Non Rotary Pallavi

8/13/2019 Non Rotary Pallavi

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Good morning


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NO DRILL DENTISTRY N

O D

R I L L D E N T I S T R Y

NON ROTARY METHODS OFCAVITY PREPARATIONS


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Contents

Introduction

Classification

Harmful effects ofdrilling

Changing concepts intreatment of caries

Contents

Air Abrasion

Air Polishing

Ultrasonic s

Sono-abrasion


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Contents

Laser therapy

Chemo-mechanicalmeans of cariesremoval

Atraumaticrestorative technique

Contents

Ozone therapy Enzymes

References

Conclusion.


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Introduction


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Drilling- good or bad??

Overcutting Low torque


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Macro-dentistry to ultraconservative micro-dentistry

Why Non-Rotary?? The Changing concepts!!


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Tomes in 1859

G V Black in 1908

An old argument!!!


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Transformation of preparation concepts: past topresent!!

G.V Blacks extension

for prevention

Mid of 20 th century..clinicians challenged

Late 20 th century..Adhesives

Prevention ofextension prevention,

remineralization and

MI

1881, Webb


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classification

Mechanical, rotary Handpieces + burs

Mechanical, non-rotary Hand excavators,Airabrasion, Airpolishing,Ultrasonics, Sono-abrasion

Chemo-mechanical Caridex,Carisolv,Enzymes

Photo-ablation Lasers

Classification of various tooth-cutting techniques


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classification Noack et al

E x c a v a

t i o n

t e c h n

i q u e s

*Manual rotary

*Sono abrasion*Air abrasion*Chemomechanicalexcavation

*Enzymaticdigestion*Photobalation

D i s

i n f e c

t i o n

t e c

h n

i q u e s

*Ozone treatment

*Photodynamictherapy*Antibacterialtherapy

S e a

l i n g

t e c

h n

i q u e s

*Fluoride releasing

materials*Dentin adhesives*Antibacterialresin materials


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classification

Mechanical: Atraumatic restorative technique (ART)Rotary (High/low speed bur)Sonic oscillation (SONICSYSmicro)

Chemomechanical: Carisolv

Kinetic: Air abrasion

Hydrokinetic: Lasers


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Air abrasion Micro-abrasion/ kinetic cavity preparation

27.5 aluminum oxide powder.. compressed air

Kinetic energy principle


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History 1940 s Dr. Robert Black

1945articles

1951..Airdent by S.S White

1955..more

Reclined

Revived1970 s,Dr. Tim Rainey + Dr. Black, and in1985

Metering systemshigh speed evacuation systems Bonded restorations. concerns over the use of amalgam


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Mechanism of action:

Kinetic cavity preparations Hard & soft material interaction


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Rainey ridgeThe sub-occlusal oblique transverse ridge.. DL & MB cusps


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The changed model concept


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disadvantages

Tactileperception..

minimal

Expenses.Small toothpreparations

only.. No crownpreparations

Precise clearlyidentifiableoutlines???

Unfamiliar

Debrisaccumulates..

Excellent suctionand air filtration

devices..

Class II and ClassIII areas.. more

extensivelearning.

Does notremove soft

decay???

Cannot removelarge amalgam

using airabrasion.


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indications

Class I, IV, V.. Class II, III Children.. no psychological trauma Local anesthesia not indicated due to health reasons Mentally disabled Geriatric pts

Contraindications

Severe dust allergy Asthma Ch. Pulmonary disease Recent extraction Open wound Periodontal surgery or compromised status Subgingival caries Emphysema risks


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Dynamics of air abrasion

E= mass x velocity2

Variables Air pressure: 60 psi 80psi Powder flow: 1.8-2.5g/min Particle size: 27m..50m10m The type of machine: continuous mode without exhaust and with exhaust Tip size: 0.011-0.032 inch0.018..0.014..0.011 Tip angle: 458..678 ....908 .... Tip distance from the tooth: 1-2mm

Recommended: 458 , 0.014 inch


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technique

Focused & defocused mode Do not move back and forth 3 second bursts Observe Deeper.. short bursts.. Less air prr..

