diagnosis &treatment planning in conservative dentistry dr arsalan
TRANSCRIPT
Diagnosis &Treatment Planning in Conservative Dentistry
Presented ByDr.M Arsalan Zubair
M.D.S resident Dow Dental CollegeDow University Of Health Sciences
Patient Assessment
• Chief Complaint Symptoms
• Medical History Communicable Disease,
Allergies or Medications,
Cardiac abnormalities,
Physiologic changes associated with aging
• Dental History
• Magnification
• Photography in Operative dentistry
• Advantages: Easy to use
We can document current esthetic condition of patient
Notice changes in existing pits and fissures
Photographs of treatment of deep carious lesion aid in future diagnosis of tooth
For digital documentation it is easier and cost effective.
• Preparation Of Clinical Examinations Clean, dry, Well illuminated mouth that’s why initial scaling, flossing, tooth
brushing is required
Proper examination instruments
Cotton rolls should be placed
Floss is good for determining over hanging, improper contours and open contacts
Starting from the upper right quadrant with posterior tooth and then moving to maxillary and mandibular arches
Risk assessmentRisk Indicators
• Categorization according to the above factors
• Identify early lesion
• Visual changes
• Tactile sensation
• But explorers are discouraged Why???
Clinical Examination of Caries
• Good for root surface caries
• Radiographs are also good
• Primary Occlusal grooves and Fossa are less prone
• Occlusal fissures and pits are more prone
• Chalkiness or softening or cavitations of tooth structure
• Brown gray discoloration radiating peripherally from pit and fissure
• Carious pits
Causes Developmental defects
Erosion or Abrasion
Occurrence
Occlusal two-third of Facial and lingual surface of tooth
May be on the palatal side of Maxillary tooth
ICDAS(International caries Detectionand Assessment system)
• Histological depth1= 90% in outer enamel & 10% into dentin2=50% inner enamel & 50% into outer one third dentin3=77% dentin4=88% dentin5=100% dentin6=100% dentin into one third of inner dentin
• Proximal surface cariesDiagnosed
Radio graphically
Visually by separating contact
Fiber optic transillumination
• Brown Spots Remineralized lesion less prone
to caries rather more resistant to caries.
• Proximal Surface Caries in
anterior teethDiagnosed
Radio graphically
Visually
Fiber optic transillumination
Probing or explorer
• Cervical Caries White spot early enamel lesion
Dry and wet is distinguishing test
Diagnosed tacitly
• Root surface Caries Root exposure, dietary changes, Systemic disease, Xerostomia
Lesion at C.E.J
Soft and spread laterally around C.E.J
Active lesion is soft and cavitated
Best diagnosed by vertical bite wing radiographs
• New Methods For Diagnosing caries DIAGNOdent
Spectra Camera
Carie ScanPro
• DIAGNOdent device
• Major disadvantage is false positive test
• Spectra Camera
• High energy violet or blue light on tooth surface
• It stimulate porphyrins metabolites which make carious lesion red while enamel appear green
• It has scale 0-5
• Carie Scan PRO Caries detection by alternating current impedance
spectroscopy(ACIST)
Detects early carious lesion
Provide color and numerical scale for severity of caries
Clinical examination Of Amalgam Restorations
• Amalgam blues• Proximal overhangs• Marginal Ditching• Voids• Fracture lines• Lines indicating the interface b/w abutted restorations• Improper anatomic contours• Marginal ridge incompatibility• Improper proximal contacts• Recurrent Caries• Improper occlusal contacts
Clinical Examination Of Tooth colored Restorations
• Proximal Over hangs
• Marginal ditching
• Recurrent caries
• Improper contour
• Marginal Ditching
• Voids
Clinical Examination of Dental implants and Implant Supported
Restorations
• In molars it is difficult to replace three roots with one implant
• Vertical loss of bone support prior to implant placement makes vertical space making crown implant ratio difficult
• Peri-implantitis
• Occlusion is difficult to maintain due to lack of cushioning
• Restoration should confined in the middle with no deflections
Clinical examination of Additional Defects
