iat Petro CARIOLOGIE st ODONTOTERAPIE RESTAURATOARE SUB REDACTIA Dr. ANDREI A. ILIESCU Mer(gSounong 2160 1020, AINA) NOsaD}9A, BUSH “sc. (ermodrunty, S042 20194, AIA) MASI IBD wUopg wANe'T ACL ‘RIOLAVOD (eluasuop ,smpiAg,, varmts-antuq) nuwaanSup, ex_W’] IC “s90 28 (nSemong ,e1iaeq joe, gHuA) edog wsnpayagy sc] “jUo> (voodey fj nuedaiiey nun, AWA) dog wp BUY “IC ‘Jord (Gemnyy BL, AWN) KOU NapUEXALY “IC ‘Jord (Sey edog “1D, AWA) asmyvaey wEZayg “1C] Joug Ipuy “4G Jou IALC [OID INA) AYRE) IROL IC JO (nSoanongy .nosoxorepy MLL, varEsIOAtUA) BALLON MEARE A “IC'JUOD (eavostunty, Soqeg 10191... JANA) MsaB AD [HALA “Iq “JuoD, (erwoSiuiy, Sqr 111A, AINA) PIOg Fosrry “ICI “FON J95 ‘MOLLOY Ad INALLOATOD 10d 405 {W809 99302150 91001» os0g sone 20 sz ah ap ang (SSLOLLPIESID (8'SLONZOO-*IE9I9 BUIIWA THPED *] 9-LiS0-GE-£L6-8L6 (€1) NES" ‘1-LLS0-6E-£L6 (01) NEST “BONG, 9007 “EIR OIPaWY eANAIpA Samong| — sEFED youIDyY “nOsaIT "y joupuly / aavowwaneysau adesayoquopo 18 330Io11) “V RIGNY ‘NosarTt pquyuoy ¥ ajeuoje yooronats € aD eaHHDSIC (Cova atoypep ad oust “upumyoson 2anpen sprednyrua) 2av0ifus 9p qworay;pur “ypoyed nes esau ~ audoqpordas v0 nnd so mon aay -eotaped op wmode oo Logo ens OROCuviNT INAINTE Caria dentarst riimine, alitari de bolle cardiovasculare si eancer una din cele mai rispindite imbolniviri ale actualei populatiia globulut. Daci tratamentul curatly al catiel dentare simple constituie obieetul Osontoterapiei restauratoare, in schimb preocupiile legate de cunoasterea etiopatogenll evolutied gi mecanismelor de combatere alcituiesc in prezent Cconfinutal unei nol diseipline, Cariologia. "Pentru evitarea confuzillor dia ultimal deceniu privind stera de abordare a patologiei fesuturilor dure ale dintelui, dar mai ales pentru ‘Sporirea effcienfei dingnosticulul carie simple dentare, planului de fratament si misurilor ferapeutice concrete care decurg, autor au dorit st semnaleze aceasti diferengiere, ‘Prin introducerea nofiunil de cariologie autorii dorese si-si atenfionezecolegt ci exist nu ,carie* dentari cl boalt carioasi Tn acest context biologic integralistcittorul tratatului de fap} poate ‘gist foate informafille necesare unui tratament modern, in care rezolvarea ‘practicé a leciunilor cariouse manifest este tasofit side evaluarea gradului dde isc la carfe al aceluiag individ. ‘La rindul situ, cunoasterea gradulul de rise la carie permite stabitirea, itr-un cadru individualiat, atit a color mai elicente misurt preventive cit si alegerea cele/ mai potrivite indicafi terapeutice. ‘Autor, cadre de mare valoare sunt cat mui realist, introductind informatia de ultimi or, dar pisirand tn acelasi timp racordarea Ix ‘mentalitatea Tne tn schimbare ca si ln condifle actule concrete de destisurare a asistentel stomatologice. "Sunt convins ci acest volumn va avea un mare succes bine meritat. ‘Acad. Prof. Dr. NICOLAE CAJAL ee Acsdemiede ine Meicledood anny pseanang, no poropouas ips osa40p 24 apinan nos 1un}8018 pxpaM dojauy jf vp “eouotow oh pups nud eg wan, yrassuo 28° 2p bp qeaupuoy 102 HF jasSojored 0 Bs usbagn “avootounoise4 aydoisonwopo 3 2y8ojo}409 2 uy wy 18209 7 par ome pdizy4ve s0s04) ook syaumu ay 1 Hoyao0 iyse1p0 ‘pdnp “22 2p ‘Puowodiy syauoand soy you 129 0 weazaud wy ppandsps ps joy oyo0o8 m2in9 aicaoxe1d o amnion et 109 iy aoquop su Dosnuanauduy seus mp. 7 wp suoioduayuo> j2180)0t0pO EAT ‘purird manos 10114 fou] ,e18qomopor0d “njo'y Said je woylojto joes “0p fpaiquou enone. nano p soda 7 unjarg “sauoy paul RMA ajeuolfounjopiow a19j981e9 FHL “suayau ufoawad ap wrtzzasdat Dy ‘esSe0> Mp 526 op boda ‘qesouge hues @d]WIIYD e1IDBIED Ep} i FuviNad auna worrwnLnsal vanLonws wr BIDOTORVD28 cARIOLOGIE se depune mai ales pe tavanul si podeaua camerei, era lepunerea se face de obicei in dreptul margi zal gi fa cructrald'a dentine! primare, prezentind tnsi 1d formatA prin intensificarea activiiti odonto- tuilor dure prin abraziune, cari, Ea se formeazd pe zone restrinse, corespunzind suprafejei pe sare un caracter de apirare prin creates unui obstacol dur in pendent de activtatea celulelor mezenchimale care tate. In aceste eazuri lipsese din stratal dentinar respecti fibrele Tomes si | fibrelenervoase Din punct de vedere st tral, aceasti dentind prezint un procent scAzut de 1.5 STRUCTURA CEMENTULUI 1.5.1 Caractere topografice ‘mezenchimala care acopert asigurind fixarea fibrelor STRUCTURA TESUTURILOR DURE DENTARE 2» 1.5.2 Caractere chimice Cemenual este consttuit din substan organick 50-53% si substan anorganic 45- 50%. Componenta of este reprezentatd deo materie fibriard de naturd colagent, iar Ia comporitia anorganicl se fatdlnese diverse siruri minerale si indeosebi a Desi rerezentarea componenetei anorganice este mai redust fn cement dectt in urald a siruilor minerale sub formd de cristale de 1.5.3 Caractere morfofunctionale fe constituit din punct de vedere morfologie din dout componenete: (Gibrlar) gi cementul celular. Din punct de vedere cronologic, ccementul acellar se depune primul, din sacul dentar, prin apozite, find denumit frecvent gi cement primar; cement celular se formeazA viterir, find denumit si cement secundar. Came ne, Si a rina scope die dea e oa, suprafats. El pf ine numercate stria{iuni perpendicular pe suprafaja corespund Wlecelor deiner ale fbelor periodontae.Lipsit de celle, ‘cementul fibre dispune de un sistem de canalicule fine, radiare, care asigutli ‘desfiguracea proceselor metabolice. ‘Substanjaorganicd este aleatuitl din filamente colagene reunite nt-un reticl fin, ‘eu ochiuri de maria variate, cuprinzind crstale minerale de volume diferte. (cementoplaste), organice a cement evolutive, {in aceste canalicule intelacunare se gisesc reunite preint-un sistem complex dé anastomozi. ‘cement gi dentind te evidenjiard o structurd organick denumita jor benz eu ‘Aceastizont are un aspect granular, Prk fibrilart, ‘margini anfractuase. Se sonsideri c& aceswlewoune youn earsuoy nated ‘o[eWisyuv3.00% sp o-nud ae2 typynu yyooq oe axede ws ix andaosns oy 38 ‘ene aaa fadnd vaanizefg exaluy 8 auomap nef gual yeoenpose 2109 ‘9Ua19 up wun fou up mespeouy pugindau + ‘sapoud un yiuseudar RIM BED 2180. jousip saooud un aise BUVLNAG ISINVO VINSDOLWdOILS Wantolidvo 18 gnyrauons ajaunoey anya areotumuos ap sv0z njowowopo e gyeimans yiuauoduioo © 18 eiSojopious uy gresSonuy ou ‘huuejnonsed 9p ayes o piujzaud so[no}pes tmuaweo go gIEIsvOD as ‘2yzn|>u0 par TsO ‘ayonstpoarso ‘sxpromedt ‘upromdsuon, “ayeaopeidns nyseidop id os wrhuozay ‘atiqiozas ap suawours 6 ode ap exe Up “jag epeyous vo Se12U98 runioaye uy #8 amide weojuawionsodyy soresedas uowou9y {gns auauia> ap Ylauné2p 8 axes2j2000 0 ¥9 1S RUNIED 1020 punqyiuos yrewoposed 2jiosu eadns 24 uucyunou aanj aS 12W2> 2p inuowag wznydsad ‘unuad jyesooou 2189. A810 uw upd yesazymieul 25 2x89 yplowuaw29 2 [ansy “10 pquni0 soMNew O- va8ujoo op Jou ap gnunuos 9p povfogerour ax upwopaid soup, jodoonu osesya as ‘ammnyso 2jeqveuodutoo [ey ‘PT “2xojduro> earjoqaaus oso00xd 200 Imps 2 CRs @IOOTORNVO HS OE OF32 CARIOLOGIE ialul cariogen al alimentelor este condijionat de canttatea si calitatea imentare. Acfiunea alimentelor se manifesth att prerezorbiiv, cit gi ‘mari grupe reprezentate de_terenul Boeab, wmerflrn bucalferogeal 3h substatul 2.1 TERENUL FAVORABIL 2.1.1 Calitatea smaltului dentar ‘este, In bunt parte, condivionatt de pe de o parte de influenjele ce s-au a unor tulburtri metabolice produse de o slimentaiie nerationali, wea o serie de repercusiuni asupra germenului sh favocizeze aparija procest ‘aris, sau si gribeased evolujiasa prin acumulare de ETIOPATOGENIA CARIEI DENTARE 3 1microorganisme bucale acidogene si hidrocarbonate fermentabile in defectele de til, poate produce microchisturi suferind de scorbut nu apar jus la descendenti jucerea general a tl de “fagure de miere”. ase. Tpoteza ef febrele eruptive ca rujeola, scarating, dentare nu a fot confirmatt pina in prezent. dimainile a gisea gi a noua de sarcind, poste produce 0 hhipoplazie accentutl a s la copilyoo vauaullueu) Eatsuap9p syd varias - out une sas yp ass se see dap gu wpnxs 300 € unl 10d a ty np yeuosodosd aS349 ‘ajewopored s0[/3ur sia bfeang Faseoonut "panos usp ayred oz m1 ‘99 puygnounods Sresautus soquruts a56 a5ed sonny uy 23 huoo 1§ yo azed 2g "235 | tae w panasasa 108 PHUDAZAA} O 15R8 BS sos vag ¥ pandausesd azeunvew op puny wis epcoy gsnpa! yu gluaaoayy o-iad yeeazso}s09 2s suzy ue yepeds 012 iopazyodny + ued rose a8 yuap 9p wazouoy 29 du eisuoa 95 tuyjoqos suaui22 ojnuedi0 eon “qeuouoy URE we naued 1505 tquad “yes2ua eo ed sony 2p vases aynedeo ezuDAKy 10d “axsajop gaydeo nies jenuodiuoo ya “age-t poseaedap you no no plop 0 "eo aud "guuesoy-t10q 0-24 dyou no “ainiuep sojpininsal eammyoxzap 18 watoySous yzeacape put 12] sonpuoo 29 v999 mynleUs I 2p voo 18 4go “pounsw © arEwo} op upeouod wre pu ‘eadnse foun a1saje ate punyroy araonpar areutin adaup am hyews ango ap snynosny waren "3540 ans aogoo nu ps ayo. ous vj ehussyax araiaye nu EuMaMs ap LROK|POU! ois208 EO uruap wong yresasany 29 1§jsoUm ensiueD apeos sep ‘yuuos ysol ap way yuma9ze 2389 AU ayE9 Ul BJS} 9p a31qeH0ep auds “vo erouru onourluos yout wiDaye.v By “rouos w aap aunp ajumnse} ApEAUED sonpat noqeo ap wzgos auwos jouode yo axed 2g v30yR0j YF NPIBD UL BhuaswD « Injnjous yoonjew yeresouw eoLequnued ZLL'z soynSejgowewepe yupz9 nes suaBenip fe renzas eo ojemyonss 1 BD wosouND 949 “PoUDUIDSE OC] % BUVINGC 1aTavO VINGOOLVEONT © SIDOTORIVS ve36 CARIOLOGIE. = clearance (diluarea subst + lubrefianté (prin mucin si fonayer care 10% rispindeste sub im, fa permanent migcare, care acopert ‘explicd prin aceea c& sunt 0 alti-dovadi este cl, iradierer gland jsmul nu reugeste si ica, 0 datd in plus, cor -3 ml/minut pentru secreia salivark stimula, a salivard de repaos. ETIOPATOGENIA CARIEI DENTARE. 37 vvascoast favorizeazi rejnerea gi aderarea rest spafile retertive ale arcadelor dentare, generind astfel condi optime debutului proceselor carioase. 2.4.2.2 Proprietit! chimice ‘mai important, fated fate scare este de dena = “iderea pH-ului bucal. La un pH neutral calc valori sub pH 4 intreg cal ine direct in declangarea sau Jonizat reprevintd 50% di salivar se geste sub form’ Caleta! nefonteat se glseste In proporie de 10-20% in fosfatis bicarbon 10-30% legat de idins). 0 ide cofactor legat de smilaza salivari inca salivar, independents de regimul alimentar, este insiuy (opyao4{sin 1p “ou ung. aqedtouud sojapuels wiasoes uy YSU 001-08 Bune aveuyres opapdeT ‘2p}on18 asor asad pupuriuoo ‘aru pioinoajous yseus nd oupposd "guauaizeg 2pze9}sue 2001 zor 18 feroon(f fe paunjod 1§ (auiaoidooy(a) sujoioxd 9p a¥e32) apponj8 ‘Creu Srepion|# ip aun) 32293 eproniS 9p EULNO} qns osDins 9s axeares opopM19 totlqlospe wasaipau und # €9 mI9qe9 -923uouGoy 2 2p Hhys0y of soquninsel| fp sojunags © sunppnosed wat fw gud aoursto}9 2p indun auausioeg nogid eaulyoquny ~ njasonyy (2z80 UO 1 1 auuraind yzojaus axé> owore lao ajosnposd ap *ylunisqns S940 naiwed vo ‘Weunos ays9 msaoe FOUL p faqeuony w onDeIoud elvaru 18 varojfosep uud oqeonq [10 musyoqeW: osempuygined “(RuszuIe sp jor om ‘ise azaule ap jnsonyj eareuuy wd sraroqila 36 Bs adaou jusony ¢ earvopen suds jrv0qoo 141d paED “to[80 2p Jo4e}80pfluscaud weneo wip yesHNaU Hd BL HHANIOSN a9 hoje ap wanwongy nyzaueur if nloqeo @p HhuaeaIg yuo! Rr¥=|SO uong tyoap asour yeu po 9p OOO'L =P. HoIpE “CE T) JANES. nj ty widd ggg “B29 9p tnvasonyy w aies1u20u00 0 v| efunfe os Bi ‘eazensquwupe und go indy UU yt 1 asotadap uqmiod ede epun ojooy anwap aueurp yoruqgts> fp ajuounuuiad ajasa903! Inpioe und y2vaqsojg axeo ‘aieinpise sionyy op lunons }4d yuquanas eansgur ad ‘3012 gh 3p qnunsuo> und yoeid 1 aunyznyip 2p 20] 212 youd je9© 05 ¥1 upd ap aaibo19 ‘olyjoods s0pojeae ee BUVINAG TaRIVO, VINIDOLVAOLT ‘HIDOTORIVD rd40 © cARIOLOGIE ETIOPATOGENIA CARIEI DENTARE. 4 Saliva mai contine colinesteraza, fosfataza acid, esteraze nespeciice, succindehidrogenaza, peroxidaza, 1s oferd 0 protectie anticaroastefic ji rezultate din activitatea de neutralitate sau de zonele alealine, dimpotivs, ofert dinjitor 0 evtralizat aproape sk acjioneze prac ‘coboarit pH servi orienta gi ca test de tampon nu tn acolo unde se i carlat. Saliva umanf are un potential deosebit de stl de constant la acelagi individ, dar pon scjoneaz numa pe © ‘penirafiecare sistem fn pate: reologia bucald, care dirijeazt sistemele tampon prin filmul salivar in zonele al microorganismelor —fatre a hidroxilapatté si provoact liza lor. ‘aturt hormonald a ritmului secre vare se bazeazi pe afiniatea pentr fier si con metabolice care decurg. Se giseyte1 optony8 us eoq offenwaune o sop ‘ajawp no auaiaing sed wlapanayymyaate oe "yn o¢]"2SC0uNEY MO earaposs [pads sojeyeuoqeoOIpIY |e UABOHED INjOU E-Z'z 00 wluspouy pu ' a1euLy 2p epousd soyestoa ameongzudns aso i "pandadsiad yaseoot UIC, goroey weyoduy wn Puy Gqns mys nag EsMEZ_InIMIDgEIP Bivo sjpcaea aneud apvagruwss 20] un yéno0 uesodwarwoo syn exer TWaVLNaWHa4 HVLNAWMY TnivuLsEns 2% soooud ‘npsfeo op yiys0s und ‘ermasoou ‘ansaydiou nfjous yevoforosd amo sjuezyesouurey sluvisgns wy aveueIoeg ‘auaigoroqu unyzape ware = ‘augqiaiseg opptusue 1 umn drud 2p afaueSnue “2jaufona 20181905 ‘yi aumopasd ys amo uj “2upuEgoD PINDIad uo ¥ BANS|96 ¥asSOUIpOUE Und susdojms aaustuedsooso1 ango 9p usioeg 10979 Wud so NooUn vee peoued xn eau no yjouoibodoud ssoxut ‘pogo ‘ppasod wisaoe yo sifapacop [89N9 InP rusupnise 12y2 ay 5 18 axosyen os auvo preayes putoioudroy 0 aise soqe your 399 nudosd woo od ‘euafoe2) suaBo1rdowopo se-o} ouaSue 2ysoae Yo PEWaIBAS 99 voD9 “2|eIoE| so|pIon|f JojoUaTED w oungiod up ons di op emu a os soyuarseg woseugdopus wax "peeyD1O9 2189) apduts sodiapy) inert soy usBoredowopo 2p yBeanuy 235 soohysap arreprxouod [aWaStS sjotozod vj vareidna id) prousteq gzvauorioe zuusjoioejod ap (0) re moayg “ous0an9] usp aBunfe opun YeaISui rnjoluet yaepasuen uy @ FUVINGC TERI VINIDOLVEOIE WRIDOTORIVD von te“4 CARIOLOGIE: ac{iona si postrezorbtiv, tn cursul odontogeneze, pe eal sistemicl,influenjind negativ ‘constatat de asemenea ck dach aceasté populate se limentia ancestral, procesele carioase se opreau din evoluie ginu mal apireaualtele Fe de alti pare, mestecarea produce scddere mai redusi a pH © soluis induet ‘griu, melasa gi siropul de te iv cae produce rent pin Taare fr, éateril recenel nor esa Inteprics la Vipeholm (Suedi (Creserea carioa avut loc diferenjiat fn functie de mcdalittea de administrare a dulciurilor. Astfel, 2 ETIOPATOGENIA CARIEI DENTARE. 45 4 riscu! maxim la cari apare la consumul de zahér sub o forma de preparare culnart care favorizeazt un timp declearance mult experimental a fi aja tradiionali contin foarte unde al usin zahar; = eresterea dramaticd @ freevenjei cariei la aceiagi indivisi dact tree Ia 0 ‘aha gi produse zaharoaserafinate; relaja cariogend semnificaiva dirte frecvenja carei dentare ji consumul de + efectul cariogen rapid exercitat de zaharoz4 prin contactul direct eu placa bacteria; = caries ‘expuneri la zeh flcidicd), prt modelaes sade etre al fctor 2.2.2 Obligativitatea contact cu dedivtatea unor"produse zaharoase (caramele, Jeteur, rant, Indelungatt fa € insuficient, a bucalindeosebi in leur retentive, unde auocurirea este;a8o}1n0 suntia0 p2 foo 19 "eroreyeZ uN mu a aud ajylipuod uy > SSup ese oqua0a1 Feu R912 jeuopuue § ajeunxep 20; *yz0on(8 2p ayewum ‘A avanys 2s undo sjouinyn ag “Weare soreyee “USBOUP9 ft p wauunuap qs aewou u 90} Yofeau99 nes YOR Up wazaid Uy .od 98 Pz09n{9 "arCO1L09%1 Tozoreyr2 vammuouliay utd #8 wuoy 10d 28 ‘anangg) asap U ADO Bo Os08Y8 2S nad as-mpupusiy yun uyp wseooe "(gum ‘ourgd) ezoyeu “anynna nidiouud ae oxo 1yo9p 1yMUT yur wTUEBLOOID|UI ap yrEZHINN 259 - 00z800p ado 309 rsluayod rowseuy you pO nd ymBUOGIEDOIPR au9p ap supURL wrasDyDr “IO japa 18 yap squioind your oosuny) ayye2 16 uopIuie 2p wyfotuquio> oajo un ate (22 ap) “yoagyer 18 aga o1sa tno “yueLseeq eed uy pides 273 erenawo wy s1eTunjapur ou sienues up wyxew ouaBoyseo jeijueiod no ejeuoqueOIpIH Ze ‘sou gdnp repo nfeuiad ~ 1f cojpinn(t ements purace “pares wos awe de HO TRS 5 Sleetosp aide "bngiap 3 Inunsoo penp Yoansw sp UNE was) — : i eoproe Imp ap ysNpUT znd nes ginosaio pl ‘2p ayuaunye soun vasysoy uud anysous 1 apides ameaes paxoos youn varaonput ~ z027eq 25 J0}2pLon1F ‘op nez0eo 1 aod ‘yurzu04e} vaBouED soroe ‘zouere ap yn ez no e999 UN are spayseu progtos fasoas 0 pzeat voupg “2}edseoud soponiy 18 JojeyeuoGeooIpIY |e AWAIIES N-BoULILE|D EZ ‘ayenatnou foap 6 ‘quip ad aiuores ap tnd! sonpar aj asearayes ojaeedaud kj sojepidi wassio0sy w “FUVINGC GRAV, VINEQOLVA OIL ‘IDOTORVS y48 : CARIOLOGIE + de cobortre a pronuniatl. 2.25 Hidrocarbonatele alimentare - sursd de sintezd a hidrocarbonatelor placii bacteriene 183i plectind de Ia acelagi substat bacterian extracelular rganisi a ciruisitez& de hidrocarbonate pent placa bacteriand nu iv de zaharozA este Actinomyces viscosus, El produce levan si un Dterogluci, 2.2.6 Degradarea enzimaticd a hidrocarbonatelor — scéderea pH-ulul jogene pot utiliza multiple cli de propice demineralizsri ETIOPATOGENIA CARIEI DENTARE 49 de injeles de ce ingestia freeventt de hidrocarbonate precum st eald (in special a celor aderente) fac ca perioada de bactesiant dentaré pare ca surst de seidere a pH- in care alimentatia creste riscul la carie 2.2.7 Grupe de popul legatt de siscul la carie cénd impune gustaea freeventt a ursul preparrii(ofetar) sau se perturba regularitatea meselor| in schimburi. prin apettul crescu care necesitl mai multe mese sau prin consumul 24 prin creserea frecvenjei carilor, urmare a acelulas cconsum sport de zahir. Dependenfa medicamentoasi poste fi fnsojt uneori (hais) de un consum ‘exagerat de dul area de eat pe suprafejele netede coronare. Bol casie prin sucuri compoturi \dmnistrarea unorsiropuri medicamentoase (antihistaminice,antibiotice). in mod reflex #8 consume freevent ghucide ea wrmare seul nevoiti e-si modifice alimentatia traditionalt (aleduité preponderent din polizaharide complexe), prin prteine, ac hidrocarbonaterafinate, ca $ prin consummul freevent sub formt de gustiri al ‘unor noi tipur de alimente preparte industrial. 