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The Perio Tray is an FDA cleared, prescription
medical device to place solutions of the dentist’s
choice into the gingival sulcus or periodontal pocket.
Flexible comfortable material for non-invasive
delivery.
The Perio Tray differs from other trays or mouth guards
in that the flexible material is custom formed with
specialized seals and extensions for the shape and
depth of each pocket so that a gasket-like seal directs
and maintains medication in the pocket long enough for
medication to have therapeutic effect.
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Crevicular flow cleans out the pocket
area 40 times per hour under healthy
conditions and even more so when the
pocket becomes infected
With the biofilms attached to the tooth
and tissue, these areas become even
more resistant to being flushed out
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In Vitro PEROXIDE GEL EXPERIMENT
Confocal micrograph, untreated control,
3 days in vitro Streptococcus mutans
(S. mutans, strain UA 159) biofilm.
Confocal micrograph, 3 day in vitro S.
mutans biofilm treated for 5 minutes with
1.7% hydrogen peroxide gel.
REPORT ON PEROXIDE GEL EXPERIMENT
Confocal microscope, S. mutans biofilm
treated for 10 minutes with 1.7% hydrogen
peroxide.
Confocal microscope, S. mutans treated
with placebo gel without hydrogen peroxide.
10 minutes BID as maintenance….TID during treatment
So When?
We recommend place them in prior to your am
shower
Then brush and do your regimen after
Evening time is easy but it can be when you
watch TV or really when you want
Clean with your toothbrush and water
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Fluoride gels with high caries
MI Paste with high caries patients or
sensitivity
Vibramycin for antibiotic usage in the trays
when you want alternatives or patient wants
alternatives to systemic
Truly what you want in customized trays
An explorer….a probe….traditional x-rays
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Tell me, and
I will forget.
Show me, and
I will remember.
Involve me, and
I will understand.
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It has been suggested that the majority of all plans that
go untreated are a direct result of the patient’s lack of
understanding.
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15 Distal Occlusal Pit 31 Occlusal 18 Occlusal
45 year old… 1 implant crown, 1 crown, 2 restorations on 3 and 14
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Visual diagnosis can be highly subjective, Kefley and Holt
1993
Dentin involvement can occur under an intact enamel layer
Pitts, 1997
On X-ray, detecting occlusal decay is only when there is
dentin penetration by 2-3mm due to the thickness of the x-ray
having to penetrate buccal/lingually the thickest
portion of the tooth.
Bite Wing x-rays can identify inter-proximal lesions
earlier because x-rays pass through a narrower part of
the tooth yet their sensitivity is still not excellent
40-60% demineralization required to produce image
Underestimates size or depth
Insufficient to determine activity level
Low sensitivity
39% occlusal
50% interproximal
Bader et al 2001
70% of overall adolescents experience tooth decay, and
far more in lower income families
90% of caries in pit and fissures, and most are in molars
Pit and fissures account for 12.5% of the surface area of
a tooth and yet this is where 88% of caries occur
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The overall annual attack rate for caries for all occlusal
first permanent molar surfaces is 5.9% per year, while
the approximal surfaces is 1.3% in a representative
group of children, seven to fifteen years of age.
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Transference of infective S mutans to other sites?
62% sensitivity / low reliability
Loesche et al, J Dent Res 1979
Hujoel et al, Caries Res 1995
False positives & false negatives
Lussi, Caries Res 1991
Di Disrupts intact i surface f layer, l eliminating li i i potential i l f
for
reversal
Al-Sehaibany showed tug back by an explorer
was only 24% diagnostic, meaning that 76% of
the time that tug back was present, there was no
caries!
Ekstrand showed that a sharp explorer tip can
damage an early de-mineralized white spot
lesion of the enamel by cavitating the surface
.
15 Distal Occlusal Pit 31 Occlusal 18 Occlusal
15 and 31 slight sticks…18 no stick…Do you Drill?
What is the patient’s caries risk?