• Non hereditary hypo calcified areas of enamel
• Chemical erosion
• Idiopathic Erosion
• Abrasion
• Attrition
• Fracture
• Craze line
• Dental anomalies…
Radiographic Examination of Teethand Restorations
• Indications of Radiographs
• Proximal caries, overhang, poorly contoured restorations
• Pulpal abnormalities
• Periapical changes in peridontium
• Impacted tooth or congenital abnormality
• False positive and negative diagnosis
Guide lines for Prescribing Dental Radiographs For Dentate Adults
New Patients
• Recall Patient
• Clinically caries present or High risk
• No Clinically Caries or No Risk Factors
• Periodontal disease
Adjunctive Aids in diagnosis of teeth and Restorations
• Percussion• Palpation• Vitality Test Hot test Cold test Electric pulp tester Test Cavity
• Study Cast
Examination Of Occlusion• Signs of enamel cracks, occlusal trauma• Potential effect of restoration on occlusion• Class of occlusion• Over jet• Over bite• Midline shifts• Position of malposed teeth, super erupted, spacing• Dynamic occlusion should be evaluated• Relation should also be assessed in centric relation• Canine guidance or group function exist• Presence and amount of anterior guidance• Non working side contacts• Abnormal wear should be checked• Plunger cusp
Review Of PeridontiumClinical Examination• Gingival color,shape,texture• Depth of sulcus• Instrument used for measuring depth• Six locations• Normal sulcus depth• Involvement of furcation• Gingival recession• Mobility• Plaque presence• Proper contoured restorations
Radiographic Examination
• Bitewing are good for assessing bone level
• What is Biologic width?
• Normal value?
• What will happen if restoration encroach biologic width?
• What method is done to avoid these condition?
Treatment Planning• General Consideration
• Sequencing
• Interdisciplinary Consideration Endodontic
Periodontics
Orthodontics
Oral Surgery
Fixed and Removable prosthodontics
• Indications for Operative Treatment
• Preventive treatment
• Restoration of incipient lesion
• Treatment Of Abrasion, Erosion and Attrition
• Root surface Sensitivity
• Repairing of Restoration
• Replacement of Restorations
• Indication of Amalgam Restoration
• Indication of Direct Composites
• Indication of Indirect tooth Color restoration
• Geriatric Patient
Sequencing
Inter-disciplinary Consideration in Operative treatment
• Pulpal or periapical Pathology
• Endodontic ally treated tooth show no evidence of healing,
• Inadequate fill
• Fill exposed to oral fluids
• Precede operative treatment
• Poor periodontal prognosis=no extensive restoration
• Good health = Before or after
• Surgical procedure indicated= before permanent restorations
• Biological width: Crown lengthening ( 6 week after surgery)
• Extrusion
• Realignment
• Impacted, Unerupted
• Grossly carious tooth should be extracted especially 2nd molars whose has to receive cast restoration are damaged due to removal of 3rd
molars
• Core buildup can be done from amalgam or composite
• Preparation for receiving clasp, rests in removable prosthesis
Treatment Of Abrasion, Erosion, Abfraction and Attrition
Considered for restoration only• Area is affected by caries
• Defect is sufficiently deep compromise structural integrity of tooth
• Intolerable sensitivity
• Defect continue to peridontal problem
• Area is to be involved in design of partial denture
• Involving the pulp
• Actively progressing
• Desire for esthetic improvement
Treatment of root surface caries
• Arrested lesion not need to be restored until for aesthetic purposes
• Active lesion can be restored by tooth color restorations
Treatment of root surface sensitivity• Fluoride varnishes• Oxalate solutions• Resin based adhesives• Desensitizing tooth paste contain Potassium nitrate• Restorative treatment
Replacement of Existing restoration
Non tooth color restoration• Marginal void• Gingival overhang• Marginal ridge
discrepancy• Over contouring of facial
and lingual surface• Poor proximal Contact• Recurrent Caries• Ditching deeper than
0.5mm
Tooth color restoration• Improper contour that
cannot be repaired• Large voids• Deep marginal staining• Recurrent caries• Unacceptable aesthetics