Micropreparations

Surendra

Introduction Aims and objectives of restorative dentistry Need for micropreparations - Slogans - Changes in concepts of treatment of caries, materials Benefits of conserving tooth structure Requirements of micropreparations Caries - etiology - detection - treatment - instruments - materials - maintenance - re evaluation Ultraconservative preparations Treatment of proximal caries sonoabrasion Magnification Microsurgery Conclusion References

Introduction

Aims and objectives of restorative dentistry

Aims - prevention - interception - preservation - restoration Objectives - provision of access - removal of caries and tissue weakened by caries - production of biologically satisfactory shape - production of a mechanically satisfactory shape

Need for micropreparations

Slogans

Extension for prevention Cutting for immunity Need for access Conservative approach - Enameloplasty - Prophylytic odontomy - pit and fissure sealant application Minimal intervention Microdentistry

Changes in concepts
Blacks

concept Conservative approach Micro dentistry

Changes in materials
Amalgam

Gold

restorations Improvements in amalgam absence of adhesion Pins Adhesive materials Composites Glass ionomer cements

Benefits of conserving tooth structure

Opportunity

to develop recurrent caries is

minimized Incidence of early restoration failure is minimized Incidence of tooth fracture is decreased Pulp vitality is retained throughout the life

Caries

Methods of caries detection

Radiographs Clinical visual tactile Electric conductance Fiber optic transillumination Quantitative laser fluorescence Diagnodent Difoti Chemical dyes Electronic caries monitor Impression materials

Classification of caries
Gv

black New cavity classification

 Comparision

of G V Blacks and new

classfication
- site 1 - site 2 - site 2 - site 2 - site 3 > size 2,3,4 - blacks class1 > size 2,3,4 - blacks class2 > size 2,3 - blacks class3 > size 4 - blacks class4 > size 1,2,3,4 - not mentioned

Changes in trends in caries

Classification

V Black New classification G J Mount

Conservative operative management strategies Ultra conservative cavity preparations

Ultra

conservative sealed restorations Air abrasion Preventive resin restorations fissurotomy

Air abrasion

Advanced beam technology, micro abrasive technology Robert black- 1943 Airdent unit, ss white 1953 FDA approved 1982- microprep, kcp series Compressed air 40 to 140 psi Aluminium oxide particles 20 to 50 microns One inch above tooth surface Current recommendations - access to the lesion with air abrasive unit, caries detection dye, excavation with small round burs

Clinical uses -remove debris - diagnose and treatment of pit and fissures - cleaning Advantages - in preparation of initial occlusal and cervical lesions - management of approximal lesions Disadvantages - inability to remove caries - chronic respiratory disorders - very expensive - require skill

Preventive resin restorations

Simonsen

1977 round bur, 331/2 bur

advantages : - less traumatic to the tooth - minimally invasive to the tooth

Fissurotomy
Def

; the process of opening or widening tortuous posterior grooves and or fissures as a prelude to the placement of sealants or resin restoration. Fissurotomy system- ss white original micro NTF micro STF Goals

Other systems

Thin and narrow diamonds for minimal invasive cavity preparation (brasseler)

Smart prep

Sono abrasion
Frequency 6.5khz 3.5 bar air pressure for cavity preparations, lower pressure for finishing the margins 4 different working tips - angulated type - the half torpedo - longitudnally sectioned torpedo - small half sphere - large half sphere

 Angulated

type (0.8mm) - has cylindrical or conical working end with circular diamond coating and a flat smooth non cutting front end - used for intracoronal and extracoronal tunnel preparations

The half torpedo - has uncoated working side, non coated beveled circumferential edge and a concave working side - used to cavosurface beveling of cl2, cl3 @ ci4 adhesive and cast gold preparations. - marginal beveling of crown and veneer preparations Hemi spherical blade - convex diamond coated tip -direct access preparations (especially when enamel is already demineralized) - in preparation and cavosurface beveling of cl2 & cl3 cavity designs

 Internal

approximal cavity preparation The Micro chip approximal cavity preparation

Box

preparations - the mini box approximal cavity preparation - the full box approximal cavity preparation Simple preparations

Internal approximal cavity preparation

Other

names tunnel preparation - internal fossa preparation - internal oblique preparation - internal preparation

Micro chip
This

procedure is usually followed when removal of porous enamel is required Also used when fractures in enamel wall are found to extend own from the marginal ridge to porous region

The mini box

Design

is Similar to slot restoration -- conservative design -- simple box

simple
Same

as simple design by Marzouk

Magnification

Methods - loupes - surgical head lamps or conventional surgical telescopes - surgical microscopes Advantages - wider fields - variable magnifications - better depth of focus - coaxial illumination