What does the patient want?
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64
31 38
15 Distal Occlusal Pit 31 Occlusal 18 Occlusal
Yes……dark stained pits, DRILL or NOT
to Drill?
1.0 1.5 2.0 2.5 > 3.0
Sound Enamel Deep Dentin Caries
Beginning Enamel
C i
Deep Enamel Caries
Dentin Caries
Caries
“Doppler Radar” for Caries Detection
A Picture is Worth a Thousand Words
Analysis of Spectra images Color Scale and Diagnostic Value
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D0 – sound fissure
system
D1‐D2 – Enamel
Caries
D3‐D4 – Dentin
Caries
Diss. Madani, 2004 Uni
Jena
Histological Clinical Analysis
Nomenclature of Dental Lesions
15 Distal Occlusal Pit 31 Occlusal 18 Occlusal
Color Mapping with Air Techniques and
Spectra
15 Distal Occlusal Pit 31 Occlusal 18 Occlusal
Infrared Technology…..Continuing to Advance
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15 Distal Occlusal Pit 31 Occlusal 18 Occlusal
Minimal preparations…well into enamel patient preferred to
treat early and avoid shots and future work
Treatment with Equia or Low stress bulk fills or Activa
•Non stress bearing Class I & II restorations
•Deciduous teeth restorations
•Geriatric restorations
•Base / dentine replacement
•Cervical (Class V) restorations
•Core build up
•Temporary fillings
•ART (Atraumatic Restorative Technique)
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41
37
No stick
Class 1’s
Into Dentin
Without major occlusal
function
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Application of EQUIA Coat…
...30-50 μm of penetration in to EQUIA Fil to fill up porosities
…increases fracture toughness by 212%
…increases flexural strength by 72%
…increases flexural fatigue resistance
…protects from acid erosion
…improves aesthetics
…takes long to wear off (6 months or more)
EQUIA Coat
EQUIA Fil
No delamination layer at the
interphase
EQUIA Coat filling
up porosities
Depth of penetraition 30-
50μm
EQUIA Fil
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0,20
0,15
0,10
0,05
0,00
Fuji IX GP EXTRA Fuji IX GP EXTRA + G-COAT
PLUS
Acid erosion / mm
Extra Protection
EQUIA Fil EQUIA Fil +
EQUIA Coat
EQUIA Coat protects from acid erosion, important in High Caries Risk
119999
patients…
What happens
when Coating
wears off?
What happens when EQUIA Coat Wears off?
The EQUIA restoration undergoes a unique maturation effect attributed to
saliva…
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1500
1000
500
0
0 20 40 60 80 100
Fluoride release / μg cm-2
Fuji Triage
Fuji II LC improve
Fuji IX GP FAST
Fuji Filling LC
EQUIA Fil
202
days
Once coating wears off, fluoride recharge cycle is initiated...
120
100
80
60
40
20
0
1day 4 days 7 days 30 days 90 days
μm
Fuji IX Fuji IX GP Fast
GIC have high early wear ……… however due to maturation a long term wear
similar to composite
I Placed in 1984
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Chew the enclosed wax, then
spit to the A line
Add 1 drop of Reagent 1:
Tap the container 15 times
Add 4 drops of Reagent 2:
Shake until saliva sample turns
green
Now Dispense 3 scales of saliva
into the sample window and wait
15 minutes
The red arrow shows the pipet
The yellow arrow shows the
plastic vehicle we use to mix
Drops from Solutions 1 and 2 to
mix prior to testing
The white plastic testing piece is
how we evaluate Strep Mutans
results
1. Identification of Antigenic Epitopes in an Alanine-Rich Repeating Region of a
Surface Protein Antigen of Streptococcus mutans. N. Okahashi, I. Takahashi, M.
Nakai, H. Senpuku, T. Nisizawa and T. Koga. Infection and Immunity, Apr. 1993,
vol. 61, N°4:p.1301-1306
2. Rapid and quantitative detection of Streptococcus mutans with species specific
monoclonal antibodies. W. Shi, A. Jewett, W.R. Hume. Hybridoma 1998;17:365-
371.