2.2.8 Rolul carioprotector al limentele pot modela efectul cariogen al-ypunsnpuy syedaud aseoseyer asnpox ip nnusd a}pouoU Np armjoyua8ouns 19 i youre aud uy ssqe) 2s “oust # gocld ap quyynunae vosoonpay Bp ajeang fasoljosus eayyoedeour od op a1pord "749 ps TEU F29 Uy 1d wtp Rjnfasap teunsu09 “Ps0Ie> 10 espa wes teow 2 tin “pu oo ‘snouesodwiayxe FeyuaUt suosge muss pny yooye on 8 soo 808 sue un pss 850g 2D Uognou Tans na esq OAH HOTT Fe gts wu um eo pure TON Spy ap wuss 3p 254) 20123 feo eon fen 00 8 20 gos 8 yeoiansy 440s) mHeAUT ino ayeuoqzesoapini xleaiSuj8 vourBseu 19 injnagyez Je fuampsans O12'e up foun at past 7p ERI 99 12 i if \dxa ood ‘youu aru owe tayo ‘yeuinsuco easapan Ul 210 9p $2 &P arena, uy pisueo € 2p gprowad 0 ad yeunsu0 ‘2% doas 1so08 uf wzyenprazpur pes uy ammuauige sojareucqieocupry te ve80%e9 jod wamooap sundasaig jojoed e]e elenpiipuy exeyuaue ojelupajaid easySeoung 67z {@ojnp nowy wp) FUTZENPSE nes (e[o90%> wp) HOEDHS y xe wiND “ateuuue e| paxop soparoudoypo 199}9 aze9ar00 no axeyuowHye asnposd asz981q “auaSoredoyuopo sojeuusiueBiooso unpaid ‘smoyooydoyeo awsluoau aysiu Your ud yz5U -yuruoioeg voaid uy uqoon gquul 21> sex8 eIpe somUNLE [e ME;GOrOHUIRUE MD=Ae - iaudoud vareaypou foun eaneuso} ymwizuo 40 varepexop gayparduy, id wanes009 + * “quajaus aqomioxdoue9 1992 un pulporop ‘eDDIsoul ap aun uy nes Ye ‘syesndaxd squauife uy noo 9p rezYZOJSO} Nes w|E-T THPOS 2 1s HUVINGC [HRI VINGOOLVAOUE32 CARIOLOGIE 2.3 MICROFLORA ODONTOPATOGENA (CARIOGENA) 2.3.1 Placa bacteriand ‘lu. Ea apare sub forma unui agregat de imuleazd pe suprafaa pldcibacteriene sau a dintlu, ch plc. ri de depozite este detenninatt de calitatea aderentet ul se poste fndeptra prin aciunea mecanic a spray acd, inst acestarezst tentative de indepirare, lacd coronard sau contact ait cu © arumith grosime. O impregnare cu pigmenji iazd de la individ la individ si poste na bucal, alniamental dngjlor,afecioni tepernd 10-80% din consinengieaumera. Un eulimc cub de plac bacterand care ETIOPATOGENIA CARIEI DENTARE 33 rgsnisme, care sunt dispuse intr- bacteriene. oat evident microscope prin forme cists posit Ing cone mal at urn compe cupid ine 200-005 Compleat ecossem robin lp color gram cre dising microrgansme gram pou orme flame ‘onagelor gram poctve reprezinii 14 din microorge sprind membei din genul Corynebacterium, Noca vincent pot fi eutivat cu ajtorul unor metode speciale. Formare $1 biochimie11909 tluszand ap awwapudep “wo oH s7euUe Bf jo thane ez rod 9 "puvjuop @/169 [8 opId le ueqosD|ul INWWa}s|SO93 g'1'EZ anvzesun fauouo} ass pod up avourey y 10d sue nid a "oougpedsou sao ap ayeuszaidas nuns ania 2 av sours Eno mnouno3s op 408A pound ‘ydeosorg GUD Ut om jopared apSund uy you 1 Dqz0ut ‘ayaqoad uy awaiongo iy 10d weoepe yzvoqnuunae 2s 29 auaHaise, apRtd Wy iHEsU09 pou uodaxd ayoomnuesd judg “sesonoef Suan a8 ojo 89 ya RID aye EOS fd ap arm Sjeonuias apaucres asounaay asa ours wamxy uy apoeye ydionmed oo (puny os pu rupoad apd ro ss BOVINA aT VO VINTDOLVAOLE sojnoqed wamuuos uid “fuasspe 1 os no ra4dui09 {3 un preauuoy are> “pmAyfes Ulan ap veAs Un 9p sIuadooe 1uns aijealns ‘ymigoront efuaepe nnued auenp mnswarrese> Bt 4 sopayesdns 9 ae xouaizeg fqn wheyesdns anu eaunyoesont 2p reuru nu enyut aso 6 soyrpads wuejqouoju euoropy yee Maun mes al es aplwpods,§ proeM ‘ ‘lvong eEINARD UEP o[pus|UDELOoIN ‘guoyiaz0q oluavopo ap vues ase sewuad oSoqooe yaueunUoi9p “nz ojoquie ‘uy aye 3,29 9p 20] wamuape no “ayers grepo 105.309 van ojeustunaioouoqu v epiut wazezope ‘esos as2o0ud ynop £2 ewozatdas ‘onueBiowe pur tn evouoy atsnesinabpa yao ap anu spun un no gun ye ap Huot no jods Wy SEWED LY UIA ap auuopoutdsaue> foun vaveidaoo susad veep vests anppooj.niuad sudan ajniouadte up |AReog -soyeadns efeanuypodooe ‘xi2osquoouop atop np esmcusny row smojngo(d few py “yerenyuoo plo o ydap amo ‘jodno fon 9p Guu} gns ‘3qe arzajep aor up sar on yoUAIU HF uMUyEZ, RU nD am 1 pours exe ‘up ap taued yruoinfe n> axe ap wys0} ayuydeuB anuy yoruor vount udns od sojourjoxd eiqiospe 1 Pinoypd vaxowuof uy mpor ‘wap afetgeads ad ojeusstuvsoozo v sour i yynayed w amworgzundsar00 wluape (8 wamuzo) zou ej Tis SIDOTORIV V > e56 0 CARIOLOGIBS din salivl si hidrai de carbon determin sparijia demineralizasi postulatl conform cra bacterile reprezint factorul etiological care, lor acide sau prosolitce determing distrucia componentei minerale §1 serie de studi inteprinse de Orlando subliniA fapul ck evoluia. $i lr. de de st ‘a apirat leiunicariease doar atunc cind au leziuni sau au fost infecate cu ettoare la modalitat sau pal de microorganisme accept unanim ideea cd proceso carios nu poate Firma se bazeazk pe urmitoareleevidenfe majore nu sunt afectate de procesulcarios; state pain alimentaie sunt eficace tn reducerea severtii ie, cu toate eb este feevent, nu reprezitho ret ETIOPATOGENIA CARIEI DENTARE Ed yacal, unde fash din punct de ‘doar a 1/2000-a pare din total mieroorganismelr si 1/3000-2 de acid, realizind rumai 0.025% din acidiatea dezvoltati de ‘microorganismee orale. le expuse suport concluziac& lactobacilii pot fi consi leziuni carioase, unde contsibuie la progresiunea datoritssbundeatei lor in ‘cu pulpiele apirute in Sireprococul mutans produce glicoitransferaz i fructoziluansfeazi, pe folosee in descompunerea zaharozei la olfinerea de polizabaiaiextraelulatt dk desiranului$levanui raul mine stagat pereelu cellars ntervine ea elemer iii: bucale, cum at fi Leptorichia, ‘produc acid in canttate mai redust. impor fogeneza carei rezidl in sinergismul care exist tne ele, pregitind terenul pena steptococi gi potenilizand producerea de acid, sexi in‘by sungzope 9p ynjuawop * eur 9799 3 suoud up gieBeq 9252 cy YoUn|Bas) we somewrzuaau ouypioud 2p dd ur aquinu ‘uuu ep drud un pordu ojos soquemap wzaH yn waSnue Sp voutunuep ans pujard 2p dail un reoqdun a80j © ap apuidep ‘poluaBpue eleojen no sucinus sojoo9a\denns 12 fsqo asvosacanu vwz2q 2d "wo {upymues) suoynus sn220s01dou5 ‘ean vluozaud yous Uf Sn0}ap faNED janqep 1 nyes viuongj tod sep “avewuep Hopid wide] up enuep pezsuIL InjMDdns easaprO}d e1ewep joue9 eGojounwy ez ‘papoodsax edu punupsuo aise areo wip siuaBe soxqdpynus windse wejauns azouoyioe 3 ase sovoy{iur ous puyisxaou “yuszaid “onoesd pow up ard w] sop ze anBiys ‘yen earezyyennau ‘opaioay usin foo “go yz "yop fp vounfoe uy euo{tpuos 21s yo.ses op dru sue und sojrapuioqu, iso pds aneoouy 2p uoisey op ade fan afs0 ue Uy yp erpaide ateod 2F ‘gepronie 1ejdwoour you “¢y euygorfounay, ‘quusyore, ‘yzepproxdoise, ‘wzozy) euluoo 2] mijsoe awe od susigansunue syaluesgns 9p viey eepoiot 16 yronq mjmpryoH eeIUHR=Te BuOD aM afkmsqns ued gyqeuuaday) a9 pusuoreeq e2ed soasso9p wzeat aod 25 amu2p juntonns 2p whey yoqusGomed ws waneyoedeo yoydun 1S yuwsei0eg goed 2p vamjnuInoy, ung ons ‘smo poe wy snoop y seo aes mp“ ypu! e7 sR o pew duoosep uns eunsodoqnue 1 yaw] mo puyMuD ‘alata sjroxay pede wy 'uog ap exp Yojusueioaro Foun qns ''5 99 2nd es yom to euyopu f RUNSUOD wasapRoE ‘doos nse uy (rpoenet peezod) unas eods Uh Ao, vary wuld poe eanpaud v 9p eomisedes a summa ooodaig “aehollTe tal tuogms ap Hap ap reigns node non esi ty 8 poe sonpasd ap waqSOd - 18 amuuoy * sSonoey ‘oe 2p sy areur © asus 6 pss puree! “woos 2p Hep =p anouma cisu © busy ¥ 9p seme moozoidans eDads i ‘Suntioosp oun ened « ‘noe ap antp kis oe sutuop ys anja eusvedio0 asS58 ye dey 8 naan ap sunt 9 ronson yunLopaid augue aot wy areOUe es UVINGG [RIV VINZDOLVAOLLA So SIDOTORVO. rr60 caRIOLoGIE rad de conservars(consensul LPXTO),, ‘ prelungirecitoplasmatici. re este Tn consens cu varats proteine de supraays , chiar dick exist heterogenitate i structura gi funcjia stribate peretele celular), o regiune eu fale coelor gram-pozit acestors format din 4.695 perechi de baze, Secventaea nucl ransferazele (GTFs) sunt proteine “homoloage, ai efror produy, Sependen de earch in pene de edete foal Jependente structural: un Iimpiedict tndepirtarea in metatolisroul bacterian, 1 difertelor GTFs streptococice a aritat cl toate posed 0 ‘500 de ainoaciat si patra regiuni structurale caracteristice, permit dete “reslnee cu greutate molecular sctzut int-o (GT-s; 15SkDa) sintetizeazs dextrani ians au 0 agezare Tn tandem; in unele cazuri ele se ‘un dextran diferit de cel obignuit. diferite ce Smwans, din punct In cariogenicitatea ETIOPATOGENIA CARIEI DENTARE, 6 importante din punct de vedere teoretic in patogeneza cariei dentare, Aceste proteine ipB (GBP 59) si GbpC. Ee promoveazt At sf cu mediol extracellar, 3B si GbpC. te posibil ca GbpA s& contribuie Ia aderenja S.mutans gia ‘ek absenja GbpA creste potenialul cariogenic pli .gereazK c& prezintt un pote in comparatie cu GbpA. In ciuda acestor ob: 4 sabilit, decodificarea genetid fi Je (glucanaze; enzime ce e028Iduoonue ep eye|paw sueynu 40}9090;de.3s eA|Odwy ajjsajoid ep ejauisjuesoW ¢'E'z ow ouuzus 9p 2 urzaid os psonop woe us 0 uo yoda ods ut “gR201 vaseztuojo0 Blnpow ® 3 (nyesusrod wlep a0UDs O8: yo gzwanazas ug, "29U8 JjeuyNgo|Tounuy 1 ysNdxo y oivod yrewep eon axeun v9 ‘eAUs Inpiny woup esndxa uns amuap ajalazeidng “1yS] du ap 1S youowouour aise i ‘areradooo up pwvapuodap-dioonue a “9UDUUSSPEp 2) uayaio0g soyuaBored © fe 9p 18 eo ‘suena *jourea,, 2unfBas © waKe 9p U>DD0 "BD (406 wuuzasdas | uejnaup yousWouoW V3} ap (Wy/ZU! £2) wxoide) [y81 ewounnopaid n> 122190 2p. 2 oi IV Sogo op aN 8 V0] Ga | Pius] Uedomponl ped) oda op mg me | et en pe sd pees nuns poerppase eres weanaepen | 96H war sr ar leases: ‘yuoun gavares eyassas uy (yu/losoqur oypou) B90) “(euorata2s ewouodwwos) 1p wiefap purroxdoon® ye ono) f yu, no gM ‘V1 up sndusoo Bro] xojdusoo un vo axede yj-s “pouss v3] 2p “LIVIN? timp. ‘up 08 op ynur reus “ 18 sojepuey8 royarnnda © ye 2uotasoas v8} 2189 gucfeu pz sown aun sojinsundsys wassonpuy aifantid 29 229 a uilnd uadapur Rzeovottoury (1-T¥W)) 4o|9svoKW! Ie;9058 ‘up sojsus8pu0 soon, awo1o9j9 eswoonut joredowwopo eanodult goyisods earopdy ' ylerunus amoyyidute 0 pups“ 9 ‘SUVINGC TRAV YINGOOLVAOLT IDOTORIVI vi °64 CARIOLOGIE’ ETIOPATOGENIA CARIEI DENTARE 65 le de fstal protector al In modelle cae onl lspus ig oncom Jen yarozi posit si fie respons hia ‘Anticorgi s-1gAumani, ca s1antiserul proven de la de clire GTFS, Acest efect este mediat ude cea de legare a dextranoli intrerupe activites, Deoarece dextranii sunt im i si acumularea steptococilor mutans, inhibarea sinlezei lor poate pic dentae cariogene. tro av arStat ch snticorpl IgA de iepure genera pulernic inhibitor ai sintezei dextranului foarte redusk sau chiar absent. Acest paradox pos explieat numa daci anticorpii sunt incapat scunsd intro depresiune structural, sau dac ex anioeph Sclcaten Raut Arsene de sopra ‘angen de uprait ‘Agu ore: ptide, corespunzitome secven{elor ibijie funesionald moderaté a GTFS ‘Aceste rezultae biologice relevante in animale, ce arathc& inducerea cariei cu S. sulans pice conservate fie din regiunea SB, anti-Gop av un potenfil protector impotriva cariei dentare. ‘Atit GbpA, eit gi GBpB pot participa ca receptor celulari pentru dextran in faza ‘de acummulare a patogenezei moleculare a S. murans. In consecingS, blocarea mediatd de fanticorpi a acestor receptor poate diminuavirulenja S. . celor dou’ mecanisme descrise anterior, anticorpil ivar peroxidazd / SCN:np es dnp WP opp ap nesta ons ond soquaineg siuamyas 0 D UVINAG TANI VINIDOLVAOUS jee za 2 aoe ap asso urdsps ej808 0d 9 59 vioyousnte zeal syutoou Bnop arjmusod Jundstu vareyonzap yzostuanyut ouoreut sy "UZ joud © sop putiasuoa ‘ayer uy eyqiosqe uns NU gsuy axe *Y8] ye yu 18 2-1 99 ‘iso mu ajdoud vifonpoud sot ‘aww 93] autind upus reo rans uteul 3] #8 yze=r20u) Vode wsa0e asoiseu ‘0 ayfousd gy se ‘oveFopua uns Seu | aquadique vareDo nou e nuns ympany wip OF es fas pasoiieaponapnodeyasueyy yrupy ar} 394 ap sareauid uyoe CARIOLOGIE de timp de la erupiia ‘este crite pentru gazd8. In acest reprezentaji de Tavorizangi in patogeneza afectiunii sunt deficiente a. infectiet_(raultiple ‘de clone) gi de al fed pent GTF S. sanguis, dar nu si -GTF §. mutans permite colonizarea cu acest larea eispunsurilor imune a fost art spect nu apar pin Etiopatogenia cariei dentare consttuie unol dine cele mai studiate capi ‘Omane, ceea ce explicd numeroasele ipoteze cmise in legaturh cu cauzele §1 : ineazi ca ele vergi factor inerni_ depends jee sau neuroviscerale generale cu risunet la nivelul dintelui. ETIOPATOGENIA CARIEI DENTARE o interne sunt impregnate de gan ‘Tocmel acest insuficient pentru cupindrea 9 expliarea dpling« uel proces alt de complex ci eae caia dent ric saw au fost chiar vitae, alele ins orgarice din (esuturile dure dentare ca urmare ‘nicroorganismelor proteolitce din flora saprofith bucalt in profunzimea mai departe in dentin. junit cariogene i loc, dupt adept teoriei jemineralizerea si prabusires Rolul mecanismelor proteolitice unmitosrele ergumente: + pigmentarea galben-brun a lexiunit carioase ca urmare a eliberiit unot pigmeng sub acne enziai saflococsl aris crescute de aminoaciai liber Ta timita dint pata lb ‘etiopatogenia cariei dentare se bazeax8 peuoi9q 1s wp sqqued.0 plueisgns ueEnNsIp gopid aye sontioaaxd avewun ep au080u Ut BIEWAP tezey apoooud yotuesio arepesdap ap Uz<) a] 2240 ny asd psuns ESEIY "BOHPIUD ve jaune 2p TOHRIGRS esuod soqnseh wilzodne> wp 9 prapysu09 ys. ammpesfap x2 36-NpUpIEIswOS soaned 28 axoup ap wiloeat BO ruap amp sojumnss}yuyat[exourwep eae > wHOe O-sApe v aNtD ad vi ou sas | eu anu sojunae eis soy Caso 189 af myauog earapunsd go0no suyzaud 2 poor gamionns 0 Wap tvs pnop #8 85 #389 wno woRED Un a18]24> 9p soy foes rupawwares aad asewap Ut 5 BOURSUN 1 UVINGG [SIV VINADOLVAONE Pies aIDOTORIVD E oun CARIOLOGIE ©" 80°" Eliberarea pe aceastt cs find necesark pentra asigurarea invaziei sgerea_mecanismelor de ovedirea posibiltigi de demine Ta pH neuteu sau alcalin ‘nu reugeyte s% ofere 0 imagine patogeniel procesului carios. trate, din placd gi are poate fi eBberat sub forma ‘degrabit un rol de protecjie a laume a crest pink a asta in concluzi dentare tari ca reaultat al tulburarior produse Uni autori consider cara dr dure dentare se integreaz in biologice pe care 0 formears ipa dentars. ‘membrane semirermeabile care dirjeazi le ionice gi hidrice dine ai jormale a acestorschimburi este rezutat ic slivar cu rol cariopreveniv, a citate dea impiedica sau reface deperdivia de fosfagi de calcu dn stuctara sn ETIOPATOGENIA CARIEI DENTARE B istenje jesuturilor dure dentare peri i enzimele, sa devin’ act fo ef mas 2soUN ‘niu wradas pou uy guunsuad 9 29 uuoioed e edu as wno we ‘dun ap yun ypeotd o fd anqwuap afeljeadns no ayatue 21sa0e yryeiuoo op resaUs8 aso gayzojdeo VEE 1 4] Baxd0yy nes 2ssKH ap su 2190 paza|2i00 Jo|poINe va UOIEHY "BAO ‘2p weulogos pulsquun aoe) 28 eayzoydx9 seo wieue8 10d arvo so ao|uaBoyedons ewsjuedoy 19% YAIZO1dX3 VINVO $% uonsayy wauatais - eluede - ‘as amo sjeunosiod mj asv0u09 Hog 4 0 yond nu ausaquy 2otteSoredon ‘quauunduo ud resus y ood nu j30 9p pul BO UD wOp|suOD v pL gud “PSU \unrSarep v gr2aup wlLis05u09 21 ‘sqjonsip 2s2oqud Jou varejisub| 20np ate> azeaep Jojuansot ‘uz annaasuog "yaeasunjo—p pur 91s9 yuaSoueo susie 0 soK24a1 si goudius fusuod oor ap s0;RIqN ate ‘lend sine “04094 no ayezedusoo‘oreuap 3 “ad pues tueomosd vate ne 0 pteon avodng "ang 00 se UVINGC 191A VINZDOLVAOLLE SBIDOTORIVD, Gn ¥16, CARIOLOGIE. au ape cert pl ele orm aa ‘evolifie pid, la bolnavii care acestor forme de cari nu este diferits genia carci dentare. Ceea ce difert iviaie catioatl pot s8 llemeze eu perioade de ETIOPATOGENIA CARIEI DENTARE n nu poate fo stare permanent re de clemente laborte oath ar la psihopaiatrage de asemenea modific rganismelor cariogene fin muliplicare lor, Ia cariogene; ~ afectarea terenului de cite boald sas de cttrediversele terapii aplcate.sao no fa}2ed Hay “Sanu}oHNe tr 00g #1 fap BlL3i2aaid o no "yh eluaep aso 3810 oop wns O81 NS “VBI ap wweBA.-x wom quouqo(seno- queda - waza 9 pany wD ud wes op yr yd wy 00 Sustod go mds eae> wip psy nema pap seg HOUNO se¢fojouma aust f= ype\op 0 pury 89 mespisuea 9 pEIPNS ed soy ¥ B9‘sa_Y>POUNUT atzexo wus oq. aiejoyepoun 2eR—0p 1 Mofoemr 9:9 paniop soe Up =ywaIxg ep REDON pe SHOUT: OA yoq sos 8 s00002psouBeyp use am 9p 8 "H09 1 osgoou no vod uy 2488 u 30019) “yoo nado seupa no oyu) “peo awsi20 Ue sesa]ueut ‘fel yisubur ean tod uepursss 1 row ‘aluapyspounu ap Und equ “oisate ee el “FAVINGC [FTE VINADOLYAOLLE lapse osasp amo tas? sosaoe wunsy yandise “auouute feo no yunasdus, Buosuadwtoa 2p tnpes8 n> juste Youn man oder ut “pas uouad vassyoazop yzvazi0Ny Bates UIP EzOPE * je wow zou “semua snd] mA og ‘rs mea os U7 “angaogdxa n> ap wi ‘SIDOTORIVD aCARIOLOGIE. cient lcere orale recurente, hepes labial evidenya componenia imunosecretoe liber8 3 aria dentari © constiuie placa bacterin’, dar pentru boalt, rebue si posede anumite exoioxinele de naturl protect rez ETIOPATOGENIA CARIEI DENTARE a1 Gran negativi patogeni si nepatogeai, Tormate din intern alt pe cale digestive, edt gi pe cale In mod otignuit, coroanadintelui este acoperii de small, ‘mai pujn, defecte anatomice (amele, prisme, fisuri, i s& absoarbl sirurle minerale, moleculele de, mici ‘sau comporente ale plicit dentate, indeplinind asfl rolul smucozai, gingival sau prin di ‘care poate prezenta, mai smocuri, etc). Small dimen ci din flora bucdA, In zona reculo-endotela de us in evident imunoglogulinele IgG, Ip Dp acste decade se asitt la depresatreptati a rispunsurilorimune. Aceasta poate fi una din explicate aparigielcarillor acute sa explozive mai freevent a visa copiliiei si ddupS o anumits visti, Este descrist o varietate foarte mare de boli cu repercusiuni negative ‘supra reacillr de apirare ale orgenismalui, © po fi prezents in unul sau mai mule din cee pate sisteme lui contra antigenilr. De aici gi clasificarea lr in patrw mai in anticorpi sau acelulelor B; “munodeicien celular sau a ello T,“Sain innxa{suroo ® Eanaoroxd “rojnoqeeo y20usp9s nos ajesodas op ey Sune 2s ‘saooud soiseot © ype sffojone eq “2 fuomne “aieipns ued sop me garorx> euEs ul oxfojoyedoyou we FUVINGC GRAV VINGDOLVAOLLT ‘uj a9jSojounuat 209 uns e0/Zojountsy soqupangiay aye 9 wus.oypount ‘vaysonpay se jus widase ye20] vafoust> inp a8asyd 28 apun ideo o1v9 “soKoy, ‘pou uy pu 2s stigeqod, jedppuyd owe} no odes ‘goyoiaud araprad wo epedoroiua‘snovjeu joworpas goto axpoid no 2 ‘tezupioans| vaIDOTORVS = we4 2 CARIOLOGIE © ETIOPATOGENIA CARIEI DENTARE 85 = elaborazea unei pitusl de cartilagin-like tn care s-a identfcat colagen tip TI six Deci local rispunsul odontotalstic se consider a fl similar cu rispunsul elulelorosoase la injrit remineralizaze a dinjlor de ede salivi, carile explozive la .olnavi ala ripe de gh dare rice eels miner ne si bbegate fn hidrocarbonate fare nese sau care de mune eredem c& se product 0 dezvoltare lor bacteriene acidogene cu eresterea depozitelor de plac pe dini gi tae acid continuu pe digi. lipsind perioadele de repaus in progresia carillor, reparayile no ‘se mai produc gi caile vor duce, fte-un timp seurt la distrugerea coroanelor dentare. tri prin carl explocive credem c& pot contrbui mai multi proceselor carioase sub influenta ice iau nastereo serie de metabol 1¢ poate extinde sla celulele pulpare rea formriidentinei de sclerozl i inefionala) de crigine salivard cu rol structur a jesuturilor dure; deficient; supra organiza citoscheletului odostoblatic; ‘pirate contra microorganismelor din placd incomplet nar atunci reacjilor de fectat uncori de boli generale; em iti dll a ees hiposialie. La extirderea rapid a acestor catii eredem ind urmafi de remineralizare Desi mal de interventie a mecanismelor imunologice in controlul ct .derareaplicii bacteriene entare este cunoscut, se mai poart Tcl discuyji in legiturd cu eficienfa lor in co plicit bactriene localizarea sailor explozi lative salivare, cu afectarea“urana ayunysa ode Jf prouuin vo ¥f azeagde 9p Jojajnjao vasenutuip ‘yhjodiad ap wazeunoy piepoatg> - 1 yuessouy 1 BI eeneeret snd auoure & winjon ‘ivpunsss punuap wap pata 2 "yosto rou # Sosy 8018 RRA ~ :eznyso afar ‘ap sojouor wylurdsip # winzn ap soyestey eiuede uid aoeojojiow upoypou ‘9p areonpat no ‘sued faseulto of ‘2p aflzode wud ‘eooaad ow puluanap aarp ‘ade ap y9puoNd annoesuOD ExEasy HOI riqiosge und quou ousep foam ewe ‘aonpoud suo suofouva 1 peas aud 0 99 oued talone spaposd gs 20} apues ef toe sep 2p steht 308 2yqoNO ESA fut np ‘anges nua nawuad aofZojod ayos9p}su09 wRsngia 40] ‘wlvosa.qul 2489 ppoypoU! ap ass © anpaud as alouEnG ET nu ‘eupydoo #8 v9 "walaugnea “axe}Uap-oong JojpuTI0 whuD: ‘quoyu au azejnojpes Jol220 Je jJuBzuoney Horse '9°2 yuVvinolavy vivo 9% is “BUVINAA [ATEVO VINADOLAOU ‘BIDOTORVD ry88 CARIOLOGIE! consecini a unor condi variate: iarcoidoza produce reducerea fu ‘landelorsalivae vare modificind secreta; pot determina seiderea temporaria iplocie care afecteazs zonele cervicale sau reduce atrofie progresiv, fibroast, a ETIOPATOGENIA CARIBI DENTARE 89 radiculare aparute dupS iradiere cervico-faciald, desi din ‘au 0 severtate deoset Scuideressistemelor tampon salvar se reflec florei orale cv sclderea numarului de Vielonele, gant fn fara ‘edmpul para carilorexplozive. Boon citeazi un numar de 250 medicamente cu potenjial xerosiomic, Cele mai sccrjelsalivare cu 90-100%. rmumerosi autori care semnaleazt aspecte particulare de carit zat, poluatd sub diverse aspecte. ‘mai multe cintre sistemelemuna ga judy ap yIe!OIA a9 axArUFOgUEE 2p pu 8 guujzaud vvuncopi ojoifei2 ‘auusopu JojepuE(s ‘e99 uy DUI e189 go/FojopsoUO}g easOj2pOU PUBD sHINPE w joxzap 2p epuourd uy ‘aroun ve oyeroues unan pugs aYVLNAG IaIYVD VIDOTOINAdIdS Mm Tn TOLldvo ‘omivap sojauvosoo vareBansyp no aypos ‘oxzo}d¥9 ul JojsB9 wiluede vj onp tuazaud 2 wSIph 29 nnuad [Os0U98 nes 1290] UIpIO sp aay -epounuay eisoo8 ap sreluengut aise (FS6r UE PHENO IRIE © wad we yyONzAP 2s MU ip aqu2106q ap wieaoxaxd pt -arcitap-0onq, soquiya yo wod aie x Jofewiauearpou vase y arnod punue 7 RIDOTORIV Mee as92. CARIOLOGIE suprafaf. de contact cu cei invecin Ingreuneaza actele fiziologice de au fea cariei este mai ridicath pentru aceleasi grupe de cel masculin, Acest fat poate fi consecinja unel pubs lor. Astel indicele cel mal mare se gase permanenté care erupe. Ca ordine de molar de 12 ani | _ | EPIDEMIOLOGIA CARIEI DENTARE. 