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INDIAN DENTAL ACADEMY Leader in Continuing Dental Educationwww.indiandentalacademy.com  www.indiandentalacademy.com
CONTENTS1.   Introduction2.   Chemomechanical Caries Removal3.   Ozone technology4.   Air Abrasion (Kinetic)5.   Lasers (H...
INTRODUCTION   Dental caries   G.V.Black in 1893   Recently newer techniques            www.indiandentalacademy.com
CHEMOMECHANICAL CARIES REMOVAL     CMCR involves     When caries occurs     Principle - Goldman & Kronman (1970)       ...
CARIDEX   NMAB system - Caridex (1980)   2 - Solutions (pH – 11)    Solution I                     Solution II    1% NaO...
   A delivery system, reservoir, heater and a pump   Limitation       -     Slow procedure                     -     Lar...
CARISOLV    Latest CMCR 1998     Pink gel, specially designed hand instruments,volume required less than 1mm, neither he...
     Available as 2 syringes      Syringe I                      Syringe IIGlutamic Acid – 2.5g/l          NaOCl – 0.95%L...
Application   Contents of 2 syringes mixed              www.indiandentalacademy.com
   Gel applied to the carious lesion             www.indiandentalacademy.com
      Time required 9 -12 minute, volume of gelrequired 0.2 – 1.0ml, system is much easier thancaridex.Mechanism of Actio...
Advantages   Reduced need for L.A.   Conservation of sound tooth structure   Reduced risk of pulp exposure      Well s...
OZONE TECHNOLOGY     Ozone (O3) – energized form of oxygen, partof the natural gas, surrounds earth at high altitude,bloc...
OZONE THERAPY IN DENTISTRY     Dr.Edward Lynch (1980)         Various dental treatment offered by ozonetherapy.      -  ...
OZONE THERAPY FOR DENTAL CARIESPrinciple      Development of caries lesion by “nicheenvironment theory”.    Concept of o...
Description of Oxygen Delivery Unit &          Patient kit for Ozone Therapy     Ozone unit – Heal ozone TEC 3 (Curozone,...
Polyurethane console   Ozone generator   Vacuum pump   Desiccent   Hydrophobic filter            www.indiandentalacade...
HANDPIECE    Stainless steel, contra angle handpiece    Disposable sealing cup attaches to the head     Handpiece attac...
PATIENT KIT    Tooth paste, oral rinseClinical Steps in Ozone Therapy    Polymer cup adapted to carious lesion and airsu...
     Suction activated for 10 sec while cup is stillattached to carious lesion to remove residual.     Reductant fluid i...
Indications     Primary root carious lesions     Primary pit and fissure caries     Early carious lesions around crown ...
    Potentially whitens discoloured caries    Decreased treatment time    Treatment painless and noiseless    Does not...
AIR ABRASION (Kinetic)     Air abrasive technology uses compressed airto propel aluminium oxide particles     Dr.Robert ...
Principle     Based on formula for kinetic energy E=½ MV2     Cutting capability attributable to the energy ofmass in mo...
Type and Size of Abrasive Particles   Aluminium oxide particles   2 sizes – 27µm (more comfortable less               ef...
Air Abrasive Variable   Pressure – 40 – 140pounds per sq.inch.   Tip size - ranges from 0.015 – 0.027 diameter    Small ...
Tip Angle –   40 – 125°Tip distance - less than 2mm from the lesionDwell time – longer the exposure, further thepreparatio...
Application of Air Abrasion    Cavity Preparation    Internal cleaning of tunnel preparation    Removal of temporary ce...
Situation in which air abrasion not effective    Crown preparation    Large caries defect    Amalgam removalAdvantages ...
Disadvantages of Air abrasion     Lack of tactile sensation     Risk of cavity over preparation and inadequatecaries den...
Contraindication to Air abrasion treatment    Asthma patients    Severe dust allergy    Any open wounds in the oral cav...
LASERS (Hydrokinetic)     Devices that produce beams of coherent andvery high intensity light.     Large number of uses ...
FDA HUMAN CLINICAL TRIALS     Clinical studies of more than 1,700 teeth with hardtissue laser treatment showed that      ...
MECHANISM OF ACTION OF LASERS ON           HARD TISSUE ABLATION     Lasers have photomechanical effects, laserlight is hi...
      Water molecules in the target tooth aresuperheated, explode and inturn ablate toothstructure and caries.      Mech...
LASER CURRENTLY BEING INVESTIGATED FOR     MORE SELECTIVE HARD TISSUE ABLATION     Er : YAG (2,940nm) and Nd:YAG      (1,...
    Of all the available lasers Er:YAG laser can ablatedental hard tissue with minimal damage to the pulp andapproved by ...
