CARIOLOGY PRESENTATION

TOPIC: TREATMENT OF
DENTAL CARIES
Presenter: AYESIGA WALTER BDS III
21/U/3871
Moderator: DR. KUTESA ANNET
29th Feb, 2024
OUTLINE
1. Technique for proper removal of carious dentine
2. Management of the occlusal carious lesion
3. Principles and objectives of cavity preparation
4. Cavity preparation for class I & V amalgam restoration
5. Effects of cavity preparations on the pulp
6. Reasons for failure of restorations
 Technique for proper removal of carious
dentine
1. Chemochemical Caries Removal
• It Involves the selective removal of carious dentin
• The reagent is prepared by mixing solutions of amino acids and
sodium hydrochlorite
Mechanism of Action of Chemochemical Caries Removal Method
• Dentine contains; 70% mineral, 10% Water, 20% organic Matrix
• Organic matrix Contains 18% collagen and 2% non collagenous
compounds
• Acids produced by bacteria cause demineralization.
Contn
• With respect to collagen degradation, two layers are formed
1. Inner layer; partially demineralized; can be remineralized; collagen
fibrils are still intact.
2. Outer layer; collagen fibrils are partially degraded and cannot be
remineralized.
. Goldman and Kronman in 1970; were studying the effect of sodium
hypochlorite on the removal of carious material from dentin
it was mixed with Sorensen’s buffer
This caused chlorination of glycine to form N-monochloroglycine NMG.
Contn
• Reagents commonly available in market are Caridex and Carisolv
• Caridex contains 2 solutions
• Solution I; sodium hypochlorite
• Solution II; glycine, aminobutyric acid, sodium chloride and sodium hydroxide.
• The two solutions are mixed immediately before use.
• Solution is applied to the carious lesion by means of applicator.
• Application is done until the sound dentin comes.
• Advantages
• No need for local anesthesia
• Suited for treatment of anxious and pediatric patients.
• Indicated in medically compromised patients.
• Conservation of sound tooth structure
• Reduced risk of pulp exposure.
Disadvantages of caridex
• Instruments may still be needed for the removal of caries or material
• It leaves a surface with many overhangs and undercuts
• Large volumes of solution are needed
• Procedure is slow.
• It is ineffective in the removal of hard eburnated parts of the lesion
• Unpleasant taste
 CARISOLVE GEL
• In 1998, carisolve was introduced
• Contents;
1. Sodium hypochlorite.
2. A pink viscous gel (lysine, leucine and glutamic acid, amino acids, carboxymethylcellulose) to
make it viscous.
3. Erythrocin to make it readily visible in use.
• Advantages.
1. Volume required is less
2. Does not require heating or a delivery system
3. Since it involves gel not liquid, it is much easier to use than caridex.
4. Better contact with the carious lesion.
• Disadvantages
1. Use of rotary instruments may still be required for some cavities.
Chemomechanical caries removal procedures
using Carisolv gel
• a) Dentinal caries lesion.
• (b) The carious lesion was treated
with Carisolv gel.
• (c) Excavation of the caries using
Carisolv non-cutting instruments.
• (d) The same process was
repeated until successive
application of the gel failed to
become cloudy. (e), (f) Post-
excavation view of the lesion site.
 2. Ozone Treatment of Dental Caries
• At the decay interface inside the tooth preparation, there are three types of
dental tissues:
1. soft: Decayed dentin and enamel.
2. Leathery: Infected dentin.
3. Hard: Healthy tissue.
• Very soft tissues must be removed from the cavity.
• The leathery tissues if are given the proper ionic compartment, can
remineralize and harden.
• Hard tissues are generally healthy and should be left intact
• Ozone is a proven antimicrobial agent; 10 seconds application eliminates >
99% of the microorganisms found in dental biofilm.
Ozone Treatment of Dental Caries
 Formation and action of Ozone
• Molecular oxygen (O2) is photodissociated into activated ions (O-)
• O- combines with other oxygen molecules (O2) to form transient radical anions
(O3)
• Ozone ultimately decomposes to a hydroxyl radical which is a powerful oxidant.
• It oxidizes biomolecules like cysteine, methionine, and histidine resulting in cell
death.
• 20 to 40 second exposure of ozone kills all oral microbes and their protective
biofilm environment.
• Because of this change in microenvironment, the remineralization of enamel
and dentin can be accomplished.
 Technique of Using Ozone Therapy
• Carious lesion is diagnosed visually, tactilely
and/or radiographically.
• Entry through the enamel is made with airotor.
• Disposable sterile cup on the ozone is used to form
a seal around the prepared tooth.
• Once the seal is obvious, ozone is delivered, and
refreshed 300 times per second, for 40 seconds.
• Healozone remineralizing solution which contains
xylitol, fluoride, calcium, phosphate and zinc, is
applied to the demineralized tooth surface.
