Ultraconservative dental restoration

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Overview

Enamel and dentin are still the best dental materials at this time. Therefore, minimally invasive techniques that preserve much of the healthy tooth structure must be preferred.

Minimally invasive techniques are beneficial in terms of the patient. There is less discomfort and less likely to use anesthesia. And, finally, is the perspective that the restoration will last a lifetime. Replacement of amalgam fillings lead to bigger fillings that have a more limited prognostic and replacement techniques can cause damage to healthy adjacent teeth.


Contents

1. Overview
2. Restorative dentistry
3. Very small lesions
4. Ultraconservative treatment


Restorative dentistry

In many countries, restorative dentistry was called conservative dentistry. We can hardly call conservative dentistry, but considering that the traditional methods were highly invasive and require removal of healthy enamel and dentin, we can understand this.

Fortunately, modern dentistry has brought with it new materials, techniques and tools that make conservative dentistry practicable, while ultra-conservative dentistry is a reality. Adhesive restorations eliminate the need for preventive extension. Enamel-like composites (hybrid and fluid) allow fillings with minimal long-term dental sacrifice.

Early detection of cavities and ultraconservative fillings prevent secondary caries. New tools such as the hydroabrasive one and cutters for grooves offer to the dentist techniques for minimum preparation and full acceptance of the patient.

In the last few decades there has been a change in how to deal with tooth decay due to increased patient education, but also because the dentists started to use preventive methods. As a result, the incidence of cavities and cavity size is smaller, especially in young people.

Although this change represents real progress for dentistry, there are some questions to ask:
How can a dentist to diagnose these more smaller lesions?
These lesions should be allowed to increase to a diagnosis and easier access, or they should be treated when they are still small?


Very small lesions

Very small lesions can be hardly diagnosed using traditional methods. Histological sections confirmed an accuracy of 25% in diagnosing caries just under occlusal surface using traditional methods of exploration. Radiographs can detect caries that, in normal situations (using traditional methods) would not been identified, but also there are frequent cases when radiographs can’t show cavities that exist. This is known as hidden caries.

The problem of diagnosing these small carious lesions in early stages is real and it can’t be solved easily by using the available diagnostic methods. One thing complicating this problem is the use of excessive fluoride.

The effect of fluoride on the enamel surface causes it to be impenetrable to exploration. This is the problem that makes some early carious lesions to hide just below the enamel or over-dentin enamel junction. Dentist is asked to choose between two situations: to wait for this book to become larger and to destroy even more healthy tissue or to remove these lesions and obscure tooth by ultraconservative restorations.

Sealing grooves and fosse was accepted on a large scale. There is still the problem of placing sealants over an undiagnosed cavity. It is difficult to determine the existence of caries in grooves and fosse, being preferably the exploratory technique or the excisional biopsy combined with maximum preservation of healthy dental tissue and completely safe removal of carious process.

This method reshapes the anatomy grooves and fosse, facilitating etching and the adherence of composite resin into the cavity. If this method can be performed with a low degree of discomfort for the patient and without anesthesia, his cooperation will be very good and the conservative puropose of the dentist will be achieved.

The purposes of ultraconservative preparation are:
- reshaping ditches and fosse for easy access and visibility
- cavity inspection to ensure that there is no carious lesions
- ultraconservative caries removal (complete)


Ultraconservative treatment

Dentist has some ultraconservative treatment options:

Small spherical cutters

While these cutters provide a conservative preparation and a good access, they slowly remove the enamel. Local anesthesia is often required and the preparation form will let the enamel intact. However, their use requires no extra learning process.

Air abrasion

In recent years, many dentists have begun to use advanced technologies based on air abrasion for cavity preparation. Air abrasion allows conservative removal of dental tissues and good access into the cavity using a minimal local anesthesia.

There is a learning process associated with this technique in terms of direction, depth and focus airflow because, unlike cutters, there is no tactile feedback during preparation. Most techniques based on air abrasion are not accurate and tend to reach areas around the target. Equipment can be quite expensive.

Excisional biopsy cutters

These cutters are very sharp, conservative and are not expensive, being especially designed to reshape grooves and fosse and access cavity with minimal removal of enamel. These tools are familiar to any dentist. In most cases, no anesthesia is required.

Cutters for sealing

The cutters used for sealing represents a new approach of ultraconservative treatment. Size and shape of these cutters are specifically designed for treatment of grooves and fosse. Active part length is 2.5mm, allowing the dentist to control cutting to not exceed enamel-dentin junction.

Form of these cutters has been designed to minimize the heat generated and vibration. Considering that the use of these sealing cutters is restricted to the enamel, patient discomfort is minimal, while the need to use local anesthesia is eliminated. The form of sealing cutters ensures less loss of substance than a normal cutter.

Traditional cutters remove more enamel and are designed to remove decay that passed of the enamel-dentin junction.

Cavity preparation must be adapted to restoration materials. Material that has the closest contact with the enamel is composite resin. Taking into account that the preparation is very narrow, long and has an irregular shape, it is important that the filling material to flow easily into all irregularities of preparation.

The material of choice is a fluid composite. While hybrid composites are stronger and more resistant, it can be difficult to ensure their penetration across the prepared surface without leaving gaps.

Ultraconservative dentistry is a great step forward for dentist and dental patient. It requires early diagnosis and complete removal of all decayed surfaces of the tooth.

Untreated cavities can be very destructive. Early treatment of tooth maintains dental health and increases the likelihood that the restoration to be maintained as long as possible.

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