3 Je minte apar mult mai trziu, imbontvirea lor mi freeventt se zona incisvilor, cel mai eriori 8 de care © grezinth pri doilea premolar superior gi ‘de'mbolnivite a dus la citeva coxeluzi sm oe raro singuri legiune. Cel mai adesea sunt cele de intensitate inte 1/7 gi V/2 feresind premolarii i molarit gi se ani se localizeazi dé ps lecje in regiunea nile expuse mediulut ~ freeventa proceselorcarioase este a2roximati egal inte digi aeleasi arcade.‘putoasuy a9 w290 “EWR 2p 245 HS HU ZL 9p FISHER EL LANG 22apUt ‘QO0E [NUE uadopus (dus 3 reopens arse 2p “29n uo> “ervuxufe ajasnpoud 8 ‘sxouoroeynjd axPoqon2 no yywoq vo “ENEP we suru eujndod vj soye ru “ayepe aisspa np puedoouy “pnujiy $9p aims jezayordou aforuapo | nes (oyauoq 18 sts Fe) grEuep vavezeraid ef sap ¥ 29 F300 ‘esupa no assiaio uy 1§ auido wip purdeouy “assorqiofuBuy aluoaseay peze (psvOUED ‘eys0q ap sfeeye suns tuo gy sisod op ps aUDUE UIP g8'99) U29e ELDaude porBojoieuiois worENPIGIOW RIONIP 2uM> ap sjuIpIdE pul uy 2182 UQWOY ‘sn you sruoyluout sojsznes woe * aungor® eiizjdod wp ¢7@) axeyjoazap op sano ul Joy x ‘qu yaayu un aun 2x09 399 azeuaio9 afayeudas SILANE [o}2IPUL B asoax9 |p glERIDE vlupuar ge aoVZojonapide a maid porsojorewors eh unsuo> ajssour und ion aptostd> 40; afouTunjaud nes 2ye}odad yeuout 0 are oq, put no 1 ep indod uy urpueds afore ap gieunp ywesun|=puy yous v99 no wounifs9y YHVLNIG VINVS NI YOMOTOINAGIdS VLSHONV AL 1n10didvo96 CARIOLOGIE sl fie eu $0% mai mics onstituie o parte atologice din file industrializate au epidemiel de carie penta tratamentele 4.1 IDENTIFICAREA FACTORILOR DE RISC 14, formularea ipotezelor de asociere cauzald ‘general i sanitard, 5a le epidemiologice (populationale), alegerea formei de expresic de morbidtate pentnt caria dentari-ine dena sau prevalenja-necesiti elemente si indicator ia dagnosticului de moment si tendinei individuale gi acariei dentare, anchetele DENTARA Aprecierea fac prin adiptarea’ metodelor de cun bolileeronice. ANCHETA EPIDEMIOLOGICA IN CARIA DENTARA a & cauzalitate (factor de risehmbolntvire) poate fi cert doveditf numai itatea executiit experimentului 1a, om, epidemiologia ‘a cariei dentare, foloseste metodele epidemiologice din medio de viagh gi descrierea cariei dentare tn popvayii se folosese tebnici exis prezeneire (boala) apare + asocierea este prezent = factor de vise presupus precede fxotdeauna boal i, profesie,§.2.) si pretupun uni factor de re boald ji factorul de rise presupes cu ajutorul tehnicilor de epidemiotogi a observurea scideri de rise adaugtNf ma |e ee oe — smu aps00e3 veep eH89, nosy 28 yoyo wip sojereyue ae etosiod “2st 2p sojuoiey wivazaid yy nes no “y}eoq YOU woty we 9 ajeuound ap za ae mse nodal ogo Hf ‘rBAso5qo 2p pieanp 0 nati 3109 jnoqea ayvod 95 189 90 sie2ososd prewep 2169 UL G01 YOK I-A (yw) vagengine (nose as sito no (Of $PPO) YO-fnINasH HEL uIsd ye¥s|Na[EO 7 TS an sg 6 YUVINGG WIIVO NJ YOIDOTOINACIAT VIAHONY — E 1 x) 98 9p qruoioey ay ‘snd {8 emugde eyeog ef 2p purwd ‘yo nnuod > juoreuopio0d runued STENpEUNSY WE ep “ruon) e{ Sojpusa, 159 goyBojonapide wieyoue ap dn 1829¥ jeoose oun ow el soqporuyer juoinge no 8 {Bopaoe wy anus 209 ofoioodse t] 2p (eanoedsosjea) joquoo-zeo oj}o4oUy ZZ"P c2 2511 2p so|HOW ae 18 1p 20] 01995 & 1 Jtre9 waarSeoun> emus 30H unos yeanp 0 2 ‘2 rnnuad (grevofledno0 mnuyop a1eyAsr2}09 0% fouv jnzeo us wo ‘ainoAD ap yun] Epeotsed #1 Inq—p. ‘gusipa x8 od (gjuajencid ap) ejesonsuen ojoyeyouy |'2"b (jovojesedo) ayeuoussadxs aoyfojomuoprdsajerayoue tporfoyeos salfojomtopida ajaioqoue eee - 7 aIDOIORVS 6100 CARIOLOGIE ANCHETA EPIDEMIOLOGICK IN CARIA DENTARA ‘101 de rise sau de protectie) este pentru care motiv se mai ru nu cunose apartenen{a la unul din cele dout four). de contingent si se calculeazd: RR, RA, ele, 43 ETAPELE ANCHETE! EPIDEMIOLOGICE topice eu Muoruti sau clatrea guri cu soli forurve pe luuri de geoar, 5op sao ‘sua ap “yEau 18 exongno ad ‘papas ~ souaioo8 vjzod - 11 ewAHD9|0 o1Bo} pyoyoue ezvazi|ead es 2189 UI 40} nosloo eyesBouoW Seb ‘a ‘arjoo$‘ougin “ayn af 10d ju rnnuod (ore ‘aeyaveur ‘sousunnsut ‘oreede ‘afo) axesaaau 2[UOp Sp 8 youd yUrpipoul 9p 1aulqED no yeo|paUK sesuedsyp nun vie fay gs ano ‘nypats 8 sojzadns yeoypaur yousrod ars}xo ys plvoypow wat ojos afexpau sojauauexs omssoou wu Foy oreWOK feUoUUNSLY |S oye avayaais sewap nigoro) afean no "IIo RUNNY Ng ‘xBoOIEWOI op 1 yEIUDs ‘yuotpou 9p fouigeD no “gleo;poul aIHUN O dISIXD Ys mMU=D ap waIEN209] Uy ~ or YAVINGG RIVA NJ YOIOTOINECIAa VISHONY | i nipnys ep sojfeiarios|oo eaiaBely bey dod wy 2orZojoquspida ‘ayeuauua 1 aadea staypue Sanus oye axnefZo, apumsioe 8 aqaanvego “e tezjoand pupae “si1dut auuoine vj 9p :njnpsode wa leuofesedo njnuejd eazezyeoy c'e'y ‘pannodsed wiejadod naw "(gyeuouodx ap ‘Yosiwoo-ze9 “gyesiansues) 1Sojonuraprd2 stayore wud fo {puea earzonpoud uy 40 "8 aout 2p 2,94 ‘ap eiiyndod uy artuap [ape 8 panduosap erSojomuog vyaypur anued 1 a varundise -aynyan9j09 nos nu goad 8 2818 9p | yuOIBeY No ‘azEIUOp ‘2p 0 ee ~ BIDOTORIVS zorCARIOLOGIE 5 ani, cu principalele cu produse (clind, urde), medalieri pentru 43.6 Calculul eganticanelor la colectivitatile de studiu or de calcul probabi ecole pentru calculu egantionului pe grupe de vars si sectivateliere =005; ea gresila 0,05 = 1,96; ) = varias; ANCHETA EPIDEMIOLOGIC IN CARIA DENTARA 105 P = freevenja persoanelor cu afeefiuni dentare gisiti intro anchett anterioar, N= populaia de baz din care extras esantionul ‘grupe de virst sare grupl de varsté din list eatagrafic @ in utimul recensimént perteyintreprinderi, ete . la fiecare grupa de virstd se extrage pentru esantion un numr egal de birbai si ragerea persoanelor se face stfel ca pe nafionaliiii st fie proporti asemiinitoare cu cea din populjia de bazd; pentru intreprinder se iain calcul ramrulsalarailor din locurle de productie de rise presupusi/ cunoascut. iteprinderi se calculeazt pe fiecare se includ femei gi bisbayi proportional cu structura pe de productie 4.3.7. Intocmirea figelor de ancheta stomatologica Exemplficim o fisi de anchett stomatologici pentru caria dentar’, ali de fice de tocha semi pot foci i ate mate neces chestionare, boy Se adresea2t’ membrilor echipel care vor patticipa Ia examinarea bol Exemplificim pentru Cap I Identitatea se completeaztastel = numele si prenumele, cu majuscule;hunwased any wu g citneny (ens) wie wants 09 a10010nynons JS yt aiavmuya os by 203 35 18904 1 wor SMTA WoUSvAMh wa dibdn a WinevNe YUFINGG VIVO Nf YOIOOTOUNIGIAT, VLAHONY amjosar 9p oiusyp atins anuad rnguad nu 9¢3 26 anqinod rode v gycion ereyunp *e> “uuony anuad ojuyUIUISI9p .ofosaqo) ap puwsriad = "88S reauny samoygaundsan 2119505 “yoysureqoue vareunwex> ydnp 1 98 “pose amoy wf “ze gdp tasundsry ‘puptuap - oang aiscyoudjasy ap yore, - "do ymyoyoue & prauap-oang weiiguRs fn yamgBay axe 2720 2je mes ynaeIayoue | aiemnsuoo jog jmdaxp UIP ANY layou oy Boye rouga ajetopored ‘yoxounur ‘wased “yowjouse 709 Edap aussuy id unjaeryoue roiese,2ep wropto> yz22}9}dui60 9 "eae /0u0} ‘wOOTORIVD 307108 2 CARIOLOGIE, | Tie Te Econo aucaa iljgca tse, sine ANCHETA EPIDEMIOLOGICA IN CARIA DENTARA 109 4.3.9 Validarea tehnicilor de diagnostic in ancheta stomatologica Pe “plusysdx> axeaaseo o png] “nasou ,jnuseU295,, tu o9 ‘yewasoqoure a5 nes prequiyosou cup ‘eameofoyur n> piopo 2anpas 2s 1oyABujog "uzistdop esuet ‘uy vo aquaawd 9p jrumsoud upd “dun up whuayexaid onpat AVINGG VIVO NI YOIDOTOINAGIAT VIEHONY xal+@s¥d)+1 (oreo x9eal+erooxseo +t Ul e8'r6 = (6260 9E'0)-1 (sx (ete o-D x9C0-DI+GI6Ox9EO — [se 38e¢ = <= 6160960 56°76 =(ds) em 4496 ap a sluaqeanad Ow NaA BadA HoxEIN>TED p myajoqe miojuoo "age 9p enp Jae w yluarenaid © w| UOHoIput iuqeaoad op nodes W NaA Sad wea wig w rUEg [G6i6oD xz1Ol+ GeEOXZILO-T_ Kes-DXal+ GS Xa) -1 sec0s= = Nal ox zILO-T (sx a) (ez6'0-D x +@IsoxZLO (aD) + @s¥ a) ggg = aa @e0¥TILO Bra 46°26 =( ds) vor 56°16 = (98) 891 ‘ec'iL= (@) ehuopeaaig mayoue wep ef ap ostemys Uy ‘usjuap fae eluayenad ap affouny BINA GAA TMTED syaeouun ao jnjogn uy yowtyduiote os wno gap ‘arewap yours wluopenaud ap wureas wl 29-2144) jeuurmxo ap nuonueSaqnse ,4sEU295,,tAHUNIUOD ES yar yeu we wind wy "51820 igogosd 0 no (gseorguys) ase Joau pow wy as2 aU 9p RUULapLE wun 29 du UL ‘BIDOTORIVD16 CARIOLOGIE testele exeevth trajul, examenele mai rafinate le accepiarea acestora, Céutarea si selectarea ‘accepiaile ofest condi de iere gi notare a cariel dentare in le populationale si complicate se face pe baza anamnezei, a nda dentar, jd stomatologict are tnsrish formula dentaré ale pentru afeciuai gi nevoi de tratament. reais mente: inte siinitos-un dinte de aspect normal, dintele cu pete albe sav creioase decoloate,rugortai, defecte (brazse) care nu agafl varful soncei, nu precntd eavitate si irk denting rami F -ingit care prezint tp de carie de caracterizeaza_ pri pronunjaul a fesuturil in suprafala eat. si in profunzime. La fel se ecu mater (-obturaje; un dinte eu una sau mai multe obi i dite care a fo AP-absenja unui di sau IY determinatt de o parodon conservat pe arcad dentare de gradul I fen mai poate fi ANCHETA EPIDEMIOLODICA IN CARIA DENTARA ur RR tes: radicular datorts distrucie eoronarefntinse; RCR-reconsituire coronoradicuard ‘acoperit eu o microproter4, individual sau flcind parte dinte-o lucrare protetick co termediar ce aleatuieste corpul ce punte al unei lucrisi protetice (easeta cu sau spat DDI-dizarmonil demtare izolate (de fom’, nur, volum, poze) 43.12 Indicatori de apreciere a st&rli de sanatate/morbiditate odontal Se ealculeazd fa catia dentard pe colct fs (egantioane) anchetate pe grupe de vars, sexe, eupati La din temporart i demtare1 Up 2389 pu Joyeinojeo ad eieyoue ap sojeSy Bares|Ga1u pL'E"y tune ainustgo dso pms ty zoFBojoyuopida w antiouanaud soqunsgu ygaqid eatojoaude 8 erm) sieuurns soyloyp ymjupune w ratloreded ap ou usuaoosy, PIPL aiB aquvs euasqo sod nu opsouBeyp 9p oqemziA feporour wou ‘ano wy ayiesouzees vf 2p) axeiuop roue> ye ATnjoKe ype Zeans}Somm MU = our WUVINGG VIIVO N] YOISOIOINGAIda VLAHONY ‘area soya vaceziv90] as0sapysuos Ue AU = ‘yesouad ars 204 v tnoqeo Uy wasn Ud avvosrad foun © EEp anREURS op eamms FoUDUINY arTojen o-siuy RLEEZHaIUIS tporBojorowors 204 jeqjueuo op touoyTewryut ued ad inasounaas 219 - mene “yueosiod © | nes dud uni ‘oyiejndod o-muy xseoqs vyooq arieyues pimosgur « “aoiBojorewors on jodns gigjo #8 sxvousiue 9 98 vassunsgul 18254 9p ns © op nes arozied zojoud “(ur and i pusioo sp ayxau ne 20 sopiaoue reno0. N Hap ateaago sp aaxa ne so DU 9p Hp ap APE IN, ‘azewap tfsngo op apnou ne 20 e.g oe do0id mms nes armazosion ap afonou ne 39 Joy eayoue [ani ao0d iN BIDOIORVD ait120 “ARIOLOGIE 4 4.3.15 Calcularea indicatorilor 4.3.16 Extrapolarea rezultatelor anchetel Reaulatele enchetelor stomuologice realizath pe egantioane se poate extrapols ga colectvitate, De exemplu n20+ani=8.2% din N 5): 210 = $697 obturai + 284 (adicd cu eroare de 5%). 4.3.17 Compararea rezultatelor studiulut stomatologicd fer rezultate ce pot fi comparate le sunt realizate dupi aceeasi logistct si folosese si demonstreze ut Se prevengie primar crete pentru un program tert bolnavilor. Lafinalul de prevenire a cariei denuwe gi de tezolvare a si epidemiologice stomatologice webuiese mentionate gi , materiale folosite in desfigurarea anchetei = colectivel care a lut parte I realizarea anchetei ANCHETA EPIDEMIOLOGICK INCA \RIA DENTARA,taiSloud azvzytsa seuoduy or un yeonf ne 2 dasa nua 20u2U0q swuuiad ne “33033{dx9 9p U:9POW eporew op 2128 0 2p pul Sinpout 2ssonip ad nes Sesixe spdseaad up od qunvzo) louis pasar “soup 1s fyzaduoa op resods wy apuldop 20 snes Je ue oy pluses 9p Imp eaustouivo sp sojsebe1d yt yeeauBait2p 25 kn 3p 19 20 ayse woseoe aterm WISIUEBIO up azee19ut op pe eu fel fo eo ns eles qerapsuoo sisa [e201 1UBTOUED A|UOISE eLuED FOjrNIp wv aiaarosd ap mUNSAL rufoqu anwussoide easep pueda pas ap ns aqesouurourdio sojazodap eluszaid wud Yous 2p nz, ¥sioluap}4e 2p J0|20e0iu Tosi - szvesowp 98 nlyous waxinggid e samp atinjoxs ud azo “azounuap apuryord auoz ul sous ud vatapunngd yz09pE0 tava vilisede "uQ “uieazope aidesa © ynisut v nnuad ayfeyan> 9p jsoooud pred BS hredaise aie Hojorewols yuatonsead ap pifaou dum yous wsoy © fyews 29 Bue Jovws ni Wiuvs i's BYVLNAG IaIYVD VIDO1OLVdOsSHOW A IN1OLldvo124 CARIOLOGIE seaderea produ pli, preze 1 acolo unde trams organic nu a fost ‘MORFOLOGIA CARIEI DENTARE Rs ‘voli 19% fay su demonstrat de aserrenea cl sp prin eresterea volumului porilor la 1% au fost cauzate de pierederea mineralelor $i nu de aceastf zon8 sunt crea Ia lorie jonetional i indice de refraiie cu small si de aceea ce apare coloratt fn maro inoleiné sau balsam de Canada, © prezenjt mai idenjaza in 95% din leziunile ‘Aceasti zon este mult mai poroast decit cea ‘ocuptind 2-4%. Se pare ed fn aceasti zon, por Zona cepiti aspectul de “sit moleculard” deoarece conjine leculele foarte mict, dar bloctnd moleculele mari, deci 3Fs-ar produce ca urmare a demineralizii, deschiderii Fie, care mu au fost fac atacate in frontul de avansare al ‘sontatat cf ele8 ada0uy Soya inssoaud wu uns ad yuuspunge yom ouyAap"puvensteaiopIoe yes paunilouof ef afunfe 2s 29 ona ga "Hz ‘4 2p HOU TO ‘2d gleyeudns ap ymymens © pen 2 ‘s9a\onv0a 1 anourorde uoistea ap voor 'gs1'9 sop 984p Joqod jnuunjon 9pul pwazandas p149901QNs CUO? UL IBDEP qs no Ings EU 219. wen Up Inno, pas8 nulsmei0 ‘9p #8 auuddo ap monavea 2285 no Fejal0 ndioo wud 20n 20 arezfs3u ung 0 89 F2vOUOIIIE wOE|d 9 220P1 2 8 ghepeadns ap eu0z, 3p ap auudoasap 2uoz ‘axfaus 18 gods ap yysfas namnanss uy} Sunjso1 0 aonpul mony 839 Buyplny] ano 2p pats ts pos *nyzauou “Touogzes op uot ap ww uw fen SAVANE TAIN VIDOTOSION doo uy (uod t] apunngd ede) Ranvrod pluofuusong ep yuoz 0 no “wapIeD “svede nunjze] jneuoo puy> "yde no oiiqgut ednp = ‘ounyzar ayeaseWs 2uxg 1 10d smIZ2y 3 refou puedes 9 ee IDOTORIV oe128 CARIOLOGIE, exterior de o placi bacteriand, iau nastere tot dou corelate etiologies cu inchiderea Ia exterior @ \denjiazk amploarera ace sediul Ia nivelul i ale. gantl la nivelul dentnei, ceea ce favorizesz onde sa ul sindtos; acestea reprezintA probabil zone sinttos si cin cele patru zone de ledor este cuprins ine 30-40 MORFOLOGIA CARIEI DENTARE 129 spring jcrodiseciie au permis recoltarea de prebe din toate small, probe care au putut fi analizate chimic. Asfel, -a putut Constata cA mineral se pierde din zona tansivcidl fr nici o dovada de sehimbare tn matrices organiel, ceea ce confirma ipoteza conform cireia demineralzarea precede ceunoscut, Se stiec, din punct de vedere voluriet structura smaljuhi, pind la 50% si ea este cispust in s1 ilard interprismatic8, constituind si trama prismelor, @ ccariat este mai mare fn interior cat sith exte ‘eventuaele defecte ale smalfului pin la 5-10 " ariel de smal, dovedese faptul cf ierenjiaet de simplele procese de igete care mu poate fi observat in nici o alti ‘ienfald in dezvoltarea lezini or carioase st sa smalul afectat, Pe masuri ce ea creste, mumil de cristaleURIage “yenyEp arse mel ap any 89 ap ws ap apsedasazu Youn w Rand9|95 =xeAI \iosofaud are ‘aruguap msmsiop no avigéuin (,oMoeoyonl 2p R294 id 18 acinus ‘ose02t3e4 w Aap no spd gop pista gfey 9p Tt ani Yewauian 6 aunjzey ap RULOS peau 9189 WURWUAP 99 gunsyU 2g iopupdspl 96 yswoueD eounyza, “yunuap -v| puRdunly ‘iuoimp ‘pides your wsufosd ayeod vauntcay “eds os YNILNAG NI VIHVO 2's “feszas ‘uo? $28q, uo sojauauefese FUVINGG [ERI VIDOTOLION SIDOTOWVI C74132 s CARIOLOGIE schemel descrise de fare se inlneste o dezintegrare a structuritor dentinare si 0 a microscopului electronic precisa acestor zone, carisle se abservi doar zonele disiruse, zonele d si de reacje. Colorarea hist iden organismele invadatoare, opriva tel zon Zona extemi (de distrugere) aleatuité din dentng parfal te cu microorganisme apar sub id indepaitatd ew un escavcator manual si are © ‘cu progresie lent, dentina are aspect ozite neregulate nu sont formate de celulele pul itirit pasive a mineralelor cizolvate din partea cea mai perifer MORFOLOGIA CARIEI DENTARE. 133, 5.3 CARIA IN CEMENT larg, manifestindu-se uneori ca 0" ate penetra dea lungul strugerea ‘de apatitl pire si aib§ Toc in profunzim ‘sk pitrundl in cement, asemindtor fenomenelor care au avut loc -avia fn small; lar Tomes care este mai sunt similare cu cele ‘observate in aria coronarf cu avansare lent i anume: + aparitiazonei de scleroz; = formarea dentnei de reayie fm camera pulpard, 5.4 RASPUNSUL PULPO-DENTINAR Interrelite morfofinctionale dintre pulp i der inte ea procesulcarios s4 ajungi la imecanisrul de apirare al corpului rispunde prin ele produce energie in formerea de dentin’ in canttii erescute fn timpul rispunsului I‘souvo mynsaooud jp ap wausonpasd und yzeauor}ooas oylustaed tnperor up age B9 YwALRSAO w aU lap y oivod nus pdjnd axds youy 8ons2 peop yreauun reo quay jnoo$ 2% amon 3329 faso409 © a4aonipoud 2p waa BUERUILUOD UY aSOUED HUNIZA,HSAHBOR w aiaifais © 20) 218 dum ‘spot0a > area mes nBuny e-2p “uwojrun asio9je 8 yo azodind "puowes uy ouoe gas oseaido ys o¥oSnar nu piste pseape ines enugwup tod asedynd oyaoureyus oi8ouy jaws uy 32q "woopu rod 9s soy fa8oue9 ynoeie goup ‘amu 2D ‘pdjnd ads ysvouvo vouni2a| wip uma, round varenuip gas 250598 25 “quis uy o1uIp jttoweqv> yruouotut gg end 999 ‘quapy runs area 1 2[ajnaroue> ta\duioo eiaigo 10d ate ap aiqy ud prynoyyeuraued eunwap 2p soqnuesd eyowu 2p puLioy gns 2xn|noWouT reuorfouny #f oxSoqorsy ese] spuudad au ysesoy aes prepunsos eas 9p fouNuap # Falcaosd woxeoIeA “A ‘adzouy sao0ud 3829) ounusp qRNgO. Te 1821 9s wundep v9 ate Lu adaouy aieod a ap pkg xeupuep-odyd saynxojdaroo & ‘2p zPaioaye (quate nes fo ‘2p soooud un aso Founuap 1% nin four yao wlusjata op guapuadap 2159 upd ‘sanpuy nes warp 2pxo10N9 ro9pe und redjad yoo uns wouar90q ‘2189 PIse998 19 joynoqeue up VseCHED eTUNIZ=| UIP ejeUIsIUERIOOIOTN onda 2p op ma) canp ansal ap vaswuoy aud nes ayo nsundsey ser FUVINGG TaIWVO VIDOTOLION ‘SIDOTORIVD ver136 CARIOLOGIE MORFOLOGIA CARIEI DENTARE 5 impenetrabitt permijandu-se edontoblagilor pulpari prin fermarea unui Roparaia se produce ‘numaral si diamecul eanaliculelordeserese cu vrsta prin apori i ‘as cariei Ia adult. De avert Jagene si prin diminvares numicului de celulele, ceea ce altereazt apirare ale pulpei ele dentare 1a persoanele tn virsti, produse de supra Tent, aroape nedureros. izare, ca o functie eparaorie a jesutuli slab sau chiar contestatf, deoarece atunci le de rezorbyie precum 31 depunerile de esut dur nou, aceasta reprezentind efectl0 18 amyngasen aetrds erway) ae ye10 vfyj ad 2p aftidoud ns juejouiand 1 ojusjou v gieznyoo vfeyus. 