.

1. Recent Methodology in Management
of Non-carious Lesions
Presented to Dr. Mohammad Atef Ibrahim Ali

2. Presented by:
 Reem Barbeer
 Andreas Dagher
 Serena Dakik
 Sara Doughan
 Alaa Dokmak

3. Outline
 Management of discoloration
 Management of abfraction
 Management of erosion
 Management of fracture
 Management of attrition
 Management of abrasion
 Veneers in management of non-carious lesions

4. Discoloration
 It is defined as the
deviation from the normal
color of the tooth.
 It can be either intrinsic
or extrinsic.
 It also can affect the
gingiva.
 The mode of
management depends of
the type:

5. Management of Intrinsic Discoloration
1. Micro-abrasion:
 It’s a technique by which small amount of surface enamel
is removed.
 It is done by hydrochloric pumice technique or
phosphoric acid pumice technique.

6. Management of Intrinsic Discoloration:
2- Chair side bleaching: 3- Night guard bleaching:
 Application of hydrogen
peroxide to the external
surface of the tooth
 Applying heat to activate
the applicant
 Application of carbamide
peroxide gel in a special
tray

7. Management of Extrinsic Discoloration
1- Ultrasonic and sonic scaling:
 Power driven scalers that depends on quick vibration
with the combination of water flow.
 Advantage: increase the efficiency in the removal of
calculus.

8. Management of Extrinsic Discoloration
2- Toothpastes containing titanium oxides:
 Recent tooth pastes contain titanium oxides that cover
the extrinsic stain.
 Titanium dioxide is an intensely white pigment. It has a
high refractive index, which means it scatters light to
create a very white product.

9. Gingival Discoloration
 The color of the gingival depends on several factors the
most important one is the pigments (mainly melanin).
 Hyper-pigmentation cause discoloration of the gingiva
and it can be caused hormonal, chemical, or physical
factors.
 It an esthetic problem especially if it occur on facial
aspect of gingiva.

10. Management of Gingival Discoloration
1. Laser irradiations:
 Used to ablate cells
containing and producing the
melanin pigmentation.
 The remnants of the ablated
cells are removed by sterile
gauze damped with saline.
 Different lasers have been
used for gingival
depigmentation including:
carbon dioxide , argon,
diode, and others.

11. Management of Gingival Discoloration
 Advantages: Easy handling, homeostasis, and
decontamination and sterilization effects and it doesn’t
require periodontal dressing.
 Disadvantages: Expensive, require specialized
equipment that are not commonly available.

12. Management of Gingival Discoloration
2. Surgical procedures:
 It is a surgical removal of undesired pigmentation using
scalpels.
 Gingival epithelium is removed surgically along with the
layer of underlying connective tissue.
 The denuded connective tissue then heals by secondary
intention.

13. Abfraction
 Wedge shaped defect in cervical region of the teeth
caused by excessive forces in this area.

14. Management of abfraction
1. Advanced types of GIC used for restoration:
 Fuji VII-EP (extra protection):
o Advanced by addition of 3% CPP-ACP (recaldent)
o Releases calcium, phosphate, and fluoride that increases
protection against demineralization.
o It has antibacterial effects.

15. Management of abfraction
 Riva Protect (SDI):
o Advanced by incorporation of
FCA ( amorphous calcium
phosphate).
o FCA:
 Absorbed easily by the tooth
since it is derived from the
same material.
 Supercharge the
remineralization effect of GIC.
 It adds calcium and phosphate
to aid in protection.

16. Management of abfraction
2. Finite elemental analysis:
 Deformation and stresses are generated when loads
are applied to structure, if excessive stresses
exceeds elastic limit, failure may occur.
 These stresses cant be directly measured and it is
not easy to understand why and when a failure
process initiate.
 So, it is useful to use the application of engineering
knowledge in dentistry which is the FEA.
 Finite element method is a series of computational
procedure used to calculate the stress in each
element which performs a model solution.

17. Management of abfraction
 This analysis allows us to determine the stress resulting from
external force pressure, thermal changes and other factors.
 When the stress are well known quantitatively and qualitatively
proper restoration and prevention of abfraction can occur.

18. Erosion
 Erosion is the loss of tooth hard structure as a result
of a non-bacterial chemical reaction.
 This reaction is caused by acids that can be extrinsic
and intrinsic.

