ARTART

ATRAUMATIC/ ATRAUMATIC/ ALTERNATIVE ALTERNATIVE

RESTORATIVE TREATMENTRESTORATIVE TREATMENT

Caries has been defined in many Caries has been defined in many ways but it can be considered to beways but it can be considered to be

A process that result in gradual A process that result in gradual loss of the mineral that make up loss of the mineral that make up the tooth structuresthe tooth structures

This applies to both enamel and This applies to both enamel and dentin cariesdentin caries

INTERACTION OF INTERACTION OF AETIOLOGICAL FACTORS IN AETIOLOGICAL FACTORS IN

THE ORAL CAVITYTHE ORAL CAVITY BACTERIAL PLAQUEBACTERIAL PLAQUE

++ REFINED REFINED

CARBOHYDRATECARBOHYDRATE

SALIVA+HYGIENE+SALIVA+HYGIENE+

FLOURIDEFLOURIDE

++ NATURAL NATURAL

PROTECTIVE PROTECTIVE FACTORFACTOR

DEMINERALISATION REMINALISATION

INTRODUCTIONINTRODUCTION

PREVENTION AND TREATMENT OF DENTAL PREVENTION AND TREATMENT OF DENTAL CARIESCARIES

BASED ON EXCAVATING AND REMOVING BASED ON EXCAVATING AND REMOVING CARIES USING HAND INSTRUMENT ONLY CARIES USING HAND INSTRUMENT ONLY OR ROTARY INSTRUMENT (LOW SPEED)OR ROTARY INSTRUMENT (LOW SPEED)

RESTORING TOOTH WITH ADHESIVE RESTORING TOOTH WITH ADHESIVE FILLING MATERIAL (GLASS – IONOMER)FILLING MATERIAL (GLASS – IONOMER)

SIMPLE , INEXPENSIVE, NON-THREATNING, SIMPLE , INEXPENSIVE, NON-THREATNING, NOT-PAINFULNOT-PAINFUL

ALTERNATIVE RESTORATIVE ALTERNATIVE RESTORATIVE TREATMENTTREATMENT

► RESTORATIVE CARE FOR INFANT, CHILDREN, RESTORATIVE CARE FOR INFANT, CHILDREN, ADOLESCENT AND PERSON WITH SPECIAL ADOLESCENT AND PERSON WITH SPECIAL HEALTH CARE NEEDS IN CLINICAL HEALTH CARE NEEDS IN CLINICAL CIRCUMTANCES ARE UNIQUECIRCUMTANCES ARE UNIQUE

► WHEN THIS CLINICAL CIRCUMTANCES DO WHEN THIS CLINICAL CIRCUMTANCES DO NOT PERMIT TRADITIONAL CAVITY NOT PERMIT TRADITIONAL CAVITY PREPARATION AND PLACEMENT OF PREPARATION AND PLACEMENT OF TRADITIONAL DENTAL RESTORATION, USE TRADITIONAL DENTAL RESTORATION, USE OF ART MAY BE BENEFICIALOF ART MAY BE BENEFICIAL

DEFINITION

DENTAL CARIES TREATMENT PROCEDURE INVOLVING THE REMOVAL OF SOFT DEMINERALIZED TOOTH TISSUE USING HAND INSTRUMENT ONLY, FOLLOWED BY RESTORATION OF THE TOOTH WITH AN ADHESIVE MATERIAL, ROUNTINELY GLASS IONOMER

Yip HK, Smales RJ, Ngo HC, Tay FR 2001

INDICATION AND INDICATION AND CONTRAINDICATIONCONTRAINDICATION

Small cavity involving Small cavity involving dentinedentine

The cavity is The cavity is accessible to hand accessible to hand instrumentinstrument

There is of presence of There is of presence of swelling or fistulaswelling or fistula

The pulp of the tooth is The pulp of the tooth is exposedexposed

Teeth had been painful Teeth had been painful for a long time and for a long time and there may be chronic there may be chronic inflammation of the inflammation of the pulppulp