3. Simple and Rapid Immunoassay for the Estimation of Streptococcus mutans in
Human Saliva. Y Matsumoto, N. Sugihara, M. Koseki, Y. Maki. Abstract –50th
ORCA Congress, July 2-6, 2003, Konstanz, Germany
4. Evaluation of Rapid Screening Test for S. mutans Using Species-specific
Monoclonal Antibodies. Y. Maki, N. Sugihara and M. Koseki. Abstract 2077–81st
General Session of IADR, June 25-28, 2003, Goteborg, Sweden
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After placing Reagent 1 and taping
the container 15 times
4 Drops of Reagent 2 are then
added to the solution and again
mixed until the saliva turns green
The solution is THEN placed into the
orifice via the pipet and you wait 15
minutes
Positive result - Either a faint or
clear red line appearing means
there are over 500,000 cfu/ml of
S. MUTANS.
How do you customize their therapy?
Cariogenic biofilms thrive in acidic environments.
These environments are partially created by
eating and drinking certain foods.
In order to fight mouth bacteria we need to work
on the saliva as well as the surface of the teeth.
By working on both aspects we can win the war of
caries management.
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Real time (15 second )
inexpensive screening test
for separating at risk from
low risk individuals
Cariscreen- Meter that when a swab with pellicle is
placed inside , it can read the degree of
cariogenicity of the patients biofilm.
Depending on the reading, patient can be treated
with their proprietary series of rinses.
PH of the rinses are in the 8,9, and 10 range. Very
basic to change the environment in the oral cavity.
(“Measurement of ATP Bioluminescence from Oral Bacteria Contained in Dental Plaque:
Basic Sciences and Clinical Assessments for Testing of Caries Risk” by Drs. R. Sauerwein,
J. Kimmell, T. Finlayson, S. Fazilat, P. Pellegrini, I. Kasimi, D. Covell, P. Gagneja, J. Engle,
K. Kutsch, T. Maier, and C.A. Machida , representing [not in corresponding order],
Department of Integrative Biosciences, Academic DMD Program and OCTRI Research
Fellowship Program, Department of Pediatric Dentistry, and Department of Orthodontics,
School of Dentistry, Oregon Health & Science University, Portland, and Oral Biotech)
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What will affect the
population of a biofilm
Intense heat = 175 degrees F
Complete mechanical debrasion
Chemotherapeutics
What will not affect the
population of a biofilm
Systemic antibiotics
Brushing
Flossing
Introduction and Science
What is Dental Caries: The New Paradigm
pH Neutralization: Reduces growth and acid
production of cariogenic bacteria, supports
healthy oral bacteria growth
Antibacterial: Significantly reduces total
bacteria levels when high levels are identified
Fluoride: Aids in remineralization and inhibits
acid production of cariogenic bacteria
Xylitol: Reduces growth and acid production of
cariogenic bacteria
Nano HA (Ca PO4): Aids in remineralization
with nano particles of hydroxyapatite
Targeted Therapy
What is CTx?
