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www.indiandentalacademy.com
Definition :Dental caries is an infectious micro-biologic disease of the teeth that results inlocalized dissolution & dest...
Etiologyfood           bacteri               a       tooth               www.indiandentalacademy.com
Dentine CariesAffected & Infected Dentin:     In operative procedures, it is convenient to     term dentin as either..   ...
www.indiandentalacademy.com
Caries Detecting Die   Caries detection solutions have been used    by clinicians to distinguish between    affected and ...
Response to dental cariesIn the earliest stages of exposure tomicroorganisms, there is an effort to sealthe tubules. This ...
In addition, pulpal odontoblasts, stimulated bythe advancing carious lesion, will rapidly depositdentin. The dentinal tubu...
Management of deep cariesThe objective is to focus on the: Diagnosis ttt modalities             www.indiandentalacademy....
Treatment Modalities    The results of diagnosis :No exposure                               Pulp ExposureConventional     ...
Indirect Pulp Capping  When caries is thought to extend closeto, or into the pulp, excavation of thepulpal caries can be s...
Medication is left for 6 – 8 weeks .During this waiting period :   The carious process is arrested   Soft caries hardene...
However the difficulty with this tecnique is knowing:   how rapid the carious process has been   how much tertiary denti...
Materials used for indirect pulp capping :   Calcium Hydroxide    Although CaOH is the most commonly used it    has been ...
www.indiandentalacademy.com
Direct Pulp Capping    Technique for treating a pulp    exposure with a material that    seals over the exposure site &   ...
Direct Pulp Capping Techniques Calcium Hydroxide                         Total etch techniqueTechnique       hemostasis   ...
Calcium Hydroxide    Technique :1. Bleeding must be controlled.    This control may be achieved by :    Washing the area ...
2. The area is then air dried3. Calcium Hydroxide is placed directly in contact   with pulp tissue. This step is very impo...
An alternative is to place a zinc oxide-eugenolrestoration over the calcium hydroxide cap.Zinc oxide-eugenol provides an e...
Total Etch Technique :1. Enamel and dentin are etched with 32% phosphoric     acid for 15 seconds.2.   The acid is rinsed ...
Chemo-mechanical caries removal    Carisolv™ is a chemo-mechanical method for    minimally invasive caries removal .    Th...
Carisolv gel consists of two carboxymethylcellulose    based gels:   a red gel containing :    amino acids (glutamic acid...
   The two gels are thoroughly mixed in equal parts at    room temperature before use . The solution has a    pH 11.   T...
A soft caries lesion               Gel application. Let gel slide onto the                                       lesion. W...
The gel is removed with a                                       Complete caries removal isdry pellet                      ...
Advantages of carisolv   The patients perceive the    method as much more    comfortable than drilling and    anaesthetic...
Smartprep instrument   The SMARTPREPTM Instrument is a polymer    instrument that safely and effectively remove    decaye...
www.indiandentalacademy.com
Advantages :   Conserve healthy tooth structure,   Virtually no risk of inadvertent pulp    exposure,   Reduce the need...
The restorative treatment doesntcure the caries process, soidentifying & eliminating thecausative factors for caries mustb...