Cavity in accessible to Cavity in accessible to hand instrument hand instrument

BIOLOGICAL PRINCIPLES OF BIOLOGICAL PRINCIPLES OF CAVITY PREPARATIONCAVITY PREPARATION

This should be restricted to cavity cleaningThis should be restricted to cavity cleaning It only involves :It only involves : - obtaining access and- obtaining access and - removal of dead, non- remineralizeable - removal of dead, non- remineralizeable

dentine and enameldentine and enamelThus the shape of the cavity is determined by Thus the shape of the cavity is determined by

thethe““anatomy of the carious lesion as is presents at anatomy of the carious lesion as is presents at

the time of cavity preparation”the time of cavity preparation”Therefore there cannot be some preconceived Therefore there cannot be some preconceived

mechanical cavity design (Black principles)mechanical cavity design (Black principles)

ADHESIVE MATERIAL FOR ADHESIVE MATERIAL FOR MINIMAL CAVITY PREPARATIONMINIMAL CAVITY PREPARATION

GLASS IONOMERGLASS IONOMERA DENTAL GLASS IONOMER IS A DENTAL GLASS IONOMER IS

SUPPLIED AS : - POWDER AND LIQUID SUPPLIED AS : - POWDER AND LIQUID IN SEPARATE BOTTLES (HAND-MIX IN SEPARATE BOTTLES (HAND-MIX VERSION)VERSION)

- IN AN ENCAPSULATED FORM- IN AN ENCAPSULATED FORM• COMPOSITECOMPOSITE• COMPOMERCOMPOMER

INSTRUMENT AND INSTRUMENT AND MATERIALMATERIAL

MOUTH MIRRORSMOUTH MIRRORS EXPLORERSEXPLORERS TWEEZERSTWEEZERS SPOON SPOON

EXCAVATOREXCAVATOR HATCHETS/HOEHATCHETS/HOE CARVERCARVER

GLASS-IONOMER GLASS-IONOMER CEMENTCEMENT

COTTON COTTON ROOL/PELLETSROOL/PELLETS

SPATULASPATULA PETROLEUM PETROLEUM

JELY/VASELINEJELY/VASELINE WEDGESWEDGES

CLINICAL CHARATERISTICCLINICAL CHARATERISTIC

Glass-ionomer bond chemically to enamel Glass-ionomer bond chemically to enamel and dentine and provide good cavity sealand dentine and provide good cavity seal

Slow release of fluoride after it has setSlow release of fluoride after it has set Pulpal friendly, during setting the material Pulpal friendly, during setting the material

may cause the pulp to feel tender. After may cause the pulp to feel tender. After 24 hours, when completely set, adverse 24 hours, when completely set, adverse reaction do not occur anymorereaction do not occur anymore

TECHNIQUE TECHNIQUE THE AREA AROUND THE CARIOUS TOOTH TO BE TREATED IS KEPT THE AREA AROUND THE CARIOUS TOOTH TO BE TREATED IS KEPT

DRY BY PLACING COTTON ROLLSDRY BY PLACING COTTON ROLLS THEN THE CAVITY ENTRANCE IS WIDENED BY USING HATCHET/ THEN THE CAVITY ENTRANCE IS WIDENED BY USING HATCHET/

HOEHOE WITH SPOON EXCAVATOR CARIES IS REMOVEDWITH SPOON EXCAVATOR CARIES IS REMOVED WHEN ALL CARIES HAS BEEN REMOVED AND THE CAVITY WHEN ALL CARIES HAS BEEN REMOVED AND THE CAVITY

CLEANED AND DRIED A DENTINE CONDITIONER IS APPLIED ON CLEANED AND DRIED A DENTINE CONDITIONER IS APPLIED ON THE CAVITY TO IMPROVE THE BONDING MATERIAL TO THE TOOTHTHE CAVITY TO IMPROVE THE BONDING MATERIAL TO THE TOOTH

MIXING THE GLASS-IONOMER IN 20 – 32 SECONDSMIXING THE GLASS-IONOMER IN 20 – 32 SECONDS THE MIXTURE IS INSERTED WITH FLAT END OF THE CARVER. THE THE MIXTURE IS INSERTED WITH FLAT END OF THE CARVER. THE

