OPERATIVE .GROUP 7.pptx

GROUP 7
OPERATIVE DENTISTRY
PRESENTATION
BY
WASUKILA AMNONI PHD/028/2021/2022
MUTESI AMNINA PHD/042/2021/2022
ASIIMWE DANIEL PHD/040/2021/2022

TOPICS;
1.DIAGNOSIS OF DENTAL CARIES
2.CARIES RISK ASSESSMENT
3. APPROACHES OF CARIES MANAGMENT
DIAGNOSIS OF DENTAL CARIES
VARIOUS METHODS FOR DIAGNOSIS OF DENTAL CARIES
A. Visual-tactile method
This is the most commonly used method for tooth examination
This method involves the use of mirrors,explorers and light for detecting caries.
Convection method
1.Tactile examination
In this method explorer has been used used for the tactile examination of tooth for a long time.
The explorer is used to detect softened tooth structures. When an explorer sticks it is usually a
good indication that there is decay beneath, however, when when it does not stick, it does not mean that
decay is not present

TYPES OF EXPLORERS USED
1. Right angled probe
2.Shepherds crook
3.Backaction probe
4.Cowhorn with curved end
5.Sharp curved probe

Disadvantages of using explorers
• Sharp edge of explorer may fracture the demineralized enamel, if left
alone such lesion could have remineralised and reverted back to
normal.
• Cariogenic bacteria on the tip of explorer can be seeded into pits and
fissures so that un infected tooth can be infected
• For pits and fissures the explorer is incapable of determining
presence of most occlusal caries.
• Use of explorers have a low sensitivity and specificity
• A dental explorer is not effective for interproximal caries detection.

2.Visual examination
Use of visual examination only is known as the European
method, while use of sharp or blunt probe in visual tactile system is
popularly known as the American system for diagnosis of dental caries
It is based on criteria such as cavitation, surface roughness,
opacification and discoloration of clean and dried teeth under
adequate light source.
ADVANTAGES
Preferred over probing because of harmful effects of probing

DISADVANTAGES
 Visual examination by a skilled clinician, in some cases, can be
successful, but often, a large percentage of the occurrence of decay is
too small to generate a distinctive visual signature for proper
detection of caries even in advanced stages
Discoloration of the pits and fissures which is found in normal health
teeth, can be mistaken for presence of caries

ADVANCES IN VISUAL METHOD
1.Illumination
Ultraviolet illumination;
Ultraviolet light increases optical contrast between
carious areas and the surrounding healthy tissue
ADVANTAGES
• More sensitive method as compared to the visual tactile method
• More reliable
DISADVANTAGES
 Difficult to differentiate developmental defects and caries
 It is not a quantitative method

Ultrasonic imaging
Ultrasonic imaging was introduced for detecting the early carious
lesions on the smooth surface.
The demineralization of the enamel is assessed by ultrasound
pulse echo technique.
The ultrasonic probe is used which sends longitudinal waves to
the surface of the tooth and also serves the function of receiving the waves.
Initial white spot lesion which extends only up to enamel,
produces no or weak surface echoes
The sites with visible cavitation produces echoes with
substantially high amplitude.

ADVANTAGES
More sensitive than visual tactile mehod
DISADVANTAGES
It is not a quantitative method.
OTHERS INCLUDE
Fiberoptic transillumination
Wavelength dependent
Digital imaging fiberoptic transillumination

2.Dyes
Dyes can visualize a subject from its routine background or if several
objects have similar appearance, coloring by a dye helps in their
identification.
In caries diagnosis, qualitative examination is sufficient .
Observation of colored dye signifies presence of caries
DYES SHOULD FULFILL THE FOLLOWING
Should be absolutely safe for intraoral use
Should be specific and stain only the tissues it is intended to stain
Should be easily removed and not lead to permanent staining

DISADVANTAGES OF USING DYES
 Dyes are cariogenic/toxic
3.Endoscopic filter fluorescence (EFF)methods
This technique based on observing the fluorescence that occurs when tooth
is illuminated with blue light (wavelength range 400-500nm)
Difference is seen in the fluorescence of sound enamel and carious enamel.
When this fluoresced tooth is viewed through a specific broadband gelatin
filter, white spot lesions appear darker than enamel.