LASER CAVITY PREPARATION TECHNIQUE     Different laser techniques required for ablation ofenamel, dentin and caries becau...
PROCEDURE     Gently touch target tissue with tip end     Direct water stream to the target tissue     Always keep oper...
ADVANTAGES     Lasers capable of ablating and preparing cavity inan irregular fashion ideal for composite and GICrestorat...
CONCLUSION     With the advent of adhesive dentistry, andcurrently available caries removal techniques, greaterconservatio...
REFERENCES1.    Beeley. J.A. et al, Chemomechanical caries removal areview of the techniques and latest developments. BDJ,...
5.    Robert Reyto, Lasers and Air-abrasion new modalities fortooth preparation, Dental clinics of North America, 2001, 45...
Thank you for watchingwww.indiandentalacademy.com     www.indiandentalacademy.com
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Newer techniques in caries removal /certified fixed orthodontic courses by Indian dental academy

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Welcome to Indian Dental Academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.


Indian dental academy has a unique training program & curriculum that provides students with exceptional clinical skills and enabling them to return to their office with high level confidence and start treating patients

State of the art comprehensive training-Faculty of world wide repute &Very affordable.

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Transcript of "Newer techniques in caries removal /certified fixed orthodontic courses by Indian dental academy "

  1. 1. INDIAN DENTAL ACADEMY Leader in Continuing Dental Educationwww.indiandentalacademy.com www.indiandentalacademy.com
  2. 2. CONTENTS1. Introduction2. Chemomechanical Caries Removal3. Ozone technology4. Air Abrasion (Kinetic)5. Lasers (Hydrokinetic)6. Conclusion www.indiandentalacademy.com
  3. 3. INTRODUCTION Dental caries G.V.Black in 1893 Recently newer techniques www.indiandentalacademy.com
  4. 4. CHEMOMECHANICAL CARIES REMOVAL CMCR involves When caries occurs Principle - Goldman & Kronman (1970) ----- Sorensen’s Buffer (Glycine, Nacl &NaOH) N-Monochloroglycine (NMG)- GK-1019 ----- Amino butyric acid – N-Monochloroamino butyric acid (NMAB) – GK-101E. www.indiandentalacademy.com
  5. 5. CARIDEX NMAB system - Caridex (1980) 2 - Solutions (pH – 11) Solution I Solution II 1% NaOCl 0.1m amino butyric acid 0.1m NaCl 0.1m NaOH www.indiandentalacademy.com
  6. 6.  A delivery system, reservoir, heater and a pump Limitation - Slow procedure - Large volumes of solutions (200 – 500ml) - Delivery system commercially not available www.indiandentalacademy.com
  7. 7. CARISOLV Latest CMCR 1998 Pink gel, specially designed hand instruments,volume required less than 1mm, neither heating nor adelivery system www.indiandentalacademy.com
  8. 8.  Available as 2 syringes Syringe I Syringe IIGlutamic Acid – 2.5g/l NaOCl – 0.95%Leucine – 2.5g/lLysine – 2.5g/lNaCl – 5.8g/lNaOH – 17.5g/lCarmellose – 25g/lErythrocin (Pink dye) www.indiandentalacademy.com
  9. 9. Application Contents of 2 syringes mixed www.indiandentalacademy.com
  10. 10.  Gel applied to the carious lesion www.indiandentalacademy.com
  11. 11.  Time required 9 -12 minute, volume of gelrequired 0.2 – 1.0ml, system is much easier thancaridex.Mechanism of Action 3 - amino acids (glutamic acid -ve, lysine +ve,Leucine – neutral) On mixing the carisolv solutions Chlorinated aminoacids with different sidechain properties and charges. High pH www.indiandentalacademy.com
  12. 12. Advantages Reduced need for L.A. Conservation of sound tooth structure Reduced risk of pulp exposure Well suited for anxious, medicallycompromised and paediatric patients.Limitations Time consuming Rotary and hand instrument still be needed www.indiandentalacademy.com
  13. 13. OZONE TECHNOLOGY Ozone (O3) – energized form of oxygen, partof the natural gas, surrounds earth at high altitude,blocks UV rays, produced by lightening. Extensively used in medical profession, fortherapeutic purposes produced in ozone generators. Powerful biocide, strong oxidizer. www.indiandentalacademy.com
  14. 14. OZONE THERAPY IN DENTISTRY Dr.Edward Lynch (1980) Various dental treatment offered by ozonetherapy. - Treatment and prevention of caries,RCT, Tooth whitening, Elimination of Sensitivity,Gum disease, Dental implant material (Pre washingof surgical sites prior to implant placement, controlof contamination in dental units water lines www.indiandentalacademy.com
