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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]8/13/2019 Non Rotary Pallavi
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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/ILM8/13/2019 Non Rotary Pallavi
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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!!!
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