1S pSnope 9s ante) “uae fy uy Panos 108 a BSI “PPMP 1A 20h sae ‘sjamamguun yehp sojuniza} walauosap pnssoou 269 SnMBUE mIpMS UN read “SHSWOTS yo pst ameiop foveo ae soyulfooworsue afaun wy oq, SOINMOOWOLVNY SWHOS 19 SYVINAG ISIYVO 31V SOINITO STAYALOVYVO Wo INnIOLidvo140 CARIOLOGIE lr ptf imaginate a2 trunghiu, lor, det de © modifiare piedick examinarea descoperind dentina uteazi pe fejelenetede sunt extinse fr supraffs. Evoluia cariei est, in mare, paralel& cu lamele smalului din zona, Pe secjune, kzinileearioase au ‘Caria radicular. Apare pe rdacina expus8 medilui oral tun ctnd aceasta este scoperiti de plac bacterian’, Suprafsja ; incidenje carilr deoarece a crescut esniclor eare pein reesn! gingival pach bateca pe bopafle CARACTERELE CLINICE ALE CARIEI DENTARE. M41 aceste cari vor ocupa 0 proporte mai mare in scivitatea o 2 syovid ap varmjnueo nu # voyetuaBoyed ‘yuruusiap axes vaae ais2 auazirsed so4(é wflzoduico “uo atau 9p "e208 ag cduy, ys oveod auisue®sonsoqu oun w gpelusrajaud eorex njoprny earee> (ean: ‘pudap axeueve> 232001 qo tunz2a| ap tnd 21saoe mved geytoods pol © fe moioug sorse00 sappogouud (neo ap euro uip a uogppz yelajetdns elwe> puadose ama yogid ¥ ReVBojousI2eq yrunquyy aappaneisr on 2orfojrewos sued pon er “FUVINEC IERIVD 1 SOINTIO TAWALIVAVD HIDOTONVS ho,eal : caRIoLoGIE pigmentase) Posibilitatea de penetrare in eumera pulpard reste cu cit viteza de evoluie A cariei este mai mare. ising tm ut ae de i a mai co ec tenuate sau absente, and loe morificarea pul usu) alenjonen2d’ eX aceste procese carioase coprese nummai daci dereglrile produse de wepresor au fostremediate. demineral zi Co Carla ero ingilor expusautoc fe vorba de 0 care incipient opt ‘4 punctelor de contat, ca ui 6.2 DIAGNOSTICUL CARIEI DENTARE 6.2.1 Examenul clinic Depistarea precoce a carilorincpiente gi limitawea activiiit caioase, nainte de produceres de distri semniicaive ale dintelui sunt scopurileesenfale ale unui plan de dentare, Ea este precedatt de 0 lung perioads de demineralizare subsupertic furnizeazi m smatolog oportunitatea diagnosticulul si tatamen inijalé a carieideotare Diggnosticul carei dentare ‘anamnezi gi pe semnele obiectiv bareazs pe analiza semnelor sutiective obginute prin ie prin examenulstomatologic. CARACTERELE CLINICE ALE CARIEI DENTARE us Semnele subicetive objinure prin anamnez4 sunt relative pentru stabilrea dia rie dentari. De cele mai mute os, pacientul na poate presiza momentul mplomatologia ‘mult sau mai putin dureroast, provocati de , dry), eventuale modifica de volum si culoare , efeciuath eu sonda dental rigid, care (dach este vorba de o path netedt sau rugoast, Iparea cu sonda di o prim’ ofentare asupra #4 a cael, conginutulul cavity (detritus, dentin Inlocut cu celeste semne clnice, Agitarea sondei se poate datora gi alto sauze decit un proces carios. Pe feele ascunse, tn spaile interdentre, palparea se face cu sondele speciale cu nu reugeste. te negativi (in cazul unei cari dentare necesardi pent diagnosticul lope este necesar pentru depistarea carilor incipente, tn special ‘ce scapli examenuiui stomatologic (inspectie, palpare) end su-sieesouuis 16 amzyesoumunp ap fey {assooxd wip (F (geausSouapoeu) soqnSejqoIuepe F=REANDE v9 wo9Ia Bap ‘eazy painp reo (e1uousou ceyseaoy “axed soy inp Wpen esobe> seas ep pate aa "p vameeuoutuas wf earezyesourwep puNUEP UL JeL1e0 ae eD[UIID eIJoNSHa}IBBD PZ" ao yo ses obese | "oe pay es sods EP youuap v po(@ojomedony aso pupistxo wsueas w Sry eounyzoy yo RULIEOSU ‘nu ep "xq ad sBop [qr o19 yeuaud Souea tnsso0xd youd “ero Fdns (a ‘yhuanedstrnosper groin 0 v9 ‘oy ad Yoaun syu9pi4a runs syuaid‘ou 3 ‘ap nou8 yeu yuns 29 “2yeupxoud apploymdns of 6 de amyrus quot "paoe ume ap uu aso ypuos no euRdapus ij aod az pms ny ey op nuns mod ee 5 jajexins *epuos no andjed und greioapp yy awed nu sruoxd}ou ou ‘sao “yesh aiso preiep vy tanfust 9p gaeupgens ais "pry 18 arenqusan ajay ad ooigo ap “aede yuna] asa0y 2[e spawu applajndns od fouwa v atetuapine eund gunn pe 9p nent soun gasorep se waned tdod eys2Bu09 aoarvoap ioaos ap yusund ges ‘ayeuxoud aha a ouSuip ap ane[ss utuas un 959 9peay2uN8 Faseoonun waseIs “uum 2p sojrrzodep 1 0189 souyos d00seoap ‘onsoueIp 2p near nus un ers “SO'TED nyis2o0.d ue oqiuSzew up poetouyDS Ian v| feoads ul AUSpIONL sNpaUL asERUL =p yA! jeaSur8 (IpIogsy) mvoIsay wotuso 0p ons varesdap nuuod ns cSupns uHo} wns saEIUED 9p zjaajead it ‘BUVINGA [SIV FTV GOINTIO FTAULLIVAVS ‘BIDOTORNVD en148 CARIOLOGIE Baistt 3 niveluri de reactie dentaard ta procesulcarios: 1 Reacfia pe termen lung, cu demineralizare acid redust asoviaté une leziuni lent ‘Zenele hipermineralizate pot f radioopadiatecreseut. Acest proces de 6.2.5 Caracteristi + sibstanja dentinara moe la basa gropielor CARACTERELE CLINICE ALE CARIEI DENTARE + coloraisbrun-cenusie sub small subjacent + radiotransparen sub sma “inecavtart indie fisuri si fosete indemne, nd earacterizatt Prevent “rina au ome) Dba ue popes) ce cle netede. Radiografi netede apreximal“= -aaunouns uns € side aso ansusiaaeD “iH op aun) ap wedse no Hesans 9p sd Sido “eunyoza ap gun qos purl 35 2 pound pouaus oad (© -arejuop opeedodyy S omeyesTC, “podjnd waures wsasoy od 29 ‘ajdiuoo at “eifoue) pene guBUDP HA BINDE op MMT mjuMDouy slp ae sooprzy sean uey amin v9 “youpioxd Yumsqns op vanpadd ¥ spnou “ausuose unyosed nes oqeonouny Jojszosn Te mmm vo “ean|90 naiv aqUCoaU aunoe ud wap! a9 wILay (p -ae oy 2p nism pnp ade ‘opis no waned 1 eo} ues Hosa aeanBn gus 9p 5102p asap 95 RUDY UND BUNSE] “ssuam § aunu29%9 sqenig0 oj oun wounfoe ul sooty v aroun 99 2perArD UMDROIDN pd ayoued sonedo! afunizr wns (ezqo EE) awojouna ajauvry (0 qos su oe azeqasan aay) apie usuaypa ap wns nes arr ap ons 2p vast 0 apie ad) apie ajaueSal ap wezuoAty “Fonoouron “emai alana ap (no) sojued “apeagemypour sou wiuazaud jou mHOWED 9990) 95 ajdws exequep jopeo fe jeussey1p inonsouBela 22'9 1st FUMING TAPAVD TV BOINTTO ATTUELIVUVD evorsouy ar (sass) jouer uae “(uae “oqnp) ‘soup ojameorguum ad grvazeg os ejdus erejuep jayieo je apizod jnopsouBbeiq 9°29 jd use ay YS ainqan spuos no earedyed "gawopur weyeadns joo adeoxde exvdsip redo we * snug maveany | rout deeds rap opsoeteg | nevi 18 mopsouaud oyu jmoadse ap affouny up “109 ap ouuepul 24 ys vaEDE fod ysyxe ajuamedsuanoypes is nu ajlagoadns puyo toumy “unzeo 1t Uip p uy taI09 ats9 xZoloypes fouausEND od Yeu YezeG AED ep o1s0U eyesoxpeseolaeun: V SIDOTORIV] or132 CARIOLOGIE ente, dispar foal sau paral dact ‘nu esieafectat de deshidratare (Jacl ©) Amelogeneca imperfecta, cu smal{ defieitar ea forma sau eakifiere, de cauzs creda. 6) Dentinogeneza imperfect ca modifies de siructur tn dentin, 6.3 APRECIEREA RISCULUI CRESCUT LA CARIE jea carioasi) infelege detectarea gi factor etiologic: imoruiale ale ui diagnostic ei ‘de metode eare pot detecta act zai inspect, radiogratie) lor de medi (pH-ul, fluxol salivar, cpacitatea de tamponare fost promavat conceptul de rise la care. trata prin metode de prevenire care si Observt care atest creer scull Cogs ae me einai ae ee Ta ar (CARACTERELE CLINICE ALE CARIE! DENTARE 153 Sen snplome ence ssc rcoll reset Ia caie pact. Alle teste misoara indicele de placa Pentru evaluarea complet a lepiturd ca necestatea ierialelor si procedecle Tee (Casi de pare Fock Dense Sie ences BGR [Esineash nar Dae Ge Sink pe andre Colao Je Bi Seeaieat (acpcrolsiousas |jngey ep teased uns (sorinut yrooooxang) fue}qosonu uous “oj ofa "ups}zai-oppe gues 0 no OWNS #8 ojless v yoquesourwasojdn yz ‘9p yuod w 2pojaut uy BABI YaEED Wostuaaatd wp mipot ap whey 2p ' uvjozt ap ppareut o 2s9 (@4uoys2j0ad yandq 1 amjuotaD ap eoavayde) raseITIS ple00] affoajoid ap epoyoyy |Z 02 © yoypourl vara uu niodoue> soyoroe v ao0neid IS uinoaid Jojiuip elyeidns od areorseid afeseq soun vammsidap proacia armani wud we zou vassoypour wid peor vounisiBe 2p wey trymyous faluasyzas eaigau ofazguun asso sjaporsul puuidno 2[eads 9/900 SSVOIMVOLLNY laLNaisIzau V SuINYIN 3d ATVIOadS SOVOTTIN FZ SYV.LINAG IBIYVD VIXV1dOud WA INTOLIdvo ypu @ arate ap dais luatoys puratd wanjsun ty. SIDOTORIVD D $51136 canio06re — 2 sare desi sunt fvorizai sistemic sau topic (cu formarea carilor recomporté urmatori tipi a dintelui de contaminare cu saliva (ideal eu diga; tn lipst cu * pactengicu multe leziuni proximale 7 ‘or prefera obturaile Timpul 3. Se bulets de vat sau secunde pent din ‘cu spray-ul de apd 10 secunde, indepértandu-se prin demineralizarea smalulu emineralzat pare acopert cu gheaté in mod curent c similird cu a compozitelor. Diferenfele prinepale inte fe comorte este primul trebuie sf fie mult mai fluid t zonele demineralizate fn vederea amplifciit (420-450nm) sunt comer ina este un monomer de di 2 altele cont ua pigment i De obicel pe supra rine un stat de material de sigilare lipicos, aparent sae ign eo ae plintizn Lapp sigilare creat rigbile sunt formate din dowd sisteme '31 5% amin ongaaicl ca gi accelerator. le comercalzate sunt: Epoxidet 9070 si 9075, Nuva Seal, Elmex Gel. ra se datoreazi mai degrabt nor gee ds epare (Conaminae saliva) decat capaciutit reduse de adezimne a‘eayes9uyuop ap ways) und tres no ajeyun 0 puyuuy pod wy spunea 18 ajedae poodsar nus ruoietado goup vaapde aod oo8e ap innpes spd yyspz no paquasaid amunstooas op woo wo aris op Bo P MIND 95187 (HO)ED Uype BOUL “amosn 8 ede ro wasnygds op reuu ‘ous 8 osuosop ajeznjoo aojlayoudes wreyjoug € nd, ‘9p 1209 0 wreayjde omngan “yunUap ¥| yuRd ase MhyHAED €: ‘op sod az mise no yousys yzay 0 no areoyeyounuap vazeudop yor “7 dc, Sonat pup w apulna 25 vane) {30 Daune a4) SDIDE “y nda 9 zodwoo nat 18 pamnjdian op use) ap gun © ouNUOD 20 ggeANp sitzzodwwod “Z/| ES S118 sway sop squnoed vm set o 500 -Y - 101 9p und ‘nes yes pone mo wojduoo earsmaqo # {pun eluszaud puyol .leBe, wpaos 2pun ae sy 18 appre onsod ye 9 Pirgnsuooou 91892109 5 eeayy 18 0qMSy 1S wate inoeoyeo sued yo uy 20 4399 “509 ap jnlaud aoauad 29 220 iui raguad pondoooe woureyen ap ageytepous © purzasdas yo azo 9s asvoun9 yunz2] oun ‘2 moworlvar vawpllg "FZeanjoxs nu aIp|s asveue> ojunIZD] yO yeNsUOWP NE 2PM ‘quoi ynjeuoreut qs soso ssaoxd wa © ap ojteuTigsod aiSoaud 29 ¥390 Uy sr ‘SUVINAC THRIVD WIXWTdOUa Wo BIDOTORVD ast160 CARIOLOGIE merfaa sm iplutura de rigind) nu face olegiturd simp cu suprafaa seal lizare, cee ce permite ejnere sgiant nedie penetreaz srualal demineralzat inindu-se ins lao adincime de 100 de milimicroni reazao hater protectore impotriva colonzirifisurilor din ‘impiedet patrunderea resturilor alimentare in santurile ée1 mgpentu entra copii ean fu baut opi ce api cu ute ‘pi nau nevoie de adus suplmentar. sta de 3-6 ai, 123%, ultimele 2 gisindu-se ¢ sub forma de gel sau jonal pe scar lagi care demonstrexzi Jderea numarului suprafeelorafectate la profesional de fluor av fest controverste. Unele profesional Je fluor este © misura preventivs important pent i de noi leciuni earioas, fir si tink cont de cont de ace factor care (esemplu : accesul la ap profesionsi ered ca decizisterapei cu Moors ‘un grup de in ins terpia ocald cu fluor se adreseazi doa ‘de costul asociat arestor servic ca si de opulari agenyi topiei utlizati ast sunt ode {esfatulacid de fluor (APF) s luorua de sodiu (NAF). PROFILAXIA CARIEI DENTARE 161 1d 1.23% F la ph 3,2. Citeva produsenoi contin © lean, Muli din aceste produse nu au fost fac int-o portamprenth de polistren, sub forms de ge, imp redus de Ir ( pot tata ambeearade simular). Excepional a cop pot ‘zur ‘n care ase po lian amble portamprente deodai. In sete cxzur i cerebrale pot prezerta ificulti in ceeace priveyte tolerenta portamprentelr. Fuoriaarea topich se poate fice eu o pensuld stu o bule de vali trai cu radial sau chimioterapie prezints adesea-ulcerait ale fesuturlor ice pot deveui duteroase in prezenia unor agent fuorizanyi, cu pH sczut (exempht Ay sa agent cu gust ue. Se va fos pens ce pice agen ev ia 7.2 CONTROLUL IMUNOLOGIC $1 PROFILAXIA CARIEL DENTARE. 7.2.1 Imunizarea activa Dintre toate strategie de control a plac demtare bacteriene, cea mai specificd lor microbiene, de suprafata sauor 2[a198n{uoo 2ocavot wy wen]849 nua jreaodaud no 119 BY suo g 3]9 291K wuonoury swsjeanys> ay gs sod (sunejed ys >jeauLyozeu adbar ajouoz uy souaSnue yumdeD wluaoya joe oat go wjrasod 319 “980 [ale2[0)w atzanpu ap "uoutuo2u09 04299 9¢ BINS sundsgs $0 yevansuowap ‘BOVINA TAY VIXVISOUd | | ‘souayied plueojor = a1gonpu ap pinosounoqyse eporous o murzaudas usiquo ynun v yyezooniu vazEASIUNpY “pouo puny viucsejor 8 SID (rudsoucD Freq v| ME eyezoonU apuNUID.eD, ‘sunuay unsundses95-spupuigo ‘alnuneu ad ajautiadxa uy s209n8 no eoqutysis wosezq SIDOTORIVD wt164 carroLocie (CTB are 0 aviditate de legare a gangliozidului GMI, prezent la nivelul suprafefelor tuturor celulelor mucleate, de aceea aste prelust rapid de celulele M de suprafatd ale Payer si difuzat adiacente, ce iniiazd rdspunsul jul SBR Recombinantul SBR legat genetic ce CTA2/B, ‘ecombinantul C © gantitae adjuvs Recombinantul netoxic CTB-imunogeni ai steptoco evaluat ls om. Administrarea in a recombinantului CTB la volun i induce rispunsuri mucozale IgA spesifice, chiar daci nu au fost abservate rispunsuri fe genetic (GTF-PI si GTF-P2), indicat prezerta tn ser gi saliva PROFILAXIA CARIEI DENTARE 165, Aaticorpit de iepure ant ina de fuziune Agl-GB (construté din regiunea ‘A a AgUiT si domeniul GB al GTF- ib semnifiatv sinteza dextranului de icabilitatea acestor anticorpi in contol istent decat specia 2e exprimd numai SBR, sugerdndu-se roll TB, 7.2.2 Imunizarea pasiva je de imunizare pasivs eu fost fol experimentale pe animale si oameni, eu scopul determi i de streplococii mutans gi forma IgY specifici antigenelor_steptococice laptele imur de vacé, a aritat o reducere @ aplicareais ayudeun eau woes peuorap axdnp ~ yanruypp eze; saqus yaQHD yuavodwoo ‘aies20%u Joympeoaid vassBoqe gurzeudoy yids WHVINSO VIHVO NI LNSWVIVHL 3a INNWId WA INTOLIdvO “yung ulnd yo nanuad suennut sooaoidans no e20 yuyzttojonex eatnody ‘wo a goupoads fos wn BY nued yousGsucs) waepLOqe ‘no woreztuofooas net gafinaesuoo wasmUD}dus PEIYUY yUHWIN JOysEIUN|OA oye apez|Ue!BL ‘HIDOTORVD 99r168 CARIOLOGIE Aceasté include si unele forme de teripie endodonticd, parodontoigiet, ortodonticl, se regulate cate releva necesitaea lor majore, Cu aceasthocazie devine seleroasi" care a fermi la explorare care poate se observa la pacies care gi-au modificat diets “Aeeste lesiuni nu vor Fi restaurate, c4 exceptia dorinjei CAPITOLUL IX inte persone cu aceeasi profesiune, care-iajutl sl se ineleaga "unghiuldiedru = jonetiunea a dowd suprafefe, dea lungul unei lini definite ‘unghiul diedru intern = unghiul al eri virf rw se observa lunghiul diedru extern = unghiul al cfrui varf se observ at de jonejiunea a tei suprafe(eint-un punct ‘contur marginal = este unghiul format de jonctiunea dint pereii caviti i suprafaja exter adi cextinde pe suprafaa exter li perete axial este © suprafaé intern a unei cavititi prepaite care este paralel cu axul lung al dintelui pereele pulpar este suprafaji intern a unei. cavitii preparate perpendicular pe axul lung al dinelui“asojoy foaup 2p ‘mp ed aivz joy eounfae qns 2289 e149 © purigo ua cared “ydiod nuruad Jounna waseupdapuy suns aojfhaeavo yupsedard ejanioe.go yqesoua8 yusuusy Up ULyLIAVS VINHOS £°6 14530 ino 204 iguanas, vzme9 uIP warmudopuy woundust nidiound 1s200 fepsuarxa yrudisuud 329 f ap jndoos no ‘yeu0% ‘oyoya aparu aoleyeadns 2d 9p "yituop UIp FOLD FarnUOD 18 980) uy Bo u00 9p pu of Bpsunfe wea AP. 1e70q no vou {Beane yzeazeat 18 YUNG Uy pides apulnxo 9s sun Oe __ WOTLYLAVO VauVEVdd NJ Yea AC TdlINId jaBoun8s0 ro9jpp no fouls Nenu, YZeeINGeD nu apareU rales “dnd aud yere}99 6 109 © yunyapa ro “pz UI PzEq AYO PROP 7 MIO} imBoup s19pas 9p round UIC, yours wopeo ad vdjnd auds punuop w yunyZa © axapunxa 0 2anpoud [2alU ‘pum foumye 1ps9p apunxa a5 nu 3189 yous uy aztiouad op aye popu 0 parouuo} apse BUD 3 flows 8 pevaimmey quowopseu ajtioy pups yuvd augieia wosun “Suoz aysooe uy pzeasaido.d aseo aque) “njeIup v asEONz=p auluvO 76 -qeanjoo peau nu 18 prvenjoo-ofzaw 4 ws pauzumuap “O $8 J njduson9 :yssory 2oyluyp e slagesdns audsop {uyqion pugy “umyBun areyaje0 runud rupaip fauna GA JouCNUe uIP yun ev greziour 1 2p wu jays 0, Uf BUO}SUEH BA 25 «FP, Njaxyaid ‘un yeu nes Ehop ¥ AIEUIgWIGD © OUR 99 uauLo, Uh WIDLDS nes LARIADSIP PUR wun no tnjnjeus eoxun puurzazdas 20 eum =puRUap-}owss voumfouoy — (e up 1 yuoixs vlojoidns a9 atesedasd soygnaes soyed wounifouoteonursioyy (¢ ‘ifuoiaspurnansuoo wasope 18 punuop 1ne9w slated 9p vouns.od aise seunuap ojeiased sndwoo syezedaid yfquaso © siaied ep vounyiod aisa frets op ojarared ‘snd oyfgnaeo uy ears jarred smd ‘medind nes pepe aqorased y 39 uno ‘asnduioa nes aids ‘igneous yunauad w youype you! v2o euoz gurzaidou envapod nes puny (2 upp gsnduio> “sesedad ‘HIDOTORIVA ‘out1m, CARIOLOGIE, ren. Aceste prepairi diverse se vor ‘in prepararea cavity 9.5 CLASIFICAREA CAVITATILOR Exist complexe-care implica (@)aumele supratefei dentare implicate: declara ci am debutt in terapia carei de importa capital: PRINCIPII DE BAZA IN PREPARAREA CAVITATILOR 23 - progresiunea I are deci att un rl 9.6 FAZELE PREPARARII CAVITATILOR jam indeptctarea i pli de yesutur Jsivilor $i eanialor cu pistarea unghivlu ich prin tehuica comund de preparare si matWoo fesmyot pour up 1 €201FDBP"o|sUayx9¥ azeoyeA9sUO9 you sazeuosloayzad uno ou psveapups promop pa tu 24m aynsy 21001 Suny wap pINOR) 21 BS aingan ase wIsUA 4012 1092p 18 280} nluo$ wy ezedaad sojigeo ynzeo ‘oparau soatayesdas 2p p y ato UL app aaareosp ‘18z{Aip © BUSHOOU TOPIZOP LOOP [e-2P 12D ung o agua! ys axeo atlrcod on su BOUL YLAVO VauVaVdad NI Y2VE AC HAIONDA ‘pease es “aaa yo ase wind “edwwors> ‘se joujBseu snpuco imONIA ye BALD kaxezyPNe|A aseD UL wens 16 aUTS uenzta Ba a6 eure jou wayosejd. QuUIO>SH] jnamjuos waayngers (1 tuna pnp adere Tojo by ssao0ud wluasayp 2 eatouose 2p aundult 25 x nquuoo 38 2209 L028) ap “npsjours wouisoxd “jews =p 20, sogayut ud 9 ‘sooau. 2189 aaup "yaswouno 98 ES a1Nga1), 2p aij ys osado ap aa1U1P sorry aquyp 2u19 > ¥ glpaio> vareredag sow igiavo jpiedeid ajadera 19°6 ‘ayegz0un8ts no vad sox a5 prs a a8v9 ‘uaocy yop 8-A B Bse]9 2p ofe0 no puguIaS foo 9p sy jowowerea, ous ‘eqioa aisa 229159081 O49 ne 2:29 J 29» amsodard ap aunsjp ayiguepou id yous a5 yuan tesaoe sasesedaig vapid 199 fozpuL jmyfun 9109 ut fay ad 9p oueo ymuauweren wuUN up ye ajowioud 82B-D-AJ D OEE] BP vEIEHIAD? « ‘wIDOTOINWD i vt176 CARIOLOGIE PRINCIPI DE BAZK IN PREPARAREA CAVITATILOR 7 mandibular. toate ganfurile vor ft incluse in conturul marginal, extinindu-se in fisurile lor existe Peniru fosele de pe suprafaya 23 ocluzale ale molarile, extinderea gi minimum de proceduri, vor fi ri in cadrul extensici, din cele de baz azul prepardrii cavititior pe suprafeele jele netede, cu excepfa preparirilor de clasa a V-a includ m ‘enor Timite gi ma favoarea unor restrifioririi extensiel sunt care pot ‘dud la sporirea extensiei sun 1. handicap psihie sau 2) Ameloplas Uncori fosele si si alege zonele |. Dac este mai mick deedt 1/3 fisura va fi pregalits dup procedura fisurd va grosimea se practic prepaarea de cavitate cu siguranflse va trece pe alt fat a dinteh a imine eu cavitatea pe o singuri ddentare cu materialu!restauraty. ‘Un exemplu este fisura lingualdi a molarului 1 mandibular eare se terminf pe creasta de smalj oclozo-linguali, Extensia ganfului poate s& ajungi la eva 2 mm inguald si restul de gan, remodelat va oferi portunea te anticipatdo preparare. Oricum este necesard o prudenfé extrema in selecjiosarea acestor zone gi adincimea pan la care smaltul va fi indepartat poate si fie transforatd sac nu poste fie menginut san u baz plat prinr-o reducere minima de smal 3) Objinsrea formed de rezisten(a. Forma de cezistenj& poate a4 fie defiitt ca o sculptare si plasare a pereilor care 88 permit si dintele s& rexiste forfelor {in afarapericolului de factrare. Principii fundamentale implicate in sunt urmatoarele: cu baz plank, care ajuth dintele si rezise la forele tea existenjei unghiurilor drepte, (2) reducerea extensei peretilor cavitiyi, pentru a permite cuspizilr gi erestelor acestor pl proceduri dar exe de dorit2p ate 28990 Uy “2 veameedaid y oud mad vs ame dopo RS 9OEDU2 (e ul ymysoow vareupdepiy pur 908 th 96 PULA IED Uae e nued yewNY oqOwOID found ro prose uy aseurs oxeiuap 20] ISAS no a0ja) § 18 wuodaoe wo UIP pluaistzas ‘pseonus wuwap no 8599 so]pustURLOOIOI ‘arenauad epavoud upoutoreeep ap guce o 16 "punuap ul yzvosaiBoud ee “gwaus}pow ya nu iad nfao0 ad ypumsos guoz o zum 189 PInUap 2p BOOZ RoE sopfared y Ba guoz gisease feu "te od ‘9p yous varvoinde paw un a mfigeis 6 ruUof 9Is9 sodyndened 6 edjnd 09994 uy BaAE BA 95 “aeztOUI-ou ‘pwupdapuy 24s winoe vo aug aso ‘edn pistooe yap “yrets0> nv no pur tunuep sun va Pep “WH mredaid 9p aseouatue sjadeio n> sop © wuRdepuy naod-wus ¢*| op 2150 ureyeurerujuod yjeznj20 jurul euusous“yluaistzax