ADVANTAGES
It offers a magnified image
Clinically feasible
DISADVANTAGES
Necessitate through drying and isolation of teeth
Time consuming
Expensive

B.RADIOGRAPHIC METHOD OF DIAGNOSIS
Radiographs play an important role in diagnosis of the dental disease.
Dental radiographs provide useful information for diagnosing
carious lesions.
The interpretation of radiographs should be done in a systemic
manner.
The clinician should be familiar with normal radiographic
landmarks

NORMAL RADIOGRAPHIC LANDMARKS
Enamel: it is the most radiopaque structure
Dentin: Slightly darker than enamel
Cementum: Similar to dentin in appearance
Periodontal ligament: Appears as a narrow radiolucent line around
the root surface
Lamina dura: It is a radiopaque line representing the tooth socket
Pulp cavity: Pulp chamber and canals are seen as radiolucent lines
within the tooth

TYPES OF RADIOGRAPHIC METHOD USED
Convectional
-Intraoral periapical radiographs
-Bitewing radiographs
-Occlusal and panoramic radiograph (rarely used)
-Xeroradiography
Recent advances in radiographic techniques
-Digital imaging
-Computerized image analysis
-Subtraction radiography
-Tuned aperture computed tomography (TACT)
-Magnetic resonance microimaging(MRMI)

CLASSIFICATION OF CARIES AS SEEN ON
RADIOGRAPH
E0- No Visible radiographic lesion
E1- Lesion in outer one-half of enamel
E2- Lesion in inner one-half of enamel
D1-Lesion in outer third of dentin
D2- Lesion in middle third of dentin
D3- Lesion in inner third of dentin

C) Electrical conductance (Resistance) measurements
Sound tooth enamel is a good electrical insulator due to its high
inorganic content.
Caries result in increased porosity. Saliva fills the pores and
forms conductive pathway for electrical current.
The electrical conductivity is directly proportional to the
amount of demineralization that has occurred.
Electrical resistance refers to measuring the electrical
conductivity through these pores.

Vanguard Electric Caries Detection
It has been designed to measure the electrical conductivity of the
tooth.
The electrical conductivity is expressed numerically on a scale
from 0 to 9, indicating a change from sound tooth to an increased
degree of demineralization
ADVANTAGES
Very effective in detecting early pits and fissure caries
It can also monitor the progress of caries

DISADVANTAGES
 C an only recognize demineralization and not caries specifically
 Presence of enamel cracks may lead to false positive diagnosis
 Areas of diagnosis is confined to the dimension of the probe
D)Lasers
DIFFERENT TYPES OF LASERS USED FOR THE DIAGNOSIS OF CARIES
i. Argon laser
ii. Diode laser
iii. Qualitative laser fluorescence
iv. Diagnodent quantitative laser fluorescence
v. Optical coherence tomography
vi. Dye enhanced laser fluorescence

CARIES RISK ASSESSMENT
Caries Risk Assessment;
This is a procedure to predict future caries
development before the clinical onset of the disease.
• Caries risk assessment is the determination of the likehood of the
incidence of caries (i.e. the number if new cavitated or incipient
lesions) during a certain time period.
• It also involves the probability that there will be a chance in the size
or activity of the lesion in the mouth.

Caries activity tests
Estimates the activity or progression of caries
1.Unstimulated salivary flow test. In this a patient is asked to sit
upright in chair to drool into a collection cup for 5minutes
More than 0.25 normal
0.1 to 0.25 low
Less than 0.1 very low
2. saliva viscosity test
• For this test visually inspect the viscosity of resting saliva. it is frothy
or bubbly ,it indicates low water content in saliva because of low
saliva production.

cont
3. Resting PH of unstimulated saliva
To measure the PH of resting saliva drop the saliva on PH paper stripe
and notice the value.
• Healthy resting PH 6.8 to 7.8
• Moderately acidic resting PH 6.0 to 6.6
• Acidic resting PH 5.0 to 5.8

Patient is said to be at high risk if there is
• Exposure to sugary snacks for more than three times a day.
• Past dental history with multiple restorations
• Systemic disorders
• Patients on medications that cause hyposalivation
• Senility
• One new lesion on smooth surface during past one year
• New carious lesion o root surface

Factors commonly seen in patients with high
risk caries.
• Status of oral hygiene.
poor oral hygiene
orthodontic treatment
use of non fluoridated tooth paste
partial dentures
• Dental history
history of multiple restorations
frequent replacement of restorations
• Socioeconomic factors.
low education status, poverty

cont
• Medical factors.
medications causing xerostomia
gastric reflux
sugar containing medications
Sjogren syndrome
• Behavioral factors
bottle feeding at night
more sugary foods
nonfluoridated tooth paste

