indiandentalacademy.com
  57. 57. Dental Caries Tooth preservation versus cavity preparation1234 Sealant restorations
  58. 58. Dental Caries Tooth preservation versus cavity preparation12  For carious lesions in occlusal,3 buccal and lingual surfaces of4 posterior teeth:  Preventive resin restoration  Preventive glass-ionomer restoration  Atraumatic Restorative Treatment (ART ) www.indiandentalacademy.com
  59. 59. Dental Caries Tooth preservation versus cavity preparation12  For carious lesions in approximal3 surfaces of posterior teeth:4  Box-type restorations (outcome: good).  Tunnel preparation (outcome: dubious).  ART (outcome: unknown yet).
  60. 60. Dental CariesEffect of sealed versus non-sealed restorations Clinical trial in the USA.  more sound tooth structure was conserved  restoration margins were better protected  recurrent caries was less frequent  clinical survival of restorations was prolonged. www.indiandentalacademy.com
  61. 61. Dental Caries Summary1  The biological principle to the management of a23 dentine lesion is to only remove soft, completely4 demineralized tooth tissue. This is best achieved through using hand instruments and/or a slowly rotating drill rather than a high-speed drill. In doing so, less sound tooth tissues are removed and damage to surfaces of other teeth is minimized.
  62. 62. Dental Caries Summary1  Since only soft, completely2 demineralized tissue is removed, there3 can be no preconceived cavity design;4 the anatomy of the carious lesion dictates the size and shape of the cavity preparation. www.indiandentalacademy.com
  63. 63. Dental Caries Summary  The treatment is completed by placing an12 adhesive filling material into the cleaned cavity3 preparation, over its margin, and over the4 adjacent pits and fissures. This sealant restoration will arrest caries activity that is present in dentine and enamel, provided that the bonding of the material to these tooth tissues is adequately established. www.indiandentalacademy.com
  64. 64. Dental Caries Summary1  This treatment modality has the potential2 to:3  control dentine caries4  increase survival of the restoration  save tooth tissues and thus  increase tooth life expectancy.
  65. 65. Dental Caries Remember:  TO APPLY PREVENTIVE MEASURES  TO ENCOURAGE ORAL HYGIENE AND  TO PROMOTE THE USE OF FLUORIDE TOOTHPASTE.
  66. 66. Dental CariesThank you for watching,For more details please visit www.indiandentalacademy.com

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