ynjeoweUd “yu o82 ySEOUED veUIz3| OI &| pel wap vaseiagdapuy (9 juaso wouewese op ais 2[ezn|o0 rowl0y veunsnSUy, ayueysaa oyeaay(e apenpyz9s fo Lt WOTLYLIAVD VaUVEVATUE NI YZVE IC TdIONTE IDOTORIVD aur180, CARIOLOGIE in general se accept ch zone me th ceed ce privese fadeptrarea dentine d folosirea excavatosreloe,feezelor glsbulare din ofl eu lobular din carbid a tra le profan - Palpa se poat mdzy oso vlajeadns yo exopisuon s0-s Joep se) Sareoyde spunyoud ayfise> up soda pow { Réind nnuad Joon 298049 a “reap HspNEses 8 fe poyMzes e> PARE, BINS way up soyuor20q 9 grezodap yuoresedos reunuap vluazaid a ‘esnesas 9 qusioeg a1s200 ep H> 2159 jeyexdns e gDep o1u yeu ze up ys 0d puoueg 0 ‘uy sou jassooid epunsD 4s 98 2809 wul|sqorg "aseou Mu > snjauoa ne #8 axeunuap Pun np axeuRuap aiqnaieuR) “youtdue ULYLIAVS VaHVZIIMaLS 2°6 er OMLYLIAVO VaRIVEVATUd NI YZVA 90 MdTONTa 29 aofe01 e avemoaje ep Funuligo winposaig aidsep foun equa UBAE Op EOSEOSOIO} 95 nna gs mnyruoresedo ayruuod goruyo) pIsE=9y ueBeure ysHSOjO} 170 Hp ‘yzoduios oqugsedaud juoo (jaadq) vaaysoy, ‘owsquyy nod ‘BIDOTORIVS . wrta CARIOLOGIE ack se urmeazi sceste precautuni, sterilizarea cavitayjloe prin aplicarea de canvente este inexplicabill, 9.8 SOLVENT! ORGANICI CA AGENTI DE DEGRESARE © mare diversitate de solvenj organici au fost sugeraii gentra uzul intraoral pentru aindepictauleiurile gi alte astel de materiale de Ia nivelul smaljulu si suprafejei dentinare. Unele din acestea cum arf: eloroformul, acetona, benzonele gi alcool au fie fect toxic, fe irtant sau deshidrateazs excesiv dentina iat (neaflina) este un agent degresanteficace, Prk a aves 3 denture sau fesuturilor moi 9.9 NEUTRALIZAREA ACIDULUI fosforici: ca tn FOZ, 9.10 PREPARARILE MULTIPLE binei a fcut posibild pregitirea a mul proceduri mult accepiate de_paci Ge preparare se reduce i tensiunea pacientului iar una din fieabile probleme ale PRINCIPIL DE BAZK IN PREPARAREA CAVITATILOR 185 preparirilor multiple este cresterea oportnitigis pentru restaurarea_conturl contacter, - marginilor, -ocluziei, le care se fac la Treg cadranul in acelasi timp realizeazi o armonie lor de suport se dnjilor. Avantajl preparitilor multiple De acestea pot benetcin de asemenea ho serie de avi dela V gil. Dal mentar modem de ai reset lendinj de a prepara mai mt fn conclize oat seste avant, ait al pacientlu cit ale soratotoguu renutate din miele preprkt pot se anlate din cauzeprocedurior estauratod ares.‘o1ezijun p8ae] 0 90 1231 rewnu ysuj ‘suaspuew ap asejo g yzearstvas azvivep azeay nawad ¢z AU [N]OD!E Va “Aantios wounsisus S998 teusscu Iso ez niued yapW 2p roserd Is9p Renp PZCLvA [o-ustsaq “yup ep wseId B| RZEXY 1 RZEaLdepE as a9 ynjmivounsisuy v oued wooe aise invospueyY “InjnuszpuoUE [r-u3}seq_ ovojs2}Uo uns aD wp pyOHerOW 1 jreud}sop yrealuonyuy 2 oflouny yyumUE © pupae tlRd owsaoe Up axeoo4y ‘yapou vauedindea« ‘meB4nj0o asprew © «| ‘lg ¢ up um ais anpios wows aze99E “aunuos 13 uinue ne oj9 uous aszoe anutd sino 99 fineiea pasar epno uf "pURW 2p Jojasard jworn(e no suo! Y w SIEUNSAP duns #8 zou} ap Paslwnuap qas sinosouno lung swouNASUaIso98 BjomPe WO “ayezypyarouoo y v docu sjaounsnsur ‘emonzap up arnjoss s9901d un pxyns aneios yewtawediyos “sy6t tne xdag, ‘auoiospenuoe ais9 aavSojoreusoxs asoor up syeuo(foajuo> soy wip eiuuun 2) 000s Haul ap MAID 208 12 meMI99J9 36 20 yewors ayoquounien aadsop rec youly.LiAvo VAUVEVdaed NULNSd ALLVLOY “INUVLNSWNYLSNI FOL yotlyLAvo V SHVHVdaHd 30 INYVLNAWNYLSNI xX INTOLIdvVO188 CARIOLOGIE Design-ul gatului, Gatwl sau colul este partea intermediarh de instrument ce leag’ mandrenul de corpul instrumentului rotativ. Are forms conic cu baza mare Ia mandren, baza nivelul capului, Colul transmite forjele sapului nal = po Din aceast4 cauza dimensiunilegituluireprezintt un compromis inte necestatea de a avea o dimensiune mai mare, ceea ce oferl rezstenti gio secfiune in diametra redusti,care presupune acces gi vii Desiga-ul eapul reze dentare Forma pi fe, Termenul de “forma” aplicat usei freze dentare se eta capuli jangul timpului fe forme pentru ca ft prezent si se foloseasct numai: globul nsrrumenranul bl brépanane a caver 199 Oricum, un numir mic defineste o frezA de dimensiune redusi, un nimi mare 0 imensiune mare. Astfel vom lua in considerare: 150) Diasrad ‘xpult, Gs F a Few gabatre Fea sec Te ress lech i oe 2 0 e oi + wid 3 we Freeza past cobturirit lor eu aur coe vvederea prepar pistreazt design ul origi Iaterala re I. Dr. Miles Markley © modificé tn de clasa I ce vor fi obturate cu amalgam. Aceasté fez far are partea frontal plat si unghiul de jmea capului este de tei ori mai mare decdt lijimea avind 70 nny; 331 = 1,00 mum; 332 = 1,20 mm ‘care lungimea capului frezei este de'3 mmm, freza fi ineepe ‘numerotarea eu 745, 10.1.3 Freza cilindricd Aceste freze sunt destinate preparii evi ilor ce vor fi obturate cu amalgam: dae ita anetoo ma pley upg nozig azo y 280 18900 uy “(pBuIg #6 pidoauct) 1p gas aiosyd 96 iC wisp utp 11 yaUap — 2oFa0das (2 (ers28s) aon op areofnu o-nutd yu2Aoo4y 1 9p arms four 2489 oye Jour mynIyBln wousUSIND iaigp "eye> n> areomuguse o1ss-ohdys (G ‘veep uid aun ap amet (5) v -ouow pideasp y a1eed (¢) 106 @P yun un gevowuo} ou |S amwoiagp vaUlsroN (2) nun vfuszoid op yrewo) aise arcoryn vous ( roufdap ey nynious wemayD nos vamued anuad areoja1g} aqueuinaysul ep |uNdiL e°Z"OL oupus 208 = 9pessqu29~ 3 foun] Pawn — Q1 xv f pas} om ues 25 suo} 1nydun Pupaudas = uf oud :aivoynuept ap Bo 0 gout azede youre, 1 8 st smduoxg, 06 9p 29 gue] exvoyoKR waved anuip(auysun aqueunAysUF soe ET “(@o) operon nes 120 9p am ap ytupns uy edo “yojnsougus jx no wero] yzeaunos yf aue9 26 juySun yulzaudad = pufl> wads“ Wa fou] waUNTun| = pal vHop DZ pu op uso uy fou] eau] = eas usd 161 ‘UAYLIAVO WAVED IO TANVINGATULSNT anno ayy ‘1 2p Hau eauuDpr ap aobn w an gueul ep Jojeyounsysuy BINWIES Z'Z"OL up wowed yrurzeudas 18 jug wuosbuny aed aiso wiseant = pane awed mes bwNE] fejnue yur nes prop “our n> nas xdoup ty aveod (nyruuatunnsu eaued 8 souyuh any eimedey 295) = (mig « te au nas ynzgaaid ‘fouodo}2o “Grou mes mypoul “fur nuSWIEIP op = IBUR «| ‘oqeivasesagd fan uipyrsuon RupUL ap ywoUINAISU UF, luoispda upd es w am 18 snjayeouinasuy © 1 amoreye ewe) EAN tat In-uByseq 1'2"0b ‘21soj0y 9p warwow ne upur 9p ofoqusunnsuy anuad yaniejsusutOU 0 3: yoTLyLiAvo VaUVHVdald NULNAd YNYW 3G S73LNAWNULSNI 2'Ob eum @ arm aaa = sd ww ps2 wage tu 92pm wat ow a y= ea eo wugo| oi Tepe les90. ost |_ mama Pasty Ro|UoDOApUIIID BZO44 HOF IDOTORND 06192 CARIOLOGIE dentine In cael fn care este dublu prima modificare = intre margines ‘8 doua modificare = lama bizotatorull este curba si pe acest rumente perechi: R gi L, Dia aceasti cauz4 sunt neceare doul pentru cavitatea i doud pentra cea distal: cea distal num identifica: 10,95, pentru ea pentru eavitatea meziala numaridentificare: 10, 80,6 12 10.3 CONSIDERATII BIOLOGICE sade a asigura un medi 3 de man, a instrume 10.3.1 Reactia pulpei la instrumentele taietoare rotative 1 indepartii structurilor rile de restaurare), se formeazi dentind de reparaie per. pe peresele adiacent al cav INSTRUMENTARUL DE PREPARARE A CAVITATIL 193 12 arltat 8 oferdo protecie foarte bunt re. ln zonele neprotjate de ast push fire cavitate camera fe pulpard impotev agen waumatct imase ese sub 2 mm fspunsl pulpr este prompt indicat prin canttatea de fn regiunea in care au fost tate erioase, puternice, fenomenele distrctive se ulele dentinare, adesea rezultind abcese pulpare i moartea rea ine 2 siptimfni gi 6 tun sau msi fn timpul fenomenelor reparative egenerare $i moarte a odontoblast moderatt, se localizate si ace ‘© pulpi imbirdntt in care puterea de recupersre este slab. {n plus polpa unui dinte imbatrnit este foarte posibil s4 prezinte diverse grade de inflamajie cronicl, rezultat al traumatismelot anterioare, abraziei, eroziu © eee rer pe on afl de de ezele gi instrumentele diamantate care nu sunt 2c rezultat generarea de multa cildurs. Frezele cu cujite helicoidale produc mai multl cildurs decit cele eu eu‘q2IuIp m9 1981409 en Bp ‘vue ge 9p yrymuaanawisayap yuanaid w nauod otenoeas ap jmuaurediyse 2z2jont anuy waujogi 6 yur 1408 2p xoYu un anaze>2p ‘uoreIado roed wore vaydeacadns Ba og 6) JOA 98 Ba008 uuoyuayu ares yp YzAN no 39 MO BNI BUTALUOD eA 3 eusNEN aoNpat mn aot ¥ndung “anes ap sojunpaonid jada up ooype ass U vormdaud uy puuo|qoid 0 2159 ys nos aadaife 2s ys ingen ta eostapy Tadind warezreuinen outs 3s nu ayasoid yo evn 98 nu w "Og ep afasid mes wING g9 opaio po nuntod msajoed nated we “oveigugs nawued yuoustwed osu un 29 490 no yopE Hf anyrunny (odu mmgo op reusieu 1f suisyueSsooi0qu ‘axeUap MUGep) yoso49y -qumdnd sour (Soyenae9 anur gunuop uta Z =p und s Ww3}949 soqua ;puod goypul au zo|UHD efauordaus yo FULLY amo of SY 3D no fouMU AUDIoyns asIRT O nptyo yutind eanposd 2s 49 Koads) ede + 400 “yao uae jonuoa un pei resl eters yey | i omnes ie Sansa st gop rio 2 Ao a ee TL fund som op vlgpge wan ode pecan eee Raney al ne are vomts Sage ot 9 So Ea aia Ye mao 9s > manent uy edt von, and op be tind pd guwsaaqu a a 361 TRLIAWO VaaPEVAAET 30 TDAKINAANRISNT We NwIOOTORVO Ve196 0 be CARIOLOGIE Tecomandat ase folosifreze globulare, cu traf redusi, cu lumink bun aplicaiintermitente pentru a evita sceste neplicer. Foarte des ss va inspecta zona de ‘operat ss va spor alengi, pentru este preferabil un coafaj indirect decdt unul direct 10.3.3 Protectia ochilor ins dct empl un acon nest ses, Scopert oh cu compress ei trimite la seviciul de specialitate. ms me 11 slomatologic este posi 1 fn Jocurile inehise unde pérsoane. Bi ues, herpes : INSTRUMENTARUL DE PREPARARE A CAVITATI 197 ______INSTRUMENTARUL DE PREPARAREA CAVITAH _N7 sistemului rapid de evacuare, de asemenea, reduce cantitatea de bacteii din mediul nconjurdtor. Purtarea mit chirurgicale pro ssistenta, deoarece acestes filtreaad bacerile, Sunt ecomandate mistileconturabile, fat de cele moi sau de cele eu bordra metalic je operatorii 10.3.5 Pacientul $1 poz 8, att pentru binele pacienttu ct intro pozitie confortabla prezint& 0 rea vasculard si este mult ai capabil de pposturd bund, operatorul reduce coloanei veebrale sau cierea uneril De asemenes, sprijinel pe ambele pitioare este esengal atu lucreaai din po sinitalea generald a st profesiunea stomatologict moderne sunt concepute ca st de lweru. © variant’ sunt puse la locul de piept. In aceasté po pentru stomatologie este cer culeat si cea ie de operator, tipul de procedurt gi zona din n porta culeat, gitul, spatele si picioarele au-arpasoq JSomu 22 pun sina od nyoyasosyuoj9ox9 un BMY39}> 1y BA tmjnde> € supjeq un 9] FuoTEIO ‘areoroid ut Sojiog areionp WH 952929 UIP BGS TO RAdfad BA yoilaisse |maungey, pu ap aprzodsip no nzpaaud yj vA ny[o10} 2p vareugdopuy p squysieAIp areur o BsING ~soyesedo ToRINGES, od up brya9j9 0A 25 pau jfezodo- varevejr oj puginfe sojerado nnuod {roua vatepiaid wip gonpas 18 yiuexe|at sone vaepa0ouy apoos ‘duu g0 0 vaio Bs ojlrzod HSe200e uy yBvamt Sep poe yun no yuzag sa-REL ‘ sap purD I! “aosge wu uN roadse ary “anwthiaw ie otood jaaywateidoude ut won va nu ynuoriedd vfog fuou ips oingan juoreiedo erouojlueu ung wamisod 0, Soaps quns wouarue uoyn 9 tasapuld ‘28 pugs “wn249 “sopTUSURUISU wax9pund anued c}oTap ruyed2s9s0)o} seoup aunzps oy ws 20d ‘yu four of20 ranted eseale soyetuaus 1P aye ajeznso sopsfa} & HS uoUTsod iKiup wejnqipuew #6 uEYEMW soy 194 ey 9¢ ojarodousws nnuad yqeuo;uo> e1s2 atyzod yiseaoy “tm|MUDIoed ado ‘ze> 18208 Uj (6) vIEdd4p WIP viz soreiado 209 “WoraID syooqu WS oteod gs ynfewueae axe afrzod audsuy yajnuatoed yaa 408n un go sojeiuouinnsus ateu 18 dvaup vaued yepeds fd qruon Trip VEVAVARR TO TWVENANARISNT aIDOTORVD =~CAPITOLUL XI IZOLAREA CAMPULUI OPERATOR singivel’, deceit psi ‘operatare, fn nod obisnuit este minuit de esstenta medical gi este foateeficientcind se Tucreazi la ratru mi 44.3 RULOURILE DE VATA vat acopertt cu rulourile ordinetamexu 9: 28 sojotuep sopping jnpodse op ‘ad aresooute ap jor na “nay pop 2saspd 2s Jeg 218201) aq ‘ag un i janxe pop 292 e) 2 wdrsanut four un ~ enquoesdo upuutos exodus pod 2 yrauotged whey ad aeyous o piso I 99 ¥99D-px2At00 tun H EAOUOD Ble} 9 n> RITEAC bap waredwuesjoipes pseld Teysreus up gIeTo{!s—yU0D KqNsO PMN "wasdsueno} ‘nsejd uip greuofsajuon sep sns fet 9p vaD NO ‘aise eo tnfewwenezag, yejndiueu 9p Jo8n ,f, 9p BULIOY UE ya nupes um ase ~jo-tusp = HU, aida a}U0pO ‘anton ap as01d yrvaxty 9 ome 29 ojun2a| 8 “eufou ‘nfo ‘a seg “9pIBArwasBOICO PeyaIe foxes (ami sp) $08 Yu G20) wm ree ales 1S 1S yluisojoy FoIUN ep aIsz oq OND vodwooilng -unse ap psy ano ystnd op saa w= ‘ude tod cpa uoz=50 SuaUNEp no pen wUsLOg ae “we ExT nos g*r1xS'ZI H 18 (odin) ay 2p HIB jorewors sojppopaeut oye euindo uy efesiaauoo -pupuruae *yoRUoUO22 ‘ayrong day juoresedo yzeefaosd arqozt 0 {nzodwo> 16 uo) wid “ajunoqny: iaus0s Rqrvosqe ys 23 atoufuau 2p ‘aisaoe goojsp 2yeang 1 ‘no Sn Iu

0 eo eames zy preuoi09 unioey 2p foouad Uf a9 [aU “Nz ap UL eioeudanunesad ap yyeusow aeansuoo yeu au our eu “dure oyna 2 ‘Sux nn 289 soueD [OseDCA asa U, [ED UY “aeAsAUOD wrested 9 U1 pw 89 901} 28 ¥ ap vave asa BY 2p udu Yeu wap ansy #8 a9 UE JqaeD EOIBPUIDX 1 ese 20 avorun a5 puja unre aseapisuos UL en| JON a5 sof feu op fo nes qwodjewe ap so18 was un-nwyp soryeundsaios aoejar #8 sanpar 10s 25 qleoppuyesquoo [8 yeolpul FEZ sea w aesedand youd 2 16 soyoqeorou oye 2ofzy sojneudosd v yioai0> ea1afeoluy axesaoeu eure no asosnensas o naWUOg “a[oua}eU aye nO 1~DOp “wedleUE no yqEIBaP guns yee] jndaul ip Huyp Sour yeu! 19 ~Imymueoed dun op ¥Buny yauas sou} a1to ames'sal o yzeezyeas By 2p tnundyeury apeouad 0 ned NvoTviy nd IlyuNVLSaY WauaaaA NI VSY10 3a HOTLYLIAVS VaHVuVdaud FZb WVSTVNVY NO HOTINYYNVLSSY VaYa0SA NI YOTLYLIAVS WauvuWdadd WX TNTOLldvO oon aed ronan ‘apa said op 209 uo annus ajo suns uBlp ameingi 9p snpaooig Aes Bp fond 16 pode 35 noe 1 ae os ed 38 BONED 9p ON "o> aude euneopio grown oF 1 ssuofzod of ode set nutes amucing ‘Sp SIDOTORIV 3208 CARIOLOGIE PREPARAREA CAVITATILOR IN’ VEDEREA RESTAURARILOR CU AMALGAM _ 209 cost pe termen lie. O obturaie 12.1.2 Prepararea conservativa a cavit Prepararea conservativi a cavi pupa, de a pistra dintele puternie lor profunde unde se prevede sau se induce © inca « camerei pulp, se recomands aplicarea dig sesemenea necesari in timpul condensirii amalgamulul gia aceluia care ind paralelf cu acesta si se irsertfreza direct fn fisura sau ‘incepe cu fosa distalé ~ reducdindt-se la ‘Aceastésincime poate sau-nu total de penetrre a unei freze se va misura gi fnsemna Inainte de a fi luatd drept lungime de rete de diametru mai mic, cum ar fi freaa ‘conservi structutile dentare gi rezstr Continuded si si adancimea cu presiuni intermitente, ne extindem dea lungul sangului central spre fosa mezial8, urmérind ridieaturile 3i sprafefei ocluzale. Cand fisura central are o carie mie’, o migcare de-t orali se extind, ack este necesar, pentru a Tndeparta Yor rimne margini de smal} puternice, 0 dad pent ci sunt formate din prsme d {regi sia doua oar pentru cd se sprijind pe dentink sindtoasi,nes asndxa 2}ou07 oivon aradose Bs 2409 ‘yzeq #9 Ut CZO-C'9 2p ‘2p afeous yasedaud un poasuy as ‘aunysaud ay poqUL 0 pUIsOIOS na eaopaf wa as (aredind jaiowes vasspmpsop) fodind wasaundxe 20] am RoR “a100}N0 nupsapuns jou zonpauny vasapo asaundse 12982 yadynd masziuapisa yd udnsy pluonfiy vaso ox 2409 pdjnd uy aug 2p jafiso o “wsrpuyosay ovesuene iigyaeo woresedaig eL-2h Tie HVOTVAV Ao YOTMPHAVISSY VALICIA Nj NOTLYLIAVO Wau VaVaaad ‘rou feu P39 UL soep lunes ap wusoy wiaye eA nu atu Houne sreueo YouRUSP waseedapuy “yeayyowpsep peop our yu yours wauntfouof aso asamp yiseane wy nydusowa, gies /uy 24) x8 oouDsip eunwap fre0} eo aimoUs 20] ya Es dup nod as Byseaze 7G "yseoigugs guuep ap ‘sap "uu2y y2odse un page ys aingan arentep ‘jmonns ‘axsdousus aysooe avon ping “ysnpax penta e| yuAcnod PIINgOLS Fz2H} 0 nD ines juploosip soyexvaxe un no wusgdopuy 24 Ys ouIG feu J9o ISD (2OUAIUE HAUS aiatod 2s90e op o[oouip sudjrd suse -s are wea) auesas xejuop yauBD vansupdapu, ‘ojngors 22330 no wrRdapu son 95 eoissou twunn ‘songuys sal ap asunuy Hund ap ovendas ‘atvo ap fou 2402 Pasig UpUEE aunouype vj F9EC "FUNUEP UI W Z'Q ep UPKELN wawLiouEpe urd “Ofe mes yz wz mo 1 yisod aw reus woo ad gietoaje supp! glenuso pinsij 0 goep nes Bopod ‘a upungs tansy 18 as0y exare> noe “aroudapul Uy J0A zedjnd ofotazod od eyes sew sojunsy oyekog “aqumsau ape fouAp 8 19/9p Inyn}ouIs waxEURdapL, “aqunsy pugenjouy 2 Bau 9st no mustsed ap) uraubigo pofdo9 aezedaud v90 1oeWoD un Fords Yep POPUL a5 nu BNsE\dojoLUY sa 1YBun un B94 eA NU ‘nu yeusSseu vy 8un aur RIN v axe eu? uns [2382 wauuiouype EU9sqO wa 9s 9 auad U3 “oHmEABO ‘punuy 98 ago 10exe ofan 2s nu yupd emay9 ojeod 2s nu wnseidojauty “gpaiou klajesdns © purse > 9] ¥ naved RARDEY| 2p GUO} gas YIUOUNNAP BuoWRNsu un FOISO}O} ‘azajop wyoazap nes am ad yunidar 4 9 va1apunxo 3p99p RqRs89p fouL up g/L mes 4/1 1829p YoUEPE UL o1S9 RU SIUBISA BINS PURD “fan S998 ¥] suNXD ‘jeiated od yressonsuen ounioes ut einzea y oreod sunsy v ysetga eoWUUppe “esuaNXD 9 janse sun jedusp up “2m 18 amjnqnseA-orsour sojunsy, varppayouy 18 wisuorxo najuad axkesojos 28 OFE mes Soe RZAN Fen pour vy - ensepdojauy 7qunuap uy nunes ay ys ood “nyrowaswaursoud 2p pupzuidap ‘sedjnd apiarag “eqrapr srezeprsuo ques runisuouroyp aisaoy “um ¢'T ap woINoURPR Jef “UNL | 9p azul RU! 4 ¥A nu FojMaNSEnyaANYw] BOUNTY cIouNSYP BEEN no “rejapuD JofN taNgIND no yfinjuoo e uoy 0 wane vA AnEALDSUOD fesedaud | BSHIO 9p BHEHAED Q) 21 "unfjoure nnued gi ‘un-nuy aesedaud win.s0> . ‘SIDOTORIVD ore212 cARIOLOGIE PREPARAREA CAVITATILOR IN VEDEREA SESTAURARILOR CU AMALGAM 213, le resunte spre vestibular de punctul de intrare. ‘ . : zul fisurii spre fata palatinali. prin zonele ce subsminare Jesutuli carat care nu a fost acopert de baza de Ca(OH). fn dentin’ dup IndepArtarea Tot la aceeasi adiacime ——_ | se atc pers si rian puternice, peretele pulpar (eliméndad i pentru cl szeasta ar duce la cresterea unghi e acceptabil | pe poriunea inteli, suprafaiapalatinall pentru a accentua unghiurils mezio: ‘sor convergenticomform formei frezei. Pistdind freza perpediculard pe suprafaja Iasi aceasth muchie bine exprimati, se 5 din cauza addacimii neadecvate cit si a unghiurilor Prepararea primar este acum gata, fa mod obignupuna ssunvlouof ap ofdoup wi 19 49 sed}xd snjarased vasepunss prostoau a1s 1 as 950) top 239 g8va] avo (eznIoo eS Un 9 2089 [eH Wy eUNLUQRS 6 nu © op nes giesip 1$ glorzow Sous ap wsveio vforoud 2s w woxodt aisq sane ea yosndaad sojnqusos tnjersed efoan runs Barosuod 24 Hf ouifuoul Ba 95 one opgo © rnuod jenSuyy aids pre es jaro ato}op 21280) enuazasd spouzind Suis ep s958239 0 9p TI ‘is whey s6D00 201 “2 pidsno un ne go mquad ayeanjoo Hnfuss puuzaad ue wojoutand (y | ese|o eye}A¥0) seINqiPUEW sejoW INjMLULC Bye ajeznj20 9}9s0} UL | BS¥|O op |N}EWABO BoLeIeGOd ZLZL pup © yopse youd varesnesoy jung Jou woud wa 99 — py wzaIS uOWOU UIP “nst #6 aasO} eae wy HEDOP a aerial yupnaued rowiouypy 2 [D9}eP PU DUE eaxopuXD 9p YeUsDAne ‘earoredaid ydop ‘we nue 12 fay ad ap a100j9p ajs19805, (9 1 esejo ayenaea) e104 e18 ereunered ejaas0} ‘uy weBjewe naqued | eselo op Ileneo Bosesederg O12 159) #20 no syredand "ona organo wy spe