• Tooth is restored with glass ionomer cement.
• Carving and finishing of glass ionomer cement is
done.
• Over it, after confirming remineralization, place
composite restoration.
3. Caries Removal Using Air Abrasion
• Here kinetic energy is used to remove
carious lesion.
• In this method, a powerful fine stream
of aluminum oxide particles is targeted
against the surface to be removed.
• The abrasive particles hit the tooth with
high velocity and remove small amounts
of tooth structure.
• Contraindications;
• patients with dust allergy, asthma,
advanced periodontal disease, fresh
extraction and recent placement of
orthodontic appliances.
Air abrasion used to remove & restore pit & fissure
caries using 27 micron-sized powder particles.
• 1) Fissure caries seen on occlusal
surface of mandibular 2nd molar.
• 2) Tip of air abrasion device
placed on molar.
• 3) Removal of caries with
minimal cavity preparation width.
• 4) Cavity restored with preventive
resin restoration. (Seen at 16X
under dental operating
microscope)
 4. Lasers
• Lasers have shown to remove caries
selectively while leaving the sound enamel
and dentin.
• They can be used without application of
local anesthetics.
• Commonly used lasers for caries removal
are Erbium:yttrium-aluminum garnet
lasers and erbium, chromium:yttrium-
scandiumgallium-garnet lasers.
• These lasers can remove soft caries, as
well as hard tissue.
• Added advantages of lasers include little
noise, no smell and vibrations.
Management of the occlusal carious lesion
 Tooth Preparation on Occlusal Surface

• Tooth Preparation on Occlusal Surface

with Buccal or Lingual Extension
• For removal of caries from buccal or
lingual pits and fissures, slight
modification in preparation is needed
• In this, extend the pulpal floor in the
same plane to include the caries
• Make a box type preparation with
mesial and distal walls parallel
• Place retention grooves in the mesial
and distal walls
• Remove all the unsupported enamel by
using slow speed bur
• Finally, inspect the preparation to
evaluate the need of additional cleaning
and additional fi nishing.
Principles and objectives of cavity preparation
Objectives of cavity preparation
1. Remove all the defects and Give the necessary protection to the
pulp
2. Locate the margins as conservatively as possible.
3. Form the cavity so that Both the restoration and the tooth Can
withstand the load of mastication
4. Allow for esthetic and functional placement Of a restorative
material
5. Prevent further fracture of the tooth
 Principles of Cavity Preparation
• Cavity preparation is the procedure used to remove demineralized enamel and
infected dentin
• It consists of four steps:
• Opening a cavity or removing a poorly fitting restoration
• Removing infected dentin
• Evaluating residual tooth tissue and removing unsupported or structurally compromised
enamel
1. Finishing cavity margins
• The requirements are as follows:
• Removing carious dental tissue
• Removing unsupported healthy tooth to prevent its mechanical breakdown during function
1. Preparing space required for the restoration material, respecting the dental structural
requirements and minimum thicknesses for the material in question
 Cavity preparation for class I & V
amalgam restoration
• Amalgam Restoration for Class I
Tooth Preparations
1. Initial tooth preparation:
• Outline form
• Primary resistance form
• Primary retention form
• Convenience form.
2. Final tooth preparation:
• Management of remaining caries
• Secondary resistance and retention form
• Pulp protection, if required
• Finishing of enamel margins
• Final inspection of the preparation.
 Class V Tooth Preparation for Amalgam
Restoration
• Present on The gingival third of facial and lingual surfaces of all teeth.
• Initial Tooth Preparation.
• The outline form of class V lesions is dictated by the extension of caries process.
• Like in others, prepare the Pulp protection is by using base or liner
• Secondary resistance and retention form is by butt joint, rounded internal angles and sufficient bulk of amalgam.
• Retention; By retention groove with a small round bur in the axiofaciogingival point angle and lingual dovetail.
• Lingual dovetail is not required for small sized class III preparation butIt is for large preparations.
• Lingual dovetail is only when the preparation of proximal portion is complete because otherwise tooth structure needed
for isthmus between proximal portion and dovetail might be removed when the proximal outline form is prepared.
• Tooth in normal manner, i.e. breaking down the undermined enamel and extending the preparation to the sound tooth
structure.
This is by using inverted cone bur held perpendicular to the long axis of tooth.
• Initial axial wall depth should be 0.5 mm into the dentin.
• Axial wall depth at the occlusal wall should be more than at the gingival wall.  is on will result in a curved axial wall
which to conforms to the contour of the tooth
• Prepare the mesial and distal wall surfaces perpendicular to the outer tooth surface, paralleling the direction of enamel
rods.
Final class v Tooth Preparation
• Remove any remaining caries using a round bur
• Since preparation walls diverge towards the facial aspect, retention is mandatory
in these preparations.