CAVITY IS OVERFILLED TO INCLUDE REMAINING PIT AN FISSURESCAVITY IS OVERFILLED TO INCLUDE REMAINING PIT AN FISSURES RUB SOME VASELINE ON THE GLOVE INDEX FINGER AND THE RUB SOME VASELINE ON THE GLOVE INDEX FINGER AND THE

FILLING MATERIAL PRESSED FIRMLY WITH THE FINGER ON THE FILLING MATERIAL PRESSED FIRMLY WITH THE FINGER ON THE TOOTHTOOTH

REMOVED THE EXCESS MATERIAL USING CARVERREMOVED THE EXCESS MATERIAL USING CARVER INSTRUCT THE PASIEN NOT TO EAT AT LEAST 1 HOURINSTRUCT THE PASIEN NOT TO EAT AT LEAST 1 HOUR

MIXINGMIXING

Powder and liquid ratio Powder and liquid ratio Place a spoonful of powder on a glass slab/ mixing Place a spoonful of powder on a glass slab/ mixing

pad. Use spatula to divide the powder into two equal pad. Use spatula to divide the powder into two equal portions then dispense a drop of liquid next to the portions then dispense a drop of liquid next to the powderpowder

First spread the liquid with the spatula over a surface First spread the liquid with the spatula over a surface 1,5 cm1,5 cm2, 2, start mixing by adding one half of the powder start mixing by adding one half of the powder into the liquid using spatula. Roll the powder into liquid into the liquid using spatula. Roll the powder into liquid gently wetting the particle without spreading them gently wetting the particle without spreading them around the slab. around the slab.

As soon as all powder particle are wetted, the second As soon as all powder particle are wetted, the second portion is folded into the mix. Now mix firmly while portion is folded into the mix. Now mix firmly while keeping the mass together.keeping the mass together.

The mixing should be completed within 20 – 30 secondThe mixing should be completed within 20 – 30 second The final mixture should look smooth like chewing gumThe final mixture should look smooth like chewing gum

What is the function of surface conditioner ?What is the function of surface conditioner ?

A surface conditioner is an organic acid, usually a weak A surface conditioner is an organic acid, usually a weak polyacrylic acidpolyacrylic acid

The removal of outer carious dentine either with hand The removal of outer carious dentine either with hand instrument or a drill result in the production of a smear instrument or a drill result in the production of a smear layerlayer

This smear layer prevents adequate bonding of the glass-This smear layer prevents adequate bonding of the glass-ionomer to the tooth tissue and should therefore be ionomer to the tooth tissue and should therefore be removedremoved

In order to achieve this, a surface conditioner is usedIn order to achieve this, a surface conditioner is used A Chemical solvent is used for conditioningA Chemical solvent is used for conditioning 1. Dentin conditioner : 10% solution of polyacrylic acid1. Dentin conditioner : 10% solution of polyacrylic acid 2. Liquid supplied with glassionomer itself2. Liquid supplied with glassionomer itself

Conditioning is how to clean the prepared cavityConditioning is how to clean the prepared cavity

1. Dentine conditioner1. Dentine conditioner - Apply one drop of the conditioner on a pad or the slab- Apply one drop of the conditioner on a pad or the slab - Dip a cotton pellet in the drop of the conditioner and clean the - Dip a cotton pellet in the drop of the conditioner and clean the

entire cavity and adjacent fissures for 10 – 15 “entire cavity and adjacent fissures for 10 – 15 “ - Wash the cavity and fissures at least twice with cotton pellet - Wash the cavity and fissures at least twice with cotton pellet

dipped in clean waterdipped in clean water

2. The glassionomer liquid2. The glassionomer liquid - The liquid is too strong and needs to be diluted- The liquid is too strong and needs to be diluted - Placing one drop of liquid on a pad or slab - Placing one drop of liquid on a pad or slab - Moisten a cotton pellet by dipping it in water- Moisten a cotton pellet by dipping it in water - Remove the excess water by touching the pellet against a dry - Remove the excess water by touching the pellet against a dry

cotton rollcotton roll - Dip the moist pellet in the glassionomer liquid and use it as a - Dip the moist pellet in the glassionomer liquid and use it as a

dentine conditioner in the way described abovedentine conditioner in the way described above

                        .............                            

cariespreparation

Glass-ionomer filling