  15. 15. OZONE THERAPY FOR DENTAL CARIESPrinciple Development of caries lesion by “nicheenvironment theory”. Concept of ozone therapy for dental caries 10sec application of ozone gas at a con of2200ppm. The acidic carious niche environment takesyears to establish. www.indiandentalacademy.com
  16. 16. Description of Oxygen Delivery Unit & Patient kit for Ozone Therapy Ozone unit – Heal ozone TEC 3 (Curozone,USA Inc.,) Consists of two main parts : 1. Polyurethane console 2. Handpiece www.indiandentalacademy.com
  17. 17. Polyurethane console Ozone generator Vacuum pump Desiccent Hydrophobic filter www.indiandentalacademy.com
  18. 18. HANDPIECE Stainless steel, contra angle handpiece Disposable sealing cup attaches to the head Handpiece attaches to the console viadetachable hose. Delivers ozone at a rate of 13.33ml/sec. www.indiandentalacademy.com
  19. 19. PATIENT KIT Tooth paste, oral rinseClinical Steps in Ozone Therapy Polymer cup adapted to carious lesion and airsucked to create a vaccum. Ozone gas produceddelivered at a presetconcentration for 10sec intothe cup around the toothsurface. www.indiandentalacademy.com
  20. 20.  Suction activated for 10 sec while cup is stillattached to carious lesion to remove residual. Reductant fluid is pumped for 5sec on to thetreatment site to start the demineralization process. Patient instructed to use home care kit If restoration is required place after threemonths www.indiandentalacademy.com
  21. 21. Indications Primary root carious lesions Primary pit and fissure caries Early carious lesions around crown and bridges.Advantages Kills more than 99% of microorganisms in cariouslesion Oxidizes caries and speeds up remineralization Helps to remove organic debris on carious lesion. Removed volatile sulphur compounds (Maincause of halitosis) from root caries. www.indiandentalacademy.com
  22. 22.  Potentially whitens discoloured caries Decreased treatment time Treatment painless and noiseless Does not cause any allergic reaction Microorganisms do not developed resistance toozone. www.indiandentalacademy.com
  23. 23. AIR ABRASION (Kinetic) Air abrasive technology uses compressed airto propel aluminium oxide particles Dr.Robert B Black in 1950 : first developedand described Later Dr.Rainey :improved and combined S.S.White in 1951:introduced first commerciallyavailable unit – Air-dent. www.indiandentalacademy.com
  24. 24. Principle Based on formula for kinetic energy E=½ MV2 Cutting capability attributable to the energy ofmass in motion. When the rapidly moving mass strikes itstarget – KINETIC CAVITY PREPARATION . www.indiandentalacademy.com
  25. 25. Type and Size of Abrasive Particles Aluminium oxide particles 2 sizes – 27µm (more comfortable less effective cutting). - 50µm (more abrasive cutting but more discomfort). www.indiandentalacademy.com
  26. 26. Air Abrasive Variable Pressure – 40 – 140pounds per sq.inch. Tip size - ranges from 0.015 – 0.027 diameter Small lesions – 0.015 Large lesions and existing restorations - 0.018. www.indiandentalacademy.com
  27. 27. Tip Angle – 40 – 125°Tip distance - less than 2mm from the lesionDwell time – longer the exposure, further thepreparation will advance (start always with 3secburst). Decay Detection Air Abrasion Preparation www.indiandentalacademy.com
  28. 28. Application of Air Abrasion Cavity Preparation Internal cleaning of tunnel preparation Removal of temporary cement from inside thecrown Microabrasion of white spot enamelhypoplasia Stain removal Repair of acrylic, composite and porcelain www.indiandentalacademy.com
  29. 29. Situation in which air abrasion not effective Crown preparation Large caries defect Amalgam removalAdvantages of Air abrasion Non-traumatic No micro chipping or microfracturing Less discomfort No anaesthesia Decreased thermal buildup Less invasive www.indiandentalacademy.com
  30. 30. Disadvantages of Air abrasion Lack of tactile sensation Risk of cavity over preparation and inadequatecaries dentin removal Spread of aluminium oxide around the dentaloperatory. Danger of air embolism and emphysema Impaired indirect view Damaged to dental mirrors, optical deviceslike magnifying lopes. www.indiandentalacademy.com
  31. 31. Contraindication to Air abrasion treatment Asthma patients Severe dust allergy Any open wounds in the oral cavity subgingival caries removalSafety Issues To reduce respiratory exposure – surgicalmask, dry vacuum systems. Use rubber dam, protective eyeglass andmetal matrix to protect adjacent tooth structure. Use disposable mouth mirrors. www.indiandentalacademy.com
