micro preparations 1
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Micropreparations
Surendra
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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
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Introduction
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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
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Need for micropreparations
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Slogans
Extension for prevention
Cutting for immunity
Need for access
Conservative approach- Enameloplasty
- Prophylytic odontomy
- pit and fissure sealant application Minimal intervention
Microdentistry
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Changes in concepts
Blacks concept
Conservative approach
Micro dentistry
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Changes in materials
Amalgam
Gold restorations
Improvements in amalgam
absence of adhesion
Pins
Adhesive materials
Composites
Glass ionomer cements
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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
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Caries
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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
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Classification of caries
Gv black
New cavity classification
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Comparision of G V Blacks and new
classfication
- site 1 > size 2,3,4 - blacks class1
- site 2 > size 2,3,4 - blacks class2
- site 2 > size 2,3 - blacks class3
- site 2 > size 4 - blacks class4
- site 3 > size 1,2,3,4 - not mentioned
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Changes in trends in caries
Classification
G V Black
New classification G J Mount
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Conservative operative management
strategies
Ultra conservative cavity preparations
Ultra conservative sealed restorations
Air abrasion
Preventive resin restorations fissurotomy
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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, cariesdetection dye, excavation with small round burs
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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
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Preventive resin restorations
Simonsen 1977
round bur, 331/2 bur
advantages :
- less traumatic to the tooth
- minimally invasive to the tooth
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Fissurotomy
Def ; the process of opening or wideningtortuous posterior grooves and or fissuresas a prelude to the placement of sealants
or resin restoration. Fissurotomy system- ss white
original
micro NTFmicro STF
Goals
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Other systems
Thin and narrow diamonds for minimal invasive
cavity preparation (brasseler)
Smart prep
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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
A l t d t (0 8 )
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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
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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
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Internal approximal cavity preparation
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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
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Internal approximal cavity
preparation
Other names tunnel preparation
- internal fossa preparation
- internal oblique preparation- internal preparation
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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
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The mini box
Design is Similar to slot restoration
-- conservative design
-- simple box
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simple
Same as simple design by Marzouk
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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
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Sugical microscopes
advantages
- minute details- fewer or no radiographs
- videorecording possible
- stress reduction- communication with referral dentists
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Micro surgeryDef: is defined as a surgical procedure on exceptionally small and
complex structures with an operation microscope
The triad of endodontic microsurgery
Advantages
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Advantages
- small osteotomies and shallow bevels
- under high illumination and magnificationbetter visualization of anatomic details
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Differences b/w traditional and
microsurgery
Traditional
1. Difficult
2. Large >10mm
3. None4. Large 450
5. Nearly
impossible
6. Approximate
7. imprecise
Microsurgery
1. Precise
2. Small
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Classification
Class A the absence of periapical lesion butunresolved symptoms after non surgical approacheshave 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-periocommunication but no root fracture
Class F a tooth with an apical lesion and completedenudation of apical plate
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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
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Diagnostic instruments:
Compared with a conventional mouth mirror
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CM-1 5mmRound
CM-2 3mmRound
CM-3 Medium Oval
CM-6 Large Oval
Micro mirrors with sapphire surfaces makes them scratch proof !!
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Large oval micro mirrors used to view root end
preparations in the molar region
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Conventional scalpels
Micro scalpel (double edge)
R t t
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Retractors
Comparison with conventionalretractors
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conventional microsurgical
Area specific retractors
Micro needle holders
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Micro needle holders
CASTROVIEJONEEDLE HOLDER
DERF NEEDLE HOLDER
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Procedure
Identification of the apex in the intact buccal
plate
Ostetomy size
Inspection of resected root surface under themicroscope
Bevel angle
Isthmus identification and preparation Ultrasonic root end preparation
Retrograde filling
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IsthmusDef : a narrow connection between two root
apices and contains pulp tissue (kim)
green (1973) isthmus as corridor between tworoots.
Pineda (1973) phenomenon as lateral canalsvertucci (1984) stated isthmus was ananastomosis
Weller (1995) as a narrow, ribbon shapedcommunication between two roots canals thatcontains pulp tissue
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Classification
Type 1 either two or three canals with nonotable communications
Type2 -- 2 canals that possessed a definiteconnection between the two main canals
Type3 -- differs from the latter only withpresence of 3 canals were also included in thiscategory
Type4 when canals extended into the isthmus
area Type5 as a true connection or corridor
throughout the section
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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
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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
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p y
preparation
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Ultrasonic root end preparation
Developed to address and solve the majorinadequacies of the conventional bur typeretropreparations
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
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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
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conclusion
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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
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