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


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

  1. 1. INDIAN DENTAL ACADEMY Leader in Continuing Dental
  2. 2. CONTENTS1. Introduction2. Chemomechanical Caries Removal3. Ozone technology4. Air Abrasion (Kinetic)5. Lasers (Hydrokinetic)6. Conclusion
  3. 3. INTRODUCTION Dental caries G.V.Black in 1893 Recently newer techniques
  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.
  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
  6. 6.  A delivery system, reservoir, heater and a pump Limitation - Slow procedure - Large volumes of solutions (200 – 500ml) - Delivery system commercially not available
  7. 7. CARISOLV Latest CMCR 1998 Pink gel, specially designed hand instruments,volume required less than 1mm, neither heating nor adelivery system
  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)
  9. 9. Application Contents of 2 syringes mixed
  10. 10.  Gel applied to the carious lesion
  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
  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
  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.
  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
  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.
  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
  17. 17. Polyurethane console Ozone generator Vacuum pump Desiccent Hydrophobic filter
  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.
  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.
  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
  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.
  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.
  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.
  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 .
  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).
  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.
  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
  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
  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
  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.
  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.
  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.
  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
  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.
  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.
  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) 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.
  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.
  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)
  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
  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.
  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.
  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.
  44. 44. Thank you for