Disadvantages - very expensive - visual dislocation even with moderate head movements - loss of visual field at higher magnifications - skill Types of magnification low magnification - 2.5x to 8x mid range magnification - 10x to 16x high magnification 20x to 30x

 Sugical

microscopes advantages - minute details - fewer or no radiographs - videorecording possible - stress reduction - communication with referral dentists

Micro surgery
Def: is defined as a surgical procedure on exceptionally small and complex structures with an operation microscope

The triad of endodontic microsurgery

 Advantages

- small osteotomies and shallow bevels - under high illumination and magnification better visualization of anatomic details

Differences b/w traditional and microsurgery

Identification of apex Ostetomy Root surface inspection Bevel angle Isthmus identification Retro preparation Root end filling

1. 2. 3. 4. 5. 6. 7.

Traditional Difficult 1. Large >10mm 2. None 3. Large 450 4. Nearly 5. impossible Approximate 6. imprecise 7.

Microsurgery Precise Small <5mm Always Small <100 Easy Precise Precise

Classification

Class A the absence of periapical lesion but unresolved symptoms after non surgical approaches have been exhausted Class B the presence of a small periapical and no periodontal probe depth Class C presence of a large periapical lesion progressing coronally but without a periodontal pocket Class D same as class c but with a periodontal pocket Class E a periapical lesion with an endo-perio communication but no root fracture Class F a tooth with an apical lesion and complete denudation of apical plate

Instruments

Microexplorer Microblade Micromirrors Kp retractors Stropko drier Impact air 45 handpiece H161 lindemann bone cutting bur Mini endodontic curettes Mini jacquettes Minirounger Mini bone file Microplugger Retro fill carriers Laschal microscissors Castro veigo needles

Diagnostic instruments:

Compared with a conventional mouth mirror

CM-1 5mm Round CM-2 3mm Round CM-3 Medium Oval CM-6 Large Oval

Micro mirrors with sapphire surfaces makes them scratch proof !!

Large oval micro mirrors used to view root end preparations in the molar region

Conventional scalpels

Micro scalpel (double edge)

Retractors

Comparison with conventional retractors

conventional

microsurgical

Area specific retractors

Micro needle holders

DERF NEEDLE HOLDER CASTROVIEJO NEEDLE HOLDER

Procedure

Identification of the apex in the intact buccal plate Ostetomy size Inspection of resected root surface under the microscope Bevel angle Isthmus identification and preparation Ultrasonic root end preparation Retrograde filling

Isthmus
Def

: a narrow connection between two root apices and contains pulp tissue (kim) green (1973) isthmus as corridor between two roots. Pineda (1973) phenomenon as lateral canals vertucci (1984) stated isthmus was an anastomosis Weller (1995) as a narrow, ribbon shaped communication between two roots canals that contains pulp tissue

Classification

Type 1 either two or three canals with no notable communications Type2 -- 2 canals that possessed a definite connection between the two main canals Type3 -- differs from the latter only with presence of 3 canals were also included in this category Type4 when canals extended into the isthmus area Type5 as a true connection or corridor throughout the section

Ultrasonics
Ultra

sonic tips & needles - carr tips - kim surgical tips Carr tips ct1 max& mand anterior ct2 posterior teeth ct3 posterior teeth ct4 ct5 max & mand anterior

 Kim

surgical ultrasonic tips - kis 1 --- mand anterior & premolar - kis 2 --- max anterior - kis 3 --- posterior teeth - kis 4 --- lingual apex of molar teeth - kis 5 --- posterior teeth - kis 6

Ultrasonic KiS tips for root-end cavity preparation

Ultrasonic root end preparation

Developed to address and solve the major inadequacies of the conventional bur type retropreparations

Creating tracking groove with CX- 1 explorer With water off use the CT5 or UT5 to deepen the tracking grooves With water on use the CT2,CT3 & CT5 to deepen the preparation to its full length Flatten the floor of the preparation with CT1 or UT1

Root end filling materials

Commonly used amalgam - GIC - zinc oxide eugenol cement - IRM -super EBA - Cavit - Guttapercha - Composite resin Less commonly used gold foil - zinc phosphate cement - diaket - teflon - titanium screws Potential materials MTA - cyano acrylates - apatite cement - gallium alloy Combination of different materials double seal - sandwich seal

conclusion

References
DCNA incipient and hidden caries, oct 2005. DCNA restorative dentistry, 2000 Text book of Microsurgery , kim 1st Ed Art and science of operative dentistry, strudevant Adhesion Jean Rouselt Operative dentistry -- Vimal Sikri Advances in operative dentistry Product profile fissurotomy kit, jol fam dent, 2005: 7. Operative dentistry, Baum