Safety..Commercially

Micadent Prepstart Whisperjet Aquacut Quattro Air Abrasion System (Velopex)


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Accessories

Air abrasion resistant mouth mirrors (CrystalMark) Sand trap Power plus booster: 135psi Disposable air abrasion headpiece: Airbrator..high, medium and low

performance

Super high volume evacuation system MicroVibe


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Recent advances

Softer abrasives.. crushed polycarbonate resin.. sizes: 60# (338)..80#(215)..[Oper Dent. 1998 Sep-Oct;23(5):236-43.Selective caries removal with airabrasion. Horiguchi S, Yamada T , Inokoshi S, Tagami J.]

Parallel water technique : hydroabrasion.. Hydrojet and Rondoflex by KavoDeeper penetration & efficient.. dust over spray.. warm water
http://www.ncbi.nlm.nih.gov/pubmed?term=%22Horiguchi%20S%22[Author]http://www.ncbi.nlm.nih.gov/pubmed?term=%22Yamada%20T%22[Author]http://www.ncbi.nlm.nih.gov/pubmed?term=%22Inokoshi%20S%22[Author]http://www.ncbi.nlm.nih.gov/pubmed?term=%22Tagami%20J%22[Author]http://www.ncbi.nlm.nih.gov/pubmed?term=%22Tagami%20J%22[Author]http://www.ncbi.nlm.nih.gov/pubmed?term=%22Inokoshi%20S%22[Author]http://www.ncbi.nlm.nih.gov/pubmed?term=%22Inokoshi%20S%22[Author]http://www.ncbi.nlm.nih.gov/pubmed?term=%22Inokoshi%20S%22[Author]http://www.ncbi.nlm.nih.gov/pubmed?term=%22Yamada%20T%22[Author]http://www.ncbi.nlm.nih.gov/pubmed?term=%22Horiguchi%20S%22[Author]http://www.ncbi.nlm.nih.gov/pubmed?term=%22Horiguchi%20S%22[Author]http://www.ncbi.nlm.nih.gov/pubmed?term=%22Horiguchi%20S%22[Author]


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Air polishing

Soluble particles of Na-bicarbonate + tri-calcium phosphate (0.08%) Air pressureshrouded in a concentric jet of water

Choked flow.. beyond 90psi

Indications: Satins Carious dentin at the end Pit & fissure prep..

MicroProphy II


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ultrasonics

1950s.. Nielsen et al.. Magnetostrictive inst. With 25kHz Conjunction with thick aluminum oxide and water slurry

MOA Kinetic energy of water to tooth via abrasives Harder tissue easy to cut Soft not removed.. However Reduced vibrations and noise

CVD tips

Advantages Formation


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Sono-abrasion Development of high-frequency sonic air scalers with modified abrasive tips.

Sonicsys micro unit..by Drs. Hugo, Uterbrink, Mosele < 6.5kHz

Elliptical motion.. 0.08-0.15mm

Longitudinal motion.. 0.055-0.135mm Diamond coating..40m & flow rate 20-30ml/min Operational prr: 3.5bar Torque: 2N.. If > damping..


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lasers

Light Amplification by Stimulated Emission of Radiation

HISTORY: 1960- Maiman..1st laserred from ruby 1970- CO2 and Nd:YAG

1987- model of Nd:YAG May 1997.. Er:YAG 1998: Er:YSGG


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properties

Coherence Collimation Mono-chromaticity

Interaction with target tissues:


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Types of lasers

Tissue interaction: Hard & soft lasers

Power output: High & low power lasers

Lasing media: Solid, liquid & gas

Emission modes: Continuous

Gated Free-running

Contact or non-contact mode

Mechanism of action


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Mechanism of action

Enamel: 12% waterErbium based laser.. ablation well belowthe melting and vaporization temperatures of enamel

Removes composite and GICs

Popping sound on hard tissues propagation of an acousticshock wave within the tooth.. and varies..

Er,Cr:YSGG laser system creates a loud snapping sound..plasma de-coupling due to??

The rear surface of atomized water molecules HydroKinetic cutting

Explosive subsurface expansion of interstitially trappedwater


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Hard tissue lasers

Infrared spectrum Biolase s Millennium: (2780nm wavelength).. erbium, chromium, yttrium, scandium, gallium

& garnet. (Er,Cr:YSGG)

ContinuumBiomedical s DElight dental laser: (2940nm wavelength) combines erbium with

yttrium, aluminum & garnet (Er:YAG).