  32. 32. LASERS (Hydrokinetic) Devices that produce beams of coherent andvery high intensity light. Large number of uses of lasers in dentistry Maiman in 1960 developed the first Ruby laser. Since these early beginnings, field of lasers hasdeveloped considerably. Efficiency of Lasers – wavelength characteristics,pulse energy and the optical properties of the incidenttissue. www.indiandentalacademy.com
  33. 33. FDA HUMAN CLINICAL TRIALS Clinical studies of more than 1,700 teeth with hardtissue laser treatment showed that 1. Pulp vitality not compromised 2. Tooth structure equivalent between laser treated and control group 3. Can remove caries effectively 4. Can perform cavity preparation effectively 5. Quality of cavity preparation equivalent to that with the handpiece www.indiandentalacademy.com
  34. 34. MECHANISM OF ACTION OF LASERS ON HARD TISSUE ABLATION Lasers have photomechanical effects, laserlight is highly energetic and when exposed causesfast heating of dental tissues in small area. Fast shockwave created when energydissipates explosively as a volumetric expansion ofwater in hard tissue occurs. www.indiandentalacademy.com
  35. 35.  Water molecules in the target tooth aresuperheated, explode and inturn ablate toothstructure and caries. Mechanical shock waves occur due tophotovapourization of water within the tooth. Thischange creates high pressure, removing anddestroying selective areas of adjacent tooth. Pulpal temperature rise is less than 2°C at2sec exposure time with water cooling. www.indiandentalacademy.com
  36. 36. LASER CURRENTLY BEING INVESTIGATED FOR MORE SELECTIVE HARD TISSUE ABLATION Er : YAG (2,940nm) and Nd:YAG (1,064) Co2 Laser (10,600nm) Co 2 Laser Excimer lasers (Arf – 193nm) and (Xecl – 308nm) www.indiandentalacademy.com Er: YAG Laser
  37. 37.  Of all the available lasers Er:YAG laser can ablatedental hard tissue with minimal damage to the pulp andapproved by the FDA for the following, - Removal of caries, Enamel, Dentin, Cementum, composite, GIC. - Can be used for enamel etching Limitation of Er:YAG – do not ablate amalgam,gold and porcelain. www.indiandentalacademy.com www.indiandentalacademy.com
  38. 38. LASER CAVITY PREPARATION TECHNIQUE Different laser techniques required for ablation ofenamel, dentin and caries because of difference inwater content in increasing order for enamel, dentin andcaries. Recommended setting for Er:YAG laser Caries : 100 – 200mj, Dentin : 150-200mj, Enamel– 200 – 250mj, Etching : 30-50mj. www.indiandentalacademy.com
  39. 39. PROCEDURE Gently touch target tissue with tip end Direct water stream to the target tissue Always keep operation area wet Keep tip moving to provoke effective ablation andbetter cooling. For deep cut move the tip constantly up and down(pumping action) www.indiandentalacademy.com
  40. 40. ADVANTAGES Lasers capable of ablating and preparing cavity inan irregular fashion ideal for composite and GICrestorations. Conservation of tooth structure Reduced need for L.A. More comfortable www.indiandentalacademy.com
  41. 41. CONCLUSION With the advent of adhesive dentistry, andcurrently available caries removal techniques, greaterconservation of tooth structure is possible with lessdiscomfort to the patient. When operative care isindicated, it should be aimed at prevention of extensionrather than extension for prevention. www.indiandentalacademy.com
  42. 42. REFERENCES1. Beeley. J.A. et al, Chemomechanical caries removal areview of the techniques and latest developments. BDJ, 2000,188, 8, 427- 430.2. Dr.Poonam Bogra, Ozone therapy for dental caries – Arevolutionary treatment for the future. JIDA, 2003, 74, 41-45.3. Banarjee et al, Dentin caries excavation : a review ofcurrent clinical techniques. BDJ, 2000, 188, 9, 476-482.4. E.Goldstein et al, Air-Abrasive technology : New role inrestorative dentistry. JADA, 1994, 125, 551 – 557. www.indiandentalacademy.com
  43. 43. 5. Robert Reyto, Lasers and Air-abrasion new modalities fortooth preparation, Dental clinics of North America, 2001, 45, 1,189-213.6. J.Tim Rainey, Air-Abrasion : an emerging standard of carein conservative operative dentistry, Dental clinics of NorthAmerica, 2002, 46, 185 – 209.7. Hans J. Koort and Methias Frentzen, Laser effects onDental hard tissues, Lasers in Dentistry. www.indiandentalacademy.com
  44. 44. Thank you for watchingwww.indiandentalacademy.com www.indiandentalacademy.com

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