www.indiandentalacademy.com
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Management of Deep caries /certified fixed orthodontic courses by Indian dental academy

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Management of Deep caries /certified fixed orthodontic courses by Indian dental academy

  1. 1. www.indiandentalacademy.com
  2. 2. Definition :Dental caries is an infectious micro-biologic disease of the teeth that results inlocalized dissolution & destruction of thecalcified tissues. requiring restorativeintervention & even extraction.. www.indiandentalacademy.com
  3. 3. Etiologyfood bacteri a tooth www.indiandentalacademy.com
  4. 4. Dentine CariesAffected & Infected Dentin: In operative procedures, it is convenient to term dentin as either..  Affected dentin: is softened, demineralized dentin that is not yet invaded by bacteria  inner carious dentin ( does not requires removal ). OR  Infected dentin:  outer carious dentin & Bacterial plaque is both softened & contaminated with bacteria ( requires removal ). www.indiandentalacademy.com
  5. 5. www.indiandentalacademy.com
  6. 6. Caries Detecting Die Caries detection solutions have been used by clinicians to distinguish between affected and infected dentin. These are protein dyes that stain denatured callagen of carious dentine www.indiandentalacademy.com
  7. 7. Response to dental cariesIn the earliest stages of exposure tomicroorganisms, there is an effort to sealthe tubules. This is accomplished byincreased calcification. The result is avisible change known as transparentdentin or dentinal sclerosis . www.indiandentalacademy.com
  8. 8. In addition, pulpal odontoblasts, stimulated bythe advancing carious lesion, will rapidly depositdentin. The dentinal tubules in this new dentinare irregular, making them less permeable thistype of dentin is known as : irregular dentin ,reparative dentin , secondary dentin ortertiary dentin . Dentinal sclerosis andreparative dentin may be successful deterrents ifthe carious lesion progresses slowly. www.indiandentalacademy.com
  9. 9. Management of deep cariesThe objective is to focus on the: Diagnosis ttt modalities www.indiandentalacademy.com
  10. 10. Treatment Modalities The results of diagnosis :No exposure Pulp ExposureConventional Indirect pulp Vital Non-vital capping (traumatic) (carious) exposure exposurecavitypreparationand restoration Direct pulp capping RCT Recent advances of caries removal : carisolv Smartprep instrument www.indiandentalacademy.com
  11. 11. Indirect Pulp Capping When caries is thought to extend closeto, or into the pulp, excavation of thepulpal caries can be stopped at softaffected but not infected dentine ( affecteddentine could be remineralised if the acidproduction was halted). Medication is thenapplied over the pulpal dentine prior toplacement of the definitive restoration. www.indiandentalacademy.com
  12. 12. Medication is left for 6 – 8 weeks .During this waiting period : The carious process is arrested Soft caries hardened A protective layer of reparative dentine is laid down www.indiandentalacademy.com
  13. 13. However the difficulty with this tecnique is knowing: how rapid the carious process has been how much tertiary dentine has been formed knowing exactly when to stop excavating to avoid pulp exposure. www.indiandentalacademy.com
  14. 14. Materials used for indirect pulp capping : Calcium Hydroxide Although CaOH is the most commonly used it has been argued that its effect occurs only in case of its direct contact with pulp tissues . Therefore a material with better sealing ability should be used . Zinc oxide and Eugenol Recently adhesive resin has been used www.indiandentalacademy.com
  15. 15. www.indiandentalacademy.com
  16. 16. Direct Pulp Capping Technique for treating a pulp exposure with a material that seals over the exposure site & promotes reparative dentin formation.. Requirements of direct pulp capping: Asymptomatic vital tooth Pin-point exposure (0.5mm or less in diameter) Non-hemorrhagic or easily controlled. Dry, sterile filed Non-carious atraumatic exposure www.indiandentalacademy.com
  17. 17. Direct Pulp Capping Techniques Calcium Hydroxide Total etch techniqueTechnique hemostasis hemostasis Disinfect cavity Disinfect cavity CaOH primersResin modifieed glass ionomer adhesives IRM Resin modifieed glass ionomer Restoration Restoration www.indiandentalacademy.com
  18. 18. Calcium Hydroxide Technique :1. Bleeding must be controlled. This control may be achieved by : Washing the area with sterile saline and drying it with either paper points or cotton pellets, Using cotton pellets soaked with hydrogen peroxide or 5.25% sodium hypochlorite, OR Using a hemostatic agent . If bleeding fails to stop after two or three attempts, then endodontic therapy should be considered. A disinfectant should be placed on the cavity floor. www.indiandentalacademy.com