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similarities

Since 1999 Solid state lasers Use water to accomplish their task No need of anesthesia, hence quadrant dentistry Abrades surface, but requires etching

Conservative Tolerable, light, popping noise is produced No touching the tooth, hence no vibrations Unlike air abrasion cuts, removes, or ablates soft

tissue

Both the wavelengths are placed in the beginningof the mid infrared, invisible and non ionizingportion of the spectrum.

Both the wavelengths are emitted in free runningpulsed mode.


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differencesErbium: YAG

(Delight)

Erbium, Chromium: YSGG

(Biolase)

Delivery by hollow waveguide or fiber

optic bundle or articulated arm.

Er,Cr: YSGG use only fiber optics.

Er: YAG has a 20 % higher absorption

in hydroxyapatite

Lower absorption in hydroxyapatite

Higher absorption in water Lower absorption in water.

Mass removal of dentin is greater Mass removal of dentin is lesser.

Causes less of pulpal temperatureincrease.

Causes more of pulpal temperatureincreaseThinner hand piece so that there is

good access & visibility. Pulse can be

adjusted from 3-30Hz

Emulates the traditional hand piecedesign. Fixed pulse repetition rate at20Hz.


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Non-contact mode Quieter Less vibrations

Sterilizes Seal the periphery

Cracking of enamel Severe carbonization of

dentine Irreversible damage to

adjacent tissues Expensive No tactile sensation


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safety

Protective glasses Warning signs Class IV lasers.. registration and inspection

guidelines


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guidelines Higher waterlower energy Enamel> dentin, caries & soft tissue Erbium laser:

Enamel: 4-8 WDentin: 2-5 WCaries: 1-3 WBone: 1.5-3 WSoft tissue: 1-3 W

End cutting devices.. Slow lateral movements Deeper lesions.. broad tip 1st Always kept in motion Water spray.. slow and steady

Contact and non-contact mode Focal point Popping sound.. controversial Anesthesia Tech.: Erbium lasers defocused at high energy (5-6W) for 2 mins

Gradual increase from 0.2W upwards


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Laser abrasion

Theoretical extension of water based laser ablation.. Er:YAG laser energy accelerates the movement of sapphire 30-50m Brittle splitting.. hence tooth removal Velocities range of 50- 100m/s

Dispensing systems Ceramic restorations


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Chemo-mechanical means of caries removal

Definition: Structure of collagen


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Carious lesion & collagen


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indications

Tooth preservation Removal of root/ cervical caries Caries removal at the margins of crowns and bridge abutments Completion of tunnel prep LA contraindicated

Anxious pts Deciduous dentition ART


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Evolution of chemo-mechanical agents

NaOCl: Goldman and Kronman working in New Jersey, U.S. inthe 1970 s. So combined it with Sorensen s buffer (which contains glycine, sodium chloride

and sodium hydroxide)

NMG: N-monochloroglycine by cholrination of glycine

GK 1019

More effective if glycine was replaced by amino butyric acid,N- monochloroaminobutyc acid (NMAB).


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Role of NMG and NMAB on collagenHydroxyproline to pyrrole 2 carboxylic acid.Cleavage by oxidation of glycine residues

US.. FDA..CARIDEX


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techniqueDelivery: Reservoir Heater Pump

Tech: 5-10mins

Dentin surfaceoverhangs & undercuts Dentine scales

GK 101 (NMG): collagen status

Fraying fibrils Spinaling fibrils Dissociating fibrils Amorphous material


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Painless Conservative DiscolorationMillards

reaction Reduced need for LA Reduced risk of pulpal

exposure Anxious, medically

compromised, pediatric pts

Access to caries,interproximal caries

Existing restoration

Non adhesive rests needcavity prep Large vol of soln (200-

500ml) Time (10-15mins)

Bulky delivery system


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carisolv


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Mechanism of action Alkaline Amino acids gets chlorinated due to prs of NaCl and NaOH constitutes

Proteolytic degradation of collagen Gel..adv??


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Insts and technique


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Insts and technique


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Insts and technique


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Insts and technique


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papacarie

Papain, chloramines, toluidine blue, salts, thickening vehicle

Papain: is a proteolytic enzyme.. bacteriostatic, bactericide and anti-inflammatory characteristics.. accelerates the cicatricial process.

Chloramies: bactericide and disinfectant.. These are broadly used tochemically soften the carious dentine.. secondary &/or quaternary structureof the collagen are affected due to disruption of hydrogen bonding.


