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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 …

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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  • 1. DENTINE CARIESITS PROGRESSION ANDHOW BEST TO STOP IT INDIAN DENTAL ACADEMY Leader in Continuing Dental Education www.indiandentalacademy.com
  • 2. Dental CariesSugar and plaque, the archcriminals of dental caries
  • 3. Dental CariesDemineralization, remineralization Sugar + Dental Plaque ACID S Demineralization Cavities
  • 4. Dental CariesDemineralization, remineralization Subsurface demineralization of enamel www.indiandentalacademy.com
  • 5. Dental Caries Demineralization, remineralizationOcclusal lesions can be arrested by remineralization
  • 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. Dental CariesDemineralization, remineralization No sugar before sleeping www.indiandentalacademy.com
  • 8. Dental CariesThe Caries BalanceResistance  Plaque removal  Sugar reduction  Fluoride  Sealants  Chlorhexidine www.indiandentalacademy.com
  • 9. Dental CariesStructure of dentine Living tissue Peritubular dentine Intertubular dentine Apatite crystals Intermolecular cross-linking www.indiandentalacademy.com
  • 10. Dental CariesDentine Structure
  • 11. Dental Caries Progression of dentine caries Bacterial Invasion12345678 www.indiandentalacademy.com
  • 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. Dental Caries Progression of dentine caries Crystal Removal Process12345678
  • 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. 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. Dental Caries Progression of dentine caries Defense reaction in dentine12345678
  • 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. 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. 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. Dental CariesTwo layers of carious dentineOuter (‘infected’) Inner (‘affected’)  BacterialInvasion  Few Bacterial  Unreminerizable  Reminerizable  Dead  Alive  Without sensation  Sensitive www.indiandentalacademy.com
  • 21. Dental CariesRemineralization of inner cariousdentinePrerequisites physiological remineralization:  Presence collagen fibers  Living odontoblastic processExternal remineralization:  Saliva , calcium and phosphate  Exposure bio-active agents
  • 22. Dental Caries Characteristics of occlusal caries Fissure enamel caries1234
  • 23. Dental Caries Characteristics of occlusal caries Fissure enamel and1 dentine caries234
  • 24. Dental Caries Characteristics of occlusal caries Fissure cavity1234 3.6 mm
  • 25. Dental Caries Characteristics of occlusal caries Lateral spread of fissure1 cavity234 3.6 mm
  • 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. 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. Dental Caries Characteristics of approximal caries 1. Subsurface demineralization of enamel.1234 www.indiandentalacademy.com
  • 29. Dental Caries Characteristics of approximal caries 2. Partial demineralization of dentine directly1 underneath enamel lesion234
  • 30. Dental Caries Characteristics of approximal caries 3. The dentine demineralization follows the1 dentine tubules234
  • 31. Dental Caries Characteristics of approximal caries 4. Lateral spread of dentine caries occurs1 mainly in cavitated lesions234
  • 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. 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. Dental Caries Traditional concepts of cavity design12 Mechanical retention3  Flatfloors4  Vertical walls  Triangular retention niches  Undercut areas
  • 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. Dental Caries Traditional concepts of cavity design ‘The application of a mechanical design on a biological process1234
  • 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. Dental Caries Repeat restoration cycle12 Repeat restoration cycle3  Occlusal lesion and occlusal restoration  2-Surface restoration  Extended restoration  Crown or Extraction
  • 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. 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. 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. 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. 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. Dental Caries Biological principals of cavity preparation12 www.indiandentalacademy.com
  • 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. 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. 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. Dental Caries Appropriate instrumentation  Hand instrument:1  Dental hatchet2345678 (e.g., 10 – 6 - 12) www.indiandentalacademy.com
  • 49. Dental Caries Appropriate instrumentation  Hand instrument:1  Excavator2345678 (e.g., 153 – 154)
  • 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. 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. 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. 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. 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. 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. Dental Caries Tooth preservation versus cavity preparation1234 Preservation = restoration + prevention www.indiandentalacademy.com
  • 57. Dental Caries Tooth preservation versus cavity preparation1234 Sealant restorations
  • 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. 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. 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. 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. 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. 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. 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. Dental Caries Remember:  TO APPLY PREVENTIVE MEASURES  TO ENCOURAGE ORAL HYGIENE AND  TO PROMOTE THE USE OF FLUORIDE TOOTHPASTE.
  • 66. Dental CariesThank you for watching,For more details please visit www.indiandentalacademy.com