  19. 19. 2. The area is then air dried3. Calcium Hydroxide is placed directly in contact with pulp tissue. This step is very important, for the better the contact of the calcium hydroxide dressing with the pulpal wound, the better the healing.4. The calcium hydroxide should then be covered with a resin-modified glass ionomer extended onto dentin.5. A permanent restoration is placed, with a dentin bonding system used to seal the margins of the restoration. www.indiandentalacademy.com
  20. 20. An alternative is to place a zinc oxide-eugenolrestoration over the calcium hydroxide cap.Zinc oxide-eugenol provides an excellent sealand, with its anti-microbial properties, makesfor a very good temporary restoration. After three months, assuming pulp vitality andno symptoms, the zinc oxide-eugenol can beremoved and a more permanent sealedrestoration placed. www.indiandentalacademy.com
  21. 21. Total Etch Technique :1. Enamel and dentin are etched with 32% phosphoric acid for 15 seconds.2. The acid is rinsed off and the preparation is lightly dried.3. The entire preparation , including enamel, dentin and pulpal tissue , is treated with a dentin bonding system.4. Adhesive resin is applied onto the enamel, dentin and pulpal tissue and light cured, and a thin layer of resin- modified glass ionomer is also applied over and around the exposure site ( mechanically protect the perforation from intrusion of the restorative material during packing or condensation) and then cured.5. The restoration is subsequently completed in conventional fashion. www.indiandentalacademy.com
  22. 22. Chemo-mechanical caries removal Carisolv™ is a chemo-mechanical method for minimally invasive caries removal . The system comprises : a gel that selectively attacks denatured collagen in the carious dentine, thus making the carious dentine softer. a set of specially designed instruments used for removal of the softened material. www.indiandentalacademy.com
  23. 23. Carisolv gel consists of two carboxymethylcellulose based gels: a red gel containing : amino acids (glutamic acid, leucine and lysine), NaCl NaOH Erythrosine (added in order to make the gel visible during use ). and a second containing sodium hypochlorite www.indiandentalacademy.com
  24. 24.  The two gels are thoroughly mixed in equal parts at room temperature before use . The solution has a pH 11. The positively and negatively charged groups on the amino acids become chlorinated and further disrupt the collagen crosslinkage in the matrix of the . carious dentine. The gel is then applied onto the exposed carious dentine and left for 30 to 60 seconds then the softened dentine is gently but firmly abraded away leaving a hard, caries-free cavity www.indiandentalacademy.com
  25. 25. A soft caries lesion Gel application. Let gel slide onto the lesion. Wait 30 seconds.The lesion is gently scraped with Re-applied gel stays clear. Cavitya star instrument is hard with a probe. www.indiandentalacademy.com
  26. 26. The gel is removed with a Complete caries removal isdry pellet checked with an explorerThe cavity is cleaned with Finished cavitywet pellets www.indiandentalacademy.com
  27. 27. Advantages of carisolv The patients perceive the method as much more comfortable than drilling and anaesthetics are seldom needed. Action of excavator. Healthy dentine is also removed. Saves time Avoids removal of unnecessary healthy dental tissues Selective removal of softened dentine caries with the Carisolv™ instrument. Healthy dentine is not affected. www.indiandentalacademy.com
  28. 28. Smartprep instrument The SMARTPREPTM Instrument is a polymer instrument that safely and effectively remove decayed dentin, leaving healthy dentin intact. It is a self-limiting instrument and is not hard enough to penetrate healthy dentin. As it gently removes decay and contacts the healthy dentin, the instruments edges become rounded and unable to cut healthy tooth structure. A high-speed carbide bur is first used to gain access to the decay. After access has been created, the SMARTPREPTM Instrument is used in a slow speed handpiece (500-800 rpm) to complete caries removal. They are single-patient-use rotary instruments. www.indiandentalacademy.com
  29. 29. www.indiandentalacademy.com
  30. 30. Advantages : Conserve healthy tooth structure, Virtually no risk of inadvertent pulp exposure, Reduce the need for anesthesia and allow for same-visit cavity preparations on multiple quadrants, Designed to reduce post-operative sensitivity. www.indiandentalacademy.com
  31. 31. The restorative treatment doesntcure the caries process, soidentifying & eliminating thecausative factors for caries mustbe the primary focus, in additionto the restorative repair ofdamage caused by caries. www.indiandentalacademy.com
  32. 32. www.indiandentalacademy.com

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