How the CTx Guide Applies
to Products
Number of agents equals CTx Score
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CTx4 Treatment Rinse
pH Neutralization
Antibacterial (.2% sodium
hypochlorite)
Fluoride (0.05%)
Xylitol (Greater than 10%)
3 Main Products
CTx4 Gel 5000
pH Neutralization
Fluoride (1.1% Neutral
Sodium Fluoride)
HA Nano (Ca PO4)
Xylitol (Greater than
10%)
CTx3 Rinse
pH Neutralization
Fluoride (0.05%)
Xylitol (Greater than 10%)
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† Distributed exclusively by dental
professionals
† Extra-strength blend of ProBiora3®
crowds out harmful bacteria around
teeth and gums
† Use once daily for 90 days after a
professional cleaning
† Extends the benefits of a dental prophy
ProBiora3 – Ingredient in branded
products
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† For companion pets
† Freshens breath, cleans and
whitens teeth
†Tasteless, odorless powder
† Strains weighted for gum
health
†ProBiora3 is the most comprehensive oral care probiotic technology
available
†Developed from research into dental caries and periodontal disease
†Blend of 3 naturally occurring Streptococcal strains – S. oralis, S. uberis,
S. rattus
†ProBiora3 promotes:
†dental and periodontal health
†whiter teeth
†fresher breath
Probiora3: Product Overview
ProBiora3 Marketed as Food Ingredient
†Self-affirmed GRAS status
†ProBiora3 is safe and effective
15 peer-reviewed publicationsProBiora3
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Competitive Advantage
†Strong scientific basis for safety and efficacy
†ProBiora3 is the first and only
comprehensive oral care probiotic on the
market
ProBiora3 – Competitive Advantage
The ProBiora3 contains a formulation of beneficial
bacteria, found in naturally healthy human mouths.
S. oralis KJ3
S. uberis KJ2
S. rattus JH145
S.rattus JH145 is a unique strain of streptococcus that does not produce lactic acid, and
has been shown to successfully compete for nutrients and space on tooth surfaces with
the native strain of streptococcus that produces lactic acid.
ProBiora3 – How it works
A spontaneous lactacte dehydrogenase deficient mutant of Streptococcus rattus for use
as a probiotic in the prevention of dental caries. Hillman JD, McDonell E, Cramm T,
Hillman CH, Zahradnik RT. Journal of Applied Microbiology 2009 Nov;107(5):1551-8.
Epub 2009 Apr 24)
ProBiora3 – How it works
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Remin Pro supports remineralization.
Remin Pro strengthens teeth.
Remin Pro smooths tooth surfaces.
Remin Pro neutralizes acids.
Remin Pro desensitizes.
Remin Pro tastes good.
Contains all ingredients of
natural tooth substance...
Calcium ions
Ph h i
hydroxyapatite
- Phosphate ions
- Water/fluorides
y yp
[Ca5(PO4)3OH]
• Remin Pro is ideal for
protective tooth care
Three Key Ingredients:
- Fluoride (1450 ppm) - Hydroxyapatite (Calcium
and Phosphate) = natural tooth substance
- Xylitol (non-sugar sweetener with cariostatic effect)
Natural tooth substance consists largely of hydroxyapatite (calcium and
phosphate).
It fills superficial enamel lesions and the tiniest irregularities that arise from
erosion.
Remin Pro adheres to the tooth substance and protects the tooth against
demineralization and erosion.
Smooths the surface by sealing dentin tubules.
A smooth surface impairs
the adhesion of bacterial plaque.
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Reduction of caries formation
Sealing of tooth surfaces, desensitization
Repair of incipient caries
(remineralization)
Delay of plaque formation and smoother
surfaces
Teeth whitening and gloss increase
Kani T, Kani M, Isozaki A, Kato H, Fukuoka Y, Ohashi T, Tokumoto T: The
effect of apatitecontaining dentifrices on artificial caries lesions. I Dent Health
38, 364–366 (1988).
Okashi T, Kani T, Isozaki A, Nishida A, Shintani H, Tokumoto T, Ishizu E,
Kuwahara Y, Kani, M: Remineralization of artificial caries lesions by
Hydroxyapatite. I Dent Health 41, 214 – 223 (1991).
Nishio M, Kawamata H, Fujita K, Ishizaki T, Hayman R, Ikemi T: A new enamel
restoring agent for use after PMTC. Posterpresentation 82nd General Session
& Exhibition of the IADR / March 2004.
Kawamata H, Nishio M, Fujita K, Ishizaki T, Hayman R, Ikemi T:
Posterpresentation 82nd General Session & Exhibition of the IADR / March
2004.