USES OF CARIES RISK ASSESSMENT
Evaluate the degree of patient risk of developing caries to determine
the intensity of treatment.
Help identify main etiologic agent to determine the type of
treatment
Determine if additional diagnostic procedures are required salivary
flow rate analysis, diet analysis
Improve the reliability of the prognosis of the planned treatments
Assess the efficacy of proposed management and preventive
treatment plan at recall visits

MANAGEMENT OF DENTAL CARIES
• The invention and application of engine drive or rotary instruments in
operative treatment of carious lesions has resulted in removal of
considerable tooth structure.
• But now a days other procedures have also been used for removal of
caries like;
Air abrasion
Ozone treatment of dental caries
Chemo mechanical caries removal
Lasers

AIR ABRASION
The study of the use of air abrasion technology for dental
applications initiated by Dr. Robert Black in the 1940s was successfully
introduced in 1951 with the Ardent air abrasion unit (S.S. White)
Kinetic energy is used to removal carious lesion. In this method, a
powerful fine stream of aluminum oxide particle is targeted against
the surface to be removed.
Nowadays, a number of variations in tip angulation and nozzle
diameters are available. Small nozzle diameter can be used for areas
that are difficult to access. The various tip angulations allow easy
placement and orientation of the handpiece thus easing the strain off
the operators hands.

ADVANTAGES OF AIR ABRASIONS
1. Non-traumatic
2. No micro chipping or micro fracturing
3. Less discomfort
4. No anesthesia
5. Decreased thermal buildup
DISADVANTAGES OF AIR ABRASION
1. Lack of tactile sensation
2. Risk of cavity over preparation and inadequate caries dentine removal
3. Spread of aluminum oxide around dental operatory
4. Danger of air emphysema
5. Impaired indirect view

AIR ABRASION USED IN
i. Cavity preparation
ii. Internal cleaning of tunnel preparation
iii. Micro abrasion of while spot enamel hypoplasia
iv. Stain removal
AIR ABRASION NOT USED IN
i. Crown preparation
ii. Large caries defect
iii. Amalgam removal

OZONE THERAPY
• Within the past few years, ozone therapy has been launched as a
new method for treating caries by Edward LyGh.
• Ozone (03) is a gas with a characteristic, penetrating odor that is
present in small amounts in atmospheric air.
• Ozone reacts with numerous inorganic and organic compounds. It
bleaches dyes and kills bacteria.
• Ozone destroys the bacterial cell membrane, where after the bacteria
die. As bacteria cause caries, it was natural to investigate whether
ozone could be used to treat caries

INDICATIONS OF OZONE
1. Primary root carious lesions
2. Primary pit and fissure caries
ADVANTAGES OF OZONE
Kills more than 99% of microorganisms in carious lesion at a concentration
of 2,200ppm.
Oxidizes caries and speeds up remineralization
Helps to remove organic debris on carious lesion
Decrease treatment time
Does not cause any allergic reaction

CHEMOMECHANICAL CARIES REMOVAL
(CMCR)
Chemo mechanical caries removal (CMCR] is a noninvasive technique
of removal of caries via eliminating the infected dentin and
preservance of affected dentine and healthy tissue via a chemical
agent avoiding pulpal irritation and patient discomfort.
A chemical agent assisted by atraumatic force is used for removal of
soft caries.
Reagent is generated by mixing amino acids with sodium
hypochlorite.
A reagent chemically soften carious tooth tissue facilitating its easier
removal using a hand instrument.

Lasers
The use of lasers for cavity and caries removal is based on ablation
mechanism, in which a dental hard tissue can be removed by thermal
or mechanical effect during laser irradiation.
Lasers have shown to remove caries selectively while leaving the sound
enamel and dentine.
They can be used without use of local anesthetics.

Advantages of hard tissue laser treatment
• Can remove caries effectively
• Pulp vitality not compromised
• Less anxiety, pain free and anesthesia free
• Little or no post operative discomfort
• Ideal for children and adults

DEVELOPMENTAL TEETH DEFECTS
The developmental defects involves ;
• Size of teeth
• Shape of teeth
• Number of teeth
• Structure of teeth
• Eruption of teeth

DEVELOPMENTAL DEFECTS IN SIZE OF TEETH

DEVELOPMENTAL DEFECTS IN NUMBER OF
TEETH

DEVELOPMENTAL DEFECTS IN STRUCTURE OF
TEETH

DEVELOPMENTAL DEFECTS IN TEETH
ERUPTION

OPERATIVE .GROUP 7.pptx

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