Retention is made by giving grooves incisally and gingivally along axioincisal and
axiogingival line angles using an inverted cone bur
• To prevent secondary caries, extend the preparation close to but not to axial
angles of the tooth.
• In young patients, it is extended under free margins of gingiva and in older
patients, it is determined by extent of the lesion
• Finally, hoes and chisels are used to finish the mesial, distal and gingival walls
• Inspect the preparation using clean air and water spray followed by drying.
Class V lesion and completed preparation
Effects of cavity preparations on the pulp
• General features of the pulp
• Mass of specialized mesodermal tissue having a remarkably dense vascular network.
• Being a vascular tissue, the pulp is Capable of exhibiting a typical inflammatory
reaction to irritation.
• One of the changes that accompany inflammation is swelling, but The pulp can not
swell because It is almost completely enclosed Within the rigid tooth structure
• As a result of this enclosure, acute Inflammation may lead to Compression of the
apical vessels And consequent pulp necrosis.
• The dental pulp also Posses a special defense mechanism, in it’s capability to retreat
and lay down Reactive secondary dentine( many of the tubules within the
secondary dentine Are in direct continuity with the tubules of the underlying
dentine)
Effects
• Pulp reaction to cavity
• Pulpitis due To cavity preparation effect
• Speed, heat, pressure and coolant may all cause Pulp irritation
• Pulp reactivity to cavity preparation may be structural, inflammatory
and vascular
1. Structural changes involve displacement of Odontoblastic Nuclei into the
dentinal vestibule.
It includes Transection of the odontoblastic Processes
2. Vascular changes include Reduced blood flow, hemorrhages in wide areas,
Interstitial edema, and vascular stasis.
Contn
3. Inflammatory changes Include reactions even in absence of bacteria
• Pulpal necrosis which can be liquefactive Or coagulative
• Formation of reparative dentine
• Hypersensitivity of Pulp
• Effect Of cavity preparation could complicate the existing pulpitis
• Thickness of the surrounding dentine And nature of dentine can
determine Pulp’s reaction to restorative material.
Deep cavity preparation showing what is
most likely caries-affected dentin remaining
 Reasons for failure of restorations
• GENERAL CAUSES OF FAILURE
• They are divided into inherent and Induced factors
1. Inherent factors
• Tough conditions in the oral cavity
• Different types of stress
• Temperature fluctuations
• pH cycling
• Humidity
• Microorganisms
• Shelters and stagnation areas
2. Induced Factors.
• Misjudgments in selecting the correct restorative material
• Incorrect design of cavity preparation
• Imperfect manipulation Of the restoration
 AMALGAM
• Most common failures associated with dental
amalgam restoration
1. At microscopic level:
• Pain after amalgam restoration.
• Periodontal tissue injury due to proximal overhangs.
• Pulpal involvement.
• Tarnish and corrosion.
• Internal stresses due to excessive masticatory forces
2. At macroscopic level:
• Bulk fracture of restoration.
• Tooth fracture.
• Marginal fracture of amalgam.
• Secondary or recurrent caries commonly takes place due to
marginal leakage.
• Dimensional changes especially in zinc containing amalgam.
• Discoloration of restoration.
• Discolorati on of tooth.
 The reasons for failure of amalgam
restoration
• Poor case selection.
• Defective tooth preparation.
The following defects usually occur during tooth preparation.
1. Inadequate occlusal extension:
2. Under extension of the proximal box
3. Overextended tooth preparation
4. Depth of preparation:
• Defective amalgam manipulation.
May occur in the following forms.
1. Inappropriate condensation
2. Contamination during manipulation:
3. Incorrect mercury alloy ratio
4. Faulty finishing and polishing.
• Defective matrix adaptation.
• Postrestorative failures.
FAILURES IN COMPOSITE
RESTORATIONS
• Reasons include:
1. Incomplete removal of carious lesion.
2. Incomplete etching or incomplete removal of residual acid from tooth
surface.
3. Excess or deficient application of bonding agent.
4. Lack of moisture control.
5. Contamination of composite with finger/saliva.
6. Following bulk placement technique during polymerization of composite.
7. Improper polymerization method.
8. Incomplete finishing and polishing of composites.
9. Inadequate occlusion of restored tooth.
Following failures are commonly seen in
composite restorations with time
• Discoloration, especially at the margins.
• Fracture of margins.
• Secondary caries.
• Postoperative sensitivity.
• Gross fracture of restoration.
• Loss of contact after a period of time.
• Accumulation of plaque around the restorations.
References
• A textbook of operative dentistry By Nisha Garg And Amiti Garg 2nd
edition
• Dental Materials Foundation and Applications by Powers Wataha 11th
edition
• Internet
**HAVE A GOOD EVENING**
AYESIGA WALTER ABOOKI