Professional Documents
Culture Documents
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relevance today and then. (21st vs past)
Dental caries
ü most prevailing
ü pre historic infectious diseases
ü exist in developed, developing and under developed counties
Once restored
ü Secondary account for 60%
ü Irrespective of material type
Other reason for restoration failure
ü Material failure,
ü Tooth fracture or defect,
ü Endodontic involvement,
ü Prosthetic abutment use,
ü Technical errors, and
ü Deterioration of aesthetic quality with tooth-colored restoratives.
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PREVENTION
THE ULTIMATE WEAPON IN CARIES
F
But again the complex material
brings the complex understanding of L
THE ULTIMATE WEAPON IN CARIES PREVENTION
its judicious use and technique.
O
U
R
responsibility.
Big power brings big
I
D
E
S
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Secondary caries and the past.
PREVENTION
THE ULTIMATE WEAPON IN CARIES
F
L
ü Proper condensation of gold
restoration . O
ü Secondary expansion of amalgam U
and resiliency of dentine came
into play.
R
ü With the development of silicate I
------------------------------------------------ D
------------------------------------------------
--------------------------the story E
continues. S
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fluorides
qFluorine word is derived from the Russian word
"flor" ---------- "flois" meaning destruction
in Greek and from Latin word "fluor" that
means to flow since it was used as a flux.
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Optimum Fluoride intake
Depending upon the mean maximum daily
temperature:
ü Cold climate 1.2 ppm
ü Summer season or temperate climate 0.7
ppm
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Self applied topical flouride
Concentration ranges from 1,000- 1,500 ppm
of fluoride.
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Storage of Fluoride
Chronic fluorosis:
1. Skeletal fluorosis and
2. Dental fluorosis.
Skeletal fluorosis –
1. Joint stiffness and osteosclerosis (milder forms),
2. Calcification of ligaments, muscle wasting, osteoporosis, and neurologic
deficits (severe forms).
Symptomatic after about 10 years of fluoride exposure at least 10
mg/day.
Dental fluorosis-
1. Diffuse opacities on the enamel surfaces of the teeth.
2. Noteworthy because of cosmetic concern
May be associated with increased porosity. porosity may stained
or coalesce into discrete pits.
3. 5% calcium gluconate
7. Gastric levage.
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Extension of caries lesion into dentine
5 Possible
Extension of caries into pulp formation of
apical
abscess
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Mechanism Of Action of fluorides
Increase in enamel resistance OR reduction in
enamel solubility.
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Increase in post eruptive maturation.
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Remineralization of incipient lesions.
Fluoride is provide from
1.Saliva
2.tooth mineral dissolved during demineralization
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Interference with plaque microorganism.
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Fluoride releasing restorative material
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Salivary [Ca2+]
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Restorations life varies as per restorative
material.
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diagnosis
Diagnosis of secondary caries is dependent on
following features.
2. visual inspection,
3. tactile sensation with judicious explorer usage,
and
4. radiographic interpretation.
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Cont.
Prevention is better then cure.
fluoride regimen implementation (rinses, gels,
fluoridated toothpastes);
Antimicrobials (chlorhexidine);
Dietary review.
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Factors influencing the release of
fluorides
The release of fluoride is a complex process.
It can be affected by several intrinsic variables,
such as
1. formulation and fillers .
2. composition and pH-value of saliva,
3. plaque and
4. pellicle formation.
It was shown that factor like
1. powder–liquid ratio of two-phase-systems,
2. mixing procedure,
3. curing time and
4. the amount of exposed area
5. different storage media affected the fluoride release.
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Cont.
Cont.
The highest release is found in acidic and
demineralizing–remineralizing regimes and lowest
in saliva.
Formation of fluorapatite
Enhancement of Remineralization .
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Ho much is enough?
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Classification
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Comparison of various f contaning
restorative
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Review of various fluoride releasing
materials
1. Glass-ionomers,
2. Resinmodified glass-ionomer cements,
3. Polyacid-modified composites (compomers)
4. Giomer,
5. Composites,
6. Amalgams.
7. Polycarboxylates
8. Sealents
9. Varnishes
10. silicates
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History of development of f releasing
materials
1935 joseph H. SCHLESINGER- "Neutralization of
acids exuding from silicious cements“ .
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Commercial products
Ketac-fil >>>>>>3M ESPE
Fuji II>>>>>>>>GC America
Ketac-molar>>> 3M ESPE
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F release from RM-GICs
Vetremer>>>>>>> 3M ESPE
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Polyacid-modified resin composites
(Compomers)
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The advantages of compomers include;
1. ease of placement,
2. no mixing,
3. easy to polish,
4. good aesthetics,
5. excellent handling,
6. less susceptibility to dehydration, and
7. radiopacity.
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Disadvantages of compomers include;
1. limited clinical experience
2. few long-term clinical trials
3. requirement for a bonding agent like composites
4. more marginal staining and chipping
5. wear more than composites
6. enormous variation in products makes longevity
difficult to predict
7. weaker physical properties than composites and
8. clinical significance of fluoride release undetermined
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Cont.
The maximum fluoride release from the
compomer occurs within the first day.
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Compomer in nutshell
No initial F ‘burst’ effect, but levels of F
release
Compoglass>>>Ivoclar vivadent
F 2000>>>>>>>3M ESPE
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giomer
Unlike compomers, fluoro-alumino-silicate
glass particles react with polyacrylic acid prior
to inclusion into the resin matrix.
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Include pre-reacted glass-
ionomers(PRG) to form a
stable phase of glass-ionomer fillers
in the restorative
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cont.
F released from giomers-
1. Less information is available currently
2. - No initial ‘burst’ effect could be observed
3. - Amounts of F leached from giomers
☺slightly > Composites & Compomers
☹ < GICs
F recharging ability
- F release from materials was greatly reduced
➔ Only recharge superficial part
- GICs > Giomers
- PRG in Giomers is surrounded with resin matrix
➔ Porosity of Giomers is lower than GICs
78
F-containing resin composite materials
Recently, ‘fluoride-releasing’ resin composite
materials have been introduced which may
liberate fluoride through passive leaching from
suitably selected filler particles or from the
addition of fluoridated monomers.
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Composites in nut shell
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Commercial products
Haliomolar>>>>>Caulk Dentsply
Tetric>>>>>>>>>Ivoclar Vivadent
Solitaire>>>>>>>Heraeus Kulzer
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SMART COMPOSITES
Active dental polymers contaning bioactive amorphous
calcium phosphate (ACP) filler
Fluoride-releasing sealants
1. ProSeal,
2. GC Fuji Triage
showed a significant reduction in wall lesion
frequency when compared with a nonfluoride-
containing sealant
1. Delton
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Silicate cements
First F-releasing material
Not much used presently because,
2. Poor bonding
3. High solubility
4. Poor mechanical properties
5. Do not survive well in oral environment.
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summary
 Dental caries is a progressive disease
characterised by demineralization
(dissolution) and destruction of enamel
and dentine
 Fluoride can reduce caries by
preventing demineralization and
promoting remineralization of tooth
surfaces and can also inhibit plaque
acid production
 Optimizing the base formulation can
increase fluoride bioactivity without
altering the fluoride level, with the
potential to enhance anti-caries efficacy
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References:-
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Thank you for
bearing me
on toes.
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