caries removal

1. New Developments in Caries
Removal and Restoration
NUHA ELKADIKI
Benghazi University
Cairo University

2. Content
New Developments in Caries Removal and
Restoration 1.1 Caries Removal.
1.1.1 Lasers.
1.1.2 Polymer Bur .
1.1.3 Micro preparation Burs
1.1.4 Air Abrasion (or Kinetic Cavity Preparation)
1.1.5 Photo activated Disinfection
1.1.6 Carisgolv Gel .
1.1.7 Caries-Detector Dyes

3. New Developments in Caries
Removal and Restoration
Caries Removal
There have been several recent developments with
regard to methods of caries removal, and new
laser, air abrasion, and chemo-mechanical methods
have been introduced, as well as improvements in
the more traditional bur technology.

4. Traditional methods of caries removal, such as
burs and spoon excavators, tend to remove
uninfected as well as infected dentin, because it
is difficult clinically to distinguish between the
two.
However, total removal of all caries may not
be necessary to control progression of the
lesion, provided the restoration is sealed
adequately from the oral environment.
New Developments in Caries
Removal and Restoration

5. Recent developments in caries removal have
therefore involved removal of only soft
infected dentin.
New Developments in Caries
Removal and Restoration

6. Caries Removal
2.1.1 Lasers:
Lasers have achieved success
with removal of hyperplastic
soft tissue, but sufficient
research has now established
the use of other laser
technologies in restorative
dentistry.
New Developments in Caries
Removal and Restoration

7. Caries Removal 2.1.1 Lasers:
Advantage :
a) Absence of vibration, which alleviates much of the
discomfort experienced by patients.
Disadvantage :
a) Slow removal of tissue.
b) Excessive heat transfer to the dental pulp.
c) Absence of tactile contact with the tooth during
cavity preparation can make detection of softened
dentin difficult for the dentist
New Developments in Caries
Removal and Restoration

8. The erbium-YAG laser is commercially
available, but many perceive it as
costly and offering few advantages
over conventional methods of cavity
preparation. The machine is large and
occupies considerable space in the
dental office
New Developments in Caries
Removal and Restoration

9. These holes were created by a
femtosecond laser (laser pulse
duration = 10−15 s). The femtosecond
laser can photo ablate bone, enamel,
and dentine with the minimum of
collateral thermal damage. This laser
is still in the experimental stage of
development for dental
use
New Developments in Caries
Removal and Restoration

10. Caries removal :2.1.2 Polymer Bur:
Boston (2000) has described a polymer bur that
only removed softened and infected dentin and
not normal dentin. The cutting elements of the
bur were made of a softer polyamide/imide
polymer material than the traditional carbide
bur.
Use in slow speed hand-piece with size 2,4,6.
New Developments in Caries
Removal and Restoration

11. One disadvantage was that by
keeping to the recommendation to
excavate caries from the center to
the periphery in order to avoid
contact with sound tooth tissue, the
bur would be prematurely and
irreversibly damaged.

12. Advantages:
• Preserve healthy tooth structure
• Minimize chance of pulp exposure
• Reduce trauma to adjacent gingiva.
a selective caries-removal rotating instrument
(Designed only to remove carious dentine).

13. 2.1.3 Micro-preparation Burs
The Fissurotomy Bur is designed to allow
exploration of the fissure with minimal
removal of enamel. It is 1.5–2.5mm in length
and tapers to a fine carbide tip so that only
one-sixth to one-tenth of the inter-cuspal
width is removed.
New Developments in Caries
Removal and Restoration

14. New Developments in Caries
Removal and Restoration

15. 2.1.4 Air Abrasion (or Kinetic Cavity
Preparation)
This technique uses a stream of small
aluminum oxide particles, created using
pressurized air, that impact the caries and
abrade it away.
However, the abrasive particles tend to remove
normal dentin more easily than the softer,
carious dentin.
New Developments in Caries
Removal and Restoration

16. Advantages of the air abrasion technique:
1. less pain associated with cavity preparation
2. less noise and vibration.
Rafique et al. (2003) also showed that a
substantial majority (75%) of their patients
were unperturbed by any dust or pain sensation
during cavity preparation.
New Developments in Caries
Removal and Restoration

17. Disadvantage of the air abrasion technique:
1. Air abrasion of enamel does not provide
enough micromechanical roughening of
enamel for the retention.
2. There is little tactile sensation when removing
softened carious dentin as the instrument does
not touch the tooth.
New Developments in Caries
Removal and Restoration

18. Indications :
1. Instrument tend to be limited to minimal cavity
preparation and the removal of surface enamel
stain.
New Developments in Caries
Removal and Restoration

19. Complication related to air polishing
Air polishing devices use sodium bicarbonate
powder, and can remove plaque and stain
effectively. These devices cause no harm to the
gingiva, but they have the disadvantage that
they can easily cause iatrogenic damage by
removing exposed cementum and root dentin
in teeth affected by gingival recession and
periodontal disease.
New Developments in Caries
Removal and Restoration

20. Air abrasion
systems allow minimal
cavity preparation and
the removal of surface
stain
The air abrasion
hand piece is light
and the flow of powder
has a controlled variable
outflow
New Developments in Caries
Removal and Restoration

22. 2.1.5Photoactivated Disinfection
1. The photo activated disinfection technique uses
a disinfectant solution(dilute toluidine blue )that
is applied to deep caries, allowed to penetrate
into the remaining softened dentin for 60s, and
then photo activated for 1min using a low-
powered diode laser (635nm).
2. Activation with the red light releases oxygen,
which kills the cells.
New Developments in Caries
Removal and Restoration

23. Carisolv Gel : is a chemo mechanical method
of removing dental caries that is minimally
invasive.
involves the application of a gel to tooth tissue.
This selectively softens the carious dentine,
thus facilitating its removal.
New Developments in Caries
Removal and Restoration

24. mixed consisting of amino acids and
0.5%sodiumhypochlorite, and is applied to the
dentin.
The amino acids and hypochlorite form high-
pH chloramines (pH 12), which react with the
denatured collagen in the carious dentin.
allowing it to be removed more easily. The
softened dentin is removed by scraping the
surface with special hand instruments.
New Developments in Caries
Removal and Restoration

25. Advantage of Carisolv Gel
a) Pulpal irritation and pain are all reduced when
compared with conventional mechanical methods.
b) No noise or vibration associated with the cavity
preparation.
c) There is no need for anesthesia.
which is a major advantage in dental-phobic
patients, children, and special needs patients.
New Developments in Caries
Removal and Restoration

26. Disadvantage of Carisolv Gel:
a) This technique requires longer clinic time than similar
cavity preparation employing conventional bur
removal.
b) May requires a repeated application of the solution
over the caries.
c) an in efficient method of removing caries at the
enamel dentin junction.
New Developments in Caries
Removal and Restoration

27. Caries-Detector Dyes:
Modern management of caries
involves removing infected
dentin, but in as conservative a
manner as possible to preserve
tooth tissue.
New Developments in Caries
Removal and Restoration

29. Advantage of caries detection method:
1. weakening of tooth structure is prevented.
2. pulp vitality preserved.
Caries-detecting dyes (e.g., 1.0% acid red in
propylene glycol) have been developed to assist
the dentist in distinguishing between the two types
of caries
New Developments in Caries
Removal and Restoration