Management of Deep Caries - PowerPoint PPT Presentation

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Management of Deep Caries

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Dental caries is an infectious micro-biologic disease of the teeth that results in localized dissolution & destruction of the calcified tissues. requiring restorative ... – PowerPoint PPT presentation

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Title: Management of Deep Caries


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Management of Deep Caries
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Definition
  • Dental caries is an infectious micro-biologic
    disease of the teeth that results in localized
    dissolution destruction of the calcified
    tissues. requiring restorative intervention
    even extraction..

4
Etiology
bacteria
food
tooth
5
Dentine Caries
  • Affected 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 ).

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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

8
Response to dental caries
  • In the earliest stages of exposure to
    microorganisms, there is an effort to seal the
    tubules. This is accomplished by increased
    calcification. The result is a visible change
    known as transparent dentin or dentinal sclerosis
    .

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  • In addition, pulpal odontoblasts, stimulated by
    the advancing carious lesion, will rapidly
    deposit dentin. The dentinal tubules in this new
    dentin are irregular, making them less permeable
    this type of dentin is known as irregular
    dentin , reparative dentin , secondary dentin or
    tertiary dentin . Dentinal sclerosis and
    reparative dentin may be successful deterrents if
    the carious lesion progresses slowly.

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Management of deep caries
  • The objective is to focus on the
  • Diagnosis
  • ttt modalities

11
Treatment Modalities
  • The results of diagnosis

Pulp Exposure
No exposure
Indirect pulp capping
Vital (traumatic)exposure
Non-vital (carious) exposure
Conventional cavity preparation
and restoration
Direct pulp capping
RCT
  • Recent advances of caries removal
    carisolv

    Smartprep instrument

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Indirect Pulp Capping
  • When caries is thought to extend close to, or
    into the pulp, excavation of the pulpal caries
    can be stopped at soft affected but not infected
    dentine (affected dentine could be remineralised
    if the acid production was halted). Medication is
    then applied over the pulpal dentine prior to
    placement of the definitive restoration.

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  • 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

14
  • 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.

15
  • 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

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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

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  • Direct Pulp Capping Techniques

Calcium Hydroxide Technique
Total etch technique
hemostasis
hemostasis
Disinfect cavity
Disinfect cavity
primers
CaOH
Resin modifieed glass ionomer
adhesives
IRM
Resin modifieed glass ionomer
Restoration
Restoration
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  • Calcium Hydroxide Technique
  • 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.

20
  • The area is then air dried
  • 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.
  • The calcium hydroxide should then be covered with
    a resin-modified glass ionomer extended onto
    dentin.
  • A permanent restoration is placed, with a dentin
    bonding system used to seal the margins of the
    restoration.

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  • An alternative is to place a zinc oxide-eugenol
    restoration over the calcium hydroxide cap. Zinc
    oxide-eugenol provides an excellent seal and,
    with its anti-microbial properties, makes for a
    very good temporary restoration.
  • After three months, assuming pulp vitality and
    no symptoms, the zinc oxide-eugenol can be
    removed and a more permanent sealed restoration
    placed.

22
  • Total Etch Technique
  • Enamel and dentin are etched with 32 phosphoric
    acid for 15 seconds.
  • The acid is rinsed off and the preparation is
    lightly dried.
  • The entire preparation , including enamel, dentin
    and pulpal tissue , is treated with a dentin
    bonding system.
  • 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.
  • The restoration is subsequently completed in
    conventional fashion.

23
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.

24
  • Carisolv gel consists of two carboxymethylcellulo
    se 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

25
  • 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

.
26
A soft caries lesion
Gel application. Let gel slide onto the lesion.
Wait 30 seconds.
Re-applied gel stays clear. Cavity is hard with a
probe.
The lesion is gently scraped with a star
instrument
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The gel is removed with a dry pellet
Complete caries removal is checked with an
explorer

The cavity is cleaned with wet pellets
Finished cavity
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Advantages of carisolv
  • The patients perceive the method as much more
    comfortable than drilling and anaesthetics are
    seldom needed.
  • Saves time
  • Avoids removal of unnecessary healthy dental
    tissues

Action of excavator. Healthy dentine is also
removed.
Selective removal of softened dentine caries with
the Carisolv instrument. Healthy dentine is not
affected.
29
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 instrument's 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.

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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.

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  • The restorative treatment doesn't cure the
    caries process, so identifying eliminating the
    causative factors for caries must be the primary
    focus, in addition to the restorative repair of
    damage caused by caries.

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Thank you
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