19. Management of erosion
1. CO2 laser irradiation:
 It is a method used to increase enamel resistance to
demineralization and thus prevent effect of erosive acids.
 The absorption of CO2 lasers by enamel is associated
with the absorption of the phosphate mineral bands of the
structure.

20. Management of erosion
2. Proton pump inhibitors (PPLs):
 They suppresses stomach acid and treat conditions such
as acid reflux thus preventing erosion.
 Studies shows that are associated with dangerous side
effects that may be sometimes fatal.
 Prilosec is the most common type of these inhibitors.

21. Fracture
 loss of tooth structure that can occur as a result of
injury or trauma.
 Fractures can be:
o crown fractures
o Enamel infraction
o Enamel and dentin w/o pulp involvement
o Enamel and dentin with pulp involvement
o root fractures
o crown-root fractures

22. Enamel
Enamel and dentin
without pulp
Enamel and dentin
with pulp
Root fracture
Crown-root fracture

23. Management of fracture:
1. Fiber optics trans-illumination:
 Fiber optics optical fiber refers to flexible thin cylindrical
fibers of high optical quality glass or plastic.
 Can be used to diagnose enamel fractures particularly
incomplete cusp fracture before they reach their end
stage.

24. Management of fracture:
The trans-illuminated teeth
can be documented by
intraoral photography, using
a two-handed technique by
holding a trans-illumination
device and an intraoral
camera simultaneously, with
the resulting images shared
with the patient.

25. Attrition
 Attrition is a physiological loss of hard tooth structure
as a result of tooth to tooth contact with possible
presence of abrasive medium.
 These lesion are mostly located on incisal or
occlusal surface but can also occur in proximal
surface.

26. Management of attrition:
1. Sleepright slim comfort
night guard:
 It is designed specifically
for sufferers of teeth
bruxism who have
sensitive gums and small
mouth.
 Like the traditional night
guards, it keeps our upper
and lower teeth apart and
prevent premature tooth
wear and noise from teeth
grinding.

27. Management if attrition:
 Advantages
o Can be adjusted to fit all
sizes
o Requires no boiling
o Easy to fit within seconds
o Not bulky
o TMJ protection

28. Abrasion
 Abrasion is loss of hard tooth structure due to
frictional forces between tooth and external object or
between teeth in presence of abrasive medium.
 Main cause is aggressive tooth brushing technique

29. Management of brushing abrasion:
1. Oral B Bluetooth connected
toothbrush:
 It is the first available
interactive electric tooth brush .
 It records brushing activities as
data that you can chart on your
own and share with dental
professionals.
 You can use your smart
phones as a remote control to
customize your brush to your
needs, including setting you
target session length and
selecting you preferred modes.

30. Management of brushing abrasion
 Advantages:
o It can tell us if our brushing is too hard
o If we are brushing long enough
o If our brushing habits have improved.

31. Veneers
 Indications of veneers in non-carious lesions
1) Correct the discoloration of teeth (caused by
hypocalcification and hypoplasia).
2) Repair of tooth fracture.
3) Repair enamel alteration (attrition, abrasion).
4) Treat teeth staining.

32. The Latest Advances in Teeth Veneers
Lumineers:
 Thin veneers.
 High resilience.
 Can last for twenty years or more.
 Easily applied with little to no pain.
 Reach patient’s satisfaction.
 Can be completed in just two dental
visits.

38. References
 Prevention of enamel erosion through CO2 laser
irradiation: An in situ study/ Karen Müller Ramalho.
 Proton Pump Inhibitors: Dangerous and Habit-
Forming Heartburn Drugs/ Sidney m. Wolfe.
 Inhibition of enamel erosion by stannous and fluoride
containing rinsing solutions/ Dr. E. Rakhmatullina.
 http://www.bruxism.org.uk/shop/sleepright/slim-
comfort.php
 Application of the finite element method in Dentistry/
Máyra Andressa R. V. Piccioni, Edson Alves
Campos.

39. References:
 connected toothbrush.com
 Using Fiber Optic Transillumination as a Diagnostic
Aid in Dental Practice/ Dr H. Strassler.
 Ceramic laminate veneers: materials advances and
selection/ Nasrin R. Sadaqa.
 Gingival depigmentation as an effective treatment
modality for enhancing esthetics: A case report and
literature review/ Sandeep A. Lawandee.

40. THANK YOU