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Mechanism of action & technique

Anti-trypsin

30-40 sec and the removal can be started using excavator in pendulum motion.

Advantages:

Proven effectiveness The method s safety Elimination of bur and local anesthesia Low anxiety seen in patients Conservation of sound tooth structure

Easy to manipulate, economical and simple Ideal consistency to work with Fast action


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technique


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Recommendation:.. Indications..

Survival rate..3yrs..85-88%


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Ozone tehrapy

O3 Sterilization & remineralization

Production: Ultraviolet system

Corona discharge system Cold plasma system

Safety limits=0.06ppm for 8hrs/day,5 days a week OR 0.3ppm for 15mins

Fatal=50ppm for 60mins


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Principles of ozone therapy

The niche environmental theory Demineralization remineralization 10s application of 2200ppm..99% elimination

14 weeks of elimination followed by remineralization


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Mechanism of action

Removal of ecological niche Antimicrobial Removes acidity Removes proteins Oxidizes poly unsaturated fatty acids

I di i & i di i


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Indications & contraindications

Pit & fissure Early occlusal Open accessible caries around

crowns & bridges Accessible root caries

Hidden caries

Proximal lesions


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healozone


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enzymes

In 1989, Goldberg and Keil successfully removed soft carious dentine usingbacterial Achromobacter collagenase.

This did not affect the sound layers of dentin beneath the lesion.

Also a more recent study has used the enzyme pronase, a non-specificproteolytic enzyme originating from Streptomyces griseus, to help removecarious dentine.


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l


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conclusion

references


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Air abrasion: An emerging standard of care in conservativeoperative dentistry. J. Tim Rainey, Dent Clin N Am 2002; 46:185209

Chemochemical caries removal: A review of the techniques andlatest developments. J. A. Beeley, H. K. Yip, and A. G.Stevenson. British dental journal 2000; 188(8): 22

Dentine caries excavation: a review of current clinicaltechniques A. Banerjee, T. F. Watson, and E. A. M. Kidd. Britishdental journal 2000; 188(9): 13

The cutting edge: instrumentation and preparation conceptsDouglas A. Terry. Fundamentals of Adhesion

The current status of laser applications in dentistry LJ Walsh.Australian Dental Journal 2003;48(3):146-155

Lasers in Dentistry from Beginning to Automatic SystemsInstitut fr Lasertechn ologien in der Medizin und Messtechnikan der Universitt Ulm www.uni-ulm.de/ILM

Lasers and air abrasion. New modalities for tooth preparation.Robert Reyto. Dent Clin N Am 2001; 45: 189206

Chemo-mechanical caries removal: a comprehensive review of

the literature. International dental journal 2001; 51: 291-9.

references
http://www.uni-ulm.de/ILMhttp://www.uni-ulm.de/ILMhttp://www.uni-ulm.de/ILMhttp://www.uni-ulm.de/ILMhttp://www.uni-ulm.de/ILM


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Air-abrasion enamel microsurgery to treat enamel white spot lesionsof traumatic origin. Lambrechts et al. Journal of esthetic andrestorative dentistry 2002; 14(3): 167-87

Filling without drilling-not a myth but a reality. Dr. Farhan k. Shah, Dr.R. K. Tiwari. JIDA 2003; 74: 563-4 Minimally invasive operative care. II contemporary techniques and

materials: An overview. Mathilde C. Peters/ Mary Ellen McLean. J ofAdhesive Dent 2001; 3: 17-31

A new dimension to conservative dentistry: Air abrasion. Vivek SHegde, Roheet A Khatavkar. 2010; 13(1): 4-8 An overview of the use of lasers in general dental practice: 1. laser

physics and tissue interactions. Munther Sulieman. Dental update2005; 32: 228-36

Nogales CG, Ferrari PH, Kantorovich EO, Lage-Marques JL. OzoneTherapy in Medicine and Dentistry. J Contemp Dent Pract, 2008; 9:75-84.

Azarpazhooh A, Limeback H. The application of ozone in dentistry: Asystematic review of literature. J Dent, 2008; 36: 104-16.

Papain gel: a new chemo-mechanical caries removal agent. J Clinpediatr dent 2005, 30 (20): 115-20.


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Thank you!!!

Non Rotary Pallavi

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