vu yopuy 25 aiuc.at 3p ransy ‘elews pupuugessu "yunuop us undueS fon yzeczHat seo 4/1 3 YOURS rai ojo} Was “roNauyfdns yaasavessveu wus nor yoec areas HD 00 ehyudns 319 BEC, ayearasuo9 yes9u28 uy ‘a1opuypxo op gIewoANd 29 pI2s0} piso" apnjouyaseD yromedaid oyeNAED Q “um E°] 90 9p o1so FIoso} guseaoe uf nyaleUIs vaMNsOsD “psBINqHSOA wres0} op Truszaudat 19yep un Rivard uPjngipUNUA sO[LTON ¥ EAINGNSEA efeyeIdNs vospY (G1 esepo eyeyAe0) pseINq\PUeW! Jo] 4e}0W! B pieingysen eyeso} Ul | BSeI9 Op JOUN\g}ABO BoLeIEdeld SZ) “yleanoxo eanfuoouy va sedind shared un yep gHoaiis ap wuoy woe 8A RUIUAP w aUeSa! fou wareLSpA yoqure me "oyea8oxo un nes puAUnod Be gore wa3s} 0 pursojo; “‘mdndesed ses sedend ojareiod ad op ames emuop ajunonns nes aunses ajunsy nes [9505 zvauigdapuy 95 9s0qHeD sO}UNH © WS BHo}ep so|EMONIS wosH)2edapHy “las praigs rr 9p es0=p HU 0 waNE wa 9g “Fednd-of tnnyun uy ofluawss ou o waar we nnuod Z| EE wzaly 180}0} vA. 38 tundse nau yoesedou ulood pugae yeznypo waned “qu 4jujou yoz89 U “yep mjapsed (oun &-2p yauseyp vag? sy quuuor as 16 yleyadns axds waeupeuy n> ep 9 auouype 2p sjunlueg “sanoodses sojunySun vareoiosig 29 auojeu op Lnfue$ srseoe ¥a:8IR ap efsaug eyo un ase g]enBu eneapod a ala.as ap soquniues eauouepy “ua z0 ‘9p YORU yeu oy AU" ys yuHUEpHows vaunZouol Hf foes, anuip eupKep at SIZ HIVOTVAY 19 HOMAPUNVISHY VILIGIA NI HOULYLIAYO VaUVEVE TLE rE ‘HIDO701aWD Ge vie216 CARIOLOGIE diedru pulper, care tebuil si fe la tim e& anceloplastia poate uneor molarilor mandibulari (cavitate clasa | A) ‘desea pe molarii man se extind sf se i ist sanquri ada PREPARAREA CAVITATILOR IN VEDEREA SESTAURARILOR CU AMALGAM _217 dlicteszX extinderea preparirii ocluzale pe suprafaja vestibular pentru include toste perpendicular pe suprafi perefii mezio-axl gi dst i conferitea weet convergente ve {in cazul in care accesuldinspre vestibular este limita, se poate folosi freza 169 L irectionats part cu suprafata vestibular Un perete gingival plat al extensiei este de dorit pentru a realiza forma de rezistenj8. Dac pere(ii meziali i distali surt parleli sau usor convergenti, nu este necesarl retenfa suplimentar3, Dack sunt necesare ganfuri suplimentare de reten vor efectua in manevra cavitiii ocluzo-palatiaele a molarului prim maxilar si fm cazul foosicifrezei 1¢9L la prepararea cavitii 12.2 PREPARAREA CAVITATILOR DE CLASA a RESTAURATE CU AMALGAM [Nerespectarea acestor prncipi va reaizao restaurajie de proasti calle. proximal, unntori ji restaurator pentru clasaa TL alul de elecyie pentru refacerealeziu este sufci nu va diuna rezistenjeistucturilor dentare rl Varsta pacient lecje pentru resaurare, ca material de pare si fle cel maind s-npugzunxa jun speeonisaja 95 DEP PROP sjpICOWRLAsN teuvoud yoejuoo un gsixa apn preuyxoxd tox un :jeueoud triseuoo ap ojooup O IS A TaIBpUNNXD ‘A 2xdsuy yourxoud yohusS ysoBexa opus ta 25 ON 8 youprosd yoqun aunvz91 oy 30 ‘yuad 95 ru) woay 205 2p 1uSun un gate jysvalo pussuo> 29 Ww OF #8 A JO[UIBzOU yse|d prior Flue. op WuLIO) e| MHETUOD rEAITUIS ‘luoSienqp pswooy “yn 120 8u8 lp wzaly ays09s 38 resnsgu ay gs o180d jowasd yo vane UIP tod fuejoutang fas igo no snjawup @ yusaxo vleyeidas od fauds feznjgoaudsurp auslgas reus autxap trunrxoud jljeus Ro feuyugns nu e nintad ~ ayfuoisx ap aqua exedaid 30% ‘uy po fd “(wu g'Q W99) RUNHOP uj oURPE ep IaIHHS ‘ajeuopored njoq ye wean 1y 404 99 woWOR wp ) guy ap auaWNNsHE no 8) 20] whzod ‘ue unsrde ‘eds + euigam now wp aifesojoy ag “21ue}sou ajourSzeus “dnd oaatad ad yrouotizod ats “tezayyw azejuauo 1600098 nD - uespoou aise ypouotipe asi] o po nauad “psndo wuo7 op el 289 sun giseane uy yeznjoo ynseg “ECU 13518 Jauns09 nx no gpyered ausfusu 9s wz “g]v2n 30 PaTEHAR W mp O. >]ubu ou! WSHOSap BYezn}90 ware #8 29 Ine “ayeznyp0 wiguiavo waswsedasg oszuou iSr3090 uy profoud 95 ye2n|o0 wa 819 tnjruoise wareoxe Uy JO|dou sof ap yulyxeus aqusouoas ounduty 95 w2008 9p ‘ola ox-orzout ajelay ad ap aquniza ‘soe uy aoquiouorZEy 20}P9}eUL © gun 9p vars mpodse epun voremgo nnued Git WVDTVAV 22 YOTAYAN VIS VIXITIA Nj NOULYLIAVD VaNVaVE TA SIDOTOLIVD a Bie220 : CARIOLOGIE emeargt ugor spre supra la niv ‘Aceastt fazi slibeste s idiacent numa la 0,2-0,3 mm. ‘de-a lungul peretelui gin inte acest perete cor cu 9 sond’ fink sau Uwebuie a teacd prin Cn sunt gata pe Ii, a cirei grosime ese de 0,5 mm si care proximale, vor converge oclizal. Pe HingX faptul imale, acest convergent conserva A se nota cl aceasts curburl ese sufcientl pentru igual (oral) curba PREPARAREA CAVITATILOR IN VEDEREA RESTAURARILOR CU AMALGAM _221 excavaliaclind se constatd ct locu este dur la ralpare side culoare normal. Indepactaea fefect nu va inflenta forma Ge rezistent, Pent ‘avea cel putin dout se la periferiaexcavatici. ‘nu se recomand’ e extind elt este era de prezenja cariei pe peretele axial". Dentina ‘arial de pe acest perete se va Indepara cu fteza globular pocivitd sau cu un excavator sau eu amfadou, adapta in dat se fc o peu mare fn pl cl 3 odsles2h fn aceasta eval acestea au f unui unghi de 9C*‘upd sosaoou aso poup 2nd 23s jody “OEE nes spe Uz) qst200 nc PUNO eK ied arse peor dug coud W505 312000 ud eredaid vA 25 gana 208 UI vedas eq “iseaio giseo0e weIDAEA BA MU BE 1280} ynop s0f29 rome8o) med nu ‘o pupiuazaud aous redaud 96 geoye ‘aseuedaud 2188 1 ‘ezne> up ‘3d ueSjoue noad Ty] © WES |p aVNAeD o giodand 9s om uy InzB9 UL pjewyxoud pieesdns panBu;s o ad e-|] 8 BSe/9 op JOWN\eyAeO BaseIedeld LZ'Zh ce eso ap seo youn uo! ap 2yeuusxoud of oygon spe ead oso yun eC “Fodns gt jadns yo} Bf 2189 [pee [myysun you, -amdind ‘6 2urlgo 9s nu x9 munud “pixe jautese aq “I vasourugns e260 vrodaud ta 05 inijews yuodns are vunuop efojoud w ninuod yulanx2 Squnue’ pevazyfeat ame vporeu of ataud n3) Sora sufun oun 2H mes 973 B20) Bon snxoad 1 igijavo vaumagus ap apuidep af joiyo aetpiins seados afta p prin yd sy 2 alas op ames nud ene ook nomena eeeaye OA (ulaed “ ed pee-odjad faqyonu syorunpur ap peo ep 1102599 usin ap ws euUO} ep aOU9q jad puyD “Jebus MEDI BIE YEU! mE jews op auisjad wunise & nnd 12s000u Eee WVOTVAY ND UOMBYUNVISTE VaRTCAA NI YOTLLYLIAVS WaRNVAV AEE ‘ ® ‘IDOTORIVS eee24 CARIOLOGIE ra se extinde pe Preparatea M-O in general ou este complicats, Atunci cénd ea smelopl Se pou inept rd extinde marge Fe ni ‘ibulard direct fn nnecesurl pentr a realiza 0 form de rezstenti bun’, 12.2.3 Premolarul unu superior repararea unei ca ‘Tea pe fafa mezial a premolar necesito atenje specala, preparare din i accesible clind se clasaa superior. 12.2.4 Variante in design-ul cavitatii Prepararea de ci fe. Almguist, Coman gi Lambert recomanda preparare tunel cavitti proximale firk faza ocluzald, Acest tip de cavitate va fi PREPARAREA CAVITATILOR IN VEDEREA RESTAURARILOR CU AMALGAM _225 ald cu eontacte interproximale siinse,permifénd o extensie vestibular gi oral de etenji proximal va avea 0,5 mm adincime in unghiul diedru, conicizindu'se la o distanyl de 03 mm de suprafaja ocluzala. i, cu un perete axial mai ‘mijlocul drumulsi dint jonejunea smaljdeaind si marginea ocluzala. 12.2.5 Prepararea in gant sau tunel vars care au recesiune i ‘pe suprafala proximald radiculra, ce conct id cont de punctul de cont f-dentind cu 0,2 sum. Dack marginile nu <1 um la nivel ocluzal 18 pe suprafaa vestibular, fe care include virful ¢ va face 0 preparare in gan, desi marginile ‘ocluzale pot si fie in zona de contact sau usoroeluzal de ea.lust ap pnluos wsejd 408 a5 eayBur8 Bead [99 9p u wa yoarsus Ineo 0 YIEALSUIS ouBseyy “soynqusas antangsop 2p pnt Su wasauduode w puEd A-Cl 1 luoaaos auesedaud yisr29e yep eq aso ap sub fred apse aso ylurstza ap euog injndesd eau] “es8uss yrumuoo vue eA ‘>pnjouy 3: ‘ued ‘youre woo na LS | BA DUO, “UMW (9 ap FOUL Feu MSOF O nd EOHRO FISEAID © AP ‘arosedas auns sjeunxoud yhatavo nop afao mes auppe iuo$ un ap yrosiaann mes “aun> 2p Tioutuugas ais giswaza se29° YouP Four CHPD;pUEAIS9 20mg atsaza fasage eaxLUOI IG 2 Roop 399 Ro yfezn|90 eaIOHAED Jun wD)nd w ruqUEH aoq\G0 [IsaI9 uysap gysss0u prsedaid GOW WarENAYD “THEW Y JOURIONY “prowtouiyjdhs flusia 9p Bas0) tutuad fo Mus yen jared anus seus pasosvoo pinpaooid iseary “suusos8 uw) wus ¢*| yBnfyo wrodjewr 2p eatutsor8 ze9 5000 uy Jf wus [-<"9 n> fewuns apy ous0u8 1soo8 Uy 1 yioazoo wauegeis uy nso 99 annus 28 auejagsaaaxeiuop ajumonuis wp Hou You 9p ‘9 a1eo uy ‘2]e2nf00 Joznj vasosedasd ud wasosuo9 21 ys attod yenBuy pidsn snyro.ue Tnuodas ‘GOW amiedaud op axlemis pistaor uy “seINqIPHLNE | yRUBjouDIg usar ap jouuoy easeandise (8) ap soytarad © esa njliod ye [LUFuBUEyryramuo9 eOAINAEIS (2) ‘tp vaseayde (1) jong gow fhntava oisaoe yapredaid afaderg ‘enum uns earsooe yo ‘arandas alayeidas tnop ad jae gaop eitdad 16-5 arco up wifems n> ny need “ynoydwioseu quns wndfeue nawed GOW Jopleuses vassodaig sat ‘ajew)xord ajojeudns ojequie goyidwi 20 Jo)\jeyAeo earesedald 6 ZZh AL ‘esp lode 18-1] © esejo mip ead pupsnersay 16 puysdaxd vague rod 2s aseo awojqoid eu t asestpt09 &{ aula{qoud Boxpu JOA 2s pIUPORP reeds ‘uniad y ae wno “Eeompu ' wspj9 9p ana] © n> 1EILOD uy 2189 amo as az a nes nop uj wie sjeiue ap Hfoxneyss (oun warezr|eas"[euotze9Q tpouabu vastorjde up yjseds uf 38009 re 2189 C-O-W atfenrses 0 2es80ap jewvosd affeunesar pyp 0 nad wanpacod gand se aoau 89 Wp ured o nes ‘afesneisaz wad #9 aundtut yfounetsos ynop 2j2o vj © 2p eiz109q ‘ajussixofafounoisat e gotumpeEs 2p prod e pug ptsodad ‘ay gs avvod lesmsat fun 8 Rolunpugs ep wpedd apan wojou a4 wandeyy reuN gyfuUY br uowiouay wsaSy "weaoope faluorou 16 fpluaisfzar wuluoy axe yewSu0 wifmnessas soe wieBjeue ap weango foun v sued 0 mooqu) mes wiedas v ap syuod ats ayun ojiifeaneysey g'z'Zb 1 g{9 uiind joo 2p asvorguys 2500.8 arowtop unjonus ap aesndas 24 gs ajuredaud 9 wiipuos no tmipstodes (382895 wyEN1 40K 98 a1vaUides nop 220 — ews ap IsEAID © ‘ap nuns pequausas 259 eoep "ye GHEIEA Y tA glean|DO EaNsy © ‘3[e2090 1980} uO? oud sgavo foun v yeuina ysqsedaud yp wweuowia gansy 0 af pioypuy ats9 nu poop 3 inzeo uy gjzenjoo wanes Uy puvsedeu 2189 a HoH eso ap aleqabo ap 219 Indi wesa20u pou uy nu 1 myaVUP ‘ ansuneisas ap warey|seraU 1 uJ0jU09 4 EA [euERseAHfuanIU0d aifents wIsE—De Uy aide jeuj6sew named Lz [ee HVOIWAV 1D HO TEYUAVISTY VLATIA NI UOULY.LIAVD VaRVUVETId BIDOTORVD 9228 «© CARIOLOGIE 12.210 Proceduri pentru cuspidul distal al molarului 1 mandibular ‘Acost cuspid ridic§ freeveat probleme daci sust poztionai pereti sau mar ar. Extensia vestibulard a marg ‘estbulare desfiinjeazl conta Fe cenirul cuspidulu, ev scopul de a real Desfiinjarea si refacerea exspidului D-V, cfnd ext ierativ, O reducere minima de 2 mm va realtaint-o reeonstituire rea se va face ia aga mAsurl ca si rezulte 0 strinsd ie amalgam 4 structorile dentare. ‘Oricum reducerea si restaurarea cuspiduldi D-V este mai de dorit dectt refacerea, pentru c& portiunea rimasi ne va asta in apicarea matrcei refacerea unei ambrazuri corespunziloare. 12.2.11 Reducerea gi refacerea cuspizilor A nd catia este extinst pe unul sau mai multi caspizi, ia mod obigauit acest se vor reduce in vederea refecerit cu amalgam. Cand exensia V sau O es din saul pi reducerea lui este indicath pentru a cauza pierderit tare cum ar fi ini, De asemenea retenfia poste i puri TMS, 12.3 PREPARAREA CAVITATILOR DE CLASA alll-a,aV-a IN VEDEREA RESTAURARII CU AMALGAM ‘ocluzie clinicd corect, rSbdare sf ingeniozitate | | PREPARAREA CAVITATILOR IN VEDEREA RESTAURARILOR CU AMALGAM _ 229 clasa a V-a sunt difcile, din cauza localizii, extinderi 12.3.1 Prepararea caviti{ilor de clasa a Ill-a in vederea restaurarii cu amalgam fn cazul in care unghiul ‘gen de nateriale; aria cea miler ete cel ed. Clnd amalgam este dct se va folosi indiferent de varst i eu anulgas ete a ei arial, Restart cu amalgamiuoidiout ese “asv0: fou wins au 2jelaztadn 9 ane9 up suce ynuSigo pow up aqeo.as22 =e weBjewe no |l4euneyses +n. © wsEIO Op sOIN\euNed easwiedoid ZEZL pelepen ogous varzonde dnp apo9p ymsedoud vorerisaja_ydnp mynystue easeoyide epuctunsas ag vuodns 9p yunuap u eypouu mu eg ezayy no pevozytvas 9s whydous“porunpue! 2p 1209 f1s900 Ut oriuatas 2p Hiidos# 0 wmi20j0 va 95 es ajo cp e204, no sfesoyied gyes0 tle) ad op ut isvane uy aeynuinae aytiasons 2anpad eA 1 font 8990 iva predjnd-orxe payor mo2zigw nnued [eafBui8 Heid 9p jo veo no yfeunosd vounsliod y822|“puuoy yiseane oziou justo nuyauryp un ead & Anuad [earsus fod jRonpUan, “inarurp v yIBIO vleperdes ad sejnorpuadiod asa yay ye Bury jnxe 19 founyy 249 410009 wAe|nzuy “yelzau aoa uy yaw 2s rode M arporezunds i she P2ayy wzeaseid 9g "yuuap u ay ps nu ns 210d atasod a0 njowuIp Jo wloyesdns no ojezed y va sedjnd 2jaaied se] ius | 829 ep 1 wa vlaiseoe BeKN}DUEPY fa} © CW U/1 Hd9p BA nu IS paEr.ozuaD 15 va HIE goLUNpuUEs =p epEOD ie ais grestp vao1Aa a9 ydnp yeu wsedoud ea 95 yuo yS!umpuEL 2p poop “gleuorlipe aYlusial o pHesooou 9189 a1 uy “yIEZIOUI BISUaX® ND J0}20 & Ipods uj “asuxa sojainvo piearozou awa “resopour nes tu ajIAeD wy BrBseD=U 3152 Ss so FNP PED 0 END HD fan 8 yeziout uodie> waseorfoauc 224) Ins 18 z5jnqusea 12 nf no ote) 95 fezDut wyBun S308 seojnqyison pouorlooup 2189 wzai4 “ol[ews yuodns nu axe RUA Ut ¥/I juaas o wzedasd a as yexout-orxe |r ysn 2p 18 ayvod ode 1 yldaiu uogo nue nnusd yexe ‘sjaraad no gory a5 nu ys ofunlued v9 asous gfaB waar ws og “(2704 junouetp) wl <9 3p qluwsip 0 pupisixa suSreu 16 [2 anu, eysoo8 uy yeunu 20ey vA a5 yolusk "yunep ‘0 suBaiiuy yas (ears ajaased pug ‘Twhous szounugns nu ys pj ofe uf wun js0oe Uy ouojlmup va 2s ynlue§ “fz ines eouruepy “pe Djrated uy aed 0 ynogy ue ous ets app stated pug isooe un waseoI32s1q UL vom vaze2feas sunduut 2s “surdaad gwua}ns inva wuuio} YO ruwuag “auayar 2p Duuog eduny e-op Sun$ un wzyear on 8 joatTuiB-oqnsond ‘p71 au wzais wseyd Ba ag “2olUEDOUT Dyluaias yuajo nu oresedaxd (apse TEE AVOTIAV 19 NOTIYAINVISTY YAWIAIA NI NOULYLIAVD VaUVIVETIA ysoo0 ajorased wun e mnusd Bou “aruagas jes psnpar team res vaxeurdapt, io p mas z 2u geayy 0.89 208) £4 251 ngisoooe aise nu aus ppsedaud youn w gyezjou waulSs lest] areuruigns #8 asvodna ews ap sopusBsew vasequy nawiod iseanr vouswase ac] “[2ajRus8-o1e [20 ad yetoods pow be ama Z/| 31 guejngors vza4) no ugar & growd eaxeuedaid yze=iaduio> 2S “apunjoud anata sojuySz0w jnze9 ws puntos ESOP souyuns 1 Un 89 wo;PUE seus yao go tupin nu Bg RAN} n> aBuNEoyvod as 2 wseDe “Tue Ind unynso}efpoad 4 wsaud ea argo eanzesquie Ul 2f tun (3 varorondy wy aso wisaow eas ojaresed grodad os puyd, yun eazeasosuoo sueyoduy 2uvos sq 1961409 ap mound ezahuys=p ‘pasta Buna ango ap rRUIgNS TznED Up ‘esadeU a9 BEC. rmypuup v auror¥9 ajexosd tofageadas wuuoy nwusza.d en 1 punUAP UL RuLo4lUn oUHoUNpE O EOE Ea FEIXE 2131%q feb ataiad 9 anutivoo 9s ES a}vod nos zmago tySun Una eINe apeiazad fio ayorauag “rae afaisied no ydaup 14Sun vy gostoupaul 28 gS tnogy ty 408 yoarDUIS osinqusan tog WuiBar Bt .O6 2914Sun wn EEA wa TeH/SIE [AMIUOD ‘stauad pig) 2p nes 2} ou un ns axesedasd 0 pupzicas visas wunzasqune rout “pou aca © eswod 16 [eepL 98 a PISESDE ESO ougpe yous aso svoiva woungeay goech “(H/T 3 foals snouryp) russe 6 afus.as unjust auuy vluvisp tu cg sTuiod Ba Joe ajeiaiad pugs uu | nes YUNOP Uy fouppe 6] tun Zep “yseauv9 wauneZ yzeaupdopuy 1127835 "uo 7 ap tj €# ynsaa3e Je “Us GQ = WDD mewvip WadeIpE =U ap ease Iigewy op uDe 0 voz! ta afogy kad amvo atlzod Se uy ezaujpsojd va Ses ip waroujauod 41 njayeyp © peso eleeadas od senotpuadsod aun wa 98 v2.34 1po}u99 9p mound 1d aio 1 enfBu® aude yinSas ap aso amo ‘a4 Uy oan szanouad ys ou ja ESE Uy YzE=UOIlzOd atsa19 wiaguint nyo res 2/1 Ju vz) 2189S0[0) 9$ aAnearosu0D 29 uy Jo} “ZW ayy nD DUIP evapIOgE 2g Woy aiso mu proso Fa|uNPUB ap Epson -gjeuUIXoHd ao auunUR 8 ky © wEuINY ] puRD foun ee ‘HOO TONY 823237 caRIOLOGIE PREPARAREA CAVITATILOR IN VEDEREA RESTAURARILOR CU AMALGAM 233 vestibular a taturor dinilor, Aceste ari seapa freevent ingivae, mai freevent pe istoric, restauraia cervical’ a fost asociat4 cu un contur marginal supra extins. In operator’ au adoptat o flozofie mult mai conservatoare ~ avind ca inal care se extinde att ct st includ leziunea, clasa a V-a ps caninul man M gi D aceasta se va fi de 3/4, mm iarinspre incizal are o adincime uniform de je M-D urmind forma fejei furs) necorespunzatoare, Ins aces x de preparare, manipulare grei includ folosiea In acest eaz gant ‘aceeagiadincime ca in cazul cel asi) pent a eregte retenia se pot aplica pinari in de pulps, peretele axial cit mai depart posi+ Dinda el 2p ‘euees ginwiradiuy Gosup jaeyeoo 122 * ons 9p sau0Uo} oUsI9 +*(HO}ED = a + 1yOgRDKO4 + HOD = 204+ 981+ HOD ~ 261+ ZOa + wx Jz, sgaeauun win pnp ayo. sora. & axuutquso> o gies 3189 ‘usaid 9p pry UUs FUR 2p IEES “xeUAHD p dn so9e UL > Indy 2301+ HPNS ap JoUIOUDY WKH = 2 + 1yp09 1104 - 203+ 3% e+ ou 407 - :pjagoruun iy 20a sjunpaand “aiezinn ajaeuereu 2p afouny uy Tuo1saee ae uD NES 2709 28 9p vas} GHSAOSU LO eyIMU YOU aR9 9p “BIES920U 1 ouages fysod alasgo 95 agou puoquBUl v80 ap wot Nid 21wyHNVISaY ENS yHvdInd viloaLoud ret SEC AVOTVAV ND HOTAYANVISA VINIAAA NI HOTULYLIAVD VaavavETAE “vamyjigns tuosaud wamtod veupdapuy nue piu purse ‘2 24 pyt 82013 n> ay wsOLU, yes 95 huang 99 ye plusiszay 0 wajo wand 4gns 9p reypaust ays wuatauns aise un ‘avstose 2p 21s9 PIA v es0|9 op migans vaseedaig mnzusgo nes ajvzng "equal F973, pe — yunLap sunuap yauodas 6 95 sIeO0E 35 s099y “yusoergns tes ‘2p psu feu UO © gundxo gs 1S ezas ppuisdy7 -napo# un punyrzat soxeanfu0out ‘ysndxo wunuap prep Q "SYA wy speuEOsiod jes 19999 rupasay youu pr ap sndxa v 16 jriqews wezn © ‘2p uigmedaid ap yayi8y "wousisod fap vt 20 oujieut puneysa) nnuod wesovou 2189 IA © SED 9p 1 apun oppoe aiepar 1W9A93 xs IMBEA nos JOGO © s1=215u) 9 waresodad webjewe no pyeuneysay ep & ese|O op |iimineo woseIedelg C'ezL slewnxoud womava eanensau ba 28 pep sun yypusivosdvley adap vilamsar ib umooyuy nqan aze> yf |nze9 UI e-A, © ESe[9 2p SYED RIseaDe UL SMS YoU 18 epaKe 19 98 ~ pi38109 215916 preunxoudeley ad aiuto o yisxe axv> w jnze9 Up qucsodard e yeisip eo ergunt 1-2 Z-SEL EMIYBUN 2p axvoreT Hep AES aIBOTEIOZ} houUrunsul No RZvonto3}9 28 e204} sod 35 AU HBP AS “h/t WAY} ND ss LEU E> BO vaase uy yzeanioaja 3taiuaiau 2p ajanfun§yerxe myaixad wf sojungino nu bs ale no *pL-OT-SL-t1 {eA/TUIS Road 9p sojareoyenzg :jnu>8 9p yuyu 2p aivounasut ho yetaiaquioa 36 eaundasd ~ yrozynn 1 aio! nu yuyu 9p wserd pur, “ouitxosd wuor axds soooe #8 aemuqizin toate nmad ‘A vounjiod predard as prep euted “auraiuy aysnngun puladxo a6 pieAsope BrINgOI8 tray no ody "eunist gray 0 arfosojoy af “ajeuurxox! ojahay dd anoan 8-5 pega 30] °9 80s a wley 2d poqu0s-ospulgo eza4j no 294) 9s eastsedalg "asvongugs nuns pop atojeidas aiseoe ad yorsey wasezedaud puyuna (re2aye runs nu olay 215998 ¥9209 Uy) WW tes q tlejeadns ad yun 2p ojoouIp apunxd 2s parezedaud ajfomys yisc2oe Uy souadns z yupjoutcesods uy w8 uouod oayv fou! 135 lu reuaH0> 18 (Q Nes A) (uaa aidsop eqyon ais ‘9SulyxD a[E}A199 JOHUnyzay [zed tig paseo suns ‘BIOOTORVD veeCARIOLOGIE 12.5 INSERTIA AMALGAMULUI aurislor cu amalgam depinde de aie jiva avea un fect marcant asupra proprititilor rice, ese de obicel o band& subjre metalic ixath ferm , varind care, Atit maticea cit si portmatricea trebue si aib& un design se sterilize cu ugurins are. Portmticea Sau midnerul ei nu trebuie st interfereze cu se Indeplrteze ugor, rk a buie si fie suficient de rigid pentru a reine ceazul restauririlor extinse, pentru preveni bbombarea benzit cu amalgam in exces. Deformarea benzil spre vestibular sau oral o indgpiteizi din zonele de contact proximal si deci, In aceasté zon8, pot spirea deficiente PREPARAREA CAVITATILOR IN VEDEREA'RESTAURARILOR CU AMALGAM _237 au formt de clopt, ings gingival care ‘banda si poatt reproduce 0 fejelor proxinale decat la ent de material pentra a models un 1d amalgamul ia exces care poate fi ‘impins dincolo de marg Presiune proximali