CARIES STABILIZATION AND TEMPORARY RESTORATION

CARIES STABILIZATION AND TEMPORARY RESTORATION

LEARNING OUTCOMES Justify the importance of caries stabilisation procedure in operative care. List and discuss the methods to stabilise caries ( include preventive and operative measures) Choose, mix and place the temporary restorative material in the prepared tooth cavity. List and discuss the biological and physical functions of temporary restorations Define and discuss the benefits and limitations of stepwise caries excavation.

PREVENTIVE MX STRATEGIES Ensure Oral Self- Care steady improvement in OH helps to condone caries (brushing effectively twice daily) regular daily administration of Fluoride use of dental floss assess quality of OH Procedures evaluate risk factors :- sugar containing food If still fails- Professionally applied preventive measures application of topical fluoride- solutions, gel or varnishes

THE IMPORTANCE OF CARIES STABILISATION IN OPERATIVE CARE do no harm Stabilise ot arrest the disease progression with preventive self OH care and Professionally Operative measures operative procedures should result in polished restorations that would not cause / prevent plaque accumulation ease for pt home care management ensure that operative procedure is easy for the operator to conduct- health gingiva, easy isolation, dry clean field of working area, ensuring the longevity of restorative material placed

MANAGEMENT OF DEEP CARIES

RISK ASSESSMENT

PROTECTING THE PULP Management of deep caries Caries removal technique Partial caries removal Partial caries removal Indirect pulp therapy Step wise excavation

CARIES STABILISATION Improve OH care Effective plaque control with F _ Tooth Brushing Dental Floss Mouth rinses Diet monitoring Operative care Utilising remineraisation capacity of tooth structure Choice of materials Ensure tight seal between material and tooth

PROCEDURE Deep caries management (must be done under rubber dam) Access to caries to look for DEJ Start removing caries from the periphery (WHY?) Ensure DEJ is free from stained dentin Central caries may be removed using sharp spoon excavator or sharp slow speed round Caries- disclosing dyes to assist excavation of carious dentin Dyes stain not only demineralised dentin but anything porous eg debris/ smear layer Caution- non-carious dentine will absorb dye- if removed pulp exposure will result

TEMPORARY RESTORATIONS must be functional preferably aesthetically acceptable arrest disease progressing stage- stop caries activities pulp therapy gingival therapy easy to use

TEMPORIZATION Types of materials Zinc Oxide Eugenol - IRM Cavit- at least 3mm to ensure seal GIC Fuji 2, Fuji 9 and Fuji 7 Kalzinol

PLACEMENT OF TEMPORIZATION Place material with plastic instruments Material is placed by increments starting at the base and walls by packing against them The center depression is filled last DO NOT simply push one bolus in

FUJI VII

ASSIGNMENT/ DISCUSSION TO SEND TO ME VI A I FOLIO G RP 7 TH N OV 2 0 1 4

IRM TEMPORARY RESTORATIONS List and discuss the biological and physical functions of temporary restorations:- Kalzinol Cavit

Glass ionomer cement Tooth coloured Pink coloured automix hand mix

Glass Ionomer- chemically bonds to tooth - Provide antibacterial seal physical barrier, reduce microleakages - Very low solubility - Material of choice for use as a base, or dentine substitute, beneath all plastic restorations, stronger than set CaoH but less compressive strength compared to composite resins or amalgam - Long term temporary, or provisional, restoration in the treatment of active caries

STEP WISE EXCAVATION Pulp is not exposed Central dentine Affected dentine may be left behind if:- Dentine is hard At this point dentine may be stained If soft step wise excavation technique Caries is removed in increments in two or three visits over a few months or with in a year in timely manner Each time caries is removed, GIC is placed which may contribute to remineralization followed by well-sealing temporary filling

BENEFITS Prevent pulpal exposure Ideal opportunity for tooth to develop tertiary dentine

LIMITATION OF STEP WISE EXCAVATION Leaving? affected dentine behind Use of CaOH (Setting CaoH- Dycal) or MTA ensures adequate sealibility, thus prevent further irritation to the pulp Have to en-enter the cavity after 3 months to remove the affected dentine when re-enter likely to remove more tooth structure

THE END ANY QUE STIONS?