Yamagishi K, Onuma K, Suzuki T, Okada F, Tagami J, Otsuki M, Senawangse
P: Materials chemistry: A synthetic enamel for rapid tooth repair. Nature. 2005
Feb 24; 433 (7028): 819.
Sugar substitute comes from the Xylitol portion of
a plant.
Cannot be metabolized by acid producing
cariogenic bacteria.
Excreted as whole molecule. Natural population
shift to helpful bacteria.
6- 10 grams per day.
Potentially toxic to dogs.
Xlear, Dr. John’s candies, Xylitol USA
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The Glucose is absorbed by the Strep Mutan the
Glucose then goes through a metabolic
breakdown and ultimately gets excreted as
acids and thus the pathway to caries
Xylitol gets absorbed by the Strep Mutans,
occupies or keeps the Strep Mutans busy but
DOES NOT get broken down, and is excreted in
whole…
After short and long-term use, xylitol significantly reduces
the amount of Strep Mutans in plaque and saliva.
The growth of lactobacilli is reduced during long-term use of
xylitol.
Xylitol shows effects which promote tooth remineralization.
Xylitol actively prevents acid production in dental
plaque (enamel dissolves when the pH decreases below
5.7).
Regular xylitol consumption reduces the adhesive property
of plaque, making it easier to brush off.
http://www.ncbi.nlm.nih.gov/pubmed/12693818 An overview of studies about xylitol and dental caries
Mäkinen K.K. The rocky road of xylitol to its clinical application. J. Dent. Res. 2000; 79: 1352.
Lynch H, Milgrom P. Department of Dental Public Health Sciences, Northwest/Alaska Center to Reduce Oral Health Disparities, University of
Washington, Seattle 98195-7475, USA. Xylitol and dental caries: an overview for clinicians. J Calif Dent Assoc. 2003 Mar;31(3):205-9.
K.K. Mäkinen, K.P.Isotupa, T. Kivilompolo, P.L. Mäkinen, J.Toivanen, E. Söderling. Comparison of Erythritol and Xylitol Saliva Stimulants in the Control
of Dental Plaque and Mutans Streptococci. Caries Research 2001;35:129-135.
Kandelman D., Gagnon G. A 24-month clinical study of the incidence and progression of dental caries in relation to consumption of chewing gum
containing xylitol in school preventive programs. J. Dent. Res. 1990; 69: 1771.
Kauko K. Mäkinen, MS, Phd, Kauko P. Isotupa, DDS, Taina Kivilompolo, RDH, Pirkko-Liisa Mäkinen, MS, PhD, Satu Murtomaa, DDS, Juhani Petäjä,
DDS,
Jukka Toivanen, DDS, Eva Söderling, MS, PhD. The effect of polyol-combinant saliva stimulants on S. mutans levels in the plaque and saliva of
patients with mental retardation. Special Care Dentistry 2002; 22(5): 187-193.
Isotupa K.P., Gunn S., Chen C.Y., Lopatin D., Mäkinen K.K. Effect of polyol gums on dental plaque in orthodontic patients Am. J. Orthod. Dentofac.
Orthop. 1995; 107: 497.
Mäkinen K.K., Bennett C.A., Hujoel P.P., Isokangas P., Isotupa K.P., Pape H.R. Jr., Mäkinen P.-L. Xylitol gums and caries rates: A 40-month cohort study.
J. Dent. Res. 1995; 74: 1904.
Autio J.T., Courts F.J. Acceptance of the xylitol chewing gum regiment by preschool children and teachers in a Head Start program: a pilot study.
Pediatr. Dent. 2001; 23:71.
Autio J.T. Effect of xylitol chewing gum on salivary streptococcus mutans in preschool children. ASDC J. Dent. Child. 2002; 69: 81-6, 13.
Alanen, P., Holsti, M.-L., Pienihäkkinen, K. (2000) Sealants and xylitol chewing gum are equal in caries prevention. Acta Odontol. Scand. 58:279-
284.