pozitivl. La indepirtarea matric, dup4 condensare, ack depageste cu 2-3 mm marginea ocluzali a corul unei forfecue. Aceasti manoperd se cealizeazi cu scopul dea objine usurin fn aplicar st prealail o mai bund adaplare,ridope ap ynsoaoud ao wgaaud 1UCS 2Y9)8U!) 2 ug (ojeuorsuaunp vareisojas yng jounew esi0njg sszh ad op wevoundopus a5 °¢ 9 aesuapiog 00g "> aque 2039 1g PaioBugns nua Z soa Buo7 u yjnatap gieuoslzod 0 95 eo 9p eu jzes v yougpe vasonauad '$ 19 soynqusan audsuip rye poude 9s azeo 3) yoedo-uou "ypronjsuen uses ©) Jocofe up zaeIN sea ap ming 0 1S0[0j Ba 98 Bop 2Jou07 uy YUSEr FasestapuOD nag "IseIBE BaNSOIOS fuovooou otsa fu yusNoed) "mut FEIN ADVE 9p [sund qas ¥ rojo fan UL sofa wu. Hswul a5 eisaoy “egezuowjodoio) yZodwor un n> wmsqns a) otwod yre[UIy “sejoqnsea su2s us rzeoupdopuy ‘8 wsuad no sputsd 9s peau ypung ynjow|uDe 8 anynoteaxEURSOpUE ROT“ ‘Baouneus 18 winooud j-0 8 s21NqhseA uta foun usofo} [nen UY "BHaHSOM oso aseoutL ‘pluarssuen euored “0 a1dsu Ssoreanse ©] of yusuuny eaxsyUsuEN KzE to eoyejaeayzasmigo 95 wnoy “90] aA” paid y> imide poxpul oxEztDUNOM ap wANp|2D pupa gud teiune ap sojunoyed vlzod at ‘rout [m289p m3 6 euuusrep offend wy UI9e wy yeATe sonposs 9$°S arejnqnses yananagiue jn2e ut 18 ynap2o0ud wiodas 2g °L pete wnzesquie uy wu} punidiuos ag "yzeDI05 25 ‘sluaisisuoo ap muasop ® nHE|498 PUES “9 ‘scaysojq nt YS 1YDU) [ANSE ONUEY ap BYEABE op RILING O ErEaXY 96 {8 jnqgsoa aids [239 pou vy NPUNXD 25 ws arcofuoouy Bs 1gouy fase Feeaqinaut 95 8 gpuEg Op Kote eIong o 2IE Og “| ‘usayide ap a}uasoag vwyyoe ro ainso}uy poy sruaslire ap yeBoTeW! “IajmwWeT|ewR ynzeD uy yLIGEdaD2e voLeUIAsE ‘oop varesu9puoo nquad aySosejay 25 aouTeW Fiseane 162Cq “presuapuod ap ajausdouew 2704019 yeunsod yeioupw wspx9 nu abareop ‘arsuapuod niued J9q TW “TeaiSui8 qas yn pura 25 nu aseo Ym A wsBunjepuy Feu dh 190 DEOL xeyou YoOHNeW BosvoIdy E'S'Zt puo> yydsooxd inure Spout Bouse noo ailoanp uy woseupdapuy aaasvoap "gosam aflautp ul wzeourdoput 2s epucg ‘nde wopueunod pzvaugdoput 2s eu “aresu=puoo edag, ido iynoe| wareis pzeaunsexs ag "¢ Buys mos untsgad “t “wip ap anjonea ms roatSur8 yasa}osuod aso au a1 18 gpung anny go eandpe ou w nnuad mlgnaco w gyeaiSui8 cuoe yevoroodsut ag “7 1y ayeod ‘ojerzauryguseo foun yea uy “yR|NOL HuRIOSUL wOIOPEA up nsVOdy “9 se yeu ais preatBur® wanzerquveareo wy ouo? “zejnqnsan udsuIp ‘osu 96 amra]uos #6 eusos8 vo yeidepe “smfury wu 9-¢ ap “(Ino!) eura “S “¢eued) nor erasut va 25 ip nan uy Suro yeu ago epteg rode aBpsis 2 "F aye udp “eusoyep 0 Bi Cid HVOTWNV 1D YOTRYUAVISL VIVACHA NI YOULYLIAVD VaUVaVARE Tush» SIDOTORIVIS = a gee240 Ls) carroroaie jutocul icurlor, se condenseazit amalgamul, se ‘nu fie rugoase. Se Tncepirtenzi icucle si rameezi dupa minim 24 ore, fn urmditoarea sedinji se secjioneaza turd. Modelarea care nu s-a pututrealiza fn gedinga inal smatzice care nu necesité portmatrice. Ac sth sau lath; curbd sau dreaptd si este Confectionté din alamd. Prelungirle se sectioneaz’ spre vestibular, pentru a 0 putea Stelnge imprejural dintelui, Este infedoaré multor benzi, dar se apic8 foarte rapid si 12.5.6 Penele (icurile) comatologi i stude gest si nu un segment important al mati Tntroduse arbitrar intr bandi i dntele invecinat, adesea fae mai mn vid in inserja unui ie gingival doar un si acolo unde mu ste eazul. © margine gingival plasatd peo suprafaja proximal coavexd nu necesit ic. PREPARAREA CAVITATILOR IN VEDEREA RESTAURARILOR CU AMALGAM 241 3, Margisile gingivale ale icurilor corespunzitoare spaiului din 2ona de operat. Cav adapteazi mai bine dacd este insert dinspe vestibular. le uebuie adaptate. Nu existt un ic universal si lecare enbuie st fle lui care se va insera, Sculptarea se face cel mai bine cu un Ksturi S48 0 ate diamant, 12.5.7 Condensarea si modelarea amalgamului ppunctul de contect adjacent, pentru a asigura un contact pozitiv cu Indepistarea matics© pot B00 2189 (eamemuooes) ans. aye2ni90 ‘arejapoul waysa0x9 2182 jeidns vaieonpos yuesooou aisa nu “2 ibaq "es YoUH}043 ap apuldep mjnunsppure ‘amma aepno nignp asvojay es 2ise08 uy nyo eure eaxzonponiur nnuod arituiod ans nu sojareojny Bat szpu99 ap swo|gard vamp rod ‘nydusaxe 2p ‘wousdas z sojURIoU! 2ye axe|nqnsoA-osIp 2]240z ‘poo # pe prectyea ois waveanoysot 12) as200 uy “wsU9pUOD [+o ARUad ou MES mypoUr seO\Ng UN |S afizod uy jmuodsuEN 2onponut e nquad peveziam 9s azou Yu eO(n un et 48 nO UrEBfeUTENNd yun jornt ro snposiiy y stood jmuredjeur “vaseesu) a8aunaoUy injeuo| Fuso} FONE ouajs wesjoure ‘up y ea ‘urud no oniseus sojmunersar ymze> uy “insdes wud uyfnd [29 “eaa98 2c jeaiyuy Jolsnuyd junt uy aexdepe gung few 0 ued 2010}5 uejadaxsu ul ausq fous [99 EzEadaps 2s 25u94S ajnonred no ynuedjeuy ‘reaDape BuO) 9p {SM azBoqny 25950[0) 28 puyD feads wy "stuU9d rapse aise soqunuyd ysnf uy #8 Gnlue$ uy pppy earedopy “wedswen area yzvasuapu0s 22 Inpury ad “Iojmunozjowe eamisnse|d 2p wou v) myoud 2 nauay ‘uy uSguAvo ropury ad aorponur 25 8 piedaid 2s yinsdeD wung ld no“aatseu punesas four fozeo ut [useds uy yuo] ya no jauesows rojad os "au “nz aie uf “tunioey (nas eaudsip nsivad EU Ye yasBINgaN ru ys easelar0u your JyIS8 “eprdes gud mo yeuereus un nd ezaion, FS yluouodys fo injoyesedo tnfewueae Uy 019 “sjtinze> varewofeu uf “sua, mes spices wzUd no 1) aleod jotaeSjeuy -(oqsauyd) azedindexed sopamign$ plant wy wazesuapwecy ‘iezy820] ‘yrouorhiodord yeu anu ais9 preouay raxeepout *yez -nypo ehyeschs 9p s1uleuy gzeajapoUr as vaisene Ie “e|apou ap KuuToud axiqas uno zvozoa1 95 glezn|s0 1B "ps0 “wue]ngnsta sojunzeaquie in aod a1vousgasuaoe if “}x9 Yow WA nu Jluuiip wadese yondo een 1 op aye) ajewrxose aatajeadns “jeanjse unzeaqure Bj ‘ouedap voud a1esoyd isp #8 yjezu 2[s2sjop cone eA 20109 youu 9eIs949 se Gee WVOIVA 1 WO VAS VEGAN] BOTILYLIAVO VanVavaRNG joanusg “satagexdns japau & ap elupusr yisxa v-11 PEsEI9 9p gjesoua6 WWesopisusg g's'zh “¢-au sewou, ya Ww aso oyeznypo aysuor ty -(apursaeut ‘pxeauoo eountiod sof a1c0d 39 pdap ug youl 9 pz ed 2944 408 moreso ‘azsd ton no jruorssdo ense w najuad “tou 299 1gap avesuapuoo nnuod du 20] no uadoae 404 35 jeunxoad ajou0e wy ezud goes ys ndaou & us youKe 2s piouifiew eamdspo 1S vameswug “et 9 ajoutsd “sen1u09 2° uy ‘s0aNv09p‘pldes 220490 UN "snp9d FOU ‘Le ripers 18958 up "RIEZN}I0 ‘jopuewooar ans mt dnuge vad arepou aalajedns 1Son0} stuoSu aoxUID ‘we 8youre an Ws YS geepuANe aingan yayuaioed “aha piso youn w mes (© von wand apr vod aIsixo ps 38990u 289 MN eifumgo ad 230 fe ajauad uy soupURLE Yo], “Taypey} FOU eA 2s mU jmUUES{eu . Se poate opt, ins, pentru separares gi lustruirea se realizeazi cu periy cele convexe. Trebuie folosite cu grijf pentru a nu degajaeBldura in urma freciwoworay sojmesas 1 2p du, Indoss uy sor) HOLVUNVLSAY STVIEALVI Leh ‘ipuosatsaoe up ape o rewn 55 aso “yinpusesdap “8 us nu sibseprzap a1s208 sauydopuy 96 au wy aisgquodsip armory o aiajo ys 18 Yoyndaueus ap soSn ur fp sound uip 2 1qnedaioo ay gs “S1ueIss axzep ns 29 ' 19 “iota {ow 1p9 yoNewoL9 FUMES o alas Fs “BAIZapE ay YS [NUT ap eadorn airaprzap ‘2p aus 0 nevundasd 1S 2aKuoUO!Zy AvOTEANEISAL a>|ONAIOY “RISOPEWONS [aUOH! up tun asa ovouorzy aseaneysau 9p (euotew un 18 nnuod sos6199-) ‘yfvojalu ys yaryas ‘ound pie ap ad ‘fuatord op wa ws20y -gonaise ul TS pleuotiouny wazeojea quouds rhusised wooy “ymax wuoz Ip 4 ‘reut yhueuoduy © ppvooe ylusioed jou: “giouosiod “yousrue soyluyp(o]2auu 5] 2p soyun29jwaresnesas i ‘aSzoua ap aiwique> az © 16 dun Ruunsuod " no 12 2p eonIsesd wy 180.07 AOIWONOIZI4S JIVINALVINND YOTYVENVLSSY VAYSCSA NI HOTLYLIAVO VauVuWdadd IX TN1OLldVvO248 CARIOLOGIE. 2 § a V-a pentru amalgam), sun unghi de 90°, deoarece: mates retedi a unei plicuie unei spatute din care se va mengine pe toall subjieoferit de fabricaat 1 ocluis, Finisarea final se fe Sgt Imbundtjjeasc sie sunt caracteristici inolator, ir coeficientul stu de leat este de oca 4 ani, iar a ali rarea unei astfl de restaurati se detectea24 ugor prin prezenta colori fn ‘mas sia pierderii conturului. La explorarea cu sonda obtuatiapreznthtugeul uni ticle rugoase. amino-peroxid, Aceast rising este nslubid th medil ora, dar © cremated In plus, polimerzare sunt grev a fi erezute, conduc ia ce microinfiltayt in jurul obturaiei. Acsste microti proc necorespenzitoare duc a moastea poli PREPARAREA CAVITATILOR IN VEDERE RESTAURARILOR CU MATERIALE 249 consisten(S red creeai dup’ fost inevi xnile acrilice au proprieti inerente ce xatoare si Inceapi si au eApitat numele de compozite 13.1.3 Raginile compozite Compoztele conventionale. Rasinile ac compozite numite dupa specificaia ADA. rin ‘material este in princi ‘Termenul de material compozt se referé 1a © combinaie tidimensionali a cel putin don mater ale diferte din punct de vedere chimie, compo; monomer dimetacrilat sintetizat Aceasti reacje este catalizatl print-un ‘modified ale rg9p} 9y ys RIMONDUY RsEade eo ruUEg “CUE FLLIOY j2 B 9p e207 Wo} & alouertws sorso0e mdaqu0y ‘0 ap ounisuauup o az yjnansed aseaory “yose8s0ue ‘2 a|nonued yreseitin 2709 2[eusIeM 2p yFED BROW john eulsqaud eajozasv 2p ynuoye uy eyfzodaeg you pe ay Bs tnqen se seo want sagan: © mde © aipou ts ap azsigulu0> 1 oumvapesn as aan ssoenns a op ura mpd gu "puoyond © Ss | dus 9 peremn Un ny "RoweSiowe wumipagouy a sans sgns ois sunssidwuo 0 eiog yezaurdaig m9 212 17 jugjo "fan anoqused no PUGH "F i c wearPDUOIDI — ve2ne> wp “tebe 24 i aynoned A vayomoysai ay games} 2p an 1 ‘stouorluasuag ‘y08210) 2p y + a8unfe aod eu geo gu 9 BENBPe azvod as uiSg 18 puodeao of juanjos "eo up awedsip wuns axejdno op mode uLjouo}> [69 2p 1240S un no yA jodv ap au azaind i ggde © 301119 30 auligo v nba, puyullqo pulser ap eised u pevexodsoout 2s eso\eus now s29y epH09 ‘9p anand no gieaayou ey ais9 axe yrezuowjed-oud ezoduino pugs 0 | 9p | 1, NOW augo ¥ 2p kaade ass powEBiOuE esmpasyout ods v aniad ypora unoo yeu! wap -[q!SOd ais2 nu 90 kao: “fseoUskE! eaDUNEM Wj 19auF axeU! exENUED * nprxorad-yozueq no yevauoriovas wulwe “puneidyy awexeyeur runs aysed prop jo PAN MISH RAIA NI HOMLELIAVD VEU 150 STVIAELOA nD HOTS oT die San z252 cariotocie Risinile compozite pentru vestaurs singurul material de obturatiefolosit pentna rest © att cu cresterea et ale. Amalgamul a fost mult timp ‘Punctului de contac. pul polimerizari, cele mai multe materiale suferd 0 w2ur8 mai dar eerminat pe o pean seu de timp (a acd pacien sa mereur. rizabile, Aceste materiale oferio sere de avan Se gisete int-o singuri component! — past, Ti iar priza se Face rapid dupS expunerea la lamin. fadincimea setivirt este limitatd si de aceea tn ca PREPARAREA CAVITATILOR IN VEDEREA RESTAURARILOR CU MATERIALE 253 Lumina emist poate si lezeze retina sie aceea se indica purtarea ochelarilor de protecti, 13.2 SELECTAREA TRATAMENTELOR Indicayt penteu restaurarile eu risa! compozite sugereazi o gant variaté de Ieziuni cam ar + restaurarea leziunilor proximale al + Festaurarea leiunilor facial ale premotarilor (elasa a V-a); + fracturi cle unghiutlorinczale; taurarcaleziunilor ocluzale gi provinale ale diayior la nicrofile se vor uliza pentru restaurarealeziu use poste elabora un ghid pentru selectarea metodelor de 3 de pe faa distal a caninilor, de ru su material moa: fesu 13.3 SELECTAREA CULORII te dea se aplica diga, se va oarea materalului de obturaje. ueingors Sw B-oz1oUt-ojnqnsaa grEIeAO MES EpURIOL RUD} O e2AE js caus o bane ta nu eaeanD‘arzedaid apps 290 Uf arcs0usi9p igoap “sE|nqnseA yourdsEU dts 20 va00 "04 ‘eauuougpe me ‘proumyxoud sey "2 epee ‘e=pou He asa op > Uf -afayoudns yotsape © ‘yeyqoyaudsup e588 nyzajw xopioge 0 dza90 ag ‘souadns a1aiso un ouayn “auflgo & 2p ness | funfod ensyd © nnuod jeso aldsutp 29R5 Ba “oge mes 1 Zt “pL 30wzay ~ UuoUN Sup ayzodwoo ejeyoyews no jupsnseysos 8 esel0 ep ieuAeo easssedarg z'y'eL “arsooou rujuod asedaid wy 3°S%0U 2fevoyluanueo 25 eee ii ah ojos jnpdeo aansh? 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De aceea se nivelul Wu se vor face concesii In ceea ce pri finisarea restauririi de compo 13.4.3 Prepararea cavitatii de clasa a V-a in vederea compozite PREPARAREA CAVITATILOR IN VEDEREA RESTAURARILOR CU MATERIALE 257 ‘este de © mare Viti de clasa 8 V-a preparate nu este uniform, ci variat. de carie sau gradul de decaleificae, Cind jesuurile al nstitite din smal séndtos, conturul marginal poate s8 fe riform, Se sugereazi turbing, In aceasta si previzut cu sanjuri de re offset-l free Pentru fnisarea pereilor cavi ‘mono-angulara Wedelstedt Accastfcavitae va fi previzutl cu bizou fn toate zone de small care fnconjoars cavitatea, Dacd un perete este terminat fn ciment, acesta nu se va bizots. Bizoul se Va efectua de smal se va folosi data sl reteatie. In cazul existenjei unor lev i de geaul 2onelor decalificat in treimea cervicald a coroanei ding adecvatd ca mirime iar smalful defect atl rotund sau elipticd pind Ia cteaea un ale Se consider8 cavitaea preparals, iar restaurlree va [Nu sunt expuse la zambet sau ris dar de regult sensi ‘mecanici. Termindndu-se pe cement, vor fi trata diferet 13.4.5 Prepararea cavitatii de clasa aV-a in vecerea restaurérli cu materiale fizionomice Preparare ceazul in care un accident sau 029 9p pupzusdap ‘azow ew m ead no cp 9 t4Bun idan uf eampdapuy 8 208 ‘soqunyns as afsvods ‘anow yaw opsisa ynzay sofas of aunt up avast v2o ad ropayp imjnyfun-vaswonosiq wy O 18 sjapuod ad - sea ‘ad [easduiS ojoraied od ~ rupatp jojnyBun saseoresiq uy wouTuny gre 19g e204 no :posop1ogy “umn poop © eareoyde ‘synused “yor sofn 21:9 s]enup goedy “afuares guuDjoox9 0 G10}0 1801 EOIsDOy rear lyoo| ‘uy (id) oyluoras ap fur$ no setoose “yoarSur¥ pene 8 yezfout jun youd 96 18 2yearBui8 opuoray nes (aeqnantyy axediadered fined wareuygas und auilgo as atetat> 2p 200 uy ena oyeaisews soi wn409 se[2 9p atEuaea Q. apeuoyiuaauod “pezouteu07 25 unuid prop ns 99 aieospuy ply uofuanuyd ¥ays0I0} 21 i290 zeal ¥ 9p aE O. ora foun wasezearap apuldap A WAT © BSED 29 1 auaygaud suzoj 289 sedjad yniuo> UU oun v azouure ap 2189 © tmisu09 orE0d ausyen 9p fue ul Jor3ey un ay ys a10od 4 Sk TIVIGALY ND UOMAYUAVISAL VANACIA NJ HOTLY LIAVD VAUVAVER IE IDOTORIV) 88t200 CARIOLOGIE. PREPARAREA CAVITATILOR IN VEDEREA RESTAURARILOR CU MATERIALE *61 13.4.6 Tehnica etching si procedura bonding ni de gino reprezintdtehnica in caaul te tipuri de restau (clasa a H-a, a | Jaterlilor; ; Bondingul este o substan limpede, cu vascoztate redusl si ujor de Sompori,detina ‘mic pensuld furnizati de Fabricant. npozite, decarece for, Hisind un strat moale la interfaja 13.4.7 Aplicarea restaurarii olan, deoarcee fraciiunea Ca recomandare pentru toate risnile compozite, este utlizares De asemenes, sol wr protector. Daca in |, se poate reaplica. deoarece scesia aden intim de acesta seva indepirta.js ys aqedeo “yiwezuoise at RpuEg no anseId ap Tzyjan Jon 9s aigeauaunodcioy 2uzeduo> soquitys wee uy “oats ty 21 yun wate amen foe np ay 8 Fn (0 aitasoj 25 y5eq T2ENOD ap ymauNd wu 4 asnsapuod 2p alioy puodas nu soarboap “reaHce BOOKIE “Cenpaeuooss eur “ep anny» nad ‘98009 asnpoud 5998 up 325 oduyy gundiad ayfoaiord 0 wzypar va 98: ayzodwos jujSe1 no v-y] 8 Bsejo op | leyNeo lHEINeISe1 eoUYaL EY'EL -oqwiedo over aondepe ‘ooeseig uo8 azoweuriojuoo ajedé9 ypusmozes 2s “yigezywHodome giroduioo yuises no gevoziear es wyfeanesar pugD “amtoay emuod yleazope azeAne no lox qUOKEAS fad wmoaja BA 96 TISeaDE “aIDUNETSOL SCOITUNION prESDODU 91S> BO TUNNEY pod 9 ws0a9y moalse pzeayoseus loae xpuswosa) 2s vaaDe 2} 1 pluameds 0 ‘uoviooe huasndsuen ron ‘upunessas ‘aye sysop atue oud ayjou yur your ound pI © WS8[9 9p myuAED wasMNSDR ‘@SUNXe EI}ABINEISOH BPEL rwypwu wrgaaja aipod as 1S snpau nu 2s festa YiDaye Indu oaHU0% ‘arpjgpou ayuuiod 99 9999 aioe Hy muoressdo) Ibe ap vrs sonpas 9 “le Wu roid 8 [e 35 yous, ‘puny ‘9p worennteo te }unysqns donpas@ 1 ojaiqy wamoe3y nw nnuod aiuoqe RUE nN yeRaUDUE £92 FIVREALY No UO TRIyuN VISTH VENACIA N] NOTLYLIAVD VANAWAaIE Juoo a> ynuopi0D "Pupus 9p wsoyd v] JoreIsUD! 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EasoUndxe eIA2 tA 2g spe) eo asp eo sees ans ‘pst ap sojuMESaL [MzE9 Uy reapeouy ays0r8 ox] yroydwoo axezuoujod 0 sulgo v nnusd a 39 aplunaas sp OF ap afoundxo 0 yo PAPHOS 2g vesqyasop 2199 weoep reFunjapul your stoundxa op Jun un gusoo9U asiYouy 2qL[A> ‘umodtto9 yuyspa Bazeoys> ap axlouny Uy FZ URN] fe xauNdx9 op radu ‘qurumy easeznyep aud v ned son sansa no yapiadaowojuyos ey a8smoat wa 25 uw 7 2p are owwjsou8 yoeq{ ‘jaluumgo widose worm yoyde a 1ody “eA w ‘eaouneu nos prmope 39] © ea>tNEW 99 pnp TeUENN aaHACD ty 2onpoH 2p wou juuod w ruwued ‘nu y ¥99 20 ad aurfuau 26 20d uy renope aise veomnew 29 dng wun va 95 wayegavo pugs gugd rodau a 96 ‘9p mined 0 150} wa 2s eaBNALD (of ap dup pzvoxeyeus syneds: m2 gIDOTORV To To 9264 CARIOLOGIE Se va utiliza acidul gel care se va aplica strict pe small, men 20 secure, dup care se va pila eu aps cel pujin 20 secunde. Se va usca enin cl sunt radioo afi mi groash de 2m jor wansparente cu banc se aplicl fie pe peretele vestibular fie pe cel oral. jona pe pertele pe care sa fécut aplicarea de perete si se procedeazi jar dach exists 0 cavitate 8, Dack s-au folosit Poryjianea ocluzalé se obtureaz cu respectarea contu fuloare mici rot smente de modelat adeevate Polimerizarea se va face timp de mininr60 de secunde. 13.5 FINISAREA FESTAURARILOR DIN RASINI COMPOZITE 13.51 Instrumentar freze diamantate cu granulaie fink: desenul varia de ta rodunds *eze din carburk cu 12-20 fame: desenul variazd de ta PREPARAREA CAVITATILOR IN VEDEREA RESTAURARILOR CU MATERIALE 265 2p aietiaeo o prudand 2s am Uy oylipen woo 1 38 BU ropared-oqwopo snes yun ahuszaad ‘39 up 29 Uip yuanap nw FoymuaUDS H FounEp vazeendxe no afeorateo sjumiZaT| vznomN + BLVGOUS HOY VSHVENVLSSY NULNAd INISYH Z'Eb yD isopout o 18 winseid seeupuep sooqnoqeuso v avopiyosep 0 18 pzE -saKorPaus pear zdop sad uy (VLC oa, eet a9 Fa|NpIDE BINION, 18 wamogide op wreuun 219 wISC29y “VINE 21m yelodioaus 2jafew Inpfe quvaIouILNEp 1waBe v> qns smorz2jaud ) wotputenues 2g oy pumg8ay 0 geaztuny mssoy “a y dn ap tnmuauioa 2180 Joyoaraud 89 ayzodutoa apts qns @ ‘SIO tn2¥9 w to yuruep-¥z0q lejanuy esis ws nw are e> 8 puuaseigas eunuap no nd {(HO)ED sup “eur 120m Brape ws amo EL siujzaud ripqe9 op Inprroupry 20 du ‘qld 1§ yesosuy _OpO S19 “21Z0dwo9 2} ‘2p sok aise proIpouLl redjnd ajumnsat ‘iu 208 ateo‘oyfzodtwoo punSps tnjruowouou & mes yweZBISURWUAP IMM N9pUREd © puysuo "yunluep 29 wa! yBeoq 9s -Jewouo) |mIuatH unuap od 16 axapryosop ‘ereg ‘ysndxo a1s9 edynd. am Uy, ze9 Uy] Rut ots seu! FONE Op [MENS ae9 up ruvounnsuy £9 pratod © wes aun uno} gas ysndxo gunuop od gy 8A 9p aia}aq no reas 1 plop iva earemnéaid ud gsnposd vauniseite py 'EaAE 8 ap arEDI29U 6 Is2 pilaniod puodjnd 2180]0°9 2odjnd sundsys uanoud fog “pull “snyd U]“suowuap as rnin ‘ba auto dyn Uy mypout Spjinionns © e99 09 PEO Bs endo pe jmpraied yrunsio9 no Ruuoyuoo ay ys wou 19} w8e UL 2easeld 28 arfaoiod gseaoy euarew 2p jadi 39 ise pzeq_nmuad rnnuad atfeoqpur 0 1 yeevzuowyod ‘yevaumuoo ‘yevaxcepe as aso “uzoduo> esp yoyde 25 visoae Reng ‘husjayep vastus en azn "poudo pirzoduro yuskes ap aus yes un wo sone I €9 navg s0UN, ls Jo) ad woyde ea 2s sounuep inBuIpLog “arrzodui09 nud reworfuonuoo eoquya ydnp piedeoap gleyesdns o wzusny vA wiseaay “295 op ap du tun no aedeoap 1 mu injn-OUY SI wasezud pen axa no ysndxo Wunwap Uadooe Bh 20 J0UN, ‘ounuop ofejosdng eq20duo9 o1juisei no yeulquios SID L'e"eb bare 618391929: S6syernn u ¥ pan jun no 929 SLAW TD, epsMIUaUHED URS BOIS Tz STVIALLVW 0D HOUAYANVIST PLAGIA NI UOTLY.LAVO VaRVAVEEIE ‘aISOTORVD oz2m ARIOLOGIE cu pete colorate (albe, brune), in inderea cavitii preparate nu este 13.10 TRATAMENTE ADITIONALE CONSERVATIVE $I ESTETICE compozite este recunoscutt ca 0 metod ‘conservatoare. In afard de restraurarea eficace ‘pentru multe persoane, una din cele mai mari dorige este de a avea un ‘care sunt ‘ch al aplic fsetelor mai sunt fnc¥ discuiicontradictorit, dar ip indicl cB aceasth ese o metoda sigurd gi ineii adult a plsegte cea mai mare implic i ig, ceea ce formeazi fuziune incompletd a smaljului pe suprafaja ocul rivi din riginile 1 dus Ia reducerea polimerieiii sa o mai bund rezsteni la wzurd entra cd exist diverse materiale gi tehniei, cel mai important Iucru de ductor, In continuare este prezeatatt metoda standard PREPARAREA CAVITATILOR IN VEDEREA RESTAURARILOR CU MATERIALE 273 abundent g se controleaz4, iar dact este nevoie se racleazi restane. Se usued zona, se aplict pe aceasti rarea in cele mai a fevoriza pene! vay foo, dar fn ulin leplrteacd diga si se controleazlock se procedeazi lobular, iar 2 ‘Suprafafasiilatl se acoper, fn final, e2 © past luorurat (Dura ete),enes vip "39o2r soresdo duno unpenesn0o =p Fue ropa SUP amas 2 un mds eur aiso ynueBejoo vaxpuog wLO}}UR=L prequndas uns td 16 anjnogeutas mp aye uaSioo ap 2a1gy Sp waldo wnspur 2d “soonoep Rulon wosano ape gpunJoud joyadns eunusp rus ueSI09 sp ajay ap sug ase Us (aCe) HoIUERUO wzejpzEaULIN“(ay9s) aTederxoupry * ping “kseuunjon ayeznedas jeRSut gye “quaBoxo}a4 yaMONNS O no Yeu SSL UN aS? BUNLOGY YHVNILNIC VOVId Ft SYVNILNAC HOVId INLNAWVLVEL AK 1NTOLldvo276 CARIOLOGTE inclusivhibidizarea, i anume prezenga derriusulul dentinar remaneat (DDR) care copers suprafja orice pligi dentinare 14.1.1 Proprietatile fizice ale dentine! cascade clad se compromite structura corona prin evolyia plaga dentnard pot apare microfisurt ea fibrelor de colagen imercanaiculare; fidarea arial a sructuti de rezisten( Gentiard pin simolarea deponeri de entinare, nisud terapeutit care permite preharea tensiunilor de ete riginaadeziva cu cae se impregneazi dentina pe © oper de pulps din eauza reducer durti nt de profunzime, rimie intotdesuna mai mic prin diferena dintre modulul de elastctate al runes unei substan prin demi se desfasoaritn- un itm proportional eu ‘gradient de concentrate + suprafata dentinars disponib 8 ‘canalctlelor dentinare (aumira lor pe teu difuziune, cae este functie de densitaten iamewl acestora (ambit prametit de distana fay de emera pul seein, suprafaja real de difuiune reprezintd doar un procent din inteaga ia suprafajia pligii derinare disponibile pentru difuziune. Ea reprezinté produsul de canalictlelor cu suprafsja de secjune fieccuia, conform formule: Sy Nae ce ne apropiem de camera pulpari, De nit amelodentinare, la 22% in vecindtatea face prin: smare la una eu zoncentajia mai mics, Ja-soprafua pli dec lapirunderea fn camera pulpard difwiunea poate fi un mecanism de proectc « flrare-deplasarea lichiduli se fae la © concenraje constant, prin interventia unui gradient de presiune care se reduce cu dstanja parcurs. = TRATAMENTUL PLAGHI DENTINARE 27 Deplasarea lichidiant prin denind respec legea lui Poiseull- Hagen: mA Pe Q = sitmal decurgere = raza canaliculi dentinar BVI AP=gradienal de 1 = fungimea eaaliculul (grosimea dentine! rimase) v = viscoziatea li Decarece difuriunea variant fn funcie de pltratl raze canaliculi dentinar (x). jar filtarea eu purea a patra dntinare prin DDR deplasarea constant deplasarea fuidelor analiculelo, grosinea dentine sf gradienul de pesiune. 14.1.2 Proprietatile chimice ale dentinei demayg*Paciates excelent de tamponare Protectie a e 1-2 mm se generate de evelgia carei im pullin misurk Se 90-100% lao grosime a pligit dentinare estu de efcinth gla grosimi de numa 0.5 mm (75%) 14.2 DETRITUSUL DENTINAR REMANENT (DDR) CConstituirea pligii dentinare este un fenamen complex, in car, pe lingl sarificiul prod deform plaice elastic tn ene Se genereczlclldura de fecjune care conribuie la ateraressubsratului morfologic DR apare aleuit dint-o peliculd organicd amor. relay neteda, cu 2 pm in care sunt incorporate cristae de hidroxiapatié cu merimea:2oarenep amuapojoonre sojeqeuna_ runyowut uy yweo varedad uy wre Preaious’ 9¢ qq “unt s1-01 2 upd puydiow "gure aunsosd ap yaa. rzvano} orem axon no aqewuEUIp 10 susvapuodaid autnoad ieuis asndns JoUpEpEL 9fe e700 : 09 28 CIA 20 nppomd two net nunue 8 5 DOWN Foto ‘zp jnusud w sraseoop "swags BURU Ui sv0r2}25)yrunmdsuen BU upp yuanaid cia & Fanose.9 vluaiszaropio 1 yoydxo 9s Jp ap aupvo e2o20 uy ip and (201209 ” i wsBop ¥. va0 pases o Mele hte af punme® no Secu ee wane. elt ‘FAVNLLNAC HOYT TAINTW VEAL “sounap rnpua8j09 aremimuep up yuasoxd eu]? fF amma pour pERduosur opbodoud ou yBnUpE 2 Yaa eeodwoo w oquuar yrudsyo waneD UIP NOK nuEUOUUTUSUE ze 3 opaid ap emauiey ns arnjeo aye yuse4dons Had & gojwyyo eizodwos zz'yl 0061) aumzy ap 30 nyusund apuryosd aes ‘pdind 2p wardoude ‘aid spuryaid epgaeo wy pup ad ‘ur g'0 ans 29 angan YI 2p 20, “sHjnoyeueoeny aundso suuoy as © nnd ‘epyindas ple Uy ¥3aD8 act wad ‘onuopopue ofaneumen SIDOTORYI.. ae280, “CARIOLOGIE:" 16 cementogenezs; cementul nu se Formeazt I fel de ujor pe dentina rplitrunderea fasciculelor de colagen ale ligamentelor i i; unde ersisth DDR cement I= volun de ich i) ‘A supra (on?) i) I de presine (em #,0) pinath de curgerea ntnare ‘bsucolu, creind inst o des reducerea cex mai semi 5 smenitaruui rola, cum se confirm gia finisaes cu past profilscice a transfer al pre are. Dac cimentul pltrunde cumva si ‘naintea aizei va deplasa sun volum egal de limfitin pulp TRATAMENTUL PLAGH DENTINARE aa Se par ctcimentl fost de zine ete cipabils dzave in parte sat de DDR in favea loc gi la cendensarea amalgamului. Ete presiune mult mai mick pent a forja ciculayjalimfei dentinare prin dent ‘unde iar cfteva produse comerc Tubulicid Red Label (Dental Therapeutics AB). Protec{ia ini. DDR mpiedicd penetrarea bac ypioe wa uy aging 0 ax spunyoud 319 ‘eyeadns sonpar aig aypour auuouype 9p aimiAND Up ‘un pupa ad“seiqeaued op aluasnip “s9usioeq 201401 esnpoxd i are ‘ane up sdjad nied an}20u yleysxe 2p fevaiod Jowezas rnun are ‘bun ap sojntpre nas ou ampunos syns vans 3p aqepH a fua.ar woes 20 umn ed es) jae 18 go YIBE e) Ya ® wteoo eanUyY = 5 ap wouior no 2,99 ns souToqzEaod 2 unde foun eau) gxpeiduy ame “yqC] waruRd=puy azounuep jityd vaseeoyhpuas “pundnd xfopoad wy ws ype 0 ad sjnoqeuvo jnda> wp aud 0 e149 30 euRdapuy void se-s IS Ing} UL est ‘BYYNLINGC HOYTd IALNEWKLVEL { i { (unt me emabigo 220) ut 0g: Yaa ap yndao soun vases wg a$ e ap e2ep pe funy ow amnoyeu> yaqyan ws eaG0e ‘uawouous # youd no weneuSasduy| und "yer » 212209 ap paiof nai ‘aay rtdiwo> agndasay Bovens poop upd "2407 Py my inoaxd aqeaiawien asnpoxd suas waoe wy ypuswosas Bop YA vaensyd oundassud are -SIPUnDp op apuidap aqpufsm pienjuyosoqu w axpyeqwos 9p Yex0UOD vou “parzape wy 18 ya weno eucdnsand un gar ws 6 amuousjod ‘ aquny> wuofaeas se nu a7e9 98} nes Jou YaAPIUO 2p fen atens nas am yarape aanigo 2p “adj and 9 aeuorod sea B90 ‘omsoy ajeuarew ap pues au yur up ysnduos Feuasoo eieumago o-uf NDE “grenp 9p axlurago ap ryesrout ‘gmuguop vfoyd ny yzvandope 96 aura 9p 129 12 Dy prvaidope 2s aun 2px amo audsop "LgeUEA aUsO18 ‘up peu indoos ase ‘2509 wsjusooun uid 308) 2s yunuop 18 amu iyi fe asayud op Inqeqareur anu redo warepan foap “acl 9p fnew uou=.U wy FzesuOHAI2pI0} ap Jaanueu> viepa wp azape wiswesou uud ay “2zapo0 38 adaou) eT ap wats yun wluasope BAN $2 asaydap diy sa08 pur up Apa000 2 oUmvap we ‘BIDOTOWNND we286 cartoLoaie Censecinga di ‘este reducereareteniel compuativ eu eanaliculele nepravate cu perefi paraleli, car fi pisteazd astfel retentvitatea. Cu eit plaga dentinart este mai spropiat de pulp, cu ait cregediametulacestor pi CCombaterea influenjei sale negative asupra adeziunii se fivea eliminand-o prin urile convengionale de fosfat de zine sau la cele ste ezolvatd in mad fii pin folosirea sprafaja CDR prin umectarea gi infltrara sa paral, Fir al wre) pevficiledetagabile a DDR print-uncondionant deni atu profund vedetaiil al DDR, pec modifica iydepirarea poriu Ge tipal NaOCi 5%, care patrunde pl Iasi Inst practic nemoditiat ( deninar remanent PDR). TRATAMENTUL PLAGII DENTINARE 285 Prin uemar, cin punt de vedere al permeabiltitplagit dentinare, PER poste f considerat ea echivalent functional DDR. ‘Acest protector dentinar remanent este un strat artifical care conferd 0 cuplare Joarte pusemict ize plaga densnact si waternlele de obturaie utlizate prin tehnici adezive ‘5. Ameliorarea reistenet la acii a DDR win rtamentul lagi dentinare eu fosfat acid de cae ne fn cure prepartica Expleaj red inroples one cana ee de 14,3 TRATAMENTUL PLAGII DENTINARE propriettile ‘coeficientul dedi uit 1 $-npupnsed “grersape samara ago ‘xenoayut a1 ;avofeus auraygoud yncp ound guna 9 248908 Uy aie aloaoid o msixe 2p jojor pansyur sxeaozeo osu, j}oads uy ‘oy 0e] foes preuyzonuy youpisu guvoso> © M9 19BNIp EOS jssu28 asetep ‘reo ey yanyesoduiay jaca ‘nyduiaxs 2p “ureeue 2p soquieamgo (nze9 Up seiofexo puuoioxa prud ap atlas o usu > ijonzap nu ys - 9 w 9 3S} HD opm I ‘neo “yospaioeg eoeid 9p sle1ogp|> soppus 2s aoadse 1ej2oy o.oq 9p yrUWONDS Ud YzESZ yuoulay 29 y219e sHIYD jeoy UY MQ1 vaNURE EGU nes IOIdWOD Up owoys0y'98 1p 4B wino “aieumge ep 2} ‘ads yuznjip patnodwy asoueq foun vamanBise 2 ‘aqvang 2]2pIgoH UB fous wfinjono 2p seinus8 soqewodwise axed jaowoyut faBounuapoas) aiesedas p azepunses ounvep iuoundap vase (eseorapos ayateds (quuezyneats au areupuap ajqnoqgeo uy asunngd pou 18 “FAIVNLINEG DY Td TALNEVLVEL ‘aIDOTORIV]- ‘98288 CARIOLOGIE 41, Dentina de aspect normal (apasent stnitoasi lin din 2on2 aternante de: i, fenomen ce precede de regula invazia bacteriant, ‘2 opacd {dentina cu eanalicule devitale), care cferd poarta de electie ‘culoare intre dentina de aspect normal i dentina ra pune probleme pentru o complet rapid aceasth dierentiere devine foarte ‘ulizarea unor colorant cor i de carle, cam ar fi fuesina bazic& (0,59 sau galben tartrazin. S-a consttat thsi practich deoarece ei indie in aceleagi zone distincte sara deosebire constind in are in condile ptr unei al catiei se wraduce la vel structural printe-o ficarea sclerozirii canaliculelor dentnare, cu 8 de denting transparent "Aspectul de pigmentare matin a plighi dentinare corespunde fazei clinice de TRATAMENTUL PLAGH DENTINARE. 289 3. Dentina dura cu mict zone de den de denting mai sus amintt gi supafays entinare este ireversibi re nai find suscep tna alteratt canaiculele det ar dent A pulpard prin permeabilitatea sa crescuts, fepieteaz din cauza riscului deschiderit energice de anhilare & ‘microorganismelor si produsilr lor patogeni fn orice tip ‘35-50% din cazuri un ii ploniere", care trebuiese ‘Datele actune aratl'c& dupa exereza 6 de plaga dentinaré rimine fn canalicl ums de microorganisme, asa m tament medicamentos al pli supravieuiese inet 30%, piereandu-si inst ded LLunga perioada de supraviejuire a bacterillorpioniere 8 acceptabill terapeutic deoarece cca.90% din materalul organic al septic se rezum’ Ia toaleta caviti, alcool, iar pentru degresare cloroform sauaoe fue nu sxeuusp Seid earewanp yoep 20 i999 uN, mnzeo Up 335899 Wy wIUa!I9 IPaAep 16 2709 “asvode ysuadss oun D ae Th esd doe He ane ngs yep Hd ‘wuezysseutui auniloe 0 are Au 2jsujaiosd soqssoiong saajo 4 2809 ad rayde ‘eaysso0 2921009p ‘aqiqvauusad nod ypanseas 3 je ud ‘s12u0109 ep oupuiydns redid a “yoynfeyeos wsenoox uoxdute> yuns 90 0 Wo gpuEwoDas 25 ni spuds 71 Fou 9p WIousBT no 1a ‘uy pompur as epuryosd apdguae uy yor 16 FUVNLINGC HOY Td TINDALL ‘HDOTORVI xr 062292 CARIOLOGIE: cdllele de releu, fn scopul inlocurii odontcblastlor chiar gravarea in cavtiileprofunde reacia pulpare prin contaminarea ‘corecte sau deficiente efectele pleteazi prin substanfele uiizate) proce rupturi de capilare si emt prin coagularea proteinelor prin evaporare; de aer prin viteza de tate, ceea ce poate afecta pula; ‘un excelent compus antiseptic, declangand vonor paste complexe cu ani in depresiareacjilor defensive recomindate mune sia procesului de TRATAMENTUL PLAGH DENTINARE, 293 oa, soos Bucur de alegere a mateialelor desinate rutamentuluipldiglt dent ipard a unui material crete pe misura reduceiiigrosimi fr presupune canalicule dentinare larg deschise cd neces matersle cu mare 18 oplicarea unui lac, care va fmpiedica Permise retuguri dupa priza, sub ricie cu op Desi nu 5-2 renungat la eugenolatul de adincime medic, tebuie subl {in schimb la cald est cel mai putin efcient interegen igeaausad v 9569 P| Yupd no e2:20091 ods “abypauias nunad ap nies iyo Hauge nod “(epumnoes O¢-C2 39 S009p W) IUBDRIGAS [RIE UIP Im|AVUDAIOS sssuodoao wep feu purdop 9s YS 9e{ 2p mas [SoU Ho MOIEIOO AB AUG yun si es un no afro asvep By yung eu yeu aoe © ‘esjuoo gigas our MEAS Sanaa Rpungoss 26 SuO}N pumicnas nd 2g 'st!0 @ ap vidi ap aus Foun pw nos a234 8 ind nguad amhurganuy axto0u sou japse weougey ep resedas ys np aides feynoe] PawnzooszA UODEY Uy inp 280 gf-He Humes eatnoduy aeofi98u09 $1) uP isco ous ap uasod ad aga prounuap wBejdad wee poy 25) sp wore usp argues ayyfemgo w aeurdzew rea vane prtoda yfoaoid = -epsoy WUD No HAULS WaHOPOA ‘aquopas Younuap voUsuf youp prs uDUlp ap 2fzeq 2p By ayiquuosysu ano >a roenos ap inyun yrs, ago ap upuap w woxgcundsaoo vamDsUN YI par ausor3)arvoyraundsat0 6-2 wnuprau) asndexhs wags ni eBeld up au ap 2eys05 UDI UH (ojjsn-ystusea) oxeyuap oyun z'e"PL foud ap ayesuadiuoo runs aysioajap aeamos> elunuos you “og no uegjeue ‘op atfeamige © yoquesout elesizai 2onpar wn sig yeusnu op vawiso:# no 224g) ogo 9p PHOIpKY up WOUND ap nuy}UoD eAIs mun woneoyde yo Yuyhas ac, rus yoann" 2p 99 oz UE 108 sjouoreu se ‘BUVNLINGG HOY Td TAINAN VL VAL ‘HISOIORIVD ee296 CARIOLOGIE ‘TRATAMENTUL PLAGH OENTINARE 297 ligt dentinare cu obtura ‘amalgam de arg pin 1a Formarea produsilor de corozi care nila fost apa; alterior sau mer sitetc in solvent organic imentiibr incrustailor sau | ‘apd sau un pin adaos de met fet de baru ‘sfomatologicd exist 3 flur de liner, consti din: solvengi organict sult de 8 MPa, marginal a lichidelor bucale gi buct ~2u cit mai resus a pligit dentine, ’ area coofajull, prin acoperizea in ingegime a pert cavitii, se face eu iments coon desc.aunsoou aeuoroyy -uan) 2 DOL ind apaseorzzundsai09 turd puede tuouy no anemduoo yinepe wu 3s spGezssuMOdOIOS SID RAED Uy 2p we8jewe no asso qas eurSreut 8 VINDSIg -2uouow ap seIseUe un-MUD arEUO} “a;gozuaLUyodoIAf $19 ~ !arooigupwese afizodtuoo no aynsdeo oun w apuncas¢ 1-9 Jones ouTE ‘9p wjous8na ap asad razou pupedaad my 9p von ‘orcu atemisouo uu ap ysxe sn 2:1 js) aN feyeOD ane (zom) 212 9p wous8n9 Up 149m" -sojauutus yp iigeauuedu, any ap ff] saseounue $ varopudsop - syougos ap pd ao ameds ud sonny 6 yrds ad 2p tased asap ynsepuouseysuyware}esn (genuounodony um ep spares ge 2p ate 240% eysauodomne wa 9p snyruowoy ‘wo wf 29] a emud songuptase uous meds vansSias upd profgups® o-nuy fesed easeunpe = ‘unnoaisaus v auosun poyno 5 tagspa no gpides vamyneds ~ iqeounodisy ywe> soun vassundep ~ sgn 2p yay, ~oqesoqe] 2p ruuwouasS~ | !ngeprxout flo 9p gyn 2p foo) vauydiou {pun varausigo w| popd “punoes og ep dius ‘squgy ap yoy ad sowzyero 18 weg 9p oye ugezuouodoroy yoo rn ugezyauodome you ned (sreziee9 + yeeg= Ng "mp 9p prxcupy 2p eised - ‘usa39u 3]0U2I09y 66. ‘BUVNLING MOY TE MAINTWVL VAL ‘HIDOTORIVD 862300 CARIOLOGIE 2, aut rdicate se prefer plcuja de stclé deoarece poate introducere 5 minute tn spl rece (in acest din nentarizolataplicat terial de obturajie TRATAMENTUL PLAGIt DENTINARE 301 rominesti de stomatologie (Ga ate de adincime medie e face, dup ct 3 obturagia de bak se imenturi timolcte (Fouco, ‘de zinc sau ciment antiseptic. ial care realizeazt att dein‘ soeasth categorie este incus pentru calle sale amtiseptice si dacdrezistenta sa Ia compresiune nu este pe misura celoralte plagit dentinare cu oFice tp de ciment deoarece toatelssad anug “unt gz ans ‘pny typ sojsza.axdo.ten waseauoUND Wy ago foun waremuoaye RUAP ato 9p ¥7 2FouN 55 aoamto giuyzad usted up 3505 aso > anh 25 op gue suiso08 ono gsz-npdoxd yzeq o-p ayonau 250 amwap tad w aworoy som, [proz! nun earouigo nausd yo RInpisuoo of “2a5/unu 9% 9p ROIWN Es PeITATANIP Je "uy, /guapaseo ¢S0'0 9p 2189 tnjoue Seu ¥ FORT waNE & UR 9p 15805 ‘95/4 18 axfosySou of aojuguose odes ua, 9 ppusuooa: as ‘reosgzundsasoo yoquuay afooioid 0 nad 1uoryns aye UM S1'0-<'9 ums 9p soxjozs 7eNS UN yo vareEIsuOD YBnepe 9s aD B| “aANOW aise MG 9 pny any poo ous oF ‘SUVNILNGG HOYTd TAINSAVLVEL usr ean ap efesmigo anu eye 2p ‘apuidsp amo ep von) oinupsuos asiz-nudaud yozry rauusox8 injnpou viuapuods snes pare jar W898 UH) EIEN EP ‘isan gs yz0q ap wflesigo wo nujued unos dun unonuy sue ainqan nnauTezed 1s20y sjareq ajodsat of ys angen amo ad 2jomsuopuny apiprydoud ‘suas 15290 Uy ‘amp tadind vajoriousig #8199 soysfsrago yp opresou jrsodns re eunsev ap 2189 UNE ws wiND Fd I OR ndoud ojszea FEL cued 95 aeznq nya prassoe u0;UoD ‘rTeonseE ‘azesupuoa) azouauo9 paeimeqo warese|d ap aso yrog 2p ayloa tuoutlgo vaIepa4 _ssusoo ayiamago 2p 209 ‘Go founUop es “HIQOTORIVD TE304 \caRioLoGie ‘ip I1-cu particule mai mari de palbere, capabil dea forma in stat de cimentare de ri de ciment, cu speciicaia consistenja care + confere de baa se fot folosi ambele sporite de pulbere pentru a obj rigidilate corespunzitoare. i mecanicl dine toate bazele propriv-zise inge 2/3 din valoarea final. Conferd un suport toate bazele propriu-zise (rmodul de eastictate de ia compresiune combinatl cu 0 slab rezistents la tensiune 44 pH acid (pH 2-42) la apliarea pe plaga dentine, protect pulpard, i, de eugenolat de /-ul i se apropie de produstl de prizt este un ciment amor hidatat sub forma unei sninia care inglobeazd in masa sa partculele iniile incompletdizolvate de oxid de 6- excelent izolae temic 7 -contracia de pra d 8- priza (5-9 minute) pe rapor mari pulberel ber eu parole de dimensiuneredus jeromecanici gi nu prin adeziune a indice reds ce inensitate a cai; | TRATAMENTUL PLAGH DENTINARE 305, Tebitea de lueru: ‘Spatularea polberi de oxid de zine ew acfosforie dX nastere unei cilduraducdnd ta ndrirea premature a cimentuli, De aceea, pentru controlarea riz, se impun urmstoarele masur Ja frigider sau gnu S = plicuja tebuie uscati perfect intruct ap (inclusiv cea rezultat din conden ammestecul spatula, rabestepria acelertnd neutalzarea acid de cendens format pe plicuele pstate ta frgider (4-6°C) sau ) pemnite incorporarea in amesec in decurs de 30 secunde suplimentare de pulbere de 50-75% fa de normal (21°C) pent 0 com Rezistenjl mecanicd gi solubilitatea, penta aceeasi co influenjate de modalitatea de 5 temperatur normal sav la rece. pnd la 11° minute peotra cimentul spatula pe 0 = spatularea trebuie Ficut pe o suprafaf ct mai mare a plicuei pentw ca print-o ‘mai bund cispersieaedlduri si se pisreze tempeatura la un nivel edt mai cobost if repeat a unor miei canitii de pulbere tn ich, care condose + dispersarea rapid a clduri eliberae Incetinivea prizei gi prelungrea ti Materiate necesaresur foo ap gprs graeds = una no yo ap uooey Jo1wz0p no arsqind 2p uODey - sBresOoUra/EUa)Ey magn 9p voquya, ) Sosonp nes aude wuss wp auaoeyeadas ‘afesnago ap ajeieuaieur prea usuy pirqduin 0 ‘yusod ssan0ep eunyse ayur pune oun 0 ¥ 9 owe juejay> =p Sa Op-Le owns eur wumsouduioa 61 PUNSZAS TIPU Ida 9p ourz ap rB}oussna ap inj i ny ua8o> 9p 2]a70— 9p auygosoa> auds “Yaa. rousBre urfad rou wsoo 5 say injcusn por “(our ap mpozuaqevors 5 no sndoo un 242 9p lot no FeoKNO} eso} ad 101 yzeor0g 236779 omRqQHO}-OU0 “De -owo) ouz ap pjozuqxo 12 sp spouse) Ve ra SS 256-58 ousino py jod "4508 oUrz 9p pIxo i tp esp “yeud op soqueoou onssojo0m9 beaja08 yop sax) 1 mda ravewia #8 ysoj0j aieod ag presao0u | sparooas 2s ‘gga WAVASNY F nynseyaouanayuy eareseany i "ston wluastsuoo dup anus unsnuy algo as» 9p wopoerdguexpurenu ais ‘esecinyo ohusstsu00 w azoulgo ap enop & 18 aseoua. pfuattsu0s onto eownar "iuop prey jueudoes pesodioouy axaqind 9p e=reINUED luzi}suoo my sunfo fj ‘amaquaa pnp own Ye 2p ' oj gupd wRnwpe 25 “spansos

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