Caufield, P.W., Cutter, G.R., Dasanayake, A.P. (1993) Initial acquisition of mutans streptococci by infants: evidence for a discrete window of
infectivity. J. Dent. Res. 72:37-45.
Trahan, L. (1995) Xylitol: a review of its action on mutans streptococci and dental plaque – its significance. Int. Dent. J. 45:77-92.
Scheinin, A., Mäkinen, K.K. (1971) The effect of various sugars on the formation and chemical composition of dental plaque. Int. Dent. J. 21:302-
321.
Scheinin, A., Mäkinen, K.K. (1972) Effect of sugars and sugar mixtures on dental plaque. Acta Odontol. Scand. 30:235-257.
Scheinin, A., Mäkinen, K.K. (1975) Turku Sugar Studies I-XXI. Acta Odontol. Scand. 33 (Suppl. 70):1-349.
Isokangas, P. (1987) Xylitol chewing gum in caries prevention. Academic Dissertation, University of Turku.
Isokangas, P., Mäkinen, K.K., Tiekso, J., Alanen, P. (1993) Long-term effect of xylitol chewing gum in the prevention of dental caries: a follow-up 5
years after termination of a prevention program. Caries Res. 27:495-498.
Mäkinen, K.K., Bennett, C.A., Hujoel, P.P., Isokangas, P.J., Isotupa, K.P., Pape, H.R., Jr., Mäkinen, P.-L. (1995) Xylitol chewing gums and caries rates: a
40-month cohort study. J. Dent. Res. 74:1904-1913.
Hujoel, P.P., Mäkinen, K.K., Bennett, C.A., Isotupa, K.P., Isokangas, P.J., Allen, P., Mäkinen, P.-L. (1999) The optimum time to initiate habitual xylitol
gum-chewing for obtaining long-term caries prevention. J. Dent. Res. 78:797-803.
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• With the finger
• Using a soft toothbrush
• Plaed in a tray
Recaldent- Casein phosphopeptide (CPP)- amorphous calcium
phosphate (ACP)
Unique chemical in that it is substantive with a 3 hour half life
MI Paste +----5 Calcium,3 phosphate,1 Fluoride—Ideal
biochemical ratio to drive remineralization.
Made from a milk protein, so contraindicated in patients with
true milk allergy.
OK for patients who are lactose intolerant
Caution with young children.
• Two Components
1. ACP:Amorphous Calcium Phosphate
2. CPP: Casein Phosphopeptide – natural
occurring molecule
• Milk Protein
• Protects the ACP component
• Delivery vehicle
• Very sticky
Functions:
CPP-ACP attached to strep mutans
making them non-viable
252
– Remineralization
– Desensitization
What is RecaldentTM (CPP-ACP)?
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Molecular model of the CPP-ACP
complex. Casein phosphopeptide (CPP)
is a milk derived protein able to bind
calcium and phosphate ions and
stabilize them as Amorphous Calcium
Phosphate (ACP).
ACP alone does not remain stable
enough for effective
long-term remineralization*
253
g
*Cross KJ, Huq NL, Reynolds EC. Casein phosphopeptides in oral health—chemistry and clinical
applications. Curr Pharm Des. 2007;13:793-800.
CPP-ACP is added to the oral cavity.
The ‘sticky’ CPP part binds readily to enamel, pellicle,
plaque and soft tissue
254
H+
H+
H+
H+
Under acidic conditions, RecaldentTM is able to release
Calcium and Phosphate ions
255
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The free Ca and P ions move out of the CPP, enter the
256
enamel rods and reform into apatite crystals
• Helps to maintain a state of super-saturation of Calcium and Phosphate
ions on the tooth surface
• RecaldentTM Depressing enamel demineralization
is the ‘fluid enamel’
• Buffers plaque pH
• which The longer CPP-restores ACP is maintained mineral in the mouth, the balance
more effective the
result
257
Improved Plaque Uptake and Enamel Remineralization by Fluoride with CPP-ACPE C Reynolds, N.J. COCHRANE, P. SHEN,
F. CAI, G.D. WALKER, M.V. MORGAN, and C. REYNOLDS, Cooperative Research Centre for Oral Health Science, School of
Dental Science, The University of Melbourne, Victoria, Australia Casein phosphopeptide-amorphous calcium phosphate (CPP-ACP)
has been shown to slow the progression of caries and to remineralize enamel subsurface lesions. Objectives: The aim of
the studies was to determine the ability of CPP-ACP to increase the incorporation of fluoride into supragingival plaque and
to promote enamel remineralization in situ with acid resistant mineral. Methods: Randomized, double-blind cross-over studies
were designed involving three mouthrinses and five toothpastes as follows: Mouthrinses (i) 2% CPP-ACP, (ii) 2% CPP-ACP
plus 450 ppm F and (iii) 450 ppm F; and Toothpastes: (i) placebo, (ii) 1100 ppm F, (iii) 2800 ppm F, (iv) 2% CPP-ACP and
(v) 2% CPP-ACP plus 1100 ppm F. The mouthrinses (15 ml) were used for 60 s, three times per day for 5 d and
supragingival plaque collected and analyzed for F content. The toothpastes (1 g) were added to 4 ml water to form a slurry
and used for 60 s four times per day for 14 days in an in situ remineralization model. Results: The addition of 2% CPP-ACP
to the 450 ppm F rinse significantly increased the incorporation of fluoride ions into plaque where the plaque fluoride level
(33.0±17.6 nmol/mg dry wt) was over double that obtained with the fluoride-only rinse (14.4±6.7 nmol/mg dry wt).
Fluoride in the toothpaste slurry produced a dose-response related remineralization of subsurface enamel lesions. The
toothpaste containing 2% CPP-ACP produced a level of remineralization (13.5%±1.5%) similar to the 2800 ppm F paste
(15.5%±2.4%) and the paste containing 2% CPP-ACP plus 1100 ppm F was superior (21.0%±5.9%) to all other
formulations in enamel lesion remineralization. Acid challenge of the remineralized lesions showed that the CPP-ACP/F
mineralized lesions were relatively acid resistant.
Conclusion: CPP-ACP promotes the incorporation of fluoride
into plaque and sub-surface enamel producing effects
superior to fluoride alone.
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Reduces sensitivity
Decreases or eliminates white spots
Assists in Caries management
Children with cavitations and positive caries tests
Children undergoing orthodontics.
Adults with positive caries tests and cavitations
People with sensitive teeth
People taking medications that alter quantity and quality
of saliva
People undergoing a lot of restorative Dentistry.
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Documentation and progession control.
262
263
Before treatment (cleaning) After treatment (cleaning)
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HCL Acid etch of all the teeth.
Prema- Premier
Opalustre- Ultradent
Brown & white enamel
demineralization
PREMA® is applied using 10:1
reduction angle – slow speed
After a 14-day take home
whitening treatment
Immediately after
PREMA® treatment
Approximately 15 seconds per tooth- open the enamel pores.
Following this a 37% phosphoric acid is applied to the teeth for 30
seconds.
After rinsing it off, Remin Pro( MI Paste), is applied in the office for
5 minutes.
This can be achieved with a gloved finger and leaving the cream
in place or with a gloved finger and then placing the tray over the
cream.
Patient is sent home and told to wear the trays as much as possible
daily with the cream in place.
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37% Phosphoric acid for 30 seconds followed by 5
minutes of therapeutic cream.
This is done weekly till 50-60% remineralization is
seen.
Now Pola Night (10% for kids or Pola Day CP
35% for adults) is added to the protocol daily for
ten days.
Continue etch/cream protocol till desired result is
achieved
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MI Paste in a bleaching tray for as long as
she can wear it everyday. (Homework)
Pola night — 15% started at week 8 for 2
weeks.
Continued with MI Paste
